UWorld Journal: Final 2 weeks Flashcards
Hep B serum marker for increased infectivity
HBeAg
Cheyne-Stokes breathing
apnea followed by gradually increasing then decreasing tidal volumes
see in CHF
what is in amniotic fluid with NTDs
AFP
acetylcholinesterase
condition from abnormal apoptosis en utero
duodenal atresia
vessels damaged in hip fracture → osteonecrosis of femoral head
medial femoral circumflex artery
mechanism of urge incontinence
overactive bladder
detrusor instability
diff btwn EBV and CMV mono
EBV has (+) monospot test (tests for anti-heterophil Abs)
when can you get a fat embolism
fractured bone
amputation
stroke w/ nothing on CT
ischemic (think lacunar), not hemorrhagic
determining factor in cyanosis in tetralogy of fallot
right ventricular outflow tract obstruction
what kind of channel is the CFTR channel in CF?
ATP-gated Cl channel
who’s at risk for first dose hTN with ACE inhibitors
pts w/ volume depletion (diuretics)
pts w/ CHF
ALL is precursor or mature T/B cells?
precursor
things that can trigger prinzmetal angina
smoking
cocaine/amphetamines
dihydroergotamine/triptans
when can you get Dressler synd?
1 wk to 1 month post MI
chest pain exacerbated by swallowing
pericarditis
mechanism of pericarditis 2-4 days most MI
inflammatory rxn to cardiac muscle necrosis
normal aging changes in heart
decreased LV chamber size (apex to base)
sigmoid-shaped septum
myocardial atrophy w/ more collagen
accumulation of lipofuscin pigment in cardiomyocytes
thyroid: branching papillary structures w/ concentric calcifications
papillary thyroid cancer
thyroid: diffuse lymphocytic infiltration w/ formation of germinal centers
Hashimoto’s thyroiditis
thyroid: lymphocytic infiltrate w/ macs and multi-nuc giant cells
subacute granulomatous (de Quervain) thyroiditis
painful thyroid enlargement after viral illness
subacute granulomatous (de Quervain) thyroiditis
fibrous dysplasia of bone
endocrine abnormalities
cafe-au-lait spots
McCune-Albright syndrome
tumors of tuberous sclerosis
angiomyolipomas subependymal hamartomas of the brain cardiac rhabdomyomas facial angiofibromas (+ ash-leaf patches)
mechanism of overflow incontinence
impaired detrusor contractility
bladder outlet obstruction
thyroid: nests/sheets of polygonal or spindle shaped cells w/ extracellular amyloid deposits
medullary thyroid cancer
unilateral hearing loss and tinnitus
recurrent vertigo
Meniere disease
Meniere disease pathophys
increased volume and pressure of endolymph in vestibular apparatus
best protection against influenza A
antibodies against hemagglutinin
what do you cut through for a crichothyrotomy
skin
superficial cervical fascia
investing and pretracheal layers of the deep cervical fascia
cricothyroid membrane
what regulates TRH?
T3
signs of hyperaldosteronism
HTN
hK
metabolic alkalosis
depressed renin
subcutaneous bumps on achilles tendons
xanthomas (hyperlipidemia)
when do you see Dohle bodies
leukemoid rxn
toxic systemic illness
tx for organophosphate poisoning
pralidoxime (both muscarinic and nicotinic effects)
atropine (muscarinic only)
PCP mechanism
NMDA receptor antagonist
stroke after DVT
paradoxical embolism (w/ patent foramen ovale, ASDs, VSDs, pulm AV malformations)
fixed split S2
ASD
proximal muscles in Duchenne
early: hypertrophy of calves
late: muscle fibers replaced by fat and CT (pseudohypertrophy)
spinal levels a/w cauda equina syndrome
S2 - S4
different forms of aspergillosis infection
opportunistic/invasive: immunocomp
colonizing: aspergilloma in TB cavities
hypersensitivity/allergic: asthma pts
cells/cytokines in granuloma formation
TH1s make IL-2 and IFN-gamma → TH1 proliferation and mac activation
lucid interval followed by loss of consciousness
epidural hematoma
CSF of aseptic meningitis
lymphocytic pleocytosis
modestly elevated protein
normal glucose
prolonged QT and neurosensory deafness
Jervell and Lange Nielsen syndrome
whats in Thayer-Martin medium
vancomycin
colistin (polymyxin)
nystatin
trimethoprim
hTN, pulsus paradoxus, JVD
cardiac tamponade
properties of drugs processed by the liver
lipophilic
non-fusion of urethral folds in males →
hypospadias
malunion of the labioscrotal folds →
bifid scrotum
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
meconium ileus associated d/o
CF
when do you use continuous vs pulsatile GnRH
continuous: prostate cancer, endometriosis, precocious puberty, premeno breast cancer
pulsatile: infertility
D-xylose tests for…
pancreatic vs intestinal malabsorption
what does sorbitol usually become?
fructose
which ligament contains the ovarian artery?
suspensory ligament of the ovary (infundibulopelvic ligament)
what is ligated to prevent heavy bleeding in an oophorectomy?
suspensory ligament of the ovary (infundibulopelvic ligament)
dyspnea, hypoxemia, hypocapnia
alveolar hyperventilation (from V/Q mismatch: pneumonia or PE)
alveolar hyperventilation mechanism
pneumonia/PE → V/Q mismatch → hypoxemia → chemoreceptors increase respiratory drive → hypocapnia (but still hypoxemia since it can’t absorb more O2)
how do beta blockers help in glaucoma?
decrease secretion of aqueous humor by ciliary epithelium (same place as acetazolamide
mechanism of bicornate uterus
failed lateral fusion of paramesonephric ducts
mechanism of longitudinal uterine septum
involution of paramesonephric ducts
nerve for external hemorrhoids (below dentate line)
inferior rectal nerve (from pudendal nerve)
non neoplastic polyps (colon)
hyperplastic
hamartomatous
inflammatory
mucosal/submucosal
hypoketotic hypoglycemia after fasting
impaired beta-oxidation of fatty acids (impaired glycogenolysis would still make ketones)
MC def: Acyl-CoA dehydrogenase
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
bioavailability equation
(area under the curve oral x dose IV) / (area under the curve IV x dose oral)
which blood gas levels are maintained in peak exercise?
arterial O2, pH and CO2
mixed venous CO2 goes up
which bacteria have IgA protease
staph aureus?
strep pneumo
neisseria
H flu
pathogenesis of osler nodes vs janeway lesions
osler: immune complex deposition (painful)
janeway: septic embolization (painless)
mediators of angiogenesis
VEGF (vascular endothelial GF)
FGF (fibroblast GF)
which BPH drug actually affects size of prostate
5-alpha-reductase inhibitors (finasteride)
MCC febrile seizures
roseola (HHV-6)
sx of congenital hydrocephalus
macrocephaly
bulging fontanelle
developmental delay
spasticity and hyperreflexia
mechanism of spasticity in congenital hydrocephalus
enlarged ventricles → stretch periventricular pyramidal tracts
vitiligo mechanism
loss of epidermal melanocytes
what influences potency in anesthetics?
MAC (not solubility)
what influences onset of action in anesthetics?
solubility (not MAC)
what acidifies urine
ammonium
what kind of cardio problems does doxorubicin et al lead to?
swelling of sarcoplasmic reticulum (early)
loss of cardiomyocytes
dilated CM
normal PaO2, % saturation, low O2 content
anemia (less Hgb)
UC colon cancer vs typical colon cancer
arise from non-polypoid dysplastic lesions
multi-focal
develop early p53 and late APC mutations
higher grade
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
causes of reduced lung compliance
CHF (L)
pulmonary fibrosis
insufficient surfactant
platelet count in von willebrand
normal
granulosa cell tumor description
call-exner bodies (rosette) coffee bean nuclei secrete estrogen yellow (lipid content) usually unilateral
what is a hamartoma made up of
disorganized cartilage, fibrous and adipose tissue
renal problem a/w sickle cell
renal papillary necrosis
sickle cell → renal problems mechanism
sickled cells obstruct vessels → ischemia
robertsonian translocation
t(14; 21)
a/w arsenic, thorotrast and polyniyl chloride
hepatic angiosarcoma
complication of scaphoid fracture
avascular necrosis
MC deficiency of urea cycle (→ hyperammonemia)
ornithine transcarbamylase
lungs: columnar cells that line alveolar septa w/o stromal invasion
adenocarcinoma in situ
hamartoma in lungs description
coin lesions
excess estrogen in cirrhosis →
gynecomastia
testicular atrophy
decreased body hair
spider angiomata
clearance of stuff in lungs: mechanism by size
10-15: upper resp
2.5-10: mucociliary in trachea/bronchi
vitamins to give to breastfeeding newborns
D (prevent rickets)
K (prevent hemorrhagic dz)
what lets TB live in macs
sulfatides (inhibit fusion of lysosomes to phagosomes)
what lets TB inactivate neuts, damage mitochondria and release TNF
cord factor
JAK2 vs JAK-STAT
JAK2 = cytoplasmic (polycythemia) JAK-STAT = receptor (insulin)
prooximal tubular cell ballooning and vacuolar degeneration
acute tubular necrosis
acute tubular necrosis + oxalate crystals
ethylene glycol poisoning
kidney problems in BPH
urinary retention → hydronephrosis → atrophic/scarred parenchyma
dystonia vs myoclonus
dystonia: sustained involuntary contraction (eg torticollis)
myoclonus: sudden, brief contraction
myasthenia gravis vs Lambert Eaton (sx)
MG: eyes first, weakness gets worse in day
LE: proximal muscles, weakness gets better in day (+CANCER)
myasthenia gravis vs Lambert Eaton (mech)
MG: Abs against Ach receptors
LE: Abs against pre-synaptic Ca channels
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
FF equation
GFR/RPF
RPF equation
RBF x (1 - hematocrit)
hepatitis with high mortality in preggers
hep E (naked, single-stranded RNA; fecal oral)
complications of psoriasis
psoriatic arthritis (up risk w/ HLA-B27)
nail pitting, discoloration
uveitis/conjunctivitis
which sx of pericarditis are chronic vs acute
chronic: Kussmaul, pericardial knock
acute: friction rub
sx of serotonin syndrome
confusion agitation tremor tachycardia HTN clonus hyperreflexia hyperthermia diaphoresis
large eosinophilic casts
Bence-Jones proteins (multiple myeloma)
MCC spontaneous lobar hemorrhage (especially in elderly)
cerebral amyloid angiopathy
where does fluid accumulate in a hydrocele?
tunica vaginalis (patent processus vaginalis)
where does blood accumulate in a varicocele?
pampiniform plexus
ion changes in nicotinic cells when Ach binds
influx of Na and Ca
outflux of K
how are fat and insulin resistance related
free fatty acids → impair insulin dependent glucose uptake and increase hepatic gluconeogenesis
how does puffer fish toxin cause problems
binds to Na channels
inhibits influx → no action potential conduction
(same as red tide dinoflagellates)
how does ciguatoxin cause problems? (from warm water fish/moray eel)
binds to Na channels
keeps them open → persistent depolarization
(same as frogs)
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
what is the diff between alpha helices and beta pleated sheets?
H bonds
where are the majority of anal fissures?
posterior midline
alcohols effects on glycemia
inhibits gluconeogenesis and fatty acid oxidation → hypoglycemia
what vessels are damaged in a subdural hematoma?
cortical bridging veins
what color are the thick/thin myofilaments on a sarcomere EM image?
light = thin dark = thick
hemosiderin-laden macs in pulmonary alveoli
chronic elevated pulm capillary hydrostatic P (left-sided heart failure)
what mutation causes maturity-onset diabetes of the young
glucokinase gene
what is maturity-onset diabetes of the young?
mild, non-progressive hyperglycemia that often worsens w/ pregnancy
pathophys of diabetic neuropathy
- non-enzymatic glycosylation of proteins → thicken/hyalinize artery walls → microangiopathy of endoneural arterioles → ischemia
- intracellular hyperglycemia → glucose → sorbitol/fructose → water follows → osmotic damage
what causes decerebrate posturing?
lesion to midbrain, pons (brainstem)
what causes decorticate posturing?
lesion to cerebral hemispheres
causes of impetigo
staph aureus (MC) strep pyogenes
abortion meds (+ MOAs)
misoprostol (PGE1 agonist)
mifepristone (progesterone antagonist, glucocorticoid antagonist)
methotrexate (folic acid antagonist)
anterior dislocation of the humerus →
flattening of the deltoid
acromion prominence
ant axillary fullness
injury to axillary nerve → loss of sense @ lateral shoulder
half life equation
(0. 7 x Vd) / CL
0. 7 x volume of distribution divided by clearance rate
first order kinetics (half lives → % eliminated)
0 → 0%
1 → 50
2 → 75
on and on and on
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)
paraneoplastics from squamous cell lung cancer
PTH-related prt → HCa
smoker + collapsed lung
obstruction of mainstem bronchus (central tumor) → alveolar collapse → trachea deviates toward affected side
what enzyme do fibrates inhibit
cholesterol 7-alpha-hydroxylase (make bile acids)
untreated obstructive sleep apnea →
pulmonary HTN and right heart failure
pt w/ UC/Crohn + shock
toxic megacolon (may be a/w C diff too) order an x ray
why is dubin johnson liver dark?
accumulates epi metabolites (dense pigments in lysosomes)
defect in dubin johnson
cant excrete bilirubin glucuronides across canalicular membrane
degeneration in ALS
anterior horn
lateral CSTs
motor nucs: V, IX, X, XII
atypical cells in EBV
activated CD8 cells
where do nosebleeds come from?
Kiesselbach’s plexus on nasal septum
why do you give fluid in hypovolemic shock?
increase end-diastolic sarcomere length → increase SV
onion-like concentric thickening of arteriole walls
hyperplastic arteriosclerosis (diastolic BPs > 120-130)
what hep B serum markers cross placenta in acute infection
viral load
HBeAg
types of nevi
junctional (@ dermis, not in)
compound (epi + dermis)
intradermal (only in dermis)
Rb actions
w/o P: active - prevents damaged cells from progressing
w/ P: inactive - lets damaged cells replicate
what is the sudan III test for
malabsorption (test stool for fat)
proximal muscle weakness, elevated CK, endomysial mononuclear inflammatory infiltrate
polymyositis
ca sensing receptors for PTH
G-protein coupled
vessels likely to be athersclerotic
aorta > coronary> carotid > iliac > circle of willis
golgi tendon vs muscle spindle
golgi tendon: monitors tension (drop something too heavy) muscle spindle (intrafusal muscle fibers): monitor stretch (DTRs)
high lipid bone marrow
aplastic anemia (pancytopenia + high EPO)
kidney: dilated calyces with overlying renal cortical scarring
vesicoureteral reflux
cell levels in SLE
pancytopenia (type II HSR)
dihydrofolate reductase inhibitors
trimethoprim (bacteria)
methotrexate (humans)
pyrimethamine (protozoa)
what cells are in watery diarrhea
(noninflammatory)
no leukocytes
no RBCs
what cells are in dysentery/inflammatory diarrhea
PMNs
+/- RBCs
what cells are in enteric fever? (typhi)
mononuclear leukocytes
ToF developmental problem
anterior and cephalad deviation of the infundibular septum
dysphagia, iron deficiency and shiny red tongue
Plummer Vinson syndrome
maintenance dose equation
Cpss x CL / [bioavailability fraction]
intellectual disability, gait or posture abnormality, eczema and a musty body odor
PKU
henoch-shonlein purpura features
GI (colicky)
kidneys (IgA)
skin
joints (migratory arthralgias)
components of preeclamsia
gestational HTN (>140, >90) proteinuria or signs of organ damage
MCC of unilateral fetal hydronephrosis
inadequate canalization of the uteropelvic junction
possible treatments for c diff
metronidazole
vancomycin
fidaxomicin
treatment for infertility in PCOS
clomiphene (estrogen receptor modulator prevents negative feedback inhibition)
neutrophils don’t turn blue on nitroblue tetrazolium testing
CGD
drugs that cause disulfiram rxn w/ alcohol
metronidazole
sulfas?
valvular fibrous plaques (R > L)
carcinoid syndrome
how does carcinoid syndrome → heart plaques
excessive serotonin → fibroblast growth → deposit in endocardium → tricuspid regurg
what is elevated in carcinoid syndrome?
serotonin
5-HIAA (serotonin metabolite: %-hydroxyindoleacetic acid)
ways to get down syndrome
meiotic nondisjunction
unbalanced translocation (Robertsonian)
mosaicism
enterocytes with clear/foamy cytoplasm
abetalipoproteinemia (can’t make apo-B → lipids can’t get into blood so they stay in intestinal epithelium)
excessive matrix metalloproteinase activity and myofibroblast accumulation
wound contracture (happens a lot on palms/soles/ant thorax)
wound dehiscence
rupturing of previously closed wound (from insufficient granulation/scar tissue)
see in abdominal wounds a lot
low cortisol post partum
Sheehan syndrome (hypopituitarism)
sheehan syndrome pathophys
preg → lots of E → adrenal hyperplasia (doesn’t change blood supply though)
peripartum hemorrhage → hypotension → ISCHEMIA
pathophys of mallory-weiss
lots of retching (drunks, bulimics) → rapid changes in intraabdominal/luminal pressure → longitudinal tears
hiatal hernias are a risk too
tremor when maintaining a certain posture, symmetrical upper extremity, may improve with EtOH
essential tremor
biggest RFs for coronary heart disease
noncoronary atherosclerosis
DM
chronic kidney dz
crypt abscesses vs crypt hyperplasia (causes)
abscesses = UC hyperplasia = celiacs
fever, facial edema, rash, eosinophilia
DRESS syndrome (drug rxn w/ eosinophilia and systemic sx)
viral meningitis CSF
normal glucose
elevated protein
lymphocytic predominance
bacterial meningitis CSF
low glucose
high protein
neutrophilic predominance
what reflects osteoblast activity
bone-specific alkaline phosphatase
muscle weakness overcome by repetitive stimulation
Lambert Eaton
Botulinum
what do you test with the slit lamp exam?
Kayser-Fleischer rings in Wilson dz
brain complication of ADPKD
berry aneurysms, subarachnoid hemorrhages, nuchal rigidity
hexagonal crystals in urine
cysteine stones
why do you get cysteine stones?
usually kids
AutoRec: cystinuria
prevent some AAs from being reabsorbed in PCTs
lymph nodes - benign vs malignant?
benign: polyclonal proliferation of lymphocytes
malignant: monoclonal
which coronary artery does the nodes?
right
ADEs of SERMs
hot flashes
venous thromboembolism
endometrial hyperplasia/carcinoma (tamoxifen)
dry vs wet age related macular degeneration
dry: gradual, from oxidative damage
wet: acute, from neovascularization (form VEGF)
when does calcification take place with normal Ca levels?
necrosis
beta adrenergic drugs
epi (B1) dopa (B1) dobutamine (B1 > B2) isoproterenol (B1, B2) terbutaline (B2)
MCC morbidity in rheumatic fever
pancarditis
which do you see in adults, ADPKD or ARPKD?
ADPKD
enzyme that carboxylates coag factors X, IX, VII, II
gamma-glutamyl carboxylase (and vit K)
shoulder pain, Horner syndrome, lung involvement
pancoast tumor
what should people with pyruvate dehydrogenase def eat?
only ketogenic amino acids (lysine, leucine, etc)
fetal Hb structure
alpha2, gamma 2
genetic mechanism of fragile X
increased number of CGG repeats on FMR1 gene → hypermethylation/inactivation of FMR1
substances that are freely filtered @ glomerulus and poorly reabsorbed
Cr
inulin
PAH
femoral artery/vein/nerve layout
vein = medial artery = middle nerve = lateral
dental bleeding and hemarthrosis
hemophila
concentrations in SIADH
low plasma Na
low plasma osm
concentrated urine
normal body fluid volume
which BPH tx grows hair
finasteride (5-alpha-reductase inhibitor)
how does desmopressin treat von Willebrand?
increase circulating factor VIII and endothelial secretion of vWF
where do you bx for Hirschsprung dz?
submucosa of narrow lumen of rectum (see if ganglia are missing)
congenital CMV eye thing
chorioretinitis
lymphoma w/ crazy high mitotic index?
Burkitt
what causes fistulas in crohn dz
transmural inflammation
what causes intestinal strictures in crohn dz
partial bowel obstruction
cerebellar tumors in kids
pilocytic astrocytomas
medulloblastomas (primitive neuroectodermal tumors)
why do you get hypercalcemia in sarcoidosis
activated macs make 1,25-dihydroxyvitamin D
how are cells adhered to the extracellular matrix?
intracellular actin
transmembrane integrins
fibronectin
collagen
things accumulated in cardiac cells during ischemia
Na and Ca (ATP pumps dont work)
→ swelling
clues that pack pain is malignant
occurrence at night
not relieved with rest/analgesics
systemic sx
blue-black spots on sclerae
alkaptonuria (homogentisic acid dehydrogenase def)
MC malignant hepatic lesion
mets
watery diarrhea, hK, achlorhydria
VIPomas
whats in the cells in renal clear cell carcinoma
high glycogen/lipid
ASD and VSD
Down syndrome (MC cardiac defect) complete AV septal defect
destruction of intrahepatic, interlobular bile ducts by granulomatous inflammation
primary biliary cirrhosis
G6PD inheritance
X linked recessive
hereditary spherocytosis inheritance
AutoDom
what stores/releases surfactant?
lamellar bodies of type II pneumocytes
hypoplasia or cerebellar vermis and cystic dilation of 4th ventricle w/ posterior fossa enlargement
Dandy-Walker malformation
gait ataxia, impaired joint/vibration sense, skeletal abnormalities
Friedreich ataxia
MCC death in Friedreich ataxia
hypertrophic cardiomyopathy
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
what measurement is off in hemophilia
PTT only
infection in septic abortion
staph aureus, gram negative bacilli
whos got cutis aplasia?
patau
moms that took methamizole for hyperthyroid
marker for hepatocellular carcinoma
AFP (not unique, just watch for spikes)
chronic liver disease has it elevated too
what is rasburicase and when do you give it?
urate oxidase approximation → metabolizes uric acid into more soluble things
use in tumor lysis syndrome
liver: blood filled vascular spaces of variable size lined by a single epithelial layer
cavernous hemangioma
primary mechanism behind giant cell arteritis
cell mediated immunity
what endothelium secretes to inhibit platelet aggregation
prostacyclin (yin to thromboxane A2’s yang)
reid index
mucous gland / everything but cartilage
esophagus: solid nests of squamous cells w/ abundant eosinophilic cytoplasm and distinct broders
squamous cell carcinoma
boy: tall, learning disability, small/firm testes, gynecomastia
klinefelters, 47 XXY
levels in klinefelters
low T, low inhibin
high LH, FSH, estradiol
cell surface-bound Ab crosslinking
IgE → type I HSR
risks for bladder cancer
smoking
occupational: rubber, dyes, textiles, leather
which vitamin def is like Friedreich ataxia
vit E
mechanism of AAA
transmural inflammation
injury to what nerve → loss of suprapubic sensation
iliohypogastric
pancytopenia, hepatosplenomegaly, huge macs
Gaucher dz (glucocerebroside accumulation)
first step of infective endocarditis
form sterile fibrin-platelet nidus on valves
what does enteropeptidase activate
trypsinogen → trypsin
upper extremity: loss of pain/temp, LMN
lower: UMN
scoliosis
syringomyelia
description of bone in osteoporosis
trabecular thinning
description of bone in pagets
lamellar bone resembling mosaic
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
temporal lobe expansion →
transtentorial uncal herniation
uncal herniation eyes
CN III is there
oculomotor nerve palse
fixed dilated pupil
what kind of a receptor is HER2?
tyrosine kinase
alcohol induced hepatic steatosis path
decrease in free fatty acid oxidation
for how long is the heart normal after an MI
4 hrs
why are spleens hurt in sickle cell?
repetitive infarctions from microvessel occlusion → fibrosis, brown → autosplenectomy
lipoprotein lipase/ApoC-II defect →
acute pancreatitis
hepatosplenomegaly
LDL receptor/ApoB-100 defect →
coronary artery dz
xanthelasmas
ApoE defect →
coronary artery dz
nerve involved in temporomandibular disorder
mandibular branch of CN V
→ jaw pain and ear problems
problems with fructose metabolism
fructokinase def → benign → fructose in urine
aldolase B def → shows when they start to eat → FtT, jaundice, hepatomegaly
cancers (and gene) in Li Fraumeni
sarcomas breast cancer brain tumors adrenocortical carcinoma leukemia (TP53)
how to avoid neonatal tetanus
vaccination of preggers
fever, limping, passive motion ok
hematogenous osteomyelitis (MC in children, boys)
where in the bone is osteomyelitis
metaphysis of long bones (kids) vertebral bodies (adults)
MC causes of osteomyelitis in sickle cell pts
salmonella
staph aureus
e coli
vaccines: live-attenuated vs inactivated
live-attenuated → cell mediated immune response
inactivated → humoral response
flu vaccine is response against…
hemagglutinin (prevents binding)
what gets clamped in a pringle maneuver
hepatoduodenal ligament (common bile duct, hepatic artery, portal vein)
when do you get adult Hb?
get more and more in first 6 months
@ birth HbF = 60-80%
hepatotox from inhaled anesthetics (halothane) does what to the liver?
looks like acute viral hep - looks shrunken
elevated aminotransferases
prolonged PT
GI bugs → reactive arthritis
salmonella shigella yersinia campylobacter c diff
reactive arthritis pathophys
deposition of immune complexes – no bacteria!
a/w HLA-B27
things that lead to a low Vd
high molecular weight
high protein binding
high charge
hydrophilic
what do brain mets look like grossly
multiple, well circumscribed masses @ white-gray jxn
underlying cause of megaloblastosis
defect in DNA synthesis
MCC chronic pancreatitis
alcohol abuse
what does CREST stand for?
calcinosis raynaud esophageal dysmotility sclerodactyly telangiectasia
mechanism of esophageal dysmotility in CREST
atrophy and fibrous replacement of muscularis in esophagus
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
fever, RUQ pain, leukocytosis
acute acalculous cholecystitis (usually in critically ill)
acute calculus cholecystitis
chronic cholecystitis gallbladder looks like
shrunken fibrosed gallbladder
black vs brown pigment stones
black: from intravascular hemolysis
brown: from biliary infection
where do you see a change in minimal change disease
electron microscope (foot process effacement)
how do thin cap fibroatheromas come about
lots of macs secreting metalloproteinases
unstable → plaque rupture
why are reticulocytes blue w/ wright-giemsa stain?
no cell nucleus - has basophilic reticular network of residual RNA
why is elastin stretchy
extensive cross linking btwn elastin monomers, facilitated by lysyl oxidase (need copper)
injections to ovulate
1st menotropin → like FSH → triggers formation of dominant follicle
causes of diastolic heart failure
HTN, obesity, infiltrative d/os
ligament injured in nursemaid’s elbow
annular (radial head subluxation)
hep A histo
spotty necrosis, ballooning degeneration, councilman bodies, mononuclear infiltrates
what does protein M do in strep pyogenes?
inhibits phagocytosis and complement activation
mediates bacterial adherence
conjugate vs polysaccharide vaccine (pneumococcus)
conjugate → B and T
polysaccharide → B (not great for infants)
where is iron absorbed?
duodenum and proximal jejunum
abdominal pain and facial swelling
C1 inhibitor deficiency
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
low erythroid elements with normal granulopoiesis and thrombopoiesis
pure red cell aplasia
things a/w pure red cell aplasia
thymoma
lymphocytic leukemias
parvo B19
DM, steatorrhea, chololithiasis, hypochlorhydria
somatostatinoma (panc)
hyperglycemia, anemia, necrolytic migratory erythema
glucagonoma
how does prostate cancer get to the vertebrae
prostatic venous plexus → vertebral venous plexus
most will go to lymph nodes tho
accentuated 2nd heart sound makes you think of
pulmonary arterial HTN
how does estrogen influence cholesterol
increases cholesterol by upregulating hepatic HMG-CoA reductase activity
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
stomach lymph node
celiac
duodenum, jejunum lymph node
superior mesenteric
sigmoid node
inferior mesenteric
upper rectum nodes
pararectal
lower rectum (above pectinate line) nodes
internal iliac
lower rectum (below pectinate line) nodes
superficial inguinal
testes node
paraaortic node
scrotum node
superficial inguinal node
dementia + hallucinations
Lewy body dementia
dementia + personality changes
Picks
CD on all NK, binds IgG
CD16
CD inhibits C9 binding
CD55, CD59
CD endotox receptor on macs
CD14
HLA B27 –>
psoriatic arthritis
ankylosing spondylitis
inflammatory bowel (arthritis)
reactive arthritis
HLA a/w type I DM
HLA DR3/4
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)
what is costim for Th and Tc?
CD28 on T bind with B7 protein on APC
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
no thymic shadow on CXR
DiGeorge
SCID
IgA def
selective IgA def
ataxia-telangiectasia (T cell too)
signs of ataxia-telangiectasia (besides ataxia and telangiectasia)
poor smooth pursuit of moving targets
elevated AFP
complications of ataxia-telangiectasia
radiation sensitivity
risk of lymphoma/leukemia
truncal eczema
Wiskott-Aldrich
low IgM, high IgA
Wiskott-Aldrich
mechanism for hyper-IgM syndrome
no CD40 on B-cells → no switching (AutoRec)
no CD40L on Th → no switching (X-linked, MC)
deficiency in CGD
NADPH oxidase (can’t kill catalase + orgs)
partial albinism, recurrent resp/skin infections, neuro d/o
Chediak-Higashi
eczema, cold abscesses, coarse facial features
hyper-IgE syndrome (Job)
two rows of teeth
hyper-IgE syndrome (Job)
defect in leukocyte adhesion deficiency
abnormal integrins
phagocytes cant leave circulation
delayed umbilical cord falling off
LAD
X linked immunodeficiencies
WACH Wiskott-Aldrich Agammaglobulinemia CGD Hyper IgM
FTT, chronic diarrhea, recurrent infections
SCID
immunodeficiency w/ thrombocytopenia/purpura
Wiskott-Aldrich
large lysosomal vesicles in phagocytes
Chediak-Higashi
somatostatinoma →
less secretin, CCK, glucagon, insulin, gastrin
→ DM, steatorrhea, gallstones
diseases of anterior horn
polio
west nile
ALS
Werdnig-Hoffman
hypoglycemia, increased lactate, TGs, uric acid, hepatomegaly
Von Gierke (glucose-6-P def)
cardiomegaly, exercise intolerance
Pompe (lysosomal alpha-1,4-glucosidase)
normal lactate levels, hypoglycemia, hepatomegaly
Cori (alpha-1,6-glucosidase)
muscle cramps, myoglobinuria, arrhythmia
McArdle (myophosphorylase)
growth/mental retardation, seizures, fair skin, musty body odor
PKU
intellectual disability, tall, osteoporosis, kyphosis, subluxation of lens
homocystinuria
subluxation of the lens
marfan (upward)
homocystinuria (downward)
black urine, dark sclera, arthralgias
alkaptonuria
broca/wernicke aphasia (vessel affected)
middle cerebral artery
unilateral lower extremity sensory/motor loss (vessel)
anterior cerebral artery
unilateral sensory/motor loss in face and arm
middle cerebral artery
condition a/w berry aneurysms
Ehlers-Danlos
PCKD
(Marfan - not really tho)
agraphia, acalculia, R/L disorientation, finger agnosia
Gerstmann syndrome (dominant angular gyrus lesion in parietal lobe)
hemispatial neglect lesion
nondominant angular gyrus (parietal)
paralysis of upper gaze
Parinaud’s syndrome (superior colliculus in brainstem)
striatum/internal capsule lesion (vessel)
lenticulostriate artery (MC: unmanaged HTN)
locked in syndrome (vessel)
basilar
hemianopia w/ macular sparing (vessel)
posterior cerebral artery
facial paralysis, decreased lacrimation
lateral pontine syndrome (facial nucleus is anterior inferior cerebellar artery)
dysphagia, hoarseness, decreased gag reflex
lateral medullary syndrome (nucleus ambiguus is posterior inferior cerebellar artery)
long tract lesion on one side, CN lesion on other
brain stem lesion
4 medial structures of brain stem
Motor (CST)
Medial lemniscus (top of DCs)
Medial longitudinal fasciculus
Motor CNs
midline motor CN nuclei
III, IV, VI, XII
weak contra arm/leg
CST lesion deficit
lose vibe/prop/touch in contra arm/leg
medial lemniscus lesion deficit
ipsilateral internuclear opthalmoplegia
medial longitudinal fasciculus lesion deficit
4 lateral structures of brain stem
Spinocerebellar tract
Spinothalamic tract
Sensory (V) m
Sympathetic
ipsilateral arm/leg ataxia
SCT lesion def
lose pain/temp in contra arm/leg
STT lesion def
ipsilateral pain/temp face
sensory CN V lesion def
ipsilateral Horner (ptosis, miosis, anhidrosis)
symp path lesion def
damage in Wallenberg syndrome
STT CNV nuc nuc ambiguus (X) symp usually vestibular nuc/inferior cerebellar peduncle too
lateral medulla vessel
PICA
aneurysm → basal ganglia or thalamus lesion
Charcot-Bouchard microaneurysm on lenticulostriate arteries
layers of LP
skin superficial fascia supraspinous lig interspinous lig ligamentum flavum epidural space dura mater (+subdural) arachnoid membrane subarachnoid space
temporal fracture →
epidural hematoma
may herniate → CN III palsy (blown, down and out)
may have lucid interval
rupture of bridging veins →
subdural hematoma
brain hematoma (circular/lens vs crescent)
circular: epidural
crescent: subdural
areas must susceptible to ischemia in the brain
cerebellum
neocortex
hippocampus
watershed (btwn ACA/MCA, btwn MCA/PCA)
soap bubble bone appearance
osteoclastoma
MC hip dislocation
posterior (MVA)
terrible triad
ACL, MCL, meniscus
tenderness in anatomical snuffbox
scaphoid frx
anterior knee bursa
prepatellar (housemaid)
infrapatellar (clergyman)
joint pain after prolonged use
OA
when do you use N-acetylcysteine?
acetaminophen overdose
mucolytic (CF)
prevent contrast nephropathy
joint pain with morning stiffness
RA
which arthritis has eburnation
OA
psoriatic arthritis
inflammatory a/w psoriasis
asymmetric
affects DIP
sausage fingers
extra-skeletal ankylosing spondylitis sx
uveitis
CV (aortic regurg, conduction anomalies)
kinds of juvenile idiopathic arthritis
polyarticular (dactylitis)
pauciarticular (large jnts)
systemic-onset (Still’s dz)
MC septic arthritis
staph aureus
streptococcus
neisseria
pencil in cup deformity
psoriatic arthritis
painless oral ulcers
SLE
false positive VDRL
anti-phospholipid
SLE
ANA (+)
SLE Sjogren scleroderma polymyositis/dermatomyositis RA JRA (JIA) mixed CT dz
diffuse scleroderma Abs
anti-DNA topoisomerase I Abs (anti-Scl-70)
CREST
Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangiectasia
CREST vs diffuse scleroderma
CREST is less: limited skin involvement, less visceral, progress more slowly, anti-centromere Abs
dry eyes, dry mouth (dysphagia), arthritis
sjogrens
cancer a/w Sjogrens
B cell lymphoma
duchenne vs becker
duchenne worse and earlier (
pain/stiffness in shoulders/hips, malaise, weight loss, fever
polymyalgia rheumatica
polymyalgia rheumatica muscle involvement
no muscle weakness
normal CK
proximal vs distal muscle weakness
proximal → muscle dz
distal → neuro dz
polymyositis mech
CD8 injury and inflammation of muscle
skin things in dermatomyositis
malar heliotrope (eyelids) Gottron's papules (knuckles/knees) shawl sign V sign mechanics hands/feet
MCC death in SLE
lupus nephritis/nephropathy
layers of epidermis
come, lets get sun burnt corneum lucidium granulosum spinosum basale
protein types in tight junctions (zonula occludens)
claudins
occludens
protein types in intermediate junctions (zonula adherens)
cadherins
protein types in desmosomes (macula adherens)
desmoglein
protein types in hemidesmosomes
integrins
what do fibroblasts make
collagen
glycosaminoglycans (GAGs)
reticular and elastic fibers
glycoproteins
where are melanocytes?
stratum basale (bottom layer of epidermis) from neural crest
itch that rashes
eczema
pruritis linear rash
poison ivy (type IV)
silvery scales
psoriasis
parakeratosis
psoriasis (nuc in corneum)
pruritis a/w asthma
eczema (atopic dermatitis, type I HSR)
MCCs cellulitis
staph aureus
strep pyogenes
scalded skin syndrome pathophys
s. aureus exotoxin A/B → destroy keratinocyte attachments in stratum granulosum
what Ig is in dermatitis herpetiformis
IgA
SJS vs TEN
toxic epidermal necrolysis is > 30% of the skin
drugs causing SJS
seizure meds
sulfa drugs
penicillins
allopurinol
disease a/w lichen planus
hep C
conditions a/w erythema nodosum
sarcoidosis histoplasmosis coccidioidomycosis TB leprosy strep pyogenes
herald patch + christmas tree pattern
pityriasis rosea
MC skin cancers
basal > squamous > melanoma
malignant-ness is reversed
keratin pearls
squamous cell carcinoma
rolled edges, pearly, telangiectasias
basal cell carcinoma
collagen in mature scars
type I
peripheral neuropathy, heart failure
wet beriberi (thiamine deficiency)
why does CK go up with muscle injury
apoptosis: CK from inside cell goes into circulation
when do you see fat necrosis?
acute pancreatitis
differential clubbing and cyanosis
patent PDA → Eisenmenger synd
what is transthyretin
protein made in liver
carries thyroxine and retinol
mutation → misfolding → infiltrative CM
what receptors does NE affect
alpha > B1
what murmur do you get with bicuspid aortic valve?
same as AS: crescendo/decrescendo systolic
sperm sequence
spermatogonium (2N) 1/1 spermatocyte (2N) 2/2 spermatocyte (1N) spermatid spermatozoon
kid can’t smell, amenorrhea
Kallmann syndrome (no GnRH → no FSH, LH)
male: hypogonadism, learning disability, gynecomastia, tall
Klinefelters
injury in straddle injury
bulbous urethral segment
epididymitis vs torsion
torsion is higher up, epididymitis gets better if you lift it up
girl, 2/2 sex, amenorrhea, short vagina, rudimentary uterus
Muellerian aplasia (Mayer-Rokitansky-kuster-hauser synd)
2/2 female sex characteristics, XY, no uterus/ovaries
androgen insensitivity
unilateral, bloody nipple discharge
intraductal papilloma
ovarian tumor: increased AFP
endodermal sinus (yolk sac) tumor
ovarian tumor: increased androgens
sertoli-leydig tumor
ovarian tumor: increased E/inhibin
granulosa cell tumor
ovarian tumor: increased beta-HCG, LDH
dysgerminoma
ovarian tumor: increased CA-125
epithelial tumors (serous/mucinous)
breast mass: single file cells
lobular breast tissue
short, hypotonia, intellectual disability, obesity
prader willi
episodic peripheral neuropathy, angiokeratomas, hypohydrosis
Fabry (alpha-galactosidase A def)
progressive neurodegeneration, hepatosplenomegaly, cherry red spot, foam cells
Niemann-Pick (sphingomyelinase def)
progressive neurodegeneration, cherry red spot on macula, NO hepatosplenomegaly
Tay-Sachs (hexosaminidase A)
peripheral neuropathy, developmental delay, optic atrophy, globoid cells
Krabbe dz (galactocerebrosidase def)
central/peripheral demyelination, ataxia, dementia
metachromatic leukodystrophy (arylsulfatase A)
developmental delay, gargoylism, corneal clouding, hepatosplenimegaly
Hurler synd (alpha-L-iduronidase def)
diff btwn Hurler and Hunter
Hunter isn’t as bad and no corneal deposits (Hunter = iduronate sulfatase def)
Brisk, painless lower gi bleeding
Meckel
What kind of thing crosses placenta
Lipophilic
Tumor → Parinaud
pineal
