UW Flashcards
What would you see where an MI took place on histo about 2 months later
Dense collagenous scar composed primarily of type I collagen
*type 1 collagen also found in dermis, bone, TENDONS, LIGAMENTS, dentin, cornea, blood vessels
What are white, lacy markings that can be seen with chronic Lichen Planus?
Wickham striae
Although simple mitochondrial swelling may be associated w/ reversible cellular injury, what mitochondrial finding is associated w/ IRReversible
Appearance of vacuoles and phospholipid-containing amorphous densities within mitochondria
What class of medications inhibits the phosphodiester bond formation by HIV enzyme reverse transcriptase? How do these drugs cause this?
Nucleoside reverse transcriptase inhibitors (NRTIs).
NRTIs don’t have a 3’-hydroxyl group. When reverse transcriptase incorporates an NRTI into a growing DNA strand, it results in chain termination because no 3’-hydroxyl group is available to add additional base pairs
What are the two Epithelial ovarian neoplasms in which you would see an increase in CA-125?
Epithelial—> serous cystadenocarcinoma, and mucinous cystadenocarcinoma
What does Methionine synthase do?
what cofactor does it need?
Converts homocysteine into methionine
Needs B12, folate
Activation of the RAS/MAP kinase pathway by insulin leads to?
Mitogenic functions such as DNA synthesis and cell growth.
Diphenoxylate, meperidine are what?
Diarrhea drugs. Diphenoxylate is combined with atropine to make people not abuse it.
What kind of nerve inflammation is present in polymyositis?
Endomysial inflammatory infiltration
What is the mechanism of penicillins and cephalosporins?
Irreversible binding to pcn-binding proteins such as transpeptidases.
Which CYP-450 enzyme metabolizes the statin drugs, and erythromycin? What can this cause? Which statin is not metabolized by this CYP?
CYP-450 3A4
Increased serum levels of statin, which is in turn associated with increased risk for myopathy.
Pravastatin is not metabolized by CYP450 3A4
What are two diuretics that provide an improval in survival for CHF and reduced LV ejection fraction patients?
Mineralocorticoid receptor antagonists: spironolactone, eplerenone. They work by blocking the deleterious effects of aldosterone on the heart (remodeling)
Why do people with sarcoidosis have high ACE levels and hypercalcemia?
Activated macrophages can ectopically produce ACE and 1-alpha-hydroxylase (increases production of 1,25-dihydroxycholecalciferol, the active form of vitamin D).
Patient has:
- external female genitalia
- blind-ended vaginal pouch, uterine agenesis
- scant/missing pubic hair
- presents for primary amenorrhea
Complete androgen insensitivity
What drug is required to kill the liver hypnozoites of P. Vivax/Ovale?
Primaquine
APC, BRCA1, RB, and TP53 are all what?
Tumor suppressor genes
Testosterone, secreted by Leydig cells, differentiates the mesonephric duct into male internal genitalia including?
Seminal vesicles, epididymis, ejaculatory duct, ductus deferens
NOT the prostate
Tay Sach’s
“A GANG of 6 SMALL JEWS” Enzyme: HEXosaminidase A Buildup: GM2 GANGlioside **cherry red spot** **ashkenazi jews** **NO HEPATOSPLENOMEGALY, because they are SMALL jews**
What is the MOA of Acetaminophen
Where does it act
Toxic metabolite, antidote
Reversibly inhibits cyclooxygenase, but mostly in CNS. Inactivated peripherally.
Antipyretic, analgesic, but NOT anti-inflammatory. Use this instead of aspirin with kids.
Overdose makes NAPQI toxin, depletes glutathione.
N-acetylcysteine is antidote
What are the broad-spectrum anticonvulsants and what are they used for
Lamotrigine, Levetiracetam, Topiramate, Valproic Acid
- Generalized seizures (involve both hemispheres at onset)
- Generalized seizures include Tonic-Clonic, Myoclonic, and Absence
High insulin levels despite low blood sugar is likely a mutation in which channel
Katp channel mutation causing increased affinity for ATP that results in fewer open channels and depolarization at lower glucose concentrations
MAAM
COCO
Mnemonic for Pressure Volume loop
Starting from bottom right, going counter clockwise Mv Close Av Open Av Close Mv Open
What is Power in statistics? How is Power related to sample size?
Power=1-Beta
Sample size and power are related in that studies with a larger sample size have greater power to detect differences if THEY EXIST
What drug class blocks the formation of Arachidonic acid from membrane phospholipids by inhibiting Phospholipase A2?
Glucocorticoids (corticosteroids)
What is germ cell ovarian neoplasm that has increased AFP, is aggressive, and has glomeruli resembling bodies?
Endodermal sinus (yolk sac) tumor. Schiller Duval Bodies
PSaMMoma bodies
Papillary thyroid cancer
Serous ovarian cancer
Meningioma
Mesothelioma
What are three notable changes of a AR tracing?
- loss of dichrotic notch, which is NORMALLY created by a small and abrupt increase in aortic pressure as blood is secured in the aorta by closure of the aortic valve
- steep diastolic decline of aortic pressure, drops to lower level: makes sense because it is leaking back into the LV
Discuss the physiology of high altitude
Low PiO2–>hypoxemia (low PaO2)—>carotid bodies stimulate hyperventilation (due to hypoxemia) leading to increased exhalation of CO2, leading to respiratory alkalosis. Over several days kidneys compensate by increasing bicarb EXcretion.
Lac operon: repressor interacts w/ what?
Repressor binds the operator preventing binding of RNA polymerase
Describe excitation-contraction coupling in cardiomyocytes
Voltage dependent Ca channels (L-type) permit influx of calcium—>influx sensed by ryanodine receptors in the sarcoplasmic reticulum—>further release of calcium (calcium-induced calcium release)into the cytoplasm—>calcium from sarc ret diffuse through myofilament network and bind troponin C—>Tropomyosin is then moved out of the way so actin/myosin can interact.
Final stage is myocite relaxation; subsequent to calcium efflux. Primarily done via Na/Ca exchange pump and Ca-ATPase pump on Sarc Ret.NCX pump removes one intracellular calcium in exchange for 3 extracellular sodiums
What is hartnup disease?
Impaired transport of neutral amino acids in the small intestine and proximal tubules (neutral aa: alanine,serine, threonine, valine, leucine, isoleucine, phenylalanine, tyrosine, tryptophan). Symptoms include pellagra-like skin eruptions and cerebellar ataxia, which occur as a result of niacin deficiency.
What are the two short acting benzos w/ half lifes less than 6 hours?
Triazolam, midazolam
What does the metanephric blastema (mesoderm) give rise to? x5 things
Glomeruli Bowman’s space Proximal tubules Loop of henle Distal convoluted tubules
Where are the left ventricular leads in biventricular pacemakers placed?
They are coursed through the coronary sinus, which resides in the AV groove on the posterior aspect of the heart.
Timeline of MI: what do you see from 7-10 days
Robust phagocytosis of dead cells by macrophages
Beginning formation of granulation tisse at margins
When would you see coagulation necrosis and marginal contraction band necrosis?
12-24 hours
What are the genetics of NF1?
Single-gene autosomal dominant disorder.
NF1 has high penetrance (most ppl who inherit gene develop disease in some form) but has high variability (often times all of the typical symptoms)
Which murmur is heard best at the base of the heart and radiates into the carotids? Hint: systolic crescendo-decrescendo murmur
Aortic stenosis
lac p region of lac operon is the binding site for?
RNA polymerase during the initiation of transcription
What does the ureteric bud give rise to?
Collecting system: collecting tubules/ducts, major and minor calyces, renal pelvis, and ureters
What enzyme from neutrophils is responsible for the green color of pus and sputum in bacterial infections?
Neutrophil myeloperoxidase
Which sex cord (stromal) ovarian tumor exhibits an increase in estrogen (post meno bleeding), and granulosa cells arranged haphazardly aroudn collections of eosinophilic fluid that resemble primordial follicles?
Granulosa cell tumor
Call-Exner bodies, Coffee bean nuclei
coffee bean nuclei also seen in Brenner tumors
What are the lab values for platelets, PT, PTT in Von Willebrand disease
Autosomal dominant
Normal platelets, normal PT, either normal or prolonged PTT due to low levels of factor VIII
Pjirovecii can’t be cultured, requires ID using methanamine silver stain to located the crescent shaped pathogens in respiratory secretions. How do you treat?
TMP-SMX
What disorder is marked by thrombocytopenia (Platelets decreased) and NORMAL PT/PTT?
ITP: autoimmune disease assoicated with immune-mediated platelet destruction. Type II HSR, Anti-GpIIb/IIIa antibodies
Which two drugs are Leukotriene receptor antagonists that block the formation of LTC4, LTD4, and LTE4 and thus prevent an increase in bronchial tone?
monteLUkast
zafirLUkast
What do snRNPs do?
RNA splicing: removal of introns by splicesomes, which consist of snRNPs and other proteins
How do you calculate TPR of vessels in series?
1/TPR=1/R1+1/R2+1/R3 etc
Lipopolysaccharide of G(-) bacteria can initiate a signal cascade that results in the destruction of IkappaB and translocation of free (what) to the nucleus?
NF-kB
What secretes MIF and what is the purpose of MIF?
MIF is secreted by embryonic testes (sertoli cells); it is responsible for the regression of the paramesonephric (mullerian) ducts that normally give rise to internal female genitalia.
Blood cultures incubated for 3 hours at 37C show sphere with bud on it
Inoculation of candida albicans into the serum at 37C for 3 hours leads to the formation of true hyphae from the yeast, these growing hyphae are called “germ tubes”
What is cord factor, and what does it do?
Surface glycolipid on the cell wall of TB, primary virulence factor; prevents macrophages from being bactericidal due to the inhibition of phagolysosome acidification and also leads to the formation of caseating granulomas
What parts of the pancreas does the VENTRAL bud contribute
Uncinate process and main pancreatic duct
What are 5 drugs associated with drug-induced lupus?
Hydralazine, Procainamide, Isoniazid, Minocycline, and Quinidine
Transplant becomes cyanotic and mottled after anastomosis within minutes to hours. What type of rejection? What is etiology?
This is a hyperacute rejection; preformed antibodies against graft in recipient’s circulation. This is a type II HSR with IgG abs. anti-ABO and anti-HLA
What does Fomepizole do, and what is it used for?
Blocks Alcohol Dehydrogenase; antidote for Methanol or Ethylene glycol. It decreases conversion rate of poision into a toxic metabolite. Formic acid is the toxic agent eventually made from methanol intox (retinal injury/blindness). Glycolic acid (renal tubular tox) and Oxalic acid (crystalline precip within renal tubules) are the two toxic metabolites from Ethylene glycol
What is Suvorexant?
- moa:
- contraindications
Orexin (hypocretin) receptor antagonist that is used for insomnia.
Contraindicated for use with CYP3A4 inhibitors.
Orexin~lateral hypothalamus
What is it called when a constant amount of drug is metabolized and eliminated per unit of time regardless of its concenration or dose?
Zero order kinetics
5a-reductase deficiency
Inability to convert testosterone into DHT, so you get male internal genitalia but ambiguous external genitalia UNTIL puberty when increased testosterone levels cause masculinization
When would you see granulation tissue and neovascularization?
When would you see collagen deposition/scar formation
10-14 days
2 weeks to 2 months
How does Flutamide work?
Competitive testosterone receptor inhibitor.
Who is especially susceptible to infection with the CURVED, GRAM (-) rod, Vibrio Vulnificus?
People with hx of liver disease. Especially hemochromatosis as free iron acts as an exponential catalyst for the bacterium
What are two first line agents for treating localized psoriasis?
-how do they work
Topical corticosteroids and vitamin D analogs.
Vitamin D analogs inhibit T-cell and keratinocyte proliferation and stimulate keratinocyte differentiation. Corticosteroids also have anti-inflammatory and antiproliferative properties; their mechanism of action is complementary to the vitamin d analogs
In pregnancy, DIC is mediated by what?
-where is this found in high concentration?
DIC is mediated by tissue factor (thromboplastin) in pregnancy. Tissue factor is found in high concentration in the placental trophoblast.
What is a Recombinant Uricase drug that catalyzes uric acid to allantoin (a more water-soluble product)
Pegloticase
What is the MOA of phentolamine?
Reversible nonselective alpha blocker, used for patients on MAO inhibitors who eat tyramine-containing foods and for severe cocaine-induced HTN
Lesion to which part of the cerebellum is associated with Truncal ataxia, possible degerneration associated with alcohol use?
Vermis: “wide-based, drunken sailor gait”
Mutation in the CYP19A1 gene
Aromatase deficiency—> decrease in serum estrogen and increase in serum testosterone. This is because aromatase converts testosterone to estradiol, and androstenedione to estrone.
What is PGI2?
Analog?
PGI2 is a prostacyclin that decreases platelet aggregation, and decreases vascular tone.
Epoprostenol
How does ADH work?
- binds to which receptor on principal cell
- second messenger system
Stimulates V2 receptors on principal cells in the renal collecting ducts, activating a cAMP second-messenger G-protein system that leads to insertion of endosomes contaning aquaporin 2 into the apical cell membrane.
How does the intestinal phase of acid secretion actually down-regulate gastric acid secretion? What peptide is release by the ileum/colon?
Peptide YY is released from the ileum and colon which binds to receptors on the endocrine, histamine-containing cells described as ECLs. Such binding counteracts the cephalic and gastric phases of acid secretion by inhibiting gastrin-stimulated histamine release from ECLs.
What are the four intermediate halflife 6-50 benzos?
Oxazepam, alprazolam, lorazepam, clonazepam
What stage of the cell cycle is the oocyte most likely arrested in immediately prior to fertilization?
Metaphase of meiosis II*****
What two toxins bind to Na channels, keeping them open and causing persistent depolarization?
CIguatoxin (exotic fish, moray eel) and Batrachotoxin (south american frogs)
Describe the effect on Urea excretion that ADH has
ADH produces V2 mediated increase in water permeability within the cortical and medullary collecting ducts. As water leaves, urea concentration goes way up.
- cortical collecting duct is imperable to urea
- vasopressin activates urea transporters in the medullary collecting duct, increasing urea reabsorption and decreasing renal urea clearance. This increases medullary osmotic gradient allowing for increased urine concentration.
Angioedema due to excess bradykinin can be caused by two different entities: C1 inhibitor deficiency, and which medication?
-what symptoms are missing with this type of angioedema?
- ace inhibitors
- no itching or hives
What are Auer rods and which cancer are they seen in
Fused lysosomal granules are seen in APL, which is a subtype of AML.
How does an erythrocyte bypass the step in glycolysis where 1,3-BPG is converted to 3-phosphoglycerate by the enzyme phosphoglycerate kinase? (ATP generating step of glycoslysis)
They use bisphosphoglycerate mutase; which converts 1,3-BPG to 2,3-BPG in a step that produces no ATP. They do this because in times of hypoxia you want to have more 2,3-BPG as it shifts the curve to the right, decreasing Hb affinity for O2 and thus delivering more oxygen to the tissues.
What is an immune mediated disease characterized histologically by cytokine-drive acathosis (with CLUBBED rete ridges), keratinocyte hyperproliferation, and parakeratosis?
Psoriasis
What intensifies the holosystolic murmur of Tricuspid Regurgitation?
Maneuvers that increase right ventricular preload such as deep inspiration, leg raise
Developmental anomaly characterized by hypoplasia/absence of the cerebellar vermis, and cystic dilation of the fourth ventricle with posterior fossa enlargement
Dandy-Walker malformation
Multiple small plasmodium rings representing developing trophozoites in RBCs: which species
Falciparum
What are two Low-potency First-generation antipsychotics
-side effects
Chlorpromazine, Thioridazine
SE: sedation (histaminergic blockade), Anticholinergic side effects (cholinergic blockade), Orthostatic hypotension (alpha-1 adrenergic blockade)
How do you tell difference between dry and wet beriberi?
Beriberi is thiamine deficiency.
Dry shows symmetrical peripheral neuropathy of distal extremities with resulting sensory and motor impairments
Wet includes the addition of cardiac involvement (cardiomyopathy, HO chf, peripheral edema, and tachycardia)
Common drugs that are metabolized slowly in “slow acetylators” (i.e. might see bimodal distribution on graph)
Isoniazid, Dapsone, Hydralazine, Procainamide
The Env gene of HIV codes two products; what are they and what are their functions?
gp120: surface protein-binds CD4 and coreceptors CCR5 (macrophages) and CXCR4 (Tcells), CCR5 (maraviroc) happens early on, CXCR4 later.
gp41: transmembrane protein for viral fusion to host cell
Timeline of MI: what would you see from 3-7 days
Disintegration of dead neutrophils and myofibers
Macrophage infiltration at border areas
PGF2a
What is it
Analog
Prostaglandin that increases uterine tone
Carboprost
What type of receptors cause an immediate influx of Na and Ca into the cell and an outflux of K from the cell?
Nicotinic receptors are ligand-gated ion channels that open after binding acetylcholine
What type of cell junction is associated with connexin-43?
Gap junction
Atrial flutter is caused by a large reentrant circuit that traverses what?
Traverses the cavotricuspid isthmus, the region of right atrial tissue between the inferior vena cava and the tricuspid valve annulus. Afib often originates in pulmonary vein ostia
What is the preferred initial treatment in patients w/ suspected cocaine induced myocardial ischemia? Why
Benzos; decrease sympathetic outflow and psychomotor agitation to help reduce hypertension and tachycardia and alleviate myocardial ischemia.
How does Ethosuximide work?
Blocks thalamic T-type Calcium channels
What is in the superior orbital fissure?
CN III,IV, V1 (opthalmic), Opthalmic vein, sympathetic fibers
What lab should you run before starting metformin and why
CrCl, because lactic acidosis is more common in patients w/ underlying renal insufficiency
How does rasburicase work?
Recombinant uricase that catalyzes metabolism of uric acid to allantoin; prevents and treats tumor lysis syndrome
When would you see macrophage phagocytosis of dead cells?
5-10 days
How does nontoxigenic C diphtheriae convert into a toxigenic form?
Infection with a lysogenic bacteriophage called Corynephage beta. Inserts the TOX gene into the C. Diptheriae genome, which results in the bacterial expression of the diphtheria AB toxin.
How would you get left (or right) homonymous inferior quadrantanopia? “Pie on the floor”
Right parietal lobe (dorsal optic radiation) lesion
Gaucher Disease
in a crying voice “oh my GAUCH, he’s such a BRO”
Enzyme: glucocereBROsidase
Buildup: glucocereBROsides
crying voice because of tissue paper cytoplasm
Which hemoglobin results from a mutation in the B-globin chain that causes glutamate to be replaced by lysine?
-types of crystals formed?
HbC, forms hexagonal crystals and promotes red cell dehydration, causing a mild chronic hemolytic anemia.
Neisseria gonorrhea is grown on Thayer-Martin VCN selective medium, what does the medium contain?
Vancomycin, Colistin, Nystatin, and trimethoprim.
Vanc kills the gram positives, colistin/tmp kill gram (-)’s besides N.Gonorrhea, and fungi are killed by nystatin
Impairment of the ubiquitin-proteasome system can contribute to development of neurodegernerative disorders such as Parkinson’s and alzheimer’s diseases. Failure of the system to properly degrade abnormal proteins eventually causes cell death. What is the role of Parkin, PINK1, and DJ-1? What happens when mutated?
Parkin, PINK1, DJ-1 genes code for a protein complex that promotes the degradation of misfolded proteins via the ubiquitin-proteasome system. Mutations in these genes are associated with autosomal recessive forms of Parkinson’s disease that have early age of onset less than 50 years.
What happens in the nucleolus?
Primary site of ribosomal RNA (rRNA) transcription
What is observer (expectancy)bias?
Occurs when investigators misclassify data due to preconceived expectations or prior knowledge concerning the study or its participants
Malignant tumor that arises from the trophoblast, often preceded by normal pregnancy (or molar,ectopic,aborted), abnormal bleeding, uterine enlargement, and significantly increased B-hCG?
Gestational Choriocarcinoma
What amino acid is methionine converted into?
Cysteine
What two fish toxins act by inhibiting sodium channels and preventing action potential conduction?
Tetrodotoxin (puffer) and Saxitoxin (dinoflagellates in red tide)
Fabry Disease
“My FABRite activity is CERAmics. We made a GALA(X)y”
Enzyme: Alpha-GALActosidase A
Buildup: CERAmide trihexoside (aka globotriaosylceramide)
X-linked
Chikungunya, which means stooped walk, is what type of virus? Where is it prevalent?
Alphavirus, prevalent in tropical and subtropical climates (puerto rico, africa, asia, indian/pacific islands)
Which ovarian germ cell tumor has increased B-hCG, increased LDH*, and has a Fried-Egg histology similar to a Seminoma in males?
Dysgerminoma
Where do thin (actin) and thick (myosin) filaments bind to structural proteins?
Thin (actin) binds to structural proteins at the Z line, whereas thick (myosin) filaments in the A band are bound to structural proteins at the M line
Opening snap followed by delayed rumbling mid-to-late diastolic murmur 5th ICS Midclavicular?
Distance between S2 and Opening Snap indicates what
Mitral stenosis
Decreasing interval between S2 and OS correlates with increasing severity.
Tryptophan is an essential amino acid and precursor for what three things?
Niacin, serotonin, melatonin
What is the last structure to disappear from respiratory epithelium from proximal to alveolar duct?
Cilia
What does cystathione B-synthase do?
What cofactors does it need?
Combines homocysteine+serine into cystathionine.
Needs vitamin B6
Insulin can activate the PI3K pathway, which promotes glycogen synthesis by activating which enzyme?
Protein phosphatase, an enzyme that dephosphorylates glycogen synthase, leading to its activation
Aspergillomas often colonize what?
Develop in old lung cavities (from tb, emphysema, sarcoid). Hemoptysis is common
What are the DPP4 inhibitors
- moa
- side effects
Linagliptin, saxagliptin, stiagliptin
Inhibit DPP-4 enzyme that deactivates GLP-1. Reduce glucagon release, and gastric emptying. Increase glucose-dependent insulin release, satiety
-mild urinary/ respiratory infections. Weight neutral
Exotoxin that binds to invariant region of the MHC-II complex of APC’s without first being internalized and processed
Pyrogenic toxin superantigens of S. Aureus and S. Pyogenes
How does Metformin work, who should you not give it to, and what is a possible adverse reaction?
Stimulate AMPK, inhibit mitochondrial gluconeogenesis, decrease hepatic glucose production, increase peripheral glucose uptake
contraindicated in renal failure patients
Diarrhea, LACTIC ACIDOSIS are important side effects
The pol gene of HIV encodes three enzymes; what are they and what are their functions?
Reverse Transcriptase: produces dsDNA provirus
Integrase: viral DNA integration into host cell.
Protease: Cleaves viral polyprotein
Alkaptonuria
Homogentisate oxidase deficiency
In chloroquine resistant areas, what can be used to kill erythrocytic forms of plasmodium?
Atovaquone-proguanil, and artemisinins
1st line for trigeminal neuralgia
Carbamazepine
What does ornithine transcarbamylase do and where is this enzyme found?
Catalyzes combination of ornithine and carbamoyl phosphate to form citrulline in the urea cycle.
What is a pyrophosphate analogg that is sometimes used for ganciclovir-resistant CMV infections? What are its risks?
Foscarnet
Foscarnet can chelate calcium. Foscarnet can induce renal wasting of magnesium and may lead to hypomagnesemia and a reduction in the release of PTH, which contributes to to the hypocalcemic state. Both hypocalcemia and hypomagnesemia can promote seizures.
How does the flu vaccine work?
Inactivated versions of the flu vaccine (intramuscular) stimulate the formation of neutralizing abs against HEMAGGLUTININ; subsequent exposure will prevent hemagluttinin from attaching to the SIALIC ACID receptor on host cells; thereby preventing viral entry**
Diffusely anaplastic/necrotic gestational trophoblastic neoplasm with vascular invasion, absent villi, that most commonly metz to the lungs?
Gestational Choriocarcinoma
What is the histology of Guillain-Barre syndrome?
Inflammatory infiltrate located within the endoneurium (innermost layer of connective tissue that surround a nerve axon and its corresponding blood vessels). Infiltrate contains lymphoytes and macrophages. Macrophages strip myelin sheath from axon, and lipid laden macrophages are seen following engulfment of myelin.
When Granulosa cells are stimulated by FSH, what do they secrete?
Aromatase
What exotoxin acts at the level of the anterior horn cells, blocking inhibitory neurotransmission
Tetanospasmin; travels retrograde.
C.tetani is a gram positive rod w/ a round terminal spore that grows in strict anaerobic conditions.
What is the postcentral gyrus
Primary somatosensory
The surface receptor for insulin is a transmembrane protein w/ intrinsic tyrosine kinase activity in its cytoplasmic domain. Insulin binding activates tyrosine kinase, leading to phosphorylation of IRS-1 (insulin receptor substrate-1). What are the two pathways that can be activated by IRS-1?
PI3K pathway, and RAS/MAP kinase pathway
What does 2,3-BPG do to hemoglobin binding?
Reduces the oxygen affinity of hemoglobin, allowing more oxygen to diffuse into the peripheral tissues
Valproate, lithium, lamotrigine, quetiapine
Bipolar
Normally, after delivery when the cord is clamped left atrial pressure becomes higher than right atrial, two things fuse between the atria, what are they? What happens if they dont fuse?
Septum primum, Septum secundum.
Patent foramen ovale; normally remains closed, but if patient does a valsalva release (^RA pressure) there could be a cryptogenic stroke. This is even more worrysome in patients in hypercoagulable states like OCPs.
Histology of true vocal cords and significance
Stratified squamous; HPV
In 3 Great Styles (but don’t tell)
3rd arch, Internal carotid, Glossopharyngeal nerve IX, STYLOpharyngeus m.
Patient has a struvite stone; what would their urine pH be and why?
pH would be high because urease-producing organisms (Proteus, Klebsiella) are the type of oranisms that lead to staghorn calculi. Hydrolysis of urea yields ammonia, which alkalinizes the urine and facilitates precipitation of struvite crystals.
Male pseudohermaphroditism, in which the internal genitalia developed normally under the influence of testosterone, but the external genitalia didnt develop propery due to lack of DHT, is caused by a deficiency in which enzyme?
5a-reductase
PGE1
What is it
Analog
Prostaglandin that decreases vascular tone
Alprostadil
When is fetal hemoglobin synthesized and what chains does it have?
8 weeks until term, consists of the usual 2 alpha chains but has 2 gamma chains in place of beta chains.
What happens to the levels of alpha ketoglutarate during hyperammonemia? What does the change in a-ketoglutarate inhibit?
depleted, which inhibits the TCA cycle
Niemann-Pick
“PICK your BIG nose with your SPHINGER” Enzyme: SPHINGomyelinase Buildup: SPHINGomyelin **Cherry red spot** **HEPATOSPLENOMEGALY** (BIG nose) **Ashkenazi jews**
What is the first line therapy for moderate to severe alcohol use disorders? What is its MOA?
Naltrexone; opioid agonist
If twins are male/female, or question says they are fraternal twins; what will they always be as far as chorion/amnion?
Dichorionic diamniotic (whereas if identical only 25% are dichorionic diamniotic; 75% are monochorionic diamniotic)
Pergolide is a dopamine agonist which directly stimulates which dopamine receptors in order to delay the need to use Levodopa therapy?
D2 receptors
What are the four Motor syndromes that are Midline?
Medial longitudinal Fasciculus
Motor Tract of the UMN (corticospinal Tract)
Medial Lemniscus (proprioception/vibration)
Motor Nuclei of CN
What is the effect of standing on a hypertrophic cardiomopathy murmur? What is the effect of valsalva strain phase?
- Standing decreases LV volume, worsens obstruction and accentuates murmur
- Valsalva strain phase also decreases LV volume and increases the outflow obstruction
What does Squatting do to a hypertrophic cardiomyopathy murmur? Supine leg raise? Handgrip?
Increases LV volume, lessens obstruction, decreases murmur. Same w/ supine leg raise and handgrip
Sick sinus syndrome most commonly results from age-related degeneration of the SA node. Where is this located?
Right atrial wall
Which artery is usually responsible for blood flow to the SA and AV node? What type of MI do you see bradycardia in?
RCA
What drug blocks the conversion of Arachidonic acid to 5-HPETE
-MOA
ZiLEUton is an antiLEUkotriene, prevents the formation of the leukotrienes
What are the 2 classes of dopamine agonists used in PD? What drugs do they include?
Ergot compounds: bromocriptine
Nonergot compounds: pramipexole, ropinirole
Patient is mad at parents for them getting a divorce, but can’t recognize that himself. Tells physician his parents are angry with him. What is this defense mechanism
This is projection; which is immature defense mechanism that involves misattributing undersired thoughts or feelings to another person who does not actually have them to avoid acknowledgement in oneself.
Periportal “pipestem” fibrosis
Hepatic Schistosomiasis
Timeline of MI: what would you see from 12-24 hours?
Myocyte hypereosinophilia w/ pyknotic (shrunken) nuclei
Where does the trigeminal nerve exit the brainstem?
At the lateral aspect of the mid-pons at the level of the MIDDLE CEREBELLAR PEDUNCLES
Patient gets itchy after hot shower, KIT receptor tyrosine kinase mutation. Why do they get increased gastric acid?
This is systemic mastocytosis; a clonal mast cell proliferation. Excessive histamine release from degranulation of mast cells leads to syncope, flushing, hypotension, pruitus, and urticaria. Also leads to increased gastric acid, eventually astric ulceration.
Cancers that express PD-L1 bind to the PD-1 receptor on T-cell surface and inhibit T-cell response by causing exhaustion. How can these tumors be treated?
- 2 drugs against PD-1 receptor on Tcells
- drug effective against PD-1 ligand on cancer cells
- Pembrolizumab and nivolumab bind PD-1 receptor on T cells
- Atezolizumab binds the PD-1 ligand on cancer cells
Aortic stenosis leads to pressure overload and hypertrophy of LV. What type of hypertrophy and how are the sarcomeres added?
Concentric LV hypertrophy in which the sarcomeres are added in parallel.
What disorder is characterized by 1 or more hallucinations lasting longer than a month, that has normal functioning apart from direct impact of delusions?
Delusional disorder
Ventromedial Nucleus
Center of satiey
How is the lac operon negatively and positively regulated?
Negatively: binding of the repressor protein to the operator locus
Positively: by cAMP-CAP binding upstream from the promoter region
Describe the process of HBV binding, uncoating, transcription, translation, and budding
Binds to bile salt transporter on the surface of hepatocytes and enters the cell. After the virus is uncoated in the host cytoplasm, the single-stranded DNA portion of the viral genome is completed (repaired) by cellular DNA polymerases.
This generates a double-stranded viral DNA, which is then subsequently transcribed by host RNA polymerase into a + single-stranded RNA pregenome.
What type of toxinis the diphtheria AB toxin?
Exotoxin
Irreversibly halts protein synthesis due to ADP-ribosylation of elongation factor-2.
The gag gene of HIV codes three products, what are they and what are their functions?
- p24 is the capsid protein
- p17 is matrix protein
- p7 is core nucleocapsid proteins
What are the long half life>50 hour benzos (3)
Diazepam, chlordiazepoxide, flurazepam
Pseudohyphase w/ blastoconidia that invades a catheter site?
Candida
What cranial nerves are in the midbrain?
3,4 both medial
What is most likely if acetylcholisterase and alpha-fetoprotein are seen in the amniotic fluid?
Neural tube defect: occurs due to failure of fusion of the neural plate edges during the 4th week of fetal development. Rostral neuropore failure leads to anencephaly; caudal neuropore failure leads to spina bifida.
Marfanoid habitus, ectopia lentis (downward/medially aka inferonasal), intellectual disability, increased thrombotic events
Homocystinuria: defect in Cystathione B-Synthase
If you fuck with the positively charged amino acids (histidine/lysine) of the 2,3-BPG binding groove and make them less positive, what happens?
Since negatively charged 2,3-BPG phosphate groups are attracted to the normal positively charged binding groove, if it becomes less positive you will have less 2,3-BPG binding. Less 2,3-BPG means an INCREASE in hemoglobin oxygen affinity
What do both pancreatic buds contribute to?
head
Early diastolic decrescendo murmur best heard when patient leans forward?
Aortic regurg
Why does HbS aggregate in the deoxygenated state?
Nonpolar amino acid, valine, replaces the charged amino acid glutamate at position 6. This results in alteration of a hydrophobic portion of the beta globulin chain that fits into a complementary site on the alpha globin chain of another hemoglobin molecule.
How does the inhalation of amyl nitrite help someone with cyanide poisoning?
Nitrite oxidizes ferrous iron present in hemoglobin to ferric 3+ iron generating METHEMOGLOBIN. methemoglobin is incapable of carrying oxygen, but has a high affinity for cyanide. It binds and sequesters cyanide in the blood, freeing it from cytochrome oxidase and limiting its toxic effects.
Hydroxycobalamin and sodium thiosulfate also treat cyanide poisoning.
What are the narrow spectrum anticonvulsants, and what are they generally used for ?
Carbamazepine, Gabapentin, Phenobarbital, Phenytoin
-used for focal-onset seizures. Focal meaning involves 1 cerebral hemisphere at onset.
What cranial nerves are in the pons?
6 medial
5,7,8 lateral
Timeline of MI: 10-14 days
Well-developed granulation tissue with neovascularization
What is the precentral gyrus
Motor
What are known as gram(+) cocci in CHAINS?
What does Do U <3 trees stand for?
Enterococcus (group D strep)
-Catalase (-), PYR(+), hydrolyze esculin in 40% bile (bile reistant), in 6.5% NaCl bile esculin agar turns black.
“Do U <3 Trees?” Bile/salt tolerance allows survival in bowel/gallbladder, leads to urinary and biliary tract infections, U=urinary tract infections, Trees= biliary tree infections.
Heart symbol is E. Faecalis entering blood streeam and causing endocarditis on PREVIOUSLY diseased valves
Why is the first line treatment for localized psoriasis topical corticosteroids and vitamin D analogs?
Vitamin D analogs inhibit T-cell and keratinocyte proliferation and stimulate keratinocyte differentiaion. Corticosteroids also have anti inflammatory/antiproliferative properties; their MOA is complementary to vitamin D analogs
Which cranial nerve carries the afferent limb of the carotid sinus reflex?
Glossopharyngeal CN IX
What does neprilysin do? How can this be targeted for heart failure and by which drug?
ANP/BNP released by myocardium in response to stretch. They induce vasodilation and diuresis by antagonizing RAAS and protect against cardiac remodeling.
-Neprilysin is an endogenous metalloprotease that cleaves and inactivates both ANP and BNP. Therefore, medications that inhibit neprilysin** (SACUBIRTRIL) lead to increased levels of ANP/BNP and promote beneficial effects in HF.
***Note, that neprilysin also inactivates andiotensin II. Therefore if you give someone a neprilysin inhibitor you should give them an angiotensin II-receptor blocker (eg sacubitril-valsartan)
Stool studies in lactose intolerance
Increased breath hydrogen contenet, reduced stool pH, elevated stool osmolality
Creatine over or underestimates GFR? Why?
Slightly OVERESTIMATES gfr because some of it is secreted, as in more of it ends up in urine than it would if it was only filtered.
Catalase + organisms: Cats Need PLACESS to Belch their Hairballs
Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E.coli, Staphylococci, Serratia, B cepacia, H pylori
PGE2
What is it
Analog
Prostaglandin that increases uterine tone
Dinoprostone
What parts of the pancreas does the DORSAL bud contribute?
Body, Tail, Isthmus, and accessory pancreatic duct.
What drug could you use to prevent gout attacks in a patient that works by inhibiting reabsorption of uric acid in PCT.
could also give this drug to inhibit secretion of PCN
Probenecid
Didanosine
Pancreatitis
Deficiency of which enzyme causes hereditary fructose intolerance: i.e. baby at 6 months old was weened off and now consumes fructose and gets fucked up
Aldolase B
What are the 5 P’s of Lichen Planus?
Pruitic, Purple/pink, Polygonal Papules, and Plaques
Which DNA polymerase has 5’ to 3’ exonuclease activity that can remove RNA primers and damaged DNA segments
DNA polymerase I
When would you see coagulation necrosis and neutrophilic infiltrate?
1-5 days
How do in utero intestinal atresias of the midgut (jejunum,ileum,proximal colon) occur?
-what is radiograph finding called?
Vascular occlusion in utero. Diminished intestinal perfusion leads to ischemia of a segment of bowel, with subsequent narrowing (stenosis)or obliteration (atresia) of the lumen. Proximal segment in blind pouch followed by an area of absent small bowel and associated dorsal mesentery, and finally a distal segment of ileum that assumes a spiral configuration knwon as APPLE PEEL/CHRISTMAS TREE deformity
How are dead space ventilation and tidal volume related?
Lower tidal volumes increase the proportion of each breath composed of dead space. If minute vent is unchanged, the consequence of the low-tidal volume is an increase in dead space ventilation.
What is the first line treatment for CMV colitis? How does this medication work and what are the adverse effects
Ganciclovir: guanine nucleoside analgoue that interferes w/ viral replication by competitively inhibiting the incorporation of guanosine triphosphate into CMV DNA strands by CMV DNA polymerase. Sometimes fucks up human DNA polymerase too; leading to neutropenia.
What almost always indicates a hematologic malignancy if seen in the peripheral blood?
Blast cell
What are the leading bacterial and viral causes of COPD exacerbations
Viral: rhinovirus
Bacterial: Haemophilus influenza Gram (-) coccobacillus
Expansion of the polyglutamine region of the Huntingtin protein results in GOF mutation that leads to pathological interaction w/ other proteins; what is this interaction?
Transcriptional repression through histone deacetylation of genes necessary for neuronal survival
How do the thiazolidinediones work?
Side effects
Pioglitazone, rosiglatazone activate PPAR-y (nuclear receptor), which increases insulin SENSITIVITY and levels of adiponectin.
FLUID RETENTION—>edema, HF, weight gain
What is the serology during the window period of HIV infection? How long does it take humoral response to start working?
There will be positive viral load and p24 antien with a negative serologic response (negative HIV-1/HIV-2). Humoral response to HIV takes about 6-8 weeks to develop.
The multidrug resistance protein 1 gene produces P-glycoprotein. How does this protein function?
Transmembrane ATP-dependent efflux pump.
Canagliflozin and Dapagliflozin are what type of drugs? What is their side effect?
They are SGLT2 inhibitors and because they induce osmotic diuresis by decreasing reabsorption of Na and glucose; resutls in decrease in BP/orthostatic hypotension
What is heteroplasmy and how does it affect mitochondrial disorders?
Random distribution of normal and mutated mitochondria between daughter cells during mitosis; as a result, some cells may have completely healthy mitochondria, while others have mutation.
X-linked disease due to defective CD40L on Th cells that is characterized by failure to make germinal centers and severe pyogenic infections early in life
Normal of increased IgM
Decreased IgG, IgA, IgE
Pneumocystitis, Cryptosporidium, CMV
Blood supply to Proximal, Middle, Distal ureter
Proximal: branches of renal artery
Middle: highly variable
Distal: superior vesical artery, which is off the internal iliac artery
What does a reverse transcriptase PCR detect?
MRNA levels
So in dx of CML, BCR-ABL fusion protein is a constitutively active tyrosine kinase that accelerates cell division and increases genetic instability. RT-PCR can be used to identify mRNA transcribed from the BCR-ABL fusion gene and therefore diagnose CML
A child develops HSP after an upper respiratory infection; what are some clinical manifestations?
Palpable purpura, arthralgia, abdominal pain (possible intussusception risk), renal disease similar to IgA nephropathy (hematuria)
Pt presents w/ pancytopenia, hepatosplenomegaly, and teardrop cells, along w/ dry bone tap. What do they have?
Primary myelobibrosis
What is the principal cause of high RBC chloride content in venous blood?
Most CO2 is carried in plasma as bicarbonate ion via the following process:
- CO2 from tissues enters RBCs, hydrated by carbonic anhydrase to form carbonic acid
- carbonic acid then spontaneously converts to HCO3 and H
- excess bicarb transferred out of RBCs into plasma bia “band 3 protein” in exchange for chloride ions to maintain electrical neutrality. This is known as the chloride shift.
What are two centrally acting agents that inhibit dopamine breakdown in the brain by selectively inhibiting MAO-B?
Selegiline, Rasagiline
Which hormone is responsible for development of external male genitalia, growth of prostate, male-pattern hair?
DHT
ABL, BRAF, HER1, HER2, MYC, RAS (KRAS,HRAS), SIS, TGFA are all what?
Proto-oncogenes
Anti HBcAg IgM vs IgG
IgM is acute/recent infection
IgG is prior exposure or chronic infection
What is a folic acid antagonist used to treat ectopic pregnancy?
MTX
How does the sodium potassium pump work
- pump binds three sodium ions intracellularly and a molecule of atp
- splitting of ATP provides energy to change shape, sodium driven out of the pump. (Phosphate still attached to pump)
- new shape of pump binds two potassiums outside cell; phosphate released and K+ brought into the cell
Why does hematogenous osteomyelitis usually effect the metaphysis of long bones? (In children)
This region contains slow-flowing sinusoidal vasculature that is conducive to microbial passage.
When Theca cells are stimulated by LH, what do they release?
Androstenedione
Primary myelofibrosis is a clonal expansion of?
-what do these cells secrete
Megakaryocytes that secrete TFG-B, which stimulates bone marrow fibroblasts to fill the medullary space with collage.
What ensures that each myofibril contracts at the same time?
Transverse tubules are invaginations of the sarcolemma that transmit depolarization signals to the sarcoplasmic reticulum to trigger the release of calcium and induce muscle contraction. Their uniform distribution ensures coordinated contraction
What must be known prior to starting a PCR?
It requires primers that are complementary to the regions of DNA flanking the segment of interest. Thermostable DNA polymerase, deoxynucleotide triphosphates, and a source DNA template strand are also necessary.
Why do you get marfanoid in homocystinuria?
Why do you get ectopia lentis?
Homocysteine binds to Fibrillin-1, which makes their connections weaker.
Homocysteine gets incorporated into the cysteine rich fibers of the zonular fibers in the eye
Ecoli strain K-1 capsular antigen
Neonatal meningitis
What type of mutation is characterized by deletion or insertion of any number of nucleotides that are not multiples of 3?
Frameshift mutations
Diagnosis of Cushing syndrome:
ACTH levels are suppressed upon initial evaluation, what three things are in diff dx
ADRENAL adenoma: excess cortisol production due to autonomous cortisol producing tumor
Adrenal malignancy
Exogenous glucocorticoid intake
What does Aromatase from the granulosa cells do?
Converts the androstenedione from the theca cells into 17B-estradiol, which is a member of the estrogen family
RA patients are positive for rheumatoid factor and anti-CCP antibodies; what is RF?
Typically RF is an IgM antibody specific for the Fc component of IgG.
Uniformly enlarged uterus, middle-aged parous female, heavy menstrual bleeding, normal appearing endometrial tissue on biopsy
Adenomyosis
What are the light’s criteria?
Pleural fluid:Serum protein >0.5
Pleural fluid: Serum LDH>0.6
Pleural fluid LDH>2/3rd upper limit normal for serum
1 or more of these criteria means exudative
Thick-walled spherules packed with endospores after body fluids prepped w/ 10% KOH or silver stain
Coccidioides immitis
How do Nitrites cause poisoning?
By inducing the conversion of heme bound ferrous iron (Fe+2) to the oxidized ferric (Fe+3), which leads to formation of methemoglobin. With iron in the oxidized ferric state, methemoglobin is unable to bind oxygen
Prmary oocytes are arrested in prophase of Meiosis I from childhood to puberty. Then, monthly from puberty to menopause, secondary oocytes are arrested in ____ stage just prior to being fertilized?
Meiosis II arrested in metaphase
Brieft psychotic disorder—> Schizophreniform—> Schizophrenia timeline:
Less than a month, 1-6 months, greater than or equal to 6 months
How do TCA’s cause cardiac arrythmias and refractory hypotension in overdose cases?
They inhibit sodium channel conduction, slowing down myocardial deplarization and potentially leading to arrhythmias. Refractory hypotension results from decreased cardiac contractility and direct peripheral vasodilation due to peripheral alpha-1 adrenergic receptor antagonism
What do the interferons produced by human cells in response to viral infections do?
Interferons alpha and beta are produced by most human cells in response to viral infections. THe production of these interferons helps suppress viral replication by halting protein synthesis and promoting apoptosis of infected cells, limiting the ability of viruses to spreadh through the tissues.
How do right sided colon cancers px?
Features of iron deficiency anemia due to occult blood loss. Nonspecific symptoms such as anorexia, malaise, and unintentional weight loss may also occur.
MOA of aminoglycosides?
Interfere with the aminoacyl binding site on the 30S ribosomal subunit.
What does the lac Z gene code for?
Beta galactosidase
Child doesnt eat for 24 hours, subsequently gets low blood sugar, but acetacetate (ketones) not dected in urine. Therefore, child has hypoketotic hypoglycemia; what is most likely
Medium chain acyl-CoA dehydrogenase deficiency
Apical displacement of tricuspid valve leaflets, decreased volume of right ventricle, and atrialization of the right ventricle. What is this and what teratogen
Ebstein anomaly, Lithium
Lesions on the lateral foot will cause lymphadenopathy where?
Popliteal and inguinal areas
Continuous murmur with inspiratory splitting of S2
PDA
What is donated blood mixed with that can cause hypocalcemia if large amounts of blood are transfused and overwhelm the liver’s capability of metabolizing this additive.
Citrate is calcium chelator. Hypocalcemia due to decreased serum ionized calcium concentration
What pathology would be seen in the duodenum and proximal jejunum of a patient w/ rotavirus?
Villous blunting, proliferation of secretory crypt cells, and reduced brush border enzymes
What is trastuzumab?
-adverse effect?
Monoclonal AB that blocks human epidermal growth factor receptor-2 (HER2) to disrupt malignant cell signaling and encourage apoptosis. Because HER2 helps preserve cardiomyocyte function, trastuzumab can cause cardiotoxicity that manifests as a decrease in myocardial contractility WITHOUT CARDIOMYOCYTE DESTRUCTION OR MYOCARDIAL FIBROSIS
Macrolide-like antibiotic that inhibits the sigma subunit of RNA polymerase that is bacteriacidal against Cdiff
Fidaxomicin
Immediately prior to delivery, estrogen increases expression of:
-a receptor
-cellular junction
What are they and how does their combination effect labor?
Increases expression of uterotonic (oxytocin) receptors, which mediate calcium transport through ligand-activated calcium channels.
Gap junctions
-combination causes coordinated synchronous labor
What are unique features of dermatomyositis that differ it from polymyositis? What is a diagnostic finding?
Heliotrope rash, gottron papules.
Muscle biopsy is diagnostic and shows mononuclear PERIfasicular inflammation and atrophy.
What is Type 1(a) error?
Falsely conclude there IS a difference
What type of HSR is Serum Sickness? What are some clinical findings associated with serum sickness?
Type III HSR
Clinical findings: fever, pruritic, skin rash, arthralgias, and low serum C3 and C4 complement levels.
“Islands or sheets of uniform cells with eosinophilic cytoplasm and oval-to-round stippled nuclei”
Carcinoid tumors, which are often derived from neuroendocrine cells in the Gi tract.
What is an antiviral agent that can provide moderate improvement in Parkinson patients?
-Side effects?
Amantadine has dopaminergic activity
-Toxicity= peripheral edema, livedo reticularis, ataxia
How do VanA strains of enterococcus avoid binding to vancoymycin?
VRE strains: have UPD-N-Acetylmuramyl pentapeptide with the terminal D-ala-D-ala replaced with D-ala-D-lactate. Treat VRE w/ linezolid or tigecycline
What are the SGLT-2 inhibitors?
Moa
Side effects
Canagliflozin, Dapagliflozin
Increase renal glucose excretion by blocking reabsorption of glucose in the PCT.
UTI (glucosuria feeds bacteria), HYPOTENSION due to DEHYDRATION.
What are the dibasic amino acits and in what disorder is their transporter defective? At risk for what?
Cysteine, Ornithine, Lysine, Arginine (COLA)
In cystinuria, their transporter is defective, resulting in immpaired renal and intestinal absorption.
-These patients are at risk for cystine kidney stones. Recurrent nephrolithiasis is the only clinical manifestation. Urinalysis shows pathognomonic hexagonal cystine crystals.
What species of mosquito transmits dengue, zika, and Chikungunya?
Aedes
Calretinin is positivein which cancer?
Mesothelioma
Krabbe Disease
“The KRABBE isout of this WORLD” Enzyme: beta GALACTOcerebrosidase Buildup: GALACTOcerebroside **GALACTO~Galaxy~out of this world** Krabbe dz is a globoid disease
How do you calculate filtration fraction
FF=GFR/RPF
How does a hydrocele develop? Indirect hernia?
Both are related to failure of obliteration of the processus vaginalis. If opening is small and allows for fluid leakage only you get a communicating hydrocele. If large enough, you will get indrect inguinal hernia.
Indirect is lateral to the inferior epigastric vessels
Diclofenac, Ketorlac, Ibruprofen, Indomethacin, Naproxen
Reversible NSAIDS
What does the PI3K pathway activate in order to promotee glycogen synthesis?
PROTEIN PHOSPHATASE, an enzyme thatt dephosphorylates glycogen synthase, leading to its activation.
What is the mechanism for NSAID induced prerenal azotemia (>20:1) in at risk patients?
Inhibition of afferent arteriole vasodilation
Disorder in which a beta globulin mutation results in reduced binding of 2,3-BPG
familial erythrocytosis
Patient has proximal muscle weakness, w/ additional inflammatory features involving the skin (heliotrope rash, Gottron papules). She is a 48 yr old female and has 10 pounds of unintentional weight loss. What should she be examined for?
This is dermatomyositis; can occur on its own or as a paraneoplastic syndrome. Should be checked for ovarian Ca.
What can cause galactorrhea in a patient w/ primary or secondary hypothyroidism?
Increased TRH stimulates the basophil TSH, and also stimulates the acidophil prolactin
What is the name of the enzyme responsible for loading the appropriate amino acid to the 3’ terminal hydroxyl group of the CCA tail?
Aminoacyl tRNA synthetase
Cushings syndrome dx:
After high-dose dexamethasone suppression
Differential for ACTH level that is suppressed?
Differential for ACTH level that is NOT suppressed?
Suppression: Pituitary adenoma aka Cushings DISEASE
NON Suppression: Ectopic ACTH production
What kind of ALL might present with superior vena cava syndrome?
T-cell ALL often presents as a mediastinal mass that can cause respiratory symptoms, dysphagia, or superior vena cava syndrome
Why is the inferior epigastric artery below the arcuate line more susceptible to trauma?
Below the arcuate line there is no supporting posterior sheath
What is intermittent explosive disorder
Recurrent episodes of explosive verbal or physical aggression. The aggressive behaviors are impulsive and grossly out of proportion to the provocation
What are the manifestations of Chikungunya virus?
Severe joint symptoms, high fever, symmetric polyarticular arthralgia, and a maculopapular rash
-lymphopenia and thrombocytopenia commonly occur. Many people’s symtoms go away within days, but about half develop polyarticular ARTHRITIS.
Villous adenomas of the colon can secrete large amounts of Prostaglandin E2, which results in increased mucin production and a secrety diarrhea. What can happen to patient’s serum as a result of mucin production?
Hypoproteinemia and hypokalemia because Mucin is a potassium-rich glycoprotein
How do you treat MRSA?
Generally requires the use of non-beta lactam. Ie TMP/SMX, clindamycin (50s), doxycycline (30s), or vancomycin (inhibits integration of peptidoglycan subunits)
Characterized by symptoms or deficits of voluntary motor and/or sensory function that are incompatible with any recognized neurological condition and can’t be explained by another medical or mental disorder:
Conversion disorder
How does someone with chronic diarrhea or ileostomy get a uric acid stone?
Chronic diarrhea/ ileostomy leads to state of chronic metabolic acidosis due to reduced bicarb reabsorption by the gut.
- kidneys compensate by excreting more H into urine, and reabsorbing bicarb into the collecting ducts. this lowers the pH of urine.
- this increases the conversion of soluble urate into insoluble uric acid
What is the action of the enzyme glutamine synthetase?
After astrocyte takes up glutamate in the synpase to prevent excessive neuronal excitation, glutamine synthetase takes glutamate through a condensation reaction w/ ammonia to form glutamine. Glutamine is then released by the astrocytes and taken up by neurons, where it is converted back to glutamate for use as a neurotransmitter
Derivatives of the mesonephric duct mnemonic
SEED
Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens
What are some other ways the body responds to persistently low PiO2?
Increased 2,3 BPG to encourage o2 unloading in tissues
Increased angiogenesis via increased production of VEGF
increased hemoglobin via increased production of erythropoietin.
What is a key requirement of schizoaffective disorder regarding a 2 week absence
A lifetime history of at least 2 weeks of psychotic symptoms in the absence of a mood episode.
Small, Solitary, pale nodules composed of cords of normal-appearing hepatocytes and a central stellate scar w/ fibrous septae?
Focal Nodular hyperplasia
Where and when does Positive Selection of T cells occur?
Occurs after TCR DNA rearrangement and PRIOR to the process of negative selection. Occurs in the thymic cortex.
DNA polymerase III has 3 to 5’ exonuclease activity; what is the purpose
Removal of mismatched base pairs during DNA replication
How would you develop Left (or right) homonymous superior quadrantanopia aka pie in the sky?
A lesion of the right temporal lobe (meyer’s loop)
Etanercept
Infliximab, adalimumab, certolizumab, golimumab
TNF-a inhibitors. Predispose to infection includign reactivation of latent TB since TNF is important in granuloma formation and stabilization.
What is folinic acid also known as, and what is its purpose?
Leucovorin, rescues normal cells by competing with MTX for DHF reductase binding sites. It can reactivate DHF reductase, therefore allowing re-initiation of DNA synthesis
What is a chiari 1 malformation and what is it assoicated with later in life?
Ectopia of the cerebellar tonsils inferior to foramen magnum. Manifests in adulthood w/ headaches and cerebellar symptoms. Associated with spinal cavitations
Which two flatworms (nematodes, blood flukes) cause intestinal and hepatic schistosomiasis?
S Japonicum, S mansoni
1 man
1st arch, MAN-dibular V3, M structures (mms of mastication, meckel cartilage), Maxillary artery
What is tocilizumab and why is it used for treating Giant Cell Arteritis?
IL-6 monoclonal antibody, which is correlated w/ GCA
Describe the process of erythrocyte sickling in HbS disease (sickle cell dz)
In sickle cell disease, the usual acidic (-) glutamic acid (glu) residue at the sixth position on the beta globin chain is replaced by a nonpolar (neutral) valine (val) residue, forming HbS. This single glu—> val substitution leeads to the formation of a hydrophobic pocket on the beta globin surface that interacts w/ a complementary nonpolar residue on another hemoglobin molecule
***normally globin chains in the the hemoglobin tetramer are compactly folded due to nonpolar hydrophobic residues in the interior and charged polar residues on the surface.
What is found in swollen astrocytes during hepatic encephalopathy?
Accumulation of glutamine
What is the difference between lacunar strokes and charcot bouchard?
Lacunar strokes and Charcot aneurysms are both caused by chronic hypertension.
- lacunar strokes are thrombotic vessel occlusion of vessels that have undergone hypertensive arteriolar sclerosis
- Charcot is an aneurysm rupture of the same arterioles effected by lacunar, but you would see intraparenchymal hemorrhage
What type of HSR is acute hypersensitvity pneumonitis?
Pts with AHP have specific serum IgG abs that precipitate bacterial or fungal antigens foudn in inhaled organic dust particles. THis causes interstitial alveolitis and bronchiolitis via immume complex and complement deposition in vessel walls (type III hsr)**
The superficial inguinal ring is formed by an opening in the ?
External oblique muscle aponeurosis
What kind of immune response is seen in schistosomiasis?
Th2 mediated granulomatous response directed at the eggs. This leads to development of marked fibrosis and ulceration/scarring of the bowel or bladder/ureters (depending on which species)
What is the MOA of rifaximin?
Nonabsorbable antibiotic that alters GI flora to decrease intestinal production and absorption of ammonia.
Suprachiasmatic nucleus of the hypothalamus
Circadian rhythym
Patient w/ progressively worsening dizziness, limb and truncal ataxia, dysarthria, visual disturbances. Patient has a lung mass. Autopsy reveals degeneration of purkinje cells in cerebellum. Why
This is paraneoplastic cerebellar degeneration. due to an immune response against tumor cells that cross-reacts w/ purkinje neuron antigens.
Autosomall Recessive disorder of neutrophil-phagosome-lysosomefusion that results in neurologic abnormalities, partial albinism, and an immunodeficiency caused by defective neutrophil function?
Chediak-Higashi
LMNOP: lymphohistiocytosis, microtubule dysfunction, neurologic symptoms (peripheral neuropathy, horizontal nystagmus), phagOlysosome formation problems due to microtubules, Pancytopenia
What are the findings of Goodpasture syndrome: what type of nephritic syndrome? IF: LM: HSR type: Tx:
Goodpasture is a nephritic syndrome known as RPGN (crescentic)
IF: Linear due to antibodies to GBM and Alveolar (LUNG) basement membrane (type IV) collagen.
LM: crescent moon shape. crescents consist of fibrin and plasma proteins (C3b) w/ glomerular parietal cells, monocytes, macrophages.
HSR type: Type II HSR
Tx: plasmapharesis
SRD5A2 mutation on chromosome 2
Pseudovaginal perineoscrotal hypospadias, synonym for 5a-reductase deficiency. Karyotype males present w/ ambiguous or female genitalia at birth due to lack of DHT
What gi effect does the microtubule polymerization inhibitor Colchicine have?
Diarrhea
What cranial nerves are in the medulla?
12 is medial
9,10,11 lateral
Describe the ascending auditory pathway
Cochlear nerve to cochlear nucleus (then most corss over to contralateral superior olivary nucleus)—>lateral lemniscus to inferior colliculus in the midbrain—>medial geniculate nucleus (thalamus)—> auditory cortex (lateral sulcus)
If a pathogen’s mechanism of resistance to drug X was a decrease in ergosterol incorporation into the cell membrane. And that pathogen showed enhanced growth in front of drug X, then what was drug X?
Nystatin (polyene). Bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis. Therefore, polyenes are dependent on the amount of ergosterol present in fungal cell membranes for their efficacy.
Why does HbF have significantly higher affinity to oxygen than adult hemoglobin A?
Because the gamma chains do not bind effectively to 2,3-BPG due to replacement of a histidine(+) chain with serine.
185 kD glycoprotein that spans the cell membrane and has tyrosine kinase activity in the intracellular domain. What is most likely its function?
HER2 oncogene codes for a human epidermal growth factor receptor with tyrosin kinase activity in the intracellular domain. Known to play role in ^ transduction pathways that control epithelial growth and differentiation
10 or more times the daily limit of what vitamin can lead to intracranial hypertension, skin changes, and HSM?
Vitamin A
What are the class III antiarrhythmics (AIDS) and what is their moa? Adverse effects of the “A” drug?
Amiodarone, Ibutilide, Dofetilide, Sotalol
They work on phase III by blocking the repolarizing potassium channels. They cause increased AP duration, increased ERP, and increased QT interval
Amiodarone can cause pulmonary fibrosis, hepatotoxicity, and can fuck up thyroid either way.
Sarcoidosis is thought to result from a dysregulated cell-mediated immune response to an unidentified antigen, causing formulation of granulomas. Discuss the formation of granulomas
Cell mediated immunity driven by Th1.
Activated APCs produced IL-12, which stimulates the differentiation of Th1 cells. Th1 cells secrete IL-2 and IFN-y.
IL-2 stimulates the autocrine proliferation of Th1 cells and further Th1 recruitment. IFN-y activates macrophages, promoting granuloma formation.
Lastly, Activated macrophages and T cells produce TNFa further assisting in leukocyte recruitment and granuloma maintenance.
Timeline of MI: what would you see from 1-3 days
Coagulation necrosis (loss of nuclei and striations) Prominent neutrophilic infiltrate
What are the boundaries of the deep inguinal ring?
It is an opening in the transversalis fascia
- laterally is transversus abdominis
- inferior epigastrics medially
-The genetic mutations that drive oncogenesis create unique proteins not found in healthy cells, this is known as?
Neoantigens
How do combined OCPS work?
Exhibit systemic effects by suppressing GnRH in the hypothalamus, which decreases synthesis of the gonadotropins FSH and LH in the anterior piruitary. Because an LH spike is required to stimulate ovulation, ovulation is inhibited
Viridans streptococci produce extracellular polysaccharides (dextrans) using sucrose as a substrate. What do dextrans bind to
Fibrin and platelets that are already deposited at sites of endothelial trauma. That is why they cause endocarditis of already damaged valves
How does leuprolide work?
Constant agonist of GnRH; paradoxically decreases testicular leydig cell stimulation. Will see transient rise in LH and testosterone following treatment initiation.
How does Aromatase deficiency manifest?
Early in embryonal life w/ high androgen and low estrogen levels in the female fetus. Maternal virilization common occurs as well
Swyer syndrome
SRY gene mutation—> no production of testosterone or anti-mullerian—> male genitals don’t develop—>uterus and vagina develop despite presence of XY
The etiology of Lichen Planus is unknown, but it is characterized by a CD8 T Cell mediated response to the cells along the junction of the dermis and epidermis: what are four other findings?
Chronic hyperkeratosis
Lymphocytic infiltrates at the dermoepidermal junctin (interface dermatitis)
Scattered eosinophilic, colloid (Civatte) bodies in the papillary demis (apoptotic keratinocytes)
Thickened stratum granulosum with sawtooth rete ridges
How do you treat someone with somatic symptom disorder?
Schedule regular visits w/ same provider. Mental health referral only once physician-patient relationship is well established.
Excessive and disordered bone formation with enlarged vertebral bodies with cortical thickening on imaging. What is this describing and what lab would you want to order?
Paget disease of bone
Order serum alkaline phosphatase it will be high.
Vertebrae look like picture frames.
What are three contributing factors of Oxygen-induced hypercapnia in COPD patients?
-which factor is most important?
Carotid and aortic body chemoreceptors respond to changes in oxygen, whereas central receptors dont
AFTER OXYGEN ADMIN IN COPD PATIENTS YOU CAN SEE FOLLOWING IF they have oxygen induced hypercapnia
-decrease in chemoreceptor stimulation leads to decreased minute ventilation
-decrease in Hgb affinity for CO2 (Haldane effect)—> leads to increase in blood pCO2
-vasodilation diverts blood from well-ventilated regions—> increase in physiologic dead space (V/Q mismatch)
-increased VQ mismatch triggered by alleviation of pulmonary vasoconstrictio in poorly ventilated areas is the major mechanism.
How do osteocytes remain connected to each other?
Gap jxns
What 4 Sensory Sydromes are Side (lateral)?
Spinothalamic Tract (pain/temp) Spinocerebellar Tract (rapid alternating movement) Sympathetic Chain (dilation, sweating, etc) Sensory CN Nuclei
What types of cancers are particularly susceptible to immune recognition because they rapidly accumulate mutations and generate approx 20 fold more neoantigens than other cancer types?
Cancers w/ defects in mismatch repair proteins
Why is glycolysis inhibited in patients who have lactate dehydrogenase deficiency?
Muscle cells can’t regnerate NAD+. NAD+ is normally regenerated when pyruvate is converted to lactate via lactate dehydrogenase.
If tissue solubility is high for an inhaled anesthetic, then what is the arteriovenous gradient? What does that mean?
It will be a high gradient. A large amount of anesthetic is taken up from arterial blood, which results in low venous concentration. As a result, saturation of the blood requires further absorption of anesthetic in order to replace that which is absorbed by the peripheral tissues.
NOTCH1 gene mutation
Familial bicuspid aortic valve disease
What is the chromosomal translocation associated with APL?
t(15;17). This is fusion of the retino acid receptor (RARA) with the promyelocyte leukemia gene. M3 subtype of AML
What is the MOA of Trazodone; what is a unique side effect
Sedating antidepressant that primarily blocks 5-HT2, a1-adrenergic, H1 receptors and weakly inhibits serotonin reuptake. Can cause priapism. Careful using it in HbS patients as they are predisposed to priapism already
How can the loss of proper bile acid absorption in a crohn’s patient cause ecchymoses, fatigue, dull pain, stiffness?
Bile acid absorbs ADEK. Vitamin K deficiency causes those symptoms
What is classically used as treatment for lung abscesses? What gram coverage does this treatment have?
Oral clindamycin coers oral anaerobes and aerobic gram-positive organisms such as streptoccocus pneumoiae.
Oral anaerobes includes: Bacteroides, Prevotella, Fusobacterium, and Peptostreptococcus
What is the order of steps in Base excision repair?
Glycosylase, endonuclease, lyase, polymerase, ligase
In a patient with tumor lysis syndrome, where would uric acid precipitate and lead to obstruction?
Precipitates in the normally acidic environment of distal tubules and collecting ducts.
Why do IB agents (lidocaine, Mexiletine) bind preferentially w/ ischemic myocardium?
Ischemic myocardium has higher than normal (less negative) resting membrane potential, which delays voltage-dependent recovery of sodium channels from the inactivated to the resting state.
Describe the LT (heat-labile) toxin of ETEC
LT enterotoxin, resembles cholera toxin, increases intracellular cyclic AMP in gut mucosal cells by activating the stimulatory Gs membrane G protein, thereby activating adenylate cyclase.
The finding of multiple ring-enhancing lesions in an HIV patient is most likely due to which pathogen?
Toxoplasmosis, likely will have seizures
4 Always Remember to Say that what happens in Vagus Recurs in Vagus
4th pharyngeal arch, ARS: Aortic, right subclavian arteries, Thyroid cartilage, Vaguns N, Recurrent vagus n
6th arch is just anything else
Which HIV drugs prevent integration of viral DNA into the host genome? Adverse effects?
Integrase inhibitors
raltegravir
“Tegravirs”
AE: myopathy and rhabdomyolysis
What is Lipid A?
Gram- sepsis is caused by release of LPS from bacterial cells during division or by bacteriolysis; LPS is NOT actively secreted by bacteria. Lipid A is the TOXIC component of LPS; it causes activation of macrophages, leads to release of IL-1, TNF-a—>shock
What is DRESS syndrome?
Drug Reaction w/ Eosinophilia and Systemic Symptoms
-happens 2-8 weeks after drug exposure; commonly associated with anticonvulsants, allopurinol, sulfonamides, and antibiotics.
Young obese woman with daily headaches, bilaterally symmetric papilledema, transient visual disturbances related to bending over. This is pseudotumor cerebri. What is the pathophysiology of the papilledema?
Increased intracranial pressure is transmitted through the csf in the SUBARACHNOID space, which is CONTINUOUS w/ the optic nerve sheath. This buildup of pressure compresses the optic nerves externally, which in turn impairs axoplasmic flow within the optic nerves, causing bilateral optic disc edema.
Significance of aortic isthmus during car crash
Aortic isthmus is tethered by ligamentum arteriosum and is fixed relative to other parts of aorta. Most likely to tear.
Is cAMP increased in vascular smooth muscle when Norepi is given?
No, alpha 1 receptors work through the IP3 pathway.
Testosterone is converted to DHT by which enzyme?
5a-Reductase
Patient has a stenotic kidney that is subsequently hypoperfused, describe the histological findings in the other kidney and why they occur
RAAS activation from stenotic kidney causes increased blood pressure and renal perfusion in the opposite kidney.
- arterial intimal fibroplasia and hyalinization of the arterioles (hyaline arteriolosclerosis)
- if severe you can see hyperplastic arteriolosclerosis “onion-skinning”
In females, the absence of testosterone causes the mesonephric duct to degenerate into?
Gartner ducts
Jugular foramen structures
9,10,11, jugular vein
Layers of spinal tap mnemonic
3S’s ILEDAS
Skin Superficial fascia Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space Dura mater Arachnoid Subrarachnoid space is where the fluid is
What do you use to CLOSE a PDA
Indomethacin
Fucked 2 Strippers
Facial nerve, Stapes, Stylohyoid, Smiling muscles, Stapedial A.
What hemolysis do Group D strep (enterococci) exemplify?
Gamma hemolytic: no hemolysis
When would you see coiled glands in the endometrium?
Secretory phase:
What is Type II (B) error?
Falsely conclude there is NO difference
How do you know when something is statistically significant? (In relation to p-value and alpha?)
When p<a></a>
What does the lac Y gene code for?
Permease, which allows lactose to enter the bacterium
Hypokalemia, high blood pressure, ambiguous genitalia in XY
17a-hydroxylase deficiency
Downward displacement of the cerebellar vermis and tonsils below the foramen magnum is known as
Arnold-Chiari malformation, also known as Chiari II
X-linked disorder with a deficiency in the irreversible, rate-limiting step of the HMP shunt aka Pentose Phosphate Pathway
Glucose-6-phosphate dehydrogenase deficiency Heinz bodies (denatured globin chains precipitate within RBCs due to oxidative stress) Bite cells: phagocytic removal of heinz bodies in the spleen
Why are people with silicosis at higher risk for TB
Macrophage phaolysosomes are disrupted by internalized silica particles, leading to impaired phagocytosis and increased apoptosis.
Why do you get target cells after splenectomy
Macrophages in the red pulp of the spleen remove excess membranes from red cells, a process called “splenic conditioning” patients without a splene can’t do that at first, but over time macrophages in nonsplenic tissue take up the job and you see diminished target cells
Mutations that cause production of hemoglobin w/ high oxygen affinity reduce the ability of hemoglobin to release oxygen within the peripheral tissues: what is result of this?
Erythrocytosis
leukocyte (neutrophil) alkaline phosphatase level (LAP) in CML vs Leukemoid rxn
LAP is DECREASED in CML because the WBCs are cytochemically abnormal.
Henoch-schonlein purpura is caused by ?
IgA-antigen immune complexes (type III hsr)
Describe the histology of a mesothelioma:
- can appear as cuboidal or flattened cells, or spindle cells (stromal-like)
- Immunohistochemistry: stains positive for cytokeratins and calretinin
- EM shows polygonal tumor cells with numerous long, slender microvilli and abundant tonofilaments
The insulin secrtagogues includ the Sulfonylureas, and the Meglitinides; what is their mechanism of action?
Close Beta cell K-ATPase channel, which depolarizes the cell, causing insulin release via Calcium influx
1st gen sulfonylureas: chlorpropamide, tolbutamide
2nd gen sulfonylureas: glimerpiride, glipizide, glyburide
Meglitinides: Nateglinide, repaglinide
What is relatively specific to mast cells and can be used as a marker for mast cell activation?
Tryptase
What cell mediates sarcoidosis? How does it drive granuloma formation? ratio of CD4:CD8?
CD4 T cell mediated disease in which large amounts of CD4 lymphocytes release IF-gamma and TNF-alpha to drive macrophage activation and granuloma formation.
IRS-1 activation of PI3K pathway leads to what?
Stimulates metabolic functions such as translocation of GLUT-4 to the cell membrane, GLYCOGEN SYNTHESIS, and fat synthesis.
Cardiac defects associated with turner
Bicuspid aortic, coarctation of aorta, aortic dissection/rupture
What are chlorthalidone and metolazone?
HyperGLUC mnemonic
Thiazide diuretics; inhibit NaCl reabsorption in early DCT.
hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia.
What are the commonly found antibodies against purkinje cells that are found in the serum of paraneoplastic cerebellar degeneration patients?
Anti-Yo, ant-P/Q, anti-Hu
Truncating mutation affecting the TTN gene, which encodes for the sarcomere protein titin, is the most common cause of what disorder
Familial Dilated Cardiomyopathy
Titin is an elastic protein that anchors the beta-myosin heavy chain to the Z-disks and likely contributes to passive myocardial tension.
How do you calculate NNH?
1/AR (attributable risk)
AR=[a/(a+b)]-[c/(c+b)]
Alcoholic liver disease causes fibrosis and distortion of intrahepatic vasculature and obstructs bf through liver leading to portal hypertension. Because splenic vein is part of portal system, you can see splenomegaly. What is causing the spleen to enlarge on a more specific level?
Venous congestion causes apparent expansion of the red pulp of the spleen, which is composed of blood-filled sinuses and cords lined by reticuloendothelial-type cells
Female after hitting puberty presents with virilized genitalia despite normal internal genital organs
Aromatase deficiency because aromatase converts androgens to estrogen
WAS gene, WASp protein
Thrombocytopenia
Eczema
Recurrent infections
Wiskott-aldrich
Name two GLP-1 agonists and describe their moa and adverse effects. route of administration?
Exenatide, Liraglutide
Injectables
Increase glucose dependent insulin secretion, decrease glucagon secretion, and delay gastric emptying.
Basically they mimic glucagon, which makes pancreas think there is high blood sugar, and the pancreas secretes insulin
Adverse effect is pancreatitis and WEIGHT LOSS. Which isnt necessarily an adverse effect.
Pyruvate dehydrogenase, Isocitrate dehydrogenase, a-ketoglutarate dehydrogenase, malate dehydrogenase all need what b vitamin/cofactor?
B3 (niacin)
All convert NAD+ to NADH
Right or left sided nasal hemianopia likely caused by?
R/L sided peri-chiasmal lesion such as calcification or aneurysm of the internal carotid artery impinging on uncrossed, lateral retinal fibers
How do you calculate RBF?
RBF=RPF/(1-Hct)
CAH is screened for by heel prick and measuring 17-hydroxyprogesterone levels; what CAH is the level going to be low?
17a-hydroxylase deficiency will have low level of 17-hydroxyprogesterone.
What are the alpha-glucosidase inhibitors
Moa, side effects
Acarbose, miglitol
Decrease disaccharide absorption
Diarrhea, flatulence
What is Teriparatide?
Recomninant PTH analog.
What is the inheritance pattern of Androgen insensitivity syndrome
X-linked recessive
Amphotericin B is known for its renal toxicity and causing severe hyokalemia and hypomagnesemia; where is it hurting the nephron?
TYPE 1 RTA; DISTAL RENAL TUBULAR ACIDOSIS
Urine pH>5.5
What does the suspensory ligament of the ovary (infundibulopelvic ligament) contain?
Ovarian artery
Patient w/ lupus, paradoxical aPTT prolongation but in hypercoagulable state, false positive RPR/VDRL:
Antiphospholipid antibody syndrome
How does carotid sinus massage effect reentrant tachycardia?
leads to increased afferent firing from the carotid sinus, which in turn, increases vagal pns tone. This slows conduction through the AV node and prolongs the AV node refractory period, helping to terminate the reentrant tachycardia
Describe HBV
What kind of virus:
Outer lipid envelope contains:
Icosahedral nucleocapsid core:
HBV is a hepadnavirus composed of an outer lipid envelope that contains viral-encoded proteins (HBsAg) and host lipid components.
The icosahedral nucleocapsid core contains a circular, partially double-stranded DNA genome and a DNA polymerase w/ reverse transcriptase activity.
Rotavirus characteristics:
Segmented, nonenveloped, double stranded RNA virus that is transmitted fecal-oral rout
Minutes to hours after blood transfusion; patient has fever, chills, hypotension, dyspnea, chest/back pain, HEMOGLOBINURIA. What is this condition? What are the antibodies usually present?
Type II, antibody-mediated (CYTOTOXIC) hypersensitivity reaction. Anti-ABO (mainly IgM) in the recepient bind the corresponding antigens on transfused donor erythrocytes, leading to complement activation. C3a/C5a are anaphylatoxins and cause vasodilation and symptoms of shock; complement mediated cell lysis is done by the MAC (C5b-C9).
Hemolytic disease of the newborn is another exapmple type II
Monoclonal antibody against HER2 name
Trastuzumab
What is the mechanism of opioid induced analgesia at the synapse?
They inhibit Ca2+ influx at the presynpase, this decreases eaa release (ach, norepi, serotonin, glutamate, substance P)
They encourage Potassium efflux (hyperpolarization) from the postsynapse
What is cyproheptadine? What is it used for?
Cyproheptadine can be given as an antidote; functions as a serotonin antagonist in cases of overdose. Cyproheptadine is a first generation antihistamine w/ nonspecific 5-HT1 and 5HT2 receptor antagonistic properties
What is the mnemonic for the 5 cofactors needed in:
- pyruvate dehydrogenae
- a ketoglutarate dehydrogenase
- branched-chain a-ketoacid dehydrogenase
Tender Loving Care For Nancy
Thiamine, Lipoate, Coenzyme a, Fad, Nad
What will accumulate inside a cell when it is affected by the Dihydrofolate reductase inhibiting affects of MTX?
Dihydrofolate polyglutamate
What is the MOA of lactulose in the setting of hepatic encephalopathy?
Catabolized by intestinal bacterial flora to short chain fatty acids, lowering the colonic pH and increasing conversion of ammonia to ammonium
How do eosinophils induce parasite killing?
Bind go IgE on parasites, and release granules and reactive oxygen species. Eosinophil proliferation is stimulated by IL-5 produced by Th2 and mast cells.
Describe acute retroviral syndrome in HIV patient
Most patients w/ HIV develop mono like symptoms 2-4 weeks after inoculation (acute retroviral syndrome). The presence of oropharyngeal ulcers and diffuse maculopapular rash are important diagnostic clues.
What is Chediak-Higashi’s LYST of demands?
**LYST gene, LYST of demands is LMNOP”
Lymphohistiocytosis
Microtubule dysfunction—> basis of symptoms
Neurologic sx—> peripheral neuropathy
phagOlysosome formation due to microtubule problem
Pancytopenia
When S. aureus gram (+) CLUSTERS are able to grow in the presence of oxacillin; what mobile genetic element have they likely acquired?
What does it encode?
mecA gene; which encodes for penicillin-binding protein (PBP) 2a. PBPs catalyze peptidoglycan cross-linking during cell wall synthesis; they are the target of beta-lactam medications, which bind to and irreversibly destroy the enzyme.
-unlike other PBPs, PBP 2a has a low affinity for beta-lactams and continues to cross-link peptidoglycan in the presence of oxacillin, methicillin, cephalosporins (ie cefazolin) and other beta-lactams. This is MRSA. Methicillin resistant stapph aureus
12 year old with myocardial infarction, inferonasal lens displacement, marfanoid, mental retardation:
Homocystinuria
Which RNA polymerase is in the nucleolus?
RNA polymerase I
Describe the formation of pulmonary edema in a patient with decompensated HFpEF
Chronic hypertension—>concentric hypertropy (fibers added in parallel)—> stiff/less compliant, leading to impaired diastolic relaxation and increased LV end-diastolic pressure—>that pressure begins to transmit back to pulmonary veins capillaries.
High-potency First generation antipsychotics:
Name two drugs:
Adverse side effects:
Haloperidol and Fluphenazine
Extrapyramidal symptoms: acute dystonia, akathisia, parkinsonism
What is Pure Red Cell Aplasia? What should you suspect
Severe hypoplasia of marrow erythroid elements in the setting of normal granulopoiesis and thrombopoiesis.
All patients should get scan for thymoma. It is also associated w/ lymphocytic leukemias, and parvo b19
When do you see early coagulation necrosis, edema, hemorrhage, and wavy fibers?
4-12 hours
