uw 1 Flashcards
Contralateral homonymous hemianopia
Optic tract lesion. Tested with the “swinging flashlight” test. Pupils appear to dilate when light is swung from unaffected to affected eye
Decreased bilateral pupillary constriction when light is shone in the affected eye relative to unaffected eye
optic nerve damage ( afferent pupillary defect)
Inability to contrict when you shine light into either eye
Occulomotor Nerve lesion (CN 3)
Down syndrome screening
Quadruple screen at 15-18 weeks. Low maternal AFP and unconjugated estriol levels. Increased B-HC and inhibin A
NK cells
NK cells recognize and kill cells with decreased MHC I expression, such as virus infected and tumor cells. They are large lymphoid cells that contain perforin and granzymes in cytoplasmic granules. NK cells kill by inducing apoptosis.
Vitamin D metabolism
Absorbed in GI or synthesized from precursors in skin after sunlight exposure. Converted in 24OH-vitD in liver. Converted to 1,25(OH)vit D (calcitriol) in kidney
Excess vitamin D
hypercalcemia, hypercalciuria, confusion, polydipsia, anorexia, vomiting, muscle weakness and bone demineralization.
what are patients with sarcoid or other granulomatous diseases prone to developing?
Hypercalcemia due to high levels of active vitamin D
what is elevated in rheumatoid arthritis?
Rhematoid factor and citrulline containing peptide antibodies
What is decreased in carcinoid syndrome?
Decrease levels of niacin
Where does serous fluid accumulate in a hydrocele?
Tunica Vaginalis
What is the tunica vaginalis contiguous with?
Peritonium. Testis descend through the inguinal canal drawing a diverticulum of peritonium into the scrotum.
External spematic fascia is derived from what layer?
aponeurosis of the external oblique (outermost layer)
Internal spermatic fascia is derived form what layer?
transversalis fascia
What is the tunica albuginea?
Fibrous tissue that overlies the corpus spongiosum and the corpora cavernosa of the penis
What is a common presentation of Charcot-Marie-Tooth?
Weakness of foot dorsiflexion ( foot drop) due to involvement of common peroneal nerve. Mutation that causes abnormal myeline synthesis resulting in decreased nerve conduction velocity.
Biopsy shows endomysial inflammatory infilatration.
Polymyositis. Causes proximal muscle weakness
Biopsy shows perifasicular inflammation
Dermatomyositis. Causes proximal muscle weakness
Biopsy shows endoneural infiltration
Guillain Barre. Causes an ascending flaccid paralysis and hyperreflexia
What population does Whipple disease affect?
T. whippelii affects middle aged Caucasion males and presents as malabsorption with diarrhea and weight loss. Arthropathy, polyarthritis and psychiatric and cardiac abnormalities may be present. PAS+ ( enlarged fomay macrophages packed with bacilli and diastase-resistant granules)
what is acanthosis
increase in thickness of stratum spinosum. Associated with psoriasis
what is spongiosis
Intercellular epidermal edema that histologically appwars as increase in the number of spaces between cells. Associaed with spongiotic dermatitis ( eczematous dermatitis)
what is acantholysis?
loss of cohesion between kertinocytes in epidermis or adnexal structures. Associated with spongiotic dermatitis ( eczematous dermatitis)
What is dyskeratosis?
Abnormal, premature keratinization of individual keratinocytes. Strongly eosinophilic and have small, basophilic nuclear remnant. Can be found in squamous cell carcinoma
What is urticaria?
Superficial dermal edema and lymphatic channel dilation.
What does the genitofemorial nerve innervate?
Splits into genital and femoral branches. Genital N. innervates scrotum/ labia majora. Femoral N. innervates femoral triangle.
What is blocked in a pudendal nerve block?
S2-S4 nerve roots which provides sensory innervation to perineum and genitals and motor innervation to the sphincter urethrae and external anal sphincter.
What does the lateral femoral cutaneous enrve innervate?
Derived from L2 and L3. Courses deep to inguinal liagment to innervate skin on anterolateral thigh
What does the iliohypogastric nerve innervate?
Derived from T12/ L1 it innervates the skin overlying the iliac crest.
What does the obturator nerve innervate?
Derived from L3 and L4, it innervates the adductors of the thigh
What does the inferior gluteal nerve innervate?
Derived from L5-S2, it provides motor innervation to gluteus maximus
what will be increased on a CBC after high dose prednisone?
Neutrophils. Neutrophil count increase as a result of demargination of leukocytes previosly attached to the vessel wall. Decreased lymphocyte, monocyte, basophil and eosinophil counts.
what labs should you expect from a patient on Lisinopril?
Elevated potassium ( hyperkalemia), increased Creatinine (decreased GFR). ACEi decrease ANG II and decrease GFR by preventing constriction of efferent arterioles. Can rarely cause life threatening angioedema.
what are some typical side effects of metoprolol?
Beta blocker can cause bradycardia and erectile dysfunction.
What are some side effects of atorvastatin?
HMG CoA reductase inhibitor can cause rhabdomyolysis ( esp. with fibrates and cyclosporin) Massive rhabdomyolysis can lead to acute kidney injury ( myalgias, muscle weakness and dark urine)
What are some side effects of HCTZ?
Hypokalemia. Can decrease GFR if it results in volume depletion and pre-renal azotemia
What receptor does Prazosin act on?
alpha 1 adrenergic antagonist. Used in hypertension
How does interstitial lung disease present?
progressive dypsnea, fine crackles, clubbing, diffuse reticular opacities. Pulmonary fibrosis with thickening and stiffenieng of pulmonary interestitium causes increased elastic recoil, which leads to airway widening due to increased outward pulling (radial traction) by surrounding fibrotic tissue. Results in supernormal expiratory flow rates. Spirometry: decrease FEV1 and FVC. But ratio increased because FEV1 decreases less than FVC.
What is lung compliance?
Change in lung volume for given change in pressure. Increased compliance means lung tissue stretches and expands more in response to increased pressure.
When does ischemic injury to the heart become irreversible?
After 30 minutes. Under hypxic condictions, ATP is degraded to ADP, AMP and adenosine. Adenosine is able to cross cell membrane and function as a vasodilator when coronary blood flow is insufficiency. However persistent ischemia can lead to depletion of adenosine
What is the evolution of an MI?
4-12 hours: Early coagulative necrosis, wavy fibers. Dark mottling. 12-24 hours: neutrophil migration. Reperfusion injury may cause contraction bands. 1-3 days: acute inflammation with neutrophils. 3-14 days: Hyperremic border with central yellow brown softening. Macrophages then granulation tissue at margins. 2 weeks to 1month: Gray white scar.
What are the complications post MI?
1 day: arrythmia. 1-3 days: fibrinous pericarditis 3-14 days free wall rupture. 2 weeks to month: Dressler syndrome, ventricular aneurysm
What are the functions of VIP?
Produced by pancreatic islet cells and neurons in GI mucosa. Causes relaxation of GI smooth muscle, inhibition of gastic H+ secretion and stimulates pancreatic bicarb and Cl- secretion. VIPoma causes WDHA syndrome (watery diarrhea, hypokalemia and achlorhydria). Tx: somatostatin
How does Measles and German measles present?
Maculopapular rash that begin at the head and neck and spread down. Postaurical and occipital lymphadenopathy. Develop polyarthritis and polyarthralgia as sequelae. Fetal infection can cause sensorineural deafness, cataracts, cardiac malformations (PDA)
What are typical late manifestations of congenital syphillis?
Malformed teeth (Hutchison’s incisors and mulberry molars)
what are some symptoms that suggest mucormycosis?
facial pain, headache and nasal eschar in patient with diabetic ketoacidosis
VACTERL
Veretebral defects, anal atresia, cardiac anomalies, trachesophageal fistual, esophageal atresia, renal anomalies and Limb anomalies
What is a cricothyrotomy? What layers are incised?
Indicated when an emergency airway is required. Layers include: skin, superficial cervical fascia, investing and pretracheal layers of deep cervical fascia and criothryoid membrane.
How is Diabetes insipidus diagnosed?
Vasopressin during a water deprivation test. >10% increase in urine osmolality suggests DI. >50% increase suggests complete DI
Function of ApoA
LCAT activation (choleterol esterification)
Function of ApoB-48
chylomicron assembly and secretion by intestine
Function of ApoB-100
LDL particle uptake by extrahepatic cells
Function of ApoC-II
LPL activation
Function of ApoE3 and E4
VLDL and chylomicron remnant uptake by liver cells
Antibiotics effective against pseudomonas?
Ticarcillin, Piperacillin. Ceftazidime, Cefepime. Amikacin, Gentamicin, Tobramycin. Ciprofloxacin, Levofloxacin. Aztreonam. Imipenem, Meropenem.
How does adrenal crisis present?
hypotensive, tachycardic, hypoglycemia. Hx of adrenal insufficiency: vomiting, abdominal pain, weightloss and hyperpigmentation. Start corticosteroids.
Side effects of Lithium
neuronal excitabiity (irregular tremors, fascicular twitching, rigid motor agitation, ataxia). May also cause nephrogenic DI, hypothyroidism, cardiac conduction defects. Hypothyroidism: weight gain, dry skin, hairloss and constipation (Need to measure TSH)
Methimazole side effects
edema, rash, agranulocytosis
Amiodarone side effects
thyroid dysfunction, corneal micro-deposits, blue-gray skin discoloration, drug related hepatitis, pulmonary fibrosis
characteristics of squamous cell carcinomas
solid nests of neoplastic squamous cells with abundant eosinophilic cytoplasm
when do you refer to ethics committee?
no advanced directive and family members disagree
Use dependent joint pain. Morning stiffness lasting 10-15 minutes. Bony swelling at DIP and PIP due to osteophyte formation
Osteoarthritis
Joint pain that improves with use. Last for more than 30 minutes. Involves MCP and PIP. Symmetric.
Rheumatoid arthritis
Red, swollen and painfail joint. Monoarticular. Affecting first metatarsophalangeal joint.
Gouty arthritis
Tracheal deviation towards affected side
Lung volume loss (atelectasis)
Tracheal deviation away from affected side
Pleural effusion
Pulmonary edema on CXR
fluffy infiltrates ( fluid in alveolar spaces)
Pulmonary fibrosis on CXR
Interstitial lung disease would cause reticular markings on both lungs
Pneumonthorax on CXR
increased lucency on affected side
Sharply demarcated, salmon colored, rounded plaques with a loosely adherent, silvery white scale
Psoriasis. Tx: topical vitamin D (calcipotriene) and cyclosporin, Etanercept, methotrexate, ustekinumab
Mechanism of Cyclosporin?
Inhibits NFAT ( nuclear factor of activated T cells) from entering nucleus and prevents release of IL-2 and thus inhibits activation of T-cells.
Mechanism of Etanercept?
Recombinant TNF receptor that binds TNF-a.
What is nitroblue tetrazolium testing?
Adding NBT to neutrophils will cause them to reduce yellow NBT to form a dark blue precipitate if normal. Used to test for chronic granulomatous disease
What is dihydrorhodamine flow cytometry? DHR
Measure production of superoxide radicals by measuring conversion of DHR to rhodamine. Cells with deficient NADPH oxidase will show decreased fluorescent green in chronic granulomatous disease.
What is used to estimate GFR?
Inulin/ Creatinine. Freely filtered and not absorbed or secreted.
What is used to estimate renal plasma flow?
PAH. Filtered and actively secreted in PT.
Which ribs overlie the left kidney?
12th
which ribs overlie the spleeen?
left 9, 10, 11
which ribs have the greatest risk of damaging the visceral pleura?
ribs 1-6
Which nerves go through the superior orbital fissure?
III: occulomoto, IV: trochlear, V1: trigeminal (nasociliary branch), VI: abducens ( opthalmic vein and sympathetic fibers)
What goes through the inferior orbital fissure?
V2 Trigeminal (Maxillary branch)
what goes through the optic canal?
Optic Nerve (II)
What goes through the Foramen rotundum?
V2 ( maxillary) which then goes through the inferior orbital fissure to the infraorbial foramen
What goes through the foramen ovale?
V3 ( Mandibular branch)
What does an S3 heart sound indicate?
Turbulent blood flow to ventricules due to increased volume. Heart in young adults, pregnancy, children.
What does an S4 heart sound indicate?
Heard immediately after atria contraction phase as blood is forced into a stiff ventricle in late diastole. Heathly older adults. Ventricular hypertrophy
What amino acid is deficient in Hartnup disease?
Neutral amino acids including tryptophan which can lead to B3 (Niacin) deficiency.
Atropine can reverse symptoms of organophosphate poisoning except which symptom? What can reverse this symptom?
Muscle paralysis ( nicotinic receptors) Pralidoxime restores cholinesterases and can reverse muscarinic and nicotinic effects
Side effects of carbamazepine
Aplastic anemia. Monitor CBC
Side effect of citalopram
(Selective serotonin reuptake inhibitor) Sexual dysfunction
Side effect of clozapine
(atypical antipsychotic) Causes agranulocytosis and serizure
Side effect of Lamotrigine
Risk of rash (Steven-Johnson syndrome)
Side effect of Risperidone
(atypical anti-psychotic): Hyperprolactemia ( galactorrhea and amenorrhea)
Side effect of Trazodone
Painful ereection, orthostatic hypotension and sedation
Bacterial Vaginosis: Exam, Labs, Tx
Thin, off-white discharge with fishy odor. pH > 4.5, clue cells, positive whiff test. Tx: Metronidazole
Trichomoniasis: Exams, labs, Tx
Thin, yellow-green. Malodorous, frothy discharge, vaginal inflammation. pH>4.5 motile trichomonads on smear. Tx: metronidazole. Tx sexual partner
Candida vaginitis: Exam, labs, tx
Thick, white discharge with cottage cheese appearance. Normal pH, pseudohyphae. Tx: fluconazle
Pain and swelling in proximal interphalangeal, metacarpophalangeal and wrist joint. Resolves spontaneously. In children causes fever and a rash. No rheumatoid factor
Parvovirus B19 ( Erythema infectiosum)
Inulin
Filtered not secreted
Creatinine
Filtered and secreted
Urea
Filtered and poorly absorbed in the proximal tubule.
Loss of ability to abduct and laterally rotate arm
Suprascapular nerve (supraspinatus and infraspinatus)
Damage cuases paralysis of serratus anterior and winging of scapula
Long thoracic n
Fracture of surgical neck of humerus and anterior dislocation
Axillary nerve. Paralysis of deltoid and teres minor causes weakness of abduction, extension, flexion and lateral rotation of the shoulder
injury by improperly fitted crutches or fracture at the midshaft of the humerus
Radial nerve (paralysis of the extensor muscles of the forearm and wrist)= wrist drop
Holosystolic murmur that increases in intensity during inspiration
Tricuspid regurgitation. During inspiration, intrathoracic pressure drops allowing more blood to return to the heart
Mid diastolic, low pitch murmur that starts after S2 and ends before S1
Mitral stenosis
High pitched holosystolic murmur most prominent over cardiac apex. Best heard in left lateral decubitus.
Mitral regurgitation
Mid systolic ejection click that starts after S1 and ends before S2. Crescendo-decrescendo
Aortic stenosis
Diastolic murmur that starts with S2 and ends before S1. Decrescendo and may increase in intensity during inspiration. High pitched and blowing sound over 2nd and 3rd intercostal spaces.
Pulmonic regurgitation
Effect of Norepinephrine
alpha 1: vasoconstriction in skin and viscera leading to increeased systolic and diastolic BP. Beta1: increases contractility and heart rate. NE on the heart is counteracted by baroreceptor mediated reflex bradycardia that occurs following the increase in peripheral resistance. ( HR remains unchanged even after NE administration)
small, gland-like structures that contain acidophilic material (suggestive of immature follicles)
Call Exner bodies ( Granulosa-theca cell tumor)
CA-125
Found in malignant ovarian epithelial cells in serous, endometrioid and clear cell carcinoma of the ovary. Not for screening. Used to monitor therapeutic response
Tremors, agitation, anxiety, delirium, psychosis, seizure, tachycardia, palpitations
Alcohol withdrawal
Tremors, anxiety, perceptual disturbances, psychosis, insomnia, seizures, tachycardia, palpitations
BZD withdrawal
Nausea, vomiting, abdominal cramping, muscle aches, dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds
Heroin
increased appetite, hypersomnia, intense psychomotor retardation, severe depression
Stimulant (amphetamine) withdrawal
Dysphoria, irritability, anxiety, increased appetite
Nicotine withdrawal
Progressive dypsnea and dizziness on exertion
Pulmonary hypertention ( R heart cant increase cardiac output against increased pulmonary resistance during exercise) Results in chornic pulmonary hypertension leading to right ventricular hypertrophy and cor pulmonale.
progressive fatigue, lower-extremity parathesia, megaloblastic RBC
Pernicious anemia caused by auto-antibody destruction of parietal cells. Results in chronic atrophic gatritis ( loss of parietal cells and lymphocytic and plasma cell infiltration)
Mid systolic ejection click with late systolic murmur of mitral regurgitation (heart best at mitral area in cardiac apex)
Mitral valve prolapse
Syncope, Angina, Dyspnea
Severe aortic stenosis
Expression of what proteins by osteoblsats regulate bone turnover?
RANK L and Osteoprotegerin (OPG). RANK L and MSF stimulates development of mature osteoclasts. OPG acts as a decoy receotor
loss of upper extremity pain and temperature sensation. Upper extremity weakness and hyporeflexia, ower extremity weakness and hyperreflexia, Kyphoscoliosis
Syringomyelia
Gait apraxia and urinary incontinence
Normal pressure hydrocephalus
which type of kidney stone is radiolucent?
Uric acid
What is Mesna used for?
Hemorrhagic cystitis in patients on cylophosphamide. Binds acrolein ( toxic metabolite)
What is leucovorin used for?
MTX reversal
What is filgrastim used for?
Granulocyte stimulating facotor analog that is used to stimulate proliferation and differentiation of granulocytes in patients with neutropenia
What is Dexrazoxane used for?
iron chelating agent that can prevent anthracycline induced cardiotoxicity
What is Amifostine used for?
Cytoprotective free radical scavenger used to decrease cumulative nephrotoxicity associated with platinum containing and alkylating chemotherapeutic agents
Risk of thyroidectomy?
Damage to the recurrent laryngeal nerve (ligature of inferior thyroid artery) and external branch of superior paryngeal nerve (sligature of superior thyroid artery)
which nerve is at risk of being injured in an anterior shoulder dislocation?
Axillary nerve: paralysis of deltoid and teres minor. Sensory loss of upper lateral arm
Violent stretch between head and shoulder during delivery or trauma in adult results in damage to which nerves?
Upper trunk of brachial plexus (Erb Duchenne): musculocutaneous and suprascapula nerves ( adducted shoulder, protonated arm and extended elbow)
what is the route of damage by rabies?
Wound to neuron axons to salivary glands
what is the route of damage by diptheria toxin?
Fibrinous exudate to systemic circulation (bloodstream) to cortical neurons
What is the route of damage by Listeria?
Food to systemic circulation to meninges
What is the route of damage by botulinum toxin?
Food to systemic circulation to peripheral nerves
What is the route of damage by tetanus toxin?
Wound to motor neurons to spinal cord. (retrograde transport)
hydatid cysts
Dog tapeworm Echinococcus. Ingestion of food contaminated with dog feces
B12 deficiency and megaloblastic anemia after ingestion of raw freshwater fish
Diphyllobothrium (human tapeworm)
Consumption of undercooked pork
Taenia solium. Cysticercosis caused by larval stage after ingestion of eggs in excretement of carriers
Dysuria and blood in urine after bathing in lakes. Bladder wall thickening
Schistosoma from snails that contain larvae
ST elevations in V1-V4
LAD supplies interventricular septum and anterior wall of left ventricle. ST V1, V2= septum. ST V3-4: anterior left wall
ST elevations in V5 V6
Left circumflex supplies lateral wall of left ventricle (possibly also I and avL)
ST elevations in II, III, AVF
Right coronary artery occlusion
Intermittent severe abdominal pain, mesangial proliferation and crecent formation, palpable purpura on buttocks, self limited migratory arthralgies and arthritis
Henoch Schonlein purpura
Swollen lymph nodes, red eyes, high fevers, strawberry tongue, periorbital erythema, periungual desquamation
Kawasaki
Why should you avoid TCAs in pts with BPH?
Anticholinergic side effects causes urinary retention that can be exacerbated
Why do you see sedation with TCA use?
anti-histamine actions
Why do you see orthostatic hypotension with TCA?
alpha adrenegic receptor antagonist (Imipramine)
What is amiodarone used for?
supraventricular (atrial, nodal and junctional) and ventricular tachycardia
What type of arrhythmia is lidocane indicated for?
Ventricular tachycardia
What is adenosine used for?
Convert people out out PSVT
Exertional calf pain and painful foot ulcers with hypersensitivity to tabacco extract.
Thromboangiitis obliterans (Buerger’s disease) Thrombosis of aterial walls with recanalization. Tibial and radial arteries. Seen in heavy tobacco smokers. Can lead to ulcerations and gangrene of toes, feet fingers
Granulomatous inflammation of media
Temporal (giant cell) arteritis. Usually medium branches of carotid artery (temporal artery)
Transmural inflammation of arterial wall with fibrinoid necrosis
Polyarteritis nodosa
Stains positive for enolase, chromogranin and synaptophysin, neurofilaments
Small cell lung cancer
poorly developed lumbar spine resulting in floppy baby. Flaccid paralysis of legs, contractures of feet and urinary incontinence
Caual regression syndrome related to poorly controlled maternal diabetes
cocaine in pregnancy
vasocostriciton cau cause insufficient blood flow leading to spontaneous abortion, intrauterine growth retardation and placental abruption
vitamin A overdose in pregnancy
craniofacial abnormalities, posterior fossa defects, abnormalities of great vessels
Labs for hemophilia
Normal PT, Platelet, bleeding time. Increase PTT
Labs for vWF
Normal PT, PTT, platelets. Increase bleeding time
Labs for DIC
Increase PT, PTT and bleeding time. Decrease platelets
Labs for uremic platelet dysfunction
Normal PT, PTT, Platelets. Increase bleeding time
Labs after Heparin
Normal PT and bleeding time. Increased PTT
Labs with warfarin use
increase PT (PTT), normal platelets, normal bleeding time
Labs in ITP
Normal PT, PRR. Derease platelets. Increase bleeding time
Contralateral loss of pain and temperature, ipsilateral deficients of CN 5, 8, 9, 10, 11. Horner’s syndrome
PICA infarct (lateral Medullary (wallenberg) syndrome)
Which nerve can be damaged during pelvic surgery, especially in lymph node surgery?
Obturator nerve (innervates adductors)
Abduction at the thigh
Tensor fascia lata (superior gluteal) and Sartorius (femoral). Both are in the anterior compartment
Flexion of the thigh
Psoas (lumbar plexus), iliacus (femoral n), TFL and sartorius
Extension of the thigh
Gluteus maximus (inferior gluteal nerve which exists through the greater sciatic foramem)
Extention of the leg
Quadriceps ( femoral nerve)
Diastolic murmurs
mitral stenosis, aortic regurgitation
Systolic murmurs
Aortic stenosis, mitral/ tricuspid regurgitation, VSD, mitral valve prolapse
chronic diarrhea, failure to thrive, low blood T lymphocyte and decreased Ig levels
SCID due to adenosine deaminase deficiency. Adenosine accumulation is toxic to lymphocytes and results in cellular and humoral immunodeficiency. Tx: retroviral vectors have been attempted. Usually with BM transplant
Function of xanthine oxidase
forms uric acid from hypoxanthine and xanthine (purine degradation)
reddish urine that darkens on exposure to light and air
AIP due to deficiency of PBG deaminase. oxidation of PBG due to inhibition of ALAS in heme synthesis. Upregulated by CYPE450 induces and downregulated by heme and glucose
Syncope, shortness of breath when sitting and improves when laying down. Low pitched, mid-diastolic rumble at cardiac apex
Myxoma in left atrium
Increase in systolic and diastolic BP and decrease in HR
selective a1 adrenergic agonist ( phenylephrine). Increase BP causes increase vagal influence to decrease HR and conduction
First enzyme in beta oxidation
Acyl-CoA dehydrogenase
Glucose 6 phosphatase
gluconeogenesis, glycogenolysis (Von Gierke)
Acetyl coA carboxylase
Fatty acid synthesis
Glycogen phosphorylase
glycogenolysis (McArdle)
Acid maltase
Glycogen is broken down by alpha 1,4, glucosidase (acid maltase) Deficiency leads to Pompe disease
amatoxins (amanita phalloides)
Death cap mushroom. Toxin concentrates in liver cells and bind to DNA dependant RNA polymerase type II and halt mRNA synthesis. Urine test for alpha-amanitin
Stroke like episodes, muscle weakness, increase lactate post-exercise
MELAS. Mitochondrial disease that displays heteroplasmy
Difficulty swallowing, dysphonia, stridor, apnea. Leg paralysis
Arnold Chiari type II causes symptoms of compression of the medulla. Lumbar myelomeingocere leads to leg paralysis. Abnormally formed cerebellum andmedulla. Cerebellar vermis and medulla extend downward through the foramen magnum
What is phenotypic mixing in viruses?
acquisition of new viral surface proteins that is necessary for virus to infect a new type of host cell. Virus A genome obtains some surface components from virus B while both are present on same cell. ( Co-infection with 2 strains). No genetic material is exchanged so progeny are pehnotypically mixed. Next generation will have only type A surface proteins
What is reassortment in viruses?
changes in genomic composition that occur when host cells are co-infected with 2 segmented viruses that ecchange whole genome segments. Can cause suddent alterations in surface antigens of viral progeny. Genomic changes will be present in second generation
What is recombination in viruses?
exchange of genes between 2 chromosomes by crossing over in homologous regions. Genomic change will be present in second generation
What is transformation in viruses?
Incorporation of viral DNA into a host cell chromosome. Alters genetic composition of host cell but no change in progeny virus.
What is interference in viruses?
inhibition by one virus of the replication and or release of a second virus infecting the same cell. Simple interference would not result in a new progeny phenotype
What are the situations in which patient information can be disclosed?
Suspected child or elder abuse. Gunshot or stabbing injuries. Communicable disease. Patients threatening to physically harm themselves or others (or have reasonable ability to carry out threat in future)
Transplant rejection: hyperacute
Minutes to hours. Preformed antibodies against graft in recipient circulation. Grossy mottling and cyanosis. Arterial fibrinoid necrosis and capillary thrombotic occlusion
Transplant rejection: acute
Less than 6 months. Exposure to donor antigen induces humoral or cellular activation of na¥ve immune cells Humoral (C4d deposition, neutrophilic infiltrate, necrotizing vasculitis) Cellular (lymphocytic interstitial infiltrate and endotheliitis)
Tranplant rejection: chronic
Months to years. Chronic, low grade immune response refractory to immunosuppresants. Vascular wall thickening and luminal narrowing. Interstitial fibrosis and parenchyma atrophy
Type II hypersensitivity
Antibody mediated reaction caused by preformed IgG antibodies. Hyperacute transplant rejection. Anti-ABO antibodies and anti-HLA antibodies.
Type IV hypersensitivity
Cell mediated HSR. Acute or chronic solid organ transplant rejection. TB skin test. Contact dermatitis
Graft vs host disease
competent donor T cells are transplanted into immunocompromised patient that attacks the recipient organs
Immediate hypersensitivity
Type I hypersensitivity reactions occur in sensitized individuals following an exposure to an antigen that binds preexisting igE on mast cells. Mast cell activation causes release of histamine and leukotrienes that cause vasodilation, vascular leakage
Type III hypersensitivity
deposition of antigen-antibody complexes in small vessels. Complexes lead to complement activiation and release of chemotactic mediates that lead to inflammation and tissue damage (SLE, PSGN and serum sickness)
Hypercoagulability, premature atherosclerosis. Elevated methionine
Homocystinuria is a defect in cystathionine beta synthase which converts homocystine to cystathionine. Requires cysteine and B6
Blow to the anterior proximal tibia
PCL
Acute sharp pain is carried by which type of fibers
A delta fibers (thin myelinated). Constitute reflex arc.
Muscle spindles are innervated by?
Group Ia and group II sensory axons and sensitive to changes in muscle length. Mediat the stretch reflex. When muscle is stretched, there is monosynaptic reflex activation of alpha motor neuron causes contract that resists stretch
Pacinian corpuscles vs Ruffian
Pacinian corpuscles are rapidly adapting mechanoreceptors and Ruffini’s end organs are slowly adapting. Both mediate touch, proprioception and vibratocy sensation and innervated by myelinated A-Beta fibers
Tall with disproportionally short upper and lower extremities, large head and prominent forehead
Achondroplasia: inherited autosomal dominant mutation in FGF3
Triad of findings on EKG for WPW
shortened PR, delta wave at QRS and widened QRS
selective beta blockers
Metoprolol, atenolol, esmolol, acebutolol
Hypokalemia with muscle weakness, paresthesias
Hyperaldosteronism leading to hypokalemia
wide fixed splitting of S2
ASD (left to right shunt)
Which enzymes require thiamine, lipoic acid, CoA, FAD, NAD
pyruvate dehydrogenase, alpha kg dehydrogenase, Transketolase
Primary oocytes are arrested in?
prophase of meiosis I
secondary oocytes are arrested in?
Metaphase in meiosis II
which toxins activate adenylate cyclase?
Pertussis, Edema factor (B.anthracis), heat labile toxin (ETEC), Campylobacter (enterotoxin), Heat labile toxin (B. cereus), V. cholera
Which toxins activate guanylate cyclase?
ETEC (heat stable toxin), Yersinia (watery diarrhea)
Which toxins inactivate elongation factor 2?
Diptheria, Pseudomonas (Exotoxin A) by causing ADP ribosylation
Which toxins disrupt cytoskeleton?
C. diff (toxin B) Depolymerizing actin leads to cell death
Easily fatigability, constipation, bone pain, renal failure, obstructing eosinophilic casts
Multiple myeloma
Drug of choice for status epilepticus?
IV lorazepam (administered with phenytoin or fosphenytoin)
Side effects of cholinergic agonist?
Smooth muscle contractions of GI causes nausea, vomiting, cramps and diarrhea. Decrease HR, cardiac conduction and contractility. Hypotension. Increased secretions leads to excessive sweating, salivation and lacrimation. Bronconstriction and bronchial secretions
Bethanechol
stimulates peristalsis in postoperative ileus and atonic bladder
Carbachol and pilocarpine
lower intraocular pressure in (miosis causes iris to move further from cornea to widen the anterior chamber angle and allow outflow of aquesou humor)
Intense perianal itching
Enterobiasis (pinworm)
Hyponatremia, hyperkalemia, hypoglycemia with shock.
Adrenal crisis
