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128 Cards in this Set

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woolsorter's dz
b.anthracis
b.anthracis virulence factors (2)
1) EDEMA FACTOR: adenylate cyclase --> inc cAMP; 2) LETHAL FACTOR: stims macrophages to release TNFa
Rb normal fxn
arrest cell at G1
Sx of endometriosis
ASx, or: severe dysmenorrhea, dyspareunia (pain during intercourse), and infertility; latter 2 are from adhesions
genetics of turner syndrome
classic (but minority) are XO; most are XX with mosaiced monosomic cells
role of type I vs type II fibers
TYPE I mainly postural maintenance, work by aerobic metabolism (high myoglobin and mitochondria); TYPE II: rapid, forceful pulses of movements
typical presentation of serum sickness
type III hypersensitivity -- arthralgias, pruritic skin rash, vasculitis with fibrinoid necrosis and neutorphil inflam
lab findings in serum sickness
decreased C3 -- complement binds immune complexes
type of allergic reaction provoked by sulfas
serum sickness (type 3)
causes of palm and sole rash (4)
RMSF, syphilis, coxsackie A
examples of dystonia
neurological movement disorder involving involuntary muscle contractions and movements; eg CERVICAL DYSTONIA (head turning), BLEPHAROSPASM (rapid blinking --> complete closure of eyelids), WRITER's CRAMP
shaken baby syndrome
shaking baby violently --> movement of brain against skull --> tearing of bridging veins --> SUBDURAL HEMATOMA; congested renal veins --> BILATERAL RETINAL HEMORRHAGES; suggests CHILD ABUSE;
hawthorne effect
change in behavior of study population because of knowledge that they are being studied
pygmalion effect
researcher's beliefs in the efficacy of treatment affects the outcome
relation of Ca to Phosphorus
generally, high Ca = low Phosphorus, and vice versa
steroid-mediated skin changes
dermal atrophy from inhibition of collagen and GAG production (presents as thinning dry skin, telangiectasias, easy brusiing, and striae -- think cushings)
mech and use of terbinafine
MECH: inhibits squalene epoxidase (upstream of ergosterol synth); USED for dermatophytes (often in conjunction with griseofulvin);
what drugs bind to ergosterol?
amphotericin B and nystatin
mech and use of flucytosine
transformed to 5-FU --> interferes with mRNA->protein; USED in systemic fungal infec (along w/ amphotericin B; like amp/gent, amphotericin B punches holes, allows flucytosine in)
what does digital clubbing look like and what does it suggest
thickening of distal phalanges; suggests chronic hypoxic disease (lung dz: cancer, TB, CF, bronchiectasis, pHTN; heart: congenital cyanotic heart diseases, esp tetralogy of fallot)
mech and use of capsofungin
inhibits fungal CELL WALL SYNTHESIS (beta-D-glucan, a main component in cell wall of CANDIDA and ASPERGILLUS)
types of benign breast tumors
FIBROADENOMA (MCC <25yo, small, mobile, firm, well demarcated, fluctuates with preg); PHYLLODES (leaf-like projections); INTRADUCTAL PAPILLOMA (serous/bloody nipple discharge)
paget's dz of breast
eczemtaous patch on nipple; paget cells: large cells w/ c lear halo
medullary carcinoma of breast
sheets of cells w/ LYMPHOPLASMACYTIC infiltrate
post-op persistence of muscle paralysis after AChEi administration
suggests use of DEPOLARIZING muscle relaxant (not affected by AChEi)
sx of leptospirosis
Weil disease: hepatic dysfunction --> conjugated hyperbilirubinemia; renal dysfunction; thrombocytopenia
receptors for hypothalamic hormones
all Gq except CRH = Gs (C-RH :: C-AMP)
receptors for pituitary hormones
Gs, except oxytocin and V1 of ADH: Gq
hesselbach's triangle
direct inguinal hernias; borders: LATERAL: inf epigastric a.; MEDIAL: rectus abdominis m.; INFERIOR: inguinal ligament
branchial POUCH derivatives
1: ear; 2: palatine tonsil; 3: thymus (ventral wings) + INFERIOR parathyroid glands (dorsal wings); 4: SUPERIOR thyroid glands
which part of bone most susceptible to hematogenous osteomyelitis?
metaphysis; most richly vascularized
actinic vs seborrheic keratoses
SEBORRHEIC: "stuck-on" appearance, velvety/greasy surface; ACTINIC: erythematous papules with central scaling due to hyperkeratosis --> SANDPAPER-like;
common site of RCC met?
to lungs
what vitamin needed for methionine synth?
B12
what vitamin needed for transamination?
B6
what vitamin needed for purine synthesis?
folate
what vitamin needed for oxidative decarboxylation of ketoacids
B1
which nerve and muscle indicated by positive trendelenburg sign?
superior gluteal (glut med and min)
which nerve and muscle implicated by diffifulty rising from seated position / climbing stairs?
inferior gluteal (glut max)
which vitamin useful in measles infection?
Vit A
lettering of HLA class I vs HLA class II
Class I: A, B, C; Class II: DR, DP, DQ
presentation of fibromyalgia vs polymyalgia rheumatica
POLYMYALGIA rheumatica: >50yo; morning stiffness of neck/shoulder/pelvic girdle; a/w wt loss, fever, inc ESR, and temporal arteritis; FIBROMYALGIA: 20-50yo; widespread MSK pain a/w stiffness, paresthesias, poor sleep, and emotional disturbances, exacerbated by exercise; multiple, symmetric, TENDER SPOTS over muscles/joints/tendons
fibromyalgia vs ankylosing spondylitis
can both present with back pain, but FIBROMYALGIA WORSENS with exercise, while ANKYLOSING SPONDYLITIS (along with the other RAs) IMPROVES with exercise
type of necrosis in most exogenous injuries
coagulative
liquefactive necrosis where
CNS (ischemic strokes)
Fat necrosis where
acute pancreatitis
caseous necrosis where
TB
wound w/ fruity odor
pseudomonas (blue-green)
hemorrhagic skin lesions by size, ascending
petechiae, purpura, ecchymoses
which skin lesions a/w celiac sprue?
dermatitis herpetiformis (IgA and IgG against gliadin cross-react with reticulin -- anchoring fibril in epidermal BM)
epi of bullous pemphigoid
OLD people
sx of lichen planus
5Ps: planar, polygonal, purple, pruritc plaques on wrists/hands/trunks/legs
clinical presentation of rickets
bowed legs, rachitic rosary, growth retardation
Call-Exner bodies
GRANULOSA CELL TUMOR; small follicles filled with eosinophilic secretion; ("CALL EXNER: he'll bring the CEG [Call-exner Estrogen Granulosa]")
sx of Buerger's disease
thromboangiitis obliterans -- causes vasoocclusion --> claudication, raynaud's, GANGRENE
neurotox of bilirubin
only unconjugated bilirubin (eg Crigler-Najjar) is a threat; conjugated bilirubin gets excreted in the urine
presentation of chronic mesenteric ischemia
epigastric / periumbilical abd pain 30-60 mins after meals (atherosclerotic arteries can't meet blood flow demands); weight loss: pain w/ eating; benign physical exam (no physical findings, just sporatic pain)
duod vs gastric ulcer
DUOD better linked with acid, gets better after eating/antacids (neutralizes acid) --> a/w wt GAIN; GASTRIC only 70% linked with acid, doesn't get better with food --> a/w weight LOSS
what does QT interval represent?
cardica myocyte action potential duration
changes in coronary blood flow with exercise
most coronary blood flow during diastole; during exercise, HR inc --> dec diastole --> dec filling time; to compensate, adenosine vasodilates coronary vessels ==> increase flow rate up to 5x;
relationship of pulmonary trunk to aorta at emergence from base of heart
anterior-ish and to the left (remember spiral septation)
what is a derivative of the common cardinal veins?
SVC
Beck's triad of cardiac tamponade
1) Hypotension (dec CO); 2) distended neck veins; 3) distant/muffled heart sounds; (4) tachycardia (reflex)
pulsus paradoxus
steep drop in BP with inspiration -- indicates TAMPONADE (decreased LV compliance, inspiration --> increased RH filling --> septal shift --> dec LV filling --> dec CO)
tamponade vs constrictive pericarditis TIMING
constrictive pericarditis is a CHRONIC process, tamponade can develop acutely (eg viral pericarditis --> effusion)
MCC cause of intermittent claudication
atherosclerosis (almost always)
Sx of monckeberg arteriosclerosis
none! Usu asymptomatic; causes medial band-like calcifications, usu of ppl > 50yo
cause of hyaline arteriosclerosis
diabetic microangiopathy / essential hypertension
most reliable indicator of MS severity
A2-OpeningSnap interval (shorter = more severe)
bovis in the blood
cancer in the colon
what do you do if you find s.INTERMEDIUS in the blood
INTERMEDIUS --> IMMEDIATELY ASSEESS for ABSCESS
signs of carcinoid tumor
wheezing, diarrhea, facial flushing, syncope
medical tx of carcinoid tumor
OCTREOTIDE (somatostatin analog with longer half-life; neutralizes 5-HT)
histologic appearance of abetalipoproteinemia
lipid taken up by intestinal mucosal cells can't be exported in chylomicrons ==> get foamy cytoplasm filled with lipids
sequelae of abetalipoproteinemia
serum lipid deficiency --> membrane damage (RBCs --> ACANTHOCYTES [spiny membrane projections]; neurons --> neuro abnormalities)
characteristic microscopic finding in Whipple's
PAS (+) macrophages, rod-shaped T.whippeli bacilli
what kind of cardiomyopathy in hemochromatosis
DILATED cardiomyopathy --> CHF signs
congenital cardiac defects in 22q11
truncus arteriosus and tetralogy of fallot
congenital cardiac defects in offspring of diabetic mother
tranposition of the great vessels
order of cardiac enzyme elevation after MI
Troponin, CK-MB, AST, LDH ('i TRIPped CAL and he had a heart attack')
causes of dilated cardiomyopathy
ABCD: Alcohol, Beriberi, Chronic Cocaine, Coxsacke B, Chagas, Doxorubicin, Diphtheria
most common valve affected by bacterial endocarditis
normally MITRAL valve; in IVDU, TRICUSPID
vegetations on both sides of valve
LSE; no embolic risk
findings in rheumatic fever
FEVERSS: Fever, Erythema marginatum, Valvular damage, Elevated ESR, Red hot joints (polyarthritis), Subq nodules, Sydenham chrea
source, activation, and action of pepsin
secreted by CHIEF CELLS in stomach (as pepsinogen), activated (to pepsin) by LOW PH, involved in PROTEIN DIGESTION
what GI enzyme elevated in mumps
amylase (parotits?)
positional pain in GERD
increasing pain in recumbent position
risk of hirschsprung's increases with what dz?
down syndrome
which IBD a/w CRC?
UC
"apple core" lesion on barium swallow xray
CRC
tx for type II crigler najjar
phenobarbital
causes of acute pancreatitis
GET SMASHeD: Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, HyperCa/Hyperlipid, Drugs (sulfas)
None
liverbiopsy of pt with alpha-1-antitrypsin deficiency
oval-to-round intracytoplasmic hepatocyte inclusions that are strongly PAS positive
pathophys of gallstones in crohn's dz
ileal involvement of crohns --| bile salt recycling (enterohepatic circulation) ==> increased cholesterol: bilesalt ratio ==> cholesterol precipitation --> cholesterol GALLSTONES
two forms of gastric adenocarcinoma
1) INTESTINAL: intestinal glands like colonic ACA; 2) DIFFUSE: signet-ring cells; r/f include: chronic gastritis, barretts, h.pylori, nitrates, cigs
cushing vs curling ulcers
CUSHING: stress from head trauma / elev intracranial pressure, located in esophagus/stomach/duod, prone to perf; CURLING: a/w severe trauma / burns, located in prox duod
cause of bleed in mallory-weiss tears
increased intra-abdominal / gastric pressure (vom, retching, etc.)
ras protein
G-protein; activated by binding to GTP; part of MAP-kinase pathway
HIV-associated causes of esophagitis (3)
Candida, HSV, CMV
morphology of HIV toxo
ring-enhancing brain lesions + chorioretinitis
what drugs raise HDL
Niacin and gemfibrozil
what are the s/e of HCTZ
hyperGLUC (glycemia, lipidemia [LDL and chol], uricemia, calcemia)
tx for s.epidermidis
VERY resistant -- tx with vancomycin + rifampin
INH mech and activation
inhibits mycolic acid synthesis of M.TB; must be ACTIVATED by mycobacterial catalase-peroxidase (intracellularly)
ethambutol mech
inhibits synth of mycobacterial cell wall
"Number Needed To Harm"
# of ppl that need to be tx for one adverse event to occur = 1/absolute risk increase; = 1/(%incidents1 - %incidents2)
role or Rb
regulate G1->S checkpoint; active when hypophosphorylated (stops cell cycle)
PTH molecular effects
binds PTH-receptors on OSTEOBLASTS --> upregulats RANK-ligand and M-CSF ==> stims OSTEOCLAST precursos ==> inc OSTEOCLASTS
what kind of bias with a new screening test
lead-time
polyol pathway impoariment in DIABETES
inc intracel gluc --> sorbitol --> fructose; sorbital + fructose inc osmotic pressure --> water influx --> osmotic cell injury; causes CATARACTS, PERIPHERAL NEUROPATHY
mechanism of cataract formation in galactosemia
galactose --> galactitol --> sorbitol --> inc osmotic pressure --> water influx --> osmotic cell injury --> CATARACTS (same mech as polyol pathyway of DM)
alanine reaction in the liver
alanine + a-ketogluterate -----ALT+B6-----> pyruvate + glutamate; glutamate then donates NH3 for urea cycle
"hot tub folliculitis"
superficial, self-limited pseudomonas infection of hair follicles
TGF-beta roles
1) arrests cell cycle (tumor suppressor role); 2) promotes angiogenesis ( ==> tumors resistant to TGF are helped by this); 3) stimulation of fibroblast ECM production (implicated in atherosclerosis and fibroblastic disease)
endothelin's effect on blood vessels
constriction
oseltamivir mech and use
neuraminidase inhibitor (used to tx influenza A and B); neuraminidase is reqd for relase of virus from infected cells
amantadine mech and use
used for INFLUENZA A; blocks viral uncoating inside host cell (diff from oseltamivir which inhibits virion release)
CMV manifestations in immunocompromised (organ vs HIV)
organ xplant: CMV pneumonitis; HIV: CMV retinitis
which cholesterol reducing agents cause hypertriglyceridemia? And what are their other side effects?
bile acid-binding resins (eg cholestyramine): decreased bile acid recycling --> 10x increase bile acid production, concomitant inc in TG and VLDL as well --> elev TG levels; primarily USED WITH STATINS; (can also cause cholesterol stones b/c of inc chol content)
TNF's role in hypothalamus
appetite suppression ==> cachexia
middle meningeal is a branch of which artery?
Facial artery (which is a branch of external carotid)
MCC AFP elevation
dating error (underestimation of gestational age)
acute and painless monocular vision loss
central retinal artery occlusion (CRAO), usu caused by emobolus; fundoscopic findings: pale retina + cherry red macula
what two growth factors drive angiogenesis?
VEGF (vascular endothelial GF) and FGF (fibroblast GF)
main clinical manifestations of acute rheumatic fever (2)
acute ARTHRITIS and CARDITIS
what can villous adenomas cause?
these cauliflower like polyps can cause: BLEEDING, secretory DIARHEA, and partial INTESTINAL OBSTRUCTION
why give pralidoxime (2-PAM) w/ atropine?
atropine only reverses muscarinic effects -- not nicotinic; with just atropine, still at risk for muscle paralysis, so give pralidoxime (AChE regenerator) to restore balance
side effects of giving arterial vasodilator (eg hydralazine) alone?
vasodilation --> triggers baroreceptor --> sympathetic response --> RAA activation --> sodium / water retention; ==> usu give with sympatholytics + diuretics