STEP Misc. Flashcards
Pathology of hemolytic Uremic Syndrome
Infection with enterohemorrhagic Escherichia coli and Shigella dysenteriae from a production of shiga like toxin and shiga toxin respectively
symptoms: microangiopathic hemolytic anemia (fatigue, jaundice, dark urine), thrombocytopenia, renal dysfunction
language development at 12months
says first words, points to objects, uses several gestures with vocalizing, recognizes names of two objects, looks at them when named
language development at 15 months
uses three to five words
points to one body part
mature jargoning
language development at 18 months
uses 10-25 words
points to self
imitates environmental sounds
language development at 24 months
50+ words, 50% intelligibility, uses 2 word sentences, follows two step commands
language development at 36 months
uses 200+ words, 3 word sentences, 75% intelligibility, uses pronouns correctly
language disorders
deficiency in understand and producing language
can result in frustration
4 year old child milestones
walks down stairs with alternating feet, catches a ball, balances on one foot
draws square, ties a knot, cuts with scissors
able to tell sories
imaginative play/group play
language disorders
deficiency in understand and producing language
can result in frustration
**obtain a audiology evaluation for any child with a deficient language development
etiology of Paget disease of breast
ductal carcinoma insitu has malignant cells that migrate into the lactiferous sinuses and nipple skin
accumulation of malignant cells disrupts the normal epithelial barrier
(resembles eczema- erythema and scaling crust around nipple)
- large cells with clear cytoplasm confined to the epidermis
MOA of local anesthetics
inhibit sodium channels and is most effective in rapidly firing neurons
classes of local anesthetics
esters (one i)
amides (two i’s)
side effect of bupivicaine
cardio toxicity
order or sensory loss from a local anesthetics
pain, temperature, touch, pressure
side effect of bupivicaine
cardio toxicity
order or sensory loss from a local anesthetics
pain, temperature, touch, pressure
classes of local anesthetics
esters (one i)
amides (two i’s)
side effect of benzocaine
methemoglobinemia
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
signs of riboflavin (vitamin B2) deficiency
angular chelitis, stomatitis, glossitis, rash, normocytic anemia
signs of niacin deficiency
diarrhea, dermatitis, dementia, neurological disturbances
-rash on sun exposed areas
classes of local anesthetics
esters (one i)
amides (two i’s)
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
signs of niacin deficiency
diarrhea, dermatitis, dementia, neurological disturbances
-rash on sun exposed areas
signs of folate deficiency
microcytic megalobalastic anemia with increase homocysteine levels with hyperhsegmented neutrophils
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
signs of vitamin C deficiency
easy bruising petechiae, bleeding gums, anemia, coiled hair
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
diffuse esophageal spasms and treatment
uncontrolled/uncoordiated contractions of the esophagus with a normal cardiac workup (can present with chest pain and dysphagia or solids and liquids)
calcium channel blockers ( reduce smooth muscle contractility by blocking voltage dependent L-type calcium channels)
pericarditis on ECG
diffuse ST segment elevation with reciprocal PR segment depression
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
pericarditis on ECG
diffuse ST segment elevation with reciprocal PR segment depression
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
classes of local anesthetics
esters (one i)
amides (two i’s)
signs of benzodiazepine overdose and treatment
ataxia, AMS, lethargy, slight respiratory depression
treatment: flumazenil ( inhibits alcohol dehydrogenase)
cocaine overdose signs and treatment
tachycardia, hypertension, pupillary dilation, agitation, hallucinations
treatment: bentos, Mixed a/b receptors blocker
opioid overdose signs and treatment
AMS, pupillary constriction, lethargy, respiratory depression and respiratory acidosis, constipation
treatment: naloxone
features of fragile X syndrome
prominent forehead, intellectual disability, large everted ears, long narrow face, MVP
pathogenesis of fragile X syndrome
X-linked dominant trinucleotide repeats of the CGG in the FMR1 gene that causes HYPERMETHYLATION and decreased gene expression
how does MVP sound
late systolic crescendo murmur with a mid systolic click
Down syndrome cardiac complication
endocardial cushion defect (ASD)
Duchenne muscular dystrophy defect
dilated cardiomyopathy
Friedrich ataxia cardiac complication
hypertrophic cardiomyopathy
homocystineura cardiac complication
increased risk of myocardial infarction and stroke
marfan syndrome cardiac complication
aortic dissection, aortic aneurysm, aortic regurgitation, MVP
pomp disease cardiac complications
cardiomegaly, hypertrophic cardiomyopathy
digeorge syndrome cardiac complication
conotruncal abnormalities (ToF, truncus arteriosis)
runer syndrome cardiac complications
bicuspid aortic valve, coarctation of the aorta
williams syndrome cardiac complications
supravalvular aortic stenosis
ASD
wide flexed splitting of A2
cardiac complications in alcohol exposure in utero
ASD, PDA, ToF, VSD
congenital rubella cardiac complications
PDA, pulmonary artery stenosis
cardiac complications from poorly controlled maternal diabetes
transposition of the great vessels, VSD
lithium exposure cardiac complications
ebstein anomaly ( enlarged atria)
hypertrophic cardiomyopathy murmur intensity
increases with reduced preload and decreases with increased preload
- increased preload will precent the approximation of the IV septum and the mortal calve during systole
squatting
increases preload
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
classes of local anesthetics
esters (one i)
amides (two i’s)
hand grip
increases afterload
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
familial adenomatous polyposis
AD loss of function mutation in APC suppressor gene on chromosome 5
polyps after puberty and 100% of ppl will develop colorectal cancer
can also have Desmond tumors, brain tumors, and osteomas
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
KRAS mutations are implicated in
spontaneous colorectal adenomas that give unregulated intracellular signaling
explain the spontaneous colorectal progression for colorectal adenomas
loss of APC gene leads to decreased interceulalr adhesion and increased proliferation
KRAS mutation leads to unregulated intracellular signaling
loss of TP53 leads to tumor formation
juvenilie polyposis syndrome is caused by
autosomal dominant mutations in SMAD
have hermartosous polyps before the age of 5
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
classes of local anesthetics
esters (one i)
amides (two i’s)
juvenilie polyposis syndrome is caused by
autosomal dominant mutations in SMAD
have hermartosous polyps before the age of 5
explain the spontaneous colorectal progression for colorectal adenomas
loss of APC gene leads to decreased interceulalr adhesion and increased proliferation
KRAS mutation leads to unregulated intracellular signaling
loss of TP53 leads to tumor formation
peutz-jeghers syndrome
AD mutation in STK11
-hyperpigmentaed macules on the mouth, lips, hands, and genitalia with an increased risk of breast and gi cancers.
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
classes of local anesthetics
esters (one i)
amides (two i’s)
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
class II antiarrythmics MOA
amiodarone, dofetilide, and sotalol
they block potassium channels which inhibits outward depolarizing currents during phase 3 prolonging ventricular repolarization
more common in dofetilide and sotalol
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
prolonged ventricular depolarization on ECG
wide QRS –> torasdes
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
classes of local anesthetics
esters (one i)
amides (two i’s)
pathogenesis of squamous cell carcinoma
loss of TP53 tumor suppressor gene
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
pathogenesis of melanoma
activating mutation in BRAF
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
classes of local anesthetics
esters (one i)
amides (two i’s)
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
precursor ot melanoma
dysplastic nevus or lentigo maligna
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
nevus histology
rete rige bridging, shouldering, and lamellar fibrosis
lentigo maligna histology
blue black stained skin with malignant melanocytes that grow along the stratum basalt without invasion below the epidermis
pathogenesis of basal cell carcinoma
loss of function in the PTCH1 tumor suppresor gene which activated sonic hedgehog signaling pathway
classes of local anesthetics
esters (one i)
amides (two i’s)
pathogenesis of basal cell carcinoma
loss of function in the PTCH1 tumor suppresor gene which activated sonic hedgehog signaling pathway
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
pathogenesis of psoriasis
mutation of the major histocompatibility complex receptor subtype
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
cocaine overdose signs and treatment
tachycardia, hypertension, pupillary dilation, agitation, hallucinations
treatment: bentos, Mixed a/b receptors blocker
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
signs of benzodiazepine overdose and treatment
ataxia, AMS, lethargy, slight respiratory depression
treatment: flumazenil ( inhibits alcohol dehydrogenase)
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
many round cells with multiple mitoses with clear cytoplasmic vacuoles scalloping the nucleus
liposarcomas
(most common soft tissue sarcoma)
fibroblast based malignancy that is characterized by anapestic spindle cells that may grow in an organized herringbone or a disorganized cellular fashion
fibrosarcoma
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
benign skeletal muscle tumors with fascicles of polygonal cells with a vacuolated cytoplasm and a peripherally placed nucleus
rhabdomyomas
mobile subcutaneous nodules that are composed of mature fat cells without pleomorphism
lipoma
painful bull and erosions with oral involvement and extension of lesions with direct pressure
pemphigus vulgaris
immunofluresence of pemphigus vulgaris will show
IgG and C3 deposits in a net like or chicken wire pattern along the epidermis
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
bullous pemphigoid
IgG and C3 deposits along the basement membrane (tense bullae-hemidesmosome)
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
classes of local anesthetics
esters (one i)
amides (two i’s)
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
bullous pemphigoid
IgG and C3 deposits along the basement membrane (tense bullae-hemidesmosome)
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
immunoflouresence around dermal blood vessels
porphyria cutaena tarda or henoch schonlein purpura
granular deposition of IgA in the upper papillary dermis
dermatitis herpatiformis (itchy vesicles on the elbows, knees and butt)
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
sympathetic innervation to the eye
stellate ganglion and sympathetic chain - at the apex of the lung
ciliary ganglion
carried by the oculomotor nerves and regulates parasympathetic input to the iris and lens
otic ganglion
parasympathetic innervation to the parotid gland
near the mandibular nerve
alcohol related cerebellar degeneration
cerebellar degeneration to the purkinje cells in the cerebellar vermis from long time alcohol use that leads to
wide based gait ataxia, postural tremor of the hands, truncal instability, blurred vision, falls
Hypertrophic Cardiomyopathy has angina because
increased muscle mass increases the O2 demand
there is microvascular dysfunction that decreases O2 supply (poorly developed myocardial capillary networks)
EPICARDIAL CORONARY ARTERIES ARE NORMAL
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
DNA gyrase
aka type II topoisomerase
removes supercoils
helicase
unwind double helix
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
classes of local anesthetics
esters (one i)
amides (two i’s)
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
helicase
unwind double helix
single stranded DNA binding protein
stabilization of unwound template strands
primase
aka RNA polymerase
synthesizes RNA primer
DNA polymerase III
DNA synthesis (5–>3’ polymerase)
proofreading (3’–>5’ exonuclease acitvity)
DNA polymerase I
removes RNA primer (5’–>3’ exonuclease) and replaces with DNA
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
classes of local anesthetics
esters (one i)
amides (two i’s)
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
primase
aka RNA polymerase
synthesizes RNA primer
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
DNA ligase
joins Okazaki fragment on lagging strand
DNA polymerase I
removes RNA primer (5’–>3’ exonuclease) and replaces with DNA
prokaryotic polymerase
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
primase
aka RNA polymerase
synthesizes RNA primer
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
classes of local anesthetics
esters (one i)
amides (two i’s)
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
ovarian cancer marker
CA-125
ascites and ovarian mass
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
primase
aka RNA polymerase
synthesizes RNA primer
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
classes of local anesthetics
esters (one i)
amides (two i’s)
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
caclinurein inhibitors
immunossupressive agents that inhibit calcinurien
cyclosporine and tacrolimus
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
classes of local anesthetics
esters (one i)
amides (two i’s)
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
primase
aka RNA polymerase
synthesizes RNA primer
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
adverse effects of calcineurin inhibitors
dose dependent rise in BUN and creatinine levels and obliterative vasculopathy or the efferent and afferent arteries
mammalian target of rapamycin inhibitors
sirolimus
inhibitors of de novo purine synthesis
azathioprine or mycophenolate mofetil
they inhibit purine synthesis and act as an immunosuppressant agent
azathioprine side effects
N/V
adverse of prednisone
avascular necrosis of the femoral head, osteoporosis, hyperglycemia, and physiatrics disturbances.
abdominal pain with fecal vomiting (brown fluid from the nasogastric tube) is indicative of
small bowel obstruction
metaclopromide can be used to treat small bowl obstruction but is contraindicated in who
people with Parkinson’s disease
(it is a dopamine antagonist so it would exacerbate Parkinson’s issues)
alkaptonuria
autosomal recessive defect in homogentisic acid deoxygenate which leads to impaired tyrosine metabolism
causes urine to become black with oxidized
can lead to ochronocosis (blue-black pigmentation of the eyes, ears, and nose) or ochronotic osteoarthropthy ( which is pigment deposition in the bones with pain)
incursions in parkinsons disease
alpha synuclein filaments in the cytoplasm
(loss of dopamine in the substantial nigra)
resistance to flexion/extension, resting tremor
tissue ischemia causes what cells to be intracellular and what cells to be extracellular
intracellular: Na+, Ca+, HCO3
extracellular: K+
sodium potassium pump doesn’t work
Ca+ intracellular is a hallmark of tissue injury
where are the juxtaglomerular cells located and what do they secrete
they are located by the afferent arteriole of the glomerulus (encircle it)
they produce renin in response to decreased tubular NaCL, decreased pressure in the afferent arteriole and sympathetic stimulation
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
primase
aka RNA polymerase
synthesizes RNA primer
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
in ARDS what is suggestive of lung immaturity
phospholipid levels (most indicative) - lecithin and phsophatidyglycerol
sphingomyelin and surfactant proteins B and C have a small contribution to ARDS)
classes of local anesthetics
esters (one i)
amides (two i’s)
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
fragility fracture
fracture from low level trauma like falling from standing height
indicative or significant bone loss and osteoporosis
what can cause fragility fractures in a vigorously active woman
hypogonadtrvphic hypogonadism caused by vigorous excercise, low BMI or stress
causes decreases GnRH, FSH, and LH with decreased estrogen and accelerated bone loss
homocystinuria
autosomal recessive defect in cystathionine beta synthase which leads to the buildup of methionine and homocysteine
will have marfanoid features, intellectual disability, hypercoagualbility, and downward subluxation
why can heparin be used in pregnancy
it has a larger molecular weight and cant cross the placenta
what features allow placental transfer of drugs
uncharged and lipholphilic, unbound to plasma proteins like albumin, low molecular weight
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
classes of local anesthetics
esters (one i)
amides (two i’s)
primase
aka RNA polymerase
synthesizes RNA primer
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
why can heparin be used in pregnancy
it has a larger molecular weight and cant cross the placenta
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
what features allow placental transfer of drugs
uncharged and lipholphilic, unbound to plasma proteins like albumin, low molecular weight
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
what can cause fragility fractures in a vigorously active woman
hypogonadtrvphic hypogonadism caused by vigorous excercise, low BMI or stress
causes decreases GnRH, FSH, and LH with decreased estrogen and accelerated bone loss
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
neisseria honorrhea causes gonorrhea with what virulence factor
pilli (this also is what gives it it variance- no vaccination)
CMV retinitis
cotton wool spots and retinal hemorrhage
(white opaque patches with hemorrhage at the retinal periphery)
usually in HIV patients with a CD4 count less than 50
treatment of CMV retinitis
ganciclovir which inhibits DNA chain elongation
inhibits DNA polymerase
can also use focarnet, or valancivlovir all of which interfere with DNA replication
special considerations for local anesthetics
if pt is allergic to ester compound use amide
if there is infected tissue there will need to be a higher dose (infection causes an acidic environment)
Lynch syndrome
AD mutation that leads to defective DNA mismatch repair with microsatilliate instability
-colorectal cancer, endometrial cancer, ovarian cancer
MSH2,MLH1, MSH6
medications used to treat BRAF positive melanomas
dabrafenib and vemurafenib which are BRAF inhibitors
CMV retinitis
cotton wool spots and retinal hemorrhage
(white opaque patches with hemorrhage at the retinal periphery)
usually in HIV patients with a CD4 count less than 50
wernicke encephalopathy
mammillary body atrophy
**encephalopahty, oculomotor dysfunction, ataxia
cocaine overdose signs and treatment
tachycardia, hypertension, pupillary dilation, agitation, hallucinations
treatment: bentos, Mixed a/b receptors blocker
ways RNA viruses can change genetic material
shift: reassortment that produces viral progeny and produces pandemics
drift: point mutations
DNA ligase
joins Okazaki fragment on lagging strand
recombination
gene exchange that occurs from 2 double stranded DNA molcueles from crossing over
pemphigus vulgas pathogenesis
autoantibodies target desmoglzins in the desmosomal junction which helps attach epidermal keratinocytes to each other
wit h this there will be deposits between keratinocytes and intraepithelial detachment of keratinocytes and retained keratinocytes along the basement membrane
classes of local anesthetics
esters (one i)
amides (two i’s)
signs of vitamin B6 deficiency
peripheral neuropathy, sideroblastic anemia (microcytic), chili tis, stomatitis, glossitis
primase
aka RNA polymerase
synthesizes RNA primer
mammalian target of rapamycin inhibitors
sirolimus
benign growths composed of broad fascicles of rounded fibroblasts with abundant cytoplasm and significant surrounding collagenous matrix that infiltrates adjacent soft tissue
Desmond tumors
patients with atrial fibrillation can be treated with chemical cardio version to receive rhythm control what are the options
amioderone, defetilide, flecainide, and sotalol
biopsy of actinic keratosis shows
hyperkeratosis (thickening of the stratum corneum) and parakeratosis (nuclei in the stratum corneum)
vitamin E deficiency
biliary disease, pancreatitis, hemolytic anemia , muscle weakness, ataxia
signs of benzodiazepine overdose and treatment
ataxia, AMS, lethargy, slight respiratory depression
treatment: flumazenil ( inhibits alcohol dehydrogenase)
type 1 pneumocytes vs. type 2
type 1: gas exhange
type 2: production of surfactant and regeneration of alveolar epithelium
adverse effects of calcineurin inhibitors
dose dependent rise in BUN and creatinine levels and obliterative vasculopathy or the efferent and afferent arteries
what can cause fragility fractures in a vigorously active woman
hypogonadtrvphic hypogonadism caused by vigorous excercise, low BMI or stress
causes decreases GnRH, FSH, and LH with decreased estrogen and accelerated bone loss
