UWorld Mock blocks week 1/21-1/27 Flashcards
Risk factors for pancreatic cancer
Smoking doubles the risk
Age 65-75
Diabetes
Chronic pancreatitis
Hereditary syndromes
Pancreatic cancer
Palpable, non-tener gall bladder, weight loss, obstructive jaundice (pruritus, dark urine, pale stools) = pancreatic cancer in head of pancreas
CMV retinitis
Affects HIV patients w/ CD$ <50
–> retinal detachment due to tearing of thin, atrophic scar tissue
Tx: ganciclovir - has greater activity against CMV c/w acyclovir
Herpes viruses
bud through and acquire membrane from host cell nuclear membrane
Pulmonary edema
decreased lung compliance
Dengue virus
ssRNA
4 serotypesSecondary infection w/ different serotype –> more severe infection
Hemmorrhagic: thrombocytopenia, prolonged fever, respiratory/cardiac failure, and shock. Hemmorhhage.
Primary: Flu like illness w/ myalgia, rtetroorbital pain, rash
abetalipoproteinemia
Enterocytes have clear or foamy cytoplasm (lipid accumulation)
Impaired formation of ApoB containing lipoproteins. Can’t synthesize apolipoprotein B
Auto recessive - loss of function in MTP gene
Manifests as malabsorption
Low plasma triglyceride and cholesterol levels. Chylomicrons, VLDLs and apoB are absent from blood.
Prolactin suppresses
GNRH–> DECREASED LH AND TESTOSTERONE
Gq
Phosphoinisitol second messenger system. Gq –> Phospholipase C –> IP3 –> PKC activation –> Ca2+ release
Ion pump failure in cardiac ischemia
Increased intracellular Na+ and Ca2+ –> free water is drawn into cell
myxomatous change
Pooling of proteoglycan in the media of large arteries
Predisposes to development of aortic dissection and aortic aneurysm
Medial degeneration seen in Marfan
Giant cell arteritis
granulomatous inflammation of the media and fragmentation of internal elastic lamina
De quervain thyroiditis
Painful thyroid enlargement. Follows viral illness
Bx: Lymphocytic infiltrate w/ macrophages and multinucleate giant cells
Hashimotos thyroiditis on Bx
Lymphocytes with germinal centers
Riedel thyroiditis
extensive fibrosis of thyroid glad extending into surrounding tissue
Papillary thyroid carcinoma
branching papillary structures w/ concentric calcifications (psammoma bodies)
Noncaseating granuloma, bloody diarrhea
Crohn’s
Also has transmural inflammation
Cobblestone appearance w/ skip lesions
Risk factors for epithelial ovarian cancer
Increased risk: BRCA, nulliparity, infertility
Decreased risk: OCPs, multiparty, breadtfeeding
Rivaroxaban and apixaban
Factor xa inhibitor
Used for venous thrombus or A. fib
Argatroban, bivalirudin, dabigatran
Direct thrombin inhibitors.
Aspleniz in sickle cell
Increased risk of infection w/ encapsulated organisms
Strep pneumo, and H. flu
Morbidity in rheumatic fever
pancarditis –> heart failure
effect of ACE inhibitors
Increased angiotensin I, renin, and bradykinin
Decreased angiotensin II and aldosterone
Nonbacterial thrombotic endocarditis
Chronic inflammatory disorders (e.g. Lupus) and advanced malignancy.
bosentan
Endothelin antagonist
treatment for idiopathic pulmonary arterial hypertension
Complete mole
46 XX
Hep B histology
finely granular, pale eosinophilic, ground-glass appearing inclusions
Chronic transplant rejection
Bronchiolitis obliterates - small airways
Finasteride
5alpha-reductse inhibitor
Used in male pattern baldness
Insulin resistance
Phosphorylation of serine and threonine residues of insulin receptor and insulin receptor substrate by serine kinase
This can be induced by TNF-alpha, catecholamines, glucocorticoids, and glucagon
Parvovirus
ssDNA
Children 0 fifth disease
adults - acute systemic arthropathy (similar to RA)
Chronic hemolytic anemia: transient aplastic crisis.
Trigeminal neuralgia treatment
Carbamazapine
Pyshostigmine vs. neostigmine
Physostigmine - penetrates CNS
Neostigmine - does Not cross BBB - quaternary ammonium structures prevents CNS penetration
Thiazolidinediones
Pioglitazone
Thiazolidinediones
decrease insulin resistance by finding PPAR-y - a transcriptional regulator of genes in glucose and lipid metabolism.
Delay of days-weeks since it effects gene expression and protein synthesis
Vitamin E deficiency
Vitamin E is an anti-oxidant
Neurologic sx like friedrich ataxia (degerneration of spinocerebeallar tracts). Loss of position and vibration sense (degeneration of dorsal collumn, loss of DTR (peripheral nerve degeneration).
candida
branching pseudohyphae and blastoconidia
dexamethasone suppression test
Suppressed ACTH:
Adrenal adenoma, adrenal malignancy, exogenous glucocorticoids
Elevated ACTH:
- Suppresion of ACTH/cortisol –> pituitary adenoma
Dexamethasone test cont…
ACTH & cortical unchanged –> ectopic ACTH (e.g. paraneoplastic)
Plycythemia vera
Uncontrolled erythrocyte production - mutation in Jak2 - cytoplasmic tyrosine kinase a/w EPO receptor
IgA nephropathy (berger Dz)
Recurrent, self-limited painless hematuria w/in 5 days of URI.
Mesangial IgA deposits on immunofluorescence.
PSGN
coarse IgG and c3 deposits on immunofluoresense.
Alport
Disorder of Type 4 collagen - renal failure by age 40, hearing loss, ocular abnormalities.
EM: lamellate basement membrane w/ irregular thinning and thickening (basket-weave)
Ornithine transport into mitochondria
Essentail for urea cycle function - nitrogen waste catabolism
Defects –> neurologic damage d/t accumulation of ammonia
Restrict protein to reduce AA turnover
IgE independent mast cell degranulation
opioids, radio contrast, vancomycin - diffuse itching and pain, bronchospasm, local swelling
CAndidal antigen skin test
Tests T cell immunity
Cd4+, CD8+, and macrophages - Type IV hypersensitivity reaction
Factor V Leiden
Factor Va resistance to inactivation by activated protein C
most abundant AA in collagen
Glycine - occupies every third amino acid position
secondary hyperaldosteronism
Elevated renin and aldosterone - causes: renovascular hypertension, malignant hypertension, renin-secreting tumor, diuretic use
Primary hyperaldosteronism (e.g. adrenal adenoma) have low renin d/t feedback of aldosterone on renin
Acyl-CoA dehydrogenase
catalyzes the first step in beta-oxidation of fatty acids. It is the most commonly deficient enzyme in beta-oxidation. Deficiency results in hypoketotic hypoglycemia after fasting
BCL-2
Anti-apoptotic gene over expressed in follicular lymphoma - found on chr. 18 - B cell tumor 14:18 translocation
C-MYC
Burkitt lymphona on chromosome 8 (8:14)
N-MYC
Neuroblastoma and small cell carcinoma
Vitamin A deficiency
Nightblindness and hyperkeratosis - deficiency of fat soluble vitamins forms in patients with biliary disorders, exocrine pancreatic insufficiency, or malabsorption
glargine
Basal long acting insulin
lsspro, aspart, and glulisine
short acting insulin given 3x/day w/ meals.
MSUD
defect in alpha-ketoacid dehydrogenase - involved in metabolism of branched chain AA’s (leucine, isoleucine, valine)
alpha-ketoacids accumulate in blood and urine
Sweet smelling urine, CNDS defects, mental retardation, and death
Inheritance of NF-2
Auto dominant - chr. 22
Main component of surfactant
phosphitidylcholine
Horseshoe kidney
Gets caught on IMA`
Mycoplasma pneumonia
Looks worse on CXR than patient presents
requires cholesterol in media to grow
Military recruits
Malignancy
Monoclonal proliferation
Gallstone ileus
Air in the biliary tree
Ureter
Anterior to internal iliac artery
Posterior to ovarian and uterine arteries
Glucagon
Activates GPCR’s on cardiac myocytes –> adenylate cyclase activation –> increased cAMP –> increased SA firing
Osteoclastic activity in multiple myeloma
Increased serum Ca2+
Decreased PTH production
Hypercalciuria
Renal failure - reduced 1,25 vit D synthesis
Thiazides
Raise: serum Ca, uric acid, glucose, cholesterol, and triglyceride
Lower: serum sodium, potassium, and magnesium
omega-aminolevulinate synthase
Catalyzes the rate limiting step in heme synthesis
uses pyridoxine (B6) as cofactor
Midsystolic click w/ mid-late systolic murmur at cardiac apex that disappears w/ squatting
Mitral valve prolapse in MR
Squatting tenses the chord - increased venous return + increased LV volume
Myxomatous degeneration
Gaucher disease
Auto recessive lysosomal storage disorder
beta-glucocerebrosidase deficiency –> accumulation of glucocerebroside
Presentation: bone pain abdominal distention - hepatosplenomegale, easy bleeding, bruising, pallor, and fatigue from pancytopenia.
Fanconi anemia
Inherited aplastic anemia, increased risk of malignancy, hypo/hyperpigmented skin patches, short stature, hypo plastic thumbs.
Transient aplastic crisis
Parvo B19
Hormone levels anorexia
Impaired GNrh release from hypothalamus –> decreased LH< FSH, and estrogen
Pemphigus vulgaris
Desmosomes
Present in the mouth/mucosal membranes
Painful flaccid bull and erosions. Bullae spread laterally with pressure, and blisters form w/ gentle rubbing.
Myotonic dystrophy
Sustained muscle contraction followed by weakness and atrophy. Cataracts, frontal balding, and gonadal atrophy
Auto dominant - increased tirnucleotide repeats on myotonia protein kinase gene.
Colon cancer progression
APC - normal –> small adenoma
KRAS - increased size of adenoma
TP53 - malignant transformation
Basal ganglia atrophy
present in Wilson’s disease
Opsoclonus-myoclonus
Paraneoplastic syndrome a/w neuroblastoma
Osteolytics vs. osteoblastic
Osteolytic - lucent on imaging - Aggressive - MM, non-small cell lung cancer, non-hodgkin lymphoma, RCC< melanoma
Mixed - G.I. and breast
Osteoblastic - sclerotic on imaging - indolent - Prostate, small cell lung cancer, hodgkin lymphoma
Isoproterenol
Beta-1 and beta-2 agonist - causes increased myocardial contractility and decreased SVR
Human placental lactogen
Hyperglycemia in second and third trimester
Echinococcus granulosus
Most common cause of hydatid cysts - spilling of cyst contents results in anaphylaxis - do not perform surgery, treat chemically w/ albendazole.
Cryptococcus
Latex agglutination test
Papillary carcinoma
Orphan annie eyes - Large cells with overlapping nuclei and finely dispersed cytoplasm.
Numerous intranuclear inclusion bodies and grooves can be seen
Cause >70% of thyroid nodules
MSH2 and MLH1
Mismatch repair genes - Mutations in these account for lynch syndrome
Propionyl CoA deficiency
Propionyl CoA is derived from metabolism of valine, met, threonine, and odd chain fatty acids. Deficiency in propionyl coa carboxyl’s usually convert propionyl CoA to methylmalonylCoA.
Deficiency in the carboxylase –> propionic acidemia
lethargy, poor feeding, vomitting, and hypotonic 1-2 weeks after birth
Craniopharyngioma
Suprsellar tumor in children
Composed of calcified cysts containing cholesterol crystals. Dystrophic calcification on imaging.
Remnant of rathke’s pouch - surface ectoderm
Dystrophin
Sarcolemme-cytoskeleton linker protein
Stabilizer between the sarcolemma and intracellular contraction apparatus - disruption of this protein –> membrane damage and myonecrosis.
Frameshift mutation causes duchenne muscular dystrophy
Clomiphene
Estrogen receptor modulator - decreases negative feedback inhibition by circulating estrogen –> increased gonadotropin production
Amyloidosis
Can cause ventricular hypertrophy resulting in restrictive cardiomyopathy and diastolic heart failure
Aortic stenosis
Loudest over right second intercostal - radiates to neck and carotids
Conn syndrome
Primary hyperaldosteronism - aldosterone secreting adenoma
Treat w/ spironolactone or eplenerone
Pseduogout
Calcium pyrophosphate crystals
Rhomboid shaped - positively birefringent
Minimal change disease
massive poretinuria –> hypoalbuminemia –> decreased plasma oncotic pressure –> fluid shifts into the interstitial space resulting n edema.
Low oncotic pressure triggers increased lipoprotein production in the liver
Arteries penetrated by gastric ulcers on lesser curvature
Left and right gastric arteries
PSGN prognosis
Complete recovery in children, poor prognosis in adults –> increased risk of chronic hypertension and renal insufficiency
Colchicine
Second-line therapy in acute gout - used in patients w/ contraindication to NSAID’s
Binds tubules inhibiting tubules polymerization –> decreased leukocyte migration –> reduced inflammation.
SE’s: diarrhea, nausea, vomitting, abdominal pain
DKA potassium
Normal to increased serum potassium, total body potassium defect
MUST replace K+ in DKA
Brain stimulation to treat Parkinson’s
Stimulate globus pallidus internen or subthalamic nucleus to inhibit firing of these nuclei (which are inhibitory)
–> thalami-cortical disinhibition with improved mobility
Chronic lymphedema
Predisposes to angiosarcoma development
Villous adenomas
Most likely colon polyp to undergo malignant transformation
Large, sessile, and more severely dysplastic
Can secrete large quantities of watery mucus resulting in secretory diarrhea, hypovolemia, and electrolyte abnormalities
Hamartomatous polyps
Disorganize mucosal glands, smooth muscle, and CT.
Peutz-jeghers or Juvenile polyposis.
Can cause bleeding and intessuception
Crystalline nephropathy
Can be caused by acyclovir which is nephrotoxic
Prevent w/ adequate hydration and slowed infusion
Rabies
Rhabdovirus - ssRNA - bullet shaped capsule studded by glycoprotein spikes that bind nicotinic Each receptors.
Travels retrograde to CNS
Agitation, disorientation, pharyngospasm, and photophobia –> coma –> death
Treat w/ post-exposure-prophylaxis prior to neurologic symptoms
Diastolic heart failure
Decreased ventricular compliance
Normal LVEF, normal LVEDV, elevated LV filling pressure
Curling vs. Cushing ulcer
Curlings - severe trauma/burns
Cushing’s - intracranial injury - caused by direct vagal stimulation
Myasthenia gravis
Thymoma - Ab’s against Each receptor
Lambert eaton Myasthenic syndrome - proximal muscle weakness - small cell lung cancer. Autoantibodies against presynaptic calcium channel resulting in reduced ACh release
Myasthenia NOT myasthenic syndrome would have diplopia
GP41
HIV transmembrane envelope protein - involved in fusion.
Enfuvirtide - binds HR1 of GP41 preventing fusion
Citrate and kidney stones
Citrate binds free calcium, reducing risk of stones
Increased citrate = less stones
Potassium citrate sometimes supplemented to prevent recurrent calcium stones
Kallman syndrome
Absence of GnRH secretory neurons in the hypothalamus due to defective migration from the olfactory placed.
Central hypogonadism and anosmia
Buerger’s disease (thromboangiitis obliterans)
Segmental thrombosing vasculitis with segmental vasculitis extending into contiguous veins and nerves
Heavy smokers before the age of 35 - hypersensitive intradermal injection of tobacco extract.
Barret’s esophagus
Metaplasia of the esophagus from squamous cell –> intestinal type columnar cells with goblet cells
Predisposes to adenocarcinoma
Squamous cell carcinoma of esophagus risk factors
cigarette smoke, achalasia, N-nitrosamine (smoked) foods, and alcohol use
Adenocarcinoma of esophagus risk factors
Barrett’s, GERD, obesity, tobacco
Gastric varices in the fundus
Blockage of splenic vain –> increased pressure in short gastric veins –> gastric varies ONLY in the fundus
First step in valvular vegetation pathogenesis
fibrin platelet nidus for bacteria to adhere to.
Parvovirus
Propensity for erythroid precursors - replicates in bone marrow
Teniae coli
surgical landmark for appendectomy
3 separate smooth muscle ribbons that travel longitudinally on the outside of the colon - originate at the cecal base
Kozak sequence
consensus sequence that helps start translation in eukaryotes - prior to the met start codon AUG
Analogous o to shine-dlagarno sequence in E. coli
Mitral regurg
blowing holosystolic murmur best heard over the cardiac apex with radiation to the axilla
Observed with rheumatic heart disease
Hypercalcemia in sarcoidosis
caused by parathyroid hormone independent formation of 1,25-dihydroxyvitamin D by activated macrophages –> increased intestinal absorption of calcium
C-peptide
Marker for endogenous beta-cell insulin secretion
Levels increase with sulfonylurea (glyburide) use (which increase the insulin secretion rate of residual pancreatic islet beta-cells to reduce blood glucose levels)
Auer rods
Stain positively for peroxidase
Strawberry hemangioma
Benign, infants/children
Shcistocytes
Microangiopathic hemolytic anemias
HUS, TTP,, DIC, mechanical (prosthetic valve)
Sydenham chorea
involuntary rapid, irregular jerking movements of the face, arms, and legs
Occurs months after GAS infection, and is a clinical manifestation of rheumatic fever.
Bisphosphonates (risendronate)
inhibit mature osteoclast mediated bone resorption
Treats osteoporosis
Henoch Schönlein purpura
Effects young children, preceded by URI.
IgA mediated hypersensitivity vasculitis
Abdominal pain, joint pain, lower extremity (buttocks) palpable purport, and hematuria
Types of nevi
Junctional: limited to dermoupidermal junction. Flat brown-black macule darker in the center
Compound: aggregates of nevus cells that extend into dermis. Raised papule with uniform pigmentation. Dermal and epidermal involvement
INtradermal: epidermal nests of nevi cells have been lost. Produce little to to pigment.
increased C peptide
Preproinsulin cleaved –> insulin + C-peptide
increased production of endogenous insulin - sulfonylurea use or insulinoma
Hypoglycemic drug assay positive only in oral hypoglycemic agents
Decreased c-peptide
exogenous insulin
Diphenoxylate
Anti-dirrheal - mu opiod receptor against in GI tract that slows motility.
Low dose for diarrhea, high dose produce morphine like euphoria and physical dependence. Combined w/ atropine to discourage high dosage
Tumor lysis syndrome treatment
Rasburicase or xanthine oxidase and aggressive fluid hydration
Rasburicase reduces uric acid levels - catalyzes conversion of uric acid to allantoin which is soluble
Allopurinol inhibits uric acid formation
Steroids
Increase neutrophil count acutely due to “demmargination” of neutrophils previously attached to vessels
Artery damaged in mid shaft humerus fracture
deep brachial
Cystinuria
Defective dibasic amino acid transport in intestinal and proximal renal tubular epithelial cells.
Recurrent stones at your age from decreased cysteine absorption in urine
HEXAGONAL cystine crystal and AMINOACIDURIA
K1 capsular antigen
E. coli strain that causes neonatal meningitis
K1 capsule is a virulence factor that allows the bacteria to survive in the bloodstream and establish meningeal infection
Measles
fever, cough, rhinorrhea, and conjunctivitis followed by maculopapular rash starting on the face and spreading downward
KOPLIK SPOTS - white or blue-gray lesions in buccal mucosa
Mumps
Parotitis, orchitis, aseptic meningitis
Odds ratio
(a/b)/(c/d)
e.g.
Odds of developing in exposed group 20/90 (20 w/ 70 w/o)
Odds of developing in unexposed group 30/70 w/o condition (30 w/ 40 w/o)
Total number NOT used to calculate odds ratio
= (20/70)/(30/40)
= (20x40)/(30x70)
KRAS
GPCR - constitutively active RAS-MAPK signaling –> malignant tumor development
Active-GTP
Inactive-GDP
Location of AG I–> AG II conversion
small vessels of lungs
Concentration of AT II is higher in pulmonary vein than pulmonary artery when RAAS is activated
Class IC antiarrhythmics
Use dependent, have increased effect at faster heart rates.
More effective for treating tacchyrhythmias.
Prolonged QRS at high heart rate
Fleicanide and propanefone
Collagen in scars
Type I - also found in dermis, bone, tendon, ligaments, dentin, cornea, blood vessels and scar tissue
a/w osteogenesis imperfecta
Etanercept
TNF-alpha inhibitor added to MTS for moderate to severe RA
Fusion protein - links TNF-a to Fc portion of human IgG1.
Reduces TNF-a activity by acting as decoy receptor
Suffixes
- cept = receptor
- nib = kinase inhibitor (e.g. imatinib inhibits BCR/ABL)
- mab = monoclonal Ab
Foscarnet
Sometimes used in ganciclovir-resistant CMV
Hypocalcemia and hypomagnesemia –> promotes seizures
Acyclovir toxicity
crystal nephropathy and neurotoxicity (delirium of tremor)
Cidofovir
Used in CMV retinitis
Nephrotoxic w/ proteinuria or elevated CK
Lamivudine
NRTI - rare SE’s - occasionally peripheral neuropathy or lactic acidosis
Sofosbuvir
Inhibits nonstructural protein 5B - RNA dependent RNA polymerase in Hep C infection
SE’s: fatigue and nausea
SE of ganciclovir
severe neutropenia
SIBO in gastric bypass
Small intestinal bacterial overgrowth
Glucagon effect on HR
Glucagon activates GPCR’s on cardiac myocytes –> adenylate class –> increased intracellular cAMP –> ca release and increased SA firing
Use din beta-blocker OD to increase HR and contractility independent of adrenergic receptors
Glucagon effect on HR
Glucagon activates GPCR’s on cardiac myocytes –> adenylate class –> increased intracellular cAMP –> ca release and increased SA firing
Use din beta-blocker OD to increase HR and contractility independent of adrenergic receptors
Prevention of CAD in patients that are ASA sensitive
clopidogrel 2pY12 blocker prevents platelet aggregation
Hep B virus
dsDNA circular DNA - replicates through fever stranscription
dsDNA –> +ssRNA –> translation of viral proteins AND reverse transcription into ssDNA intermediate –> partially double stranded DNA
IL-12
Stimulates differentiation to TH1 subpopulation.
Deficiency in IL-12 –> severe mycobacterial infections d/t inability to mount strong cell-mediated granulomatous immune response
Treat w/ IFN-y (which also stimulates TH1 differentiation
TH1
Activate macrophages and CD8
Mediate delayed type hypersensitivity
TH2
Initiate antibody response
Regulate Ig class switching
Primary myelofibrosis
Severe fatigue, splenomegaly, hepatomegaly, anemia, bone marrow fibrosis
Over activation of JAK2 proteins (cytoplasmic tyrosine kinase) –>constitutive activation (also seen in polycythemia and essential thrombocytosis) –> transcription factor STAT activation
Lymphedema and cystic hygroma in neonate
Turner syndrome
Diarrhea w/ Vibrio or E. coli
Toxin mediated - no leukocytosis on stool microscopy
Scopolamine
Antimuscarininc agent - can treat muscarinic overstimulation (e.g. treatment of MG w/ AChE inhibitors)
Pilocarpine
Nonselective muscarinic AGONIST
Ethosuximide
T-type Calcium channel blocker - absence seizures
phenytoin and carbamazipine
Na+ channel blockers
Levitiracetam
Modulates GABA/glutamate release
Valproic acid
Blocks Na+ channels and increases GABA levels
Meglitindes
Short-acting glucose-lowering meds that close ATP dependent K+ channel in the pancreatic beta cell membrane, inducing depolarization and stimulating insulin release. STIMULATE INSULIN RELEASE
Given w/meals and reduce postprandial glucose excursions.
Phenylephrine
Alpha-1 agonist - vasoconstrictor and increases SVR and BP –> baroreceptor mediated decrease in stroke volume and HR.
Decreased pulse pressure
Papillary thyroid carcinoma histology
“orphan annie eyes”
large cells with nuclei containing finely dispersed chromatin w/ ground glass appearance
Papillary is the most common thyroid cancer
Primary hyperaldosteronism
Increase HCO3, decreased K+, Normal Na+
Bicarb is produced d/t excess H+/K+ excretion –> metabolic alkalosis
increased Na+ reabsorption, but there is no hypernatremia d/t aldosterone escape. (increased blood flow –> pressure natures_ augmented release of ANP - limits sodium retention and prevents volume overload
Pathogenesis of atherosclerotic plaque
Release of PDGF by locally adherent platelets, endothelial cells, and macrophages –> migration of smooth muscle cells from media into the intima
alpha-glucosidease deficiency
POMPE - Type II
Presents in infancy with cardiomegaly, macroglossia, and muscular hypotonia.
Abnormal glycogen accumulation in enlarged lysosomal vesicles - positive for PAS - Glycogen can’t be broken down in lysosomes.
Canagliflozin
SGLT inhibitor (sodium glucose cotranporter 2)
SGLT2 is responsible for resorbing 90% of filtered glucose in the proximal tubule –> inhibition urinary glucose loss
SE’s: UTI and genital mycotic infections secondary to glucosuria - diuresis can cause hypotension
Activating mutation in PRPP synthetase
Leads to increased production and degradation of purines –> gout
PD-l1
PD-1 is a programmed cell death receptor - PD-L1 down regulates the immune response against tumor cells by inhibiting cytotoxic T cells.
Tumors have increased expression of PD-L1
MAB’s that block PD-1 help prevent T cell inhibition –> promotes apoptosis of tumor cell
First pharyngeal arrch
trigeminal nerve, mandible, maxilla, zygoma, incus
Second pharyngeal arch
facial nerve, stapes, soloed process, lesser horn of hyoid
Treacher collins
Defect of 1st and 2nd pharyngeal arch –> hypoplasia of zygomatic and mandibular bones
Structure injured with lateral displacement of proximal supracondylar humerus fracture fragment
Radial nerve
SE’s of amphoterecin
Renal toxicity –> hypokalemia and hypomagnesemia
Polyribosylribitol phosphate
Capsule component and virulence factor of HIB
Precursos B-ALL
TdT+, CD10+, CD19+
Precursor T-ALL
CD2, CD3, CD4, CD5, CD7, CD8
Treatment for post-op hypoparathyroidism
Calcitonin + Vitamin D to prevent post hypocalcemia
Thiamine is a cofactor for
Pyruvate dehydrogenase - pyruvate –> acetyl CoA (enters TCA)
Alpha-ketoglutarate dehydrogenase (TCA)
Branched chain alpha-ketoacid dehydrogenase (essential for catabolism of branched chain AA’s)
Transketolase - Pentose phosphate pathway
Thiamine deficiency
Decreased glucose utilization, especially in CNS
Glucose infusion in chronic thiamine deficiency –> acute cerebral damage
Supplement thiamine w/ glucose infusion
Highly oxygenated blood in fetus
Umbilical vein –> IVC (via ductus venosus)
Defect in interferon gamma signaling
macrophages can’t respond to IL-12 which stimulates T cells and NK cells to produce IFN-gamma which activates janus kinases 1/2 via SAT –> promote mycobacterial killing by phagocytes
disseminated mycobacterial disease in infants/children.
Lifelong treatment w/ anti-mycobacterial agents
Cromolyn and nedocromil
Mast cell-stabilizing agents - inhibit mast cell degranulation independent of triggering stimulus.
Second line for allergic rhinitis and bronchial asthma
Aspirin toxicity
Initial respiratory alkalosis –> mixed respiratory alkalosis and anion gap metabolic acidosis
Normal pH w/ PaCO2 and HCO3 out of range
Flutamise
non steroid anti-androgen that competitively inhibits testosterone receptors
Used w/ long-acting GNrh agonists in prostate cancer treatment.
Candida morphology
Branching pseudohyphae with blastoconidia
Low volume of distribution
3-5 L - High molecular weight, high plasma protein bending, high charge, and hydrophilicity trap drug in the plasma compartment resulting in low Vd
Valproate
Effective against Absence and generalized tonic-clinic
Theosuximide
blocks Ca channels
Glyburide and glimepiride
High incidence of hypoglycemia in elderly
Sulfonylureas - increase insulin secretion by pancreatic beta cells.
