UWorld 1st time incorrects Flashcards
Pheochromocytoma
can cause paroxysmal hypertension and is a tumor of the adrenal medulla (derived from neural crest cells)
neural crest gives rise to
- sensory neurons of spinal and cranial nerves
- autonomic postganglionic neurons
- melanocytes
- leptomeninges (arachnoid and pia mater)
- cartilage, ligaments, and bones of branchial arch origin
endoderm gives rise to
- Epithelial linining of GI and respiratory tracts
- thyroid and parathyroid glands
- thymus
- liver and gall bladder epithelium
- pancreas
- epithelial lining of urinary bladder and urethra
- epithelial lining of tympanic cavity and auditory tube
mesoderm gives rise to
- adrenal cortex (not medulla)
- connective tissue
- cartilage
- bone
- muscle
- blood cells and blood and lymph vessels
- spleen
- kidneys
- gonads
- serous membranes of lining body cavities
neuroectoderm gives rise to
- central nervous system
- somatic motor neurons of spinal and cranial nerves
- preganglionic autonomic neurons
- posterior pituitary
surface ectoderm gives rise to
- epidermis of the skin
- hair, nails, sweat and sebaceous glands
- parotid gland
- anterior pituitary (Rathke’s pouch)
- lens of the eye
notochord gives rise to
nucleus pulposus
Hirschsprung disease
congenital cause of constipation
- absence of ganglion cells in submucosal and myenteric plexuses of colon segment
- due to neural crest migration defect
- lack of peristalsis here
- distal rectum always involved
greater sciatic foramen
occupied by piriformis muscle
-superior gluteal nerve, artery, and vein exit through the greater sciatic foramen above piriformis muscle (major hip abductors lie here)
lots of fractured bones and bluish tinge to sclerae leads to what likely finding
- osteogenesis imperfecta
- AD collagen type 1 defect
- impaired osteoid production by osteoblasts
- decreased production of normal type 1 collagen
- example of pleiotropy (multiple often seemingly unrelated physical effects caused by a single genotype)
duchenne muscular dystrophy
x-linked recessive disorder caused by dystophin mutations
complication includes cardiomyopathy
patients with nonallergic bronchospastic conditions (emphysema and chronic bronchitis)are not prescribed what
non-selective beta blockers (ex: metoprolol) due to bronchoconstriction
beta blockers and pts with chronic respiratory disorders
- not recommended
- if they must be prescribed then use a beta1 selective blockers should be used (like metoprolol)
foul-smelling putrid rust colored sputum mixed in aspiration is seen with…
aspiration pneumonia caused by bacteroides species
- less likely but still possible is strep pneumo
- lung abscess usually occur in individuals with episodes of impaired consciousness (alcohol/drug abuse, dementia) or decreased ability to swallow (esophageal strictures)
- generally caused by aspiration of anaerobic and aerobic bacteria from oral cavity into the lower respiratory tract
which NSAID contains sulfa in it
celecoxib (selective COX2 inhibitor)
mixed connective tissue disease
autoimmune condition
high antibody titers to U1-ribonucleoprotein
- joint pain
- myalgias
- pleurisy
- esophageal dysmotility
- raynauds phenomenon
primary toxic agent in lipopolysaccharide in gram-negative organisms
lipid A (also causes septic shock)
what should be cut to relieve pressure in a patient with carpal tunnel?
flexor retinaculum (aka. transverse carpal ligament) –> compresses the median nerve
as part of an intake the patient should always be asked…
about advanced directives including the patients end of life care
Fragile X symptoms
x-linked (LOF)
long narrow face, prominent forehead and chin, large testes, hyperlaxity of joints, developmental delay (speech and motor), and neuropsychiatric features
klinefelter syndrome
47, XXY
- primary hypogonadism (low testosterone, elevated FSH and LH, elevated estradiol)
- tall stature, gynecomastia, small testes (often undescended), and infertility
analysis of variance (ANOVA)
used to determine whether there are any significant differences between the means of several independent groups
spironolactone
aldosterone antagonist
-anti-androgenic effects: gynecomastia
most cardiac venous blood drains into the right atrium via the…
coronary sinus
-anything that causes right atrial pressure to increase (like pulmonary hypertension) will also cause the coronary sinus to dilate
interstitial lung disease (restrictive pulmonary) causes
airway widening due to increased outward pulling (radial traction) by the surrounding fibrotic tissue
-radial traction is increased in restrictive pulmonary disease
what happens to the following 3 in isolated diastolic heart failure
- LV end-diastolic pressure
- LV end-diastolic volume
- LV ejection fraction
- Increased
- Normal
- Normal
*Conditions that reduce ventricular compliance lead to increased LV end-diastolic pressures and the same LVED volumes (upward shift in PV curve)
early group A strep pharyngitis treatment
penicillin – early treatment is good
-prevents acute rheumatic fever and can cause CV death
what three enzymes can act on pyruvate
- lactate dehydrogenase (anaerobic)
- pyruvate dehydrogenase (aerobic)
- pyruvate carboxylase–> to form oxaloacetate which is used to regenerate glucose via gluconeogenesis
what would a chest stab wound hit if its in the lateral fifth intercostal space
left lung
what would a left stab wound to the anterior chest wall hit?
right ventricle
drug-induced lupus erythematosus
- can be due to hydralazine, procainamide, quinidine, minocycline and isoniazid (metabolized via phase II liver acetylation)
- anti-histone antibodies, arthralgias, and pleuritic chest pain
lateral medullary (wallenberg) syndrome
PICA injury/obstruction which is a branch off the vertebral artery
usually due to acute ischemia (due to trauma) in a vertebral artery branch presenting with ataxia (fall toward side of lesion), loss of pain/temp on ipsi face and contra body
leprosy (hansen disease)
deforming infection primarily of skin and nerves (infect schwann cells) caused by Mycobacterium leprae
- usually via armadillo
- tuberculoid leprosy is least severe form and usually self-limited
amiodarone
- class III antiarrhythmic drug
- potassium channel blockers
- prolongs QT
- LOW risk of TDP
- must start by checking TSH then continue to check it while they are on the drug
pyridoxine (vitamin B6)
- necessary for transamination and decarboxylation of amino acids (used in gluconeogenesis)
- nitrogen involved
nystatin
drug used for oral thrush (candida fungi)
- note neutrophils typically prevent hematogenous spread of candida (you will see BOTH pseudohyphae and budding yeast)
- t lymphocytes prevent superficial candida infection
dexamethasone
positive impact on fetal survival
- corticosteroids have the greatest effect on increasing surfactant production by accelerating maturation of type II pneumocytes (note that surfactant is stored in the lamellar bodies–> organelles containing parallel stacks of membrane lamellae)
- as surfactant is degraded it is recycled back into the same type II pneumocytes via endocytosis for reprocessing
diabetic nephropathy
- earliest test for it is to see albumin in the urine
- can be manifested as a diffuse or nodular glomeruloscerlosis (aka. Kimmelstiel-Wilson)
- KW–> characterized by PAS+ deposits (hyaline) of mesangial matrix, thickened basement membranes, and nephrotic syndrome
- ovoid hyaline masses in the periphery of the glomerulus
Respiratory vs metabolic acid/alkylosis
respiratory 40 (increase, decrease) metabolic 24 (decrease, increase)
how to treat acute cholecystitis
third-generation cephalosporin (cefotaxime or ceftriaxone) + metronidazole
choledocholithiasis
gallstone impaction in the common bile duct
-results in elevated direct bilirubin in blood, leading to jaundice and colicky right upper quadrant pain
what is tertiary vs quaternary prevention
3 –> reduces likelihood of disease recurrence or exacerbation in people already diagnosed with disease
4 –> methods to mitigate or avoid consequences or unnecessary or excessive interventions in the health system
secondary prevention
identifies disease at pre-clinical state
primary prevention
reduces number of new cases by eliminating risk factors or through immunization
systemic vascular resistance (SVR)
SVR = deltaP/CO
deltaP = mean arterial pressure - right atrial pressure
what can cause syndrome of inappropriate antidiuretic hormone secretion?
SIADH can cause hyponatremia, osmolarity, which can result in a seizure
- CNS disorders
- chronic pulmonary disease
- drugs
- ectopic ADH secretion by small cell carcinoma of lung
ulceroglandular tularemia
caused by francisella tularensis
- gram-neg coccobacillus
- begins with rupturing pustule followed by ulcer and regional lymph nodes
what type of sperm are in seminiferous tubules
spermatogonia
what can result in septic arthritis
neisseria gonorrhoeae
what connects osteocytes to each other?
gap junctions
fenoldopam
short-acting, selective, peripheral dopamine-1 receptor agonist that causes renal vasodilation, arteriolar dilation, and increased natriuresis
most common cause of fatal sporadic encephalitis or inflammation of brain parenchyma
HSV-1
- presents with fever, headache, seizures, aphasia, mental status/behavior changes
- temporal lobe hemorrhage/edema on brain imaging
- cerebrospinal fluid PCR for HSV
- treat with acyclovir
familial erythrocytosis
B-globin mutation resulting in reduced binding of 2,3-BPG and increased hb oxygen affinity
-most of their blood is fetal hemoglobin
what level of the spinal cord is the lateral horn (intermediolateral cell column) located
T1-L2
-sympathetic preganglionic neurons
how to treat urge incontinence/overactive bladder syndrome/detrusor instability
anticholinergic medications
what hole in the skull does the mandibular nerve (V3) come out of?
foramen ovale
pineal gland mass
causes
- obstructive hydrocephalus (nonbloody/nonbilious emesis)
- dorsal midbrain (Parinaud) syndrome (blurry vision)
hypoxemia + reasons for elevated alveolar to arterial gradient
- right to left shunt
- ventilation/perfusion mismatch
- impaired diffusion
hypoxemia + reasons for normal alveolar to arterial gradient
- hypoventilation
2. low inspired fraction of oxygen
zika virus
- single-stranded RNA flavivirus
- microencephaly, craniofacial disproportion
- neurological abnormalities (ex: spasticity, seizures)
- ocular abnormalities
- infects and destroys fetal neural progenitor cells causing fetal death
- dx via calcifications, ventriculomegaly, cortical thinning
DiGeorge syndrome and what defects are common
maldevelopment of 3rd and 4th pharyngeal pouch derivatives
-immunodeficiency can result from thymic aplasia which causes deficiency of T cells (mainly found in the paracortex)
-thymic aplasia, hypocalcemia, tetralogy of fallot, truncus, arteriosus, transposition of great arteries
CATCH Conotruncal cardiac defects Abnormal facies Thymic aplasia/hypoplasia Cleft palate Hypocalcemia
clostridium perfringens
- gas gangrene due to penetrating injury
- can also cause transient watery diarrhea and abdominal discomfort
- can also cause late onset food poisoning
anticholinergic toxicity
- hot as a hare
- dry as a bone
- red as a beet
- blind as a bat
- mad as a hatter
- full as a flask
- fast as a fiddle
tertiary amines
physostigmine (helps with anticholinergic toxicity)
increased % of O2 saturation causes unloading of what from blood?
protons
mechanism of action of fenofibrate
reducing hepatic VLDL production by inhibiting 7-alpha-hydroxylase
neutrophil elastase released by PMNs and Macrophages … what does it do?
responsible for extracellular elastin degradation
- major serum inhibitor of alpha-1 antitrypsin
- causes panacinar emphysema
cardiac output equation
CO = SV x HR CO = rate of O2 consumption / arteriovenous O2 content difference
clues to lead to arteriosclerosis
- isolated systolic hypertension
- decreased arterial compliance
if giving a drug for a drug company and they offer to pay you for time explaining the drug you should…
give the drug if you think its the right fit BUT DO NOT ACCEPT THE MONEY AT ALL
positive vs negative predictive value
amount of true positives vs negatives
mechanism of action of macrolides
binding to P site of 50S ribosomal subunit and also decreases the elimination of warfarin via CYP450
ex: clarithromycin and erythromycin
if the patient is on hemodialysis what type if amyloid deposits are most likley
Beta-2 microglobulin is too large and does not pass through all of the dialysis membranes
how to test for pneumocystis jirovecci and who usually gets this and first line treatment
direct fluorescent antibody test or stained with methenamine silver stain
AIDS pts usually get P.jirovecci
first line treatment: TMP-SMX
how to calculate total lung capacity
FRC + IC
what is associated with pernicious anemia (antibodies to intrinsic factor/destruction of parietal cells)
atrophic gastritis
- hypochlorhydria –> compensatory increase in gastrin
- loss of parietal cells –> loss of IF and low B12
Test used to compare two mean values
Two sample t test
What does RNA polymerase I do?
Form essential ribosomal components —> works exclusively in the nucleolus
What does the posterior descending artery come off of on the heart?
Right coronary sinus
What does hypocretin do?
Aka orexin. Produced in the lateral hypothalamus and promotes wakefulness and inhibits REM
-too little in CSF causes cataplexy and narcolepsy (treat narcolepsy with modafinil— nonamphetamine stimulant to promote wakefulness)
Fracture of pterion part of skull does what?
Can cause laceration of middle meningeal artery (branch of maxillary) which can cause epidural hematoma
pagets disease
deformity of long bones + hearing loss (increased hat size and messed up hearing)
- look for receptor factor NFk-B ligand
- osteocytes in pagets are typically large and can have over 100 nuclei (normal have 2-5)
- serum ca, phosphorous, and PTH are noraml and alkphos is increased
pregnant woman with HPV genital warts… what can be affected in the baby?
true vocal cords cause of its stratified squamous epithelium
budding spherical yeast with thick polysaccharide capsules
cryptococcus neoformans and causes meningoencephalitis (mainly in AIDS pts)
- you get it from bird droppings then gets inhaled into the alveoli of lungs
- seen via india ink staining
- also stains red with mucicarmine
apical holosystolic murmur going to axilla
suggests mitral regurgitation
Henosch-Sholein purpura (palpable purpura on thighs and butt which can lead to blood in urine and stool)
due to IgA-immune complexes circulating around
-usually in children and can also cause joint pain
pulmonary arterial hypertension
hereditary AD
-can also cause smooth muscle proliferation
losartan mechanism of action
angiotensin II receptor blocker
internuclear ophthalmoplegia
conjugate horizontal gaze where ipsilateral lesion/eye is unable to adduct and contralateral eye abducts with nystagmus
-this can be seen in pts with multiple sclerosis (CD4+T lymphocytes activated by myelin basic protein)
pneumonia that requires cholesterol to grow cause of cell membrane
mycoplasma pneumoniae
Fas pathway
activation-induced t lymphocyte death/apoptosis
cystic fibrosis
CFTR gene mutation. impared post-translational processing (deltaF508)–> causes improper folding and glycosylation of CFTR
if a young child is always getting respiratory infections (pseudomonas/staph) and has pancreatic insufficiency then think CF!
enterococcus
component of normal colon flora
- grows in saline and bile and PYR positive
- cathetar or anything in gu tract can cause enterococcus endocarditis
what is needed for PCR amplification?
nucleotide sequence of regions flanking target exon
scabies
mite and eggs
- rapidly spreading rash
- spread via person to person contact
midazolam
benzodiazepine (works by binding GABA-A receptors causing an increase in the frequency of chloride channels opening in the presence of GABA)
-note that barbiturates increase duration of chloride channels opening
odds ratio
-measure of strength of association b/w exposure and outcome
OR = ad/bc
-dont use total amount but how many did/didnt respond to the drug or whatever it is
how can rheumatoid arthritis cause flaccid paralysis
involving cervical spine and vertebral malalignment subluxation
-endotracheal intubation can worsen this
inheritance of androgenetic alopecia
polygenic inheritance
trochlear nerve (CN 4) palsy
vertical diplopia (double vision)– trouble walking down stairs
-innervates superior oblique muscle
how to measure potency of inhaled anesthetic
minimal alveolar concentration
diabetic ketoacidosis
polydipsia, polyuria, and fruity odor to breath/urine (metabolic acidosis)
hyperglycemia, low bicarb, high anion gap, decreased serum sodium
strongyloides stercoralis infection youll see what
rhabditiform larvae in stool
eggs and adult parasites only seen in intestinal biopsies
continuous infusion of drug eliminated by first order kinetics… when do you hit steady state?
and… what is the formula for half-life
4-5 half-lives
Vd x 0.7 / CL
bupropion
antidepressant similar to amphetamines -work by inhibiting reuptake of norepi and dopamine (no weight gain or sexual dysfunction)
-side effects: stimulant effects (tachy and insomnia), headache, seizures in bulimic pts
amphotericin B
treatment for systemic mycoses
-preferentially binds ergosterol of fungal cell membranes and also binds slightly to cholesterol causing all the bad side effects
-known for renal toxicity
damage to waht can cause contralateral hemiballism (LARGE flinging movements of proximal limbs on one side of body)
subthalamic nucleus (part of basal ganglia)
-if they are small flinging movements then it would be more like huntingtons which is from caudate atrophy
lithium induced diabetes insipidus
lithum antagonizes action of vasopressin on principal cells in collecting duct
what is associated with cutaneous small vessel vasculitis
medication (penicillin and cephalosporins) usually you see leukoclastic vasculitis
janeway lesions
seen in infective endocarditis with mitral regurg as well
major antibody associated with mucosal immunity
secretory IgA (from the duodenum)
gout
disease caused by tissue deposition of monosodium urate crystals. a risk factor is increased purine metabolism and PRPP (phosphoribosyl pyrophosphate synthetase) is response for this
-neutrophils cause the intense inflammation and pain
TREATMENT
first line: NSAIDs
second line: Colchicine
nutcracker effect
increased pressure of left renal vein cause of compression where vein crosses aorta under SMA… can cause elevated left gonadal vein leading to varicocele formation
how old do pts realize death is final
age 7
vitamin A deficiency can cause
night blindness, thickened and dry skin
-can occur due to prolonged biliary obstruction (diffuse itchiness)
guyon canal syndrome (ulnar trap)
pins and needles, mild weakness, flattened hypothenar eminence
hydrocephalus
intracranial calcifications and chorioretinitis -usually due to congenital toxoplasmosis in utero
serotonin syndrome
altered mental status, autonomic hyperactivity, neuromuscular excitation
-antidote: cyproheptadine (antihistamine)
anaplastic tumors
- loss of cell polarity
- nuclear pleomorphism
- large nuclie/hyperchromatic
- mitotic figures
- giant, multinucleated tumor cells
*dont look like tissue of origin
neuroleptic malignant syndrome
adverse reaction to antipsychotic meds with lead pipe rigidity, hyperthermia, sympathetic hyperactivity, mental status changes
treatment: dantrolene (ryanodine receptor blocker that inhibits calcium release from SR) or bromocriptine if refractory
aflatoxin-induced p53 mutations to G –> T due to moldy food is due to what
aspergillus (increased risk of liver cancer)
scurvy
- all the symptoms are due to decreased connective tissue strength
- perifollicular hemorrhages
- myalgias
- subperiosteal hematoma
- gingivitis
- due to deficiency of ascorbic acid (vitamin c)
- abnormal proline and lysine hydroxylation
reasons for holosystolic murmur
tricuspid regurg, mitral regurg, ventricular septal defects
pt with fever, headache, delirium, petechial rash, and meningismus has what?
meningococcal meningitis
disseminated gonorrheal infection triad
arthritis
dermatitis
tenosynovitis
-all in sexually active woman due to neisseria gonorrheae
how to treat androgenetic alopecia
- 5a reductase inhibitors (finasteride)
- this is NOT autoimmune but polygenic inherited loss of hair
olanzapine and clozapine
2nd gen antipsychotic
-metabolic adverse effects
-clozapine (indicated in treatment resistant schizophrenia and when its associated with suicidal ideations) causes fatal neutropenia and agranulocytosis
tricyclic antidepressants
give to pts with treatment resistant depression
- work by inhibiting reuptake of norepi and serotonin as well as inhibiting fast sodium channel conduction (slowing myocardial depolarization leading to arrhythmias)
- strong anticholinergic properties
- side effects include urinary retention, confusion
- if you overdose the cause of death is due to inhibitory properties of Na channels
prostacyclin
= prostaglanin I2
-inhibits platelet aggregation and causes vasodilation locally
most common adverse effect of fibrinolytic therapy
hemorrhage
nissl substance
corresponds to rough ER
pathogenesis cells in COPD
- neutrophils
- macrophages
- CD8+Tcells
deficiency of B1 (thiamine) causes what clinical problems
beriberi (peripheral neuropathy and heart failure)
wernicke korsacoffs –> occulomotor, ataxia, encephalopathy
chronic can lead to korsakoffs syndrome –> memory impairment, confabulation, and apathy
-MOST SUSCEPTIBLE AREA = MAMMILLARY BODIES
most frequent CNS tumor in immunosuppressed pts and associated with EBV
primary CNS lymphoma
what to give for PTSD
SSRI, SNRI, prazosin for nightmares along with CBT
raloxifene and tamoxifin
selective estrogen receptor modulators
- inhibit the effects of estrogen on breast tissue and can reduce risk of gynecomastia in pts
- adverse effects: hot flashes and venous thromboembolism
-adverse effects of tamoxifen only: endometrial hyperplasia and carcinoma
drugs that can cause aplastic anemia
carbamazine, chloramphenicol, sulfonamides, and radiation
which enzyme in the CTA cycle uses FAD
succinate dehydrogenase
ventromedial nucleus does what
center of satiety
parts of HIV cell fusion
gp41 and gp120, cd4 receptor, and chemokine receptor
rapid hyponatremia correction can lead to what
osmotic demyelination syndrome of axons in central pons (spastic quadrapalegia and psuedobulbar palsy)
blastomyces dermatitidis
lung, skin, and bone involvement
-dimorphic fungus with thick walls
what two muscles flank the median nerve
flexor digitorum superficialis and flexor digitorum profundus
rat poison works in the body like…
kinda acts like a super warfarin
how to treat heparin overdose
protamine sulfate
lung apex tumors (superior sulcus)–> pancoast tumors cause what
invasion/compression of surrounding structures
- hoarseness –> recurrent laryngeal nerve
- horner syndrome (ipsilateral ptosis, miosis, anhidrosis) –> stellate ganglion
- SVC syndrome –> superior vena cava
- brachiocephalic syndrome (unilateral) –> brachiocephalic vein
- sensorimotor deficits –> brachial plexus
*Note the pt can present with rib destruction and atrophy of hand muscles as well
clopidogrel
irreversibly blocks P2Y12 component of ADP receptors on platelet surface and prevents platelet aggregation.
-as effective as aspirin for prevention of CV events and should be used in pts with aspirin allergy
ankylosing spondylitis
chronic inflammatory disease of axial skeleton
- progressive pain and stiffness of spine, sacroiliitis
- can also cause reactive arthritis (cant see, cant pee, cant climb a tree)
- HLA-B27 positive serology
- look at degree of chest expansion (you will see limited chest expansion and spinal mobility) –> this can eventually lead to hypoventilation
southern blots test for
DNA
northern blots detect what?
target mRNA to assess gene expression
x-linked sideroblastic anemia
due to gamma-aminolevulinate synthase mutation
-histology: ring sideroblasts
HIV-1 vs HIV-2
1: worldwide, high viral load
2: west-africa, low viral load
gancyclovir vs acyclovir
they are structurally similar but gancyclovir has a greater activity against CMV DNA polymerase
-if the person has gancyclovir-resistant CMV you can use foscarnet (can cause hypocalcemia and hypomagnesmia)
ocular disease in pts with untreated HIV
cytomegalovirus retinitis
schizotypal personality disorder
- eccentric behavior
- odd beliefs
- perceptual distortions
- social anxiety
schizoid personality disorder
tends to struggle in realtionships and is socially detached
genetic defect in NADPH oxidase
chronic granulomatous disease
- impaired intracellular killing
- more sensitive to catalase positive organisms
paradoxical embolism
venous thrombosis crosses into arterial circulation via abnormal connection b/w right and left cardiac chambers (youll see a wide splitting of S2)
mhc class I vs II structure
I: heavy chain and Beta2 microglobulin
II: alpha and beta polypeptide chains
Trazadone
sedating antidepressant that can cause priaprism (long standing erection)
zolpidem
nonbenzo hypnotic used in insomnia treatment
imipramine and clomipramine
tricyclic antidepressants used as second line therapy cause of cardiotoxicity
what does a positive babinski sign show
upper motor neuron sign
- abnormal plantar flexion
- spastic paralysis
- increased muscle tone
- clasp knife rigidity
- hyperreflexia
- pronator drift
- pyramidal weakness
lower motor neuron signs
- flaccid paralysis
- weakness
- hypotonia
- muscle atrophy
- fasciculations
- suppressed/absent reflexes
colchicine mechanism of action
- treatment of acute gouty arthritis in pts who cant take NSAIDs
- inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization
coronary dominance
depends on which gives blood to the PDA
right coronary artery –> right dominant (70%)
left circumflex artery –> left dominant (10%)
20% are both
difference between free ribosomes and ribosomes attached to ER
- free ribosomes: in cytosol and translate proteins found in cytosol
- attached ribosomes: bind to RER after protein translation begins. synthesize secretory proteins, integral membrane proteins of nucleus and cell membrane and parts of organelles
edrophonium
- short acting acetylcholinesterase inhibitor
- used to treat myasthenia gravis
- reduces heart rate, cardiac conduction, and cardiac contractility
esmolol
cardioselective beta1 blocker (short acting)
- decreases heart rate, myocardial contractility, and cardiac contraction without affecting renal blood flow
- beta blockers prolong PQ interval cause they decrease AV conduction
phenylephrine
selective a1-adrenergic receptor agonist that causes a generalized increase in peripheral vascular resistance and blood pressure
-significant renal, splanchnic, and mesenteric vasoconstriction
statin mechanism of action
inhibit HMG CoA reductase (rate limiting step in hepatic cholesterol synthesis)
-before you give a statin make sure to check their liver transaminase levels because statins are hepatotoxic and show muscle toxicity as well
cholestyramine mechanism of action
increases hepatic cholesterol and bile acid synthesis cause it binds to bile acid and prevents it from being taken back up in the terminal ileum
-they also increase hepatic production of triglycerides and can cause hypertriglyceridemia
myeloperoxidase
key component of respiratory burst of neutrophils and is released into phagocytic vacuole and extracellular space as part of immune response to bacteria/pathogens
methylmalonic acidemia
- AR organic acidemia
- methylmalonyl-CoA mutase deficient
- lethargy, vomiting, and tachypnea in newborn
- hyperammonemia, ketotic hypoglycemia, and metabolic acidosis
- elevated urine methylmalonic acid and propionic acid
what to suspect when you have a pregnant woman with alpha-fetoprotein and/or acetylcholinesterase in the amniotic fluid
neural tube defects due to neural folds not fusing in pregion of anterior or posterior neuropores
what is the main factor driving lung abceses
neutrophils releasing lysosomal content
-a sign someone has these is copious sputum (foul-smelling) as well as x-ray of cavitation with air-fluid level
anterior pons infarct
contralateral hemiparesis, babinski sign, contra lower facial palsy, dysarthria
-trigeminal nerve involvement if they have sparing of forehead muscles
how does having hep b give you a chance of getting hep d
the b surface antigen virus coats hep d antigen of hep d virus before it can infect hepatocytes and multiply
TTN gene mutation
- AD with incomplete penetrance, likely a familial inheritance
- encodes sarcomere protein titin and when mutated causes dilated cardiomyopathy
mu opioids cause what
contraction of smooth muscles in sphincter of oddi (leading to spasm and increase in common bile duct pressures)
pt has cyanotic spells that improve with squatting and a systolic murmur
tetralogy of fallot
-abnormal neural crest migration leading to anterior and cephalad deviation of infundibular septum (malaligned VSD and overriding aorta)
4 characteristics of tetralogy of fallot and what is the most important factor in degree of intracardiac shunting and cyanosis
PROVe
- Pulmonary infundibular stenosis (most important determinant for prognosis) –> right ventricular outflow tract obstruction
- Right ventricular hypertrophy (RVH) –> boot shaped heart on chest X-ray
- Overriding aorta
- VSD
failed fusion of superior and inferior endocardial cushions
- defects of av septum and values (tri and bi)
- initially left to right shunting then becomes r to left and causes delayed cyanosis
porphyria cutanea tarda
enzyme deficiency in late porphyrin synthesis steps (Uroporphyrinogen decarboxylase)
in post strep glomerulonephritis what immunofluorescence stains will be seen
- granular deposits of IgG, IgM, and C3
- discrete subepithelial humps on electron microscopy
first line treatment for trigeminal neuralgia
carbamazepine: neuroleptic medication that inhibits neuronal high frequency firing by reducing the ability of soium channels to recover from inactivation
- can cause bone marrow suppression
clasp-knife spasticity
- initial resistance then sudden release
- internal capsule stroke can cause this due to the upper motor neuron lesion
maraviroc
targets CCR5 to stop HIV from infecting macrophages
Enfuviritide
HIV fusion inhibitor (blocks gp41)
eplerenone
aldosterone antagonist
-can be used in Conn syndrome
what do you think of when someone has cataracts and no other symptoms
or when a diabetic has cataracts
galactokinase deficiency
if its a diabetic you can assume that they have cataracts due to aldose reductase converting glucose to sorbitol faster than sorbitol can be metabolized
pathologic features of hiv-associated dementia
microglial nodules and multinucleated giant cells
patient with symmetric bilateral lower extremity pitting edema and tortuous abdominal veins….
interior vena cava obstruction
what heart defect is associated with turner syndrome
bicuspid aortic valve and aortic coarctation
-you will also see a shield chest, decreased femoral pulse, shortened 4th metacarpals, high-arched palate, streak ovaries/amenorrhea/infertility, cystic hygroma (fluid filled sac due to lymphatic blockage), and horseshoe kidney
first line treatment for essential tremor
propranolol
-pts say symptoms improve with alcohol consumption
epidural hematoma
- pt with fracture of. temporal bone and rupture/tear of middle meningeal artery
- pt loses consciousness, wakes up, then loses consciousness again
Jervell and Lange-Nielsen syndrome
- AR
- bilateral sensorineural hearing loss and congenital long QT syndrome
- mutation in voltage gated K channels
- mutation in KCNQ1 and KCNE1 genes
Huntingtons disease findings
chorea, dementia, behavioral changes
- loss of neurons in caudate and putamen
- NMDA associated toxicity
- AD- CAD trinucleotide repeats
atropine
- treats bradycardia
- decreases vagal influence on SA and AV node
- side effect: increased intraocular pressure can cause acute closed-angle glaucoma
peau d’orange
erythematous, itchy breast rash with skin texture changes analogous to an orange peel
-usually due to inflammatory breast cancer and is caused by cancerous cells obstructing lymphatic drainage due to spread to dermal lymphatic spaces
horse/sheep erythrocytes in monospot test
this is done and positive in pts with EBV
-if its mono and not from EBV it could be due to CMV
how is nitric oxide synthesized and what does it do
arginine + O2 along with stress/Ca increase which then makes NO + Citrulline
-causing vasodilation
kartagener syndrome
-form of primary ciliary dyskinesia (AR)
- situs inversus
- chronic sinusitis
- bronchiectasis
*infertility can also occur due to sperm tails or cilia in fallopian tubes
where is the most common location for an anal fissure?
posterior midline –> likely due to decreased blood flow
what type of cells are in the adrenal medulla
chromaffin cells –> modified neuroendocrine cells derived from neural cresta nd are stimulated by acetylcholine to secrete catecholamines
propionyl-CoA is made from what… and if you have excess how does it present
odd chain fatty acids, branched-chain amino acids, methionine, and threonine
-presents as propionic acidemia –> lethargy, poor feeding, vomiting, hypotonia 1-2 weeks after birth
anticholinergic toxicity
- hot as a hare
- dry as a bone
- red as a beet
- blind as a bat
- mad as a hatter
- full as a flask
- fast as a fiddle
-GIVE THE PT PHYSOSTIGMINE (cholinesterase inhibitor)
anticholinergiic drugs
atropine and scopolamine
ACE inhibitor side effects
cough
hyperkalemia
decreased GFR initially cause of actions on efferent tubules of glomerulus
-angioedema is rare but can occur (increase in bradykinin increases vascular permeability) –> any pt on these with swelling or difficulty breathing should have the drug discontinued
lead time bias
apparent increase in survival time when there actually isnt one.
-detecting it earlier makes people think that pts lived longer when in reality you just found out they had is sooner
where are most things reabsorbed (including water) in the nephron
proximal tubule
how is isoniazid metabolized
via acetylation and there are fast and slow acetylators so it depends what grup people are in to see how quickly the drug will work
-its also directly hepatotoxic
what bacterial pathogens are most likely to occur after influenza virus
-the following pathogens are more likely due to the loss of cilia from influenza
- strep pneumo
- staph aureus
- haemophilus influenzae
cilostazol
pde inhibitor that inhibits platelet aggregation
nitrate moa and adverse effects
get converted to NO, activate guanylate cyclase and increase intracellular cGMP leads to myosin light chain dephosphorylation leading to vascular smooth muscle relaxation
headaches, flushing, light headedness, hypotension
-due to veinodilation (systemic dilation)
what characterizes Alzheimer disease
decfreased acetylcholine in nucleus basalis of meynert and hippocampus caused by diminished activity of choline acetyltransferase
COPD exacerbations usually occurs due to which infections
viral: rhinovirus, influenza, parainfluenza
bacterial infection: haemophilus influenzae, moraxella catarrhalis, streptococcus pneumoniae
what does cyanide poisoning look like and how do you fix it
- reddish skin discoloration , lactic acidosis, narrowing of venous-arterial PO2 gradient
- give nitrates (amyl nitrite) so iron is converted to ferric iron in the blood so it binds the cyanide and stops it from blocking cytochrome c oxidase
zidovudine (drug)
nucleoside reverse transcriptase inhibitor
-blocks phosphodiester bond so reverse transcriptase cant be made
what predisposes someone to infective endocarditis to a native valve
mitral valve prolapse with regurg
-rheumatic heart disease is common only in developing nations
if a patient has malaria from africa it is likely to be chloroquine resistant… which drugs should you give?
atovaquone-proguanil or artemisinins
pts with malaria p vivax or p ovale have…
dormant liver forms (hypnozoites) that require the addition of primaquine therapy
funtion of detrusor muscle
to squeeze the bladder so you can completely empty during urination
struvite kidney stones
usually seen in pt with upper urinary infection by urease-producing organisms (proteus, klebsiella). hydrolysis of urea yields ammonia which alkalinizes urine and facilitates precipitation of magnesium ammonium phosphate. urinalysis shows hematuria and elevated urine ph
why cant sheep blood agar support haemophilus growth
insufficient nutrients. it needs X factor (hematin) and V factor (NAD+)
-it can get V factor (NAD+) when grown alongside S aureus cause its Beta-hemolytic –> called satellite phenomenon
follicular lymphoma cytogenetic analysis
BCL-2 overexpression and t(14;18)
does carbon monoxide poisoning affect PaO2
no, it only increases carboxyhemoglobin (which represents levels of CO-bound hemoglobin)
-it decreases the O2 carrying capacity of of blood cause CO binds stronger than O2
constant vomiting leads to what acid-base disturbance
metabolic alkalosis due to net loss of acid gastric secretions
what enzymes breaks down triglycerides
hormone sensitive lipase – found in adipose tissue, allowing for glycerol to be used in glucose production and fatty acids to be used in ketone body formation during times of starvation
lipoprotein lipase – on endothelial cells that function to degrade triglycerides found in chylomicrons and VLDL, works in bloodstream to form FFAs that are then transported into adipocytes storage or used by tissues for energy production
hemolytic uremic syndrome
acute renal failure in children
- microangiopathic hemolytic anemia
- microthrombi in small vessels
- thrombocytopenia
- acute kidney injury
if portal hypertension leads to esophageal varicies… where is the portal blood shunted to?
left gastric vein
most important mediator in sepsis
TNF-alpha (acute phase cytokine produced by activated macrophages)
-also IL-1 and IL-6
what causes intestinal atresia of the midgut in newborns? “apple peel atresia” occurs when superior mesenteric artery is obstructed
vascular occlusion in utero and the first sign of this is bilious emesis
neurophysins
carrier proteins for oxytocin and vasopressin (produced in paraventricular and supraoptic nuclei) are released from posterior pituitary
DIC pathogenesis in pregnant women
placental damage –> release of tissue factor from placenta into maternal circulation –> activation of intravascular coagulation –> circulating microthrombi –> platelet/factor consumption –> bleeding
preferred antihypertensives in pts with diabetic nephropathy
ACE inhibitors and angiotensin II receptor blockers… due to antiproteinuric effects
patients with sickle cell disease and chronic splenic infarctions lead to BLANK and require BLANK
fibrosis and atrophy of spleen
they require increased folic acid due to erythrocyte turnover
–HbS allows for hydrophobic interactions among hemoglobin molecules
orotic aciduria
rare autosomal recessive disorder of de novo pyrimidine synthesis that occurs due to defect in UMP synthase
- physical and mental retardation
- megaloblastic anemia
- large amounts of urinary orotic acid
give uridine supplementation
where is the apex of the lung located on the anterior side of the body
above the clavicle and the first rib through superior aperature in the neck
broad spectrum anticonvulsants for generalized seizures
lamotrigine, levetiracetam, topiramate, valproic acid
grayish white vaginal discharge with fishy odor
overgrowth of gardnerella vaginalis (anaerobic gram variable rod) clue cells (squamous epithelial cells covered with bacterial organisms) are seen on wet mount microscopy or cytology treat with metronidazole or clindamycin
septic shock
facial flushing and altered consciousness + positive for bacteria
due to LPS toxin–> Lipid A
Terbinafine uses and mechanism of action
dermatophytosis (by tinea corporis) and suppresses enzyme squaline epoxidase to block synthesis of fungal membrane ergosterol
renal ammoniagenesis
renal epithelial cells metabolize glutamine (generating ammonia and bicarb) which buffers acids in the blood
what is strep gallolyticus associated with (aka s bovis)
colonic cancer
sphingomyelinase deficiency (Niemen-Picks disease)
accumulation of lipid sphingomyelin, hepatosplenomegaly, neurologic regression, cherry red macular spot in infancy
how does glucagon work
via adenylyl cyclase and protein kinase A
where does the lymph of the testis drain to vs the scrotum lymph
testis –> para-aortic
scrotum –> superficial inguinal lymph nodes
what is HAART therapy associated with
fat redistribution (increases abdominal girth)
what do pelvic floor strength exercises do
target levator ani to improve support around urethra and bladder
how do you tell if a pt is taking exogenous thyroid hormone or if they have graves
graves will have an elevated thyroglobulin and exogenous use will have undetectable thyroglobulin
what deficiency causes maternal virilization
aromatase, also causes ambiguous genetalia in baby
cancers of the pelvis (including prostate) spread to where via the vertebral venous plexus/prostatic venous plexus
lumbosacral spine
where is the breast tumor if you have dimpling of the skin
suspensory ligament
testicular torsion is when BLANK wraps around the BLANK leading to ischemia
twisting of testis around spermatic cord (containing gonadal artery), leading to ischemia …. note that the gonadal artery arises from the abdominal aorta
what to give for C.diff treatment
oral vancomycin or metronidazole
fidoximicin –> macrolide against RNA polymerase
what do studies show in a pt with lactose intolerance?
increased breath hydrogen test
reduced stool ph
elevated stool osmolaltiy
what do you see on xray for necrotizing enterocolitis
thin curvilinear areas of lucency that parallel the bowel wall lumen
where does heme synthesis occur and what are the precursors ?
partly in the mitoC and partly in erythrocytes
made from glycine and succinyl-CoA
recombination
gene exchange occurs through the crossing over of 2-double stranded DNA molecules
mixing of genome segments in segmented viruses that infect the same host cell
what drugs are guanosine analogs
acyclovir, famciclovir, and valacyclovir… also gancyclovir
what do thiazide diuretics do to ion levels in the body?
raises calcium, uric acid, glucose, cholesterol, and triglycerides
lower sodium, potassium, and magnesium
minimal change disease
- mostly in children
- proteinuria
- hypoalbuminemia
- edema (reversible with corticosteroids)
- may be triggered by recent URI
- foot process effacement
what can increased nsaid use do to the kidneys?
chronic interstitial nephritis and papillary necrosis
what is a sign for meckel diverticulum
-includes mucosa, submucosa, and muscularis layers
spontaneous and painless lower gi bleeding
99m-TC-pertechnetate localizes ectopic gastric mucosa and increased uptake in the lower right quadrant
- most common vitelline duct anomaly: results from partial closure of vitelline duct with patent portion attached to ileum (a fibrous band my connect tip of diverticulum to the umbilicus)
- failure of obliteration of vitelline duct (omaphalomesenteric duct) –> painless GI bleeding
pts with severe mitral regurgitation
holosystolic murmur at apex with radiation to the axilla
audible S3 gallop
-pts with severe mitral regurg develop left-sided volume overload with an S3 gallop due to the large volume of regurgitant flow reentering the ventricle during mid-diastole. The absence of an S3 gallop excludes severe chronic MR
first line treatment for pts with ADHD
stimulant medications: increase availability of norepinephrine and dopamine in the prefrontal cortex
what heart defect is common in pts with down syndrome and what are possible causes of down syndrome
Also list the As of down syndrome
complete atrioventricular defect
causes: trisomy 21 or 46 XX (14;21) robertsonian translocation or mosaicism (nondisjunction during mitosis)
5As
- Advanced maternal age
- Atresia (duodenal)
- AV septal defect
- Alzheimers
- AML/ALL
number needed to treat equation
number needed to treat = 1 / absolute risk reduction
absolute risk reduction = control event rate - experimental event rate
what virus is common in pts with lung transplants?
cytomegalovirus
staph aureus
is on the normal skin flora and intravascular catheters are causing an increase in the incidence of their bloodstream infections
Abacavir
HIV/AIDS medication that can cause an allergic reaction in pts with HLA-B*57:01 molecule
causes delayed (type 4) hypersensitivity reaction
what laboratory findings do you see in rheumatoid arthritis
anti-cyclic citrullinated peptide antibodies
-rheumatoid factor is an antibody (typically IgM) specific for the Fc component of IgG
soft tissue swelling and bony erosions
C reactive protein and ESR correlate with disease activity
-fibrinoid necrosis with palisading histiocytes/epithelioid cells
severe retrosternal pain that radiates to the back
aortic dissection (intimal tearing)
pleiotropy
multiple phenotypic manifestations from single genetic mutation (diff organs)
what to think of in a child who has pemphigus vulgaris
staph scalded skin syndrome and causes exotoxin mediated skin damage (exfoliatin exotoxin)
key clinical features of tay-sachs vs niemann-pick disease
Tay-Sachs
Beta-hexoaminidase A deficiency resulting in GM2 ganglioside accumulation
-progressive neurodegeneration, cherry red macular spot and no heptaosplenomegaly
Niemann-Pick
- sphingomyelinase deficiency
- same as tay-sachs BUT WITH HEPATOSPLENOMEGALY
metalloproteinases
zinc containing enzymes that degrade extracellular matrix
participate in normal tissue remodeling and in tumor invasion through basement membrane and connective tissue
what noise is heard with aortic regurg
decrecendo with diastolic murmur with maximal intensity just after closure of aortic valve
-more noticeable when pt leans forward on exam table
-aortic regurg causes fall in diastolic aortic pressure and a rise in systolic aortic pressure
gertsmann syndrome
- damage to angular gyrus of the dominant parietal lobe
- agraphia
- acalculia
- finger agnosia
- left/right disorientation
haloperidol
high potency first generation antipsychotic
risk of acute harm
used for delerium to treat behavioral and psychotic manifestations
chemoreceptor trigger zone
- chemotherapy goes here and triggers vomiting
- on dorsal surface of MEDULLA at caudal end of fourth ventricle (area postrema)
- to help with chemo induced n/v you can use serotonin antagonists and neurokinin 1 antagonists
malignant hyperthermia
after administration of inhalation anesthetics or succinylcholine to genetically susceptible individuals
-treated with dantrolene that blocks ryanodine receptors and prevents release of Ca into cytoplasm of skeletal muscle fibers
what medications can you give for manic features
valproate and carbamazepine
systemic mastocytosis
abnormal proliferation of mast cells and increased histamine which causes hypersecretion of gastric acid by parietal cells in stomach as well as a variety of other symptoms (hypotension, flushing, pruritus)
what do these lead to believe as a dx
- microcytic anemia
- construction worker
- constipation/abdominal pain
- mental status changes
lead poisoning
- inhibits heme synthesis pathway
- leads to basophilic stippling
first line treatment –> edetate calcium disodium (increases urinary excretion of lead)
IN CHILDREN
- lead poisoning will present with:
- loss of milestones/cognitive impairment, behavioral problems, encephalopathy
- constipation, abdominal pain, decreased vitamin D metabolism
- interstitial nephritis
- anemia
how to treat beta blocker overdose
glucagon because it increases heart rate and contractility independent of adrenergic receptors
glucagon activates G-protein coupled receptors on cardiac myocytes activating adenylate cyclase and raising intracellular cAMP —> increase SA firing
side effect of omeprazole
lower calcium absorption
prolonged use can increase risk of osteoporosis
abnormally slow relaxation of muscles
AD
increased number of trinucleotide repeats
myotonia (myotonic dystrophy)
what causes a transudate vs exudate pleural effusion
both are due to some type of heart/vascular failure
EXUDATE –> inflammatory increase in vascular membrane permeability: infection (pneumonia), malignancy, rheumatologic disease
TRANSUDATE –> pressure changes (hydrostatic or oncotic pressure): heart failure, cirrhosis, nephrotic syndrome
adenoma to carcinoma sequence
firing order of events is AK-53 (normal —> at risk —> adenoma —> carcinoma)
normal colon — (APC inactivation/B-catenin accumulation)–> hyperproliferative epithelium (methylation abnormalities and COX-2 overexpression) – (KRAS activation)–> adenoma –(p53 inactivation)–> carcinoma
lamotrigine
- treats partial and generalized seizures (anticonvulsant mood stabilizer) also used in depressed phase/maintenance of bipolar disorder
- blocks voltage gated sodium channels
- benign rash that can progress to SJS and toxic epidermal necrolysis are rare but life threatening adverse effects
what lab tests are used to check the status of the biliary tract
alk phos and gamma-glutamyl transferase
histology of adenocarcinoma of the lung
invasive glandular cells with abundant cytoplasm
-most common lung cancer among non-smokers and women
pure red cell aplasia is associated with what 3 pathologies?
- thymoma
- lymphocytic leukemia
- parvovirus B19
neurofibromatosis 1 (aka. vonRecklinghausen’s disease)
- AD, NF1 tumor suppressor
- PNS tumor syndrome
- cafe-au-lait spots
- pigmented iris nodules
- cutaneous neurofibromas (made of schwann cells)
what are schwann cells embryologically derived from
neural crest
heteroplasmy
clinical variability of mitochondrial diseases (presence of both normal and mutated mtDNA, resulting in variable expression in mitochondrially inherited disease)
neurologic deficits and megaloblastic anemia… what is deficient and what should you measure to check?
B12 (cobalmin) is deficient and you should measure methymalonic acid which will be increased
abusive head trauma
subdural hemorrhage, posterior rib fractures, and retinal hemorrhages
damage to brainstem at level of red nucleus or below results in what type of stuck posturing
extensor
damage to brainstem above red nucleus results in what type of stuck positioning
flexed
fever, stiff neck, altered mentation
bacterial meningitis
how to treat essential tremors
beta blockers
ethosuximide
treats absence seizures and blocks type T calcium channels
onset of gas anesthetic depends on what
solubility in blood (blood/gas partition coefficient)
name the first generation anti-histamines and their associated side effects
chlorpheniramine and diphenhydramine
-meant to block histamine released from mast cells
-also blocks alpha adrenergic, serotonergic, and cholinergic receptors (cholinergic blocking can cause blurriness when looking at things close up cause of the ciliary muscles impaired accomodation)
how do volatile anesthetics alter cerebral blood flow
they increase it. this is undesireable side effect as it increases cerebral vascular pressure
edrophonium
used in the tensilon test to see if a pt with myasthenia gravis is undertreated. if the pt gets better with edrophonium (a short acting ace inhibitor) then you need to increase the pts dosage of their med
pentapeptide
is a beta-endorphin thats made from the POMC precursor… the same one that makes ACTH and melanin
what nerves come off of the sciatic nerve?
branches into the common peroneal (wraps around medially to the anterior side and branches into the deep and superficial peroneal nerves) and the tibial nerve (stays posterior)
what innervates each of the eye muscles
CN III (oculomotor): SMILI (superior, medial, inferior rectus, lateral palpebrae superioris, and inferior oblique)
CNIV (trochlear): superior oblique
CNVI (abducens): lateral rectus
what nerve becomes problematic in pts with crutches
proximal radial nerve injury
- weakness in extensor muscles of arm and no triceps reflex
- radial nerve injury can also cause wrist drop (no wrist extension
von Hipple Lindau disease
AD
cerebellar hemangioblastoma and congenital cysts in kidney, liver, and pancreas
NF2
AD nervous sytem tumor
-bilateral cranial nerve 8 schwannomas and multiple meningiomas
sturge-weber syndrome
rare congenital neurocutaneous disorder
- cutaneous facial angiomas
- leptomeningeal angiomas
- V1 and V2 distributions of trigeminal nerve
- mental retardation, seizures, hemiplegia, skull radiopacities
- tram-trak calcifications
tuberous sclerosis
AD
- cortical and subependymal hamartomas
- cutaneous angiofibromas (adenoma sebaceum)
- visceral cysts
- renal and cardiac problems as well
- seizures are major complication
osler-weber-rendu syndrome
hereditary hemorrhagic telangiectasia
-AD
friedreich ataxia
- AD
- progressive gait ataxia
- hypertrophic cardiomyopathy
- DM
- kyphoscoliosis
- pes cavus
degeneration of….
lateral corticospinal tract (spastic paralysis)
spinocerebellar tract (ataxia)
dorsal columns (decrease in vibratory sense and proprioception)
dorsal root ganglia (loss of DTRs)
clostridium tetani with tetanus toxin
due to puncture wound usually
- blocks gaba and glycine
- locked jaw
- only grows at inoculation site
- clinical diagnosis (dont really test for it usually)
- give diazepam and do wound debridement/antitoxin/vaccine booster/antibiotics
uncal herniation
ipsilateral oculomotor nerve palsy with fixed dilated pupil
cholinergic toxicity and what to give the pt as a result
DUMBELS —> give the pt an antimuscarinic agent (glycopyrrolate/hyoscyamine/propantheline)
Diarrhea/diaphoresis Urination Miosis Bronchospasm, bronchorrhea, bradycardia Emesis Lacrimation Salivation
decrease in compound muscle action potential
botulinum toxin
cavernous hemangiomas cause increased risk of what
intracerebral hemorrhage and seizures
what does the iliohypogastric nerve supply blood to
sensation to suprapubic and gluteal regions
motor function to anterolateral abdominal wall muscles
restless leg syndrome (causes and treatments)
- idiopathic, iron deficiency, uremia, diabetes
- avoid triggers and use dopamine agonists (pramipexole)
what is the most common cause spontaneous lobar hemorrhage
cerebral amyloid angiopathy and these usually occur in the occipital and parietal lobes
what is the problem with using halogenated inhaled anesthetics
they can cause acute hepatitis due to their reactive intermediates (….ane drugs)
what artery supplies the occipital lobe of the brain
PCA
what happens if. you give a pt with alcoholism glucose without thiamine?
hemorrhage and necrosis of mammillary bodies
myeloperoxidase
found in neutrophils and converts hydrogen peroxide to hypochlorous acid (bactericidal compound causes oxidative damage to host cells)
NADPH oxidase
catalyzes reduction of molecular oxygen to superoxide free radicals (destroys bacteria) —> deficiency of this causes chronic granulomatous disease and pts cant destroy catalase positive organisms
superoxide dismutase
neutralizes reactive oxygen species (preventing cell injury)
two most common causes of toxic shock syndrom
-essentially shoving something in a hole for too long
- tampon use
- nasal packing after epistaxis
superantigens bind to mhc class II and no antigen processing needed (T cell receptors bind to bacterial secretory products) -due to macrophages and T lymphocytes
both bactrim and tenofovir can cause acute interstitial nephritis… what is the the key difference in the kidney damage they do?
tenofovir also causes focal damage to the proximal tubule
symptoms of chronic alcoholic pancreatitis
abdominal pain, chronic diarrhea, and recent weight loss
-due to digestive enzyme deficiency
what is the most common complication of bicuspid valves
aortic stenosis (usually in their 50s)
gomori trichrome stain
characteristic of mitochondrial myopathies (red ragged fiber disease)
milrinone
PDE3 enzyme inhibitor that reduced cAMP to provide 2 beneficial effects for treating systolic heart failure
causes vasodilation and decreases preload and afterload
mechanism of action of opiate analgesics
increased potassium efflux out of cells to cause hyperpolarization of the post-synaptic cell
why would a pt have an S4 heart sound?
decreased left ventricular compliance and associated with restrictive cardiomyopathy and left ventricular hypertrophy
what does a pulmonary artery balloon measure
left atrial pressure
ectopia
its like metaplasia but you are born with it so its congenital rather than metaplasia which is developed during adult life
what two enzymes in the process of atp production require thiamine as a co-factor
- pyruvate dehydrogenase
2. alpha-ketoglutarate dehydrogenase
new diabetes (hyperglycemia) and a rash (necrolytic migratory erythema –> blistering with erythematous plaques and central clearing), what do you think?
glucagonoma
elevated methionine, marfanoid habitus, lens subluxation, thrombosis/stroke/MI, kyphosis, and intellectual disability
its probably homocysteinuria and you should supplement B6, increase cysteine in diet, increase methionine in diet and increase folate in diet
what are the two parts of the lesser omentum
hepatogastric and hepatoduodenal ligaments
two major symptoms of hyperaldosteronism (Conn syndrome)
Paresthesias and muscle weakness
-you also get a metabolic alkalosis
aspirin intoxication
fever, tinnitus, and tachypnea
also… RESPIRATORY ALKALOSIS with increased respiration and loss of CO2 then METABOLIC ACIDOSIS
sick sinus syndrome
you will see the p wave disappear and is due to age related degeneration of the sinoatrial node located on the right atrial wall causing reduced cardiac output
if gastrin levels rise in response to secretin, what is that suggestive of?
zolinger-elison syndrome which is a gastrin secreting tumor
what two tests can you do when comparing qualitative data
chi-square and logistic regression
what do you need to check before starting a patient on metformin
renal activity because if its decreased the patient will be at greater risk for lactic acidosis
treatment of hepatic encephalopathy after eating a lot of smoked meats and having cirrhosis
increase in blood ammonia levels
lactulose (increased conversion of ammonia to ammonium)
rifaximin (decrease intraluminal ammonia production)
grayish pharyngeal exudate
corynebacterium diphtheriae
- conversion from nontoxigenic to toxigenic C.Diphtheriae occur due to infection with lysogenic bacteriophage called corynephage beta –> this inserts the tox gene into its genome which results in bacterial expression of diphtheria AB toxin (PHAGE CONVERSION PERMITTING EXOTOXIN PRODUCTION)
- stains deeply with aniline dyes
- irreversibly halts protein synthesis due to ADP-ribosylation of EF-2
alpha 1 blockers
can help with BPH and decreasing peripheral vascular resistance
-doxazosin, prazosin, and terazosin
ecological study
population level as unit of analysis (instead of individual level)
tibial nerve problems
- tibial nerve is the one that follows on the back of the leg from the sciatic nerve
- problems with this will cause difficulty in plantar flexion and decreased sensation over the sole of the foot
common peroneal nerve problems
foot drop and trouble everting ankle as well as toe extension
phenoxybenzamine
irreversible a1 and a2 blocker prevents catecholamine (hypertensive) crisis
Low serum sodium and normal urine osmolality after deprivation test and no change with vasopressin being added…. what do you think?
primary polydipsia
pringle maneuver
clamp the hepatoduodenal ligament to see if bleeding stops (common bile duct, hepatic artery, and hepatic portal vein are all in this ligament)
primary central nervous sytem lymphoma
second most common cause of ring enhancing lesions (first is toxoplasma gondii) which is usually as a result of EBV which infects B cells primarily and is seen on biopsy of the brain
T cell abnormalities can be seen on blood smear
inheritance pattern of achondroplasia
AD with full penetrance and homozygosity is lethal
mechanism of action of all hepC drugs
inhibit viral genome replication and assembly
how to treat cardiac toxicity of tricyclic antidepressants
sodium bicarbonate
-works by increasing serum pH and extracellular sodium (alleviating fast sodium channel blockade)
nonseptate hyphae that branch at wide 90degree angles
mucor, rhizopus, and absidia (all fungi)
pts with small cell lung cancer could have what major paraneoplastic syndrome
lambert-eaton myasthenic syndrome: autoantibodies to presynaptic Ca2+ channels and decreased ACh release
- proximal muscle weakness and dry mouth/impotence
- histo shows small, round/oval cells with scant cytoplasm and large hyperchromatic nuclei (chromogranin+)
hallmark of acute acute graft rejection
dense interstitial lymphocyte infiltration
most common cause of acute pericarditis
viral etiology
what causes most oral DM drugs to be contraindicated?
impaired kidney function
side effect of doxorubicin
-dilated cardiomyopaty and its a chemotherapeutic drug
where does steroidogenesis occur?
mitochondria then smooth endoplasmic reticulum
gallstone ileus
passage of large gallstone and it gets stuck usually at the ileocecal valve
- small bowel obstruction
- gas in gallbladder and biliary tree as seen on x-ray
- high pitch bowel sounds
how does hep b immunization work?
when you actually get infected the immunity stops the virus from being able to infect any cells
what are the teoxic alcohols
ethylene glycol and methanol
-give pt fomepizole (competative alcohol dehydrogenase inhibitor)
extended spectrum beta lactamases
- render penicillins and cephalosporins inactive
- on plasmids
- transmitted via conjugation
thromboxane
increases platelet aggregation and vasoconstriction
what medication do you give to a pt who suffered from a subarachnoid hemorrhage
nimodipine (calcium channel blocker)
-prevents cerebrovascular spasm
what are the extrapyramidal adverse effects of taking a typical antipsychotic medication
ADAPT AD --> acute dystonia (muscle spasm/stiffness) A --> akathisia (restlessness) P --> parkinsonism (bradykinesia) T --> Tardive dyskinesia
endemic location for histoplasmosis and path
mississippi and ohio river valley , in macrophages
endemic location for blastomycosis and path
eastern and central US, as well as great lakes, broad based budding yeast
endemic location for coccidioidomycosis and path
southwestern US and california, spherule filled with endospores
endemic location for para-coccidioidomycosis and path
latin america, budding yeast with captains wheel formation
guillan barre syndrome
immune mediated, demyelinating polyneuropathy (molecular mimicry), cross reacts with myelin of spinal roots and peripheral nerves…. causing demyelination
-you will see inflammatory infiltrate in the endoneurium
what are the differentials for pulsus paradoxus
- cardiac tamponade
- pericarditis
- asthma/COPD
- obstructive sleep apnea
- croup
what do alcohol based disinfectants target
lipid bilayer membranes and then they denature proteins after
how can you tell the difference between PTSD and acute stress disorder
acute stress disorder occurs for more than three days but less than 1 month
PTSD is the same thing but it lasts for longer than 1 month
acute stress disorder just changes to PTSD after the one month mark
hemagluttinin and neuraminidase
HA: binds sialic acid and promotes viral entry
NA: promotes progeny virion release (inhibited by oseltamivir)
maintenance dose
CPss x CL / bioavailability fraction
loading dose
Vd x CPss / bioavailability fraction
what is the drug of choice in a pt in cardiogenic shock
dobutamine due to the increase in CO and increase in end-organ perfusion
how to treat an SSRI/SNRI/MAOI/TCA overdose
cyproheptadine (serotonin antagonist)
how to treat a benzo overdose and what are the signs of benzo withdrawal
flumazenil (benzo competitive antagonist)
W/D
- rebound anxiety
- tremor
- insomnia
- sympathetic hyperactivity (diaphoresis and palpitations)
- severe cases: psychotic symptoms, seizure, death
whatre the most common causes of acute pancreatitis
- gall stones
2. alcohol abuse (you will also see macrocytosis)
if a patient has bulemia nervous, where does her BMI usually stand?
in normal range (this is the main distinguishing factor compared to anorexia where BMI is below 18.5)
-they also may have bilateral painless parotid gland enlargement and hypokalemia
equation of the PPP?
oxidative/irreversible part: glucose-6-phosphate –> ribulose-5-phosphate
-enzyme used is G6PD
what causes hypertrophic cardiomyopathy
AD mutation in genes encoding sarcomeric proteins like myosin binding protein C and beta-myosin heavy chain
- can cause sudden cardiac death
- avoid vasodilators and diuretics in these pts cause you need to make sure enough blood is getting to their heart
how do right sided colon cancers typically present
iron deficiency anemia (fatigue and pallor)
occult blood loss (not visible in the poop yet)
adverse effect of permanent pacemaker
tricuspid regurg which can lead to right sided heart failure (edema, hepatomegaly, distended jugular veins)
how to help with hypoglycemia
mild: eat candy bar or juice
severe (pt passed out): emergency glucagon IM injection (will work w/i 10-15mins) and if you cant find this then put something sweet on buccal mucosa but this may not work and if so it will work slowly
rotavirus pathologic finding
blunting of villi in duodenum and proximal jejunum
hepatic angiosarcoma
associated with: arsenic, thorotrast, and polyvinyl chloride
tumor cells express CD31 (endothelial cell marker)
future mother with pain in both knees and feet then stillbirth probably has what
parvovirus B19 (non-enveloped single stranded DNA)
most common location of traumatic aortic rupture
aortic isthmus (directly after the arch)–> tethered by the ligamentum arteriosum (relatively fixed and immobile due to adjacent descending aorta)
- usually due to a motor vehicle accident/sudden deceleration
- you will also see a widened mediastinum on x-ray
where do acoustic shwannomas (aka. acoustic neuroma) usually occur
cerebellar pontine angle, due to vestibulocochlear nerve problem (CN8)
what allows viruses to go through a genetic shift mutation
reassortment is due to segmented nature of genomes
inositol triphosphate and its second messenger system
-binds to receptor on ER and causes increase in cytoplasmic Ca2+ —> increases smooth muscle contraction
phospholipase C cleaves PIP2 into IP3 (causes Ca2+ release from ER) and DAG (activates PKC to phosphorylate proteins and cause smooth muscle contraction)
recurrent sinopulmonary and gi infections as well as failure to thrive and lack of proper signaling b/w CD4 Tcells and B lymphocytes…
hyperimmunoglobulin M syndrome (defective class switiching)
problem with or absence of CD40 or CD40L could cause this (so you have lots of IgM and not much of the other ones)
someone normally at sea level is hiking up a mountain, what do you think?
possible high altitude sickness. most cases subside within two days but it can cause cerebral/pulmonary edema
- pt starts hyperventilating–> respiratory alkalosis (blowing off too much CO2)
- hypobaric hypoxia
Wiskott-Aldrich vs Chediak-Higashi
Wiskott-Aldrich
- mutation is WAS gene (defective antigen presentation cause leukocytes and platelets are unable to reorganize actin cytoskeleton)
- WATER (wiskott-aldrich, thrombocytopenia, eczema, recurrent infections)
- fewer and smaller platelets
Chediak-Higashi
- defect in LYST (lysosomal trafficking regulator gene)–> microtubule dysfunction in phagosome-lysosome fusion
- PLAIN (progressive neurodegeneration, lymphohistiocytosis, albinism, recurrent pyogenic infections, peripheral neuropathy)
- giant granules in granulocytes and platelets
how do you determine the power of a study
power = chance of detecting difference power = 1 - B B = probability that there is no difference
what part of neisseria meningitis can cause septic shock
lipooligosaccharide (LOS) –> endotoxin (like LPS) that causes toxicity when released into plasma via shedding of outer membrane or bacterial lysis
*contrast with lipoteichoic acid found in gram + bacteria and acts as a regulator of of autolytic cell wall enzymes
overuse injury caused by repetitive strain and chronic avulsion of secondary ossification center of WHAT
- proximal tibial tubercle
- called Osgood-Schlatter disease (traction apophysitis)
first line treatment for panic disorder
SSRI
-for an acute attack you can give a benzo
pyrrolidonyl arylamidase positivity leads you to think what
strep pyogenes or enterococcus
what does enterococci grow in
bile and hypertonic solutions
how to test for fat malabsorption
stool microscopy with sudan III stain
where is airway resistance highest in the respiratory tract
highest in the medium-sized bronchii then goes down from there
linkage disequilibrium
when respective alleles are inherited together in the same gamete (haplotype) more or less frequently than expected at random –> this is usually because the alleles are in close proximity
aTTrition bias
form of selection bias (they are ASSes and dont follow up again)
-disproportionate loss to follow-up b/w exposed and unexposed groups
caseating granulomas with centra necrosis is what type of tb and what do you look for … how are they formed
secondary–> look for CD14+ cells at periphery (monocyte/marcophage lineage)
-you will also see langhans giant cells
caseating granuloma formation
- form after macrophages come into contact with something they cant eat fully/degrade
- IL-12 is released by macrophage–> Th1 differentiation (CD4 lymphocytes)
- Th1 goes to site and releases IFN-gamma to activate more macrophages
- then TNF-a gets released to call for even more help from macrophages/monocytes
- macrophages differentiate into epitheliod and langhans giant cells to wall off the area to limit bacterial spreading
if you are not absorbing (gastrectomy) or are not taking in (strict vegan diet) enough B12
this would take 4-5 years to develop because body stores SO MUCH OF IT
list the torch infections
Toxoplasma OTHER --> strep agalactiae, ecoli, listeria, and parvob19 Rubella CMV HIV/herpes Syphilis
altered level of consciousness, pinpoint pupils, and central respiratory depression
opioid overdose: acute respiratory acidosis (low pH and high PaCO2) due to hypoventilation
bicarb is still near normal
rotator cuff muscles
supraspinatus–> abduction (suprascapular nerve)
infraspinatus–> external rotation (suprascapular nerve)
teres minor–> adduction and external rotation (axillary nerve)
subscapularis–> adduction and internal rotation (upper and lower subscapular nerve)
rotator cuff syndrome
tendon impingement trauma of supraspinatus between humeral head and acromion
problems/pain with abduction of arm
krabbe disease defect
lysosomal storage disease: deficiency of galactocerebrosidase
-destroys myelin sheath (oligodendrocytes)
metachromatic leukodystrophy defect
arylsulfatase A deficiency
-impaired myelin production
adrenoleukodystrophy
peroxisomal disorder: VLCFA CoA synthetase defect
- dementia, hearing loss, seizures
- gray discoloration of white matter/severe demyelination/perivascular inflammation
what do proteosomes do?
degradation of ubiquitinated proteins
name the three peroxisomal diseases
- Adrenoleukodystrophy
- Zellweger syndrome
- Infantile refsum disease
prevalence dependent values
positive and negative predictive values
around what age is it acceptable to diagnose ADHD
around 4-5years old
what are the 5Ps of acute intermittent porphyria and how do you treat it
- Painful abdomen
- Port-wine-colored urine
- Polyneuropathy
- Psychological disturbances
- Precipitated by drugs (cytochrome P-450 inducers), alcohol, starvation
-porphobilinogen deaminase defect (excess porphobilinogen and ALA)
Treated with hemin and glucose
if pt comes in with blistering cutaneous photosensitivity and hyperpigmentation
- Porphyria cutanea tarda: most common porphyria
- uroporphyrinogen decarboxylase defect (increase in uroporphyrin)
- causes tea-colored urine
- exacerbated with alcohol consumption and associated with hep C
- treated with phlebotomy, sun avoidance, antimalarials
weakness of quadriceps muscle, loss of patellar reflex, and loss of sensation over anterior and medial thigh and medial leg
femoral nerve injury (can be due to trauma, compression, stretch injury, or ischemia)
if hematin (factor 10) and nicotinamide (factor 5) adenine dinucleotide (NAD+) are in a question what should you automatically think about
haemophilus influenzae
-major virulence factor is the polysaccharide capsule (polyribosylribitol phosphate (prp)) by binding to factor H and stopping complement by degrading C3b
mild renal insufficiency, normocytic anemia, hypercalcemia, bone pain, osteolytic radiolucent bone lesions
multiple myeloma –> plasma cell malignancy associated with excessive IgG
gamma gap: serum protein - serum albumin > 4
myeloma cells replicate in the bone marrow and release cytokines that stimulate osteoclasts (by secreting RANKL and destroying osteoprotegrin) and inhibit osteoblasts
- M spike due to IgG, rouleaux formation, bence jones protein
- decreased PTH, normal PTH-related protein, increased urinary calcium, decreased 1,25vitD
CRAB hyperCalcemia Renal involvement Anemia Bone lytic lesions/Back pain
list two DNA-binding proteins that are transcription factors and how do you look for them
c-Jun and c-Fos (leucine zipper motif) –> transcription factors
-southwestern blots look for these as well as nucleases, and histones—-IF YOU SEE DOUBLE STRANDED DNA BEING USED ITS SOUTHWESTERN
what does the latissimus dorsi do and what innervates it
extension, adduction, and medial rotation of humerus
thoracodorsal nerve
how does mycoplasma pneumoniae cause anemia
IgM cold agglutanins cross react and cause clumping and lysis of RBCs
-anemia decreases with fading of immune response against bacteria
neprilysin
responsible for the breakdown of natriuretic peptides (ANP and BNP–> released due to cardiac stretch) and angiotensin II
methotrexate vs trimethoprim and pyrimethamine
all block dihydrofolate reductase –> so it blocks rapidly dividing cells
- methotrexate does it humans
- trimethoprim does it in bacteria
- pyrimethamine does it in protazoa
adverse effects: stomatitis, bone marrow suppression, liver function abnormalities
eosinophilia, winter months, proximal bronchiectasis
aspergillus fumigatus
the PPD skin test, patch test, and candida skin test are testing what?
T cell immune function, so they are causing type IV hypersensitivity reactions
do platelets express COX1 or COX2
COX1 so if you dont wanna mess with platelet aggregation then you can give celecoxib which is selective for COX 2
COX enzymes block prostaglandin synthesis
1–> in areas of platelets and gi system
2–> in areas of acute inflammation (by IL-1 and TNF-a)
pts with new or worsening back pain, fever, and recent endocarditis or bacteremia (especially staph aureus)
vertebral osteomyelitis
-get MRI of spine for dx
what does the body do in response to fatty foods
the pancreas secretes CCK from acinar cells
what acid base disorder does a pulmonary embolism cause
respiratory alkalosis due to hyperventilation (hypocapnia)
what to think when the scapula lifts off the thoracic wall and becomes prominent (winged scapula)
paralysis of serratus anterior due to long thoracic nerve injury –> serratus anterior is along surface of first 8 ribs and inserts on the medial boarder of the scapula
-causes impaired abduction of shoulder past horizontal
BRAF V600E
melanoma (usually metastasizes)
how to determine true negatives and false positives with specificity
true negatives = (specificity) x (number of pts confirmed w/o disease)
false positives = (1 - specificity) x (number of pts confirmed w/o disease)
coughing spells that last a very long time even after your sickness gets better
pertussis (esp. in pt who hasnt had booster shots)
how to remember ECG waveforms during wake/sleep cycle
BATSDB (BATS Drink Blood)
B: awake eyes open A: awake eyes closed T: n1 S/K: n2 --> TWOoth grinding D: n3 --> parasomnias B: REM
primary cytokines involved in pathogenesis of RA
IL-1 and TNF-alpha
multiple myeloma vs waldenstroms macroglobulinemia
MM has CRAB findings and M spike due to IgG
WM has M spike due to IgM and hyperviscosity syndrome (blurred vision, raynaud phenomenon), no CRAB findings
when is PTH-related protein increased
malignancy
heart problems mixed with bibasilar crackles and S3
left sided heart failure so fluid is backing up into the lungs and causing a decrease in heart compliance
P bodies
in cytoplasm only
-play a role in mRNA translation, regulation, and mRNA degradation … also maybe storage
migraine therapy: abortive and preventative
abortive: NSAIDs, triptans, dihydroergotamine
preventative: lifestyle changes, b-blockers, amitriptyline, topiramate, valproate, botox injections
glaucoma medications
increase trabecular outflow–> carbachol, pilocarpine (M3 agonists)
increase uveoscleral outflow–> lantanoprost, bimatoprost (prostaglandin agonists)
decrease aqueous humor synthesis–> timolol (beta blocker), brimonidine (a2 agonist), and acetazolamide (carbonic anhydrase inhibitor)
typical bruise is called what
ecchymosis (cutaneous or subcutaneous collection of extravasated blood at least 1cm in diameter)
lentigines
on a little old mans head –> brown sunspots
fanconi syndrome
generalized reabsorption defect in all of proximal tubule (increase excretion in pretty much everything)
-leads to metabolic acidosis, hypophosphatemia, osteopenia
how does ALL present
mediastinal mass
- lymphadenopathy and hepatosplenomegaly
- hypercellularity of bone masses
homeobox genes typically code for what
transcription factors
how to tell the difference between a left or right sided colon adenocarcinoma
right sided –> bleeding, iron deficiency anemia,
left sided –> obstructing symptoms like constipation, abdominal distension, nausea, and vomiting
what can trigger erythema multiforme
mycoplasma pneumoniae and HSV
sulfa drugs, beta-lactams, and phenytoin
you will see a targetoid rash (target lesions)
-cytotoxic T cell mediated rash
when the clavicle breaks, what causes the two ends to go in each direction
medial fragment–> displaced superiorly due to sternocleidomastoid
lateral fragment–> displaced inferiorly due to weight of arm and pectoralis major
if someones rheumatoid arthritis drugs arent working well what the first line drug to add
methotrexate
fulminant hepatitis in pregnant women
HepE
- high mortality rate
- patchy necrosis on liver biopsy
- enteric and epidemic
- fecal oral transmission
- ssRNA
- unenveloped
waxing and waning lymphadenopathy
Follicular lymphoma
- indolent course
- t(14;18)
- translocation of heavy chain Ig with BCL-2(18)
regardless of lipid levels what lipid related drug should you give to decrease risk of cardiovascular events
always give a statin (hmg-coa reductase inhibitor)
when diagnosing a metabolic alkalosis what can you look at next to help with the differential
urine chloride and pts volume status
medial hypertrophy, intimal fibrosis, luminal narrowing of pulmonary arteries
pulmonary arterial hypertension
-give pt Bosentan (endothelin receptor competitive antagonist)–> causes vasodilation and decreases progression of vascular remodeling and right ventricular hypertrophy
mechanism of action of sulfonylureas and meglitinides
close K+ channel in pancreatic B-cell membrane –> cell depolarizes –> insulin release via increase Ca2+ influx
interscalene nerve block
- anesthetizes the brachial plexus as it passes through the scalene triangle
- anesthetic for shoulder and upper arm
- nearly all pts develop transient ipsilateral diaphragmatic paralysis due to involvement of phrenic nerve roots
ulcers where in the gi tract are not likely to be malignant
duodenum
-gastric ones should be biopsied
bone pain in a young boy with systemic symptoms
hematogenous osteomyelitis
- common in metaphysis of long bone due to slower blood flow and capillary fenesrae
- w/o proper treatment can progress to chronic suppurative osteomyelitis
cardiac description: decreased LV cavity, sigmoid shaped ventricular septum, increased collagen in ventricular wall, brownish perinuclear cytoplasmic inclusions (lipofucsin pigment)
what is this?
normal aging heart
what do interferon alpha and beta do?
type 1 interferons are synthesized due to viral infections andincrease MHC I and transcribe enzymes to HALT protein synthesis
Note these are only active with dsRNA to selectively target virally infected cells only
- RNase L: endonuclease to degrade all RNA
- protein kinase R: block eIF-2 to stop translation initiation
what to suspect with back pain that wont get better no matter what and is worse at night
malignancy/metastasis
if a pt has back pain when they walk but feels better leaning forward on something while they walk… what do you think?… shopping cart sign
LUMBAR PAIN/PROBLEM
spinal stenosis usually caused hypertrophied ligamentum flavum and can cause those symptoms
three causes of narrowing of spinal canal
- disc herniation
- ligamentum flavum hypertrophy
- osteophyte formation affecting facet joints
other name for end-diastolic volume
preload
most common trigger of afib
aberrant electrical foci in the pulmonary veins near their ostia into the left atrium
post MI: gross, microscopic, problems
1 day: none, coag necrosis, arrhythmias
3 days: hyperemia, PMN and coag necrosis, fibrinous/inflammatory pericarditis
2 weeks: yellow/brown softening, macrophages/granulation tissue, pseudoaneyrism of inferior wall/free wall rupture/papillary muscle rupture/septal (VSD) rupture
> 2weeks: recancalized artery/gray-white scar, contracted scar, aneurysm of anterior wall/Dressler (immune pericarditis)
pt presents with proximal muscle weakness, gottron papules, photodistributed facial erythema, darkening and thickening of facial tips, increased risk of occult malignancy
-perimysial inflammation and atrophy with CD4+T cells
dermatomyositis (autoimmune) –> may occur alone or as paraneoplastic syndrome due to underlying adenocarcinoma
treat with glucocorticoids
-if they have all these symptoms without the skin problems its polymyositis and involves CD8T cells and endomysial inflammation
both are a problem with autoantibodies against tRNA synthetase
how does fibromuscular dysplasia look
alternating areas with aneuyrsmal dilation (string of beads appearance) and loss of internal elastic lamina
midshaft humerus break… which artery/nerve is affected?
deep brachial artery and radial nerve
where is the most common location for epistaxis
anterior NASAL SEPTUM which includes Kiesselbachs plexus
distal humerus break… which artery/nerve is affected?
pinches median nerve and brachial artery
congenital torticollis
- noted by 2-4 weeks of age
- after this the child prefers to hold their head to one side
- usually results from malposition of head in utero or birth trauma
- usually resolve with stretching it out over time
why should you not administer high O2 to a pt with COPD
you could cause a COPD exacerbation due to increased CO2 retention (O2 induced hypercapnia) resulting in confusion and lethargy —> ventilation/perfusion mismatch
what nerve, artery, and vein are in the anterior compartment of the leg
deep peroneal nerve, anterior tibial artery and vein
what nerve is in the lateral compartment of the leg?
superficial peroneal nerve
whats in the posterior compartment of the leg?
tibial nerve, posterior tibial artery and vein, peroneal artery and vein
whats the best way to avoid a fall for an elderly person, whats the first thing the physician should do?
look at their medications
-psychotropic (aripiprazole, sertraline, amitriptyline, and benzos) and cardiovascular drugs (calcium channel blockers, beta blockers, and diuretics) can cause an increased falling risk
what infection causes hypo/hyperpigmented areas of the skin specifically seen in sun exposed areas and in hot/humid weather
-just found in stratum corneum of skin
Pityriasis versicolor (tinea versicolor) --> Malassezia globosa) -can dx via KOH preparation
etanercept mechanism of action
TNF-alpha inhibitor that acts as a decoy receptor
-this drug is added onto methotrexate fro those with bad RA
what type of MHC class is on an antigen presenting cell?
MHC class II
-MHC class I is found mainly on most of the human nucleated cells that present either self or antigen and are never lysosomed
dog bite that becomes erythematous and grows gram negative coccobacilli with the culture having a mouse-like odor
pasteurella multocida
why would you have an enlarged coronary sinus?
elevated right sided heart pressure (anything that can cause this like pulmonary hypertension)
thickening of pleura and what is seen on histology
mesothelioma
- may result in hemorrhagic pleural effusion (exudative), pleural thickening
- psammoma bodies, calretinin positive
honeycomb appearance of lung
idiopathic pulmonary fibrosis
- loss of type 1 pneumocytes and hyperplasia of type 2 pneumocytes
- traction bronchiectasis and digital clubbing
what happens to someones kidney after they drink ethylene glycol
toxic alcohol found in antifreeze
- acute kidney injury causing acute tubular necrosis
- vacuolar degeneration with ballooning of proximal tubular cells
overall symptoms –> altered mentation, renal failure, high anion gap metabolic acidosis, increased osmolar gap, and calcium oxalate crystals in urine
two major adverse effects of theophylline
seizures and tachyarrhythmias
plummer vinson syndrome
PLUMBERS DIE
- Dysphagia
- Iron deficiency anemia –> leads to koilonychia (spoon shaped nails) and shiny red tongue secondary to atrophy of lingual papillae
- Esophageal web
-treat with iron supplementation
what to expect if someone has lead poisoning on peripheral blood smear
basophilic stippling of hypochromatic RBCs
Hibernating myocardium
-state of chronic myocardial ischemia
presence of left ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization
positive trendelenburg gait, what nerve is affected?
superior gluteal nerve
-make sure to give injections in the superiolateral quadrant of the butt, not the superiomedial quadrant cause you can mess up this nerve
what does thymidylate synthase do?
converts dUMP into dTMP and its important cause its a dihydrofolate reductase
U –> T (important to make DNA without apoptosis due to incorporation of uracil)
first line treatment for generalized/social anxiety disorder
ssri and snri
majority of overdose deaths are due to what
opioids
what finding is pathognomonic for pyelonephritis
WBC casts
explain noise induced hearing loss
damage to stereociliated hair cells of organ of corti
- due to shearing forces against tectorial membrane
- high frequency hearing is lost first regardless of damaging noise frequency
noncaseating granuloma formation
-usually seen in autoinflammatory conditions
- chronic t-lymphocyte and macrophage activation
- macrophages secrete TNF-alpha, IL-1, IL-6, and IL-12
- IL-12 causes Th1 differentiation
- Th1 produces IL-2 and IFN-gamma (more macrophages/giant cells)
most common reason to have a COPD exacerbation
viral or bacterial respiratory infections
manifestations of arsenic poisoning and how to treat
- garlic breath, watery diarrhea, vomiting, prolonged QTc
- give dimercaprol or DMSA
marker of mast cell activation
tryptase is a specific marker
what reaction does G6PD catalyze?
glucose-6-P ——–> 6-phosphogluconolactone
what type of damage is caused by CCl4
free radical injury
-its oxidized by cp450 in the liver forming free radical CCl3 which reacts to structural lipids of the cell membrane leading to hepatocyte necrosis
what medications do you give to someone who had a TIA (transient ischemic attack)?
statin and low dose aspirin (predominantly inhibiting cox-1/blocking platelet aggregation)
peripheral neuropathy (wrist/foot drop), asthma, sinusitis, skin nodules/purpura
can also involve heart, GI, kidneys
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
- granulomatous, necrotizing vasculitis with eosinophilia
- MPO-ANCA/p-ANCA, increased IgE level
interruption of what dopaminergic pathway can lead to galactorrhea and amenorrhea
tuberoinfundibular pathway
artery with the lesser curvature of the stomach causes bleeding what could it be?
left or right gastric arteries
painless, solid testicular mass in man age bw 15-35
testicular cancer
what makes elastin so elastic?
cross linking of lysine residues
bilateral acoustic neuromas
NF2
what enzymes require B1 (TTP) as a cofactor?
Be APT
Branched-chain ketoacid dehydrogenase
Alpha-ketoglutarate dehydrogenase
Pyruvate dehydrogenase
Transketolase
flattening of deltoid muscle with acromial prominence suggests what
anterior humerus dislocation
Rb mutation causes what two types of cancer
retinoblastoma and osteosarcoma
what causes peripheral neuropathy
endoneural arteriole hyalinization
explain the metyrapone stimulation test
- sensitive indicator of the HPA-axis
- metyrapone blocks cortisol synthesis so you dont have feedback so you should have a surge in ACTH being released and 17-hydroxysteroids will accumulate in the urine
what is associated with hirschsprung disease vs meconium ileus?
H: down syndrome, rectosigmoid obstruction, normal meconium, positive squirt sign
M: cystic fibrosis, ileus obstruction, inspissated mass(dehydrated meconium), negative squirt sign
what is messed up/inhibited if you eat poison mushrooms
RNA polymerase II (mRNA)
c-ANCA (cytoplasmic staining antineutrophil cytoplasmic antibodies)
pathognomonic for granulomatosis with polyangiitis (Wegener)
-may target neutrophil proteinase 3
what causes varicose veins (dilated, torturous veins in superficial leg)
chronically increased intraluminal pressure and/or loss of tensile strength in vessel wall —> leading to incompetent venous valves
complications
- edema
- skin ulcerations
- stasis dermatitis
- poor wound healing
- infections
post-prandial epigastric pain with food aversion and weight loss
associated with generalized atherosclerosis
chronic mesenteric ischemia
MEN type 1 vs type 2a vs type 2b
1: primary hyperpara, pituitary tumor, and pancreatic tumors
2a: primary hyperpara, medullary thyroid cancer, pheochromocytoma
2b: medullary thyroid cancer, pheochromocytoma, mucosal neuroma/marfanoid habitus
what does alcohol inhibit that can lead to hypoglycemia
gluconeogenesis
blue-black spots on connective tissue and osteoarthropathy later in life
Alkaptonuria: congenital deficiency of homogentisate oxidase
elevated HGA
treat with dietary restriction of tyrosine and phenylalanine
common cause of eccentric hypertrophy
chronic aortic regurg which can be due to aortic root dilatation
immune mediated noncaseating granulomas, hypercalcemia, elevated ACE
african american female
enlarged lymph nodes
hilar and mediastinal adenopathy
involves: lungs (most common), skin, eyes, heart
-can also cause weight loss
what is this and what is it associated with?
sarcoidosis
- large number of CD4+ T lymphocytes release IFN-gamma and TNF-alpha to drive macrophage activation and granuloma formation
- bronchoalveolar lavage fluid in pulmonary sarcoidosis demonstrates high CD4/CD8 ratio
assoiated with Bell palsy, Uveitis, Granulomas, Lupus pernio, Interstitial fibrosis, Erythema nodosum, Rheumatoid arthritis-like arthropathy
a FACIAL DROOP is UGLIER
hypercalcemia is due to increase 1alpha-hydroxylase mediated vitamin D activation in macrophages
CD4+ T cell mediated
severe constant middle or left chest pain that may radiate to neck and shoulders
pain increases on inspiration
relieved by sitting up and leaning forward
acute pericarditis
hyperphosphatemia can lead to what with calcium
hypocalcemia
hypertensive crisis
- blood pressure >180/120 with end organ damage
- malignant nephrosclerosis in the kidney–> fibrinoid necrosis of small arteriolar walls and hyperplastic arteriosclerosis (onion skin appearance)
- maha can occur due to erythrocyte fragmentation and platelet consumption at narrowed arteriolar lumen
false positive VLDR/RPR with prolonged PTT due to lupus anticoagulant
antiphospholipid syndrome
treat with systemic anticoagulation
if you see a young woman with rash, joint pain, and fever (and sometimes proteinuria) what should you think?
systemic lupus erythematosus
-hypocomplement, ANA+, anti-dsDNA, anti-smith
lateral prefrontal corte vs orbitofrontal cortex
lateral prefrontal –> executive functioning, organization, motivation, planning, and purposeful action
orbitofrontal –> personality and inhibition
how to beta blockers affect the R-A-A axis
they block the formation of renin so none is made
breast carcinoma with human epidermal growth factor 2 (HER2) positivity
you can give Trastuzumab –> monoclonal antibody that targets tyrosine kinase receptors (these receptors are commonly overexpressed in breast cancer pts)
- major adverse effect is cardiotoxicity (reducing cardiomyocyte contractility with no fibrosis)
- blocking these receptors downregulates cellular proliferation and promotes apoptosis
- HER2+ is associated with aggressive disease
what can predispose someone to develop angiosarcoma
Stewart-Treves Syndrome –> chronic lymphedema
selegiline mechanism of action
MAO-B inhibitor
amorphous extracellular matrix with scattered stellate or globular myxoma cells within abundant mucopolysaccharide ground substance
myxoma tumor (usually found in left atrium)
- mobile and small
- tumor plop sound
- glycosaminoglycans
- breath worse when sitting/better when lying down
explain the difference between pemphigus vulgaris and bullous pemphigoid
pemphigus vulgaris
- autoantibodies against desmosomes
- painful flaccid bullae
- erosions affecting skin and MUCOSAL membranes
- bullae spread laterally with pressure and new blisters may form with gentle rubbing
- mucosal involvement is common
- positive nikolsky sign
bullous pemphigoid
- autoantibodies against hemidesmosomes
- tense/firm bullae
- separates entire dermis from epidermis
- no mucosal involvement and negative nikolsky sign
tumor grade vs tumor stage
grade –> differentiation
stage –> tumor expansion** this is more important for prognosis
azathioprine metabolism
azathioprine –> 6-MP
6-MP –HGPRT–> active metabolites block purine synthesis
6-MP –TPMP/Xanthine Oxidase–> inactive metabolites
Note: allopurinol blocks xanthine oxidase
what do alveolar hyaline membranes in the lungs represent
acute respiratory distress syndrome (restrictive)
-macrophages and neutrophils involved in initial part
axonal reaction and wallerian degeneration
changes made in the neuron after the axon is severed/damaged
- increased protein synthesis to facilitate axon repair
- enlarged rounded cells with peripherally located nuclei and dispersed finely granular nissl substance (everything pushed to periphery)
Wallerian degeneration is essentially just the axon/myelin breaking down and macrophages remvoing the debris all distal to the site of injury
- this occurs much faster in the PNS b/c you dont have the BBB
- in the CNS you could have axonal debris for years, suppressing axonal growth via myelin associated inhibitory factors
also note that glial scars can inhibit axonal growth/regeneration
whats the one part of the body that cannot use ketone bodies for energy
erythrocytes
what type of anemia does a pt have with chronic kidney disease and why
normocytic anemia because the kidneys cannot make enough EPO (epo is made and released from the peritubular interstitial cells/fibroblasts in renal cortex)
-also chronic kidney disease causes decreased Ca and increased phosphate leading to secondary hyperparathyroidism which can cause osteitis fibrosa cystica
what is the single most important measure to to reduce the risk of transmission of hospital acquired infections
hand hygiene
common precipitating factors of G6PD deficiency anemia
- infections
- drugs (dapsone, antimalarials, sulfonamides)
- DKA
- favism (eating fava beans)
pt eats cheese then gets meningitis, what causes this?
listeria monocytogenes
-can also cause meningitis in baby and has intrinsic resistance to cephalosporins due to PBPs
-use ampicillin to treat
tinitis, vertigo, sensoryneural hearing loss
menire disease
-pathogenesis related to increased volume and pressure of endolymph in vestibular apparatus
why would pus/sputum have a green discoloration
due to presence of myeloperoxidase (blue-green-heme-based enzyme that is released from neutrophil azurophilic granules and forms hypochlorous acid/bleach)
hemorrhage and subsequent hypotension can do what to the kidneys?
acute tubular necrosis (3 phases)
- initiation (24-36hrs) –> initial ischemic or toxic insult
- maintenance (1-2weeks) –> fully established tubular damage with oliguria, fluid overload, electrolyte abnormalities, low GFR, high serum creatinine
- recovery –> re-epithelialization of tubules (electrolyte wasting– decrease K, phosphorous, mg, ca)
diffuse medium sized lymphocytes and high proliferation index indicated via Ki-67 fraction (approaching 100%)
Burkitt lymphoma
- strong association with EBV
- starry sky appearance (due to macrophages)
- 8;14 translocation –> c-myc acts as transcription activator controlling proliferation, differentiation, and apoptosis
symptoms of schizophrenia and mood disorders together (pt must have >2wks of psychotic symptoms without a manic or depressive episode)
schizoaffective disorder
immature defense mechanism. I actually feel mad but i dont want to admit it so im gonna think that youre mad
projection
get yelled at by the boss so you go home and yell at your neighbor
displacement
what nerve is around the posterior wall of the external auditory canal
small auricular branch of vagus nerve
explain muscle loss in cancer related cachexia
ubiquidine -proteosome pathway mediates protein degradation
-MAINLY DUE TO TNF-A (suppresses appetite and increases basal metabolic rate)
- rapid disposal of unneeded intracellular proteins
- high levels of proinflammatory cytokines lead to increased ubiquidination of sarcomeric muscle proteins –> extensive skeletal muscle loss
digoxin mechanism and toxicity
MECHANISM
- used in a pt with afib that decreases conduction through the AV node and increases contractility in pts with heart failure
- blocks Na/K ATPase
TOXICITY
-one of the ways it works is by slowing down heart rate via increasing parasympathetic tone
color vision alterations
nausea, vomiting, abdominal pain, fatigue, confusion, weakness
-most serious complication = life threatening ventricular arrhythmias
what stains positive for GFAP (glial fibrillary acidic protein)
neoplasms of glial origin: astrocytoma, ependymoma, and oligodendroglioma
-gfap is essentially just staining for astrocytes
what gives reticulocytes their blue-ish color
blue-ish cytoplasm and reticular precipitates of residual ribosomal RNA
if you see a serum calcium of over 13, what should you be suspicious of
underlying malignancy and secretion of PTHrP (causes hypercalcemia and loss of phosphate usually seen with squamous cell carcinomas
if you see nail clubbing what should you automatically think of
the pt has had prolonged hypoxia
- large cell lung cance
- TB
- cystic fibrosis
- suppurative lung diseases: empyema, bronchiectasis, and chronic lung abscesses
pt with severe long-bone and/or pelvic fractures who develops acute onset neurologic abnormalities, hypoxemia, and a petechial rash
fat embolsim syndrome –> occlusion of pulmonary microvessels by fat globules (early histological finding)
octreotide
synthetic analog of somatostatin given to help the symptoms of carcinoid syndrome
wheezing, facial flushing, diarrhea
-associated with ileal tumor with hepatic metastasis
carcinoid syndrome
intracellular protazoa with rod shaped kinetoplasts
cutaneous leishmaniasis (enlarging pinkish papule at site of bite then eventually develops into a nodule or plaque)
- infected from sand flies
- obligate intracellular protazoa that mature in macrophages
what drugs should you not give to someone on lithium
thiazide diuretics, ACE inhibitors, and NSAIDs
-volume depletion and drug interactions
what are you likely to see on histological examination from the bowel of an individual with Crohns disease vs UC
Crohns: patchy transmural inflammation and noncaseating granulomas, mouth to anus, strictures (due to bowel wall edema, fibrosis, thickening of muscularis mucosae), fistulas (penetration of ulcers through intestinal wall), and abscesses
UC: involves mucosa and submucosa in the colon only,
gross hematuria, acute flank pain, and passage of tissue fragments in the urine
-usually seen in pts with sickle cell or sickle trait, DM, analgesic nephropathy, or severe obstructive pyelonephritis
renal papillary necrosis
CREST SYNDROME
limited scleroderma and anti-centromere antibodies
- calcinosis
- raynauds
- esophageal dysmotility
- sclerodactyly
- telangiectasias
physician burnout vs fatigue
burnout –> emotional exhaustion, cynicism, depersonalization, decreased sense of personal accomplishment that can result in suboptimal pt care and medical errors
fatigue –> caused by sleep deprivation resulting in cognitive impairment and medical errors
musculocutaneous nerve injury
usually due to trauma or overuse (C5-C9)
innervated forearm flexors (biceps brachii and brachialis), corachobrachialis (flexes and adducts arm), and sensory innervation to lateral forearm
painless genital ulcer
with lymphadenopathy: syphilis
without lymphadenopathy: klebsiella granulomatis
what part of the brain does the pupillary light reflex go to?
afferent limb: optic nerve (CN2)
efferent limb: occulomotor (CN3)
upper midbrain: pretectal nucleus –> Edinger-westphal nuclei (via CN3)
*if a pt has no direct or indirect pupillary constriction this means its likely a CN3 problem
diphenoxylate
opioid antidiarrheal drug
- binds mu opiate receptors in gut to slow motility
- overuse can lead to euphoria and physical dependence -usually combined with atropine to discourage abuse by inducing adverse effects if taken in high doses
leser trelat sign
- usually a sign of internal malignancy (typically GI cancer)
- seborrheic keratosis all over frontal trunk of body
alendronate, ibandronate, risedronate, and zoledronate
bisphosphonates
- pyrophosphate analogs that bind hydroxyapatite in bone, inhibiting osteoclast activity
- used in osteoporosis, hypercalcemia, paget disease of bone, metastatic bone disease, and osteogenesis imperfecta
- may cause esophagitis and kinda a pain to take cause you have to take with water and remain upright for 30 mins after, can also cause osteonecrosis of jaw, and atypical femoral stress fractures
- if taken IV can cause flu-like symptoms
what can cause foamy frothy urine
proteinuria or bile salts in urine
ezetimibe mechanism of action
blocks cholesterol absorption on brush boarder of small intestine
what causes wrinkles?
decrease in collagen fibril production
- this is due to UVA penetration causing photoaging due to the reactive oxygen species activating inflammatory cell receptors and nuclear transcription factors (leading to decreased production)
- metalloproteinases and collagenases are upregulated to degrade type I and III collagen and elastin
where are uva and uvb light absorbed?
UVB –> upper dermis and contribute to sunburn and increased risk of malignancy
UVA –> deeper into skin and cause photoaging (leads to decreased collagen fibril production and upregulation of metalloproteinases) that degrade type I and III collagen and elastin
Note: photoaging is first seen with thinning of epidermis and increased crosslinking of collagen with a deposition of collagen breakdown products
explain the difference between brief psychotic disorder, schizophreniform, schizophrenia, schizoaffective, and delusional disorder
BPD –> one day to one month of sudden onset psychosis, full return to function
schizophreniform –> one month to 6 months of schizophrenia, functional decline not required
schizophrenia –> more than 6 months with included functional decline
schizoaffective disorder –> mood disorder + schizophrenia
delusional disorder –> more than 1 month of delusion(s) with no other psychotic symptoms
what type of infectyions should you be most worried about in a neutropenic pt?
pts own endogenous bacterial flora (fever is only sign of infection)
diffusely homogenous pale eosinophilic cytoplasm in hepatocytes
hepatits B (ground glass appearance)
pathogenesis of diffuse esophageal spasm
impaired neural inhibition
markers for chronic lymphocytic leukemia
b cell markers: CD 19,20,23 with smudge cells seen on peripheral blood smear
chronic myeloid leukemia, what cells are increased?
increased number of granulocytes (neutrophils at different ages of maturation)
-low leukocyte/neurtrophil alk phos
arthritis, diarrhea, fever and maybe sometimes hyperpigmentation of skin
tropheryma whippelii (whipple disease)
most susceptible cells in the brain to ischemia
CA1 pyramidal neurons of the hippocampus (can cause anterograde amnesia and disorientation to place and time)
what to think of with a new onset of left varicocele associated with flank pain and hematuria
renal vein thrombosis possibly due to hypercoagulable state (in nephrotic syndrome for example)
-loss of anticoagulant factors can increase the risk of thrombotic and thromboembolic complications
what is the cause of acute appendicitis?
obstruction of the lumen of the appendix
-then a bacterial infection can result from the backing up of the poop
prostate cancer that metastasizes to the spinal cord and causes compression
results from local extension of vertebral metastases into the epidural space
pilocytic astrocytoma
cystic tumor usually in kids and you will see rosenthal fibers and granular eosinophilic bodies
pancytopenia, hepatosplenomegaly (extramedullary hematopoiesis), dry tap, and teardrop cells (aka dacryocytes)
-associated with clonal expansion of megakaryocytes –> secrete cytokine TGF-beta
primary myelofibrosis
what causes actinic keratosis and what is it a precursor for
sun exposure and squamous cell carcinoma
what medication can you give to a pt with spasticity
baclofen (gaba-b agonist) –> also used for dystonia and multiple sclerosis, acts on the BACk
tizanidine (alpha2 agonist)
if someone has a foreign object stuck in their throat like a fishbone or something where is this and what problem can it cause if the nearby nerve is messed up
gets lodged in the piriform recess and may cause damage to the superior/internal laryngeal nerve (affects afferent limb of cough reflex) –> CN10
bone metastases can be osteoblastic, mixed, or osteolytic
Osteoblastic (SCLEROTIC): prostate, small cell lung cancer, hodgkin lymphoma
Mixed: GI and breast
Osteolytic (LUCENT): MM, non-small cell lung cancer, non-hodgkin lymphoma, renal cell carcinoma, melanoma
rhabdomyolysis
granular muddy brown casts seen due to skeletal muscle necrosis causing acute tubular necrosis
- direct cytotoxicity and renal vasoconstriction
- can be due to crush injury, prolonged muscle activity (seizure, marathon), drugs (tatins, amphetamines, heroin)
what property of a drug makes it more likely to be metabolized and cleared by the liver rather than the kidney
liver = more lipophilic drugs
lidocaine and mexiletine
- class 1B antiarrhythmic drug
- binds inactivated sodium channels and rapidly dissociates –> preferentially binds to rapidly depolarizing and ischemic ventricular myocardial fibers
- suppresses v.tach induced by rapidly depolarizing and ischemic myocardium
explain the high dose dexamethasone suppression test
ectopic sources will show no difference in cortisol or ACTH levels
what type of cancer can you treat with vitamin A derivatives
APL/AML (treated with all-trans-retinoic acid)
what type of cells line the ventricles?
ependymal cells
lateral displacement of proximal fracture fragment during supracondylar humeral fractures
radial nerve injury
in a pt with mitral stenosis why would the left recurrent laryngeal nerve become impinged and what would this cause
this causes left atrial enlargement which can cause too much compression on the nerve causing hoarseness and left vocal cord paresis
avoidant personality disorder
they WANT to be with people but avoid it due to fear of criticism and rejection
two possible diagnoses when seeing an increase in endogenous insulin
- insulinoma
2. sulfonylurea medication (increases endogenous insulin release)
what do you see on IF in goodpasatures?
linear IgG and C3 deposits
- also antibodies to alpha 3 chain to type IV collagen
- treat with plasmapheresis
whats the first step of tertiary syphillus?
vasa vasorum endarteritis
here is the problem, list the nerve involved
- weakness in knee flexion
- weakness in dorsiflexion and numbness on dorsal foot and posterolateral calf
- weakness in plantar flexion and inversion, absent ankle reflex
- sciatic nerve
- common peroneal nerve
- tibial nerve
what type of neoplasm can a blue-ish tumor under the nail be?
glomus tumor/glomangioma (thermoregulation)
melanoma (pigmentation)
most common benign vascular tumors in adults
cherry hemangiomas (small, bright red, papular lesions)
whats the purpose of Protein A
virulence factor on staph aureus that binds to Fc of IgG leading to impaired complement activation, opsonization, and phagocytosis
indole + (what bacteria)
ecoli
signet ring on histology slide of stomach, what do you think?
-kinda looks like a circle with two darker sides (nucleus pushed to the side)
GASTRIC ADENOCARCINOMA
- no glands formed, just abundant mucin droplets that push nucleus to one side
- diffuse involvement of stomach wall due to loss of E-cadherin
- leather bottle stomach –> linitis plastica
how do you treat rickettsia species
doxycycline–> blocks 30S ribosomal subunit
rapidly progressive dementia, myoclonus, death within a year of symptom onset
spongiform changes in brain (uniform intracellular vaculoes throughout gray matter), widespread neuronal loss and no inflammatory response
creutzfeldt-jakob disease (alpha helix to beta sheet)
-most cases are sporadic but they can also be inherited or iatrogenic
flulike illness, conjunctival suffusion (noninflammatory), corkscrew shaped organism
leptospira (via water sports and being in contact with contaminated water)
IgE-dependent vs independent mast cell degranulation
dependent –> due to environmental exposure/food/beta-lactam/sulfonamide antibiotics
independent –> due to opiods, radiocontrast agents, and vancomycin (work by activating PKA and PI3 kinase)
renal cell carcinoma
-risk factors and what gets obstructed
- smoking, hypertension, obesity, toxin exposure
- inferior vena cava gets obstructed
- also note that the tumor can sometimes make EPO which causes erythrocytosis
mannitol
osmotic diuretic (increases plasma or tubular fluid osmolality)
- causes extraction of water from interstitial spaces around the body to go be peed out
- this can reduce edema and intracranial pressure in pts with cerebral edema
- severe toxicity is pulmonary edema
main causes of toxic megacolon and how will the pt present
ulcerative colitis and c.diff
abdominal pain/distension, bloody diarrhea, ever, shock (hypotension and tachypnea)
best way to see this is via x-ray
black vs brown gallstone pigments
brown –> biliary tract infection
black –> chronic hemolytic anemia, increased cycling of bilirubin
tumor in metaphyses of long bone, worsening pain and soft tissue swelling, lytic bone lesion
osteosarcoma (pleomorphic spindle shaped tumor that generate osteoid and thin trabeculae of neoplastic bone)
- malignant proliferation of osteoblasts
- risk factors: familial retinoblastoma, paget disease, and radiation exposure
what type of ALL causes a mediastinal mass making it difficult to breath, swallow, or it can also cause superior vena cava syndrome
T-cell ALL
pathogenesis in diabetic gastroparesis
destruction of enteric neurons due to chronic hyperglycemia leading to impaired peristalsis
how do heparin and enoxaparin work and how do they differ?
they bind to antithrombin III to activate it so it can go bind to factor 10a and stop it from converting prothrombin into thrombin (preventing coagulation)
heparin is a high molecular weight so it can also bind to factor 10a and facilitate binding
anicteric
no jaundice accompanied. this is usually seen in a pt who had hepA as a child and grows up with IgG titer but no active symptoms
trabecular thinning with fewer interconnections of bone is seen in what disorder?
osteoporosis
subperiosteal resorption with cortical thinning of bone is seen in what disorder?
hyperparathyroidism leading to osteoporosis but since the cause is different its pathogenesis differs as well
what bone structure is seen in someone who has osteopetrosis?
“marble bone disease”
-spongiosa filling medullary canals with no mature trabeculae
how does bone look in vitamin D deficiencty
osteoid matrix accumulation around trabeculae
lamellar bone structure with mosaic pattern is associated with what disease?
pagets disease of bone
hamartoma
common benign tumor made of cartilage, fibrous/fatty tissue
-most common benign tumor of lung
what can you use to check if someone has osteitis deformans (paget disase of bone)
increased alk phos
-increased osteoclasts followed by increased osteoblasts
tick-bite that leads to mulberry shaped intracytoplasmic inclusions in monocytes
Ehrlichiosis (Ehrlichia chaffeensis)
-transmitted by the Ixodes tick (same as lyme disease tick) or the lonestar tick
dancing eyes and dancing feet tumor in children with elevated catecholamine metabolites
neuroblastoma (normotensive)
N-myc oncogene = poor prognosis
what two substances promote angiogenesis
VEGF and FGF2
what type of cancers are usually associated with glandular cells
adenocarcinoma
facial edema/plethora and venous distension in neck veins and upper abdomen
superior vena cava syndrome (most common causes are lung cancer and non-hodgkin lymphoma) –> some mediastinal mass is most common but another reason could be due to superior sulcus tumor (less common)
biceps and brachioradialis reflex
C5-C6
what does a bruit mean
that you have turbulent blood flow and possible stenosis of whatever blood vessel youre listening to
vitiligo
partial or complete loss of epidermal melanocytes
risperidone
2nd gen. atypical antipsychotic
- used for schizophrenia and bipolar disorder
- can cause hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)
painless unilateral visual disturbances with a flame like hemorrhage in the eye… underlying cause?
hypertension (hypertensive renal hemorrhage)
two main causes of acute pancreatitis and if those are negative whats the next test you should run and why
- gall stones
- alcoholism (macrocytosis and AST:ALT ratio > 2 are indirect indicators of chronic alcohol consumption)
test for triglycerides cause if they are over 1000 they can cause direct injury to pancreatic acinar cells
painless blood int he urine and and peeing out malignant cells with no kidney abnormalities
urothelial transitional cell bladder cancer
major risk factors: cigarette smoking, occupational exposure to rubber plastics, aromatic amine-dyes, textiles, and leather
-cyclophosphamide therapy also increases risk
causes of primary vs secondary spontaneous pneumothorax
primary –> apical subpleural blebs (in tall thin men)
secondary –> diseased lung (bullae in emphysema, infections), mechanical ventilation with use of high pressures leading to barotrauma
rising fever, abdominal pain, rose spots on trunk and abdomen, hepatosplenomegaly
-possible intestinal bleeding and perforation
salmonella typhi (typhoid fever)
what causes hydatid cysts “eggshell calcification” in the liver and what can happen to it?
echinococcus granulosis via ingestion of eggs in food contaminated with dog feces and the cyst can rupture and cause anaphylaxis
spike and dome appearance on EM in kidney
membranous nephropathy
what medication can you give to CF pts with phe508 deletion?
lumacaftor (corrects misfolded proteins and improves their transport to cell surface)
ivacaftor (opens Cl- channels to improve chloride transport)
whats the most common mechanism of sudden cardiac death in a pt within the first 48hrs of a MI?
v. fib
inflammation of what causes acne vulgaris
pilosebaceous follicles
compare and contrast psoriasis to atopic dermatitis in an adult
psoriasis –> scaly (on back of arm/elbow), erythematous plaques, neutrophilic infiltration, positive auzputzs sign, dilated blood vessels
atopic dermatitis (eczema) –> itchy dry skin (on flexure surfaces), eosinophilic infiltration
both have hyperkeratosis
pt presents with increased neutrophils and what seems like a cold or something bacterial but only alk phos is slightly elevated
leukemoid reaction
-expect to see PMN with Dohle bodies (basophilic granules in the PMNs)
list the class 1A antiarrhythmics
quinidine, procainamide, and disopyramide
cardiac ischemia, when does that part of the heart stop beating and when does the damage become irreversible
stops beating after 1min
becomes irreversible after 30mins
painless obstructive jaundice (elevated bilirubin, dark urine, pale stool)
PANCREATIC ADENOCARCINOMA
- smoking is the most important risk factor
- other risk factors include advanced age, chronic pancreatitis, and genetic predisposition (Peutz-Jeghers syndrome)
hemeangioma on the butt of an infant that is slowly growing in size
strawberry (capillary) hemeangioma
absence of CD55 on red blood cells
paroxysmal nocturnal hemoglobinuria
- compliment mediated hemolysis due to mutated PIGA (helps synthesize GPI)
- hemolytic anemia (hemoglobinuria), pancytopenia, and thrombosis at atypical sites
- chronic hemolysis can cause iron deposition in the kidney (hemosiderosis)
what is the pathogenesis of the problem when a child has nonbilious vomiting
pyloric stenosis which is due to smooth muscle cell hypertrophy
infant doesnt develop social smile and fails to track objects
infantile cataracts due to galactokinase deficiency
leucovorin
aka. folinic acid
- can reverse toxicity of methotrexate in non-cancerous cells in gastric mucosa and bone marrow
- serves as reduced form of folic acid that does not require dihydrofolate reductase
whats a secondary cause someone would develop pulmonary hypertension
prolonged untreated obstructive sleep apnea
