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873 Cards in this Set
- Front
- Back
What is sensitivity? |
probabilty that a test detects a disease when disease is present. TP/(TP+FN)
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What is specificity?
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probability that a disease non-disease when disease is absent. TN/(TN+FP)
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100% sensitivity means what? |
low false negative rate: good for screening disease with low prevelance
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100% specificity means what?
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low flase positive rate: good for confirmatory test after a positive screening test.
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What is case-control study? what does it measure?
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compares group of people with a disease to a group without the disease. Measures odds ratio.
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What is a cohort study?What does it measure?
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compares a group with an exposure or risk to a group without it. Measures relative risk.
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What is a cross-sectional study? what does it measure?
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collects data from a group to assess frequency of a disease in a population. Measures prevalence.
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What is the difference between a double and triple blinded study?
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double = patients and doctors don't know: triple = even researchers analyzing data don't know
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what does a phase I trial do?
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small number of healthy people: assess safety:toxicity: and pharmokinetics
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what does a phase II trial do?
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small number of people with the disease studied; assess efficacy: dosing: and adverse effects
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what do phase III trials do?
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large: randomly assigned groups. compares standard of care to new treatment.
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what do phase IV trials do?
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postmarketing surviellance: looks for longterm adverse events.
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What is positive predictive value? (PPV)
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proportion of positive tests that are a true positive. TP/(TP+FP)
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What is negative predicitive value?
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proportion of negative tests that are a true negative. TN/(FN+TN)
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contrast prevalence to incidence
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incidence = new cases: prevalence = all currents cases
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What is an odds ratio?
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used in case-control studies. odds that a group with a disease was exposed to a risk.
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What is relative risk?
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used in cohort studies. risk of developing a disease if exposed to a risk.
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what is attrutitable risk?
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proportion of disease occurences cause by an exposure.
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what is absolute risk reduction (ARR)?
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absolute reduction in risk between treatment group and a control group.
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How is number needed to treat calculated?
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number of patients needed to treat for 1 patient to get a benefit. 1/ARR
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How is number to harm calculared?
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number of patients needed tobe exposed to a risk in order to get it. 1/attributable risk.
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constract precision vs. accuracy.
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reproducability vs trueness of result
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What does random error cause?
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reduces precision of a test
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How do you decrese standard deviation?
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by increasing precision.
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What does systematic error cause?
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reduces accuracy in a test.
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What is selection bias?
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nonrandom assignment to a group.
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what is recall bias?
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knowledge of presence of a disease alters recall of subjects; common in retrospective.
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what is sampling bias
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subjects are not representative of the general population - is a selection bias
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what is late-look bias?
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information gathered at inapporiate time
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what is procedure bias?
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subjects in different groups are not treated the same
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what is confounding bias?
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occurs when a factor is related to both exposure and outcome
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what is lead-time bias?
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early detection confused with increased survival.
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what is observer-expectancy effect?
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when researchers belief in the efficacy of a treatment alters treatment changes
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what is hawthorne effect?
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group being studied changes behavior because they know they are being studied.
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5 ways bias can be reduced:
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1.blind studies. 2.placebo groups. 3.crossover studies. 4.randomization limits selection and confounding bias 5. matching to reduce confoudning bias.
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what is postive skew
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mound to the left: tail to the right mean>median>mode.
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What is negative skew?
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mound to the right: tail to the left. mean
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What is type I error?
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stating there is an effect when there isn't one
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What is type II error?
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stating there is not an effect when one does exist (to fail to reject the null hypothesis)
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What is statistical power and how do you increase it?
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probability of rejecting null hypothesis when it is false. increases with: larger sample size: large expected effect size: increased precision of measurement.
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What is a confidence interval?
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range of values in which a specificed probability of means would expected to fall.
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when to use t-test?
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comparing difference of means in 2 groups.
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when to use ANOVA
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check differences of means in 3 or more groups.
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When to use Chi-square test?
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check differences in 2 of more percentages or proportions: NOT MEANS.
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what is pearson's correlation coefficient?
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r is between -1 and +1. closer to 1 the stronger the linear correlation between 2 variables.
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compare primary: secondary: and tertiary prevention.
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PDR Prevent(vaccines): Detect(pap smear): Reduce disability(chemotherapy)
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Medicare and medicaid are for what groups?
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medicarE = elderly: medicaiD = destitute.
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What is apgar score?
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done at 1min and 5min. appearance: pulse: grimace: activity: respiration. >7 is good: <4 means resuscitate!
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What is a low birth weight?
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<2500g. increased risk or SIDS and increased overall mortality.
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Give developmental milestones birth-3mo(motor:social:verbal)
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rooting reflex:head up:moro reflex gone;smile;orient to voice.
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Give developmental milestones b7-9mo(motor:social:verbal)
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sits alone:crawl:transfer toys in hand;stranger anxiety;responds to name: instructions:peekaboo.
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Give developmental milestones 12-15mo(motor:social:verbal)
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climb stairs: stack blocks by agex3 blocks;rapprochment of mom;200 words and 2 word phrases by 2
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Give developmental milestones 24-36mo(motor:social:verbal)
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feeds self:kick ball;core gender identity:parallel play;pee at age 3
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Give developmental milestones 3yr(motor:social:verbal)
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ride tricycle:copy circle;spends part of a day away from mom;900 words and complete sentences
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Give developmental milestones 4yr(motor:social:verbal)
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uses zippers:grooms self:can hop on 1 foot;imaginary friend:cooperative play;can tell detailed story
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what is rooting reflex
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turn head to stimulus and make sucking face for nipple
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what is moro reflex
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kid startled by being dropped
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what is babinski sign
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tickle foot: toe goes up. not normal after age 2
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give BMI formula
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weight in kg/(height in meters)^2
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when does grief become patholgoic
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after 1 year.
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What is orotic aciduria(physiology:findings:tx)
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inability to convert orotic acid to UMP due to defect in UMP synthetase; increased orotic acid in urine:megaloblastic anemia that isn't improved by B12: failure to thrive:no hyperammonemia;oral uridine administration.
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What is adenosine deaminase deficiency(give physiology)
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Excess ATP and dATP via inhibition of ribonucleotide reductase->prevents dna synthesis and decrease lymphocyte count causing SCID.
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What is Lesch-Nyan syndrome(physiology:findings)
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defective purine salvage pathway due to absence of HGPRT; excess uric acid leads to retardation:self-mutilation:hyperuricemia:gout:choresoathetosis.
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Mutation in ataxia telangiestica
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nonhomologous end joining: which repairs dsDNA breaks.
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mutaiton in xeroderma pigmentosum
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nucleotide excision repair: which releases damaged bases
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What cell types are permanent
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neurons: skeletal and cardiac muscle: RBCs
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what cells types are stable(quiescent)
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hepatocytes:lymphocytes
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what cell types are labile?
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bone marrow: gut epithelium:skin:hair follicles:germ cells
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I-cell disease(physiology:findings)
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inclusion cell disease: failure of addition of mannose-6-phosphate to lysosome proteins which leads to lysosomal storage disease(proteins never added to lysosome);coarse face:clouded cornea:high plasma levels of lysosomal enzymes.
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Chediak-Higashi syndrome(physiology:findings)
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mutation in lysosomal trafficking regulator gene (LYST): microtubule sorting does not occur;recurrent pyogenic infections:partial albinism:peripheral neuropathy.
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vimentin stains:
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connective tissue
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desmin stains:
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muscle
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cytokeratin stains:
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epithelial cells
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GFAP stains
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neuroglia
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neurofilaments stain
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neurons
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type I collagen(found in:defective in:)
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bone:skin:tendon:dentin:cornea:late wound repair;defective in osteogenesis imperfecta.
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type II collagen(found in)
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Cartilage(hyaline):vitreous body:nucleus pulposus)
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type III collagen(found in: defective in)
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reticuin:skin:blood vessels:uterus:granulation tissue:fetal tissue;Ehler's danlos
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Type IV collagen(found in: defective in)
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basement membrance and basal lamina;alport sydrome
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Marfans syndrome is a defect of:
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Fibrillin(found in elastin)
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Prader-Willi syndrome(genetics:findings)
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paternal allele on chromosome 15 is not expressed;mental retardation:hyperphagia:obesity:hypogonadism:hypotonia
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Angelman's syndrome(genetics:findings)
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Inactivation of mother's allele on chromosome 15; mental retardation:seizures:ataxia:inappropriate laughter
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Achondroplasia(dominance:physiology:findings)
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Autosomal dominant. defect in fibroblast growth factor(FGF)receptor 3.;Dwarfism:short limbs:larger head but normal trunk.assoc with advanced paternal age.
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Autosomal-dominant polycycstic kidney disease(ADPKD)(dominance:physiology:findings)
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Autosomal dominant;mutation in PKD1: chromosome 16;bilat. massively enlarged kidneys: multiple huge cysts. assoc w/polycystic liver dx:berry anerusyms:mitral valve prolapse.
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what diseases are associated with ADPKD?
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polycystic liver disease: berry aneurysms: mitral valve prolapse.
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Familial adenomatous polyposis(dominance:physiology:findings)
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autosomal dominant;mutation on APC gene. chromosome 5;colon covered in polyps after puberty.
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Hereditary hemorrhagic telangiectasia(osler-weber-rendu syndrome)(dominance:physiology:findings)
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autosomal dominant;inherited disorder of blood vessels;telangiectasia: recurrent epistaxis: AVMS: skin discolorations.
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Hereditary spherocytosis(dominance:physiology:findings)
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autosomal dominance;spheroids due to spectrin or ankyrin defects;hemolytic anemia: increased MCHC: need spleenectomy to cure.
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Huntington's disease(dominance:physiology:findings)
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autosomal dominant;CAG trinucleotide repeat gene on chromosome 4;depression:caudate nucleus atrophy:chorioform movements:decreased levels of GABA and Ach in the brain.
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Neurofibromatosis type 1(von recklinghausen disease)(dominance:physiology:findings)
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autosomal dominant;mutation in long arm of chromosome 17;cafe-au-lait spots:neural tumors:lisch nodules: optic gliomas.
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neurofibromatosis type 2(dominance:physiology:findings)
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autosomal domaint;NF2 gene on chromosome 22;bilateral acoustic schwannomas: juvenile cataracts
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Tuberous sclerosis(dominance:findings)
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autosomal dominant;facial lesions:hypopigmented ash leaf spots:cotical and retinal hamartomas:seizures:cardiac rhabdomyomas:increased incidence of astrocytomas.
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von Hippel-Lindau(dominance:physiology:findings)
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autosomal dominant;deletion of VHL gene(a suppressor) on chromosome 3 which results in constitutive expression of HIF and increased angiogenic factos;hemangioblastomas:bilateral multiple renal cell carcinomas.
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Cystic fibrosis(dominance:physiology:findings)
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autosomal-recessive;defect in CFTR on chromosome 7. CFTR is a calcium channel;meconium ileus in newborns:bronchiectasis:pancreatic insufficiency:nasal polyps:intertility in males due to missing vas deferns.
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what lab is diagnostic for cystic fibrosis?
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increased calcium concentration in sweat (calcium channel can't resorb in skin. Note: in lungs this channel is supposed to EXCRETE calcium).
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Fragile-X syndrome(dominance:physiology:findings)
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X-linked;defect in methylation of FMRI gene:is a CGG trinucleotide repeat;mental retardation:macroorchidism:long face and jaw:everted ears:autism: mitral valve prolapse.
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Duchenne's dystrophy(dominance:physiology:findings)
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X-linked frameshift;deletion of dystrophin gene leads to accelerated muscle breakdown;pseudohypertophy of calf:pelvic and girdle muscle weakness at first:onset before 5: use gowers manuever.
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Why do mutaitons in dystrophin gene occur so often?
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longest gene in the human genome: anchors muscle fibers.
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What are the pregancy quad screen results for down syndrome?
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decrease a-fetoprotein:estirol. increased B-HcG: inhibin A.
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What are the pregancy quad screen results for edwards syndrome?
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decreased: a-fetoprotein:BHcg: estriol. normal: inhibin A.
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What are the pregnancy quad screens for Patau's syndrome?
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decreased: B-HcG: PAPPa and increased:Nuchal translucency.
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Cri-du-chat syndrome(dominance:physiology:findings)
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congenital microdeletion of short arm of chromosome 5;microcephaly:mental retardation:mewing sounds:epicanthal folds:VSD.
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Williams syndrome(dominance:physiology:findings)
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congenital microdeletion of long arm of chromosome 7:region deleted contains elastin gene;elfin facies:intellectual disability:extreme friendliness.
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What are the fat soluble vitamins?
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ADEK. dependent on ileum and pancreas: tend to accumulate in fat more.
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vitamin A(function: defiency:excess)
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visual pigments(retinal):essential for epithielial ceel differentiation:prevents squamous metaplasia: used in measles and AML type M3 tx; night blindness: dry skin;arthralgias:fatigue:alopecia:teratogenic!
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Vitamin B1(thiamin)(function: defiency)
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thiamine pyrophosphotase part of: pyruvate DH:A-ketoglutartate DH:trasketolase:branched-amino acid DH; defiency causes wernicke-korsakoff: berberi: low ATP.
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Wernicke-Korsakoff syndrome(cause: findings)
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B1(thiamin) defienceincy;confusion: opthalmoplegia:ataxia:confabulation:permanent memory loss:damage to medial dorsal nucleus of thalamus: mammary bodies.
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Dry beriberi(cause: findings)
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low B1(thiamin); polyneuritis: symmetrical muscle wasting
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Wet beriberi(cause:findings)
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high output cardiac failure(dilated cardiomyopathy): edema.
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vitamen B2(riboflavin)(function: defiency)
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cofactor in ox/redux reactions: make FAD and FMN; Cheilosis(inflammation and scaling of lips: corner of mouth): corneal vascularization (2C's of B2)
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vitamin B3(niacin)(function: defiency:excess)
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made from tryptophan: makes NAD. synthesis requires B6!;Glossitis:pellagra(diarrhea:dementia:dermatitis); excess = facial flushing.
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vitamin B3 deficiency can be caused by what primary things?
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1. hartnup disease (decreased tryptophan absorption) 2.Malignant carcinoid syndrome(increased tryptophan metabolism) 3. INH (decrease B6). All lead to pellagra.
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Vitamin B5(pantothenate)(function: defiency)
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Essential part of CoA and fatty acid synthase; dermatitis:enteritis:alopecia:adrenal insufficiency.
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vitamin B6(pyridoxine)(function: defiency)
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converted to pyridoxal phosphate which transaminates ALT and AST:synthesizes heme:niacin:histamine:serotonin:epinephrine:norepi: GABA.;convulsions:hyperirratability:peripheral neuropathy:sideroblastic anemia due to increased heme production.
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Vitamin B7(biotin)(function: defiency)
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cofactor for carboxylation enyzmes(pyruvate carboxylase:acetyl-Coa carboxylase:Propionyl-CoA carboxylase.;very rare: dermatitis:alopecia:enterisis. can be caused by antibiotic use or raw egg overconsumption.
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Vitamin B9(folic acid)(function: defiency)
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converted to tetrahydrofolate: makes nitrogenous bases for RNA and DNA; small pool in liver: macrocytic:megaloblastic anemia: common in alcoholism and pregnancy.
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vitamin B12(cobalamin)(function: defiency)
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cofactor for homocysteine methytransferase and methylmalonyl-CoA mutase: very large reserve pool in liver that takes years to use; macrocytic:megalobastic anemia: hypersegmented PMNs:neurologic symptons.
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What are the two vitamin defiency causes of macrocytic:megalolastic anemia? Differences?
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B9(folic acid) -> no neurologic symptoms. most common type: very small reserve pool. common in pregnancy and alcoholism. B12(cobalamin)has neuro symptoms. HUGE reserve pool in liver.
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Vitamin C(function: defiency:excess)
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facilitates Fe absorption: needed to make collagen: also needed to convert dopamine to NE; scurvy-swollen gums:brusing:hemearthrosis:weak immune system;nausea:vomitting:sleep problems: increased risk of iron toxicity.
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Vitamin D(function: defiency:excess)
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increased intestinal absorption of calcium and phosphate: increased bone minerlization; Rickets in kids: osteomalacia in adults: hypocalcemic tetany; hypercalcemia:hypercalciuria:loss of appetite: seen in sarcoidosis.
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Vitamin E(function: defiency:excess)
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antioxidant: protects erthrocytes and membranes from free radical damage; increased fragility of erythrocytes: posterior column and spinocerebellar tract demyelination.
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Vitmain K(function: defiency:excess)
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Catalyzes gamma-carboxylation of glutamic acid residues on clotting factors. needed for 2:7:9:10:C and S.; neonatal hemorrhage but normal bleeding time: need to give injection to newborns.
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Zinc(function: defiency)
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essential for 100+ enzymes;delayed wound healing:decreased adult hair:dysgeudia: anosmia.
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Nitric oxide is made from what amino acid?
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arginine
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Urea is made from what amino acids?
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arginine and aspartate
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Heme is made from what amino acid?
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glycine and succinyl CoA
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Creatine is made from what amino acid?
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glycine + arginine + SAM
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GABA is made from what amino acid?
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glutamate
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glutathione is made from what amino acid?
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glutamate
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pyrimidines are made from what amino acids?
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glutamate and aspartate
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purines are made from what amino acids?
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glutamate + aspartate + glycine
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histamine is made from what amino acid?
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histidine
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describe dopamine synthesis by reactants
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phenylalanine->tyrosine->DOPA->dopamine
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describe melatonin synthesis by reactants
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tryptophan->serotonin->melatonin
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niacin is made from what amino acid?
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tryptophan
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thyroxine and melanin are made from what amino acid?
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tyrosine
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what test can be done to diagnose chronic granulamtous disease?
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blue pigment DOESN'T form after adding nitroblue tetrazolium to patient's neutrophils. Does form = no disease.
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Coldaggulintins are seen in what organism. They are responsible for what?
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M. Pneumoniae. They lyse red blood cells leading to anemia.
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What are the trinucleotide repeats in Fragile X syndrome?
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CGG
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What are the trinucleotide repeats in Friedreich's Ataxia?
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GAA
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what are the trinucleotide repeats in huntington's disease?
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CAG
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What are the trinucleotide repeats in myotonic dystrophy?
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CTG
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What is the most common leathal:genetic disease in white populations?
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cystic fibrosis
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What are the two 22q11 deletion syndromes?
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1. DiGeorge - thymic: parathyroid: and cardiac defects. 2. Velocardiofacial syndrome - palate:facial: and cardiac defects.
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Pyruvate dehydrogenase complex deficiency(physioogy: findings: treatment)
|
X-linked mutation in gene for E1-a-subunit of pyruvate DH: causes backup of pyruvate and alanine: resulting in lactic acidosis; neurologic defects in infant;give Lysine and leucine because they are ketogenically metabolized.
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Essential fructosuria(physiology:findings)
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defect in fructosuria: autosomal recessive;fructose is high in blood and urine but is a benign disease/
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fructose intolerance(physiology: findings: treatment)
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autsomal recessive problem in Aldolase B: F-1-P accumulates: causing decrease in phosphate and then a decrease in glyconeolysis and gluconeogenesis; hypoglycemia: jaundice: cirrhosis; decrease intake of fructose and sucrose.
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Galastose deficiency(physiology:treatment)
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problem in galactokinse: galactitol accumulates if galactose present in diet. autsomal recessive;galactose in blood and urine: infantile cataracts:very mild disease.
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Classic galactosemia(physiology: findings: treatment)
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absense of galactose-1-phosphate uridyltransferase: autsomal recessive: accumulation of toxic galactitol; failure thrive: hepatomegaly: infantile cataracts: mental retardation; exclude galactose and lactose from diet.
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Which tissues are at risk for sorbitol damage? how does this damage occur?
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schweann cells: retina: kidnets. They contain low levels of sorbitol dehydrogenase. sorbitol is osmotically active: causing swelling and damage.
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ornithine transcarboxylase deficiency(physiology: findings)
|
x-linked recessive: can't eliminate ammonia. Excess caramoyl phosphate is converted into orotic acid; increased orotic acid in blood and urine: decreased BUN: ammonia overdose.
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Phenylketonura(physiology: findings: treatment)
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Due to decrease in phenylalanine hydroxylase or tetrahydrobiopterin: making tyrosine essential; increased PKU in urine: mental retardation: musty body odor: growth retardation; screen 2-3 days AFTER birth(mom hides condition): decrease phentlyalanine intake and increase tyrosine intake.
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Alkaptonuria(symptoms:findings)
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problem in homogentistic acid oxidase in the tyrosine degrdation pathway: autosomal recessive; dark connective tissue: brown pigmented sclera: urine turns black in air: homogenistic acid eats cartilage -> artraglia.
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Albinism(physiology: findings)
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deficient tyrosinase or defective tyrosinase transporter: can result from lack of neural crest cell migration; lack of tyrosine->lack of melain->no skin color: increased skin cancer common.
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Homocystinuria(physiology:findings)
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3 forms:cystathione synthetase deficiency or decreased affinity for cystathionine synthase for pyridoxial phosphate or homocysteine methyltransferase: all lead to excess homocysteine; increased homocysteine in urine: mental retardation: osteoporosis: tall stature: lens subluxation and atherosclerosis.
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Cystinuria(physiology: symptom: treatment)
|
defect in transporter in renal PCT for cysteine: ornithine: lysine: and arginine; excess cysteine in urine causes hexagonal crystals and renal staghorn crystals; good hydration and alkalinize urine.
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Maple syrup urine disease(physiology: findings)
|
blocked degradation of Ile: Leu: Val due to deficient a-ketoacid DH; increased ketoacids in blood: causes CNS defects: mental retardation: death.
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Hartnup disease (physiology: findings)
|
autosomal-recessive disease: defective neutral amino acid transporter in renal + intestinal cells; causes tryptophan excretion and decreased absorption in gut: leading to pellagra.
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What are the two types of emphysema?
|
1. centriacinar - associated with smoking. 2. panacinar - associated with A1-antitypsin deficiency.
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Why do people with emphysema exhale through pursed lips?
|
increased in airway pressure prevents airways from premature collapse.
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What disease is associated with curschman's spirals and leyden crystals?
|
asthma. spirals = epitheium forms mucus plugs. leyden crystals = eosinophil breakdown.
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inhale to exhale ratio changes how in asthma?
|
decreased I/E ratio
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Antracosis: silicosis: and asbestosis all increase risk for what other diseases?
|
cor pulmonale and Caplan's syndrome
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Calcified pleural plaques are pathonomic for what? Are they precancerous?
|
Asbestos exposure. Are NOT precancerous.
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What lechitin:sphingomyelin ratio is predictive of neonatal respiratory distress?
|
1.5 or below. 2.0 or above is normal.
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neonatal therapuetic oxygen can result in what negative outcomes?
|
1. retinopathy of prematurity. 2. bronchopumonary dysplasia.
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What are th risk factors for neonatal respiratory distress?
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1. prematurity 2.maternal diabetes(elevated fetal insulin) 3. cesarean birth (less fetal glucocorticoids)
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What is the treatment for neonatal respirtatory distress syndrome?
|
maternal steriods before birth: artificial surfactant after birth.
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the initial damage to lung sin ARDS is due to what?
|
1. neutrophillic substances toxic to lungs 2. coagulation cascade 3. oxygen-derived free radicals
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Obstructive lung disease has a FEV1/FVC of what?
|
UNDER 80!
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Restrictive lung diseases has an FEV1/FVC of what
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80 or above BUT both FEV1 and FVC decrease about equally.
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How does sleep apnea relate to RBC formation?
|
hypoxic intervals -> increased EPO release -> increased erthryopoesis.
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contrast tension pneumothorax to spontaneous pneumothorax.
|
tension: check valce forms: air can enter but it can't leave thus overinflation. spontaneous: bleb in pleura pops: making the lung collapse on itself and become smaller.
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What cancer is the leading cause of cancer death?
|
lung
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what are lung metastases sites?
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adrenals: bone: liver.
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what the the classic lung cancer complications?
|
(SPHERE) Superior vena cava syndrome: pancoast tumor: horner syndrome: endocrine: recurrent laryngeal symptoms(hoarse): effusions (pleural or pericardial)
|
|
Which lung cancers are peripheral? which are central?
|
peripheral - adenocarcinoma: large cell. central - squamous cell: small cell. mesothelioma - pleural.
|
|
Psammoma bodies are found in what pathology?
|
(PSaMMoma) Papillary carcinoma of the thyroid: serous cysadenocarcinoma of the ovary: meningioma: mesothelioma.
|
|
what organisms cause lobar pneumonia?
|
S. Pneumoniae: klebsiella.
|
|
what organisms cause interstitial pneumonia?
|
atypical organisms. Viruses(influenza: RSV: adenocarcinoma): Mycoplasma: Legionella: Chlamydia.
|
|
Hypersensitivity pneumonitis is caused by what type of hypersensitivty reaction?
|
Mixed III/IV. Often seen in farmers and bird owners.
|
|
Allergic rhinitis is due to what type of hypersensitivity reaction?
|
type I: inflammatory infiltrate with esosinohils.
|
|
What is the triad of aspirin-intolerant asthma?
|
asthma: aspirin-induced bronchospams:nasal polyps.
|
|
must suspect what disease in a child with nasal polyps?
|
cystic fibrosis
|
|
angiofibroma(presentation:age group)
|
benign tumor of nasal mucosa: composed of blood vessels and fibrous tissue. Presents in young males with recurring epistaxis.
|
|
Nasopharyngeal carcinoma(presents: pathology)
|
associated with EBV. biopsy will reveal pleomorphic keratin filled cells: like a poorly differentiated squamous cell carcinoma. Often presents with lymph node enlargement.
|
|
What are the risk factors for laryngeal carcinoma?
|
alcohol use and tobacco use.
|
|
what organims cause bronchopneumonia?
|
S. aureus: HiB: pseudomonas: Moraxella.
|
|
How does TLC change in obstructive lung disease?
|
increased due to lung trapping
|
|
Panacinar emphysema is most severe in what lobes? What about centroacinar?
|
Centri - smoking: upper lobes where smoke goes! Pan - A1-antitrypin: worse in lower lobes.
|
|
A1-antitrypsin deficiency is associated with damage to what two organs?
|
lungs and liver.
|
|
Allergic bronchopulmonary aspergilliosis(pathophys: associations)
|
is a hypersensitivity reaction to aspergillus. occurs in people with asthma or cystic fibrosis.
|
|
honey comb lung pathology is associated with what?
|
idopathic pulmonary fibrosis: usually end-stage.
|
|
hyaline membranes in the lungs are associated with what?
|
acute respiratory distress syndrome
|
|
what levels increase as surfact is produced in the neonate?
|
lecithin(phospatidylcholine) increase: spingomyelin levels stay constant.
|
|
hypoxemia in the neonate increases risks of devleoping what?
|
1. patent ductus arteriosus 2. necrotizing enterocolitis.
|
|
diaphram is inervated by what cervical levels?
|
C345: keeps the diaphram alive!
|
|
What are the muscles of inspiration during exercise?
|
external intercostals: Scalene: sternomastocleiod
|
|
what are the muscles of expiration during exercise?
|
rectus abdomins: int + ext obliques: internal intercostals
|
|
What causes right shift on the oxygen-hemoglobin binding curve?
|
CBEAT - CO2: BPG: Exercise: Acid/Altitude: temperature
|
|
What gases are perfusion limited?
|
O2(in normal lungs): CO2: N20
|
|
what gases are diffusion limited?
|
CO: O2(in empysema: interstial fibrosis: etc)
|
|
Carbon dioxide is transported to the lung in mostly what form?
|
bicarbonate
|
|
How does glucose and amino acid clearance change in normal pregnancy?
|
reduced reabsorption leads to glycosuria and aminoaciduria.
|
|
What causes increased anion gap in metabolic acidosis?
|
(MUDPILES) MeOH: uremia: DKA: propylene glycol: iron tablets or INH: lactic acidosis: ethylene glycol: salycylates.
|
|
what causes normal anion gap metabolic acidosis?
|
(HARD-ASS) hyperalimentation: addisons: renal tubular acidosis: diarrhea: acetazolamide: spironolactone: saline infusion.
|
|
what causes respiratory acidosis?
|
opiods: obstruction: chronic lung disease.
|
|
what causes metabolic alkalosis?
|
loop diuretics: vomitting: antacid use: hyperaldosternoism
|
|
granular: muddy brown casts are associated with what?
|
Acute tubular necrosis
|
|
hyaline casts are associated with what?
|
nonspecific: can be normal.
|
|
List 4 things found in nephrotic syndrome.
|
1. proteinura (>3.5g/d): hyperlipidemia: fatty casts: edema.
|
|
list associations with nephritic syndrome
|
hematuria: RBC casts: azotemia: hypertension: proteinuria (<3.5 g/d)
|
|
What is the most common type of kidney stone?
|
calcium
|
|
Renal cell carcinoma mets to where?
|
invades renal vein -> IVC -> blood. goes to lung and bone.
|
|
What is the most common renal cancer of childhod?
|
Wilm's tumor.
|
|
What are the risk factors for transitional cell carcinoma?
|
Pee SAC: phenacetin: smoking: aniline dye: cyclophosamide.
|
|
What is the most common cause of intrinsic renal failure?
|
Acute tubular necrosis.
|
|
What are the 3 stages of acute tubular necrosis?
|
1. inciting event 2. maintenance phase - oliguric: last 1-3 week: risk of hyperkalemia 3. recovery phase - polyuric: BUN and serum creatinine fall: risk of hypokalemia
|
|
Acute tubular necrosis is associated with what?
|
shock: sepsis: myoglobinuria: toxins
|
|
What is renal papillary necrosis associated with?
|
DM: acute pyelonephritis: phenacetin use: sickle cell anemia or trait
|
|
Can postrenal azotemia occur unilaterally?
|
No. Must be bilateral.
|
|
What are the 2 forms of renal failure?
|
1. acute tubular necrosis 2. chronic ->DM or hypertension
|
|
ADPKD is associated with?
|
berry aneurysms: mitral valve prolapse: benign hepatic cysts
|
|
What are the toxicities of ACE inhibitors
|
CATCHH- cough: angioedma: teratogen (fetal renal malformation): creatinine increase (decreased GFR): hyperkalemia: hypotension.
|
|
side-effects of lithium
|
LMNOP: lithium side effects: movement: nephrogenic diabetes insipidus: hypOthyroidism: pregnancy issues
|
|
What is classical conditioning?
|
Learning in which a natural response is elicted by a learned stimulus (think pavlov's dog)
|
|
what is operant conditioning?
|
learning in which a particular action is elicted because it generates a reward.
|
|
What is excition (psych)
|
discontinuation of reinforcement (+ or -) eventually eliminates the behavior
|
|
What is transference?
|
patient projects feelings about another person onto the doctor (sees doc as parent)
|
|
what is countertransferance?
|
doctor projects feelings about important person unto patient
|
|
What are ego defenses?
|
Unconscious mental processes used to resolve conflict and prevent undesireable feelings
|
|
What is dissociation?
|
temporary: drastic changes in personality: memory: behavior: etc to avoid emotional distress
|
|
compare displacement to projection
|
displacement = avoided ideas or feelings are transferred to some neutral person or object. projection = an unacceptable impulse is attributed to an external source.
|
|
compare fixation to regression
|
fixation = remain at some childish level. regression = turning back to a past maturational level.
|
|
what is identification (psych)
|
modeling behavior after a more powerful person
|
|
what is isolation of an affect?
|
seperation of feelings from an event (describe a murder in cold detail)
|
|
what is rationalization?
|
proclaiming logical reasons for actions actually performed for other reaons to avoid self-blame
|
|
compare reaction formation to sublimination
|
reaction formation = a warded off idea or feeling is replaced by the opposite response (homophobic is gay). sublimation = replace an unacceptable wish with one that doesn't conflict with morals.
|
|
What are the mature defenses?
|
Mature people wear a SASH Sublimation: suppression: humor: altruism.
|
|
What are effects of infant deprivation?
|
4W's: weak: wordless: wanting: wary.
|
|
Infant deprivation can be irreverisble after how long?
|
6 months
|
|
Who is usually the abuser in child abuse?
|
male caregiver
|
|
How often does ADHD continue into adulthood?
|
50% of the time.
|
|
What physical change is ADHD associated with?
|
decreased frontal lobe volume.
|
|
What is conduct disorder?
|
a childhood disorder where there is constant behavior violating the basic rights of others: often becomes antisocial personality disorder.
|
|
what is oppositional defiant disorder?
|
a childhood disorder with a pattern of defiant behavior towards authority figures in the absence of abuse of sociatal norms.
|
|
When does tourette's onset? how long does it need to persist before dx? what is it associated with?
|
before 18: it must persist for greater than 1 year. associated with OCD.
|
|
when does seperation anxiety disorder onset?
|
onsets between 7-9.
|
|
what is the largest difference between austism and asperger's disease?
|
autism: speech disoder: often below average intelligence aspergers: no language disorder: often normal intelligence.
|
|
what is Rett's disorder?
|
x-linked disorder seen exclusively in girls: males die in utero. loss of development: loss of verbal abilities: mental retardation: ataxia.
|
|
what is childhood disintegrative disorder?
|
onset of 304 years: marked regression after at least 2 years of normal development. loss of speech: social skills: bowels: etc: more common in boys.
|
|
neurotransmitter change in anxiety:
|
increase NE. decreased GABA: 5-HT.
|
|
neurotransmitter change in depression:
|
decreased ne: 5-ht:dopamine
|
|
neurotransmitter change in alzheimer's:
|
decreased ach
|
|
neurotransmitter change in huntington's disease
|
decreased gaba and ach: increased dopamine
|
|
neurotransmitter change in schizophrenia
|
increased dopamine
|
|
neurotransmitter change in parkinson's disease
|
decreased: dopamine: increased: 5-ht: ACh
|
|
order of loss of orientation:
|
1st - time: 2nd - place: 3rd - person.
|
|
what is a hallucination?
|
perceptions in the absence of external stimuli.
|
|
what is a delusions
|
false beliefs despite facts to contray
|
|
what is disorganized speech?
|
words slung together through loose associations
|
|
visual hallucinations are likely:
|
from a medical illness: i.e. drug intoxication
|
|
auditory hallucinations are likely:
|
psychiatric
|
|
olfactory hallucinations are likely:
|
part of epilepsy: seizure and brain tumors
|
|
tactile hallucinations are likely:
|
common in alcohol withdrawl or cocaine abuse
|
|
when do hypnagogic hallucinations occur?
|
while GOing to sleep
|
|
when do hypnopompic hallucinations occur?
|
while pompously awakening
|
|
How long must psychosis last before schizophrenia can be diagnosed?
|
6 mo.
|
|
Diagnosis of schizophrenia requires 2 of the following:
|
(+)= symp: delusions: hallucinations: disorganized speech: disorganized or catanoic behavior. - symp: flat affect: social withdraw: lack of motivation: lack of speech
|
|
What are the 5 subtypes of schizophrenia?
|
1. paranoid (delusions) 2. disroganized (speech) 3. catatonic (automatisms) 4. undifferentiated (elements of all types) 5. residual
|
|
Patients with schizophrenia are at increased risk for:
|
suicide
|
|
does schizophrenia present earlier in males or females?
|
Males (teens). Females present in late 20's to 30's.
|
|
What is a brief psychotic disorder?
|
under 1 mo: usually stress related
|
|
What is schizophreniform disorder?
|
lasts 1-6 mo
|
|
What is schizoaffective disorder?
|
atleast 2 weeks of of stable mood with psychotic symptoms plus depressive manic or both
|
|
What is a delusional disorder?
|
fixed: persistent: nonbizarre belief system lasting over 1 mo.
|
|
What is a shared psychotic disorder?
|
(also called folie a deux) development of delusions in a person in a close relationship with someone who has a delusion disorder. resolves upon seperation.
|
|
What is dissociative identity disorder?
|
presence of 2 or more personalities. more common in women w/hx of sexual abuse
|
|
What is depersonalization disorder?
|
persistent feelings of detachment from one's body or situation
|
|
What is a dissociative fugue?
|
abrupt change in location causes inabilty to recall past and to general confusion. not related to drugs or a medical condition.
|
|
Diagnosis of a manic episode requires atleast three of the following:
|
Must last 1 week or more. (DIG FAST) 1. distracted 2. Irresponsibility 3.Grandiosity 4. Flight of ideas 5. Agitation 6. less need for sleep 7. talkative
|
|
What is a hypomanic episode?
|
less severe manic episode. no psychotic featues.
|
|
How is bipolar disorder?
|
must have atleast 1 manic episode and 1 hypomanic episode
|
|
What is a cyclothymic disorder?
|
dysthymia and hypomania: mild form of bipolar lasting at least 2 years.
|
|
What is major depressive disorder? how do you diagnosis it?
|
self-limited disorder with depressive episodes alsting 6-12 mo. Must have 5 of the following symptoms for 2 or more weeks. (SIG E CAPS) Sleep disturbance: loss on interest: guilt: loss of energy and concentration: appetite change: psychomotor retardation: suicidal ideation.
|
|
What is dysthymia?
|
mild form of depression lasting at least 2 years
|
|
Who has a higher lifetime incidence of major depressive episode: male or females?
|
females (25%) to males (12%)
|
|
What is the most common type of depression?
|
atypical depression.
|
|
What are the 3 postpartum modd disturbances? treament for each.
|
1. the blues - 50% get: resolves in 10-14 days: no drugs. 2. depression 10% get: lasts 2 weeks to a year: give antidepressants. 3. psychosis .1%: get delusions. lasts 4-6weeks. antipsychotics
|
|
When is electroconvulsive therapy used? side effects of treatment?
|
It is used in major depressive disorder that is refractory to treatment. sldo in immediate treatment of suicidality. side effects are amenesia lasting 6 mo.
|
|
What are the risk factors for suicide?
|
SAD PERSONS: Sex(male): Age(teenage or elderly) Depression: Previous attempt: ethanol or drug use: loss of Rational thinking: sickness (a medical illness): organized plan: no spouse: social support lacking.
|
|
who attempts suicide more often? who succeds more often?
|
women attempt more: males succed more often.
|
|
How is panic disorder diagnosed?
|
must have 4 of the following : PANICS- Palpations: paresthisias: Abdominal distress: nausea: intense fear of dying: lIghtheadedness: ches pains: chills: choking: sweating: shaking: SOB.
|
|
What is the difference between acute stress disorder and PTSD?
|
PTSD lasts atleast 1 month: acute stress disorder lasts 2 days to 1 month.
|
|
What is the different between GAD and adjustment disorder?
|
GAD is anxiety for atleast 6 mo: adjustment disorder lasts under 6 months.
|
|
What are somatoform disorders?
|
disorders with physical symptoms that have no physical cause but are not being intentionally faked.
|
|
What is conversion disorder?
|
actue loss of sensory or motor functions following an acute stressor
|
|
what is body dysmorphic disorder?
|
Preoccupation with minor deficiets in body: constantly seeking cosmetic changes.
|
|
What is the difference between malingering and a factitous disorder?
|
malingering = secondary gain: i.e. getting days off work or a pension. factitous disorder = gets medical attention from a madeup illnes.
|
|
What are the cluster A personality disorders?
|
Paranoid = distrust: schzoid = social withdrawl and likes it: schizotypal = magical thinking.
|
|
What are the cluster B personality disorders?
|
Antisocial = disregard for others rights: boderline = impulsive: unstable relationships: histrionic = excessive emotions: narcissistic = gradiosis: sense of entitlement.
|
|
what are the cluster C personality disorders?
|
Avoidant= feels inadequate: fear of rejection. Obsessive-compulsive = perfectionism: dependent = submissive and clingy.
|
|
what are the stages of overcoming substance addiction?
|
1. precontemplation. 2. contemplation 3. preparation 4. action 5. maintenance 6. relapse
|
|
What are mallory-weiss tears?
|
lacerations at the gastroesophageal junction from excessive vomitting: often painful in contrast to espophageal varices.
|
|
What is neuroleptic malignant syndrome? What is the treatment?
|
rigidity: myoglobinuria: autonomic instability. seen with antipsychotics overdose. treatment: dantrolene and bromocriptine (d2 agonist)
|
|
What is tardive dyskinesa? Is it reversible?
|
sterotypical oral-facial movements: from long term antipsychotic use. often NOT reversible.
|
|
What is serotonin syndrome? what is the treatment?
|
occurs with any drug that increases serotonin (MAO inhibitor: SNRI: TCA) hyperthermia: confusion: myoclonus: cardio collapse: flushing. tx: cyproheptadine (5ht antagonist)
|
|
What is the most common site of obstructive in the fetus?
|
ureteropelvic junction. Failure to canalize -> block.
|
|
What does the mesonephros become?
|
male genital system
|
|
What are the causes of potter sydrome?
|
1. AEPKD 2. bilat renal aplasia 3. posterior urethral valve.
|
|
How does horseshoe kidney form? what is it associated with?
|
inferior poles of kidnet fuse. turner syndrome
|
|
Plasma volume is measured with what? What about ECF volume?
|
ECF - inulin. plasma - radiolabeled albumin.
|
|
Why is inulin used to estimate GFR?
|
it is freely filtered but is it not secreted or reabsorbed.
|
|
why is PAH used to estimate ERPF?
|
all PAH entering the kidney is excreted. It is borth freely filtered and actively excreted.
|
|
What is the formula for filtration fraction?
|
FF = GFR/RPF.
|
|
what affect do prostaglandins have on the afferent arteriole?
|
dilates it: so RPF and GFR both increase: keeping FF the same.
|
|
what affect does angiotension II have on the efferent arteriole?
|
constricts it: so RPF decreased and GFR increased making FF jump drastically.
|
|
At what plasma glucose are all glucose transports saturated in the kidney?
|
360 mg/dL
|
|
ADH primarily regulates what?
|
low blood volume but it secondarily regulates osmolarity.
|
|
aldosterone primarily regulates what?
|
blod volume
|
|
What affect to B-blocks have at the juxtatomegular apparatus?
|
they inhibit b-receptors: and thus DECREASE renin release thus DECREASING bloodpressure!
|
|
What are the endocrine functions of the kidney?
|
1. erythropoietin 2. PT converts 25-OH vit d to 1:23-OH vit d 3. JG make renin 4. prostaglandins dilate affterent arteriole
|
|
What causes K shift OUT of cells?
|
(DO Insulin LAB) Digitalis: hyperOsmolarity: Insulin deficiency: lysis of cells: acidosis: B0adrenergix antagonist
|
|
Describe high vs low Ca serum concentration
|
low: tetany: seizure high: stones: bones: groans: psychyiatric overtones.
|
|
describe low vs high K serum concentration findings
|
low: U wave on ECG: flat T wave: muscle weakness. High: wide QRS: peaked T wave: muscle weakness
|
|
describe low vs high Mg serum concentration findings
|
low: tetany: arrhythmias.high: decreased DTR: lethargy: bradycardia: hypotension: cardiac arrest: hypocalcemia
|
|
describe low vs high PO4 serum concentration findings
|
low:bone loss: osteomalacia. high: renal stones: hypocalcemia.
|
|
compare K changes in types 1: 2: and 4 RTA
|
1+2: hypokalemia. 4: hyperkalemia.
|
|
What do muddy brown: granular casts indicate?
|
acute tubular necrosis
|
|
does painless hematuria: no casts indicate a renal or bladder source?
|
bladder.
|
|
are WBC casts indicative of pyelonephritis or cystitis?
|
casts = also renal origin
|
|
What are hylaine casts specific for?
|
nothing: are often nornmal
|
|
What are fatty casts specific for?
|
Nephrotic syndrome
|
|
Focal segmental glomeruosclerosis is associated with what?
|
HIV infection: heroin use: obesity: interferon treatment
|
|
What are kimmel-wilson lesions specific for?
|
they are eosinohilic: nodular glomerulosclerosis found in diabetic glomerulonephropathy
|
|
Renal cell carcinoma originates from what cells?
|
proximal tubule cells.
|
|
RCC can cause testicular varoceole on only which side?
|
the LEFT. left testicular vein dumps into the left renal vein. on the right: the testicular vein goes right into the IVC.
|
|
What is the WAGR complex?
|
Wilms tumors: aniridia (no iris): genituurniary malformations: and mental retardation
|
|
What is the most common childhood renal malignancy?
|
wilms tumor
|
|
Transitional cell carcinoma of the GU system is associated with what?
|
Pee SAC: phenacetin: smoking: aniline dye: cyclophosamide.
|
|
In what phase does death usually occur during acute tubular necrosis?
|
the maintenance phase: during oliguria
|
|
Renal papillary necrosis is associasted with:
|
1. DM 2. acute pyelonephritis 3. chronic phenacetin use 4. sickle cell anemia and trait
|
|
why is bun creatine serum ratio useful?
|
BUN is usually resorbed but creatine is not. decreased ratio ->renal failure
|
|
uremia causes:
|
Nausea: pericarditis: asterixis(flapping of wrist): encephalopathy: platlet dysfunction
|
|
ADPKD is associated with?
|
PKD1 and PKD2 mutaitons
|
|
Where is most common ectopic thyroid site? why?
|
tongue: foramen cecum connects tongue to pyrimidal lobe of thyroid
|
|
Contrast physical exam of persistent thyroglossal duct cyst to a branchial cleft cyst.
|
thyroglossal = midline: moves with swallowing. Brahcial = lateral: doesn't move with swallowing.
|
|
What chemical determines fetal lung maturation and surfactant production?
|
cortisol
|
|
What is the most common tumor of adults and children in the adrenal medulla? how do they relate to hypertension?
|
adult = pheochromocytoma. kids = neuroblastoma. pheo = episodic hypertension: neuroblastoma doesn't cause this.
|
|
what is is the posterior pituitary derived from? what about the anterior?
|
postier = neuroectoderm. anterior = oral ectoderm (rathke's pouch).
|
|
What do alpha: beta: and gamma cells secrete in the pancreas?
|
alpha - glucagon. beta - insulin. gamma - somatostatin.
|
|
what cell types are insulin independent?
|
(BRICKL) brain: renal: intenstine: cornea: kidney: liver
|
|
describe function of GLUT1: GLUT2 and GLUT4:
|
1: insulin dependent - RBC: brain. 2: bidirectiona: B islet: liver: kidney: small intestine. 4= insulin dependent. adipose tissue: skeletal muscle.
|
|
What causes increased insulin release in normal physiology?
|
hyperglycemia: GH: b2 agonists.
|
|
whar causes decreased insulin release in normal physiology?
|
hypoglycemia: somatostatin: A2 agonists
|
|
Why do RBCs always depend on glucose?
|
they have no mitochondria: thay can't do aerobic metabolism
|
|
How does prolactin inhibit spermatogenesis and ovulation?
|
it inibits GnRH release.
|
|
What is the function of cortisol?
|
(BBIIG) maintain Blood pressue: decease Bone formation: anti-Inflammatory: increase Insulin resistance: increased Gluconeogenesis.
|
|
What is the source of PTH?
|
Chief cells in the parathyroid.
|
|
Where does vitamin D3 come from? What about D2?
|
D3 = sun exposure. D2 = ingested via plants.
|
|
Where is calcitonin made?
|
parafollicular C cells of thyriod.
|
|
What are the 4 functions of T3?
|
(4 b's) brain maturation: bone growth: beta-adrenergic effects: basal metabolic rate
|
|
in men: increased SHBG leads to what?
|
less free testosterone ->gynecomastia
|
|
in women: decreased SHBG leads to what?
|
more free testosterone ->hirsutism
|
|
Where is most t3 formed?
|
AT the target tissue.
|
|
What is the wolf-chaikoff effect?
|
excress iodine temporarily inhibits thyroid peroxidase -> decreased iodine organification ->decreased T3/T4.
|
|
What converts t4 to T3?
|
5'-deiodinase
|
|
What enzyme is responsible for oxidation and organification of iodide aswell as formation of MIT and DIT?
|
peroxidase
|
|
What is a difference in the mechanism of PTU and methimazole?
|
PTU disables peroxidase AND 5'-deiodinase. Methimazole only inhibits peroxidase.
|
|
What is waterhouse friderichsen syndrome?
|
primary adrenal insufficiency due to adrenal hemorrhafge associated with N. Meningitidis septicemia: DIC: and endotoxic shock.
|
|
what are the signs of episodic hyperadrenergic symptoms associated with pheochromocytoma?
|
5P's: Pressure (bp increased): Pain (headache): perspiration: palpitaitons: pallow.
|
|
Why must alpha blockers be given BEFORE b-blockers before pheochromocytoma surgery?
|
pheochromo makes epi and nor-epi (alpha and beta agonists). Blocking only beta will cause unchallenged stimulation of a recepors: causing hypertensive crisis. Block A first to control the a receptors and then block b.
|
|
What is jod-basedow phenomenon?
|
thryotoxicosis when a person with iodine deficency goiter is made iodine replete.
|
|
lymphoma is associated with what thyroid condition?
|
hashimoto's thyroiditis.
|
|
What is psuedohypoparathyroidism? findings?
|
also called Albright's hereditary osteodystrophy. kidnet doesn't respond to PTH. findings: hypocalcemia: short 4/5th digits: short stature.
|
|
compare treatment for nephrogenic diabetes insipidus and central DI.
|
central - give desmopression (ADH analong). for nephrogenic: ADH won't cause a response. instead: give HCTZ: indomethacin or amiloride.
|
|
What is sheehan's sydrome?
|
inschemic infarct of pituitary following pospartum bleeding.
|
|
insulsin is ALWAYS required in what types of diabetes?
|
type 1. type 2 might not need.
|
|
Why does carcinoid syndrome NOT occur if the tumor is limited to the GI tract?
|
5-ht undergoes first pass elimination in the liver
|
|
What is th rule of 1/3 with carcinoid tumors?
|
1/3 metastasize: 1/3 present with a secondary malignancy: 1/3 are at multiple sites.
|
|
What is the pathology seen with Zollinger-ellison syndrome?
|
gsstrin increased causes rugal thickening due to acid hypersecretion.
|
|
What is the treatment stratergy in type 1 DM?
|
low sugar diet and required insulin replacement.
|
|
What is the treatment stratergy in type 2 DM?
|
dietary modification and exercise first: then medicaitons after that. insulin not always required.
|
|
Renal amyloidosis will be positive for what test?
|
the light microscopy - congo red stain shows apple-green birefringece under polarized light.
|
|
What are the derivatives of the: foregut: midget: and hindgut?
|
forgut - pharynx to duodenum. midgut - doudenum to transverse colon. hindgut - distal transverse colon to rectum.
|
|
abdominal wall: rostral fold closure failure results in:
|
sternal defects
|
|
abdominal wall: lateral fold closure failure results in:
|
omphalocele: gastrochisis
|
|
abdominal wall:caudal fold closure failure results in:
|
bladder exostrophy
|
|
What is the difference in pathology between duodeinal atresia and jejunal: ileal: or colonic atresia?
|
Duodenal - failure to recanalize (like in down syndrome). others: due to a vascular accident (apple peel atresia).
|
|
Give difference between gastroschisis and omphalocele.
|
gastro - abdominal contents NOT covered by peritoneum. omphalocele - contents ARE covered by peritoneum.
|
|
Congenital pyloric stenosis occurs most often in who?
|
firstborn males.
|
|
What is an annular pancreas? what are the bed sequalue of one?
|
ventral pancreatic bud abnormally encircles 2nd part of duodenum. Causes duodenal narrowing.
|
|
What causes pancreas divisum?
|
ventral and doral pancreatic buds do not fuse.
|
|
What sturcture does the spleen rise from? What about the pancreas?
|
spleen = mesodermal. pancreas = foregut.
|
|
What structures are contained in the retroperitoneum?
|
GI structures without and mesentery and non-GI stuff. (SAD PUCKER) Suprarenal gland (adrenal): Aorta and IVC: Duodenum(2nd+3rd): pancreae (except tail): ureters: colon(desc and ascend): kidneys: esophagus: rectum.
|
|
What are the layers of the gut wall?
|
in to out (MSMS) mucosa: submucosa: muscularis externa: serosa.
|
|
Describe difference between an ulcer and an erosion in the digestive tract.
|
errosion = mucosal layer only. ulcer = submucosa muscular layer.
|
|
Where are meissner's and auerbach's plexuses located?
|
meissner = submucosa layer. auerbach = muscularis.
|
|
What are the frequencies of basal rhythm in the: stomach: duodenum: ileum?
|
stomach = 3 wave/min. Duodenum = 12w/m. Ileum = 8-9 w/m.
|
|
What causes superior mesenteric artery syndrome?
|
3rd part of duodenum is trapped between the SMA and the aorta: restricting it's lumen.
|
|
What is a surgerical treatment for protal hypertension?
|
TIPS (transjugular intrahepatic portosystemic shunt) which connects portal vein to hepatic vein.
|
|
What the pectinate line?
|
line in the anus where endoderm meets the ectoderm.
|
|
What are the 3 liver zones? which is affected by viruses? which is sensitive to toxic injury?
|
1. periportal. sensitive to viral hepatitis. 2. intermediate 3. pericentral sensitive to toxins and alcoholic hepatitis.
|
|
What must a gallstone reach to block both bile and pancrastic ducts.
|
The ampulla of vater.
|
|
Tumors in what part of the pancreas are most likely to obstruct the common bile duct?
|
the head of pancreas.
|
|
Describe the organization of the femoral vessels.
|
(if you go lateral to medical you hit your NAVEL) Femoral Nerve: Femoral Artery: Femoral Vein: empty space: Lymphatics.
|
|
What is contained in the femoral triange? what are the borders?
|
femoral artery: vein: nerve. Borders are inguinal ligmant: sartoris muscle and adductor longus muscle.
|
|
What runs in the femoral sheath? what important structute does not?
|
femoral artery: vein:and deep inguinal lymph nodes do. Femoral NERVE does not!!!
|
|
What is hasselbach's triangle? What type of hernia goes through it?
|
inferior epigrastric vessel: lateral border of rectus abdominis: inguinal ligament. DIRECT comes through it!
|
|
Can atropine block parietal cells? what aout G cells?
|
Parietal = yes: they work through Ach. G cells = NO. they are signled by GRP.
|
|
What are brunner's glands? what are their purpose? when do they hypertrophy?
|
located in duodenum. Secrete alkaline mucus. they hypertrophy in peptic ulcer disease.
|
|
Where is iron absorbed?
|
absorbed as Fe2+ in the duodenum.
|
|
Where is folate absorbed?
|
absorbed in the jejunum.
|
|
Where is B12 and bile acid absorbed?
|
in the terminal iluem.
|
|
What is the rate limiting step in cholesterol degredation? what occurs if it is messed up: what drugs cause this?
|
Cholesterol 7alpha-hydroxylase. if defiecient: will get gallstones. Fibrates may cause this.
|
|
What are the funcitons of bile:
|
1. helps absorb fat. 2. cholesterol excretion. 3. antimicrobial activity via membrane disruption.
|
|
What is the bodies only way of eliminating cholesterol?
|
Via bile salts.
|
|
What are the differences between direct and indirect billirubin?
|
direct - conjugated with glucuronic acid: water soluble. indirect - unconjugated: water insoluble.
|
|
What causes GERD?
|
decrease in lower esphogeal sphincter tone.
|
|
What are the 3 organisms that cause esophagitis? describe gross path.
|
Candida - white pseudomembrane. HSV-1: punched out ulcers. CMV: linear ulcers.
|
|
What is boerhaave syndrome?
|
transmural esophageal rupture due to violent retching.
|
|
what is plummer-vinson syndrome?
|
triad of: dysphagia due to esophageal webs: glossitis: iron defiency anemia.
|
|
Where are squamous cell esophageal cancers found? what about adenocarcinoma?
|
squamous - upper 2/3. adenocarinoma - lower 1/3.
|
|
pancreatic insufficiency leads to malabsportion of what vitamins?
|
ADEK
|
|
Celiac sprue is related to what HLA?
|
HLA-DQ2: HLA-DQ8: and nothern european descent.
|
|
What antibodes are found in celiac sprue? Which is used for screening?
|
1. anti-endomysial. 2. anti-tissue transglutaminase. 3. anti-gliadin. Tissue transglutaminase is use for screening.
|
|
What is curler's ucler?
|
acute gastritis causes by decreased plasma volume yielded burns and then sloughing of gastric mucosa.
|
|
What is cushing's ulcer?
|
acutue gastritis caused by increased vagal stimulation from brain injury: leading to increased Ach and then increased H+ production.
|
|
What is the difference between type A and type B gastritis? which is most common?
|
A: antibodies to partietal cells causes pernicious anemia and achlorhydia. In fundus/body/ B: H. Pylori infection. in anturm: most common.
|
|
Which stomach cancer is associated with H. Pylori?
|
associated: intestinal and MALT lymphoma. not associated: diffuse.
|
|
What causes appendicits?
|
adult: obstruction by fecalith. kids: lymphoid hyperplasia.
|
|
What are the five 2's of Meckel's diverticulum?
|
2 inches long: within 2 inches of ileocecal valve: 2% of population: first 2 years of life:2 types of epithelia (gastric +pancreatic)
|
|
Ishcemic coloitis most commonly occurs where?
|
splenic flexure and distal colon.
|
|
What is familial adenomatous polyposis?
|
autosomal dominat APC mutation on 5q. 2 hit hypothesis. 100% get colorectal cancer: always involves rectum.
|
|
What is Gardner's syndrome?
|
Familial adenomatous popylposis + osseous and soft tissue tumors + hypertrophy of retinal pigment epithelium.
|
|
What is Turcot's syndrome?
|
familal adenomatous syndrome + malignant CNS tumors.
|
|
what is hereditary nonpolyposis colorectal caner (or lynch) syndrome?
|
autosomal dominant mutation in DNA-mismatch repair genes. 80% get colorectal cancer. proximal colon always involved.
|
|
What are the risk factors for colorectal cancer?
|
1. IBD 2. Smoking 3. villous adenomas 4. juvenile polyposis sydrome 4. peutz-jeghers syndrome.
|
|
What is the order of pathogenesis of colorectal cancer?
|
AK-53. loss of APC gene: K-ras mutation: loss of p53.
|
|
What are the most common site of carcinoid tumors?
|
1. appendix 2. ileum 3. rectum.
|
|
What are the aminotransferase (AST and ALT) markers for?
|
Viral hep (ALT>AST) and alcoholic hepatitis (AST>ALT).
|
|
What is alkaline phosphastase a marker for?
|
obstructive liver disease (HCC): bone disase: bile duct disease.
|
|
what is gamma-glutamyl transpeptidase a marker for?
|
increaed in liver + biliary disease: not bone.
|
|
what is amylase a marker for?
|
mumps and acute pancreatitis
|
|
what is lipase a marker for?
|
acutepancreatitis.
|
|
What is ceruloplasmin a maker for?
|
it is decreased in wilson's disease.
|
|
Aspirin is avoided in kids EXCEPT when?
|
always avoided EXCEPT in kawasaki's disease.
|
|
Is hepatic steatosis reversible?
|
it can be
|
|
What is associated with hepatocellular carcinoma?
|
Hepatitis B+C: wilson's disease: hemochromatosis: a1-antitrypsin deficiency: alcoholic cirrhosis: and alfatoxin.
|
|
What lab is increased specific to HCC?
|
alpha-fetoprotein.
|
|
What is a cavernous hemangioma? what is contraindicated in it?
|
benign liver tumor in people over 30. do NOT biopsy due to bleeding risk!
|
|
What is a hepatic adenoma?
|
benign liver tumor: related of OCP or steriod use. can regress spontaneously.
|
|
what is a angiosarcoma?
|
malignant tumor of liver endothelial cells: associated with PVC and arsenix.
|
|
What is the classic triad of hemochromatosis?
|
1. micronodular cirrhosis 2. DM 3. skin pigmentation and dermal deposits (all add up to bronze diabetes).
|
|
What genes are associated with hemochromatosis?
|
c282Y or H63D mutation in HFE gene. Associated with HLA-A3.
|
|
What are the causes of acute pancreatitis?
|
(GET SMASHED) gallstones: ethanol: trauma: steroids: mumps: autoimmune: scorpion sting: hypercalcemia/hypertriglycemia: ERCP: drugs(sulfa)
|
|
What lab has the highest specificity for acute pancreastitis?
|
lipase.
|
|
What causes a pancreatic psuedocyst? why is it dangerous?
|
causes by acute pancreatitis. lined by granulation tissue which makes it tend to rupture and causes huge hemorrhage.
|
|
What are the major causes of chronic pancreatitis?
|
idiopathic and alcohol abuse.
|
|
What are the risk factors for pancreatic adenocarcinoma?
|
tobacco use: chronic pancreatitis: age over 50: jewis or african american.
|
|
What is Trousseau's syndrome?
|
a migratory thromophlebitis that causes redness and tenderness on extrememities - seen in pancreatic adenocarcinoma.
|
|
What are the casues of eosinophilla?
|
(NAACP) Neoplastic: asthma: allergic: collagen vacular disease: parasites.
|
|
What is anisocytosis?
|
varying size RBC
|
|
what is poikilocytosis?
|
varying shaped RBC
|
|
What are platelt's derived from?
|
megakaryocyte
|
|
what are in alpha granules and dense granules in platlets?
|
alpha - vWF and fibrinogen. dense - ADP: calcium.
|
|
platlet dysfunction results in:
|
petechiae
|
|
What is the vWF receptor? what about fibrinogen?
|
VWF - GpIb. fibrinogen - GpIIb/IIIa.
|
|
What is a normal WBC differential?
|
Neutrophil (54-62%): Lymphocytes (25-33%): monocytes(3-7%): Eosinophils (1-3%): basophils (0.-0.75%)
|
|
What is contained in neutrophil granules?
|
alkaline phosphotase: collagenase: lysozyme: lactoferrin.
|
|
What do azurophilic (lysozyme) granules contain?
|
acid phosphotase: peroxidase: B-glucuronidase.
|
|
What is CD14 a cell maker for?
|
Macrophage.
|
|
Macrophages differentiate from what other cell?
|
monocyte.
|
|
What do eosinophils produce that limits mast cell degranulation?
|
histaminase and arylsulfatase
|
|
What do basohil granules contain?
|
heparin: histamine: leukotrienes.
|
|
What is the universal donor of plasma: the universal donor to RBCs and universal recipient of plasma?
|
donor of RBC = O type: donor of plasma = AB type. reciepent of plasma = O type.
|
|
What DECREASES ESR?
|
polycthemia: sickle cell anemia: CHF: microcytosis: hypofibrinogenemia.
|
|
Basophillic stippling of RBC's is seen in what diseases?
|
Thalasemia: Anemia of chronic disease: Pb poisoning.
|
|
What dieases cause target cell RBC's?
|
HbC disease: asplenia: liver disease: thalassemia.
|
|
Which coronary arteries supplies the cardiac papillary muscles?
|
Anterior = LAD. Posterior = RCA.
|
|
What can cause a U wave on EKG?
|
bradycardia or hypokalemia
|
|
What infections are associated with Reiter's arthritis?
|
chlamydia: N. gonhorreae: salmonella: shigella: yersinia: campylobacter: and ureaplasma.
|
|
What causes basophillic stippling in RBCs?
|
(TAL) thakassemia: anemia of chronix disease: lead poisoning.
|
|
what causes an elliptocyte RBC?
|
hereditary elliptocytosis.
|
|
what causes a macro-ovalocyte?
|
megaloblastic anemia or marrow failure.
|
|
what causes ringed sideroblasts?
|
excess iron in RBC mitochondria.
|
|
what causes schistocytes and helmet cells?
|
DIC: TTP/HUS: traumatic hemolysis.
|
|
what causes spherocytes?
|
hereditary spherocytosis: autoimmune hemolysis
|
|
what causes teardrop RBCs?
|
bone marrow infiltration
|
|
what causes target cell RBCs?
|
(HALT) HbC disease: Asplenia: liver disease: Thalassemia.
|
|
What causes heinz bodies?
|
oxidation of hemoglobin sulfhydryl groups causes denaturation of heme and precipitation. eventually leads to bite cells. Seen in G6PD.
|
|
What causes howell-jolly bodies?
|
basophillic nuclear remnants in RBCs. normally removed in the spleen so they are seen in aslpenia or naphthalene ingestion (mothballs)
|
|
What are the iron labs in iron deficiency anemia?
|
decreased serumiron: increased TIBC: decreased ferritin: decreased % transferrin saturation.
|
|
What are the iron labs in chronic disease?
|
decreased serum iron: decreased TIBC: increased ferritin: NC in %transferrin.
|
|
what are the iron labs in hemochromatosis?
|
increased: serum iron: %transferrin: and ferritin. decreased: transferrin.
|
|
what are the iron labs in pregancy/ OCP use?
|
increased transferrin making %transferrin decrease.
|
|
What are the cis/trans deletions in alpha-thallessemia?
|
cis - common in asians: trans - common in africans
|
|
How does lead poisoning decrease heme synthesis?
|
lead inhibits ferrochetalase and ALA dehydratase: decreasing heme synthesis. also inhibits rRNA deg: causing basophillic stippling.
|
|
What are the signs of lead poisining?
|
(LEAD) Lead lines on gingivae (burton's lines) and metaphysis of long bones: Encephalopathy and erthryocyte basophilling stippling: abdominal colic and sideroblastic anemia: drops in wrist and foot.
|
|
What are the hereditary and reversible causes of sideroblastic anemia?
|
hereditary: x-linked defect in gamma-ALA synthase. Reversible: EtOH: lead: INH.
|
|
What is the treatment for sideroblastic anemia?
|
B6: pyroxidine which is a cofactor for gamma -ala synthase.
|
|
Describe difference in labs between folate defiecency and B12 deficiency.
|
folate: high homocysteine but normal methymalonic acid. b12: both are high.
|
|
What is the difference between the PT and PTT test?
|
PT: tests extrinic + common pathway: (only factors I: II: V: VII: X). PTT: intrinic + common: (all factors except VII and XIII)
|
|
What induces ectoderm to differentiate into neuroectoderm?
|
notochord underneath the ectoderm
|
|
What does neural plate give rise to?
|
neural tube and neural crest cells.
|
|
What do the alar and basal plate become in CNS development?
|
Alar(dorsal) - sensory. Basal(ventral)-motor
|
|
What is the embyronic structure that failes to fuse that causes neural tube defects?
|
neuropores fail to fuse in week 4.
|
|
After an aminotic or materal serum a-fetoprotein is detected: what is the confirmatory for neural tube defects?
|
increased AchE in aminotic fluid.
|
|
Describe difference in spina bifida occuta: meningocele: and meningomyelocele.
|
spina bifida occulta - failure of spine canal to close: dura intact: no herniation. can see tuff of hair above it. Meningocele - meninges but NOT spinal cord herniates. Meningomyelocele - spinal cord and meninges herniate.
|
|
What is anencephaly in utero associated with?
|
1. polyhydramnios ->no swallowing center: fluid not decreased. 2. maternal DM: type 1.
|
|
What is holoprosencepahaly?
|
failure of light and right cerebral hemispheres to seperate.
|
|
What is a chiari II(arnold-chiari) malformation?
|
cerebellar herniation through foramen magnum with aqueductal stenosis and thus hydrocephalus. usually paralysed beneath defect.
|
|
what is a dandy-walker malformation?
|
agenesis of cerebellar vermis with enlargement of 4th ventricle -> associated with hydrocephalus and spina bifida.
|
|
What is a chiari I malformation associated with?
|
syringomyelia: usually c8-t1.
|
|
What embryologicaly structute do microglia come from?
|
are Marcophages: come from Mesoderm!
|
|
What is nissl substance?
|
RER: found only in cell bodies and dendrites. NOT found in axons!
|
|
each oligodendrocyte myelinates how many axons? how about schwann cells?
|
oligo = multiple. schawnn = one.
|
|
what cells are destroyed in mulitiple sclerosis?
|
oligodendrocytes.
|
|
What cells are destroyed in Gullain-Barre syndrome?
|
schwann cells
|
|
Describe 3 layers of peripheral nerve.
|
endoneurium - on single nerve: inflammed in gullian-barre. peri - permeability barrier around fasicle: much rejoin in reattachment. epi - aroud entire nerve: has blood and connective tissue.
|
|
What is the limbic system responsible for?
|
5 F's: feeding: fleeing: fighting: feeling: sex.
|
|
lateral cerebellar injury causes: medial causes:
|
lateral: injured movement in extremeties: wil fall TOWARD injured side. medial: balance: truncal coordination.
|
|
What are the 2 major pathology changes in parkinsons?
|
1. lewy bodies (alpha-synuclein inclusions) and loss of dopaminergic neurons (depigmentaiton) in substantia nigra pars compacta.
|
|
Compare damage ro paramedian pontine reticular formation to frontal eye fields.
|
PPRF = eyes look AWAY from lesion. frontal eye field = eyes look TOWARD lesion.
|
|
Damage to hippocampus results in?
|
inability to make new memories: antereograde amnesia.
|
|
what are the signs of central pontine myelinolysis?
|
acute paralysis: dysarthria: dysphagia: diplopia: LOC. Can cause locked in syndrome!
|
|
What is Kluver-blucy syndrome and what is it associated with?
|
damage to bilateral amygdala. results in hyperorality: hypersexuality: disinhibition. associated with HSV-1.
|
|
What parts of brain are more vulnerable to hypoxia?
|
Hippocampus: neocortex: cerebellum: watershed areas.
|
|
Give time course of irreversible neuronal damage.
|
(12-48h) red neuron. (24-72h) necrosis +PMN. (3-5d)marcopahges. (1-2w)gliosis+vascularization. (>2w) glial scar.
|
|
What vein can infect spread from the face to the brain?
|
superior opthalamic vein->cavernous sinus
|
|
Primitive lesions reemerge after what kind of lesion?
|
damage to frontal lobe.
|
|
What is medial medullary syndrome?
|
caused by paramedian branchs of ASA and vertebral arteries ->contra hemiparesis of body: contra decreased in body proprioception: ipsil hypoglossal dysfunction.
|
|
Nucleus ambigous lesions are specific to what artery?
|
PICA
|
|
Where are most Charcot-bouchard microaneurysms?
|
usually in small vessels: like basal ganglia or thalamus
|
|
differntiate lower motor neuron injuries from upper.
|
lower - less muscle mass: less tone: less reflexes: downgoing toes:flaccid paralysis. upper - increaed tone: DTR: + babinski: spastic paralysis.
|
|
Poliomyeltis and Wednig-horrman disease specifically destroys:
|
anterior horns: leading to LMN destruction.
|
|
How does b12 degerneration differ from tabes dorsalis?
|
Tabes->dorsal column destruction only. b12->dorsal column AND lateral corticospinal AND spinocerebellar. b12 has more movement ataxia.
|
|
What is werdnig-hoffman disease:
|
congenital degeneration of anterior horns->LMN damage. causes floppy baby with hypotonia and tongue fasiculations: who dies by 7 months.
|
|
Where does spinal cord damate have to occur to cause Horner's syndrome?
|
above T1.
|
|
compare superior colliculi to inferior culliculi.
|
superior = conjugate gaze center: inferior = auditory. (eyes are above the ears)
|
|
What is perinaud syndrome?
|
Paralysis of conjugate gaze due to a lesion in the superior colliculi.
|
|
What is the only cranial nerve WITHOUT thalamic relay to the cortex?
|
1: olfactory
|
|
What does nucleus Solitarius control?
|
visceral Sensory information (taste: baroreceptor: gut distension) from CN VII: IX: X.
|
|
What does nucleus aMbiguous control?
|
Motor innervation of pharynx: larynx: upper esophagus (swallowing: palate elevation) CN IX: X
|
|
What does dorsal motor nucleus control?
|
sends autonomic fibers to heart: lungs: GI. CN X.
|
|
How do you tell if a facial nerve palsy is UMN or LMN damage?
|
forehead spared? yes = UMN damage. Bilateral UMN innervation to each LMN. LMN damage = forehead NOT spared.
|
|
What is cavernous sinus syndrome?
|
mass effects in the CS: ophthalmoplegia and decreased corneal + maxiliiary sensation with NORMAL vision.
|
|
What nerves lay in the cavenrous sinus?
|
III: IV: V1: V2: VI and postganglionic sympathetics.
|
|
HPV proteins E6 and E7 have what functions?
|
E6= p53: E7=Rb.
|
|
Koiliocytes are associated with what infection?
|
HPV
|
|
How does C-peptide relate to insulin?
|
C-peptide is made when proinsulin is cleaved into insulin. This means the insulin comes from in the body and is no the result of insulin medication overdose.
|
|
Delirum tremens usually occurs how often after the patients last drink of alcohol? How is it treated?
|
2-5 days. with benzodiazepenes to stop seizures.
|
|
During what stage of infenction can pertussis infection be treated with antibiotics?
|
1st 1-2 weeks: during the flu like stage. during the paroxysmal stage when coughing is bad antibiotics will not help.
|
|
In CN V3 motor injury: what is the physical defect?
|
jaw deviates TOWARDS the injury due to unopposed opposite ptergoid muscle.
|
|
In a CN x lesion: what is the motor deficit in the mouth?
|
uvula deviates AWAY from the lesion: weak side collapses and points uvula away.
|
|
What is the motor deficit in CN XI lesions?
|
weakness in turning head to contralateral side and shoulder droop on ipsilateral side.
|
|
What is the motor deficit in CN XII lesions?
|
tongue deviates TOWARD side of the lesion due to weak tongue muscles on affected side.
|
|
Compare Rhine and weber test for conductive and sensineural hearing loss
|
conductive: abnormal rhine (bone>air): weber localizes to affected ear. sensineural: normal rhine (air>bone): weber localizes to unaffecred ear.
|
|
What produces aqueous humor? what collects it?
|
produces it:Cilliary epithelim (B agonist control). collects it: canal of schlemm.
|
|
What is closed/narrow angle glaucoma? what are the two types?
|
Lens pushes the iris into the canal of schlemm/trabecular meshwork. this prevents flow of aqueous humor -> IOP goes up.types: Chronic (asymptomatic: peripheral vision loss and optic n. damage) and acute (emergency! painful: sudden vision loss: rock hard eye.)
|
|
What drug should NEVER be given in acute closed angle glaucoma? why?
|
Epinephrine: it stimulates myradiasis which worsens the block.
|
|
People with CN IV injury have trouble doing what specific action?
|
Going down stairs. They cannot look down while eyes look towards nose.
|
|
Cranial nerve III carries what two types of components?
|
motor ->ocular muscles. Parasympathetic ->are first affected by compression. deficit->blown pupil.
|
|
Retinal detachment is associated with:
|
1. high myopia 2. seeing floaters and flashes
|
|
What is age related macular degenation?
|
degeneration of macula->central blindness. dry degeneration->slow: prevent with multivitamins. wet->fast: due to chorodial neovascularization. prevent with anti-VEGF.
|
|
What are the alzheimiers onset/protection genes?
|
early onset = APP(Ch 21): presenilin-1(Ch 14). late onset = ApoE4(Ch 19). protective = ApoE2(19).
|
|
What is Charcot's triad of MS?
|
(SIN) scanning speech: Intention tremor(+incontience + internuclear opthalmoplegia): Nstagmus
|
|
What is the pathophysiology of neurodegernation in Krabbe's disease?
|
buildup of galactocerebroside destroy's myelin sheath.
|
|
Reed sternburg cells are positive for:
|
CD30: CD15.
|
|
what is the best lab test to confirm menupause?
|
increased FSH: due to lost estrogen feedback control.
|
|
Duodenal ulcers are at risk for perforating what artery?
|
gastroduodenal
|
|
People with defects in Ryanotidine are prone to get what crisis?
|
Malignat hyperthermia following succinylcholine or sevoflurance: isoflurance: devolfurance.
|
|
What is codominance?
|
2 seperate alleles contribute to a a phenotype. example: blid type (a and b).
|
|
What is variable espressivity?
|
when a phenotype varies among individuals with same same genotype. ex: neurofibromatosis 1.
|
|
what is incomplete penetrance?
|
when not all people with a mutant genotype show the mutant genotype. ex: not all people with BRCA1 get breast cancer
|
|
What is pleiotropy?
|
Gone gene contributes to multiple phenotypic events
|
|
what is imprinting?
|
differences in gene mutations depend on if they are maternal or paternal in origin.
|
|
What is a dominant-negative phenotype?
|
whena mutation exerts a dominate effect: like when a heterozygote makes a nonfunctional gene that keeps the normal gene from functioning.
|
|
What is linke disequilibrum?
|
Tendency for 2 alleles at 2 linked foci to occur together more often than expected by chance.
|
|
What is a chimeric individual?
|
A person derived from 2 fused zygotes
|
|
What is locus heterogeneity?
|
mutations at different loci can make the same phenotype. exp: marfans: MEN2B: and homocystinuria all cause Marfan habitus. albinism: too.
|
|
What is heteroplasmy?
|
presence of both normal and mutated mtDNA resulting in a variable expression mitochondrial disease.
|
|
What is uniparental disomy?
|
offspring recieves 2 copies of a chromosome from 1 parent and none from the other. example: consider UPD when only 1 parent is carrier!
|
|
Hardy weinburg assumes what 4 things:
|
1. no mutation: no selection for any genotypes: random mating: no net migration.
|
|
What is the difference between heterodisomy and isodisomy?
|
hetero = UPD causes by a meiosis I error. iso = UPD caused by a meiosis II or postzygotic duplication.
|
|
What is Lhermitte's sign? What causes it?
|
A shock felt down peripheral extremities on neck flexion. Commonly seen in mulitple sclerosis or cobalamin deficiency.
|
|
What is myasthenia gravis associated with?
|
Thymoma or thymic hyperplasia.
|
|
What is Lambert-eaton myasthenic syndrome associated with?
|
small cell lung cancer.
|
|
What is the function of sertoli cells?
|
(Sertoli cells Support Sperm Synthesis) 1. secrete inhibin (lowers fsh) 2. secretes androgen binding protein (maintains local levels of testesterone) 3. supports spermatogonia. ALSO: products MIH and makes blood-testes barrier!
|
|
What does red safarin O strain?
|
1. cartilage 2. mucin 3. Mast cell granules
|
|
What is usedas an ovarian cancer maker?
|
CA-125. good for progression NOT FOR SCREENING.
|
|
What is the most important risk factor in ovarian cancers?
|
genetic predisposition - family HX: BRCA1: BRCA2: HNPCC.
|
|
What is Meig's syndrome?
|
Triad of ovarian fibroma: ascites: and hydrothorax.
|
|
DES exposure in utero is a risk for what?
|
exposure to DES in utero is a risk factor for clear cell adenocarcinoma of the vagina later in life
|
|
What are the most common gynecologic tumors? what are the worst prognosis?
|
most common: endometrial>ovarian>cervical. worst prognosis: ovarian>cervical>endometrial.
|
|
Pagophobia is specific for what nutrient defiecency?
|
pagophobia = wanting to chew on ice. It is specific for iron depletion.
|
|
What is the Reiter's syndrome triad?
|
1. urethritis 2. conjunctivites 4. seronegative arthritis (cant see: cant pee: cant climb a tree)
|
|
Who is leukemoid reaction and CML differentiated?
|
Both cause a increase in WBC with a left shift (increased neutophil precursors). Leukomoid: increase leukocyte aklaline phosphotase. CML: decreased leukocyte alkaline phosphotase.
|
|
What is "blast crisis"
|
when CML accelerates and transforms into AML or ALL.
|
|
what is the difference between vinca alkoloids and paclitaxel?
|
vinca = inhibit microtubule formation. paclitaxil = inhibits DISSASSEMBLY!
|
|
What is McCune-Albright syndrome?
|
bone is replaced with fibroblasts: collagen: and weird bone structure. triad: multipe unilateral bone lesions: endocrine abnormalities (precocious puberty): cafe-au-lair spots.
|
|
Pannus in a joint is associated with what?
|
RA
|
|
What are heberden and bouchard nodules?
|
heberden = DIP: bouchard = PIP. seen in osteoarthritis.
|
|
What are the genetic finds in RA?
|
80% have RA factor (an IgG). more specific is Anti-cylic citrullinated peptide. HLA-DR4 is also associated.
|
|
What is the difference getween gout crystals and psuedogout?
|
gout =yellow. psuedogout = blue.
|
|
What causes osteonecrosis?
|
Trauma: high dose corticosteroids: alcoholism: sickle cell.
|
|
What is hypercalcemia found in Sarcoidosis?
|
Due to elevated 1Alpha-hydroylase-mediated vitamin D activation in epitheliod macrophages.
|
|
What is CREST syndrome
|
a type of scleroderma. Calcinosis: Raynaud's: Esophageal dysmotility: Sclerodactyly: Telangiectasia.
|
|
What is lesler-trelat sign?
|
sudden appearance of multiple suborrheic keratoses. indicates an underlying malignancy: often lymphoid.
|
|
What is Nikolsky's sign?
|
seperation on stroking of a bullous. + in pemigous vulgaris: - in bullous phemigould.
|
|
What is toxic epidermal necrolysis?
|
SJS with greater than 30% of the body involved.
|
|
What is Acanthosis Nigricans associated with?
|
hyperinsulenemia (DM: obesity: cushing's syndrome) or malignancy.
|
|
What is the difference between staph scalded skin syndrome and toxic epidermal necrolysis?
|
SSSS = keratinocytes destroyed only in the stratum granulosum. TEN = epidermal-dermal junction is destroyed.
|
|
What causes hairy leukoplakia?
|
EBV but it often occurs in HIV + patients.
|
|
What is squamous cell carcinoma of the skin associated with?
|
sunlight: immunosuppession: and arsenic.
|
|
Breast milk from women with a health diet have all nutients EXCEPT what: which need supplement?
|
Vitamin K and D: this occurs by 6 mo if no supplement if given.
|
|
What bone cell are PTH receptors found?
|
on osteoBLASTS. they upregulate M-CSF and RANK-L in themselves which then stimulates osteoCLASTS.
|
|
What is Alpha-amantin?
|
poison found in Amanita Phalloides. It blocks DNA-dependent RNA polymerase II: stopping mRNA production. causes diffude hepatic necrosis.
|
|
What is the MOST effective preventive intervention leading to reduced mortality?
|
smoking cessation. It is better than almost anything else that can be initiated.
|
|
What are the 4 causes of night blindness?
|
toxic retinopathy (ohenithiazines: chloroquine): Vit A def: Congenital rubella: syphillis: diabetic retinopathy.
|
|
How does splenic dysfunction result in decreased encapsulated organism fighting?
|
lower IgM is made -> lower complement and MAC.
|
|
What is the only lymphocye member of innate immunity?
|
Natural Killer cell
|
|
Hartnup disease leads to what skin condition. Why?
|
Pellagra. There is loss of tryptophan: thus niacin can't be made.
|
|
What is Anergy?
|
when self-reactive T or B cells become nonreactive without a costimulatory molecule.
|
|
For what diseases are people given preformed antibodies?
|
(this is passive immunity) (To Be Rapidly Healed) Tetanus: Botulinum: HBV: Rabies.
|
|
What are the 4 T's of type IV hypersensitivity?
|
T Lymphocytes: Transplant rejection: TB skin test: Touching (contact dermatitis)
|
|
Which hypersensitivty reactions involve antibodies?
|
I: II: III. NOT IV!!!!
|
|
What immunological disease is associated with false pregnancy tests?
|
Selective IgG deficiency: casuses a false positive HcG due to heterophile antibody.
|
|
Why are watershed areas susceptible to ischemia?
|
watershed = fed by distal ends of 2 different arteries. Good if one if blocked. BAD in systemic hypoperfusion.
|
|
what tissues get pale infarcts?
|
tissues with a single blood supply. include heart: kidney: spleen.
|
|
What are the signals for leukocyte migration from blood into interstituim?
|
(CILK) C5a: IL-8: LTB4: Kallikrein.
|
|
What causes death in iron poisioning?
|
cell death due to peroxidation of membrane lipids: causes bleeding and metabolic acidosis.
|
|
Which is usually more prognostic: stage or grade?
|
stage.
|
|
What is Heyde's syndrome?
|
induction of a vWF deficiency due to aortic stenosis. Associated with GI bleeding and colonic angiodysplasia.
|
|
What causes extraocular eye movements during REM?
|
paramedian pontine reticular formation
|
|
Depressed people have have sleep pattern?
|
increased overall REM: decreased REM latency: more early morning wakefullness.
|
|
Myasthenia Gravis is associated with what?
|
1. Thymoma 2. Thymic hyperplasia
|
|
What causes xeroderma pigmentosum?
|
Lack of UV-endonucleases. Can't cut out thymidine dimers.
|
|
How is Bartonella Hensalae differentiated from Kaposi Sarcoma?
|
Silver stain is positive in Bartonella. Also: bartonella = pmn inflammation. Kaposi = lymphocytic inflammation.
|
|
What does NF1 and NF2 encode (they are different?)
|
NF1 = neurofibromin: NF2 = merlin
|
|
What is the difference between histone methylation and acetylation?
|
Methylation = inactivates: no transcription. Acetylation = Active: relaxes DNA coil: transcription is a go.
|
|
What amino acids are encoded by only 1 codon?
|
Methionine (AUG) and Tryptophan (UGG)
|
|
What is the purpose of single-stranded binding proteins?
|
Prevent DNA strands from reannealing
|
|
What are the 3 RNA polymerases in eukaryotes?
|
poly 1 =makes rRNA: poly II = mRNA: poly III = tRNA. None can proofread!
|
|
p53 and hypophosphorylated Rb do what function?
|
inhibit G1->S transition
|
|
What is the function of COP I: COP II: and Clarithin?
|
COP I - retrograde transport and golgi -> er: COPII - anterograde transport and ER -> Golgi: Clathrin - trans-golgi->lysosomes and cell membrane to endosomes.
|
|
What is the function of peroxisome?
|
catabolism of very long fatty acids and amino acids.
|
|
What is associated with Ehler's-Danlos?
|
Joint dislocation: easy bruising: berry aneurysms: organ rupture.
|
|
What is alport syndrome associated with?
|
nephritis: deafness: and ocular disturbances.
|
|
What are southern: nothern: and western blots for?
|
SNoW DRoP - south -DNA: North - RNA: West - Protein.
|
|
How does ethanol metabolism lead to inhibited gluconeogenesis and fatty liver?
|
increased NADH/NAD ratio causes diversion of pyruvate to lactate and OAA to malate: stimulating fatt acid synthesis -> steatosis.
|
|
What causes fatty liver in Kwashiorkor?
|
Decreased protein = decreased apolipoprotein. lipids not pushed out of liver = steatosis.
|
|
What are the 3 possible causes of albinism?
|
1. tyrosinase (can't make melanin from tyrosine) 2. defective tyrosine transporter - decreased levels of tyosine: and thus less melanin 3. lack of neural migration of neural crest cells.
|
|
Where are many of the B-lactames held in bacteria?
|
In the periplasm: the space between cytoplasmic membrane and outer membrane in G- bacteria.
|
|
What segement of collecting tubules does ADH work on?
|
medullary
|
|
An activating mutation in what can lead to gout?
|
5'phosphoriboysl-1-pyrophosphate synthetase (PRPP).
|
|
What does an increased RV/TLC ratio indicate?
|
Air trapping: aka obstrutive lung disease
|
|
What is the most common cystic fibrosis gene defect?
|
(delta)F508
|
|
Where are negri bodies typically found?
|
In the purkinje cells of the cerebellum
|
|
what groups have a high mortality from HEV infection?
|
pregnant women
|
|
During the latent phase of HIV where does the virus replicate?
|
in the lymph nodes
|
|
Define mean: median: mode
|
mean = average: mode = most often occuring: median = middle of all values
|
|
What are the 5 P's seen in cretenism?
|
Pot-bellied: pale: puffy-face: protruding umbillicus: protuberant tongue
|
|
What part of lymph node becomes massive during an infection?
|
Paracortex: it houses T cells. also: this part is not well developed in DiGeorge.
|
|
What cytokines enchance macrophage activity?
|
IL-2: IL-12: IFN-B: IFN-A.
|
|
B cells mediate what immune reactions?
|
type I (IgE): type II and III (IgG)
|
|
T cells mediate what immune reactions?
|
type IV.
|
|
What are the only cell types that can activate naive T-cells?
|
Dendritic cells
|
|
What CD do regulatory(not helper or cytotoxic!!!) T cells have? What cytokines do they make?
|
CD3: CD4: CD25. Make ANTIinflammatory cytokines! IL 10 and TGFB.
|
|
Mature lymphocytes carry what Ig on their surface?
|
IgM and IgD
|
|
What are the markers for NK cells?
|
CD 16 (binds Fc of IgG): cd56
|
|
When are preformed antibodies given?
|
(To Be Healed Rapidly) after exposure to Tetanus: Botulinum: HBV: Rabies)
|
|
What is serum sickness?
|
type III hypersensitivty. After transfusions: drugs in fluid act as haptans.
|
|
What happens if you give someone with IgA defieicny a tranfusions of normal blood?
|
They have SEVERE anaphylactic shock: host attacks the new IgA! Must give IgA free blood!
|
|
What cytokines mediate cachexia?
|
TNF-alpha: IFN-gamma: IL-6.
|
|
What do stop codons code for?
|
releasing factor 1.
|
|
How does hypercalcemia affect renal concentrating abilities?
|
causes something very similar to nephrogenic diabetes insipidus.
|
|
Why isn't atrial repolarization shown on an EKG?
|
it is masked by the QRS complex
|
|
What effect does ANP have on renal aterioles?
|
dilate afferent: constrict efferent causing an "escape" from aldosterone.
|
|
What is the difference between the carotid body and carotid sinus?
|
body = chemoreceptor (senses decreased pO2 and pH: increased pCO2. sinus = baroreceptor
|
|
what is amarouex fugax?
|
atheriosclerosis at carotid: causes microemboli-> vision loss
|
|
What is the triad of pre-eclampsia?
|
hypertension: proteinuria: edema.
|
|
What is eclampsia?
|
pre-eclampsia + seizures
|
|
What is the best indicator of the severity of mitral stenosis?
|
the shorter the gap between A2 sound and the opening snap: the worse the stenosis.
|
|
Leukemoid reaction results in what?
|
glucocorticids or CML causes demarginilzation of PMN = increased neutrophils (left shift.) Lymphocyes and other leukocytes numbers go DOWN.
|
|
Deficiency of CD 55 and CD 50 is diagnostic of what?
|
Paroxsymal Nocturnal Hemoglobinuria (cell surface proteins needed to inactivate complement)
|
|
What causes hemiballism?
|
This is flinging of the joints on one side of the body: occurs due to contralateral injury in the subthalamic nucleus.
|
|
Why is hypocalcemia seen after massive blood transfusions?
|
Citrate (added to the blood to prevent coagulation) chelates calcium and magnisum: which may cause paresthesias.
|
|
Villous adenomas may secrete what into stool?
|
lots of mucus: causing large volume:liquid stools and hypovolemia and electrolyte imbalances. Blood is common: too.
|
|
Is ascites common in portal vein thrombosis? Why?
|
No. Uncommon because sinusoidal hypertension does not develop.
|
|
What are the findings in friedrich's ataxia?
|
1. progessive ataxia in all 4 limbs 2. hypertrophic cardiomyopathy 3. kyphosis: pes cavus: hammer toes 4. DM
|
|
Compare femur and tibia insertions for PCL and ACL (medial or lateral?)
|
ACL: femur: lat: tibia: medial. PCL: femur: medial: tibia: lateral.
|
|
Chronic rejection of lung transplants results in what lung change?
|
blockage of small airways = bronchiolitis obliterans
|
|
what is the difference between dysplasia and carcinoma?
|
dysplasia = reversible. Carcinoma - not reversible.
|
|
what is the only cranial nerve that originates outside of the skull?
|
XI: it enters the foramen magnum and comes back out the jugular foramen.
|
|
What is the single bigest risk of intimal tears in the aorta?
|
Hypertension
|
|
What four symptoms can accompany bells palsy?
|
1. decreased face expression 2. less PS input to salivaary: subman: and sublingual gland. 3. lost of tase to ant 2/3 of tongue. 4. feeling to pinna and external ear canal
|
|
How is most copper excreted?
|
vila bile salts and into stool
|
|
What is the tuberoinfundibular pathway?
|
dopaminergic pathway that connects hypothalamus to pituitary gland: inhibits prolactin excretion.
|
|
What can be used to determine if a high alkaline phosphatase is due to a bony cause or a hepato-billiary cause?
|
gamma-gtuamyl-transpeptidase
|
|
what is mult-drug resistance 1 gene?
|
A p-glycoprotein: transmembrane ATP-dependent pump that stops import in and increases pumping out of chemo drugs. MDR1 is upregulated in cancer trying to become resistant to chemo.
|
|
An ulcer found in the distal duodenum or an typical place (not stomach but in GI system) is suspicious for..?
|
Look for Zollinger-Ellison syndrome.
|
|
What genes are altered by PPAR-Y?
|
1. increased adiponectin 2. increased fatty acid transport protein 3. increased insulin receptors 4 inceased glut-4
|
|
What is meniere's disease?
|
increased in endolymph causes triad of episodic tinnitus: vertigo: and sensorineural loss.
|
|
What relationship does magnesium have on PTH?
|
Low magnesium = increased PTH secretion.
|
|
What is the difference between Auerbach's and Meissner's plexus?
|
Auerbach = in muscularis externa: parasym and sym: controls muscle contraction. Meissner's = in sumucosa: parasymp only: controls secretions
|
|
What is the syndrome causes by VIPomas?
|
WDHA: Watery Diarrhea: Hypokalemia: Achlorhydria
|
|
What is the rate limiting step in bile synthesis?
|
cholesterol 7alpha-hydroxylase
|
|
What are the symptoms of whipple's disease?
|
(CAN) Cardiac symptoms: Arthralgias: neurologic symptoms.
|
|
What is angiodysplasia?
|
Tortuous dilation of vessels: often found in cecum: terminal ileum: and ascending colon. causes hematochezia.
|
|
What is the most common malignancy in the small intestine?
|
Carcinoid tumor.
|
|
What is the treatment for neonatal jaundice?
|
caused by immature UDP-glucuronyl transferase -> kernicterus. tx: phototherapy -> converts UCB to a water soluble form.
|
|
What are the common causes of acute pancreatitis?
|
(GET SMASHED)Gallstone: ethanol: truama: steriods: mumps: autoimmune: scorpion sting: hypercalcemia: hypertiglycerima: ERCP: drugs.
|
|
What immune cell provides the major stimulus needed for atherslerotic plaque development?
|
platlets
|
|
What three cytokines mediate the systemic inflammation response?
|
IL-1: IL-6: TNF-alpha. these causes ESR to increase.
|
|
Thiamine deficiency can be diagnosed using what lab?
|
Erthrocyte transketolase.
|
|
What nerve fibers are tested on DTR testing?
|
muscle spindles (intrafusal muscle fibers)
|
|
activation of what pancreatic enzyme causes acute pancreatitis?
|
trypsin. It then goes on to activate all others.
|
|
What is the most common congential heart malformation associated with turners disease
|
bicuspid aortic valve
|
|
What is the difference between apoplexy and sheehan's syndrome?
|
sheehan = normal pituitary gland undergoes ischemic necrosis due to hypotension due to postpartum bleeding.usually no headache or vision problems. Apoplexy = a pitutary adenoma undergoes a hemorrhage. has headache: vision problems.
|
|
How is vascular dementia differentiated from alzheimers?
|
vascular is a stepwise progression: caused by slow lacunar infarcts. Alzheimer's is progressive and continual.
|
|
What is the specific receptor needed for parvovirus B19 to infect?
|
erythrocyte P antigen.
|
|
Mucucarmine stain is used to detect what organism?
|
Cryptococcus: Methanamine silver can also be used.
|
|
What causes permanent central DI: posterior hypophysis damage or hypothalamic damage?
|
hypothalamic or the stalk. Pituitary injury itself hardly ever causes permanent central DI.
|
|
What are lab predictors of liver failure?
|
Hypoalbuminemia and prolonged PT. AST and ALT are NOT! ALT and AST determine if injury is occuring: not how well the liver is functioning!
|
|
Why does vWF defiency cause prolonged PTT?
|
vWF protects factor VIII. There there is no vWF VIII is destroyed: causing intrinsic pathway problems.
|
|
What factors does antithrombim inhibit?
|
II: VII: IX: X: XI: XII.
|
|
What effects do kallikrein and ACE have on bradykinin?
|
Kalil = ACTIVATE bradykinin -> decreased permeability: vasoconstriction. ACE = inactivate bradykini
|
|
B-thallesemia is cause by mutations in what?
|
Point mutations in splice sites and promoter sequences -> decreased production.
|
|
Waht is the most common bleeding disorder?
|
von Willebrand's disease.
|
|
What is the most common cause of hypercoaguability in white people?
|
Factor V leiden
|
|
ALL is often positive for what markers?
|
TdT+ (pre T or B cell marker): CALLA+.
|
|
Hairy cell Leukemia is positive for what? what is treatment?
|
TRAP (tartrate-resistant acid phosphate). TX: clardribine (adenosine analog)
|
|
What are auer rods made of?
|
Peroxidase+ cytoplasmic inclusions. treatment may release them -> DIC.
|
|
Langerhan's cell histiocytosis express what markers?
|
S-100 (neural crest cell marker) and CD1a.
|
|
What can cause inappropriate absolute polycythemia?
|
RCC: Wilms tumor: HCC: hydronephrosis. All can stimulate ectopic EPO.
|
|
In what layer of epidermis are desmosomes: keratin: and stem cells found?
|
Desmosomes = spinosum: stem cells = basale: keratin = corneum.
|
|
What do the dorsal and palmar interosseous muscles do?
|
dorsal = abduct the fingers: palmer = adduct the fingers (DAB and PAD)
|
|
Why is FTA-ABS not useful for recurrent syphillis infections?
|
after first infection you are positive for life. must rely on the non-treponemal tests
|
|
What are the amyloid deposits in DM type 2 pancreatic B islet cells made of?
|
Amylin
|
|
How does abetalipoproteinemia cause acanthocytes?
|
deficient lipid absorption messes up the cell membranes of RBCs
|
|
what is the most common cause of shigelliosis?
|
S. Sonnei
|
|
What is the purpose of iNOS?
|
found in phagolysosomes: used to make reactive nitrogen products that destroy bacterias.
|
|
what is the only way to diagnose tetanus exposure?
|
purely based on history: there are no diagnostics tests that can be done
|
|
Most of the blood supplied by bronchial arteries is returned to the heart how?
|
in pulmonary veins!
|
|
What is the mechanism of lithium causes diabetes insipidus?
|
lithium inhibits vasopression receptors in the collecting ducts
|
|
What causes intraventricular hemorrhage and what increaes incidence of it?
|
the germinal zone is very dense soon after birth: also very weak and prone to hemorrhage. increaes with prematurity and smaller weight.
|
|
What is the area postrema and where is it located?
|
it is the chemorecptor zone: it samples blood as it lacks a BBB. found on the DORSAL medulla: near the 4th ventricle.
|
|
Can linkage disequilibrium occur with genes in different chromosomes?
|
YES!!!
|
|
What are signs of ACUTE hepatitis?
|
1. ballon hepatocyte degeneration 2. mononuclear cell infiltrates 3. councilman bodies`
|
|
C. Perferingens has what toxin? It destroys what?
|
Lecithinase (alpha toxin) which destroys phospholipids and thus cell membranes
|
|
Sudan III stain is used for what?
|
used on stool to identify fecal fat-> looks for malabsorption
|
|
Why does intraparrum HBV infection cause only mild liver injury?
|
The neonate has a very weak immune system. Much of the damage is mediated by our own immune system.
|
|
women with PCOS are at an increased risk for developing what?
|
1. type 2 DM 2. endometrial adenocarcinoma (due to unopposed estrogen)
|
|
waht bacteria form "serpentine" or "medusa head" chains on culture?
|
b. antracis
|
|
what causes hemorrhagic mediastinis?
|
inhalational anthrax
|
|
Where does nonenzymatic fat necrosis occur?
|
in the breast is a typical place
|
|
GLUT transporters have a preference for what type of glucose?
|
D-glucose
|
|
What are the risk factors for osteoporosis?
|
1. smoking 2. menopause 3. glucocorticoids 4. physical inactivity 5. white 6. loe body weight 7. etoh use
|
|
How does bone density relate to BMI?
|
higher bmi = more bone density
|
|
What is the shine-delgarno sequence?
|
sequence in mRNA found only in prokaryotes. It finds to the 16s rRNA.
|
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Calcification (like in valves and cholesterol plaques) is a hallmark for what cellular process?
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Necrosis and injury. These make Psammoma bodies. Ca from dead cells is released and collected.
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What is the most common cause of aortic stenosis?
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Calcinification of the leaflets: due to age related changes.
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What 2 tumors are S100 positive?
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1. Schwannoma 2. Melanoma. (both are derived from neural crest cells!!!!)
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The hindgut descends along what artery?
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IMA
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What virus can present like RA? How are they differentiated?
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Parvovirus in adults can. You can differentiate them by resolution: Parvo will resolve on its on: RA does not.
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What is the cause of congenital torticollosis?
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malposition of the head in utero or birthing problems.
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What are neurofibromas made of?
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schwann cells (neural crest)
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What is hemosiderin?
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An accumulation of iron in micelles. Seen in hemolytic anemia.
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What is effect modification? Is it a bias?
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When the effect of an exposure changes the outcome. This is not a bias.
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What is biliary sludge?
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Precursor to gallstones: forms when there is gallbladder hypomotility.
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What forms brown and black gall stones?
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Brown = biliary infection. black = intravascular hemolysis
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What test is used to detect cysteine in the urine?
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sodium cyanide-nitroprusside test turns urine red.
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Where are neurons lost from in huntington's disease?
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1. caudate nucleus 2. putamen
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What stops local fungal spread? what about hemotagenous?
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local -> T cells. Why HIV patients mostly get thrush. disseminated -> PMN. Loss of PMN = terrible: systemic infection.
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What is the most common congenital deformity associated with imperforate anus?
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urogenitcal tract malformations.
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What is the most likely cause of death in diabetes?
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mycardial infarction via coronary disease
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In what diseases is HbA2 increased?
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B-thalessemia minor and intermedia.
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How do you cause severe wenicke encephalopathy when intiailly treating a patient?
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Give glucose but not thiamine! This greatly enchances the syndrome and can cause hermorrhage in the mammillary bodies!
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What is a major cause of osteopetrosis?
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impaird carbonic anhydrase: osteoclasts do not function!
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What bone disease can cause high output cardiac failure?
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Paget's -> increased blood flow from increased arteriovenous shunt.
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What are the labs for osteoclast activity?
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1. TRAP 2. urianry hydroxyproline 3. urinary deoxypyridinoline
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What translocation is associated with Ewing's Sarcoma?
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(11:22) (11+22=Ewings Sarcoma)
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What are the risk factors for osteosarcoma?
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Pagets: bone infarct: radiation: familal retinoblastoma
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How is smoking screened for with a lab?
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cotinine levels
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Why do gout attacks occur more after etoh/fatty meals?
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alcohol metabolites compete for same excretion sites as uric acid ->decreased uric acid secretion.
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What is the symptom difference between gonococcal arthrirtis and destructive infectious?
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gonococal is migratory: asymmetric. destructive is one joint.
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What are the two microscopic changes seen in psoriasis?
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1. Hyperkeratosis (increased thickness of corneum 2. parakeratosis (rentention of nuclei in corneum)
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What is the difference between intradermal nevi and junctional nevi?
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intradermal = papular. junctional = flat.
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What are the epidermal layer changes in psoriasis?
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increased spinosum: decreased granulosom.
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What are target lesions associated with?
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Erythema Multiforme
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What is erythema nodosum associated with?
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1. sarcoid 2. fungal infections 3. leprosy 4. chrohns
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What is lichen planus associated with?
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1. hep c 2. sawtooth infiltrate in dermal-epidermal junction
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What is pityriasis rosea associated with
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herald patch and then christmas tree plaques days later
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What is the difference in UVA and UVB damage?
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UVA = photoaging: tanning. UVB = sunburn.
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How does acetaminphen cause hepatic necrosis?
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depletes glutathione and forms toxic tissue adducts in liver.
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Holoprosencephaly is caused by a defieincy in what pathway?
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sonic hedgehog.
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What nucleus makes ADH? Which makes oxytocin?
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ADH = supraoptic. Oxytocin = paraventricular.
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What causes neuronal death in Huntington's disease?
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NMDA-R binding and glutmate toxicity.
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Damage to arcuate fasciculus causes what?
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conduction apashia
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How does normal pressure hydrocephalus cause its clinical triad?
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Expansion of ventricles streches the corona radiata (the parts running to and from cortex).
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How does SCM turn the head?
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Turns the head to contralateral side
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What is a familal mutation that can lead to ALS?
|
Zinc-copper superoxide dismutase
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How do gallbladder infections cause a rise in levels of indirect bilirubin?
|
injured hepatocytes -> release of B-glucuronidase -> de-glucornide firect bilirubin. This causes increased indirect bilirubin and can cause brown gallstones.
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Can prokaryotes or eukaryotes have polycistronic mRNA?
|
Prokaryotes do (exp: lac operon) eukaryotes hardly ever have more than one protein encoded into an mRNA.
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What is the most specific lab for legionella pneumonia that differentiates it from other pneumonia?
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Hyponatremia
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vitamin E defieicny closely mimics what disease?
|
Freidrich's Ataxia -> both involve degeneration of the spinocerebellar tracts.
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What is auspitz sign?
|
when a plaque is scraped away: there is pinpoint bleeding. This is suggestive of psoriasis -> thin epidermis.
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What are the risk factors for cervical cancer?
|
1. HPV 2. Immunosuppression 3. low SES 4. sexual activity(early and many) 5. smoking
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what is the mechanism of kidney stones in crohns?
|
Fat can't be absored due to ileum inflammation. Calcium binds to fat instead of to oxalate. Oxalate is now free to be absorbed -> high oxalte = rish for kidney stones.
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What is the difference between adult botulism and infant?
|
infant = eat spores: adults = eat toxin
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What is the function of JAK2?
|
It is a non-receptor tyrosine kinase
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|
What artery is most often severed in hip fractures?
|
medial circumflex
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Cachexia is caused by what?
|
TNF-alpha
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|
What are the risk factors for open/wide angle glaucoma?
|
increased age: black: family hx
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|
What is a marcus gunn pupil?
|
Afferent nerve problem: swinning light test constricts both eyes when in good eye: no eyes in bad eye.
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|
Where are MS plaques often found?
|
paraventricular
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|
Where do most partial seizures originate?
|
Temporal lobe
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|
What are the ECG changes between delirium and dementia?
|
Delerium = abnormal. dementia = normal.
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Which kidney is used for renal transplant? why?
|
left. longer ureter.
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What are JG cells? Macula densa?
|
JG = modified smooth muscle of afferent arteriole. MD =salt senor in DCT.
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In amyloidosis of the kidney: where is amyloid typical found?
|
In the mesangium.
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What paraneoplastic syndromes are associated with RCC?
|
1. EPO 2. ACTH 3. PTHrP
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|
Wilm's tumor is associated with what gene?
|
WT1
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|
Why is BUN resorbed in the kidney?
|
Used for countercurrent multiplication
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|
What labs must be checked when giving amioderone?
|
1. pft 2. lft 3. tft
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|
What explains amioderones multi-class action?
|
alters lipid membrane -> acts like all four classes.
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|
How does valproate causes teratogenic effects?
|
inhibits materal folate absorption->NTDefects
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|
What is treacher-collins syndrome?
|
1st arch neural crest cells fail to migrate -> mandibular hypoplasia and face abnormailities
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|
What is mittelschmerz?
|
blood from ruptured follicle can cause peritoneal irratiation that mimics appendicitis.
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|
Barr body is present in what syndrome?
|
Klinefelters (extra x is inactive)
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|
Can XYY people reproduce? What are typical traits?
|
Tall: phenotypically normal. normal fertility: have severe acne and antisocial behavior.
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|
What is the difference between adenomyosis and endometriosis?
|
Adeny = uterus is enlarged. endo = uterus is not enlarged. both = have abnormal menstral bleeding
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|
Why is varicocele more common in the left testicle?
|
due to resistance to flow in the drainage point at the left renal vein.
|
|
PABA-sunscreens protect against what rays?
|
UVB only.
|
|
What viruses have a nuclear membrane envelope?
|
herpesviruses
|
|
What urine metabolite is high in carcinoid syndrome?
|
the serotonin metabolite 5-hydroxyindoleacetic acid.
|
|
What syndrome can cause right side of the heart only endocardial fibrosis?
|
Carcinoid syndrome. serotonin and bradykinin are inactivated in the lungs.
|
|
Which atypical antipsychotic is most likely to cause EPS?
|
Risapiradone. Clonzapine is least likely.
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|
What vitamin MUST be avoided in levodopa users?
|
B6. It increases peripheral metabolism of levodopa -> more parkinson's symptoms.
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|
What is the function of clara cells?
|
screte clara cell secretory protein which inhibits pmn recruitment.
|
|
What is medial degeneration?
|
fragmentation of elastic tissue
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|
What is the primary abnormality in paget's disease?
|
activation of osteoclasts -> bone resorption. Osteoblast activation follows that.
|
|
what most occur in HIV lifecycle for mRNA to be made?
|
DNA must be integrate into the host genome. If integrase is blocked: this does not occur. Then: host replicative enzymes can't be used to make HIV mRNA.
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|
What is the spinal N for umbillicus: nipples: and anus?
|
unbillicus = t10: nipples = t4: anus = s4.
|
|
What is the most common outcome of HCV infection?
|
60% get chronic hep C with slow cirrhosis.
|
|
CYP2E1 is zero-order kinetcs for:
|
ETOH: Acetaminophen: INH
|
|
List mesoderm defects:
|
VACTERL: vertebral defect: anal atresia: cardiac defect: Tracho-esophageal defect: Limb defects
|
|
Difference between malformation: deformation: and disruption?
|
deform: extrinsic defect: potters. malform: intrinsic: holoprosephaly. disruption: normal tissue is destroyed: aminiotic band sydndrome
|
|
Valproate causes what embyonic defects?
|
neural tube defect
|
|
List androgen potency
|
DHT>testo>androstendione
|
|
List potency of estrogens. where are they made?
|
Estradiol(ovary)>estrone(fat)>estriol(placenta)
|
|
During what tanner stage is the maximal growth spurt?
|
stage III
|
|
What stages do eggs complete replication?
|
meiosis I -> pro I. Meiosis II -> meta II.
|
|
What does human placental lactogen do?
|
increaes blood glucose in increased insulin resistance -> more glucose for baby.
|
|
What causes mortality in HELLP?
|
ARDS or cerebral hemorrhage
|
|
What is an idicator of ectopic pregnancy: via lab?
|
low hCG.
|
|
at FRC: what are airway and alveolar pressure? what about intrapleural?
|
airway + alveolar = 0. Intrapleural = negative: to prevent pneumothorax.
|
|
What causes primary pulmonary HTN?
|
defect in BMPR2 gene: which normally inhibits vascular smooth muscle proliferation.
|
|
In patients with renal or hepatic impairment: does the loading or mateinence dose change?
|
loading is unchanged: maintence must decrease
|
|
In CF: what is the primary problem with the protein?
|
abnormal trafficking. Protein can't be postranslationally processed.
|
|
What is prophylaxis to prevent MAC in HIV patients?
|
Azithromycin
|
|
Injury to what nerve causes the tredelenburg gait?
|
Superior gluteal = all gluteal muscles except maximus!
|
|
Increase in ADH causes a decrease in what compound in the urine (not water..)
|
Urea. ADH increased water and urea uptake -> this stregthens the counter current.
|
|
What is the most common cause of VIRAL meningitis?
|
echovirus and coxsackie(the enterovirus group makes up 90% of them)
|
|
What activates trypsinogen?
|
Doudenal enteropeptidase
|
|
What is the difference between DIL and systemix lupus?
|
DIL is causes NO renal or CNS involvement!
|
|
Antiphospholipid is associated with what?
|
lupus anticoagulant. PTT is increased but they actually clot more.
|
|
Colonic polyps over what size are likely to progress to adenocarcinoma?
|
>4 cm.
|
|
Why do people pass out during panic attacks?
|
Hyperventilate -> loss of pCO2 -> brain vasoconstricts -> pass out due to lack of blood flow.
|
|
What causes Akathisia?
|
Neuroleptics. This is a tense feeling and restlessness. treated by decreasing doss and adding antiparkinson drugs.
|
|
What is special about ulcerative colitis associated CRC?
|
1. flat: non-polypoid dysplasia 2. develop early p53 mutation: late APC 3. multifocal in nature
|
|
In between what ribs should thoracentesis be done to prevent lung damage?
|
Between 8-10: above the rib to avoid the neurovascular bundle. |