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.
Mu opioids analgesics produces:
histamine release leading to vasodilation, constipation, decreased parietal cell acid secretion and contraction of the smooth muscle cells at the sphincter of Oddi.
Vasovagal syncope
after stimulation of his posterior external auditory canal by an otoscope speculum. In this form of syncope, parasympathetic outflow via the vagus nerve leads to decreased heart rate and blood pressure.
Penile erection is initiated by
release of acetylcholine and nitric oxide from parasympathetic fibers, leading to a rise in intracellular cGMP and vasodilation of the arteries supplying the corpus cavernosum.
Sildenafil mechanism of action
is a phosphodiesterase-5 inhibitor that decrease degradation of cGMP
Atrial and brain natriuretic peptides
polypeptides hormone that exert their effect by binding ANP receptors, these transmembrane receptors are linked to a guanylyl cyclase that converts guanosine 5-triphosphate to cyclic guanosine 3,5-monophosphate cGMP.
Monoclonal antibodies against PD-1
prevent the binding of PD-1 to PD-1L, this blocks cell inhibition, restoring the cytotoxic response and promoting apoptosis of tumor cells. It it used in advanced melanoma and lung cancer.
Chemokine coreceptor 5 (CCR5)
serves as a coreceptor used by HIV to bind to CD4+ T cells.
Homeobox genes encode for:
DNA-binding transcription factors that play an important role in the segmental organization of the embryo along the cranio-caudal axis.
Strep pneumo
optochin sensitive and bile-soluble.
Neprilysin mechanism of action
is a metalloprotease that metabolizes brain natriuretic peptides and inactivates glucagon, oxytocin and bradykinin.
Temporal arteritis comorbilities
Polymyalgia rheumatica, fatigue, fever, weight loss and monocular vision loss.
Bile-acids resins
binds bile acids in the GI tract, inhibiting enterohepatic circulation, leading to hepatic cholesterol synthesis of new bile acids, and triglycerides.
Ezetimibe
selectively inhibits the intestinal absorption of cholesterol and lowers LDL levels.
Fibrates (gemfibrozil, fenofibrates)
inhibit hepatic production of triglycerides and are first-line tx for hypertriglyceridemia.
INF-gamma is produced by ___________ and serves to______________.
is produced by activated T cells and serves to recruit leukocytes and activate phagocytosis.
Systemic inflammatory response is induced by
TNF-alpha, IL-1 and IL-6.
Prevalence equals
Incidence X duration of disease
A factor that prolongs disease duration (improved quality of care) will increase disease prevalence.
HbC and HbS type of mutation
Missense mutation in which a single base substitution results in a codon that codes for a different amino acid.
Phases of Paget disease of the bone
osteolytic (osteoclast-dominant)phase: increased numbers of osteoclasts that appear abnormally large with an excessive number of nuclei. Increased resorption activity is prominent.
MIXED: defined by a rapid increase in osteoblastic bone formation with persistent osteoclastic activity. The newly made bone is abnormal, with interspersed areas of disorganized lamellar and woven bone.
Osteosclerotic phase: characterized by continued osteoblastic bone formation and remodeling that results in a dense, hypo vascular, mosaic pattern of lamellar bone with irregular, haphazardly oriented sections separated by prominent cement lines.
The end result is a thickened, deformed bone that is weaker than normal and prone to fracture.
Paget disease of the bone pathophysiology
Environmental factors and gene mutations (RANK, osteoprotegerin) that results in excessive RANK and NF-kB activation, that results in accelerated bone remodeling with eventual bony overgrowth.
Acute intermittent porphyria pathophysiology
AD, characterized by porphobilinogen (PBG) deaminase deficiency. Management includes infusion of hemming, which down regulates aminolevunate (ALA) synthase. Symptoms includes: nausea, constipation, severe and poorly localized abdominal pain, anxiety, difficulty concentrating, poor sleep and tingling of the limbs.
Radiologically features of hyper parathyrodism
subperiosteal erosions in phalanges of the hand, a granular “salt-and pepper”skull and osteolytic cyst in the long bones (osteitis fibrosa cystica).
Paget of the bone histology
disorganized lamellar bone structure in a mosaic pattern
vit D deficiency histology
osteoid matrix accumulation around trabeculae
Osteopetrosis (marble bone disease)
persistence of the primary spongiosa in the medullary cavity with no mature trabeculae (marble bone disease)
Osteoporosis pathology
trabecular thinning with fewer interconnections
Low volume of distribution can be obtained by:
high molecular weight, high plasma protein binding, high charge and hydrophilicity, which tends to trap the drug in the plasma compartment.
Cross-sectional study evaluates
prevalence
Cohort study evaluates
incidence
Cystic fibrosis is most commonly due to
a 3-base pair deletion on the CF transmembrane conductance regulator (CFTR) gene at amino acid position 508. This mutation impairs post-translational processing of CFTR, resulting in shunting of CFTR toward the proteasome, with complete absence of the protein on the cell surface.
During inspiration, MR, TR and VSD murmur tends to
TR tends to increase do to decreased intrathoracic pressure, increasing venous return. In MR and VSD murmur decreases due to decreased left ventricular venous return from pulmonary vein due to increased pulmonary vessel capacity.
Transamination reactions cofactor
B6 (pyridoxine)
Transformation
allows bacterias to take up exogenous DNA fragments and express encoded proteins.
Transduction
a bacteriophage transfers DNA from one bacterial cell to another.
Etanercept mechanism of action
inhibition of TNF-alpha. Check for TUBERCULIN SKIN TEST
Vasopressin and desmopressin effect on V2 receptors
Cause a V2 receptor-mediated increase in water and urea permeability at the inner medullary collecting duct, resulting in urea reabsorption, enhanced osmotic gradient, allowing the production of maximally concentrated urine.
Beta-blockers work by
inhibiting the neurotransmitter-receptor interaction in adrenergic synapses.
ARPKD is caused by
a mutation in PKHD1, the gene for fibrocystin founded in the epithelial cells of both the renal tubule and the bile ducts.
Digoxin use and side effects:
CHF
S.E.: arrhythmias, anorexia, nausea and vomiting, abdominal pain, fatigue, confusion, weakness and color vision alterations.
Side effects of Levo-dopa
anxiety and agitation
RPF
RPF= RBF x (1-Hematocrit) FF= GFR/RPF
Absolute Risk Reduction
event rate in the control group - event rate in the treatment group.
Event rate= #of events in the group/# of subjects in the group.
Congenital Toxoplasmosis classic triad
hydrocephalus (macrocephaly and enlargement of the ventricles), intracranial calcifications and chorioretinitis (white-yellow chorioretinal lesions).
Erythropoiesis-stimulating agents side effects
hypertension and thromboembolic events.
Atrial septal defect
cause left to right shunts that can facilitate paradoxical embolism due to periods of transient shunt reversal. It cause a wide and fixed splitting of S2 and can facilitate paradoxical embolism.
Kartagener syndrome triad
situs inversus, chronic sinusitis and bronchiectasis.
Acute stress disorder
after exposure to prior trauma, lasting from 3 days to 1 month, if it last more than 1 month is PTSD
Granuloma formation
Activated TH1 CD4+ cells secrete interferon gamma, which activates macrophages. Macrophages in response secretes TNF-alpha, which result in further macrophage maturation and formation of the granuloma.
Most abundant amino acid in collagen
glycine
Vitamin E deficiency
neurologic symptoms closely mimic Friedrich ataxia and include ataxia (due to degeneration of spinocerebellar tracts), loss of position and vibration sense and loss of deep tendon reflexes.
Why does calcium channel blockers do not affect skeletal muscle contractility?
because skeletal muscle is not dependent on extracellular calcium influx.
Troponin
is responsible for contraction of both cardiac and skeletal muscle. Unlike skeletal, cardiac muscle is affected by verapamil due to its dependence on extracellular calcium to induce calcium release from sarcoplasmic reticulum.
A drug with low volume of distribution tends to be
hydrophilic, protein bounded, renal excreted,
Genetic transition
a point mutation that results in replacement of a purine nucleotide for another purine or a pyrimidine for another pyrimidine.
Genetic transversion
a point mutation that results in the replacement of a purine nucleotide for a pyrimidine or a pyrimidine for a purine.
Wobble hypothesis
states that the first 2 nucleotide positions on the mRNA codon require traditional (Watson-Crick) base pairing, whereas the third wobble nucleotide position may undergo less stringent base pairing.
Neprilysin inhibitors
prevents degradation of ANP, enhancing its beneficial hemodynamic effects in heart failure patients (dilates afferent arterioles in the kidney increasing filtration, restricts aldosterone secretion and relaxes vascular smooth muscle in arterioles and venues producing vasodilation)
Phenytoin side effects
gingival hyperplasia, coarsening facial features and hirsutism. Can cause megaloblastic anemia.
Alendronate
bisphosphonate that inhibits osteoclast function
Cinacalcet
calcimimetic that allosterically activates the calcium-sensing receptor in the parathyroid gland, decreasing parathyroid hormone release, used for secondary hyperparathyroidism.
Sickle cell trait or disease can produce:
renal papillary necrosis
Renal papillary necrosis can be produced by
NSAID’s, sickle cell trait or disease, acute pyelonephritis and diabetes mellitus.
Cerebellar hemisphere affection results in
dysdiadochokinesia and tremor
Cerebellar vermis affection results in
ataxia, nystagmus and vertigo.
Patellar injury results in
inability to extend the knee against gravity,
Anterior cruciate ligament can be injured during________ and results in ______.
Sudden acceleration and deceleration, laxity of forward movement of the tibia against a fixed femur.
Posterior cruciate ligament protects against
excessive posterior knee movement and is the least injured knee ligament.
Medial collateral ligament
protects against values stress on the knee and excessive external tibial rotation. Injury occurs after a lateral blow to the knee or indirect stress from excessive lower leg rotation or abduction.
Osteoarthritis involves
DIP and PIP, with osteophyte formation, in contrast of RA, which involves PIP and synovitis.
Nigrostriatal degeneration in Parkinson disease results in
excessive excitation of the globes pallid us interns by the sub thalamic nucleus, which in turn causes excessive inhibition of the thalamus. Reduced activity of the thalamus and its projections to the cortex consequently result in rigidity and bradykinesia.
Pneumocystic pneumonia is an ________ seen primarily in those with ______________.
atypical fungal infection seen primarily in those with impaired cell-mediated immunity. The cystic organism can be visualized using silver stain of respiratory secretions.
Inactivated version of the influenza vaccine function mainly by
inducing neutralizing antibodies against the hemagglutinin antigen in selected viral strains. These antibodies inhibit binding of hemagglutinin to sialylated receptors on the host cell membrane. This prevents thee live virus from entering cells via endocytosis.
Extended-spectrum beta-lactamases can be produced by_________ making _____ inactive. These genes can be transmitted between organisms through _________.
Gram-negative bacteria, cephalosporins and other beta-lactam antibiotics, plasmid conjugation.
Porphiria cutanea tarda
deficiency in the uroporphyrinogen decarboxylase. Photosensitivity presents as vesicle and blister formation on sun-exposed areas, as well as edema, pruritus, pain and erythema.
Pseudomonas type of infections
pneumonia in cystic fibrosis and ventilated patients,infections in burned patients, otitis externa, hot tub folliculitis and ecthyma gangrenous.
Antimalarials
chloroquine and mefloquine
Halogenated anesthetics side effects
they are metabolized by the hepatic cytochrome P450 system by which they are converted to reactive intermediates that can directly injure the liver or lead to immune-mediated hepatocellular damage.
It can show centrilobular hepatic necrosis that is distinguishable from viral hepatitis.
MCAD deficiency manifestation
lethargy, seizures and hypoketotic hypoglycemia following a period of fasting.
Insulin inhibits _______ production, in unborn child of a diabetic mother
surfactant production, due to high levels of insulin because of high levels of sugar in blood from the mother
Complications of Neonatal respiratory distress syndrome
patent ductus arteriosus due to low oxygen levels and necrotizing enterocolitis. Supplemental oxygen can lead to blindness and bronchopulmonary dysplasia.
Primary pulmonary hypertension is due to
inactivating mutations of BMPR2, leading to proliferation of vascular smooth muscle.
Bronchial hamartoma
benign tumor composed of lung tissue and cartilage often calcified on imaging.
Tumor on lung can compress
sympathetic chain, which leads to Horner syndrome characterized by ptosis, mitosis and anhidrosis; usually due to an apical Pancoast tumor.
Unique site for distant metastasis of the lung is the
adrenal gland
Lung cancers that arises from neuroendocrine cells
small cell carcinoma and carcinoid tumor.
Aplastic crisis in sickle cell disease is due to
Parvovirus B19
Neurocysticercosis is due to ________ and can cause _____________.
Taenia solium (pork tapeworm) ingestion and can cause multiple brain lesions.
Daptomycin mechanism of action and uses
MRSA S. aureus// depolarizes cellular membrane by creating transmembrane channels.
Daptomycin side effects
myopathy and CPK elevation
Baclofen is an______
agonist at the GABA-B receptor, effectively mono therapy for the treatment of spasticity secondary to both brain and spinal cord disease.
Melanoma mutation
BRAF, a protein kinase for melanocyte proliferation.
Gliosis
proliferation of astrocytes in an area of neuron degeneration, it leads to the formation of a glial scar which compensates for the volume loss that occurs after neuronal death.
Mumps is an infection with the bump virus that can result in
bilateral inflamed parotid glands, orchitis (in teenagers with high risk of sterility) and pancreatitis.
Pleomorphic adenoma
MC tumor of the salivary glands, benign tumor composed of stroll and epithelial cell
Warthin tumor
benign cystic tumor with abundant lymphocytes and germinal centers
Mucoepidermoid carcinoma
malignant tumor composed of mucinous and squamous cells; usually involves the facial nerve.
Boerhaave syndrome risk
subcutaneous emphysema
Metaplasia of the esophagus results in
stratified squamous epithelium to nonciliated columnar epithelium with goblet cells.
Primary mediators in COPD
neutrophils, macrophages and CD8+ T lymphocytes
Theophilline is a
adenosine receptor antagonist and a phosphodiesterase inhibitor. It increases cAMP levels. P450 metabolized.
P450 Substrates
Theophilline, Warfarine, OCP’s and anti-epileptics drugs.
P450 Inhibitors (crackamigos)
Sodium valproate, isoniazid, cimetidine, ketoconazole, fluconazole, acute alcohol abuse, chloramphenicol, erythromycin(macrolides), sulfonamides, ciprofloxacin, omeprazole, metronidazole.
Silicosis
assoc. with sandblasting and mines. Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to Tb.
Eosinophilic parasitic defense
eosinophil proliferation is stimulated by IL-5 produced by TH2 and mast cells. Then it is coated by IgG and IgE. This triggers eosinophil degranulation and release of cytotoxic proteins. This mechanism is an example of antibody-dependent cell-mediated cytotoxicity.
Smooth endoplasmic reticulum function
synthesis of steroids hormones.
Rough endoplasmic reticulum function
peptide hormones production
Dobutamine is a _________ and causes an increase in ________.
beta adrenergic agonist and causes an increase in heart rate and cardiac contractility, leading to an increase in myocardial oxygen consumption.
Arsenic poisoning Tx:
Dimercaprol
Pulmonary actinomycosis develops
following aspiration and can be confused with lung abscess, malignancy or Tb. Microscopic findings include filamentous, branching, gram positive bacteria and sulfur granules.
Mucor is a
ubiquitous fungus naturally found in soil and decaying material. Usually results in mucormycosis in DKa patients. Microscopic examination shows broad, ribbon-like, nonseptate hyphae with right-angle branching.
Sickle cell disease are more prone to
folic acid deficiency and megaloblastic anemia due to increased folic acid requirements and erythrocytes turnover.
Chromogranin A and synaptophysin are
markers used for neuroendocrine tumors like Small cell lung carcinoma and carcinoid tumor.
Vimentin is an intermediate filament present in
mesenchymal tissue and can be used to detect sarcomas.
Clathrin is an intracellular protein that helps form
rounded vesicles in the cytoplasm, it help mediate intracellular trafficking and endocytosis.
Prinzmetal angina can be precipitated by
tobacco, coccaine, amphetamines and dihydroergotamine/triptans.
Adenosine effect in cardiac pacemaker
prolongs phase 4, reducing the rate of spontaneous depolarization in cardiac pacemaker cells
The locus ceruleus is located in
the posterior rostral pons near the lateral floor of the fourth ventricle
Von Hippel-Lindau disease is characterized by
the presence of capillary hemangioblastoma in the retina or cerebellum as well as congenital cyst or neoplasms in the kidney, liver and pancreas.
Sturge Weber syndrome
is a rare congenital neurocutaneous disorder characterized by the presence of cutaneous facial angiomas as well as leptomeningeal angiomas.
Tuberous sclerosis presents with
cortical and subependymal hamartomas, cutaneous angiofibromas, visceral cyst, renal angiomyolipomas and cardiac rhabdomyomas.
Osler-Weber-Rendu syndrome
congenital telangiectasias (may cause epistaxis, gastrointestinal bleeding or hematuria).
Ionizing radiation induces
DNA damage through DNA double strand fractures and the formation of oxygen free radicals.
Ethylene glycol ingestion leads to:
toxic, acute tubular necrosis with vacuolar degeneration and ballooning of the proximal tubular cells. Typical clinical findings include high anion gap metabolic acidosis, increased osmolar gap and calcium oxalate crystals in the urine.
Roseola infantum
caused by HHV-6
Primary symptoms include high fever for 305 days followed by an erythematous maculopapular rash that usually starts on the trunk and spreads to face and extremities.
Coxsackievirus A16
common cause of hand-foot-mouth disease in children
Parvovirus B19 causes
erythema infectious or fifth disease, which can present as a flulike illness followed by a characteristic slapped cheek rash and truncal reticular rash.
Fenoldopam is a
selective peripheral dopamine-1 receptor agonist, given to lower pressure in hypertensive emergency, especially in patients with renal insufficiency. Causes arteriolar dilation, increases renal perfusion and promotes diuresis and natriuresis.
Centricinar emphysema associated with heavy smocking involves the release of
proteinases (elastase) from infiltrating neutrophils and alveolar macrophages.
Oseltamivir is a ______ and is given in _______
is a neuraminidase inhibitor useful in the tx of influenza. Neuraminidase is required for the release of virus from infected cells and for the spread of virus within the respiratory tract. Neuraminidase inhibitors cause the newly synthesized virions to adhere to the host cell surface and form viral aggregates, thereby reducing the spread of virus to other host cells.
Tamiflu
I-cell disease manifestations
lysosomal storage disorder, due to defects in protein targeting. A phosphotransferase enzyme catalyzes the phosphorylation of mannose residues on lysosome-bound proteins, allowing them to traverse the Golgi network and ultimately be transported to the lysosome, where they serve as catalysts for degradation of cellular components. A defective phosphotransferase enzyme causes extracellular secretion of these proteins and accumulation of cellular debris in the lysosome forming inclusion bodies.
Tissue plasminogen activator (t-PA) converts
plasminogen to plasmin, plasmin functions to break down fibrin, resulting in thrombolysis.
Down syndrome quadruple screen will show
elevated inhibin A and beta-hCG, low AFP and unconjugated estriol
5’-3’ exonuclease activity
removes RNA primers as well as damaged DNA segments
3’-5’ exonuclease activity
performs a proofreading function that removes and replaces mismatched nucleotides on the newly formed daughter strands.
lactose intolerance presents with
increased breath hydrogen content, reduced stool pH and elevated stool osmolality.
CCl4 produces
free radicals that start a vicious cycle of hepatic injury.
Succinylcholine can cause
significant potassium release and life-threatening arrhythmias
Malignant hyperthermia
occurs after administration of inhalation anesthetics and/or succinylcholine to genetically susceptible individuals. It is treated with dantrolene that blocks ryanodine receptors and prevents release of Calcium into the cytoplasm of skeletal muscle fibers.
Tinnitus and unilateral hearing loss are common presenting features of
vestibular schwannoma
Neurofibromatosis 1 codes for _____ protein
Neurofibromin
Neurofibromatosis 2 codes for _______ protein
Merlin
One of the side effects of ACE inhibitors is that they can produce________ due to the lack if inhibition of__________-
angioedema/bradykinin
Pseudogout
synovial fluid showing rhomboid-shaped calcium pyrophosphate crystals with positive birefringent
Efficacy refers to
the ability of a drug to elicit an effect
Potency refers to
the dose of drug that is required to produce a given effect.It is primarily affected by the affinity of the drug for its receptor and the amount of drug that is able to reach the target tissues.
Alternative splicing
process by which a single gene can code for various unique proteins by selectively including or excluding different DNA coding regions into mature mRNA.
Vessels involved in atherosclerotic plaques
Aorta,coronary arteries, popliteal arteries, internal carotid arteries and the circle of willis.
microglia
move to the area of ischemic infarct apron 3-5 days after the onset of ischemia and phagocytize the fragments of neurons, myelin and necrotic debris, a cystic space replace the necrosis and Astrocytes then form a glial scar along the periphery
Fail in the omphalomesenteric obliteration leads to
meckel’s diverticulum, persistent vitelline duct, vitelline sinus and vitelline duct cyst.
Iron accumulation mechanisms
enterocytes increase apical expression of divalent metal transporter, increasing intestinal iron absorption from the lumen and hepatocytes decrease hepcidin synthesis, which increases ferroportin expression on the basolateral surface of enterocytes and promotes iron secretion into the circulation.
Myasthenia graves causes a decrease in
the number of ACh receptors, this reduces the number of postsynaptic cation channels that can open in response to Each, which reduces the amplitude of motor end plate potential and prevents muscle fiber depolarization.
Glycopyrrolate use
cholinesterase inhibitors may cause adverse effects related to muscarinic overstimulation, which can be ameliorated by the use of an antimuscarinic agent such as glycopyrrolate, hyoscyamine or propantheline.
Reye syndrome histology
micro vesicular steatosis of hepatocytes without inflammation, and cerebral edema.
Viridians can
adhere to fibrin-platelet aggregates and establish infection that leads to endocarditis.
Locus heterogeneity
refers to the ability of one disease or trait to be caused by mutations in multiple different genes.
Lithium can induce
Nephrogenic diabetes insipidus
Urachus
Remnant of the allantois that connecta the yolk sack with the bladder
Sebrr pharyngitis with exudates and cervical lymphadenopathy in a group of people with unknown vaccination status should raise suspicion for
Diphtheria infection
Hepatic steatosis is characterized by _______ in the hepatocellular cytoplasm
Triglyceride accumulation
Pathogenesis of alcohol-induced hepatic steatosis
A decrease in free acid oxidation secondary to excess NADH production by the two major alcohol metabolism enzymes.
The alteration of the hepatic NAD/NADH ratio in alcoholics induces fatty liver through inhibition of
Gluconeogenesis and fatty acid oxidation.
MESNA is given to prevent
Hemorragic cystitis produced by cyclophosphamide metabolite acrolein, which is toxic to uroepithelial cells and cause cell death and necrosis if allowed to be in contact with this cells for a prolonged period.
Down syndrome can increase risk of
ALL
In Status Epilepticus you should give
Phenytoin and lorazepam
The structures of the mesonephros persist in the male as:_____________ and in the woman as:_____________.
It persist in the male as the Wolffian Duct which laters form the ductus deferens and epididymis. In females it regress and convert in the vestigial Gartner’s duct.
The ureteric bud give raise to
The collecting system of the kydney, renal calyses, renal pelvis and ureters.
The metanephric mesoderm gives raise to (Blastema)
bowmanns space, glomeruli, proximal tubules, loop of henle and convulated tubules.
Asbestosis characteristics
associated with shipbuilding, plumbing, affects lower lobes. Asbestos bodies are golden-brown fusiform rods resembling dumbbells. Can be visualized with prussian blue stain.
Berrylliosis characteristics
asoc. with aerospace and manufacturing industries, affects lower lobes.
Coal workers pneumoconiosis characteristics
prolonged coal dust exposure, macrophages laden with carbon, affect upper lobes.
Anthracosis (asymptomatic condition found in many urban dwellers exposed to sooty air.
Silicosis characteristics
Asoc with sandblasting. May disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB. Affects upper lobes and eggshell calcification of hilar lymph nodes.
Only cranial nerve not covered with schwann cells:
CN II, which is covered with oligodendrocytes
Most common site for intracranial schannomas is
cerebellopontine angle at craneal nerve VIII (acoustic neuromas)
Fibrates mechanism of action
inhibits cholesterol 7-alpha hydroxyls, rate-limiting enzyme in the bile salt production, leading to gallstones.
S3 sound is caused by
sudden limitation of ventricular movement during rapid passive ventricular filling and suggest ventricular volume overload or enlargement (aortic/mitral regurgitation, dilated or ischemic cardiomyopathy). Listening at end of expiration make it more audible by decreasing lung volume and brings the heart closer to the chest wall.
HAART for HIV (NRTI’s) can produce
body fat redistribution
Chronic granulomatous disease test characteristic
failure of neutrophils to turn blue on nitroblue tetrazolium testing.
Methylphenidate and amphetamines side effects
decreased appetite, weight loss and insomnia.
Opioids side effects:
can stimulate the mu receptor in the GI tract, causing decreased secretions and gastric motility (constipation), can produce significant euphoria by dopaminergic pathways in the nucleus accumbens, nausea, respiratory depression, sedation and urinary retention.
Who stimulate and inhibit gastric acid secretion?
histamine, acetylcholine and gastrin increase acid secretion but prostaglandins, secretin and somatostatin inhibits it.
Gastrin not only stimulates HCl secretion, but it also has
trophic effect on parietal cells.
carotid sinus afferent and efferent limbs
afferent limb that arises from the baroreceptors in the carotid sinus and travels to the vagal nucleus via the glossopharyngeal nerve; the efferent limb carries parasympathetic impulses via the vagus nerve.
Ezetimibe mechanism of action
reduces the intestinal absorption of cholesterol
Bile acids sequestrants (colesevelam) mechanism of action
binds bile salts in the intestine, decreasing their absorption
Fibrates mechanism of action
activates PPAR’s which leads to stimulation of lipoprotein lipase activity and a decrease in TG levels.
Epistacis is when
A allele from one gene interferes with the phenotipic expression of another gene
Mycobacterium tuberculosis can not be visualized on gran stain because of
High lipid content, mycolic acid
Valsalva maneuver increase the ______ using the ____________ muscle.
Increase the vagal tonenin paroxysmal ventricular tachycardia using the rectus abdominis.
Statins mechanism of action
Inhibits HMG CoA reductase and stimulates the LDL receptor recycling.
Vasa vasorum endarteritis
Mechanism by which syphilis cause thoracic aorta dilation
Aorta aneurism lead to
Transmural aortic inflammation
Drug metabolism phases
Phase I (RHO) slightly polar molecules; and phase II (SMAG) very polar molecules
Geriatric patients tend to lose phase ___ first
ONE; they have more phase II
Patients who are low acetylators have higher side effects because of lower rate of metabolism like for example
drug induced SLE (SPECIALLY HYDRALAZINE)
Zero-order elimination
a constant amount of drug is eliminated per unit time, they have no fixed half life. Rate of elimination is independent of plasma concentration.
Examples: phenytoin, ethanol and salicylates.
First order elimination
a constant fraction of drug is eliminated per unit time, rate of elimination is directly dependent of plasma concentration.
Steady state is reached when
rate in=rate out
Fragile X syndrome increased number of CGG leads to
hypermethylation and inactivation of FMR1, preventing transcription and production of fragile X mental retardation protein.
Tx for psoriasis
calcipotriene (calcipotriol, calcitriol, tacalcitol), binds the vit D receptor (a nuclear transcription factor that cause inhibition of keratinocyte proliferation).
Hallmark histologic findings of acute viral hepatitis include
Hepatocyte necrosis and apoptosis with mononuclear infiltration. Hepatocyte becrosis is characterized by cellular swelling and cytoplasmic emptying (ballooning degeneration).
Fibrinoid necrosis is characterized by
The deposition of amorphous material in the wall of blood vessels affected by immune vasculitis or malignant hypertension.
Liquefactive necrosis occurs due to
Enzymatic degradation of tissue in the central nervous system
Part of the spleen involved in removal of damaged RBC’s
red pulp
Candidiasis local defense: (systemic and local)
local defense against candida is performed by t cells, whereas systemic infection is prevented by neutrophils.
Indole positivity
ability to convert tryptophan to indole, a characteristic of E. Coli.
Holosystolic murmur
Mitral valve prolapse
Crescendo-decrescendo systolic murmur
Aortic or pulmonary stenosis
Diastolic murmur
Aortic valve regurg
How a deug can bypass the portal circulation
Intravenous, sublingual and rectal
Chronic stimulation of the fetal beta cells leads to
Beta cells hyperplasia and hyperinsulinism, which contribute to increased fat deposition and enhanced fetal growth, resulting in macrosomia.
Serum tumor markers for HCC, GI, pancreatic, ovarian, germ cell and prostate.
HCC: aFP Pancreatic: CA 19-9 Ovarian: CA 125 GI: CEA Choriocarcinoma: bHCG Germ cells: aFP and bHCG Prostate: PSA
Haptoglobin function:
is a serum protein that binds free hemoglobin and promotes its uptake by the reticuloendothelial system. Haptoglobin levels decrease when significant quantities of hemoglobin are released into the circulation as occurs with intravascular hemolysis.
Gs is present in which receptors
glucagon, TSH and PTH, activating adenylate cyclase, and therefore protein kinase.
cGMP mediates which intracellular effects:
smooth muscle relaxation, platelets activation and sperm metabolism.
Ubiquitin proteasome pathway function:
for breakdown of intracellular proteins, both native and foreign, helps recycle the into amino acid building blocks. Ubiquitin functions as a tag that is attached to proteins to mark them for destruction. It is coupled to MHC I.
Light microscopy of histoplasma capsulatum:
macrophages with intracellular ovoid or round yeast
Light microscopy of crypto coccus neoformans:
budding yeast with a THICK POLYSACCHARIDE CAPSULE
Peruses should be considered in
any adult who has not had updated vaccination boosters. The clinical presentation is a paroxysmal cough lasting more than 2 weeks that is associated with post-tussive emesis or inspiratory whoop after a severe coughing episode.
Cutaneous receptors: Merkel Pacinian Meissner Krause Ruffini
Merkel: position and static touch (textures) Pacinian: vibration and deep pressure Meissner: position and light touch Krause: temperature Ruffini: pressure and skin stretch
Nerve roots reflexes:
Ankle (S1-2)
Patellar (L3-4)
Biceps (C5-6)
Triceps (C7-8)
Plasma renin activity PRA is a:
measure of the amount of angiotensin I generated per unit of time. It provides a useful assessment of the renin-angiotensin-aldosterone axis. Factors that increase PRA include low sodium intake and antihypertensive medications such as diuretics, ACE inhibitors and angiotensin II receptor blockers.
Triad of aplastic anemia:
low hemoglobin, thrombocytopenia and absent hematopoietic cells in the bone marrow.
Compensatory reaction is an elevation of erythropoietin levels in patients with normal renal function.
MCC of self-limited childhood diarrhea in unvaccinated individuals:
Rotavirus, it infects villous enterocytes in the duodenum and proximal jejunum and results in villous blunting, proliferation of secretory crypt cells and a loss of brush border enzymes.
brown pigment gallstones due to increase of
beta-glucuronidase release by injured hepatocytes.
Blocks binding of RANK-L to RANK and reduces formation of mature osteoclasts:
osteoprotegerin
decreases osteoprotegerin production, increasing RANK-L production and increasing RANK expression in osteoclast precursor:
estrogen
can cause cutaneous flushing:
niacin, which is mediated by prostaglandins and can be diminished by pretreatment with aspirin.
GERD is caused primarily by
gastroesophageal junction incompetence and can be associated with extra esophageal symptoms (nocturnal cough) in the absence of heartburn.
Histologic findings include: basal zone hyperplasia, elongation of the lamina propia papillae and scattered eosinophils.
Ohrenic nerve lesion symptoms:
hiccups, diaphragmatic paralysis and dyspnea. The phrenic nerve arises from C3-C5.
Osler-Weber-Rendu syndrome symptoms:
telangiectasia in the skin, mucus membrane (lips, oronasopharynx, respiratory tract, GI and urinary tract. Rupture may cause epistaxis,GI bleeding or hematuria.
Hemosiderin-laden macrophages are:
located in the lungs, and are usually the result of chronic passive lung congestion in the setting of heart failure.
Fomepizole MOA and uses:
a competitive inhibitor of alcohol dehydrogenase and is used for the treatment of acute poisoning.
Lumbar puncture site
L3-L4,L4-L5, below the spinal cord L1. The L4 vertebral body lies on a line drawn between the highest points of the iliac crests.
Vibrio vulnificus is a:
curved, gram-negative, free-living bacterium that grows in marine environments. Manifestations are often mild, but individuals with liver disease or iron overload are at high risk of severe, fulminant infection (sepsis and necrotizing fasciitis)
Pseudomonas infections are common in
patients who are neutropenic, hospitalized, have burns or have indwelling catheters.
Mucromycosis is:
an opportunistic infection caused by Rhizopus, Mucor and Absidia species. The clinical picture is paranasal sinus involvement in a immunosuppressed patient. The fungi form broad nonseptate hyphae that branch at right angles.
BNP diagnostic utility in patients with shortness of breath of unknown cause:
for patients in whom the serum BNP level is not elevated, shortness of breath is unlikely to be due to heart failure
stress-induced (takotsubo) is characterized by:
hypokinesis of the mid and apical segments and hyperkinesis of the basal segments of the left ventricle, resulting in systolic dysfunction. The condition is likely caused by a surge of catecholamines in the setting of physical or emotional stress. Catecholamines may cause microvascular spasm leading to ischemia and myocardial stunning or they may cause direct myocardial dysfunction. It usually affects postmenopausal women and resolves on its own within several weeks.
Pityriasis versicolor is caused by
Malassezia species (spaghetti and meatballs histologic appearance on KOH preparation light microscopy).
Prevents the action of chemotherapeutic agents
the human multi drug resistance (MDR1) gene codes por P-glycoprotein, a transmembrane ATP- dependent efflux pump protein.
hot tube folliculitis is a
superficial and self-limited Pseudomonas eruginosa infection of the hair follicles, that tends to occur in minor outbreaks following exposure to a pool or spa, characterized by pruritic, papulopustular rash.
Can insert the genome into host chromosome
HBV
CREST syndrome
Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia. It affects primarily the face, forearms and fingers. The pathogenesis of systemic sclerosis involves chronic autoimmune inflammation, vascular endothelial injury resulting in chronic ischemic tissue damage (fingertip ulcers) and excessive activation of fibroblasts leading to progressive tissue fibrosis (this increases the risk of Barrett’s esophagus and fibrous stricture formation).
DNA polymerase I special function in prokaryotes
5’ to 3’ exonuclease activity which function to remove the RNA primer created by RNA primase and repair damaged DNA sequences.
E Coli for ex.
TGF-B function
fibroblast migration, proliferation and connective tissue synthesis. Increased TGF-B activity is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver, and kidney in chronic inflammation.
Sturge Weber Syndrome
developmental anomaly of neural crest derivatives that affects small vessels of: the face (port-wine stain in the face, leptomeningeal angiomas, seizures, epilepsy) and intellectual disabilities, glaucoma). GNAQ gene
Tuberous Sclerosis:
HAMARTOMAS in CNS and skin, mitral valve regurg, ash-leaf spot, rhabdomyoma, renal angiomyolipoma, mental retard.
Isoniazid MOA and MOR:
MOA: inhibition of mycolic acid synthesis by M tuberculosis.
MOR: non-expression of the catalase-peroxidase enzyme
Ethambutol MOA and MOR:
MOA: inhibits the synthesis of the mycobacterial cell wall.
MOR: when the mycobacteria increase the production of arabinosyl transferase.
Asherman syndrome is:
obstruction and scarring of the uterine cavity, this is a sequela of uterine infection or procedures.
Kallmann syndrome is:
impaired synthesis of GnRH by the hypothalamus, and presents with primary amenorrhea, absent secondary sexual characteristics and an olfactory sensory defect.
V2 passes throw:
Foramen rotundum
V3 passes throw:
Foramen ovale
Asthma and COPD exacerbations are controlled by
beta-adrenergic agonist, causing bronchial smooth muscle relaxation via increased intracellular cAMP.
Angiodema can occur by two ways:
- Hereditary AD
- Acquired, associated with ACE inhibitors tx.
In Hereditary Angioedema there’s low C1 esterase inhibitor. ACE inhibitors lead to accumulation of bradykinin, because ACE converts bradykinin into inactive metabolites, if we inhibit it, it will build up.
Digoxin MOA:
inhibits Na/K ATPase pump in myocardial cells, leading o a decrease in sodium efflux and an increase in intracellular sodium levels. This reduces the forward activity of the sodium-calcium exchanger, causing increased intracellular calcium concentration and improved myocyte contractility.
How to differentiate pericarditis from angina?
Pericarditis is sharp and pleuritic and may be exacerbated by swallowing or coughing.
Hashimoto histology:
intense lymphocytic infiltrate with germinal centers
Estrogen effect on T4?
An increase in estrogen (OCP, pregnancy, hormone replacement treatment) increases the TBG, decreasing the free T4 and T3 levels.
pulmonary hypertension clues:
loud S2, and an impulse palpated at the left upper sternal border
Rheumatoid arthritis histology
is characterized by synovial hyperplasia with inflammatory infiltrates. The accelerated metabolic rate of the inflamed synovium causes local hypoxia, which leads to synovial angiogenesis.
Activated macrophages in sarcoidosis and other granulomatous diseases express 1-alpha-hydroxylase leading to
excess production of 1,25-dihydroxyvitamin D and hypercalcemia.
X-linked recessive inheritance
Duchenne and Becker muscular dystrophy, hemophilia and G6PD deficiency. All males who inherited the X chromosome will display the phenotype whereas only homozygous females will display the phenotype.
Wiskott-Aldrich syndrome
is a combined B and T lymphocyte disorder, with findings characteristics of eczema, recurrent infections, and thrombocytopenia. Patients are at increased risk of pyogenic infections specially organisms with a polysaccharide capsule.
Ataxia-telangiectasia syndrome is defined by
the presence of a progressive ataxia together with telangiectasia and an immunodeficiency due to a combined defect of both B and T-lymphocytes.
Polycythemia (erythrocytosis) levels in women and men
Men >52% and women > 48%.
*Measurement of red blood cell mass is necessary to distinguish absolute from relative erythrocytosis.
Opioids MOA:
presynaptic mu receptor activation that leads to closure of voltage-gated calcium channels; postsynaptic binding to mu receptor causes opening of potassium channels and membrane hyper polarization.
In malabsorption we test for
fat in stool with Sudan III stain
C difficile infection can be detected with
NAAT by PCR
Polyethylene glycol is a
osmotic laxative
Hydrocephalus ex-vacuo is related with
neurodegenerative diseases like AIDS dementia, due to significant cortical atrophy, which allows the ventricles to expand while maintaining normal pressure.
Pseudodemetia can be seen in:
diabetes, hypothyroidism, b12 deficiency, depression, neurosyphilis, normal pressure hydrocephalus
Alcohol intoxication
slurred speech, AST over ALT 2:1,
Opioid intoxication
CNS depression, pupillary constriction (pinpoint pupils, decreased gag reflex.
tx: naloxone, naltrexone
Barbiturates intoxication
marked respiratory depression
Benzodiazepines intoxication
minor respiratory depression, ataxia
tx: flumazenil
Amphetamines intoxication
pupillary dilation, tachycardia, anorexia, paranoia, hypertension, wakefulness and attention
tx: benzodiazepines
Cocaine intoxication
impaired judgment, pupillary dilation (mydriasis), hallucinations, angina
Caffeine intoxication
increased diuresis, muscle twitching
Phencyclidine intoxication
violence, impulsivity, psychomotor agitation, nystagmus, tachycardia, hypertension, analgesia, psychosis, delirium
tx: benzodiazepines/ antipsychotics
LSD intoxication
Perceptual distortion (visual, auditory), depersonalization, paranoia, psychosis
Marijuana intoxication
euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations
MDMA intoxication
disinhibition, hyperactivity, hypertension, tachycardia, serotonin syndrome, hyponatremia, hyperthermia
Heroin intoxication
euphoria, mitosis, respiratory depression.
Antipsychotics endocrine side effect:
hyperprolactinemia, galactorrhea, oligomenorrhea, gynecomastia,
Antipsychotics cardiac side effect:
can prolong QT, Torsades de point,
Antipsychotics MOA:
blocks D2 receptors, increasing cAMP.
Extrapiramidal system side effects:
Hours to days: acute dystonia (muscle spasm)
Days to months: akathisia (restlessness) and Parkisonism (bradikinesia)
Months to years: Tardive dyskinesia (orofacial chorea)
Neuroleptic Malignant Syndrome presentation:
rigidity, myoglobinuria, autonomic instability, hyperpyrexia, fever, encephalopathy, visual unstable.
tx:dantrolene, bromocriptine
Clozapine side effects
Agranulocytosis
Only for treatment resistant patient.
Side effect of olanzapine
metabolic syndrome (hypercholesterolemia)
Risperidone side effects
hyperprolactinemia
General side effect of atypical antipsychotics
QT prolongation
Lithium side effects:
hypothyroidism, polyuria (nephrogenic diabetes insipidus), Ebstein anomaly.
Lithium toxicity can be obtained by:
combination with thiazides
Buspirone MOA
stimulates serotonin receptors
tx: generalized anxiety disorder, does not cause sedation, addiction, or tolerance. Does not interacts with alcohol.
SSRI’s
Citalopram, and -ine.
inhibits serotonin reuptake
SSRI’s side effects
SIADH, GI upset, sexual dysfunction, anorgasmia, decreased libido, anorexia, bruxism,
SNRI’s side effect
hypertension
TCA’s antidepressants
amitriptyline, imipramine, doxepin
TCA’s MOA
Blocks serotonin and norepinephrine reuptake
TCA’s side effects
sedation, postural hypotension, anticholinergic side effects, can prolong QT interval, convulsions, coma, cardio toxicity (arrhythmia due to NA channel inhibition).
use bicarbonate in toxicity.
MAO inhibitors
tranylcypromine, phenelzine, isocarboxazid, selegiline
MAO inhibitors clinical use
atypical depression
MAO inhibitors side effects
hypertensive crisis, CNS stimulation.
Wait 2 weeks after stopping MAO inhibitors before starting serotonergic drugs or stopping dietary restrictions.
Bupropion
tx: smoking cessation
Trazodone use
insomnia
can cause priapism and painful erections
Varenicline
nicotinic ACh receptor partial agonist. used for smoking cessation.
Sarcoidosis laboratory findings
hypercalcemia
hypercalciuria
Elevated ACE levels
G6PD deficiency anemia precipitators are:
infections, drugs (dapsone, antimalarials, sulfonamide antibiotics, DKA, favism (ingestion of lava beans)
G6PD defiance anemia is characterized by:
bite cells and heinz body, reticulocytosis, jaundice and dark urine.
Whipple disease is a
systemic illness that involves the small intestine, joints and CNS, caused by the gram positive tropheryma whippelii. Classic histologic findings include small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase resistant granules.
Lecithinase is a
Toxin A, produced by Clostridium perfringens, inducing cell lysis and the development of gas gangrene.
Polyribosylribitol phosphate is a
capsule component and major virulence factor of H. influenzae type b.
Trehalose dimycolate is a
cell wall component and major virulence factor of Mycobacterium tuberculosis. It protects it from being killed by macrophages and stimulates granuloma formation.
Acute intermittent porphyria is a
AD condition caused by porphobilinogen deaminase deficiency. Symptoms includes: abdominal pain, vomiting, peripheral neuropathy, reddish-brown urine.
TX: IV glucose, heme preparations, which down regulate ALA synthase
Haptoglobin in sickle cell disease
decreased
Pronephros, mesonephros and metanephros
pronephros degenerates, mesonephros function as interim kidney then contributes to male genitalia system; metanephros is permanent.
Ureteric bud is derived from
mesonephric duct; and gives rise to ureter, pelvises, calyces, collecting ducts.
Glomerulus differentiation is induces by
ureteric bud and metanephric mesenchyme
Potter sequence is associated with
oligohydramnios, pulmonary hypoplasia, extremity defects, renal failure, flatted nose.
Causes os potter syndrome
ARPKD, bilateral renal agenesis, chronic placental insufficiency
Horseshoe kidney is associated with
Turner syndrome
Extracellular volume can be measured by
inulin or mannitol, because they can not pass to the intracellular compartment
Plasma volume can be measure by
radio labeling albumin
Cx and GFR relation
if
cx>gfr= secretion
cx
Inulin clearance can be used to calculate GFR because
it is freely filtered and is neither reabsorbed or secreted
Renal plasma flow can be measured by
PAH, because it is filtered and also secreted
Eritroproyectin is produced by
phagocytes and interstitial cells
Fanconi syndrome
generalized reabsorption defect in PCT, leading to metabolic acidosis, increased excretion of glucose, phosphate, aminoacids. Causes include hereditary defects.
Bartter syndrome
reabsorption defect in thick ascending loop of hence, affects NA/K/2CL cotransporter, presents similar to chronic loop diuretic use, presents with hypokalemia, hypercalciuria, and metabolic alkalosis.
Gitelman syndrome
reabsorption defect of NaCl in DCT, similar to using lifelong thiazides, results in hypertension, hypokalemia, metabolic alkalosis and decreased aldosterone. tx:amiloride
Prostaglandin and NSAID’s effect in the kidney
prostaglandins vasodilator afferent arterioles and NSAID’s constricts afferent arterioles.
PTH hormone action
increased calcium and phosphate absorption at the level of the gut, calcium absorption and phosphate excretion at the level of the kidney and 1,25-(OH)2D3 production.
Acidemia levels
HCO2 <20mEq/L and CO2>44mmHg
Respiratory acidosis causes:
airways obstruction, lung disease, opioids, sedatives, weakening of lung muscles.
Metabolic acidosis causes:
Check anion gap! High Anion Gap: MUDPILES methanol uremia DKA Propylene glycol iron tablets or INH Lactic acidosis Ethylen glycol salicilates (aspirin) (late)
Normal Gap: HARDASS Hyperalimentation addison disease renal tubular acidosis diarrhea acetazolamide spironolactone saline infusion
Alkalemia levels:
CO2<36 OR HCO3 >28
Respiratory alkalosis causes:
hysteria hypoxemia (high altitude) salicylates tumor pulmonary embolism
Metabolic alkalosis causes:
loop diuretics
vomiting
antacid use
hyperaldosteronism
Erythema infectiosum (fifth disease)
caused by parvovirus B19 and presents with a nonspecific prodrome, followed by a classic “slapped-cheek” facial rash and a lacy, reticular body rash. Is highly tropic for erythroid precursor cells.
Laboratory findings in Neuroleptic malignant syndrome
creatine kinase elevation due to rhabdomyolysis
Dantrolene MOA
Antagonizes ryanodine receptors and inhibits calcium release from the sarcoplasmic reticulum.
NMS symptoms:
diffuse muscle rigidity, hyperthermia, altered sensorium.
Ewing sarcoma is
the second most common malignant bone tumor of childhood, it commonly involves the lower extremity and pelvis and often metastasizes to the lungs.
vitamin A deficiency causes
blindness and hyperkeratosis, can be developed in patients with biliary disorders, exocrine pancreatic insufficiency or intestinal malabsorption.
Essential tremor is
the most common movement disorder, patients experience a slowly progressive, symmetric postural or kinetic tremor that most commonly affects the upper extremities. It is often inherited in a autosomal dominant fashion and first line treatment is propranolol.
Henoch-Schonlein purpura is a
small vessel vasculitis in children, preceded by an upper respiratory infection, (IgA mediated), causes abdominal pain, joint pain, lower extremities palpable purpura and hematuria.
Acute post streptococcal glomerulonephritis findings
low C3 levels
IgG and IgM deposition
type III HS
Rapidly progress glomerulonephritis findings
crescents consist of fibrin and plasma protein
Goodpasture syndrome findings
type II H.S.
antibodies against GBM (IgG to IgE)
Linear IF
HEMOPTISIS AND HEMATURIA
Granulomatosis with polyangiitis (Wegener) findings
necrotizing granuloma in upper and lower respiratory system
c-ANCA
Also presents with sinusitis
Microscopic polyangiitis findings
p-ANCA
upper respiratory tract only
no granulomas
Diffuse proliferative glomerulonephritis findings
due to SLE
wire looping of capillaries
IgA nephropathy (Berger) findings
IgA deposition in mesangium
occurs concurrently with respiratory or GI tract infection
Alport syndrome findings
mutation in type IV collagen
thinning and splitting of glomerular basement membrane
eye problems, sensorineural deafness
Membranoproliferative glomerulonephritis findings
tram-track appearance on PAS stain
cop resents with nephrotic syndrome
Minimal change disease findings
most common in children
recent infection, lymphoma
Focal segmental glomerulosclerosis findings
segmental sclerosis with hyalinosis effacement of foot processes most common in african american can be due to heroin use, HIV, sickle cell, may progress to chronic renal disease
Membranous nephropathy findings
diffuse capillary and GBM thickening
nephrotic presentation of SLE
spike and dome appearance
antibodies to phospholipase A2 receptors
Amyloidosis findings
congo red stain shows apple green birefringence
in mesangium
Diabetic glomerulonephropathy
eosinophilic nodular glomerulosclerosis
kimmelstiel-wilson lesions
nonezymatic glycosylation of GBM=increase permeability and thickening
non enzymatic glycosylation of efferent arterioles=increase GFR and mesangial expansion
Most common cause of end-stage renal disease in US
Struvite stones
magnesium, ammonium and phosphate
precipitates with high pH
caused by infection with urease positive organisms (proteus, stap saprophyticus, klebsiella) that hydrolyze urea to ammonia which lead to urine alkalization. Commonly form stag horn calculi
Renal papillary necrosis is associated with:
diabetes, sickle cell disease, NSAID’s, acute pyelonephritis
ADPKD chromosomes
PKD1 (Cr16) and PKD2 (Cr4)
ADPKD is associated with
berry aneurism, mitral valve prolaps, benign hepatic cyst
ARPKD is associated with
Potter sequence and liver fibrosis
Adverse effect of loop diuretics
gout, ototoxicity, allergy
Thiazide diuretics side effects
Hyper glycemic, lipidemia, uricemia and calcemia.
Prevents unfavorable heart remodeling
ACEI
DIRECT RENIN INHIBITOR
Aliskiren
Direct arteriolar vasodilators
hydralazine, minoxidil
Fluorescence in situ hybridization can be used to
identify specific chromosomal translocation, duplications or deletions. `
Hallmark of asbestos exposure
pleural plaques
D-xylose is a
monosaccharide whose absorption is not affected by exocrine pancreatic insufficiency and can be used to differentiate between pancreatic versus mucosal causes of malabsorption
Chronic obstructive pulmonary disease exacerbation organisms
rhinovirus, influenza, H. influenzae, M catarrali, S. pneumoniae
Congenital toxoplasmosis is characterized by
retinal lesions, hydrocephalus, jaundice and hepatosplenomegaly
Congenital rubella infection
growth restriction, hearing loss, cloudy cornea and meningoencephalitis
Pregnant woman should avoid unpasteurized milk to prevent
Listeria monocytogenes infection
Foregut, midgut and hindgut
foregut=pharynx and 3/4 duodenum
midgut=duodenum to 2/3 of transverse colon
hindgut= distal 1/3 of transverse colon to anal canal
Ventran pancreatic duct gives raise to
pancreatic duct
Dorsal pancreatic duct gives raise to
body, tail, isthmus and accessory pancreatic duct
The head of the pancreas came from
ventral and dorsal pancreatic duct
SADPUCKER
suprarenal glands aorta/ivc duodenum pancreas ureters colon kidney esophagus rectum
Hepatoduodenal ligament contains
portal triad: proper hepatic artery, portal vein, common bile duct
Celiac trunk branches
common hepatic, splenic and left gastric
Site of varices anastomosis
esophageal varices=left gastric with azygos
caput medusae= para umbilical with small epigastric veins of the wall
anorectal varices= superior rectal with middle and inferior rectal
Ito cells functions
storage of vitamin A, matrix production, collagen type II in cell injury
Hepatic zone I
periportal zone, affected first by viral hepatitis
Hepatic zone III
pericentral vein, affected first by ischemia, contains cytochrome p-450, site of alcoholic hepatitis.
Sliding hiatal hernias are:
gastroesophageal junction is displaced upward; hourglass stomach
Paraesophageal hernias are:
gastroesophageal junction is usually normal, fungus protrudes into the thorax.
Hernia Covered by the 3 layers if spermatic fascia
indirect hernia/ most common in young men or child
Hernia Covered by the external spermatic fascia only
direct hernia/ most common in older men
Complication of hernia repair
can compromise the vas deferens
