Tia's Deck USMLE Flashcards
difficulty sleeping
problem with LEFT heart
pain after delivery
most likely ovarian thrombus drains into right or left ivc. Uterin vein frained into internal iliac
new house after painting - child with constipation
lead posion - constipation , anemia and neurological symptoms
chronic hemolytic anemia
hemoglobin c- glutamate to lysin - dehydration of rbc
bacterial infection
gluco < 45 , protein > 250
gout pt
cox2 inhibitors can reduce il1 at the site of inflammation
reid index
mucous \ lamina propia + submucosa
adenocarcinoma
smoking , age over 65 , chrnoic panceratitis , men , herditary pancreatitis, pautz jagher
ani smith
against snRNP together with Mrna is the splicesosome
BRAFF
valin to glutamic
mutation
BRACA 1 BRACA 2
crackels
fine - pulmonary fibrosis. Due to opening of small aw
methylation
azathioprin
integrins
integrins bind fibronectin that bind collagen . Intacelular domain of fibronectin binds actin
keratin sulfate
keratin sulfate in ecm organized type 1 collagen in cornea
virulence
transformation - uptake dna , transduction - phage , conjugation - f factor
acne
anabolic steroids eg methyltestestoron can cause acne
area postreme
indirectly by ht3 via afferent vegal nerves or directly via dubstance p nk1
aortic dissection
htn marfan sy , severe pain , >20 hg variation in bp
ddx vsd and regurgitation mitral
radiation to axilla
myxedema degeneration
valves are formed from gag and thus can be degenrated by mafan or eheler danlor
performance anxiety
b blockers
qt prolangation
romano - no deafness and jurval
burgasa sy
rbbb and st elevation v1 v3 - can cause ventricular tachyarrythmias
theophillin over dose
tachycardia and seizures - treated with bb
ami smooth muscle cell ab
autoimmune hepatitis
speach
broca - not fluent vs wernice - fluent . In conduction (arcuate fasiculus) - very poor repetition.
sarcoidosis
increase ectopic ACE producation and increase ca - non caseating mainly african american
monckeberg calcification
effect only media , no itima . Asymptomamtic . Do not acclude vessel
onion conceric hyperthrophy
only above 180 bp usually and effects arterioles mainly kidney retina intestine .
leriche syndrome
aortoilliac occlusion
hpv
can cause squmous cell carcinoma in hiv pt in anal region
sevalamer
phosphate binder
cri du chat
cat cry hypotonoa , low ears broad nasal bridge
digeorge syndrome
trancus arteriolus , clrft plate , low ears
patau
cleft and polydactly
edowars
prominent occipital and overlapping fingers clench
big hematoma
ecchymosis. <5 mm is petachia and smaller is porpura
scotoma
any visueal defect sorrounded by unimpaired field of vision
trigeminal neuralgia
pain in one side of the face - treatment is carbamazepine.
sputum
green color is indicative of neutrophil myeloperoxodase activity
ependymoma
histo perivascular rossete.
blood supply
lad- supplies anterior aspect of left ventrical - v1-v4. distal will spare the v1v2
dilated coronory sinus
pulmonary htn \ presistent left superior vena cava
hypersensativity reaction hiv drugs
abacavir - hla b 57 : 01
emtrictiban
nrti - palmar rush
pulmonic stenosis
soft s2 pluse wide spleating
systemic scelrosis
pulmonery htn many times is cause of death
heptitic c
no proofreading of exonuclease 3 to 5 prime
eosinophilic inclusion
negri bodies - rabies virus
delusional
more than 1 month of delusional and no other psychotic symptoms!!
bullemia nervosa
hypokalemia , metabolic alkalosis , enlargment of parotid glnd bilateraly
alcohol withdrowal
erly sighn : anxiety , tremor , palpitation , gi
negative symptoms
lack of facial expression monotome voice poor eye contact
nacrolepsy
dx by low hypocretin -1 in csf
adhd dx
hyperactivity interfering with functioning in more than 2 setting ( school \ home ) . Dx before age 12 with more than 6 events over 2 months
opioids
incresed pain sensetivity in long term use due to - upregulation of nmda receptors .
opioids
mu receptor g coupled
phencyclidine
presistent nystagmus , psychosis and violent behavioral
seratonin precursor
tryptophan - fun syndrome
adjusment disorder
if pt meets the critria of mdd than it rules out adjusment
pharma - benzos
avoided in pt with substance use history
panic
acute - benz , chronic - ssri
mao inhibitors
good for atypical antodepressents and anxiety and seleglin for parkinson
nacrolepsy
treatment : modafenil , sodium oxybate
low calcium
increase ph increses the bound calcium to albumin , less free clacium . Low albomin - less total calcium but same free ionized
oculomotor nerve
in diabitic neuropathy the peropheral part is intact ( ehre parasympathetic is ) but the xentral part is smaged thus down and put and ptosis. In aneurysmal - compreesion of periphery too , parasympatetic - loss of accomodation to light
young pt sudden caraic death
hyperthropic cardiomyopathy
encephalitis causes
hsv , rabies , tick born virus, enteroviruses . Temporal lobe encephalitis- hsv1
secretin test
gastrinoma
pseupalsisatinf with central necrosis
glioblastoma with new vessel formation , age 40 70 year od age
diabitis
fetus develops hyperinsulinemia due to high glucxose for mom , thus in delivery where will be transient hypoglycemia
wide splitting
pulmonic stenosis
sle
can cause serositis- pericarditis , pleuritis and peritonitis
hemartoma
hemartomas are common in lung , cartilage in biopsy
testicular cancer
does not transilluminate . Ususlally in young age , not painfull
dilated cardiomyopathy
sudden cardiac death at around age 30 40 , fatgue people
bph
can predispose to urinary tract infection
mutation
in apc we must have polyp while in the other no
atheroembolic event
vascular procedures can dislodge a plaque into small arteries. Symp: blue tue , bowek ischemia , acute tubualar necrosis , livedo reticularis
aortic stenosis
fibroblast differentiat onto osteoblast like cells thay causes progeressive valvular clacification
deposition of sterile platelet thrombi eg limban sacks
leads to regurgiatation rather than stenosis
mxomatous
mitral valve prolapse ( mardan eheler danlor )
ckd
low clalcium high pth
osler weber rendu syndrome
hereditary hemorrhagic telangiectasia , epistaxis
abdominal annurism
below renal above bifurcation , can radiate to the back , different pulses
irreversible damage
red neurons - eosinophilic cytoplasm and basophilic nuclei
kaposi
spindle cells sorrounding blood vessels
entamoeba histolytica
trophozoite ingested rbc
rapiddly progressive demantia with myclonous and spongiform changes
creutzfeldt jakob disease .
diabtis
can cause hylalinization of nerve arterioles leading to ischemic damage.
lab value
after alp cheack ggtp to see if its liver damage
absence and tonic clonic
valproic acid is the first line treatment for the combination
atheroscelrosis suseptabilty
abdominal aorta and coronory
diabetis
lengh depended axonopathy - amall fiber- prodominance of positive symptoms while large fiber involvment predominance of negative symptoms
zolinger elison
distal duadenal ulcer
ttp
normal pt and ptt
drug induced toxisity
takes time and is not acute
systemic mastocytosis
clonal cell proliferation in bone marrow assocated with mutation in kit receptor tyrosin kinase
neuropenic patient
oppurnotist mycosis .
tenofovir
can cause fanconi syndrome and on histo - eosinophilic sytoplasmic inclusions
negative endocardidtis
coxiella and batonella
s3
best heard in lateral decubitis and in expiration
etaercept
decoy protein
brachicephlic vs svc syndrome
in svc syndrome both sides will be affected
gullian barre
albuminocytologic dissociation 0 increase protein and low wbc
pneumonia
staph aureus - productive cough
parvovirus
begins as flu and than rush spreading from face to trunk .
gastroenteritis
no mucous no bloody if its viral
prostatectomy
damnge cavernous nerves - eractile dysfunction
nucleus arcute hypoth
dopamin
hcg
mimcs lh in alpha subunit thus can mimic lh surge- used in pcos
syphilid
raised ulcer clean base - syphilis
syphilis - dx
nontreponemal - humoral response takes time thus its not sensative in the first 4 weeks
alcohol absitenence
natrexon and then disulfiram
gestational diabetes
glucokianse mutation - less insulin release
strep viridans
adherence to fibron and platlets
increase icp treatment
increase cerebral vascular resistance via decreasing co2
purulent pericarditis
staph aurous …
head traume leading to lost of taste
avulsion of olfactory outlets
hypertansion
can can hemorrhage of retina via fibrinoid necroiss. Htn can be seen as cotton wool spots too
tarrry stool and fatigue
associated with alkylating agents - causing death of repidly devideing cell in upper gi – > blood in atool ( tarry - melane)
bacterial meningitis
dexamethason is given broew treatment to reduce inflammtory responce and increase mortality
acute memory loss
suspect depression
irregular enlargment of uterus
leiomoma
levodopa + carbidopa
less vomit , tachyarrythmias but more anxity agitation .
seratonin syndrome
accours in combination with other seratogenic agent
aging
increase residual volume decrease forced vital capacity , unchanges tlc due to decrease chest wall compliance but increased compliance of lung
PE
hypotension , persistent hypoxemia , hypocapnia , respiratory alkalosis –> v\q mismatch - can be pneumoni or more probable to luhypotension to be PE
LHF
pulmonary edema severe dyspnea
pulmonary htn
rhf - no pulmonary edema ( at least unril lhf occurs too )
fat embolism syndrome
petachie , dyspnea , neurological abnor
malposition of gential tubrcle
epispadis
descent of testis
4 months
dwarfism
achrondroplesia \ laron syndrome - achondroplasia- not propotional - prominent forhead saddle nose normal genitelia .
swarfism
small genitellia ( laron not doing sex) small head , propotional
meckel diverticulum
kjelly bloody urine - can cause intessuspetion
bronchopulmonary shunting
decrease only in 4 mmhg between alveolar and vein pressure of oxygen
hepatic adenoma
can regress after discontnuetion of OCP ( unlike hemagioma)
alaptonuria
AR -black urine , blue black pigmentaation in ear nose cheeks .
acute rejection
less than 6 months - lymphocytic infiltrate
spleen
9 10 11 rib , liver 8- 11 rib , viceral pleura - dan 4 - 6 rib
reye syndrome
liver - microvesicular steatosis ( apaptosis seen in viral infection )
pyruvate dh deficeincy
XL
cleft lip
defect in fusion of maxillary and intermaxillary segments
malate aspartate shuttle
heart and liver
preterm labor
terbutulin , nifedipin , indimethacin
perineal nerve
deep -anterior compartment of leg - > muscles of dorsiflexio and sensation toes. Lateral comp - sip perineal - sense doral leg
anabolic steroid use
concentric lv hypethrophy , reduce diastolic function and reduce coronary vascularization
negative tuberculin test
low cellular immunity
inspiration
increases right ventricular blood return - thus tricuspid regurgitation can be heart the most . Left side is heard less- like valsava on the left.
narrow spectrum anticunvolsion
eg arbamzapin and phentoyn can excerbate myclonic and absence seizure . Only broad spectrum can treat myclonic seiuzures.
staning pas
demonstats - glycoproteins and polysacharides - can be seen in hyalin atherosclerosis
aortic regurgitaion
hpistol shot , wide pulse pressure ,
amino acids
arginine and hitadine are the ones needed drung fast growth .
ddx oroti aciduria and ornithin tranca def
only orotic aciduria has megaloblastic anemia and has no elvated ammonia and decrease bun
albinism
tyrsinase enzyme deficiency
homocystinuria
subluxation of eye is inward and downword unlike in marfin where its upwards
mucous in stool
secretory diarrha can be seen in polyps as villous or tubullar
fibromascular dysplasia
young woman , involve the medial layer , anneurysms of vessels , common in renal and carotid , renal artery stenosis
fetus defect analysis
elvated AFP AND AChE
RA
has vascular phenomena and immunological - janway - vascular and osler and roth - immunological
gi metastasis
via pertitoneum space - krukenberg and gastric tumor
bmpr2 mutation
enlraged artery on imaging ( smooth muscle proliferation )
rebound rhinorrhea
after using decongestions more than 3 days develops tachypalxis and rebound vasodilation woithout couphig
honycombing on lung
suspect idiopathic pulmonary fibrosis
lehf
patient can have pulmonary edema thus decreasing the lung compliance having restrictive like symptoms .
cell awelling
increases ca in cell will drow water into the cell
dysmorphic rbc
seen in glumerolar damge , isomorphic seen in non glomerular source as urinary tract malg
high dofe folic
antagonise phenytoin can cause seiuzers
cephalic phase
secretion of acid before meal
basal phase
here is always mild acid secretion bw meals
all
tdt is a marker of pre b cells or t cells
entral chemoreceptorss
esponce to hypercapnia rather to o2 ( unlike carotid body )
carotid sinus
baroreceptors
CANCER
LIPID PEROXIDATION - YELLOW BROWN - due to raddiation in cancer
right cornory artery blockage
supply the sa and av thus can cause bradycardia in case of blockage .
surfectant
transferred by lamellar bodies
informed consent
by someone who does the procedure - its adialoge!!
incapacitated pt
protect privacy by telling the relative if he is stable but no other info
saddle nose
can be part of weagner triad
steady state
reaches in 4 5 hf
hear remodeling recovery
after reperfusion it will take months for remodeling eg ventricular to be healed
low EF in ischemic heart
hibernation of myocardium “ - decrease contractility and metabolism to adjust to lack of oxygen state
renal cell carcinoma
orginated from proximal renal tubules
to increase compliance of pt - eldery
if present and close - doughter . If not check list .
mother refusing to treat child
obtain court injunction
hospital ethics committee
only in ethically dificult situation
management of somatic symptomes
regular visitis with same providor
prognosis of breast canceer
worse in TN and in HER +
falcifarom ligament
contains the round ligament - fetal umblical vein . Used to be anterior mesentery in fetal development
exudate teansudate
pleural fluid ldh >2 upper limint of the serum =light criteria. If it meets it that might indicate exudate. Glucose is high in transudate due to lack of inflammatory cells eating it
adenocarcinoma
kras mutataion is seen in smokers while alk gene and egfr in non smokers
adenocarcinoma
paraneoplastic syn: hyperthropic osteoathropayh
atheroscelrotic plague
stemi- rapture and thrombus formation - fully ocllusion
hemosiderin laded macrophages
present in chronic lung congestion but not in acute
red blood cell cast
glumerolar disease . Red cells are in disruption of urethral epithelium
congenital torticollis
sternocleidomastoid fibrosis due to malposition of head in fetus
reassortment
genetic shift heppans only in those who are segmented
minute ventila
tidal volume * resp rate
mechanical ventilation weaning
weak respiratory muscles - increase respiratory rate but low tisal volume . Rsvi - low indicated high tidal volume–> cant be discontinoued of ventilation
nitrates
have moderate effect on arteries too
antiarrythmics
class c - rate depended manner can increase the qrs and the qt a little.
sedative drugs
high gas blood partition –> low onset
femoral hernia
far more common in woman , can cause icarceration due to small area. Lateraly is the femoral vein
melanoma
s100 + hmb 45
midical history taking
open ended quations
matched ventilation and perfusion defect
-obstruction atalctasis and airway inflammation - poor ventilation and hypoxic vasoconstriction
dilitiazam
constipation is a major se
aspirin
protective in barret esophagus , protective in colorectal cancer
salt wasting
due to excessive salrt wasting via sweat ( also cl )
hyperchloremia
can develop to exsseve sweating
systemic infection candida
imunodeficiency in granulocytes number while in t deficienct is more local
differentiation of trigeminal neuralgia and cluster
duration . Cluster ( 15 min to hours ) while trigeminal neuralgia seconeds
restless leg syndrome
iron defeciency , ckd -
prion disease jacob
periodic sharp wave EEG
ALZHAIMER
PRESENILIN 1 and 2 –> earlier onset
whare the partial sezures orginiate ?
midial temporal lobe
what do you rule out before dx dementia ?
depression
drug damage substansia nigra
mptp
huntington neural death
nmda toxisity - glutamate
sevirity of alzhimer
corrolets with neurofibrillary tangles
sabouraud agar
growing fungi - “fun guy - sab +
e coli
gores green in eosin methilin blue culture
infants
the minarales they really need is vitamin k and vitamin d
duadenal atresia
down syndrome
normal aa gradient hypoxemia
high altitude or obesity hypoventilation syndrome
complete mole
more common to have xx than x y
up to 2 weeks after mi
ventricu;ar free wall rapture = can lead to severe hypotention
increased dlco
asthma - intact alveolar arterial membrane and icrease flow to the area
osmolarity urine > 100
indicative to sidh
seep deprevation
can effect cognitive behavioral , can cause mistakes at handeling patients
temporary local hypoxia in retina
up regulated vegf
treatment of congenital syphilis
1 trisemester - penicillin
neisseria ganneria prevention
erythoromycin ointment for infants
dx of neisseria
gonococi- nat , maningo- pcr + culture
leprosy dx
tissue biopsy or pcr
salmonella - why do we need flagella?
hematogenous spread
shigela vs salmonela typhi
bloody diarreha- salmonela –> constpation before
salmonela typhi
monocyte response unlike the others pmn
h influenza culture
needs factor five and ten. Five is given by hemolysis by staph aerous
osteomylitis after oancture wound
pseudomona
spirocetes
light microscopy - borrelia is the only spirochete big enough to visualize
e coli
can be trasmited from row leaf veg too
etec
enterotoxins!
helicobacter
oxidate catalase urease +
only e coli that invaded intestinal nucosa
enteroinvasive
klebsiella normal flora
intestine
sudan staining
dx of steatorea - kind of screening test non specific . For specific - checking oca parasites
t cell all
presents ad mediastinal mass can cause dysphagia
wilson
treament : zinc \ chelators
cavernous hemangioma
can heppan in brain and liveer
glioblastoma
necrosis pseudopalsiating
ependymoma
perivascular pseudorossetes
glucorticoids
chronic use of glucorticoids can cause hypotention in surgery due to not suffcient increase in cortisol level due to stress
tensor tympani
dampening the noices produced by chewing by streching it. Inerveted by trigeminal nerve
crohn
less absorbtion of bile due to inflammation , more wasting , increase odds of developing stones
nrti
inhibit phosphodiester bond formation
pure motor symptoms , nocortical
lacunar infract
neuropenic patient
endogenous bacterial flora , neutropenia causes fever to be only side of infection
vasculitis
first of all anyursm than inflammation and fibrosis . Beads on a string.
vasculitis
fibrinoid necrosis : polyarthritis nodosa , weagner , chraug , microscopic polyangitis
tau alzhaimer
microtubule associated protein
alzhimer
early onset - presinilin 1 and 2 , down syndrome
alzhimer
if app undergo beta cleavage instead of alpha –> ab amyloid is formed
pick
early change in language and behavioral , personality , rem disturbacnes hallucination
lewy disease
dimentia and parkinson within 1 year . ( in parkinson dementia is after years )
what is common cause of death in hantgton
suicide
prpcs
congo red , resistente,spongiform encephalopathy - intracellular vacuols. Ataxia,periodic sharp waves,dmentia , death 1 year.
creutzfeldt
rarely can transmited via cotact with prion infected tissue eg retinal transplant
fetal familiar insomnia
inherited spongiform encephalopathy
arachnoid post maningtis
can cause arachnoid granulation scarring and eventtually lack of absorbtin
ddx bw norml pressure and ex vaco
wet, webby , wacky
adjesment disorder
markej dysfunction !!! Functional impirment
hbsag
vaccination –> impir virion entry to hepatocyte !!
sle
anti nuclear r sensative but ani smith and ani dsdna is spesific
delirium
indicates some medical problem . If a patient is in delirium in hospital suspect ilness
h pylori
can cause hyperplasia of submucosal galnds such as brenner .
kit cd117
systemic matocytosis - clonal mast cell proliferation .. More histamin more gastric secretion
ebv
reactive ly,phocytes - accumolation of proferins
heptatitis
where cooporation isnt good idea. Coinfection of d and b is longer!
hepatitic c
lack of 3 5 exonuclease activity lead to antigenic varietion of the envelope proteins
circadian rythem disorder
sleep in day , wakt ar night
infraction in mca
homonymois hemianopia- due to damaging the radiations to both temporal and prietal
anion gap
calculated as : na - (chloride + bicarbonate ) . Normal 10 -14
ethynyl glycol
can cause calcium oxalate stones , acute kidney injury + non anion gap !
preload
increase preload increases the overlapping bw actin and myosin. Too much preload will decrease contractility evetually
velocity of ocntraction
depended on after load
decresing extracelular ca
reduced contractility cause more ca will leave the cell
sam
conversion of norepinephrin to epinephrin , controled by cortsiol , in adrenal medulla
varicoceles
when patient lies than the blood returns and is wont be seen
celliac
dermatitis hepatiformis is on the extensors
eactive arthritis
the joint aspiration is aterile
prokaryotes
have no nucleus
aphtous ulcers and perianl inflammtion
indicative of crohn
osteomalacia
decrease mineralization of osteoid
iron deficiency
burning sansation in the mouth
arthritis
children - h influenza athritis . Adult- staph aureus
nitrates
reflex tachycardia!!!!
polygenic
defect in numerus unrelated genes eg in diabetis
histamin 1
does not praticipate in pathogenesis of asthma. Histamin 4 does
isotretinoin
ear anomalities microcephalyu hydrocephalot microganthia ..
vagotomy
peptic ulcer disease treatmnet
globus sensation
functional abnormality usually due to stress emotional problems
diabetis
achilis tendon inspection is one a year while foot inspection is every month
fde5 inhibitors
eaffect corpus cavernosa via c gmp
acute hymokytic transfusion
antibody mediated type 2 hs
sudden vision loss and pain
vasculitis ! Fibromylga rehumatica- pain!!
urine test vs serum
urine test is postive for pregnancy after 14 days( level = 20 u\l) while serum is after 8 days
cauda equina
disruption of pelvic slechnic nervs provide parasympatethis inervation . No urniation .
inguinal hernia
inguinal canal contains illiogunal nerve round ligament and spermatic cord
