Uworld Flashcards
Bronchiectasis is associated with:
Bronchial obstruction, poor ciliary motility (smoking, kartagener syndrome), cystic fibrosis and aspergillosis.
Heteroplasmy?
Different mitochondrial genomes within a single cell. Ex: ragged skeletal muscle fibers
Fragile X syndrome?
most common inherited cause of intellectual disability, the defect is an unstable expansion of trinucleotide repeats CGG in the FMR1 gene, located on the long arm of the X chromosome. Classic physical features include macrocephaly, long narrow face, prominent forehead, jaw, chin and ears.
Paroxysmal supraventricular tachycardia?
Sudden onset palpitations and rapid regular tachycardia Vagal maneuvers such as carotid sinus massage, valsalva and cold water immersion can be used to acutely terminate PSVT.
Carotid sinus massage effect:
increases vagal parasympathetic tone, this slows conduction through the AV node and prolongs the AV node refractory period, helping to terminate the reentrant tachycardia.
Cholesteatoma?
collections of squamous cell debris that form a round, pearly mass behind the tympanic membrane in the middle ear.
Hepatitis A histologically?
spotty necrosis with balloting degeneration (hepatocyte swelling with wispy/clear cytoplasm), councilman bodies (eosinophilic apoptotic hepatocytes) and mononuclear cell infiltrates.
Warfarin prolongs…
PT time
ACE inhibitors stimulates…
Bradykinin
Acyclovir S.E.
Nephrotoxicity, give enough hydration
Heparin increases the effect of….
antithrombin III
Carbamazepine SE:
Bone marrow suppression, which may lead to anemia, agranulocytosis and thrombocytopenia, and SIDH, leading to hyponatremia.
Valproate use:
Anticonvulsant used to treat bipolar disorder with manic episodes.
Dopamine effects at low and high doses:
At lower doses, stimulates D1 receptors in the renal vasculature and tubules, inducing an increase in renal blood flow, glomerular filtration rate amd sodium excretion. As the dosage increases, dopamine begins to stimulates B1 adrenergic receptors in the heart, increasing cardiac contractility, heart rate and systolic blood pressure.
Influenza infection can alters the risk of…
secondary bacterial pneumonia, which the leading pathogen are: S. pneumonia, S.aureus and H. influenza.
Mosaicism classification…
the presence of multiple different cell lines within the body. It can be divided in somatic and germline. Somatic produce disease manifestation, whereas germline does not, but can be pass to the offsprint.
Complete monosomy X disease:
Turner syndrome
Histology of MS:
perivenular inflammatory infiltrates made up primarily of auto reactive T lymphocytes and macrophages directed against myelin components.
Varenicline MA:
Partial stimulation of receptor, reduces nicotine withdrawal, prevents nicotine from binding and inducing reward response. Is a partial agonist that compites with nicotine and prevents it from binding.
Middle cerebral artery stroke symptoms:
contralateral paralysis and sensory loss, face and upper limb. Aphasia if in dominant hemisphere. Hemineglect if lesion affects non dominant side.
Anterior cerebral artery stroke symptoms:
contralateral paralysis and sensory loss of lower limbs.
Lenticulo-striate artery stroke symptoms:
contralateral paralysis and sensory loss of face and body.
Anterior spinal artery stroke symptoms:
contralateral paralysis of upper and lower limbs, decreased contralateral proprioception and ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally).
Posterior inferior cerebellar artery stroke symptoms:
vomiting, vertigo, nystagmus, decreased pain and temperature sensation from ipsilateral face and contralateral body, dysphagia, hoarseness, decreased gag reflex, ipsilateral horner syndrome, ataxia and dysmetria.
Anterior inferior cerebellar artery stroke symptoms:
vomiting, vertigo, nystagmus, paralysis of the face, decreased lacrimation, salivation, decreased taste, ipsilateral pain and temperature of the face, contralateral of the body. Ataxia and dysmetria.
Basilar artery stroke symptoms:
vertical eye movement, blinking, quadriplegia, loss of voluntary facial, mouth and tongue movements.
Posterior cerebral artery stroke symptoms:
contralateral hemianopia with macular sparing.
Huntington disease PF:
Atrophy of the caudate nucleus, which is caracterized by the insidious onset of chorea, dementia and behavioral abnormalities.
Atrophy of the lentiform nucleus…
Wilson disease (hepatolenticular degenerarion) which is caracterized by liver (hepatitis, cirrhosis), psychiatric (depression, personality changes), and neurologic (dysarthria, movement disorder) abnormalities.
Degenerarion of the substancia nigra occurs in…
Parkinson disease, which is characterized by bradykinesia, rigidity and resting tremos.
Damage to the subthalamic nucleus…
Can decrease excitation of the globus pallidus, thereby reducing inhibition of the thalamus. This may result in contralateral hemiballism, a movement disorder characterized by wild, involuntary, large-amplitude, flinging movements involving the proximal limbs on one side of the body.
Theophylline…
Asthma drug that inhibits phosphodiesterase, increasing cAMP by inhibiting cAMP hydrolysis. Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity), metabolized by cytochrome p450. Blocks action of adenosine and can cause tachyarrhythmias and seizures.
Necrotizing pancreatitis by pancreatic inflammation and autodigestion…
Trypsinogen
Kinesin function…
Carries vesicles amd organelles away from the cell body and toward the nerve terminal. Is a microtubule associated motor protein.
Influenza immunity is given by…
Antibodies against hemagglutinin
Friedreich ataxia…
AR Gait ataxia Pes cavus Kyphoscoliosis Diabetes mellitus Complicarions from cardiomyopathy: cardiac arrhytmias, congestive heart failure.
Tamoxifen
A selective esteogen receptor modulator that acts as an estrogen antagonisy in the breast, can reduce the risk of gynecomastia in these patients.
Major receptors involved in stimulating the vomiting reflex in the area postrema and adjacent vomiting center nuclei are:
M1, D2, H1, 5-HT3, NK1 (neurokinin-1)
Duchenne muscular dystrophy is most commonly caused by:
Deletions resulting in frameshift mutations or nonsense mutations.
Dermatomyositis is a…
systemic autoimmune disease characterized by proximal weakness resembling polymyositis, but with additional inflammatory features involving the skin. May occur along or as a paraneoplastic syndrome of an underlying malignancy.
Gilbert syndrome pathophysiology:
Mildly decreased UDP-glucuronosyltransferase conjugation and impaired bilirubin uptake.
Crigler-Najjar syndrome pathophysiology:
Absent UDP-glucuronosyltransferase. Presents early in life; patients die within a few years.
Dubin-Johnson syndrome pathophysiology:
Conjugated hyperbilirubinemia due to defective liver excretion. Grossly black liver. Benign.
Rotor syndrome pathophysiology:
Conjugated hyperbilirubinemia due to defective liver excretion, but milder in presentation without black liver.
Reumatoid factors
Antibody specific for the Fc component of IgG, anti-CCP antibodies.
5-alpha-reductase function:
conversion of testosterone to DHT
Ayer Martin Agar media contents:
Selectively favor growth of Neisseria by inhibiting growth of gram + organisms with Vancomycin, gram - organism except Neisseria with Trimethoprim and Colistin, and fungi with Nystatin.
Triad of WPW:
shortened PR intervals, widening of the QRS interval and slurred and broad initial upstroke of the QRS complex, referred to as delta waves.
Las of 3’-5’ exonuclease activity
Hep C virus
Propranolol effects in the thyroid synthesis:
Inhibits the conversion of T4 to T3 in the periphery.
Transthyretin gene mutation manifestation:
Cardiac amyloidosis seen in age-related (senile)
beta-myosin heavy chain gene mutation manifestation:
Hypertrophic cardiomyopathy
Mononucleosis-like syndrome manifestation:
Fever, fatigue, splenomegaly, atypical lymphocytosis
Causes: CMV,HHV-6, HIV and toxoplasmosis.
Serotonin Syndrome tx:
Cyproheptadine
Cefuroxime use and MA:
Second gen. cephalosporins that inhibit cell wall synthesis… HENS PEcK
Second generation antihistamine:
Loratadine
First generation anti-histamine side effects:
cholinergic (urinary retention, blurred vision, constipation, glaucoma and delirium), alpha-adrenergic (dizziness and fall) and serotonergic (weight gain)
Methotrexate SE:
Pulmonary fibrosis, restrictive lung disease (honey combs)
LMN symptoms:
muscle weakness, fasciculations and atrophy.
UMN symptoms:
spasticity, hyperreflexia, and pathologic reflexes.
Mutation seen in ALS:
mutation of the gene that codes for cooper-zinc superoxide dismutase
Tx for ALS:
Riluzole which decrease glutamate release
Poliomyelitis PF:
IS AN ENTEROVIRAL INFECTION THAT DAMAGES MOTOR NEURONS OF THE ANTERIOR HORNS. iT IS A PURE LOWER MOTOR NEURON DISEASE.
Huntington disease PF:
AD disease, that leads to atrophy of the caudate nucleus and putamen.
Friedrich ataxia is associated with:
Hypertrophic cardiomyopathy, kyphoscoliosis, foot abnormalities and diabetes.
terminating codon encodes for
releasing factors
Parasites that can cause disease in RBC’s include:
Plasmodium (malaria) and Babesia (babesiosis, transmitted by a Ixodes tick).
Parvovirus B19 presentation:
SS DNA virus, that can be acquired respiratory, congenital or hematogenous. In child erythema infectious, in adults acute symmetric arthropathy, chronic hemolytic anemia, transient aplastic crisis.
Cheyne-Stokes Breathing?
It is seen in CHF, is a combination of episodes of apnea and low and high tidal volumes (hyper and hypoventilation)
Kussmaul breathing
deep and labored breathing, seen in DKa patients.
Neurofibromatosis type 1 manifestations
Café-au-lait spot= hyperpigmented macules over the trunk soon after birth and are at increased risk of developing CNS neoplasms.
Cutaneous neurofibromas= manifest during early adolescence as multiple, raised, fleshy tumors. These are benign nerve sheath neoplasms predominantly comprised os Schwann cells, derived from neural crest cells.
Hypocalcemia after transfussion is due to…
Chelating agents in transfused blood, like citrate anticoagulant.
Linkage disequilibrium
Gamete posibilities varies in frequency
Penetrance
Proportion of people with a given genotype who express its associated phenotype.
Pleiotropy
Is the occurrence of multiple phenotypic manifestations, often in different organ systems, which result from a mutation in a single gene.
PPV depends on…
Sensitivity, specificity, and prevalence.
Donepezil
Cholinesterase inhibitor used in AD
Age-related macular degeneration (AMD)
Vascular endothelial growth factor (VEGF): Ranibizumab, bevacizumab
Transmembrane domains composed of alpha helices with hydrophobic amino acids residues helps…
Help anchor the protein to the phospholipid bilayer of the cell membrane.
Common medical conditions with polygenic inheritance
Androgenetic alopecia Epilepsy Glaucoma Hypertension Ischemic heart disease Schizophrenia Type II diabetes mellitus
Polygenic traits
Exhibit incomplete dominance so the phenotype displayed in offspring is a mixture of the phenotypes displayed in the parents.
Sedating antidepressant associated with priapism:
Trazodone
Trazodone MA:
Serotonin modulator (antagonizes postsynaptic serotonin receptors and inhibits serotonin reuptake)
Aspergillus fumigatus
Can cause lung disease in immunocompromised patients. In tissue samole it is seen as septate hyphae that at 45-degree angles.
Candida albicans
Small oval yeast with narrow-based budding.
Coccidioides immitis
Dimorphic fungus seen as spherules (round encapsulated structures containing many endospores).
Cryptococcus neoformans
Forma yeast with variable sizes and narrow-based buds.
Multiple myeloma Tx:
Bortezomib, a proteasome inhibitor
CML translocation
(9:22) BCR-ABL
RT-PCR
detects mRNA
Shiga-like toxin may cause
Kidney damage, HUS, hemolytic anemia, increased increased indirect bilirubin
Prolonged and untreated obstructive sleep apnea can cause:
pulmonary hypertension and right heart failure.
Pancreas divisum occurs when…
ventral and dorsal pancreatic buds fail to fuse. The ventral bud gives rise to posterior portion of the head and the major pancreatic bud.
Clinical features of amniotic fluid embolism:
Cardiogenic shock, hypoxemic respiratory failure, disseminated intravascular coagulation and seizures or coma.
Anaerobic bacterias from the mouth that can cause aspiration pneumonia…
Peptostreptococcus, prevotella, bacteroides and fusobacterium.
Presence of erythroid precursor cells in the liver indicates…
extra medullary hematopoyesis
Myosin light chain dephosphorilation causes…
relaxation of vessels…. (nitrates)
Leuprolide mechanism of action…
it is an agonist of GnRH when given in a pulsatile manner causing a transient rise of LH. Continuos stimulation of GnRH suppressed the pituitary LH release, and subsequent production of testosterone from Leydig cells.
Small cell lung carcinoma express…
neuron-specific enolase, chromogranin, synaptophysin
Sarcoidosis mode of presentation…
fever, malaise, macules or erythema nodosum, non-caseating granuloma, hilar lymphadenopathy.
Vitamin A helps…
differentiation of epithelial cell into specialized cells (pancreatic cells, mucus-secreating cells).
Cleft palate PF:
failure of fusion of the maxillary prominence and intermaxillary segment
Filtration factor division:
GFR/RPF
PPAR’S effect:
Increase fatty acid uptake
adiponectin production
increase insulin sensitivity
decrease leptin production
Can occur after an administration of monoclonal antibodies:
Serum sickness
Serum sickness symptoms:
fever, pruritic rash and arthralgia, vessel vasculitis, fibrinoid necrosis and neutrophil infiltration. Type III H.S.
SSRI’s side effects:
sexual dysfunction: decreased libido, decreased arousal, anorgasmia in woman and increased ejaculationlatency in men.
PTSD requires symptoms for how long:
1 month
familial erythrocytosis
mutation in the b-globin resulting in a reduced binding to 2-3bpg
Benzodiazepine mechanism of action:
binds allosterically GABA receptors.
Innulin and Manitol are (in the kidney)…
freely filtered and excreted, no reabsorption or secretion occurs.
PAH is (in the kidney)….
filtered and also excreted.
Giant cell arteritis…
visual and muscular symptoms, headaches, enlarged temporal artery, elevated erythrocyte sedimentation rate, associated with poly myalgia rheumatica. The production of IL-6 appears to correlate with the severity of the disease. Tx: monoclonal antibody against IL-6 (tocilizumab)
Clozapine tx:
treatment-resistant schizophrenia and schizophrenia associated with suicidality. Adverse effects includes: agranulocytosis, seizures, myocarditis and metabolic syndrome.
Anaphylaxis reaction produce:
mast cell and basophil degranulation and histamine and tryptase release.
5-hydroxyindoleic acid
metabolite of serotonin, measured in serotonin syndrome.
Scurvy manifestations:
Petechiae, hemarthrosis, swollen gums, poor wound healing, hemorrhages and myalgia. Due to a Bit C deficiency.
Dystrophin is:
a structural component of skeletal muscle fibers that provides mechanical stability to the sarcolemma.
Neurophysins are…
are carrier proteins of oxytocin and vasopressin.
MCC of osteomyelitis in children with Sickle cell disease:
Salmonella
Turner syndrome PF:
lack of the paternal chromosome (45,X). Presents with streak ovaries, webbed neck, coarctation of the aorta, bicuspid aortic valve, horseshoe kidney, short stature, widely separated nipples, low hairline and high arched palate.
Cryptoccocus neoformans stain:
Stains red with mucicarmine.
paraneoplastic cachexia mediators…
IL-1, IL-6 and TNF-alpha
Aqueous humor is produced by:
Ciliary bodies
Glioblastoma arises from:
astrocytes
brain metastases typically appears as:
multiple, well-circumscribed masses at the junction of the white and gray matter.
Meningiomas are:
benign adult brain tumors that arise from arachnoid cells.
complications of hereditary spherocytosis:
aplastic crisis from Parvovirus B19 infection
Entacapone effects:
COMT inhibitor; lowers the degradation of levodopa at peripheral level
Influenza virus can infect different species via:
genetic reassortment. IV is a orthomyxovirus.
Milrinone mechanism of action:
Inhibits de degradation of cAMP to AMP, thus promotes vasodilation and heart muscle contractility, by Gs receptor.
Intraductal papilloma PF:
papillary cells in a duct or cyst wall with a fibrovascular core.
fibrocystic changes of the breast
premenstrual breast pain with lumps, often multifocal and bilaterally. Non proliferative lesions include simple cyst, papillary apocrine change, stromal fibrosis.
age-related macular degeneration
causes central scotomas, the tx is ranibizumab. Can be dry (deposition of yellowish material or wet (neovascularization).
In pernicious anemia we will see…
increased gastrin levels, increased pH and decreased parietal cells.
B12 deficiency do to decreased intrinsic factor production by the parietal cells.
Hyper-IgM syndrome:
defective or absent CD40Ligand, causes severe infections (cryptosporidium) and increased IgM. It is a combines B and T cell disorder.
Hernias more prone to incarceration and strangulation:
femoral hernias because the femoral canal is small, and they can not be reduced.
Sideroblastic anemia results of:
ALA synthase deficiency, B6 deficiency, Isoniazid, alcohol, myelodysplastic syndrome and cooper deficiency. It forms ringed sideroblast. Tx is B6.
Lead poisoning results from:
ALA dehydratase and ferrochelate inhibition by lead. Presents with foot drop, encephalopathy, lead lines.
Homocystinuria results from:
Cystathionine synthase deficiency or B6 deficiency, which catalyzes the conversion of cystathionine to homocysteine. It presents with marfanoid habits and hyper coagulation.
Sumatriptan for the tx of:
cluster headache and migraine. It is a serotonin agonist. Inhibit trigeminal nerve activation, prevents vasoactive peptide release and induce vasoconstriction.
DNA polymerase I
removes RNA primers and replace them with DNA. Is the only DNA polymerase with 5 to 3 exonuclease activity.
Tests used to diagnose Chronic granulomatous disease:
NBT testing (can reduce NBT from yellow to dark blue) and DHR flow cytometry which measure the conversion of DHR to rhodamine, a fluorescent green compound that can be detected by flow cytometry. Both detects properly functioning neutrophils.
Corynebacterium diphtheriae vaccine creates:
IgI against circulating proteins
Perchlorate and pertechnetate MA:
competitive inhibitor of the sodium-iodide symporter. Iodine uptake is regulated by TSH.
Manifestations of Graves ophthalmopathy usually responds to:
glucocorticoid therapy.
They are immune mediated.
Neurofibromatosis manifestations:
cafe au last spot, gliomas, cutaneous neurofibromas, bone abnormalities and lisch nodules and pheochromocytoma.
Fidaxomicin use and mechanism of action:
to treat C.difficile. It inhibits the sigma subunits of RNA polymerase leading to protein synthesis impairment and cell death.
decreased number of functional t-tubules leads to:
uncoordinated muscle contraction of myofibrils which manifest as muscle weakness.
PAH is:
freely filtered and secreted by a carrier protein-mediated process.
The red cell index most specific for spherocytosis is:
an elevation in mean corpuscular hemoglobin concentration (MCHC)
Primary site for ribosome synthesis and assembly:
nucleolus; except the 5S rRNA.
Torsades de pointes can be precipitated by:
antiarrhythmics class I and III(sotalol, quinidine), antipsychotics (haloperidol) and antibiotics(macrolides and fluoroquinolone)
Warfarin induced skin necrosis is due to:
Protein C or Protein S deficiency. The tx include stop treatment with Warfarin and nice fresh frozen plasma or Protein C concentration.
Accessory nipples are due to:
failure of involution of the mammary ridge.
Insulin-dependent Glucose transporter:
GLUT-4 (skeletal muscle and adipocytes)
GLUT-1,2,3,4,5:
GLUT-1 brain and adipocytes
GLUT-2 hepatocytes, pancreatic b-cells, renal tubules and small intestinal mucosa.
GLUT-3 placental and neuronal glucose transport
GLUT-4 skeletal muscle and adipocytes
GLUT-5 fructose transporter found in spermatocytes and GI tract.
MHC Class II is presented on
antigen presenting cells to present bacterias to TH cells and activate the humoral and cell mediated inmune response
MHC Class I consist of:
one heavy chain and a beta2 microglobin and is present in all nucleated cells to induce apoptosis of viruses, tumor proteins,
Thyroid dermopathy
caused by stimulation of fibroblast by TRAb and activated T-cells, leading to excess production of glycosaminoglycans and adipogenesis, this lead to induration and thickening of the skin over the shins.
Glucocorticoids effect on calcium:
glucocorticoids decrease the G.I. absorption of calcium, inhibit collagen synthesis by osteoblasts, decrease GnRH (leading to hypogonadism) and increase urinary calcium loss.
Turner syndrome findings:
cystic hygroma, lymphedema (bilateral extremity swelling) and coarctation of the aorta.
Androgen insensitivity syndrome
results from a deficit in testosterone receptors. The typical presentation is a 46,XY adolescent who appears phenotypically female but has primary amenorrhea due to the absence of an internal female reproductive tract and the presence of cryptorchid testes.
Gap junctions protein
connexins
tight junction protein
claudine, occludin
Adherens junction protein
cadherins
desmosomes protein
cadherins (desmoglzins,desmoplakin)
hemidesmosomes protein
integrins
McArdle disease enzyme deficient
glycogen phosphorylase
Pompe disease enzyme deficient
acid alpha-glucosidase
Cori disease enzyme deficient
debranching enzyme
von Gierke disease enzyme deficient
glucose 6-phosphatase
Bulimia nervosa Tx:
fluoxetine (SSRI)
Anorexia nervosa Tx:
Olanzapine
Homocystinuria
defect in cystathionine synthase, resulting in an inability to form cysteine from homocysteine. Homocysteine buildup leads to elevated methionine. Homocysteine is prothrombotic, resulting in premature thromboembolic events (atherosclerosis, acute coronary syndrome)
Polymialgias antibodies
antinuclear antibodies (ANA) and anti-histidyl synthetase (anti-Jo)
Serotonergic neurons are primarily found in
Raphe nuclei
Norepinephrine-secreting neurons are found in
The locus ceruleus
Cholinergic neuron nucleus
The nucleus basalis of Meynert
Red nucleus participates in
motor coordination of the upper extremities.
Substantia nigra contains
dopaminergic neurons.
Ankylosing spondylitis is characterized by:
stiffness and fusion of axial joint, enthesitis, uveitis, aortic deficiency and respiratory expansion problems.
Narcolepsy criteria:
Recurrent passes into sleep or naps more than 3 times a week for 3 months, cataplexy, low cerebrospinal fluid levels of hypocretin-1 and shortened REM sleep latency.
Sarcoidosis manifestations:
hilar adenopathy, pulmonary infiltrates and non-caseating granulomas.
TH1 type CD4+ helper T cell is a….
cell mediated immunity
TH2 type CD4+ helper T cell is a
humoral immune response.
Niemann-Pick disease
AR
SPHINGOMYELINASE DEFICIENCY
lipid-laden foam cells,hepatosplenomegaly, hypotonia, neurologic degeneration and cherry-red macular spot.
Metachromatic leukodystrophy
arylsulfatase A deficiency
central and peripheral demyelination leads to peripheral neuropathy and ataxia.
Krabbe disease
galactocerebrosidase deficiency
developmental delay, regression, hypotonia, optic neuropathy and seizures.
Fabry disease
alpha-galactosidase deficiency
neuropathic pain and dermatologic pathology (telangiectasis, angiokeratomas)
Gaucher disease
beta-glucocerebrosidase deficiency
hepatosplenomegaly, pancytopenia and skeletal problems.
alpha1-antitrypsin function:
inhibits neutrophil elastase and prevents hydrolization of elastin.
congenital hypothyroidism clinical manifestations:
lethargy, enlarged fontanelle, protruding tongue, umbilical hernia, poor feeding, constipation, dry skin, jaundice. Diagnosis: high TSH and low free T4. Tx: levothyroxine.
Viral-dependent nucleosides are
all nucleoside analogues that require both herpes viral and cellular kinase for conversion to their active nucleoside triphosphate form.
Viral-dependent nucleoside drugs:
Acyclovir, valacyclovir, famciclovir and ganciclovir.
Efficacy does not depend on the presence of a virally encoded kinase…
Cidofovir (Nucleotide)
Cell-dependent nucleoside:
zidovudine and lamivudine
Features of drug-induced lupus erythematous:
new onset lupus symptoms, ANA and anti-histone antibodies present. Implicated drugs (hydrazine, procainamide, isoniazid, minocycline, quinidine).
Q fever
zoonosis caused by Coxiella burnetii, from air contaminated by animal waste. Usually in farm workers exposed to waste from cattle and sheep. Common symptoms includes: headaches, fever, myalgia, fatigue and Pneumonia. Classic laboratories includes: thrombocytopenia and increased liver enzymes.
In hypertrophic cardiomyopathy, how to increase and decrease murmur intensity:
Increased murmur preload can be obtained by: sudden standing, valsalva or nitroglycerin. Decreased murmur intensity can be obtained by squatting, sustained hang grip or passive leg raise.
Topiramate
blocks Na channels and increase GABA action, anti epileptic also used for migraine prevention.
Zolpidem, zaleplon and Eszopiclone
nonbenzodiazepine hypnotics, act via BZ1 subtype of the GABA receptor. Used for insomnia.
Raloxifene
selective estrogen receptor modulator, which have agonist activity on bone, which decreases bone resorption and improves bone density, has estrogen antagonist effect on breast tissue and can decrease the risk of breast cancer, it also acts as an estrogen antagonist in the uterus and does not increase the risk of endometrial cancer.
Small intestinal bacteria overgrowth is characterized by overproduction of:
Vitamin K and folate, associated with nausea, bloating, abdominal discomfort and malabsorption.
Fabry disease
alpha-galactosidase A deficiency (X-linked recessive), which can present with cataracts, neurological findings like numbness, tingling, burning pain and angiokeratomas.
Tay-Sachs disease
hexosaminidase A deficiency, affected infants have retinal cherry-red spots and loss of motor skills.
TCA’s side effects
inhibit fast sodium channel conduction, slowing down myocardial depolarization and leading to cardiac arrhythmias.
live attenuated vaccines:
rotavirus, varicella and measles-mumps-rubella vaccinations.
Notochord becomes the ______ in adults
Nucleus pulpous of the intervertebral disk
JAK2 inhibitor fot tx of primary myelofibrosis
Ruxolitinib
JAK2 (nonreceotir cytoplasmic tyrosine kinase)
Activates de STAT pathway
Conversion disorder
is characterized by neurological symptoms that are incompatible with a neurological disease.
Parvovirus
slapped cheek(fifth disease), arthalgias, and hydros fetalis(can lead to interruption of erythropoyesis.
Xeroderma pigmentosum
a condition characterized by severe photosensitivity and the development of skin cancer at young age.
Pyramidine dimers
abnormal covalent bonds between adjacent thymine or cytosine residues do to ultraviolet rays.
Nucleotide excision repair
a specific process where an endonuclease complex detects abnormalities in the DNA structure caused by the formation of DNA photoproducts.
Early and late-onset Alzheimer disease is associated with_______mutation:
Early: APP in Cr 21, presenilin 1 and presenilin 2; Late:is associated with apolipoprotein E4 genotype.
anti-centromere
CREST syndrome
Anti-mitochondrial antibodies
primary biliary cirrhosis
Hirschsprung disease
arrest of migration of neural crest cells
Squatting in Tetralogy of Fallot:
increases systemic vascular resistance and decrease right-to-left shunting, thereby increasing pulmonary blood flow and improving oxygenation status.
Gerstmann syndrome
results from damage to the angular gyrus of the dominant parietal lobe and is characterized by agraphia, acalculia, finger agnosia and left-right disorientation.
Hypospadias
abnormal opening of penile urethra on ventral surface of penis due to failure of urethral folds to fuse.
Epispadias
abnormal opening of penile urethra on dorsal surface of penis due to faulty positioning of genital tubercle.
Becomes the penis in males and the clitoris in female
genital tubercle
Thiazides
hydrochlorothiazide, chlorthalidone
Hypokalemia
muscle weakness, cramps and possible rhabdomyolysis.
Extrinsic apoptosis is induced by
tumor necrosis factor (TNF) and Fas ligand
Caspases are activated by
cytochrome C
Caspases are
proteolytic enzymes that destroy cell components, they contain cysteine and are able to cleave aspartic acid residues.
Metalloproteinases are
zinc-containing enzymes that degrade the components of the extracellular matrix, they are essential for proper tissue remodeling during wound healing.
Phenylalanine byproducts
tyrosine, thyroxine, melanin, dopamine, NE, Epinephrine
Tryptophan byproducts
NAD+/NADP+ and melatonin
Histidine byproducts
histamine
Glycine byproduct
Heme
Glutamate byproducts
GABA, glutathione
Arginine byproducts
creatine, urea, nitric oxide
Park At Venture Avenue
Conduction in cardiac impulses:
Purkinje, Atrial muscle, Ventricular muscle and AV node
Desmopressin effect on central diabetes insidious and nocturnal enuresis
binds to V2 receptors in renal tubular cells, leading to increased aquaporin channels, increased water reabsorption and decreased urine output.
Effect of desmopressin in hemophilia A and vWf disease
Increases circulating factor VIII and endothelial secretion of vWF to stop bleeding, endothelial produced!!!
Hemochromatosis side effects
skin pigmentation, hepatomegaly, impaired glucose homeostasis, cardiac dysfunction, atypical arthritis, hypogonadism.
Enveloped virus are sensitive to
ether
Naloxone
pure opioid receptor antagonist, used in the setting of acute opioid intoxication or overdose.
Sodium bicarbonate is used to threat:
the overdose of tricyclic antidepressants
Neonatal abstinence syndrome(opioids) presents with
irritability, hypertonia, jittery movements, seizures, diarrhea, vomiting, feeding intolerance, sweating, sneezing, pupillary dilation. Tx:opioid therapy (morphine, methadone).
Causes of fibrinoid necrosis
malignant hypertension and vasculitis
Heme is converted to biliverdin(green color) by:
heme oxygenate, then to unconjugated bilirubin by biliverdin reductase.
Congenital rubella triad:
congenital cataracts (white pupils), sensory-neural deafness and patent ductus arteriosus.
Rubella vaccine type
live-attenuated vaccine
Killed vaccines examples
hepatitis A and rabies
Live vaccines examples
Measles, mumps and rubella vaccines.
1,25-dihydroxyvitamin D effects
Bone (increased mineralization)
Small intestine (increase calcium and phosphate absorption-major effect)
Kidney (increase calcium and phosphate reabsorption)
Parathyroid glands(decrease PTH secretion)
TCA antidepressant overdose symptoms
mental status changes, seizures, respiratory depression, tachycardia, hypotension, prolonged PR, QRS,QT intervals, arrhythmia and anticholinergic effects (dry mouth, blurred vision, dilated pupils, urinary retention, flushing and hyperthermia. Tx with sodium bicarbonate.
Opioids overdose symptoms:
miosis and respiratory overdose.
NMYC
oncogene seen in neuroblastoma
Methotrexate mechanism of action
competitive inhibition of dihydrofolate reductase
Minocycline
tetracycline antibiotic with photosensitivity dermatitis side effect.
Hyaluronidase
enzyme used by bacterias (S. aureus, S. progenies and C perfringens) to digest extracellular ground substance and enhance their ability to spread.
Drug-induced Parkinsonism occurs in the
nigrostriatal pathway, by dopamine D2 receptor blockade
Neuroleptic malignant syndrome Tx
dantrolene (skeletal muscle relaxant)
Galactose intolerance (galactosemia)
patients are predispose to E. Coli sepsis
The marginal artery of Drummond
colateral circulation of the descending colon between the SMA and the IMA.
