Things to know 3 Flashcards
Langerhan histocytes two markers
S-100
CD1a
G6PD drugs
” Spleen Purges Nasty Inclusions From Damaged Cells”
Sulfonamides Primaquine Nitrofurantonin Isoniazid Fava beans Dapsone Chloroquine
Woke up peeing red
Pancytopenia
Anemia
Hypercoagulability
Paroxysmal nocturnal hemoglobinuria (PNH)
Mutation PIGA
Deficiency: glycosylphosphatidylinositol (GPI) anchor
Deficiency: CD55 CD59 (Decay accelerating factor DAF)
Causes complement mediated lysis of RBCs
Misoprostol
PGE1 analog
Increase production and secretion of gastric mucus barrier
Decrease gastric acid secretion
Induction of labor
Diarrhea
Tx MM
Proteasome inhibitor
Borteozomib
- boronic acid containing dipeptidase
Sulfasalazine
- MOA
- Use
- Adverse
Combo of sulfapyridine (antibacterial) and 5- aminosalicylic acid (anti-inflammatory)
Activated by colonic bacteria
UC and chrons
Nausea, sulfa toxicity
Oligospermia** (reversible)
Cancer drug causes
1) Pulmonary fibrosis
2) Hyperpigmentation
3) Nephrotoxicity, Neurotoxicity
4) Megaloblastic anemia, myelosuppression
5) Redness, swelling and pain on palms or soles
6) Hepatotoxicty
7) Cardiotoxicity
8) Convulsions, dizziness, ataxia
9) Mouth ulcers
10) Alopecia
11) Neuropathy and hypersensitivity
12) Areflexia, peripheral neuritis, constipation
13) Nephrotoxicity, peripheral neuropathy, ototoxicity
14) Diarrhea and myelosuppression
15) Hemorrhagic cystitis
16) Hemorrhage, blood clots, impaired wound healing
17) Rash only
18) Rash, Elevated LFTs, diarrhea
19) Fluid retention
20) Increased risk of thromboembolic events
1) Methotrexate, Bleomycin, Busulfan
2) Bleomycin, Busulfan
3) Cladribine
4) Cytarabine
5) 5-fluorouracil
6) Methotrexate
7) Doxorubicin, Daunorubicin , Trastuzumab (Herceptin)
8) Nitrosoureas
9) Methotrexate
10) Doxorubicin, Daunorubicin, Etoposide, teniposide
11) Paclitaxel
12) Vincristine, Vinblastine
13) Cisplatin, carboplatin
14) Irinotecan, topotecan
15) Cyclophosphamide, ifosfamide
16) Bevacizumab
17) Erlotinib
18) Cetuximab
19) Imatinib
20) Tamoxifen, Raloxifene
PAX8-PPAR gamma associated with
Follicular carcinoma of thyroid
- RAS mutation
Short 3rd and 4th finger
Pseudohypoparathyroidism type 1 A
G3 protein alpha subunit defective
Increased PTH but unresponsive
Decreased Ca
MAO inhibitors
Mom Take Serotonin Increasing Pills
MAO inhibitors Tranylcypromine Selegiline Isocarboxazid Phenelzine
Increase level of amine NT (NE, 5-HT, dopamine)
Antigenic shift caused by
Reassortment
How does a Statin work
Increase transcription of HMG-CoA reductase
Diphenhydramine MOA and receptor
Antagonist at Muscarinic-3 (M3) receptors
Athletic dilated heart with normal function. What are the findings?
A. Congestive cardiomyopathy B. Diastolic dysfunction C. Eccentric hypertrophy D. Hypertrophic cardiomyopathy E. Increased myocardial stiffness
C. Eccentric hypertrophy
(in-line or in-series) building and enlargements of muscle cells and fibers
Thick heart thats normal sized (not dilated ) is build from
concentric hypertrophy (parallel building) and enlargement of muscle cells
Thickening of left ventricular wall, HTN, effects of these in cardiac muscle
Transcription Factor c-JUN
beta-Myosin
Heavy Chain
Endothelin
Hypertrophy
- C-jun= increase transcription –> increase cell size and/or number of cells
Increase in myosin heavy chain
Increase Endothelin
- increased because endothelin causes vasoconstriction
COPD effect on pulmonary vascular smooth muscle
- Decrease in
COPD –> hypoxemia –> alveoli constrict in attempt to send blood to more diffused part of lung –> high pressure in pulmonary circuit –> atherosclerosis of pulmonary trunk, smooth muscle hypertrophy of pulmonary arteries and intimal fibrosis so less vasodilated happening and less endothelial nitric oxidase synthase production
Decrease in nitric oxidase synthase production
Cog wheel rigidity
Difficulty writing and walking
Bland facial expressions
Tremor in both hands
Inclusion?
Alpha-synuclein (intracellular eosinophilic inclusion)
Parkinsons
Also see loss of dopaminergic neurons (depigmentation) in substantia nigra pars compacta
Tx for Kaposi Sarcoma
Anti-neoplastic
IFN-alpha
IFN-alpha uses
Chronic Hep B and C Kaposi Sarcoma Hairy cell leukemia Condyloma acuminatum RCC Malignant melonma
IFN-beta use
Multiple sclerosis
IFN-gamma use
Crhonic granulomatous disease
Patient has unilateral Renal Artery stenosis
Effect on
- Total peripheral resistance
- Plasma Renin Activity
- Serum Aldosterone Concentration
Total peripheral resistance= Increase
Plasma Renin Activity= Increase
Serum Aldosterone Concentration= Increase
Kidneys starved for blood, think low blood pressure. So release factors to increase pressure via RAAS cascade
- Increase renin
- Release aldosterone, increase blood pressure –>
- Increase total peripheral resistance
Histological seen in heart 7 days after MI
Erythrocytes, cellular debris, macrophages, and early granulation tissue
Post MI
1) Coagulation necrosis of myocardial fibers with no inflammatory cell infiltrate
2) Contraction band necrosis of myocardial fibers
3) Erythrocytes, cellular debris, macrophages, and early granulation tissue
4) Extensive fibrous connective tissue
1) 0-12 hrs
- Early coagulative necrosis release of necrotic cell content into blood
- Edema, hemorrhage, wavy fibers
12-24 hrs
- Neurophils appear
- Reperfusion injury associated with generation of free radicals
- Leads to hypercontraction of myfibrils through increase free calcium influx
2) 12-24 hrs
3) 7-10 days
- Macrophages
- Granulation tissue at margins
4) 2 weeks
63 y.o w/o emphysema gets HA, myalgia, and rising temp. Dry cough. No bacteria on gram stain. Severe pneumonia. Specialized culture shows gram negative rods. Responds to macrolide Ab. This infection was most likely acquired from which of the following?
A. Inhalation of aerosols from an environmental source
B. Inhalation of dust from bird droppings
C. Inhalation of respiratory secretions from an infected animal
D. Inhalation of respiratory secretions from another infected person
E. The patients normal flora
Inhalation of aerosols from an environmental source
Legionella
- Gram Neg rod that stains poorly
Repetitive unilateral shooting/ shock like pain in face. Triggered by chewing, talking touching certain parts of face. Lasts seconds to minutes. Increase in intensity and frequency over time
Tx
Trigeminal neuralgia
Carbamazepine
- Blocks Na channels
Tubular osmolarity Hypotonic, Isotonic or hypertonic in dehydrated patient. Compare nephron to serum
1) PCT
2) Macula Densa
3) Medullary Collecting Duct
1) PCT
- Isotonic always
2) Macula Densa
- Ascending loop and distal tubule
- Reabsorbs and dilutes tubular fluid –> Hypotonic
3) Medullary Collecting duct
- Draws H20 and urea out
- Hypertonic
Sunburst pattern
- Histology
Osteosarcoma
Pleomorphic osteoid-producing cells
Bone tumor
1) Anaplastic small blue cells of neuroectodermal origin
2) Tumor of malignant chondrocytes
3) Neoplastic mononuclear cells that express RANKL and reactive multinucleated giant cells
4) Neoplastic plasma cells in sheets
1) Ewing
2) Chondrosarcoma
3) Giant Cell Tumor
- osteoclastoma
4) Multiple myeloma
Calcium infusion which will be increased?
A) 7- Dehydrocholesterol B) 1,25 Dihydroxycholecalciferol C) 24,25 Dihydroxycholecalciferol D) Previtamin D3 E) Vitamin D3
C. 24,25 dihydroxycholecalciferol
Kidney spinal level
Spleen level
Kidney T12- L3
Ribs 9 and 10
Spermatogenesis
“Gonium” is going to be a sperm;
“Zoon” is Zooming to egg
Spermatogonium
- Diploid, 2N 2C
- 46 single chromosomes
Primary spermocyte
- Diploid, 2N, 4C
- 46 sister chromatids
- division of X and Y at end of meiosis I
Secondary spermatocyte
- Haploid, 1N, 2C
- division of X-X
- division of Y-Y at meiosis II
Spermatid
- 1N 1C
Spermatozoon
47 XXY male, one X chromosome from patients father error occurred at what stage of spermatogenesis?
Primary spermatocyte
- division of X and Y occurs at end of meiosis I
Spermiogenesis
Spermatid Haploid (1N, 1C ) –> Mature spermatozoon (1N, 1C) with acrosome, tail
47 XYY male, both Y from father, occur at what stage of spermatogenesis
Secondary spermatocyte
Lab findings on patient with polycystic kidney disease and elevated creatinine concentration
- HCO3
- PO4
- PTH
Renal failure
Increase PO4
Increase PTH
Decrease HCO3
Patient with elevated 17-hydroxyprogesterone
21-hydroxylase deficiency
Barefoot on beach
Cellulitis on lower extremity
Blister formation
Gram negative lactose fermenting organism
Vibrio vulnificus
- swimming with brackish water
- Shucking oysters
Tx Tetracycline or 3rd generation cephalosporin
Endothelin-1
Stimulated myofibroblasts contraction
Thrombomodulin
As thrombin is swept away in the blood stream and encounters uninjured vessels, converted to anticoagulant through binding thrombomodulin.
Protein on surface of endothelial cells
Complex Activates protein C
Decreased gastric hydrogen chloride production
Decreased mucosal thickness and hyperplasia of enterochromaffin-like cells.
Resemebles what disease?
Chronic gastritis
Appendectomy, Anesthesia by mask to quickly anesthetize would have what characteristic
A. High blood solubility B. High cerebrospinal fluid solubility C. High lipid solubility D. Low blood solubility E. Low lipid solubility
D. Low Blood solubility
CNS drugs must be lipid soluble (cross the bbb)
Drugs with low solubility in blood= rapidly induction and recovery time
Increase solubility in lipids= increased potency
Homeless man, alcohol smell. Bronzed skin and spider angiomata on chest.
Elevated MCV
Elevated segmented neutrophils
Decreased RBC folate
Normal B12
Increase or decrease in methymalonic acid / homocysteine
Mehtylmalnic acid normal
Homocysteine increased
Alcoholic –> Folate deficiency
Folate and B12 needed for Homocysteine –> Methionine –> DNA synthesis
B12 only needed for Methylomalonic acid –> succinic acid –> myelin synthesis
Rib at 7th cervical vertebrae.
7th cervical vertebrae –> thoracic identity resulted from which alteration in HOX
A. Expression of HOX gene normally expressed only caudal to C-7
B. Expression of HOX gene normally expressed only cranial to C-7
C. Lack of expression of a HOX gene normally expressed at C-7
D. Overexpression of a HOX gene normally expressed at C-7
E. Underexpression of a HOX gene normally expressed at C-7
A. Expression of HOX gene normally expressed only caudal to C-7
Hox responsible for appendages
Vaginal pain with urination
Bilateral vesiculoulcerative lesions of the introitus
Antimicrobial therapy? A. Acyclovir B. Amoxicillin/ clavulanate C. Ganciclovir D. Penicillin E. Vidarabine
HSV
A. Acyclovir
Non-painful ulcerated indurated genital lesion
Syphilis
Pencillin G
Increased number of megakaryocytes
Nose bleeds and easy bruising
Decreased platelet count
A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex
B) Decreased binding of Gpla/IIa to collagen
c) Decreased concentration of the Gp1b/IX complex
D) Decreased concentration of the GpIIb/IIIa complex
E) Decreased synthesis of thromboxane A2
F) Deficient binding of von Willebrand factor to the Gp1b/IX complex
ITP
A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex
A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex
c) Decreased concentration of the GpIb/IX complex
D) Decreased concentration of the GpIIb/IIIa complex
F) Deficient binding of von Willebrand factor to the GpIb/IX complex
A) ITP
C) Bernard-Soulier
D) Glanzman thromboasthenia
F) Von Willebrand def
Relative risk reduction?
W recurrent stroke standard tx: 0.12
M recurrent stroke standard tx: 0.24
Overall recurrent stroke standard tx: 0.18
W New tx: 0.04
M New tx: 0.08
Overall : 0.06
Relative risk reduction= 1- RR
1- Relative risk
RR= risk of developing dz in exposed ground/ risk of developing dz in unexposed group
0.04/ 0.012= 0.3333
1- 0.33333= 0.67
Raynauds phenomenon avoid which drugs
Phenylephrine
- avoid alpha agonists
Blistering lesions in sun exposed areas. Recurrent hx of these lesions.
Increased Total porphyrin
Increase Urine uroporphyrin III
Precursor to uroporphyrin?
Dx: Porphyria
Precursor= Succinyl-CoA
Defective uroporphyrinogen decarboxylase= porphyria cutanea tardia.
Succinyl-CoA combines with glycine to form ALA start of heme synthesis
Red spots on shins, joint pains and fatigue.
Purpura on lower extremities
Liver edge palpated 4 cm below margin
AST 142 ALT 154 Positive Hep C virus RNA Positive anti Hep C virus Ab Positive Cryoglobulins Decreased C4
Urine Protein 4+
Renal damage due to?
Cryoglobulinemia secondary to hepatitis C
Cryoglobulins in kidney cause nephrotic syndrome by settling in kidney
Type III HS
Enlarged tongue Progressive weakness Hypotonia Cardiomegaly Increased glycogen
Impairment of what enzyme?
A. Branching enzyme B. Glucose-6-phosphatase C. alpha-1,4-glucosidase D. Glycogen synthase E. Phosphoglucomutase
C. Alpha-1,4- glucosidase
Pompe disease
Necrosis of bacteria infections
Liquefactive
Or brain infarct
Necrosis of TB or systemic fungi
Caseous necrosis
NE infusion. After 2 min coronary dilation
A) Adenosine B) Angiontensin II C) Epinephrine D) Histamine E) Thromboxane A2
Adenosine
Adenosine causes coronary dilation mediated by A2 receptors
Cecum metastasis to liver pathway
Ileocolic –> superior mesenteric –> portal –> right hepatic branch of portal
Vertical gaze palsy
Enlargement of third and lateral ventricles. Location of mass?
Pineal gland
- Pinealoma
Fever
Large flaccid, Bullous lesions over trunk and abdomen
Additional finding?
S. Aureus
- Impetigo
Positive nares culture for toxin producing S. aureus
Tx Malignant hyperthermia
Dantrolene
Decreases Ca release from Sarcoplasmic reticulum
Antifungal which targets glucan expression on the fungal cell surface
- type
- use
- adverse
Capsofungin
Anidulafungin
Micafungin
(All Echinocandins)
Inhibit cell wall synthesis by inhibiting synthesis of beta-glucan
Tx: invasive aspergillosis, candida
GI upset
Flushing (histamine release)
Amphotericin B
- MOA
Binds ergosterol
- forms membrane pore that allows leakage of elecrtrolytes
Aspirin overdose
pH
PCo2
HCO3
Salicylates
- cause increase anion gap metabolic acidosis with immediate hyperventilation as compensatory
Decrease pH
Decrease HCO3
Decrease PCO2 from hyperventilation
14 y.o girl, heavy menstrual flow. Frequent nosebleeds and easy bruisability. Father has problem with nosebleeds and clotting. Mild gum bleeding and mile ecchymoses.
Decreased Hemoglobin Decreased Hematocrit Normal platelets Prolonged Bleeding time Normal PT Prolonged PTT
Von Willebrand deficiency
Prolonged BT
Prolonged PTT
Normal platelets so not TTP
Normal PT so not Vit K
(Vit K def= increase PT and PTT)
Heart transplant
One year later, increase BP and creatinine. Which immunosuppressive drug would cause this?
A) Azathioprine B) Corticosteroid C) Cyclophosphamide D) Cyclosporine E) Muromonab CD3
D) Cyclosporine
- Nephrotoxicity
- HTN
- Gingival hyperplasia
- Hirsutism
Azathioprine
- Pancytopenia
Cyclophosphamade
- Hemorrhagic ycstitis
- SIADH
CCK is released from
Enteroendocrine cells (I cells) found in upper small intestine (duodenum and jejunum)
Prolong QT due to decrease of what activity
Outward (delayed) rectify potassium channel
Not inward activating potassium channel
Vitamin from dairy
Vit D3
Organisms that cause microcytic anemia
Necator
Ancylostoma
Kidney with dilated ureter/ calyx in image
Tubular atrophy
Small and nonfunctional kidnye
Man with PKD
Elevated BUN/Cr
pH?
PCO2?
HCO3?
Renal failure
Metabolic acidosis
- Decreased pH
- Normal PCO2
- Decreased HCO3
Neonatal respiratory distress due to deficiency in
Dipalmitoylphosphatidylcholine
Pulmonary surfactant composed of: lecithins (most important is dipalmitoylphosphatidylcholine)
Surfactant subtypes
A and D pulmonary host defense
B and C reduce tension
Supplemented in chronic kidney disease
erythropoietin
Patient with Diabetes has diarrhea due to
Motility disorder
Bulimia values
K
HCO3
Anion Gap
pH
Increase pH
Increase HCO3
Decrease K
Normal Anion gap
Diabetic ketoacidosis
PCO2
HCO3
Anion Gap
Increased Anion gap
Decrease HCO3
Decreased PCO2
Coccus in chains
Dental procedure
Viridians Streptococcus
Partially green on blood agar
Optochin resistant
What would cause ciprofloxacin for UTI to not work
Alendronate Calcium carbonate Ezetimibe Hydrocholorthiazide Simvastatin
Calcium carbonate
Dont take ciprofloxacin with
antiacids
2 month old
Fever, vomiting, diarrhea
Viral particles with a wheel- like shape
Rotavirus
Segmented dsRNA viru
(reovirus)
No envelop
Icoshedral
Primary pericarditis most commonly caused by
virus
A study is conducted to assess the incidence and outcome of subarachnoid hemorrhage in a midwestern state. The annual incidence of this condition is 15 per 100,000 people and the annual mortality rate is 6 per 100,000 people. Assuming that the incidence remains constant, which of the following is the case fatality rate for this condition in this state?
40%
Case-fatality rate= proportion of people with a particular disease that die as a result of that disease.
Compares number of cases to the number of fatalities
6/15= 40%
20 y.o 2 week history of fever, shaking chills, HA, fatigue, joint and muscle pain. Summer lifeguard in long Island. No spleen. Small intraerythrocytic rings. Negative Plasmodium spp.
- Disease
- Location
- Vector
- Blood smear
- Tx
Babesia
Fever and hemolytic anemia
Northeastern U.S
Increase risk with asplenia
Ixodes tick
Ring form
Maltese Cross
Tx: Atovaquone + azithromycin
Antibiotic tx for meningitis –> develop hypotension and bilateral flank pain
Waterhouse- Friedrichsen syndrome
Acute primary adrenal insufficiency due to adrenal hemorrhage
Test with ACTH stimulation test
Condition in which slow recovery from paralysis
Pseudocholinesterase deficiency
Slow at breakdown choline easters
Sensitive to anesthetic drugs like succinylcholinen and mivacurium
5 cm blind outpouching on terminal ileum. Pathology will show
Hetertopic gastric mucosa
Meckel diverticulum
- Partial closure of vitelline duct
- May have heterotropic gastric and/or pancreatic tissue
Splenectomy
Target erythrocytes due loss of what part of spleen
Red pulp
Primarily a filter designed to screen and eliminate defective or foreign cells
White pulp= T cells
Location of most active cell division in epithelial repair
A) Base of crypt
B) Brunner glands
C) Peyer patches
D) Top of Villi
A) Base of crypt
1 wk hx SOB
Carotid artery shows light upstroke to be brisk and downstroke to fall precipitously.
Aortic coarctation Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis Ventricular septal defect
Aortic regurgitation
Hyperdynamic pulse
Vancomycin-resistant Enterococcus mechanism
VRE strain of enterococcus that has acquired resistance to vancomycin through the uptake of a PLASMID that has the resistance
Crush injury
Damage to which of the following is most likely to preclude restoration of normal tissue architecture and pulmonary function?
A) Basement membrane B) Capillaries C) Fibroblasts D) Macrophages E) Mast cells F) Type I pneumocytes
A) Basement membrane
Cor pulmonale
Pulmonary hypertension heart disease
Consists of right ventricular hypertropy, dilation and potentially failure secondary to pulmonary hypertension caused by disorders of the lung or pulmonary vasculature
Scleroderma risk of developing
Pulmonary htn
Epilepsy driving rule
1 year w/o seizure
Blood dots on tongue and lips
Progressive SOB
Nosebleeds
CLubbing nails
Disease?
What is causing SOB
Hereditary hemorrhagic telangiectasia (osler-weber-rondu)
Arteriovenous malformations (AVMS) - atrial septal defect
Tx for IBD
- MOA
Tx Diarrhea
Loperamide
Agonist at u-opiod receptors
SLows gut motility
Poor CNS penetration
Multiple sclerosis pathogenesis of the disease
CD4 T lymphocytes activated by myelin basic protein
High BP
Hypokalemia
Metabolic alkalosis
Increased Renin and aldosterone
Administer captopril
- results in increase in renin
Renal artery stenosis
Renal osteodystrophy
Renal disease –> secondary hyperparathyroidism –> bone lesions
Hypocalcemia
Hyperphosphatemia
Thinning of bones
2 weeks back pain
Two lesions in spine
Metastatic carcinoma of the breast
Missing superior parathyroid gland
Abnormal migration of endoderm for the fourth pharyngeal pouch
3rd pouch: inferior parathyroid and thymus
4th pouch: superior parathyroid
Lung that is underventilated but well perfused. This condition will lead to an increase in
Physiologic shunt
Chloroquine tx for Malaria (plamodium vivax). Initial response good but recurretn parasitemia 2 months later. Why?
Chloroquine is ineffective on the exoerythroytic malarial tissue stages
Lower GI bleeding
Nothing on upper endoscopy or colonoscopy
Blood in stool
Cause of GI symptoms
Angiodysplasia
Tortuous dilation of vessels –> hematochezia
Right sided colon
Older adults
Confirmed by angiography
Associated with
- Aortic stenosis
- Von willebrand disease
6 hr hx fever and shaking chills
Took aspirin for fever
Blood pressure 102/60
Bilateral tenderness in costovertebral area
Increased Leukocyte count
4+ Leukocyte esterase
4+ nitrates
Leukomoid rxn
Acute pyelonephritis
+ nitrates
Leukomoid rxn
Increased white blood cell count, or leukocytosis which is a physiological response to stress or infection. Often describes the presence of immature cellls such as myelofibroblasts or red blood cell with nuclei in peripheral blood.
2 y.o fever sore throat rash
Widespread sandpaper like rash over extremities. Purulent exudate on tonsils. Streptococcus pyogenes (group A) infection. Which toxin?
Erythrogenic toxin
Cross link MHC II to TCR release IL-1, IL-2, IFN-gamma, TNF alpha –> shock
Fever rash shock
Scarlet fever
Toxic shock-like syndrome
Streptolysin O toxin
Protein degrades cell membrane
Rheumatic fever
Beta-hemolysis
Pancreatitis cant digest triglycerides due to deficiency of
Colipase
Alcohol wipe inactivates which viruses
Enveloped virion
1 week hx of low grade fever and joint pain. Chronic headaches takes ibuprofen several times daily. Maculopapular rash. 2+ protein. 10-20 WBC and eosinophils. Renal biopsy most likely to show
Inflammatory infiltrates in the interstitium
Acute pyelonephritis
- WBC in urine
Liver covered in yellow stuff
Fibrin
Low hemoglobin
Anemia
Hematocrit
Volume of RBC compared to total volume
Phase I reactions
- result
Oxidation
Reduction
Hydrolysis
Slightly more polar
Slightly more water soluble
Phase II reactions
- result
Methylation
Acetylation
Sulfation
Glucuronidation
Very polar
Inactive
Major manifestations
Familial chylomicronemia assoc with
Familial hypercholesterolemia assoc with
Familial dysbetalipoproteinemia assoc with
Familial hypertriglyceridemia
Familial chylomicronemia - Acute pancreatitis - Hepatomegaly - Eruptive skin xanthomas (Tendon xanthomas)
Familial hypercholesterolemia
- Premature MI
- Tendon xanthomas
- Corneal arcus
Familial dysbetalipoproteinemia
- Premature MI
- Palmar xanthomas
Familial hypertriglyceridemia
- Pancreatitis risk
- Obesity
- Insulin resistance
Hypoglycemia in Type I DM can be induced by (3)
- Overdose of insulin
- Decreased carbohydrate intake (skipped meal)
- Physical activity/ exercise
Medullary thyroid cancer on histology
Nest of polygonal cells with congo red positive deposits
Polygonal or spindle shaped cells with extrameduallary amyloid deposits
Branching structures with interspersed calcified bodies
Papillary thyroid cancer
Psammoma bodies
Polygonal shaped cells with extramedullary amyloid deposits
Medullary thyroid cancer
Follicular hyperplasia with tall cells forming intrafollicular projections
Tall cell variant of papillary thyroid cancer
Pleomorphic giant cell nests with occasional multinucleated cells
Anaplastic thyroid cancer, aggressive
Often irregular giant cellsa dn biphasic spindle cells
Sheets of uniform cells forming small follicles
Colloid containing microfollicles suggests benign follicular adenoma
Fabry disease most at risk for developing
Renal failure
Neuropathic pain Angiokeratomas Telangiectasias glomerular disease (proteinuria) Cerebrovascular disease (stroke) Cardiac disease (left ventricular hypertrophy)
13 yo girl. Blood pressure 152/91. Lack of secondary sexual characteristics and pelvic examination shows a blind vagina. Lab studies show hypokalemia and low testosterone and estradiol levels. Cytogenetic analysis shows 46, XY karyotype. What is deficient
A. 21-hydroxylase B. 17a- hydroxylase C. 11b-hydroxylase D. Side chain cleavage enzyme E. 5a-reductase
B. 17a- hydroxylase
Alpha cell tumor
Glucagonoma
Insulin increasing drugs
sulfonylureas
Spliceosomes remove introns at
GU at 5’ splice site
AG at 3’ splice site
What helps the mRNA exit the cytosol
poly A tail
What assists in ribosomal attachment to mRNA and prevents degradation of mRNA by 5’ exonucleases
5’ Cap
Androgenetic alopecia
- inheritance
Polygenic
Alkaline phosphatase does what
Promotes normal bone mineralization by increasing local concentrations of inorganic phosphorus
Low grade fever Skin rash Started on face and spread down 8 y.o LAD behind ears
Measles
- Togavirus
Progressive back pain
Intermittent fever
Vertebral boen destruction with fluid collection
Mycobacterium tuberculosis spondylitis (potts disease)
What promotes acen
Androgens
Not estrogen
First like tx for Gout
NSAIDS
- cyclooxygenase inhibitor
Chronic application of corticosteriods causes what to skin
Dermal atrophy
Osteoporosis histology description
Trabecular thinning with fewer interconnections
Pruritic skin rash
Pink papules symmetrically over anterior surface of shins and ankles
Hyperkeratosis with a thickened granular layer
Rete ridges with sawtooth appearance
Scattered colloid bodies
Lichen Planus
Lichen Planus features
Pruritis skin rash Pink Polygonal papules and plaques Chronic lesions show white lacy markings Hyperkeratosis Lymphocyte infiltrates at dermoepidermal junction (interface dermatitis) Scattered esoinophilic, colloid bodies Thickened stratum granulosum - sawtooth appearance
Bluish tumor under nail bed
Glomus tumor (glomangioma) or a subungual melanoma
Glomangioma
- Modified smooth muscle cells of a glomus body
- fxn thermoregulation
Terbinafine
Inhibits synthesis of ergosterol of the fungal membrane by inhibiting enzyme squalene epoxidase
Patient 40 y.o with diabetes having incontinence issues
Overflow incontinence due to impair detrusor contractility or bladder outlet obstruction
Acute dystonic reaction
- is what
- due to
Spasmodic torticollis
Antipsychotic medication
D2 antagonism of nigrostriatal pathway
What do you have to restrict in patient with ornithine build up?
Proteins
Defect in urea cycle
Gingival hyperplasia
Phenytoin
Sudden onset of pain over right cheek lasting several seconds. Triggered by shaving or chewing. Shock like pain
Tx
MOA
Trigeminal neuralgia
Carbamazepine
- Reduces ability of Na channels to recover from inactivation
S. Pneumonae characteristics
A. Bacitracin sensitivity B. Bile solubility C. Catalase positivity D. Complete hemolysis on agar E. Growth in hypertonic saline F. Optochin resistance
B. Bile solubility
Optochin sensitive
Bacitracin sensitive
Streptococcus pyogenes
Complete hemolysis
Group A Strep (s. pyogenes)
Group B Strep ( S. agalactiae)
Growth in hypertonic saline
gamma- hemolytic
No hemolysis
Enterococci
S. bovis
Optochin resistance
Viridans group streptococci
Bile insoluble
Tx Lyme disease
Doxycycline
More chloride in RBC
Enzyme responsible
Excess HCO3 transferred out of RBC in exchange for Cl
Carbonic anhydrase
Thickening of pleural membranes around whole lung
Disease
Due to
Histology
Mesothelioma
- Asbestos exposure
Spindle cell positive for cytokeratin
Central areas of whorled collagen fibers in lungs
SIlicosis
- inhaled silica
Nodules of whorled collagen fibers and dust-laden macrophages
Small cell lung cancer positive for
Chromogranin
- neuroendocrine marker
Thick fibrinous exudate and pus in histology of lung
Empyema
- assoc w/ pneumonia
Primary diffusion impairment due to
Pulmonary fibrosis
Emphysema
Impaired gas diffusion
Baby born to diabetic mother as risk for
Transient hypoglycemia
Glucose can cross but not insulin from mother
Superior sulcus tumor
Pancoast tumor
- SVC syndrome
- Horner syndrome
- Spinal cord compression
- Brachial plexus
Tumor in apex of lung
Schizoaffective disorder. On Haloperidol and sertaline
Found diffusely rigid without clonus
Elevated serum creatinine
Antidote?
Neuoleptic malignant syndrome
Elevated creatine kinase due to rhabdomyolysis
Tx dantrolene
Riboflavin deficiency
WHat enzyme impaired? A. Fumarase B. G6PD C. HMG-COA reductase D. Isocitrate dehydrogenase E. Malate dehydrogenase F. Succinate dehydrogenase G. Succinate thiokinase
F. Succinate dehydrogenase
Brain tumor in HIV patient
Primary CNS lymphoma
- arise from B cells
- assoc with EBV
Ureter obstruction leads into increase in what in the nephron
A. Bowman space oncotic pressure B. Glomerular filtration C. Intraglomerular capillary hydrostatic pressure D. Tubular hydrostatic pressure E. Tubular oncotic pressure
Increased Tubular hydrostatic pressure
Overdose of theophylline can cause
Seizures and tachyarrhythmias
Cardiotoxicity
Neurotoxicity
Pneumocystis pneumonia vs aspergillus
Pneumocystis pneumonia
- diffuse bilateral interstitial infiltrates
Aspergillus
- dense infiltrate involving right upper lung lobe
Cytotoxic exotoxin organisms
Clostridium botulinum
Clostridium tetani
Corynebacterium diphtheriae
Promote host cell death
Hyaluronidase used by
S. aureus
Streptococcus pyogenes
Clostridum perfringens
DIgest extracellular ground substance and enhance ability to spread
Fever and skin rash Brazil Headache Retro-orbital pain High fever joint and muscle pain Epistaxis Rash all over body Diffuse maculopapular rash Scttered petechiae Throbmocytopenia
Dengue fever
- mosquito
Dysphagia Dry mouth Blurred vision Mydriasis Poorly reactive pupils
Suggests
Clostridium botulinum toxin
- neurotoxin
Inhibit ACh release
Canned foods
Dynamic left ventricular outflow obstruction
Hypertrophic cardiomyopathy
Crescendo-decrescendo systolic murmur
Integrase function
After HIV enters host cell, transcribed into double stranded DNA by reverse transcriptase
Viral DNA then enters nucleus via integrase, inserts into host chromosomes and products viral mRNA
Swelling of knee and pain
Facial palsy 3 months ago
Hiking trip to New Hampshire
Knee swelling with no erythema
Tx
Lyme disease
Asymmetric arthritis, single knee joint
Encephalopathy with decreased memroy, somnolence and mood changes
Tx Doxycycline
- Penicillin type Ab
- Ceftriaxone
Nephrotic syndromes
- proteinuria
- albumin
- feature
Does not have
Examples
Heavy proteinuria
Low albumin
Edema
No hematuria or red blood cell casts
Diabetic nephropathy
Membranous nephropathy
Minimal change disease
Nephritic syndrome
- proteinuria
- albumin
- features
<3.5 proteinuria
Hematuria
Red blood cell casts
Azotemia
HTN
PSGN
Membranoproliferative
Lupus nephritis
IgA nephropathy
Nephritic syndrome associated iwth normal complement levels
IgA neprhopathy
Use to test pancreatic function
D-xylose
- monosaccharide
Oliguria
High serum creatinine level
Intranasal ulcer that wont heal
Ab against?
A. Glomerular basement membrane B. Smooth m. cells C. Neutrophils D. Erythrocytes E. Platelets F. Mitochondria
C. Neutrophils
Granulomatosis with polyangiitis (wegners)
Nasal mucosal ulcerations and glomerulonephritis
+ c-ANCA
( cytoplasmic staining anti-neutrophil cytoplasmic antibodies)
Hamartoma of lung
Pulmonary chondroma
Coin lesion
Popcorn calcifications
Excessive growth of a tissue type native to organ
Would find cartilage tissue in biopsy sample
Lung lesion with alveolar growth pattern without invasion
Bronchioloalveolar carcinoma (variatn of adenocarcinoma)
Areas most susceptible to atherosclerosis
Branch points that encourage tubulent blood flow
Lower abdominal aorta
Coronary arteries
Excessive bleeding in patient with renal dysfunction due to
Accumulation of uremic toxins
Impair platelet aggregation and adhesion
Prolonged bleeding
Normal platelet count
Normal PT and PTT
Other side effect of ACE thats not cough and angioedema
Hyperkalemia
Increase creatinine
Sore throat and fever
Mild tonsillar erythema and exudates
Clumped gram positive bacteria with polar granules that stain deeply with analine dyes
Pathogenesis?
Diphtheria
AB Exotoxin
- B binds heparin-binding epidermal growth factor
- A inhibits host cell protein synthesis by catalyzing the ADP-ribosylation of protein elongation factor EF-2
Impairment of protein synthesis
Complete molecule karyotype
46, XX
only paternal DNA
Jejunum removal requires what supplementation after
Decrease in gastric acidity as diminishes iron absorption
Iron absorption duodenum and proximal jejunum
Ascorbic acid absorbed where
Pyridoxine absorbed where
Biotin absorbed where
Panthothenic acid absorbed where
Vit C: distal small bowel
Pyridoxine (B6) jejunum and ileum
Biotin (B7) small and large intestine
Panthothenic aicd (B5) small and large intestine
Patients with panic disorder often develop
Agoraphobia
Patients that undergo organ transplantation and are on immunosuppressive therapy at risk for what
Presentation
Biopsy shows
First line therapy
-MOA
Can cause
CMV reactivation
Fever, fatigue, abdominal pain, diarrhea
Ulcerations
Large cells iwth intranuclear eosinophilic inclusions, intracytoplasmic basophilic inclusions (owls eye)
Ganciclovir
- interferes with viral replication by competitvely inhibiting the incorporation of guanosine triphosphate into CMV stands by CMV DNA polymerase
Side effect
- Neutropenia
- Anemia
- Thrombocytopenia
Fever, HA, myalgia, maculopapular rash
Camping in appalachian mounts
Tx
- MOA
Rocky mountain spotted fever
Rickettsia rickettsii
- tick bite
Doxycycline
- Inhibits protein synthesis by binding 30s subunit
Pruritis
Fatigue
Sister has Sjogren
+ Antimitochondria Ab
Histology of liver similar to what condition
Primary biliary cirrhosis
- chronic autoimmune liver disease characterized by destruction of small and mid-sized intrahepatic bile ducts resulting in cholestasis
Grast vs host disease
Diazepam dont use with
Long acting benzodiazepam
Dont use with other CNS depressants
Alcohols
Barbiturates
Neuroleptics
1st generation antihistamines (chlorpheniramine)
Right gaze
- right eye: right
- left eye: forward
Neutral normal
Left gaze
- both look left
Convergence: normal
Left internuclear ophthalmoplegia
Damage to medial longitudinal fasciculus
Lesion at left dorsal pons
Bacteriodes tx
Gram negative anaerobic rods
(beta lactamase can break down penicillins)
Pipercillin + tazobactams
Azithromycin use
Macrolide
50S
Inhibit protein synthesis
Chlamydia
Mycoplasma
Haemophilus influenza
Moraxella catarrhalis
Ceftriaxone use against
H. influenzae
Klebsiella
Neisseria
Serratia
Ciprofoxacin used against
Second generation quinolone
Inhibit topoisomerase II
Legionella
Pseudomonas
Vancomycin use against
MRSA (s. aureus)
Clostridium difficile
Fever Body aches Generalized weakness Rash on legs Abdominal pain and weight loss Decreased sensation in leftfoot Edema Biopsy: necrotizing vasculitis without IgA deposition c-ANCA and p-ANCA negative Image: red dots all over legs
What is most likely associated with the vasculitis?
A. Hepatitis B seropositivity B. History of heavy smoking C. Jaw claudication D. Recent upper respiratory infection E. Weak pulses in upper extremities
A. Hepatitis B seropositivity
Patient has polyarteritis nodosa (PAN)
Vasculitis of medium vessels Spares lungs Palpable purpura Assoc w/ Hep B Necrotizing inflammatory lesions HTN Asymmetric polyneuropathy Skin lesions GI
+ p-ANCA
Lungs
Kidneys
Nasophagyngeal
Microscopic polyangitis
Amaurosis fugax
Acute painless onset of monoocular visual loss with normal funduscopic examination
With background of atherosclerosis
Transient retinal ischemia originating from atherosclerotic carotid artery disease
Ischemia from hypoperfusion of optic nerve or retina
V1, V2, V3 elevations what artery associated
Left anterior descending artery
5 y.o low grade fever and rash
Bright red erythemaous rash on face prominent on cheeks
Blanching reticulated rash on arms and trunk. Up to date on vaccinations. Facial rash erupted 3 days ago and body rash this morning. Reticulocytopenia
A. Coxsackievirus A B. Human herpesvirus 6 C. Measles D. Parvovirus B19 E. Streptococcus pyogenes
D. Parvovirus B19
Fifth’s disease
Erythema infectiosum
Slapped cheek
- respiratory droplets
- bone marrow suppression
Hand foot and mouth disease
Coxsackievirus type A
- nonenveloped
- linear ssRNA virus
- fecal oral or contact
- summer to early fall
Herpesvirus type 6
Roseola infantum
- enveloped linear ds DNA virus
High fever
Macular rash over body
9-12 months
High fever 3-5 days
Rash after fever
Streptococcus pyogenes
- rash
Scarlet fever
Fever
Exudative pharyngitis
Scarlatiniform rash
Fever and sore throat
Sand-paper rash
Strawberry tongue 1-2 days following sore throat
Rash begins in groin and armpits
Delayed type skin reactivity to pyrogenic exotoxins
Hyperacusis
Increased sensitivity to certain frequencies and volume ranges of sound
Decreased tolerance to sounds
Lesion of facial nerve
1) Spinothalamic tract conveys
2) Lateral corticospinal tract
1) Pain
Temp
Crude touch
2) Primary motor
3)
Brain is from what embryonic layer
Ectoderm
- Neural tube
Bone tumor
1) Anaplastic stromal cells make a tumor osteoid bone matrix
2) Epitheloid clusters with vesicular nuclei and abundant vacuolated soap bubble like cytoplasm
3) Sheets of oval/spindle cell with interspersed large multinuclearted ostoclast like giant cells
4) Small round cells some of which are binucleated with abundant cartilage like matrix
1) Osteosarcoma
2) Chordomas
3) Giant cell tumor
4) Chondrosarcoma
Cardiogenic shock
A. High cardiac output B. Hyperkalemic hyponatremic metabolic acidosis C. Inadequate ventricular function D. Low cardiac filling pressures E. Low pulmonary wedge pressure
C. Inadequate ventricular function
Shock
- Low blood pressure
- Hypoperfusion
- Adequate blood volume
Inability of heart to generate flow thorughout the body due to myocardial infarction
Unable to maintain oxygenation of its tissues
A. High cardiac output
- Septic shock early presentation
B. Hyperkalemic hyponatremic metabolic acidosis
- adrenal shock secondary to addisonian crisis
D. Low cardiac filling pressure
- opposite in shock, have high cardiac filling pressures due to failure of cardiac output to match venous return
E. Wedge pressure= left atrial pressure is elevated in shock
Case control
Know outcome looking for risk factors
Odds ratio
Odds ratio is for
Case control
Not cohort studies
Measured in cohort studies
relative risk
Extrinsic eye muscles
- Innervation
- fxn
1) Superior rectus muscle
- Oculomotor (III)
- Moves gaze up and in
2) Medial rectus muscle
- Oculomotor (III)
- Adducts eye
3) Lateral rectus muscle
- Abducens muscle (VI)
- Abducts eye
4) Inferior rectus muscle
- Oculomotor (III)
- Move gaze down and in
5) Superior oblique
- Trochlear (IV)
- abducts, depress, IR
6) Inferior oblique
- Oculomotor (III)
- Up and out, adduct
Diplopia when looks down what extraocular muscle
Superior oblique
- trochlear nerve
What channels blood to muscles during exercise
Metabolites
- CO2, H, K, Adenosine
- decreased O2
Dilates arteroles locally
Describes what
1) 2 micron spherical micro-organism in the brush border
2) 4-6 micron single cell organisms in the lumen near teh absorptive surface
3) Macrophages in the lamina propria bearing PAS positive bacteria
4) Superficial penertrating ulcers with a mixed inflammatory infiltrate perhaps containing non-caseating granulomas
1) Cryptosporidia
- malabsorption in immunocompromised
2) Giardiasis
- prevent absorption of nutrients
- nausea
- purple burps
- belching sulfurous taste
Ghost face on stain (ghost balloon)
3) whipple disease
4) crohns disease
Boerhaave syndrome
excruciating retrosternal chest pain due to intrathoracic esophageal perforation after vomiting
Female altered mental status and convulsions. Took unknown amount of medication to commit suicide.
Tachycardia Fever Large pupils with slow reactivity Gag reflex minimal No response to auditory stimuli Withdraws from pain Widened QRS complex
A. Alprazolam B. Amitriptyline C. Amlodipine D. Fluoxetine E. Sertraline
B. Amitriptyline
TCA
- Cardiotoxicity
- Convulsions
- antiCholinergic
Barretts esophagus is what
Columnar metaplasia replacing normal squamous epithelium; esophageal adenocarcinoma
CTG trinucleotide in a serine-threonine kinase
caused by
Myotonic dystrophy type I (DM1)
Instability during maternal meiosis
Instability during both maternal and paternal meiosis
Friedreich ataxia
- AR
GAA repeat
Limb and gait ataxia
Cardiomyopathy
DM
Instability during paternal meiosis
Huntington disease
CAG repeat
BRCA mutation affects what gene repair
Homologous recombination
Intrauterine adhesions what is seen in tissue biopsy
Absent stratum basalis in an endometrial biopsy
Uncontrollable facial and chest flushing
Diarrhea
Wheezing
Elevated 5-HIAA
Tx
Can led to
Additonal finding
Carcinoid syndrome
- secretion of serotonin
Octreotide
Niacin deficiency
Tricuspid regurgitation
Arterial blood gas volumes on COPD patient
pH
Oxygen tension
Carbon dioxide tension
Oxyhemoglobin saturation
Decreased pH
Decreased oxygen tension
Increased carbon dioxide tension
Decreased oxyhemoglobin
Patient has chronic bronchitis
- Airway resistance increased due to dynamic airway compression
- Leads to air trapping
Retention of carbon dioxide (hypercapnia)
Respiratory acidosis
Reduced alveolar ventilation –> decreased partial pressure of O2 –> decreased oxygen tension and decreased oxyhemoglobin saturation
Metformin
Atorvastatin
Lisinopril
Drug taht prevents progression of kidney disease inhibits an enzyme found where
Lisinopril
- inhibits ACE which is found in the lung
Diabetic nephropathy on renal biopsy
Uniform glomerular basement membrane thickening
RUQ pain
Nausea
Loss of appetite
Fever fatigue
Drank water in mexico
Dark urine and pale stools
Negative for E.colli and H2S enterobacteriaceae
ALT and AST elevated
Alk Phos elevated
Most likely due to?
Hepatitis A virus
2-6 weeks incubation
Not Ecoli Not salmonella (H2S positive)
Patient traveled to Congo. Altered mental status, fever, chills, headache. Nausea and vomiting.
Diffuse erythematous nonpruritic maculopapular rash on trunk. Petechiae on arms and hands. Positive fecal occult blood test. Bleeding from intravenous line.
Elevated D-dimer Low Fibrinogen Elevated PTT Elevated PT and INR Low platelets
Condition?
Treatment
Ebola causing DIC
Quarantine and fresh frozen plasma
16 AA with sickle cell disease. Has malar rash, extreme fatigue and weakness. Two days prior, temp, nasal congestion, HA and dry cough. Mom had same presentation 2 weeks earlier without rash, followed by arthralgia of wrist and knees
Low Hemoglobin
Low hematocrit
Low reticulocytes
Aplastic crisis due to parvovirus B19
Evident by decreased hemoglobin and hematocrit and decrease in reticulocyte count.
Slap Cheek “Fifths disease”
Malar rash seen with children
Adults will get arthralgias of knee and wrist
Self-limiting and transient bone marrow suppression in healthy individuals
Heart issue seen in alcoholics
Dilated cardiomyopathy
Shows left and right heart failure
S3 heart sound
Systolic impairment
Dilated ventricles have fibrotic non-contractile tissue replacing their myocardium –> weak contractions of left ventricle
Disorganized hypertrophic myocardial fibers with
hypertrophic cardiomyopathy (HCM).
LV hypertrophy
Obstruction of LV outflow
Diastolic dysfunction
1) Microcytic hypochromic RBC with coarse basophilic stippling
2) Microcytic hypochromic RBC with elongation
1) Beta-thalassemia
2) Iron deficiency anemia
Basophilic stippling
Lead poisoning
65 y.o man with diarrhea and steatorrhea for 2 weeks associated with intermittent diffuse abdominal pain and cramping. Joint pain for 6 months. Negative for RA. Murphy negative. HIV negative.
Whipple disease
Diarrhea
Steatorrhea
Malabsorption
Joint pain
PAS stain
Gram positive bacillus
IBS characteristics
Recurrent abdominal pain on average 1 day per week in last 3 months related to defecation and associated with changes in stool frequency and form (appearance)
21 y.o rash 1 week. Red ring with central clearing. Single ring initially spread over back. Pruritic. Fine scaling pink oval papules scattered along the lines of skin folds, heavier distribution along lower aspect of back. Face palms and soles spared.
A. Drug reaction B. Erythema migrans C. Pityriasis rosea D. Secondary syphilis E. Tinea corporis
C. Pityriasis rosea
Key: Scattered along lines of skin folds
Herald rash
Christmas tree
Initial oval 5 cm plaque scaly
Secondary eruption in tree like pattern
Supportive tx
25 y.o with major depression. Found with empty bottle of medication. Agitated and confused. Emesis, diarrhea. Fever, high blood pressure
Anxious, restless Oriented to self only Diaphroetic Mydriasis Upper DTR 3+ Lower DTR 4+ with myoclonus Tremor No rigidity Sinus tachycardia Increased creatine phospholkinase
A. Hypertensive crisis B. Malignant hyperthermia C. Neuroleptic malignant syndrome D. Serotonin syndrome E. Tricyclic antidepressant overdose
D. Serotonin syndrome
Cognitive impairments
Autonomic instability
Somatic effects
Hyperreflexia **
Hypertensive crisis
Severe HTN End organ symptoms Tachycardia Cardia arrthymias Stroke
Too much monoamine oxidase inhibitors
or taken with drugs that potentiate catecholamine activity or tyramine (wine cheese)
Malignant hyperthermia
Inherited genetic mutation of the ryanodine calcium channel receptor responsible for Ca release within SR of skeletal muscle
When exposed to anesthetic agents during surgery –> prolonged muscle contraction
Tachycardia Tachypnea Hyperthermia Acidosis Muscle rigidity Rhabdomyolysis
Neuroleptic malignant syndrome
Adverse drug rxn to antipsychotic
Increased dopamine blockade throughout body
Autonomic instability
Muscle rigidity
high fever
Decreased reflexes
"FEVER" Fever Encephalopathy Vital signs unstable Elevated creatine phosphokinase Rigidity of muscle
TCA overdose
Dry mouth
Constipation
Urinary retention
Fatal arrhythmia
Tachycardia
Hand foot and mouth
- virus
- description of virus
Coxsackie A virus
Naked icosahedral capsid, single stranded RNA
Positive sense (+)
Food stuck in throat
Iron deficiency anemia
At risk for what cancer
Plummer vision syndrome
Esophageal webs
Iron deficiency anemia
Dysphagia
Esophageal squamous cell carcinoma
Sleep walking
CNS immaturity
Normal
TCA (imiprmine), benzo, SSRI if continued or injury high risk
What would increase MVP murmur
Valsalva maneuver
Decrease volume of left ventricle, causes the prolapse to occur sooner
Increase preload maneuver
Squatting
Isometric handgrip
Aortic regurg louder
Inspiration on heart murmur
increase right heart sounds
Hand grip
Increase afterload
Increase intensity MR, AR, VSD
Decrease hypertrophic cardiomyopathy and AS murmurs
Valsalva
Decrease preload
Decrease intensity of most murmurs
Increase hypertrophic cardiomyopathy
MVP earlier onset
Rapid squatting
Increase venous return
Increase preload
Incerase afterload
Decrease intensity of hypertrophy cardiomyopathy
Increase MR, AR, and VSD murmur
MVP later onset
Cirrhosis on liver
- Alcohol
- Autoimmune
causes nodules in the lobules
Alcohol
- uniform small nodules (micronodular) hepatic fibrosis
Autoimmune
- lymphocytes, large nodules hepatic fibrosis
Triangular space
Quadrangular space
Triangular interval
1) Triangular space
- Circumflex scapular artery
2) Quadrangular space
- Axillary n.
- Posterior circumflex humeral artery.
3) Triangular interval
- deep brachial artery
- radial nerve
VHL syndrome
AD
Multiple tumors including hemangioblastomas, RCC, pheochromocytomas
Uses
1) Amphotericin B
2) Ivermectin/ thiabendazole
3) Metronidazole
1) Severe systemic fungal infections
2) nematode infection, strongyloides stercoralis
3) Anti-protozoan drug, and anaerobic bacteria (not fungal infections)
28 y.o episodes of weakness and paresthesia over past few years. Trouble walking and falls easily. Can not make it to the bathroom to urinate in time. Blurry vision. Symptoms come and go. Last few days to weeks. Symptoms free for months.
Imaging?
MS
Periventricular plaques on MRI
Enlarged bilateral cystic ovaries in obese infertile female
due to
lab values
associated with
Polycystic ovarian syndrome
Increased LH production and slightly decreased FSH
Abnormal fxn of HPO axis
Deranged steroid synthesis by theca cells
Increased LH Decreased FSH Increased testosterone Increased androgens Increased estrogen
Insulin resistance type 2 DM
Infectious colitis
Common cause of acute diarrhea by infectious etiologies including viruses (norovirus, rotavirus, adenovirus), bacteria (salmonella, shigella, e.coli, c. diff) and protozoa (cryptoporidium, girdia, entamoeba)
Self limiting
Associated with obstructive sleep apnea
A. Cataplexy B. Cheyne-Stokes respirations C. Hallucination while falling asleep D. Increased sleep latency E. Pulmonary hypertension
E. Pulmonary hypertension
Cheyne-Stokes respiration
Pattern of cyclic bradypnea followed by apnea and then hyperventilation.
Central sleep apnea
Dysfunctional respiratory drive resulting from lesion in the central nervous system respiratory centers
Assoc w/ strokes, brain injuries, brain tumors and other CNS insults.
Patient experiences rapid eye movements. This stage of sleep is associated with
A. a rise in acetylcholine B. an increase in muscle tone C. slow and high amplitude EEG waves D. High dopamine levels E. High melatonin levels
A. a rise in acetylcholine
REM sleep
Slowest and highest amplitude waves on EEG
Delta brain waves
non-REM stage 3
3 y.o SOB with changes in facial skin color when crying or running. Has to squat to catch her breath. Systolic crescendo-descrscendo murmur in left upper border. Upturned cardiac apex
A. Malformation of the interatrial septum
B. Isolated malformation of the interventricular septum
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
D. Shunt between aorta and pulmonary artery
E. Thickened aortic wall media
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
Tetralogy of Fallot
16 y.o sports physical, blowing pansystolic murmur over left middle and lower sternal border.
A. Malformation of the interatrial septum
B. Isolated malformation of the interventricular septum
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
D. Shunt between aorta and pulmonary artery
E. Thickened aortic wall media
B. Isolated malformation of the interventricular septum
VSD
24 y.o uncontrolled HTN. Short stature. Elevated blood pressure in upper limbs. Increased caprefill in lower extremities. Cramping in calves and cold feet
A. Malformation of the interatrial septum
B. Isolated malformation of the interventricular septum
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
D. Shunt between aorta and pulmonary artery
E. Thickened aortic wall media
E. Thickened aortic wall media
Turner syndrome
Coarctation of aorta
4 month old, regular examination. Tires quickly with nursing. Persistent flow murmur throughout systole and diastole
A. Malformation of the interatrial septum
B. Isolated malformation of the interventricular septum
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
D. Shunt between aorta and pulmonary artery
E. Thickened aortic wall media
D. Shunt between aorta and pulmonary artery
PDA
Machine like murmur
24 y.o with pelvic pain 3 days. burning sensation when urinating, 2 days ago notice vaginal discharge. 101 temp. Elevated white blood count 80% neutrophils. Pelvic exam displays cervical motion tenderness and thin, mucopurulent discharge.
Thayer-Martin agar fail
NAAT successful
A. Catalase-negative, gram positive cocci
B. Coagulate-positive, gram positive cocci
C. Gram negative diplococci
D. Lactose-positive, gram-negative rod
E. Non-gram staining bacteria
E. Non-gram staining bacteria
Chlamydia trachomatis
- lacks cell wall
- gram negative like
NAATs**
Thayer-Martin
Gonorrhea
Tx Chlamydia
Doxycycline
Azithromycin
Used to tx? STI
1) 5-flurouracil
2) Acyclovir
3) Metronidazole
4) Penicillin
1) HPV
2) HSV
3) Gardnerella vaginalis
4) Syphilis (trepponema pallidum)
Organism that requires similar environmental conditions for growth and production as chlamydia trachomatis
Rickettsia prowazekii
Obligate intracellular bacteria
Type of organism environment
1) E.coli
2) Listeria monocytogenes
3) Pasteurella multocida
4) Staphylococcus species
1) Facultative anaerobe
2) Facultative intracellular anaerobe
3) Facultative anaerobe
4) Facultative anaerobes
cecum location
right lower corner right before ascending colon
Topiramate on other medication
CYP3A4 inducer
Increases metabolism of hormones
Measles type of virus
Paramyxoviridae virus
Picronaviridae
Coxsackievirus
Togaviridae virus
Rubella
ss linear RNA virus with icosahedral capsid
A. Bunyavirus B. Orthomyxovirus C. Picornavirus D. Polyomyavirus E. Reovirus
C. Picornavirus
Description
1) Bunyavirus
2) Orthomyxovirus
3) Picornavirus
4) Polyomyavirus
5) Reovirus
1) Bunyavirus
- enveloped
- ss negative sense circular RNA
- helical capsule
2) Orthomyxovirus
- enveloped
- ss, negative sense, linear RNA virus
- helical capsule
3) Picornavirus
- ss linear RNA virus
- icosahedral capsid
4) Polyomyavirus
- ds circular DNA virus
5) Reovirus
- ds linear RNA virus
- icosahedral capsid
Turkish Mediterranean descent Mouth and genital ulcers No sexual history Uveitis Erythema nodosum
What is it
Associated with
Behcet syndrome
Immune complex vasculitis
Associated iwth HLA-B51
Nucleoside reverse transcriptase inhibitor (NRTI)
A. Acyclovir B. Efavirenz C. Nelfinavir D. Saquinavir E. Zidovudine
E. Zidovudine
Acyclovir
- Guanosine analog
- HSV tx
Efavirenz
- non-nucleoside reverse transcriptase inhibitor
Nelfinavir and saquinavir: protease inhibitors
Alcoholic with swelling in extremities. Shifting dullness to percussion. Periumbilical vessels. Tender nodules at 5th intercostal space. Mechanism of edema?
A. Decreased plasma colloid oncotic pressure
B. Increased capillary hydrostatic pressure
C. Increased interstitial colloid oncotic pressure
D. Increased interstitial glycosaminoglycans accumulation
E. Increased permeability of the capillary walls
A. Decreased plasma colloid oncotic pressure
Cirrhosis of liver
Decreased production of albumin
Meissner
Ruffini
Merkel
Pacinian
Meissner
- superficial
- fine/ light touch
Ruffini
- superficial
- pressure, finger tips
Merkel
- Deep
- Pressure, deep static touch
Pacinian
- Deep
- Vibration and pressure
16 y.o with mild scleral icterus without jaundice. Elevated direct and total bilirubin. Elevated urinary coproporphyrin I.
Due to
Rotor syndrome
Altered ability to transport bilirubin glucuronides into bile canaliculi
Esophageal varices due to what vessels
Left gastric
Azygos
Periumbilical varices due to what vessels
Superficial epigastric
Branches of paraumbilical veins
Rectal varices due to what vessels
Superior rectal vein with the middle and inferior rectal veins
Alcoholic in ER Weakness, dizzinuess Numbness in both lower extremities Malnourished Homeless Bilateral rotatry nystagmus Angular cheilitis
Microcytic hypochromic red cells with coarse basophilic granules
Vitamin B6 deficiency
Sideroblastic anemia
Numbness of extremities
Glossitis
Cheilosis
Bullet that is necrosis
Gas gangrene
Clostridium perfringens
Gram positive spore forming obligate anaerobic bacillus.
Produce alpha toxin
- a phospholipase that degrades tissue and cell membranes
Organism?
1) Cleaving SNARE protein required for neurotransmitter release
2) Inactivation of the 60S ribosome by cleaving rRNA
3) Inactivation of mitogen-activated protein kinase kinases
1) Clostridium tetani
2) Shigella species
- dysentery due to shiga toxin
- shiga toxin works by inactivating 60S ribosome through cleaving rRNA
3) Bacillus anthracis
- black eschar
- Protective factor and lethal factor combine on surface they form lethal toxin
- Lethal toxin is a Zn-dependent endoprotease that clips off the N-terminus of mitogen-activated protein kinase kinases (MAPKK)
Paget disease of breast biopsy
Large, atypical cell with clear halos within the epidermis
Nodular proliferation of cells extending from the stratum basalis
Basal cell carcinoma
Stromal overgrowth with compressed glandular structures
Phyllodes tumor
- fibroepithelial stroma of teh breast
Multinodular firm and painless masses
Latent infection
Capitans wheel
Fungal
Central america
Paracoccidioidomycosis brasiliensis
Diarrhea
1) Motile trophozoites on microscopy
2) Genome identified by reverse transcriptase PCR
3) growth at 42 C (107.6 F)
4) Growth on thiosulphase citrate bile salt sucrose agar
5) Lactose fermentation on MacConkey agar
1) Giardia lamblia
2) Norovirus
3) Campylobacter jejuni
4) Vibrio cholerae
5) E. Coli
Lab findings with CLL
Associated anemia
Elevated LDH
Elevated beta-2 microglobulin
Autoimmune hemolytic anemia
- Spherocytes
Lung maturity when
36 weeks
Camping trip
HIV male
Watery diarrhea, nausea foul smelling flatulence
Acid fast stain negative
Iodine stain reveals oval cysts
A. Cryptococcus neoformans B. Cryptosporidium parvum C. Entamoeba histolytica D. Giardia lamblia e. Isospora belli
D. Giardia lamblia
Motile trophozoites or oval cysts
Cryptococcus neoforms
encapsulated yeast
Meningococcal manifestation in AIDs patients
Cryptosporidium parvum
chronic watery diarrhea in IC patients
AIDs associated diarrhea
Positive for acid fast stain
Tx Giardia lamblia
Metronidazole
Assoc disulfram like rxn
Metronidazole
GET GAP on the Metro
Giardia Entameoba Trichomonas Gardnerella Anaerobes (clostridium, bacteroids, actinomyces) h. Pylori
8 y.o Not vaccinated Stiff neck Trouble swallowing water Jaw hurting Hypertonicity of masseter muscles
After playing in old tree house
A. Acid fast positive aerobic, rod
B. Gram positive catalase negative cocci
C. Gram positive coagulase positive cocci
D. Gram positive obligate aerobic coccobacilli
E. Gram positive spore forming rod
E. Gram positive spore forming rod
Clostridium tetani
Clostridium tetani exotoxin MOA
Decreased release of inhibitory neurotransmitters GABA adn glycine
Pain and temperature sensations from the body are transmitted to the ventral posterolateral nucleus of thalamus by which pathway
A. Lateral corticospinal tract B. Medial lemniscus C. Reticulospinal tracts D. Spinocerebellar tract E. Spinothalamic tract
E. Spinothalamic tract
Patient with MS and spasticity tx
Baclofen
(Agonist at the GABA-B receptor)
Tizanidine
(alpha 2 agonist)
Alcoholic unconscious
Pulseless electrical activity
Necrosis of mammillary bodies and gray matter surrounding third and fourth ventricles
Brain findings associated with a decrease in?
A. G6PD B. Glutathione reductase activity C. Transketolase activity D. Serum methylmalonic acid E. Serum NADPH
C. Transketolase activity
Wernicke encephalopathy
Hemorrhage and necrosis in mammillary bodies and periaqueductal gray matter
Thiamine deficiency
- Pyruvate dehydrogenase (pyruvate –> acetyl-CoA)
- a-ketoglutarate dehydrogenase (citric acid cycle)
- branched chain a-ketoacid dehydrogenase
- Transketolase (pentose phosphate pathway, ribulose 5-P to glyceraldehyde 3 P
Insulin uses which molecules for effect
A. Janus kinase (JAK) B. Lipoxygenase C. Phospholipase C D. Protein kinase A E. Protein phosphatase
E. Protein phosphatase
Receptor tyrosine kinase
- MAP kinase
- PI3K –> protein phosphatase
JAK second messenger for
Growth hormone
Prolactin
IFN
IL-..
Patient begins nasal cannular oxygen supplementation. Respiratory rate decreases shortly after beginning.
Caused by?
Carotid bodies
Supplemental oxygen administered rapid increase in PaO2 –> reduced peripheral chemoreceptor stimulation and decrease respiratory rate
Carotid bodies vs central chemoreceptors
Central chemoreceptors
- medulla
- respiraotry response to hypercapnia (not hypoxemia)
- CO2 readily diffuses through BBB
- decreased pH detected
Carotid bodies
- sense PaO2
- stimulated by hypoxemia
Parenternal nutrition and gall stones
Decreased cholecystokinin release due to lack of enteral stimulation
Reverse methotrexate toxicity
Folinic acid
Leucovorin
HIV associated nephropathy (3)
Hematuria
Hypertension
Edema
HIV started treatment Edema Fatigue Elevated creatinine Decreased phosphorus Proteinuria Glucosuria Loss of brush border and basement membrane denudation Intracytoplasmic eosinophilic inclusions
Tenofovir-induced nephrotoxicity
NRTI
Acute kidney injury (elevated creatinine, water retention)
Proximal tubule dysfunction ( phosphaturia, glucosuria, proteinuria)
Loss of brush border
Basement membrane denudation
Evidence of giant mitochondria (large eosinophilic inclusions)
Sudden cardiac death in 20 y.o Mutation in protein belong to which structure
Sarcomere
- beta myosin heavy chain
- Myosin-binding protein C
Results from mutations affecting proteins that make up desmosomes (plakoglobin, desmoplakin)
Arrhythmogenic right ventricular cardiomyopathy
Metformin tx measure what ahead of time
creatinine level
renal insufficiency
Male
Sclerotic bony metastases in lumbar spine
Prostate cancer
Osteolytic (lucent)
- osteoclast stimulation
Osteoblastic (sclerotic)
- osteoblast activity
Angiogenesis is driven by
Blood vessel formation
Vascular endothelial growth factor (VEGF)
Fibroblast growth factor
Epidermal growth factor (EGF) does waht
mitogenic influence of epithelial cells, hepatocytes and fibroblasts
Artery associated with elevation in leads II, III, avf
Right coronary artery
Tumor penetration of basement membrane uses which substances
Collagenases and hydrolases (Metalloproteinase)
Pancreas of 22 y.o recurrent pulmonary infections and finger clubbing shows extensive exocrine gland atrophy and fibrosis. Pancreatic ducts are lined with squamous epithelium with areas of keratinization. Deficiency of?
Vitamin A
Cystic fibrosis
- deficiency of fat soluble vitamins (ADEK)
Myelofibrosis
- type of malignancy
- clonal expansion of
- secretion of
Hematopoietic stem cell malignancy
Megakaryocytes
TGF-beta secretion
- stimualtes fibroblasts to fill medullary space with collagen.
Risk factors for diverticular disease
Diet high in red meat, fat and low in fiber
Hip fracture. Damage to which artery causes osteonecrosis
Medial circumflex
Metabolism of calories per gram
1) Protein and carbs
2) Fat
1) Protein and carbs
- 4 calories/ gram
2) Fat
- 9 calories/ gram
Solid left adnexal mass
Ovarian mass is yellow and firm
Small cuboidal cells in sheet with glandular structures containing acidophilic material
Cells are arranged in microfollicular pattern around a pink eosinophilic center
Granulosa cell tumor
- secreting estrogen
Call-Exner bodies
Duchenne muscular dystrophy mRNA change
Nonsense mutation
UCA –> [ UAA, UAG, UGA]
Monoclonal Ab for CD20
Rituximab
Infliximab
- type
- use
TNF-alpha monoclonal Ab
Rheumatoid arthritis
ankylosing spondylitis
Crohns
Interleukin-2
- MOA
- use
Regulates activation and differentiation of T-cells to aid in tumor cell destruction
RCC
Melanoma
Imatinib
- MOA
- Use
BCR/ ABL
CML
Abciximab
- MOA
- Use
Monoclonal Ab againts platelet GP IIb/IIIa receptor
Block platelet aggregation
Acute coronary syndrome
Gardnerella vaginalis vis Giardia lambila
Gardnerella vaginalis
- Gram variable rod, anaerobic
- Vaginal discharge
- Fishy smell
- Clue cells
- Metronidzole or clindamycin
Giardia lambila
- bloating, flatulence
- foul smelling diarrhea
- campers
- motile trophozoites and ovoid cysts
- Metronidazole
Alcohol associated level of hepatic injury
Poor prognosis
Alcohol steatosis (reversible) Alcoholic hepatitis (reversible) Alcohol cirrhosis (irreversible)
Prolonged PT time
Gamma glutamyl transferase level
High level more specific for biliary injury
Decrease risk of bone fractures and breast cancer
Raloxifene
Rifaximin
- mOA
- given in addition to
Antibiotic taht alters GI flora to decrease intestinal production and absorption of ammonia
Lactulose
- catabolized by intestinal bacterial flora to short chain fatty acids, lowering the pH and increasing conversion of ammonia to ammonium
Celiac disease
- Calcium
- Phosphorus
- PTH
Vitamin D deficiency
Deficiency calcium
Increase PTH
Decrease phosphorus
60 y.o with lactose intolerance for 2 months
- due to
- decrease what
Secondary lactase deficiency
- inflammation/ infection
Injury at mucosal brush border
Fermentation of undigested lactose by gut bacteria leads to increase in production of short chain fatty acids –> acidify stool
Decrease in pH stool
Neurologic regression
Hepatosplenomegaly
Diminished reflexes
Cherry red spot
Niemann Pick
- Spingomyelin
Lung tissue microscopic examination: spherules packed with endospores
Coccidioides immitus
- dimorphic fungus
- central california, arizona, new mexico
Pyelonephritis –> hypoxic and breathing issues
Due to?
Phases
Sepsis
Acute respiratory distress syndrome (ARDS)
- bilateral pulmonary infiltrates and hypoxemia in the absence of heart failure
Exudative phase
- inflammatory cytokines
- increased capillary permeability
- leakage of protein-rich fluid in the alveolar space
- hyaline membranes
Proliferative phase
- one to two weeks later
- collagen deposited adn scarring
- edema reabsorbed
Fibrotic phase
- excessive collagen deposition leads to irreversible pulmonary fibrosis and pulmonary htn
Pica
compulsie consumption of nonstaple food or non-nutritive substance for >= 1 month
Total gastrectomy need to supplement
A water soluble vitamin
B12
Midline posterior fossa mass
Sheets of primitive cells and mitotic figures
Medulloblastoma
Impaired neuromuscular transmission
Myasthenia gravis
- autoantibodies to ACh receptors
Lysing of blood cells when incubated in hypotonic saline with glycerol
Hereditary spherocytosis (HS)
Rheumatoid arthritis affects what part of spine
Cervical
SLE
Prolonged PTT
False positive rapid plasma reagin (RPR)
Greatest risk for
A. Esophageal dysmotility B. Menorrhagia C. Painful hemarthroses D. Recurrent miscarriages E.Sclerodactyly F. Tabes dorsalis
D. Recurrent miscarriages
SLE
- antiphospholipid antibodies
Hypercoagulable state
Influenza vaccine MOA
Inhibition of viral entry into cells
Inactivated versions
- neutralizing antibodies to hemagluttinin ag
HIV patient
CD4 400
Fever chills productive cough
Organism?
Strep. pneumoniae
Increases urea reabsorption in collecting tubules
Vasopressin (ADH)
Systolic murmur along the left sternal border that decreases in intensity with hand grip
Left venticular mass
Left ventricular cavity size
Left ventricular ejection fraction
Left ventricular relaxation
Hypertrophic cardiomyopathy
Involves hypertrophy of interventricular septum and obstruct LV outflow
Mass: increased
Cavity size: small
Ejection fraction: preserved
Relaxation: impaired
Patients with MG are extremely sensitive to what drug
Vecuronium
Rocuronium
Nondepolarizing agaents
Progressive weakness and fatigue over last year. Loss of expression of mutation that codes for a protein found on basolateral surface of hepatocytes and enterocytes. Protein is known to interact with transferrin receptor
Greatest risk of developing?
Primary hemochromatosis
- mutation of HFE protein
Detects falsely low iron levels
Get iron accumulation
Enterocytes: increase apical expression of DMT1, increasing iron absorption
Hepatocytes: decreasing hepcidin synthsis, increased feroportin expression –> increased iron secretion
Iron excess –> bronze diabetes
At risk for hepatocellular carcinoma
Erratic behavior
HIV CD4 of 30/ mm3
Demyelination
JC virus
- no edema
- latent infection
- attack olgiodendrocytes
Produce progressive multifocal leukoencephalopathy
Gout can be caused by
Increased urate production
- myeloproliferative/ lymphoproliferative disorders (polycythemia vera)
- tumor lysis syndrome
- HGPPT deficiency
Decreased urate clearance
- chronic kidney disease
- thiazide/ loop diuretics
Type 2 DM
Confusion lethargy
Hypoglycemia
Elevated C-protein
What drug was used
Medication that stimulates pancreatic insulin secretion independent of blood glucose levels
Sulfonylureas (glyburide)
Epinephrine administered after pretreatment with Drug A cause increase in insulin.
Drug A blocks?
Alpha 2 adrenergic receptors
Epinephrine with what receptors increase insulin secretion
Muscarinic M3 (Gq)
Glucagon (Gs/Gq)
Beta 2 adrenergic (Gs)
GLP-1 (Gs)
Painless Testicular tumor
Elevated lactate dehydrogenase
Elevated alpha fetoprotein
Nonseminomatous germ cell tumor
- embryonal carcinoma
- yolk sac tumor
- choriocarcinoma
hCG
AFP
Li-Fraumeni syndrome
TP53
Sarcomas Breast cancer Brain tumors Adrenocortical carcinoma Leukemia
AD
5 y.o sunburns easily. Skin becomes red and scaly with minimal sun exposure. Hyperpigmented skin. Few nevi on hands.
Defect of?
Xeroderma pigmentosum
- AR
- defective nucleotide excision repair of DNA dmaged by UV light
Flutamide MOA
Impaired androgen receptor interaction
Competitive testosterone receptor inhibitor
Leuprolide MOA
Long acting GnRH agonist
- decrease testicular leydig cell stimualtion
Anastrozole MOA
Aromatase inhibitors
Decrease peripheral convertsion of androgens to estrogen
Finasteride MOA
Decreases peripheral convertsion of testosterone to DHT by binding 5alpha reductase
Shigella infects via what cell
microfold (M) cells at base of mucosal villi within a Peyers patch
35 y.o female to clinic due to severe heart burn that is resistant to over the counter anti-acids. Scattered telangiectasias on the face, several ulcers at tips of fingers, small calcium deposit in soft tissues of hands and elbows. Processes most likely cause of this heart burn?
A. Abnormal location of gastroesophageal junction
B. Fibrous replacement of the muscularis in the lower esophagus
C. Increased gastric acid production
D. Increase in resting lower esophageal sphincter tone
E. Uncoordianted, simulataneous muscle contractions in the lower esophagus
B. Fibrous replacement of the muscularis in the lower esophagus
CREST syndrome
latent infection in neuronal cell bodies
Ganglia
HSV
Kidney stone given morphine sulfate for pain. Fifteen minutes later, develops diffuse itchy rash
MOA?
IgE INDependent mast cell degranulation
Pompe disease deficiency of
acid alpha-glucosidase
Concentrations of K along nephron
Bowman capsule
PCT
Ascending Loop of Henle
Collecting duct
Bowman capsule 100%
PCT 35%
LOH 10%
Collecting duct 110%
Prion disease causes what in brain
sponge-like vacuolated neurons in gray matter
Intranuclear inclusions in oligodendrocytes
Progressive multifocal leukocencephalopathy due to JC virus
PTSD tx
SSRI
Prevention for Group B strep infection
Intrapartum ampicillin
Gas gangrene
Clostridium perfringens
Also causes transient watery diarrhea and abdominal discomfort
Bone pain
Hearing impairment
Multinucleated cells with over 100 nuclei
-Factor essential for differentiation of cells
Paget’s disease of bone
RANK-L
Receptor activator of nuclear factor kappa-B ligand
Mitral regurgitation
- Afterload
- Preload
- Ejection fraction
Afterload: decrease
(regurg so low resistance)
Preload: increase
(LV end-diastolic volume)
EF: Increase
(decreased afterload –> increase EF)
Polyp formation steps
1) Normal mucosa –> small adenomatous polyp (adenoma)
= APC mutation
2) Increase size of adenoma
= KRAS mutation
3) Malignant transformation, adenoma to carcinoma
= TP53 mutation
Pretreatment for MPTP toxicity produced by MAO type B
Selegiline
5 y.o, bites on inbetween toes. Stool shows smooth thin walled eggs.
Infection?
Complication
Hookworm
- Necator americanus
- Ancylostoma duodenale
Egg-containing human feces in soil
- skin direct contact with soil
Larvae to lungs, rupture, coughed up and swallowed. In small intestine, mature into adults and attach to GI mucosa and feed on uman blood by lacerating capillaries
Iron- deficiency anemia
Microcytic anemia
Fever HA confusion
Allergic to penicillin
Antibiotic started
Low Erythrocytes
Low Platelets
Low Leukocytes
which antibiotic?
A. Chloramphenicol B. Clindamycin C. Gentamicin D. Metronidazole E. Vancomycin
A. Chloramphenicol
Aplastic anemia
- Carbamazepine
- Chloramphenicol
- Sulfonamides
42 y.o episodic SOB adn cough. FEV1 is 71%. Predominant eosinophils
Causea
Asthma
- Animal dander
- Dust mites and cockroaches
- Pollens and molds
Nondepolarizing block vs depolarizing block
Nondepolarizing block
- vecuronium
- Gradual decrease
Depolarizing block
- Succinylcholine
- phase I: constant but diminished
phase 2: gradual decrease
Outcome Hep B virus
Complete resolution (>95%) Chronic hepatitis (with or without cirrhosis) Fulminant hepatitis with massive liver necrosis
Brain natriuretic effect on kidney
Increases sodium excretion
Increase GFR
Anterior nucleus of hypothalamus
Fxn
Lesion
Panting or sweating
Lesion= hyperthermia
Dorsomedial nucleus of hypothalamus
Fxn
Lesion
Rage
Lesion= decreased aggression and feeding
Lateral nucleus of hypothalamus
Fxn
Lesion
Increased feeding
Lesion= decreased feeding
Supraoptic nucleus of hypothalamus
Fxn
Lesion
Increased blood volume, blood pressure and metabolism
Lesion= diabetes insipidus
Ventromedial nucleus of hypothalamus
Fxn
Lesion
Decreased feeding
Lesion= increased feeding
34 y.o male present with dull epigastric pain for several weeks, worse after meals. Progressively worsened and now is symptomatic despite ranitidine use. History of recurrent kidney stones. Family history of same symptoms. Bitemporal hemianopsia
Elevated Calcium level
Elevated PTH
Epigastric pain due to
A. Ab directed toward parietal cells
B. Decreased gastric motility
C. Gastrin overproduction leading to acid release
D. H. pylori infection
E. Inhibition of prostaglandin E2 synthesis
C.Gastrin overproduction leading to acid release
MEN1
Hyperparathyroidism
Bitemporal hemianopsia (pituitary adenoma)
Peptic ulcer disease (gastrinoma)
Abdominal pain due to gastrin-secreting gastrinoma which triggers acid release
Otitis media organism
Streptococcus pneumoniae
Strain not in vaccine
H. influenza type b less common since vaccination (Hib)
- Non typeable remains major cause of AOM in children
Unilateral painless testicular enlargement. Bilateral gynecomastia. Elevated serum beta human chorionic gonadotropin level.
A. Choriocarcinoma B. Diffuse large B cell lymphoma C. Leydig cell tumor D. Sertoli cell tumor E. Yolk sac tumor
A. Choriocarcinoma
hCG has an analogue similar to LH –> precocious puberty, gynecomastia, impotence or loss of libido
Leydig
- increased testosterone
- Virulization and gynecomastia
Sertoli
- androgens or estrogens
- not enough to cause endocrinologic changes
Yolk Sac tumor
- infants and children
- painless bulky testicular mass
- Alpha-fetoprotein
Leydig cell tumor
- secretion
- causes
- description
- feature associated with
- Marker
- histology
Sertoli cell tumor
- secretion
- causes
- description
- histology
- feature associated with
- marker
Yolk Sac tumor
- affects who
- description
- pattern
- histology
- feature associated with and description of
- marker
Leydig
- increased testosterone
- Virulization and gynecomastia
- yellow tan color
- solid lobulated
- Reinke crystals
- Inhibin A
- round nuclei, single prominent nucleoli and abundant eosinophilic cytoplasm or clear cytoplasm
Sertoli
- androgens or estrogens
- not enough to cause endocrinologic changes
- well circumscribed, pale yellow to whitish gray
- tall polyhedral cells arranged in nests, sheets and cords resembling spermatic tubules
- perinuclear aggregates of intermediate filaments
- Inhibin A marker
Yolk Sac tumor - infants and children - painless bulky testicular mass -honey comb pattern - reticular network is formed by vacuolated cytoplasm of tumor cells -Schiller-Duvall bodies (Central vessel rimmed by fibrous tissue and surrounded by malignant epithelial cells in a cystic space - Alpha-fetoprotein
First line A-fib
Dofetilide
Class III antiarrhythmic
Blocks K channels
First line tx SVT
Adenosine
Sarcoidosis causes elevated level of
CXR
ACE
ACE is produced by the granulomas in sarcoidosis
Enlarged hilar lymph nodes and bilateral pulmonary reticular opacities
Ramelteon MOA
Positive actions on the suprachiasmatic nucleus
Selective melatonin receptor AGONIST
- binds MT1 and MT2 in suprachiasmatic nucleus
29 y.o recurrent epistaxis. Frequent nose bleeds now anemic. Father same symptoms with GI bleeding.
Decreased hemoglobin
Positive hemoccult
Osler- Weber Rendu
- hereditary hemorrhagic telangiectasia
- AD
Dilated blood vessels
Achalasia
- loss of
Loss of myenteric plexus
Loss of nitric oxide synthease producing neurons
Was in water in Africa
Rapidly decreasing vision
A. Behcet B. Kala-azar C. Loiasis D. Onchocerciasis E. Sarcoidosis
Transmission? A. Black fly B. Deer fly C. Idiopathic D. Sand fly E. Tsetse fly
Treatment? A. Diethylcarbamazine B. Ivermectin C. Nifurtimox D. Prednisolone E. Sodium stibogluconate
D. Onchocerciasis
Onchocerca volvulus
- parasite
- black fly
Parasitic larvae into blood stream with bite
Ivermectin
Oral ulcers
Genital ulcers
Eye redness and pain
Behcet syndrome
Turkish descent
Immune complex vasculitis
Spiking fevers
hepatosplenomegaly
Pancrytopenia
- Disease
- organism
- transmitted
- tx
Kala-azar
aka visceral leishmaniasis
Caused by parasite Leishmania donovani
Sand fly
India
Sodium stibogluconate
Worms seen in eyes (conjunctiva)
Swelling of skin
- Disease
- organism
- transmitted
- tx
Loiasis
Parasite Loa Loa
Chrysops flies
(Deer fly, horse fly, mango fly)
Tx: Diethylcarbamazine
Tsetse fly
Trypanosoma brucei gambiense adn T.b. rhodesiense
African sleeping sickness
4 y.o runny nose and trouble breathing. High pitched noise everytime he breathes in. LAD. Hypertonic scalenes and sternocleidomastoid muscles. Temperature
- Disease
- Seen on radiograph
- organism
Laryngotracheobronchitis
- aka croup
Bark like cough
Subglottic narrowing
“Steeple sign”
Parainfluenza virus type 1
- Paramyxoviridae
- enveloped helical nucleocapsid negative sense ssRNA virus
MRI of child’s brain reveals enamel-like calcifications and tumor that is located supratentorially
A. Containing foamy cells that are highly vascular
B. A remnant of Rathke’s pouch
C. Containing solid rosettes of small blue cells
D. Composed of Rosenthal fibers
E. Having a “Fried egg” appearance on histology
B. A remnant of Rathke’s pouch
Craniopharyngioma
Ectoderm
Supra cellar calcifications
Brain tumor
1) Highly vascular foamy cells
2) Containing solid rosettes of small blue cells
3) Composed of Rosenthal fibers
4) Having a “fried egg” appearance on histology
1) Von Hippel-Lindau disease
2) Neuroblastoma
3) Rosenthal fibers are corkscrew-shaped intracytoplasmic inclusions that are seen in optic gliomas of neurofibromatosis 1 and pilocystic astrocytomas
- AD
- Cafe au lait
- visual disturbances
4) Oligodendrogliomas
Infraorbital nerve
- division of
- does what
Terminal branch of maxillary division (V2) of trigeminal CN V
Sensory information from the lower eyelid, side of the nose and upper lip
Tumor in proximal colon
Signet ring cells
Father and grandfather same presentation
A. Alternative splicing B. Base excision repair C. Mismatch repair D. Nucleotide excision repair E. Purine salvage
Lynch syndrome
- Hereditary nonpolyposis colorectal cancer
C. Mismatch repair
Purine salvage defects
Lesch-Nyhan syndrome
- deficency of HGPRT
- self mutilation
- hyperuricemia
- mental retardation
Side effect of diphenhydramine
Dry mouth
21 month old Sick all the time Oral thrush RSV and influenza Impetigo and exudative tonsillitis
Severe combined immunodefiviency
Fasiculations in quadriceps muscles and tongue
Clonus of ankle reflexes
Dysarthria
Spasticity of elbow flexion
A. Anterior horn B. Lateral horn C. Posterior horn D. Primary motor cortex E. Reticular formation
A. Anterior horn
UMN
- dysarthria
- spasticity of elbow flexion
- clonus of ankle reflexes
LMN
- Fasciculation of tongue
- Fasciculations in biceps muscles
50 y.o man. Fatigue, fevers, joint and muscle pain and weight loss. Cough and dyspnea and occasional hemoptysis. Denies upper respiratory involvement. Peripheral sensory loss. Palpable purpura on skin and elevated erythrocyte sedimentary rate. Hematuria and mild proteinuira. Biopsy: vasculitis with an absence of granuloma formation.
Diagnosis
Marker
Tx
Microscopic polyangiitis (MPA)
Males 50 y.o
[Dont have chronic sinusitis seen in granulomatosis w/ polyangiitis]
Necrotizing vasculitis involving kidneys, lungs and skin with pauci-immune glomerulonephritis and palpable purpura
p-ANCA +
(anti-myeloperoxidase)
Tx Cyclophosphamide
Nausea, vomiting Vertigo Numbness on right side of face Dysarthria and dysphagia Uvula deviation to left Hemianalgesia on right side of face and left side of body Ataxia
Artery involved
Lateral medullary syndrome
RIght PICA
Loss of pain and temp on face and body
Ipsl facial hemiparesis
Ipsilateral deafness
C/L body analgesia
Lateral pontine syndrome
AICA
Contralateral hemianesthesia
C/L homonymous hemianopia
Ips horizontal gaze preference
MCA
Fever that rises and falls through day Night sweats Joint pain Heart murmur Mexico Goat cheese and unpasteurized milk
Brucellosis
Recurrent pyogenic infections
Oculocutaneous albinism
Progressive neurologic abnormalities
Coagulation defects
Chediak-Higashi syndrome
- AR
Abnormal lysosomal trafficking protein that results in defective phagolysosome formation
Skin infection on leg. Red shiny and tender. Fever. Gram positive cocci, catalase negative, sensitive to bacitracin
Virulence factor?
Cellulitis
Streptococcus pyogenes
M protein
Iron poisoning tx
Deferoxamine
Lead poisoning tx
Dimercaprol
EDTA
Succimer
Flumazenil
Antidote for benzodiazepine overdose
Deferoxamine
Tx iron poisoning
Type 2 diabetic
Sweating, dizziness, heart palpitations and tremor thirty minutes after taking meds. Appetite increased.
Diaphoresis
Tachycardia
A. Glucagon B. Glyburide C. Metformin D. Propranolol E. Rosiglitazone
Hypoglycemia
Second generation sulfonylureas
- glyburide
- glimepiride
- glipizide
Nephritic vs Nephrotic types
Nephritic [ HTN, Inc BUN/CR, Oliguria, RBC casts] 1) Post streptococcal glomerul 2) Rapidly progressive glomer 3) IgA nephropathy (berger) 4) Alport 5) Membranoproliferative glome
Nephrotic [Proteinuria, edema] 1) Focal segmental glomeruloscl 2) Minimal change 3) Membranous nephropathy 4) Amyloidosis 5) Diabetic glomerulonephri
Nephritic/Nephrotic
- Diffuse proliferative glomerulonephrtis
- Membranoproliferative glomerulonephritis
14 y.o weight gain Fatigue Swelling in ankles and feet Dark foamy urine Hematuria and proteinuria
Proliferation of mesangial and endothelial cells of the glomeruli and expansion of the mesangial matrix along with immune deposits
Membranoproliferative glomerulonephritis
Hematuria and proteinuria
Edema
Edema Foamy urination Proteinuria Low hematuria Biopsy: diffuse thickening of walls of the glomerular capillaries
Membranous glomerulonephritis
Temporal vs parietal radiation visual defect
Temporal
-upper right quadrant
Parietal
- Lower left quadrant
Fever Rash Dysuria Urinary urgency Hematuria, mild proteinuria WBC (eosinophils) in urine Azotemia Costovertebral angle tenderness
Diagnosis
Caused by
Acute interstitial nephritis
Drug induced
5 P's Pee (diuretics) Pain-free (NSAIDs) Penicillins and cephalosporins Proton pump inhibitors RifamPin
Polyribosylribitol phosphate (PRP)
Makes polysaccaride capsule
Eosinophilic cell
Bright pink cell
Hep B vs Hep C
Nephrotic disease
Hep B
Membranous GN > Membranoproliferative GN
Hep C
Membranoproliferative GN > Membranous GN
