* Wrong Answers (Second Pass) Flashcards
Antihypertensive emergency drug (IV):
- arteriolar dilation
- increases renal perfusion (only IV one!)
- promotes natriuresis
Fendolopam
selective dopamine-1 agonist
(no effect on alpha or beta receptors)
antihypertensive that relaxes arterioles but not veins;
adverse effect?
Na and fluid retention
(reflex symp action –> tachycarida and edema)
(e.g. hydralazine and minoxidil)
bacteria makes dextrans from sucrose;
adherence site?
FIBRIN -platelet aggregates
viridans strep
nerves and vessels supplying ovary are in what ligament
suspensory
cancer cells resist chemo drugs with what type of surface glycoprotein
ATP-dependent transporter
efflux pump
zenker divrituculum cause
cricopharyngeal muscle dysfunction
diminshed relaxation of pharyngeal muscles during swallowing –> increased pressure –> mucosa herniates through wall
isolated diastolic HF;
LVEDP?
LVEDV?
LV EF?
LVEDP increased
LVEDV and EF are normal
(dyastolic HF = decreased ventricular diastolic compliance but normal contraction)
Hyperaldosteronism (primary mineral corticoid excess) Renin? Na? K? Bicarb? Fluid status? BP
Renin- low Na - NORMAL K - low Bicarb - high Euvolemic HTN
- H exretion –> incrased bicarb reabsob in alpha-intercalated cells
- rise in volume causes ANP and increased pressure natiuresis –> compensates for Na and fluid effects of aldo)
3 effects of aldo
- Increase ENaC (luminal - brings Na in)
- Increase Na/K ATPase (basal - Na to blood)
- Increase H pump (luminal - H out to urine)
aortic stenosis loudest at what point on cath tracing
peak of aortic pressure (intensity related to magnitude) LV/AS pressure gradient
neurofibromas - cell type/embryologic origin
schwann cells
neural crest
anti-CD20 med
rituximab
used for some lymphomas
anti-TNF alpha med
infliximab
used for RA, ank spon, fistulizing crohn’s
provides major proliferative stimuli for cellualr components of atherosclerotic plaques
platelets
endothelial cells
macrophages
(release PDGF –> sm muscle migrates from media into intima and prolif)
least common site of malignancy in GI tract
duodenum
impairment of glucose –> ribulose-5-phosphate would inhibit what biochem pathways
- cholesterol synth
- FA synth
- glutathione antiox mech
(all require NADPH)
how to handle somatic symptom d/o pt
increase freq of outpatient visits (with same provider)
Parvo B19 virus description
DNA
single-stranded
non-env
Bruise –> green
what enzyme
Heme oxygenase
heme –> biliverdin
biotin reaction types
CO2 carrier
e.g. pyruvate to oxaloacetate
ziovudine mech
NRTI
- binds to RT and is incorporated into genome
- does NOT have a 3’-OH –> blocks 3’-5’ phospodiester bond formation
TB drug that causes cells to lose their acid-fast-ness
isoniazid
inhibits synth of mycolic acids (lose acid fast-ness) and stop muliplying
1st gen antihistamines also have effects on what other receptors
anti- muscarinic
anti- alpha
anti -serotonin
(chorpehniramine and diphenhydramine)
diphenhydramine –> blurred vision
antagonism of what
acetylcholine
lung bx:
colmnar mucin-secreting cells that line the alveolar spaces w/o invading stroma or vessels
Malignant neoplasm:
Adenocarcinoma in situ (aka bronchioalveolar carcinoma)
pre-invasive
well differentiated dysplastic columnar cells arising from alveolar epithelium (w/ or w/o mucin)
possible aerogenous spread if not resected
infant: hypotonia mild jaundice enlarged tongue umbilical hernia
hypothyroidism
(also poor feeding, lethargic, constipation, hoarse cry)
increased incidence of ASD/VSD
hyperammonemia –> depletion of what in brain
depletes alpha-KG (–> inhib krebs cycle)
depletes glutaMATE (excititory) –> accumulation of glutaMINE –> astrocyte swelling and dysfx
Flow relation to radius
Flow is directly proportional to the radius to the FOURTH power (r^4)
chemotherapeutic agent that binds with viral-encoded enzymes (DNA pol, RNA pol, RT) that does not need intracellular activation
Foscarnet
(pyrophosphate analog)
binds DNA pol in herpes
binds RT in HIV
General rule - what is NOT an effective way to kill bacteria transmitted fecal/oral
acid
they survive the stomach!
How to kill HAV on contaminated products
- water chlorination
- bleach (1:100 dilution)
- formalin
- UV
- boiling to 85C for ONE MINUTE
( or autoclaving 120C for 20mins)
JAK kinase tyrosine receptor ligands
JAK/STAT pathway
GH PRL IL-2 cytokines Colony stim factors
receptor tyrosine kinase ligands
MAP-kinase –> Ras….
Growth factors
(EGF, PDGF, FGF, etc)
Insulin
Enzyme that is defective in MSUD requires what cofactors
remember: branched chain alpha-ketoacid dehrogenase is like pyruvate dehydrogenase and alpha-KG dehdrogenase
TLC For Nobody
Some MSUD pts improve with what supplement
Thiamine (high dose)
apoptosis from folate deficiency would be somewhat helped with what supplementation
thymidine
folate def inhibits formation of dTMP
isolated systolic HTN after 50 from what?
(SBP >160 and DBP
age-related decrease in compliance of aorta and it’s proximal major branches
COPD –> cerebral vascular resistance?
decreased
genetic exchange b/w two virus strains that have non-fragmented dsDNA
recombination
other possibilities?
Group A Strep - virulence factor that protects against phagocytic killing
Protein M
- major virulence factor
- inhibits phagocytosis and activation of complement
- cytotoxic to neutrophils in seurm
- mediator of bacterial attachment
Streptolysin O
- lyses erythrocytes and neutrophils
- oxygen labile
(NOT antiphagocytic)
weak wrist extension
- where was the nerve injured
head of radius
“nursmaid’s elbow”
- radial nerve divides at lateral epicondyle
- superficial = pure sensory (radial half of dorsal hand except distal fingers)
- deep branch = forearm extensor compartment –> dmg = wrist drop
(no sensory)
erythema of antral mucosa
bx: inflammatory cell infiltrates
type B chronic gastritis
- aka H pylori associated
- aka antrum predominate
- inflammatory infl cell type distiguishes chronic vs acute
- a/w risk of MALToma and gastric adenocarcinoma
gastritis a/w megaloblastic anemia
Type A
- aka autoimmune
- body of stomach
MCC of meningitis in adults
strep pneumo
lancet shaped gram pos cocci in pairs
Contribute to a low Vd (3-5L)
(things that trap it in plasma)
- HIGH molecular weight
- HIGH plasma protein binding
- HIGH charge
- hydroPHILLIC
note: Bioavailability is UNRELATED
Actions of nitroprusside
(must be IV)
- short acting balanced venous AND arterial vasodilator
- decreases both preload and afterload
- stroke volume maintained
Decreased preload on P/V loop
EDV decreases
- right edge of curve moves toward y axis
Decreased afterload on P/V loop
Mean Systolic intraventricular pressure decreases
- top curve lower
Bilateral renal masses composed of fat, smooth muscle, and blood vessels in young woman….
(renal angiomyolipomas)
a/w tuberous sclerosis
bilateral = 80-90%
Tuberous sclerosis features
Autosomal Dom
- cortical tubers
- subependymal hamartomas (brain)
- seizures
- mental retardation
- cardiac rhabdomyomas
- facial angiofibromas
- ASH LEAF spots (depigmented)
Fragile X mech
increased CGG repeats on X –> hypermethylation of cytosine bases –> gene inactivation
- ambiguous external genitalia in XX
- maternal virilization
placental aromatase deficiency
what catalyzes first step in beta-oxidation
Acyl-CoA dehydrogenase
most commonly deficient enzyme in that pathway
holosystolic
apex
radiates to axilla
… best indicator of severity
presence of S3
- indicative of large volume of regurgitant flow –> increased rate of LV filling
(mitral regurg)
opening snap to S2 interval = diag of intensity of what
mitral STENOSIS
aburpt halting of valve leaflets
what shares an origin with endogenous opiods (endorphins, enkephalins, dynorphins)
ACTH
MSH
(POMC precursor for all)
Lithium induced nephrogenic DI - med tx?
hydrochlorathiazide
same for any nephrogenic DI
viral glycoprotein that poorly correlates with viral replication
HBsAg,
which is a component of the ENVELOPE
HBeAg
- core component assembles virion w/in hepatocytes (like HBcAg)
- precore component directs secretion into blood
von Willebrand factor binds to what
sub endothelial collagen
bilateral wedge shaped strips of necrosis over cerebral convexity
ischemia in watershed areas
- hypoxic-ischemic encephalopathy
(global cerebral ischemia due to profound hypoperfusion)
taking exogenous glucocoricoids… post surgery levels of CRH, ACTH, and Cortisol compared to normal response
all decreased
autoAb that have high specificity for RA
anti-citrullinated peptides (anti CCP)
RF factor = anti Fc portion of IgG, but they are not as specific
actions of interferon alpha and beta
activate cells to synthesize antiviral proteins that degrade intracellular mRNA —> halts protein synth
(activated by viral dsRNA)
produced by wide variety of cells
interferon gamma
produced mainly by NK and T cells
- increases MCH II expression
- promotes Th1 dfferentiation
- activates macrophages
“saddle anesthesia” + loss of anocutaneous reflex
cauda equina syndrome
- dmg to S2-S4 nerve roots
viruses that bud through nuclear membrane
herpes viruses
e. g:
- cytomegalovirus
- HSV
- VZV
- HHV-8
drug (3):
- blocks synthesis of viral DNA from the RNA template
- not phosphorylated intracellularly
- structurally unrelated to nucleosides
nevirapine
efavienz
delavirdine
(NNRTIs)
comedocarcinoma
DCIS
breast nodule
- ducts distended by pleomorphic cells with prominent central necrosis
- does not extend beyond ductal basal membrane
comedocarcinoma
(subtype of DCIS)
characterized by solid sheets of pleomorphic high grade cells w/central necrosis
Paget disease of nipple
malignant cells spread from superficial DCIS into nipple skin w/o crossing basement membrane
- unilateral erythema and scale crust around nipple
fibroadenoma histo
cellular often mixoid stroma that encircles and sometimes compresses epithelium-lined glandular cystic spaces
common carotid - which aortic arch
3rd
porphyria cutanea tarda - enzyme def
uroporphyrinogen decarboxylase
increased ejection fraction on pressure volume loop
widening of graph
(isovolumetric relaxation line shifted toward y axis showing less volume remaining in ventricle after contraction complete)
test that is specific for acute cholocystitis
failed gallbladder visualization on radionuclide biliary scan
(indicates obstx)
contrast given IV - normally goes from liver to gallbladder
hematologic d/o a/w JAK/STAT pathway
- essential thrombocytosis
- polycythemia vera
- primary myelofibrosis
pregnant w/ hypertension and leg swelling - other likely finding
proteinuria
Triad of pre-eclampsia:
- HTN
- edema
- proteinuria
*can progress to HELLP
hyperuricemia after an episode of arthritis - what’s the best long-term tx
xanthine oxidase inhib
how does silicosis increase risk of TB
disrupts macrophage phagolysomes by internalized silica particles
(macrophage killing of intracellular mycobacteria by be impaired as a result)
how is elastin able to recoil
crosslinking between four lysine residues on 4 different elastin chains
(extracellular lysyl hydroxylase crosslinks)
mech of DDAVP in hemophilia
induces release of vWF and factor VIII from ENDOTHELIAL cells
(temporarily increases factor VIII levels 2-3x)
NB: factor VIII made by liver and stored in endothelial cells
- mouth ulcers
- fever
- low WBC
(hx of TIA and HTN)
Ticlopidine induced neutropenia
1% of ppl - should monitor blood count biweekly for first 3 months
Ticlopidine
ADP antagonist
(like clopidigril)
*risk of neutropenia
Mechanism to address in infertility tx for PCOS
Estrogen receptor modulaiton
- tx with clomiphene or letrazole
(decreases negative feedback inhib on hypothalamus–> increases gonadotropin production)
drug –> direct dilation of arteries and inhib of platelet aggregation
cilostazol
- decreases activity of platelet phosphodiesterase (enzyme that breaks down cAMP) –> prevents platelet shape change/granule release
- direct arterial vasodialtor
(used for intermittent claudication; better than asprin in peripheral arterial disease)
argatroban
antithrombotic drug used in tx of heparin-induced thrompocytopenia
direct thrombin inhibitor
kid w/
toe cyanosis and clubbing but no finger abnormalities
patent ductus arteriosus w/ late-onset reversal of shunt
- PDA after branches from aorta to upper body
- coartation does not typically cause cyanois, just differences in BP
IgA nephropathy (Berger’s)
IgA neph
- followed by URI
- present w/ painless hematuria
- often subsides and returns every few months
- IgA in MESANGIUM
- dx = HSP if a/w extrarenal symp (e.g. abdominal pain, purpura)
analgesic into epidural space - what’s the effect on postsynaptic neuron
Increases K efflux out of cell (one way)
Opiods
- bind to mu receptors
- g-protein coupled activation of K channels (efflux)
- hyperpolarization of postynaptic cesll
or
inhibit adenyl cyclase, inhib calcium conductance, inhbib transmitter release
biologically active form of pantothenic acid
Coenzyme A
cofactor for oxaloacetate to citrate
Pantothenic acid (CoA)
first step in TCA cycle
CoA important in synthesis of…
- Vit A
- Vit D
- Cholesterol
- Steroids
- Heme A
- FAs
- AAs
- Proteins
RNA containing odd nucleosides
e.g. pseudouridine, thymidine, dihyrouracil
tRNA
3’ end of tRNA
(acceptor stem - binds AA)
CCA (- OH)
Bacillus anthracis capsule
D-glutamate
instead of polysaccharide
MAC prophylaxis
Azithromycin
(CD4
HIV proph
CD4
TB drug that requires acidic environment
Pyrazinamide (PZA)
*most bacterialcidal to intracellular bac that are in the macrophages
- Precocious puberty
- Parinaud syndrome aka dorsal midbrain syndrome (paralysis of upward gaze/convergence)
- obstructive hydrocephalus
Pineal germinomas
germ cell tumors histologically simialr to testicular seminomas
infant w/ meningitis - what are the bacteria + meds
Group B –> ceftriaxone
Listeria –> AMPicillin
Note:
ceftriaxone would also cover N. meningitidis, strep pneumo, and Hflu
pt tx for arrhythmia (esp aFib w/vent tach) –> constipation, bradycardia, 2nd or 3rd degree heart block, gingival hyperplasia
SE of what drug?
Verapamil
note: digoxin –> diarrhea and n/v
excess 17-hyroxyprogesterone and testosterone
- histo findings
adrenal cortical hyperplasia
passive extension —> initial resistance —> sudden release of tension
“clasp-knife” spasticity
UMN lesion - lack of UMN inhibition of stretch reflex
internal capsule, cortical spinal tracts, medulla, pons, midbrain
internal capsule stroke usually = pure motor (contralateral)
Bleeding tests results for end stage renal disease
(uremia –> qualitative platelet d/o)
- prolonged bleeding time
- normal platelet count
- normal PT and PTT
hyperlipidemia drug that can trigger gout
Niacin
also can –> hyperglycemia/ancanthosis nigricans
kid w/ involuntary jerking of face, arms legs
- sore throat 3 mo ago
- all vaccines up to date
rhumatic fever
molecular mimicry to cardiac and neuronal tissue
env
gp 160
- gp 41
- gp 120
(Go Put the ENVelope in the mail)
gag
p24
p7
(nucleocapsid)
HIV pt w/ impaired vision–>
- generalized seizures
- hypocalcemic
- hypomagnesemic
SE of what drug?
Foscarnet
- chelates calcium
- nephrotxic renal Mg wasting
tx for CMV retinitis - gancyclovir =1st (a/w neutropenia) - foscarnet - cidofovir
dark gallstones w/ 7% cholesterol
- what enzyme contributed
Beta-glucuronidase
(2/2 infx of biliary tract injuring hepatocytes)
- hydrolysis of bilirubin glucuronides and increases amt of unconj biliurbin in bile
NB: pigment stones most common in rural Asian pop
parasites that increase risk of pigmented gallstones
Ascaris Opisthorchis sinensis (liver fluke)
(also biliary infx w/ e coli)
- symmetric myeling layer vaculization
- axonal degen
- posterior columns
- lateral corticospinal tracts
Vit B12 def
(subacute combined - i.e. ascendign and descending)
position/vibration,
ataxia,
spastic paresis
dmg to dorsal columns and dorsal roots
tabes dorsalis
exacerbates myocardial ischemia by redistributing blood away from ischemic areas
CORONARY artery dilation
- ischemic arterioles are already dilated while others are not, increasing collateral flow; dilating decreases pressure in non-ischemic vessels, decreasing collateral flow
- shipyard
- hemorrhagic pleural effusion
- columnar cells joined by desmosomes
- TONOFILAMENTS
- long microvilli
(asbestos)
Mesothelioma
EM gold standard for dx
- tonofilaments and slender microvilli (vs short plump microvili of adeno)
hypophysectomy –> decreased epinephrine from adrenals
what enzyme?
Phenylethanolamine-N-methyltransferase
- stimulated by CORTISOL
- NE –> E
underlying issue in beta thalasemia
beta chain production via defects in
- mRNA transcription
- mRNA processing
- mRNA translation
MC mt –> aberrant spicing of precursor mRNA or premature chain termination during translation
hemorrhage in left temporal lobe and compression of anterior medial temporal lobe agains the free margin of tentorium cerebelli
UNCAL herniation
(transtentorial)
- compression of CN III (oculomotor)
- “down and out”
(ipsilateral)
first sign of uncal/transtentorial herniation
fixed dilated pupil on side of the lesion
ipsilateral paralysis of CN III
+/- contralateral homonymous hemianopsia w/macular sparing
needs a viral protease
single stranded RNA
positive sense
nonsegmented
(e.g. picornaviruses - echo,etc)
drug used in emergent tx of pts with acute coronary symptoms (decrease mortality)
- what is an adverse effect
Beta-blockers
(work at level of receptor)
can –> bronchochonstriction and wheezing
Odds Ratio
*write it out!
(a/B)/(c/D) = ad/bc
aka - across tx row
tetrahydrobiopterin
cofactor in:
pheylalanine –>tyrosine
tyrosine –> dopa
tryptophan –> serotonin precursor
nitric oxide synth
many of amphotericin B’s toxic effect are due to it’s binding of…
cell membrane cholesterol
21 yr old w/ chronic headaches and ataxia found to have low-lying cerebellar tonsils extending into vertebral canal
arnold chiari type 1 malformation
(congenital)
usu asymptomatic in infants but manifests as adult w/ headaches and cerebellar symptoms (e.g. ataxia)
(type II more severe and usu presents in infancy; abnormally formed cerbellum and medulla –> myelomenigocele and hydroceph)
mechanism of tissue damage in TB infx
delayed type hypersensitivity (type 4)
granulmatous inflammation and caseous necrosis
eosinophil anti-hemilinth action
- stimulated to destroy parasite via ANTIBODY dependent cell-mediated cytotoxicity with enzyme from their cytoplasmic granules
7 alpha hydroxylase
converts cholesterol into bile acids
- suppressed by fibrates –> increased cholesterol in bile –> risk of stones (esp w/ hypomobility)
anti-mitochondrial abs…
dx and description
Primary biliary cirrhosis (PBC)
autoimmune destruction of intrahepatic bile ducts and cholestasis
“florid duct lesion”
- granulomatous infl
similar infiltrate to graft vs host
eventually liver grossly stained green and uniformly micronodular
high fructose 2,6- bisphosphate will inhibit conversion of…
gluconeogenesis
via inhib fructose 1,6-bisphosphatase
e.g.
alanine –> glucose
NB: will NOT inhibit glycogen synth; in fact both are stim by insulin so often occur together
lipid drug that increases TGs
cholestyramine
bile acid-binding resins
TTP vs DIC
TTP = thromotic thrombocytopenic purpura (on same path with HUS) - usually do NOT bleed - only platelets activated - normal PT/PTT - normal fibrinogen
DIC
- bleed
- coag cascade activated
- PT/PTT long
- low fibrinogen
- high FDP (esp D-dimer)
cecum fixed to right upper quadrant
failure of midgut rotation around SMA
inhibition of lactate dehydrogenase in strenously exercising skeletal muscles would eventually inhibit glycolysis due to depletion of…
NAD+
acute viral hepatitis symptoms
dark urine (increased serum bilirubin) n/v fever malise hepatomegaly jaundice
aspirin ingestion process
1 - resp alkalosis
(directly STIMULATE resp center –> increased ventilation)
2 - AG met acidosis shortly afterward
(increase lipolysis, uncouple oxidative phosphorylation, inhibit TCA cycle —> accum of organic ions in blood - ketoacids, lactate, pyruvate)
therefore usu present w/mixed acidosis/alkalosis
aspirin ingestion labs
mixed resp alk/met acidosis
pH: in normal range
CO2: low
HCO3: low
note: CO2 will be lower than what it would be for compensation - means it is not due to comp alone (concurrent primary resp alkalosis)
- hypotension
- tachycardia
- JVD (increased central venous pressure)
- pulsus paradoxus
cardiac tamponade
hypercalcemia in sarcoidosis
increased extrarenal formation of 1,25-vit D by activated MACROPHAGES
(hypercalcemia suppresses PTH)
resistance in parallel
1/R =
1/R1 + 1/R2 + 1/R#…
*remember the total is the reciprocal too!
high fever
watery diarrhea
mildly productive cough
legionella
*will not gram stain (will see neutrophils)
clubbing - bronchial ashtma or bronchiectasis
bronchiectasis
hereditary spherocytosis (or any hemolytic anemia) at risk for…
pigmented gallstones
NOT splenic infarction
- normal CT at first
- weeks later CT shows
lake-like cavitary lesion in deep brain structures
hypertensive arteriolar sclerosis –> lacunar infarct
chronic htn (MCC) –>arterioles undergo lipohyalinosis –>microatheroma formation —> occlusion
(note: charcot-bouchard aneuysm would appear as a focus of intraparynchymal hyperdensity on intitial CT)
Increased in CHF (CV measure)
arteriolar resistance
- decreased CO –> renal flow –> activates RAAS
- decreased CO –> sympathetic outflow
this increases afterload and exacerbates HF
vegetations on heart of relatively young person w/o other risk factors
mitral valve prolapse
*MC cardiac abnormality predisposing to “native valve bacterial endocarditis” in 15-60 y/o in US
(rheumatic fever potential, but less common)
Abx a/w serotonin syndrome
Linezolid
Analgesic a/w serotonin syndrome
Tramadol
directly supplies nitrogen to urea cycle
Aspartate
“TAke nitrogen from asparTAte”
(aspartate + citrulline —> arginosuccinate)
infant w/ lethargy, vomiting, tachypnea soon after birth
met acidosis w/ large AG, ketosis, hypoglycemia
increased methylmalonic acid in urine and serum– what type of reaction is deficient
isomerization
pt has methylmalonic aciduria
- defect in isomerization reaction of meythylmalonyl CoA –> succinyl CoA (—> TCA)
(B12 cofactor in isomerization)
TNF-alpha decreases glucose uptake via…
serine and threonine residue phosphorylation (via activation of kinases)
- phosphorylation of serine/threo in beta subunit of insulin receptors hinders signalling
- phosyphorylation of IRS-1 serine/threo residues inhibits tyrosine phosphyroyaltion by insulin
- mech of insulin resistance in catecholamines, glucocorticoids, and glucagon (and FFAs)
neonatal:
- pupillary dilation
- rhinorrhea
- sneezing
- nasal stuffiness
- diarrhea
- n/v
- chills, tremors, jittery movements
- rarely seizures
narcotic/optiate withdrawl
tx with opium tincture (orally)
histo of hashimotos
- intense mononuclear infiltration (lymphocytes and plasma cells)
- germinal centers
- Hurthle cells - large oxyphilic cells w/ granular cytoplasm (follicular epithelial cell metaplastic chanbe)
drug for idiopathic pulmonary artery htn
bosentan
competitive antagonist of endothelin receptors
post GU infx:
- conjunctivitis
- rt knee pain
- vesicular rash on palms and soles
Reactive arthritis
also may a/w:
- ethesitis
- dactylitis
- sacroiilitis (20%)
- oral ulcers
reactive arthritis
vs
secondary syph
(skin findings)
ReA
- keratoderma blennorrhagicum = hyperkeratotic vesicles on palms and soles
- circinate balantis = serpiginous annular dermatitis of glans penis
Syph:
- maculopapular or pustular (but NOT vesicular) rash that can involve palms and soles
NB: syph a/w POLYarthritis
external branch of superior
laryngeal nerve
(innervates what muscle)
cricothyroid
*near SUPERIOR thyroid arter/vein
alkaptonuria
what reaction pathway
tyrosine –> –> fumarate
enzyme:
homogentisate oxidase
IgG against phospholipase A2 (on podocytes)
idopathic membranous nephropathy
- homonymous hemianopia
- marcus gunn pupil
(relative afferent pupillary defect)
(where’s the lesion)
Optic tract (contralateral)
*note: the nasal portion of the retina contributes more reflex (why contralateral damage of optic tract will decrease reaction)
PAH lowest concentration where
bowman’s space
vascular tumor a/w aresenic or PVC exposure
hepatic angiosarcoma
*express CD 31
endothelial cell marker
Atypical lymphocytes seen in infectious mono
CD 8 cytotox T cells
B cells infected, but only ~5% of smear
Cytotoxic T-lymphocytes destroy virally infected B cells
Abdomina aortic aneurysm begins with what
intimal streak
(atherosclerosis)
atheromas can progress to weaken underlying media
fam hx of:
osteosarcoma
brain tumors
rhabdosarcoma
Li-Fraumeni
mt of p53
AD
cancers at young age (30s)
MC: breast, brain, adrenal cortex
fibrous deposits around tricuspid and pulmonary valves
left chambers and valves normal
Carcinoid heart disease
a/w carcinoid syndrome
degree of endocardial fibrosis correlates w/ levels of serotonin and urinary excretion of -HIAA (serotonin metabolite)
limited to rt heart b/c serotonin and bradykinin in blood are inactivated by pulm vasculature endothelial MAO
Osteomyelitis in SCD caused by salmonella
- what is the virulence factor most contributing
resistance to opsonization
- asplenic/fucntionally asplenic pts at risk of infx by encapsulated organisms
NB: staph also common cause of osteomyelitis in SCD, so abx should be directed at both
glycerol kinase
liver specific enzyme
uses triglyceride breakdown products for energy and glucose synth
glycerol -*-> glycerol-3-phospate (–> DHAP –> glycolysis or gluconeogenesis)
- trauma
- acute onset neurologic abnormalities
- hypoxemia
- petechial rash
Fat embolism syndrome
trauma of long bones/pelvis
Non-pupil-sparing CN 3 palsy
aneurysm of what artery
- posterior cerebral
(or) - superior cerebellar
(courses b/w them as it exits midbrain)
Prinical site of uric acid precipitation
collecting ducts
due to low pH
verapimil will slow what portion of AP
diastolic depolarization
AML will stain for…
myeloperoxidase
often cells have Auer rods
VSD heart sounds
holosystolic murmer loudest over left mid-sternal border
bifid carotid pulse with brisk upstroke
hypertrophic obstuctive cardiomyopathy
a/w dynamic left ventricular outflow tract obstx
14:18
Bcl2
follicular lymphoma
indurated painless nodule on vulva
pleocytosis in CSF
tertiary syph
gummas
neurosyph
drug for drug-induced parkinsonism (from antipsychotics)
BENZtropine
or
amantadine
(anti-cholinergics)
*do not use DA agonists (e.g. bromocriptine) b/c they can precipitate psychosis
hemochromotosis issue with…
intestinal absorption
NB: gene on ch 6
theophylline tox
- abdominal pain
- vomiting
- seizures *main M/M
- tachyarrhythmias (NOT qt elongation)
- diarrhea
loss of pain and temp in arms and hands (LE fine)
syringomyelia
compresses ventral white comissure - where lateral spinothalamic tract decussates
xanthelasma a/w what other organ disease
chronic chosetatic processes:
- primary biliary cirrhosis
- obstx biliary lesions
NB: hypOthyroidism a/w hyperlipidemia
Leukomoid reaction vs CML
Leukocyte alkaline phosphatase:
- Nml/High in leukamoid
- LOW in CML
NB: definitite diagnosis of CML requires t(9;22)
Leukomoid reaction
over-exuberant white blood cell response
- leuk >50,000
- left shift
- neutrophil alk phos levels norm or elevated
E coli that
- does NOT ferment sorbitol - - does NOT invade intestinal mucosa
O157: H7
(80% of other ecoli do)
also does not produce glucuronidase (other ecoli do)
bacteria that activate Guanylate cyclase
ETEC
(heat STABLE toxin)
Yersinia enterocolitica
bacteria that activate Adenylate cyclase
- ETEC
(heat LABILE toxin) - B. Pertussis
- B. antrhacis (edema factor)
- Campylobacter
- B. cereus (heat labile)
- Cholera
nucleoside analog anitviral that does not need to be phosphoyrlated
(Nucleotides)
- cidofovir
- tenofovir
what part of the nephron does vasopressin act to increase urea absobtion
MEDULLARY segment of collecting duct
nerve that runs under mucosa of piriform recess
internal laryngeal nerve
(branch of superior laryngeal nerve, from vagus)
mediates afferent limb of cough reflex
(larynx and epiglottis - stim stimulates cough not gag)
gag reflex
afferent:
glossopharyngeal
efferent:
vagus
cheyne stokes respirations a/w…
- cardiac disease
(congestive heart failure) - neurologic disease
lyase
cleaves 3’ sugar
order of enzymes in base excision repair
-glycosylase
(cleaves base)
- endonuclease (5’) and lyase (3’)
(cleave backbone) - polymerase
- ligase
sickle cell pt w/ sepsis
1) streptococcus pneumoniae
(at increased risk of encapsulated organisms)
malignant otitis externa
pseudomonas
*typically seen in elderly diabetic patients
alveolar cells with golden cytoplasmic granules that turn dark blue w/ prussian blue staining
(iron)
“heart failure cells” or “siderophages”
indicates episodes of pulmonary congestion
(a/w left ventricular dysfx)
side effect of bupropion
seizures
indication for an MAOI
atypical depression
treatment-resistant depression
what distinguishes atypical depression from major depression
mood reactivity in atypical
will have improvemetn in mood in response to something positive
adrenergic receptor in the eye
Alpha-1
contraction of pupillary dilator
microangiopathic
hemoytic
anemias
TTP/HUS
DIC
penicillins are structural analogs to…
D-Ala-D-Ala
bind transpeptidase
Underlying event in death from TCA overdose
MCC of death is hypotension and cardiac arrhythmias
thought to be caused by inhib of fast sodium channels on heart
*fluid resuscitation w/ normal saline and hypertonic sodium bicarb crucial
marker that should be monitored in cirrhotic pt
to watch for developing hepatocellular carcinoma
AFP
(alpha fetoprotein)
NB: level not correlated to stage, size, or prognosis
occurs outside osteoblast during collagen synth
N- and C-terminal peptide removal
covalent crosslinks by LYSYL oxidase
macrophages loaded with PAS-positive granules in intestinal lamina propria
Whipple’s disease
(tropheryma whippellii)
(tx w/ abx)
erosion defined as….
mucosal defect that do not fully extend through the MUSCULARIS MUCOSA
(ulcers penetrate through to the SUBmucosal layer)
regardless of hydration status, where does the majority of water reabsorption occur
proximal tubule
(passively with solutes)
PT >60%
LOH ~20%
precipitating events for hepatic enceph (high ammonia)
- Excessive nitrogen load
(bleeding, constipation) - drugs (sedatives, narcotics)
- hypovolemia or met disturbances
- infections
**NOT a/w increased BUN (actually less BUN b/c can’t make urea well in liver failure)
- pt w/ asthma
- recurrent transient pulmonary infiltrates
- eosinophilia
- proximal bronchiectasis
colonized with…
Aspergillus
NB: strongyloides not a/w bronchietasis
adult intracranial mass
- elongated cells w/ regular, oval nuclei
- biphasic growth (dense/myxoid)
- S-100
schwanomma
S-100 = neural crest
rate of glycogen degradation in skeletal muscles increases after onset of contraction due to enzyme activation of…
- Ca 2+
(calcium-mediated myophosphorylase activation)
Also:
- cAMP
- AMP
Cardiac ouput - increased
and
Venous return - increased
chronic arteriovenous fistula
restriction of blood flow to kidney will —> hyperplasia and hypertrophy of…
modified smooth muscle cells of the afferent arteriole
JG cells
main site of digestion and absorption of dietary lipids
digestion = duodenum
absorption = jejunum
mitral regurg –> hoarsness
mech?
Left atrial enlargement –>
left recurrant laryngeal nerve impingement—>
left vocal cord paresis —> hoarseness
produced by macrophages and —> neutrophil chemotaxis and phagocytosis
IL -8
location of aortic rupture caused by rapid deceleration
aortic isthmus
- tethered by ligamentum arteriosum
- just past the 3 branches
Thiamine cofactor reactions
- useful for dx of deficiency
- Transketolase
- pyruvate dehydrogenase
- alpha-KG dh
- erythrocyte transketolase activity useful for dx
side effect of mannitol
pulmonary edema
(caused by rapid rise in volume)
can also lead to dilutional hyponaturemia, met acidosis, hyperkalemia)
route of cryptococcus infection
soil/pigeon droppings –>
yeast transmitted via resp route to lungs (primary site of entry)
can disseminate to CNS
end stage cirrhosis
- diffuse hepatic fibrosis
- regenerative parenchymal nodules
charcot-bouchard aneurysm
hyperechoic spot in deep brain
saccular would be on outter edge and highlight sulci
painful symmetrical swelling of hands and feet
- common presentation of sickle cell in young children
- due to vasooclusion
- will also see low hapatoglobin levels due to the hemolysis of sickle cells
RNA polymeryase I, II, III
I - rRNA
II - mRNA
III - tRNA
mode of decreasing lap operator activity in presence of glucose
w/o glucose:
- cAMP binds to CAP (catabolite activator protein) —> binds upstream of promoter increases transciption
glucose decreases activity of adelylyl cyclase—> less cAMP –> less transcription
riboflavin coenzyme in what enzyme
succinate dehydrogenase
(succinate –> fumarate in TCA)
*sucker snake fuming
- ulcer NOT in duodenal bulb
- multiple ulcers refractory to tx
- recurrence of ulcers after acid-reducing surgery
non-gastric neoplasm (2/3 malignant)
(Zollinger-ellison - hyper secretion of gastrin from pancreas tumor)
- peptic ulcers (most pts)
- diarrhea (inactivation of enzymes by excess acid)
cells that directly produce intimal response of thickening and collagen depo in arteries
smooth muscle cells
- migrate from media to intima and make collagen
cellular protein goes from alpha-helix –> beta pleated sheet –> resistant to proteases –> intracellular accumulation
Prion disease
- PrP (prion protein)
–> spongiform transformation in gray matter
stimulates angiogenesis
FGF
VEGF
(not EGF)
K concentration along nephron (% of filtered)
Bowmans - 100% –>
[65% filtered K reab in PT]
PT - 35%
[ 25-30% filtered K reab in TAL of LOH]
early DT - 5-10%
[K secretion by principle cells in later DT - 5-100+% of filtered]
CD - 10-100+%
mt –> protein larger with altered fuction but preserved immune reaction
splice site mt
NB: shorter nonfuntional proteins result from frame shift mt
sudden upward stretching of arm at shoulder –> “right hand clumsiness”
damage to the lower trunk of the brachial plexus
- C8 and T1
- medial and ulnar nerves
- innervate all the intrinsic muscles of the hand
tx for TCA associated cardiac abnormalities
Sodium Bicarbonate
corrects QRS prolongation, reverse hypotn, tx ventricular dysrhythmia
Ischemic ATN
- what part of nephron
Proximal tubules
TAL of LOH
Digoxin clearance
kidneys
*careful in elderly (can have renal insufficiency in the presence of normal creatinine)
- loss of upper extremity pain/temp
- UE LMN signs
- +/- LE UMN signs
syringomyelia
esp in setting of scoliosis
Sickle cell + macrocytosis
folic acid deficiency
predisposed due to high cell turnover
important clue in cardiac tamponade
pulsus paradoxus
digoxin mech for decreasing HR
increases parasympathetic tone
vagus nerve
paradoxical embolism - what heart sounds
fixed spitting of S2
from ASD
PRP (polyribosyl-ribitol-phosphate)
= component of what capsule
Hflu type B
Hib
1st line med for juvenille myoclonic seizures
should use BROAD spectrum:
Valproate
- narrow should be avoided in generalized epilepsy syndromes (may aggravate seizures)
- e.g. carbamazapine, gabapentin, phenobarbital, phenytoin
Juvenille Myoclonic Epilepsy
- adolescents (poss familial)
- generalized
- no LOC
- brief, involuntary jerking movements of both UEs
- usu w/in first hour of waking
- provoked by sleep deprivation
presntation of mass in ASCENDING colon
- symptoms of Fe deficient anemia and systemic symptoms
- -> weight loss
- ->progressive fatigue
- -> palor
(ususally exophytic masses and rt larger caliber than left- so no obstx )
Tx for restless leg syndrome
dopamine agonist
e.g. pramipexole
lung mass + brain degen
mech?
automimmune
- paraneoplastic syndrome
- subacute cerebellar degeneration
(anti yo, anti p/q, anti hu)
(small cell lung, breat, ovarian, uterine)
cells most susceptible to global cerebral ischemia
aka hypoxic-ischemic enceph
- pyramidal cells of the hippocampus and neocortex
- perkinje cells of the cerebellum
**hippocampus FIRST area damaged
cutaneous + systemic symptoms
recently started a new med
2-8wks
DRESS syndrome:
“drug reaction with EOSINOPHILIA and systemic symptoms”
commonly a/w: anticonvulsants allopurinol sulonamides abx
sx:
fever, generalized lymphadenopathy, facial edema, diffuse mobilliofrm skin rash –> confluent erythema
organs affected:
liver, kidney, lung
portal circulation of esophagus
left gastric vein
enzyme that decreases plaque stability
mettaloproteinases
from macrophages
high output heart failure + neurologic symptoms
what vitamin def
B 1
(thiamine)
Wet Beriberi
PT still prolonged after Vit K injection
Factor VII def
- shortest half life
- part of EXtrinsic pathway
usu liver disease (so vit K doesnt help)
V/Q from apex to base
V/Q - HIGHEST at APEX
(decreases towards base - LOWest at BASE)
- blood flow (Q) increases linearly from apex –> base (highest at base)
- ventilation increases exponentially from apex —> base (highest at base)
both are highest at base but ventilation changes much more
HUS vascular finding
microthrombi in small blood vessels
pruritis
rash
flushing
abdominal cramps
bx = mast cells in small bowel mucosa
Gastric hypersecretion due to systemic mastocytosis –> histamine
Gastric acid increase inactivates pancreatic enzymes –> diarrhea
- postprandial epigastric pain
- food aversion/wt loss
- atherosclerosis
chronic mesenteric ischemia
“intestinal angina”
atherosclerosis of mesenteric arteries –> decreased blood flow to intestine after meals
- pedunculated mass in left atrium
- constitutional symptoms
- mid-diastolic rumbling murmur heard best at apex
- positional cardiovascular symptoms
atrial myxomoa
- scattered cells w/in a mucopolysacccharide stroma
- abnormal blood vessels
- hemorrhaging
symptoms often position dependednt
blood transfusion
- –(mins to hrs)–>
- fever/chills
- chest/back pain
- hemoglobinuria
acute hemolytic transfusion reaction
Ab-mediated (type II) hypersensitivity rx
—> complement mediated cell lysis
lower lung fields
califications
pleural thickening
asbestos
glucagon pathway
GCPR
adenylate cyclase
cAMP
protein kinase A
unable to adduct + no corneal reflex
what hole
superior orbital fissure
III
IV
V-1
VI
(and superior opthalmic vein)
