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
