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)
