Uworld34 Flashcards
What is the haldane and Bohr effect?
The binding of O2 to hemoglobin increases the affinity for binding of subsequent O2 molecules (cooperative binding). In the lungs, the binding of O2 to hemoglobin drives the release of H+ and CO2 from hemoglobin (Haldane effect).
In the peripheral tissues, high concentrations of CO2 and H+ facilitate O2 unloading from hemoglobin (Bohr effect)
Risk factors for aortic dissection versus aortic aneurysms
Hypertension is the single most important risk factor for the development of intimal tears leading to aortic dissection.
Hypertension, smoking, diabetes mellitus, and hypercholesterolemia are all major risk factors for atherosclerosis, which predisposes more to aortic aneurysm formation than aortic dissection.
MOA of amiodarone
Amiodarone primarily functions as a class III antiarrhythmic, inhibiting the delayed rectifier potassium current to slow ventricular repolarization and prolong the QT interval.
It also inhibits fast sodium channels (class I effect) to slow ventricular depolarization and prolong QRS complex duration.
Beta blockade (class II effect) and inhibition of slow L-type calcium channels (class IV effect) slow conduction in the sinus node and atrioventricular node causing decreased sinus rate and a prolonged PR interval
What is the clinical presentation of tertiary syphilis?
cardiovascular involvement and gummas.
Gummas are necrotizing granulomas occuring on the skin, mucosa, subcutaneous tissue, and bones and within other organs. Neurosyphilis can occur at any stage of infection.
What is observer bias?
occurs when the investigator’s evaluation is affected by preconceived expectations or prior knowledge, typically leading to overestimation of the disease association or treatment effects. This type of bias can be reduced by conducting a blinded study in which observers are unaware of study details and patient characteristics that could unduly influence them.
Chronic adminstration of GnRH agonists (leuprolide) suppresses?
pituitary LH release and leads to reduced production of testosterone.
Lower levels of circulating testosterone produce a clinical effect similar to that of surgical orchiectomy and can lead to accelerated bone loss and increased risk for osteoporosis
Restrictive cardiomyopathy can be caused by?
infiltrative diseases (eg, amyloidosis, sarcoidosis, hemochromatosis) and often results in diastolic heart failure due to ventricular hypertrophy with impaired ventricular filling.
Cardiac amyloidosis is characterized histologically by areas of myocardium infiltrated by an amorphous and acellular pink material (amyloid)
What is the effect of pregnancy and the pituitary?
High estrogen levels during pregnancy cause enlargement of the pituitary gland without a proportional increase in blood supply.
Peripartum hypotension can cause ischemic necrosis of the pituitary leading to panhypopituitarism (Sheehan syndrome). Patients commonly develop failure of lactation due to deficiency of prolactin.
What are the diagnostic tests for syphilis?
Syphilis is caused by the spirochete Treponema pallidum. Confirmation of the diagnosis requires 2 forms of serologic testing to prevent false-positive results.
Nontreponemal tests (eg, rapid plasma reagin, VDRL) evaluate for anticardiolipin antibodies (nonspecific); treponemal tests evaluate for antibodies targeted against T pallidum
What are the watershed areas of the large intestine?
The splenic flexure and rectosigmoid junction lie between regions of perfusion of major arteries.
These “watershed” areas are susceptible to ischemic damage during hypotensive states, especially in patients with underlying arterial insufficiency
Location of the caudate
The head of the caudate lies in the inferolateral wall of the frontal horn of the lateral ventricle.
It is separated from the globus pallidus and putamen by the internal capsule.
Atrophy of the caudate nuclei with enlargement of the lateral ventricles is characteristic of Huntington disease and can be observed on neuroimaging
What is hereditary hemorrhagic telangiectasia?
presents with mucocutaneous telangiectasias, epistaxis, and visceral arteriovenous malformations (liver, lung, brain).
Lung involvement includes pulmonary AVMs (digital clubbing, platypnea) and pulmonary hypertension (a loud P2) due to high output heart failure from underlying systemic AVMs.
Treatment of organophosphate poisoning?
Organophosphates inhibit cholinesterase in both muscarinic and nicotinic cholinergic synapses, leading to decreased acetylcholine degradation and overstimulation of the corresponding receptors.
Atropine reverses muscarinic effects but does not prevent the development of nicotinic effects such as muscle paralysis.
Pralidoxime is a cholinesterasae-reactiviting agent that allows for degradation of excess acetylcholine and treats both the muscarinic and nicotinic effects of organophosphates
Function of germinal centers
Germinal centers are the sites where activated B cells proliferate and undergo affinity maturation during generation of humoral immune response.
The formation of multiple germinal centers is typically marked by lymphadenopathy, pain, and inflammation in the affected lymph node due to cellular recruitment and the release of inflammatory cytokines
Digoxin toxicity presents with?
cardiac arrhythmias and nonspecific gastrointestinal (nausea, vomiting), neurological (confusion, weakness), and visual symptoms.
Elevated potassium is another sign of toxicity and is caused by inhibition of Na-K-ATPase pumps
Initial empiric treatment of coagulase-negative staphylococcal infection should include?
vancomycin due to widespread methicillin resistance, especially in nosocomial infections.
If susceptibility results indicate a methicillin-susceptible isolate, vancomycin can be switched to nafcillin or oxacillin
Lateral ankle sprain is due to?
inversion of a plantar-flexed foot and most commonly involves the anterior talofibular ligament.
Stronger forces can cause joint instability by injuring additional ligaments.
Neonates versus adult body water
Neonates have a higher proportion of body water compared to adults. This can result in lower plasma concentrations of water-soluble drugs if they are administered at the same weight-based dosage as given to adult patients
Pleural effusion causes what to tactile fremitus and breath sounds
Fluid in the pleural space acts to insulate sound vibrations that originate in the airways; therefore, pleural effusion causes decreased tactile fremitus and decreased intensity of breath sounds.
The high density of pleural fluid compared to normal lung tissue also causes dullness to percussion
What is atopic dermatitis (eczema)?
Atopic dermatitis is a common, chronic inflammatory disorder caused by impairment of the skin’s barrier funciton.
Eczema presents with pruritus and erythematous papules and plaques and is associated with other atopic disease, such as allergic rhinitis and asthma
Stress related mucosal disease is usually caused by?
local ischemia in the setting of severe physiologic stress (eg, shock, extensive burns, sepsis, severe trauma). Ulcers arising in the setting of severe trauma/burns are called Curling ulcers. Ulcers arising from intracranial injury are caused by direct vagal stimulation and are called Cushing ulcers
What are risk factors for candidemia?
The presence of a central vascular catheter and receipt of parenteral nutrition are risk factors for candidemia.
Candida display a morphology of branching pseudohyphae with blastoconidia
What is the main mechanism underlying all types of renal stones
Urine supersaturation is the main mechanism underlying all types of renal stones.
Low fluid intake increases the concentration of stone-forming agents, thereby promoting stone formation. All patients with nephrolithiasis should be advised to maintain adequate fluid intake
What is a lipoma?
Lipomas are common, benign tumors that arise from the subcutaneous fat and present as soft, mobile masses that are stable or enlarge slowly over time. The diagnosis is usually made clinically, but histopath shows well-differentiated, mature adipocytes with a fibrous capsule
What is a pleural effusion?
a collection of fluid between the visceral pleura that lines the lungs and the parietal pleura that lines the thoracic cavity.
The fluid acts to insulate vibrations and sounds that originate in the airways of the lung; therefore, tactile fremitus and breath sounds are decreased over a pleural effusion. Dullness to percussion is also present.
What is locked in syndrome
Ischemic injury to the bilateral ventral pons can lead to locked-in syndrome, a condition in which patients are unable to move or speak (due to interruption of the corticospinal and corticobulbar tracts) but retain consciousness, sensation, eye opening, and vertical eye movements
What is hematogenous osteomyelitis?
occurs most commonly in children. It usually affects the metaphysis of long bones due to the presence of slow-flowing sinusoids that are conducive to bacterial seeding. Fever and refusal to bear weight are common in young children who are unable to localize the pain.
What is responsible for the thrombotic and thromboembolic complications of nephrotic syndrome?
Neprotic syndrome is a hyper coagulable state. Sudden-onest abdominal or flank pain, hematuria and left sided varicoceles suggest renal vein thrombosis, a well known complication of nephrotic syndrome.
Loss of anticoagulant factors, especially antithrombin III, is responsible for the thrombotic and thromboembolic complications of nephrotic syndrome
Mutations of fas receptor leads to
The fas receptor acts to initiate the extrinsic pathway of apoptosis. Mutations involving the Fas receptor or Fas ligand can prevent apoptosis of autoreactive lymphocytes, thereby increasing the risk of autoimmune disorders such as systemic lupus erythematosus
What processes occur in the mitochondria versus the cytosol?
Cellular compartmentalization allows multiple biochemical processes to occur simultaneously at maximum efficiency.
Beta-oxidation of fatty acids, the TCA cycle, and the carboxylation of pyruvate (gluconeogenesis) all occur within the mitochondria.
The enzymes responsible for glycolysis, fatty acid synthesis, and the pentose phosphate pathway reside in the cytosol
What can increase GFR and decrease it?
Increases in capillary hydrostatic pressure or the Bowman’s space oncotic pressure will increase GFR, while increases in capillary oncotic pressure or Bowman’s space hydrostatic pressure will decrease GFR.
The filtration fraction can be calculated by dividing the GFR by the renal plasma flow (RPF). Increases in GFR or decrease in RPF will increase the FF.
What is first line pharmacotherapy for moderate to severe alcohol use disorder?
The opioid antagonist natrexone, and works by preventing the reinforcing effects of alcohol use.
What is poststreptococcal glomerulonephritis?
the most common cause of nephritic syndrome in children.
Light microscopy demonstrates enlarged, hypercellular glomeruli.
Labs: elevated antistreptococcal antibodies (eg, antistreptolysin O, anti-DNase B) and decreased C3 and total complement levels. C4 levels are usually normal.
What is the pathogenesis of e coli sepsis?
Pathogenesis of e coli sepsis involved the release of lipopolysaccharide (endotoxin) from bacterial cells.
Lipid A is the major virulence factor of lipopolysaccarides that induces macrophages to release cytokines (IL-1, tumor necrosis factor-alpha), leading to the manifestations of septic shock (end organ dysfunction)
What is seen in left sided heart failure
Left sided heart failure is common following myocardial infarction affecting the left ventricle. The resulting accumulation of edema in the pulmonary interstitium makes the lungs heavy and stiff, restricting inspiratory expansion and decreasing lung compliance.
Severe hypertension in retinal precapillary arterioles causes?
endothelial disruption, leakage of plasma into the arteriolar wall, and fibrinous necrosis. The necrotic vessels can then bleed into the nerve fiber layer, which can be seen on examination as dot or flamed shaped hemorrhages
Inflammatory bowel disease, especially ulcerative pancolitis, is associated with a significant risk for?
colorectal carcinoma. Compared with sporadic colorectal cancer, colitis-associated colorectal cancer is more likely to occur at a younger age, is typically more aggressive with a higher histopathologic grade, often evolves from flat (nonpolypoid) lesions, and is frequently multifocal.
patients should be monitored regularly via colonoscopy with random biopsies
What is the most common cause of familial dilated cardiomyopathy?
Autosomal dominant mutations in the TTN gene, which encodes for the sarcomere protein titin
What is seen in orbitofrontal cortex injury?
Patients with orbitofrontal cortex injury often experience personality changes, disinhibition, and irritability secondary to impairment of the behavioral and emotional modulatory systems
What is dumping syndrome?
The pyloric sphincter prevents incompletely digested hyperosmolar food particles from entering the intestines too rapidly; when the sphincter is bypassed or surgically removed, dumping syndrome may occur.
Symptoms are related to excessive intestinal fluid (eg, abdominal cramps, diarrhea, nausea), vasomotor hyperactivity (eg, diaphoresis, palpitations, flushing) and intravascular volume depletion (eg, hypotension, tachycardia)
What is the meaning of a p value <0.05?
A result is considered statistically significant if the 95% confidence interval does not cross the null value, which corresponds to a p-value <0.05
Classic triad of congenital rubella syndrome
cataracts, sensorineural hearing loss, and patent ductus arteriosis. Prevention consists of maternal preconception immunization with live attenuated rubella vaccine
Histopath of asbestosis?
Asbestosis is a pneumoconiosis that occurs with inhalation of asbestos fibers, most commonly in patients with occupational exposure (eg, insulation installation, shipbuilding, pipework).
histopath: diffuse interstitial fibrosis and ferruginous asbestos bodies (translucent fibers coated with a golden iron-containing material). Pleural disease (eg, plaques, benign effusions) is common.
Myocardial infarction on cardiac function curve
Myocardial infarction causes a sharp decrease in cardiac output due to loss of function of a zone of myocardium. On a cardiac function curve, myocardial infarction would decrease both the slope and the maximal height of the line
What is Paget disease of bone?
characterized by disordered bone formation. Involvement of long bones can lead to bone pain, bowing, fracture, or arthritis of adjacent joints.
Serum alkaline phosphatase is elevated due to increased production of new bone, but calcium and phosphorus levels remain normal
Patients with long-standing, poorly controlled diabetes mellitus are high risk for developing?
distal symmetric polyneuropathy (diabetic neuropathy). Symptoms generally include progressive numbness, tingling, and burning/stabbing pain in the feet and/or toes that progresses proximally.
Painful neuropathy is treated with serotonin-norepinephrine reuptake inhibitors, gabapentinoids, or tricyclic antidepressants
What is the virulence factor of neisseria meningitidis in sepsis?
Neisseria meningitidis can cause sepsis and rapid circulatory collapse in previously healthy young individuals.
Lipooligosaccharide, a virulence factor in the pathogen’s outer membrane, is the major underlying cause of disease severity.
Red blood cell fragments, burr cells, and helmet cells are associated with?
either microangiopathic hemolytic anemia or mechanical red cell destruction.
In patietns with prosthetic valves, red blood cells are exposed to excessive shear and turbulence in the circulation, causing damage from mechanical trauma
Chronic opioid use leads to the development of?
tolerance to analgesic effects and most side effects, with the exception of constipation and miosis.
To prevent bowel complications, it is recommended that patients be treated prophylactically with adequate fluid intake and daily laxatives.
What is henoch-schonlein purpura?
an IgA mediated leukocytoclastic vasculitis that commonly causes lower extremity palpable purpura, abdominal pain (+- gastrointestinal bleeding), renal disease (eg, hematuria) and joint pain
MOA of carbonic anhydrase inhibitors (eg acetazolamide)
are weak diuretics that block reabsorption of sodium bicarbonate (NaHCO3) in the proximal tubule. The main effect is increased HCO3 excretion, leading to increased urine pH, mild metabolic acidosis (with compensatory respiratory alkalosis), mild hypokalemia, and mild hypocalcemia
Teratogenic effects of valproate
Valproate is a teratogenic medication that decreases maternal folate levels and increases the risk of fetal neural tube defects (eg, meningocele, myelomeningocele)
What is idiopathic pulmonary fibrosis?
an interstitial lung disease characterized by chronic progressive dyspnea, nonproductive cough, inspiratory crackles, and subpleural (peripheral) lung honeycombing.
In IPF, repetitive micro injury to the alveolar epithelium (smoking, acid reflux) is focally repaired by fibroblast proliferation/collagen deposition instead of normal restoration via type 2 pneumocyte differentiation
Pupillary asymmetry (anisocoria) is caused by
a lesion in the ocular parasympathetic (pupillary constriction or sympathetic (pupillary dilation) pathways.
If the pupillary asymmetry increases in a dim room, it indicates that the smaller right pupil is unable to dilate due to a lesion in the right oculosympathetic pathway
Pudendal nerve injury during vaginal delivery leads to?
gradual denervation and weakness of the pelvic floor muscles. In combination with age-related tissue atrophy, this injury contributes to pelvic organ prolapse (cystocele)
What is acute intermittent porphyria?
an autosomal dominant condition caused by porphobilinogen deaminase deficiency.
Most patients remain asymptomatic, but a minority present with acute attacks characterized by abdominal pain and vomiting, peripheral neuropathy, neuropsychological symptoms, and reddish-brown urine.
Treatment consists of intravenous glucose or heme preparations, which downregulate ALA synthase activity
How does acute aortic dissection typically present?
with sudden-onset, severe chest pain that is sharp or tearing in nature. Upper extremity blood pressure asymmetry can result from extension of the dissection into other vessels.
Extension into the pericardium can cause acute tamponade with reduced cardiac output and shock.
What is Osgood-Schlatter disease?
Repetitive traction at the tibial tubercle due to quadriceps contractions can lead to avulsion and fragmentation of the tibial tubercle in skeletally immature children, causing Osgood-Schlatter disease
Acute lung transplant rejection
is a cell mediated response involving T lymphocyte activation against donor antigens and typically occurs within 6 months of transplant.
Affected patients can have shortness of breath, cough, and low grade fever.
Lung biopsy reveals perivascular and peribronchiolar lymphocytic infiltrate and absence of epithelial cell viral inclusions (ruling out cytomegalovirus)
What is a communicating hydrocephalus?
Symmetrical enlargement of the ventriculi is characteristic of communicating hydrocephalus.
Communicating hydrocephalus usually occurs secondary to dysfunction or obliteration of subarachnoid villi.
This dysfunction is usually a sequelae of meningeal infection (including tuberculosis meningitis) or subarachnoid/intraventricular hemorrhage)
Heparin-induced thrombocytopenia and thrombosis results from?
results from the production of IgG antibodies against complexes of heparin and platelet factor-4.
The Fc component of these antibodies binds to platelets, resulting in widespread platelet activation and a prothrombotic state.
What beta2-microglobulin
Beta2-microglobulin is renally cleared and poorly dialyzed. It accumulates as amyloid in dialysis patients, increasing in prevalence with dialysis duration, and has a predilection for osteoarticular surfaces.
Shoulder pain and carpal tunnel syndrome are common. Bone cysts and pathologic fracures may also occur.
What is friedreich ataxia?
AR condition that presents during childhood/adolescence with progressive gait ataxia (due to degeneration of the spinocerebellar tracts) and impaired joint and vibration sense (due to degeneration of the posterior columns and dorsal root ganglia). Other features include hypertrophic cardiomyopathy (most common cause of death), skeletal abnormalities (kyphoscoliosis, pes cavus), and diabetes mellitus
Side effects of tricyclic antidepressants
Tricyclic antidepressants have strong anticholinergic properties. Potential side effects include confusion, constipation, and urinary retention. These meds should be used with caution in elderly patients
Factors that promote formation of cholesterol stones
Most gallstones occur due to the supersaturation of cholesterol, which precipitates out of bile with mucin and calcium salts to form white or yellow cholesterol stones.
Factors that promote the formation of cholesterol stones include increased cholesterol synthesis, gallbladder hypomotility, increased calcium or mucin concentration, and decreased bile acid synthesis or recirculation.
What is phenylketonuria?
Intellectual disability, gait abnormalities, and a musty body odor are signs of phenylketonuria, an AR disorder.
The probability that a child will inherit an autosomal recessive disease from heterozygous carrier parents is 1/4
What is AA amyloidosis?
AA amyloidosis results from excessive serum amyloid A produced in rheumatoid arthritis and other chronic inflammatory conditions.
Renal disease, the most common manifestation, presents as nephrotic syndrome.
Light microscopy shows amorphous pink deposits with apple-green birefringence on Congo red stain under polarized light.
What is the virulence of strep pneumo?
predominantly due to its polysaccharide capsule, which impedes phagocytosis and complement binding.
What is seen in tumor lysis syndrome?
Patients with hematologic malignancies that have high tumor cell burdens or rapid turnover rates are at high risk for electrolyte abnormalities following the initiation of cytotoxic chemotherapy due to the massive lysis of tumor cells.
Patients generally develop hyperphosphatemia, hyperkalemia, hyperkalemia, hyperuricemia, and elevated lactate dehydrogenase
What is gender dysphoria?
characterized by a strong and persistent desire to live and be treated as another gender, which causes distress or impairment. It is often accompanied by a desire to change one’s primary or secondary sexual characteristics
What is type 1 HSR?
Type I HSR are an allergic response triggered by the binding of previously recognized antigen to IgE antibodies on mast cells.
In the early phase of the response, histamine, already stored in preformed granules in mast cells, is the first chemical mediator released.
Once released, histamine stimulates smooth muscle contraction (bronchoconstriction), increases vascular permeability (edema) and increases mucus secretion
What is southern blotting?
a technique used to identify DNA mutations. It involves restriction endonuclease digestion of sample DNA, gel electrophoresis, and gene identification with a labeled DNA probe
Heparin increases the effect of?
Heparin is commonly used for the prevention of deep venous thrombosis in nonambulatory patients or those undergoing elective surgery, especially hip and knee surgery.
Heparin increases the effect of the naturally occuring anticoagulant antithrombin III
What is Zollinger Ellison syndrome?
Patients with zollinger-ellison syndrome develop peptic ulcer disease and parietal cell hyperplasia with gastric fold enlargement due to gastrin hypersecretion
Subdural hematoma is due to?
Looks like a cresent on CT.
Subdural hematoma occurs due to rupture of cortical bridging veins. In young patients, it results from a fall or motor vehicle accident, and manifests with gradual onset of headache and confusion. In elderly patients it may occur after a minor trauma and present with a variety of neurologic symptoms
What is obstructive sleep apnea?
characterized by sleep related apnea/choking spells, loud snoring, disrupted sleep, excessive daytime somnolence, and symptoms that may overlap with depression (eg, low mood, fatigue, impaired concentration)
Inferior surface of the heart is supplied by?
The inferior wall of the left ventricle forms most of the inferior (diaphragmatic) surface of the heart and is supplied by the posterior descending artery.
In 85-90% of people, the posterior descending artery derives from the right coronary artery (right dominant coronary circulation)
What is exercise-associated collapse?
typically occurs after intense exercise in well-conditioned athletes. It is characterized by loss of postural tone or syncope immediately following the cessation of exercise and occurs due to impaired venous return to the heart
The most common cause of community acquired pneumonia in both HIV infected and HIV uninfected people
Strep pneumo.
Risk of invasive pneumococcal disease is significantly increased in patients with HIV regardless of CD4 count
What is polymyalgia rheumatica?
Polymyalgia rheumatica occurs in more than half of patients with temporal arteritis.
It is characterized by neck, torso, shoulder, and pelvic girdle pain and morning stiffness.
Fatigue, fever, and weight loss may also occur.
Monocular vision loss is a common complication of temporal arteritis
What is pure red cell aplasia?
a rare form of bone marrow failure characterized by severe anemia with reticulocytopenia and morphologically normal platelets and leukocytes.
It is most common with thymoma, lymphocytic leukemia, and parvo B19 infection
Mefloquine chemoprophylaxis for malaria must be continued for 4 weeks after return from a malaria-endemic region to ensure the elimination of?
hepatic schizonts (which mature in the liver over 8-30 days)
What is the number needed to treat?
the number of patients that need to be treated with a medication to avoid an additional negative outcome.
NNT is calculated by dividing 1 by the absolute risk reduction (the difference between the control and experimental group event rates)
Lower NNT values represent more beneficial treatments.
Histopath for chronic lymphocytic (hashimoto) thyroiditis
a common cause of primary hypothyroidism.
Histopath: intense lymphoplasmacytic infiltrate, often with germinal centers.
Residual follicles may be surrounded by Hurthle cells (large cells with granular, eosinophilic cytoplasm)
What is seen in acute cardiac tamponade?
Blunt chest trauma can lead to several life-threatening cardiopulmonary injuries. Progresssive hypotension with tachycardia, jugular venous distension, and bilateral vesicular breath sounds suggest acute cardiac tamponade
What is Dandy Walker malformation?
a developmental anomaly characterized by hypoplasia/absence of the cerebellar vermis and cystic dilation of the fourth ventricle with posterior fossa enlargement.
Patients often present during infancy with developmental delay and progressive skull enlargement. Other features may include cerebellar dysfunction and non-communicating hydrocephalus
What is a ganglion cyst?
a connective tissue outpouching arising from tendon sheaths and joint structures. It is typically round, firm, well circumscribed, and transilluminates on penlight. Most resolve spontaneously
Function of the lessor omentum
The lesser omentum is a double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the beginning of the duodenum. It is divided into the hepatogastric and hepatoduodenal ligaments.
What is eosinophilic granulomatosis with polyangiitis (Churg Strauss)?
a small to medium vessel vasculitis characterized by late onset asthma, rhinosinusitis, and eosinophilia.
Mononeuritis multiplex due to involvement of the epineural vessels of peripheral nerves is common.
What is aortic coarctation?
classically leads to lower extremity claudication and increased blood pressure in the arms compared to the legs.
Over time, if the defect remains unrepaired, a compensatory collateral circulation develops and supplies blood to the descending aorta.
Blood flow through collateral vessels creates a continuous murmur heard over the interscapular area
What can increase the risk for sudden infant death syndrome?
Maternal tobacco use during pregnancy and secondhand smoke exposure are associated with an increased risk for SIDS.
Pathophysiology of the association between smoke exposure and SIDS may relate to impaired arousal and cardiovascular response to stimuli (airflow obstruction)
Frontal lobe function
The frontal lobes are involved in personality, language, motor functions, and executive functions (eg, abstraction).
Frontal lobe function may be diagnosed by testing abstraction ability (asking about the similarities between two related objects)
What is buspirone?
Buspirone is a nonbenzodiazepine anxiolytic used to treat generalized anxiety disorder. It has a slow onset of action, lacks muscle relaxant or anticonvulsants properties, and carries no risk of dependence
Prostate cancer relation with the bone
Prostate cancer is common in older men and metastasizes primarily to bone due to bone-specific tumor adhesion molecules and receptor ligands on the cellular surface.
Prostate cancer causes osteoblastic lesions that result in new bone growth. Biopsy would show disordered trabeculae and signs of prostate cancer such as irregular glands with enlarged nuclei and prominent nucleoli
MOA of thiazide diuretics
Thiazide diuretics work by blocking NaCl symporters in the distal convoluted tubules, causing enhanced Na, Cl, and water excretion.
Since only a small amount of filtered Na reaches the distal tubules, thiazides are not as efficacious as loop diuretics.
Unlike loop diuretics, thiazides can cause hypercalcemia
What is multiple sclerosis?
characterized by episodic, progressive neurologic deficits involving multiple anatomic regions within the central nervous system. Demyelinating plaques are commonly seen in hyperintense lesions on T2-weighted MRI of the brain and spinal cord.
Common manifestations include optic neuritis, internuclear ophthalmoplegia, sensory deficits, and fatigue, which may worsen with heat exposure
What is Wiskott-Aldrich syndrome
triad of eczema, thrombocytopenia, and combined B and T cell deficiency.
Patients can have thrombocytopenia at birth, with eczema and repeated infections due to encapsulated and/or opportunistic organisms usually developing later around 6 to 12 months of age
What is postoperative urinary retention?
Postoperative urinary retention, with incomplete bladder emptying, is a common complication thought to involve decreased micturition reflex activity, decreased contractility of the bladder detrusor, and/or increased vesical sphincter tone. This condition may be treated with a muscarinic agonist (bethanechol) or an alpha 1 blocking drug
Most available rodenticides contain brodifacoum, a long acting 4-hydroxycoumarin derivative. A patient who has ingested a quantity of rodenticide sufficient to cause coagulopathy and abnormal bleeding requires?
immediate treatment with fresh frozen plasma in addition to vitamin K
Pulmonary hypertension leads to?
Pulmonary hypertension should be suspected in young and otherwise healthy patients with fatigue, progressive dyspnea, atypical chest pain, or unexplained syncope.
Long standing pulmonary hypertension leads to hypertrophy and/or dilation of the right ventricle (cor pulmonale)
