Step Random Tidbits Flashcards
What residues are hydroxylated in the RER during collagen synthesis?
Proline, lysine
Vitamin C is cofactor
Function of teres minor
SITS muscle
Adduction, external rotation
Axillary nerve innervation
Where do the right and left ovarian vein flow to?
Right ovarian vein feeds into the IVC
Left ovarian vein feeds into the left renal vein
Culture negative endocarditis
Organism also causes bacilliary angiomatosis in immunocomprimised
Bartonella Henselae
Mutations in transthyretin result in
hereditary cardiac amyloidosis –> infiltrative cardiomyopathy
HLA Subtype associates with what disease?
DR4
Rheumatoid arthritis
DM type I (also DR3)
Addison disease (also B8, DR3)
DPCC is a major component of:
pulmonary surfactant
What do these have in common?
S. pneumoniae
Haemophilus influenzae
Neisseria meningitidis
Salmonella typhi
Group B strep
Encapsulated
risk of infection in SCD post autosplenectomy
When does acute rejection occur?
1-4 weeks dense infiltrate of mostly T cells (against foreign MHC)
Basket weave pattern of media of large arteries
cystic medial degeneration –> aneurysm Marfan syndrome
Embryonic vitelline veins become:
the portal system
Damage to optic nerve
Effect on pupillary light reflex
Light in affected eye –> no response in either eye
Light in unaffected eye –> both eyes constrict (motor pathways are intact)
HLA Subtype associates with what disease?
DR5
Pernicious anemia
Hashimoto thyroiditis (also DR3)
Larger VSDs present with:
Softer murmurs bc the pressure gradient is not there
Prior to fertilization, secondary oocytes are arrested in what cell cycle phase?
Metaphase of meiosis II
Where is the SA node?
Junction of the SVC and RA
What is the difference between binge eating disorder and bulemia?
Binge eating disorder has no compensatory behaviors ie vomiting or fasting or excessive exercise
Bulemia - binges and compensations have to happen at least once a week for 3 months
CV complications w/ Down syndrome
Endocardial cushion defects (ie ostium primum ASDs, regurgitant AV valves)
Armadillos are a reservoir for:
Mycobacterium leprae
Two main anomalies presenting with cyanosis at birth:
Tetralogy of Fallot
Transposition of the great arteries
Peaked T waves on EKG indicate
Localized hyperkalemia
First sign of MI
How to treat acute dystonia?
Meds w/ M1 receptor antagonism,
ie benztropine, diphenhydramine
restore dopaminergic-cholinergic balance
What antibiotic that works by inhibiting protein synthesis can also be used to improve GI motility?
Erythromycin activates motilin receptors
Macrolide binds to 23S of 50S
Crescent shaped hematoma on CT
Subdural hematoma
Bridging cortical veins
Between dura and arachnoid
Gradual onset HA and confusion
Most common cardiac complications of Marfan syndrome
MVP
Cystic medial degeneration of the aorta
ST elevation in V1-V4 suggests MI where:
LAD
De novo mutations in MECP2 gene associated with
Rett Syndrome
MECP2 on X chromosome
“Pipestem” fibrosis of portal vein
Hepatic schistosomiasis
A single episode of severe vertigo but no hearing loss that can last for days is:
Vestibular neuritis aka labyrinthitis
viral or post viral inflammation of the vestibular nerve
Pathophys behind Crohn’s and gallstones
terminal ileum inflamed –> bile acids not reabsorbed –> cholesterol:bile ratio up –> stones
Probe used in Western blot
Antibody
Associated cranial nerve and derivative with pharyngeal and aortic arch 2
Facial nerve;
Stapedial artery (regresses)
Function of IL-4
Secreted by Th2
Induces more differentiation to Th2 Class switching
promotion to IgE and IgG
Steps in nucleotide excision repair:
Endonuclease nicks both sides of the damage (on 1 strand)
DNA polymerase makes new DNA in the place of the damaged DNA
DNA ligase seals
beta-1 receptor stimulation has what effect?
increase cAMP –> increase contractility Norepi adrenergic Gs
Gene involved in medullary thyroid cancer
RET
proto-onco gene codes for tyrosine kinase receptor in both MEN type 2 syndromes and sporadic medullary thyroid cancer
Culture Neisseria gonorrhoeae on:
Thayer-Martin VCN medium
selective
Vancomycin Colistin Nystatin Trimethoprim
Hypocapnia leads to what cerebral effect?
Cerebral vasoconstriction
pCO2 - potent cerebral vasodilator
HLA Subtype associates with what disease?
DR2
MS
Hay fever
SLE
Goodpasture syndrome
MOA terbinafine
inhibits the synthesis of ergosterol by inhibiting squalene epoxidase
tx for dermatophytosis (tinea corporis aka ringworm)
Common carotid bifurcates at
C4
Aldolase B deficiency
Cant catalyze Fructose-1-P –>DHAP/Glyceraldehyde
failure to thrive, liver and renal failure
hypoglycemia and vomiting after fructose ingestion
How does the Candida skin test work?
Like PPD
Failure to respond - anergy -
SCID Macrophages present candida to CD4T’s CD4T’s recruit CD8Ts via cytokines Induration, erythema CD4 and CD8 release interferon gamma
Interferon gamma tells macrophages to eat the Candida
Merozoite
Released by liver
Infect RBC’s
Lysis –> fevers
MacConkey’s agar and EMB agar are examples of what kind of medium?
Differential
identify organism based on metabolic and biochemical properties
Give two examples of the effects of hypocalcemia in DiGeorge
Chvostek sign (facial tapping –> twitchin of nose and lips)
Trousseau sign (wrist tapping –> carpal spasm)
Precursor for serotonin, melatonin and nicotinic acid:
Tryptophan (essential)
Parasite that causes vitamin B12 deficiency and megaloblastic anemia
Diphyllobothrium latum tapeworm from freshwater fish
pH > 7.45 HCO3 > 28
Metabolic alkalosis
Response: Hypoventilation to retain CO2
Central, cystic dilation in cervical spinal cord
Syrinx (C8-T1)
damage to vental white commisure and anterior horns
syringomelia
scoliosis common w/ dx
Complete absence of tyrosinase results in
complete albinism
production of pigment is defective
Recurrent infections with Neisseria suggest
C5b-C9 deficiency
cannot form MAC
What drug should female epileptic patients switch to of they are considering pregnancy?
Levetiracetam
CD31+
CD31 is platelet endothelial cell adhesion molecule
indicates vascular endothelial cells
liver angiosarcoma (PVC piping/arsenic/thorotrast exposure) expresses CD31
Biconvex hematoma on CT
Epidural hematoma
Lucid interval
Between skull and dura
Rupture of middle meningeal artery
Pathogenesis of PH from LHF
Passive increase in pulmonary capillary and arterial pressue secondary to pulmonary venous congestion
decreased NO
increased endothelin (vasoconstrictor)
increased vascular tone
remodeling/smooth muscle cell proliferation
Lower extremity edema
Hepatomelagy
What kind of HF?
RHF
The most common cause of RHF is LHF
What antivirals depent only on host cell kinase to work?
Cidofovir, Tenofovir
Robertsonian translocations typically involve chromosomes
13, 14, 15, 21, 22
acrocentric chromosomes (centromere at the end)
they fuse and lose the short arms
balanced translocations go unnoticed
Use what medication for gancyclovir-resistant CMV?
Foscarnet
AE: hypocalcemia
CDKN2A makes
p16 (blocks G1–>S)
TSG
melanoma and pancreatic cancer
Exaggerated drop in systolic BP during inspiration
Pulsus paradoxus
Seen in cardiac tamponade, COPD, asthma, constrictive pericarditis
WT-1 - what kind of gene and where?
TSG
11
Wilms tumor
Function of serum amyloid A
an acute phase reactant
upregulated
RB - what kind of gene and where?
TSG
13
Retinoblastoma and osteosarcoma
Function of IL-6
secreted by macrophages
fever and acute phase proteins
Normal A-a gradient
5-15
A-s gradient is normal in alveolar hypoventilation with hypoxemia - how to distinguish from other forms of hypoxemia
Immune response involved in Schisto
Th2-mediated
granulomatous Th2 cells, eosinophils, M2 macrophages –> marked fibrosis of bowel or bladder/ureters
Elevated ICP in absence of ventricular enlargement
Pseudotumor cerebri
young, obese women with HA, papilledema and optic neuropathy
First-line tx for Wilson disease
Cu chelators
- d-penicillamine
- trientine
Primary systemic amyloidosis involves deposition of
Immune globulin light chains
Function of thyroid peroxidase
oxidation of iodide to iodine, the iodination of thyroglobulin, and iodotyrosine coupling antibodies to thyroid peroxidase in Hashimoto’s
Steps in collagen synthesis
- pre-pro-alpha chain
- signal removed –> pro-alpha chain
- hydroxylation of proline and lysine (vit C)
- glycosylation of hydroxylysine
- assembly to procollagen
- to Golgi –> ECM
- terminal propeptides cleaved by N and C procollagen peptidases –> tropocollagen (EDS defect)
- spontaneous assembly to fibrils
- cross links by lysyl oxidase
Name the 4 beta-lactam classes
- Penicillins
- Cephalosporins
- Carbapenems
- Monobactams - Aztreonam
Labwork with isolated thrombocytopenia suggests what diagnosis?
ITP
autoimmune platelet destruction - ecchymoses, petechiae, mucosal bleeding, no other obvious causes of thrombocytopenia
What kind of gene is TSC1?
TSG
Tuberous sclerosis
makes hamartin
Acyclovir, Valacyclovir, Famciclovir, Ganciclovir all depend on what to work:
viral kinase class - viral-dependent nucleosides
Function of human placental lactoge (hPL) (aka chorionic somatomammotropin)
Decreases maternal fatty acid stores and increases maternal serum glucose in order to provide adequate glucose to the growing fetus (induces insulin resistance in 2nd and 3rd trimesters)
Can use Aztreonam in penicillin-allergic patient?
Yes
Gamma hemolytic means
No hemolysis on blood agar
The difference in risk attributable to the intervention
Absolute risk reduction (ARR)
c/(c+d) - a/(a+b)
How to confirm a dx of narcolepsy
low CSF levels of hypocretin-1 (orexin-A);
shortened REM latency on polysomnography
What is the function of C1 esterase inhibitor?
Suppresses activation of the C1 complement component (and therefore the rest of the complement pathway)
Also inactivates kallikrein which catalyzes the conversion of kininogen to bradykinin
Things that attract neutrophils
LTB4
C5a
IL-8
bacterial products
Function of pyruvate dehydrogenase
Enzyme in pyruvate –> Acetyl CoA
if nonfunctional, as when inhibited by NADH accumulation, pyruvate becomes lactic acid (anaerobic path)
Inhibition of DNA-dependent RNA polymerase MOA of what RIPE therapy component?
Rifampin
Innervation of Infraspinatus
SITS muscle
Suprascapular nerve
C5-C6
External and lateral rotation
Histamine upregulates what selectin in rolling?
P selectin (from Weibel-Palade bodies)
Absent bilateral vas deferens bilaterally suggests
Cystic fibrosis
Normal levels of LH, FSH, testosterone
What do trimethoprim, methotrexate and pyrimethamine have in common?
They inhibit the same step in THF synthesis
All inhibit dihydrofolate reductase
Difference in risk between exposed and unexposed groups; aka the proportion of risk attributable to an exposure
Attributable risk
beta-2 receptor stimulation has what effect?
increase cAMP –> bronchodilation, vasodilation
Apocrine glands secrete their product how?
membrane bound vesicles
ie mammary glands
AR
hypersensitivity to UV damage and chemotherapy agents
impaired DNA repair facial anomaly growth retardation
Bloom syndrome
BLM gene defect makes faulty helicase generalized chromosomal instability –> risk of neoplasms
Teratogenic effects of Aminoglycosides
ototoxicity
vestibulotixicity
How to increase fetal survival in a preterm fetus with lecthicin:sphingomyelein ratio
Corticosteroids accelerate maturation of type II pneumocytes
give to moms at risk of preterm labor
RPR positive in what infections?
Syphilis
Yaws
Pinta
Bejel
(all subspecies of Treponema pallidum)
Embryonic cardinal veins become:
the systemic circulation
The third aortic arch becomes
the common carotid artery
the proximal internal carotid artery
Fever that recurs every 48 hours
What malarial organism?
“Tertian”
P. vivax
P. ovale
P. falciparum (more irregular)
HLA-B*57:01 is associated with
Hypersensitivity to Abacavir
NRTI
Type IV hypersensitivity reaction
Immune response involved in tuberculoid leprosy
Th1 Cell mediated immunity
(+) lepromin skin test
less severe
Classical complement pathway means:
C1 binds IgG or IgM bound to antigen (GM makes classic cars) –> C3 convertase produced
At what age? Runs, kicks ball Builds tower of 2-4 cubes Removes clothing 10-25 word vocabulary, identifies 1 or more body parts understands “mine” begins pretend play
18 months
A Turner syndrom patient with a bicuspid aortic valve would have what kind of heart murmur?
Early systolic, high frequency click over the 2nd right intercostal space
CYP-450 Inhibitors
Give 3 examples
Erythromycin
grapefruit juice
Ketoconazole
Ciprofloxacin
Quinidine
Cimetidine
Omeprazole
Ritonavir
Chloramphenicol
Acute alcohol intoxication
Translocation in follicular lymphoma
t(14;18)
cleaved and noncleaved follicle center cells
B cell
bcl2 overexpression
most common indolent Non-Hodgkin lymphoma
What is the function of Rb?
inhibits E2F which blocks G1–>S
Protein involved in AD hereditary hypothalamic DI
Neurophysin II point mutation –> abnormal folding –> removal of ADH and neurophysin from the ER
Most important AEs of Amphotericin B
Nephrotoxicity
Hypokalemia
Hypomagnesemia
MAO function
Degrades excess monoamine NTs in the presynaptic nerve terminal;
Detoxifies tyramine in the GI tract
PTSD requires symptoms for how long?
at least 1 month insomnia, nightmares, avoidance, dissociative symptoms, emotional detachment, flashbacks, intrusive thoughts, sleep disturbance
Purpose of the dexamethasone suppression test
Will suppress ACTH and cortisol levels with Cushing syndrome if caused by a pituitary adenoma but not when it is caused by ectopic ACTH secretion (ie small cell carcinoma)
The probability of being free of disease if the test result is negative
NPV
varies with pre-test probability
Secreted proteins of innate immunity
Lysozyme
Complement
C-reactive protein
Defensins
MOA Finesteride
5-alpha reductase inhibitor
decreases testosterone –> DHT
can use for androgenic alopecia early in the course
Neuroendocrine cells in the basal layer of the epidermis that are felt to play a role in the perception of touch
Merkel cells
often found in association with nerve projections
Immune response involved in lepromatous leprosy
Th2
Humoral immunity
(-) lepromin skin test
bacterial load higher
Progressive splenic enlargement and weight loss over months
Organism?
Kala-azar aka leishmeniasis (leishmania is a parasite transmitted by sandflies)
Most common AE from:
Atazanavir, Darunavir, Indinavir, Ritonavir
Hyperglycemia
Protease inhibitors
Also cause lipodystrophy and drug-drug interactions
Otitis externa by a gram negative motile aerobic rod, organism?
Pseudomonas
MOE - malignant otitis externa - elderly/diabetic
Cavernous lymphangioma
Network of endothelium-lined lymph spaces beneath the epidermis
Children
Neck, Axilla
Turner syndrome
dx?
Cystic hygroma
Contact with infected freshwater
Larvae mature in liver
Adults got to bladder or intestine
Larvae start by living in freshwater snails
dx?
Schistosoma Haemobactium –> bladder Japonicum and Mansoni –> intestine –> feces
Most cases of cerebellar hemorrhage are caused by
hypertensive vasculopathy
HLA Subtype associates with what disease?
A3
Hemochromatosis
Failure of involution of the mammary ridge causes
accessory nipple aka polythelia, supernumerary nipple;
hyperpigmentation
epidermal thickening
can become tender with hormonal changes
What is heteroplasmy?
Different mitochondrial genomes in a singe cell
Determines how severe a mitochondrial-encoded disorder can end up being
Chronic reduction in CSF absorption at the arachnoid villi –> massive enlargement of ventricles
Normal pressure hydrocephalus
Wet, wacky, wobbly
G6PD inheritance
X-linked recessive
Males affected, females carriers
Teratrogenic effects of TMP-SMX
Neural tube defects
An artificial increase in survival time among tested patient who actually have an unchanged prognosis
Lead time bias
For example, “new screening test” for poor prognosis diseases ie pancreatic cancer
Pathophysiology behind normal pressure hydrocephalus
Progressive decline in absorptive capacity of arachnoid villi
Pressure remains normal because gradual distention of ventricules accomodates CSF accumulation
periventricular system –> dementia and emotional blunting;
traction of sacral motor fibers –> urinary incontinence and ataxia;
cortical afferent/efferent fibers in corona radiata
Mutation involved in anaplastic thyroid cancer
inactivating mutation of p53
How do azoles inhibit ergosterol synthesis?
They inhibit the methylation of lanosterol –> ergosterol
Weakness of foot dorsiflexion due to involvement of common peroneal nerve
Charcot-Marie-Tooth disease
mutation in myelin protein
“neural form” of muscular atrophy
The pulmonary trunk is derived from:
the truncus arteriosus
Osteogenesis Imperfecta - mutation in what collagen type?
Type I
Spontaneous fractures
Bone and tooth malformation
Blue sclerae due to exposure of choroidal veins
IL-4 IL-5 IL-10 IL-13 all secreted by
Th2 cells
ST elevation in leads II, III, aVF suggests MI where:
RCA
Involuntary movements after chronic use of antipsychotics, ie lip smacking, choreoathetoid movements
Tardive dyskinesia
Cushing syndrome with increased ACTH levels - causes?
Pituitary adenoma;
ectopic ACTH secretion
Ertapenem is unique among the carbapenems because
It does not cover pseudomonas or Acinetobacter
Failure of the distal part of the urachus to close results in
Urachal sinus
recurrent infection
Continued inflammation is mediated by what interleukin?
IL-8, attracts more neutrophils after macrophages come in to clean up the damage
Mental status changes
Muscle weakness
Constipation
Polyuria/polydipsia
Dehydration
Too much of?
Hypercalcemia seen in granulomatous diseases such as sarcoidosis from production of excess 1,25-dihydroxyvitamin D –> increased intestinal absorption of Ca and phosphate
Pulmonary hypolasia
Flat facies
Limb deformities ie club feet
dx?
Potter sequence
renal anomaly is bilateral renal agenesis –> decreased urine output = oligohydramnios
Where is IgA made?
Peyer patches
AR
hypersensitivity to DNA cross-linking agents
impaired DNA repair
Fanconi anemia - bone marrow failure (aplastic anemia), short stature, increased incidence of tumors/leukemia, cafe-au-lait spots, thumb/radial defects
hypersensitivity of DNA to cross-linking agents
Coarse features
Corneal clouding
Cognitive deficits
Failure to thrive
Presentation during first year of life
dx?
Inclusion cell disease
typically fatal in childhood
In the bronchioles, what cell secretes mucus?
Club cells
(Goblet cells in bronchi)
MOA Aminoglycosides
Bacteriocidal
Bind 30S
Ineffective against anaerobes
Buy AT 30, CCEL at 50
Suspensory ligament of the ovary is aka
Infundibulopelvic ligament
blood supply to ovary
twists in ovarian torsion (cyst or neoplasm are main risk factors)
Probe used in Southwestern blot
DS DNA S
outhwestern blotting is used to detect DNA-binding proteins such as TFs, nucleases and histones
Isoniazid must be processed by:
Mycobacterial catalase peroxidase (to activate drug)
Klinefelter syndrome is most commonly caused by:
Meiotic nondisjunction
Variants - 46,XY/47,XXY mosaic, 48,XXXY (more severe)
Delayed puberty
Anosmia
Dx?
Kallman syndrome
mutation in KAL-1 gene of the FGFR-1 gene
failure of GnRH secreting neurons to migrate from their origin in the olfactory placode to the hypothalamus
The middle meningeal artery is a branch of:
Maxillary artery (one of the terminal branches of the external carotid artery)
Enters skull in foramen spinosum and supplies dura mater and periosteum
Dizogotic twins uterus situation:
always dichorionic diamniotic (bc 2 zygotes)
What are the cardiovascular complications associated with Turner syndrome?
Aortic coarctation
Bicuspid aortic valve
ST elevation in leads I and aVL suggests MI where:
Left circumflex (V5, V6 also possible)
Teratogenic effect of tetracylcines
staining of teeth, enamel hypoplasia, potential disruption of skeletal development
do not use in kids
RNA Pol III makes
tRNA
5s rRNA (part of 60S)
What’s happening in GVHD?
Remaining immunocompetent DONOR T cells become sensitized to HOST MHC.
GI issues, rash, diarrhea, liver function abnormalities
Codeine
Dextromethorphan
Fluoxetine
Haloperidol
Loratadine
Metoprolol
Paroxetine
Risperidone
Thioridazine
Venlafaxine
all metabolized by
CYP 2D6
Defect in neutrophil phagosome lysosome function
Nystagmus
Peripheral and cranial neuropathies
Partial albinism
Chediak-Higashi syndrome
abnormal giant lysosomal inclusons that are visible on light microscopy of a peripheral blood smear
recurrent pyogenic infections (Staph and Strep)
Hemolytic anemia in SCD causes what kind of jaundice?
Unconjugated hyperbilirubinemia
80% of cardiac myxomas arise in
LA
Myxomas produce large amounts of interleukin 6 –> constitutional symptoms ie fever, weight loss
Tyramine - how it works
indirect sympathomimetic usually metabolized by MAO in the gut MAOi
- ie phenelzine, tranylcypromine ingest draft beer/aged cheeses/cured meats –> hypertensive emergency
Release of what substance is responsible for red man syndrome?
Histamine
AE from vancomycin
Prevent by slowing infusion rate
The efferent limb of the light reflex pathway is the
PS fibers of the oculomotor nerve
Pathologic fractures in children suggest
Extramedullary hematopoiesis
Also seen: chipmunk facies from maxillary overgrowth
Medullary thyroid cancer is a neuroendocrine tumor that arises from:
parafollicular calcitonin-secreting C cells
amyloid from the calcitonin - stain with congo red
Hereditary spherocytosis inheritance pattern
AD
What is the PPV?
The proportion of people who test + and actually have the disease
influenced by prevalence
What kinds of medications cause drug-induced Parkinsonism?
Antipsychotics (first gen > second gen);
Antiemetics/gastric motility agents ie prochlorperazine, metoclopramide
Both are D2 receptor blockers
Function of Ferritin
an acute phase reactant;
upregulated;
binds and sequesters iron to inhibit microbial scavenging
Incomplete division of the forebrain (prosencephalon) into 2 hemisphere is:
Holoprosencephaly
“malformation”
genetic (trisomy 13, SHH gene mutations), alcohol
range: midline cleft palate to cyclops
Teratogenic effect of chloramphenicol
gray baby syndrome - gray skin, lethargy, vomiting, cardiopulmonary collapse -
can be in infants or in infants whose mothers received med near delivery
Histological appearance of Glioblastoma Multiforme
pseudopalisading necrosis - foci of necrosis surrounded by tumor cells, new vessel formation
At what age? walks up/down stairs on both feet, jumps builds 6-cube tower copies a line, turns pages 50+ word vocab, 2 word phrases follows 2 step command, parallel play, begins toilet training
2 years
MOA Macrolides (ie Erythromycin)
Bind 50S Bacteriostatic
Same MOA as Clindamycin and Linezolid
Hereditary angioedema involves low serum levels of:
C1 esterase inhibitor
AD
What kind of gene is TSC2?
TSG
Tuberous sclerosis
makes tuberin
Enfuvirtide prevents
Viral adsorption
Fusion inhibitor
Binds gp41
Segmental thrombosing vasculitis that often extends into contiguous veins and nerves, encasing them in fibrous tissue
Buerger’s disease aka thromboangiitis obliterans;
can be toxocity or hypersensitivity to tobacco
Function of Hepcidin
an acute phase reactant
upregulated
destroys ferroportin to decrease iron absorption and release (anemia of chronic disease)
Ehlers-Danlos - mutation in what collagen type?
Type V
Pyrogens like LPS cause macrophages to do what?
IL-1 and TNF, which both upregulate E-selectin on endothelial cells (neutrophil rolling) –>
TNF ups cyclooxygenase activity in the hypothalamus –>
PGE2 also helps, set point for temp raises (fever)
Small and shallow, not painful ulcers
Large, painful, coalesced inguinal lymph nodes (buboes)
Intracytoplasmic inclusion bodies in epithelial cells and leukocytes
Lymphogranuloma venereum
Chlamydia trachomatis
serotype L1-L3
What is the effect of Mullerian Inhibitory factor?
Involution of paramesonephric ducts - to inhibit female reproductive organs
Produced by Sertoli cells
Inhibition of mycolic acid synthesis MOA of what RIPE therapy component?
Isoniazid
Mechanism of resistance acquired by Enterococcus against Aminoglycosides
Enterococcus has developed class-specific modes of resistance
Acquired via plasmids or transposons
Aminoglycoside-modifying enzymes that transfer chemical groups (ie acetyl groups) to the aminoglycoside molecule and impair their attachement to ribosomal units
Never give ACEis to patients with:
hereditary angioedema, bc the increase in bradykinin levels can trigger disease episodes
Teratogenic effects of Isotretinoin
Microcephaly
Thymic hypoplasia
Small ears
Hydrocephalus
for acne with scarring refractory to other therapy
Most common cause of meningitis in babies > 28 days
S. pneumoniae
When receptors aggregate in an allergic response, they attach to what part of IgE?
Fc portion;
cross-linking of multiple membrane bound IgE antibodies by a multivalent antigen results in aggregation of the FceRI receptors causing degranulation
What is a beta error?
Saying there is no difference between 2 groups when there actually is one (example of a random error)
Spasmodic torticollis is what kind of reaction?
Acute dystonic reaction - a type of EPS
- likely due to antipsychotic medication between 4 hours and 4 days post new meds
Other examples: oculogyric crisis (eyes up) opsthonotonus (arching of back and head thrown back); laryngospasm
What is the function of VHL?
TSG;
Inhibits hypoxia inducible factor 1a
bright red venous blood
altered mental status
lactic acidosis
seizures
cardiovascular collapse
cyanide poisoning
can be from nitroprusside tx (metabolized to release NO and CN)
tx with sulfur donor
What pharyngeal and aortic arch completely obliterates in development?
Fifth
TPO antibody dx?
Hashimoto
Most common cause of Down syndrome.
Maternal meiotic nondisjunction
When performing cardiac catheterization, arterial puncture above the inguinal ligament increases the risk of:
Retroperitoneal hemorrhage;
Cannot be controlled with manual compression;
Most common cause of unexpected mortality after cardiac cath
Clozapine
Second generation antipsychotic
Third-line for patients refractory to traditional therapy
Highest incidence of sialorrhea (drooling)
Glial scars are made up of
Astrocytes;
>2 weeks post ischemic stroke
Treatment for Wet AMD
Wet AMD - acute vision loss (days to weeks), retinal neovascularization metamorphopsia (distortion of straight lines);
Subretinal discoloration with adjacent fluid/hemorrhage
VEGF inhibitors ie ranibizumab, bevacizumab and smoking cessation
Where in the heart is the most common site for thrombus formation?
Left atrial appendage
Most common cardiovascular manifestation associated with SLE
Pericarditis
Transamination reactions occur between:
An amino acid and an alpha-keto-acid ;
Amino group given to alpha-keto acid to make another aa;
Pyridoxal phosphate (vitamin B6) is essential for transaminase action
What does MOTEL PASS stand for?
Structures arising from neural crest cells:
Melanocytes
Odontoblasts
Tracheal cartilage
Enterochromaffin cells
Laryngeal cartilage
Parafollicular cells of thyroid
Adrenal Medulla and all ganglia
Schwann cells
Spiral membrane
Intellectual disability
Gait/posture abnormality
Eczema Musty
body odor
dx?
PKU
AR
mutation in gene for phenylananine hydroxylase
Another word for nucleoside monophosphate
Nucleotide
Xeroderma pigmentosum - defect in:
nucleotide excision repair (endonuclease)
UV rays –> thymine dimers but no UV-specific endonuclease to fix
AR
alpha-1 receptors increase
IP3 –> peripheral vasoconstriction –> increase BP, decrease renal and hepatic BF
Norepi - adrenergic
An arrangement in which a payor pays a fixed (predetermined) fee to cover medical services is called:
Capitation
HMOs are structured like this
Random presentations of pellagra:
Prolonged isoniazed therapy;
Hartnup disease - intestinal and renal absorption of tryptophan is defective;
Carcinoid syndrome
Proportion of risk reduction attributable to the intervention as compared to a control
Relative Risk Reduction
1-RR
Most common site for nosebleeds
Anterior septum
Kiesselbach plexus
anterior ethmoidal, sphenopalatine and superior labial arteries anatasmose here
Teratogenic effects of Valproate
Neural tube defects ie meningomyelocele (decreases levels of folic acid)
Teratogenic effect of Warfarin
nasal hypoplasia
stippled epiphysis
Vitamin K is an essential cofactor for:
gamma-glutamyl carboxlase
carboxylates factors II, VII, IX, X
Inheritance of Wiskott-Aldrich syndrome
X-linked
combined B and T cell disorder
Function of Supraspinatus
SITS muscle
C5-C6
Suprascapular nerve
ABducts arm
Most common manifestation of CMV in HIV patients
Retinitis
MOA Etoposide
Inhibits eukaryotic topoisomerase II (anticancer)
Teniposide same MOA
Solid tumors (testicular and SCLC), leukemia, lymphoma
Cofactor for glutathione peroxidase
Selenium
Used in respiratory burst
Amantadine prevents
viral uncoating
In hypoglycemia, elevated insulin with undetectable C-peptide suggests:
injection of exogenous insulin (which does not contain C-peptide)
What is tachyphylaxis?
negative feedback (decreased production of endogenous NE from the nerve terminals) from overuse of topical nasal decongestants resulting in vasodilation and rebound rhinorrhea
examples: phenylephrine, xylometazoline, oxymetazoline = alpha adrenergic agonists
NO use can also result in tachyphylaxis
Nissl substance
RER of neurons
Red neurons = 12-24 hours post acute injury, loss of Nissl substance, pyknosis, eosinophilic, irreversible
Head and neck muscle weakness
Dysphagia
Dysarthria
Nuclei of corresponding cranial nerves remain intact
Pseudobulbar palsy
Seen in Central pontine myelinolysis = osmotic demyelination of axons in center of pons
Bulbar would be a pathologic process in the nerve nuclei
Why are dendritic cells, such as Langherhans cells of the skin and mucous membranes, the most effective APCs?
Because they constitutively express MHC II and B7
costimulatory signal Myeloid cell line
SCID inheritance
AR or X-linked recessive
recurrent severe viral, fungal, opportunistic (ie PJP) infections, chronic diarrhea, failure to thrive
tx stem cell transplant
Where is fibrocystin found?
epithelial cells of renal tubule and bile ducts
Gene involved in follicular thryoid cancer
RAS
Most common cause of unilateral fetal hydronephrosis
Obstruction - inadequate canalization of the ureteropelvic junction
Function of NF1
TSG;
RAS GTPase activating protein aka neurofibromin
Acyclovir MOA
Nucleoside analog
Activated by viral thymidine kinase
Gets incorporated –> viral DNA synthesis terminated
Function of Pyocynanin
Made by Pseudomonas aeruginosa
Makes ROS to kill competing microbes
vivid dreams, hypersomnia, hyperphagia, acute depression
what dx/toxidrome?
cocaine withdrawl
Combined UMN/LMN lesions suggest
ALS
Associated cranial nerve and derivative with pharyngeal and aortic arch 6
Recurrent laryngeal branch of vagus;
Pulmonary arteries, ductus arteriosus
Lab finding in Hartnup disease
aminoaciduria (neutrals - alanine, serine, threonine, valine, leucine, isoleucine, phenylalanine, tyrosine, tryptophan, histidine)
Treat with high protein diet and niacin
Function of Diphtheria toxin
AB exotoxin -
inhibits protein synthesis ADP-ribosylation of EF-2
How is methicillin (ie nafcillin) resistance conferred?
Alterations in PBPs involved in cell wall synthesis
For example, PBP2a has greatly reduced affinity for beta-lactams (except Ceftaroline, 5th gen)
Cleavage of the brain structures prosencephalon to telencephalon and diencephalon happens when:
5 weeks
Advanced hemochromatosis complication
Diabetes mellitus
Neurofibromin ia a key suppressor of what gene?
Ras
CV complications with DiGeorge
Tetralogy of Fallot
Interrupted aortic arch