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UWorld Journal: Final 2 weeks Flashcards

1
Q

Hep B serum marker for increased infectivity

A

HBeAg

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2
Q

Cheyne-Stokes breathing

A

apnea followed by gradually increasing then decreasing tidal volumes
see in CHF

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3
Q

what is in amniotic fluid with NTDs

A

AFP

acetylcholinesterase

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4
Q

condition from abnormal apoptosis en utero

A

duodenal atresia

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5
Q

vessels damaged in hip fracture → osteonecrosis of femoral head

A

medial femoral circumflex artery

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6
Q

mechanism of urge incontinence

A

overactive bladder

detrusor instability

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7
Q

diff btwn EBV and CMV mono

A

EBV has (+) monospot test (tests for anti-heterophil Abs)

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8
Q

when can you get a fat embolism

A

fractured bone

amputation

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9
Q

stroke w/ nothing on CT

A

ischemic (think lacunar), not hemorrhagic

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10
Q

determining factor in cyanosis in tetralogy of fallot

A

right ventricular outflow tract obstruction

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11
Q

what kind of channel is the CFTR channel in CF?

A

ATP-gated Cl channel

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12
Q

who’s at risk for first dose hTN with ACE inhibitors

A

pts w/ volume depletion (diuretics)

pts w/ CHF

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13
Q

ALL is precursor or mature T/B cells?

A

precursor

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14
Q

things that can trigger prinzmetal angina

A

smoking
cocaine/amphetamines
dihydroergotamine/triptans

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15
Q

when can you get Dressler synd?

A

1 wk to 1 month post MI

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16
Q

chest pain exacerbated by swallowing

A

pericarditis

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17
Q

mechanism of pericarditis 2-4 days most MI

A

inflammatory rxn to cardiac muscle necrosis

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18
Q

normal aging changes in heart

A

decreased LV chamber size (apex to base)
sigmoid-shaped septum
myocardial atrophy w/ more collagen
accumulation of lipofuscin pigment in cardiomyocytes

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19
Q

thyroid: branching papillary structures w/ concentric calcifications

A

papillary thyroid cancer

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20
Q

thyroid: diffuse lymphocytic infiltration w/ formation of germinal centers

A

Hashimoto’s thyroiditis

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21
Q

thyroid: lymphocytic infiltrate w/ macs and multi-nuc giant cells

A

subacute granulomatous (de Quervain) thyroiditis

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22
Q

painful thyroid enlargement after viral illness

A

subacute granulomatous (de Quervain) thyroiditis

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23
Q

fibrous dysplasia of bone
endocrine abnormalities
cafe-au-lait spots

A

McCune-Albright syndrome

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24
Q

tumors of tuberous sclerosis

A 
angiomyolipomas
subependymal hamartomas of the brain
cardiac rhabdomyomas
facial angiofibromas
(+ ash-leaf patches)
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25
mechanism of overflow incontinence
impaired detrusor contractility | bladder outlet obstruction
26
thyroid: nests/sheets of polygonal or spindle shaped cells w/ extracellular amyloid deposits
medullary thyroid cancer
27
unilateral hearing loss and tinnitus | recurrent vertigo
Meniere disease
28
Meniere disease pathophys
increased volume and pressure of endolymph in vestibular apparatus
29
best protection against influenza A
antibodies against hemagglutinin
30
what do you cut through for a crichothyrotomy
skin superficial cervical fascia investing and pretracheal layers of the deep cervical fascia cricothyroid membrane
31
what regulates TRH?
T3
32
signs of hyperaldosteronism
HTN hK metabolic alkalosis depressed renin
33
subcutaneous bumps on achilles tendons
xanthomas (hyperlipidemia)
34
when do you see Dohle bodies
leukemoid rxn | toxic systemic illness
35
tx for organophosphate poisoning
pralidoxime (both muscarinic and nicotinic effects) | atropine (muscarinic only)
36
PCP mechanism
NMDA receptor antagonist
37
stroke after DVT
paradoxical embolism (w/ patent foramen ovale, ASDs, VSDs, pulm AV malformations)
38
fixed split S2
ASD
39
proximal muscles in Duchenne
early: hypertrophy of calves late: muscle fibers replaced by fat and CT (pseudohypertrophy)
40
spinal levels a/w cauda equina syndrome
S2 - S4
41
different forms of aspergillosis infection
opportunistic/invasive: immunocomp colonizing: aspergilloma in TB cavities hypersensitivity/allergic: asthma pts
42
cells/cytokines in granuloma formation
TH1s make IL-2 and IFN-gamma → TH1 proliferation and mac activation
43
lucid interval followed by loss of consciousness
epidural hematoma
44
CSF of aseptic meningitis
lymphocytic pleocytosis modestly elevated protein normal glucose
45
prolonged QT and neurosensory deafness
Jervell and Lange Nielsen syndrome
46
whats in Thayer-Martin medium
vancomycin colistin (polymyxin) nystatin trimethoprim
47
hTN, pulsus paradoxus, JVD
cardiac tamponade
48
properties of drugs processed by the liver
lipophilic
49
non-fusion of urethral folds in males →
hypospadias
50
malunion of the labioscrotal folds →
bifid scrotum
51
precursor proteins/peptides responsible for localized amyloidosis
``` cardiac atria: ANP thyroid gland: calcitonin panc islets: islet amyloid protein (amylin) cerebrum: beta-amyloid protein pit: prolactin ```
52
meconium ileus associated d/o
CF
53
when do you use continuous vs pulsatile GnRH
continuous: prostate cancer, endometriosis, precocious puberty, premeno breast cancer pulsatile: infertility
54
D-xylose tests for...
pancreatic vs intestinal malabsorption
55
what does sorbitol usually become?
fructose
56
which ligament contains the ovarian artery?
suspensory ligament of the ovary (infundibulopelvic ligament)
57
what is ligated to prevent heavy bleeding in an oophorectomy?
suspensory ligament of the ovary (infundibulopelvic ligament)
58
dyspnea, hypoxemia, hypocapnia
alveolar hyperventilation (from V/Q mismatch: pneumonia or PE)
59
alveolar hyperventilation mechanism
pneumonia/PE → V/Q mismatch → hypoxemia → chemoreceptors increase respiratory drive → hypocapnia (but still hypoxemia since it can't absorb more O2)
60
how do beta blockers help in glaucoma?
decrease secretion of aqueous humor by ciliary epithelium (same place as acetazolamide
61
mechanism of bicornate uterus
failed lateral fusion of paramesonephric ducts
62
mechanism of longitudinal uterine septum
involution of paramesonephric ducts
63
nerve for external hemorrhoids (below dentate line)
inferior rectal nerve (from pudendal nerve)
64
non neoplastic polyps (colon)
hyperplastic hamartomatous inflammatory mucosal/submucosal
65
hypoketotic hypoglycemia after fasting
impaired beta-oxidation of fatty acids (impaired glycogenolysis would still make ketones) MC def: Acyl-CoA dehydrogenase
66
why are people with Crohns in terminal ileum prone to gallstones?
bile acids not reabsorbed → ratio of cholesterol to bile acids gets messed up → cholesterol stones
67
bioavailability equation
(area under the curve oral x dose IV) / (area under the curve IV x dose oral)
68
which blood gas levels are maintained in peak exercise?
arterial O2, pH and CO2 | mixed venous CO2 goes up
69
which bacteria have IgA protease
staph aureus? strep pneumo neisseria H flu
70
pathogenesis of osler nodes vs janeway lesions
osler: immune complex deposition (painful) janeway: septic embolization (painless)
71
mediators of angiogenesis
VEGF (vascular endothelial GF) | FGF (fibroblast GF)
72
which BPH drug actually affects size of prostate
5-alpha-reductase inhibitors (finasteride)
73
MCC febrile seizures
roseola (HHV-6)
74
sx of congenital hydrocephalus
macrocephaly bulging fontanelle developmental delay spasticity and hyperreflexia
75
mechanism of spasticity in congenital hydrocephalus
enlarged ventricles → stretch periventricular pyramidal tracts
76
vitiligo mechanism
loss of epidermal melanocytes
77
what influences potency in anesthetics?
MAC (not solubility)
78
what influences onset of action in anesthetics?
solubility (not MAC)
79
what acidifies urine
ammonium
80
what kind of cardio problems does doxorubicin et al lead to?
swelling of sarcoplasmic reticulum (early) loss of cardiomyocytes dilated CM
81
normal PaO2, % saturation, low O2 content
anemia (less Hgb)
82
UC colon cancer vs typical colon cancer
arise from non-polypoid dysplastic lesions multi-focal develop early p53 and late APC mutations higher grade
83
what lung changes happen in L sided heart failure
increased hydrostatic P in pulm circulation → transudation of fluid into interstitium → distortion of tissue → decreased lung compliance → poor gas exchange and SOB
84
causes of reduced lung compliance
CHF (L) pulmonary fibrosis insufficient surfactant
85
platelet count in von willebrand
normal
86
granulosa cell tumor description
``` call-exner bodies (rosette) coffee bean nuclei secrete estrogen yellow (lipid content) usually unilateral ```
87
what is a hamartoma made up of
disorganized cartilage, fibrous and adipose tissue
88
renal problem a/w sickle cell
renal papillary necrosis
89
sickle cell → renal problems mechanism
sickled cells obstruct vessels → ischemia
90
robertsonian translocation
t(14; 21)
91
a/w arsenic, thorotrast and polyniyl chloride
hepatic angiosarcoma
92
complication of scaphoid fracture
avascular necrosis
93
MC deficiency of urea cycle (→ hyperammonemia)
ornithine transcarbamylase
94
lungs: columnar cells that line alveolar septa w/o stromal invasion
adenocarcinoma in situ
95
hamartoma in lungs description
coin lesions
96
excess estrogen in cirrhosis →
gynecomastia testicular atrophy decreased body hair spider angiomata
97
clearance of stuff in lungs: mechanism by size
10-15: upper resp | 2.5-10: mucociliary in trachea/bronchi
98
vitamins to give to breastfeeding newborns
D (prevent rickets) | K (prevent hemorrhagic dz)
99
what lets TB live in macs
sulfatides (inhibit fusion of lysosomes to phagosomes)
100
what lets TB inactivate neuts, damage mitochondria and release TNF
cord factor
101
JAK2 vs JAK-STAT
``` JAK2 = cytoplasmic (polycythemia) JAK-STAT = receptor (insulin) ```
102
prooximal tubular cell ballooning and vacuolar degeneration
acute tubular necrosis
103
acute tubular necrosis + oxalate crystals
ethylene glycol poisoning
104
kidney problems in BPH
urinary retention → hydronephrosis → atrophic/scarred parenchyma
105
dystonia vs myoclonus
dystonia: sustained involuntary contraction (eg torticollis) myoclonus: sudden, brief contraction
106
myasthenia gravis vs Lambert Eaton (sx)
MG: eyes first, weakness gets worse in day LE: proximal muscles, weakness gets better in day (+CANCER)
107
myasthenia gravis vs Lambert Eaton (mech)
MG: Abs against Ach receptors LE: Abs against pre-synaptic Ca channels
108
myasthenia gravis vs Lambert Eaton (dx)
MG: improve/resolve w/ tensilon (edrophonium) test; decremental response w/ nerve studies LE: no improvement w/ tensilon (edrophonium) test; incremental response w/ nerve studies
109
FF equation
GFR/RPF
110
RPF equation
RBF x (1 - hematocrit)
111
hepatitis with high mortality in preggers
hep E (naked, single-stranded RNA; fecal oral)
112
complications of psoriasis
psoriatic arthritis (up risk w/ HLA-B27) nail pitting, discoloration uveitis/conjunctivitis
113
which sx of pericarditis are chronic vs acute
chronic: Kussmaul, pericardial knock acute: friction rub
114
sx of serotonin syndrome
``` confusion agitation tremor tachycardia HTN clonus hyperreflexia hyperthermia diaphoresis ```
115
large eosinophilic casts
Bence-Jones proteins (multiple myeloma)
116
MCC spontaneous lobar hemorrhage (especially in elderly)
cerebral amyloid angiopathy
117
where does fluid accumulate in a hydrocele?
tunica vaginalis (patent processus vaginalis)
118
where does blood accumulate in a varicocele?
pampiniform plexus
119
ion changes in nicotinic cells when Ach binds
influx of Na and Ca | outflux of K
120
how are fat and insulin resistance related
free fatty acids → impair insulin dependent glucose uptake and increase hepatic gluconeogenesis
121
how does puffer fish toxin cause problems
binds to Na channels inhibits influx → no action potential conduction (same as red tide dinoflagellates)
122
how does ciguatoxin cause problems? (from warm water fish/moray eel)
binds to Na channels keeps them open → persistent depolarization (same as frogs)
123
insulin signaling
intrinsic tyrosine kinase if MAP kinase → cell growth if phosphatidylinositol-3-kinase → activate protein phosphatase → glycogen synthesis, GLUT-4 translocation and fat synth
124
what is the diff between alpha helices and beta pleated sheets?
H bonds
125
where are the majority of anal fissures?
posterior midline
126
alcohols effects on glycemia
inhibits gluconeogenesis and fatty acid oxidation → hypoglycemia
127
what vessels are damaged in a subdural hematoma?
cortical bridging veins
128
what color are the thick/thin myofilaments on a sarcomere EM image?
``` light = thin dark = thick ```
129
hemosiderin-laden macs in pulmonary alveoli
chronic elevated pulm capillary hydrostatic P (left-sided heart failure)
130
what mutation causes maturity-onset diabetes of the young
glucokinase gene
131
what is maturity-onset diabetes of the young?
mild, non-progressive hyperglycemia that often worsens w/ pregnancy
132
pathophys of diabetic neuropathy
1. non-enzymatic glycosylation of proteins → thicken/hyalinize artery walls → microangiopathy of endoneural arterioles → ischemia 2. intracellular hyperglycemia → glucose → sorbitol/fructose → water follows → osmotic damage
133
what causes decerebrate posturing?
lesion to midbrain, pons (brainstem)
134
what causes decorticate posturing?
lesion to cerebral hemispheres
135
causes of impetigo
``` staph aureus (MC) strep pyogenes ```
136
abortion meds (+ MOAs)
misoprostol (PGE1 agonist) mifepristone (progesterone antagonist, glucocorticoid antagonist) methotrexate (folic acid antagonist)
137
anterior dislocation of the humerus →
flattening of the deltoid acromion prominence ant axillary fullness injury to axillary nerve → loss of sense @ lateral shoulder
138
half life equation
(0. 7 x Vd) / CL | 0. 7 x volume of distribution divided by clearance rate
139
first order kinetics (half lives → % eliminated)
0 → 0% 1 → 50 2 → 75 on and on and on
140
paraneoplastics from small cell lung cancer
ACTH → Cushing (or from panc) ADH → SIADH Abs against Ca channels → Lambert Eaton Abs against Yo/P/Q/Hu → subacute cerebellar degeneration (can get from breast/ov/uterine too)
141
paraneoplastics from squamous cell lung cancer
PTH-related prt → HCa
142
smoker + collapsed lung
obstruction of mainstem bronchus (central tumor) → alveolar collapse → trachea deviates toward affected side
143
what enzyme do fibrates inhibit
cholesterol 7-alpha-hydroxylase (make bile acids)
144
untreated obstructive sleep apnea →
pulmonary HTN and right heart failure
145
pt w/ UC/Crohn + shock
``` toxic megacolon (may be a/w C diff too) order an x ray ```
146
why is dubin johnson liver dark?
accumulates epi metabolites (dense pigments in lysosomes)
147
defect in dubin johnson
cant excrete bilirubin glucuronides across canalicular membrane
148
degeneration in ALS
anterior horn lateral CSTs motor nucs: V, IX, X, XII
149
atypical cells in EBV
activated CD8 cells
150
where do nosebleeds come from?
Kiesselbach's plexus on nasal septum
151
why do you give fluid in hypovolemic shock?
increase end-diastolic sarcomere length → increase SV
152
onion-like concentric thickening of arteriole walls
hyperplastic arteriosclerosis (diastolic BPs > 120-130)
153
what hep B serum markers cross placenta in acute infection
viral load | HBeAg
154
types of nevi
junctional (@ dermis, not in) compound (epi + dermis) intradermal (only in dermis)
155
Rb actions
w/o P: active - prevents damaged cells from progressing | w/ P: inactive - lets damaged cells replicate
156
what is the sudan III test for
malabsorption (test stool for fat)
157
proximal muscle weakness, elevated CK, endomysial mononuclear inflammatory infiltrate
polymyositis
158
ca sensing receptors for PTH
G-protein coupled
159
vessels likely to be athersclerotic
aorta > coronary> carotid > iliac > circle of willis
160
golgi tendon vs muscle spindle
``` golgi tendon: monitors tension (drop something too heavy) muscle spindle (intrafusal muscle fibers): monitor stretch (DTRs) ```
161
high lipid bone marrow
aplastic anemia (pancytopenia + high EPO)
162
kidney: dilated calyces with overlying renal cortical scarring
vesicoureteral reflux
163
cell levels in SLE
pancytopenia (type II HSR)
164
dihydrofolate reductase inhibitors
trimethoprim (bacteria) methotrexate (humans) pyrimethamine (protozoa)
165
what cells are in watery diarrhea
(noninflammatory) no leukocytes no RBCs
166
what cells are in dysentery/inflammatory diarrhea
PMNs | +/- RBCs
167
what cells are in enteric fever? (typhi)
mononuclear leukocytes
168
ToF developmental problem
anterior and cephalad deviation of the infundibular septum
169
dysphagia, iron deficiency and shiny red tongue
Plummer Vinson syndrome
170
maintenance dose equation
Cpss x CL / [bioavailability fraction]
171
intellectual disability, gait or posture abnormality, eczema and a musty body odor
PKU
172
henoch-shonlein purpura features
GI (colicky) kidneys (IgA) skin joints (migratory arthralgias)
173
components of preeclamsia
``` gestational HTN (>140, >90) proteinuria or signs of organ damage ```
174
MCC of unilateral fetal hydronephrosis
inadequate canalization of the uteropelvic junction
175
possible treatments for c diff
metronidazole vancomycin fidaxomicin
176
treatment for infertility in PCOS
clomiphene (estrogen receptor modulator prevents negative feedback inhibition)
177
neutrophils don't turn blue on nitroblue tetrazolium testing
CGD
178
drugs that cause disulfiram rxn w/ alcohol
metronidazole | sulfas?
179
valvular fibrous plaques (R > L)
carcinoid syndrome
180
how does carcinoid syndrome → heart plaques
excessive serotonin → fibroblast growth → deposit in endocardium → tricuspid regurg
181
what is elevated in carcinoid syndrome?
serotonin | 5-HIAA (serotonin metabolite: %-hydroxyindoleacetic acid)
182
ways to get down syndrome
meiotic nondisjunction unbalanced translocation (Robertsonian) mosaicism
183
enterocytes with clear/foamy cytoplasm
abetalipoproteinemia (can't make apo-B → lipids can't get into blood so they stay in intestinal epithelium)
184
excessive matrix metalloproteinase activity and myofibroblast accumulation
wound contracture (happens a lot on palms/soles/ant thorax)
185
wound dehiscence
rupturing of previously closed wound (from insufficient granulation/scar tissue) see in abdominal wounds a lot
186
low cortisol post partum
Sheehan syndrome (hypopituitarism)
187
sheehan syndrome pathophys
preg → lots of E → adrenal hyperplasia (doesn't change blood supply though) peripartum hemorrhage → hypotension → ISCHEMIA
188
pathophys of mallory-weiss
lots of retching (drunks, bulimics) → rapid changes in intraabdominal/luminal pressure → longitudinal tears hiatal hernias are a risk too
189
tremor when maintaining a certain posture, symmetrical upper extremity, may improve with EtOH
essential tremor
190
biggest RFs for coronary heart disease
noncoronary atherosclerosis DM chronic kidney dz
191
crypt abscesses vs crypt hyperplasia (causes)
``` abscesses = UC hyperplasia = celiacs ```
192
fever, facial edema, rash, eosinophilia
DRESS syndrome (drug rxn w/ eosinophilia and systemic sx)
193
viral meningitis CSF
normal glucose elevated protein lymphocytic predominance
194
bacterial meningitis CSF
low glucose high protein neutrophilic predominance
195
what reflects osteoblast activity
bone-specific alkaline phosphatase
196
muscle weakness overcome by repetitive stimulation
Lambert Eaton | Botulinum
197
what do you test with the slit lamp exam?
Kayser-Fleischer rings in Wilson dz
198
brain complication of ADPKD
berry aneurysms, subarachnoid hemorrhages, nuchal rigidity
199
hexagonal crystals in urine
cysteine stones
200
why do you get cysteine stones?
usually kids AutoRec: cystinuria prevent some AAs from being reabsorbed in PCTs
201
lymph nodes - benign vs malignant?
benign: polyclonal proliferation of lymphocytes malignant: monoclonal
202
which coronary artery does the nodes?
right
203
ADEs of SERMs
hot flashes venous thromboembolism endometrial hyperplasia/carcinoma (tamoxifen)
204
dry vs wet age related macular degeneration
dry: gradual, from oxidative damage wet: acute, from neovascularization (form VEGF)
205
when does calcification take place with normal Ca levels?
necrosis
206
beta adrenergic drugs
``` epi (B1) dopa (B1) dobutamine (B1 > B2) isoproterenol (B1, B2) terbutaline (B2) ```
207
MCC morbidity in rheumatic fever
pancarditis
208
which do you see in adults, ADPKD or ARPKD?
ADPKD
209
enzyme that carboxylates coag factors X, IX, VII, II
gamma-glutamyl carboxylase (and vit K)
210
shoulder pain, Horner syndrome, lung involvement
pancoast tumor
211
what should people with pyruvate dehydrogenase def eat?
only ketogenic amino acids (lysine, leucine, etc)
212
fetal Hb structure
alpha2, gamma 2
213
genetic mechanism of fragile X
increased number of CGG repeats on FMR1 gene → hypermethylation/inactivation of FMR1
214
substances that are freely filtered @ glomerulus and poorly reabsorbed
Cr inulin PAH
215
femoral artery/vein/nerve layout
``` vein = medial artery = middle nerve = lateral ```
216
dental bleeding and hemarthrosis
hemophila
217
concentrations in SIADH
low plasma Na low plasma osm concentrated urine normal body fluid volume
218
which BPH tx grows hair
finasteride (5-alpha-reductase inhibitor)
219
how does desmopressin treat von Willebrand?
increase circulating factor VIII and endothelial secretion of vWF
220
where do you bx for Hirschsprung dz?
submucosa of narrow lumen of rectum (see if ganglia are missing)
221
congenital CMV eye thing
chorioretinitis
222
lymphoma w/ crazy high mitotic index?
Burkitt
223
what causes fistulas in crohn dz
transmural inflammation
224
what causes intestinal strictures in crohn dz
partial bowel obstruction
225
cerebellar tumors in kids
pilocytic astrocytomas | medulloblastomas (primitive neuroectodermal tumors)
226
why do you get hypercalcemia in sarcoidosis
activated macs make 1,25-dihydroxyvitamin D
227
how are cells adhered to the extracellular matrix?
intracellular actin transmembrane integrins fibronectin collagen
228
things accumulated in cardiac cells during ischemia
Na and Ca (ATP pumps dont work) | → swelling
229
clues that pack pain is malignant
occurrence at night not relieved with rest/analgesics systemic sx
230
blue-black spots on sclerae
alkaptonuria (homogentisic acid dehydrogenase def)
231
MC malignant hepatic lesion
mets
232
watery diarrhea, hK, achlorhydria
VIPomas
233
whats in the cells in renal clear cell carcinoma
high glycogen/lipid
234
ASD and VSD
``` Down syndrome (MC cardiac defect) complete AV septal defect ```
235
destruction of intrahepatic, interlobular bile ducts by granulomatous inflammation
primary biliary cirrhosis
236
G6PD inheritance
X linked recessive
237
hereditary spherocytosis inheritance
AutoDom
238
what stores/releases surfactant?
lamellar bodies of type II pneumocytes
239
hypoplasia or cerebellar vermis and cystic dilation of 4th ventricle w/ posterior fossa enlargement
Dandy-Walker malformation
240
gait ataxia, impaired joint/vibration sense, skeletal abnormalities
Friedreich ataxia
241
MCC death in Friedreich ataxia
hypertrophic cardiomyopathy
242
why do you get warfarin skin necrosis?
warfarin inhibits vitamin K dependent things (C, S, X, IX, VII, II) C and S have shortest half lives and die off first C and S are inhibitors of coagulation, though, so → hypercoag state thrombotic occlusion of microvasculature → necrosis
243
what measurement is off in hemophilia
PTT only
244
infection in septic abortion
staph aureus, gram negative bacilli
245
whos got cutis aplasia?
patau | moms that took methamizole for hyperthyroid
246
marker for hepatocellular carcinoma
AFP (not unique, just watch for spikes) | chronic liver disease has it elevated too
247
what is rasburicase and when do you give it?
urate oxidase approximation → metabolizes uric acid into more soluble things use in tumor lysis syndrome
248
liver: blood filled vascular spaces of variable size lined by a single epithelial layer
cavernous hemangioma
249
primary mechanism behind giant cell arteritis
cell mediated immunity
250
what endothelium secretes to inhibit platelet aggregation
prostacyclin (yin to thromboxane A2's yang)
251
reid index
mucous gland / everything but cartilage
252
esophagus: solid nests of squamous cells w/ abundant eosinophilic cytoplasm and distinct broders
squamous cell carcinoma
253
boy: tall, learning disability, small/firm testes, gynecomastia
klinefelters, 47 XXY
254
levels in klinefelters
low T, low inhibin | high LH, FSH, estradiol
255
cell surface-bound Ab crosslinking
IgE → type I HSR
256
risks for bladder cancer
smoking | occupational: rubber, dyes, textiles, leather
257
which vitamin def is like Friedreich ataxia
vit E
258
mechanism of AAA
transmural inflammation
259
injury to what nerve → loss of suprapubic sensation
iliohypogastric
260
pancytopenia, hepatosplenomegaly, huge macs
Gaucher dz (glucocerebroside accumulation)
261
first step of infective endocarditis
form sterile fibrin-platelet nidus on valves
262
what does enteropeptidase activate
trypsinogen → trypsin
263
upper extremity: loss of pain/temp, LMN lower: UMN scoliosis
syringomyelia
264
description of bone in osteoporosis
trabecular thinning
265
description of bone in pagets
lamellar bone resembling mosaic
266
histo/path of HIV-associated dementia
inflammatory activation of microglial cells → microglial nodules around small areas of necrosis may fuse to form multinucleated giant cells
267
temporal lobe expansion →
transtentorial uncal herniation
268
uncal herniation eyes
CN III is there oculomotor nerve palse fixed dilated pupil
269
what kind of a receptor is HER2?
tyrosine kinase
270
alcohol induced hepatic steatosis path
decrease in free fatty acid oxidation
271
for how long is the heart normal after an MI
4 hrs
272
why are spleens hurt in sickle cell?
repetitive infarctions from microvessel occlusion → fibrosis, brown → autosplenectomy
273
lipoprotein lipase/ApoC-II defect →
acute pancreatitis | hepatosplenomegaly
274
LDL receptor/ApoB-100 defect →
coronary artery dz | xanthelasmas
275
ApoE defect →
coronary artery dz
276
nerve involved in temporomandibular disorder
mandibular branch of CN V | → jaw pain and ear problems
277
problems with fructose metabolism
fructokinase def → benign → fructose in urine | aldolase B def → shows when they start to eat → FtT, jaundice, hepatomegaly
278
cancers (and gene) in Li Fraumeni
``` sarcomas breast cancer brain tumors adrenocortical carcinoma leukemia (TP53) ```
279
how to avoid neonatal tetanus
vaccination of preggers
280
fever, limping, passive motion ok
hematogenous osteomyelitis (MC in children, boys)
281
where in the bone is osteomyelitis
``` metaphysis of long bones (kids) vertebral bodies (adults) ```
282
MC causes of osteomyelitis in sickle cell pts
salmonella staph aureus e coli
283
vaccines: live-attenuated vs inactivated
live-attenuated → cell mediated immune response | inactivated → humoral response
284
flu vaccine is response against...
hemagglutinin (prevents binding)
285
what gets clamped in a pringle maneuver
hepatoduodenal ligament (common bile duct, hepatic artery, portal vein)
286
when do you get adult Hb?
get more and more in first 6 months | @ birth HbF = 60-80%
287
hepatotox from inhaled anesthetics (halothane) does what to the liver?
looks like acute viral hep - looks shrunken elevated aminotransferases prolonged PT
288
GI bugs → reactive arthritis
``` salmonella shigella yersinia campylobacter c diff ```
289
reactive arthritis pathophys
deposition of immune complexes -- no bacteria! | a/w HLA-B27
290
things that lead to a low Vd
high molecular weight high protein binding high charge hydrophilic
291
what do brain mets look like grossly
multiple, well circumscribed masses @ white-gray jxn
292
underlying cause of megaloblastosis
defect in DNA synthesis
293
MCC chronic pancreatitis
alcohol abuse
294
what does CREST stand for?
``` calcinosis raynaud esophageal dysmotility sclerodactyly telangiectasia ```
295
mechanism of esophageal dysmotility in CREST
atrophy and fibrous replacement of muscularis in esophagus
296
how to use alk phos and GGTP
alk phos is from many things so is GGTP (gamma-glutamyl transpeptidase), but its not in bone so both elevated is prob not from bone
297
fever, RUQ pain, leukocytosis
acute acalculous cholecystitis (usually in critically ill) | acute calculus cholecystitis
298
chronic cholecystitis gallbladder looks like
shrunken fibrosed gallbladder
299
black vs brown pigment stones
black: from intravascular hemolysis brown: from biliary infection
300
where do you see a change in minimal change disease
electron microscope (foot process effacement)
301
how do thin cap fibroatheromas come about
lots of macs secreting metalloproteinases | unstable → plaque rupture
302
why are reticulocytes blue w/ wright-giemsa stain?
no cell nucleus - has basophilic reticular network of residual RNA
303
why is elastin stretchy
extensive cross linking btwn elastin monomers, facilitated by lysyl oxidase (need copper)
304
injections to ovulate
1st menotropin → like FSH → triggers formation of dominant follicle
305
causes of diastolic heart failure
HTN, obesity, infiltrative d/os
306
ligament injured in nursemaid's elbow
annular (radial head subluxation)
307
hep A histo
spotty necrosis, ballooning degeneration, councilman bodies, mononuclear infiltrates
308
what does protein M do in strep pyogenes?
inhibits phagocytosis and complement activation | mediates bacterial adherence
309
conjugate vs polysaccharide vaccine (pneumococcus)
conjugate → B and T | polysaccharide → B (not great for infants)
310
where is iron absorbed?
duodenum and proximal jejunum
311
abdominal pain and facial swelling
C1 inhibitor deficiency
312
how can renal failure lead to bleeding problems?
uremic toxins accumulate in circulation toxins impair platelet aggregation/adhesion → qualitative platelet d/o everything normal but bleeding time
313
low erythroid elements with normal granulopoiesis and thrombopoiesis
pure red cell aplasia
314
things a/w pure red cell aplasia
thymoma lymphocytic leukemias parvo B19
315
DM, steatorrhea, chololithiasis, hypochlorhydria
somatostatinoma (panc)
316
hyperglycemia, anemia, necrolytic migratory erythema
glucagonoma
317
how does prostate cancer get to the vertebrae
prostatic venous plexus → vertebral venous plexus | most will go to lymph nodes tho
318
accentuated 2nd heart sound makes you think of
pulmonary arterial HTN
319
how does estrogen influence cholesterol
increases cholesterol by upregulating hepatic HMG-CoA reductase activity
320
kidney failure and all things Ca
kidney failure → decreased P excretion and decreased calcitriol synth → decreased Ca absorption in gut PTH goes way up, can → osteitis fibrosa
321
stomach lymph node
celiac
322
duodenum, jejunum lymph node
superior mesenteric
323
sigmoid node
inferior mesenteric
324
upper rectum nodes
pararectal
325
lower rectum (above pectinate line) nodes
internal iliac
326
lower rectum (below pectinate line) nodes
superficial inguinal
327
testes node
paraaortic node
328
scrotum node
superficial inguinal node
329
dementia + hallucinations
Lewy body dementia
330
dementia + personality changes
Picks
331
CD on all NK, binds IgG
CD16
332
CD inhibits C9 binding
CD55, CD59
333
CD endotox receptor on macs
CD14
334
HLA B27 -->
psoriatic arthritis ankylosing spondylitis inflammatory bowel (arthritis) reactive arthritis
335
HLA a/w type I DM
HLA DR3/4
336
whats the diff in fxn btwn TH1 and TH2
TH1: stim Tc cells and macs TH2: stim B cells to make Abs (also antiTH1/macs w/ IL-10)
337
what is costim for Th and Tc?
CD28 on T bind with B7 protein on APC
338
what is costim for Th2/B?
B7 on B bind CD28 on T → activate Th2 | CD40 on B bind CD40 ligand on T → activate B cell
339
no thymic shadow on CXR
DiGeorge | SCID
340
IgA def
selective IgA def | ataxia-telangiectasia (T cell too)
341
signs of ataxia-telangiectasia (besides ataxia and telangiectasia)
poor smooth pursuit of moving targets | elevated AFP
342
complications of ataxia-telangiectasia
radiation sensitivity | risk of lymphoma/leukemia
343
truncal eczema
Wiskott-Aldrich
344
low IgM, high IgA
Wiskott-Aldrich
345
mechanism for hyper-IgM syndrome
no CD40 on B-cells → no switching (AutoRec) | no CD40L on Th → no switching (X-linked, MC)
346
deficiency in CGD
NADPH oxidase (can't kill catalase + orgs)
347
partial albinism, recurrent resp/skin infections, neuro d/o
Chediak-Higashi
348
eczema, cold abscesses, coarse facial features
hyper-IgE syndrome (Job)
349
two rows of teeth
hyper-IgE syndrome (Job)
350
defect in leukocyte adhesion deficiency
abnormal integrins | phagocytes cant leave circulation
351
delayed umbilical cord falling off
LAD
352
X linked immunodeficiencies
``` WACH Wiskott-Aldrich Agammaglobulinemia CGD Hyper IgM ```
353
FTT, chronic diarrhea, recurrent infections
SCID
354
immunodeficiency w/ thrombocytopenia/purpura
Wiskott-Aldrich
355
large lysosomal vesicles in phagocytes
Chediak-Higashi
356
somatostatinoma →
less secretin, CCK, glucagon, insulin, gastrin | → DM, steatorrhea, gallstones
357
diseases of anterior horn
polio west nile ALS Werdnig-Hoffman
358
hypoglycemia, increased lactate, TGs, uric acid, hepatomegaly
Von Gierke (glucose-6-P def)
359
cardiomegaly, exercise intolerance
Pompe (lysosomal alpha-1,4-glucosidase)
360
normal lactate levels, hypoglycemia, hepatomegaly
Cori (alpha-1,6-glucosidase)
361
muscle cramps, myoglobinuria, arrhythmia
McArdle (myophosphorylase)
362
growth/mental retardation, seizures, fair skin, musty body odor
PKU
363
intellectual disability, tall, osteoporosis, kyphosis, subluxation of lens
homocystinuria
364
subluxation of the lens
marfan (upward) | homocystinuria (downward)
365
black urine, dark sclera, arthralgias
alkaptonuria
366
broca/wernicke aphasia (vessel affected)
middle cerebral artery
367
unilateral lower extremity sensory/motor loss (vessel)
anterior cerebral artery
368
unilateral sensory/motor loss in face and arm
middle cerebral artery
369
condition a/w berry aneurysms
Ehlers-Danlos PCKD (Marfan - not really tho)
370
agraphia, acalculia, R/L disorientation, finger agnosia
Gerstmann syndrome (dominant angular gyrus lesion in parietal lobe)
371
hemispatial neglect lesion
nondominant angular gyrus (parietal)
372
paralysis of upper gaze
Parinaud's syndrome (superior colliculus in brainstem)
373
striatum/internal capsule lesion (vessel)
lenticulostriate artery (MC: unmanaged HTN)
374
locked in syndrome (vessel)
basilar
375
hemianopia w/ macular sparing (vessel)
posterior cerebral artery
376
facial paralysis, decreased lacrimation
lateral pontine syndrome (facial nucleus is anterior inferior cerebellar artery)
377
dysphagia, hoarseness, decreased gag reflex
lateral medullary syndrome (nucleus ambiguus is posterior inferior cerebellar artery)
378
long tract lesion on one side, CN lesion on other
brain stem lesion
379
4 medial structures of brain stem
Motor (CST) Medial lemniscus (top of DCs) Medial longitudinal fasciculus Motor CNs
380
midline motor CN nuclei
III, IV, VI, XII
381
weak contra arm/leg
CST lesion deficit
382
lose vibe/prop/touch in contra arm/leg
medial lemniscus lesion deficit
383
ipsilateral internuclear opthalmoplegia
medial longitudinal fasciculus lesion deficit
384
4 lateral structures of brain stem
Spinocerebellar tract Spinothalamic tract Sensory (V) m Sympathetic
385
ipsilateral arm/leg ataxia
SCT lesion def
386
lose pain/temp in contra arm/leg
STT lesion def
387
ipsilateral pain/temp face
sensory CN V lesion def
388
ipsilateral Horner (ptosis, miosis, anhidrosis)
symp path lesion def
389
damage in Wallenberg syndrome
``` STT CNV nuc nuc ambiguus (X) symp usually vestibular nuc/inferior cerebellar peduncle too ```
390
lateral medulla vessel
PICA
391
aneurysm → basal ganglia or thalamus lesion
Charcot-Bouchard microaneurysm on lenticulostriate arteries
392
layers of LP
``` skin superficial fascia supraspinous lig interspinous lig ligamentum flavum epidural space dura mater (+subdural) arachnoid membrane subarachnoid space ```
393
temporal fracture →
epidural hematoma may herniate → CN III palsy (blown, down and out) may have lucid interval
394
rupture of bridging veins →
subdural hematoma
395
brain hematoma (circular/lens vs crescent)
circular: epidural crescent: subdural
396
areas must susceptible to ischemia in the brain
cerebellum neocortex hippocampus watershed (btwn ACA/MCA, btwn MCA/PCA)
397
soap bubble bone appearance
osteoclastoma
398
MC hip dislocation
posterior (MVA)
399
terrible triad
ACL, MCL, meniscus
400
tenderness in anatomical snuffbox
scaphoid frx
401
anterior knee bursa
prepatellar (housemaid) | infrapatellar (clergyman)
402
joint pain after prolonged use
OA
403
when do you use N-acetylcysteine?
acetaminophen overdose mucolytic (CF) prevent contrast nephropathy
404
joint pain with morning stiffness
RA
405
which arthritis has eburnation
OA
406
psoriatic arthritis
inflammatory a/w psoriasis asymmetric affects DIP sausage fingers
407
extra-skeletal ankylosing spondylitis sx
uveitis | CV (aortic regurg, conduction anomalies)
408
kinds of juvenile idiopathic arthritis
polyarticular (dactylitis) pauciarticular (large jnts) systemic-onset (Still's dz)
409
MC septic arthritis
staph aureus streptococcus neisseria
410
pencil in cup deformity
psoriatic arthritis
411
painless oral ulcers
SLE
412
false positive VDRL
anti-phospholipid | SLE
413
ANA (+)
``` SLE Sjogren scleroderma polymyositis/dermatomyositis RA JRA (JIA) mixed CT dz ```
414
diffuse scleroderma Abs
anti-DNA topoisomerase I Abs (anti-Scl-70)
415
CREST
``` Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangiectasia ```
416
CREST vs diffuse scleroderma
CREST is less: limited skin involvement, less visceral, progress more slowly, anti-centromere Abs
417
dry eyes, dry mouth (dysphagia), arthritis
sjogrens
418
cancer a/w Sjogrens
B cell lymphoma
419
duchenne vs becker
duchenne worse and earlier (
420
pain/stiffness in shoulders/hips, malaise, weight loss, fever
polymyalgia rheumatica
421
polymyalgia rheumatica muscle involvement
no muscle weakness | normal CK
422
proximal vs distal muscle weakness
proximal → muscle dz | distal → neuro dz
423
polymyositis mech
CD8 injury and inflammation of muscle
424
skin things in dermatomyositis
``` malar heliotrope (eyelids) Gottron's papules (knuckles/knees) shawl sign V sign mechanics hands/feet ```
425
MCC death in SLE
lupus nephritis/nephropathy
426
layers of epidermis
``` come, lets get sun burnt corneum lucidium granulosum spinosum basale ```
427
protein types in tight junctions (zonula occludens)
claudins | occludens
428
protein types in intermediate junctions (zonula adherens)
cadherins
429
protein types in desmosomes (macula adherens)
desmoglein
430
protein types in hemidesmosomes
integrins
431
what do fibroblasts make
collagen glycosaminoglycans (GAGs) reticular and elastic fibers glycoproteins
432
where are melanocytes?
``` stratum basale (bottom layer of epidermis) from neural crest ```
433
itch that rashes
eczema
434
pruritis linear rash
poison ivy (type IV)
435
silvery scales
psoriasis
436
parakeratosis
psoriasis (nuc in corneum)
437
pruritis a/w asthma
eczema (atopic dermatitis, type I HSR)
438
MCCs cellulitis
staph aureus | strep pyogenes
439
scalded skin syndrome pathophys
s. aureus exotoxin A/B → destroy keratinocyte attachments in stratum granulosum
440
what Ig is in dermatitis herpetiformis
IgA
441
SJS vs TEN
toxic epidermal necrolysis is > 30% of the skin
442
drugs causing SJS
seizure meds sulfa drugs penicillins allopurinol
443
disease a/w lichen planus
hep C
444
conditions a/w erythema nodosum
``` sarcoidosis histoplasmosis coccidioidomycosis TB leprosy strep pyogenes ```
445
herald patch + christmas tree pattern
pityriasis rosea
446
MC skin cancers
basal > squamous > melanoma | malignant-ness is reversed
447
keratin pearls
squamous cell carcinoma
448
rolled edges, pearly, telangiectasias
basal cell carcinoma
449
collagen in mature scars
type I
450
peripheral neuropathy, heart failure
wet beriberi (thiamine deficiency)
451
why does CK go up with muscle injury
apoptosis: CK from inside cell goes into circulation
452
when do you see fat necrosis?
acute pancreatitis
453
differential clubbing and cyanosis
patent PDA → Eisenmenger synd
454
what is transthyretin
protein made in liver carries thyroxine and retinol mutation → misfolding → infiltrative CM
455
what receptors does NE affect
alpha > B1
456
what murmur do you get with bicuspid aortic valve?
same as AS: crescendo/decrescendo systolic
457
sperm sequence
``` spermatogonium (2N) 1/1 spermatocyte (2N) 2/2 spermatocyte (1N) spermatid spermatozoon ```
458
kid can't smell, amenorrhea
Kallmann syndrome (no GnRH → no FSH, LH)
459
male: hypogonadism, learning disability, gynecomastia, tall
Klinefelters
460
injury in straddle injury
bulbous urethral segment
461
epididymitis vs torsion
torsion is higher up, epididymitis gets better if you lift it up
462
girl, 2/2 sex, amenorrhea, short vagina, rudimentary uterus
Muellerian aplasia (Mayer-Rokitansky-kuster-hauser synd)
463
2/2 female sex characteristics, XY, no uterus/ovaries
androgen insensitivity
464
unilateral, bloody nipple discharge
intraductal papilloma
465
ovarian tumor: increased AFP
endodermal sinus (yolk sac) tumor
466
ovarian tumor: increased androgens
sertoli-leydig tumor
467
ovarian tumor: increased E/inhibin
granulosa cell tumor
468
ovarian tumor: increased beta-HCG, LDH
dysgerminoma
469
ovarian tumor: increased CA-125
epithelial tumors (serous/mucinous)
470
breast mass: single file cells
lobular breast tissue
471
short, hypotonia, intellectual disability, obesity
prader willi
472
episodic peripheral neuropathy, angiokeratomas, hypohydrosis
Fabry (alpha-galactosidase A def)
473
progressive neurodegeneration, hepatosplenomegaly, cherry red spot, foam cells
Niemann-Pick (sphingomyelinase def)
474
progressive neurodegeneration, cherry red spot on macula, NO hepatosplenomegaly
Tay-Sachs (hexosaminidase A)
475
peripheral neuropathy, developmental delay, optic atrophy, globoid cells
Krabbe dz (galactocerebrosidase def)
476
central/peripheral demyelination, ataxia, dementia
metachromatic leukodystrophy (arylsulfatase A)
477
developmental delay, gargoylism, corneal clouding, hepatosplenimegaly
Hurler synd (alpha-L-iduronidase def)
478
diff btwn Hurler and Hunter
Hunter isn't as bad and no corneal deposits (Hunter = iduronate sulfatase def)
479
Brisk, painless lower gi bleeding
Meckel
480
What kind of thing crosses placenta
Lipophilic
481
Tumor → Parinaud
pineal

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