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Obsessive Compulsive personality disorder
Pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficiency.
Patients do not use compulsions as a way to relieve anxiety.
Obsessive compulsive disorder
Person is aware that obsession and compulsions are unreasonable and excess.
Sleep Stages EEG Waveform
BATS Drink Blood
Ebstein Anomaly
Displacement of tricuspid valve leaflets downward into RV, artificially atrializing the ventricle. Associated with tricuspid regurgitation and right HF. Can be caused by lithium exposure in utero.
Wide splitting of the first heart sound.
Anamnestic antibody response
When received O- positive blood though blood type is O-negative.
Reaction present with hemolysis and fever and are seen two to ten days after transfusion. Jaundice and indirect hyperbilirubinemia signify hemolysis.
Febrile nonhemolytic reaction
Occurs one to six hours following transfusion. Symptoms are self-limited and include fever, chills and dyspnea.
A reaction due to antibodies against leykocytes.
Exposure to IgA antibodies in donor blood
Anaphylactic reaction ocurring in IgA deficient recipients. Symptoms of hypotension, edema and respirarory distress occur immediately after exposure to donor blood.
IgM antibodies against donor ABO antigens
ABO incompatible blood transfusion. Result in fever, flank pain and hemoglobinuria and sometimes shock, disseminated intravascular coagulation, or renal failure. Immediate hemolytic reactions.
Reaction of IgE antibodies against allergens in donor blood
Results in urticaria.
Wernicke- Korsakoff Syndrome
B1 deficiency
Triad of confusion, ophthalmoplegia (nystagmus) and ataxia.
Associated with periventricular hemorrage/necrosis pf mammillary bodies.
Cystinuria
Hereditary defect of renal PCT and intestinal aminoacid transporter that prevents reabsorption of Cystine, Ornithine, Lysine and Arginine. Excess cystine in the urine can lead to recurrent precipitation of hexagonal cystine stones.
Can present with mio ardial infarction, trombosis, and downward and inward eye movement.
Hypocalcemia
Tetany, lethargy, seizures, and coma.
Di George syndrome is associated with:
Congenical cardiac abnormalities, most notably tetralogy of Falot (boot shaped heart) and truncus arteriosus.
In folate deficiency, thymidine supplementation is given to…
Decrease apoptosis of erythrocyte precursors.
Folate-deficient erythroblasts have a higher rate of apoptosis than those not deficient, and the cells can be rescued by administration of thymidine.
Esophageal lymph node involvement
Upper: Cervical
Middle: Mediastinal, Paratracheal, Tracheobronchial
Lower: Gastric and Celiac
DIC
Triggered via release of tissue factor.
Idiopathic thrombocytopenic purpura
Autoantibodies to platelet glycoproteins
ADAMTS 13
Causes thrombotic thrombocytopenic purpura and hemolytic- uremic syndrome. It degrades multimers of Von Willebrand factor. Without it, multimers promote platelet aggregation and lead to siffuse clotting.
Henoch- Schonlein puepura
Palpable purpura, arthralgias, abdominal pain, and renal failure. Leukocytoclastic vasculitis with IgA immune complex deposition.
Heroin user
Staph Aureus
Aspiration pneumonia in a Parkinson patient
Klepsiella sp
Shingles Petechia Decreased breath sounds Rhonchi bilaterally Diarrhea WBC: 3.05
HIV
Sigs of Parinaud’s Syndrome
Vertical gaze palsy and absent pupillary light reflex with intact accomodation. Most commonly due to lesions within the pineal gland.
Tay- Sachs disease
Accumulation of GN2 ganglioside, deficiency of hexosaminidase A. Cherry red spot on the macula.
Multiple myeloma
Amyliodosis (heart, liver and kidneys. Problems in the kidney (nephrotic syndrome), in the heart (increased jugular vein pressure and hepatomegaly).
MALT Translocation
t(11;18)
Bile acid sequestrants
Cholestyramine, colestipol and colesevelam
Decrease LDL, no effect on HDL or triglycerides.
Ethambutol
Increase activity of arabinosyltransferase.
Ubiquitin
Proteosome degradarion of cytoskeleton
Apocrine Metaplasia
Fibrocystic changes of the breast, does not lead to Cancer.
Keratomalacia
Thickening of the conjunctiva due to a deficiency of Vit A
Myositis ossificans
Inflammation of the skeletal muscle result in a metaplastic production of skeletal muscle; usually when healing from trauma.
Lafora bodies
AR
Many cells, including neurons, develop inclusion bodies known as Lafora bodies. The most common initiql presentation is new onset seizures in adolescents. The epilepsy progresses, and there is no treatment with the exception of attempting symptom control. Stain with PAS stain. It is used to demostrate glycogen, glycoproteins or other carbohydrates.
Minute ventilation
= tidal volume X respiratory rate
= tidal volume X (weight X breath per minute)
PArotid excretory ducts
Pseudostratified columnar epithelium
Hereditary hemorrhagic telangiectasia
Osler- Weber- Rendu Syndrome
AD
Recurrent epistaxis, skin discolorations, mucosal telangiectasia and gastrointestinal bleeds.
Pathophysiology: arteriovenous malformation of the small vessels.
Pleural effusions
Transudative= <1/2 the protein concentration of the patient’s serum, 60% the LDH concentrarion of the patient’s serum or <2/3 of the upper limits of normal for serum LDH.
Exudative= high protein and LDH concentration.
Etiologies= bacterial pneumonia, malignancy, pulmonary embolism, lupus, pancreatitis and Boerhaave’s syndrome.
Ankylosibg spondylitis
Chronic inflammatory disease of the spine and sacroiliac joints that is characterized by bilateral sacroiliitis and ankylosis or fusion of the spine in an ascending manner. Enthesitis or inflammation at tendinous insertions, is a common clinical finding. The spine is prone to fracture and injury. With involvement of the thoracic spine, patients experience diminished chest expansion and present with a restrictive pattern or pulmonary fibrosis, uveitis, renal disease and cardiac abnormalities.
Memory T cells needs……
CD28 on the T cell and B7 on the APC
Microarray
Is a technique that can be used to determine the relative differences in gene expression in one sample as compared to another. In this technique, nucleic acid sequences are affixed to a plate.
Borreloa hermsii
Relapsing fever/ zoonotic illness/ spirochetal organism. Tick-borne relapsing fever.
Chocolate blood agar
Is a variant of the common blood agar plate. Contains red blood cells which are slowly heated to 56*C in order to promote the lysis of the RBC.
Locus heterogeneity
Presence of the same phenotype due to mutations in genes at different loci.
Widely split S2
Fixed S2
Patent foramen ovale
Chediak-Higashi syndrome
Microtubular function defect Recurrent pyogenic infection by Staph and Strep Partial albinism Peripheral neuropathy Nitroblue test positive
Wolf-Parkinson-White
Congenital (accessory) conduction pathway connecting the atria and ventricles, resulting in characteristic tachucardia on electrocardiogram.
Neurofibromatosis
Cr 22
AD
NF2 gene
Acoustic neuromas, dysequilibrium, hearing loss, and tinnitus.
High risk to develop meningiomas, perioheral neuropathy, cataracts and gliomas.
Cafe-au-lait spots may be present (most common on type 1)
Calcium bindings
Calcium binds to Troponin C in skeletal and cardiac muscle and binds to calmodulin in smooth muscle.
Ketogenic amino acids
Diets high in leucine and lysine are important for patients with pyruvate dehydrogenase deficiency in order to decrease the chronic lactic acidosis they would otherwise experience.
Chedial- Higashi syndrome
Recurrent Pyogenic infections, gray hair, and decreased skin pigmentation, neutropenia, thromblcytopenia and hypergammaglobulinemia. Deficit in microtubule polymerization, leading to impaired phagocytosis.
Tx: bone marrow transplant
Xeroderma pigmentosum
AR
Mutation in the nucleotiee excision repair proteins.
Extreme sun sensitivity, hyperpigmented lesions that appears as freckles. Can progress to telangectasias and can lead to multiple skin cancers. Ocular symptoms such as photophobia and conjunctivitis are common.
Scurvy syndrome
Due to deficiency of vitamin C. It is essential along with cooper, in the hydroxylation of dopamine to norepinephrine. It is also needed for adrenal steroids and reduction of Fe2+ in the GI tract and for the hydroxylation of proline and lysine residues in the endoplasmic reticulum during collagen synthesis. Symptoms and signs includes iron deficiency anemia, coagulopathies and poor wound healing.
Many CD14+ cells
Macrophages
Mast cells
Contains granules rich in histamine amd heparin. They are identified by staining for markers such as CD25 and CD117.
Creatinine clearance
(Urine Creatinine) x (volume)/serum creatinine
H influenza growth
Chocolate agar, NAD (factor V) and hematin.
POL
Gene that forms reverse transcriptase
NK Cells
Kill cells with decreased levels of MHC class I expression. CD13+ and CD16/56+
Cluster A Personality Disorder
Odd or eccentric
Paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.
Cluster B Personality Disorder
Emocional, dramatic and impulsive. These include antisocial disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.
Splitting personality
Labeling people as all good or all bad.
Cluster C Personality Disorder
Dependent, Anxious and fearful disorder
Identification
Inmature mechanism that involves modeling behavior after someone else.
Sublimation
Mature defense mechanism where one converts unacceptable impulses into an acceptable form.
VACTERL
Mesodermal defect that includes:
Vertebral anomalies, Anal atresia, cardiac malformation, tracheoesophageal fistula, renal anomalies and radial limb defect.
Also in girls, vaginal septum and bicornate uterus. Cryptorchidism is reported in males.
Ehlers Danlos syndrome
Hyperextensible skin, joint hypermobility, multiple joint dislocations, translucent skin, POOR WOUND HEALING, easy bruising and unusual scars.
Kawasaki’s disease
Necrotizing medium sized vessel vasculitis which usually presents in children less than five years.
Physical exam will show erythema and edema of hands and feet, cervical lymphadenopathy and oral erythema with cracked lips.
May develop coronary artery aneurysm.
Tuberculosis possesses a resistance to…..
Mutation of the ribosomal protein S12. This mutation has beed demostrated in isolates with streptomycin resistance.
Binds to the 30S subunit of the bacteriañ ribosome and prevents protein translation…
Streptomycin
Certain M Tuberculosis strains have a mutation to the rpsL gene that codes for ribosomal protein S12, which causes…
Antibiotic resistance
Release of exotoxins released by bacteria that disrups desmosome in epidermis…
describes the parhophysiological mechanism of exfoliative toxin seen in Staphylococcal scalded skin syndrome, who typically occurs in newborns and children less than 1 year.
Atherosclerosis
Asoc with smoking, diabetes, hypotension and hyperlipidemia.
Acute tubular necrosis pathogenesis
Trying to reabsorb myoglobulin in the proximal convulated tubule, it suffers from free radical damage from the myoglobin, ending in necrosis.
Why does Statins can cause rhabdomyolisis?
By blocking the synthesis of mevalonic acid, it also stop the formation of Farnesyl, which is a intermediary step in the synthesis of cholesterol, and the one needed to form CoQ, an essencial enzyme in the electron transport chain.
⬇️CoQ ➡️⬇️ATP⬇️Sodium pump⬆️sodium swelling➡️cell death
Creatinine kinase
How much muscle breakdown has going on (statins use).
Bile acids resins can only be used in…
Pure hypercholesterolemia
Decrease in VLDL Production…
Hepatotoxicity
Statins synergistic rxn
With Ezetimibe
The most important virulence factor that S. epidermidis produces that allows it to establish a significant infection is…
…a biofilm - an extracellular polysaccharide slime which encases the bacteria
Cystinuria
cysteine kidney stones (hexagonal crystals), give acetazolamide to alkalize the urine.
Heteroplasmy
refers to the presence of both mutated and non-mutated mitochondrial DNA within the same cell, leading to differences in disease severity
mannose 6-p
ER to lysosomes
Concentric hypertrophy
S4
Marked ventricular concentric hypertrophy
Sarcomeres added in parallel
Point of maximum impulse that is displaced to the mid-axillary line
Left ventricular hypertrophy
Dilated cardiomyopathy
HF
S3
Systolic regurgitant murmur
Eccentric hypertrophy
Anabolic steroids mechanism of action
Increasing insulin-like growth factor-1 (IGF-1) signaling
Decrease luteinizing hormone (LH) release
Decrease glucocorticoid signaling
Enhance creatine phosphokinase activity.
Failures
Pre-Renal
Post- Renal
Intrinsic renal
Pre: 20:1 or more
Post: 10-20:1
Intrinsic: <10:1
Sleep stages
N3 and N4, REM in EEG
Delta waves
Lowest frequency
Highest amplitude
REM: low amplitude and high frecuency
Delusion
Disorders of thought content or perception.
Rocuronium
Belongs to the class of non-deolarizing relaxants and is used in the induction of general anesthesia. Is a competitive antagonist of Acetylcholine.
Give Neostigmine, atropine to be reversed.
Hurler’s syndrome
Is due to a deficiency in alpha-L-iduronidase, leading to accumulation of heparin sulfate and dermatan sulfate. Patients presents with developmental delay, airway compromise, clouded corneas and hepatosplenomegaly.
Lancet shaped gram +
Streptococcus pneumoniae
Meningitis by group
Neonates: group B strept and E Coli
Infants: H influenza type B, Strept pneumoniae or Neisseria meningitidis.
Adults: Streptococcus pneumoniae
Candida
Budding cells and pseudohyphae
Aphthous ulcers
Superficial ulcerarion within the mucous membrane of the inner mouth. Do not occur on the tongue.
Ulceras bucales
Cheilosis
Scarring of the corners of the mouth that is associated with vitamin B2 deficiency.
Leukoplakia
Associated with HIV, smoking, tobacco chewing, chronic alcohol use and Epstein-Barr virus. It occurs from marked hyperkeratosis, forming q rough, hairy surface and may lead to squamous cell carcinoma.
Pericarditis
Chest pain exacerbates with lying down.
Faint heart sound during both systole and diastole.
Fever and pericardial friction rub beast heard with the patient leaning foward.
EKG will classically show ST elevations in all leads.
Tx:NSAIDs
Neural tube defects
Folate deficiency
Anticonvulsants (carbamazepine and valproic acid)
Hirschsprung’s disease
Aganglionic segment of the colon due to failure of neural crest cell migration during embryologycal development. This result in distal intestinal obstruction and failure to pass stool in the newborn period.
Wilson disease
AR
Impaired cellular cooper transport
Choreiform movements, behavioral changes, liver failure.
Accumulation of cooper in the liver, brain, cornea and other organs.
Tx: penicillamine
Systemic lupus erythematous
Arthritis, oral ulcers, malar rash, and fatigue.
Systolic murmur at the 4th intercostal space left sternal border
Normal
Hyaline casts
Normal
Mild infection pO2 and A-a difference
pO2 of 70mmHg or greater or a A-a difference of less than 35mmHg.
HIV infections at:
CD 200
CD 100
CD 50
CD 200: Pneumocystis jirovecii
CD 100: Candidal esophagitis, toxoplasmosis and histoplasmosis.
CD 50: CMV retinitis and esophagitis, M. Avium.
Clomiphene
Estrogen modulator that is frequently used to induce ovulation in patients with a history of oligoovulation, such as polycystic ovarian syndrome, this medication binds to estrogen receptors within the hypothalamus, preventing negative feedback inhibition by endogenous estrogens. This stimulates the release of both follicle stimulating hormone and luteinizing hormone.
Osmotic agents
Works in the proximal convulated tubule, thin descending limb and collecting tubule.
Triamterene
Potassium-sparing diuretic
Linkage disequilibrium
This occurs when two genes are located closely on the same chromosome. During meiosis, genes that are more closely located on a chromosome are less likely to segregate than those that are on different chromosomes or further apart on the same chromosome. Linkage disequilibrium is useful for mapping of genes on chromosomes.
Dominant negative mutation
A dominant negative mutation occurs when a mutation in a single allele causes a non-functional protein that results in the new phenotype.
Codominance
In codominance, the two different alleles are expressed at the same time and neither allele is dominant. The ABO blood type system is an example. In this example, the ABO blood type is not the question, but it is the increased correlation between the presence of an A blood type and the disease in question
Myoglobin in urine
Myoglobin is a sign of rhabdomyolysis, which can occur after severe crush injuries.
Eosinophils
Eosinophils are often seen in drug-induced interstitial nephritis.
Oval fat bodies in urine
Oval fat bodies are seen accompanying nephrotic syndromes. It is not as likely as red blood cell casts in patients with lupus nephritis.
Triple phosphate crystals
Triple phosphate crystals are a sign of Proteus infection.
Osteoprotegerin function
Marrow stromal cells naturally produce WNT proteins that bind to osteoblast receptors, increasing β-catenin and osteoprotegerin secretion. Osteoprotegerin, in turn, acts as a “decoy” receptor for RANK ligand that slows osteoclast formation and action (Answer F). Estrogen deficiency increases secretion of IL-1, IL-6, and TNF-α, resulting in increased levels of RANK and RANK-L, and hence increasing osteoclast formation and action. Estrogen deficiency also results in decreased levels of osteoprotegerin. These are the reasons estrogen deficiency contributes to development of osteoporosis in post-menopausal women.
Common peroneal neck fracture
The common peroneal nerve can be injured following a fracture to the fibular neck. This nerve injury leads to the classic presentation of foot drop and sensory loss over the dorsal foot and lateral leg.
Clear cell adenocarcinoma of the vagina
The major risk factor is a mother who took diethylstilbestrol (DES) during pregnancy. The cancer typically presents in adolescence, but can also present in childhood. It is so-named because of the large clear cytoplasm of the malignant cells. DES was used by mothers who had chronic spontaneous abortions in an attempt to maintain their pregnancy.
Cavernous sinus
Cranial nerves III, IV, V1, V2, and VI pass through the cavernous sinus. A tumor within that area can lead to cavernous sinus syndrome due to a mass effect on these nerves. The internal carotid artery also passes through the cavernous sinus. The third branch of the trigeminal nerve is the only portion of the trigeminal nerve that does not pass through the cavernous sinus.
Elevated epsinophils
IL-5
Secretin
This hormone is released from the S cells of the duodenal mucosa and stimulates the release of bicarbonate from the pancreas.
Swallowing nerves
CN IX: taste of posterior 1/3 of the tongue and assists in swallowing.
CN X: responsible for taste in the epiglottis and assists in swallowing, elevarion of the palate and speech.
Both, with XI pass throw the yugular foramen
Reference Ranges of:
Hematocrit
Platelet
White blood cells (leukocyte count)
Reference Ranges of:
Hematocrit W 36-46 M 41-53
Platelet 150,000-400,00
White blood cells (leukocyte count) 4500-11000
Wilson disease
AR
Fatigue, memory loss( due to accumulation of copper in the brain)
Kayser-Fleischer rings (brown rings in the eye)
Can cause renal tubular acidosis type II which would lead to hypokalemic, hyperchloremic nonanion gap metabolic acidosis.
Infantile polycistic kidney disease
AR
Oligohydramnios
Pulmonary hypoplasia
Hepatic cysts and fibrosis
Adult polycystic kidney disease
Berry aneurism
Ibuprofen effect on renal function
By taking Ibuprofen, there was a constriction of the afferent arteriole, decreasing GFR and RPF causing acute kidney injury.
NSAIDS blocks the synthesis of prostaglandins which helps dilate the afferent arteriole.
Hypercalcemia
“Bones, stones, abdominal groans and psychiatric overtones”
Causes: metastatic breast cancer with has likely metastasized to her bones.
Hypocalcemia
Tetany, CHF, arrythmias and seizures.
Causes: Prostate cancer with metastasis to the bone.
Goodpasture’s syndrome
Is a disorder in which anti-glomerular basement membrane antibodies damage the glomeruli and the pulmonary alveoli. PAS- staining of a renal biopsy can show epithelial crests.
IgA nephropathy
Berger’s disease
Appears as immune complexes deposited in mesangium.
Fomepizole
Methanol and Ethylene glycol antidote, inhibiting alcohol dehydrogenase.
HIGH Anion Gap
MUDPILES
Methanol
Uremia
Dka
Propylene glycol Iron tablets or INH Lactic acidosis Ethylene glycol 🔜 oxalic acid Salicylates (late)
Normal anion gap
Hardass
Hyperalimentation Addison disease Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion
Respiratory acidosis
Opioids, sedatives
Respiratory alkalosis
Kysteria Hypoxemia (high altitude) Salicylates (early) Tumor Pulmonary embolism
Metabolic alkalosis
Loop diuretics
Vomiting
Antacid use
Hyperaldosteronism
Signs of hyperkalemia
Metabolic acidosis, muscular weakness, fatigue, high T wave, low ST segment, eventually in severe hyperkalemia venteicular fibrillation.
Von Gierkes disease
Deficiency of glucose-6-phosphatase. Patients present within the first year of life with hepatosplenomegaly, lactic acidosis, thrombocytopenia, renal disease, hypertriglyceridemis and hypoglycemia.
McArdle disease
Muscle phosphorylase deficiency
Hemamgioblastoma
Are most commonly found within the cerebellum, arising from the vasculature. Patients may present with symptoms pf cerebellar ataxia due to the location of the lesion within the cerebellum.
Glioblastoma multiforme
Grade IV astrocytoma that occurs in adults. It occurs within the cerebral hemispheres and may cross the corpus callosum. It appears as a ring on MRI that enhances with contrast with a central hypodense region due to the presence of a central area of necrosis.
Medulloblastoma
Most common malignant primary brain tumor in children that occurs within the cerebellum and can lead to hydrocephalus due to compression of the fourth ventricle. Biopsy reveals rosettes.
Meningiomas
Second most common cause type of primary brain tumor and the most common benign tumor. These arise from the arachnoid cells within the meninges. Biopsy reveals spindles cells arranged in a whorled pattern with psammoma bodies.
Avoidant personality disorder
Cluster C personality
Patients desire interpersonal relationship but they are too insecure to establish them.
Schizoid personality
Socially withdrawn
No desire to establish relationships
They are happy being isolated and have flat or blunted affects.
Non seminoma tumors
Embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumors and mixed germ cell tumors.
BHCG is elevated and AFP.
Pure seminomas do not cause AFP elevation.
Leydig cell tumor
Benign testicular tumor, gynecomastia due to increased secretion of androgens.
No AFP or beta-HCG elevation.
Seminomas
Painless testicular masses that have large cell with abundant cytoplasm and central nuclei on biopsy.
No AFP elevation.
VWF
High PTT, high bleeding time, normal PT, normal platelet count.
Thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura
Neurologic manifestations such as altered mental status, fever and hemoglobinuria.
Normal PT, PTT and bleeding time with low platelets.
Disseminated intravascular coagulation
Abnormality in all coagulation parameters and thrombocytopenia.
Chorion and amnion formation time
The chorion is formed on day 3, and the amnion is formed by day 8.
Dizygotic twins do not split since they are independent embryos at all timesduring development and would never share common membranes.
Giant cell arteritis
Common vasculitis affecting medium and large sized vessels, particularly the temporal artery.
Diagnostic criteria: 55 years New on set headache Temporal artery tenderness Erythrocyte sedimentation rate greater than 50mm/h Abnormal arterial biopsy
Mechanism by which HBV leads to development of cancer
Viral integration into host genome
Causes of oligohydramnios
Bilateral renal agenesis, polycystic kidney disease, hydronephrosis and other causes of ureter obstruction.
Iodine 131 uptake
In a person with hyperthyroidism the uptake will be increased. In a person with exogenous hyperthyroidism it will be decreased.
Most common cause of otitis media
Strep pneumo
Nontypable Haemophilus influenza
Moraxella catarrhalis
HCV genomic heterogeneity
HCV RNA polymerase lacks 3’ to 5’ proofreading exonuclease. It can lead to variability to treatment response and prevents the development pf a vaccine because the virus can develop ways of evading the host immune response.
Cold agglutinin disease
Monoclonal IgM antibodies are formed against red blood cell markers.
Usually idiopathic, however, there are associations between IgM formation and leukemia as well as viral infections, such as cytomegalovirus, infectious mononucleosis, HIV, and parvovirus B19 and mycoplasma pneumoniae.
Used to treat preterm labor
Terbutaline
Beta 2 agonist
Treatment for CMV
Gancyclovir
Decompression syndrome
Due to ascending rapidly, creating bubbles of nitrogen in tissues and vessels. Patients present with a variety of complaints: pain joint and muscles, nausea, vomiting, altered mental status and seizures, respiratory distress.
Tx: 100% Oxigen
Employment in shipyards
Increase risk of asbestos exposure. Can cause mesothelioma and presents with shortness of breath.
Trypanosoma cruzi
Dilated carsiomyopathy, mega colon, megaesophagus, predominantly in South America. No bowel movement, dilated esophagus and colon.
Cell directed cytotoxicity.
Lyme disease
Doxyxycline is the drug of choice, but in pregnancy and children give amoxicillin.
Thromboxane
Is produced by activated platelets and has prothrombotic properties, it stimulates activation of new platelets as well as increases platelet aggregation.
Aspirin
Inhibits production of prostaglandins and thromboxane by inhibiting cyclooxygenase system. It also irreversibly inhibits platelets aggregation.
Why is aspirin an uncoupling agent of oxidative phosphorylation?
It increases the permeability of the inner mitochondrial membrane, this decreases the ability of the membrane to hold the proton gradient generated by the elctron transport chain.
Teratogenecity of Isotretinoin…
Severe fetal malformations such as facil asymmetry, ear abnormalities and ocular hypertelorism.
ACE inhibitors teratogenecity
Renal failure and renal dysplasia.
Hypersensitivity pneumonitis
Type III/IV HS reaction to environmental antigen.
Dyspnea, cough, chest tightness, headache.
Often seen in farmers and those exposed to birds.
Recruits neutrophils
IL-8 throw macrophages
FGG receptor 3 mutation
Achondroplasia
FMR1 gene mutation
Fragile X sybdrome
NF2 gene
Neurofibromatosis type 2
VHL inCr 3
Von Hippel Lindau disease
Fibrillin 1
Marfan’s syndrome
Collagen mutation
Ehler Danlos Syndrome
Leydig cell tumor
Reinke crystalloids (hexagonal prisms, produces testosterone in response to LH) Painless testicular mass.
Carcinoid tumor symptoms
Wheezing, flushing and diarrhea
On biopsy you will we multiple rosettes
Melatonin
Screted by the pineal gland in order to regulate circadian rhythms.
Mycoplasma pneumoniae
Atypical pneumonia
Stains poorly using Grams method
Do not have a peptidoglycan cell wall, rather it has a triple layered membrane that incorporates sterols.
Colonies are described as fried eggs.
Conversion disorder
Classic reaction in young females to stressful life events in which they present with some deficit in neurologic function. This can manifest as paralysis/paresis, blindness ans seizure-like activity.
I-cell disease
Lysosomal storage disorder
Defect in N-acetylglucosaminyl-1-phosphotransferase, failure of the Golgi to phosphorylate mannose residues, so, decrease mannose-6-phosphate, so proteins are secreted rather than being delivered to lysosomes.
Features: coarse facial features, clouded corneas, restricted joint movement and high plasma levels of lysosomal enzymes.
Osteogenesis imperfecta gene defect:
COL1A1 and COL1A2
Hereditary Spherocytosis
Spheroid erythrocytes due to spectrin or ankyrin defect.
Biotin deficiency
myalgias, dermatitis, altered mental status, nausea, and anorexia.
High levels of avidin
Avidin binds to biotin tightly, leading to decreased amounts of available biotin.
Dextromethorphan
in combination with antidepressants can cause a serotonin syndrome.
Vesicouretral reflux
congenital condition in which urine abnormally flows from the bladder back to the ureters.
Blood supply to the different regions of the ureter?
Proximal: renal artery, middle: small branches from common iliac artery and distal: superior vesicle artery.
CREST
Calcinosis, Reynaud phenomenon, Esophageal dysmotility, sclerodactily, telangiectasias.
Scleroderma autoantibody (limited and diffuse)
anti-centromere (limited)
anti-scl-70 (anti-DNA topoisomerase 1)
Fetal Alcohol syndrome
Smooth philtrum, a thin vermilion border of the upper lip and short palpebral fissures.
Rotenone
found in insecticides and some rat poisons. It inhibits complex I in the mitochondria, leading to symptoms consistent with Parkinson disease in rat models. By inhibition of complex I in the electron complex chain in the brain, there is increased oxidative stress in the brain, leading to damage.
Hydroxyurea
Decrease in concentration of Hemoglobin S in Sickle cell disease patient.
Viral Meningitis
modestly elevated protein and normal glucose.
V1, V2, V3 foramen
V1: Superior orbital fissure
V2: Foramen rotundum
V3: Foramen Ovale
Brenner tumor
Rare ovarian tumor and is a part of the surface epithelial group of ovarian cancer.
Phyllodes tumor
(Nonepithelial neoplasm) rarely, breast benign tumor, sharply demarcated, freely movable, display rapid growth, non tender, rarely involve the nipple or areola.
Total cholesterol equation
TC= HDL+LDL+(TG/5)
Epinephrine
B1=HEART RATE
B2=BRONCODILATION, DECREASE RELEASE OF MAST CELLS
A1=VASOCONSTRICTION AND DECREASE MUCOSAL EDEMA UN THE URT AND INCREASE AIR FLOW
Vit E
Necessary for protect erythrocytes from hemolysis.
Autoimmune enteropathy
anti-goblet or anti-enterocytes
chronic diarrhea and malabsorption
partial villous blunting with deep crypt lymphocytosis
Anti-Ro
Sjogren Syndrome
Autoimmune hepatitis
Anti nuclear antibody positive
fever, high transaminase levels, hepatosplenomegaly
Inulin
GFR
Freely filtered, not reabsorbed nor secreted.
PAH
RPF, freely filtered and poorly reabsorbed in the proximal tubules.
Pill esophagitis
Asoc. w/Boorhave syndrome
caused by: iron, potassium, bit C, alendronate, risedronate, tetracycline, aspirin, NSAID’s, quinidine.
Severe retrosternal chest pain, retching, vomiting, cyanosis, fever, odynophagia, shock.
Valsalva maneuver
Maneuver that reduce the left ventricular end diastolic (decreased preload, decreased after load) will worsen the outflow obstruction and intensify the murmur.
also asoc. with (squatting then standing), nitrates, vasodilators and diuretics.
Asoc with hypertrophic cardiomyopathy.
Gabapentin
anti-seizure
tonic-clonic seizures
neuropathic pain
hot flashes and menopausal woman
Hartnup disease
AR
Defective neutral amino acid transporter on renal and intestinal epithelial cells. This causes tryptophan excretion in urine and decreased tryptophan absorption from the gut. Some may present with sudden onset of skin eruptions, cerebellar ataxia and gross aminoaciduria.
Chondrocytes function
Cartilage synthesis
Osteomalacia and rickets
Decreased bone mineralization which is caused by vitamin D deficiency.
Medications that precipitate digoxin?
Verapamil and diltiazem
Vitamin B1 (thiamine) deficiency
Wet beri beri, a form of congestive cardiomyopathy.
Vitamin B2 deficiency (riboflavin)
Corneal neovascularization
Crescendo-decrescendo systolic murmur
Aortic valve stenosis
Budd-Chiari syndrome
Is characterized by an oclussion of the intrahepatic veins leading to congestive liver disease. Patients with an increased risk pf thrombus, such as those with anti-phospholipid antibody syndrome, are more likely to develop this syndrome.
Anti-centromere antibody
Scleroderma CREST
Status epilepticus first line Tx
Benzodiazepines (Lorazepam)
Ito cells
Hepatic stellate cells found in the space of Disse, involved in liver fibrosis and the formation of scar tissue. Are also responsible for absorbing Vitamin A.
Medullary syndrome
Ipsilatetal paralysis of the tongue with deviation towards the side of the infarct, hypoglossal nerve fiber paralysis, hemiplegia on the contralateral side pf the infarct due to damage of the medullary pyramid and loss of discriminative touche, conscious propio eption and vibration sense on the contralateral side of the infarct due to damage of the medial lemniscus.
Lateral medullary syndrome
Sensory deficits affecting the trunck and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct. There is a loss of pain and temperature sensation on the contralateral side of the body and ipsilateral side of the face.
Klumpke’s palsy
Damage to the C8,T1 nerve roots and presents with isolated hand paralysis and Horner’s syndrome.
Angioedema
Deficiency of C1 esterase inhibitor which deregulates many proinflammatory pathways. The disease manifests with very quick onset of edema in the face, limbs, tongue, larynx, throat and lips.
Sensory receptors:
Free Nerve endings Meissner corpuscles Pacinian corpuscles Merkel discs Ruffini corpuscles
- Pain and temperature
- Fine touch and position sence
- Vibration and pressure
- Pressure, position sense
- Pressure
Lead intoxication
Dimercaprol
Trimethoprim and benzocaine side effect:
Methemoglobinemia, give methylene blue and remove the inciting agent.
Achondroplasia
Mutation in the Fgf-3 receptor with normal levels of GH and IGF-1.
Sturge-Weber syndrome
Congenital port wine stain in the distribution of the trigeminal nerve. Common complications include seizure, mental retardation, and open angle glaucoma. Anomaly of neural crest derivatives.
Henoch-Schonleim purpura
Palpable purpura of the buttocks ans lower extremities, arthralgias and abdominal pain, typically following an upper respiratory infection.
Benzodiazepine overdose antidote:
Flumazenil
Ethylene glycol overdose antidote:
Fomepizole
Acetaminophen intoxication
N-acetylcysteine
Cerebral vermis
Controls coordination of the trunk (truncal ataxia)
Cerebellar hemispheres
Control limb propioception and coordination (ipsilateral limb ataxia)
Inferior cerebellar peduncle
Propioceptive information (unilateral symptoms)
Superior cerebellar peduncle
Efferent propioceptive information fron the cerebellum ti the midbrain and pond
Cheyne-Stokes respirations
Type if respirations characterized by cyclic, crescendo-decrescendo breathing that can be seen in patients with heart failure.
Cause contraction metabolic alkalosis through activation of the renin-angiotensin aldosterone system
Loop diuretics
Cheyne-Stokes respirations
Type if respirations characterized by cyclic, crescendo-decrescendo breathing that can be seen in patients with heart failure.
Cause contraction metabolic alkalosis through activation of the renin-angiotensin aldosterone system
Loop diuretics
Cheyne-Stokes respirations
Type if respirations characterized by cyclic, crescendo-decrescendo breathing that can be seen in patients with heart failure.
Cause contraction metabolic alkalosis through activation of the renin-angiotensin aldosterone system
Loop diuretics
Cheyne-Stokes respirations
Type if respirations characterized by cyclic, crescendo-decrescendo breathing that can be seen in patients with heart failure.
Cause contraction metabolic alkalosis through activation of the renin-angiotensin aldosterone system
Loop diuretics
Chronic pancreatitis
Caused by fibrosis and acinar cell atrophy
Polyarteritis nodosa
Immune complex mediated transmural vasculitis thatcan present with non-specific gastrointestinal complaints, fever, arthralgias, myalgias, weight loss and dermatologic complaints.
Biopsy show fibrinoid necrosis, and arteriogram usually shows multiple aneurysms and constrictions
Omphalocele
Incomplete migration of the midgut, resulting in a peritoneal sac of bowel at the umbilicus.
Gastroschisis
Lateral body walls failed to close, no peritoneum would be covering the bowel, which would likely be exposed to amniotic fluid.
Reye syndrome
Liver biopsy: microvesicular steatosis
Apneustic breathing
Prolonged inspirations alternating with a short period of expiration. It may result from a caudal pons lesion.
Biot’s breathing
Irregular periods of apnea alternating with periods of several breaths of identical depth are taken. It is seen in patients with increased intracranial pressure and with certain lesions.
Cheyne-Stokes breathing
Periodic type of breathing which has cycles of gradually increasing depth and frequency followed by a gradual decrease in depth and frequency between periods of apnea. It may result from midbrain lesions but aldo occurs in infants or during sleep particularly high altitude.
FISH
Can be used to determine chromosome number or assess for areas of deletion or duplication.
Adenosine effect on myocytes?
Detachment of myosin head from actin
Specificity
Percentage of the population without the disease who have a negative test result.
Dyskinesia
Involuntary movements, side effect of levodopa/carbidopa in Parkinson’s patients.
IgA
Secreted as a dimer in comostrum
Rheumatoid arthritis labs:
Rheumatoid factor, anti-ccp, ESR
Neostigmine
Cholinesterase inhibitor that reverses the effects of the neuronuscular blocking agents prior to intubation.
Daptomycin can not be given in pneumonitis because of….
it gets attached to the surfactant, damaging the lungs. Can not be given en pneumonia.
Lamellar bodies
vesicles that keeps surfactant
Club cells
produces surfactant
Surfactant function
decrease the surface tension
uterus didelphys
failed fusion of paramesonephric ducts
alcoholic liver disease
high AST twice the ALT, and elevated GGT
Mixed cellularity Hodgkin lymphoma
lacunar variant of Reed-Sternberg cells
Clara cells
detoxification
Globlet cells
secreting mucus cells
ALA synthase
rate limiting enzyme, glucose can interfere in the HEME synthesis.
fetal hemoglobin have more affinity for oxygen because…
2,3,BG, create less affinity for oxygen in the hemoglobin, 2,3,bg binds less avidly to the gamma chains of the fetal hemoglobin than to the beta chain of the human hemoglobin.
Copper is a cofactor of which enzymes…
Lysyl oxidase
Cytochrome C oxidase
Tyrosinase
Menkes disease
Cooper deficiency
Symptoms include osteoporosis, brittle bones, hypotonic, neurological abnormalities.
Anastrozole
Aromatase inhibitor
Von Gierke disease
glucose 6 phosphatase deficiency, glucose deficiency, hepatomegaly, hypoglycemia, hyperlipidemia.
Parkinson triad
This patient is presenting with a resting tremor, micrographia and bradykinesia.
PTH in the kidneys
stimulates the production of alpha 1-hydroxylase
Acromegaly parasellar symptoms:
bitemporal hemianopsia, cavernous sinus compression, and sphenoid sinus invasion.
amyloid light chain
Multiple myeloma,
beta-amyloid
Alzheimer’s
Transthyretin
Senile cardiac amyloidosis
beta-2 microglobulin
dialysis patients
I-CELL
I-cell disease is an autosomal recessive disorder in which there is a failure of adding a mannose-6-phosphate residue to proteins that should be directed to lysosome, and this leads to intracytoplasmic inclusions. Patients with I-cell disease can present at an early age with coarse facial features, clouded corneas and restricted joint movements.
glioblastoma multiforme
poorly differentiated astrocytes.
Neurocysticercosis
patients who consume undercooked pork, due to Taenia Solum,
Toxoplasma Gondii
close exposure to cats, immunosuppressed patients,
Jugular foramen
CN IX, 1/3 taste and swallowing, CN X, taste near the epiglotis, swallowing, elevation of the palate and speech. CN IX, turning of the head and shrugging the shoulders.
46, XXY
Klinefelter
45,XO
Turner
5-FU overdose
thymidine
Hypocalcemia
QT prolongation
Cirrhosis findings:
spider angiomata, gynecomastia, ascites.
Dapsone side effect
Methemoglobinemia, normal oxygen partial pressure, decreased saturation. Tx: methylene blue.
Imatinib
tyrosine kynase inhibitor used in CML that targets the BCR ABL gene.
Pulsus paradoxus
a decrease in systolic blood pressure of 10mmHG during inspiration.
Pericarditis
Systemic lupus erythematous, rheumatoid arthritis, viral infection, and uremia are associated with serous pericarditis. Uremia, Dressler’s syndrome, and rheumatic fever are associated with fibrinous pericarditis. Tuberculosis and malignancy can be associated with hemorrhagic pericarditis
NF type 1
Cr 17.
gliomas, pheochromocytomas, cafe au lait lesions, scoliosis, etc.
AML M3 Tx
tretinoin
Nitriprusside side effect
anti-hypertensive drug that can result in cyanide toxicity, cyanide inhibits the electron transport chain, preventing oxidative phosphorylation, binging to cytochrome C oxidase.
Ghrelin
Stimulates the secretion of GH, ACTH, Cortisol and Prolactin.
Myoclonus epilepsy and ragged red fibers
damage to the nervous system and skeletal muscle, presenting with jerking spams, and epileptic seizures. Myopathy, ataxia, dementia, hearing loss, short stature, and peripheral neuropathy.
Idiopathic thrombocytopenic purpura
can show megakaryocytes.
Sickle cell may also present with…
dactylitis (swollen of the hands and feet, painful, worse prognosis)
Major source of transmission of hepatitis B from mother to fetus:
HBeAg
Mosaicism
Mosaicism occurs when there are cell lines containing two or more different genetic makeups leading to different phenotypes
Anatomic path of the ovum:
ovary, infundibulum, ampulla, isthmus and uterus.
erythromelalgia
burning sensation in hands do to a small vessel occlusion, seen in essential thrombocytosis
Choriocarcinoma symptoms:
Gynecomastia, hyperthyroidism, bHCG
Can develop anticholinergic effects
The TCA’s. Some examples of TCAs include amitriptyline, imipramine, and nortriptyline.
Schistosoma haematobium
trematode, blood sucker, that can cause bladder cancer, specifically squamous cell carcinoma, frequently in the middle east and east Africa.
Benzodiazepines mechanism of action:
Increases GABA-A for anxiety
Increases GABA-B for anesthesia, analgesia and memory
Increases GABA-C by an unknown mechanism.
Hallmark signs of opioids:
The hallmark signs of opioid withdrawal are sweating, rhinorrhea, GI upset and pupils dilation.
Naloxone is use in which type of intoxication:
opioid
Caseous necrosis
granuloma with central necrosis, seen in tuberculous infections
liquefactive necrosis
rapid digestion of dead cells usually seen in the brain.
Liver biopsy of alpha-1-antitrypsin
Alpha1-antitrypsin deficiency is an autosomal co-dominant disorder characterized by panacinar emphysema and liver cirrhosis. The defective alpha1-antitrypsin protein accumulates in the liver and stains red with PAS
Liver biopsy in hemochromatosis
Blue granules with Prussian blue stain would be seen in hemochromatosis, an autosomal recessive disorder characterized by excess iron accumulation. Though hemochromatosis can cause liver cirrhosis, it is not associated with emphysema as seen in this patient.
Grossly Black Liver biopsy
A grossly black liver is seen in Dubin-Johnson Syndrome, an autosomal recessive disorder characterized by defective secretion of conjugated bilirubin.
Granulocyte colony stimulating factor (G-CSF) can be used to:
Granulocyte colony stimulating factor (G-CSF) can be used to prevent and treat neutropenia.
Leukotrienes
increase bronchial tone (LTC, LTD, LTE)
increase neutrophil chemotaxis (LTB)
Prostacyclin PGI2
decrease platelet aggregation,PROMOTES VASODILATION
decrease vascular tone
Decrease vascular tone
PGI2 AND PGE1
Increase uterine tone
PGE2 AND PGF2
Thromboxane
TXA2: INCREASE PLATELET AGGREGATION AND INCREASE VASCULAR TONE
Aortic stenosis
crescendo-decrescendo systolic ejection murmur
Mitral/tricuspid regurgitation
holosystolic, high-pitched “blowing murmur”
mitral valve prolapse
late systolic crescendo murmur with mid systolic click
ventricular septal defect
holosystolic, harsh sounding murmur
Aortic regurgitation
high-pitched blowing early diastolic decrescendo murmur
mitral stenosis
follows opening snap
patent ductus arteriosus
continous machine-like murmur
positive IgA tissue transglutaminase
Celiac disease and also anti-gliadin
Magnesium hydroxide side effects
Tx for GI. Diarrhea, hypotension, hyporeflexia, hypokalemia
VHL
Renal cell carcinoma, hemangioblastoma and pheochromocytoma
hereditary nonpolyposis colorectal cancer gene mutated
MSH2 (60%), MLH1 (30%), and MSH6 (7-10%)
MALT (MUCOSA ASOC. LYMPHOID TISSUE
Etranodal marginal zone lymphoma
Linezolid
acts as a weak MAO-1 inhibitor so it can not be given in a person taking SSRI
BPH and Prostate cancer occurs at:
BPH occurs at the transitional zone, whereas prostate cancer occurs at the peripheral zone.
acalculous cholecystitis
These risk factors include burns, childbirth, immunosuppression, major trauma, mechanical ventilation, multiple transfusions, sepsis, and total parenteral nutrition (TPN). Acalculous cholecystitis typically occurs as a result of gallbladder stasis as well as ischemia.
Filtration factor
Filtration fraction is the fraction of RPF filtered across the glomerular capillaries (FF = GFR/RPF). When both GFR and RPF are decreased, the net result is no change in FF.
Micturition muscles involved
relaxation of the elevator ani muscle and the contraction of detrusor muscle.
Sexual developing
Until 8 weeks gestation, the human fetus is undifferentiated sexually and contains both male (wolffian or mesonephric) and female (mullerian or paramesonephric) genital ducts. The mullerian ducts are the primordial anlage of the female reproductive tract. They differentiate to form the fallopian tubes, uterine cervix, and the superior aspect, or upper one-third of the vagina.
Wide QT interval
Another quicker way is identify QT prolongation is to see if the QT interval is longer than half of the RR interval.
Hypokalemia
To help reduce the chance of sudden death, beta-blockers are considered to be the first-line of therapy for people with long QT syndrome. Implantable cardioverter-defibrillator can also be considered in patients with long QT syndrome.
Most common cause of lung metastasizes
colon, breast, prostate, and bladder cancers.
Barrett metaplasia epithelial cells
The normal histology of the esophagus is a non-keratinized stratified squamous epithelium. With chronic irritation such as with GERD, metaplasia occurs and transforms the non-keratinized stratified squamous epithelium to intestinal epithelium, as it can better handle the stomach’s acidic contents. This can be seen on biopsy and will show a conversion to columnar epithelium with goblet cells.
Elevation of the ESR can be due to…
he ESR, defined as the rate at which erythrocytes suspended in plasma settle in a conical tube, is a non-specific finding in patients with a high inflammatory state. It elevates as a result of increased fibrinogen, which slows the rate at which red blood cells settle. Inflammatory cytokines such as interleukin-1, interleukin-6, and tumor necrosis factor-α (TNF-α), and acute phase reactants such as C-reactive protein and fibrinogen elevation the ESR.
Serum sickness?
Is a classic example of a type III, or immune complex-mediated hypersensitivity reaction. The disease results from administration of some foreign protein into the body, subsequent antibody response to the protein antigen, and formation of antibody-antigen complexes. The load of immune complexes overwhelms the body’s natural ability to clear them, and the immune complexes are deposited in tissue, which leads to inflammation and injury.
Albright’s syndrome
a pediatric disease that causes precocious puberty mostly in girls as young as 4 months of age. They have abnormal development of secondary sex characteristics such as hair and breast. Vaginal bleeding is also common. Patients may develop Cushing’s syndrome, fibrous dysplasia of the bone, hyperthyroidism, and café-au-lait spots, even sudden death from arrhythmias. The lab results are consistent. Patient’s often will not have any effect on GnRH, as would a hypothalamic tumor. It is a gonadotropin-independent process, therefore FSH and LH will often be suppressed or even undetectable. They can be low normal, but estradiol is always increased.
Boutonniere deformity
is seen in rheumatoid arthritis patients; it is a flexion of the proximal interphalangeal (PIP) joint along with hyperextension of the distal interphalangeal (DIP) of the finger.
Caplan’s syndrome
is seen only in patients with both rheumatoid arthritis and pneumoconiosis related to coal, asbestos, and silica exposure. Patients have basilar nodules with same composition as nodules seen in other tissues in rheumatoid arthritis except that the nodules are surrounded by pigmented cells. Caplan’s syndrome has a good prognosis, but some patients can develop massive fibrosis.
Dactylitis
Dactylitis, also called “sausage fingers,” is typical of psoriatic arthritis and signifies swelling of the soft tissues between joints.
Xerostomia
dry mouth is characteristic of Sjogren’s disease
Polyarteritis nodosa
Asoc. with Hepatitis B, presents with mononeuritis multiplex and livedo reticularis.
Sturge-Weber syndrome
Congenital, noninherited (sporadic), developmental anomaly of neural crest derivatives due to somatic mosaicism for an activating mutation in one copy of the GNAQ gene.
STURGE-Weber: Sporadic, port-wine Stain; Tram track calci cations (opposing gyri); Unilateral; Retardation (intellectual disability); Glaucoma, GNAQ gene; Epilepsy.
Ethambutol
Ethambutol inhibits the synthesis of the mycobacterial cell wall via inhibition of arabinosyl transferase, an enzyme that polymerizes arabinose into arabinan and then arabinogalactan, one of the constituents of the mycobacterial cell wall. Ethambutol is noted for causing optic neuritis that results in color blindness, central scotoma, and decreased visual acuity.
Isoniazid
decrease synthesis of mycelia acids, bacterial catalase-peroxidase needed to convert INH to active metabolite.
Pyrazinamide
adverse effect: hyperuricemia, hepatotoxicity
Streptomycin
interferes with 30s component of ribosomes.
A.E.: tinnitus, vertigo, ataxia, nephrotoxicity.
Succinylcholine mechanism of action and side effects:
Succinylcholine is the prototypical depolarizing muscle relaxant which is used for induction of general anesthesia. Succinylcholine binds to nicotinic acetylcholine receptors on the post-synaptic membrane to activate them.
The most common side effects of succinylcholine are hyperkalemia, muscle pain, and malignant hyperthermia.
Osteopetrosis
Osteopetrosis is a disease caused by abnormal osteoclastic function, believed to be related to defective carbonic anhydrase function, leading to problems with bone resorption. Patients have dense bones, leading to compression of the cranial nerves, auditory canals, and nasal sinuses. The thickened bones can also compress the bone marrow, leading to pancytopenia.
Parakeratosis
Parakeratosis is a benign skin condition characterized by dry, scaly skin that results from a variety of causes. Normally, the upper layer of the skin, known as the stratum corneum, consists of dead, keratinized cells that lie on each other. These cells lack nuclei and are high in keratin, allowing the skin to retain moisture. Patients with parakeratosis have cells in the stratum corneum that have retained their nuclei and are incompletely keratinized. As a result of this keratin deficiency, the skin does not retain moisture and becomes dry. Over time, these dry areas can develop cracks and fissures. Inflamed, tender, red lesions may sometimes develop over these areas of dry skin. Topical anti-inflammatories and moisturizers can be given to ease the redness and tenderness and to prevent skin dryness.
epidermolysis bullosa
keratin dysfunction
bcl-2
Follicular lymphoma
c-myc
Burkitt’s lymphoma
n-myc
neuroblastoma
c-kit
encodes a receptor tyrosine kinase that is involved in cellular proliferation and differentiation
ex. gastrointestinal stroma tumor
Abruptio placentae risk factors
Risk factors include pre-existing hypertension, cigarette smoking, clotting disorders, and advanced maternal age
Alkylating agents mechanism of action
cross-links DNA
Busulfan
CML
s.e.= pulmonary fibrosis
Cyclophosphamide
leukemias, lymphoma
Nitrosoureas
cross blood brain barrier, used in brain tumors, and can cause CNS toxicity
anatomical positions of the pulmonary arteries
The anatomical positions of the pulmonary arteries in relation to their respective bronchi can be remembered with the acronym “RALS”: right is anterior and left is superior. Since the right pulmonary artery is anterior to the right mainstem bronchus, that means that the bronchus is posterior to the artery.
yolk sac tumor
alpha-fetoprotein
child less than 3 years
schiller duvall bodies
Cofactors needed in pyruvate dehydrogenase, α-ketoglutarate dehydrogenase, and branched-chain amino acid dehydrogenase pathways:
B1,B2,B3,B5 and lipoid acid.
IFN-gamma in TB
Th1 cells and activated macrophages produce interferon-γ (IFN-γ), which activates macrophages and induces the differentiation of mononuclear cells into epithelioid cells.
ankylosing spondylitis presentation
1) Chronic inflammatory disease of spine and sacroiliac joints - The pain associated with ankylosing spondylitis is typically worse in the morning or following periods of inactivity. Patients frequently note morning stiffness lasting around 30 minutes and improvement of their symptoms with physical activity. On imaging, the spine may appear “bamboo-like” due to the formation of bridging syndesmophytes (areas of ossification within the ligaments) that leads to near fusing of the spine (see image below).
2) Uveitis - Patients typically present with acute onset of unilateral eye pain, redness, photophobia, increased lacrimation, and blurred vision.
3) Aortic regurgitation - Patients with long-standing ankylosing spondylitis can develop cardiovascular complications such as aortic valvular insufficiency.
Hashimoto’s thyroditis
Biopsy typically shows widespread destruction of follicles, lymphoid aggregates, and Hürthle cells. Hürthle cells contain an eosinophilic cytoplasm due to mitochondrial dysfunction.
