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U world journal > Uworld journal part 2 > Flashcards

Uworld journal part 2 Flashcards

1
Q

how does diptheria get its toxin

A

phage conversion

most AB toxins are aquired this way

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2
Q

amphotericin B toxicity

A

Severs hypokalemia and hypomagnezemia can result due to severe renal damage

moniter serum K+ and Mg2+

used after an infection for mucormicosis

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3
Q

PPAR Gamma

A

intracellular nuclear receptor that TZDs agonize the most important target is adiponectin

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4
Q

C. Teteni toxin directly effects the release of what neuro transmitter

A

GABA or glycine

NOT Ach thats botchulism

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5
Q

progressive spastic paresis and choreoathoid movements

lab: high arginine levels

A

Arginase deficency

makes urea and ornithine from arginine

low protein diet that is devoid of arginine

can look like cerebral palsy

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6
Q

part of long bone that osteomylites effects

A

the metaphasis because of the slow flowing sinusoidal vasculature

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7
Q

manifestation of parvo virus in adults

A

acute arthropathy that resolves on its own

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8
Q

what is close to the inferior thyroid artery

A

the recurrent laryengial nerve

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9
Q

derivitive for the R cardinal vein

A

SVC

sandwhiched between the acending aorta and R pulmonary artery

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10
Q

what is formed when a patient gets the diptheria vacciene

A

IgG circulating antibodys

protects people from when the toxin is released into their body

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11
Q

artery most likely to be affected by a midshaft humerous fracture

A

deep brachial artery

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12
Q

what does cortisol act on to induce the production of epinephrine from NE

A

phenylethanolamine-N-methyltransferase (PNMT)

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13
Q

what do people with homocystineurea need to be supplemented with

A

vitamin B6

because they have a deficency in cystethione beta-synthase

present with marfanoid habitis, clotting issues, and mental retardation

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14
Q

myoclonic seziures

A

no loss of consiousness, Brief jerking movments

treat with valproid acid

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15
Q

what pharmacotherapy for PTSD

A

SSRI or another anti depressant

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16
Q

what will you find with autonaumic neuropathy resulting in urinary incontanance

A

increase post void residual volume

this is also called overflow incontance

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17
Q

phenoxybenzamine

A

alpha 1 antagonist

used to pretreat before removal of a pheochromocytoma

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18
Q

how does HBV cause cancer

A

integration of viral DNA into the host genome

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19
Q

side effect of mannatol and other osmotic diuretics

A

flash pulmonary edema

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20
Q

thickened renal arterials that stain pink with hematoxylin eosin

A

think non-malignany hypertension or diabetes mettitus

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21
Q

what is a plausable way to decrease the ereythrocyte precurser apoptosis seen with folate deficency

A

supplement with thymidine (neucleiec acid) so that there would be some dTMP

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22
Q

aromatase deficency

A

results in maternal virulization during pregnancy and ambiguus genitalia for the XX neonate

the neonate will have an increased androgen level

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23
Q

proof reading

A

3’==> 5’

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24
Q

fidaxomicin

A

macrocyclic antibiotic (related to macrolides)

use for recurrent c-diff infections

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25
Q

are concentrations of angiotensin 2 higher in the pulmonary veins of the pulmonary arteries

A

veins

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26
Q

during a check up what should be tested in patients taking SGA (olanazpine)

A

a lipid panel and a fasting gluconse

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27
Q

side effect of methylphenidate

A

used for ADHD

Decreased appitite and weight loss

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28
Q

c-myc

A

implicated in cell proliferation

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29
Q

proteosome inhibitors cause what

A

apoptosis

used in multiple myloma

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30
Q

why dot you want to give TCAs or venlafaxine to someone with bipolar 1

A

because you may precipitate a manic episode

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31
Q

enterocept

A

TNF alpha inhibitor used in rheumatoid arthritis

acts as a soluble receptor decoy protein

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32
Q

protective facotors against ovarian cancer

A
  • oral contraceptives
  • multiparity, breastfeeding
  • tubal ligation, salpingo-oophorectomy
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33
Q

what should thrombophelibitis raise suspicion for

A

viceral cancer

most frequantly of the pancreaus

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34
Q

what should be given to a patient with sever asthma that is refractory to corticosteroids

A

andi IgE antibodies

omalizumab is an example

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35
Q

Fatigue, weight gain, myoedema (lumping with percussion), and elevated CK

A

think hypothyroid myopathy

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36
Q

what does shigella like toxin do

A

inactivates the 60s ribosomal subunit

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37
Q

how is the glycerol backbone of triglycerides salvaged for gluconeogenisis

A

glycerol kinase

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38
Q

enoxaparin binds to what?

A

antithrobin III

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39
Q

base excision repair sequance

A
  1. Glycosylase cleaves the altered base leaving an AP site
  2. endonuclease cleaves the 5’end and lyase cleaves the 3’ end
  3. DNA polymerase fills the single nucleotide gap and ligase seals the nick
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40
Q

golgi tendon organ

A

causes epontanious mucle relaxion when lifting too much weight

interacts with inhibitory interneurons that then interact with the out going alpha motor neurons

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41
Q

stimulation of what nerve can help OSA

A

hypoglossal

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42
Q

treatment for bulimia nervosa

A

SSRI like fluoxitine

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43
Q

treatment of bipolar disorder

A

lithium, valproate, or quietapine

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44
Q

Labs show hyponatremia, decreased TSH and free T4, decreased cortisol and the woman hasn’t started lactating

A

pan-hypopit

Sheehans syndrom caused by ischemia

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45
Q

where do hydroceles collect

A

tunica vaginalis

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46
Q

comedonal and inflammatory nodular eruptions on face chest and back in an 20 something athletic male

A

think steroids like methyltestosterone

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47
Q

first line therapy for chronic asthma

A

Fluticasone

immunosupression so it inhibits leukocytic infiltrate

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48
Q

causes of eisenmenger syndrome

A

uncorrected left to right shunt

VSD, ASD, PDA

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49
Q

what will you see in the spleen of a sicle cell patient

A

fibrosis and atrophy due to recurrent infections

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50
Q

cause of macrocytic anemia in a sickle cell patient

A

folic acid deficency

caused by increased cell turnover
will have a relatively low reticulocyte sndex

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51
Q

method of reporting with exposure and non exposure

A

exposure odds ratio

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52
Q

most important factors in blood flow auto regulation

A

nitric oxide and adenosine

flow mediated vasodilation

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53
Q

what does aspirgillus cause as it forms and what kind of cancer does it cause

A

aflavitoxins

strongly linked with hepatocellular carcinoma

G==>T substitution

think aspirgillus when you think of toxic moldy grains

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54
Q

Rasburicase

A

can be used to prevent build up of/excretion of uric acid seen in tumor lysis syndrome

it is a urate oxidase inhibitor and you can use it n conjunction with or as a substitute for allopurinol which inhibits xanthine oxidase

with tumor lysis syndrome you can have electrolyte abnormalities and arrythmias

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55
Q

what lines the walls of a pancreatic pseudocyst

A

fibrous and granulation tissue

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56
Q

patient on dialysis that is bleeding from a catheter site

A

uremic platelet dysfunction

The only thing that is wrong is a prolonged bleed time

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57
Q

wiscott aldrich syndrome

A

Recurrent infections, thromocytopenia, eczema

X linked disorder

mixed B cell and T cell dysfunction

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58
Q

how is PKU inherated

A

AR

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59
Q

pain that radiates to the neck with a R lower lobe PNA

A

the pain sensation of carried by the phrenic nerce which innervates the medistinal pleura and the diaphragmatic pleura

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60
Q

dopamine agonists

A

ergot: bromocriptine
Nonergot: pramipexole, ropinirole

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61
Q

extrapyramidal side effects

A
  • acute dystonic reaction: sustained muscle contractuiions
  • akathsisa: subjective restlessness with inability to sit still
  • Drug induced parkensonism
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62
Q

rifaximin

A

non-absorbable antibiotic that alters GI flora to decrease intestional synthasis and absorption of ammonia

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63
Q

lactulose

A

increases the conversion of ammonia to ammonia by acidifying the stool

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64
Q

acute stress disorder

A

presents with night mares similar to PTSD

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65
Q

what should you look for when a child has an imperferate anus

A

urinary tract defects

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66
Q

equation for alveolar gradient

A

PAO2= 150- (PaCO2/0.8)

Normal is 10-15

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67
Q

origen of schwann cells

A

neural crest

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68
Q

function on snRNPs

A

removal on introns from RNA transcripts

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69
Q

transferrance

A

applying a feeling towards someone in the past towards someone in the present

Ex. someone saying a doctor doesn’t car for them when their mother didn’t care for them in the past

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70
Q

you see atrophy of what in alzheimers disease?

A

Lentiform nucleus

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71
Q

region where frontal, parital, temporal, and sphenoid bones meet in the skull

A

Pterion

Fracture here likely severs the middle meniengial artery which is a branch of the maxillary artery

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72
Q

surface glycoproteins that confers resistance to cancer drugs

A

efflux pump

ATP dependant transporter

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73
Q

what increases right afer B12 replacment

A

reticulocyte count

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74
Q

Severe combined immune deficiency

A

low CD3+ T cells

  • recurrent viral and bacterial infections
  • can have thymic aplasia
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75
Q

juvinile cateracts but otherwise asymptomatic

A

Deficency in galactokinase

aldose reductase causes production of galactitol which causes cateracts

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76
Q

which part of the kidney responds to ADH

A

the medullary collecting duct

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77
Q

ventromedial neculeus of the hypothalamus

A

mediates saity

without it patients experiance hyperphagia

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78
Q

lateral nucleus of the mypothalamus

A

Mediates hunger

destruction leads to annorexia

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79
Q

posterior nucleus of the hypothalamus

A

mediates heat conservation

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80
Q

arcuate nuclease

A

secretes dopamine, GHRH, and RnRH

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81
Q

renin in secondary hyperaldosteroneism

A

low
K low
Bicarb high
sodium normal

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82
Q

Methylmalonic acidemia

A

-increased methylmalonic acid in urine
-increased propionic acid
decreased glucose
-increased urine ketones
-increased serum ammonia

deficency in methylmalonal co mulase which catalyses the reaction methylmalonyl CoA ==> succinyl CoA

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83
Q

what dephosforolates glycogen synthase

A

protein phosphatase 1 which is activated by insulin

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84
Q

what is really effective at inactivating thrombin

A

unfractionated heprin

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85
Q

myotonic dystrophy

A
  • AD
  • Frontal baldness, cataracts, gonadal atrophy
  • difficulty releasinf grip
  • repeat expansion of CTG in the gene that codes for myotonia protein kinase
  • type 1 muscle fibers are affected
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86
Q

what is seen on a liver biopsy in a petint with Reye syndrome

A

Microvascular steatosis

they slip into a coma because of hyperammoiema

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87
Q

side effects of CCB

A

peripheral edema

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88
Q

equations for cardiac output

A

CO=HRxSV

CO= (O2 consumption/ arteriovenous difference)

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89
Q

does left ventricular end diastolic pressure decrease with nitro

A

Yes

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90
Q

what is rho- gam

A

anti-RH D antibodies so that they can interact with fetal RBC

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91
Q

Tuberoinfundibular pathway

A

connects the hypothalamus and the pituitary gland

responsiable for dopamine dependent inhibition of prolactin

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92
Q

pallor of the substantia nigra, locus ceruleus, and vagal nucleus dorsalis

A

PKU

defeciency in phenylalanine hydroxylase

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93
Q

HIV patient with fever, hepatospleno megaly, , retroperitenoal lymphadenopathy

acid fast bacteria that grow optimally at 41 degrees

A

mycobacterium avium complex

prephalyxis: azithromycin

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94
Q

characteristics of burgers disease

A

vPVD sensitive to tobacco extract

-segmental vasculitis extending into contiguoud veins and nerves

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95
Q

decreased activity of which enzyme can cause the formation of gall stones

A

7-alpha-hydroxylase

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96
Q

emperic treatment for patient with endocardidis caused by Coag negative staph

A

VANCO because a lot of them are resistant

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97
Q

what do aurer rods stain + for

A

peroxidase

always look for auer rods when they give you a blood smear

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98
Q

uroporphobiligin decarboxylase

A

uroporphyrinogen III ==> coprophyrinogen III

most common deficency in porpheryn synthesis

abd pain, photosensativity (because it is involved in the late stages of porpheryn synthasis)

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99
Q

what explains the symptoms in mysthenia gravis

A

reduced motor end plate potential

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100
Q

probability of being free from a disease if you test - for it

A

NPV

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101
Q

Most likely diagnosis if PT does not corrcet with vit-K supplementation

A

factor VII deficency

Factor VII has the shortest half life

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102
Q

if someone is paranoid about just one thing like a group of people trying to poisen them

A

delusional disorder

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103
Q

pigment stones

A

usually secondary to infection whihc leads to the release of beta-glucuronidase by injured hepatocyted or bacteria

this enzyme contibutes to the hydrolysis of bilirubin glucuronides and increases the amount of unconjugated bili in the bile

opisthorchis sinensis is a fluke that is associated the the formation of these stones

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104
Q

what do gliomas stain posative for

A

glial fibrillary scidic protein (GFAP)

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105
Q

HLA class I

A

present on all nucleated cells (HLA B27)

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106
Q

HLA class II

A

DR, DP, DQ

expressed by antigen presenting cells

associated with rheumatoid arthritis, DM type 1,, and ciliac

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107
Q

issues with finger extention

A

radial nerve

passes through the supinator canal and that is normally where the injury is

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108
Q

dysplastic tissue is differentiated from neoplastic tissue how?

A

reversability of changes

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109
Q

Ddx if the shilling test reveals low B12 in both phases

A

Ilial disease, pancratic insufficency, intestinal bacterial overgrowth

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110
Q

Ipratroprium

A

blocks muscarinic receptors preventing vasoconstriction

acetocholene released by the vegas nerve is what stimulates these receptor

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111
Q

what amino acid precurser makes nitric oxide

A

Arginine

Arginine + O2=(eNOS)=>NO + Citruline

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112
Q

Dofetilide

A

potassium channel blocker

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113
Q

part of GI tract that celiac effects

A

small bowel

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114
Q

echinococcus granulosus

A

form hydated cysts in the liver causing anaphylaxis if antigens released

  • use ethanol or hypertonic saliene to kill daughter cysts before romoval
  • use Albendozole to treat
  • contracted from dogs
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115
Q

first line treatment in narcalepsy

A

modafinil

non-amphetamine stimulant to help people stay awake

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116
Q

Widened QRS or ventricular arrythmia

A

indication for sodium bicarb
Use in arrythmias caused by TCAs

  • it increases the serum PH making the TCA favor the non ionized form makinging less accessable to bind to sodium channels
  • it also increases extracellular sodium which helps overcome the competitive rapid sodium channel blockade by the TCAs
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117
Q

chlordiazepoxide

A

benzodiazapine

-the only one that doesn’t end in “pam”

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118
Q

muscle responsable forr lifting arm over head and stabilize and rotate the scapula upward

A

serratus anterior

  • innervated by the long thoracic nerve which arises from the C5-7 nerve roots of the brachial plexus
  • can be injured by axillary lymphnode removal
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119
Q

enerocutanious fistula

A

chrone’s disease

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120
Q

what is consistant with lymphoma on histology

A

Monoclonal T-cell receptor gene rearrangments indicating that there is a possible malignancy of that one cell type

-if a dsingle allele for the V region of the TCR predominates in a lymphocytic population monoclonal proliferation in suspected

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121
Q

strongyloides stercoralis

A
  • will see rhabditiform larvae in the stool
  • migrate to the lungs and then move to the intestine where they lay their eggs to be hatched

chronic cough and recurrent respoiratory infections

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122
Q

drug that prolongs PT and PTT but has no effect on thrombin time

A

Xa inhibitors

-Rivaroxaban, apixaban

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123
Q

mallory-weiss tears

A

occur due to rapid increases in intraabdominal pressure

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124
Q

what does silicosis do in terms of immunity

A

impairs macrophage killing predisposing these patients to having TB

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125
Q

normal liver biopsy in the setting of ruptured esophegial varicies

A

thinkportal vein thrombosis

these patients will have splenomegaly in the setting of hematemisis

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126
Q

what happens to the C-peptide of insulin

A

it is packed into secratory granules and released from the cells

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127
Q

low FEV1 with eosinaphils

A

Patient likely has asthma

Avoid animal dander

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128
Q

acute confusion

A

think delirium

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129
Q

patient that had recent surgery and presents with symptoms of cholestais, and fever

A

think drug induced hepato toxicity caused by inhailed anesthetics like halothane

will see a sshrunken liner with hepatocellular pattern of injury

Labs: elevated LFT and prolonged PT (failure of synthetic function and factor VII) , leukocytosis, eosinophilia

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130
Q

Friedreich ataxia

A
  • autosomal resessive trinucliotide repreat (GAA) on chromosome 9
  • gene code for frataxin which is an iron binding protein
  • present with kyphoscoliosis, ataxia, nystagmus, muscle weakness, pes cavus (high arched foot) , hammer toes, diabetes, and hypertrophic cardiomyopathy
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131
Q

blastomycosis

A
  • endemic in the southern states
  • caused pulmonary symptoms on IMMUNOCOMPITANT hosts
  • dimorphic, can for yeast buds in humans (look like owls eyes) and a bud with a broad base
  • can cause pulmonary infiltrates that can disseminate to the skin or bone
  • treat with azoles
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132
Q

first line of defemce whien trying to reverse heperin

A

protamine, give it beofre anything else

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133
Q

what do esophageal veins branch off of

A

the left gastric vein which comes directly off of the portal vein

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134
Q

what vessels are most suseptible to atherosclerosis

A

coronary arteries and lower abdominal aorta

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135
Q

JAK/STAT pathway

A

think JAK2 which is a tyrosine kinase which is constitutively active in chronic myeloproliferative disorders

-Treat with the JAK2 inhibitor rucolitinib

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136
Q

young patient with recurrent episodes of chest pain, sweating, and palpitations. What do you give him

A

benzos, he is having a panic attack

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137
Q

Ribavirin

A

inhibits synthasis of guanine nucliotides by competitively inhibiting inosine monophosphate dehydroginase

interferes with duplication of viral genetic material

Uses: chronic HCV, RSV

Toxicity: Hemolytic anemia, severe tetrogen

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138
Q

vision loss with temporal lobe mass

A

-it effects myers loop witch barries libers from the upper quanrent of the contrallateral eye field resulting in left homonymous quadreantanopia

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139
Q

what is scaulded skin syndrome caused by

A

exotoxin mediated skin damage

-you get endotoxin mediated response with gram - organisms

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140
Q

what land mark is useful in identifying the appendix

A

Tenia coli

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141
Q

what area of the aorta is involved in blunt aortic injury

A

aortic isthmus (decending portion of the arch of the aorta)

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142
Q

isolated systolic hypertension

A

caused by age related stiffening of the aorta

-if it were dur to renal artery stenosis then both SBP and DBP would be elevated

**Look at both numbers

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143
Q

Alkaptonuria

A
  • Autosomal Recessive
  • Deficency in homogentisate oxidase in the degradative pathway of tyrosine to funerate
  • black urine, dark connective tissue, may have debilitating arthralsias
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144
Q

IgE independent mast cell degranulation occurs in the setting of what

A

Adverse drug reaction to opioids, radiocontrase agents, and vanco

  • The induce degraulation by activation of PKA and PI3 kinase
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145
Q

equation for renal flow

A

Flow= r^4

-if the flow is decreased by a certain amount then devide by that amount

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146
Q

biliary sludge

A

precurser to developing a stone

-pain after eating a fatty meal

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147
Q

target of treatment in 21-hydroxilase deficency

A
  • supress ACTH
  • If you supress ACTH then you will decrease the amout of sex hormone being made
  • do this by giving physiologic doses of glucocorticoid
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148
Q

increased slope of both cardiac function curve and the venous return curve

A

Decreased total peripheral resistance caused by a continious arteriovenus fistula

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149
Q

delta-aminolevilinate synthase

A
  • B6 is a cofactor

- deficiency can case sideroblastic anermia in the setting of ISN use

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150
Q

histology of hoshimoto thyroiditis

A
  • mononeuculear parenchymal infiltration with well developed germinal centers
  • often surrounded by hurthle cells which are large oxyphilic cells filled with granular cytoplasm which represent follicular epithelium that have undergone metaplastic change in response to inflammation
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151
Q

how is androgenic alopecia inherited

A

polygenic inheritance

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152
Q

underlying mechanism of zenker diverticulum

A

Cricopharyngeal motor dysfunction

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153
Q

what is used for energy in cholesterol synthasis

A

NADPH made in the ribose 5-phosphate pathway

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154
Q

protein abnormality seen in patients with CF

A

abnormal post translational modifications because of the deletion of a phenylalanine

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155
Q

type of hypersensitivity with monoclonal antibodies

A

type 3

  • it causes serum
  • can present with joint pain and puritic skin rash
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156
Q

symptoms of a gastrin secreting tumor

A
  • dirrehea

- postbulbar duadenoal ulcers

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157
Q

where is the common peroneal nerve mot often injured

A

fibular head

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158
Q

what is increased in tuberculoid leprocy

A

IL-2 and IFN-gamma in the skin leasions

-TH1 cells are more active in tuberculoid leprocy and the bacterial load is low

159
Q

pure red cell aplasia

A

Associated with thymmomas and lymphocytic leukemia

  • can also be caused by parvo virus B19
  • anemic with abcence of erythroid precursers
160
Q

squamous metaplasia in the pancreatic ducts

A

vit-A deficency

remember that they have a deficency in ADEK

161
Q

bilateral wedge shaped infarcts on autopsy

A
  • watershed regions affected by ischemia

- hypoxic-ischemic encephalopathy caused by profound hypOtension

162
Q

part of urethra that is most likely injured with a pelvic fracture

A

posterior spongy urethra

163
Q

paranoid patient that has be up for days studying for exams that was totally norml previously. Hypertensive, tachycardiac, diaphoretic

A

think substance induced psychotic disorder

-ampheramined or methylphenidate could be responsiable

164
Q

common place for clear cell renal carcinoma to metastisize to

A

lungs

-characteristic cells with abundant clear cytoplasm

165
Q

most frequant predisposing factor for infectious endocarditis

A
  • mitral valve prolapse

- rheumatic heart disease is not where close to being the most common predisposing factor any more!

166
Q

the higher the arterovenous concentration gradient for a inhailed anesthetic

A

the slower the onset of action

-decreased av gradient means increased speed of equilibrium with the brain

167
Q

when UCU and bing to AGA and AGG

A

wobble

-usually the 3rd nucleotide position

168
Q

effect on constriction of the effarent arterial of FF and GFR

A

increases them both

169
Q

globus sensation

A

trouble swallowing associated with stress with no functional abnormalities

170
Q

DNA lattering in the absence of a growth factor

A

sign of apoptosis

171
Q

trouble seeing clearly, thirsty, bugs crawling on skin, after chewing plant seeds

A

think anticholonergic side effects

172
Q

when a genetic defect is identified in multiple offspring but not the parent

A

genetic mosaicism

173
Q

what should diabetics do daily

A

a foot inspection

174
Q

what is seen on byopsy of mollescum contagiosum

A

cytoplasmic inclusion bodies

175
Q

what structure is compromised when the femur is displaced posteriorly

A

popliteal artery

176
Q

main cause of endometriitis

A

bacteriodies species

177
Q

sublimation

A

channeling feelings into socially acceptible behaviors

178
Q

what part of the penis does viagra effect

A

the corporus cavernosa by increasing cyclic GMP

179
Q

transudate in CHF

A
  • low protein

- low LDH

180
Q

put a bunch of NaCl with soem blood cells and test heolysis

A

Herediatry spherocytosis

-preforming a splenectomy decreases the likelyhood of bilirubin gall stones

181
Q

what cancer is associated with mysthemia gravis

A

thymoma

182
Q

alteration to a protein before adding a carboxyl tail

A

palmitoylation

-fatty acids anchored to cytosine residues

183
Q

the pressure in which vanculature increases with cirrohis

A

splenic vein

-portal vein

184
Q

mutation in fibroblast growth factor receptor 3 on chromosome 4

A

achondroplasia

  • point mutation
  • autosomal dominant
185
Q

what receptor does glucagon act through

A

Gs

186
Q

what does red safranin stain

A

cartalage, , mast cell granules, mucin

187
Q

acid base disturbance with a PE

A

respiratory alkalosis

188
Q

weak lower extremity pulses and ischemic colitis

A

think extensive atherosclerosis

189
Q

most common genetic defect in b-oxidation

A

acyl-CoA dehydroginase deficency

190
Q

autonomic postganglionic nerves

A

unmylinated

191
Q

prader willi

A

LOSS of Pathernially inherated gene

192
Q

acanthosis nigracans that appear rapidly

A

think malignancy

193
Q

what causes the cardiac abnormalities in digeorge

A

persistant truncus arterious

194
Q

broom like appearance of a fungus

A

aspirgillus

195
Q

after load of a skeletal muscle

A

force against which they must contract

196
Q

common complication after sub arachnoid hemmorhage

A

arterial vaso spasm

-use nimopine to prevent vaso spasm

197
Q

SGLT2 inihibitor

A

2nd or 3rd line in diabetes managment

  • inhibits SGLT2 in renal tubules to lower the threshold for glucose to be lost in the urine
  • don’t use in patients with renal disfunction
198
Q

what can be used in the treatment of psorasis

A
  • Vitamin D analogs
  • calcipotriene, calcitriol, tacalcitol
  • activates vit D receptor and inhibits the differentiation of keritinocytes
199
Q

crecent formation with no anti-bodies of immune deposits

A

Test for cANCA because it is likely to be wegners

-type 3 pauci immune glomerular nephritis

200
Q

transection of the rectus abdominous laterally puts which structures at risk

A

inferior epigastric arteries

201
Q

paraneoplastic syndroms associated with SCLC

A
  • Lambert-eaton myasthenic syndrome
  • Subacute cerebellar degeneration
  • SIADH
  • Cushing syndrome
202
Q

attributable risk percent= 100 x [(risk in exposed - risk in unexposed)/risk in exposed]

A

see card

203
Q

Hereditary angioedema

A
  • AD
  • low serum levels of C1 esterase inhibitor
  • ACEI are inhibited because of their side effect of angioedema
204
Q

what is seen with an MI involving the RCA

A

RV dysfunction

  • PCWP will decrease
  • CO will decrease
  • JVP/central venous pressure will increase
205
Q

zero order kenitics

A

no matter how much you put in the same amount (not percentage) is metabolized

206
Q

what is commonly seen on blood smear in someone that has sepsis and a leukemoid reaction

A

Dohle bodies

-basophilic oval inclusions in mature neutrophils

207
Q

complications of varicose veins

A

painful thrombosis, stasis dermatitis, skin ulcerations, poor wound healing, superficial infections

208
Q

part of the nephron that is impermiable to water

A

Thick and thin acending loops of henley

209
Q

if a bacteria down regulates MHC I what kind of cell will they likely be killed by

A

NK cells

    • for CD16 or CD56
  • Activated by IFN-gamma and IL12
210
Q

Atrilization of the R ventricle

A

ebstine anamoly

- associated with lithium use

211
Q

pearly mass behind the tempanic membrane in the middle ear

A

cholesteatomas

  • squamous cell debris
  • can cause painless otorhea
212
Q

Rett syndrome

A
  • commonly seen in girls
  • deceleration in head growth
  • due to a de novo mutation in the X-linken MECP-2
  • sterotyped hand ringing
213
Q

mucor mycosis

A

can be caused by rhizopus species, mucor, or absidia

  • right angles
214
Q

Kawaski disease

A

-asain children

215
Q

hairy cell leukemia

A

older men

  • TRAP +
  • Marrow fibrosis with dru tap
  • massive splenomegaly
216
Q

nerve involved in ear problems that accompany temporalmandibular disorder.

A

Mandibular branch of the trigeminal nerve

  • Tensor tympany is innervated by this nerve
217
Q

if someone has muscurenic agonist poisening and is given atropine, what are they still at risk for?

A

muscle paralysis because the atropine takes care of the muscurinic symptoms but no tthose caused by the activation of nicotinic receptors

-must give pralidoxime as well

218
Q

specific antibodies for rheumatoid arthritis

A
  • anti-CCP (most specific)

- Rheumatoid factor

219
Q

normal A-a gradient

A

10-15

-Alveolar O2 - arterial O2

220
Q

average total body water

A

41L- lipophilic drugs

-14L extracellular fluid:
3L plasma volume
interstitial makes up the rest

large drugs will be cound to plasma proteins and then will remain mostly in the 14L of extra cellular fluid

221
Q

vascular leasions containing IgA and C3 in a child

A

Henoch- schonlein purpura

  • rash
  • abd pain
  • polyarthralsia
222
Q

progressive liver failure with HCC is most likely caused by

A

HBV because it integrates into the host genome and the liver damage is continious

223
Q

histology of the liver in primary biliary cirrohis resembles

A
  • graft vs host disease
  • inflammatory and leukocytic infiltrate
  • associtaed with anti-mitochonrial antibodies
224
Q

what is given when a DVT is present

A
  • Xa inhibitor

- riviroxiban

225
Q

where does the trigeminal nerve exit the brain stem

A
  • at the level of the middle cerebellar peduncle

- lateral aspect of the mid pons

226
Q

oxylate crystals on renal biopsy

A

ethyline glycol posiening

227
Q

what biochemical pathway does alcohol inhibit

A

Gluconeogenesis

-increaseses the NADH/NAD+ ratio and htuse inhibits anything that needs NAD+ as a substrate

228
Q

how is glucose brought into adipocytes

A

GLUT 4 transporter

-facilitated diffusions via carrier proteins

229
Q

osgood-schlotter

A

avolsion of the tibia from the secondary ossification center of the tibia

-injury to the petellar tendont which inserts on the tibial tuberosity

230
Q

nucleolus is the primary site of

A

rRNA transcripition

-RNA pol I functions here

231
Q

dermatomyositis

A

can persent as a paraneoplastic syndrome of the lung, ovary, or colon

232
Q

chronic mesentaric ischemia

A
  • angina of the gut
  • pain about an hour after eating
  • pt has a history of atherosclerosis
233
Q

the lateral epicondyle is the attachment point for what

A

-extensor carpi radialis breavis and extensor digitorum which are involved in wrist extension

234
Q

telangiectasias, recurrent epistaxis, skin discoloration, AVM, GI bleeding, hematuria

A

Osler-weber-rendu syndrome

235
Q

what does the CFTR gene encode

A
  • an ATP dependent chloride channel
  • secretes Cl- in lungs and GI tract
  • resorbs Cl- in the sweat glands
236
Q

what is responsible for synchronization between glycogen breakdown and muscle contraction

A

Ca2+

-it is a more potent activator of PK in the muscle as opposed to cAMP in the liver

237
Q

medical treatment for gall stones

A

Bile acid supplimentation

  • they will solubilize the cholesterol that is implicated in making stones and thus prevent stone formation
  • prevents gallstone dissolution by improving cholesterol solubility
238
Q

what is present in lung hamartomas

A
  • hyaline cartilage, fat, smooth muscle, and clefts liked by respirtory epithelium
  • often presents as an incidental coin leasion
239
Q

with luperlide what initially increases

A

testosterone and DHT

240
Q

topoisomerase II

A

makes double stranded breaks in DNA to relieve coiling

241
Q

which carbohydrate is metabolized the quickest

A

Fuctose-1-phosphate

-bypasses PFK-1

242
Q

how to distinguish a direct vs indirect hernia

A

MD’s don’t LIe

  • medial to the inferior epigastric artery= direct
  • lateral to the inferior epigastric artery = indirect
243
Q

what part of the stomach does pernicious anemia affect

A
  • the body

- h. pylori affects the antrum

244
Q

acute eczematous dermatitis is characterized histologicall by…

A

spongyosis

-an accumulation of edema fluid in the intercellular spaces of the epidermis

245
Q

best test to confirm the diagnosis of trichamonas

A

saline microscopy

246
Q

episodic jaundice and increased DIRECT bilirubin

A
  • defective hepatocellular excretion of bilirubin glucuronides
  • dubin johnson syndrome
247
Q

what part of the nephron absorbs the most water

A

the proximal tubules (60%)

248
Q

red blue tumor under the finger nail

A

tumer of the thermoregulatory glomus body

249
Q

stain for cryptococcal menengitis

A

india ink

wide clearing because of polysacceride capsule

-high protein, high opening pressure, low glucose

250
Q

complete collapse of one lung

A

mainstem bronchous obstruction

-trachea will deviate to that side

251
Q

holoproencephaly

A

an example of malformation

-defect in cells or tissues that form the organs

252
Q

treatment for anexity attacks

A

SSRI

253
Q

Pantothenic acid

A
  • Vit B5

- Bioten

254
Q

anal wink reflex

A

S3 S4 winks galore

255
Q

how does anastrozole work for breast cancer metastissis

A

inhibits aromaitazation of androgens by aromatase because aromotase is a CYP 450 enzyme and the azoles are cyp 450 inhibitors

256
Q

CML diagnosis

A

basophelia and eosinaphilia

  • corrilation with EBV infection
  • myleocytes
257
Q

what remains normal in the setting of nitrate poisening

A
  • partial pressure of oxygen in the blood

- oxidized iron to the Fe3+ state

258
Q

How is PAH secreted into the tubules of the nephron

A

Carrier proetin transport

259
Q

what drains internal hemmroids

A

Superior rectal veins and inferior mesentaric veins

260
Q

order of arteries involved in atherosclerosis

A

Abdominal aorta>coronary arteries>popliteal arteries >internal carotids>circle of willis

261
Q

what is give to a patient with suspected graves disease with severe proptosis

A

-glucogorticoids to supress inflammatory infiltratioon, decrease fibroblast activity, and decrease the periferal conversion of T4 to T3

262
Q

features of a glucagonoma

A
  • necrolytic migratory erythema (leasions that enlarge and coelese), indurated area around the perineum
  • normocytic anemia
  • DM
  • tumer arising from alpha cells
263
Q

Vit E deficency

A
  • posterior column and spinocerebellar tract atrophy
  • loss of DTR
  • can present like b12 deficency but the megaloblastic anemia is absent
  • leasions similar to those in fredrichs ataxia
264
Q

episodic headache

A

think pheochromocytoma especiallu when suspecting MEN

265
Q

cystine uria

A
  • it is a type of aminoaciduria

- hexagonoal crystals in the urine

266
Q

why do you want to decraese the CO2 in someone with cerebral edema

A

to increase cerebral vascular resistance (aka. decrease vasodialation)

267
Q

what are areas caused by liquifactive necrosis lined by in the brain

A

Glial cells like astrocytes

268
Q

side effects of Thiazide diuretics

A
  • Hyponatremia
  • Hypokalemia
  • Hypercalcemia
  • Hyperglycemia
  • Hypercholesterolemia
  • hyperurcemia
269
Q

HTN, increased renin, hypoK

A

JG cell tumor that is secreting renin

270
Q

symptoms of a puneal gland mass

A
  • obstructive hydrocephalis
  • dorsal midbrain syndrome (paralysis of upward gaze, ptosism pupillary abnormalities due to direct compression of the pretectal region of the midbrain
271
Q

what is IFN-gamma secreted by

A

T-cells and NK cells

272
Q

spasmatic torticolis is a type of what?

A
  • Dystonia
  • Sustained muscle contractions
  • writers cramp is another example
273
Q

injury to what artery would cause osteonecrosis of the femur head

A

-medial femoral artery

274
Q

3 phases of acid secretion

A

cephalic==> cholenergic vagal stimulous
gastric==> gastrin
intestinal==> decraeses the amount of gastric acid

275
Q

phentolamine

A

alpha-1 blocker that is used during epi extravisation

276
Q

pt with possible toxic megacolin (hx of UC)

A

get a plane film x-ray

277
Q

KRAS

A

protooncogene

-most mutations are activating mutations

278
Q

ketamine and PCP

A

NMDA receptor antagonists

279
Q

what causes the outflow obstrcution in HOCOM

A

The thickened interventricular septum and the mitral valve leaflet

280
Q

how can you prevent gynocomstia

A

Tamoxafen or selective estrogen receptor modulators

281
Q

what is JAK

A

it is a cytoplasmic tyrosine kinase

282
Q

where do the ganglionic cells of the rectum reside?

A

in the submucosa

-meissners plexus

283
Q

touretts disorder

A

symptoms greater than 1 year (multiple motor and one or more vocal tic)

284
Q

what is seen histologically in takayasu arteritis

A

giant cells in the aortic arch

-usually females

285
Q

what is seen in the stool of cholera patients

A

mucus and some sloughed off epithelial cells

-remember this is a non-inflammatory diarrhea so you will not see fecal leukocytes

286
Q

what needs to be tested before amioderone therapy is initiated

A

TSH because it carries iodine and can cause thyroid dysfunction

287
Q

how do you calculate drug concentration

A

dose/volume of distribution

288
Q

why is it important for an ASD to be corrected

A

to prevent irreversiable changes to the pulmonary artery that could result in a r==>L shunt because of increased pulm pressure

289
Q

overactivity of what causes keloids?

A

TGF-beta

transforming growth factor beta

290
Q

absence of GPI and defeciency in CD55 and CD59

A

paryoxismal nocturnal hemoglobinuria

==> compliment is activate and distroys red blood cells

triad of hemolytic anemia, pancytopenia, and hemoglobinuria

291
Q

treatment for extraparymidal side effects

A

benztropine

292
Q

side effects of theophylline

A
  • tachyarrhythmias
  • seziures
  • cyp450 DDI
293
Q

kind of inflammation with gillan birrae

A

endoneural inflammatory infiltration

294
Q

what innervates the quadracepts muscle

A

the femoral nerve (L 2, 3, 4)

295
Q

fredrech ataxia

A

degeneration of the spinocerebellar tracts

296
Q

bluish color of reticulocytes

A

From residual ribosomal RNA

instrument

297
Q

BRAF

A

Malanocytes

  • mutated in menanoma
  • protein kinase
298
Q

cilostazol

A

reduces platelet activation by inhibiting phosphodiesterase

-also a direct vaso dilator

299
Q

ulcers in the distal duodnum

A

ZE syndrome caused by a neoplasm

300
Q

how does alcohol cause hepatic statosis

A

decreased fatty acid oxidation because of an excess of NADH

  • remember that it inhibits gluconeogenesis as well
301
Q

what increases in heart failure

A

arteriolar resistance because the RAAS system is activated

302
Q

incontinants win normal pressure hydrocephalus is caused by what?

A

Stretching of decending cortical fibers that normally inhibit the spinal micturation centers

303
Q

sarcoidosis can cause an elevation in what enzyme

A

ACE

304
Q

what differentiates a gastric errosin from a gastric ulcer

A

weather it errodes completely thought the muscularic mucosa

305
Q

what do vascular endothelial cells synhtasize to inhibit platelet aggrigation

A
  • prostacyclin
306
Q

loss of DTR’s in patient that has rheumatoid arthritis that is intubated

A

Vertebral sublaxation involving the atlantoaxial joint

307
Q

what does excess bradykinin cause

A

angioedema

308
Q

hemolytic anemia, thrombosis, and pancytopenia

A

paroxysmal nocturnal hemoglobinuria

-absence of CD55 on the surface of RBCs

309
Q

renal involvment in patient with SA endocardidis

A

-circulated immune comples-mediated injury

310
Q

how does nitro improve the symptoms of angina

A

decreaseing preload of the LV via venodialation

311
Q

test for fructokinase defeciency

A

copper reduction test

312
Q

pulsion

A

increased intraluminal pressure

-responsiable for false diverticulum

313
Q

antibody in scleraderma

A

anti-centrimere

314
Q

what part of the stomach does h. pylori colonize

A

the antrium or prepyloric area

315
Q

if you don’t see nuclei what should you suspect

A

necrosis

316
Q

what pathologys can xanthomas (lipid layden macrophages on histolody) be associated with

A

primary biliary sclerosis and anything else that causes and increase in the release of cholesterol

317
Q

what can Beta-thalacemia do to hemaglibin A1c

A

it can increase it because of increased cell turnover despite approprite glycemic control

318
Q

cells involved in delayed hypersensativity reaction

A

macrophages, CD4+ cells, CD8+ cells, NK cells

319
Q

Leading cause of esophageal SCC

A

Tobacco and alcohol consumption

320
Q

what kind of kidney injury do NSAIDS cause

A

chronic interstitial nephritis

321
Q

lab pattern in vWF deficency

A

prolonged bleeding time and PTT

-bleeding time is a marker of platelet function and there is a prolonged PTT as well because of the factpr VIII deficency that comes along with it

322
Q

what does the PAS stain detect

A

it highlights polysaccharides of the fungal cell wall, mucosubstances secreted by the epithelia, and basement membranes

-can be used to detect wipple disease by reaction with the glucoprotein present in the cell walls on the gram + actinomycete

323
Q

in order to diagnose someone with ARDS what must be normal

A

PCWP so that you rule out cardiogennic pulmonary edema

324
Q

how can you diagnose wilsons disease

A

slit lamp examination of tissues

325
Q

what are the water shed areas of the colon

A
  • Splenic flexture
  • Rectosigmoid junction

NOT THE HEPATIC FLECTURE

326
Q

serum testing for SLE

A

decreased C3 and C4

327
Q

pneumonic for SLE symptoms

A

S-serositic

O-oral ulcers

A-arthritis

P-photosensitivity, pulmonary fibrosis

B-blood cells

R-renal, raynauds

A-ANA

I-Immunologic markers (anti AM, anti ds DNA)

N-neuropsych

M- malar rash

D-discoid rash

328
Q

odds ratio

A

with 2x2 table

ad/bc

329
Q

what drugs end in -navir and what are their side effects

A

viral protease inhibitors used for treatment of HIV

They cause metabolic sideeffects like lipodystrophy, insulin resistance, and dislipidemia

they also inhibit cyp450 so they have many DDI’s especially with rifampin

330
Q

name the NNRTI’s

A

Nevirapine
Efavirenz
Defviridine

all of them have “vir” in the middle

Side effects include:

  • rash (SJS)
  • Hepatotoxicity
  • Neuropsychiatric effects like vivid dreams
331
Q

side effects of NRTI’s

A
  • lactic acidosis
  • Lipodystrophy
  • pancreatitis
  • bone marrow supression that is reversed with G-CSF
332
Q

Integrase inhibitors names and side effects

A
  • Dolutegravir
  • Raltegravir

SE: myopathy

333
Q

what part of the nephron collects the most water

A

proximal tubule

334
Q

what birth defects cause an elevated AFP

A
  • open neural tube defects
  • Ventral wall defects (omphalocele, gastroschisis)
  • multiple gestation
335
Q

what causes a low AFP during pregnancy

A

Aneuploidies (trisomy, monosomy)

336
Q

Connexins

A

gap junctions

337
Q

claudins, occludin

A

tight junction

338
Q

adherens junction

A

cadherens

339
Q

hemidesmisomes

A

integrins

340
Q

where is the bladder in respect to the prostate

A

bladder is anterior to the prostate

341
Q

what is elevated in the amniotic fluid in fetuses with neural tube defects

A
  • AFP

- Acetocholenesterase

342
Q

most common risk factor for developing calcium stones

A

hypercalciuria

343
Q

what does ammonia cause depletion of

A

GlutaMATE and alphaketogluterate (which causes halting of the krebs cycle)

-it causes accumulation of glutamine

344
Q

pressures in the heart

A
  • RV==> diastolic is very low and systolic is about 25

- moving to the left heart the diastolic increases but the systolic stays the same

345
Q

erythemia multiform in herpies

A

is a reaction to a local infection, not a systemic one

346
Q

MVP

A

caused by a degeneration of connective tissue

347
Q

subthalamic nucleus

A

plays a role in basal ganglia output

-a stroke here can cause hemibalisimus

348
Q

What causes septic shock with N. menengiditis

A

-Outer membrane lipopolysaccharide

349
Q

LGN

A

vision

350
Q

most common cause of spontaneous lobar hemorrhage

A

Cerebral amyloid angiopathy

351
Q

how is lithium nephrotoxic

A

reduces the ability of the kidneys to concentrate urine by antagonizing the action of vasopressin in the collecting tubules and ducts

352
Q

campylobacter

A

gram - oxidase + rod that can be transmitted from animals (like dogs) to humans

353
Q

branches of what nerve are responsiable for the pain associated with external hemmroids

A

branches of the pudendal nerve

354
Q

cAMP

A

FLAT CHAMP Gunner

  • FSH
  • LH
  • ACTH
  • TSH
  • CRH
  • hCG
  • ADH
  • MSH
  • PTH
  • GHRH
  • Glucagon
355
Q

cGMP

A

Anything that vasodialates causes an increase in cGMP

ANP, BNP, NO

356
Q

IP3 (Gq)

A

GnRH, oxytcin, ADH, TRH, Histamine, Angiotensin II, gastrin

GOAT HAG

**If the end result is vasoconstriction think this pathway

357
Q

Intracellular receptor

A

Vit D, estrogen, testosterone, T3/T4, Cortisol, aldosterone, progesterone

**don’t forget that aldosterone and progesterone are steroid hormones

358
Q

Intensic tyrosine kinase

A

Insulin, IGF-1, FGF, PDGF, EGF

**map kinase pathway, think growth factors

359
Q

receptor associated tyrosine kinase

A

Prolactin, Immunomodulators (cytokines, IL-2, IL-6, IFN, TNF), GH, G-CSF, erythropoetin, thrombopoeiten

they can work thorough serene kinases
JAK STAT pathway

think acidophils and cytokines

360
Q

effects of glucocorticoids on the liver

A

increases protein synthasis because of increased gluconeogenesis and glycogenolysis

-upregulate the synthasis of key gluconeogenic enzymes (PEP carboxylase)

**also increase hepatic glycogen reserves by increasing the expression of glycogen synthasis

361
Q

Bile acid binding resins cause an increase in what

A

triglycerides

362
Q

what do you absolutely need to make a diagnosis of thrombotic thrombocytopenic purpura

A

decrease in ADAMTS13 leading to microvascular thrombi and hemolitic anemia

  • the other symptoms like renal failure, neurologic manifectations and fever only happen in a subset of patients
  • the treatment is plasma exchange
363
Q

equation for T1/2

A

t1/2=(0.7xVd)/CL

then to figure out the dosing you figure out how much should be excreted by a certen time (like 75%)

364
Q

serrated polyp

A

iron deficency anemia, cauliflower like leasion

  • jagged appearance
365
Q

transformation

A

Direct uptake of naked DNA

366
Q

transduction

A

bacteriophage conversion

367
Q

history of pancreatitis and only dilated veins around the gastrc fundus

A

Splenic vein thrombosis

-causes increased pressure in the short gastric veins causing hematemisis and melania

368
Q

when the IMA is out of the game, which artery supplies the decending colon

A

SMA

369
Q

where does aspiration pneumonia happen

A

If the patient is supine: posterior segment of the right upper lobe and upper segment of the middle lobe

If the patient is upright and aspirates basilar segments of the right and left lung

more likely to go down the right main stem bronchus

370
Q

for which enzyme does acetyl CoA act as an allosteric activator

A

first step of gluconeogenesis from pyruvate to oxcyloacetate

371
Q

Major depression with psycotic features

A
  • they only hear voices with their depressed mood.

- compair with schizoaffective disorder where they have some episodes of hearing voices without mood swings

372
Q

5’ to 3’ exonuclease activity

A

DNA pol 1

373
Q

rectal administration of a drug

A

partially bipass firstpass metabolism

374
Q

citalopram

A

Citalopram is an SSRI

use SSRIs to treat generalized anexity disorder

375
Q

hypomania

A
  • better functioning
  • does not require hospitalizations
  • no psycotic features
  • characteristic of bipolar 2
376
Q

Glyburide vs Glipazide

A

they are both second generation sulfonureas but glyburide has a greater risk of causing hypoglycemia

-glyburide and glimepiride are long acting and have a higher risk of hypoglycemia (think glip as in you only get a tiney glip of medicine)

377
Q

esmolol

A

bets blocker

  • prolongs PR
  • no effect of potassium channels like sotalol
378
Q

which nerve resides in the piraform recess and what is it responsiable for

A
  • Superior lyrengeal nerve of CN X

- responsible for cough reflex

379
Q

best test to see if the gene is being transcribed

A

Northern blot to look for mRNA

**be careful to pay attention to the words transcribed and translated

380
Q

how to thiozide diuretics prevent kidney stones

A

decreases rge amount of Ca2+ excretion in the urine
- it inhibits the Na+/Cl- transporter which activates the Na+/Ca2+ pump on the serum side pumping Ca2+ back into the blood

381
Q

how do benzodiazapines act on GABA

A

they bind allosterically and increase the frequancy of opening

382
Q

most important protection against influenza A

A

antibodies against hemagluttanin

-neutralize the virus and block binding to host cells

383
Q

what forms the diaphragmatic surface of the heart

A

inferior portion of the left ventricle supplied by the posterior decending artery which comes off of the RCA

384
Q

CA-125

A

epithelial ovarian cancer like serous cystadenocarcinoma and mucinous cystadenocarcinoma

385
Q

Hawthorne effect

A

the behavior changes when the people getting monitered know it

386
Q

sensation of the inner ear an passing out when it is stimulated is mediated by which nerve

A

Auricular branch of the Vagus

387
Q

synaptophysin

A

neuronal origen

388
Q

how is intracellular calcium is removed in cardiac myocytes by which mechanism

A

Na+/Ca2+ exchange pump (NCX) and sarcoplasmic reticulim Ca2+ ATPase pump (SERCA)

389
Q

with ARBS is there an increase or decrease in aldosterone

A

there is a decrease because the ACE2 receptor is needed for aldosterone release

390
Q

esiengmyer syndrome only in the lower extremities

A

think PDA which can lead to heart failure if large enough and left uncorrected

391
Q

arterial vasodilation causes what

A

water and salt retention

392
Q

milranone

A

PDE inhibitor that can cause vasodilation

393
Q

what is the cause of aortic dissection

A

HYPERTENSION

394
Q

KIT receptor +

A

systemic mastocytosis

excess histamine causes gastric hypersecretion

U world journal (4 decks)

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