UWorld Flashcards
Streptomycin mechanism
Inhibits initiation of protein synthesis by binding to and distorting the structure of the prokaryotic 30S ribosomal subunit. (aminoglycoside class)
Screening for carcinoid syndrome
5-hydroxyindoleacetic acid (Breakdown product of carcinoid syndrome)
Screening for mast cell degranulation
Tryptase (specific to mast cells)
Melanocytes are derived from what tissue
Neural crest
Aortic regurgitation
early diastolic murmur
most common cause of aortic reguritation
aortic root dilation (murmur is often best heard at the right sternal border) or bicuspid aortic valve
Goodpasture syndrome
C3 and IgG are deposited along the glomerular basement membrane. IF shows linear deposits of these complexes
Poststreptococcal glomerulonephritis
Preceded by skin or pharyngeal infections with group A beta-hemolytic streptocci.
IF shows diffuse granular pattern of IgG and C3 depostis within the glomerular capillary walls and mesangium
Rifampin
Halts bacterial protein synthesis by inhibiting bacterial DNA-dependent RNA polymerase, preventing transcription of DNA into mRNA
Streptomycin uses
Mycobacterial
Yersinia pestis
Tularemia
Ciprofloxacin drug class
Fluoroquinolone.
Inhibits DNA gyrase
Isoniazid action
antimycobacterial agent inhibiting synthesis of mycolic acids
Burkitts lymphoma
t8;14
c-myc: nuclear phosphoprotein functioning as a transcription activator controlling cell proliferation, differentiation, apoptosis
Ig heavy chain region
Follicular lymphoma
t14;18
bcl-2 gene: apoptosis inhibitor protein
CML
t9;22
BCR-abl: fusion gene encoding a proteint hat inhibits apoptosis while promoting mitogenesis and increased tyrosine kinase activity
Mantle cell lymphoma
t11;14
cyclin D1: promoter of G1 to S phase
Wilson disease mechanism
inadeq. hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin.
Wilson disease s/s
Copper is Hella BAD
Cirrhosis, corneal deposits (kayser-Fleisher rings)
Hemolytic anemia
Basal ganglia degeneration (parkinsonian symptoms
Asterixis
Dementia, dyskinesia, dysarthria
Indicator of mitral stenosis severity
A2-OS interval, shorter is worse
Myocardian stunning
less severe form of ischemia-induced reversible loss of contractile function than hibernation.
Brief ischemic episodes
Ischemic pre-conditioning
development of resistance to infarction by cardiac myocytes previously exposed to repetitive non-lethal ischemia
Myocardial hibernation
persistentnt or repetitive low flow state, that can be reversed by reperfusion
Parts of tRNA
tRNA anticodon site-ribosome complex selects soley upon its anticodon sequence, red in teh 3’ to 5’ direction
D loop-dihydrouracil residues used for recognition by proper aminoacyl tRNA synthetase
Variable loop
Tarm-contains TpsiC loop necessary for binding of tRNA to ribosomes. Has thymidine,pseudouridine, cytidine residues. ONLY RNA SPECIES CONTAINING NUCLEOSIDE THYMIDINE
Acceptor stem-CCA hanging off 3’ end with hydroxyl accepting amino acid by aminnoacyl tRNA synthetase action
Vitamin B1 (thiamine) deficiency symptoms
beriberi and wernicke syndrome
Vitamin B2 (riboflavin) deficiency
cheilosis stomatitis glossitis dermatitis corneal vascularization ariboflavinosis
Vitamin B6 (pyridoxine) deficiency
cheilosis, glossitis, dermatitis, peripheral neuropathy
Folic acid deficiency characterized by
megaloblastic anemia
neural tube defects int he fetus
Vitamin K deficiency
bleeding diathesis, but not painful gums
zinc deficiency
acrodermatitis enteropathica, growth retardation, infertility
Scurvy
hemorrhages, subperiosteal hematomas, bleeding into joint spaces, gingival swelling, secondary periodontal infection, anemia, hyperkearatotic papular rashes, impaired wound healing, weakened immune response to local infections
what causes angiogenesis?
VEGF
FGF
What indirectly causes angiogenesis?
proinflammaotry cytokines like IL-1 and INF-gamma (increased VEGF expression)
Reaction formation
transformation of an unacceptable impulse or emotion into the opposite. (patient acting extremely relaxed around physician, saying she finds her appointments to be very soothing to defend against underlying anxiety)
Classical conditioning
neutral stimulus repeatedly paired with non-neutral stimulus that elicits a reflexive, unconditioned response.
Tardive dyskinesia
involuntary movements after chronic use (lip smacking, choreoathetoid movements)
Neuroleptic malignant syndrome
fever, rigidity, mental status changes, autonomic instability
Acute dystonic reaction
Sudden onset, sustained muscle contractions
Drug-induced parkinsonism
tremor, rigidity, bradykinesia, masked facies
main transmission paths of Hepatitis B
sexual
percutaneous
Vertical
Familial pulmonary arterial hypertension cause/results/treatment
Inactivating mutations in pro-apoptotic BMPR2 gene.
Familial pulmonary arterial hypertension consequences
Medial hypertrophy (arteriolar smooth muscle) intimal fibrosis, significant luminal narrowing
Familial pulmonary arterial hypertension treatment
Definitive is lung transplant
Vasodilators can improve symptoms
Bosentan: endothelin receptor antagonist blocking effects of endothelin (potent vasoconstrictor that also stimulates endothelial proliferation. ) decreasing pulmonary arterial pressure and lesson progression of vascular and right ventricular hypertrophy
Major side effect to amphotericin B
Renal toxicity
- renal vasoconstriction, reduction in the GFR
- Direct toxin on renal epithelial cells
- acute tubular necrosis
- electrolyte disturbance
- renal tubular acidosis
- normochromic normocytic anemia
-Hypokalemia
-Hypomagnesemia
are the most serious electrolyte disturbances that require supplementation.
Phenotypic mixing
co-infection of a host cell by two viral strains, resulting in progeny virions that contain nucleocapsid proteins from one strain and the genome of the other strain. Though no change to underlying viral genomes, so next generation of virions revert to original unmixed phenotypes
Interference (viral)
inhibition of one virus of the replication and/or release of a second virus that is infecting the same cell.
Transformation (viral)
incorporation of viral DNA into a host cell chromosome. alters genetic composition of the host cell, but typically no genomic changes to virus
Transformation
Uptake of naked DNA by a prokaryotic or eukaryotic cell
Viridans streptococci virulence factor for adherence
Produce extracellular polysaccharides (dextrans) using sucrose as a substrate. Facilitates adherence to fibrin.
(fibrin and platelets are deposited at sites of endothelial trauma, providing a site for bacterial adherence and colonization during bacteremia leading to teh formation of a valvular vegetation)
Action of heparin
Activate antithrombin III, thereby decreasing activity of
thrombin
Clotting factors IX, X, XI, XII
Most important environmental risk factor for pancreatic cancer
Smoking
Others include: Age >50 Chronic pancreatitis Diabetes mellitus Genetic: Hereditary pancreatitis, MEN syndromes, Hereditary non polyposis colon cancer, Familial adenomatous polyposis syndromes
Risk for colon adenocarcinoma
low fiber diet
Alcohol as a risk factor
Head/Neck/Esophagus/Liver
Chronic pancreatitis
However, moderate alcohol use in absence of chronic pancreatitis does not add risk for pancreatic cancer
H. pylori as a risk factor
Gastric adenocarcinoma
Gastric lymphoma
S/S for adenocarcinoma at head of pancreas
(compressing the common bile duct)
Palpable but nontender gallbladder (courvoisier sign)
Wt loss
Obstructive jaundice (pruritism, dark urine, pale stools)
S/S for pancreatic cancers of body and tail.
(do not compress common bile duct)
No symptoms until invading splanchnic plexus causing midepigastric abdominal pain.
Courvoisier sign
Palpable but nontender gallbladder
Obstructive jaundice s/s
Pruritis
Dark urine
Pale stools
What is Lipofuscin
sign of wear and tear or aging in the heart and liver of aging or cachectic malnourished patients
Insoluble pigment composed of lipid polymers and protein complexed phospholipids
Oseltamivir class and action
What is it used for
Neuraminidase inhibitor, prevent release of virus from infected cells and spread within the respiratory tract
Influenza A and B
Eaton-Lambert syndrome mechanism
Autoab reacting with presynaptic calcium channels preventing release of ACh
Paraneoplastic syndrome assoc w. small cell carcinoma of the lung
Eaton-Lambert clinical presentation
resembles myasthenia gravis.
Valsalva, what is it
and what does it do
and what affect does it have on murmurs
straining to blow air out like a balloon but closed mouth and nose.
Decreases preload of heart.
Makes LVH murmur louder and mitral valve prolapse
Most other murmurs softer (aortic stenosis, pulmonic stenosis, tricuspid regurgitation)
Handgrip maneuvar
Increases afterload
M protein
major virulence factor for Strep pyogenes (group A)
Present in cell wall and antiphagocytic, interfereing with opsonization by alternative complement pathway.
Binds to fibrinogen, resluting in inflammatory mediator release and vascular leakage.
Wacky Wobbly and Wet indicates what?
How does it happen?
What does CT scan show?
What is the specific order of symptoms?
Normal pressure hydrocephalus (NPH)
Communicating hydrocephalus due to diminished reabsorptive capacity of the arachnoid villi.
CT scan shows symmetric dilation of ventriculi
(Gait abnormality, urinary incontinence are the first symptoms. Progresses to progressive dementia and emotional blunting)
How to test for Meckel diverticulum?
99-Pertechnetate study for ptake by ectopic gastric mucosa
How does Meckel’s diverticulum occur?
Failure of obliteration of the omphalomesenteric duct. May contain ectopic acid-secreting gastric mucosa and or pancreatic tissue
Presentations of Meckel’s Diverticulum
- RLQ pain (similar to acute appendicitis)
- Intussusception (colicky abd pain and currant jelly stools)
- Volvulus
- Obstruction near terminal ileum
Rule of 2s
What is the rule of 2s
- 2 inches long
- 2 feet from ileocecal valve
- 2% of population
- Presents in the first 2 years of life
- May have 2 types of epithelial (gastric/panceratic)
(Meckel’s diverticulum)
Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of oxidative phosphorylation
Genetic form of Dilated Cardiomyopathy (DCM)
Mutations in cardiac cell sarcomere proteins (beta myosin heavy chain)
Hypertrophic cardiomyopathy
Mutations of a calcium binding sarcoplasmic reticulum protein
Arrhythmogenic right ventricular cardiomyopathy (ARVC), a progressive fibrofatty replacement of the right ventricular myocardium of uncertain pathogenesis
Mutations in K+ channel protein contributing to delayed rectifier current IK of the cardiac action potential (long QT), risk for Torsades de pointes
Romano-Ward syndrome
Jervell and Lange-Nielson syndrome
Superior mesenteric artery syndrome what is it and what are some causes
When the transverse portion of the duodenum is entrapped b/w the SMA and the aorta, causing symptoms of partial intestinal obstruction.
Aortomesenteric angle critically decreased secondary to
- Diminished mesenteric fat
- Pronounced lordosis
- Surgical correction of scoliosis
What to check for confirming menopause.
FSH
Thiopental distribution
Equilibrates in brain tissue within 1 minute, ergo used fo induction of anesthesia.
Rapidly redistributes to skeletal muscles and fat.
Microvesicular fatty change in liver
Reye syndrome (children 5-10 after treatment with salicylates)
Macrovesicular fatty change
Fatty liver from chronic ethanol consumption
Drug induced cholestasis
OCP
Anabolic steroids
Chlorpromazine
Hepatic granulomatosis is associated with..
Methyldopa
Hydralazine
Quinidine
Massive hepatic necrosis
What causes it
What is seen on histo
clinical presentatino
Rare but severe complication of halothane exposure (especially halothane), due to direct liver injury by halothane metabolites and formation of autoantibodies against liver proteins. Occurs 2 days to 4 wks after the exposure.
Massive centrilobular hepatic necrosis
Hepatomegaly, liver tenderness, increased LFTs
Von Hippel-Lindau disease characterization
Gene defect?
AD
Cerebellar hemangioblastoma
Clear cell renal carcinoma
Pheochromocytoma
Deletion of VHL gene on chromosome 3p
RB location
implication of mutation
Normal Mechanism
Chr 13
Mutations lead to
- Retinoblastoma
- Osteosarcoma
Inhibits E2F normally blocking G1–>S phase
WT-1 location
implication of mutation
Chr 11
Wilms tumor
Alkaptonuria mechanism
Presentation
Congenital deficiency of homogentisate oxidase in the degradative pathway of tyrosine to fumarate
Autosomal recessive, benign. Dark connective tissue, brown pigmented sclerae, urine turns black on prolonged exposure to air. May have debilitating arthralgias (homogentisic acid toxic to cartilage)
How is Cysteine made
Sulfur containing amino acid synthesized from amino acid Serine and Homocysteine (which is derived from methionine)
Drug of choice for preventing venous thrombosis in non-ambulatory patients or patients undergoing elective surgery especially hip and knee.
Mechanism?
Heparin Unfractionated and also low molecular weight heparins
Increases the effect of the naturally occuring anticoagulant antithrombin III. Unfractionated heparin binds to antithrombin III by pentasaccharide in the heparin chain, causing a conformational change of antithrombi III, in turn increasing antithrombin binding and neutralization of thrombin
Drug of choice for managing heparin induced thrombocytopenia
Lepirudin
Argatroban
Direct thrombin inhibitors, do not require antithrombin III
Drug of choice following Percutaneous coronary intervention PCI and for treating unstable angina and non-Q wave MI
Ticlopidine and Clopidogrel
ADP inhibitors
Drug of choice for primary and secondary prevention of MI and strokes. NOT as effective for preventing perioperative thromboembolism
Aspirin
Acetylates COXI, decreased Thromboxane A2
Olanzapine use
mechanism of action
SE
Mood stabilizing in bipolar
2nd generation antipsychotic
SE:
Wt gain and metabolic side effects
What organisms produce IgA proteases?
What is the point?
Streptococcus pneumoniae and Neisseria gonorrhoeae
Cleaves IgA antibodies preventing them from interfering with bacterial adhesion to mucous membranes.
Characteristics of Klebsiella
Encapsulated
Lactose fermenting
Gram negative bacillus
Mucoid in culture
Warfarin action
Inhibits Vitamin K dependent carboxylation of glutamic acid residues of factors 2, 7, 9, 10. also protein C and protein S.
Drug of choice for long term anticoagulation to prevent venous thrombosis and resultant pulmonary embolism (VTE)
Warfarin
What is keratin a marker for
Epithelial cell origin
markers for endothelium
CD34, vWF, others
muscle tissue identification
smooth muscle actin
Caldesmon
Desmin
others
Lymphocyte pan T cell marker
CD3
Most common location for intestinal carcinoids?
Other locations?
Ileum is most common location for intestinal carcinoids
Appendix and rectum also
Histo of carcinoid tumors
nests or sheets of uniform cells
Eosinophilic cytoplasm and oval to round stippled nuclei
Where are carcinoid tumors derived from?
Enterochromaffin cells of intestinal mucosa are the source of carcinoid tumors
What is the polysarrharide-protein capsule of H. influenzae comprised of.
Linear polymer composed of ribose, ribitol, and phosphate (polyribosyl-ribitol-phosphate PRP)
Adenoma to carcinoma sequence
APC inactivation
Methylation abnormalities
[hyperproliferative epithelium]
COX-2 overexpression
K-ras activation
[adenoma]
DCC inactivation
p53 inactivation
[carcinoma]
Further accumulations of genetic abnormalities
What is the enzyme that controls glycolysis/gluconeogenesis
Bifunctional enzyme composed of PFK2 and 2,6-bisphosphatase.
How is PFK2/2,6 bisphosphatase regulated?
bifunctional enzyme.
Glucagon causes phosphorylation, inactivates kinase, activates phosphatase. Decrease in Fructose 2,6 bisphosphate. Inhibition of PFK1 and increased gluconeogenesis.
Insulin causes dephosphorylation, Inactivates phosphatase and activates the kinase. Increased Fructose 2,6 bisphosphate. Stimulates PFK1 and increased glycolysis.
periodic acid schiff stains for what
Stains glycogen, mucopolysaccharides, used to dx Tropheryma whipplei (Whipple disease).
and
Alpha1-antitrypsin deficiency (reddish-pink, PAS+ granules of unsecreted, polymerized A1AT in the periportal hepatocyteS)
Whipple disease What causes it how dx? Presentation Mnemonic?
Caused by Infection with Tropheryma whipplei (Gram positive)
Dx with PAS+ stain
Presents w/: Foamy macrophages in intestinal lamina propria, mesenteric nodes. Cardiac symptoms Arthralgias and Neurologic symptoms are common.
Commonly in old men
FOAMY WHIPPed cream in a CAN
Bronchial hyperreactivity is the hallmark of
chronic asthma
Intraalveolar substance accumulation is a finding in
Interstitial pneumonitis
Alpha1-Antitrypstin deficiency (A1AT) is what kind of disorder.
Genetics (alleles?
Autosomal co-dominant disorder affecting lungs and liver.
MM is normal
ZZ has decreased synthesis of AAT by the liver.
Ghon focus
Ghon complex
Small area of granulomatous inflammation.
Ghon complex: Hilar lymphadenopathy + Peripheral granulomatous lesion in middle or lower lung lobe
Healing of TB lung lesion may be complicated by
This persistent cavity may become secondarily infected with Aspergillus flavus and form fungus balls
How is potency of inhaled anesthetics measured?
MAC, minimal alveolar concentration (alveolar concentration preventing movement in 50% of patients exposed to noxious stimuli)
Arteriovenous concentration gradient influences what, not what?
why?
Influences the rate of induction, not anesthetic potency (MAC)
because high gradients mean you need more anesthetic to replace that uptaken by peripheral tissues
How does thyroid bring iodine into the follicle?
What does this also bring in?
Na+/I- symporter
Perchlorate and Pertechnetate
Nuclei involved in Pupillary light reflex
Pretectal nucleus followed by Edinger-Westphal nucleus followed by Ciliary ganglion
vWF function
- Platetlet adhesion by binding to and crosslinking platelet gliycoproteins (GpIb) and exposed collagen underneath damaged endothelium
Vitamin A overuse
Intracranial hypertension (papiledema) Skin changes Hepatosplenomegaly
Vitamin C overdose
False negative stool guaiac results
Assoc with diarrhea and abdominal bloating
Calcium oxalate nephrolithiasis maybe
B2 deficiency (riboflavin)
Cheilosis Stomatitis Glossitis Dermatitis Corneal vascularization Ariboflavinosis
B12 deficiency
Older mentally slow woman of northern Euro descent lemon colored (anemic and icteric) smooth shiny tongue (atrophic glossitis) shuffling broad based gait
niacin deficiency
3 Ds of pellagra,
dementia
dermatitis
diarrhea
Thiamine deficiency
Infantile and adult beriberi
wernicke korsakoff
First line Treatment of trigeminal neuralgia
mechanism
SE
Carbamazepine
By reducing ability of sodium channels to recover from inactivation, inhibits neuronal high frequency firing.
Aplastic anemia is a potential SE as well as
P450 inducer
2nd line treatment of trigeminal neuralgia
Baclofen
Valproic acid
trigeminal neuralgia presentation
first line treatment
2nd line treatment
brief episodes of sudden and severe electric shock like or stabbing pain in the distribution of CN V (particularly V2 and V3)
Carbamazepine is 1st line
Baclofen and valproic acid are second line treatments
histo finding for granulosa cell tumor
Call-Exner bodies, small follicle like structures filled with eosinophilic secretions
short acting benzodiazepines
Triazolam or alprazolam
Intermediate acting benzodiazepines
Lorazepam
long acting benzodiazepines
diazepam
flurazepam
chlordiazepoxide
treatment of GAD or panic disorder
SSRI (Fluoxetine) but needs 4 wks to start and there is sometimes an initial transient worsening of symptoms.
Give Benzodiazepine initially (preferably short acting like Alprazolam or trazolam)
what is assoc with mitochondrial toxicity
Cyanide
NRTIs
Ribosomal protein synthesis inhibited by what toxins
Shiga toxin (Shigella)
Shiga-like toxin (ETEC enterohemorrhagic E. coli O157:H7)
lithium side effects
Hypothyroidism
Nephrogenic diabetes insipidus
Ebstein’s anomaly in preg
Carbamazepine SE
Aplastic anemia (CBC required to monitor)
Citalopram SE
Sexual dysfxn
Clozapine se
agranulocytosis and seizures
Lamotrigine SE
Rash, stevens johnson syndrome
Risperidone SE (also what kind of drug is it)
atypical antipsychotic, agranulocytosis and seizures
SE of trazodone
Painful erection (priapism) Orthostatic hypotension Sedation
Transtentorial herniation can result in compression of what and what does this cause in each case?
- Ipsilateral oculomotor nerve (dilated fixed pupil down and out)
- Ipsilateral posterior cerebral artery compression (contralateral homonymous hemianopsia w/ macular sparing)
- Compression of contralateral of cerebral peduncle. or ipsilateral peduncle. (This results in hemparesis of ipsi or contra respectively.)
- Brainstem hemorrhages (Duret hemorrages, pons and midbrain due to stretch and rupture of basila artery. Fatal)
Why is heat sensitivity seen in MS
Decreased axonal transmission assoc with increased heat
What enzyme can convert procarcinogens into an active carcinogenic state in the body
Cytochrome P450 oxidase system (microsomal monooxygenase)
at what lung volume is total pulmonary vascular resistance the lowest
FRC (higher than that you get stretching of alveolar capillaries, decreasing radius increasing resistance. Lower than that you get compression radially of extraalveolar vessels)
What is seen in
Hyperacute rejection of lung
Acute rejection of lung
Chronic rejection of lung
Hyperacute rejection: graft blood vessel spasm and diffuse intravascular coagulation with resultant ischemia (due to preformed ab against ABO or HLA)
Acute rejection: 1-2 wks after, vascular dmg. Perivascular and peribronchial lymmphocytic infiltrates. Dyspnea, dry cough, low grade fever. Perihilar and lower lobe opacities (due to ricipient rxn to the HLA of the graft cell mediated imune response and CD8 t cells play central role)
Chronic rejection: mo-yrs, inflammation of the small bronchioles (bronchiolitis obliterans) inflamm and fibrosis of bronchiolar walls lead to narrowing and obstruction of the affected bronchioli. Dyspnea, nonlproductive cough, wheezing. (c/f with renal transplant chronic rejection has vascular obliteration)
Resistance to penicillin
- production of beta lactamase
2. production of a low affinity penicillin binding protein
Resistance to vancomycin
VanA ligase substitutes D-alanine D-lactate for D-alanyl-D-alanine thus preventing binding fo vancomycin.
Resistance to tetracyclines
- synthesis of protein that allows ribosome to translation even in presence of drug
- Decreeasing intracellular concentrations of the drug by increased efflux or decreased influx
Resistance to ciprofloxacin/fluoroquinolones
mutations in the DNA gyrase or topoisomerase genes
Resistance to aminoglycosides
How is it acquired?
Production of aminoglycoside modifying enzymes that transfer diff chemical groups (acetyl, adenyl, phosphate) to the aminoglycoside antibiotic molecule outside of the bacterium, thereby decreasing the ability of these drugs to bind to ribosomes and exert their antimicrobial effects.
Not chromosomally mediated but acquired resistance mediated by plasmids or transposons.
Human multidrug resistance gene codes for what?
P-glycoprotein, a transmembrane ATP dependent efflux pump protein that has a broad specificity for hydrophobic compounds. This can reduce the influx of drugs into the cytosol and increase efflux from the cytosol, thereby preventing the action of chemotherapeutic agents.
Alport syndrome mechanism
Presentation
Inherited defect in the formation of type 4 collagen
Presents with
- Thinning of the basement membrane
- Hearing loss
- Ocular abnormalities
- Hematuria
- Progressive renal insufficiency
Minimal change disease mechanism
Presentation
Immune dysreg and overproduction of specific cytokine (IL-13) that dmgs the podocytes->effacement and fusion of footprocesses
Presents
-Selective loss of albumin
Suprachiasmatic nuclei are involved in…
located immediately above the optic chiasm and receive visual input from retina via the optic tract.
Help to regulate circadian rhythms by relaying light information to other hypothalamic nuclei and to the pineal gland
Supraoptic and paraventricular nuclei produce what
Vasopressin
Oxytocin
Anterior hypothalamic nuclei coordinate what
Posterior hypothalamic nuclei coordinate what
Anterior coordinates cooling by stimulating parasympathetic NV
Posterior coordinates heat conservation and heat producxtion
What is a SE of oxygen therapy to a neonate in respiratory distress
Retinal damage. Becaues the temporary hyperoxia may induce upreg of proangiogenic factors like VEGF upon return to room air ventilation
Treatment of an acute manic episode
Mood stabilizing agent (lithium, valproate, or carbamazepine)
and
Atypical antipsychotic (olanzapine)
(mood stabilizer as monotherapy are effective in up to 60%)
What can the swinging flashlight test show a relative afferent pupillary defect in the pupil contralateral to the tract lesion?
the nasal portion of theretina contributes more input to the pretectal nucleus than the temporal portion of the retina
Lesion in the optic tract causes…
contralateral homonymous hemianopsia and a relative afferent pupillary defect (Marcus Gunn pupil) in the pupil contralateral to the tract lesion
Myasthenia gravis is a ___ hypersensitivity disorder
Type II
Contact dermatitis is a ___ hypersensitivity disorder
Type IV
Hypersensitivity pneumonitis is a ____ hypersensitivity
Type III
postinfectious glomerulonephritis is a ___ hypersensitivity disorder
Type III
Goodpasture syndrome is a type ___ hypersensitivity disorder
Type II
Sarcoidosis is a ____ hypersensitivity disorder
Type IV hypersensitivity
acute hemolytic transfusion rxns are an example of ___ hypersensitivity
Type II antibody mediated hypersensitivity rxns
avascular necrosis associations
- High dose steroid therapy and alcoholism
- Injury to the vessel wall (vasculitis) in SLE
- Sickle cell disease via thrombotic occlusion of arteries. Embolic occlusion (fat or air emboli) can also cause
Cyanotic congenital heart diseases
Truncus arteriosus Transposition of the great vessels Tricuspid atresia Tetralogy of fallot Total anomalous pulmonary venous return
Non cyanotic congenital heart diseases
Atrial septal defect
Ventricular septal defect
Patent ductus arterosus
Coarctation of the aorta
3 yo with recurrent cyanotic spells they counteract by squatting. what it his characteristic for
Tetraology of Fallot
Fixed splitting of the 2nd heart sound is caused by
Atrial spetal defect
S4 is caused by
Left ventricular hypertrophy/stiff left ventricle.
In younger patients it is always pathologic (unlike S3)
What cause Charcot-Marie-Tooth disease
How does it present
Mutation of myelin protein gene.
“neural form” of muscular atrophy
Presents with weakness of foot dorsiflexion due to involvement of the common peroneal nerve
what does a triple test test?
when is it done
What is the next step if abnormal
AFP
hCG
Estriol
done at wks 16 and 18 of gestation
Abnormal triple test indicates fetal Ultrasonography (USG). If this reveals no anatomic abnormalities and development consistent with mother’s dates, then amniocentesis is performed.
What causes increased AFP
- Dating error
- Neural tube defects
- Anterior abdominal wall defects (gastroschisis, omphalocele)
- Multiple gestation
What causes decreased AFP
Down syndrome
VSD sound
loud holosystolic murmur best heard over the left sternal border in the 3rd or 4th intercostal space
Isoniazid SE
Hepatotoxic Peripheral neuropathy (if not given pyridoxine also)
Neuroblastoma is assoc with
caused by
assoc with opsoclonus-myoclonus, a paraneoplastic syndrome assoc with neuroblastoma
increased number of N-myc gene copies
most common extracranial neoplasm in children
2nd most common brain tumor in children
Neuroblastoma is the most common extracranial
Medulloblastoma is the 2nd most common brain tumor
culture negative endocarditis
Bartonella Coxiella Mycoplasma Histoplasma Chlamydia HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)
slowly progressive symmetric postural and or kinetic tremor that most commonly affects the uppper extremities.
inheritance
other name
treatment
Essential tremor
Autosomal dominant
aka familial tremor
tx: beta adrenergic antagonist propranolol
insidious onset exertional dyspnea and dry cough, with restrictive profile on pulmonary function testing and interstitial fibrosis and subplerual cystic airspace enlargement
idiopathic pulmonary fibrosis
most common cardiac abnormality predisposing to NVBE among 15-60 yo americans. is.
what is a less common cause?
Mitral insufficiency due to myxomatous degeneration (mitral valve prolapse).
Rheumatic mitral valve deformity resulting in mitral regurgitation could predispose to bacterial endocarditis. but now treatment is better.
PCWP measures what
what is it nearly equal to in normal conditions that is elevated with mitral stenosis
left atrial end diastolic pressure
LV end diastolic pressure. but mitral stenosis would increase PCWP and PAEDP relative to the LVEDP
treatment of osteoarthritis
NSAIDs
intraarticular glucocorticoids
Treatment of Rheumatic arthritis
NSAIDs
Glucocorticoids
DMARDs (Methotrexate/Sulfasalazine/TNF-alpah inhibitors (etanercept/infliximab/adalimumab)
If given elevated Alk Phos, follow up with what to specify hepatocyte dmg
Gamma-glutamyl transpeptidase (GGTP)
