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873 Cards in this Set

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What is sensitivity?

probabilty that a test detects a disease when disease is present. TP/(TP+FN)
What is specificity?
probability that a disease non-disease when disease is absent. TN/(TN+FP)

100% sensitivity means what?

low false negative rate: good for screening disease with low prevelance
100% specificity means what?
low flase positive rate: good for confirmatory test after a positive screening test.
What is case-control study? what does it measure?
compares group of people with a disease to a group without the disease. Measures odds ratio.
What is a cohort study?What does it measure?
compares a group with an exposure or risk to a group without it. Measures relative risk.
What is a cross-sectional study? what does it measure?
collects data from a group to assess frequency of a disease in a population. Measures prevalence.
What is the difference between a double and triple blinded study?
double = patients and doctors don't know: triple = even researchers analyzing data don't know
what does a phase I trial do?
small number of healthy people: assess safety:toxicity: and pharmokinetics
what does a phase II trial do?
small number of people with the disease studied; assess efficacy: dosing: and adverse effects
what do phase III trials do?
large: randomly assigned groups. compares standard of care to new treatment.
what do phase IV trials do?
postmarketing surviellance: looks for longterm adverse events.
What is positive predictive value? (PPV)
proportion of positive tests that are a true positive. TP/(TP+FP)
What is negative predicitive value?
proportion of negative tests that are a true negative. TN/(FN+TN)
contrast prevalence to incidence
incidence = new cases: prevalence = all currents cases
What is an odds ratio?
used in case-control studies. odds that a group with a disease was exposed to a risk.
What is relative risk?
used in cohort studies. risk of developing a disease if exposed to a risk.
what is attrutitable risk?
proportion of disease occurences cause by an exposure.
what is absolute risk reduction (ARR)?
absolute reduction in risk between treatment group and a control group.
How is number needed to treat calculated?
number of patients needed to treat for 1 patient to get a benefit. 1/ARR
How is number to harm calculared?
number of patients needed tobe exposed to a risk in order to get it. 1/attributable risk.
constract precision vs. accuracy.
reproducability vs trueness of result
What does random error cause?
reduces precision of a test
How do you decrese standard deviation?
by increasing precision.
What does systematic error cause?
reduces accuracy in a test.
What is selection bias?
nonrandom assignment to a group.
what is recall bias?
knowledge of presence of a disease alters recall of subjects; common in retrospective.
what is sampling bias
subjects are not representative of the general population - is a selection bias
what is late-look bias?
information gathered at inapporiate time
what is procedure bias?
subjects in different groups are not treated the same
what is confounding bias?
occurs when a factor is related to both exposure and outcome
what is lead-time bias?
early detection confused with increased survival.
what is observer-expectancy effect?
when researchers belief in the efficacy of a treatment alters treatment changes
what is hawthorne effect?
group being studied changes behavior because they know they are being studied.
5 ways bias can be reduced:
1.blind studies. 2.placebo groups. 3.crossover studies. 4.randomization limits selection and confounding bias 5. matching to reduce confoudning bias.
what is postive skew
mound to the left: tail to the right mean>median>mode.
What is negative skew?
mound to the right: tail to the left. mean
What is type I error?
stating there is an effect when there isn't one
What is type II error?
stating there is not an effect when one does exist (to fail to reject the null hypothesis)
What is statistical power and how do you increase it?
probability of rejecting null hypothesis when it is false. increases with: larger sample size: large expected effect size: increased precision of measurement.
What is a confidence interval?
range of values in which a specificed probability of means would expected to fall.
when to use t-test?
comparing difference of means in 2 groups.
when to use ANOVA
check differences of means in 3 or more groups.
When to use Chi-square test?
check differences in 2 of more percentages or proportions: NOT MEANS.
what is pearson's correlation coefficient?
r is between -1 and +1. closer to 1 the stronger the linear correlation between 2 variables.
compare primary: secondary: and tertiary prevention.
PDR Prevent(vaccines): Detect(pap smear): Reduce disability(chemotherapy)
Medicare and medicaid are for what groups?
medicarE = elderly: medicaiD = destitute.
What is apgar score?
done at 1min and 5min. appearance: pulse: grimace: activity: respiration. >7 is good: <4 means resuscitate!
What is a low birth weight?
<2500g. increased risk or SIDS and increased overall mortality.
Give developmental milestones birth-3mo(motor:social:verbal)
rooting reflex:head up:moro reflex gone;smile;orient to voice.
Give developmental milestones b7-9mo(motor:social:verbal)
sits alone:crawl:transfer toys in hand;stranger anxiety;responds to name: instructions:peekaboo.
Give developmental milestones 12-15mo(motor:social:verbal)
climb stairs: stack blocks by agex3 blocks;rapprochment of mom;200 words and 2 word phrases by 2
Give developmental milestones 24-36mo(motor:social:verbal)
feeds self:kick ball;core gender identity:parallel play;pee at age 3
Give developmental milestones 3yr(motor:social:verbal)
ride tricycle:copy circle;spends part of a day away from mom;900 words and complete sentences
Give developmental milestones 4yr(motor:social:verbal)
uses zippers:grooms self:can hop on 1 foot;imaginary friend:cooperative play;can tell detailed story
what is rooting reflex
turn head to stimulus and make sucking face for nipple
what is moro reflex
kid startled by being dropped
what is babinski sign
tickle foot: toe goes up. not normal after age 2
give BMI formula
weight in kg/(height in meters)^2
when does grief become patholgoic
after 1 year.
What is orotic aciduria(physiology:findings:tx)
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.
What is adenosine deaminase deficiency(give physiology)
Excess ATP and dATP via inhibition of ribonucleotide reductase->prevents dna synthesis and decrease lymphocyte count causing SCID.
What is Lesch-Nyan syndrome(physiology:findings)
defective purine salvage pathway due to absence of HGPRT; excess uric acid leads to retardation:self-mutilation:hyperuricemia:gout:choresoathetosis.
Mutation in ataxia telangiestica
nonhomologous end joining: which repairs dsDNA breaks.
mutaiton in xeroderma pigmentosum
nucleotide excision repair: which releases damaged bases
What cell types are permanent
neurons: skeletal and cardiac muscle: RBCs
what cells types are stable(quiescent)
hepatocytes:lymphocytes
what cell types are labile?
bone marrow: gut epithelium:skin:hair follicles:germ cells
I-cell disease(physiology:findings)
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.
Chediak-Higashi syndrome(physiology:findings)
mutation in lysosomal trafficking regulator gene (LYST): microtubule sorting does not occur;recurrent pyogenic infections:partial albinism:peripheral neuropathy.
vimentin stains:
connective tissue
desmin stains:
muscle
cytokeratin stains:
epithelial cells
GFAP stains
neuroglia
neurofilaments stain
neurons
type I collagen(found in:defective in:)
bone:skin:tendon:dentin:cornea:late wound repair;defective in osteogenesis imperfecta.
type II collagen(found in)
Cartilage(hyaline):vitreous body:nucleus pulposus)
type III collagen(found in: defective in)
reticuin:skin:blood vessels:uterus:granulation tissue:fetal tissue;Ehler's danlos
Type IV collagen(found in: defective in)
basement membrance and basal lamina;alport sydrome
Marfans syndrome is a defect of:
Fibrillin(found in elastin)
Prader-Willi syndrome(genetics:findings)
paternal allele on chromosome 15 is not expressed;mental retardation:hyperphagia:obesity:hypogonadism:hypotonia
Angelman's syndrome(genetics:findings)
Inactivation of mother's allele on chromosome 15; mental retardation:seizures:ataxia:inappropriate laughter
Achondroplasia(dominance:physiology:findings)
Autosomal dominant. defect in fibroblast growth factor(FGF)receptor 3.;Dwarfism:short limbs:larger head but normal trunk.assoc with advanced paternal age.
Autosomal-dominant polycycstic kidney disease(ADPKD)(dominance:physiology:findings)
Autosomal dominant;mutation in PKD1: chromosome 16;bilat. massively enlarged kidneys: multiple huge cysts. assoc w/polycystic liver dx:berry anerusyms:mitral valve prolapse.
what diseases are associated with ADPKD?
polycystic liver disease: berry aneurysms: mitral valve prolapse.
Familial adenomatous polyposis(dominance:physiology:findings)
autosomal dominant;mutation on APC gene. chromosome 5;colon covered in polyps after puberty.
Hereditary hemorrhagic telangiectasia(osler-weber-rendu syndrome)(dominance:physiology:findings)
autosomal dominant;inherited disorder of blood vessels;telangiectasia: recurrent epistaxis: AVMS: skin discolorations.
Hereditary spherocytosis(dominance:physiology:findings)
autosomal dominance;spheroids due to spectrin or ankyrin defects;hemolytic anemia: increased MCHC: need spleenectomy to cure.
Huntington's disease(dominance:physiology:findings)
autosomal dominant;CAG trinucleotide repeat gene on chromosome 4;depression:caudate nucleus atrophy:chorioform movements:decreased levels of GABA and Ach in the brain.
Neurofibromatosis type 1(von recklinghausen disease)(dominance:physiology:findings)
autosomal dominant;mutation in long arm of chromosome 17;cafe-au-lait spots:neural tumors:lisch nodules: optic gliomas.
neurofibromatosis type 2(dominance:physiology:findings)
autosomal domaint;NF2 gene on chromosome 22;bilateral acoustic schwannomas: juvenile cataracts
Tuberous sclerosis(dominance:findings)
autosomal dominant;facial lesions:hypopigmented ash leaf spots:cotical and retinal hamartomas:seizures:cardiac rhabdomyomas:increased incidence of astrocytomas.
von Hippel-Lindau(dominance:physiology:findings)
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.
Cystic fibrosis(dominance:physiology:findings)
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.
what lab is diagnostic for cystic fibrosis?
increased calcium concentration in sweat (calcium channel can't resorb in skin. Note: in lungs this channel is supposed to EXCRETE calcium).
Fragile-X syndrome(dominance:physiology:findings)
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.
Duchenne's dystrophy(dominance:physiology:findings)
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.
Why do mutaitons in dystrophin gene occur so often?
longest gene in the human genome: anchors muscle fibers.
What are the pregancy quad screen results for down syndrome?
decrease a-fetoprotein:estirol. increased B-HcG: inhibin A.
What are the pregancy quad screen results for edwards syndrome?
decreased: a-fetoprotein:BHcg: estriol. normal: inhibin A.
What are the pregnancy quad screens for Patau's syndrome?
decreased: B-HcG: PAPPa and increased:Nuchal translucency.
Cri-du-chat syndrome(dominance:physiology:findings)
congenital microdeletion of short arm of chromosome 5;microcephaly:mental retardation:mewing sounds:epicanthal folds:VSD.
Williams syndrome(dominance:physiology:findings)
congenital microdeletion of long arm of chromosome 7:region deleted contains elastin gene;elfin facies:intellectual disability:extreme friendliness.
What are the fat soluble vitamins?
ADEK. dependent on ileum and pancreas: tend to accumulate in fat more.
vitamin A(function: defiency:excess)
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!
Vitamin B1(thiamin)(function: defiency)
thiamine pyrophosphotase part of: pyruvate DH:A-ketoglutartate DH:trasketolase:branched-amino acid DH; defiency causes wernicke-korsakoff: berberi: low ATP.
Wernicke-Korsakoff syndrome(cause: findings)
B1(thiamin) defienceincy;confusion: opthalmoplegia:ataxia:confabulation:permanent memory loss:damage to medial dorsal nucleus of thalamus: mammary bodies.
Dry beriberi(cause: findings)
low B1(thiamin); polyneuritis: symmetrical muscle wasting
Wet beriberi(cause:findings)
high output cardiac failure(dilated cardiomyopathy): edema.
vitamen B2(riboflavin)(function: defiency)
cofactor in ox/redux reactions: make FAD and FMN; Cheilosis(inflammation and scaling of lips: corner of mouth): corneal vascularization (2C's of B2)
vitamin B3(niacin)(function: defiency:excess)
made from tryptophan: makes NAD. synthesis requires B6!;Glossitis:pellagra(diarrhea:dementia:dermatitis); excess = facial flushing.
vitamin B3 deficiency can be caused by what primary things?
1. hartnup disease (decreased tryptophan absorption) 2.Malignant carcinoid syndrome(increased tryptophan metabolism) 3. INH (decrease B6). All lead to pellagra.
Vitamin B5(pantothenate)(function: defiency)
Essential part of CoA and fatty acid synthase; dermatitis:enteritis:alopecia:adrenal insufficiency.
vitamin B6(pyridoxine)(function: defiency)
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.
Vitamin B7(biotin)(function: defiency)
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.
Vitamin B9(folic acid)(function: defiency)
converted to tetrahydrofolate: makes nitrogenous bases for RNA and DNA; small pool in liver: macrocytic:megaloblastic anemia: common in alcoholism and pregnancy.
vitamin B12(cobalamin)(function: defiency)
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.
What are the two vitamin defiency causes of macrocytic:megalolastic anemia? Differences?
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.
Vitamin C(function: defiency:excess)
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.
Vitamin D(function: defiency:excess)
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.
Vitamin E(function: defiency:excess)
antioxidant: protects erthrocytes and membranes from free radical damage; increased fragility of erythrocytes: posterior column and spinocerebellar tract demyelination.
Vitmain K(function: defiency:excess)
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.
Zinc(function: defiency)
essential for 100+ enzymes;delayed wound healing:decreased adult hair:dysgeudia: anosmia.
Nitric oxide is made from what amino acid?
arginine
Urea is made from what amino acids?
arginine and aspartate
Heme is made from what amino acid?
glycine and succinyl CoA
Creatine is made from what amino acid?
glycine + arginine + SAM
GABA is made from what amino acid?
glutamate
glutathione is made from what amino acid?
glutamate
pyrimidines are made from what amino acids?
glutamate and aspartate
purines are made from what amino acids?
glutamate + aspartate + glycine
histamine is made from what amino acid?
histidine
describe dopamine synthesis by reactants
phenylalanine->tyrosine->DOPA->dopamine
describe melatonin synthesis by reactants
tryptophan->serotonin->melatonin
niacin is made from what amino acid?
tryptophan
thyroxine and melanin are made from what amino acid?
tyrosine
what test can be done to diagnose chronic granulamtous disease?
blue pigment DOESN'T form after adding nitroblue tetrazolium to patient's neutrophils. Does form = no disease.
Coldaggulintins are seen in what organism. They are responsible for what?
M. Pneumoniae. They lyse red blood cells leading to anemia.
What are the trinucleotide repeats in Fragile X syndrome?
CGG
What are the trinucleotide repeats in Friedreich's Ataxia?
GAA
what are the trinucleotide repeats in huntington's disease?
CAG
What are the trinucleotide repeats in myotonic dystrophy?
CTG
What is the most common leathal:genetic disease in white populations?
cystic fibrosis
What are the two 22q11 deletion syndromes?
1. DiGeorge - thymic: parathyroid: and cardiac defects. 2. Velocardiofacial syndrome - palate:facial: and cardiac defects.
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.
Essential fructosuria(physiology:findings)
defect in fructosuria: autosomal recessive;fructose is high in blood and urine but is a benign disease/
fructose intolerance(physiology: findings: treatment)
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.
Galastose deficiency(physiology:treatment)
problem in galactokinse: galactitol accumulates if galactose present in diet. autsomal recessive;galactose in blood and urine: infantile cataracts:very mild disease.
Classic galactosemia(physiology: findings: treatment)
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.
Which tissues are at risk for sorbitol damage? how does this damage occur?
schweann cells: retina: kidnets. They contain low levels of sorbitol dehydrogenase. sorbitol is osmotically active: causing swelling and damage.
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.
Phenylketonura(physiology: findings: treatment)
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.
Alkaptonuria(symptoms:findings)
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.
Albinism(physiology: findings)
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.
Homocystinuria(physiology:findings)
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.
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.
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.
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.
What are the two types of emphysema?
1. centriacinar - associated with smoking. 2. panacinar - associated with A1-antitypsin deficiency.
Why do people with emphysema exhale through pursed lips?
increased in airway pressure prevents airways from premature collapse.
What disease is associated with curschman's spirals and leyden crystals?
asthma. spirals = epitheium forms mucus plugs. leyden crystals = eosinophil breakdown.
inhale to exhale ratio changes how in asthma?
decreased I/E ratio
Antracosis: silicosis: and asbestosis all increase risk for what other diseases?
cor pulmonale and Caplan's syndrome
Calcified pleural plaques are pathonomic for what? Are they precancerous?
Asbestos exposure. Are NOT precancerous.
What lechitin:sphingomyelin ratio is predictive of neonatal respiratory distress?
1.5 or below. 2.0 or above is normal.
neonatal therapuetic oxygen can result in what negative outcomes?
1. retinopathy of prematurity. 2. bronchopumonary dysplasia.
What are th risk factors for neonatal respiratory distress?
1. prematurity 2.maternal diabetes(elevated fetal insulin) 3. cesarean birth (less fetal glucocorticoids)
What is the treatment for neonatal respirtatory distress syndrome?
maternal steriods before birth: artificial surfactant after birth.
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
Obstructive lung disease has a FEV1/FVC of what?
UNDER 80!
Restrictive lung diseases has an FEV1/FVC of what
80 or above BUT both FEV1 and FVC decrease about equally.
How does sleep apnea relate to RBC formation?
hypoxic intervals -> increased EPO release -> increased erthryopoesis.
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.
What cancer is the leading cause of cancer death?
lung
what are lung metastases sites?
adrenals: bone: liver.
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.
Calcification (like in valves and cholesterol plaques) is a hallmark for what cellular process?
Necrosis and injury. These make Psammoma bodies. Ca from dead cells is released and collected.
What is the most common cause of aortic stenosis?
Calcinification of the leaflets: due to age related changes.
What 2 tumors are S100 positive?
1. Schwannoma 2. Melanoma. (both are derived from neural crest cells!!!!)
The hindgut descends along what artery?
IMA
What virus can present like RA? How are they differentiated?
Parvovirus in adults can. You can differentiate them by resolution: Parvo will resolve on its on: RA does not.
What is the cause of congenital torticollosis?
malposition of the head in utero or birthing problems.
What are neurofibromas made of?
schwann cells (neural crest)
What is hemosiderin?
An accumulation of iron in micelles. Seen in hemolytic anemia.
What is effect modification? Is it a bias?
When the effect of an exposure changes the outcome. This is not a bias.
What is biliary sludge?
Precursor to gallstones: forms when there is gallbladder hypomotility.
What forms brown and black gall stones?
Brown = biliary infection. black = intravascular hemolysis
What test is used to detect cysteine in the urine?
sodium cyanide-nitroprusside test turns urine red.
Where are neurons lost from in huntington's disease?
1. caudate nucleus 2. putamen
What stops local fungal spread? what about hemotagenous?
local -> T cells. Why HIV patients mostly get thrush. disseminated -> PMN. Loss of PMN = terrible: systemic infection.
What is the most common congenital deformity associated with imperforate anus?
urogenitcal tract malformations.
What is the most likely cause of death in diabetes?
mycardial infarction via coronary disease
In what diseases is HbA2 increased?
B-thalessemia minor and intermedia.
How do you cause severe wenicke encephalopathy when intiailly treating a patient?
Give glucose but not thiamine! This greatly enchances the syndrome and can cause hermorrhage in the mammillary bodies!
What is a major cause of osteopetrosis?
impaird carbonic anhydrase: osteoclasts do not function!
What bone disease can cause high output cardiac failure?
Paget's -> increased blood flow from increased arteriovenous shunt.
What are the labs for osteoclast activity?
1. TRAP 2. urianry hydroxyproline 3. urinary deoxypyridinoline
What translocation is associated with Ewing's Sarcoma?
(11:22) (11+22=Ewings Sarcoma)
What are the risk factors for osteosarcoma?
Pagets: bone infarct: radiation: familal retinoblastoma
How is smoking screened for with a lab?
cotinine levels
Why do gout attacks occur more after etoh/fatty meals?
alcohol metabolites compete for same excretion sites as uric acid ->decreased uric acid secretion.
What is the symptom difference between gonococcal arthrirtis and destructive infectious?
gonococal is migratory: asymmetric. destructive is one joint.
What are the two microscopic changes seen in psoriasis?
1. Hyperkeratosis (increased thickness of corneum 2. parakeratosis (rentention of nuclei in corneum)
What is the difference between intradermal nevi and junctional nevi?
intradermal = papular. junctional = flat.
What are the epidermal layer changes in psoriasis?
increased spinosum: decreased granulosom.
What are target lesions associated with?
Erythema Multiforme
What is erythema nodosum associated with?
1. sarcoid 2. fungal infections 3. leprosy 4. chrohns
What is lichen planus associated with?
1. hep c 2. sawtooth infiltrate in dermal-epidermal junction
What is pityriasis rosea associated with
herald patch and then christmas tree plaques days later
What is the difference in UVA and UVB damage?
UVA = photoaging: tanning. UVB = sunburn.
How does acetaminphen cause hepatic necrosis?
depletes glutathione and forms toxic tissue adducts in liver.
Holoprosencephaly is caused by a defieincy in what pathway?
sonic hedgehog.
What nucleus makes ADH? Which makes oxytocin?
ADH = supraoptic. Oxytocin = paraventricular.
What causes neuronal death in Huntington's disease?
NMDA-R binding and glutmate toxicity.
Damage to arcuate fasciculus causes what?
conduction apashia
How does normal pressure hydrocephalus cause its clinical triad?
Expansion of ventricles streches the corona radiata (the parts running to and from cortex).
How does SCM turn the head?
Turns the head to contralateral side
What is a familal mutation that can lead to ALS?
Zinc-copper superoxide dismutase
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.
Can prokaryotes or eukaryotes have polycistronic mRNA?
Prokaryotes do (exp: lac operon) eukaryotes hardly ever have more than one protein encoded into an mRNA.
What is the most specific lab for legionella pneumonia that differentiates it from other pneumonia?
Hyponatremia
vitamin E defieicny closely mimics what disease?
Freidrich's Ataxia -> both involve degeneration of the spinocerebellar tracts.
What is auspitz sign?
when a plaque is scraped away: there is pinpoint bleeding. This is suggestive of psoriasis -> thin epidermis.
What are the risk factors for cervical cancer?
1. HPV 2. Immunosuppression 3. low SES 4. sexual activity(early and many) 5. smoking
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.
What is the difference between adult botulism and infant?
infant = eat spores: adults = eat toxin
What is the function of JAK2?
It is a non-receptor tyrosine kinase
What artery is most often severed in hip fractures?
medial circumflex
Cachexia is caused by what?
TNF-alpha
What are the risk factors for open/wide angle glaucoma?
increased age: black: family hx
What is a marcus gunn pupil?
Afferent nerve problem: swinning light test constricts both eyes when in good eye: no eyes in bad eye.
Where are MS plaques often found?
paraventricular
Where do most partial seizures originate?
Temporal lobe
What are the ECG changes between delirium and dementia?
Delerium = abnormal. dementia = normal.
Which kidney is used for renal transplant? why?
left. longer ureter.
What are JG cells? Macula densa?
JG = modified smooth muscle of afferent arteriole. MD =salt senor in DCT.
In amyloidosis of the kidney: where is amyloid typical found?
In the mesangium.
What paraneoplastic syndromes are associated with RCC?
1. EPO 2. ACTH 3. PTHrP
Wilm's tumor is associated with what gene?
WT1
Why is BUN resorbed in the kidney?
Used for countercurrent multiplication
What labs must be checked when giving amioderone?
1. pft 2. lft 3. tft
What explains amioderones multi-class action?
alters lipid membrane -> acts like all four classes.
How does valproate causes teratogenic effects?
inhibits materal folate absorption->NTDefects
What is treacher-collins syndrome?
1st arch neural crest cells fail to migrate -> mandibular hypoplasia and face abnormailities
What is mittelschmerz?
blood from ruptured follicle can cause peritoneal irratiation that mimics appendicitis.
Barr body is present in what syndrome?
Klinefelters (extra x is inactive)
Can XYY people reproduce? What are typical traits?
Tall: phenotypically normal. normal fertility: have severe acne and antisocial behavior.
What is the difference between adenomyosis and endometriosis?
Adeny = uterus is enlarged. endo = uterus is not enlarged. both = have abnormal menstral bleeding
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.
What vitamin MUST be avoided in levodopa users?
B6. It increases peripheral metabolism of levodopa -> more parkinson's symptoms.
What is the function of clara cells?
screte clara cell secretory protein which inhibits pmn recruitment.
What is medial degeneration?
fragmentation of elastic tissue
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.
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.