U world High Yields Flashcards
what drug blocks iodine uptake by the thyroid
Perchlorate; Pertechnetate
conversion of t4-t3
propythiouracil, beta blockers and Ipodate
erythematous papulovesicular weeping lesion
eczematous dermatitis (eczema)
histologic appearance of spongiosis refers to what
eczematous dermatitis (eczema) spongiosis is the accumulation of edema fluid in the intercellular spaces of the epidermis
thickening of stratum spinosum is referred to as
acanthosis
thickening of the stratum corneum
hyperkeratosis
dyskeratosis is associated with what layer of the skin
stratum granulosum
hypergranulosis is the thickening of stratum granulosum and is associated with what skin conditions
lichen planus
what is the MOA of PCP
an (N-Methyl-D-Aspartate) NMDA receptor antagonist
it works secondary to inhibit reuptake of NE, dopamine & Serotonin
PCP binds to sigma opiod
SE: loss of coordination, VERTICAL NYSTAGMUS, poor judgement, memory loss
a single point missense mutation in the genes for beta-myosin heavy chain and myosin binding protein refers to what pathology
Hypertrophic cardiomyopathy
mutation of DYSTROPHIN GENE refers to what three pathology
Linked Familial Dilated cardiomyopathy
DUchene muscular dystrophy
Beckers muscular dystrophy
Mutation in Transthyretin gene refers to what pathology
Hereditary form of Cardiac amyloidosis causing infiltrative cardiomyopathy (present with dyspnea, peripheral edema and ascites)
AD mutations affecting cardiac sarcomere genes refers to what disease
Hypertrophic cardiomyopathy.
selenium deficiency can lead to what cardio path
dilated cardiomyopathy
Patient develop Fever , pruritic rash and athralagia 7- 14 days after drug use/antigen exposure is an example of
serum sickness causes dec C3 levels (Type 3 hypersensitivity)
serum levels of anti Hbc AB and Anti HBs antibodies with no antiHBs antigen means what
recovery of HB
what type of vaccine do cholera patient use
killed vaccines (RIP A cholera)
what type of vaccine do TB and oral typhoid vaccine use
live attenuated bacterial vaccines
low voltage QRS despite refers to
restrictive cardiomyopathy
superficial scotum abscess drained by
Superficial inguinal lymph nodes
Testes and ovaries abscess drains by
Para-aortic nodes
lateral epicondyle (tennis elbow) damages the extensor carpal radialis brevis
Radial nerve damage
shingles causing local pain on single dermatome for many months
VZV
what another name for tras2tumab
Herceptin
a proteasome inhibitor that is used in Multiple myeloma, waldenstrom and induces cell apoptosis
Bortezomib
which med cause steven johnson syndrome
lamtrogine (for focal seizures)
SE of valproic acid
hepatotoxicity & neural tube defect
S.E of lithium
D.I, hypothyroidism, abstain bar anomaly, tremor
valporic acid function is
for tonic clonic, myoclonic, absence seizure, manic episodes
MOA= blocks voltage gated sodium channels enhancing gaba synthesis and release
drug of choice for myoclonic seizure
vampiric acid
s.e of carbamazepine
agranulocytosis
SE of Olanzipine
weight gain, metabolic syndrome(dyslipidemie, hyperglycemia,HTN)
SSRI (sertraline) induces mania so avoid in patient taking what drug
lithium (bipolar)
short stature, broad neck, shortened fourth metacarpals refers to what disease
Turner syndrome
what is the sound of bicuspid aortic valve and what other heart disease can it cause
early systolic, high frequency click heard over the right second interspace
bicuspid aortic valve high risk of infective endocarditis
Lab finding of aminoaciduria refers to what pathology
Hartnups (treat with high protein diet) and fanconi syndrome
fever and sore throat in a patient with hyperthyroidism such as graves disease taking medication should raise what concern
thuonamide induced agranulocytosis
what is the preferred drug in a patient taking PTU due to high risk of hepatic failure(hepatotoxicity)
methimazole (s.e aplastic cutis)
note methimazole and PTU both cause agranulocytosis (neutrophil count
aspirin and ibuprofen can displace thyroid hormones from binding protein and should be avoided in what patients?
hyperthyroidism patients
the region of the sarcomere containing only thick filament is
H-Band( myosin only)
unusual flexion of the left wrist and thumb and extension of the fingers are observed on cuff Blood pressure measurement refers to
Carpopedal Spasm in Digeorge syndrome (Catch 22, micro deletion)
decrease soft tissue attenuation in the right anterior mediating refers to thymic shadow
failure of anterior neurpore
ananecephaly
cryptococus neoformins occurs in the yeast form and found in soil and pigeon droppings infect Immunocompromised through
respiratory system and LUNGS( the primary site of entry)
what is the mose effective treatment of a specific phobia (fear of heights, cars, elevators)
behavioral therapy (exposure systemic desensitization is the treatment of choice)
MOA of Escitalopram
selective serotonin reuptake inhibitor
treats generalized anxiety disorder, social anxiety disorder and panic disorder
what is the formulA for net filtration pressure
Net filtration pressure=(Hydrostatic pressure in capillaries- Hydrostatic pressure in the interstitium) — (oncotic pressure in capillaries– oncotic pressure in the interstitium)
the resting membrane potential of a cell is generally composed of
RMP= High COnc of K+ & Low Conc of NA+
the difference is maintained via Na, K ATPAse pump
within the true pelvis, surgeons can palpate the right ureter immediately anterior to which of the following structures?
Internal Iliac artery
what vessels is at risk during pelvis and abdominal surgery
ureters
what is formed by the common iliac veins at level of L4
IVC
Budding yeast with latex agglutination detects polysaccharide capsular antigen refers to
cryptococus neoformins
cultured on sabouraud agar
Non septet hyphea refers to
rhizopus and Mucor
Budding yeast that forms Germ tubes refers to
Candida (pseudohyphae at 20degrees and germ tubes at 37 degrees)
An elderly man with New back pain, urinary symptoms, osteoblastic lesions in lumber spine refers to
prostate cancer
double stranded RNA activates interferons
interferons half protein synthesis except for interferon gama which activate macrophage
the most common elbow injury in children
present with injured arm held close to the body with elbow extended and forearm pronated.
annular ligament tear (radial head subluxation)
penicillin and cephalosporin works by irreversible binding on
penicillin binding proteins such as transpeptidase
cellular myxoid storm that encircles and compress epithelium-lined granular and cystic spaces on histology
Fibroadenoma
what kind of medication causes dec HR, flushing, diaphoresis and nausea
cholinergic agonist e.g.bethanecol (atonic bladder)
what is the pathophysio of TEF (symptoms : drooling, choking and vomiting during feeding)
failure of the primitive gut to separate airways
Esophageal atresia with distal TEF
diagnosis: inability to pass nasogastric tube into the stomach.
cystic or partially cystic(containing cholesterol crystals) with solid areas brown yellow fluid that resemble machine oil in a kid
craniophrangyioma (Ratkes pouch) from surface ectoderm
cholesterol crystals found in motor oil like fluid
triptans act on
post synaptic serotonin receptors (5HT1b) (1 big damn headache)
used for migraine
Other drugs CCB, topiramate, valproate BB.
Bilateral headache that is > 30 min with steady pain, no photophobia No aura
Cluster headache, NSAIDS acetaminophen , amitriptyline
beta endorphin acting on Mu receptors which is derived from
POMC which is a pentapeptide which makes ACTH and MSH and beta endorphins
Hep B pathophysio?
due to integration of virus into patient genome
inhibiting tumor suppressor and activating oncogenes which help in Viral DNA integration
what electrolyte is the most affected in cystic fibrosis?
Sodium due to defective chloride channel which regulate flow of sodium chloride and water
excessive salt wasting due to a lot of sweat causing (HYPONATREMIA) due to excessive loss of salt via sweat
recurrent pulmonary infection in C.F patients in infancy is due to what bug
staf aureus
recurrent pulmonary infection in C.F patient in adolescent is cause by what bug
pseudomonas aeuriginosa
muscurinic antagonist causes
anticholinergic side effects is common in what age group
DUMBBELLS diarrhea, urination, miosis, bronchospasm, bradycardia, excitation, lacrimation, sweat and salivation
Elderly patients
volatile fluorinated inhaled anesthetic (ISOFLURANE) usually cause what organ and why?
cause decrease vascular resistance therefore increasing cerebral blood flow due to inc CO2 causing vasodilation
all anesthetic except NO cause respiratory depression causing hypercapnia.
what get reabsorbed in the jejenum
folate and vit K from gut bacteria
prob;lem with dna excision repair is
xeroderma pigmentosa
problem with non homologous end joining
ataxia talengasteia and falconi anemia
what does E coli use to infect urinary tract
Fimbraie
the process of administration of anti toxin of corny bacterium diphtheria is referred to as
passive immunity
human placental lactogen cause
resistant to insulin to increase glucose level to the baby in a pregnant woman
produced from the placenta (Synthchioblast) and it is the reason for gestational diabetes and usually goes away in pregnant women after delivery but in obese patient leads to DM type 2
how do you kill spores
autoclave (1000degrees)
lesion to the vermis causes
truncal ataxia and dysarthria
dysmetria( finger to nose test) is due to damage to
cerebellum
what joint is more prone to destruction in RA
atlantoaxial joint is more prone to subluxation( fracture of C1)
extension of the neck worsens the subluxation by compressing on C1 compress the spinal cords and vertebral arteries
joint finding: osteophytes (bone spurr)
fingers also have ulnar deviation
cervical spine is involved in RA
what enzyme is deficient in I-cell disease
N-acetylglucosaminyl-1-phosphotransferase
I-cell disease aka inclusion cell disease is also called what
mucolipidosis type 2
what is the formula for attributable risk
AR = 1 - Relative Risk percentage
i.e if RR=5 then RR%= 1/5 therefore RR%= 1/5* 100% = 20%
then Attributable risk = 1 - relative risk percentage
AR= 100% - 20% = 80%
multinucleated cell with iintranuclear inclusion (cowdry body type A) is associated with what pathology
VZV
damaged intermediate filament within the hepatocyte
mallory bodies
Nuclear factor Kappa B
present in cytoplasm and its not activated, but activated by Toll Like Receptor that is bound to antigen. then it activates acute phase reactant like IL1, IL6 & TNF alpha
it binds to IKb
what is the antidote for serotonin syndrome ( hypereflexia, rigidity, clonus, myoclonus), hyperthermia and cardiovascular collapse
cryptoheptadine (a first generation histamine antagonist with non specific 5HT1 & 5HT2 receptor antagonist properties
Biopsy reveals nest of uniform cells with inconspicuous nuclei and a few mitotic figures involving the basal portion of the epidermis and upper dermis refers to what skin pathology
Compound melanocytic nevus
a collapsed lung occurs due to
obstruction in main stem bronchus lesion (e.g. central lung tumors in chronic smokers)
patient with Sickle cell disease are prone to what type of vitamin deficiency and why?
Folic acid deficiency (causing microcytic anemia) due to increased erythrocyte turnover
how does a splenic vein thrombosis cause gastric varies only in the fundus of the stomach
the splenic vein increase the pressure of the short gastric vein causing gastric varices
the short gastric vein usually drain blood from the gastric fundus into the splenic vein
pancreatic inflammation or pancreatic cancer causes blood clot into the splenic vein which causes the increase pressure in the short gastric vein causing gastric varices only in the fundus
what stimulate the adrenal medulla
acetylcholine released from preganglionic neurons and secrets catecholamines
Most common risk factor for developing calcium stones in the kidney (nephrolithiasis) in adult is
HYPERCALCURIA and it is usually idiopathic with a NORMOCALCEMIA due to intact regulation of vit D and parathyroid hormone
symptoms of nephrolithiasis (right flank pain that radiates to the groin), gross hematuria and no fever and no costovertebral angle tenderness
Hyperuricosuria with normouricemia is cause by
High protein diet
Hyperoxaiuria is as a result from a diet high in what
oxalate (chocolate, spinach and nuts)
seen in Crohn disease
what pathway in the brain is responsible for positive symptoms of schizophrenia
Increase Dopamine in the MESOLIMBIC PATHWAY is the cause for Positive symptoms of schizophrenia
schizophrenia is inc risk of suicide.
what pathway in the brain is responsible for negative symptoms of schizophrenia
decrease dopamine in the MESOCORTICAL TRACT may cause the negative schizophrenia symptoms
psychotic symptoms for at least 2weeks in the absence of mood disorder + a time period with both psychosis and a major mood disorder episode at the same time
schizoaffective disorder (primary psychosis with a little bit of mood disorder)
if primary problem is major depression with a little bit of psychosis then it will be major depressive disorder with psychotic features.
what is the major defense mechanism for paranoid disorder (always suspicious, lack of trust)
projection
tx of psychosis from parkinson meds
quetiapine cuz of lowest side effect
role of eosinophils in parasitic infection
Eosinophil play a role in host defense against parasitic infection by inducing antibody dependent cell mediated cytotoxicity with enzymes from their cytoplasmic granules
what is MOA of entacapone
A catechol-o-methyl transferase COMT inhibitor increasing the bioavailability of levodopa by inhibiting its peripheral methylation and decrease peripheral levodopa degradation
used in parkinson patient who experience end of dose wearing off periods
what is the blood supply for the proximal ureter in the kidney
branch of renal artery
distal ureter blood supply is
superior vesicular artery
increase bile acid supplementation causes
dissolve gall stones
MOA of metformin
inhibit hepatic gluconeogenesis via inhibiting the mitochondria isoform of glycerophosphate dehydrogenase in the liver.
cafe au last spots (shoulder, neck and buttocks), endocrine abnormalities (e.g precocious puberty(onset of secondary sexual characteristics in females before the age 8 in girls), hyperthyroidism) and fibrous dysplasia (multiple osteolytic appearing lesion of the hip and pelvis) refers to what pathology
McCune-Albright Syndrome (mutation in the GNAS gene encoding the stimulatory alpha subunit of G protein)
what muscles occupy most of the space of the greater sciatic foramen
piriformis (externally rotates the hip)
routes of meningeal contamination in nesieria meningitis (bean shaped gram negative cocci in pairs
(Mode of transmission Respiratory droplets) seen in new military recruits, college freshmen)
pharynx—-blood—–choriod plexus——meninges
route of meningeal infection in H influenza
pharynx—lymphatics—-meninges
infants and young children commonly affected
route of meningeal infection strep pneumonia
middle ear—-contigious tissues—–meninges
route of meningeal infection or CNS Abscess by staph aureus
traumatic wound (bacterial from skin)—- leaking CSF—– meninges
route of meningeal infection in mycobacterium tb
primary lung focus—blood—meninges
What other structure has a similar chemical structure to Bisphosphonate
Pyrophosphate disrupt osteoclast function by attaching to hydroxyapatite binding sites on bony surfaces.
why are patient advised to take bisphosphonate on an empty stomach with plenty of water?
due to poor gastrointestinal absorption and remain upright for 30 mins due to risk esophageal erosions
the marker for osteoclastic activity in osteoporosis
urinary hydroxyproline
in a newly born suffering flaccid lower extremities and absent ankle reflexes bilaterally and poorly developed lumber and sacrum is caused by
uncontrolled diabetes
neurologic defects, lactic acidosis and inc alaninine in infancy refers to
pyruvate dehydrogenase deficiency
Treatment: High fat content, lysine (Ketogenic a.a) and leucine (ketogenic a.a)
FSH stimulates sertolic cells to produce
inhibin A, (inhibit have a negative feedback blocking FSH release)
FSH helps in spermatogenesis and inhibin production
Estrogen up regulate gap junction which contains
connexions
spontaneous pneumothorax with apical blebs affecting the pulmonary system is seen in what other pathology apart from spontaneous pneumothorax
Marfan syndrome
IN the spleen of a sickle cell patient that is firm and brown (hemosiderosis) is most likely due to
vascular occlusion
Cheyne-strokes breathing is seen in what pathology
CHF
what contributes to the formation of gallstones
High Serum triglyceride
this inc production of free fatty acid in the capillaries by pancreatic lipase
what is androgenic alopecia and what is the mode of inheritance
made up of hormonal and genetic factors and varies between males and females
Mode of inheritance is polygenic inheritance with variable expressibility
cervicitis is detected using nucleic acid amplification testing has what presentation
Vaginal spotting and yellow vaginal discharge
cervicitis is caused by Gonnorhea and CHlamidia causing PID which leads to Infertility and ectopic pregnancy if not treated.
tx: ceftriaxone + azithromycin/doxycyline
what drug do you use due to their anti inflammatory properties to treat graves Opthalmopathy
High dose Steroids
kisslback plexus (anterior) most common cause of epistaxis occur on due to damage on
Nasal septum.
tx: pinch the nasal alae and give Cautery Silver nitrate for severe form
three major arteries branches at kisselback plexus
1) septal branch of anterior ethmoidal artery
2) Lateral nasal branch of sphenopalatine artery
3) Septal branch of superior labial artery (branch of facial artery)
posterior part of the external auditory canal is innervated by
the small auricular branch of the vagus
what organism can cause liver abscess
staph aureus
elevated alkaline phosphatase means that there is a problem with what organs
liver, gall bladder and bOnes
what antidepressant drugs causes orthostatic hypotension & a painful erection unrelated to sexual events (priapism) and used to treat OCD, depression and insomia
Trazodone post synaptic serotonin receptors and inhibit serotonin reuptake with minimal effect on NE and dopamine
primaquine is added to the hypnozoites in the liver and it is responsible for
responsible for relapse
what is used to treat TCA associated toxicity(antidote) and works by increasing serum pH and extracellular sodium
Sodium bicarbonate
which BPH medication is used to decrease prostate volume?
Finasteride
influenza virus undergo genetic shift using their segmented genome which other virus have a similar mechanism
Rotavirus & orthomyxovirus
what leads to insulin resistance in type 2 DM
Elevated free fatty acid levels
why do we have the symptoms in Normal pressure hydrocephalus
due to distortion of periventricular white matter
the bladder control (urinary issues) is due to STRETCHING OF THE DESCENDING CORTICAL FIBERS
what accumulates when a patient is on methotrexate
dihydrofolate polyglutamate
a prolong PTT and a false-positive rapid plasma reagin in a woman with SLE is at greatest risk of
Disease( Antiphospholipid syndrome) secondary to SLE
Greatest risk for Recurrent Misscarage & venous/arterial thromboembolism
what drug worsens/precipitate opioids withdrawer
Buprenorphine (partial opiod agonist that prevent other opiod frm binding.
propofol is an anesthetic that when used perfuses to highly vascularized organs like kidney brain heart and then goes to poorly vascularized organs like
skeletal muscles, Fats and bones
Neutropenia is a significant SE of Ganciclovir, what two drugs can increase its toxicity
TMP/SMX & zidovudine also cause Neutropenia worsening the bone marrow suppression
IN mitochondria inheritance disease, the reason for the variable expressibility among individuals is called
Heteroplasmy (random distribution of normal and mutated mitochondria)
supracondylar fracture resulting in anterolateral displacement of the proximal fracture fragment causes what nerve injury
Radial nerve
Supracondylar fracture resulting in anteromedial displacement of the proximal fracture segment
Median nerve and brachial artery injury
Superior Vena cava syndrome is mostly as a result of
Mediastinal mass
MOA of bisphosphonate
Inhibits osteoclast activity inducing osteoclast apoptosis
Bisphosphonate has a similar chemical structure as pyrophosphate (attaching to hydroxyapatite binding sites on bony surfaces)
A recombinant formulation identical to the 34 amino acid sequence at the N -terminal portion of endogenous PTH refers to what drug
teriparatide
what drug inhibits osteoclast differentiation
raloxifen
a monoclonal antibody that binds to Rank L (on nuclear factor kappa B) and blocks the interaction between RANKL & Rank receptor which decrease bone resorption is
DENOSUMAB
acute painless monocular vision loss is due to
Retinal artery occlusion
(presents as a cherry red spot on the macula with retinal whitening in patients with history of coronary artery disease, HTN and DM)
Internal Carotid artery are the most common cause of retinal artery occlusion due to thromboembolic complications.
travels from internal carotid artery——opthalmic artery——retinal artery
In patient with lactate dehydrogenase deficiency in strenuous exercise you stop glycolysis why?
NO NAD+ to be converted to NADH
What type of hernia is due to weakness of transversals fascia
Direct hernia ( in older men)
weakness of proximal femoral canal is what pathology
femoral Hernia
methadone overdose can cause
methadone is used to whin off opiod euphoric effects
long QT interval and respiratory depression
methadone ( a Mu receptor agonist) has a long half life, high bioavailability, high potency
facial pain, headache and nasal eschar is dedicative of mucor and rhyzopus suggesting of DKA . the procedure for diagnosis is
Mucosal Biopsy
what is the pathogenesis of rabies virus
Rhabdoviridae (rabies) are single stranded RNA virus enveloped by a bullet shaped capsule. that binds to nicotinic acetylcholine receptors.
(Retrograde transport) using DYnein
Clinical presentation: agitation, disorientation, pharyngospasm and photophobia leading to Coma and death
most common cause of osteomyletis(Pain in joint) in children is
Staph aureus
affect mostly long bones (tibia, fibula and femur)
what is the cause of a vertebral osteomyelitis after a UTI infection
Enterococcus Faecalis
upper extremity numbness, tingling and weakness refers to
thoracic outlet syndrome ( compression of the lower truck of brachial plexus)
most commonly occur within the scalene triangle affecting the scalene muscles (anterior, middle scalene and first rib makes the triangle)
repeated overhead arm movement and trauma worsen it
Infertility due to a bling vaginal pouch and lack of mullein structure is
Mayer-Rokitansky-Kuster-Hauser syndrome (due to complete genesis of paramesonephric duct)
Recurrent pregnancy loss is due to
Bicornuate Uterus (failure of lateral fusion of the paramesonephric duct to fuse) characterized by indentation in the center of the fundus
Elevated AFP is seen in what pathology
open wall defects (open neural tube), omphalocele, gastroschisis
mylomeningocele is associated with what trisomy
Trisomy 18 (edwards syndrome)
omphalocele is associated with what trisomy
trisomy 13 (PAtau) & 18 (edwards)
flank pain, gross hematuria, elevated lactate dehydrogenase is what pathology
Renal vein thrombosis,
URinary loss of Antithrombin 3 predispose this patient to acute condition
the mechanism of gallstone formation in cRohns disease is
due to decrease bile acid absorption and increase bile acid wasting
what another name for anterior drawer test
lachman test
what is congenital Torticollis
it is typically noted by 2 to 4 weeks of age after the child hold his head tilted to one side
due to malposition of the head in utero or birth trauma
can resolve with conservative therapy and stretching exercises.
what test can be used to detect fructose in the urine
copper reduction test
what pathology is due to loss of paternal chromosome X
turner syndrome
what inhibit thyroid hormone release
iodide
what is MOA of zolpidem and uses
bind on GABA-a receptor and enhance the inhibitory action of GABA on CNS (SAME MOA AS BENZODIAPAMS)
Zolpidem is Used for short term treatment of Insomnia with a rapid onset of action (15mins) and metabolized by p450 microsomal oxidases
elimination half-life is 3hrs but prolong in liver disease
an autosomal codominant genetic disorder that present with pan acing emphysema and liver disease is
alpha-1-antitrypsin deficiency
growth retardation, microcephaly(abnormal facies), photosensitive rash, immunodeficiency (recurrent infection)
Bloom syndrome (BLM gene of helices deficiency)
primary structure of protein is by what type of bond
peptide bond
conformational change in secondary structure of protein such as alpha helix and beta sheet is due to what type of bond
hydrogen bond
in tertiary structure, helps protein fold what bond helps
ionic bond
subacute sclerosing panencephalities (ataxia, myoclonus and visual problems) caused by what virus affecting kids
Measles virus (Rubeola) (enveloped single stranded RNA virus) codes for membrane bound hemagluttinin (surface adhesion) and matrix protein (important for viral assembly)
conjunctivitis, coryza, cough and koplik spot
oligoclonal bands of measles virus antibodies are found on Cerebrospinal Fluid of the patient
tx; live attenuated measles vaccine
brain biopsy showing spongiform transformation of the cerebral cortex refers to
creutfieldt-Jakob Disease (due to abnormally folded protein))
brain biopsy showing focal demyelinated plaques with relative axonal sparing refers to
Multiple sclerosis
Progressive multifocal leukoencephalopathy is caused by
JC virus (a double stranded DNA virus in the polyomavirus family) usually in immunocompromised patients
a from of parkinsonism resulting from neurodegnerating of midbrain and frontal subcortical white matter that presents as rapid gait dysfunction, falls executive function loss and vertical gaze palsy refers to
progressive supra nuclear palsy
Biopsy shows deposit of abnormal phosphorylated tau proteins
physical examination shows coalescing erythematous lesion with crusting and scaling at the borders and central areas of bronze color induration refers to
glucagonoma
biopsy shows superficial necrolysis (elevated painful and pruritic rash typically affecting the face, groins and extremities)
other symptoms hyperglycemia (DM) & nonspecific GI Symptoms with normocytic normochromic anemia
presentation of abdominal pain, gall stones, constipation, hyperglycemia and steatorrhea refers to
somatostatinoma
water diarrhea, hypokalemia and achlorydia refers to
VIPOMA (high level of vasoactive intestinal polypeptide)
skin lesion with pustules and vesicles without a central clearing, hypogonadism, azoospermia, hair loss, impaired taste, night blindness and impaired wound healing refers to
ZINC DEFICIENCY
noise induced hearing loss result from trim to the sterocilliated hair cells in the
organ of corti
sounds reaches the middle ear by vibrating …..
the tympanic membrane
what part of the ear registers low frequency sound
cochlear cupula
type 1 fibers (slow twitch) mostly by aerobic metabolism has high myoglobin, high mitochondria, glycogen poor fibers an example is postural muscles such as
Soles & paraspinal muscles which are postural muscles mostly made up of slow twice fibers (type 1)
seen in marathon runners
type 2 fibers (low myoglobin, low mitochondria, glycogen rich fibers) produce rapidly forceful arm movement and they are type two fibers which are fast twitch examples are
latismus dorsi, pectorals major, biceps brachia, deltoid
seen in 100M race (short distances)
over expression of what protooncogene is associated with breast and ovarian cancer
ERB-B2 genes (has tyrosine kinase activity related to epidermal growth factor receptor)
what is responsible for differentiation of fibroblast into myofibroblast
transformation growth factor Beta (TGF-B)
what is the diff btw keloid and hypertrophic scar
Keloid extend beyond the borders of the original wound and are raised, painful and pruritic.
Keloid is seen in remodeling phase in wound healing
(seen in ear piercing, trauma and prominent in (ASIANS/AFrican ethnicity)
Hypertrophic scar are limited to the wound area and regress spontaneously
mutation of type 5 collagen
Ehlers Danlos syndrome
MOA of phenytoin
block voltage gated sodium (NA+) channels in neurons
how does phenytoin cause gingival hyperplasia?
phenytoin causes increases expression of PDGF (platelet derived growth factor) causing gingival hyperplasia
how is propofol cleared in the body creating rapid recovery from the anesthesia
tissue redistribution of the drugs
SE of acyclovir
nephrotoxicity and neurotoxicity
Lamivudine (NRTI) SE
peripheral neuropathy and lactic acidosis
what drug blocks nonstructural protein 5B (NS5B) an RNA dependent RNA polymerase used for hep c viral replication
SOFOSBUVIR
SE of FOrscarnet
Electrolyte imbalance
what drug inhibit the incorporation of D-alanine into the UDP-MUrNAc-oligopeptide during bacterial cell wall synthesis
cycloserine
SE: HIGH LEVEL OF OTOTOXICITY that is why it is RARELY USED
explain pseudomonas resistance to aminoglycoside such as amikacin
it decreases antibiotic entry into the bacterium creating resistance
chlorothalidone is an example of what type of drug
thiazides
SE: incr cholesterol and triglyceride levels
Best treatment for Post traumatic stress disorder (a solider remembering horrific experiences)
SSRI (selective serotonin reuptake inhibitor)
in mallory weise Syndrome( tear at Gastroesophageal junction) causes what acid base disorder
metabolic alkalosis due to repetitive vomiting and loss of gastric secretion
trachoesophageal fistula with esophageal atresia is due to
failure of the primitive forgut to appropriate divide into separate trachea and esophageal structures
presentation: drooling due to inability to swallow saliva(polyhydramnious), choking, cyanosis during feeds
diagnosis: via xray due to inability to pass a nasogastric tube into the stomach.
what drug do you give for recurrent seizure activity
phenytoin (blocks Na+ channels) & its long acting
A soluble receptor decoy protein refers to what drug
Etanercept (Tumor necrosis factor alpha (TNF-A) inhibitor)
used to treat RA who have failed by methotrexate therapy
peu d orange sign and dimpling of the breast is due to
malignant infiltration of the SUSPENSORY LIGAMENT of the Breast.
severe depression, suicidal thoughts, fatigue, hypersomnia, hyperphagia, vivid dreams refers to
cocaine withdrawer
what test should be ordered before a patient begins Canagliflozin therapy in DM2
BUN & Creatinine test (Asses RENAL FUNCTION Before starting this drug)
Canagliflozin and DApagliflozin is an (SGLT2 inhibitor)
increases renal glucose excretion
SE: hypotension, UTI
w drug that inhibit RANK/RANKL activity increasing bone density to treat osteoporosis is
DENOSUMAB
edwards syndrome is associated with what GI pathology
Malrotation and Mockers diverticulum
VSD & PDA
Palau syndrome is associated with what GI path
Omphalocele/umbilical hernia
How does Morphin terminate pain in a physiological stand point
Morphine is an opiod agonist that acts on Mu receptor( family of G protein)
It causes G-protein activation of potassium channels to increase potassium efflux leading to hyper polarization and termination of pain
it also inhibit adenycyclase, inhibit calcium conductance and inhibit transmission release.
a systolic murmur at the cardiac apex that decreases with squatting refers to
hypertrophic cardiomyopathy
patient sudden onset of syncope with QT prolongation in an otherwise healthy individual refers to
Cardiac arrithmias (due to Membrane potassium channel proteins)
mutation of a calcium binding sarcoplasmic reticulum protein refers to what pathology
ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY
in duodenal ulcer, H-pylori colonizes mainly what area
The antrum of the stomach in the PREPYLORIC AREA (where there are few acid secreting parietal cells) & duodenal bulb( which is the most exposed to increase acid production)
sickness in farm workers as a result of inhalation of animal waste (mostly cattle and sheep) is caused by
coxiella Burneti cause Q fever
Fever > 10 days fatigue, myalgia and rtetroorbital headache associated with photophobia
cause inc liver enzymes and thrombocytopenia
MOA OF RIFAXIMIN
inhibits bacteria RNA synthesis through binding with DNA-dependent RNA polymerase
non absorbable antibiotic that alters GI flora decreasing intestinal production and absorption of ammonia.
Rifaximin (dec intraluminal ammonia production) used in travelers diarrhea, Hepatic encephalopathy with lactulose (which increase conversion of ammonia to ammonium)
lateral ankle sprain is due to Inversion of a plantar flexed foot damaging what muscle
anterior talofibular ligament (most damaged)
eversion of the ankle damage what ligament
Deltoid ligament (not easily sprained)
hypercalcemia with no focal lytic bone lesion suggests
humoral hypercalcemia of malignancy which is caused by parathyroid hormone related protein.
Left sided heart failure causing Pulmonary Hypertension is due to
Vasoconstriction due to pulmonary venous congestion
right sided heart failure causing pulmonary HTN is due to
Hypoxic induced pulmonary vasoconstriction via Cor Pulmonale
ANASTROZOLE AND EXEMESTANE MOA
Blocks the conversion of androgen to estrogen
AKA Decrease ANDROGEN AROMATIZATION
what decrease VLDL production
triglycerides, Fibrates and fish oil
what reduce LDL receptor degradation of the liver
Pro protein convertase subtilisin Kexin (PCSK 9 inhibitor)
what is the MOA of Cinacalcet
allosteric activator of calcium sensing receptor in parathyroid gland, decreasing parathyroid hormone release
what drug decrease phosphate absorption in the GI tract
SEVELAMER used to treat hyperphosphatemia in dialysis patients
treatment of atropine overdose
physostigmine
Hiatal hernia is a strong predisposing factor to
GERD and Mallory Weis syndrome
Acanthosis affect the stratum spinosum , what disease displays this condition
psoriasis, seborrheic dermatitis and acanthosis nigrans
dyskeratosis is found in what disease
squamous cell carcinoma
uticararia is a transient hypersensitivity disorder seen after administering a drug and the patient develop Rash edema of posterior pharynx and tonsils exudate, what is the most likely finding on biopsy?
Dermal EDEMA via mast cell degranulation
what cytokine have anti-inflammatory properties in IBD
IL-10 inhibition th1 cells reducing MHC2 expression and suppression of activated macrophages and dendritic cells
IL10 reduces inflammation
what is claudication?
intermittent muscle pain reproducibly caused by exercise and relieved by rest and it is due to athelersclerosis of large arteries
the obstruction is due to atheroma which are lipid filled intimal plaques that bulge into the arterial lumen. this prevent increase blood flow to exercising muscles resulting in ischemic muscle pain
an example of a protein that can bind cDNA is
N-MYC protein (can be detected by DNA probes)
chalky white lesion in mesentery with fat cell destruction (necrosis) and calcium deposition and intestinal edema seen on light microscopy refers to
Acute pancreatitis
Aeromonas hydrophilia
oxidative +ve non lactose fermenting, Gram negative rod cause gastroenteritis, wound infection and bacteremia due to exposure to contaminated water.
signs of opiod withdrawer in a neonate
persistent crying, tremors, tachypnea, sneezing and diarrhea and Jittering movements
TX: Methadone/ morphine
what is the MOA of Repaglinide
inc insulin secretion by inhibiting beta cell K(atp) channels
SE: hypoglycemia, weight gain
middle cerebral artery and ophthalmic artery is a branch of
internal carotid artery
skull fracture at the pterion (where frontal, parietal, temporal and sphenoid bone meet ) can cause what pathology and what artery
middle menininggeal artery damage causing epidural hematoma,
middle meningeal artery is a branch of the maxillary artery
what venus structure does internal hemmoriods drain
superior and middle rectal vein, which communicates with internal iliac & inferior mesenteric vein
what venus structure does external hemmoriods drain
inferior rectal vein into the internal pedestal vein which communicates with internal iliac vein
branches of the deep external pedestal artery supplies
the scrotum
superior vesicular artery supply
urinary bladder and ductus deferens
what area of the body do angiotensin 1 converts to angiotensin 2
lungs
analog version of ANP
Neprilysin inhibitor (Sacubitril) prevents degradation of ANP enhancing its hemodynamic effects in heart failure patients
AML contain auer rods and they stain for
MYELo-peroxidase (pinkish color)
AML presentation is Anemia (fatigue, weakness), thrombocytopenia (petechiae, hemorrhages), neutropenia(fever, opportunistic infections)
what are the presentation of hairy cell leukemia
Splenomegaly, fatigue and pancytopenia
Tartrate resistant acid phosphate (TRAP)
b-lymphocyte precursors and are CD20
what medication should be started infall Heart failure patients with left ventricular systolic dysfunction to improve survival?
Carvedilol, Metoprolol. ACE inhibitors and aldosterone antagonists
what medication do you use to treat supra ventricular and ventricular arrhythmias?
Amiodarone
enzymes that require Biotin (also seen in raw eggs (Avidin) ) as a cofactor include
pyruvate carboxylase (pyruvate to oxaloacetate)
Acetyl CoA carboxylase (acetyl coA to malonyl coA for fatty acid synthesis)
Propionyl CoA carboxylase
(Propionyl-CoA to Methyl Malonyl CoA) (Fatty Acid Oxidation)
describe the rash in measles(rubeola) & german Measles (rubella)
maculopapular rash that starts in the face and chest and spreads to trunk and extremities.
usually have post auricular lymphadenopathy
Fetus with Rubella is at risk of what congenital defects?
Cataracts, PDA, Polyarthralgia & sensorineural Deafness
what occurs in the stages of acute tubular necrosis
initial stage (ischemic injury to renal tubules precipitated by hemorrhage, acute MI, sepsis, surgery)
Maintenance stage (dec urine output, fluid overload, increase creatinine/BUN, hyperkalemia)
Recovery phase: gradual increase in urine output leading to high volume diuresis, electrolyte abnormalities decrease concentration of K, Mg, PO4 and Ca due to slowly recovering tubular functions
Clinical features of acute tubular necrosis is oliguria, brown granular/muddy cast, inc bun:creatinine ratio, hyperkalemia (due to dec resale excretion) with metabolic acidosis.
what is the requirement for referring a patient for Hospice care?
Patient has a prognosis less than or equal to 6 months.
Hospice model: focus on quality of life, not cure
they are services provided at home, assisted living facility /dedicated facility
abdominal distention and bloody stool in an infant, what is the diagnosis
necrotizing enerocolitis
as bacteria is introduced during feeding, the bacterial proliferate excessively due to compromised immune clearance.
AIR in the bowel wall confirms the diagnosis
gastric erosions are a mucosal defect that do not completely extend through what layer
muscular mucosa (i.e. erosion are limited to the mucosal layer.
what enzyme is responsible for part of interconversion of of ribose 5 phosphate and fructose 6 phosphate in the reversible step
transketolase
what do you use to study the difference between 2 or more independent group
analysis of variance (ANOVA) used to find the difference between the means of 2 or more group.
what do you use to check the difference between two category variables (e.g diff btw sexes regarding smoking)
Chi-square
what do you use to compare the means of two group
2-sample t-test
Neonatal meningitis that is resistance to third generation cephalosporins (Cefotaxime) is most likely caused by
Listeria monocytogenes
resistance to cephalosporin is due to alteration to penicillin binding proteins
however it is susceptible to ampicillin
DOC for listeria is AMPICILLIN
what type of gastric cancer infiltrates the stomach wall
Diffuse type (limits plastica) signet ring cells
what type of gastric cancer projects into the stomach lumen and is composed of glandular forming cuboidal/columnal cells
Intestinal type
what do you use to treat nausea and vomitting under chemotherpay
ODANSETRON (INhibits serotonin (5HT3) receptors and block vagus nerve too
what area is suscessitble to ischemic damage during hypotension in the colon
rectosigmoid junction in the watershed area
a test in which a patient serum is mixed with a solution of cardiolipin, cholesterol and lecithin. aggregation/flocculation of the sample present of cadiolipin antibodies refers to
Rapid plasma Reagin (RPR) test for treponema pallidum (SPirochetal antibodies) & VDRL are screening test
confirmatory test is
FTA-ABS
carcinoembryonic antigen (CEA) assay in a patient with colorectal cancer is used to measure
colorectal cancer recurrence
CEA is higher in smokers than non-smokers
NOTE: CEA levels is not used to diagnose colon cancer , it is only used for RECURRENCE
a bifid carotid pulse with brisk upstroke (Spike and dome is characteristics of
Hypertrophic cardiomyopathy
due to LV outflow obstruction
what is the most common manifestation of osteoporosis
vertebral fracture
microabsesses containing fibrin and neutrophil at the dermal papillate tips refers to
dermatitis Herpetiformis (involve formation of IgA antibodies against gliadin which is associated with Celiac disease which is characterized by INCREASE INTRAEPITHELIAL LYMPHOCYTE, Flattened villi, and hyperplasia of crypts which causes the malabsorption (Steatorrhea)
associated with small bowel cancer & t-cell lymphoma
duodenal biopsy to confirm diagnosis
shoulder pain, hypotension and tachycardia after a traumatic event such as car crash suggest
Splenic laceration
shoulder pain is due to referred pain due to peritoneal irritation
phrenic nerve irritation cause hiccups due to spasmodic diagrammatic contraction pulling hair against a closed larynx
a patient with persistent fluctuating lymphadenopathy that was initially treated with antibiotics for pharyngitis most likely has
follicular lymphoma
present as painless lymph node enlargement or abdominal discomfort from an abdominal mass
a tremor of the hands that worsen while maintaining a certain posture e.g holding an object and subside a little with alcohol use and presence of a family history refers to??? treatment??
Essental tremor, treat with propranolol
giving clavulinic acid with amoxicillin is
decrease amoxicillin cleavage by bacterial cells increase it scope to kill beta lactamase organism
whats the MOA of capscaicin
reduce pain by reducing substance P in PNS + CNS
Water shed areas (2areas)
SMA+ IMA
IMA+ HYPOGASTRIC
tinnitus, vertigo, sensoruinear earring loss
menieres disease (due to inc pressure + Volume of endolymph in inner ear)
weakness of dorsiflexion of the foot due to involvement of the common perineal nerve refers to what disease
Charcot-Marie-Tooth disease due to mutation of a myelin protein
inability to sense a full bladder and incomplete emptying in a type 1 DM can be confirmed by
PostVOid Residual testing with ultrasound or Catheterization can confirm inadequate bladder emptying.
what type of benzodiaepans are preferred in patient with impaired hepatic metabolism
LOT (lorazepam,oxazepam, temazepam)
what drug can be used for short term anxiety as needed
Lorazepam
what stores and transport Surfactant
Lamellar bodies (organ containing parallel stacks of membrane lamellae)
Surfactant deficiency : NRDS(neonatal respiratory distress syndrome)
a Dry TAP in hairy cell leukemia means
an unsuccessful bone marrow aspiration aka no marrow is aspirated.
present as pancytopenia and spleenomegally that crosses the midline or extend to the left lower quadrant
two biggest SE of tamoxifen is
Endometrial hyperplasia and endometrial carcinoma
spaghetti and meatball appearance on light microscopy with the hyphae been short and having a cigar-butt appearance treated with potassium hydroxide refers to
Pityriasis vesicular caused by MALASSEZIA GLOBOSA
clostridium difficle work by what method
disrupting actin cytoskeleton structure and intracellular signaling thereby disrupting cytoskeleton integrity
glycogen synthesis in hepatocyte by insulin is mediated by what enzyme
protein phosphatase
what is MOA of MiLRinone and Inamrinone?
Phosphodiesterase 3 inhibitor used to treat Heart failure by causing VASODILATION by decreasing the rate of CAMP degradation in cardiac tissues therefor increasing CAMP LEVELS promoting calcium influx into cardiac myocyte
Contraindication: do not give drug in severely hypotensive patients
strawberry type capillary hemangioma
First increase in size and then regress
protein deficient in atomic dermatitis affecting the component of the epidermis is
Filaggrin
for POST_EXPOSURE to Nesierria Meningitis and to prevent meningitis a patient should be giving what medication?
RIFAMPIN CHEMOPROPHYLAXIS
how does a bacteria become resistance to Isoniazid
by blocking bacteria catalase peroxidase
MOA of BUTAPHYNOL
kappa receptor agonist and cause less respiratory depression
what is Cholesteatomas
collection of SQUAMOUS CELL DEBRIS that forms PeARL MASS BEHIND THE TYMPANIC MEMBRANE in the middle ear causing CONDUCTING HEARING LOSS
chest pain, diaphoresis, history of arteriolosclerosis and type 2 diabetes suggest
acute coronary syndrome
Most common SE of ALTEPLASE is Hemorrhage which presents as loss of consciousness, asymmetric pupils and irregular breathing.
list drugs that are VEGF inhibitors
bevacizumab, Ranibizumab
Epidermal growth factor receptor inhibitor (EGFR) is
Erlotinib,Gefitinib
periodic sudden-onset of involuntary Jerking movement involving both arms with no loss of consciousness refers to
Myoclonic seizure (first line Valporic acid)
motor tics with stereotyped movement
Tourette syndrome
Tx: Fluphenazine, pimozide
extended spectrum beta lactamases e-coli how do they render betalactamase antibiotic inactive
by transmission through Plasmid conjugation
what amino acid is propionyl coA derived from
VALine, ISoleucin, Met, THroninee
igG3 antibodies to phospholipase A2 receptor (PLA2R) a transmembrane protein abundant on podocyte refers to what pathology
membranous nephropathy
list what is present in REVERSIBLE myocardial injury
Myofibril relaxation Diasagregation of polysomes disaggregation of nuclear granules triglyceride droplet accumulation glycogen loss
what is an example of IRREVERSIBLE myocardial injury
Mitochondrial vacuolization (damage causes ATP DEPLETION)
what is the MOA of the drug used to treat ALS
Riluzole: dec glutamate release
in RIght Ovarian vein thrombosis if not treated the thrombus have a risk of extension into what vessel
IVC
note: Right ovarian vein drains into IVC (MOST THROMBOSES IS RIGHT SIDED)
Left ovarian vein drains into left renal vein
what type of walking pneumonia causative agent requires cholesterol to grow on artificial media?
Mycoplasma pneumonia
what is the next best step management of a patient with septic arthritis
ATHROCENTESIS ( synovial fluid analysis)
Damage to the brainstem at/below the level of the red nucleus (Mid brain tegmenjtum and Pons) results in
Decerebrate(extensor) posturing (Check picture on ur phone) due to loss of descending excitation to the upper limb flexors (Via rubrospinal tract) and predominance of the extensors (controlled by vestibulospinal tract)
in vertical gaze palsy what part of the brain is damaged?
Midbrain tectum ( superior colliculus damage causing paranoid syndrome)
contralateral loss of sensory/motor deficit is as a result of damage to
Internal capsule
what is hyper somnolence disorder
excessive daytime sleepiness that cannot be explained by another sleep disorder
UNLike NAcolepsy, this patients do NOT feel refreshed after Naps
spindle cells with hair-like glial process that is associated with micro cysts refers to what brain tumor
pilocystic astrocytoma (rosenthal fibers)
yellow spot on the inner surface of the abdominal aorta describes
(Lipid laden macrophages aka Foam cells) FATTY STREAKS is the EARLIEST presentation of atherosclerosis and on light microscopy comprised mostly of MACROPHAGES (LIPID LADEN FOAM CELLS)
what is the function of the overexpreesion of c-myc oncogene in burritos lymphoma
promotes cell growth, differentiation aka A TRANSCRIPTION ACTIVATOR
what drug is used for painful diabetic neuropathy
Gabapentin
what is the cause of black liver in dubin johnsejn disease
due to impaired excretion of epinephrine metabolite which appear on histology as dense pigment within lysosomes
fatigue, pruritic, hepatomegaly and elevated alkaline phosphatase suggest what disease
cholestatic liver disease and if not treated incr risk of FAT SOLUBLE VITAMINS DEFICIENCY (A,D,E & K) due to reduction in bile flow
what drug inhibit topoisomerase 1
Topotecans (TECANS)
what drug inhibit topoisomerase 2
Etoposide “POSIDES”
treats testicular cancer and small cell lung cancer
cause chromosomal breaks to accumulate in dividing cells
what drug is used to treat genital warts
podophyllin
what drug is used to treat RESTLESS LEG SYNDROME
ROPINIROLE
what drug is used to reduce premature uterine contaction
Terbutaline
what substances run through the cavernous sinus
CN 3, 4 V1, V2, Cn6, internal carotid artery
which alpha blocker is used to treat BPH with No HTN
tamsulosin
dot or flame-shaped hemorrhage in the eye on fundoscopy examination refers to
hypertensive retinal hemorrhage which is due to HYPERTENSION
patient complains of a shadow developing in the eye
cheery red spot on the macula die to diffuse retinal ischemia without hemorrhage refers to
central retinal artery occlusion due to ATHEROSCLEROSIS (Giant cell arteritis)
present with acute monocular vision loss
increase phosphoribosyl pyrophosphate (PRPP ) synthase gene is most likely to affect what organ
“the Joints” causing Gout. (increase purine synthesis causes hyperuricemia)
in acute gout arteritis, drug blocks which type of cell types?
Neutrophils (swelling, erythema and tenderness) which is responsible for intense inflammatory response in gout patient which is inhibited by NSAIDS
NSAIDS are contraindicated in patients with peptic ulcer and renal impairment. GIVE COLCHICINE in such patients and it inhibits NEUtrophil CHEMOtaxis and PHAGOCYTOSIS by preventing microtubule formation
hemadsorption in cell culture is associated with what virus
influenza and parainfluenza virus
what type of cells are activated in RA?
CD4+ t cells
Recurrent miscarriage, inc PTT and hypercaogulability state refers to
Antiphospholipid syndrome
large gram postive rods that form medusa head/serpentine colonies on standard media refers to
Anthrax caused by bacillus anthraces which is an aerobic organism (antiphagocytic D-glutamate capsule)
Chest xray: widened midiasternum
seen in people who works in goat wool processing center causing woosorters disease (pulmonary anthrax )
GOAT HAIR/HIDES is the most common cause and enters alveoli and taken up by macrophages through lymph nodes causing medistinitis
what bacteria grows on Loeffler medium and stains with methylene blue
coryneabcterium diphtheria (INTRACELLULAR PHOSPHATE GRANULES ARE CHARACTERISTICS)
which part of the brain contains respiratory centers
The Brainstem
Locked in syndrome (cause brainstem Injury)
which cranial nerve is unique that it carries only motor fibers
C1
AN history of alcohol consumption for years in a patient that develops Tremors of the hand bilaterally, agitation, anxiety, high BP, high pulse 48 hours after admission to the hospital suggests
Alcohol withdrawer
alcohol is a CNS suppressant and bind to Gaba-a receptor complex enhancing inhibitory action on Gaba.
48-96 hours cause delirium tremens (disorientation, severe agitation, fever)
Benzodiazepines are FIRST LINE THERAPY for psychomotor agitation associated with ALCHOL WITHDRAWER
(DIAZEPAMS/CHLORDIAZEPOXIDE are preferred due to self tapering effects resulting in smoother cause of withdrawer)
Note: if this patient have liver disease use benzodiazepams that do not undergo oxidative metabolism and have no active metabolites (Lorazepam, oxazepam & Temazepam (LOT) are preferred)
MOA of baclofen and its use
agonist of Gaba B
treats spastic conditions
poorly developed lumber and sacral spine with flaccid paralysis in lower extremities and absent ankle reflex in an infant is as a result of
UNCONTROLLED MATERNAL DIABETES
which caused Caudal Regression SYndrome
what are the effect of cocaine on a newborn
spontaneous abortion, intrauterine growth retardation, placental abruption and prematurity
VIT A overdose in pregnancy can cause
craniofacial abnormalities, Posterior Fossa CNS Defects, auditory defects and abnormalities of great vessels (similar to DiGeorge syndrome)
what is the reason why you give PIPERACILLIN-TAZOBACTAM therapy together?
pipercilin has a beta lactam ring so it can easily be inactivated by beta-lactamase so giving betalactamase inhibitor such as TAZOBACTAM can help avoid piperacillin destruction by beta lactamases thereby INCREASING antimicrobial spectrum of activity
red reflex on physical examination refers to
Retinoblastoma
most common non-specific symptoms in a patient with Multiple sclerosis is
Fatigue (occurs after taking hot showers/after strenuous exercise in heated environment)
also cause unilateral sensation loss in the arms
MS: optic neuritis, intranuclear opthamoplegia, and sensory loss and symptoms worsen with heat exposure
pruritic in polycythemia after hot showers is due to
histamine release from basophils
to reach a 95% steady state concentration, how many half-lifes is needed
4 to 5 half lifes
what has the highest risk of colorectal cancer
Pancolitis
antibodies against cutaneous basement membrane proteins
epidermolysis bulls acquista (from tense aural bull) and cicatricial pemphigoid (cause chronic conjunctivitis and scaring)
scalp rash, lytic skull defects, DI, exompthalmus in a child greater than 3 years
Hand-Schiller-Christian Disease (type of Langherans cell histocytosis)
Skin rash and skeletal defects in an infant less than 2 years old
LetterSiwe-Disease
what is the MOA of the drug for melanoma
Vemurafenib (A BRAF kinas inhibitor to treat Melanoma)
BRAF V600E mutation substitute lysine to glutamate
what is a reliable earlier indicator of menopause
Increase FSH levels confirms the diagnosis of Menopause
chronic malabsorption leading to signs of severe vit def
Retinal degeneration, ataxia, motor dysfunction+ acanthocytosis+ low cholesterol
Abetalipoproteinnemia (APOB100 and APo b48)
Absence of VLDL and LDL
exposure to paint thiner cause anion gap metabolic acidosis + Opthalmoplagia, neurological symptoms
due to methanol exposure which is metabolized via formaldehyde dehydrogenase
(Methanol = paint thinner
methanol——-formaldehyde—– blindness and death
what leads to defective intracellular killing of mycobacteria by macrophage what def?
interferon gama receptor deficiency
Recurrent mycobacteria infection
decrease esophageal paristalysis and decrease esophageal tone
scleroderma
dec esophageal parystalysis and inc esophageal tone
achalasia
hepatic encephalopathy
Lactulose
cytoplasmic bleb, shrunken nucleus, fragmented nuclei
apoptosis
MOA of ALbendazole
inhibit tubular depolarization and impairs glucose uptake
MOA of PRaziquantel
inc calcium influx raising the threshold, causing paralysis in trematodes and cestodes
diethycarbamazeine MOA
sensitization of microfiliarie to phagocytosis which mobilizes them by an unknown mechanism
ivermectin
bind to glutamate gated chloride ion channels increasing chlorine permeability which depolazrisez them resulting in paralysis via hyper polarization
what drug stimulate IL11 that stimulate hemopoietic stem cells production
OPRELVEKIN
what drugs cause pupillary dilation
CAL is dilated
cocaine, amphetamines, LSD
persistent of colonization of pseudomonas in an individual is due to
biofilm formation in the lower respiratory tract giving them resistant
What MHC complex is associated with HLA-B27
MHC class 1 is associated with the disease
taking a patient for unnecessary procedure causing body harm
violation of non-malificience (which is Do no harm)
knowing a drug will benefit a patient and you did not prescribe it you violating what
violation of beneficence (DO GOOD to all)
what is used to alleviate(make better) the symptoms of pulmonary hypertension in infants with methemoglobinemia
Nitric OXIDE not NITROUS oxide
aseptic/avascular necrosis is a complication of what drug
corticosteroids
tx of carpal tunnel
lidocaine dec permeability of sodium
what is the mode of inheritance of AIP
Autosomal dominant
what is the first line treatment for Narcolepsy (daytime sleepiness)
Modafinil (a non-amphetamine stimulant ) that has become the first line agent and MOA is it enhance dopaminergic signaling and drug abuse is rare.
amphetamine and methylphenidate is second line SE: HTN, arrhythmia, psychosis
what is zolpidem used for
Insomnia
zolpidem is a non benzo drug
what is use to treat Jet-Lag and age related Insomnia
Melatonin
what kind of examination do you use to identify Kayer-flescher ring (brownish color surrounding the eye) of wilson disease
Slit-lamp examination
the rings are form with copper deposition on the DESCEMET membrane of the cornea
basal ganglia atrophy is also present in wilson disease
Agitation, mental status change, problem with sleeping, psychosis
delirium
tx: Haloperidol
what medication is used to treat drug induced parkinson
antimuscurinic (trihexyphenidyl, benztropine)
drug induced parkinson symptoms are: rigidity(muscle stiffness), tremor (shaking of the hand), flat faces
the only recombinant insulin without any amino acid modification used in type 1 DM patient is
Regular Insulin( start working within 30 mins) & neutral Protamin Hagedorn (NPH) (NPH has protamine and Zinc , intermediate start working within 2 hours)
post auricular and occipital lymphadenopathy behind the ears with maculopapular rash starting at the face and spread to extremities
Toga virus (rubella)
MMR (measles & Rubella rash start on the face and spread to the rest of the body)
the word ZUMAB in monoclonal antibody are all
“ZUMAB” are ALL HUMANIZED ANTIBODY thats why it works despite it being a foreign antibody
beta endorphin is derived from
POMC
it make B-endorphins, ACTH and MSH
how does carbonic anhydrase cause orthostatic hypotension
due to hypovolemia and blood pulling down
what are the histologic findings in GERD
basal zone hyperplasia, elongation of lamina propria papillae, scattered eosinophils and neutrophils within the squamous epithelium
glycine replaced by larger amino acid side chains, budge in colony complex and blocks intermolecular interactions therefore interfering cross linking is
osteogenesis imperfecta
problems with pro-collagen peptidase and faulty collagen synthesis refers to
Ehler Danlos syndrome
backpain, not relieved by rest or position change
neoplastic bone disease (prostate metastasis to Bone)
injecting needle to inferior medial side of the butt, what nerve is damaged
sciatic nerve
injecting needle superior medial side of the butt what nerve is damaged
superior gluteal nerva damage
in a lung abscess, the abscess formation is primary caused by what?
lysosomal enzymes released from neutrophils and macrophages.
Keratin is from what lineage? what amino acid makes up keratin
Epithelial linage
Alanine and Glycine makes up Keratin
what is vimentin?
an intermediate filament present in mesenchymal tissue.
A 185 kD transmembrane glycoprotein that has intracellular tyrosine kinase activity refers to what protein and what is its function?
HER2/neu oncogene
Inc risk of Breast, ovarian, gastric and endometrial cancer.
function: accelerates cell proliferation.
defective collagen synthesis which causes pro collagen peptidase deficiency which impairs N-terminal peptide removal is what disease
Ehler Danilo syndrome (inadequate cross-linking)
Dark Red non-blanching macule and papule over the buttocks groin and umbilicus is
Angiokeratomas present in Fabry disease
what type of vitamins comes from the sun?
7-dehydrocholesterol
SE of methylphenidate
Weight loss, dec appetite, insomnia
what fungal drugs inhibit cell wall synthesis
caspofungins inhibit 1,3 beta D glucans
CASPOFUNGINS are the most active against Candida species and ASPERGILLUS
what fungi drug inhibits cell membrane
Amphotericin B, Nystatin which bind to Ergosterol, Azoles which inhibits synthesis of Ergosterol
which fungi drug plays a role in DNA and RNA synthesis
Flucytosine
which Fungi drugs inhibit microtubule polymerization
Griseofulvin
accumulates in keratin containing tissues
drug used to treat dermatophytosis and inhibits squalene epoxidase is
Terbinafine
an example of atrophy is
adrenal glands during prolonged glucocorticoid therapy
this can lead to adrenal insufficiency if glucocorticosteriod is abruptly stopped
kryphoscolosis, foot deformities, Diabetes mellitus Hypertrophic cardiomyopathy (depend on LV filling) collapse of LV septum on the mitral valve due to pushing of the LV septum is associated with what disease
Friedrich Ataxia (GAA repeat)
CGG repeat is referred to
Fragile X (it has a CPG repeat which undergo Hypermethylation of the cysteine bases leading to decrease expression and no transcription the "P" between CPG denote the phosphodiesterase bond and is the signal for methylation Methylation= Mute Acetylation = turned on
what disease is associated with hypermethylation of histones
Huntington disease
what is degenerate in biochemistry ?
having 20 amino acid and coding for 61 diff codons
SE of what drug that dec peripheral vasoconstriction causes cold extermeites (hands & feet)
B-Blockers
cerebellar ataxia, telangiectasis (Superficial blanching nest of distended capillaries on sun exposed area of the skin) and inc sinupulmonary infection
ataxia telangiectasia (DNA break repair deficiency) mutation of ATM gene responsible for DNA break repair
defect in expressing HLA class 2 on surface of antigen presenting cell is called
Bare Lymphocyte syndrome
tyrosine, dopa, serotonin, Nitric oxide ( NO STD) needs a specific cofactor, what is it?
Dihydrobiopterin reductase (BH4) deficiency causing advanced PKU.
what step does DNASE when added to the petri dish block
Transformation
why? because it only works due to lysis of already dead cells and exposed DNA being taking up by another living cells. i.e DNASE only breaks down DNA that is naked
P27 protein act on which phase of the cell cycle
G1 phase inhibiting cyclin dependent kinases (CDKs)
Cross shaped intraerythrocyte inclusion (Maltese cross) in a history of recent travel to Connecticut
Lyme disease (borrielia burgdorferi)
Maltese cross is also seen in Babesia
Ringed shaped intraerythrocytic inclusion on blood smear refers to
Plasmodium falciparum (malaria)
IN obstructive sleep apnea decrease oxygen to which of the following organs is responsible for increase hematocrit
Kidneys..why?
peritubular cells in the renal cells sense hypoxia and respond by releasing erythropoietin
aneurysm may cause bilateral loss of lateral visual fields, what artery is damaged?
Anterior communicating artery (berry aneurysm ) optic chasm damaged
broca or wernicke aphasia, what artery is damaged.
Middle cerebral artery damage
unilateral lower extremity sensory and motor loss what artery is damaged
anterior cerebral artery stroke
unilateral facial and arm sensory/motor loss, what artery?
midle cerebral artery stroke
cord factors creates “Serpentine Cord” appearance on enriched media in what bacteria
TB
induce release of TNF
requires an acidic environment and used for intracellular organism what drug?
pyrazinamide
campylobacter jejuni entamoeba histolytica, giardia, do they cause diarrhea with a lot of innoculum or less?
cause diarrhea with a small inoculum
most common cause of sinusitis in children
Nontypeal H.infleunza
most common cause of bacteria conjunctivitis in children
moraxella catarhralis
ampicillin is used to treat
Listeria and enterococcus
what bacteria affects smokers and what lab values do yo see
legionella
see hyponatremia
back pain and thigh pain that worsen with walking is referred to as
neurogenic claudication aka SPINAL STENOSIS
walking up hill or leaning on a stroller relieves the pain
the thickening of the ligament contributing to this patient symptom is the LIGAMENTUM FLAVUM ( a strong ligament supporting the spinal canal), Intervertebral disk herniation and osteophyte formation of affecting the facet joint.
what is the most common elbow injury in children
Radial Head Subluxation due to TEAR OF THE ANNULAR LIGAMENT.
affected children present with the injured arm held close to the body with the elbow extended and forearm pronated
A BASeball thrower (pitcher) normally hurts what ligament
ulnar collateral ligament
what drug inhibit 11-B hydroxylase that converts 11-deoxycortisol to cortisol
metyrapone
most enveloped virus acquire their lipid bilayer enveloped by budding except———– which acquire their nuclear enveloped from host cell nuclear membrane
Herpes viruses (HSV 1,2 VZV, CMV)
what medication is giving to an elderly patient for insomnia short term with fewer side effects
RAMelteon (melatonin agonist at the suprachiasmatic nucleus) demonstrate safety and efficacy in OLDER ADULTS
NOTE:
TCAS, ANTIHISTAMINES, BENZodiaepine such as ALPRAZOLAM for insomnia should be avoided in elderly patient due to the risk of Falls, fractures and cognitive impairment
berry aneurysm is associated with what heart anomaly
coarctation of the aorta and this is due to hypertension in the branches of the aortic arch proximal to the coarctation hence leading to subarachnoid hemmorahge
light & electron microscopy of the intestinal/bowel mucosa of a patient with lactose intolerance will show
NORMAL intestinal mucosa
what the treatment for psoriasis that activate a nuclear transcription factor
vit d analog (calcipotriene), calcitriol, tacalcitol inhibiting keratinocyte proliferation and stimulate keratinocyte differentiation
cyclosporin also treat psoriasis but it inhibits nuclear factor of activated T cells (NFAT)
what monoclonal antibody used for psoriasis targets IL-12 & IL-23 and inhibiting differentiation and activation of CD4+th1 & Th-17 cells?
USTEKINUMAB
headache, retro-orbital pain, muscle pains, thrombocytopenia, high grade fever and episode of epistaxis with maculopapular rash after a trip to brazil
Dengue fever by Aedes Aegypti mosquito (mostly in tropics, southeast Asia, pacific islands, carribeans, Americas)
Aedes Aegypti also transmits the virus causing Chikungunya (flulike symptoms, polyarhralgia/arthritis (hands, wrist, ankles) and diffuse macular rash
Pulmonary TB spread through air borne contact, what type of area is the patient placed in
Negative-pressure isolation room and specific mask are worn by all visitors and contacts
what is the formula for volume of distribution
Vd=amount of drug/concentration in plasma
what is the formula for the clearance
Clearance = Rate of elimination/plasma concentration
Clearance = (0.7 x Vd) / (half-life)
what is the formula for loading dose
LD = (concentration @ steady state(Css)) x Vd
what is the formula for maintenance Dose
MD=Css (concentration @ stay state) X Clearance
what is the formula for half life
t1/2= (0.693 X vd) / clearance
pulmonary vascular resistance is lowest at———— in the lungs
FRC (functional residual capacity)
whats another name for angiosarcoma
Stewart -Treves Syndrome
compulsive consumption of a nonfood/non-staple food such as ICE common in pregnancy and associated with iron deficiency anemia causing unexplained weight loss
PICA
spotty hepatic necrosis and a history of travel refers to
Hepatitis A (symptoms Fever, anorexia and dark colored urine)
you see councilman bodies
Ipilimumab MOA
bind cytotoxic t lymphocyte associated antigen 4 (CTLA-4) used to treat metastatic melanoma
treatment for toxoplasmosis
Pyrimethamine and sulfadiazine (inhibit dihydrofolate reductase)
drugs that inhibit dihydrofolate reductase are trimethoprim, methotrexate and pyrimethamine
liquifactory necrosis is present on
ABSCESS(PUS FORMATION) & BRAIN due to activity of neutrophils
blood vessels surrounded by numerous spindle cells & high nuclear to cytoplasmic ratio in a patient that works in a chemical plantsrefers to
Angiosarcoma (vinyl chloride)
CD31 aka PECAM is the tumor marker for blood vessels
what kind of cancer does Cadmium (found in batteries) cause
Prostate Cancer
Benzene cause what cancers
Leukemia and Hodgkin Lymphoma
what kind of Cancer is Nickel cause
Cancer of Lungs and Nose
what is the most important POOR prognostic factor for Post-streptococcal glomerulonephritis (PSGN)
INCREASE AGE
only 60% of adult cases resolve completely while the rest develop htn, recurrent proteinuria, chronic renal insufficiency
PRE-EXISTING KIDNEY DISEASE is also an IMPORTANT PROGNOSTIC FACTOR.
patient with cariogenic shock and evidence of wedge shaped strips of necrosis over the cerebral convexity suggest what pathology
Hypoxic-Ischemic Encephalopathy
what drugs stimulates dopamine receptors in the brain
ERGOST COMPOUND from Ergost Fungi : BRomocriptine (dopamine agonist)
NONERGOST Compounds: Pramipexole and Ropinirole (DOPAMINE AGONIST)
both help treat Parkinson disease
which organ is the least vulnerable to infarction? and why?
Liver because it has dual blood supply, hepatic vein and portal artery
what medication increases the FREQUENCY of chloride channel opening?
BEnzodiazepames
what medication increases the DURATION of opening of opening of GABA-A Chloride channel in CNS
Barbiturates
what medication do you use to treat Restless Leg syndrome
Dopamine agonist (Pramipexole & Ropinirole)
for diphtheria infection what is the treatment
Administer antitoxin (process of administering antitoxin is PASSIVE IMMUNIZATION
then penicillin/erythromycin and then DPT vaccine (ACTIVE IMMUNIZATION)
THE GREATEST EFFECT ON SURVIVAL IS ANTITOXIN AKA PASSIVE IMMUNIZATION
what is the most common cause of death in Diphtheria patients ?
Cardiomyopathy
what are they signs of congenital hydrocephalus
macrocephaly , poor feeding, HYPERREFLEXIA and MUSCLE HYPERTONICITY
fever, skin flushing and altered mental status by Ecoli is as a result of what virulence factor
SEPTIC SHoCK By Ecoli (GRAM -ve sepsis) and its as a result of LIPID A (part of LPS)
what is the first line treatment for Major depressive disorder and does not cause sexual dysfunction
BUPROPION
contraindicated in Bulimia Nervosa,Anorexia Nervosa and seizure disorder due to lowering of seizure threshold
what is the treatment for Arsenic Poisoning
NOTE INSECTICIDE IS A COMMON SOURCE FOR ARSENIC
Dimercaprol and SUccimer
GLAM (GOLD, LEAD, ARSENIC, MERcury) Poisoning
“GLAM FOR SUCCESS AND DIAMONDS”
ANTIDOTe: SUCCIMER & DIMERCAPROL
How does sodium thiosulfate treat cyanide poisoning
sodium thiosulfate treat cyanide poisoning by donating sulfur to Liver RODANASE to enhance conversion of cyanide to thiocyanate
note: thiocyanate is a safe form for excretion
antidote for doxorubicin overdose
Dexrazoxane
what is DYSTONIA
Neurological movement disorder characterized by sustained involuntary muscle contraction, which forces certain parts of the body into ABNORMAL and PAINFUL movement and postures
due to impaired function of BASAL GANGLIA
what part of the brain gets damaged first during an ISCHEmic event?
Hippocampus(pyramidal cells) , neocortex, and purkinji cells of the cerebellum
methanol——— formaldehyde causes
Ethylene glycol(antifreeze)——- oxalic acid
acidosis, retinal damage, blindness (blocked by FOmepizole)
causes acidosis, kidney damage, CNS problems, Heart/lung toxicity,
blocked by Fomepizole or give Ethanol to compete for the enzyme
what drugs cause disulfarm-like effect
Metronidazole, Procarbazine, 1st generation sulfonylureas, cephalosporins
tell patient to avoid alcohol
drugs that cause cutaneous flushing
Vancomycin, Niacin, Adenosine, Dihydropyridine CCBs
what drugs causes Coronary Vasospasm
Cocaine, Amphetamines, Methamphetamines, Triptans, Ergotamines
what drugs cause Dilated cardiomyopathy
doxorubicin and Daunorubicin
drugs that cause thrombocytopenia
Heparin, Cimetidine (H2 blockers)
drugs that causes agranulocytosis
clozapine, carbamazepine, colchicine, methimazole, Propythiouracil, Dapsone
drugs that cause APlastice Anemia
Chloramphenicol, Benzene, NSAIDS, PTU, Methimazole
what drugs cause Gray baby syndrome
Chloramphenicol
presentation: limp muscles, cyanosis, hypotension and cardiovascular collapse
occurs cause the UDP glucourantransferase enzyme is immature
drugs that cause G6PD deficient patient
Isoniazid, Sulfonamides, primazuine, High dose Aspirin, Ibuprofen, Nitrofurantoin, Dapsone, Fava beams, Naphthalene
what causes thrombosis
OCPS
what meds causes Pulmonary Fibrosis
Amiodarone, bleomycine, bulsulfan, Methotrexate
what drugs cause pseudomembranous collitis
clindamycin, amoxicilin, ampicillin
what drug causes Massive Hepatic necrosis
Halothane, Acetaminophen, Vampiric acid, Amanita Phalloides (mushroom toxin)
what drug causes hepatitis
INH (isoniazid)
what drugs causes gout
Furosemide, Thiazides, Niacin, Cyclosporin, Pyrazinamide
what drug cause Gingival hyperplasia
Phenytoin, cyclosporin, verapamil
what drug causes osteoporosis
Corticosteroids, Heparin
what drug causes photosensitivity
SAT 5FU—-Sulfonamides, Amiodarone, Tetracycline , 5 Fluorouracil
what drug causes Steven Johnson Syndrome
Seizure drugs (Ethosuximide, Carbamazepine, Lamotrigine, Phenytoin, Phenobarbital) Sulfa Drugs, Penicillin, Allopurinol
“SSPA”
Drug Induced SLE
SHIPPE (Sulfonamide, hydralazine, Isoniazid, Procainamide, Phenytoin
what drug causes Tendon Rupture/Cartilage damage
FLuoroquinolones
drugs that cause of Interstitial Nephrities
NSAIDS, Furosemide, Antibiotics
drugs that cause Fanconi syndrome
Expired Tetracycline, Heavy Metal exposure
dug that cause hemorrhagic cystitis
cyclophosphamide, IFOsfamide
what drug causes parkinson-like syndrome
Metoclopramide (used for Gastroparesis), Antipsychotics, Reserpine
what drugs causes Cinchonism (dizziness with headache, vision changes, Tinnitus)
Quinidine, Quinine
drugs that cause seizures
Bupropion, Imipenem/Cilastatin, Tramadol, Metclopramide, Benzodiazepine or alcohol withdrawer
drugs that cause Nephrotoxicity + neurotoxicity
Aminoglycosides, Cisplatin, Polymyxin
drugs that cause Nephrotoxicity + Ototoxicity
Amino glycosides, Vancomycin, Loop Diuretics Cisplatin
Drugs that cause Anticholinergic effects
Atropine, TCAs, H1 blockers, Thioridazine, CHloropromazine
treatment for Hepatic encephalopathy
Lactulose and Rifaximin
Hepatic Encephalopathy refers to reversible decline in neurological functions that occurs due to failure of the liver to metabolize waste products such as ammonia
Bitter Almond odor is what type of posioning
Cyanide poisoning
antidote: nitrite, thiosulfate
positive Sodium cyanide nitropruside test is used to detect ?
Cysteine stones aka AminoACiduria
detect excess cysteine in the urine
tx: acetazolamide
cystinuria is due to defect in BASIC Amino acid (COLA) in proximal renal tubular epithelial cells
Hemolytic Uremic syndrome caused by 057:H7 strain decreases and increase what levels in the blood
Dec Hemoglobin and Haptoglobin levels
Increases Lactate dehydrogenase and Increase Unconjugated/INDIRECT Bilirubin levels
what test do you use to detect antibodies against Group A strept
Streptozyme test
what 4 occupation are prone to developing Lead poison
Lead paint, batteries, ammunition and CONSTRUCTION WORKERS
Basophilic stippling on blood smear
what is the characteristics of Villous adenoma
“cauliflower like projections”
Malignant transformation
what is Ortner syndrome
Mitral stenosis can cause left atria dilation sufficient to enough to compress the left recurrent laryngeal nerve causing hoarseness
what is the complication of varicose veins
Skin Ulcers due to fluid build up
What are the drugs that inhibit P450 1A2
Quinolone, Macrolides
transforming growth factor induce
Apoptosis and cell differentiation
what do you use to screen for antibody that bind to protein
immunochemistry and Western blot
In Botulism
dec End plate potential (low acetylcholine), MEPP (miniature end plate potential) (relax muscles) = 1(never changes, its the leak from the presynaptic cleft and it is NEVER Affected by botulinum toxin) and Response to ACh
Pathophysiology of HUS is what?
Mocrothrombi in small blood vessels
what is the lab value for thrombocytopenia
platelet count
what cause dilated Pupil
Dilated pupil caused by (CAL)- cocaine, amphetamine, LSD
Constricted pupil -LSD
parasympathetic fibers running through the ganglia in the head are only 4
COPS– cilliary, otic, pterygopalantine and submandibular ganglion
ganglionic layer is what is damaged in central retinal occlusion
50& of castleman disease is associated with
HHV8 and also Kaposi
Thyroid acts as a steroid in the nucleus so in graves disease it will be associated with
nuclear/retinoid x Binding to DNA
when serine/threonine kinase when phosphorylated is the way to inactivate what?
INSULIN
iN osteoporosis what effect do you see on Rank/RankL receptor
Inc RANK/RankL receptor activity
in blood transfusion in combined immunodeficiency what kind of blood do you give
Irradiated packed red blood cells(Radiate the blood cells) to kill to the T-cells so it does not affect the host and prevent GRAFT vs Host Disease
whole blood contain
Red cells, white cells and platelets and everything.
if they have pancytopenia patients (give whole blood cells)
packed red blood cells contains
contain only RBC
give patient that have low RBC
washed red blood cells give them
for IgA deficiency give Washed backed red blood cells to get rid of immunoglobulins
what is moa of ethernacept
functions as a Decoy of TNF-alpha
other TNF-alpha is Infliximab and Adalimumab
you give ethernacept when patent do not respond to methotrexate therapy for RA
so before giving Eternacept DO A Tuberculosis TEST cuz
NOTE TNF-alpha is needed to promote reactivation of latent TB
what is the long time effect of using hydroxychloroquine
IRREVERSIBLE RETINAL DAMAGE
SO a Follow-UP Ophthalmologic examination
where do you see Kerley B lines
pulmonary edema
where do you see lines of zahns
Pulmonary Embolus
found ONLY in thrombi
Primaquine is used to Kill
Hypnozoites (sleeping) for vivid and oval
list the beta lactase resistance bugs
Ecoli, staph aureus, epidermis, klebsiella
They all produce Beta-lactamase
drugs u give to treat beta lactase resistance:
aztreonem/carbapenem, sulbactam, tazobactam, clavulanic acid
slipped strand misprint is associated with what type of mutation
Frame shift mutation (either due to insertion or deletion)
what increase the amount of aortic regurgitation
Hypervolemia
what are the organ for graft and host disease
Skin, Liver and G.I transplant
Early signs of graft versus host disease is diffuse maculopapular rash that affect palms and soles
PROTEASE INHIBITORS (AVIRS) ritonavir blocks specific what steps
Protein Processing
in a starvation stage what enzyme is responsible for maintaining a normal glucose level and increase Ketones in the blood
Hormone sensitive Lipase. converts triglycerides to glycerol (undergo glucoeneogenesis in the liver to make glucose) + Fatty acids (forms ketone bodies)
Hormone sensitive lipase is inhibited by Insulin
fever, hypotension and altered mental status in an elderly refers to
Septic shock
UTI its the most common cause of sudden disorientation and confusion in the Elderly.
what is mesoblastic nephroma?
kidney tumor found before birth by ultrasound or within the first 3 months of life
TUMOR IS BILATERAL
contains fibroblastic cells (connective tissue cells)
more common in MALES
Note: Rhabdoid tumor: 1- 3 years of age
Clear cell sarcoma of the kidney: from 2-3 years of age
WILMS tumore: over 3 years of age
a kidney mass on top of the upper pole of the kidney in 10 months
Nephroblastoma
UNILATERAL TUMOR
list non germ cell/sex cord tumors
leydig cell tumors, sertoli cells, testicular lymphoma
pancreatic enzymes also breaks down
fats
a congenital absence of the gyri is known as
Lissencephaly (agyria)
symptoms: mental retardation and seizures
on gross examination: Brain surface has a smooth appearance
widespread epidermal sloughing of the skin with gentle pressure (+ve Nikolsky sign) refers what disease
scaled skin syndrome by staph aureus
mechanism of Exfoliative toxin: exotoxin mediated skin damage.
large obstructing intensely eosinophilic cast suggest what disease?
Multiple myeloma (CRAB) Fried egg appearance produce IgG(55%) & IgA (25%) in elderly (40-50 years)
Most common cause of death is : susscibility to infectn
HyperCalemia is due to IL1 & TNF alpha
Renal insufficiency—-excess antibody that forms cast (EOSINOPHILIC CAST)
ANEMIA–plasma cell in bone marrow interfering with other cell lines
Bone Lytic Lesions/Back pain
Monoclonal M protein
tx: Bortezomib: a Boronic acid dipeptide associated with PROTEOSOMES.
MOA is Cause APOPTOSIS
on XRAY: Punched out lytic bone lesion and IgG light chains in urine
intracytoplasmic Donovan Bodies are diagnostic for what bug
Klebsiella granulomatis
cause painless genital papule the ulcerates
What is Pickwickian syndrome/Obesity Hypoventilation syndrome
restricted expansion of chest wall due to severe obesity
cause hypoventilation, with elevated PCo2 and reduced Po2
what is the confirmatory test for Lactase deficiency
STOOL pH (
what test do you use to differentiate between pancreatic from intestinal malabsorption
D-Xylose test
unaffected in lactase deficiency
compression of what organnel gives rise to craniopharngyioma
compression of the PITUITARY STALK
for an Anesthestheic to be potent what must happen to the minimal alveolar concentration
Inc Potency = Low MAC(minimal alveolar concentration)
Note arteriovenous concentration gradient influences the rate of induction
arteriovenous concentration reflects overall tissue solubility of anesthetic
INC tissue Solubility = Large Arteriovenous Concentration = SLOWER ONSET OF ACTION
how does Penicillin used to treat syphilis work? and what other drug does Penicillin have a structural similarities too?
works by covalently binding to and inhibiting Transpeptidase: this enzyme catalyze the final cross -linking step in peptidoglycan cell wall formation and bind to D-alanine- D-alanine of another peptidoglycan molecule
Penicillin has a STRUCTURAL SIMILARITIES TO VANCOMYCIN (binds to D-Alanine- D-Alanine Residue) preventing incorporation of new subunits into the cell wall
what is carnitine deficiency
Impairment ofr fatty acid transport from the cytoplasm into mitochondria preventing B-oxidation of fatty acid into acetyl coA
Unable to synthesize Ketone bodies (such as acetoacetate)
presentation: myopathy, inc CK, weakness, hypoketotic hypoglycemia, S3 gallop
Damage to the MLF is located in what area in the brain
DORSAL PONS
absent of upward gaze, absent pupillary light reflex and impaired convergence
Parinaud syndrome (damage to superior colliculus)
what are the presentation of pheochromocytoma
Episodic HTN, Flushing, palpitation, HEADACHES and Diaphoresis
a mass in the kidney composed of Fat, smooth muscles and blood vessels refers to
ANgiomyolipoma of the Kidneys and associated with Tuberous Sclerosis
what is uniparental disomy and what disease are associated with it?
occurs when a person receives two copies of a chromosome from the same parents and none from the other parents. Example is Prader-Willi syndrome and Angelman syndrome
what murmur is known to increase during INSPIRATION
Tricuspid Regurgitation
What murmur increases in INTensity During Expiration
Mitral Regurgitation
during late stages of pregnancy what prevents lactation by prolactin (milk production) in a woman
Progesterone by inhibiting anterior pituitary, hence inhibiting Prolactin
although PROLACTIN levels increases as Pregnancy Progresses, Progesterone keeps PROLACTIN IN-CHeCK till delivery
it also suppreses FSH and LH
After delivery, there is a massive drop in PROGEsterone thereby allowing Prolactin to stimulate Lactation
what increases the risk of cholelithiasis in women who are pregnant or using OCPS
Estrogen Induced cholesterol Hypersecretion and progesterone induced gall bladder hypomotility
hemorrhage on head CT in the occipital and parietal areas and bleeding in parietooccipital lobe in an elderly suggests
Cerebral amyloid angiography
occipital lobe lesion causes what type of hemianopia
Homonymous hemianopsia
what is the most common cause of intracranial hemorrhage in children and tends to be a single lesion
arteriovenous malformation
trabecular thinking with fewer interconnections refers to what pathology
OSTEROPOROSIS Osteoporotic Bone (usually affect trabecular bone of the vertebrae and neck of the femur
presenting as vertebral fractures and fracture of neck of femur
unmineralized spongiosa in the medullary canal refers to
Osteopetrosis
the findings of squamous metaplasia in the pancreatic duct that causes extensive exocrine gland atrophy and fibrosis in s Cystic fibrosis patient is due to deficiency of what specific FAT soluble vitamins?
VITAMIN A
help in differentiation of epithelial and mucous secreting columnar epithelial cells of the conjunctiva, pancreas, and other exocrine ducts
Right sided weakness with a history of HTN and a Lake-like cavity lesions in the Left Internal capsule refers to what disease
Hypertensive arteriolar sclerosis
progressive headache, nausea and vomitting following confusion refers to what pathology
hypertensive encephalopathy
during neuronal death proliferation of what cells do you see in the brain
Astrocyte in area of neuron degeneration is called gliosis
treatment for Hep C
Interferon alpha, RIbavirin (also treat RSV)
RIbavirin pairs with either uracil or cytosine and causes hypermutation during RNA-dependent RNA replication
also inhibit IMP Dehydrogenase (same MOA as MOFITIL)
RIBAVIRIN MOA is MULTIFACTORIAL
Peribronchial Cuffing on chest xray refers to
Asthma
Budesonide , what is it used for?
Chronic Asthma
in anaphylaxis reaction mast cells and basophils releases inflammatory mediators what are they?
Histamine, TRYPTASE, PGE
IgE receptors cross-link with each other causing RECEPTOR AGGREGATION causing Mast Cell and Basophil Degranulation
ultrasound revealing a stenosis of subclavian artery proximal to the origin of the vertebral artery and a retrograde(caudal) flow instead of normal integrate flow is called
Subclavian steal syndrome
is severe stenosis of the proximal subclavian artery which leads to reversal in blood flow from the contralateral vertebral artery to the ipsilateral vertebral artery, e.g dizziness and vertigo.
presents with symptoms as Exercise induced fatigue, paresthesias OR vertebrobasillar insufficiency (e.g dizziness, vertigo)
(look at ur phone for pictures)
due to atherosclerosis and Takayasu Arteritis and heart surgery complication (aortic coarctation repair)
presents as ARM ISCHEMIA A(e.g arm hurting after playing table tennis) or Vertbrobasilar insufficiency (e.g Dizziness, vertigo, drop attacks).
what is the most likely target of Timolol in the eyes
what other drug has the same MOA as Timolol
what drugs decrease intraoculare pressure by increasing outflow of aqueous humor
Ciliary epithelium
non selective beta blockers that diminish aqueous humor by the CiLiary epithelium
Another drug that decrease aqueous humor by the colliery epithelium is a carbonic anhydrase inhibitor Acetazolamide.
so Acetazolamide and Timolol DECREASE production of aqueous humor dec Glaucoma
Pilocarpine, carbachol, prostaglandin F2alpha (e.g Latanprost and travoprost), MOA is by INCREASE OUTFLOW OF AQUEOUS HUMORE dec Glaucoma
what is used to transport fatty acid through the mitochondria membrane and is a necessary component in fatty acid oxidation
Carnitine
what inhibits beta oxidation of newly formed fatty acids
Malonyl CoA
by inhibiting the action of mitochondria carnitine acetyltransferase
how does TCA such as amitriptyline cause Cardiac arrhythmia which causes death
They inhibit Fast sodium Channels slowing down myocardial depolarization causing arrhythmias
TCAs also inhibit NE and serotonin reuptake
what is responsible for the skin necrosis after warfarin therapy
Warfarin induced skin necrosis which is due to a transient hyper coagulable state
Protein C has the shortest half life so its activity is reduced quickly when warfarin therapy is initiated.
the Risk of Skin Necrosis is seen in patient that have pre-existing protein C deficiency
what are the clinical features of PCP
Violent and bizarre behaviors
NYSTAGMUS (Vertical and Horizontal Nystagmus)
ATAXIA
What is the clinical features of LSD
Visual Hallucination and vivid dreams
what is the clinical features of cocaine
Chest pain and seizures, Pupillary dilation
what is the clinical features of Methamphetamine
Tooth decay, Violent behavior, CHoreioform Movement
what is the clinical feature of Heroin
Depressed mental status, Miosis, Respiratory depression
what is the histo pathogenesis of HIV associated Dementia
involves the activation of microglial cells
what the relationship between primary billiary cirrhosis and graft vs host disease
both lead to the destruction of small and medium sized intrahepatic bile ducts
Urine smelling like caramelizing sugar/burntsugar/ maple syrup requires dietary restriction of leucine, isoleucine and valine. what other substance needs to be supplemented?
Maple syrup disease,
deficiency of branched chain alpha ketoacid dehydrogenase complex (isoleucine, leucine and valine is deficiency)
Note: leucine is the most involved.
Supplement THiAMINE (Vit B1)
what is the essential amino acid in UREA cycle
ARGININE
what medication is responsible for the redistribution of fat from the extremities to the abdomen? whats the term called for fat redistribution of fat?
HAART therapy (antiretroviral medication) causing Lipodystrophy/Lipoatrophy
drugs like stavudine and Zidovudine
what alternative medication can you give to a patient for cardiovascular disease that is allergic to aspirin and is as effective as aspirin for cardiovascular disease
Clopidogrel (blocks P2Y 12 component of ADP receptors)
a phosphodiesterase inhibitor that is used for peripheral vascular disease such as Claudication, what drug?
CIlostazole
what other drug is used that inhibits glycoprotein 2b/3a apart from abixcimab
Eptifibatide
what pathology is associated with overproduction of TGF-alpha resulting in mucosal call hyperplasia with gastric fold enlargement
Menetrier disease
TGF-alpha stimulator of epithelial growth which is secreted by carcinomas, macrophages and epithelial cells
what is the major virulence factor in group A strep that inhibit phagocytosis and the activation of complements
M Protein aka Protein M
what is another name for Central pontine myelinolysis ( caused by rapidly correction of hyponatremia)
Osmotic Demyelination syndrome
what metabolizes cyanide in the tissues
Rhodanese
sodium nitroprusside induced cyanide toxicity and sodium thiosulfate can be used to reverse it by acting as a donor to what element?
Sulfur
Sodium thiosulfate act as a donor for sulfur to promote hepatic rhodanese to convert canide to thiocyanate which is excreted into the urine.
Hydroxycobalamine can revers cyanide poison by directly binding to cyanide ions
Sodium Nitrite convert Hb to methemoglobin then thiosulfate to thiocyanate which then is excreted in the urine
what is a common extra dermal manifestation of scleroderma
Pulmonary HTN
what urinary problem is seen in an MS patient
bladder hypertonia/spastic bladder few weeks after lesion to spinal cord
presenting with increase urinary frequency and urge incontenance
what type of phenomena is paraneoplastic syndromes
autoimmune phenomena
inspissated green fecal mass obstructing the DISTAL ILIEUM in a 2 day old boy with abdominal distention and dark green emesis suggests
Meconium Ilieus ( obstruction is at the iLIEUM and associated with CYSTIC FIBROSIS and most common complication is PNEUMONIA, Bronchectasis and Cor PUlmonale are most common cause of death in C.F patients) NOT Hirghsprung disease (in Hischsprungs obstruction is at the Rectosigmoid and its associated with down syndrome and ENTEROCOLITIS IS THE MOST COMMON CAUSE OF DEATH IN HISCHSPrUNGS disease
Pretrial subcutaneous fat inflammation seen in sarcoidosis refers to what
Erythema Nodosum
what drug is used prophylactics for PCP
DAPSONE
which antibiotics is giving for meningitis prophylaxis ( you don’t know what the bug is)
ceftrixone, vancomycin and ampicillin
what is the stimulation test that you use to confirm adrenal insufficiency
metyrapone stimulation test
Neutropenia with fever is also refered to as
Agranulocytosis
what do u use for thyroid storm
proponolol, pTU, predinosone,
abdominal pain out of proportion to physical findings , Diagnosis?
acute mesenteric ischemia
crampy abdominal pain followed by hematochezia
Colonic Ischemia/ISchemic colitis
what is the cause of obstructive sleep apnea in adult and in children?
what is the treatment for central sleep apnea
In adult: caused by excess parapharyngeal tissue in adults
In children: caused by adenotonsillar hypertrophy in children
tx: weight loss, CPAP(continuous positive airway pressure) and surgery
tx for central sleep apnea is CAFFEINE
in a neonate, diffuse airspace interstitial opacities in the bronchogram also called ground glass appearance, whats the diagnosis
neonatal respiratory distress syndrome
Dementia frequently associated with frequent falls and syncope
Lewy Body dementia
dementia plus visual hallucination
Lewy body dementia
Endoneural inflammatory infiltration refers to
Gillian-Barre syndrome by campylobacter jejuni
paralysis of respiratory muscles may occur and CN7 damage (bells palsy)
on light microscopy: segmented demyelination of peripheral nerve is seen
toxin penetration through blood-nerve barrier refers to
Peripheral neuropathy by DIPhtheria
endoneurial arteriole hyalinization is associated with
Diabetic micro angiopathy
a high leukocyte alkaline phosphatase refers to what? and what do you see?
Leukemoid Reaction (inc ALP) compared to CML with (low ALP)
Leukocytosis > 50,000/mm3 that occurs due to conditions such as severe infection, hemorrhage, malignancy, or acute hemolysis, peripheral blood smear shows increase band cells, neutrophil precursors (melocyte0, granules (DOhle bodies) in the neutrophil.
Leukeomoid reaction you see DOHLE BODIES (are light blue basophilic peripheral granules in neutrophils)
the blue color is due to ribosome bound to RER
you see inc bands, toxic granulation and cytoplasmic vacuoles
prolong prothrombin time (PT), hypoalbuinemia, and high bilirubin levels suggest what organ dysfunction
liver dysfunction
prolong prothrombin time indicate poor prognosis in this patients
what values indicate billiary injury
Increase alkaline phosphatase (ALP) and Gamma-glutamyl transpeptidase (exclude bone disease)
patient with untreated ulcerative colitis that experience shock (hypotension, tachycardia) is most likely suffering from what
why don’t you do colonoscopy and barium
toxic megacolon involve large intestine and it is associated with clostridium difficile
a PLAIN ABDOMINAL X-ray need to be done
barium and colonoscopy is contraindicated due to risk of PERFORATIONS
what are the two bugs that cause sepsis in a sickle cell patient
Streptococcus pneumonia and Homophiles Influenza
what are the two bugs that cause sepsis in a sickle cell patient
Streptococcus pneumonia and Homophiles Influenza
OSteomyletits in sickle cell patient is by salmonella
the conversion of NE to epinephrine is one by
Phenylethanolamine-N-methyltransferase (PNMT) and SAM which is turned on by Cortisol
3 choices for antibiotics
dicloxacilin, nafcilin, oxacillin
what is demecylclociline
ADH ANTagonist
skin lesion in the legs look orange peel appearance
Hypertheriodisim (pretrial myxedema)
patient receiving blood transfusion get hypocalcemia by loosing calcium during blood transfusion, what can you give and why?
give citrate and it act as a calcium chelator and prevents hypocalcemia
most sensitive enzyme for M.I
Myoglobin (nonspecific)
constipation, dec flatus, tympanic abdomen, dec bowel sounds, what is diagnosis?
iLieus
which bacteria cause lobar pneumonia and a typical
Legionella
Jaundice, fever and RUQ pain
ascending CHolangitis
effect of low calcium on EKG
QT prolongation
A UNILATERAL ADnexial mass with a yellow and firm mass in the ovary that has a small cuboidal cells in sheets with gland like structures that contains acidophilic material refers to
Granulose cell tumor
a large unilateral adnexal mass
Secretes INCREASE ESTROGEN and also increase inhibin
Call-Exner bodies( cuboidal granulose cells in a rosette pattern with coffee bean nuclei) and yellow theca cells with lipid on Histology
what is responsible for closure of the ductus arteriosus after delivery
Inc Infant breathing—— increase oxygenated blood in the aorta——decrease prostaglandin—–closure of ductus arterioles
what cause the closure of the foramen ovale
infant breathing—dec pulmonary vascular resistance—inc LA pressure—-pushes septum premium against septum secundum
what qualifies for systemic inflammatory response syndrome (SIRS)
More than 2 of the criteria
Fever, Increase HR, leukocytosis , tachypnea
what is the first sign of shock
Tachycardia (RAPID HEART RATE)
the pathophysiology of NRDS is the same as which other lung pathology
Atelectasis in that there is decrease surfactant and leads to lung collapse
severe shortness of breath when running or in the cold suggest what pathology? what drug causes it too?
Asthma
Asthma sensitive asthma is also called Samter’s triad: nasal polyps + asthma + aspirin sensitivity
Aspirin
for aspirin induced asthma give Montelukast and zafrilukast
decrease diffusion of oxygen in the alveolar walls due to destruction of the alveoli wall is associated with what pathology
Emphysema (diffusion limited)
what is the structure of the virus genome that predispose to subsequent bacteria pneumonia in an otherwise healthy individual that develops lobar pneumonia
INFLUENZA VIRUS (enveloped, segmented, single-stranded RNA virus)
ELISA of Nasal washing is used to diagnose bronchiolitis in a children less than 2 years , what virus?
RSV
present with nasal flaring, grunting, respiratory distress, low grade fever and crackles
ELISA of nasal flaring is used to detect RSV, rhinovirus and coronavirus
what is the virulence factor for legionere disease from contaminated water
ANK protein is virulence factor for Legionella
what is the virulence factor for staph aureus
Protein A
dyspnea (shortness of breath) on exertion, dry cough for more than 3 months and bilateral rales on examination with clubbing of the nails suggest
pulmonary fibrosis
Honeycomb lungs on CT
for sarcoidosis what is an alternate treatment apart from glucocorticoids
Methotrexate
hydroxychloroquine can also be used to control the symptoms of sarcoidosis
for good pasture disease what tx?
steroids, cyclophosphamide and azathioprine
why does the thorax shift away from the collapsed lungs during tension pneumothorax
it is due to the positive pressure from the pleural space
RSV is from paramyxovirdae virus and it is a
single stranded NEGATIVE SENSE, LINEAR enveloped RNA virus with a NONSEGMENTED genome
other virus included in paramyxoviridae family is PARAINFLUENZA VIRUS causing Croop(Barking cough, inspiratory stridor),
Measles (cough, coryza,kopek spot) and Mumps (bilateral parotid gland)
Chronic obstructive sleep apnea present has Respiratory acidosis that is compensated by metabolic alkalosis, what happens to the Bicarb?
Increase renal bicarb reabsorption/retention (METABOLIC ALKALOSIS COMPENSATION)
what are the two major risk factors for goodpastures disease
exposure to hydrocarbon solvent such as does found in dry cleaning industry and Cigarette smoking
type 2 hypersensitivity
treatment: plasmapheresis
segmental necrotizing glomerulonephritis with granuloma in the lungs refers to
Wegners
CXR: larger nodular densities/bilateral nodular infiltrates
cANCA/antiproteinase3
tx: cyclophosphamide and steroids
Hep E belongs to what virus family
CaLiciviruses (Single stranded, Positive sense, linear non-segmentted RNA virus)
influenza virus belong to what family type
Orthomyxoviruses (Single stranded, Negative sense Linear Segmented RNA virus)
what enzymes are used in the catabolism of NE
COMT(catechol-o-methyltransferase
MAO (monoamine oxidase)
what is the whole purpose of the Chloride Shift?
IT occurs when the patient is havin a HIGH RISE In CO2(aka Hypercapnia)
so the bicarb created by carbonic anhydrase in response to rising CO2 leaves RBC in exchange for chloride
what medication respond well to gram negative rods such as klebsella
Aztreonam (a monobactam antibiotic)
what is the name of the beta lacatamase inhibitor that prevents the degradation of beta lactam
clavulanic acid
a serine protease inhibitor that is deficient in emphysema
alpha-1- antitrypsin (A serine protease inhibitor)
what is the most common symptom for Panacinar emphysema
Worsening shortness of breath (worsen dyspnea)
what is both common to both obstructive and restrictive lung disease
Decrease Vital capacity
what type of histamine receptor is responsible for allergic reaction and which one is responsible for gastric acid secretion? histamine 1? and histamine 2?
seasonal allergies are a result of
Histamine -1-receptor activation which present with (pruritis, bronchoconstriction, increase nasal and bronchial mucous production
activation of Histamine-2- receptor leads to increase gastric acid production and located in the stomach.
what are the drugs that improve survival rate in a CHF patient
Ace inhibitors, ARBS, aldosterone blockers, beta blockers
BLURRY YELLOW VISION, vomitting , hyoerjakenuadiarrhea, arrhythmias, nausea are all signs of what drug toxicity
Digoxin toxicity
Most common Digioxin EKG abnormality is Bradycardia (dec HR)
TX; gradually correct Hypokalemia, Magnesium, anti-digoxin Fab Fragments, Cardiac pacer
what drug are used to treat chronic CHF
ACE inhibitors, ARBS, Aldosterone antagonist, Betablockers, Nitrates DIgioxin
what drugs are used to treat acute CHF
NMenonice: NO LIP
N—– Nitrates
O—– Oxygen
L——Loop diuretics
I——-Inotropic Drugs (e.g. dobutamine)
P—— Positioning (allow blood to flow to the legs instead of the lungs to protect against lung failure)
which central lines have the highest risk of Pneumothorax
The subclavian vein
for a central line, which site is the easiest site with the least risk
Femoral Nerve
swan-Ganz catheter preferred site arre
RIGHT internal Jugular vein or the Left subclavian vein is the most common site for a swan-Ganz Catheter
Right Internal Jugular> Left subclavian > Right Subclavian > Left Internal Injugular
in the cardiac cycle what specific disease is affected the Dicrotic notch
Tertiary SYphilis (tree backing of the aorta) cuz of decreasing elasticity
what leukotrienes worsen asthma symptoms?
LTC4, LTD4, LTE4
which drug when giving to a RA patient reactivates latent TB
Ethernacept
what is the relationship of the arteries to airways in broncho pulmonary segment
bronchial arteries and pulmonary arteries run with the airways in the center of the segments
what is the relationship of the veins and lymphatics of airways in broncho pulmonary segment
veins and lymphatics drain together along the edge of the segments
pandemics are the result of genetic/antigenic shift. which of the following characteristics of the influenza virus makes the pandemic possible?
occurs when viruses with segmented genome exchange segments. mostly hemagluttinin and neuraminidase antigen
TENSION pneumothorax can lead to
Jugular Venous Distention
pursed lips is a method emphysema patient use to breath, how it works
inc pressure in small airways thereby preventing airway trapping
list the three cephalosporins used to treat Pseudomonas (MUST KNOW)
cefoperazone, ceftazidime (more commonly used, 3rd generation)) and cefepime (4th generation)
ceftriaxone used for meningitis and gonnorhea
Ceftazidime –used for pseudomonas
what are the medication that is used for RATE CONTROL in patients with A-Fib?
Digoxin, calcium channel blockers, beta blockers
what are the medication that is used for RHYTHM CONTROL for A-FIB?
(SAF)
Sotalol
Amiodarone
Flecainide
a shifting sinusoidal waveforms on ECG is treated with?
Magnesium sulfate (treats Torsade De Pointes)
abdominal bruit suggest
renal artery stenosis
how does surfactant decrease surface tension and prevention lung collapse
it disrupt liquid intermolecular forces in the alveoli aka it breaks the hydrogen bonds between molecules of water.
this prevent alveoli collapse and increase compliance.
what drug inhibits Renin
Aliskiren
Histology showing a diffuse interstitial infiltrate of LYMPHOCYTES with MYOCYTE NECROSIS , whats the diagnosis?
Myocarditis (generalized inflammation of the myocardium)
Most common cause Coxsackie B virus
a bitter almond taste refers to cyanide poisoning, what type is it? respiratory acidosis, metabolic acidosis, etc
A increase metabolic acidosis ( due to an increase in Lactic acidosis)
High anion-gas metabolic acidosis (MUDPILES)) L-lactic acidosis
what describes diffusion limited exchange in emphysema
decrease surface area due to destruction of alveoli
Cadmium is associated with what type of cancer and where is it found?
Prostate cancer and found in batteries and metal coating
Benzene is associated with what type of cancers and where are they found?
Leukemia and Hodgkin Lymphoma
found in light oil and gasoline
what element is found in glass, ceramics and electronics
Silica
what substances increases ADH production
Nicotine, Opiates
What substances Decrease ADH production
Ethanol, atrial natriuretic factor and decrease Serum osmolarity
Osteocyte connecting to each other by
GAP Junction
hepatitis A is associated with what type of food
Steamed food and contaminated water (e.g. Shell fish)
the most common cause of abscess in the liver is
Staph aureus via hematogenous spread
what is the most likely cause of the urinary symptom in a multiple sclerosis patients
URGE INCONTENANCE
UNInhibited Bladder contraction (so UNINHIBITED DETROUSER muscle
so detrouser overactivity
why do MI pain, radiate to shoulder and left arm
Afferent pain fibers enters the spinal cord at the POSTERIOR HORN in the SAME Level as the Spinal Cord. causing pain perceived in the neck and shoulders
Greatest to lowest affinity(highest Km) for sodium channel in antiarhythmis
class 1C > 1A > 1B
most side effect of Opiod therapy
Constipation and Miosis (dilated pupil)
partial deletion is associated with what disease?
Cru-DU-Chat
cells that lack sorbitol dehydrogenase and are sensitive to osmotic damage by sorbitol
SLRK (schwann cells, Lens, Retina & Kidneys)
what is lipodystrophy? and what care the causes?
abdominal fat with a buffalo hump and THIN EXTREMITIES.
what are the causes of lipodystrophy?
Leptin Deficiency
HIV Medications (e.g. Protease Inhibitors)
Ventromedial nuclei is stimulated by Leptin which causes increase Satiety
Lateral Hypothalamus stimulates Hunger and its Inhibited by Leptin
what is metabolic syndrome
3 of the following to make the diagnosis
1) abdominal Obesity
2) Increase Triglyceride > 150
3) decrease HDL
what drug blocks 3 beta hydroxysteriod dehyrogenase
Trilostane
what is Killan triangel and pathology associated with it?
thryophrangeal, cricopharngeal and inferior pharyngeal constrictor
disease associated is Zenker diverticulum
what drug ? blocks detoxification of heme into hemozine
Chloroquine
what drug do you use to treat hypnozoite which is dormant in RBC
Primaquine
for INH to work it needs what
Catalase peroxidase to work
to amplify signal what do you need
DNA polymerase, primer and base
where do you do a femoral nerve block
Inguinal Crease at lateral border of femoral artery
what are the artery that anastomostose in kissle back plexus
septal branch of anterior ethmoidal artery
Lateral nasal branch of sphenopalatine artery
septal branch of superior labial artery
what is responsible for green color of Pus in bacterial infection
Myeloperoxidase
what is responsible for the green color in bruises several days after an injury?
Billiverdin (green color in Bruises)
Heme convert to Biliverdin via the enzyme HEME OXYGENASE
what amino acids are the stimulators of gastric secretions
Phenylalanine, tryptophan and calcium
PTC stimulate gastrin
List the G.I pathology that is associated with down syndrom
Duodenal atresia, hirschsprung disease, annular pancreas and celiac disease
what is the microscopic presentation of Kaposi Sarcoma
spindled cells with slit like vasculature
hearing loss in one ear in an elderly refers to damaged to what nucleus?
Cochlear Nucleus
sensourinearal hearing loss below the trapezius body
which are the FIRST NODE TO receive lymphatic node from the lateral breast?
Pectoral Nodes
what do you see on histology on endometrial cancer
well differentiated epithelial cells with glandular epithelium
Slit-light examination is in what pathology
Wilson disease
what is the MOA of the drug used to treat primary billiary cirrosis
URSODIOL (dec synthesis of cholesterol in the liver)
Changes the composition of Bile.
delays progression of Primary billiary cirrhosis
jaundice, fever, RUQ pain refers to
CHolangitis
Jaundice, fever, RUQ pain, Hypotension and altered mental status refers to
REYNOLDS PENTAD
what drugs causes intrahepatic damage
Chlorpromazine and Arsenic
what is the problem with aortic stenosis in terms of the cardiac cycle
aortic stenosis is due to delayed opening of the aortic valve so you will have a PROLONGED isovolumetric Contraction and DECREASE the period of systolic ejection
Defect in erythroid progenitor cells refers to what pathology
Diamond-Blackfan Anemia
a form of megaloblastic anemia
inc in HBF (dec in total Hb)
Presentation:
Short stature, craniofacial abnormalities and upper extremity abnormality with triphalangeal thumb in up to 50% of cases
Defect in DNA Repair refers to what pathology
Fanconi Anemia (pancytopenia, aplastic anemia, Hypoplastic thumb)
Defect in DNA synthesis refers to
Megaloblastic Anemia
Metastasis to Bones
Primary Relocated Tumors Like Bones
Prostate cancer Renal cell carcinoma testes cancer Lung cancer Breast Cancer
Metastasis of Cancer to Brain
Lots of Bad Stuff Kills Glia
Lungs Breast Skin (melanoma) Kidneys (renal cell carcinoma) G.I tract (colon cancer)
Metastasis to Liver
Cancer Sometimes Penetrates Benign Liver
Colon Skin Prostate cancer Breast Lung cancer
treatment for testicular cancer
“ERADICATE BALL CANCER”
EToposide, Bleomycin, Cisplatin
what are the SE of steroid use
Cushion syndrome
“BAM CUSHINGOID”
Bufalo hump
Ammenorhea
Moon facies
Crazy (psychosis, agitation) Ulcers Skin Changes HTN Infection Necrosis of Femoral head Glaucoma and cataracts Osteoporosis Immunosupresion Diabetes
by what mechanism does lithium cause thyroid dysfunction
by blocking thyroid hormone release by an unknown mechanism
what is the electron carrier needed to make steroid synthesis
NADPH From HMP shunt
what type of cells is present in the pancreas of type 1 diabetes? i.e is it granulomas, monocyte, lymphocyte
LYMPHOCYTE
type 1 DM is auto immune so Lymphocyte present
negative symptoms of schizophrenia is by what tract
Mesocortical tract
positive symptoms of schizophrenia is by what tract
Mesolimbic tract
what do you use to treat vancomycin resistance staph aureus
Linezoid and DAPTOMYCIN (cause myopathy and increase CCK)
methicillin resistance staph aureus is used for
Ciprofloxacin
elevated level of diphosphogylcerol and glucose 6 phosphate refers to what blood pathology
Pyruvate Kinase Deficiency (echinocytes will be seen which is Burr cells)
what gland is found between the thalamic bodies on an MRI
PINEAL GLAND (PRODUCING MELATONIN)
MASS IN THIS REGIONS IS PINEOBLASTOMA (Symptom is a HEADACHE and Drowsiness and vivid dreams due to excessive melatonin production)
in a patient with an Ileal/Ilieum Resection, what bacteria can’t affect this patient?
Shigella because it infects the M cells in Payers patches in the Ilieum. Since no Ilieum , Shigella cannot invade through M-Cells
M-Cells Produce IgA
Other bacteria that use payers patches for invasion include salmonella, Yersinia, certain strains of E-coli and mycobacterium avium
what is the treatment for Hep B infection
Lamivudine and Interferon alpha
what is the treatment for Hep C infection
Ribavirin and interferon alpha
sickness as a result of bear meat is as a result of what parasite
Trichinella spiralis
list the aromatase inhibitor drugs
Letrozole, anastrozole, exemestane
what antibiotics cause clostridium deficile
clindamycin, ampicillin and cephalosporin
High Fever, black vomit, aching pain and Jaundice refers to
Yellow Fever ( councilman bodies which are eosinophilic globules believed to be the result of apoptosis)
what drug worsen raynaud phenomena
phenelphrine
which amino acid are modified in the golgi aparatus
SAG (serine, threonine and Asparagine)
what is responsible for extra ocular movement during REM Sleep
PPRF (paramedian pontine reticular formation)
what is marcus Gunn Pupil
Optic nerve injury or Retinal detachment in which leads to an inability of both eyes to constrict when eye is shone into the affected eye
what drug causes an increases in coronary blood flow 1-2 mins after NE infusion
Adenosine
what causes weight loss in a patient with small cell carcinoma of the lungs
Cytokine effect
6-year-old boy with 5-day history of intermittent vomiting and 3-month hx of progressive clumsiness. Can no longer ride bicycle and difficulty getting out of car. Funduscopic exam shows bilateral papilledema. Neuro exam shows impaired upward gaze and pupil response to light. Walks shuffling gait. CT shows enlarged lateral and third ventricles and a 2-cm mass. Location of mass?
Pineal Gland
Herniated lumbar intervertebral disc asking for most appropriate location for surgical entrance to neural canal?
for this lamina is the answer because this is the only place which doesnt lie directly on a nerve or spinal cord. i dont remember the option number
what enzyme is responsible for digesting triglyceride
Colipase
Workbench wiped down with alcohol, successfully inactivates viruses with which characteristic?
Enveloped virion
6-year-old girl with 15-minute history of severe shortness of breath. Diagnosed with throat tumor 3 years ago. RR 32. PE nasal flaring. Laryngoscopy shows multiple raised, finger-shaped lesions from vocal cords and epiglottis. Lesions excised and shows finger-shaped fibrovascular cores lined with benign squamous epithelium. Causal virus?
Human papillomavirus, type 6
unilateral lower extremity sensory and motor loss, what artery?
ACA
unilateral facial and arm sensory and motor loss, what artery?
MCA
where does the dorsal column, lateral corticospinal tract cross?
medulla
Caudal medulla
what antipsychotics drugs are associated with blood dyscartias
Carbamazepine and ethisuoximide
Pink round bacteria in pairs in a 24 year old refers to what bacteria
Neiseeria Gonnorhea
RUQ pain and inflammation of the liver capsule refers to what pathology
Fitz-Hugh-Curtis Syndrome
unilateral left lower abdominal pain on ovulation due to rupture of the mature follicle is called
Mittelschmerz
what is the most significant risk factor for endometrial cancer
Obesity
Fever, RUQ Abdominal Pain and Vaginal discharge and on Laparoscopy ,
Violin-String adhesions are present, Diagnosis?
Fitz-Hugh-Curtis Syndrome ( infection of the LIVER CAPSULE and VIOLIN STRING ADHESION ON PERITONEUM to LIVER)
its a complication of PID
