UWA1 Flashcards
acute onset lung dysfunction, pulmonary edema, normal LA pressure and PaO2/FIO2
ARDS
pathogenesis of ARDS
injury to the endothelial cells that allows fluid to enter the alveoli leading to respiratory compromise during initial exudative stage. Followed by proliferative stage where edema resolves and there is proliferation of type II pneumocytes
What does ARDS look like on CXR
Near complete opacification with obscured cardiomediastinal sihoulette. Fluffy, diffuse, alveolar infiltrates
cardiac conduction velocity
Purkinje > Atrial > Ventricular > AV node
what bone tumor is associated with Paget’s disease?
Osteosarcoma
Characteristic findings of osteosarcoma
periosteal elevation and reactive new bone formation. Ossification of soft tissue in a sunburst pattern
what pharmacological agent increaes risk of avascular necrosis
Glucocorticoids
sunchondral radiolucent line of the femoral head
avascular necrosis
Bony eburnation, joint mice, bony outgrowths at the articular margins
Osteoarthritis
immune complex deposition, neutrophil accumulation in synovial fluid, pannus formation
Rheumatoid arthritis
Presence of endometrial glands outside of uterus
Endometriosis
Whorled smooth muscle bundles with intervening connective tissue on biopsy
Leiomyoma
DNA fragments of 180bp on gel electrophoresis
DNA laddering due to apoptosis (cleaves DNA at iinker regions)
Physostigmine
Cholinesterase inhibitor “Phyxes” atropine overdose
Atropine
muscarinic antagonist. Increases AcH. Pupil dilation, decreased secretions, decreased gut motility
Pralidoxime
Reactivates cholinesterase (antidote for organophosphate poisoning)
Pyridostimine
anti-cholinesterase (increases AcH) in myastenia gravis (gets rid of MG)
not seeing clearing, asking for water due to extreme thirst
Hot as a hare, dry as a bone, red as beet, blind as a bat, mad as a hatter. Anti-cholinergic syndrome
fever, dry skin, flushing, mydriasis, cycloplegia, AMS
Anticholinergic syndrome
Drugs associated with anticholinergic syndrome
antihistamine (diphenhydramine), chlorpromazine, olanzapine, amitryline, desipramine
CNS depression, seizures, pinpoint pupils
Heroin OD
CNS stimulation, mydriasis
Cocaine OD
two or more genetically different cell lines within the body
Mosaicism
genetic mutation is identified in offspring but NOT parents
Germline mosaicism
Pleiotropy
impact of a single gene on multiple phenotypes
t(15:17)
Acute promyelocytic leukemia
t(8;14)
Burkitt lymphoma. Round nuclei with basophilic cytoplasm containing lipid vacuoles (starry sky)
t(9:22)
CML (immature myeloid)
t(12;21)
Acute lymphoblastic leukemia
t(14;18)
Follicular lymphoma (malignant cells with notches or clefts) BCl-2
which adhesion molecules bind intermediate filaments to form adherens junction and desmosomes
Cadherins
easy flushing, persistent erythema, telangiectasia and sensitivity to sunlight
Rosacea
Blue vioet dermal plaque that starts on feet and spreads proximally
Kaposi Sarcoma
blunt trauma to lateral knee
Common peroneal injury
vessel at risk for injury in a knee dislocation
Popliteal artery
Fever, uterine tenderness, foul smelling discharge, leukocytosis following delivery
Bacteroides (endometritis)
Sublimation
Converting unacceptable feelings or drives into more acceptable ones
Displacement
Shifting feelings or conflicts associated with one situation to another
Acting out
Expressing unconcious wishes or impulses through actions (temper tantrums)
Projection
individual attributes own unacceptable thoughts and feelings to another
Facilitation
encouraging the patient to talk more about his or her experience “tell me how”
Sildenafil
PDE5 inhibitor that promotes erection by relaxing venous sinus smooth muscle in the corpora cavernosa
atherosclerosis of bilateral intracranial portions of ICA can cause what visual changes
Binasal hemianopsia ( b/l pressure on optichiasm)
Flashblacks, hypervigilance following a life treatening event LESS than 4 weeks
Acute Stress disorder
2 or more of (delusions, hallucinations, disorganized speech/behavior, negative sxs) at least 1 month but less than 6
Schizophreniform
pervasive pattern of behavior including odd believes, telepathy, superstition, bizarre fantasy
Schizotypal ( no hallucination)
no desire for close relationships with family, friends
Schizoid
False positive rate
1-specificity
urine darkens on exposure to sunlight
AIP defect in HMB synthase (aka prophobilinogen deaminase and uroporphyrinogen I)
First heart sound
AV valves are closed (systole)
Second heart sound
Aortic and pulmonic valves are closed (end of systole)
3rd heart sound
filling of ventricles in mid-diastole (resulting from sudden deceleration of blood) in ventricular failure
pleural fluid protein>0.5, pleural fluid LDH >0.6
Exudate
Burr cells, echinocytes
RBC with multiple projections seen in uremia or pyruvate kinase deficiency
Which tumor is associated with myastenia gravis?
Thymoma
difficulty chewing, diplopia
Myastenia gravis ( ptosis, diplopia, dysarthria, dysphagia, fatigable chewing are common presenting s/s)
cyst on lateral neck that is connected to skin via a sinus tract
second branchial cleft
DKA labs
Hyperkalemia ( d/t H+K+ pump) Decreased sodium due to osmotic diuresis (leads to sodium and water loss)
Cryptorchid testes, no axillary or pubic hair, no ovaries or uterus
Androgen insensitivity syndrome
Intraventricular hemorrhage
Often begins in germinal matrix ( highly cellular and vascular subventricular region that generates neurons and glia during development)
Tx for NSAID induced peptic ulcers
Misoprostol (PGE1 analog) that decreases gastric acid secretion
Mechanism of ASA sensitive asthma
COX-1 inhibition causes increased lipoxygenase (LTC4,D4,E4) leading to bronchocontstriction
mutations in different genes cause similar phenotype
genetic heterogeneity
mutations in same gene result in different phenotypes
phenotypic heterogeneity
proportion of individuals with a given genotype that express the associated phenotype
Penetrance
t(11:22)
Ewing Sarcoma
X linked agammaglobulinemia
Defect in signal transduction in BTK gene (Bruton’s tyrosine kinase) B cells can’t leave bone marrow to enter circulation so antibodies are not produced
what normally maintains the high levels of testosterone in the semiferous tubules
ABP Androgen binding protein (secreted by sertoli cells)
Red safranin O stain
cartilage, mast cell granules and mucin
Change in pH, PaCO2 in PE
hypoxemia leads to hyperventilation and respiratory alkalosis
cyclic pelvic pain, dysmenorrhea, bleeding
Endometriosis
african american female with menorrhagia, pelvic pain
leiomyoma
crampy abdominal pain, tenderness to palpation, bloody stool
Ischemic colitis
Fasting hypoglycemia and low blood ketones
deficiency in acyl-coA dehydrogenase (fatty acid metabolism)
Fasting hypoglycemia and excessive accumulation of glycogen in liver and kidneys
Glucose 6 phosphatase deficiency
hypoglycemia and hyperketosis
Glycogen phosphorylase deficiency (McArdle in muscle and Hers in Liver)
increase in amount of enzymes
increases Vmax
competitive inhibitor
increase Km (takes more substrate to reach 1/2 Vmax)
Rosiglitazone
PPAR that induces transcription of insulin responsive genes (GLUT4 transporter), does not promote insulin release
Glyburide
Sulfonylurea that closes K+ channels in pancreatic B cell membrane inducing depolarization stimulating insulin release
most frequent site affected in Crohn’s
terminal ileum
How does Cimetidine affect p450
inhibits p450
cramping pain in calf, thinned skin, shiny colored skin, hair loss, nail changes
Peripheral arterial disease
Hemangioblastoma, clear cell renal carcinoma
Von Hippel Lindau
where is broca’s area?
inferior frontal gyrus of frontal lobe
Where is wernicke’s area
Superior temporal gyrus
Good comprehension, non-fluent speech and poor repetition
Broca’s aphasia
Fluent speech, Poor comprehension, poor repetition
Wernicke’s aphasia
Dilation of afferent arteriole
increase RPF and GFR
Dilation of the efferent arteriole
increase RPF and decrease GFR
Constriction of afferent arteriole
Decrease RPF and GFR
Dilation of both afferent and efferent arterioles
Increase RPF and decrease GFR
unmyelinated nerves
C fibers. Heat sensation, slow, dull, burning or visceral pain, autonomic post-ganglionic nerve
Delusions for 1 month, but able to function apart from delusions
Delusional Disorder
Mechanism of action for Flucytosine
Inhibits thymidylate synthetase
white patches of thinned skin on the labia, pruritus, dysuria, pain with defecation
Lichen sclerosus ( cigarette paper thin)
white, curd like malodorous discharge
candidiasis
neonatal hypotonia, hyperphagia, obesity, hypogonadism
Loss of paternally inherited chr. 15 ( both from mother)
Epilepsy/seizures, ataxia, inappropriate laughter
Loss of maternally inheritaed allel ( both from father)
amenorrhea, obesity, hirsutism, virilization, peripheral insulin resistance, dyslipidemia
PCOS
PCOS
Increase LH, causes theca cells to produce more androgens. FSH isdecreased and unable to aromatize androgen to Estrogen in granulosa cell
pilocarpine
cholinomimetic. Contracts ciliary muscle of the eye. Resistant to AChE
Cholinesterase poisoning
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle, Lacrimation, Sweating, Salivation
pernicious anemia
immune destruction of gastric mucosa leads to hypochlorhydria which causes an increase in gastrin levels.
pigmented mucocutaneous macules and hamartomatous polyps
Peutz-Jerghers
what are common heart malformations associated with DiGeorge
Truncus arteriosus, tetralogy of Fallor or interrupted aortic arch
Cells that look like “wrinkled” tissue
Gaucher
Hepatosplenomegaly, anemia, bone pain, bone fractures
Gaucher ( accumulation of glucocerebroside)
weakness, loss of motor skills, cherry red macula
Tay Sachs ( hexoaminidase A) causes accumulation of GM2
Decreased ability to sweat, corneal changes, angiokeratoma
Fabry ( a-galactosidase A deficiency) causes Ceramide trihexoside to accumulate
Progressive neurodegeneration, hepatosplenomegaly, lipid laden macrophages
Niemann Pick ( sphingomyelinase deficiency) causes sphingomyelin to accumulate
Peipheral neuropathy with dementia
Metachromatic leukodystrophy (arylsulfatase A deficiency) Cerebroside sulfate accumulates
LTB4
chemotaxis
LTC4, LTD4, LTE4
vasoconstriction, increase vascular permeability, bronchospasms (pro-inflammatory)
Thromboxane A2
prothrombotic ( vasoconstriction, platelet aggregation)
Prostacyclin
Antithrombotic (vasodilation and decrease platelet aggregation)
Prostaglandin D2 and E2
Edema formation ( vasodilation, increase vascular permeability)
Transformation
bacteria take up naked DNA and imcorporate it into genome
Conjucation
DNA is passed from one bacterium to another by direct cell to cell interaction ( sex pillus)
Transdunction
bacteriophage mediated transfer of genetic information
high anion gap acidosis
normal -10-14. Methanol, uremia, DKA, Propylene glycol, INH, Lactic acidosis, ethylene glycol, salicylates
Sarcomere
ZIHM
Scarcomere thin only
I
Sarcomere thick only
H
Sarcomere overlap
A
fatigue, candidiasis, gingival bleeding, retinal hemorrhage
Pancytopenia