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1488 Cards in this Set
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Calcium Pyrophosphate Crystals
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Rhomboid Crystals with Positive Birefringence
pseudogout aka Calcium Pyrophosphate Depsoition Dz CPDD: NB: usually presents Knee >> Foot Tx: NSAIDs [Steroids, & Colchecine] |
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NF- κB
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transcription factor which induces cytokine prodxn in response to microbial infx
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#immunology #molecules
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NOD2
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[Nucleotide Binding Oligomerization Domain]
intracellular microbial receptor which which triggers NF- κB transcription factor → cyokine prodxn |
#immunology #molecules
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Pseudogout
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aka Calcium Pyrophosphate Depsoition Dz CPDD:
Inflammed Knee, aspirate of PMNs + Rhomboid Crystals with Positive Birefringence NB: usually presents Knee >> Foot Tx: NSAIDs [Steroids, & Colchecine] |
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Galactosyl β-1,4 - glucose
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aka Lactose
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#biochemistry #molecules
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↑ pH ↑ HCO3 ↑ pCO2
↓ Urinary Cloride, Hypovolemic |
Saline Responsive Metabolic Alkalosis
3 Causes of Metabolic Alkalosis 1. "Saline Responsive" 2° to loss of Gastric Contents (vomitting) + volume contraxn → maintain HCO3 to retain volume ↓ Urine Chloride, Volume Depleted Tx: Normal Saline 2. "Contraction Alkalosis" Diuretic → Na delivered to distal collecting duct → Na/H+ antiporter ↑ Urine Chloride, Volume Depleted 3. "Saline Resistant" Conn Sro or Mineralcorticoid Excess: Aldosterone upregulates Na/H+ antiporter ↑ Urine Chloride, Hypervolemic |
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Thalamic Nuclei
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VPL
--incoming from Spinothalamic (pain & temp) tract and Medial Lemniscus (position, proprioception), ---relays to Somatosensory Cortex (Brodman's areas 1-3) VPM Ventral Posteromedial Nucleus ---incoming from Trigeminal & Gustatory pathways ---relays to same Lateral Geniculate --Relay for Vision Medial Geniculate: relay for audition --input from superior olivary nucleus & inferior colliculus NB: smell not relayed through thalamus |
#neurology #cns #anatomy
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↑ pH ↑ HCO3 ↑ pCO2
↑ Urinary Cloride, Hypovolemic |
Contraction Alkalosis
3 Causes of Metabolic Alkalosis 1. "Saline Responsive" 2° to loss of Gastric Contents (vomitting) + volume contraxn → maintain HCO3 to retain volume ↓ Urine Chloride, Volume Depleted Tx: Normal Saline 2. "Contraction Alkalosis" Diuretic → Na delivered to distal collecting duct → Na/H+ antiporter ↑ Urine Chloride, Volume Depleted 3. "Saline Resistant" Conn Sro or Mineralcorticoid Excess: Aldosterone upregulates Na/H+ antiporter ↑ Urine Chloride, Hypervolemic |
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VPL Nucleus
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Thalamic Nucleus
--incoming from Spinothalamic (pain & temp) tract and Medial Lemniscus (position, proprioception), ---relays to Somatosensory Cortex (Brodman's areas 1-3) NB: does not relay face/pharynx that is VPM |
#neurology #cns #anatomy
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↑ pH ↑ HCO3 ↑ pCO2
↑ Urinary Cloride, Hypervolemic |
Saline Resistant Metabolic Alkalosis
3 Causes of Metabolic Alkalosis 1. "Saline Responsive" 2° to loss of Gastric Contents (vomitting) + volume contraxn → maintain HCO3 to retain volume ↓ Urine Chloride, Volume Depleted Tx: Normal Saline 2. "Contraction Alkalosis" Diuretic → Na delivered to distal collecting duct → Na/H+ antiporter ↑ Urine Chloride, Volume Depleted 3. "Saline Resistant" Conn Sro or Mineralcorticoid Excess: Aldosterone upregulates Na/H+ antiporter ↑ Urine Chloride, Hypervolemic |
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Adult Brain Tumors by Frequency
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1. Glioblastoma multiform (Grade 4 Astrocytoma)
--Astrocytes which strain for GFAP --Pseudopalisading borders around necrosis --Bad Px 2. Meningioma --Arachnoid cells --Psammoma bodies --Benign --Surgically Resectable 3. Schwannoma --Cerebellopontine Angle, S100+ 4. Oligodendroma --Indolent "Fried Eggs" Chicken wire capillaries & calcifications 5. Pituitary adenoma |
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VPM Nucleus
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Ventral Posteromedial Nucleus iof the Thalamus
---incoming from Trigeminal & Gustatory pathways ---relays to Somatosensory Cortex (Brodman's areas 1-3) |
#neurology #cns #anatomy
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Glioblastoma Multiform
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Most common adult brain tumor
Grade 4 Astrocytoma --Astrocytes which strain for GFAP --Pseudopalisading borders around necrosis --Bad Px |
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Lateral Geniculate Nucleus
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Thalamic Nucleus Responsible for Vision
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#neurology #cns #anatomy
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Brain Tumor stains for GFAP
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Glioblastoma Multiform
Grade 4 Astrocytoma --Astrocytes which strain for GFAP --Pseudopalisading borders around necrosis --Bad Px Most common adult brain tumor |
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Medial Geniculate Nucleus
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Thalamic Nucleus Responsible for Audition
input from superior olivary nucleus & inferior output to temporal lobe |
#neurology #cns #anatomy
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Adult tumor of Astrocytes
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Glioblastoma Multiform
Grade 4 Astrocytoma --Astrocytes which strain for GFAP --Pseudopalisading borders around necrosis --Bad Px Most common adult brain tumor |
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Phenoxybenzamine
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long acting α blocker used in pheos
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#pharmacology #autonomics #drugs
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Ephedrine
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sympatheticomimentic
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#pharmacology #autonomics #drugs
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Meningioma
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2nd most common adult brain tumor
(Gioblastoma Multiform > Meningioma > Schwannoma) --Arachnoid cells --Psammoma bodies --Benign --Surgically Resectable |
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Adult tumor of Arachnoid Cells
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2nd most common adult brain tumor
(Gioblastoma Multiform > Meningioma > Schwannoma) --Arachnoid cells --Psammoma bodies --Benign --Surgically Resectable |
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oxybutynin
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anticholinergic agent used for overactive bladder
does not affect nicotininc receptors |
#pharmacology #autonomics #drugs
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Adult Brain Tumor of "Fried Egg" Cells
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Oligodendroma
--Indolent "Fried Eggs" Chicken wire capillaries & calcifications |
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phentolamine
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α1, 2 antagonist
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#pharmacology #autonomics #drugs
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Brain Tumor with Psammoma Bodies
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Meningioma
2nd most common adult brain tumor (Gioblastoma Multiform > Meningioma > Schwannoma) --Arachnoid cells --Psammoma bodies --Benign --Surgically Resectable |
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ergonovine
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α + 5HT stimulator
constricts VSMCs used to prevent post-partum bleed out used diagnostically to induced prinzmetal's angina |
#pharmacology #autonomics
#cardiovascular #pathology #reproductive #diagnostics #drugs |
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Parvovirus B19 loves which cells
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erythroid precurosors
[esp pronormoblasts and normoblasts] |
#microbiology
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thiolase
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enzyme which conjugates 2 acetyl-CaA → acetoacetyl-CoA
the necessary substrate for HMG CoA Synthase in the formation of cholesterol |
#biochemistry #molecules #cardiovascular
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DOC: Heparin OD
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Protamine
aka protamine sulfate binds to heparin to form inactive complex |
#pharmacology #drugs #toxicities
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Protamine Sufate
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ie protamine
DOC: Heparin OD binds to heparin to form inactive complex |
#pharmacology #drugs #toxicities
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Aminocaproic Acid
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inhibits plasminogen activation
used to inhibit fibrinolysis ie tPA or streptokinase OD [sibling Rx: tranexamic acid] |
#drugs #pharmacology #cardiovascular
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Tranexamic Acid
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inhibits plasminogen activation
used to inhibit fibrinolysis ie tPA or streptokinase OD [sibling Rx: Aminocaproic Acid] |
#drugs #pharmacology #cardiovascular
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DOC: tPA overload
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Aminocaproic Acid or Tranexamic Acid
inhibits plasminogen activation used to inhibit fibrinolysis ie tPA or streptokinase OD |
#drugs #pharmacology #cardiovascular
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The Absorption of B12
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1. Salivary Glands Secrete R protein haptocorrin which binds B12 to prevent acid denaturation in Stomach
2. stomach parietal cells (located midway down gastric pits) secrete intrinsic factor R factor binds B12 in stomach once released from food by Acid 3. Pancreatic proteases cleave R factor which is immediately bound by intrinsic factor (to prevent degredation in SI by pancreatic enzymes) 4. IF-B12 complex abosrbed in distal ileum by IF specific receptor |
#biochemistry #nutrition #gastrointestinal
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Haptocorrin
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R factor
secreted by salivary glands binds to B12 to prevent hydrolysis by gastric acidity degraded by pancreatic proteases (where IF binds to prevents proteolytic degradation of B12) |
#biochemistry #nutrition #gastrointestinal
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Elderly Patient with Anemia and negative Fecal Occult Blood
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Probably B12 deficiency 2° aging → gastric atrophy → [relative] achlorhydria → poor B12 release from eaten foods
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#biochemistry #nutrition #gastrointestinal #hematology
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Neuroblastoma
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N-myc Amplification
medullary adrenal mass: small round blue cells displaces kidney, causes anorexia 2 yo presents with paraneoplasic "Opsoclonus-Myoclonus Sro" Opsoclonus: Non-rhythmic conjugate eye movements in various directions (ie not nystagmus) Px: better w/ younger age (<1) and fewer N-mycs |
#pathology #neoplasia
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Toddler with spontaneous bursts of non-rhythmic eye movement and occasional myoclonus
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Neuroblastoma
N-myc Amplification medullary adrenal mass: small round blue cells displaces kidney, causes anorexia 2 yo presents with paraneoplasic "Opsoclonus-Myoclonus Sro" Opsoclonus: Non-rhythmic conjugate eye movements in various directions (ie not nystagmus) Px: better w/ younger age (<1) and fewer N-mycs |
#pathology #neoplasia
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N-myx
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Neuroblastoma
N-myc Amplification medullary adrenal mass: small round blue cells displaces kidney, causes anorexia 2 yo presents with paraneoplasic "Opsoclonus-Myoclonus Sro" Opsoclonus: Non-rhythmic conjugate eye movements in various directions (ie not nystagmus) Px: better w/ younger age (<1) and fewer N-mycs |
#pathology #neoplasia
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Toddler presents with palpable flank mass
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Wilm's Tumor
Histologically: primitive metanephric ts (primtive nephrons) Malignant WT1 is a tumor suppressor gene Chrom 11p [WAGR: Wilm's Tumor, Aniridia, GU Malformation, MR] |
#pathology #neoplasia #nephrology #childhood
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Wilm's Tumor
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Toddler presents with palpable flank mass
Histologically: primitive metanephric ts (primtive nephrons) Malignant WT1 is a tumor suppressor gene Chrom 11p [WAGR: Wilm's Tumor, Aniridia, GU Malformation, MR] |
#pathology #neoplasia #nephrology #childhood
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WT1
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WT1 is a tumor suppressor gene
Chrom 11p WAGR: Wilm's Tumor, Aniridia, GU Malformation, MR |
#pathology #neoplasia #nephrology #childhood
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WAGR
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WT1 is a tumor suppressor gene
Chrom 11p WAGR: Wilm's Tumor, Aniridia, GU Malformation, MR |
#pathology #neoplasia #nephrology #childhood #syndromes
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BP 180/70
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isolated systolic hypertension 2° age related aortic stiffening
also seen in panic attacks |
#cardiovascular #pathology #geriatrics
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isolated systolic hypertension
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isolated systolic hypertension 2° age related aortic stiffening
common in elderly also seen in panic attacks |
#cardiovascular #pathology #geriatrics
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Haptoglobin Levels
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Haptoglobin Binds Free Hemoglobin within Blood Vessels
Complexed Hemoglobin-Haptoglobin is phagocytized by Spenic M∅ ↓ serum haptoglobin levels ≈ intravascular hemolysis normal serum haptoglobin levels rules out intravascular hemolysis (ie extravascular = direct splenic phagocytosis) |
#hematology #diagnostics #molecules
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Differentiating Intravascular from Extravascular Hemolysis
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Haptoglobin Levels
Haptoglobin Binds Free Hemoglobin within Blood Vessels Complexed Hemoglobin-Haptoglobin is phagocytized by Spenic M∅ ↓ serum haptoglobin levels ≈ intravascular hemolysis normal serum haptoglobin levels rules out intravascular hemolysis (ie extravascular = direct splenic phagocytosis) NB: Extravascular includes Splenic Phagocytosis |
#hematology #diagnostics #molecules
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Rhomboid Crystals with Positive Birefringence from Inflammed Knee Aspirate
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Calcium Pyrophosphate
pseudogout aka Calcium Pyrophosphate Depsoition Dz CPDD: NB: usually presents Knee >> Foot Tx: NSAIDs [Steroids, & Colchecine] |
#pathology #crystals #inflammation #joints
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DOC: anaphylaxis
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Epinephrine
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#pharmacology #immunology
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Pathogenesis Presbyopia
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age related lens sclerosis → ↓ elasticity
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#geriatrics #pathology #eye
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Myasthenia Gravis vs Lambert Eaton Sro
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MG:
Begins with Optic Muscles Worsens at End of Day & after effort Risk of Thymoma Anti-ACh receptor antibodies Edrophonium improves weakness Nerve Stimulation → decrementalresponse LE: Begins with proximal muslces improves through day & w/ exercise 2° to an already existing malignancy Anti-Pre-Synaptic Ca2+ channel Antibodies Edrophonium does not improve Nerve Stimulation → incremental response |
#neurology #neoplasia #pathology
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Danger of appetite suppressants
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Fenfluramine or Phentermine
↑ 5-HT release ↑ risk pulmonary htn after 3 mo → sudden cardiac death |
#pathology #nutrition #pulmonology
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Phentermine
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appetite suppressent
↑ 5-HT release like fenfluramine ↑ risk pulmonary htn after 3 mo → sudden cardiac death |
#pathology #nutrition #pulmonology #drugs
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Fenfluramine
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appetite suppressant
↑ 5-HT release like phentermine ↑ risk pulmonary htn after 3 mo → sudden cardiac death |
#pathology #nutrition #pulmonology #drugs
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Endomysial Inflammatory Infiltration
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characteristic of polymyositis
progresssive symmetrix proximal muslce weakness Path: CD8 vs myofibers Findings: ↑ CK, ↑ aldolase, muscle weakness most often involves shoulders Similar to Dermatomyositis (∅ shoulders, ✓ Grotton/Heliotrope/perifasicular atrophy) |
#pathology #rheumatology
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Diarrhea, Weight Loss, Arthralgia
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Whipple's Dz
"Foamy" PAS+ M∅ Mn: CAN of Whipped Cream Cardiac Sx Arthralgias Neurologic Sx |
#gastrointestinal #microbiology #pathology
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Acute Stress Ulcers
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Trauma/Shock/Burns
Curling Ulcers: duodenal 2° to hypoxia Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate |
#gastrointestinal #pathology #ulcers
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Curling Ulcers
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duodenal ulcers 2° to shock hypoxia
NB: not Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate |
#gastrointestinal #pathology #ulcers
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Cushing Ulcers
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Esophageal, Gastric, Duodenal Ulcers
2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate NB: not Curling Ulcers: duodenal ulcers 2° to shock hypoxia |
#gastrointestinal #pathology #ulcers
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Mannitol OD
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excessive volume depletion → hypernatremia
even worse rapid administration rapidly draws fluid from interstitial → vascular compartment, ↑ hydrostatic pressure in lungs → pulmonary edema & death [Mannitol used for ↑ ICP/Cerebral Edema] |
#pharmacology #toxicities
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DOC: ↑ ICP/Cerebral Edema
OD? |
Mannitol
overaggressive → excessive volume depletion → hypernatremia even worse rapid administration rapidly draws fluid from interstitial → vascular compartment, ↑ hydrostatic pressure in lungs → pulmonary edema & death |
#pharmacology #toxicities #drugs
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Bumetanide
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Loop Diuretic like Furosimide
[Loop Diuretic toxicities: Ototixicity, Hypokalemia, Dehydration, Allergic Rxn, Interstitial Nephritis, Gout Mn: OH DANG!] |
#pharmacology #nephrology #cardiovascular
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c-myc fnx
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nuclear transcription factor
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#molecules #pathology #neoplasia
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Radius vs Resistance
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R = viscosity * length / radius ^4
NB: ^4 |
#physiology
#cardiovascular |
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DOC: Refractorily High LDL
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First Line Drug: Statin
Competitively (vs Mevalonate) inhibits HMG CoA Reductase Hepatocytes ↑ LDL receptors to compensate Tox: Hepatotixic, Rhabdotoxic Refractory: Add Ezetimibe Inhibits Brush Border Cholesterol Resorption Tox: Rare, hepatotoxic |
#pharmacology #cardiovascular #lipids
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DOC: Refractorily High TAGs
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First Line Drug: Fibrates
↑ LPL Tox: Hepatotoxic, Rhabdotoxic, Gallstones Refractory: Add Niacin Inhibits TAG synthesis & VLDL secretion Tox: Hyperglycemia, Hyperuricemia |
#pharmacology #cardiovascular #lipids
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DOC: Refractorily Low HDL
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Niacin:
Inhibits TAG synthesis & VLDL secretion Tox: Hyperglycemia, Hyperuricemia No 2ndry Drug |
#pharmacology #cardiovascular #lipids
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TGFα mutation
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oncogene
astrocytoma, hepatocellular carinoma |
#pathology #neoplasia #molecules
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Periacinar v Centriacinar Emphysema
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Periacinar: air trapped in terminal bronchioles before acini
α1 anti-trypsin deficiency lower lung fields worse: ↑ perfusion = ↑ PMN's Centriacinar: air trapped in acini after TB's smoking upper fields worse: ↓ perfusion = ↓ α1 anti-trypsin |
#pathology #pulmonology
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Diathesis Panel
Laboratory Abnormality of HUS |
↑ Bleeding Time from Platelet consuming thrombi
oddly no ↑ PT, or PTT Shiga toxin producing Shigella or E Coli O157H7 |
#microbiology #pathology #hematology
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Pentazocine
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opiod partial agonist
will precipitate withdrawal in dependents sibling: buprenorphine |
#pharmacology #drugs #analgesia
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Buprenorphine
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opiod partial agonist
will precipitate withdrawal in dependents sibling: Pentazocine |
#pharmacology #drugs #analgesia
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Opiod Partial Agonists
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Pentazocine and Buprenorphine
will precipitate withdrawal in dependents |
#pharmacology #drugs #analgesia
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Levorphanol
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an opioid
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#pharmacology #drugs #analgesia
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continuous murmur heard best at left infraclavicular regioj
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PDA
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#cardiovascular #pathology
#anatomy |
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How do OCP's inhibit ovulation
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1° by inhibiting the LH spike
also thickened cervical mumus plug |
#pharmacology #endocrine #reproductive
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Warfarin Necrosis
|
Proteins C & S are natural anticoagulants
Protien C is vitamin K dependent and has much shorter λ than factors 2, 7, 9 and X. Rare complication: in pts w/ already defective Protein C, warfarin creates a transient hypercoagulable state Tx: Vitamin K + FFP |
#hematology #pharmacology #toxicity
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What part of airways are attacked in lung transplant rejexn
|
small airways
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#pathology #pulmonology
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Rofecoxib
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a selective COX2 inhibitor
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#pharmacology #drugs #analgesics
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Why does systemic granulomatous dz → hypercalcemia
|
↑ M∅ 1-α hydroxylase
apparently activated M∅ just naturally convert vitamin D to active form |
#pathology #chemistry
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TNF α inhibitors by name
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infliximab, etanercept, adalimumab
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#pharmacology #drugs
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new onset aortic stenosis in 50 yo
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bicuspid aortic valve
recently calcificied |
#pathology #cardiovascular
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Ehrlichia
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zoonotic infx from amblyoma lone star
obligate intracellular inhibits phagolysosomal fusion a rickettsia |
#microbiology
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Obligate intracytoplasmic bacterieria
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chlamydia and rickettsia
NB: only these survive intracytoplasmically outside of phagosomes |
#microbiology
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Causes of LV dilation
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CAD
Valvular Heat Dz Dilated Cardiomyopathy Arrhytmias |
#pathology #cardiovascular
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Preventing Morbidity of Subarachnoid Hemorrhage
|
Calcium Channel Blockers
Nimodipine prevents vasospasm → ischemia, the real cause of morbidity |
#neurology #pharmacology
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Nimodipine
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calcium channel blocker
used both for hypertension and uniquely used to prevent mobidity following SubArachnoid Hemorrhage |
#neurology #cardiovascular #pharmacology
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The polyol pathway
|
Aldose Reductase
Glucose → Sorbitol Sorbitol Dehydrogenase Sorbitol → Fructose |
#biochemistry #energymetzm
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Bile Soluble Streptococci
|
ie cannot grow in presence of bile
all non enterococcal strep |
#microbiology
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What is the main mechanism for regulating iron stores?
|
Hepatically produced Hepcidin produced by liver binds ferroportin and causes its degradation
[Ferroportin is basolateral iron transporter on gut epithelium. No ferroportin → iron lost in gut shedding] Hepcidin prodxn ↑ w/ high [iron] or inflammation |
#nutrition #biochemistry #molecules
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Hepcidin
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Hepatically produced Hepcidin produced by liver binds ferroportin and causes its degradation
[Ferroportin is basolateral iron transporter on gut epithelium. No ferroportin → iron lost in gut shedding] Hepcidin prodxn ↑ w/ high [iron] or inflammation Main mechanism of iron regulation |
#nutrition #biochemistry #molecules
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Erosions vs Ulcers
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Erosions do not cross muscularis mucosa
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#pathology #gastrointestinal
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Antipsychotic associated with retinitis pigmentosa
|
Thioridazine
Mn: thior-eye-disease NB: Chlorpormazine ≈ corneal deposits |
#pharmacology #toxicity
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Toxicity of Thioridazine
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retinitis-pigmentosa like retinal deposits
Mn: Thior-eye-disease NB: Chlorpormazine ≈ corneal deposits |
#pharmacology #toxicity
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Antipsychotic assocaited with corneal deposits
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Chlorpromazine
NB: Thioridazine ≈ Retinal Deposits |
#pharmacology #toxicity
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Toxicity of Chlorpromazine
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Corneal Deposits
NB: Thioridazien ≈ Retinal Deposits |
#pharmacology #toxicity
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most important strx/molecular defects in Alzhemiers
|
↓ ACh in Nucleus Basalis and Hippocampus
|
#pathology #neurology #dementia
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Hemangiomas:
Strawberry, Cherry, Cavernous |
Benign vascular tumors
Strawberry: infantile few weeks of rapid growth → regression in elementary school Cherry: senile ↑ # w/ age, ∅ regress Vacernous: blue palpable masses assoc. w/ VHL Dz may also exist in viscera and CNS as well as dermally |
#pathology #dermatology
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Eicosonoid responsible for PMN chemotaxis
|
LTB4
|
#pathology #inflammation
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LTB4
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Eicosonoid responsible for PMN chemotaxis
|
#pathology #inflammation
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Hemosiderin
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aggregation of ferritin micelles
maker of iron accumulation golden yellow brown pigment indicative of chronic iron overload/hemolytic anemia |
#pathology #molecules #diagnostics #hematology
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Pigment found in chronic iron overload
|
Hemosiderin
aggregation of ferritin micelles golden yellow brown pigment indicative of chronic iron overload/hemolytic anemia |
#pathology #molecules #diagnostics #hematology
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Cause of Death: Hypertrophic Cardiomyopathy
|
Mitral Valve leaflets get sucked into the outflow tract
|
#pathology #cardiovascular
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The first portion of the brain damaged during global ischemia
|
The Hippocampus goes first, within 5 minutes
Then watershet ischemia follow LATER |
#neurology #pathology #shock
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3-Hydroxy-3-methylglutaryl- lyaseCoA
|
HMG CoA Lyase
responsible for ketogenesis from HMG CoA (which itself is produced yby degradation of leucine or synthesis via HMG coA synthase) |
#biochemistry #molecules
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Reid Index
|
Submucosal Gland thickness/ thickenss of wall from epithlium to cartilage (not including cartilage)
normally 0.4 higher index ≈ severity/duration of chronic bornchitis |
#pathology #pulmonology #diognostics
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Pemphigus Vulgaris
|
anti-desmoglein IgG
Flaccid Bullae Asboe-Hansen sign: bullae spread laterally w/ pressure Nikolsky Sign: new bullae form with gentile traction Reticular Immunofluorescence |
#dermatology #pathology #rheumatology
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Skin covered with Blisters which spread laterally with pressure
|
Asboe-Hansen sign of Pemphigus Vulgaris
anti-desmoglein IgG Flaccid Bullae Reticular Immunofluorescence also: Nikolsky Sign: new bullae form with gentile traction |
#dermatology #pathology #rheumatology
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Skin Covered with Blisters, New Blisters formed with Gentle Traction
|
Nikolsky's Sign of Pemphigus Vulgaris
anti-desmoglein IgG Flaccid Bullae Reticular Immunofluorescence also: Asboe-Hansen sign: bullae spread laterally w/ pressure |
#dermatology #pathology #rheumatology
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Skin Covered with Blisters, Immunofluorescence shows Reticular Pattern of IgGs
|
Pemphigus Vulgaris; anti-desmoglein IgG
Flaccid Bullae Reticular Immunofluoresence may affect oral mucosa Asboe-Hansen sign: bullae spread laterally w/ pressure Nikolsky Sign: new bullae form with gentile traction |
#dermatology #pathology #rheumatology
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Blistering Skin Dz which Also Affects Oral Mucosa
|
Pemphigus Vulgaris; anti-desmoglein IgG
Flaccid Bullae Reticular Immunofluoresence may affect oral mucosa Asboe-Hansen sign: bullae spread laterally w/ pressure Nikolsky Sign: new bullae form with gentile traction |
#dermatology #pathology #rheumatology
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Bullous Pemphigoid vs Pemphigus Vulgaris
|
Pemphigus Vulgaris:
anti-desmosomal IgG → flaccid blisters & reticular immunofluorescence may affect oral mucosa Positive Nikolsky Sign: new bullae form with gentile traction Bullous Pemphigoid anti-hemidesmosomal IgG → tense blisters & linear IF w/ oral sparing & negative Nikolsky's sign |
#dermatology #pathology #rheumatology
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Skin Covered with Blisters, New Blisters do not formed with Gentle Traction
|
Bullous Pemphigoid
anti-hemidesmosomal IgG spares oral mucosa tense bullae linear immunofluorescence (contrast to PV: reticular) NB: negative Nikolsky's sign (new blisters formwith gentle traction, indicative of Pemphigus Vulgaris anti-desmoglein IgG) |
#dermatology #pathology #rheumatology
|
|
Skin Covered with Blisters, Immunofluorescence shows Linear Pattern of IgGs
|
Bullous Pemphigoid
anti-hemidesmosomal IgG spares oral mucosa tense bullae linear immunofluorescence (contrast to PV: reticular) NB: negative Nikolsky's sign (new blisters formwith gentle traction, indicative of Pemphigus Vulgaris anti-desmoglein IgG) |
#dermatology #pathology #rheumatology
|
|
Bullous Pemphigoid
|
Bullous Pemphigoid
anti-hemidesmosomal IgG spares oral mucosa tense bullae linear immunofluorescence (contrast to PV: reticular) NB: negative Nikolsky's sign (new blisters formwith gentle traction, indicative of Pemphigus Vulgaris anti-desmoglein IgG) |
#dermatology #pathology #rheumatology
|
|
↑ Lipase & Amylase → Dyspnea
|
Acute Pancreatitis → ARDS
|
#pathology #pulmonology
|
|
Councilman Bodies
|
acidophilic bodies within apoptitic hepatocytes
|
#pathology #hepatobiliary
|
|
acidophilic bodies within insulted hepatocytes
|
Councilman bodies indicative of apoptosis
|
#pathology #hepatobiliary
|
|
Blue Babies
|
5 T's
Tetrology of Fallot (most common) Transposition fo GReat Vessels Trucus Arteriosus (persistent, non-divided) Tricuspid Atresia: hypoplastic RV + ASD + VSD Total anamalous bulmonary venous return (2 systems) |
#pathology #cardiovascular #neonatology
|
|
New Onset Cyanosis in Children
|
Eisenmenger
By Freq: 1. VSD 2. ASD (fixed split S2) 3. PDA |
#pathology #cardiovascular
|
|
DOC: Nitroprusside OD
|
Nitroprosside: Ca2+ blocker which acts on both arteries an veins
Cyanide Toxicity DOC: Sulfur ie Sodium Thiosulfate provides extra substrate for liver rhodanase to form thiocyanate |
#pharmacology #cardiovascular #toxicity
|
|
Calcification is indicative of what
|
prior cell death
|
#pathology
|
|
Toxicity of Hydrocyhloroquine
|
retinal damage
|
#pharmacology #antimicrobial #toxicity
|
|
electrolyte abnormality following massive packed RBC transfusion
|
Hypocalcemia
Packed RBC's contain citrate anticoagulant citrate chelates calcium |
#pathology #electrolytes #hematology
|
|
nasal transepithelial potential difference
|
a sensitive test for Cystic Fibrosis (more sensitive than Cl- sweat test)
test is positive if difference is more negative CFTR both secretes chloride and inhibits Na+ secretion reduced CFTR fnx → ↓ Cl- secretion ↑ Na+ secretion more negative nasoepithlial surface NB: sweat glands are the only glands where CFTR fnx to resporb Cl- |
#pathology #molecules #diagnostics #geneticdzs
|
|
HIV gp41
|
gp41 is fusion protein allows entry into cell after adherence
[gp120 allows adherence to CD4] both cleaved from gp160 from env gene |
#HIV #microbiology
|
|
HIV gp120
|
gp120 allows adherence to CD4
[gp41 is fusion protein allows entry into cell after adherence] both cleaved from gp160 from env gene |
#HIV #microbiology
|
|
How does mom's blood type determine whether the baby could suffer from hemolytic dz?
|
Blood Types A & B usually have IgM anti-B & anti-A
Mom w/ Blood Type O often has IgG anti-A and anti-B Mom with blood type O more likely to have hemolytic dz for baby than otherwise |
#pathology #reproductive #immunology
|
|
DOC: acute gout
|
first line Rx is NSAID
glucocorticoid close 2nd |
#pharmacology #analgesia
|
|
Heparin vs LMWH
|
enoxapren = LMWH
both activate AT3 to bind Factors 9 X & 2 Only require pentasaccharide to bind AT3 & ↑ affinity Heparin has >18 sacchardies, allowing it to wrap around AT3 and form a stable bond with factor 2 (ie thrombin) LMWH cannot and thus has higher affinity for X than 2 |
#pharmacology #hematology
|
|
What is a good mini-mental status test for concentration
|
reciting months of the year backwards, counting down from 100 by 7's or spelling world backward
|
#psychology
|
|
First sign of uncal herniation
sequelae thereof |
ipsilateral dilated pupil from compression of CN3
sequelae: down & out eye PCA compression → homonymous hemianopia contralateral cerebral peuncle → ipsilateral hemiparesis alternatively isilateral " " → contralateral brainstem duret hemorrhages 2° rupture of basilar artery → fatal |
#neurology #pathology
|
|
unilateral dilated pupil
|
uncal herniation compressing CN3
|
#neurology #pathology
|
|
epigastric pain following food after ~30 min → weight loss
no abnormalities on scope |
chronic mesenteric ischemia 2° to atherosclerotic narrowing of Celiac Trunk, SMA or IMA
microscopy would reveal atrophy |
#gastrointestinal #pathology
|
|
Calcium stones
Frequency, Radiography, Microscopy, Causes |
Calcium Stones
Caclium Phosphate or Caclium Oxalate Frequency: Majority of all Stones Radiography: all stones radioopaque except uric acid stones Microscopy: octahedrons (square w/ cross hitching in 2d) Causes: hypercalcemia; calcium oxalate stones may form from ethylene glycol/methanol or vitamin C abuse |
#pathology #nephrology #neprholithalisis
|
|
Stones from Vitamin C Abuse
|
Caclium Oxalate
Frequency: Majority of all Stones Radiography: all stones radioopaque except uric acid stones Microscopy: octahedrons (square w/ cross hitching in 2d) Causes: hypercalcemia; calcium oxalate stones may form from ethylene glycol/methanol or vitamin C abuse |
#pathology #nephrology #neprholithalisis
|
|
Most common Nephrolithiasis
|
Calcium Stones
Caclium Phosphate or Caclium Oxalate Frequency: Majority of all Stones Radiography: all stones radioopaque except uric acid stones Microscopy: octahedrons (square w/ cross hitching in 2d) Causes: hypercalcemia; calcium oxalate stones may form from ethylene glycol/methanol or vitamin C abuse |
#pathology #nephrology #neprholithalisis
|
|
Struvite Stones
Frequency, Radiography, Microscopy, Causes |
Struvite Stones
Ammonium Magnesium or Phosphate Freq: uncommon, 2nd most common to calcium stones Radiography: all stones radioopaque except uric acid stones Microscopy: "coffin lid" rectuangular prism Causes: bugs: Proteus, Staph, Kleb Worsened by Alkalinuria |
#pathology #nephrology #neprholithalisis
|
|
octahedron nephrolithaisis
|
Calcium Stones
Caclium Phosphate or Caclium Oxalate Frequency: Majority of all Stones Radiography: all stones radioopaque except uric acid stones Microscopy: octahedrons (square w/ cross hitching in 2d) Causes: hypercalcemia; calcium oxalate stones may form from ethylene glycol/methanol or vitamin C abuse |
#pathology #nephrology #neprholithalisis
|
|
Ammonium Stones
|
Struvite Stones
Ammonium Magnesium or Phosphate Freq: uncommon, 2nd most common to calcium stones Radiography: all stones radioopaque except uric acid stones Microscopy: "coffin lid" rectuangular prism Causes: bugs: Proteus, Staph, Kleb Worsened by Alkalinuria |
#pathology #nephrology #neprholithalisis
|
|
Rectangular Prism Stones
|
Struvite Stones
Ammonium Magnesium or Phosphate Freq: uncommon, 2nd most common to calcium stones Radiography: all stones radioopaque except uric acid stones Microscopy: "coffin lid" rectuangular prism Causes: bugs: Proteus, Staph, Kleb Worsened by Alkalinuria |
#pathology #nephrology #neprholithalisis
|
|
Uric Acid Stones
Radiography, Microscopy, Causes |
Radiography: THE ONLY RADIOLUCENT KIDNEY STONE
Microscopy: Rhombus Causes: uric acidemia (gout, leukemia etc) |
#pathology #nephrology #neprholithalisis
|
|
Radiolucent Kidney Stones
|
Uric Acid Stones
Radiography: THE ONLY RADIOLUCENT KIDNEY STONE Microscopy: Rhombus Causes: uric acidemia (gout, leukemia etc) |
#pathology #nephrology #neprholithalisis
|
|
Cysteine Kidney Stones
Radiography, Microscopy, Causes |
Radiography: all kidney stones are radiopaque except uric acid stones
Microscopy: flat hexagons Causes: cysteinuria; tx w/ alkalinization |
#pathology #nephrology #neprholithalisis
|
|
Hexagonal Kidney Stones
|
Cysteine Stones
Radiography: all kidney stones are radiopaque except uric acid stones Microscopy: flat hexagons Causes: cysteinuria; tx w/ alkalinization |
#pathology #nephrology #neprholithalisis
|
|
"Hotdog" looking inclusions in eosinophils
|
Major Basic Protein
Kills helminths damages epithlium |
#immunology
#hematology |
|
Cauliflower mass in sigmoid colon causing mucoid diarrhea
|
villous adenoma
NB: carcinoid tumors also cause diarrhea, but not polypoid (?) |
#pathology #gastrointestinal #neoplasia
|
|
HBV vs HCV
& Hepatocellular CA |
HBV: integrates into genomes
HBx protein encodes for growth promoting and p53 inactivating proteins HCV induces hepatocellular cancer simply through chronic inflammation, does not encorporate into genome, no specific pro-CA molecules |
#pathology #microbiology #neoplasia
|
|
what dz is assoc. w/ polyarteritis nodosum
|
[fibrinoid necrosis of small/medium vessels]
HBV in some not all |
#pathology #cardiovascular
|
|
Zenker Diverticulum
|
Esophageal Diverticium 2° inncreased pressure 3* to crichopharyngeal hypertony
crichopharyngeal muscles don't relax, more force required to push food → outpouching retained food, regurgitation, aspiration all complications |
#pathology #gastrointestinal
|
|
the pathology of 3* syphilis
|
obliteration of vasa vasorum
|
#microbiology
|
|
Bosentan
|
endothelin-receptor antagonist
prevents vasoconstriction and endothelial proliferation DOC: pumonary artery hypertension |
#pharmacology #pulmonology
|
|
DOC: pulmonary artery hypertension
|
Bosentan
endothelin-receptor antagonist prevents vasoconstriction and endothelial proliferation |
#pharmacology #pulmonology
|
|
Cause of Death:
Acute Rheumatic Fever |
Myocarditis
NB: mitral stenosis req's years to dvlp |
#microbiology #pathology
|
|
HIV gp24
|
gp24 and gp7 are nucleocapsid proteins encoded by gag
|
#HIV
|
|
HIV gp7
|
gp24 and gp7 are nucleocapsid proteins encoded by gag
|
#HIV
|
|
HIV gag
|
encodes nucleocapside proteins gp24 and gp7
|
#HIV
|
|
HIV nef
|
downregulates CD4 and MHC 1
↑ virlence |
#HIV
|
|
HIV rev
|
faciliates transport of unspliced viral transcripts from nucleus
|
#HIV
|
|
HIV tat
|
Transcription AcTivator
↑ virulenc |
#HIV
|
|
Anastrozole
|
aromatase inhibitor
useful v estrogen dpt breast tumors anastrozole, letrozole, exemestane |
#pharmacology #neoplasia #endocrine
|
|
Letrozole
|
aromatase inhibitor
useful v estrogen dpt breast tumors anastrozole, letrozole, exemestane |
#pharmacology #neoplasia #endocrine
|
|
Exemestane
|
aromatase inhibitor
useful v estrogen dpt breast tumors anastrozole, letrozole, exemestane |
#pharmacology #neoplasia #endocrine
|
|
aromatase inhibitors
|
anastrozole, letrozole, exemestane
useful v estrogen dpt breast tumors |
#pharmacology #neoplasia #endocrine
|
|
Double Barrel Aorta
|
Aortic Dissection
Begins as an intimal tear Hypertension is the most important risk factor |
#pathology #cardiovascular
|
|
Timeline for correcting B12 deficiency
|
Immediate ↑ Reticulocyte Count, drops off again
slow ↑ hemoglobin |
#nutrition #hematology
|
|
Refractory PUD
Gastric Hypertrophy 2° to ? |
Gastrin (ZE)
|
#pathology #gastrointestinal
|
|
Buspirone vs BZD's
|
selective gor 5HT1A
no muscle relaxn no anticonvulant greatly ↓ addxn potential |
#pharmacology
|
|
Source of ↑ AP
|
Largely from OsteoBlast activity and Liver
--Differentiatable by elecctrophoresis, specific antibodies and boiling --Bone specific AP easily denatured in heat (Bone = Boil) Follow-Up test for ↑ AP is γ Glutamyl Transpeptidase (GGTP): Hepatobiliary Specific |
#pathology #diagnostis #bone #hepatobiliary
|
|
Urinary product of osteoclastic activity
|
deoxypyridinoline --most specific
tartrate resistant acid phosphatase --specific but cross reacting with other acid phosphatases urinary hydroxyproline present but non-specific |
#pathology #diagnostis #bone
|
|
urinary deoxypyridinoline
|
the most specific marker of osteoclastic activity
other markers: tartrate resistant acid phosphatase --specific but cross reacting with other acid phosphatases urinary hydroxyproline present but non-specific |
#pathology #diagnostis #bone
|
|
tartrate resistant acid phosphatase
|
tartrate resistant acid phosphatase --specific but cross reacting with other acid phosphatases
most specific: urinary deoxypyridinoline |
#pathology #diagnostis #bone
|
|
How is glycogen synthase activated
|
Insulin → tyrosine kinase → protein phosphatase-1 →
dephosphyrlates glycogen synthase (activating) also dephosphorylates Fructose 1,6 bisphosphatase, inactivating and inhibiting gluconeogeneis |
#biochemistry #energymetzm #molecules
|
|
protein phosphatase-1
|
Insulin → tyrosine kinase → protein phosphatase-1 →
dephosphyrlates glycogen synthase (activating) also dephosphorylates Fructose 1,6 bisphosphatase, inactivating and inhibiting gluconeogeneis |
#biochemistry #energymetzm #molecules
|
|
Transporter Defect in Cysteinuria
|
Dibasic Cation Transporter
COAL Cystine Ornithine Arginine Lysine |
#pathology #nephrology #nephrolithiasis #molecules
|
|
What is the Nitrogen Source for the Urea Cycle?
How does that molecule originally get its nitrogen? |
Nitrogen Source for Urea Cycle is Aspartate (combines with Citrate to form arginosuccinate)
Oxaloacetate + NH3 = Asparatate The NH3 for that reaction comes from Glutamate via B6 (NB: Glutamate losing NH3 becomes α-ketoglutarate) And how does glutamate get its NH3+ you ask? Substrate specific transaminases like AST and ALT (the two most significant): Alanine → Pyruvate Aspartate → Oxaloacetate |
#biochemistry #energymetzm #molecules
|
|
homogenous hyalinization vs onion skinning of arteries
|
hyaline: low level Htn
onion skinning: malignant htn |
#pathology #cardiovascular
|
|
describe mechanism of hearing in the inner ear
|
3 chambers: scala vestibuli: Na+ rich, onnected to oval window
scala media: K+, organ of corti basilar membrane separates media from tympani scala tympani: Na+: connected to round window scala vestibuli and scala tympani meet at helicotremma at top low freq's cause vibration at top near helicotremma high freqs at base near oval window |
#neurology #physiology
|
|
immunolytic effects of corticosteroids
|
inhibit PLA2
inhibit phagocytosis inhibit IL1 prodxn |
#pharmacology #immunology
|
|
Leucovorin
|
N5 Formyl THF
Rescules MTX toxicity potentiates 5FU effectiveness 5FU binds THF & Thymidilate Synthase in stable intermediate state |
#pharmacology #chemotheraputics
|
|
Gemcitabine
|
pyrimidine analogue
-abine = dNTP analogue |
#pharmacology #chemotheraputics
|
|
Cytarabine
|
pyrimidine analogue
-abine = dNTP analogue |
#pharmacology #chemotheraputics
|
|
Fludarabine
|
purine analogue
used v CLL -abine = dNTP analogue |
#pharmacology #chemotheraputics
|
|
Loss of FAS → SLE
pathogenesis? |
impaired "Clonal deletion" of activated T's by CTL's in peripheral ts
|
#pathology #hematology #immunology
|
|
Most common cause of superior vena cava sro?
|
1. bronchogenic carcinoma
esp 20 years after asbestos exposure |
#pathology #pulmonology
|
|
Sodium Cyanide Nitroprusside Test for Nephrolithasis
|
If urine becomes red-purple then you are looking at cystine stones
Cyanide converts cystine → cysteine Nitroprusside + Cysteine → Blue Molecule Dibasic AA transporter Cystine Ornithine Arginine Lysine Tx: alkalinize the urine |
#pathology #diagnostics #nephrology #nephrolithaisis
|
|
Confirmatory Test for Cystine Cyrstaluria
|
Sodium Cyanide Nitroprusside Tes
If urine becomes red-purple then you are looking at cystine stones Cyanide converts cystine → cysteine Nitroprusside + Cysteine → Blue Molecule Dibasic AA transporter Cystine Ornithine Arginine Lysine Tx: alkalinize the urine |
#pathology #diagnostics #nephrology #nephrolithaisis
|
|
Cystic pancreatic lesion 3 weeks post pancreatitis
|
pancreatic pseudocyst 2° pancreateic enzymatic degradation of pancreas
not a true cyst, lined by fibrosis and granulation ts, no epithlelium most commonly lesser peritoneal sac posterior to stomach |
#pathology #gastrointestinal
|
|
Mifepristone
|
progesterone antagonist abortificant
NB: often combined with misoprostol 5x affinity for progesterone receptor as progesterone |
#pharmacology #reproductive
|
|
fetus no longer has a heartbeat
|
dead
risk of DIC monitor fibrinogen closely |
#pathology #reproductive
|
|
Cystic degeneration of putamen likely 2° to
|
Wilson's Dz
|
#pathology #neurology
|
|
What blotting technique should you use to determine if a gene is being transcribed
|
Northern blot for mRNA
|
#diagnostics
|
|
Medullary Sponge Kidney
|
common benign disorder
linear dilations of medullary collecting ducts w/ cortical sparing incidental finding majority of pts will dvlp kidney stones 10% of all kidney stones 2° to MSK NB: not medullary cystic kidney dz fibrosis → inability to concentrate urine → end stage renal dz |
#pathology #nephrology
|
|
Kidney with cystically dilated medullary collecting ducts
|
Medullary Sponge Kidney
common benign disorder linear dilations of medullary collecting ducts w/ cortical sparing incidental finding majority of pts will dvlp kidney stones 10% of all kidney stones 2° to MSK NB: not medullary cystic kidney dz fibrosis → inability to concentrate urine → end stage renal dz |
#pathology #nephrology
|
|
Most common Amino Acid in Collagen
|
Glycine every 3rd position
Strx is always (Gly-X-Y)x333 Proline also essential, but not as frequent |
#biochemistry #molecules
|
|
Gestational Diabetes
|
human placental lactogen hPL from syncytiotrophoblasts induces insulin resistance to provide glucose for baby
if maternal insulin prodxn overwhelmed → gestational diabetes |
#endocrine #reproductive #physiology
|
|
Cromolyn
|
Inhibit mast cell degranulation
useful in tx of asthma sibling: nedocromil |
#pharmacology #pulmonology
|
|
Nedocromil
|
Inhibit mast cell degranulation
useful in tx of asthma sibling: cromolyn |
#pharmacology #pulmonology
|
|
inhibitors of mast cell degranualtion
|
cromolyn and nedocromil
useful vs asthma |
#pharmacology #pulmonology
|
|
Recurrent Bacterial and Viral Infx
|
indicative of combined T and B cell deficiency (SCID)
|
#immunology #pathology
|
|
The progression of lobar pneumonia
|
First 24h: Congestion
macro: red, heavy boggy micro: vascular dilation, bacteria rich exudate d2-3: Red hepatization macro: red, firm micro: RBC, PMN & fibrin infiltrate d4-6: Grey hepatization macro: grew brown & firm micro: PMN's & Fibrin resolution macro: normal architecture enzymatic degradation of exudate |
#pathology #pulmonology
|
|
Akathisia
|
side effect of anti-psychotics
anxiety, restlessness timeline 4h: dystonia 4d: parkinsonianism 4wk: akathisia 4mo: tardive dyskinesia |
#pharmacology #toxicity
|
|
anti-Mtb Rx most active in acidic environment
|
pyrazinhamide
ie within phagolysosomes unknown mechanism of action |
#pharmacology #antimicrobials
|
|
Pick's Dz: brain region
|
frontotemoral specificty
inappropriate behavior and speach decline unknown genetic basis |
#neurology #pathology
|
|
Conoloscopy Findings:
protuberant mass Likely Dz? |
adenocarcinoma
biopsy: dysplastic mucosa w/ gland formation |
#pathology #gastrointestinal
|
|
Conoloscopy Findings:
multiple ulcers and mucosal erosions Likely Dz? |
CMV
|
#pathology #gastrointestinal
|
|
Conoloscopy Findings:
nonulcerative inflammation Likely Dz? |
cryptosporidium
biopsy: basophilic clusters seen on surface of intestinal mucosal cells |
#pathology #gastrointestinal
|
|
Conoloscopy Findings:
numerous discrete flash-shaped ulcerations Likely Dz? |
entamoeba histolytica
biopsy: trophozoites contianing RBC's |
#pathology #gastrointestinal
|
|
Conoloscopy Findings:
violet flat maculopaular lesions & hemorrhagic nodules Likely Dz? |
Kaposi's sarcoma
HHV-8 biopsy: spindle shpaed tumor cells w/ small vessel proliferation |
#pathology #gastrointestinal
|
|
Biopsy Findings:
dysplastic mucosa w/ gland formation Likely Dz? |
adenocarcinoma
|
#pathology #gastrointestinal
|
|
Biopsy Findings:
basophilic clusters seen on surface of intestinal mucosal cells Likely Dz? |
cryptosporidium
nonulcerative inflammation |
#pathology #gastrointestinal
|
|
Biopsy Findings:
trophozoites containing RBC's Likely Dz? |
entamoeba histolytica
numerous flask shaped uilcerative lesiosn |
#pathology #gastrointestinal
|
|
Biopsy Findings:
spindle shaped tumor cells with small vessel proliferation Likely Dz? |
Kaposi's sarcoma
HHV-8 |
#pathology #gastrointestinal
|
|
HCV v HBV: which more likely from sexual transmission
|
HBV
|
#pathology #micobiology #hepatobiliary
|
|
DOC: AML
|
t(15:17) RAR-PML
DOC: all-trans-retinoic acid induces remission in 90% of pts |
#hematology #pharmacology #chemotheraputic #neoplasia #pathology
|
|
Murmurs v Respiration
|
Inspiration induces/increases Right Sided Murmurs
Expiration induces/increases Left Sided Murmurs |
#pathology #cardiovascular #diagnostics
|
|
Murmurs v Valsalva Maneuver
|
same as standing
Most murmurs diminish except for Hypertrophic Cardiomyopathy and Mitral Valve Prolapse NB: these also the only mumurs to become quieter with passive leg raise/squatting |
#pathology #cardiovascular #diagnostics
|
|
Murmurs v Standing
|
same as valsalva maneover
Most murmurs diminish except for Hypertrophic Cardiomyopathy and Mitral Valve Prolapse NB: these also the only mumurs to become quieter with passive leg raise/squatting |
#pathology #cardiovascular #diagnostics
|
|
Mumurs v Squatting
|
same as passive leg raising
most murmurs become louder except hypertrophic cardiomyopathy and mitral valve prolapse NB: these are also the only murmurs to become louder with valsalva maneuver/standing |
#pathology #cardiovascular #diagnostics
|
|
Murmurs v Passive Leg Raise
|
same as passive leg raising
most murmurs become louder except hypertrophic cardiomyopathy and mitral valve prolapse NB: these are also the only murmurs to become louder with valsalva maneuver/standing |
#pathology #cardiovascular #diagnostics
|
|
Murmurs v Handgrip
|
MR, VSD, and AR become Louder
Hypertrophic Cardiomyopathy murmur becomes queiter |
#pathology #cardiovascular #diagnostics
|
|
many immature myelogenous cells on blood smear
|
Not AML: would be "blast cells" rather than immature cells (bands, metamyelocytes, myelocytes)
either CML t(9:22) or leukemoid rxn (ie infx) depends on AP low AP: CML normal or high: leukemoid rxn |
#pathology #diagnostics #hematology #neoplasia
|
|
D-glutamate capsule
|
The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide
"wool-workers dz" grows "medusa head" colonies on media spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death anthrax toxin |
#microbiology #pulmonology
|
|
Wool Worker with Widened Mediastinum
|
Bacillus anthracis --"wool workers dz"
spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death D-glutamate capsule is the The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide grows "medusa head" colonies on media anthrax toxin |
#microbiology #pulmonology
|
|
"medusa head" colonies on agar
|
Bacillus anthracis --"wool workers dz"
spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death D-glutamate capsule is the The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide anthrax toxin |
#microbiology #pulmonology
|
|
Drug Interaxns of Niacin
|
Potentiates Anti-Hypertensives
Induces Insulin Resistance also causes hyperuricemia |
#pharmacology #cardiovascular #toxicity
|
|
Diphenoxylate
|
opiod used motility diarrhea
often combined with atropine as lomotil |
#pharmacology #drugs #gastrointestinal
|
|
Desmopressin
|
aka DDAVP
ADH analogue used for central diabetes insipidus and also coagulopathies → induces release of vWF & Factor 8 from endothelial cells (where they are produced and stored) |
#pharmacology #drugs #hematology #nephrology
|
|
DDAVP
|
aka Desmopressin
ADH analogue used for central diabetes insipidus and also coagulopathies → induces release of vWF & Factor 8 from endothelial cells (where they are produced and stored) |
#pharmacology #drugs #hematology #nephrology
|
|
Daptomycin
|
Rx v MRSA
Mech: creates transmembrane channels → electrolyte flow → depolarization → proteins now nonfnx Limitation: cannot get through to inner membrane of gram negatives; also inactivated by pulmonary surfactant Side Effects: Myopathy ( ↑ CPK) |
#pharmacology #drugs #antimicrobials
|
|
MRSA Rx
non-fnx vs pneumonia |
Daptomycin
Mech: creates transmembrane channels → electrolyte flow → depolarization → proteins now nonfnx Limitation: cannot get through to inner membrane of gram negatives; also inactivated by pulmonary surfactant Side Effects: Myopathy ( ↑ CPK) |
#pharmacology #drugs #antimicrobials
|
|
MRSA Rx:
depolarizes cellular membrane |
Daptomycin
Mech: creates transmembrane channels → electrolyte flow → depolarization → proteins now nonfnx Limitation: cannot get through to inner membrane of gram negatives; also inactivated by pulmonary surfactant Side Effects: Myopathy ( ↑ CPK) |
#pharmacology #drugs #antimicrobials
|
|
MRSA Rx:
↑ CPK |
Daptomycin
Mech: creates transmembrane channels → electrolyte flow → depolarization → proteins now nonfnx Limitation: cannot get through to inner membrane of gram negatives; also inactivated by pulmonary surfactant Side Effects: Myopathy ( ↑ CPK) |
#pharmacology #drugs #antimicrobials #toxicity
|
|
Linezolid
|
good Rx v MRSA
binds 23S portn of 50S Toxicities: Thrombocytopenia Optic neuritis 5HT Sro |
#pharmacology #drugs #antimicrobials
|
|
MRSA Rx:
Binds 23S |
Linezolid
binds 23S portn of 50S Toxicities: Thrombocytopenia Optic neuritis 5HT Sro |
#pharmacology #drugs #antimicrobials
|
|
MRSA Rx:
Thrombocytopenia |
Linezolid
binds 23S portn of 50S Toxicities: Thrombocytopenia Optic neuritis 5HT Sro |
#pharmacology #drugs #antimicrobials #toxicity
|
|
MRSA Rx:
Optic Neuritis |
Linezolid
binds 23S portn of 50S Toxicities: Thrombocytopenia Optic neuritis 5HT Sro |
#pharmacology #drugs #antimicrobials #toxicity
|
|
MRSA Rx:
5HT Sro |
Linezolid
binds 23S portn of 50S Toxicities: Thrombocytopenia Optic neuritis 5HT Sro |
#pharmacology #drugs #antimicrobials #toxicity
|
|
rT3
|
rT3 is nonfnx product of peripheral T4 conversion
T4 can be converted to T3 or rT3 NB: T3 cannot be converted to T4 or rT3 |
#physiology #endocrine
|
|
Libman-Sacks Dz
|
Libman Sacks Endocarditis of SLE
sterile endocarditis likely IC deposition may progress to regurgitation or stenosis |
#pathology #cardiovascular #rheumatology
|
|
Frequency:
Esophageal Cancers |
Adenocarcinoma > Squamous Cell Carcinoma
People are fatter and smoking less |
#neoplasia #pathology #gastrointestinal
|
|
Dressler's Dz
|
autoimmune myocarditis which follows MI by months
|
#pathology #rheumatology #cardiovascular
|
|
autoimmune myocarditis which follows MI by months
|
Dressler's Dz
|
#pathology #rheumatology #cardiovascular
|
|
Relative Conduction Speeds Throughout the Heart
|
Purkinje
Atrial Muscle Ventricular Muscle AV Node Mn: Park At VENTura AVenue |
#physiology #cardiovascular
|
|
Cholelithiasis 2° to Cholecystitis
|
Brown Pigment Stones
Infx → β-glucuronidase spillage → deconjugates bilirubin → Cholelithiasis Esp E Coli, Ascaris Lumbricoides or Opisthorchis sinesis Elderly Women in Rural Asia |
#pathology #hepatobiliary
|
|
Cholelithiasis in Rural Central Asia
|
Brown Pigment Stones
Infx → β-glucuronidase spillage → deconjugates bilirubin → Cholelithiasis Esp E Coli, Ascaris Lumbricoides or Opisthorchis sinesis Elderly Women in Rural Asia |
#pathology #hepatobiliary
|
|
Brown Pigment Stones
|
Infx → β-glucuronidase spillage → deconjugates bilirubin → Cholelithiasis
Esp E Coli, Ascaris Lumbricoides or Opisthorchis sinesis Elderly Women in Rural Asia |
#pathology #hepatobiliary
|
|
Cause of Death: CF
|
Pneumonia
|
#pathology #geneticdzs
|
|
anti-PLAR2 IgG
|
PLAR2 = transmembrane phsopholipase A2 receptor abundant on podocyutes
ideopathic membranous nephropathy neophrotic sro) |
#pathology #nephrology
|
|
ideopathic membranous nephropathy
|
nephrotic sro 2° to anti-PLAR2 IgG
PLAR2 = transmembrane phsopholipase A2 receptor abundant on podocyutes ideopathic membranous nephropathy NB: not the same as 2° membranous nephropathy (SLE) |
#pathology #nephrology
|
|
Most reliable prognostic indicators for liver damage
|
PT and albumin
NB: AST & ALT only indicative of damage, not of outcome |
#pathology #diagnostics #hepatobiliary
|
|
Anti-depressant which causes priapism
|
Trazodone
contraindicated in adolescent boys |
#pharmacology #toxicities #drugs
|
|
DOC: DKA
|
regular insulin
oddly not rapid acting insuilins (lispro aspart) |
#pharmacology #DOCs #endocrine
|
|
HNPCC adenocarcinoma vs Sporadic Adnocarcinoma
|
HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 Sporadic >50 yo left sided single arise from adenomatous polyps genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC |
#pathology #neoplasia #genticdzs #gastrointestinal
|
|
Right Sided Adenocarcinoma
|
HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
|
|
MLH1
|
HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
|
|
MLH2
|
HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
|
|
MSH6
|
HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
|
|
PMS2
|
HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
|
|
Colonic Adenocarcinoma in a 30 yo
|
HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
|
|
Colonic Adenocarcinoma in a 70 yo
|
Sporadic
>50 yo left sided single arise from adenomatous polyps genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC |
#pathology #neoplasia #gastrointestinal
|
|
Digoxin: mechanism of action
|
1. Blocks NaK ATPase → ↑ [Ca2+]
2. ↑ PSNS tone → ↓ AV node condxn |
#pharmacology #cardiovascular
|
|
S3 indicative of
|
stiff or partially filled
best heart in left lateral decupitus position at ventricular apex at end of expiration |
#cardiovascular #pathology #diagnostics
|
|
Gastric Adenocarinomas
|
2 variants
signet ring: do not form glands, contain mucin diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica intestinal type resemble colon cancers: grow as well demarcated masses of well formed glands |
#pathology #gastrointestinal #neoplasia
|
|
Rugal thickening of stomach
|
indicative of ZE sro
|
#pathology #gastrointestinal #neoplasia
|
|
"leather bottle" stomach
|
signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica |
#pathology #gastrointestinal #neoplasia
|
|
linitis plastica
|
signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica |
#pathology #gastrointestinal #neoplasia
|
|
What good is HMP shunt?
|
does not produce ATP
produces 2 NADPH's Required for --FA, cholesterol & steroid synthesis --Rx metzm |
#biochemistry #energymetzm
|
|
Reyes Sro
|
Child c Fever + Aspirin
Hepatic Failure → Acute Encephalopathy Biopsy: microvesicular steatosis (yes, there was a question on this) No necrosis or inflammation all LFT's ↑ cerebral edema |
#pathology #hepatobiliary
|
|
DOC: anti-depressant with least sexual side effects
|
Burproprion does not cause sexual dysfnx
DA NE RI does cause seizures and insomnia |
#pharmacology #physciatric
|
|
NE activates which receptors
|
both α and β1
little effect on β2 |
#pharmacology #autonomic
|
|
What signals drive angiogenesis
|
VEGF: endothelial cell motility and proliferation
FGF: also contributes |
#physiology #cardiovascular
|
|
Pathogenesis of Crohn's Nephrolithiasis
|
normally dietary Ca2+ binds dietary Oxalate → insoluble salts → oxalate excretion
Crohns: loss of bile acids → impaired fat absorption → Ca2+ FA Soap formation → excretion → unbound oxalate taken up → Calcium Oxalate Stones Radiopaque Octahedrons |
#pathology #gastrointestinal #nephrology #nephrolithiasis #inflammation
|
|
Fever, GI distress, Hepatosplenomegaly, Periumbilical Rose Spots
|
Salmonella typhi
|
#microbiology #gastrointestinal #hepatobiliary #pathology
|
|
Adrenal Cortex Dz's caused by Hypertrophy and Hyperplasia
|
Hypertrophy: Conn
Hyperplasia: Cushing |
#endocrine #pathology
|
|
Histology of Conn & Cushing Sros
|
Conn: Hypertrophy
Cushing: Hyperplasia |
#endocrine #pathology
|
|
Signal which gathers Myofibroblasts at wound
|
MMP's gather myofibroblasts at wound edges
|
#physiology #molecules
|
|
DIC vs TTP vs HUS
|
DIC:
Pts bleed Activated Coagulation Cascade ↑ PT & ↑ PTT ↓ fibrinogen, ↑ FDP (D-dimer) TTP-HUS usually do not bleed Only Platelets activated normal PT, PTT, fibrinogen, ∅ FDP |
#hematology #pathology
|
|
Rectal Prolapse in Children
|
CF
|
#pathology #geneticdzs #gastrointestinal
|
|
Osmotic Laxitives
|
Polyethylene Glycol
& Magnesium Chloride |
#pharmacology #gastrointestinal
|
|
Microbe: produce diarrhea with small innoculum
|
Entamoeba Histolytica (1)
Giardia (1) Shigella (10) Campylobacter jejuni (500) |
#microbiology #gastrointestinal
|
|
Dilated Cardiomyopathies
|
90% of cardiomyopathies are dilated cariomyopathies
Pathogenesis: ↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx All chambers dilated, valvular insufficiencies, heart failure Etiologies: Mn: ABCCCD (-PH) Alcohol, Beriberi Coxsackie B, Cocaine, Chagas Doxorubicin/Daunorubicin Post Partum Hemochromatosis (may be restrictive) |
#pathology #cardiovascular
|
|
Alcoholic Cardiac Abnormality
|
Dilated Cardiomyopathy
↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx All chambers dilated, valvular insufficiencies, heart failure 90% of cardiomyopathies are dilated cariomyopathies Etiologies: Mn: ABCCCD (-PH) Alcohol, Beriberi Coxsackie B, Cocaine, Chagas Doxorubicin/Daunorubicin Post Partum Hemochromatosis (may be restrictive) |
#pathology #cardiovascular
|
|
Thiamine Deficiency Cardiac Abnormality
|
Dilated Cardiomyopathy
↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx All chambers dilated, valvular insufficiencies, heart failure 90% of cardiomyopathies are dilated cariomyopathies Etiologies: Mn: ABCCCD (-PH) Alcohol, Beriberi Coxsackie B, Cocaine, Chagas Doxorubicin/Daunorubicin Post Partum Hemochromatosis (may be restrictive) |
#pathology #cardiovascular
|
|
Coxsackie Cardiac Abnormality
|
Dilated Cardiomyopathy
↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx All chambers dilated, valvular insufficiencies, heart failure 90% of cardiomyopathies are dilated cariomyopathies Etiologies: Mn: ABCCCD (-PH) Alcohol, Beriberi Coxsackie B, Cocaine, Chagas Doxorubicin/Daunorubicin Post Partum Hemochromatosis (may be restrictive) |
#pathology #cardiovascular
|
|
Doxorubicin Cardiac Abnormality
|
Dilated Cardiomyopathy
↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx All chambers dilated, valvular insufficiencies, heart failure 90% of cardiomyopathies are dilated cariomyopathies Etiologies: Mn: ABCCCD (-PH) Alcohol, Beriberi Coxsackie B, Cocaine, Chagas Doxorubicin/Daunorubicin Post Partum Hemochromatosis (may be restrictive) |
#pathology #cardiovascular
|
|
Hemochromatosis Cardiac Abnormality
|
May be Dilated or Restrictive Cardiomyopathy!
Dilated: ↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx All chambers dilated, valvular insufficiencies, heart failure Restrictive: ↓ compliance → diastolic dysnfx heart failure |
#pathology #cardiovascular
|
|
Cocaine Cardiac Abnormality
|
Dilated Cardiomyopathy
↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx All chambers dilated, valvular insufficiencies, heart failure 90% of cardiomyopathies are dilated cariomyopathies Etiologies: Mn: ABCCCD (-PH) Alcohol, Beriberi Coxsackie B, Cocaine, Chagas Doxorubicin/Daunorubicin Post Partum Hemochromatosis (may be restrictive) |
#pathology #cardiovascular
|
|
Chagas Cardiac Abnormality
|
Dilated Cardiomyopathy
↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx All chambers dilated, valvular insufficiencies, heart failure 90% of cardiomyopathies are dilated cariomyopathies Etiologies: Mn: ABCCCD (-PH) Alcohol, Beriberi Coxsackie B, Cocaine, Chagas Doxorubicin/Daunorubicin Post Partum Hemochromatosis (may be restrictive) |
#pathology #cardiovascular
|
|
Restrictive Cariomyopathy
|
restrictive cardiomyopathy
↓ compliance → diastolic dysnfx heart failure Causes: 1. Amyloidosis 2. Post-surgical fibrosis 3. Radiation-induced Fibrosis also Genetics: pompe's dz, hemochromatosis (may also be dilated) Metastatic Cancers, Genetic abnormalities childhood fibroelastosis |
#pathology #cardiovascular
|
|
Amyloidosis Cardiac Abnormality
|
restrictive cardiomyopathy
↓ compliance → diastolic dysnfx heart failure Causes: 1. Amyloidosis 2. Post-surgical fibrosis 3. Radiation-induced Fibrosis also Genetics: pompe's dz, hemochromatosis (may also be dilated) Metastatic Cancers, Genetic abnormalities childhood fibroelastosis |
#pathology #cardiovascular
|
|
Radiation Induced Cardiac Abnormality
|
restrictive cardiomyopathy
↓ compliance → diastolic dysnfx heart failure Causes: 1. Amyloidosis 2. Post-surgical fibrosis 3. Radiation-induced Fibrosis also Genetics: pompe's dz, hemochromatosis (may also be dilated) Metastatic Cancers, Genetic abnormalities childhood fibroelastosis |
#pathology #cardiovascular
|
|
Pompe's Dz Cardiac Abnormality
|
deficiency of Lysosomal α 1,4 glucosidase (aka acid maltase)
restrictive cardiomyopathy ↓ compliance → diastolic dysnfx heart failure Causes of Restrictive Cardiomyopathy 1. Amyloidosis 2. Post-surgical fibrosis 3. Radiation-induced Fibrosis also Genetics: pompe's dz, hemochromatosis (may also be dilated) Metastatic Cancers, Genetic abnormalities childhood fibroelastosis |
#pathology #cardiovascular
|
|
Px of ITP
|
Ideopathic thrombocytopenic purprua
Bleeding from platelet destrx Chidlren: acute and self-limited Adults: insidious and chronic |
#pathology #hematology #rheumatology
|
|
Best test to monitor for HCC recurrence
|
Hepatocellular Carcinoma:
Alpha fetoprotein |
#pathology #neoplasia #diagnostics
|
|
Vitamin K deficiency
|
Bleeding
Extremely unlikely in adults as colonic bacteria produce vitamin K |
#pathology #nutrition
|
|
Nails which bow in and bend out
|
Spoon nails aka Koilonychia
specific for iron deficiency anemia ___________________ Plummer Vincent Sro: Triad of Iron Deficiency Anemia Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology
|
|
Plummer Vincent Sro
|
Triad of
Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
|
|
Anemia + Dysphagia
|
Plummer Vincent Sro
Triad of Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
|
|
Spoon Nails + Dysphagia
|
Plummer Vincent Sro
Triad of Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
|
|
Spoon Nails
|
aka Koilonychia
Specific for Iron Deficiency Anemia ___________________ Plummer Vincent Sro: Triad of Iron Deficiency Anemia Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology
|
|
Koilonychia
|
aka spoon nails
Specific for Iron Deficiency Anemia ___________________ Plummer Vincent Sro: Triad of Iron Deficiency Anemia Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology
|
|
B6 deficiency anemia
|
required for first step of heme synthesis
microcytic hypochromatic B6 responsive anemia same morphology as X linked Sideroblastic Anemia, but B6 responsive |
#pathology #nutrition #hematology
|
|
Neutral Aminoaciduria
|
Hartnup Dz
Defective Neutral AA transporters in both Kidneys and Intestine Tryptophan is the only essential AA, necessary for (BH4 dpt) 5HT and (B6 dpt) Niacin synth mostly aSx, though som pts present with pelagra: Diarrhea (Photosensative) Dermatitis Dementia (Ataxia) These pts benefit from Niacin supplementation |
#pathology #geneticdzs #nutrition
|
|
Ataxia + Photosensitive Skin Lesions + Loose stools
|
Pellagra 2° to Niacin Deficiency
Diarrhea, Dermatitis, Dementia causes: Corn Based Diets Carcinoid Tumor (uses up all the 5HT) Hartnup Dz: defective transport of neutral AA's in intestine and nephrons → no Tryptophan absorption → no Niacin prodxn |
#pathology #nutrition #neoplasia #geneticdzs
|
|
Pellagra
|
Diarrhea,
(Photosenstive) Dermatitis Dementia (Ataxia) causes: Corn Based Diets Carcinoid Tumor (uses up all the 5HT) Hartnup Dz: defective transport of neutral AA's in intestine and nephrons → no Tryptophan absorption → no Niacin prodxn |
#pathology #nutrition #neoplasia #geneticdzs
|
|
Tocopherol
|
Vitamin E
|
#nutrition #molecules
|
|
Vitamin E molecule name
|
Tocopherol
|
#nutrition #molecules
|
|
E Coli & Sorbitol
|
Most E coli Strains ferment sobitol Rapidly
Most EHEC O157H7 cannot ferment sorbitol |
#micriobiology #diagnostics
|
|
Test for EHEC from other E coli
|
Sobitol Containin McConkey's Agar
Most E coli Strains ferment sobitol Rapidly Most ETEC O157H7 cannot ferment sorbitol |
#micriobiology #diagnostics
|
|
Cause of Death: TCA OD
|
Fast Na+ Channel inhibition → slowed conduction + prolonged QRS → fatal arrhytmias
else ↓ CO (arrthmias) + α blockade → Refractory Hypotension |
#pharmacology #toxicity
|
|
Rapid Lactose Fermenters
|
Kleb: Citrate + Urease +
Enterobacter: Citrate + Urease Neg E Coli: Citrate, Urease Double Neg |
#microbiology #diagnostics
|
|
Biochemical Profile of Kleb
|
Rapid Lactose Fermenter
Citrate + Urease + |
#microbiology #diagnostics
|
|
Biochemical Profile of Enterobacter
|
Rapid Lactose Fermenter
Citrate + Urease Neg |
#microbiology #diagnostics
|
|
Biochemical Profile of E coli
|
Rapid Lactose Fermenter
Citrate Neg Urease Neg |
#microbiology #diagnostics
|
|
Biochemical Profile of Shigella
|
Oxidase Negative
Lactose Nonfermenter Which does not produce H2S on TSI Agar |
#microbiology #diagnostics
|
|
Biochemical Profile of Salmonella
|
Oxidase Negative Lactose Nonfermenter
Which Produces H2S on TSI Agar Identical Profile to Proteus |
#microbiology #diagnostics
|
|
Biochemical Profile of Proteus
|
Oxidase Negative Lactose Nonfermenter
Which Produces H2S on TSI Agar Identical Profile to Salmonella |
#microbiology #diagnostics
|
|
Biochemical Profile of Pseudomonas
|
Oxidase Positive Lactose Nonfermenter
|
#microbiology #diagnostics
|
|
Gram Negative Rod
Which Ferments Lactose Slowly |
Both Citrobacter and Serratia
|
#microbiology #diagnostics
|
|
Urease + Citrate +
Rapid Lactose Fermenting Gram Negative Rod |
Kleb
|
#microbiology #diagnostics
|
|
Urease Neg Citrate +
Rapid Lactose Fermenting Gram Negative Rod |
Enterobacter
|
#microbiology #diagnostics
|
|
Urease Neg Citrate Neg
Rapid Lactose Fermenting Gram Negative Rod |
E coli
|
#microbiology #diagnostics
|
|
Oxidase Negative Lactose Non-Fermenting
Gram Negative Rod Which Does Not Produce H2S on TSI Agar |
Shigella
|
#microbiology #diagnostics
|
|
Oxidase Negative Lactose Non-Fermenting
Gram Negative Rod Which Produces H2S on TSI Agar |
Either Salmonella or Proteus
|
#microbiology #diagnostics
|
|
Oxidase Positive
Lactose Non-Fermenting Gram Negative Rod |
Pseudomonas
|
#microbiology #diagnostics
|
|
Lactose Non Fermenting
Oxidase Negative Gram Negative Rod |
TSI Agar:
∅ H2S Prodxn: Shigella H2S Prodxn: Salmonella or Proteus |
#microbiology #diagnostics
|
|
Maltose Fermenting
Gram Negative Cocci |
N meningitidis
NB: Maltose Non-Fermenting = N gonorrhoeae |
#microbiology #diagnostics
|
|
Maltose Non-Fermenting
Gram Negative Cocci |
N gonorrhoeae
NB: Maltose Fermenting = N meningitidis |
#microbiology #diagnostics
|
|
ANS innervation of the Uterus
|
beta 2 causes relaxation
beta 2 agonists used to defer premature labor: ritodrine, terbutaline allows time for cortisol to work |
#pharmacology #autonomics #reproductive
|
|
Ritodrine
|
beta 2 agonist
used to relax the uterus and defer labor allowing time for cortisol to work |
#pharmacology #autonomics #reproductive #drugs
|
|
Terbutaline
|
beta 2 agonist
used to relax uterus and defer labor allowing time for cortisol to work |
#drugs #pharmacology #autonomics #reproductive
|
|
deferring labor
|
beta 2 agonists
ritodrine and terbutaline allowing time for cortisol to work |
#drugs #pharmacology #autonomics #reproductive
|
|
Kussmaul's Sign
|
normally JVP decreases with inspiration
Kussmaul's sign is an increase in JVP w/ inspiration indicative of constrictive pericarditis -Kussmaul's Sign -Pericardial Knock (earlier than S3 which normallly indicates rapid filling from dilated/weak ventricle) -Pulsus Paradoxus |
#cardiology #pathology #diagnostics
|
|
Increase in JVP on inspiration
|
normally JVP decreases with inspiration
Kussmaul's sign is an increase in JVP w/ inspiration indicative of constrictive pericarditis -Kussmaul's Sign -Pericardial Knock (earlier than S3 which normallly indicates rapid filling from dilated/weak ventricle) -Pulsus Paradoxus |
#cardiology #pathology #diagnostics
|
|
Decrease in JVP on inspiration
|
Physiologic
_________________________ Kussmaul's sign is an increase in JVP w/ inspiration indicative of constrictive pericarditis -Kussmaul's Sign -Pericardial Knock (earlier than S3 which normallly indicates rapid filling from dilated/weak ventricle) -Pulsus Paradoxus |
#cardiology #pathology #diagnostics
|
|
Pericardial Knock
|
Heart Sound heard before S3 indicative of extremely restricted filling
Restrictive Pericarditis --Kussmaul's increase in JVP on inspiration --Pericardial Knock --Pulsus Paradoxus |
#cardiology #pathology #diagnostics
|
|
Heart sound immediately following S2
|
Pericardial Knock
before S3 (ventricular splash from dilation) indicative of restrictive pericarditis --Kussmaul's increase in JVP on inspiration --Pulsus Paradoxus --Pericardial Knock |
#pathology #cardiovascular #diagnostics
|
|
Small Cell Lung Cancer
Risk Factors, Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx |
Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium
Arises Centrally Px: Very Aggressuve, Mets Early & Widely Genetics: c-myc Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase Risks: Smoking Tx: Chemo Many PNP Sros: Cushing, Lambert Eaton, SIADH |
#pathology #neoplasia #pulmonology
|
|
Bronchial Adenocarcinoma
Risk Factors, Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx |
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
|
|
Bronchioalveolar Carcinoma
Risk Factors, Histology, Location, Behavior/Px |
Risk Factors: not assoc. with smoking
Histology: lepidic growth w/o invasion Location: Periphery, Terminal broncheolavoli Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn |
#pathology #neoplasia #pulmonology
|
|
Squamous Cell Carcinoma of the Lung
Risk Factors, Histology, Location, Behavior/Px, PNP Sros |
Risk Factors: Males, Smoking
Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #neoplasia #pulmonology
|
|
Methylene Blue
|
Antidote for methemoglobin
reduces iron Fe3+ to Fe2+ |
|
|
Antidote for poisoned pt with garlic breath
|
Dimercaprol
Antidote for acute arsenic poisoning. Note: garlic odor. Displaces Arsenic ions from sulfhydryl groups. Side effects of antidote: nephrotoxic & hypertension |
|
|
Large Cell Lung Cancer
Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx |
Histology: Highly anaplastic: large cells with large nuclei
Location: Peripheral Behavior/Px: Extensive Local Growth PNP Sros: Gynecomastia, Galactorrhea Tx: non responsive to chemotheray |
#pathology #neoplasia #pulmonology
|
|
Antidote for Acute Lead Poisoning
|
Antidote for Acute Lead and Mercury Poisoning. Forms complexes with mono, di, and trivalent ions.CaNa2EDTA
|
|
|
Antidote for Acute Mercury Poisoning
|
Antidote for Acute Lead and Mercury Poisoning. Forms complexes with mono, di, and trivalent ions.CaNa2EDTA
|
|
|
Lung Cancer:
Dark Blue Cells |
Small Cell Lung Cancer
Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium Arises Centrally Px: Very Aggressuve, Mets Early & Widely Genetics: c-myc Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase Risks: Smoking Many PNP Sros: Cushing, Lambert Eaton, SIADH Tx: Chemo |
#pathology #neoplasia #pulmonology
|
|
Antidote for Iron Poisoning
|
Deferoxamine
most common after multiple blood transfusions facilitates urinary excretion |
|
|
Lung Cancer:
C-Myc |
Small Cell Lung Cancer
Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium Arises Centrally Px: Very Aggressuve, Mets Early & Widely Genetics: c-myc Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase Risks: Smoking Many PNP Sros: Cushing, Lambert Eaton, SIADH Tx: Chemo |
#pathology #neoplasia #pulmonology
|
|
Antidote for Cyanide Poisoning
|
Amyl Nitrite
Forms methemoglobin that binds cyanide, distracting it from binding to mitochondiral enzymes |
|
|
Lung Cancer:
TTF-1 positive Stain |
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
|
|
Antidote for methemoglobin
|
Methylene Blue
reduces iron Fe3+ to Fe2+ |
|
|
Destroying Hep A
|
Boiling for to 85* for 1 min
Chlorination Bleach, Formalin UV Rad |
|
|
Female Child with Ambiguous Genitalia
Hyponatremia, Hyperkalemia, Hypotension |
21β hydroxylase deficiency
↓corticosteroids & mineralcorticoids ↑ testosterone |
|
|
Lung Cancer
CEA positive Stain |
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
|
|
Female Child with Ambiguous Genitalia
Hypertension |
11β hydroxylase deficiency
↓ cortisol, aldosterone ↑11-deoxycorticosteone (weak mineralcorticocoid) ↑ testosterone |
|
|
Male child with female genitalia
Hypertension |
17α hydroxylase deficiency
↑ mineralcorticoids ↓ sex hormones and corticosteroid fluid and salt retention |
|
|
Lung Cancer
Hypertrophic Osteoarthropathy |
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg Bronchioalveolar Carcinoma Risk Factors: not assoc. with smoking Histology: lepidic growth w/o invasion Location: Periphery, Terminal broncheolavoli PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn |
#pathology #neoplasia #pulmonology
|
|
21β hydroxylase deficiency
|
↓corticosteroids & mineralcorticoids
↑ testosterone Ambiguous Genitalia in Females Hyponatremia, Hyperkalemia, Hypotension |
|
|
11β hydroxylase deficiency
|
↓ cortisol, aldosterone
↑11-deoxycorticosteone (weak mineralcorticocoid) ↑ testosterone Ambiguous Genitalia in Females fluid and salt retention → hyeprtension |
|
|
Lung Cancer: EGFR
|
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
|
|
17α hydroxylase deficiency
|
↑ mineralcorticoids
↓ sex hormones and corticosteroid all patients phenotypically female fluid and salt retention → hypertension |
|
|
What blood has the lowest oxygen content in the body
|
blood in the coronary sinus
myocardium extracts 80% of all O2 normally, 90% when stressed, consuming 5% of all CO |
|
|
Pt treated for depression
↓ BP, ↑ HR, ↑ QRS, & PVC's What is wrong? How do you treat? |
TCA overdose
quinidine like effect: inhibition of fast Na+ channels most effective tx: NaHCO3 |
|
|
Describe the perfusion of the Heart
|
Left and Right Coronary Arteries
Left becomes Left Anterior Descending and Circumflex Arteries, supplies the anterior and left lateral surfaces of heart Right gives rise to Posterior Descending Artery which supplies most of the inferior wall of the left ventricle including the diaphragmatic surface of the heart, as well as the SA and AV node arteries. In 10% of pts the Left Circumflex artery gives rise to the posterior descending arteries. |
|
|
Lung Cancer: Kras
|
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
|
|
Describe the K+ distribution in DKA
describe the causes |
↓ total body K+
↓ intracellular [K] ↑ extracellular [K] 2° to -osmotic loss -acidosis pulls K from intracellular to extracellular -lack of insulin which normally promotes cellular influx of K |
|
|
Lung Cancer:
Gyneocomastia |
Large Cell Lung Cancer
Histology: Highly anaplastic: large cells with large nuclei Location: Peripheral Behavior/Px: Extensive Local Growth PNP Sros: Gynecomastia, Galactorrhea Tx: non responsive to chemotheray |
#pathology #neoplasia #pulmonology
|
|
Progressive weakening with repeated use
|
the hallmark of myasthenia gravis
|
|
|
Amino Acids with Titratable Protons
|
Bases:
H Histidine R Arginine K Lysine Acids: D Aspartic Acid E Glutamic Acid Neutral: C Cysteine (-SH) Y Tyrosine (-OH) |
|
|
2 most common causes of focal brain lesions in HIV+ pts
|
Toxoplasmosis
Lymphoma esp 2° to EBV |
|
|
Lung Cancer:
Galactorrhea |
Large Cell Lung Cancer
Histology: Highly anaplastic: large cells with large nuclei Location: Peripheral Behavior/Px: Extensive Local Growth PNP Sros: Gynecomastia, Galactorrhea Tx: non responsive to chemotheray |
#pathology #neoplasia #pulmonology
|
|
Phenytoin
|
DOC: partial seizures and tonic clonic seizures
blocks sodium channels ↑ CYP |
|
|
DOC: tonic clonic seizures
|
Phenytoin
also for partial seizures blocks sodium channels ↑ CYP450 |
|
|
Peripheral Lung Cancers
|
Bronchial & Bronchioalveolar Adenocarcinoma
Large Cell Lung Cancer |
#pathology #pulmonology #neoplasia
|
|
Anti-seizure drug which blocks sodium channels
|
phenytoin
carbamazepine lamotrigine valproic acid-also blocks NDMA receptors in hippocampal neurons |
|
|
Central Lung Cancers
|
Small Cell & Squamous Cell Carcinomas
|
#pathology #pulmonology #neoplasia
|
|
Anti-seizure drug which blocks calcium channels in the thalamus
|
Ethosuximide
first line tx for absence |
|
|
Lung Cancer:
Non-smoking Women |
Bronchial Adenocarcinoma
_____________________ Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #pulmonology #neoplasia
|
|
Anti-seizure drug which ↑ Cl- flow
|
Benzos, Barbituates, ETOH, enhance inhibitory action of GABA on GABAa and thus ↑ Cl- flux
|
|
|
Anti-seizure drug which blocks NMDA receptors in hippocampal neurons
|
Valproic acid
also has some sodium channel blocking effect |
|
|
DOC partial seizures
|
carbamazepine
blocks Na+ channels ↑ CYP450 |
|
|
Ethosuximide
|
Anti-seizure drug which blocks calcium channels in the thalamus
first line tx for absence |
|
|
Lung Cancer
Definitively Not Caused by Smoking |
Bronchioalveolar Carcinoma
____________________________ Risk Factors: not assoc. with smoking Histology: lepidic growth w/o invasion Location: Periphery, Terminal broncheolavoli PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn |
#pathology #pulmonology #neoplasia
|
|
DOC: Absence Seizures
|
Ethosuximide
blocks calcium channels in the thalamus |
|
|
Lung Cancer
Slow Growth Early Mets |
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #pulmonology #neoplasia
|
|
Sertaline
|
Zoloft, an SSRI
|
|
|
Phentolamine
|
competitive αantagonist
|
|
|
Labetalol
|
competitive antagonist of α1 and β1 with partial agonism at β2
|
|
|
Lung Cancer
Fast Growth Early Mets |
Small Cell
Large Cell _____________________ Small Cell Lung Cancer Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium Arises Centrally Px: Very Aggressuve, Mets Early & Widely Genetics: c-myc Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase Risks: Smoking Many PNP Sros: Cushing, Lambert Eaton, SIADH Tx: Chemo Large Cell Lung Cancer Histology: Highly anaplastic: large cells with large nuclei Location: Peripheral Behavior/Px: Extensive Local Growth, Early Mets PNP Sros: Gynecomastia, Galactorrhea Tx: non responsive to chemotheray |
#pathology #pulmonology #neoplasia
|
|
Phenoxybenzamine
|
nonselective, irreversible α1 and 2 antagonist
|
|
|
Pramipexole
|
a non-ergot dopamine agonist
sibling to rppinerole |
|
|
Lung Cancer
Slow Growth Late Mets |
Squamous Cell
________________________ Risk Factors: Males, Smoking Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #pulmonology #neoplasia
|
|
ropinerole
|
a non-ergot dopamine agonist
|
|
|
Lung Cancer
Hypercalcemia |
Squamous Cell Carcinoma
___________________________ Risk Factors: Males, Smoking Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #pulmonology #neoplasia
|
|
non-ergot DA agonists
|
pramipexole and ropinerole
|
|
|
ergot DA agonists
|
bromocriptine, pergolide
|
|
|
Lung Cancer
Mucin Producing Glands |
Bronchial Adenocarcinoma
_____________________ Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #pulmonology #neoplasia
|
|
bromocriptine
|
an ergot DA agonist
like pergolide |
|
|
pergolide
|
an ergot DA agonist like bromocriptine
|
|
|
tirhexyphenidyl
|
anticholinergic
|
|
|
benztropine
|
anticholinergic
|
|
|
Lung Cancer
Cavitating |
Squamous Cell Carcinoma
_____________________ Risk Factors: Males, Smoking Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #pulmonology #neoplasia
|
|
Amantadine
|
primarily an anti-flu agent
indirect and direct dopaminergic agent used initially in parkinsons |
|
|
Lung Cancer
Intercellular Bridges |
Squamous Cell Carcinoma
_____________________ Risk Factors: Males, Smoking Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #pulmonology #neoplasia
|
|
Auer Rods
|
Stain for peroxidase
inducative of AML t(15:17) Retinoic Acid Receptor α + Promylogenous Leukemia RARα-PML bone marrow repalcement produces anemia, thrombocytopenia and neutropenia |
|
|
Major Basic Protein
|
found in eosinophil granules, used against parasites
|
|
|
Terminal deoxynucleotidyl transferase
|
adds nucleotides to V D and J regions
makrer of immature lymphocytes as seen in ALL mainly affect children |
|
|
Acyclovir v Herpesviruses
|
Guanosine Analogue
must be converted to acyclovir monophosphate by virally encoded Thymidine Kinase before being incorporated (rate limiting step) HSV-1 & VZV produce thymidine kinase EBV and CMV do not [some fnxality at extremely high concentrations] |
#pharmacology #microbiology #antimicrobials
|
|
Tartarate resistant Acid PHosphatase
|
Stain for Hairy Cell Leukemia
CD20+ B cell precursors splenomegaly, fatigue, pancytopenia |
|
|
Peroxidase Stain in Leukemia
|
detects Auer Rods
Stain for peroxidase inducative of AML t(15:17) Retinoic Acid Receptor α + Promylogenous Leukemia RARα-PML bone marrow repalcement produces anemia, thrombocytopenia and neutropenia |
|
|
platelet derived growth factor receptor mutations
|
Chronic myelomonocytic leukemia
|
|
|
Pure Red Cell Aplasia
Pathogenesis |
Parvovirus B19
or Thymoma |
#pathology #hematology #microbiology #noplasia
|
|
p27
|
protein cell cycle inhibitor which acts to inhibit cyclin depdent kinases from allowing G1-G2 crossing
|
|
|
Rb's job
|
binding E2F, the transciption factor necessary for G1 → S transition
Cyclin D, E and CDK4 and 6 hyperphosphyrlate Rb to relase EF2 |
|
|
Fnx of Nucleolus
|
Synthesis of rRNA
|
#biochemistry
|
|
Bacterial DNA polymerases
|
I: the only bacterial DNA polymerase with exonuclease activity
|
|
|
Cystic Fibrosis and Sweating
|
sweat is produced isotonic to plasma
it is the CFTR channels which reabsorb Chloride and Sodium. CF pts secrete high sodium high cloride sweat and thus experience hypovolemia |
|
|
relationship of λ, CL and Vd
|
λ = (Vd * 0.7)/CL
|
#pharmacology #pharmacokinetics
|
|
Azole antifungals & CYP450
|
CYP450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit Juice Isoniazid Ritonavir/Protease Inihbitors |
#pharmacology #pharmacodynamics
|
|
What part of the brain does Huntington's Damage and how
|
NMDA receptors bind gluatamate and cause NMA associated toxicity and neuronal death in the caudate nucleus and putamen
Chrom 4 Decreases ACh, GABA and Substantce P in caudate nucleus and putamen |
|
|
Ethnicity and Bone Mass
|
African American Women have better bone mass than Caucausian Women
Caucasian race assoc with ↓ bone mass |
|
|
Delta Nerve endings
|
Thing myelinated
Acute pain and temp, contribute to reflex withddrawal |
|
|
Grapefruit Juice & CYP450
|
CYP450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit Juice Isoniazid Ritonavir/Protease Inihbitors |
#pharmacology #pharmacodynamics
|
|
Pacinian corpuscels
|
rapidly adapting mechanoreceptors
like Ruffini's end organs(slowly adapating), mediate touch, proprioception and virbratory sensation myelinated A β fibers |
|
|
Ruffini's end organs
|
slowly adapting mechanoreceptors
like Pacinian (rapidly adapating), mediate touch, proprioception and virbratory sensation myelinated A β fibers |
|
|
Isoniazid & CYP450
|
CYP450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit Juice Isoniazid Ritonavir/Protease Inihbitors |
#pharmacology #pharmacodynamics
|
|
MAP Kinase Pathway
|
RTK autophosphorylation
SOS Ras GTPase Raf Kinase MAP Kinase Kinase MAP Kinase (Mitogen Activated Protein Kinase) enters nucleus and influences gene granscription |
|
|
Hemoglobin which does not bind 2,3-BPG
|
Fetal Hemoglobin
HbF 2α2γ Production begins around 2nd trimester Majority of Hb at time of birth Slowly drops off to zero by 6 mo Lack of interaction with 2,3 BPG accounts for stronger affinity for oxygen than maternal hemoglobin Charged Histidine in β subunit responsible for 2,3 BPG interaction |
|
|
Alcoholic excreting fat in feces
|
pancreatic insufficiency
|
|
|
Ritonavir & CYP450
|
CYP450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit Juice Isoniazid Ritonavir/Protease Inihbitors |
#pharmacology #pharmacodynamics
|
|
Azithromycin
|
Chalmydia
Mycoplasma H influenza Moraxella |
|
|
CYP450 inducers
|
CYP450 Inducers
Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin |
#pharmacology #pharmacodynamics
|
|
S-100
|
Neural Crest Derivative Marker
Schwannoma & Melanoma |
|
|
Intracranial mass with mixed areas: some densely cellular, some sporatically cellular
|
Antoni pattern of schwannoma
Antoni A Pattern is density Antoni B Pattern is sporatic S-100+ (also S-100+: melanoma) |
|
|
urinary trends in DKA
|
excess H+ excreted
Bicarbonate retained in exchange for Na+ titratable acids excreted H2PO4- and NH4+ |
|
|
CYP 450 inhibitors
|
CYP450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit Juice Isoniazid Ritonavir/Protease Inihbitors |
#pharmacology #pharmacodynamics
|
|
Male
Recurrent infections Induration vs Skin Challenge (TB, Candida, etc) |
Bruton's X linked agammaglobulinemia
B lymphocyte maturation defect [Induration = Fnx T cells] |
|
|
Carbamazepine & CYP450
|
CYP450 Inducers
Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin |
#pharmacology #pharmacodynamics
|
|
Tetrology of Fallot
|
VSD
Overriding Aorta Pulmonary Stenosis RV Hypertrophy Initially acts as a left to right shunt, but progressive increase in pulmonary hypertension leads to shunt reversal with increase in cyanotic sx releived by increasing systemic pressure (squatting) Problem is with abnormal migration of neural crest cells which form the aorticopulmonary septum may manifest cyanosis at birth |
|
|
Endocardial cushion defects
|
acyanotic left-too-right shunt → pulmonary hypertesnion → shunt reversal (Eisenmenger Sro) → cyanosis
will NOT manifest cyanosis at birth |
|
|
southwestern blot
|
identify and isolate proteins that bind to DNA
|
|
|
jun
|
DNA binding protein
proto-oncogene will show up via southwestern blot (DNA binding proteins) |
|
|
pigmented spots on trunk, headaches, ruberry cutaneous tumors
|
Neurofibromatosis Type 1
cafe-au-lait macules gliomas neurofibromas of Schwann Cells |
|
|
Phenobarbitol & CYP450
|
CYP450 Inducers
Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin |
#pharmacology #pharmacodynamics
|
|
Renal Failure: Calcium Status
|
no renal 1-α-hydroxylase → no 1,25-dihydroxy vitamin D → no gut Ca2+ absorption
↓ renal flow → ↑ phosphate retention → calcium binding ↓ serum [Ca2+] compensatory ↑ [PTH] 2° hyperparathyroidism |
|
|
Insulin & Glucagon
|
Insulin decreases Glucagon secretion
[Glucagon does not decrease Insulin Secretion--right?] |
|
|
What are the major factors affecting coronary blood flow
|
Coronary blood flow almost entirely controlled by local metabolites
almost no input from nervous system NO: arteries adenosine: arterioles |
|
|
Phenytoin & CYP450
|
CYP450 Inducers
Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin |
#pharmacology #pharmacodynamics
|
|
DOC: Tic Douloureaux
|
Carbamazepine
like phenytoin, inhibits Na+ channel recovery following discharge, inhibiting high frequency signalling may cause aplastic anemia powerful CYP450 inducer |
|
|
What is the major mechanism by which hormones/cytokines induce insulin resistance
|
TNFα, catecholamines, glucocorticoids and glucagons
all activate serine kinase which phosphorylates serine and threonine residues on insulin receptor normally insulin receptor RTK phosphorylates tyrosines phosphorylating serines/threonines inhibits phosphorylation of tyrosines and inhibits downstream signalling. |
|
|
Competant Bacteria
|
can uptake DNA for transformation
Strep pneumo H influenzae N meningitidis |
|
|
Rifampin & CYP450
|
CYP450 Inducers
Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin |
#pharmacology #pharmacodynamics
|
|
Acid Fast Stain
|
Analine dye (carbolfuscion)
Hydrochloric Acid (dissolves outer membranes) Counter stain: methylene blue Stains mycolic acid Mycoplasma: Acid Fast Nocardia: Weakly acid fast |
|
|
Griseofulvin & CYP450
|
CYP450 Inducers
Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin |
#pharmacology #pharmacodynamics
|
|
Oral Thrush, Interstitial Pneumonia, Severe Lymphopenia during first year of life
|
HIV+ maternal → fetal transmission
prevent with zidovudine nucleoside analogue RTI |
|
|
DOC: Serotonin Sro
|
Cyproheptadine
antihistamine with anti-serotonergic properties |
|
|
Cimetidine & CYP450
|
CYP450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit Juice Isoniazid Ritonavir/Protease Inihbitors |
#pharmacology #pharmacodynamics
|
|
Inheritence pattern of G6PD
|
X linked
|
|
|
Cirpofloxacin & CYP450
|
CYP450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit Juice Isoniazid Ritonavir/Protease Inihbitors |
#pharmacology #pharmacodynamics
|
|
Fx at hook of hamate: neurologic consequence?
|
Ulnar nerve injury
passes btw hook of hamate and pisiform bone in Guyon's fibroosseus tunnel Dysesthesias on ulnar side of hand and weakness of intrinsic mucles of the hand |
|
|
dysthesias on ulnar side of hand and weakness of intrinsic mucles of the hand
|
Fx at hook of hamate: Ulnar nerve injury
passes btw hook of hamate and pisiform bone in Guyon's fibroosseus tunnel |
|
|
Erythromycin & CYP450
|
CYP450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit Juice Isoniazid Ritonavir/Protease Inihbitors |
#pharmacology #pharmacodynamics
|
|
Fx at Radeal head:
neurologic consequence? |
radial nerve innervates muscles of the extensor compartment of the upper arm, passes through lateral epicondyle and divides into superficial and deep branches.
superficial branch: sensory innervation to dorsal half of hand, radial side. Damage to radial nerve injury at radial head (including subluxation) damages deep branch: wakenss of forarm extensors with wrist drop |
|
|
Radial nerve
|
radial nerve innervates muscles of the extensor compartment of the upper arm, passes through lateral epicondyle and divides into superficial and deep branches.
superficial branch: sensory innervation to dorsal half of hand, radial side. Damage to radial nerve injury at radial head (including subluxation) damages deep branch: wakenss of forarm extensors with wrist drop |
|
|
Aspirin Induced Kidney Damage
|
Chronic Interstital Nephritis
|
#pharmacology #toxicity #pathology #nephrology
|
|
Fx at the surgical neck of the humerus
|
axillary nerve damage
paralysis of deltoid and teres major muscles, loss of sensation to lateral upper arm |
|
|
paralysis of deltoid and teres major muscles, loss of sensation to lateral upper arm
Fx? |
surgical neck of humerus
|
|
|
Coracobrachialis
adjacent strx, innervation |
overlies median nerve and brachial artery
innervated by musculocutaneous nerve. |
|
|
Vitamin E deficiency
|
anti-oxidant which preserves cell membranes
most affected: neurons (large surface area) RBC's (poor antioxidant fnx) manifestation: Friederick's ataxia-like neuropathy w/ ataxi a & loss of proprioception and vibration + hemolytic anemia |
#pathology #nutrition #neurology #hematology
|
|
Hibernating Myocardium
|
repetitive ischemia of myocytes or persistent hypoperfusion → chronic but reversible loss of contractile fnx "hibernation"
Repetitive "stunning" (mild <30 min ischemic episodes) can result in hibernation |
|
|
Myocardial stunning
|
mild ischemia induced reversible loss of contractile function
Repetitive Stunning can lead to hibernation <30 min full recovery w/in days |
|
|
Compare Subclasses of Class I antiarrhytmics
|
1A (DQP)
prolonged QRS intermediate inhibition of phase 0 1B Shortened QRS Weak inhibition of Phase 0 1C ∅Δ QRS Strong inhibition phase zero |
#cardiovascular #pharmacology
|
|
Ischemic preconditioning
|
cardiac myocytes which develop resistence to infarction via non-lethal ischemia
sub-lethal ischemia protect myocardium vs later ischemic events |
|
|
Chronic reversible loss of cardiomyocyte contractile fnx
|
Hibernating myocardium
repetitive ischemia of myocytes or persistent hypoperfusion → chronic but reversible loss of contractile fnx "hibernation" Repetitive "stunning" (mild <30 min ischemic episodes) can result in hibernation |
|
|
Short term reversible loss of cardiomyocyte contractile fnx
|
Myocardial Stunning
mild ischemia induced reversible loss of contractile function Repetitive Stunning can lead to hibernation NB: ischemic preconditioning = cardiac myocytes which develop resistence to infarction via non-lethal ischemia sub-lethal ischemia protect myocardium vs later ischemic events |
|
|
Teardrop RBC's
|
indicative of myelofibrosis or metastatic cancer
RBC's which had had to squeeze through fibrous strands (not sliced like schistocytes) |
#hematology #pathology #diagnostics
|
|
Sequelae of sublethal ischemia on myocardium
|
ischemic preconditioning
cardiac myocytes which develop resistence to infarction via non-lethal ischemia sub-lethal ischemia protect myocardium vs later ischemic events |
|
|
Pantothenic Acid
|
actively transported into the cell and then ATP-dependently phosphorylated to become Coenzyme A
particularly important for first step of TCA cycle: binds with oxaloacetate to form citrate and then succinyl-CoA also important in the syntehsis of vitamin A, D, cholesterol, steroids, heme A, fatty acids, amino acids and proteins Deficiency rare, severley malnourished with "burning feet" paresthesias and GI distress |
|
|
Acanthrocytosis
|
indicative of abetalipoproteinemia
or liver dz no fat absorption (no vitamin E absorption) |
#hematology #pathology #diagnostics
|
|
Spur cells
|
extreme form of acanthrocytosis
or liver dz indicative of abetalipoproteinemia |
#hematology #pathology #diagnostics
|
|
Most common location of colon cancer
|
rectosigmoid colon
|
#pathology #neoplasia #gastrointestinal
|
|
anatomic landmarks of ureters to bladder
|
start retroperitoneally on top of psoas
pass under gonadal vasculature cross over the common or external illiac arteries (depending on laterality) stay laterl to internal ilac vessels and medial to gonadal vessels before entering uterosacral ligament and gaining access to bladder |
#anatomy #genitourinary
|
|
Helmet Cell
|
Schistocyte
ie mechanical trauma |
#hematology #pathology #diagnostics
|
|
Most Likely Outcomes:
Acute Hep B and C |
Hep B: Complete Resolution
Hep C: Chronic Stable Hepatitis |
#microbiology #hepatobiliary #pathology
|
|
Ki 67
|
protein expressed in S phase
maker for proliferation near 100% in cancers |
#pathology #neoplasia #molecules #diagnostics
|
|
Familial QT prolongation
|
predisposes to TdP
accompanied by neurosensory deafness |
#pathology #cardiovascular #neurology #geneticdzs
|
|
Familial Neurosensory Deafness
Likely Accompanying Condition? |
Familial QT prolongation
predisposes to TdP |
#pathology #cardiovascular #neurology #geneticdzs
|
|
Pathogenesis of aortic aneurysm
|
myxomatous changes in media of large arteries 2* gragementation of elastic ts
may be caused by marfan sro β-aminopropionitrile (sweat peas) inhibits lysyl oxidase which cross links elastin |
#pathology #cardiovascular
|
|
SERM: agonist in bones antagonist in breast and uterus
|
Raloxifene
|
#pharmacology #endocrine #neoplasia
|
|
Raloxifene
|
SERM: agonist in bones antagonist in breast and uterus
|
#pharmacology #endocrine #neoplasia
|
|
Uremia v. Hemostasis
|
only ↑ Bleeding Time
∅Δ platelet count just makes platelets non-fnx |
#pathology #henmatology #nephrology
|
|
azoospermia
|
not having measurable sperm in semen
think CF bilateral absence of vas deferens |
#pathology #reproductive #geneticdzs
|
|
bilateral absence of vas deferens
|
CF
|
#pathology #reproductive #geneticdzs
|
|
Cutoff for Sweat Chloride Test
|
above 60 mM/L is diagnostic
|
#pathology #geneticdzs #diagnostics
|
|
Thiazide Diuretics
and Serum Constituents |
Causes Hyper
-Uricemia, Calcemia, Glycemia, Lipidemia "GLUC" Hypo Kalmia & Tension |
#pharmacology #toxicity
|
|
Heart Abnormality of DiGeorge Sro
|
Tetrology of Fallot
|
#pathology #cardiovascular #geneticdzs
|
|
Heart Abnormality of Down Sro
|
Endocardial Cushion Defects:
--ASD --Regurgitant AV vales |
#pathology #cardiovascular #geneticdzs
|
|
ApoA
Lipoproteins Fnx Dysfnx manifestation |
ApoA1
Present on Chylomicrons and HDL's (not Chylomycron Remants interestingly) LCAT activation induces cholesterol esterification Dysnfx: not a clinical entity |
#biochemistry #energymetzm #lipids
|
|
Apolipoprotein: LCAT Activation
Lipoproteins, Dysnfx |
ApoA1
Present on Chylomicrons and HDL's (not Chylomycron Remants interestingly) LCAT activation induces cholesterol esterification Dysnfx: not a clinical entity |
#biochemistry #energymetzm
|
|
ApoB-48
Lipoproteins Fnx Dysfnx manifestation |
ApoB-48
Present on Chylomicrons and CM Remnants Fnx: Chylomicron assembly and secretion by small intestine Dysnfx: not a clinical entity |
#biochemistry #energymetzm
|
|
Apolipoprotein: Chylomicron assembly and secretion
Lipoproteins, Dysnfx |
ApoB-48
Present on Chylomicrons and CM Remnants Fnx: Chylomicron assembly and secretion by small intestine Dysnfx: not a clinical entity |
#biochemistry #energymetzm
|
|
ApoB-100
Lipoproteins Fnx Dysfnx manifestation |
ApoB-100
Present on VLDL, IDL and LDL Binds LDL receptor Dysnfx: inherited overexpression = Type 2b combined familial hyperlipidemia HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL] ∅xanthoma ✓ ↑ CVD Risk Tx: aggressive lifestyle modification + Rx's |
#biochemistry #energymetzm
|
|
Apolipoprotein which binds LDL receptor
Lipoproteins, Dysnfx |
ApoB-100
Present on VLDL, IDL and LDL Binds LDL receptor Dysnfx: inherited overexpression = Type 2b combined familial hyperlipidemia HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL] ∅xanthoma ✓ ↑ CVD Risk Tx: aggressive lifestyle modification + Rx's |
#biochemistry #energymetzm
|
|
HyperTAGemia + Hypercholesterolemia c ↑ LDL & VLDL
|
ApoB-100
Present on VLDL, IDL and LDL Binds LDL receptor Dysnfx: inherited overexpression = Type 2b combined familial hyperlipidemia HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL] ∅xanthoma ✓ ↑ CVD Risk Tx: aggressive lifestyle modification + Rx's |
#biochemistry #energymetzm
|
|
ApoC-II
Lipoproteins Fnx Dysnfx |
ApoC-II: Lipoprotein lipase activation
Lipoproteins: HDL, CM, VLDL Dysnfx: Type I Familial Chylomicronemia --identical to LPL deficiency Isolated HyperTAGemia c ↑ CM & Normal VLDL Xanthoma, Pancreatitis, Hepatosplenomegaly Presentation: Abdominal Pain 2° Acute Pancreatitis NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol) |
#biochemistry #energymetzm
|
|
Apolipoprotein:
Activates Lipoprotein Lipase Lipoproteins Dysnfx |
ApoC-II: Lipoprotein lipase activation
Lipoproteins: HDL, CM, VLDL Dysnfx: Type I Familial Chylomicronemia --identical to LPL deficiency Isolated HyperTAGemia c ↑ CM & Normal VLDL Xanthoma, Pancreatitis, Hepatosplenomegaly Presentation: Abdominal Pain 2° Acute Pancreatitis NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol) |
#biochemistry #energymetzm
|
|
Isolated HyperTAGemia c ↑ CM & Normal VLDL
|
ApoC-II: Lipoprotein lipase activation
Lipoproteins: HDL, CM, VLDL Dysnfx: Type I Familial Chylomicronemia --identical to LPL deficiency Isolated HyperTAGemia c ↑ CM & Normal VLDL Xanthoma, Pancreatitis, Hepatosplenomegaly Presentation: Abdominal Pain 2° Acute Pancreatitis NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol) |
#biochemistry #energymetzm
|
|
Type I Familial Chylomicronemia
|
ApoC-II: Lipoprotein lipase activation
Lipoproteins: HDL, CM, VLDL Dysnfx: Type I Familial Chylomicronemia --identical to LPL deficiency Isolated HyperTAGemia c ↑ CM & Normal VLDL Xanthoma, Pancreatitis, Hepatosplenomegaly Presentation: Abdominal Pain 2° Acute Pancreatitis NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol) |
#biochemistry #energymetzm
|
|
Type 2b combined familial hyperlipidemia
|
ApoB-100
Present on VLDL, IDL and LDL Binds LDL receptor Dysnfx: inherited overexpression = Type 2 combined familial hyperlipidemia HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL] ∅xanthoma ✓ ↑ CVD Risk Tx: aggressive lifestyle modification + Rx's |
#biochemistry #energymetzm
|
|
ApoE (3 & 4)
Lipoproteins Fnx Dysnfx |
ApoE3 & ApoE4
CM CMR, VLDL, IDL (not LDL or HDL) VLDL and Chylomicron remnant uptake by liver cells Dysnfx: Type III Hyperlipidemia Dysbetalipoproteinemia mostly manifests as poor clearance of IDL Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL Xanthoma and ↑ RIsk CVD |
#biochemistry #energymetzm
|
|
Apolipoprotein: Hepatic Remanant Clearance
Lipoproteins, Dyfnx |
ApoE3 & ApoE4
CM CMR, VLDL, IDL (not LDL or HDL) VLDL and Chylomicron remnant uptake by liver cells Dysnfx: Type III Hyperlipidemia Dysbetalipoproteinemia mostly manifests as poor clearance of IDL Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL Xanthoma and ↑ RIsk CVD |
#biochemistry #energymetzm
|
|
Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL
|
ApoE3 & ApoE4
CM CMR, VLDL, IDL (not LDL or HDL) VLDL and Chylomicron remnant uptake by liver cells Dysnfx: Type III Hyperlipidemia Dysbetalipoproteinemia mostly manifests as poor clearance of IDL Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL Xanthoma and ↑ RIsk CVD |
#biochemistry #energymetzm
|
|
Type III Hyperlipidemia Dysbetalipoproteinemia
|
ApoE3 & ApoE4
CM CMR, VLDL, IDL (not LDL or HDL) VLDL and Chylomicron remnant uptake by liver cells Dysnfx: Type III Hyperlipidemia Dysbetalipoproteinemia mostly manifests as poor clearance of IDL Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL Xanthoma and ↑ RIsk CVD |
#biochemistry #energymetzm
|
|
Isolated Hypercholesterolemia c ↑ LDL
|
Type IIa Familial Hypercholesterolemia
Isolated Hypercholesterolemia c ↑ LDL Deficiency of LDL receptor Xanthomas, Corneal Arcus, ↑ Risk CVD |
#biochemistry #energymetzm
|
|
Corneal Arcus
|
Type IIa Familial Hypercholesterolemia
Isolated Hypercholesterolemia c ↑ LDL Deficiency of LDL receptor Xanthomas, Corneal Arcus, ↑ Risk CVD |
#biochemistry #energymetzm
|
|
Deficiency of LDL receptor
|
Type IIa Familial Hypercholesterolemia
Isolated Hypercholesterolemia c ↑ LDL Deficiency of LDL receptor Xanthomas, Corneal Arcus, ↑ Risk CVD |
#biochemistry #energymetzm
|
|
Type IIa Familial Hypercholesterolemia
|
Type IIa Familial Hypercholesterolemia
Isolated Hypercholesterolemia c ↑ LDL Deficiency of LDL receptor Xanthomas, Corneal Arcus, ↑ Risk CVD |
#biochemistry #energymetzm
|
|
Isolated Hypertagemia c ↑ VLDL
|
Type IV Familial HyperTAGemia
Isolated Hypertagemia c ↑ VLDL VLDL over-expression ↑ Risk of CVD |
#biochemistry #energymetzm
|
|
VLDL overexpression
|
Type IV Familial HyperTAGemia
Isolated Hypertagemia c ↑ VLDL VLDL over-expression ↑ Risk of CVD |
#biochemistry #energymetzm
|
|
LPL deficiency
|
ApoC-II: Lipoprotein lipase activation
Lipoproteins: HDL, CM, VLDL Dysnfx: Type I Familial Chylomicronemia --identical to LPL deficiency Isolated HyperTAGemia c ↑ CM & Normal VLDL Xanthoma, Pancreatitis, Hepatosplenomegaly NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol) |
#biochemistry #energymetzm
|
|
Type IV Familial HyperTAGemia
|
Type IV Familial HyperTAGemia
Isolated Hypertagemia c ↑ VLDL VLDL over-expression ↑ Risk of CVD |
#biochemistry #energymetzm
|
|
Tubular Xanthomas
|
aka Tendinous Xanthomas
the hallmark of type 2a familial hypercholesterolemia Type IIa Familial Hypercholesterolemia Isolated ↑ LDL 2° to LDL receptor deficiency Xanthomas, Corneal Arcus, ↑ Risk CVD Type 2 B ApoB-100 (binds LDL receptor) overexpression = HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL] ∅xanthoma, ✓ ↑ CVD Risk Tx: aggressive lifestyle modification + Rx's |
#biochemistry #energymetzm
|
|
Tendinous Xanthomas
|
aka Tuberous Xanthomas
the hallmark of type 2a familial hypercholesterolemia Type IIa Familial Hypercholesterolemia Isolated ↑ LDL 2° to LDL receptor deficiency Xanthomas, Corneal Arcus, ↑ Risk CVD Type 2 B ApoB-100 (binds LDL receptor) overexpression = HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL] ∅xanthoma, ✓ ↑ CVD Risk Tx: aggressive lifestyle modification + Rx's |
#biochemistry #energymetzm
|
|
What should you monitor when giving Lithium?
|
T3 and T4
|
#pharmacology #toxicities
|
|
What should you monitor when giving Amiodarone?
|
PFT's: Pulmonary Fibrosis
LFT's TFTs |
#pharmacology #toxicities
|
|
What should you monitor when giving INH?
|
LFT's
|
#pharmacology #toxicities
|
|
What should you monitor when giving Carbamazapine?
|
LFT's
|
#pharmacology #toxicities
|
|
For what drugs should you monitor thyroid hormone levels?
|
Lithium
Amiodarone (LFT, PFT, TFTs) |
#pharmacology #toxicities
|
|
For what drugs should you vigilently monitor LFT's?
|
INH
Carbamazapine Amiodarone (LFT, PFT, TFTs) |
#pharmacology #toxicities
|
|
Which heart chamber is closest to the esophagus?
|
left atrium makes up the majority of heart's posterior surface
RA makes up the right border of X-ray LV makes up the left border and paex RV is the front of the heart and inferior border on X ray |
#anatomy #cardiovascular
|
|
Why doesn't blood flow back into lungs during atrial systole?
|
cardiac muscle in proximal few cm of pulmonary veins fnx like sphincters
|
#phsyiology #cardiovascular
|
|
5' 3'
3' 5' which way does DNA polymerize? |
DNA adds onto the 3' end
the 3' end is out front and then the next piece clips a 5' onto that 5' → 3' |
#biochemistry #DNA
|
|
3' 5'
5' 3' which way does DNA polymerize? |
DNA adds onto the 3' end
the 3' end is out front and then the next piece clips a 5' onto that 5' → 3' |
#biochemistry #DNA
|
|
bisphosphoglycerate mutase
|
bisphosphoglycerate mutase
present only in RBC's & Placenta alternative glycolytic pathway which produces no ATP BPG mutase: 1,3 BPG → 2,3 BPG Phosphatase: 2,3 BPG → 3 Phosphoglycerate Bypasses one step by Phosphoglycerate kinase which would have produced ATP 2,3 BPG allosterically induces a right shift → O2 dumping [I guess BPG mutase fnx is upregulated by hypoxia] |
#biochemistry #hemoglobin #molecules #energymetzm
|
|
1,3 BPG → 2,3 BPG
|
bisphosphoglycerate mutase
present only in RBC's & Placenta alternative glycolytic pathway which produces no ATP BPG mutase: 1,3 BPG → 2,3 BPG Phosphatase: 2,3 BPG → 3 Phosphoglycerate Bypasses one step by Phosphoglycerate kinase which would have produced ATP 2,3 BPG allosterically induces a right shift → O2 dumping |
#biochemistry #hemoglobin #molecules #energymetzm
|
|
2,3-bisphosphoglycerate
|
bisphosphoglycerate mutase
present only in RBC's & Placenta alternative glycolytic pathway which produces no ATP BPG mutase: 1,3 BPG → 2,3 BPG Phosphatase: 2,3 BPG → 3 Phosphoglycerate Bypasses one step by Phosphoglycerate kinase which would have produced ATP 2,3 BPG allosterically induces a right shift → O2 dumping |
#biochemistry #hemoglobin #molecules #energymetzm
|
|
Factors which induce K+ secretion in the proximal tubule
|
Dietary K
Aldosterone Alkalosis K non sparing diuretics. |
#physiology #nephrology
|
|
CD55
|
Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal Constant w/ ↑ visualization in first urine of day mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment CD55 & 59 important to inactivate complement a disorder of the stem cells → pancytopenia chronic hemolysis → recurrent venous thromboses >>deficiency of CD55 and CD59 diagnostic of PNH<< |
#pathology #hematology
|
|
Paroxysmal Nocturnal Hemoglobinuria
|
Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal Constant w/ ↑ visualization in first urine of day mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment CD55 & 59 important to inactivate complement a disorder of the stem cells → pancytopenia chronic hemolysis → recurrent venous thromboses >>deficiency of CD55 and CD59 diagnostic of PNH<< |
#pathology #hematology
|
|
CD59
|
Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal Constant w/ ↑ visualization in first urine of day mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment CD55 & 59 important to inactivate complement a disorder of the stem cells → pancytopenia chronic hemolysis → recurrent venous thromboses >>deficiency of CD55 and CD59 diagnostic of PNH<< |
#pathology #hematology
|
|
Mycoplasma v Mycobacterium
Species, DOC's |
Mycobacterium: tuberculosis, leprosy, M avium
Mycolic acid cell wall: acid fast INH (B6 analogue) inhibits mycolic acid synth Mycoplasma: M pneumo & ureaplasma urealyticam single cell membrane composed of cholesterol containing pospholipid bilayer DOC: erythromycin or tetracycline |
#microbiology #antimicrobials #pharmacology
|
|
ACEI's → ↑ Cr
|
Slight ↑ Cr physiologic 2° to ↓ Renal Filtration
(relaxed efferent arteriole) |
#pharmacology #toxicities #nephrology
|
|
Renal damage from heroine
|
focal segmental glomeruloscelrosis
same as pamidronate |
#pharmacology #toxicities #nephrology
|
|
Renal damage from pramidronate
|
focal segmental glomeruloscelrosis
same as heroin |
#pharmacology #toxicities #nephrology
|
|
Renal damage from Gold
|
membranous nephropathy
|
#pharmacology #toxicities #nephrology
|
|
Renal damage from Sulfonamides
|
precipitation in renal tubules → failure
sulfonamides, MTX, acyclovir, triamterene |
#pharmacology #toxicities #nephrology
|
|
Acid-Base State of Pulmonary Ebolus Pt
|
Respiratory Alkalosis
PE → V/Q mismatch → hypoxia → hyperventilation → ↓ pCO2 |
#pathology #pulmonology
|
|
Renal damage from MTX
|
precipitation in renal tubules → failure
sulfonamides, MTX, acyclovir, triamterene |
#pharmacology #toxicities #nephrology
|
|
Renal damage from acyclovir
|
precipitation in renal tubules → failure
sulfonamides, MTX, acyclovir, triamterene |
#pharmacology #toxicities #nephrology
|
|
What Amino Acid is essential in PKU
|
Tyrosine
|
#biochemistry #pathology
|
|
Crescenteric Glomerulonephritis:
what could you stain for? |
Monocytes, M∅& fibrin
as it progresses ↑ sclerosis: mroe and mroe fibrin if and only if goodpasture IgG & C3 |
#pathology #diagnostics #nephrology
|
|
Renal damage from triamterene
|
precipitation in renal tubules → failure
sulfonamides, MTX, acyclovir, triamterene |
#pharmacology #toxicities #nephrology
|
|
Renal damage from foscarnet
|
drug induced tubular necrosis
aminoglycosides, radiocontrast media, cisplatin, amphotericin B, foscarnet |
#pharmacology #toxicities #nephrology
|
|
Varicose Veins: most problematic complication
|
skin
thrombi do occur, but no thromboemboli all PE's from deep veins of leg (sic: DVT) varicosities occur in superficial veins |
#cardiovascular #pathology
|
|
Mechanism of Action: NO
|
primarily a venodilator
↓ preload → ↓ cardiac O2 demand large doses can affect arterioles → HA, flushing |
#pharmacology #cardiovascular
|
|
phlegmaisa alba dolens
|
painful white leg
ilofemoral venous thrombosis which occurs in peripartum women 2° uterus pressure on deep pevic veins + hypercoagulaable state non-ischemic state if superficial flow lost also "Phlegmasia cerulea dolens"→ ischemia & gangrene |
#reproductive #pathology #cardiovascular
|
|
Flunisolide
|
inhaled glucocorticoid
prophylaxis vs bronchial asthma DOC vs bronchial asthma for anti-inflam effects |
#pharmacology #pulmonology
|
|
Regulation: precapillary sphincters
|
pericytes
location dpt response to NE & E dilate irt histamine, ↓ O2, ↑ CO2, ↓ pH |
#physiology #cardiovascular
|
|
Palpable But Non-Tender Gallbladder
|
Courvoisier Sign
indicative of adenocarcinoma of head of pancreas compressing bile duct Biggest environmental contributor: smoking |
#pathology #gastrointestinal
#neoplasia |
|
Theophylline
|
Methylxanthines: theophylline & aminophylline
phosphodiesterase inhibitor, increases [cAMP] → bronchodilation also block adensoine receptors |
#pharmacology #pulmonology
|
|
aminophylline
|
Methylxanthines: theophylline & aminophylline
phosphodiesterase inhibitor, increases [cAMP] → bronchodilation also block adensoine receptors |
#pharmacology #pulmonology
|
|
Low Fiber Diet v CA
|
Colonic Adenocarcinoma
|
#pathology #gastrointestinal #neoplasia |
|
"Starry Sky" Lymphoma
|
Burkitt's Lymphoma
appearance from M∅ &apoptotic bodies almost all assoc. w/ c-MYC translocations on chrom 8 usually w/ Ig on 14 t(18;14) |
#pathology #neoplasia #hematology
|
|
Phosphodiesterase Inhibitors vs Asthma
|
Methylxanthines: theophylline & aminophylline
phosphodiesterase inhibitor, increases [cAMP] → bronchodilation also block adensoine receptors |
#pharmacology #pulmonology
|
|
Most common cause of asthma
|
inhaled allergens like animal dander >> other stuff like cold air & exercise
|
#pathology #pulmonology
|
|
What does intracellular [citrate] affect?
|
↑ Acetyl CoA carboxylase (FA synth)
↓ Posphofructokinase 1 (Glycolysis) |
#bicohemistry #energymetzm
|
|
DOC: Mac
|
clarithormycin or azithromycin + others
|
#antimicrobials #pharmacology #microbiology
|
|
To where is blastomyces native
|
Mississippi River & Great Lakes regions
|
#microbiology
|
|
DOC: kaospi's sarcoma
|
IFN α (roferon)
|
#antimicrobials #pharmacology #microbiology
|
|
Flecainide
|
IC antiarrhytmic
blocks sodium channels and primarily acts by slowing phase 0 depolarization no effect on duration of QT contrast to IA: Qunidine, Procainimide, Disopyramide blocks K channels ↑ QT IB: Lidocaine, Mixiletine, Tocainide shortens QT by ↓ Funny Current (Background Na) |
#drugs #cardiology #pharmacology
|
|
DOC: Pneumocystis pneumonia
|
pentamidine
also for tyrpanosoma brucei |
#antimicrobials #pharmacology #microbiology
|
|
Dofetilide
|
Class III antiarrhthmic
blocks K⁺ channels dofetilide, ibutilide, amiodarone, sotalol |
#drugs #cardiology #pharmacology
|
|
Ibutilide
|
Class III antiarrhthmic
blocks K⁺ channels dofetilide, ibutilide, amiodarone, sotalol |
#drugs #cardiology #pharmacology
|
|
pentamidine
|
DOC: Pneumocystis pneumonia & Tyrpanosoma brucei
[unknown mech] |
#antimicrobials #pharmacology #microbiology
|
|
Major causes of Hepatocellular Carcinoma
|
Hep B, Hep C, Chronic EtOH, Afloatoxins
|
#pathology #neoplasia #hepatobiliary
|
|
Mutations in the HIV genome which enhance its virulence/survival
|
pol genes: resistance to HIV reverse transcriptase inhibitors & other antiretroviral drugs (reverse transcriptase inhibitor)
env: escape host neurtalizing antibodies (codes glycoproteins) |
#microbiology #resistance
|
|
Ticlopidine
|
Ticlopidine
ADP antagonist like Clopidogrel 2nd line drug for pts who are allergic to clopidogrel serious side effects: neutropenia → fever & mouth ulcers |
#pharmacology #cardiovascular #toxicities
|
|
Why inverted nipple w/ breast ca?
|
suspensory ligament infiltration
|
#pathology #diagnostics #reproductive #neoplasia
|
|
Best Diagnostic Test for Distended, Tympanic Abdomen
|
Potential Toxic Megacolon
Flat Plain X Ray Anything that invades (scope, enema) may induce perforation |
#pathology #diagnostics #gastrointestinal
|
|
Pt on Rx after TIA dvlps fever & oral ulcers
|
Ticlopidine
ADP antagonist like Clopidogrel 2nd line drug for pts who are allergic to clopidogrel serious side effects: neutropenia → fever & mouth ulcers |
#pharmacology #cardiovascular #toxicities
|
|
Most cardioselective calcium channel blocker
|
Verapamil
|
#cardiovascular #pharmacology
|
|
Pt cannot clear Giardia infx
|
IgA deficiency
|
#microbiology #immunology #gastrointestinal
|
|
anti-arrhythmic which ↑ PR & QT intervals
|
Sotalol
Class II: β1 blockade ↑ PR Class III: K+ blockade ↑ QR uniquely so |
#pharmacology #cardiovascular
|
|
Where are ulcers not likely to be malignant
|
Vast Majority of Ulcers Duodenal
Even when H pylori induced, not likely malignant Esewhere assoc. w/ malignancy Stomach: adenocarcinoma, maltoma Esophagus: adenocarcinoam Colon: annular "napkin rings" or UC (still ↑ risk) |
#neoplasia #pathology #gastrointestinal
|
|
Hydrocephalus, Intracranial Calcifications, Chorioretinitis
|
Classic Traid of Congenital Toxoplasmosis
1st exposed when pregnant |
#pathology #neonatology #microbiology
|
|
Layers of the Gastric Mucosa
|
Surface: simple columnar epithelium which secretes mucus to protect lining
Gastric Pits short things Midway down Gastric PIts: parietal Cells: HCl & Intrinsic Factor Botton of the PIts: Cheif Cells: Pepsinogen |
#physiology #gastrointestinal
|
|
Congential Toxoplasmosis
|
Classic Triad:
Hydrocephalus Intracranial Calcifications Chorioretinitis 1st exposed when pregnant |
#pathology #neonatology #microbiology
|
|
Neurophysiology of Urination
|
Sacrial mMicturation center S2-4
Pontine center: coordinates sphincter relaxn Cerebral corteex: inhibits sacral center normal pressure hydrocephalus (elderly) ↑ ventricular area stretches descending cortical fibers → urinary incontenence |
#neurology #physiology
|
|
Pt presents with bruised looking eyes and grey scaling papules on extensor surfaces of hands
|
Dermatomyositis
↑ CK, ↑ aldolase, muscle weakness Heliotrope Rash: bruised looking eyes Grotton's Papules: grey scaling papules on extensor surfaces of hands Path: CD8 vs myofibers Dx: perifasicular atrophy on muscle biopsy positive ANA, anti-Jo-1 Similar to Polymyositis (∅ Grotton/Heliotrope, ✓ shoulders) |
#pathology #rheumatology
|
|
Urinary incontenence of demention: pathophysiology
|
Sacrial mMicturation center S2-4
Pontine center: coordinates sphincter relaxn Cerebral corteex: inhibits sacral center normal pressure hydrocephalus (elderly) ↑ ventricular area stretches descending cortical fibers → urinary incontenence |
#neurology #pathology
|
|
anti-Jo-1
|
Dermatomyositis or Polymyositis
Path: CD8 vs myofibers Findings: ↑ CK, ↑ aldolase, muscle weakness positive ANA, anti-Jo-1 Dermatomyositis Heliotrope Rash: bruised looking eyes Grotton's Papules: grey scaling papules on extensor surfaces of hands Dx: perifasicular atrophy on muscle biopsy Polymyositis ∅ Grotton/Heliotrope/perifasicular atrophy Mostly affects shoulders |
#pathology #rheumatology
|
|
Size cutoff:
mucociliary elevator vs M∅ |
>2.5 mucociliary elevator
≤2mm Alveolar M∅ [Pneumoconiosis = interstital lung fibrosis 2° to M∅ stimulation & growth factor prodxn] |
#physiology #pulmonology
|
|
perifasicular atrophy on muscle biopsy
|
Dermatomyositis
Heliotrope Rash: bruised looking eyes Grotton's Papules: grey scaling papules on extensor surfaces of hands Path: CD8 vs myofibers Findings: ↑ CK, ↑ aldolase, muscle weakness positive ANA, anti-Jo-1 Dx: perifasicular atrophy on muscle biopsy Similar to Polymyositis (∅ Grotton/Heliotrope/perifasicular atrophy, ✓ shoulders) |
#pathology #rheumatology
|
|
Primary biliary cirrhosis: primary pathology
|
antimitochondrial antibody
|
#pathology #hepatobiliary
|
|
Dermatomyositis
|
Dermatomyositis
Heliotrope Rash: bruised looking eyes Grotton's Papules: grey scaling papules on extensor surfaces of hands Path: CD8 vs myofibers Findings: ↑ CK, ↑ aldolase, muscle weakness positive ANA, anti-Jo-1 Dx: perifasicular atrophy on muscle biopsy Similar to Polymyositis (∅ Grotton/Heliotrope/perifasicular atrophy, ✓ shoulders) |
#pathology #rheumatology
|
|
serum marker of chronic alcoholism
|
elevated gamma glutamylthransferase (GGT)
NB: the whole ALT/AST > 2:1 thing is for alcoholic hepatitis, not chronic alcoholism |
#pathology #diagnostics
|
|
Coronary Steal Effect
|
Vessels in Ischemic Regions are often maximally dilated
addition of adenosine and dipyridamole (coronary-selective vasodilators) may dilate surrounding vessels and divert flow away from ischemic areas. |
#pharmacology #cardiovascular #toxicity
|
|
Polymyositis
|
progresssive symmetrix proximal muslce weakness
Path: CD8 vs myofibers Endomysial Inflammatory Infiltration Findings: ↑ CK, ↑ aldolase, muscle weakness most often involves shoulders Similar to Dermatomyositis (∅ shoulders, ✓ Grotton/Heliotrope/perifasicular atrophy) |
#pathology #rheumatology
|
|
dipyridamole
|
a coronary-selective vasodilator like adenosine
also inhibits thromboxane synthesis and prevents platelet thrombus formation |
#pharmacology #cardiovascular
|
|
progressive weakness of proximal shoulder muscles
↑ CK aldolase |
progresssive symmetrix proximal muslce weakness
Path: CD8 vs myofibers Findings: ↑ CK, ↑ aldolase, muscle weakness most often involves shoulders Similar to Dermatomyositis (∅ shoulders, ✓ Grotton/Heliotrope/perifasicular atrophy) |
#pathology #rheumatology
|
|
Polymyalgia Rheumatica
|
Pain and stiffness of axillary muscles w/o weakness
>50yo, occurs in 1/2 of pts w/ temporal arteritis ↑ ESR, normal CK Tx: prednisone |
#pathology #rheumatology
|
|
Pulmonary perfusion
|
Left and Right Bronchial Arteries arise from Descending Aorta.
These perfuse the areas which would not be perfused by simple flow of pulmonary arteries. Majority drains into the Right atrium → RA blood is less oxygenated than blood from pulmonary veins. |
#physiology #anatomy #pulmonology
|
|
DOC: Listeria
|
Ampicillin
(& Aminoglycosides) |
#microbiology #antimicrobials #pharmacology
|
|
elderly pt with stiffness & pain in neck, pelvis, shoulders
|
Polymyalgia Rheumatica
Pain and stiffness of axillary muscles w/o weakness >50yo, occurs in 1/2 of pts w/ temporal arteritis ↑ ESR, normal CK Tx: prednisone |
#pathology #rheumatology
|
|
Emperical Treatment for Meningitis
|
Ceftriaxone + Ampicillin
Ceftriaxone: -Neisseria -Strep pneumo -Strep pyo -H influenzae Ampicillin -Listeria Monocytogenes |
#microbiology #antimicrobials #pharmacology
|
|
Fibromyalgia
|
Diffuse muscle Pain
Pinpoints Insomnia Δ emotional |
#pathology #rheumatology
|
|
Distinguishing causes of metabolic alkalosis
|
Urine Chloride + Volume Status
1. "Saline Responsive" 2° to loss of Gastric Contents (vomitting) + volume contraxn → maintain HCO3 to retain volume ↓ Urine Chloride, Volume Depleted Tx: Normal Saline 2. "Contraction Alkalosis" Diuretic → Na delivered to distal collecting duct → Na/H+ antiporter ↑ Urine Chloride, Volume Depleted 3. "Saline Resistant" Conn Sro or Mineralcorticoid Excess: Aldosterone upregulates Na/H+ antiporter ↑ Urine Chloride, Hypervolemic |
#pathology #nephrology #diagnostics
|
|
The initial lesion of atherosclerosis
|
Intimal Streak
NB: not intimal tear this is the initial lesion of dissecting aortic aneurysm |
#pathology #cardiovascular
|
|
Pathogenesis of Aortic Aneurysms
|
Atherosclerotic Atheroma: wall swells with fat until it is too weak to handle the pressure
Initial Lesion is Intimal Streak NB: not intimal tear this is the initial lesion of dissecting aortic aneurysm |
#pathology #cardiovascular
|
|
Vaccine from recombinant outer surface protein
|
Borrelia burgdorferi
|
#microbiology #vaccines
|
|
46XY neonate with functional gonads but female genitals
|
5α reductase deficiency
No DHT may only present as small phallus/hypospadias |
#pathology #neonatal #urgoenital
|
|
Brief uncontrollable jerky movements which occur episodically
|
Myoclonic Seizures
DOC: Valproate |
#neurology #pharmacology
|
|
46XY neonate with functional gonads but small phallus and hypospadias
|
5α reductase deficiency
No DHT may present as female at birth will masculinize at puberty |
#pathology #neonatal #urgoenital
|
|
DOC: Tourettes
|
Haloperidol
|
#neurology #pharmacology
|
|
Pulmonary infarction:
what kind of necrosis? |
almost always hemorrhagic thanks to dual blood supply (pulmonary and bronchial arteries)
|
#pathology #pulmonology
|
|
Drug using population:
what organisms cause endocarditis |
1. Staph aureus
2. Pseudomonas aeruginosa NB: Tricuspid endocarditis, septic emboli to lungs → hemorrhagic necrosis |
#microbiology #pulmonology
|
|
Attachment Molecule for CMV
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Attachment Molecule for EBV
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Attachment Molecule for HIV
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Attachment Molecule for Rabies
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Attachment Molecule for Rhinovirus
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Virus Which attaches to Cellular Integrins
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Virus Which attaches to CD21
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Virus Which attaches to DR2
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Virus Which attaches to ICAM1
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Virus Which attaches to CD54
|
CMV: Cellular Integrins
EBV: DR2 (CD21) HIV: CD4, CXCR4 & CXCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM1 (CD54) |
#microbiology
|
|
Basement Membrane Splitting
|
Alport Sro: Deafness, Ocular Problems
or Membranoproliferative Glomerulonephritis type 1 granular IF, mesangial proliferation on LM |
#nephrology #pathology
|
|
Octreotide
|
Somatostatin analogue
|
#pharmacology #drugs
|
|
Inferior wall STEMI
which artery? |
Right Coronary Artery
Sinus Bradycardia |
#cardiovascular #pathology #diagnostics
|
|
Anterior Wall STEMI
which artery? |
Left Anterior Descending
also supplies interventricular septum Mobitz Type 2, 2° or 3° possible |
#cardiovascular #pathology #diagnostics
|
|
Left Lateral Wall STEMI
Which artery |
Left Circumflex
|
#cardiovascular #pathology #diagnostics
|
|
Right Coronary Artery Ischemia: EKG Findings
|
Inferior wall MI
Sinus bradycardia |
#cardiovascular #pathology #diagnostics
|
|
Left Anterior Descending Ischemia: EKG Findings
|
Anterior Wall MI
also supplies interventricular septum: Mobitz Type 2, 2° or 3° possible |
#cardiovascular #pathology #diagnostics
|
|
Left Circumflex Artery Ischemia: EKG Findings
|
Left Lateral Wall MI
|
#cardiovascular #pathology #diagnostics
|
|
High Arginine Levels
What Enzyme Deficiency? |
arginase
progressive spastic paralysis releived by arginine free diet |
#biochemistry #energymetzm
|
|
Atrial Myxoma
|
pedunculated gelatenous masses
scattered cells w/in mucopolysaccharide stroma large amts of VEGF and IL6 produced → intrapeduncular hemorrhaging → constitutional sx either embolize or obstruct valves dyspnea improves lying down most common cardiac neoplasm |
#pathology #cardiology #neoplasia
|
|
systemic inflammatory response, mid-diastolic murmur at apex, dyspnea which improves when supine
|
pedunculated gelatenous masses
scattered cells w/in mucopolysaccharide stroma large amts of VEGF and IL6 produced → intrapeduncular hemorrhaging → constitutional sx either embolize or obstruct valves dyspnea improves lying down most common cardiac neoplasm |
#pathology #cardiology #neoplasia
|
|
Dysphagia 2° to Cardiac Hypertrophy,
which chamber? causes? |
Left Atrium
mitral stensosis or ↑ Left Ventricular Pressure |
#cardiology #pathology
|
|
Preventhing Calcium renal stones without diuretics
|
1. Increase Fluid intake (& thus outgo)
2. Citrate (eg in the form of Potassium Citrate) will bind calcium and prevent it from precipitating with oxalate or phosphate 3. Preventing ↓ pH |
#pathology #nephrology
|
|
Hyperthyroidism with Pain in Neck following Flu like Sx
|
de Quervain's subacute thyroiditis
Granulomatous Inflammation Early stages = Hyperthyroidism --release of stored hormones from local destrx ↑ ESR, Jaw Pain, Tender Thyroid Progresses to Hypothyroidism usually make complete recovery in months NB: no antithyroid peroxidase Ab |
#pathology
#endocrine #thyroid |
|
De Quervain's Dz
|
de Quervain's subacute thyroiditis
Granulomatous Inflammation following flulike illness Early stages = Hyperthyroidism --release of stored hormones from local destrx ↑ ESR, Jaw Pain, Tender Thyroid Progresses to Hypothyroidism usually make complete recovery in months NB: no antithyroid peroxidase Ab |
#pathology
#endocrine #thyroid |
|
subacute thyroiditis
|
de Quervain's subacute thyroiditis
Granulomatous Inflammation following flulike illness Early stages = Hyperthyroidism --release of stored hormones from local destrx ↑ ESR, Jaw Pain, Tender Thyroid Progresses to Hypothyroidism usually make complete recovery in months NB: no antithyroid peroxidase Ab |
#pathology
#endocrine #thyroid |
|
Riedel's Dz
|
Riedel's Thyroiditis
Hypothyroidism Thyroid Replaced by Fibrous Ts Rock Hard, Painless Goiter |
#pathology
#endocrine #thyroid |
|
Thyroid Replaced by Fibrous Ts
|
Riedel's Thyroiditis
Hypothyroidism Thyroid Replaced by Fibrous Ts Rock Hard, Painless Goiter |
#pathology
#endocrine #thyroid |
|
Hypothyroidism w/ Rock Hard, Painless Goiter
|
Riedel's Thyroiditis
Hypothyroidism Thyroid Replaced by Fibrous Ts Rock Hard, Painless Goiter |
#pathology
#endocrine #thyroid |
|
Vessels Spared by PAN
|
Pulmonary Arteries & Bronchial Arteries
Chronically ongoing inflammation of medium & small arteries Presents as livedo reticularis (purple network) or palpable purpura, propensity for bead like aneurysm Segmentally distinct acute inflam → Mixed WBC infiltrate → Fibrinoid necrosis (Contrast Mixed WBC Infitlrate to eosinophil dominated Churgg-Strauss, and PMN dominanted -ie leukocytoclastic- Microscopic polyangitis) Histology: thick hyalinosis in adventitia All stages concurrent around the body (Contrast to Kawasaki's lock-step progression) Not assoc with ANCA's (Contrast to Wegener's and Microscopic Polyangitis) Fatal if UnTx Rx: immunosuppressents |
#pathology #cardiovascular
|
|
Intestinal Invasion: Agents
|
Salmonella
Shigella EIEC Campylobacter jejunu Entamoeba histolitica |
#microbiology #gastrointestinal
|
|
"Stacked Brick" Intestinal Bacterial Adhesions
|
Enteroaggregative E coli EAEC
|
#microbiology #gastrointestinal
|
|
Where do the respiratory drive signals originate
|
Hypercapnea (normal individuals):
-Medulla detects pH Hypoxia (<60 mmHg or chronic hypercapnics) -Chemoreceptors in aotic arch and carotid bodies via CN9 |
#cardiovascular
#pulmonary #neurology #physiology |
|
Accute Intermittent Porphyria
|
Deficiency of HMB synthase (Uroporphyrinogen I Synthase)
responsible for condensing 2 PBG's → HMB aka uroporphyrinogen 1 1. Abodminal Pain, Neurologic Sx w/o Photosensitivity 2. Urine Darkens on standing 3. ALA & PBG-uria precipitated by EtOH, Barbituates, Hypoglycemia, Phenytoin & Griseofulvin relieved by: heme, glucose |
#pathology #biochemistry #hematology
|
|
HMB synthase
|
responsible for condensing 2 PBG's → HMB aka uroporphyrinogen 1
Deficiency: Acute Intermittent Porphyria 1. Abodminal Pain, Neurologic Sx w/o Photosensitivity 2. Urine Darkens on standing 3. ALA & PBG-uria precipitated by EtOH, Barbituates, Hypoglycemia, Phenytoin & Griseofulvin relieved by: heme, glucose |
#pathology #biochemistry #hematology
|
|
Hormones which signal via cAMP 2nd Messengers
|
Mn: FLATCHAMP Good Guy Craig
all the releasing hormones except GnRH & TRH (IP3) FSH LH ACTH TSH CRH hCG ADH -V2 in the Kidney MSH PTH Calcitonin GHRH Glucagon [Non endocrine: Gs: β's, D1, H2, V2 ↑ cAMP Gi: M2 α2 D2 ↓ cAMP] |
#endocrine #physiology
|
|
Hormones which signal via IP3 2nd Messengers
|
GnRH, Oxytocin, ADH V1, TRH, H1 AT2, Gastrin
GOAT HAG [Non-endocrine: H1, α1, V1, M1, M3] |
#endocrine #physiology
|
|
Hormones which signal via Cytosolic Steroid Receptors
|
Vitamin D, Estrogen, Testosterone, Cortisol, Aldosterone, Progesterone
Mn: VET CAP Think Adrenal Hormones and Vitamin D |
#endocrine #physiology
|
|
Hormones which signal via Nuclear Steroid Receptors
|
T3 & T4 only
|
#endocrine #physiology
|
|
Hormones which signal via RTK/MAP pathway
|
Insulin, IGF-1, FGF, PDGF
Think Growth Factors (but not growth hormone) |
#endocrine #physiology
|
|
Hormones which signal via RTK/JAK-STAT
|
Prolactin
Cytokines - eg IL2, IL6 etc GH Mn: Jack Stacked Pigs |
#endocrine #physiology
|
|
Sequence of Ig Isotype Switching
|
Requires interaction of B cell CD40 and T cell CD40L (CD154)
Once you go on to the next you cannot come back M D G E A |
#hematology #immunology
|
|
Drugs implicated in Serotonin Syndrome
|
Anti-Depressants
--SSRI's --SNRI (Venlafaxine) --MAOI's --TCA's Analgesics --Tramadol Anti-Emetics --Ondansetron (5HT3 antagonist) Antibiotics --Linezolid (Vancomycin resistant enterococcus, MRSA) Neuropsychiatrics --Triptans |
#pharmcology
#toxicities |
|
Antidepressents implicated in Serotonin Sro
|
Anti-Depressants
--SSRI's --SNRI (Venlafaxine) --MAOI's --TCA's |
#pharmcology
#toxicities |
|
Analgesics implicated in Serotonin Sro
|
Tramadol
|
#pharmcology
#toxicities |
|
Anti-emetics implicated in Serotonin Sro
|
Ondansetron (5HT3 antagonist)
|
#pharmcology
#toxicities |
|
Antibiotics implicated in Serotonin Sro
|
Linezolid (Vancomycin resistant enterococcus, MRSA)
|
#pharmcology
#toxicities |
|
Headache Medicine implicated in Serotonin Sro
|
Triptans
|
#pharmcology
#toxicities |
|
Mononucleus like Sro with negative monospot test
|
CMV HHV-6 Toxoplasmosis
|
#microbiology
|
|
Differentiating Septate Hyphae
|
V-branching: Aspergillus
Right Angle: Mucor/Rhizapus |
#microbiology
|
|
Epinephrine Dosing
|
always activates β1
systolic responds to α1 stimualtion diastolic more β2 > α2 at low doses α1 overwhelms β2 at high doses → vasoconstrx |
#physiology #pharmacology
#ans |
|
phentolamine vs phenylephrine
|
phenylephrine is α agonist
phetolamine is α blocker |
#physiology #pharmacology #ans
|
|
Horner's Sro + UE LMN signs
|
pancoast tumor esp adenocarcinoma from apex of lung
|
#pathology #neurology #neoplasia
|
|
Elevated Creatine Kinase from a Drug
|
Lipids: Statins, Fibrates, Niacin
Hydroxychloroquine Glucocorticoids Colchecine IFN α Penicillamine |
#pharmacology #tocities
|
|
Kyphoscoliosis and a High Foot Arch
|
Frederick's Ataxia
AR ↑ tinucleotide repeats in "Frataxin" Chrom 9, improtant for Mitochondrial Fnx --Hypertrophic Cariomyopathy --Kyphoscoliosis & Pes Cavus --Degeneration of Dorsal Root Ganglia & Columns → loss of position & vibration sensation --Degeneration of Ascending & Decending Spinocerebellar Tracts → Ataxia --DM |
#pathology #genetics
|
|
Frederick's Ataxia
|
Frederick's Ataxia
AR ↑ tinucleotide repeats in "Frataxin" Chrom 9, improtant for Mitochondrial Fnx --Hypertrophic Cariomyopathy --Kyphoscoliosis & Pes Cavus --Degeneration of Dorsal Root Ganglia & Columns → loss of position & vibration sensation --Degeneration of Ascending & Decending Spinocerebellar Tracts → Ataxia --DM |
#pathology #genetics
|
|
Topoisomerase I vs II
|
1: single stranded nicks to relieve supercoiling
2: transient doublestranded breaks Topoisomerase II is the target of etoposide and podophyllin etoposide esp useful for testicular cancer and small cell lung cancer |
#molecules #pharmacology #neoplasia
|
|
Dihydropyridine Clalcium Channels
|
L type calcium channels goddamn it
|
#molecules #physiology #pharmacology
|
|
Heart Medicine which causes and AV block
|
Class IV: Ca2+ channels
Verapamil, Diltiazem non-dihydropyridine ↑ PR interval |
#pharmacology #cardiovascular
|
|
Dimeric IgA
|
only found in secretions never in blood
|
#immunology #hematology
|
|
Mitotane
|
adrenocorticolytic used for adrenocortical carcinoma
|
#pharmacology #endocrine
|
|
DOC: Hirsutism
|
Spirolactone
Else --Flutamide: testosterone receptor antagonist --Finasteride 5 α Reductase inhibitor |
#pharmacology #endocrine
|
|
Organ of Corti
|
The actual part of the inner ear that takes mechanical sound and turns it into energy signals
|
#neurology
|
|
Cupula of the Cochlea
|
the very apex of the cochlea
houses the cells that sense rotation |
#neurology
|
|
Carpal Bones
|
|
|
|
Renal Tubule Osmolarity
|
Proximal Convoluted: 300
Loop of Henle: gets up to 1200 Distal Convoluted: 100 NB Lowest Osmolarity Collecting Duct: 100-1200 |
#physiology #nephrology
|
|
Sunlight and Vitamin D
|
UVB ( λ ≈ 320 )
7-dehydrocholesterol → Cholecalciferol which may enter circulation NB: Cholecalciferol is the form of Vitamin D absorbed by the Gut |
#physiology #vitamins #endocrine
|
|
Activation of Vitamin D
|
First step
Cholecacliferol → 25 hydroxy vitaminD p450 not regulated 1-α- hydroxylase in Kidney creates active 1,25 dihydroxyD ↑ by PTH ↓ by Ca2+ or Phospahte NB 24 hydroxylase will create 24, 25 dihydroxyD which is inactive |
#physiology #vitamins #endocrine #renal
|
|
Where is tetrahydrobiopterin actually used?
|
by phenylalanin hydroxylase in the production of tyrosine
by tyrosine hydroxylase in the prodxn of DOPA and also by tryptophan hydroxylase in teh prodxn of 5HT defective dihydrobiopterin reductase (needed to regenerate BH4 from BH2) causes rare form of PKU |
#biochemistry #pathology
|
|
measles-like rash, recurrent respiratory infx in neonate
supplement? |
Vitamin A deficiency
night/complete blindness, xeropthalmia Bitot's spots, corneal perforation, keratomalacia immunosuppression via phagocytes and T's Research has shown that vitamin A effective in treatment of measles |
#pathology #vitamins
|
|
|
|
#renal #physiology
|
|
transposition of the great vessels is a failure of
|
septation
|
|
|
Reactive Arthritis
Urethritis Conjunctivitis |
Reiter's Sro
HLA B27 assoc w/ infx of : Chlamydia Shigella, Salmonella, Yersinia Campylobacter |
#microbiology #pathology
|
|
Reiter's Sro
|
Reactive Arthritis
Urethritis Conjunctivitis HLA B27 assoc w/ infx of : Chlamydia Shigella, Salmonella, Yersinia Campylobacter |
#microbiology #pathology
|
|
Anatomy of the Eye Socket:
What comes out which hole? |
Superior orbital fissure: CN3, 4 & 6 + Nasociliary branch of facial nerve,
Lesion: lack of EOM's & corneal reflex Optic Canal: CN2 & Ophthalmic Artery Inferior Orbital Fissure: V2, Infraorbital vessels, branches of sphenopalatine ganglion; Do not enter orbit! |
|
|
What is absorbed in the duodenum?
|
Iron
|
#physiology #gastrointestinal
|
|
Blue sclera
|
osteogenesis imperfecta
|
|
|
Fried Egg sign on Facial Blisters
|
Impetigo
NB may be either staph or strep! also note: while APSGN may follow strep impetigo, Rheumatic Fever will not! Rheumatic Fever ONLY assoc w/ throat infx |
#microbiology
|
|
Know table 5-1 listing autosomal dominant diseases
|
Nervous System: Huntingtons 4p, Neurofibromatosis 17q, Myotonic dystrophy
Tuberous Sclerosis Urinary: Polycystic Kidney Disease (Adult) 4q, Wilm's Tumor 11p, GI familial polyposis coli 5q Musculoskeletal: Marfan's, Ehler-Danlos (some), Osteogenesis Imperfecta 1-4, Achondroplasia Metabolic: Familial hypercholesterolemia, Acute intermittent porphyria Hematopoietic: Hereditary Spherocytosis, Von Willebrand's Disease |
|
|
Terbinafine mechanism of action
|
inhibition of squaline epoxidase necessary for ergosterol synthesis
|
#microbiology #pharmacology #antimicrobials
|
|
Anti-fungal: inhibits squalline epoxide
|
Terbinafine
prevents ergosterol synth |
#microbiology #pharmacology #antimicrobials
|
|
Know table 5-1, autosomal recessive disorders
|
---Metabolic: CF, Phenylketonuria, Galactosemia, Homocystinuria, Lysosomal Storage Dz's, alpha1 anti-trypsin deficiency, Wilson's disease, Hemochromatosis, Glycogen storage disease
--Hematopoietic: Sickle Cell Anemia, Thalassemias --Endocrine: Congenital adrenal hyperplasia --Skeletal: Ehelrs Danlos (some), Alkaptonuria --Nervous: Neurogenic muscular atrophies, Friedreich ataxia, spinal muscular atrophy |
|
|
Gram + Catalase + Coagulase + Organism
|
Staph Aureus
also β hemolytic produces a yellow pigment |
#microbiology
|
|
Autosomal Recessive Disorder Characteristics
|
low frequency likely consanguinous marriages
high frequency likely confers disease resistance expression within kindred is uniform (no variable expressivity) complete penetrance is common onset usually early in life sporadic new mutations not readily manifested usually enzymatic defects |
|
|
Gram +
Catalase + Coagulase -- Novobiocin Sensitive Bacterium |
Staph epidermidis
1. Prosthetic valve endocarditis 2. Catheter Related Infx 3. Prosthetic Joint Septic Arthritis Coagulase Negative Staph part of normal flora Infx = special circumstances |
#microbiology
|
|
Gram +
Catalase + Coagulase -- Novobiocin Resistant Bacterium |
Staph saprophyticus
UTI's in sexually active young women Coagulase Negative Staph part of normal flora Infx = special circumstances |
#microbiology
|
|
Know table 5-3, list of X-linked recessive disorders.
|
Musculoskeletal: Duchenne Muscular Dystrophy, Becker Musculodistrophy
Blood: Hemophilia's A & B, Chronic granulomatous disease, G-6-P dehydrogenase deficiency Immune: Bruton's Agammaglobulinemia, Wiskott-Aldrich Syndrome, SCID Metabolic: Diabetes insipidus, Lesch-Nyhan Syndrome Nervous: fragile X syndrome Reproductive: Testicular Feminization Misc: Hunter's Syndrome, Fabry's Disease |
|
|
Major Resistance of the bronchial tree
|
there are 23 generations total
major resistance from first 10 generations (>2mm), peaking at 5th gen ↑ cross sectional area after 10th generation |
|
|
Gram + Catalase + Organism
assoc. w/ UTI's in sexually active young women |
Staph saprophyticus
Coagulase Negative Novobiocin Resistant Coagulase Negative Staph part of normal flora Infx = special circumstances |
#microbiology
|
|
Rx: ↑ HgF synthesis
|
HgF = α2γ2
hydroxyurea used for sickle cell anemia |
|
|
Gram + Catalase + Organism
assoc. w/ Prosthetic Valve Endocarditis |
Staph epidermidis
Coagulase negative Novobiocin sensitive 1. Prosthetic valve endocarditis 2. Catheter Related Infx 3. Prosthetic Joint Septic Arthritis Coagulase Negative Staph part of normal flora Infx = special circumstances |
#microbiology
|
|
Childhood Brain Tumors by Frequency
|
1. Pilocytic Astrocytoma
Usually cerebellum Appearance: Solid (white on MRI) and Cystic (dark no MRI) Histology: pilocytic astrocytes with rosenthol fibers (pink corkscrews) Px: Low Grade, Good Px 2. Medulloblastoma Most Common Malignant Brain Tumor in Childhood Appearnce: Solid, Uniform Appearance Always in cerebellum Histology: Small blue cells (hyperchromatic nuclei, scant cytoplasm) Px: Bad 3. Ependymoma Presentation: Hydrocephalus Histology: Rosettes: glandlike structures w/ ependymal processes Psuedorosettes: glandlike strx around blood vessel |
|
|
Gram + Catalase + Organism
assoc. w/ catheter related infx |
Staph epidermidis
Coagulase negative Novobiocin sensitive 1. Prosthetic valve endocarditis 2. Catheter Related Infx 3. Prosthetic Joint Septic Arthritis Coagulase Negative Staph part of normal flora Infx = special circumstances |
#microbiology
|
|
Childhood Brain Tumors with Small Blue Cells
|
Hyperchromatic Nuclei, Scant Cytoplasm: Medulloblastoma
2nd most common brain neoplasm in children (to pilocytic astrocytoma), Most common malignant neoplasm Always in cerebellum Histology: Small blue cells (hyperchromatic nuclei, scant cytoplasm) Px: Bad |
|
|
Gram + Catalase + Organism
assoc. w/ prosthetic joint septic arthritis |
Staph epidermidis
Coagulase negative Novobiocin sensitive 1. Prosthetic valve endocarditis 2. Catheter Related Infx 3. Prosthetic Joint Septic Arthritis Coagulase Negative Staph part of normal flora Infx = special circumstances |
#microbiology
|
|
Gram + Catalase + β Hemolytic Organism
|
Staph aureus
Coagulase + produces a yellow pigment |
#microbiology
|
|
Most common brain neoplasm in children
|
1. Pilocytic Astrocytoma
Usually cerebellum Appearance: Solid (white on MRI) and Cystic (dark no MRI) Histology: pilocytic astrocytes with rosenthol fibers (pink corkscrews) Px: Low Grade, Good Px |
|
|
Staph epidermidis
|
Staph epidermidis
Gram + Catalase + Coagulase negative Novobiocin sensitive 1. Prosthetic valve endocarditis 2. Catheter Related Infx 3. Prosthetic Joint Septic Arthritis Coagulase Negative Staph part of normal flora Infx = special circumstances |
#microbiology
|
|
Staph saprophyticus
|
Gram + Catalase +
Coagulase Negative Novobiocin Resistant Assoc w/ UTI's in sexually active young women |
#microbiology
|
|
Childhood Brain Tumor
Histology: cells that look like fibers with dark pink corkscrews |
Pilocytic (fibrous) Astrocytoma with Rosenthal Fibers
Usually cerebellum Appearance: Solid (white on MRI) and Cystic (dark no MRI) Histology: pilocytic astrocytes with rosenthol fibers (pink corkscrews) Px: Low Grade, Good Px |
|
|
DOC: Loss of Consciousness 2° to hypoglycemia
|
Non medical setting: IM glucagon
Medical Setting: IV Dextrose |
#pharmacology #endocrine
|
|
What exacerbates Multiple Sclerosis?
|
heat leads to worsening fatigue and deficits
heat = ↓ axona transmission |
#pathology #neurology
|
|
Childhood Brain Tumor with glandlike Strx around blood vessels, with cytoplasmic processes directed towards wall of vessel
|
psuedorosettes of Ependymoma
3rd most common Brain neoplasm in children Presentation: Hydrocephalus Histology: Rosettes: glandlike structures w/ ependymal processes Psuedorosettes: glandlike strx around blood vessel |
|
|
neurologic condition worsened by heat
|
Multiple Sclerosis
heat = ↓ axona transmission |
#pathology #neurology
|
|
describe the pathogenesis of HBV assoc hepatocellular carcinoma
|
viral integration into host genome
viral protein HBx activates both synthesis of IGF-II and IGF-I-R |
#pathology #neoplasia #microbiology
|
|
Genetics of Sexual Differentiation
|
Y chromosome determines male sex regardless of number of X chroms
SRY: Sex Determining Region in Y is in the short arm of the chrom and includes translational activator SIP-1 for dvlpt of male phenotype SRY mutations/translocations → XY females, XX males Lyon Hypothesis: Inactivation of either paternal or maternal X chromosome happens randomly in each cell at gestation day 16; all females are mosaics. XIST gene inactivates one X chrom by coating it with non-coding RNA; Pseudoautosomal region: 25% of X genes remain active on both chroms: these have normal, non-sex determining functions & a homologous region on Y. |
|
|
What kind of necrosis occurs with a spider bite?
|
Liquifactive Necrosis
ie characterized by preservation of cell outlines eosinophilic cytoplasm w/ protein denatuation nucleus pyknocytosis and haryorrhexis lysis |
#pathology
|
|
what enzyme converts benz(o)pyrine into a carcinogen
|
most inactive metabolites converted to carcinogens are converted by the p450 microsomal monoogenase system.
|
|
|
Factor XIII deficiecy
|
clot instability, recurrent bleeding after trauma
extremely rare condition does not manifest hemophilia like bleedin |
|
|
Moldy Grain mutates p53 causes
|
Aflotoxin G to T mutation causes Hepatocellular Carcinoma
|
#neoplasia #microbiology #pathology
|
|
Galactose Metzm & Disorders
|
Galactokinase(Galactose → Galactose-1-P)
Galactose-1-Phosphate Uridyltransferase( galactose -1-P → glucose-1-P) Aldose Reductase (Galactose → Galactitol) Galactokinase deficiency: AR; galactitol accumulates → cataracts, galactosuria. G1P Uridyltransferase deficiency: AR: accumulation of galactitol and toxic Galactose-1-P → Failure to thrive, cataracts, MR, jaundice, hepatomegaly Tx: exclude galactose & lactose |
|
|
Subacute Sclerosing Panecephalitis
|
Complication of Measles which lacks the M protein
No protein, no good antigen for clearing cough coryza conjunctivitis koplic's spots |
#microbiology
|
|
Where is IGF-1 produced
|
The liver
also some IGF-1 from hypothalamus, but that regulates CNS activity, not linear growth |
|
|
DOC: Gestational Diabetes
|
Insulin
|
#pharmacology #endocrinology #pregnancy
|
|
Ketogenic vs. Glucogenic Amino Acids
|
Exclusively Ketogenic: Leucine & Lysine
Ketogenic and Glucogenic: Phenylalanine, Isoleucine, Tryptophan |
|
|
inv(16)
|
inversion of chrom 16
M3Eo (eosinophilic subtype) of AML |
#neoplasia #pathology #genetics
|
|
genetics: M3Eo AML
|
inv(16)
inversion of chrom 16 M3Eo (eosinophilic subtype) of AML |
#neoplasia #pathology #genetics
|
|
Rining Ears, Dizziness, and Difficulty Hearing
|
Meniere's Dz: failure to resporb endolymph
|
#pathology #neurology
|
|
Inhibin B
|
produced by Sertoli Cells allows for negative feedback of FSH
|
|
|
Community Acquired Pneumonia with high fever and nothing on gram stain
|
legionella
Tx: floroquinolones or azithromycin |
|
|
Failure to resporb endolymph in the inner ear
|
Meniere's Dz:
Triad of Tinnitus, Vertigo and Hearing Loss |
#pathology #neurology
|
|
IFNα & IFNβ
|
produced by many cells in resposne to ifnection
stimulates neighbors to synthesize antiviral proteins to inhibit viral mRNA translation (without affecting eukaryotic mRNA translation) |
|
|
NF-2
|
Autosomal Dominant
Tumor suppressor gene merlin on chrom 22 --bilateral accoustic shwannomas --few cutaneous signs |
#pathology #neurology #neoplasia
|
|
merlin protein
|
Autosomal Dominant
NF-2 Tumor suppressor gene merlin on chrom 22 --bilateral accoustic shwannomas --few cutaneous signs |
#pathology #neurology #neoplasia
|
|
Where should you do IM injxns into the buttock and why
|
Inject into the superolateral corner to avoid superior gluteal nerve (superomedial) and Sciatic Nerve (Medial Half)
Many muscles of the gluteal regions have tendinous insertinos in the inferolateral quadrant |
|
|
Fructose 2, 6 Bisphosphate
|
ATP dpt prodxn from F6P by PFK-2 in the presence of insulin
Positive Influence on PFK-1: helps drive Glycolysis |
#biochemistry #energymetzm
|
|
Differentiating Causes of Esophagitis in AIDS pts
|
3 main Causes
Candida albicans: pseudomembranes HSV-1: vesicles → ulcers; esoinophilic intranuclear inclusions (Cowdry bodies) in multinuclear squamous cells at margins of ulcers CMV: linear ulcerations, intranuclear and cytoplasmic inclusions |
|
|
PFK-1
|
Fructose 6 phosphate to Fructose 1,6 bisphophate
an irreversible forward reaction in glycolysis (circumvented by Frictose bisphosphatase 1, FBP1) ↑ fnx by Fructose 2,6 Bisphosphate (produced from F6P in presence of Insulin by PFK2) ↓ fnx by citrate and ATP |
#biochemistry #energymetzm
|
|
Hemiballism
|
unilateral flinging limbs contralateral to injury in/around subthalamic nucleus
|
|
|
Neurons with eosinophilic cytoplasm, no nisssl substance, and pyknosis of nucleus
|
Red Neuron
Transient Severe Insult which Will Result in Death |
#pathology #neurology
|
|
New Mother Feels Depressed Since Birth
Tx? |
Postpartum "Blues"
--majority of women, resolves within 10 days Tx: reassurance, schedule reevaluation in 2 weeks Postpartum Depression: --10% of women, >2 weeks Tx: Antidepressants, psychotherapy Postpartum Psychosis --Rare Tx: Antipsychotics, Antidepressants, Hospitalization |
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|
Neuron with enlarged body, dispersed nissl substance, and eccentric nucleus
|
Axonal Reaction, about to regrow axon
|
#pathology #neurology
|
|
Borders of the Lungs and Pleura
|
Pleura
Midclavicular Line: 7th Rib Midaxillary Line: 10th Rib Paravertebral Line: 12th Rib Lung is 2 spaces above pleural border |
|
|
Pt treated for hyperthyroidism presents with fever and sore throat
|
agranulocytosis (PMN <500) rare but serious complication of thyrolytics
PTU - DOC in pregnants Methimazole - DOC in nonpregnants, teratogenic both are thionamide class inhibit thyroid peroxidase which is resposnbiel for I- → I0 and coupling of iodotyrosines |
#pharmacology #toxicity
|
|
Toxin Route:
Wound → Motor Neurons → Spinal Cord Toxin |
Tetanus Toxin
NB: Not the Bacterium |
|
|
methimazole
|
thyrolytic doc for non-pregnant hyperthyroidism,
teratogenic thionamide class inhibit thyroid peroxidase which is resposnbiel for I- → I0 and coupling of iodotyrosines assoc with agranulocytosis |
#pharmacology #drugs
|
|
Toxin Route:
Fibrinous Exudate → Systemic Circulation → Cortical Neurons Toxin |
diphtheria
attacks cardiac and cerebral cortical ts |
|
|
Calymmatobacterium inguinal
|
donovanosis
unTx → elephantiasis papule → ulcer → soft exophytic w/ indurated boarders |
#microbiology
|
|
Meningitis
Food → Systemic Circulation → Meninges |
Listeria monocytogenes
|
|
|
Genital papule ulcerates and produces grey-yellow exudate
|
H ducreyi
regional LN's swell and may become chronic ulcers themselves |
#microbiology
|
|
Toxin Route:
Food → Systemic Circulation → Peripheral Nerves Toxin |
Botulism Toxin
|
|
|
Arteriovenous Concentration of an Inhaled Anesthetic
|
A large gradient means that the tissue is absorbing it and not being saturated = Slower onset of action
|
|
|
Regulation of ACE's
|
Apparently the lung endothelium upregulates ACE's when BP is low I don't know I don't think that's true
|
#physiology #cardiovascular
|
|
Selective Albuminuria following upper respiratory tract infection
|
Loss of sialic acid (polyanion) → loss of electrical barrier to albumin without damage to GBM
Minimal change dz most common nephrotic sro in children |
|
|
Tryptase
|
Indicative of Mast Cell Degranulation
|
#physiology #hematology
|
|
Three phases of stomach activity
|
Stimulation of H+ secretion
Cephalic phase: Vagal ACh triggered by percception of food Gastric Phase: gastrin stimulates histamine secretion Intestinal phase: protein containing food enters duodenum (minor) Inhibition: Intestinal influences Major influence is Peptide YY from ileum and colon binds Enterochromaffin-like cells (↓ Histamine release) Also Somatostatin & Prostaglandins |
|
|
Blood Product indicative of Mast Cell Degranulation
|
Tryptase
|
#physiology #hematology
|
|
Purine Salvage Pathways
|
90% of purines salvaged
avoids spending 6ATP & 2x 510-formyl-THF's HGPRT: major enzyme Guanine + PRPP → GMP Hypoxanthine + PRPP → IMP HGPRT KO: no salvage, Lesch-Neyhan → massive urate prodxn → severe gout, MR, self mutilation |
|
|
Acute onset chest pain relieved by sitting up
|
pericarditis
friction rub, sero-firbinous exudate |
#pathology #cardiovascular
|
|
Neurologic consequence: anterior dislocation of the humerus
|
axillary nerve: deltoid and teres minor, provides sensory innervation to skin over deltoid
|
|
|
Patholophysiologic of a Lung Abscess with Air Fluid Levels
|
Release of PMN & M∅ lysosomal contents into the parenchyma: fnx is to fight bacteria and chemotactic for PMN's & M∅, but creates abscess
|
#pathology #pumonary
|
|
BUN and Cr
|
Both freely filtered
BUN reabsorbed some in the proximal tubule Cr not really absorbed or secreted ↓ GFR will slow down the flow through the proximal tubule, allow more time for reabsoprtion of BUN ↓ kidney function will affect both BUN & Cr equally >15:1 ratio = pre-renal azotemia (decreased <15:1 ratio = kidney problem |
|
|
Vasopressin
|
V1: vascular smooth muscle contraction and what not
V2 receptor mediated increase in both permeability to water and urea in luminal membrane of medullary collecting duct (MCD) |
|
|
unwanted sustained muscle contractions + cataracts
|
Myotonic Dystrophy
CTG trinucleotide expansion within myotponia protein kinase AD inheritance Cataracts & Myotonia Myotonia: unwanted sustained muscle contractions --cannot release doohandles Type 1 fibers more affected Also: frontal balding & gonadal atrophy differentiate from Duchenne: Myotonic Dystrophy does not have necrosis of muscle fiber sand fibrofatty replacement |
|
|
Pleural Pressure Through Inspiration and Expriation
|
always negative (collapses pleural space)
-8 at fully inspired -5 at fully expired |
#physiology #pulmonology
|
|
CTG trinucleotide expansion
|
Myotonic Dystrophy
CTG trinucleotide expansion within myotponia protein kinase AD inheritance Cataracts & Myotonia Myotonia: unwanted sustained muscle contractions --cannot release doohandles Type 1 fibers more affected Also: frontal balding & gonadal atrophy differentiate from Duchenne: Myotonic Dystrophy does not have necrosis of muscle fiber sand fibrofatty replacement |
|
|
Duchenne's Muscular Dystrophy
|
X linked frameshift → nonsense mutation within dystrophin gene
dystrophin anchors skeletal and muscle fibers → accelerated muscle breakdown starts in pelvic girdle → progresses superiorly Onset <5yo pseudohypertrophy of calves 2° fibro-fatty replacement Gower's sign: coming to a stand via spreading legs apart and "walking" backwards on their hands so as not to need lower extremities Dx: ↑CPK and muscle biopsy: necrosis and fibrofatty replacement |
|
|
CREST Sro
|
CREST Sro
Calcinosis Raynauds (may present with ulceration) Esophageal Dysmotility Sclerodactyly Telangeictasia CD4 mediated hyperreactivity to unknown antigen → excessive tissue fibrosis Barium swallow: dilated esophagus absent peristalsis. Risk for barret's Esophagus → adenocarcinoma Anti-centromere antibodies are very Specific for CREST |
#pathology #rheumatology
|
|
OTC Rx resitant heartburn + finger ulceration
|
CREST Sro
Calcinosis Raynauds (may present with ulceration) Esophageal Dysmotility Sclerodactyly Telangeictasia CD4 mediated hyperreactivity to unknown antigen → excessive tissue fibrosis Barium swallow: dilated esophagus absent peristalsis. Risk for barret's Esophagus → adenocarcinoma Anti-centromere antibodies are very Specific for CREST |
#pathology #rheumatology
|
|
Why does Hepatitis C become chronic
|
no proofreading 3' → 5' exonucease activity within the RNA-dependent-RNA polymerase
hypervariable region of envelope glycoprotein dozens of subspecies of HepC in each pt's blood at any given time |
|
|
Which virus is enveloped in nuclear membrane
|
herpesviruses
-HSV 1 & 2 -HHV 6 - 8 -EBV -CMV -VZV |
|
|
Virulence Factors of Strep Pyogenes
|
M protein: >100 antigenic forms
--protects cell from phagocytosis & inhibits complement --is the epitope to which human antibodies eventually bind Protein F: binds fibronectin LTA: attaches to pharyngeal epithelium Capsule of hyaluronic acid: immunologic hiding Streptolysin O: Oxygen labil: β hemolysis (& destroys RBC's) Streptolysin S: induced by being in serum β hemolysis " " C5a peptidase Streptodornase- allows mvmt Streptokinase- breaks down clots to allow mvmt |
|
|
Barium Swallow: dilated esophagus, no peristalsis
|
CREST Sro
Calcinosis Raynauds (may present with ulceration) Esophageal Dysmotility Sclerodactyly Telangeictasia CD4 mediated hyperreactivity to unknown antigen → excessive tissue fibrosis Barium swallow: dilated esophagus absent peristalsis. Risk for barret's Esophagus → adenocarcinoma Anti-centromere antibodies are very Specific for CREST |
#pathology #rheumatology
|
|
Specificity vs. Sensitivity
|
Sensitivity:
True Test Positives/All Actual Positives Specificity: True Test Negatives/All Actual Negatives |
|
|
Rathke's Cysts
|
occur in vestigial intermediate lobe of pituitary gland between adenohypophysis and neurohypophysis
|
|
|
Anti-centromere antibodies
|
CREST Sro
Calcinosis Raynauds (may present with ulceration) Esophageal Dysmotility Sclerodactyly Telangeictasia CD4 mediated hyperreactivity to unknown antigen → excessive tissue fibrosis Barium swallow: dilated esophagus absent peristalsis. Risk for barret's Esophagus → adenocarcinoma Anti-centromere antibodies are very Specific for CREST |
#pathology #rheumatology
|
|
The most common cause of E coli sepsis
|
UTI
|
|
|
Anti-Topoisomerase antibodies
|
Highly specific for diffuse scleroderma form of systemic sclerosis (other form is CREST Sro, anti-centromere antibodies)
|
#pathology #rheumatology
|
|
Concommittent treatment to aerosolized corticosteroids for athsma
|
oral rinsing to avoid candidiasis
|
|
|
Anti-dsDNA antibodies
|
SLE
|
#pathology #rheumatology
|
|
Which organs cannot survive on ketones
|
RBC's and Liver
RBC's done have the mitochondria Liver doesn't have the enzyme |
|
|
Anti-histone antibodies
|
Drug induced Lupus
Procainamide Hydralazine Isoniazid Penicillamine |
#pathology #pharmacology #toxicity
|
|
Lymphadenopathy and Serum Sickness from an Anti-Siezure Drug
|
Phenytoin
hirsutism gingival hypertrophy |
#pharmacology #toxicities
|
|
During an action potential when is K+ conduction highest
|
during the repolarization
NB: not during the overshoot, K+ is close to equilibrium at the overshoot and thus not rushing in anymore |
|
|
Esophageal Neoplasm with Keratin Pearls
|
Squamous Cell Carcinoma
EtOH & Tob Poor Px |
#pathology #neoplasia #gastrointestinal
|
|
Gastrin secreting tumors
|
Zollinger Ellison Sro
↑ histamine release from enterochromaffin like cells → ↑ ↑ H+ prodxn by parietal cells multiple ulcers in odd places diarrhea 2° to inactivated pancreatic enzymes |
#pathology #neoplasia #gastrointestinal
|
|
Slowly growing mass following oral trauma which drains yellow pus through Skin
|
Actinomyces israelii
Gram positive member of oral flora growth pattern looks mycelial (reason for name) "Sulfur Granules" are yellow aggregations of actinomyces bound by proteins (not sulfur) Tx: surgical debridement & penicillin |
|
|
Calculating Maintenance Dose for Steady State given Vd and clearance
|
Maintenance Dose = interval* [Rx]ss * CL/F
|
#pharmacology
|
|
Lac Operon
|
i is a regulatory region
p is a promotor o is the operator z y and are fnx genes Glucose decreases adenylyl cyclase ↓ glucose → ↑ cAMP cAMP binds CAP Catabolite Activator Protein cAMP-CAP complex binds to upstream promtor region and increases lac operon expression i is upstream of everything and encodes a repressor protein which will bind to o and prevent RNApol from passing O o is upstrem of z, y & a lactose will bind the repressor and prevent it from binding o z codes for βgalactosidase (hydrolysis of lactose) y gene for permease (lets lactose in) a for βgalactoside transacetylase, unecessary for metzm this arrangement is "polycistronic" one mRNA for several proteins |
#genetics #microbiology
|
|
Actinomyces israelii
|
Slowly growing mass following oral trauma which drains yellow pus through Skin
Gram positive member of oral flora growth pattern looks mycelial (reason for name) "Sulfur Granules" are yellow aggregations of actinomyces bound by proteins (not sulfur) Tx: surgical debridement & penicillin |
|
|
Fnx Mitral Regurgitation
|
Mitral Regurgitation which dissappears upon reduction of afterload
|
#cardiovascular #pathology
|
|
Pudendal Nerve Block
|
Intravaginal injection near tip of ischeal spine
S2-S4 → Innervates perineum and genitals of both sexes given if woman has progressed too far to receive epidural |
|
|
Myocardial Granulomas
|
Aschoff bodies indicative of acute rheumatic carditis
plump M∅ w/ abundant cytoplasm and slender ribbons of chromatin = Anitschkow Cells (within Aschoff bodies) |
#cardiovascular #pathology #microbiology #rheumatology
|
|
Genitofemoral Nerve
|
L1-L2
courses over psoas muscle to innervate scrotum or labia majora and femoral triangle cutaneously |
|
|
DOC: febrile seizures
|
>40 C = hyperpyrexia
>42 = Neurologic Sequelae 43 = dead Cooling blankets, cool saline bags in groin and axilla, water enemas THEN follow with oral antipyretics, NSAIDs, acetaminophen --these take time to act and you don't have it |
#pharmacology
|
|
Intravaginal Lidocaine next to Ischial Spines
|
Pudendal Nerve Block
S2-S4 → Innervates perineum and genitals of both sexes given if woman has progressed too far to receive epidural |
|
|
What is the most common cause of Native Valve Bacterial Endocarditis
|
Mitral valve prolapse
rheumatic dz less common |
#microbiology #pathology
|
|
Fixed splitting of S2
|
A-V defect
Left-to-Right Shunt: RA pressure normally <8 LA pressure up to 12 Abnormally large blood volume in RV → delays emptying Eisenmenger Sro: Left-to-Right Shunt → ↑ Pulmonary Flow → Pulmonary Hypertension → Right-to-Left Shunt |
#cardiology #pathology
|
|
Low Grade Fever and Skin Rash Beginning on Face and Spreading down to the rest of the body
|
Either Measles (Rubeola) or German Measles (Rubella)
Differentiate via Post-Auricular Lymphadenopathy, present in Rubella Rubella = Togavirus Rubeola = Paramyxovirus |
|
|
Acyclovir Toxicity
|
Crytalline Nephropathy if dehydrated
|
#pharmacology #toxicity #antimicrobials
|
|
Small Bluish Lesion under the Fingernail
|
May be either glomus tumor (glomangioma) or subungual melanoma
Glomangioma = benign tumor of modified smooth muscles cells Glomus body small encapsulated neurovascular organs found in dermis of nail beds, digit pads, and ears. Senses temperature to shunt blood away from skin during cold temperatures and into the skin during hot temperatures |
|
|
Encapsulated Bacterial Organisms
|
Pneumococcus
Meningococcus H influenzi S typhi Group B Strep agalactae |
#microbiology #agents
|
|
Glomus body
|
small encapsulated neurovascular organs found in dermis of nail beds, digit pads, and ears. Senses temperature to shunt blood away from skin during cold temperatures and into the skin during hot temperatures
Glomangioma = benign blue tumor beneith nails DDx: melanoma |
|
|
Sickler with Macrocellular Anemia
|
Folic Acid Deficiency 2° to ↑ Bone Marrow Turnover
|
#pathology #hematology
|
|
Anormal embryologic rotation of midgut
|
intestinal malrotation
→ intestinal obstruction due to compression by adhesive "Ladd's" bands between cecum and duodenum or midgut volvulus |
|
|
Stages of acute Tubular Necrosis
|
Initiation: Ischemic Injury
Maintenence: oliguria, hypervolemia, ↑ BUN & Cr, HyperKalemia retention of H+ & Anions → high metabolic gap acidosis ↓ Na, Ca, PO4 Muddy Brown casts, low urine osmolarity high Fractioanl sodium excretion Most Serious complication: HyperKalemia Recovery: Body rapidly diuresing, but tubules not yet recovered enough to resporb things properly ↓ K, Mg, PO4, Ca Most serious complciation: Hypokalemia |
#pathology #nephrology
|
|
Cecum fixed in Right Upper Quadrant of Vomitting Neonate
|
midgut malrotation
→ intestinal obstruction due to compression by adhesive "Ladd's" bands between cecum and duodenum or midgut volvulus |
|
|
p vs Confidence interval
|
if confidence interval does not include null hypothesis then p<0.05
if confidence interval includes null hypothesis then p >0.5 |
#biostats
|
|
Small Bluish Lesion under the Fingernail
|
May be either glomus tumor (glomangioma) or subungual melanoma
Glomangioma = benign tumor of modified smooth muscles cells Glomus body small encapsulated neurovascular organs found in dermis of nail beds, digit pads, and ears. Senses temperature to shunt blood away from skin during cold temperatures and into the skin during hot temperatures |
|
|
Vi antigen
|
virulence angiten of salmonell the capsule which protects it from opsonization
|
#microbiology
|
|
Glomus body
|
small encapsulated neurovascular organs found in dermis of nail beds, digit pads, and ears. Senses temperature to shunt blood away from skin during cold temperatures and into the skin during hot temperatures
Glomangioma = benign blue tumor beneith nails DDx: melanoma |
|
|
Cardiac Ischemia:
How long until Contraxns Stop? When does Injury Become Irreversible? |
Contraxn stops w/in first minute
damage permenant after 30 min |
#pathology #cardiovascular
|
|
Young Child with Thromboembolitic Infarcts in Various stages of healing
|
Homocysteinuria: Cystathionine synthase deficiency
Marfanoid Habitus and Thromboemboli --Homocysteine produced as end product of SAM usage --Methionine Synthase aka Homocysteine methyltransferase[B12] (Homocysteine + N5-methyl-THF → Methionine) --Methionine + ATP → SAM --Methyltransferase(SAM → S-adensoyl homocysteine + methyl group on other subtrate) --Unimportant enzyme (SAH → Homocysteine & Adenosine) --at this point Homocysteine may be recycled or Cystathione synthetase[B6](Homocysteine + Serine → Cystathione Csystathionase[B6](Cystathione → Cysteine) 1/2 of pts respond positively to B6 supplementation (↑ functionality of poorly functioning cystathione synthetase) |
|
|
Abnormal Breathing Pattern
|
Cheyne-Stokes Breathing of Advanced CHF
delayed feedback to hypercapnea start breathing hard to blow off CO2 → suppress drive cyclic variation in tidal volume with periods of apnea contrast to OSA which has on-off phenomenon not cyclic variation in tidal volume |
#pathology #cardiovascular
|
|
Li Frauman Sro
|
p53 KO
Breast, Brain Adrenal Cortex Sarcomas Leukemias |
#genetics #pathology #neoplasia
|
|
Anormal embryologic rotation of midgut
|
intestinal malrotation
→ intestinal obstruction due to compression by adhesive "Ladd's" bands between cecum and duodenum or midgut volvulus |
|
|
Cancer 2° to EBV
|
Hodgkin's Lymphoma
Non-Hodgkin's Lymphoma Nasopharyngeal Carcinoma esp in China & Africa Burkitt's Lymphoma in Africa & new Guinea |
#pathology #neoplasia #microbiology
|
|
The end result of Fabry's Dz
|
Renal failure
|
#pathology #genetics #biochemistry
|
|
Cecum fixed in Right Upper Quadrant of Vomitting Neonate
|
midgut malrotation
→ intestinal obstruction due to compression by adhesive "Ladd's" bands between cecum and duodenum or midgut volvulus |
|
|
Where do aspirations go?
|
superior regions of lower lobes
posterior regions of upper lobes |
#pathology #pulmonology
|
|
Odds ratio of event x happening in population y vs population z
|
AD/BC
Technically: (A/C)/(B/D) NB: not the same as relative risk [a/(x)] / [c/(y)] |
|
|
Why do we get wrinkles in our skin?
|
↓ collagen synth
→ net loss of dermal collagen & elastin |
#pathology #skin
|
|
Trihexyphenidyl
|
Muscarinic Antagonist
|
#pharmacology
|
|
DOC: catheter endocarditis
|
Staph epidermidis
Gram + Catalase + Coagulase Neg Novobiocin Sensitive Usually MRSE start with Vancomycin |
#microbiology #pathology #cardiovascular #pharmacology #antimicrobials
|
|
Anti-epileptic drug metzd to barbituate
|
Primidone
metabolized to phenobarbital and PEMA (phenylethylmalonamide) All 3 compounds are anticonvulsants |
#pharmacology #seizures #neurology
|
|
Primidone
|
Anti sieizure drug Primidone
metabolized to phenobarbital and PEMA (phenylethylmalonamide) All 3 compounds are anticonvulsants |
#pharmacology #seizures #neurology
|
|
Cyproterone
|
prevents interaxn of DHT and receptors
like flutamide and spirolactone (NB spirolactone also decreases leydig synth of T) |
#pharmacology #endocrinology #reproductive
|
|
Naked Viral RNA can be processed by human Ribosomes
|
must be single stranded and positive sense
|
#microbiology #molecules
|
|
Satellite Phenomenon on Sheep Plate
|
Blood Agar Plate
Beta hemolytic organism like Staph aureus allows permissive growth of H influenzae which needs NAD+ & Hementin from blood |
#microbiology
|
|
Electrolyte balance of ACEI's
|
Sodium wasting
K retaining so check K levels before and during NB: other side effects --angioedema --cough --first dose hypotension |
#pharmcology #toxicities
|
|
Amiloride
|
an ACEI
|
#pharmacology #drugs
|
|
Pt started on antibiotic
2 weeks later dvlps fever, rash, & oliguria |
Drug Induced Acute Interstitial Nephritis
Fever, Maculopapular Rash, Oliguria a few weeks after starting a new drug β-Lactams, sulfas, rifampin, or diuretics interstital damage and WBC infiltrate, usu. Eosinohpils Resolves if Med Terminated |
#pharmacology #pathology #nephrology
|
|
Drug Induced Interstitial Nephritis
|
Drug Induced Acute Interstitial Nephritis
Fever, Maculopapular Rash, Oliguria a few weeks after starting a new drug β-Lactams, sulfas, rifampin, or diuretics interstital damage and WBC infiltrate, usu. Eosinohpils Resolves if Med Terminated |
#pharmacology #pathology #nephrology
|
|
Lipid containing cells 1 week post stroke
|
M∅'s arrive day 3-5
|
#pathology #neurology
|
|
Killed vaccines generate what kind of response and why?
|
humoral response instead of T cell response because they can't actually infect cells, so they never get expressed on MHC I so they never induce mCD8T's
|
#microbiology #immunology
|
|
What part of the testicles are sensitive to heat?
|
The sertoli cells
which are responsible for producing inhibin leydig cells keep chugging thus no lack of sexual dvlpt in cryptorchidism but ↑ risk of testicular cancer |
#anatomy #physiology #endocrine #reproductive
|
|
Sudden Cardiac Death:
pathogenesis |
Majority due to Coronary artery desiease
acute plaque rupture & thrombus → ischemia ischemia → arrhytmias → ventricular fibrillation |
#pathology #cardiovascular
|
|
Heart Drug
Visual changes and GI disturbances |
Digoxin toxicity
|
#cardiovascular #pharmacology #toxicity
|
|
haptoblogin
|
a plasma protein which binds free hemoglobin in order to prevent its renal excretion
5d λ of haptoglobin alone 1h λ bound to heme ↓↓↓ in hemolytic anemias |
#molecules #biochemistry
|
|
a plasma protein which binds free hemoglobin
|
haptoblogin
a plasma protein which binds free hemoglobin in order to prevent its renal excretion 5d λ of haptoglobin alone 1h λ bound to heme ↓↓↓ in hemolytic anemias |
#molecules #biochemistry
|
|
ARDS
|
diffuse injury to endothelium or epithelium
→ ↑ permeability → interstitial & alveolar edema, inflam, hyalin membranization ↓ compliance, ↑ workload ↓ diffusion severe involvment or atalectasis will cause V/Q mismatch requires an absence of cardiogenic ie hemodynamic causes ie wedge pressures, atrial pressures should not be hchanged |
#pathology #pulmonlogy
|
|
define bioavailability
|
Area under [route] curve divided by area under IV curve
IV bioavailability always 100% |
#pharmacology
|
|
Laplace's law
|
Pressure necessary to distend a hollow organ is directly proprtional to the tension and inversely proprortional to the radius
P = 2T/r assuming constant surface tension, sphere with smaller radius will have higher distending pressure requirement thus will want to collapse when in communication with a larger sphere of the same surface tension (ergo we need surfactant) |
#physiology #pulmonology
|
|
How does nitroglycerin help the heart?
|
cGMP → venodilation → decreased preload
nitrates do dilate the coronary arterioles, but this is not where the bulk of their effectiveness comes from, the bulk of the effectiveness comes from venorelaxn |
#pharmacology #cardiovascular
|
|
CD40
|
CD40 is a receptor on the B cell for CD154 aka CD40L on T cells
This interaction allows for class switching to occur |
#immunology
|
|
Most likely organisms within hair follicles
|
Follicullitis: S aureus & P aeruginosa
Furuncles/Carbuncles: S aureus |
#microbiology #skin
|
|
Which part of HAART is responsible for the cushing-like presentation?
|
Protease inhibitors
-navirs lipodystrophy, hyperglycemia, and p450 inhibition |
#microbiology #pharmacology #antimicrobials #toxicities
|
|
What reactions is necessary for the primary catabolized amino acid to enter Gluconeogeneis/Glycogenoslysis
|
one step reversible transamination by alanine aminotransferase
B6 dependent alanine → pyruvate amino group transfered to α-ketoglutarate to form glutamate glutamate cleaved by glutamate dehydrogenase → α ketoglutarate + NH3 |
#biochemistry #energymetzm
|
|
Compare Crohn's to UC in terms of
Involvement, Cheif Complaint and Complications |
Crohns: anywhere along gut w/ skip lesions
inflammation of entire thickness w/ linear ulcerations & granulomas CC: abdominal pain>diarrhea Complications: Fistulas & Strictures UC: Starting from the rectum w/ continous progression only mucosal/submucosal only (thus no fistulas) CC: Bloody Diarrhea Complixn: Toxic Megacolon |
#pathology #gastrointestinal
|
|
Caspofungin
|
an echinocandin
inhibits glucan synthesis like micafungin |
#microbiology #pharmacology #antimicrobials
|
|
Micafungin
|
an echinocandin
inhibits glucan synthesis like caspofungin |
#microbiology #pharmacology #antimicrobials
|
|
What biologically active molecules are derived from Pheynylalanine?
|
BH4 dpt conversion to Tyrosine
Tyrosine may be converted to Thyroxine or DOPA* [DOPA may be converted to dopamine^ or melanin] *also req BH4 ^B6 dpt |
#biochemistry #molecules
|
|
What biologically active molecules are derived from Tryptophan?
|
B6 dpt conversion to Niacin
→ NAD+ and NADP+ BH4 dpt conversion to Serotonin → Melatonin |
#biochemistry #molecules
|
|
What biologically active molecules are derived from Glycine?
|
B6 dpt combination with Succinyl CoA to dALA
|
#biochemistry #molecules
|
|
What biologically active molecules are derived from Arginine?
|
Creatinine
Urea & NO |
#biochemistry #molecules
|
|
What biologically active molecules are derived from Glutamate?
|
Glutathione
B6 dpt conversion to GABA |
#biochemistry #molecules
|
|
What is the necessary precursor molecule for DOPA synthesis?
|
Tyrosine
BH4 dpt conversion to DOPA |
#biochemistry #molecules
|
|
What is the necessary precursor molecule for Tyrosine synthesis?
|
Phenylalanine
BH4 dpt conversion to Tyrsoine Tyrosine may be converted to Thyroxine or DOPA* [DOPA may be converted to dopamine^ or melanin] *also req BH4 ^B6 dpt |
#biochemistry #molecules
|
|
What is the necessary precursor molecule for Niacin synthesis?
|
Trytpophan
B6 dpt conversion to Niacin necessary for NAD+ & NADP+ Tryptophan may also undergo BH4 dpt conversion to Serotonin |
#biochemistry #molecules
|
|
What is the necessary precursor molecule for Serotonin synthesis?
|
BH4 dpt conversion of Tryptophan
necessary for Melanonin prodxn Tryptophan may also be converted to Niacin (w/ B6) |
#biochemistry #molecules
|
|
What is the necessary precursor molecule for NO synthesis?
|
Arginine
|
#biochemistry #molecules
|
|
What is precursor molecule to Urea prodxn?
|
Arginine
also precursor to NO & Creatinine |
#biochemistry #molecules
|
|
What is the precursor molecule to Creatinine prodxn?
|
Arginine
also precursor to NO & Urea |
#biochemistry #molecules
|
|
What is the necessary precursor molecule for GABA synthesis?
|
Glutamate & B6
Glutamate also precursor to Glutathione |
#biochemistry #molecules
|
|
What is the necessary precursor molecule for Glutathione synthesis?
|
Glutamate
Glutamate also precursor to GABA (w/ B6) |
#biochemistry #molecules
|
|
In pulmonary edema what accounts for dyspnea?
|
↓ lung compliance from interstitial fluid
|
#pathology #pulmonology
|
|
How does folate deficiency cause anemia?
|
decreased thymidine synthesis
|
#biochemistry #vitamins #pathology
|
|
Brown Pigment Stones vs Black Pigment Stones
|
black: hemolysis
brown: biliary tract infx |
#gastrointestinal #pathology
|
|
HLA
class I vs class II |
HLA Class I = MHC Class I
large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#rheumatology #immunology
|
|
HLA Class 2
|
HLA Class II = MHC Class II
Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
|
|
HLA Class 1
|
HLA Class I = MHC Class I
large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
|
|
HLA associated with Hemochromatosis
|
HLA A3
____________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#pathology #rheumatology
|
|
HLA associated with Psoriasis
|
HLA B27
assoc. w/ Psoriasis, Ankylosing Spondylitis, Inflmmatory Bowel Dz & Reiter's Sro ____________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#pathology #rheumatology
|
|
HLA associated with Ankylosing Spondylitis
|
HLA B27
assoc. w/ Psoriasis, Ankylosing Spondylitis, Inflmmatory Bowel Dz & Reiter's Sro ____________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#pathology #rheumatology
|
|
HLA associated with Inflammatory Bowel Dz
|
HLA B27
assoc. w/ Psoriasis, Ankylosing Spondylitis, Inflmmatory Bowel Dz & Reiter's Sro ____________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#pathology #rheumatology
|
|
HLA associated with Reiter's Sro
|
HLA B27
assoc. w/ Psoriasis, Ankylosing Spondylitis, Inflmmatory Bowel Dz & Reiter's Sro ____________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#pathology #rheumatology
|
|
HLA associated with Grave's Dz
|
HLA B8
____________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#pathology #rheumatology
|
|
HLA associated with Multiple Sclerosis
|
HLA DR2
assoc. with multiple Sclerosis, Hay Fever, SLE and Goodpasture's ____________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA associated with Hay Fever
|
HLA DR2
assoc. with multiple Sclerosis, Hay Fever, SLE and Goodpasture's ____________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA associated with SLE
|
HLA DR2
assoc. with multiple Sclerosis, Hay Fever, SLE and Goodpasture's ____________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA associated with Goodpasture
|
HLA DR2
assoc. with multiple Sclerosis, Hay Fever, SLE and Goodpasture's ____________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA associated with T1DM
|
HLA's DR3 & DR4
DR4 also assoc w/ rheumatoid arthritis ___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA associated with Rheumatoid Arthritis
|
HLA DR4
also associated with T1DM (which is also associated with HLA DR3) ___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA associated with Pernicious Anemia
|
HLA DR5
also associated with Hashimoto's Thyroiditis ___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA associated with Hashimoto's
|
HLA DR5
also associated with Perniciosu Anemia ___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA associated with Steroid Responsive Nephrotic Sro
|
HLA DR7
___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA DR7
|
assoc. w/ steroid responsive nephrotic sro
___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA DR5
|
Pernicious anemia and Hashimoto's
___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA DR4
|
Rheumatoid Arthritis
& T1DM NB: T1DM also assoc. w/ DR3 ___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA DR3
|
T1DM
NB: NB: T1DM also assoc. w/ DR4 which is also assoc. with Rheumatoid Arthritis ___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA DR2
|
Multiple Sclerosis, Goodpasture, Hay Fever, SLE
___________________ HLA Class II = MHC Class II Equal sized α and βglobulins Inclues HLA-DR, HLA-DP and HLA DQ |
#pathology #rheumatology
|
|
HLA B8
|
Grave's Dz
________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#rheumatology #pathology
|
|
HLA B27
|
Mn: PAIR
Psoraisis Ankylosing Spondylitis IBD Reiter's Sro ________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#rheumatology #pathology
|
|
HLA A3
|
Hemochromatosis
________________ HLA Class I = MHC Class I large α, β2 microglobulin Includes HLA-A, HLA-B & HLA-C |
#rheumatology #pathology
|
|
Rx: Alzhemier's Demetia
|
Central acting Cholinergic enhancers:
Donepezil, Rivastigmin NMDA antagonists: memantidine Antioxidants: Eitamin E |
#pharmacology #neurology
|
|
Gibbs Free Energy & Keq
|
Gibbs Free Energy
ΔG0 = -RlnKeq Keq = products/reactants if ΔG0 is negative Keq > 1 and products accumulate if ΔG0 is positive than Keq <1 and substrates will accumualte ΔG = 1 is steady state ΔG = 0 is mathmatically impossible |
#formulas
|
|
What kind of heart damage doe doxorubicin & daunocrubicin produce?
|
anthracyclines
dose dpt cardiact toxicity swelling SR → loss of individual cardiomyocytes ("myofibrillar dropout" → dilated cariomyopathy preventable with dexrazocane |
#pharmacology #toxocities
|
|
ACEI's vs Kidneys
what is contraindication |
renal artery stenosis
these people are depending on dilated efferent arteriole to decreases resistance and maintain glomerular filtration and interstitial perfusion |
#pharmacology #toxicities
|
|
Killed bacterial vaccines
|
Cholera
Anthrax Pertussis Plague |
#microbiology #immunology
|
|
Live attenuated bacterial vaccines
|
BCG: tuberculosis
thyphoid vaccine Tularemia |
#microbiology #immunology
|
|
Capsular polysaccharide vaccines
|
Pneumococcus
Hib Meningococcus |
#microbiology #immunology
|
|
Ig which does not contribute to Neisseria killing
|
IgA cannot trigger complement cascade
only IgM and IgG too much IgA leaves pts vulnerable to Neisseria by blocking IgG and IgM from epitopes |
#micobiology #immunology
|
|
Lewy Bodies
|
Parkinsons & Lewy Body Dementia
|
#pathology #neurology #dementia
|
|
IL10
|
produced by TH2 and inhibits the synthesis of IFNγ
|
#immunology
|
|
S3 & S4
|
S4 = Atrial Kick
NB: caused by non-compliant ventricle S3 = Opening Splash caused by ↑ Atrial Pressure or Dilated ventricles ie ↑ mitral regurg or end stage CHF physiologic in children & pregnants |
#cardiology #pathology
|
|
Heart Problems on a Med
Nausea, Vomiting, Confusion, Visual Changes |
Digoxin used for atrial fib w/ undelrying systolic dysnfx
Not only ↑ contractility, but also induces vagal stim of AV node Toxicity: Nausea/Vomitting/Anorexia/Diarrhea fatigue/HA/Dizziness/Confusion/Delerium Blurry Vision, Δcolor perception Hyperkalemia Tx: activated charcoal insulin, kayexalate or hemodyalysis for hyperK avoid Ca2+ gluconate 3. Fab NB: hypokalemic state ↑ susceptibility to digoxin tocitity |
#cardiology #pharmacology #toxicity
|
|
Where do the testicular and adrenal veins drain?
|
Right Adrenal drains via right suprarenal vein directly into IVC
Right Testical Drains directly into IVC Both left Adrenal and Left Testical Drain into Left Renal Vein |
#anatomy #cardiovascular
|
|
Potassium perchlorate
|
K Cl O4
Competitively inhibits Na+/I- symporter (NIS) on basolateral membrane of thyroid follicular cells useful for decreasing radioactive iodine uptake sibling drug: Pertechnetate TcO4- |
#pharmacology #endocrine #thyroid
|
|
Pertechnetate
|
TcO4-
Competitively inhibits Na+/I- symporter (NIS) on basolateral membrane of thyroid follicular cells useful for decreasing radioactive iodine uptake sibling drug: Perchlorate (aka potassium perchlorate) K Cl O4- |
#pharmacology #endocrine #thyroid
|
|
Hypotonic Baby dies at 7 mo
|
Werdnig Hoffman
infantile spinal muscular atrophy AR degeneration of anterior horn cells LMN involvment only Floppy at birth, dies w/in year |
#pathology #genetics #neurology
|
|
Werdnig Hoffman
|
Werdnig Hoffman
infantile spinal muscular atrophy AR degeneration of anterior horn cells LMN involvment only Floppy at birth, dies w/in year |
#pathology #genetics #neurology
|
|
infantile spinal muscular atrophy
|
Werdnig Hoffman
infantile spinal muscular atrophy AR degeneration of anterior horn cells LMN involvment only Floppy at birth, dies w/in year |
#pathology #genetics #neurology
|
|
Alcohol detoxification process
|
Most common manifestation is tremulousness "shakes" which start w/in 12 hours and peak at day 3 and subside by day 5
Delerium tremens peaks on the 3rd day: fluctuant level of arousal, hallucinations, SNS hyperactivity etc only 1/4 will have vision disturbances only 1/20 will actually undergo tonic clonic seizures |
#pharmacology #alcohol
|
|
Serum Creatine Kinase indicative of
|
aka CPK
Muscle Cell membrane damage gets out when membrane is damage |
#pathology #diagnostics
|
|
Potent CYP450 inducers and inhibitors
Top 12 |
Inducors
Carbamazepine Phenobarbital Phenytoin Reifampin Griseofulvin Inhibitors Cimetidine Ciprofloxavin erythromycin Azoles Grape Fruit Juice Isoniazid Ritonavir & other protease inhibors |
#pharmacology
|
|
Best Diagnostic Test for Acute Cholecystitis
|
Failed visualization of gallbladder on HIDA scan
Almost all acute cholecystitises 2° to gallstone obstrx of cystic duct radiolabelled nucleotide uptaken by bladder excreted via biliary ducts but does not enter gallbladder w/in 4 h indicates obstxn of cystic duct and therefore actue cholecystitis |
#pathology #diagnostics #hepatobiliary
|
|
HIDA scan
|
Best Diagnostic Test for Acute Cholecystitis
Almost all acute cholecystitises 2° to gallstone obstrx of cystic duct radiolabelled nucleotide uptaken by bladder excreted via biliary ducts but does not enter gallbladder w/in 4 h: indicates obstxn of cystic duct and therefore actue cholecystitis |
#pathology #diagnostics #hepatobiliary
|
|
"Normal" Cardiac Abnormality
|
1/4 of adult population has a patent foramen ovale
normal atrial pressures keep it closed problems arise if RA pressures > LA pressures thromboses/strokes |
#cardiovascular #pathology
|
|
Ideopathic Pulmonary Artery Hypertension
|
Ideopathic Pulmonary Hypertension
abnormal Bone Morphogenic Protein Receptor Type 2 BMPR2 30 yo women ↓ NO & Prostaglandins ↑ endothelin ↑ VSMC proliferation |
#pathology #pulmonology
|
|
BMPR2
|
Ideopathic Pulmonary Hypertension
abnormal Bone Morphogenic Protein Receptor Type 2 BMPR2 30 yo women ↓ NO & Prostaglandins ↑ endothelin ↑ VSMC proliferation |
#pathology #pulmonology
|
|
Colonic Polyps
What features indicate malignant vs benign |
Non-neoplastic Polyps:
Hyperplastic (well differentiated w/ crypts and glands) Hamartomatous: sporatic or Peutz-Jeghers and Juvenile Polyposis Inflammatory: regenerating (Crohns) Lymphoid: children Neoplastic factors: Degree of dysplasia Villous>Tubular Size esp >4 |
#pathology #gastrointestinal #neoplasia
|
|
Carcinoid Tumor: Benign vs Metastatic
|
5-hydroxyindolacetetic aciduria
Liver will metabolize any products normally If there are systemic sx then it has metastesized to the liver already |
#pathology #neoplasia
|
|
Cardiovascular Defects of Turner Sro
|
1. Bicuspid Aortic Valve <<most common
2. Coarctation of aorta |
#pathology #genetics #cardiovascular
|
|
FGF gene in embryogenesis
|
produced at apical dermal ectodermal ridge (thickened ectoderm at distal end of each developin limb). Stimulates mitosis of underlying mesoderm responsible for lengthening limbs.
|
#embryology #molecules
|
|
Wnt-7 gene
|
produced at apical ectodermal ridge (thickened ectoderm at distal end of each developin limb). Necessary for proper organization along dorsal-ventral axis
|
#embryology #molecules
|
|
Sonic Hedgehog Gene
|
produced at base of limbs in zone of polarizing activity. involved in patternining along A-P axis
|
#embryology #molecules
|
|
produced at base of limbs in zone of polarizing activity. involved in patternining along A-P axis
|
Sonic Hedgehog Gene
|
#embryology #molecules
|
|
produced at apical ectodermal ridge-- necessary for proper organization along dorsal-ventral axis
|
Wnt-7 gene
ectodermal ridge: (thickened ectoderm at distal end of each developin limb |
#embryology #molecules
|
|
produced at apical dermal ectodermal ridge-- stimulates mitosis of underlying mesoderm responsible for lengthening limbs.
|
FGF gene
ectodermal ridge: (thickened ectoderm at distal end of each developin limb |
#embryology #molecules
|
|
Electrolytes through the pancreatic ducts
|
released isotonic to plasma
regulated by secretin from duodenal S cells in response to H+ HCO3 exchanged for Cl along the way the more secretin, the more these exchange by the end, the more alkaline the secretions |
#physiology #gastrointestinal
|
|
Eplerenone
|
Aldosterone antagonist useful in Conns
1/10th as many reports of gynecomastia with Eplerenone as Spirolactone |
#pharmacology #drugs
|
|
Cord factor
|
mycoside: 2 mycolic acids molecules bound via disaccharide [trehalose]
Virulence factor of mycobacteria, mycobacteria which do not have cord factor are not infectious allows Mtb to grow in thick serpeinte cords, inactivates PMN,s damages mitochondria and induces TNF prodxn |
#microbiology
|
|
sulfatides
|
virulence factor of Mtb prevent fusion of lysosomes to phagosomes
|
#microbiology
|
|
congenital inability to smell
|
assoc w/ Kallman sro
hypogonadotrophic hypogonadism GnRH releasing neurons do not travel from primitive olfactory bulb to hypothalamus |
#pathology #endocrine
|
|
Anti-hyperlipidemic agent which precipitates gouty attack
|
Niacin
esp w/ initial threatment also hyperglycemia and then hepatotoxicity at high doses |
#drugs #toxicities
|
|
HMP Shunt
|
Irreversible Oxidative Rxns
G6PDehydrogenase G6P + NADP → 6 Phosphogluconate + NADPH Rate Limiting Step 6 Phosphogluconate Dehydrogenase Phosphogluconate + NADP → Ribulose 5 Phosphate + NADPH all subsequent rxns reversible Transketolase Ribose 5 Phsophate → Glyceraldehyde 3 Phosphate Transaldolse Glyceraldehyde 3 phsophate → Fructose 6 Phosphate |
#biochemistry #energymetzm
|
|
What Rx must be taken to eliminate the hepatic stages of malaria
|
primaquin
|
#microbiology #antimicrobials #pharmacology
|
|
Single lymph node grows and shrinks cyclically
|
Follicular lymphoma
benign most common non-hodgkin lymphoma in adult t(14:28) Bcl2 |
#neoplasia #pathology
|
|
Follicular lymphoma
|
benign
most common non-hodgkin lymphoma in adult t(14:28) Bcl2 Single lymph node grows and shrinks cyclically |
#neoplasia #pathology
|
|
Where do urate stones form and why
|
collecting ducts due to low pH
uric acid pKa 5.4 |
#pathology #nephrology
|
|
1° mtb infx
|
Gohn focus: fibrotic focus in lower lobe of lung
Ispilateral hilar adenopathy (w/ calcification) Gohn complex = both of those aspiration of <2mm droplets → M∅ phagocytosis → intracellular proliferation → lymphatic cirulation → dissemination |
#microbiology #pulmonology
|
|
Gohn Focus vs Gohn Complex
|
Gohn focus: fibrotic focus in lower lobe of lung
Ispilateral hilar adenopathy (w/ calcification) Gohn complex = both of those aspiration of <2mm droplets → M∅ phagocytosis → intracellular proliferation → lymphatic cirulation → dissemination |
#microbiology #pulmonology
|
|
Which antimicrobials should always be monitored with a complete blood count
|
cloramphenicol: aplastic anemia
dapsone TMP SMX: megaloblastic anemia |
#antimicrobials #pharmacology #toxicity
|
|
Which antimicrobials should always be monitored for LFT's
|
INH, rifampin, pyrazinamide
|
#antimicrobials #pharmacology #toxicity
|
|
subdural hematoma and bilateral retinal hemorrhages in an infant
|
shaken baby sro
|
#pathology #ethics
|
|
cardinal signs of shaken baby sro
|
subdural hematoma and bilateral retinal hemorrhages in an infant
|
#pathology #ethics
|
|
HIV proteins
|
env: gp160
cleaved into gp120 & gp41 gp120: attachment to T cell gp41: fusion & entry gag (p24) capsid protein pol: reverse transcriptase |
#microbiology
|
|
How can you diagnose a B12 deficiency (before empirically providing B12)
|
serum methylmalonic acid level
|
#pathology #diagnostics
|
|
low serum methylmalonic acid
|
not a b12 deficiency
high would be a b12 deficiency |
#pathology #diagnostics
|
|
high serum methylmalonic acid
|
B12 deficiency
|
#pathology #diagnostics
|
|
Calories/Gram by Nutrient
|
CHO & Proteins: 4
EtOH: 7 Fat: 9 |
#biochemistry #energymetzm
|
|
Lambert-Eaton Sro is 2° to what?
|
Classically Small Cell Lung Cancer
|
#pathology #neoplasia
|
|
easy fatigability, constpitation, back pain and azotemia
|
multiple myeloma
Bence Jones Light Chainse |
#pathology #neoplasia #presentations
|
|
Carcinoid Tumor which produces diarrhea
|
WDHA
whatery Diarrhea Hypokalemia Achlorhydria Vasoactive Peptide relaces GI smm inhbitis gastric H+ stims pancreatic bicarbonate |
#pathology #neoplasia
|
|
PI3K-ATK Pathway
|
Too much time on graph, return to this
|
|
|
PTEN mutations
|
Endometrial Hyperplasia & Carcinoma
Melanoma Cowden Sro: AD Bannayan-Ruvalcaba-Riley Sro: AD Both present with macrocephaly, intestinal hamartomous polyps and benign skin lesions: lipomas, hamngiomas & pigmented macules on penis Cowden Sro: no ↑ risk of GI malignancy, yes ↑ risk breast, thyroid follicular and endometrial CA Bannayan-Ruvalcaba-Riley: ↓ risk malignancy, yes dvlptl delays |
|
|
PIK3 & Malignancy
|
Part of the PI3K-ATK pathway
PIK3CA is the catalytic subunit amplification is involved in -the invasiveness of endometrial cancers, esp those s PTEN mutations (not the hyperplasia) also in follicular thyroid carcinoma [FTC else RAS gain of fnx w/ PTE loss of fnx or q13p25 translocation PAX8 (thyroid) + PPARG |
|
|
MDM2
|
anti-apoptotic 2nd messenger in PI3K-ATK pathway
promotes degradation of p53 mutated in 1/3 of sarcomas esp those s p53 KO's |
|
|
Surfactant Dynamics In Utero: Molecules, Timeline
|
Sphingomyeline is a common membrane lipid, the relative concentration of sphingomyelin does not increase
Phosphatidyl glycoerol is a component of surfactant which rises after 36 weeks Phosphatidylcholine aka lecithin is a component of pulmonary surfactant which increases sharply after 30 wks a ratio of L/S of 2:1 by week 35 indicates fetal lung maturity |
|
|
How do you deal with a language barrier
|
always use a trained interpreter, not a family member.
Even for sign language: writing and/or lip reading is not an good substitute as these are imperfect or abridged. |
|
|
What are the cells and hormonal dynamics of the maturing follicle
|
Theca Interna: Leutinizing Hormone induces the production of Progesterone and Androgens
Theca Externa is a non-participatory layer of smm and fibroblasts Granulosa Cells: FSH induces aromatase to convert the androgens into estradiol |
|
|
What Sro presents with Aortic Coarctation
|
Turner Sro
|
|
|
What sro Presents with Hypertrophic Cardiomyopathy
|
Freidrick's Ataxia
|
|
|
What Sro Presents with Situs Inversus
|
kartagener's Sro
|
|
|
What Sro may present with Atrial septal defect and a regurgitant AV valve
|
Down Sro
|
|
|
Mitochondrial Dz's
|
3 types:
MERRF: Myoclonic Epilepsy with Ragged Red Fibers MELAS: Mitochondrial Encephalopathy with Stroke Like Episodes and Lactic Acidosis Leber Optic Neuropathy (Blindness) |
|
|
What are the stop codons
|
UAA, UAG, UGA
|
|
|
Orexin
|
aka hypocretin, produced in lateral hypothalamus, maintains wakefulness
most common form of narcolepsy 2° to destrxn of orexin producing neurons |
|
|
hypocretin
|
aka orexin, produced in lateral hypothalamus, maintains wakefulness
most common form of narcolepsy 2° to destrxn of orexin producing neurons |
|
|
CO: 2 formulas
|
SV*HR
or O2 consumption/arteriovenous O2 difference |
|
|
Horseshoe Kidney
|
1/500 people
get caught under IMA cause UTI's & Obstrx |
|
|
T tubules
|
invagination of extracellular memgrane between A & I
fnx: coordinated contraction |
|
|
Sarcomere Organization
|
M line: Middle Line: attachment points of myosin
H band: Heller german for lighter, just myosin A band: anisotropic: two types of things actin and myosin I band: isotropic one type of thing: just actin Z disk: attachments of actin T tubules lay across the jnx of the A and I bands |
|
|
Dihydropyridine Receptors
|
Voltage Gated Calcium Channels on Muscle Cell Membrane
|
|
|
How could two non-virulent mutant strains of the same, non-segmented virus produce virulent progeny
|
recomination
|
|
|
viral phenotype mixing
|
combination of cytopathic effects from coinfx of 2 viruses
eg virus A acquires surface glycoproteins of virus B virus A has ability to infect the cells for which B is tropic, but only for one generation |
|
|
Virus Interference
|
Viral coinfex but one virus blocks the action of a 2nd.
Eg? |
|
|
Describe Excitation Signals in All Muscle Types
|
SkM: Direct physical interaction exists btw sarcolemmal ca2+ dihydropyridine L type calclium channel and the Ryanidine Receptor. this induces immediate release of Ca2+ from within the cell. There is no significant influx of Ca2+ from the extracellular environment. Ergo calcium channel blockers have no effect on SkM
CrM: L type Ca2+ channels allow influx of Ca2+. Ca2+ then acts as a 2nd messenger to open the RyR2 channels and allow a Calcium dependent calcium release. SmM: similar mechanism, however, Ca2+ does not act directly on the TroponinC. Ca2+ binds and activates calmodulin, which activates myosin light chain kinase allowing for the phosphorylation of myosin & excitation contraxn coupling. |
|
|
Respiratory Tree: Epithelium
|
Pseudostratified columnar with goblet cells, basal cells, and submucosal glands from trachea to 3* bronchi
Bronchioles transition to cuboidal cells with clara cells and no longer contain submucosal glands [not part of question but the smooth muscle of the bronchioles is the primary site of bronchoconstriction] Respiratory Bronchioles transition to squamous still with clara cells Ciliation continues from trachea through respiratory bronchioles, only not present in alveoli |
|
|
Embryology Week 1
|
d0: fertilization
d1: cleavage d2: 8 cells, compaction d3: morula d4: enter uterus, blastocystic cavity appears d6: hatches, implants d6-8 trophoblast divides into two layers d8: syncytiotrophoblast βHCG production begins |
|
|
Embryology Week 2
|
d6-8 trophoblast divides into two layers
d8: syncytiotrophoblast βHCG production begins embryoblast differentiates into epiblast and hypoblast amnioblasts from epiblasts form rim of amniotic sac d9: lacunar stage & formation of the primitive yolk sac --hypoblast migrates around exocoelomic cavity to form primitive yolk sac (aka exocoeolemic) membrane d11 & 12 uroplacental circulation begins, extraembryonic mesoderm forms d13: extraembryonic coelem forms w/in extraembryonic mesoderm, new cells emegrate from hypoblast to form 2° yolk sac as 1° yolk sac pinches off; NB: 2° yolk sac ≠ extraembryonic coelem; NB: Chorion = trophoblast layers + extraembryonic (somatic) coelom Weeks of twos: 2 germs layers 2 cavities form: amniotic and yolk sac 2 components of placenta: cytotrophoblast & syncytiotrophoblast 2 derivatives of extrembryonic mesoderm: somatopleure, splanchopleure |
|
|
Embryology Week 3
|
Trilaminar Disc, gastrulation;
primitive streak, notochord, mesoderm and organization, and neural plate begin to form |
|
|
Embryonic Period
|
Weeks 3-8
Neural tube formed by enuroectoderm and closes by week 4 Organogenesis Extremely susceptible to teratogens |
|
|
Embryology Week 4
|
4 heart chambers: heart begins to beat
4 limb buds begin to form |
|
|
Week 8
|
fetal movement, fetus looks like a baby
|
|
|
Weekk 10
|
gentialia have male/female characteristics
|
|
|
Alar plate
|
primitive sensory neurons, dorsally oriented
|
|
|
basal plate
|
primitive motor neurons, ventrally oriented
|
|
|
Notochord Development
|
notochord formed from primitive streak on surface of epiblast invaginating and intercalating with hypoblast. cells proliferate and detach until forming definitive notochord.
|
|
|
Pharyngeal Cleft Derivatives
|
1: EAM
2-4: Persistent Cervical Sinuses |
|
|
Pharyngeal Pouch Derivatives
|
1: IAM
2: Palatine Tonsil Lining 3: Dorsal: Inferior Parathyroid Glands Ventral: Thymus 4: Superior Parathyroid Glands, Ultimobranchial body (neural crest) → calcitonin producing clear cells |
|
|
Pharyngeal Arch I
|
Maxillary Division: V2, midface dermis, mucosa of nose & palate
Mandibular Division: V3, Meckel's cartilage → malleus & incus, mandible, most of temporal bone, sphenomandibular ligament mucosa: anterior 2/3 of tongue + oral cavity muscles: anterior belly of digastric, mylohyoid, tensor hypani, tenso verli palatini 1st aortic arch → part of maxillary artery |
|
|
Pharyngeal Arch 2:
|
Richert's Cartilages: Stapes, Styloid Process, Lesser Horn of Hyoid, Stylohyoid ligament, top 1/2 of hyoid body
Muscles: Facial Expression, Stapedius, Stylohyoid, Posterior Belly of Digastric Nerve: CN7 Aortic Arch → Stapedial Artery, regresses in humans |
|
|
Pharyngeal Arch 3
|
Greater Horn of Hyoid & Lower 1/2 of body
Mucles: Stylopharygeus Mucosa: Orophayrnx, posterior 1/3 of tongue, posterior tongue taste buds Nerve: CN9 Aortic Arch → Common & Proximal Internal Carotid |
|
|
Pharyngeal Arch 4
|
Upper portn of thyroid cartilage & some laryngeal cartilage
mucosa: supperglottic laryngopharynx, epiglottic taste buds Nerve: CNX via Superior Laryngeal Nerve & Pharyngeal Branch Muscles: Pharyngeal Constrictors & Crichothyroid Aortic Arch: Part of True Aorta & Subclavian |
|
|
Pharyngeal Arch 5
|
Obliterated
|
|
|
Pharyngeal Arch 6
|
Lower Thyroid Cartilage, crichoid cartilage, some laryngeal cartilage
mucosa: infraglottic laryngeopharynx CNX via Recurrent laryngeal N controlls all intrinsic muscles of the larynx except the crichothyroid Aortic Arch: Pulmonary Arteries & Ductus Arteriosus |
|
|
Aortic Arch Derivatices
|
1: Part of Maxillary Artery
2: Stapedial Artery (regresses) 3: Common & Proximal Internal Carotid 4: Part of True Aorta & Subclavian 5: Obliterated 6: Pulmonary arteries & Ductus Arteriosus |
|
|
Nerve Injury
Sign: Wrist Drop Nerve, Levels, Cause, Motor & Sensory Deficits? |
radialnerve
C5-C8 Injury: Fx midshaft of humerus "saturday night palsy" (compression on chair or crutches" Motor: B.E.S.T. extensors Brachioradialis, Extensors of Wrist & Fingers, Supinators, Triceps Sensory Deficit: posterior arm + dorsal hand & thumb Sign: Wrist Drop |
|
|
Sign: Loss of opposability of thumb
Nerve, Levels, Cause, Motor & Sensory Deficits? |
Median Nerve
Proximal Lesion: Fx of supracondylar humerus Motor: opposition of thumb Sensory: lateral 3.5 fingers Sign: "ape hand" thenar atrophy Distal Lesion: Carpal Tunnel, Dislocated Lunate Motor: Wrist & Lateral Finger Flexion Sensory:Same Sign: Claw hand, ulnar deviation of wrist upon flexion |
|
|
Sign: Ulnar deviation of wrist upon Flexion
Nerve, Levels, Cause, Motor & Sensory Deficits? |
Median Nerve
Proximal Lesion: Fx of supracondylar humerus Motor: opposition of thumb Sensory: lateral 3.5 fingers Sign: "ape hand" thenar atrophy Distal Lesion: Carpal Tunnel, Dislocated Lunate Motor: Wrist & Lateral Finger Flexion Sensory:Same Sign: Claw hand, ulnar deviation of wrist upon flexion |
|
|
Sign: Claw Hand, Index & Middle Finger's Flexed
Nerve, Levels, Cause, Motor & Sensory Deficits? |
Median Nerve
Proximal Lesion: Fx of supracondylar humerus Motor: opposition of thumb Sensory: lateral 3.5 fingers Sign: "ape hand" thenar atrophy Distal Lesion: Carpal Tunnel, Dislocated Lunate Motor: Wrist & Lateral Finger Flexion Sensory:Same Sign: Claw hand, ulnar deviation of wrist upon flexion |
|
|
Sign: Radial deviation of wrist upon flexion
|
Ulnar Nerve
Proximal Lesion; Fx of medial epicondyle "funny bone" Motor: Medial finger flexion, wrist flexion Sensory: medial 1.5 fingers & hypothenar eminence Sign: radial deviation of wrist on flexion Distal Lesion: Fx hook of hamate Motor: Interossei (Ab/addxn), Addxn of thumb, lumbricals extension of 4th & 5th) sign: ulnar claw hand "Pope's blessing" |
|
|
Sign: claw hand of 4th & 5th digits
|
Ulnar Nerve
Proximal Lesion; Fx of medial epicondyle "funny bone" Motor: Medial finger flexion, wrist flexion Sensory: medial 1.5 fingers & hypothenar eminence Sign: radial deviation of wrist on flexion Distal Lesion: Fx hook of hamate Motor: Interossei (Ab/addxn), Addxn of thumb, lumbricals extension of 4th & 5th) sign: ulnar claw hand "Pope's blessing" |
|
|
Injury: Fx surgical neck of humerus
|
Axillary Nerve
C5- C6 Injury: Fx surgical neck of humerus or dislocated humoral head Motor: detloid Sensory: skin over deltoid Sign: Flattened Deltoid |
|
|
Injury: Fx midshaft of humerus
|
Radial Nerve
C5-C8 Injury: Fx midshaft of humerus "saturday night palsy" (compression on chair or crutches" Motor: B.E.S.T. extensors Brachioradialis, Extensors of Wrist & Fingers, Supinators, Triceps Sensory Deficit: posterior arm + dorsal hand & thumb Sign: Wrist Drop |
|
|
Injury: Fx of supracondylar humerus
|
Median Nerve
Proximal Lesion: Fx of supracondylar humerus Motor: opposition of thumb Sensory: lateral 3.5 fingers Sign: "ape hand" thenar atrophy Distal Lesion: Carpal Tunnel, Dislocated Lunate Motor: Wrist & Lateral Finger Flexion Sensory:Same Sign: Claw hand, ulnar deviation of wrist upon flexion |
|
|
Injury: Carpal Tunnel
|
Median Nerve
Proximal Lesion: Fx of supracondylar humerus Motor: opposition of thumb Sensory: lateral 3.5 fingers Sign: "ape hand" thenar atrophy Distal Lesion: Carpal Tunnel, Dislocated Lunate Motor: Wrist & Lateral Finger Flexion Sensory:Same Sign: Claw hand, ulnar deviation of wrist upon flexion |
|
|
Injury: Dislocated Lunate
|
Median Nerve
Proximal Lesion: Fx of supracondylar humerus Motor: opposition of thumb Sensory: lateral 3.5 fingers Sign: "ape hand" thenar atrophy Distal Lesion: Carpal Tunnel, Dislocated Lunate Motor: Wrist & Lateral Finger Flexion Sensory:Same Sign: Claw hand, ulnar deviation of wrist upon flexion |
|
|
Injury: Fx of medial epicondyle
|
Ulnar Nerve
Proximal Lesion; Fx of medial epicondyle "funny bone" Motor: Medial finger flexion, wrist flexion Sensory: medial 1.5 fingers & hypothenar eminence Sign: radial deviation of wrist on flexion Distal Lesion: Fx hook of hamate Motor: Interossei (Ab/addxn), Addxn of thumb, lumbricals extension of 4th & 5th) sign: ulnar claw hand "Pope's blessing" |
|
|
Injury: Upper Trunk Compression
|
Musculocutaneous Nerve
C5-C7 Injury: Upper trunk compression Motor: Biceps, Brachialis, Coracobrachialis Flexion of arm at elbow Sensory: Lateral Forearm |
|
|
Injury: Dislocated Humerus
|
Axillary Nerve
C5- C6 Injury: Fx surgical neck of humerus or dislocated humoral head Motor: detloid Sensory: skin over deltoid Sign: Flattened Deltoid |
|
|
Axillary Nerve
|
Axillary Nerve
C5- C6 Injury: Fx surgical neck of humerus or dislocated humoral head Motor: detloid Sensory: skin over deltoid Sign: Flattened Deltoid |
|
|
Radial Nerve
|
radialnerve
C5-C8 Injury: Fx midshaft of humerus "saturday night palsy" (compression on chair or crutches" Motor: B.E.S.T. extensors Brachioradialis, Extensors of Wrist & Fingers, Supinators, Triceps Sensory Deficit: posterior arm + dorsal hand & thumb Sign: Wrist Drop |
|
|
Median Nerve
|
Median Nerve
Proximal Lesion: Fx of supracondylar humerus Motor: opposition of thumb Sensory: lateral 3.5 fingers Sign: "ape hand" thenar atrophy Distal Lesion: Carpal Tunnel, Dislocated Lunate Motor: Wrist & Lateral Finger Flexion Sensory:Same Sign: Claw hand, ulnar deviation of wrist upon flexion |
|
|
Ulnar Nerve
|
Ulnar Nerve
Proximal Lesion; Fx of medial epicondyle "funny bone" Motor: Medial finger flexion, wrist flexion Sensory: medial 1.5 fingers & hypothenar eminence Sign: radial deviation of wrist on flexion Distal Lesion: Fx hook of hamate Motor: Interossei (Ab/addxn), Addxn of thumb, lumbricals extension of 4th & 5th) sign: ulnar claw hand "Pope's blessing" |
|
|
Musculocutaneous Nerve
|
Musculocutaneous Nerve
C5-C7 Injury: Upper trunk compression Motor: Biceps, Brachialis, Coracobrachialis Flexion of arm at elbow Sensory: Lateral Forearm |
|
|
|
|
|
|
Brachial Plexus
Draw and Label |
|
|
|
Leg numbness, slapping gait unable to evert
|
damage to common peroneal nerve:
equinovarus foot: plantarflexed & inverted |
|
|
Sole numbness, dorsiflexion and eversion
|
Tibial Nerve Injury
|
|
|
Sensory loss in posterolateral leg and foot
|
Sural nerve injuury
|
|
|
Obturator nerve
|
adductor muscles of the thigh
|
|
|
Omalizumab
|
humanized anti-IgE IgG
DOC for recurrent IgE mediated anaphylaxis/severe asthma |
|
|
DOC for recurrent IgE mediated anaphylaxis/severe asthma
|
Omalizumab
humanized anti-IgE IgG |
|
|
Trastuzumab
|
anti-HER2/neu receptor
effective vs. breast cancer |
|
|
Bortezomib
|
Prosteasome inhibitor used to treat multiple myelma and Waldenstrom macroglobinemia
|
|
|
Crigler Najjar Sro Type 1
|
AR lack of UGT (uridine diphsphate-glucouronyltransferase) in the ER
results in kernicterus |
|
|
Dubin-Johson Sro
|
AR lack of MRP2 multidrug resistance protein 2 important in hepatocellular excretion of conjugated bilirubin
Liver becomes darkly pigmented, but sro is aSx |
|
|
Rotor Sro
|
AR defects in hepatic uptake of conjugated bilirubin
Pt is jaundiced, but condition is benign |
|
|
lack of UGT
|
Crigler Najjar Sro Type 1 (AR)
(uridine diphsphate-glucouronyltransferase) in the ER results in kernicterus |
|
|
defects in hepatic uptake of conjugated bilirubin
|
Rotor Sro (AR)
Pt is jaundiced, but condition is benign |
|
|
lack of MRP2
|
Dubin-Johnson Sro
AR lack of MRP2 multidrug resistance protein 2 important in hepatocellular excretion of conjugated bilirubin Liver becomes darkly pigmented, but sro is aSx |
|
|
Floppy Baby, mild jaundice, enlarged tongue, umbilical hernia
|
Infantile hypothyroidism
except ASD/VSD's T4 essential for myelination |
|
|
Floppy Baby, Fed Honey
|
Botulism
|
|
|
Prolyl Hydroxylase
|
hydroxylation of proline on procollagen chains, important to form stable triple helix
|
|
|
Lysyl Oxidase
|
catalyzes conversion of lysine's amino terminus to aldehyde to stengthen collagen fibers
|
|
|
Procollagen peptidase
|
cleaves terminal regions of procollagen producing insoluble tropocollogen which may aggregate
deficient in Ehlers Danlos Sro: Stretchable Skin, Hypermobile Joints, Short Stature, CT defects |
|
|
Ehelrs Danlos Sro
|
Procollagen peptidase cleaves terminal regions of procollagen producing insoluble tropocollogen which may aggregate
deficient in Ehlers Danlos Sro: Stretchable Skin, Hypermobile Joints, Short Stature, CT defects |
|
|
Short Stature Stretchable Skin, Hypermobile Joints
|
Ehlers Danlos Sro: deficiency of Procollagen peptidase
Procollagen peptidase cleaves terminal regions of procollagen producing insoluble tropocollogen which may aggregate |
|
|
Lipoic Acid
|
aka lipoate
essential cofactor in many steps of arobic metabolism -trasfer of acyl group in 2 oxoacid dehydrogenase -transfer of methylamine group in glycine cleavage complexes also an antioxidant |
|
|
Biotin
|
cofactor mecessary for many carboxylation enzymes
eg acetyl CoA Carboxylase Pyrovate carboxylase |
|
|
δ-ALA
|
δ Aminolevuloinic Acid
Glycine + Succinyl CoA → catalyzed by ALA synthase with Pyridoxal Phosphate cofactor → δ-ALA the first, committing and rate limiting step of heme synthesis occurs in mitochondria of liver and hematopoietic cells subsequent steps in heme synthesis occur in cytosol upregulated by EtOH, Barbituates and Hypoxia downregulated by heme and glucose 2 forms of ALASynthase only ALAS2 produced in hematopoietic cells KO = X linked sideroblastic anemia |
|
|
X linked Sideroblastic Anemia
|
Glycine + Succinyl CoA → catalyzed by ALA synthase with Pyridoxal Phosphate cofactor → δ-Aminolevuloinic Acid
the first, committing and rate limiting step of heme synthesis occurs in mitochondria of liver and hematopoietic cells subsequent steps in heme synthesis occur in cytosol 2 forms of ALASynthase only ALAS2 produced in hematopoietic cells KO = X linked sideroblastic anemia |
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|
What essential nutrients are not found in breast milk?
|
Vitamins K and D
Most infants given a shot of vitamin K at birth Vitamin D produced by sun Exposure African babies may need vitamin D supplements |
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|
Th1 cells
What cells induce Th1 differentiation via what signals? What do Th1 cells produce and what do those signals do? |
DC's & M∅: IL12
IL12 induces NK's & Th1 to produce IFNγ IFNγ & IL12 both induce Th1 differentation TH1's produce IL-2 which maintains the T cell population and IFN γ which promotes → phagocytosis → class switching to phagocytosable Ig's (I assume IgG) DC & M∅ expression of MHCII and B7 costimulators [B7 costimulators necessary otherwise MHCII stimulation would drive T's into anergy] |
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|
Th2 cells
What cells induce Th2 differentiation via what signals? What do Th2 cells produce and what do those signals do? |
Exposure to antigens in absence of IL12 or IFNγ → autocrine IL4 production → Th2 differentiation
IL5: activates eosinophils and IgA prodxn IL4: induces IgE prodxn, mucus secretion IL13: Mucus secretion IL4, 10, 13: Inhibit M∅ anti-microbial activity, focuses efforts on ts repair |
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|
Th17 cells
What cells induce Th17 differentiation via what signals? What do Th17 cells produce and what do those signals do? |
IL1: M∅ and endothelial cells
IL6: M, endothelial cells, and T cells IL23: DC's and M∅ TGF β: Many Cells → Th17 differentiation Th17 produce: IL17 and IL22: proinflammatory |
|
|
IL12
|
produced by DC's and M∅
induces IFNγ prodxn from NK's & T's induces Th1 differentiation of CD4 |
|
|
IFNγ
|
Produced by NK's in response to IL12 from M∅
Produced by Th1 CD4's induces Th1 differentiation of CD4's induces phagocytosis, IgG class switching, MHCII expression and B7 costimulator presentation on M∅ and DC's |
|
|
IL4
|
Autocrine signal by CD4's in presence of antigenic stimulation with absence of IL12/IFNγ (normally direct Th1 differentation)
Induces class switching to IgE Inhibits M∅ antimicrobial activity, focuses on ts repair (also has thsi fnx: IL's 10 and 13, also produced by Th2) ↑ mucus secretion (also has this fnx: IL13) |
|
|
IL5
|
product of Th2
activates eosinophils and IgA class switching |
|
|
IL17
|
proinflammatory cytokine of Th17
|
|
|
IL22
|
proinflammatory cytokine of Th17
|
|
|
IL23
|
product of M∅ and DC's
induces Th17 differentiation |
|
|
Aspergillus filling a pre-existing lung cavity
|
common environmental fungus with septate hyphae with 45* V angle branching
colonizing aspergillosis non-invasive, grows inside cavity forming a fungus ball eg cavities left behind by tuberculosis, emphysema, or sarcoidosis |
|
|
Forms of Aspergillosis
|
common environmental fungus with septate hyphae with 45* V angle branching
Colonizing aspergillosis: non-invasive, grows inside cavity forming a fungus ball eg those cavities left behind by tuberculosis, emphysema, or sarcoidosis ABPA: Allergic bronchopulmonary aspergillosis: hypersensitivity reaction produes asthma Invasive aspergillosis only in immunosppressed; primarily lung invovlement, |
|
|
Mucicarmine stain
|
used to reveal CHO capsule of cryptococcus; stains it red (india ink = negatively staining field)
|
|
|
Cimetidine
|
H2 receptor antagonist used for to ↓ gastric acid prodxn
inhibits CYP450, likely causes gynecomastia |
|
|
What medicine likely decreases the efficacy of levodopa in parkinson's
|
OTC multivitamin containing B6 increases peripheral metzm of levodopa
|
|
|
LMN signs in UE's
UE loss of pain and Temp UMN signs in LE's scoliosis progressive ataxia |
Syringomyelia: central cystic degeneration of the cervical spinal cord
damages ventral white commissure and anterior horns ventral white commissure site of decussation of spinothalamic tract neurons for pain and temp most common at C8-T1, expansion produces LE UMN signs by damaging corticospinal tract |
|
|
Syringomyelia
|
LMN signs in UE's
UE loss of pain and Temp UMN signs in LE's scoliosis central cystic degeneration of the cervical spinal cord damages ventral white commissure and anterior horns ventral white commissure site of decussation of spinothalamic tract neurons for pain and temp most common at C8-T1, expansion produces LE UMN signs by damaging corticospinal tract |
|
|
Best way to prevent neonatal tetanus
|
maternal vaccination during pregnancy
IgG's will cross placenta |
|
|
What determines blood flow to the brain
|
CO2
hypercapnia ↑ blood flow hypocapnea ↓ blood flow panic attacks ↓ cerebral perfusion correct cerebral edema with hyperventilation only sever hypoxia pO2<50mmHg leads to increased perfusion |
|
|
Glycogen metzm in Muscles
|
Epinephrine or Glucagon bind Gs → ↑cAMP → activate PKA → activates phosphorylase kinase, deactivates glycogen synthase
phosphorylase kinase activates glycogen phosphorylase Glycogen phosphorylase breaks down glycogen >>Ca2+ directly ↑ functionality of phosphorylase kinase regardless of activation status< [Glyogen phosphorylase activated by phosphorylase kinase, deactivated by phosphoprotein phosphatase] |
|
|
Conn Sro
|
Hyperaldosteronism
Aldosterone produced by the zona glomerulosa, the outer layer of adrenal cortex Renal Na+ retention and K+ wasting → hypertension, hypokalemia, metabolic alkalosis (why?) hypokalemia → muscle weakness hypokalemic alkalosis → parasthesias |
|
|
Hyperaldosteronism
|
Conn Sro
Aldosterone produced by the zona glomerulosa, the outer layer of adrenal cortex Renal Na+ retention and K+ wasting → hypertension, hypokalemia, metabolic alkalosis (why?) hypokalemia → muscle weakness hypokalemic alkalosis → parasthesias |
|
|
Zona Glomerulosa
|
Produces Aldosterone
Overproduction: Conn Sro, Hyperaldosteronism Aldosterone produced by the zona glomerulosa, the outer layer of adrenal cortex Renal Na+ retention and K+ wasting → hypertension, hypokalemia, metabolic alkalosis (why?) hypokalemia → muscle weakness hypokalemic alkalosis → parasthesias |
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|
Zona Fasiculata
|
Cortisol Production
|
|
|
Zona Reticularis
|
Inner Layer
Adrenal Androgen Production Dehydropeiandrosterone Androstenedione |
|
|
Which Adrenal Cortex Layer Produces Adrenal Androgens?
|
Zona Reticularis
Inner Layer Adrenal Androgen Production |
|
|
Which Adrenal Cortex Layer Produces Cortisol
|
Zona Fasiculata, Middle Layer
|
|
|
Which Adrenal Cortex Layer Produces Aldosterone
|
Zona Glomerulosa
Outer Layer Overproduction: Conn Sro, Hyperaldosteronism Aldosterone produced by the zona glomerulosa, the outer layer of adrenal cortex Renal Na+ retention and K+ wasting → hypertension, hypokalemia, metabolic alkalosis (why?) hypokalemia → muscle weakness hypokalemic alkalosis → parasthesias |
|
|
What physiologic aspect of neuronal transmission is affected in MS?
|
the space constant
myelin increases the space constant |
|
|
Lung Mass + Hyponatremia
|
SIADH paraneosplastic sro of small cell carcinoma
Water Retention suppresses RAAS system → Water Loss → Euvolemia Hyponatremia hyponatremia → seizures |
|
|
SIADH
|
SIADH paraneosplastic sro of small cell carcinoma
Water Retention suppresses RAAS system → Water Loss → Euvolemia Hyponatremia hyponatremia → seizures |
|
|
probability that the child of the sister of someone with an X linked dz will have that dz?
|
1/8
1/2 probability that sis is a carrier 1/2 probability that sis will contribute defective gene 1/2 probability that child will be a girl |
|
|
Selegiline
|
MAOB inhibitor
used to delay prorgression of parkinson's to avoid untoward GI side effects of levodopa |
|
|
Carbidopa
|
Dopa-decarboxylase inhibitor
prevents peripheral conversion of levodopa to dopamine this conversion responsible for the intense nausea and vomitting caused by monotherapy of levodopa ∅xBBB |
|
|
MAOB inhibitor
|
Selegiline
used to delay prorgression of parkinson's to avoid untoward GI side effects of levodopa |
|
|
Dopa-decarboxylase inhibitor
|
Carbidopa
prevents peripheral conversion of levodopa to dopamine this conversion responsible for the intense nausea and vomitting caused by monotherapy of levodopa ∅xBBB |
|
|
Pergolide
|
Dopamine Agonist which directly simulates D2 receptors
only modest improvement in Parkinson's, but may delay use of levodopa and thus the intense nausea and vomitting assoc. w/ levodopa |
|
|
Managing initial onset dopamien
|
many neurologists favor the use of selegiline (MAOB inhibitor), anticholinergics, and amantadine until they no longer provide control of Sx
only then is levodopa/carbidopa combo introduced (intense N/V) |
|
|
Blood/Gas Coefficient
|
highly soluble drugs have a high blood/gas coefficient
their partial pressure rises slowly and they take a long time before they can act |
|
|
PT, PTT, Coagulation Pathways
|
PT: extrinsic system: 7XV2
PTT: intrinsic system 12-11-9-XV2 |
|
|
Neurovasculature of the Ovary
|
arrives via the suspensory ligament
|
|
|
Round ligament of the Uterus
|
courses through inguinal canal to extenral genitalia
contains the artery of sampson |
|
|
ALA dehydratase
|
dALA + dALA → pyrrole porphobilinogen (PBG)
the 2nd step in porphyrin production after ALA synthase (Succinyl CoA + Glucose → dALA) occurs in cytoplasm contains zinc along with Ferrochelatase (Protoporphyrin 9 + Fe2+ → heme)[mitochondria], one of two enzymes in heme synthesis inhibited by lead |
|
|
Ferrochelatase
|
Protoporphyrin 9 + Fe2+ → heme
occurs in mitochondria along with ALA dehydratase(dALA + dALA → pyrrole porphobilingoen {PBG})[cytosol], one of two enzymes in heme synthesis inhibited by lead |
|
|
Lead poisoning and heme synthesis
|
2 enzymes affected
ALA dehydratase(dALA + dALA → pyrrole PorphoBilinoGen {PBG})--cytosolic contains zinc Ferrochetolase(Protoporphyrin 9 + Fe2+ → heme) --mitochondrial in lead poisoning dALA and protoporphyrin 9 accumulate microcytic hypochromic anemia |
|
|
Type I, Type II errors
|
Type I: rejecting the null hypothesis when you shouldn't
ie- find a connection that doens't exist Type II: failing to reject the null hypothesis when you should ie- ignore a connectino that is true on that note: α is the maximum probability of making a type I error, usually 0.05 β the maximum probability of making a type II error, usually 0.2 1-β (one minus β) is the probability of rejecting the null hypothesis when it is truly fasle. Tyically 0.8 and depends on sample size and relative difference between outcomes |
|
|
α, β
(biostats) |
Type I: rejecting the null hypothesis when you shouldn't
ie- find a connection that doens't exist Type II: failing to reject the null hypothesis when you should ie- ignore a connectino that is true on that note: α is the maximum probability of making a type I error, usually 0.05 β the maximum probability of making a type II error, usually 0.2 |
|
|
1-β
(biostats) |
Type II: failing to reject the null hypothesis when you should
ie- ignore a connectino that is true β the maximum probability of making a type II error, usually 0.2 1-β (one minus β) is the probability of rejecting the null hypothesis when it is truly fasle. Tyically 0.8 and depends on sample size and relative difference between outcomes |
|
|
Pyruvate kinase
|
enzyme which converts phosphoenolpyruvate to pyruvate producing 1 ATP
simulated to function by fructose 1,6 bisphosphate, a precursor within the glycolysis pathway any deficiency in the glycolysis pathway will lead to insufficient ATP for RBC's to survive and splenic enlargement via work hypertrophy |
|
|
Charcoal yeast extract supplemented with cysteine
|
growth medium for legionella
stains silver (Fungi also stain silver) most likely from water system contamination |
|
|
Chocolate Agar with Factors V and X
|
H influenzae
V = NAD+ X = hematin |
|
|
Thayer-Martin Media
|
aka VPN
Vancomyxin, Polymixin, Nystatin only allows for neisserial growth |
|
|
VPN
|
aka Thayer-Martin Media
Vancomyxin, Polymixin, Nystatin only allows for neisserial growth |
|
|
Bordet Gengou Media
|
aka potato agar
Bordetella |
|
|
Potato agar
|
aka Bordet Gengou Media
Bordetella |
|
|
Lowenstein Jensen agar
|
M tb
|
|
|
Eaton's Agar
|
M pneumo
|
|
|
MacConkey's Agar
|
contains bile salts
lactose fermenting enterics -Kleb -Ecoli -Enterobacter -citrobacter -Serratia -et al excludes shigella, salmonella, proteus, psuedomonas |
|
|
Sabouraud's Agar
|
Fungi
|
|
|
blue black colonies with metallic sheen on eosin-methylene blue agar
|
E coli
|
|
|
Agar for Legionella
|
Charcoal yest extract buffered with cysteine and iron
|
|
|
Agar for Fungi
|
Sabouraud's Agar
|
|
|
Agar for Lactose Fermenting Enterics
|
MacConkey's Agar
contains bile salt -Kleb -Ecoli -Enterobacter -citrobacter -Serratia -et al excludes shigella, salmonella, proteus, psuedomonas |
|
|
Agar for M pneumo
|
Eaton's Agar
|
|
|
Agar for M tb
|
Lowenstein Jensen
|
|
|
Agar for C diphtheriae
|
Tellurite plate or Loffler's Media
|
|
|
Agar for B pertussis
|
Bordet Gengou (potato) agar
|
|
|
Agar for Neisseria
|
Thayer Martin (VPN) Agar
Vanxomycin (gram pos), Polymyxin (gram neg), Nystatin (fungi) |
|
|
Agar for H influenzae
|
Chcolate agar w/ Factor V (NAD_ and X (hementin)
|
|
|
Loffler's Media
|
C diphtheria
also grows on Tellurite plate media |
|
|
Tellurite Plate
|
C diphtheriae, also grows on Loffler's Media
|
|
|
In order of severity: what are the top 5 sites of atherosclerosis
|
1. Abdominal Aorta at major branching
2. Coronary Arteries 3. Popliteal Arteries 4. Internal Carotids 5. Circle of Willis |
|
|
Old School Antihypertensive Med which causes Depression
|
Reserpine, irreversibly binds presynaptic vesicles and blocks transportation of monoamines into vesicles
|
|
|
Reserpine
|
irreversibly binds presynaptic vesicles and blocks transportation of monoamines into vesicles
Old School Antihypertensive Med which causes Depression |
|
|
α-methyltyrosine
|
inhibits the coversion of tyrospine to DOPA by tyrosine hydroxylase
used in pheochromocytoma, not for hypertension |
|
|
DOC: pheo
mechanism |
α-methyltyrosine
inhibits the coversion of tyrospine to DOPA by tyrosine hydroxylase |
|
|
Mechanism of Action penicillins
|
like cephalosporins, Irreversibly binds transpeptidases
|
|
|
mechanism of action cephalosporins
|
like penicillins, irreversibly binds transpeptidases
|
|
|
pain on deification with bright red blood
lesion character & location? |
anal fissure 2° to low fiber diet & constipation
midline posterior, distal to dentate (aka pectinate) line (mucosa → skin like epithelium transition) (midline posterior has worst perfusion) may be assoc. w/ skin tag if chronic |
|
|
t(15:17)
|
creates fusion of retinoic acid receptor α with promyelocytic leukemia gene producing PML-RARα fusion gene
drives Acute myelogenous leukemeia abnormal retinoic acid receptor prevents differentiation of myeloblasts to granulocytes myeloblasts replace bone marrow → anemia, thrombocytopenia, neutropenia |
|
|
Rb gene mutation
|
retinoblastoma and osteosarcoma
|
|
|
Epidermal Growth Factor Gene mutation
|
multiple mutations
erbB1: non small cell lung Ca erbB2 aka HER2/neu: breast CA some ovarian and gastric tumors |
|
|
Defective PDGF
|
chronic myelomonocytic leukemia
|
|
|
PML/RARα
|
t(15:17) creates fusion of retinoic acid receptor α with promyelocytic leukemia gene producing PML-RARα fusion gene
drives Acute myelogenous leukemeia abnormal retinoic acid receptor prevents differentiation of myeloblasts to granulocytes myeloblasts replace bone marrow → anemia, thrombocytopenia, neutropenia |
|
|
AML
|
t(15:17) creates fusion of retinoic acid receptor α with promyelocytic leukemia gene producing PML-RARα fusion gene
drives Acute myelogenous leukemeia abnormal retinoic acid receptor prevents differentiation of myeloblasts to granulocytes myeloblasts replace bone marrow → anemia, thrombocytopenia, neutropenia |
|
|
DOC: preventing DVT in non-ambulatory/surgical candidate pts
|
Heparin, LMW Heparin
binds to and ↑ the efficacy of AT3 in neutralizing thrombin |
|
|
Progressive Ataxia and Dysarthria, Loss of Position and Vibratory Sensation
Degeneration of Posterior Columns and Spinocerebellar Tracts |
Frederick's Ataxia
NB: closely mimicked by Vitamin E deficiency |
|
|
Vitamin E deficiency
|
Progressive Ataxia and Dysarthria, Loss of Position and Vibratory Sensation
Identical presentation to Frederick's Ataxia |
|
|
Freidericks' Ataxia
|
Progressive Ataxia and Dysarthria, Loss of Position and Vibratory Sensation
Degeneration of Posterior Columns and Spinocerebellar Tracts NB: closely mimicked by Vitamin E deficiency |
|
|
Anovulation on Antipsychotics
|
D2 blockade allows prolactin production
Porlactin inhibits release of GnRH |
|
|
Premature menopause definition
|
Loss of ovarian function before age 35
|
|
|
Most common cause of elevated AFP
|
dating error, underestimation of fetal age
|
|
|
Best long term relief for gastric/duodenal ulcers
|
antibiotics v helicobacter pylori
|
|
|
Testing for Syphilis
|
Sensitive Test: RPR, VDRL
Rapid Plasma Reagin, looking for antibodies vs cardiolipin, cholesterol, lecithin (cross react with treponema) Confirm with FT0ABS look for treponema specific antibodies |
|
|
RNA Polymerase I, II, & III
|
I: formation of rRNA w/in nucleolus
II:mRNA prodxn III: short RNA molecules: tRNA and snRNA, 5S rRNA |
|
|
ATM gene
|
Ataxia Telangiectasia Mutant
responsible for DNA break repair classic triad: cerebellar ataxia telangiectasia ↑ risk sinopulmonary infx 2° IgA deficiency predisposed to hematologic malignancies hypersensitive to X rays |
|
|
cerebellar ataxia
telangiectasia ↑ risk sinopulmonary infx |
Ataxia Telangiectasia Mutant (ATM) gene
responsible for DNA break repair classic triad: cerebellar ataxia telangiectasia ↑ risk sinopulmonary infx 2° IgA deficiency predisposed to hematologic malignancies hypersensitive to X rays |
|
|
Lesch-Nyhan
|
X-linked recessive
HGPRT hypoxanthine-guanine phosphoribosyltransferase leads to severe hyperuricemia and gout classically: MR and self mutalting behavior, spastic and choreoathetoid movements |
|
|
MR and self mutalting behavior, spastic and choreoathetoid movements
|
Lesch-Nyhan: X-linked recessive
HGPRT hypoxanthine-guanine phosphoribosyltransferase leads to severe hyperuricemia and gout |
|
|
Niemann-Pick
|
Defective sphingolipid degradation
AR defective spingomyelinase death in early childhood hepatosplenomegaly, anemia, motor neuropathy → hypotonia, areflexia, cherry red spot on macula |
|
|
floppy toddler with hepatosplenomegaly, anemia, cherry red spot on macula
|
Niemann-Pick AR defective spingomyelinase
death in early childhood hepatosplenomegaly, anemia, motor neuropathy → hypotonia, areflexia, cherry red spot on macula |
|
|
PRPP synthetase
|
responsible for synthesis of activated ribose, necessary for de novo synth of nucleotides
|
|
|
CaNa2EDTA
|
Antidote for Acute Lead and Mercury Poisoning. Forms complexes with mono, di, and trivalent ions.
|
|
|
Dimercaprol
|
Antidote for acute arsenic poisoning.
Note: garlic odor. Displaces Arsenic ions from sulfhydryl groups. Side effects of antidote: nephrotoxic & hypertension |
|
|
Amyl nitrite
|
Antidote for cyanide poisoning.
Forms methemoglobin that binds cyanide, distracting it from binding to mitochondiral enzymes |
|
|
Deferoxamine
|
Antidote for iron poisoning, most common after multiple blood transfusions
facilitates urinary excretion |
|
|
Nerve Damaged during Thyroidectomy
|
Superior Thyroid Artery & Vein run adjacent to External Branch of Superior Laryngeal nerve, responsible for crichothyroid muscle
|
#anatomy #innervation
|
|
Laryngeal innervation
|
Vagus
--recurrent laryngeal nerve ------all laryngeal muscles except cricothyroid ------sensory innervation below vocal cords --Superior Laryngeal NErve ------External Branch: Circothyroid Muscle ------Internal branch: Sensory Innervation above vocal cords NB: Extenral Branch of Superior Laryngeal Nerve runs adjacent to Superior Thyroid Artery/Vein → likely to be damaged in thyroidectomy |
#anatomy #innervation
|
|
Theophylline
|
inhibits phosphodiesterase → ↑ cAMP → bronchodilation
✓ anti-inflam properties, but significantly < gluco-corticoid anti-inflam |
#drugs
|
|
Anti-asthma Rx:
acts as a phosphodiesterase |
Theophylline
inhibits phosphodiesterase → ↑ cAMP → bronchodilation ✓ anti-inflam properties, but significantly < gluco-corticoid anti-inflam |
#drugs
|
|
Ipratropium
|
muscarinic antagonist → bronchodilation
↓ mucus production 4° Ammonium → ∅x Blood-Air Barrier |
#drugs
|
|
Anti-asthma Rx:
Muscarinic antagonist |
Ipratropium
muscarinic antagonist → bronchodilation ↓ mucus production 4° Ammonium → ∅x Blood-Air Barrier also Tiotropium (↑ λ = 1/d) |
#drugs
|
|
Nifedipine
|
Dihydropyridine calcium channel blocker
used to tx hypertension also causes bronchodilation |
#drugs
|
|
Dihydropyridine calcium channel blocker used to tx hypertension
|
Nifedipine
also causes bronchodilation |
#drugs
|
|
Hib Vaccine
|
polyribosysl-ribitol-phosphate (PRP) - polysaccharide conjugated with protein toxoid from either diphtheria or tetanus
this allows for T cell processing and the production of memory humoral immunity in children under age 18 mo may be given as early as 2 mo |
#immunology
#microbiology |
|
Non-typable Haemophilus influenzae
|
unencapsulated
commensural |
#immunology
#microbiology |
|
Most common bacterial causes of acute otitis media, sinusitis and bacterial conjunctivitis
|
1. Pneumococcus
2. Non-typable Hib 3. Moraxella catarrhalis in that order for ALL infections |
#microbiology
|
|
PRP polysaccharide
|
capsular antigen of Hib
polyribosysl-ribitol-phosphate (PRP) - polysaccharide conjugated with protein toxoid from either diphtheria or tetanus this allows for T cell processing and the production of memory humoral immunity in children under age 18 mo may be given as early as 2 mo |
#microbiology
#immunology |
|
Neuropathic Pain Med which worsens Urinary Retention
|
TCA's (muscarinic blockade)
|
#drugs
|
|
Define the Parameters
|
|
#physiology
|
|
Metronidazole
Mechanism of Action |
Binds to DNA within Susceptible Cells, unravels helical strx and breaks the strands
|
#pharm: antibiotics
|
|
Limiting factor of ACEI's
|
First dose hypotension
Risk factors: hyponatremia, diuretics, low BP, high renin, aldosterone levels, renail impairment, heart fialure |
#pharm: side effects
|
|
non-communicative pt who cannot make wishes known, no documentation
end life? |
medical decision making falls to next of kin ie wife
|
#ethics
|
|
Genetics of Down Sro
|
Vast Majority Trisomy 21, 2° to maternal non-disjnx
Unbalanced Robertsonian translocation Mosaicism |
#pathology #genetics
|
|
Uniparental Disomy
|
fetus inherits two copies of homologous chroms from one parent, nothing from other parent
ie complete hydatiform mole |
#pathology #genetics
|
|
Why convert pyruvate to lactate in anaerobic conditions?
|
to regenerate NAD+ for the conversion of Glyceraldehyde-3-Phosphate to 1,3 BPG (the conversion of which creates NADH and depletes NAD+)
|
#biochemistry #metabolism
|
|
FADH2 production
|
FADH2 produced by succinate dehydrogenase (succinate → fumarate) during TCA cycle
|
#biochemistry #metabolism
|
|
Clostridium difficile
Agent, Toxin, Mechanism, Manifestation |
toxin A: enterotoxin
mechanism: PMN chemoattractant → cytokine release → mucosal inflam & fluid loss toxin B: cytotoxin mechanism: depolymerizes actin filaments result: mucosal cell death → bowel wall necrosis & pseudomembrane formation |
#microbiology #toxins
|
|
Toxin which depolymerizes actin filaments
|
Clostridium difficile toxin B: cytotoxin
mechanism: depolymerizes actin filaments result: mucosal cell death → bowel wall necrosis & pseudomembrane formation [toxin A: enterotoxin mechanism: PMN chemoattractant → cytokine release → mucosal inflam & fluid loss] |
#microbiology #toxins
|
|
Toxin which attracts PMNs
|
Clostridium difficile toxin A: enterotoxin
mechanism: PMN chemoattractant → cytokine release → mucosal inflam & fluid loss [toxin B: cytotoxin mechanism: depolymerizes actin filaments result: mucosal cell death → bowel wall necrosis & pseudomembrane formation] |
#microbiology
#toxins |
|
Hereditary pancreatitis
|
rare disorder 2° to mutation in gene that encodes trypsin
not susceptible to inhibition by pancreatic secretory trypsin inhibitor (PSTI) or trypsin (which serves as its own inhibitor at high concentrations) |
#pathology #genetics
|
|
Korotkoff Sounds
|
The sounds you hear when taking blood pressure
|
|
|
pulsus paradoxus
|
>10 mmHG ↓ in systolic BP on inspiration
indicative of some pericardial problem: tamponade, constrictive pericarditis, restrictive cardiomyopathy, severe obstructive lung dz) inspiration causes an ↑ in systemic return with limited space for expansion interventricular septum bulges into LV 2° to ↑ RV filling during diastole → ↓ LV filling & stroke volume → ↓ systemic pressure |
#pathology
|
|
>10 mmHG ↓ in systolic BP on inspiration
|
pulsus paradoxus
indicative of some pericardial problem: tamponade, constrictive pericarditis, restrictive cardiomyopathy, severe obstructive lung dz) inspiration causes an ↑ in systemic return with limited space for expansion interventricular septum bulges into LV 2° to ↑ RV filling during diastole → ↓ LV filling & stroke volume → ↓ systemic pressure |
#pathology
|
|
Risks of IBD
|
Colorectal Carcinoma 10 years after onset of Colitis
most significant risk factors are duration and extent of colitis compared to non-IBD pts: -earlier -higher histological grade -more likely to originate in non-polypoid form -mucinous or signet ring morphology -p53 mutation early, APC late (opposite normal) -proximal colon -multifocal |
#pathology
|
|
Normal Pressures in each Chamber of Heart and Major Vessel
|
(Min-Max)
RA: 0-8 RV: 4-25 Pulm Art: 9-25 LA: 2-12 LV: 9-130 Aorta: 70-130 |
#physiology #cardiovascular
|
|
pH > 7.4
PCO2 > 40 mmHG Condition, Causes |
Metabolic Alkalosis w/ Respiratory Compensation
(Blowing off HCO3 in form of CO2) Causes: -Vomitting- direct loss of H+ -Diuretic use Vomitting and diuretics both induce volume depletion. To correct for volume depletion the body resporbs as many osmotically active metabolites as possible, including HCO3 -Antacid Use- addition of HCO3 -Hyperaldosteronism: aldosterone directly ↑ H+ export pumps |
#physiology #acid-base
|
|
pH >7.4
PCO2 <40 mmHG Condition, Causes |
Respiratory Alkalosis
Hyperventilation eg high altitude Early toxicity of aspirin ingestion |
#physiology #acid-base
|
|
pH < 7.4
PCO2 > 40 |
Respiratory Acidosis 2* to hypoventilation of many causes:
Anatomic/Pathologic Opioids, Narcotics, Sedatives |
#physiology #acid-base
|
|
pH < 7.4
PCO2 < 40 |
Step 1: Calculate Anion Gap
Na - (Cl + HCO3) Normal Anion Gap <12 = diarrhea, glue sniffing, renal tubular acidosis, hyperchloremia ↑ anion Gap (>20): MUDPPIILES Methanol ( → formic acid) Uremia DKA Paraldehyde or Phenformin Iron or INH Lactic Acidosis Ethylene Glycol (Oxalic Acid, Urine Oxalate Crystals) (Late) Salycilate Poisoning (Aspirin) Calculate Osmolar Gap = measured osmolarity - [2*Na + BUN/2.8 + glucose/18] (ie measured - calculated) >10 ≈ methanol or ethylene glycol |
#physiology #acid-base
|
|
Liver Biopsy Shows Ballooning Degeneration
|
Hepatitis B
ground glass appearance |
#pathology #histology
|
|
Liver Biopsy Shows Lymphoid Aggregates within Portal Tracts
|
Hepatitis C
microvesicular steatosis |
#pathology #histology
|
|
Hepatitis B Histology
|
Ballooning Degeneration of Hepatocytes with Ground Glass Eosinophilic Cytoplasm
|
#pathology #histology
|
|
Hepatitis C Histology
|
Lymphoid Aggregates within Portal Tracts
microvesicular steatosis |
#pathology #histology
|
|
GABAa
GABAb GABAc |
GABAa in brain Cl- Ion Channel
GABAb in brain G protein K+ efflux ↓ Ca2+ influx inhibis cAMP GABAc in Retina Cl- Ion Channel |
#biochemistry #pharmacology #neurology
|
|
GABA synthesis and metzm
|
Gluatamte Decarboxylase +B6 (Glutamate → GABA)
GABA transaminase +B6 (GABA → nonfnx something) |
#biochemistry #pharmacology #neurology
|
|
What normally protects against C. dif?
|
intestinal biomass
|
#microbiology
|
|
Zoonotic Dysentery
|
Campylobacter
Gram negative rod with filament which allows it to move in corkscrew watery diarrhea which becomes dysenteric fecal-oral from 1. domestic animals 2. contaminated/undercooked/unpasturized food Most common infectious agent assoc. with Guillaine-Barre |
#microbiology
|
|
Most common infectious agent assoc. with Guillaine-Barre
|
Campylobacter
Gram negative rod with filament which allows it to move in corkscrew watery diarrhea which becomes dysenteric fecal-oral from 1. domestic animals 2. contaminated/undercooked/unpasturized food Most common infectious agent assoc. with Guillaine-Barre |
#microbiology
|
|
Campylobacter
|
Campylobacter
Gram negative rod with filament which allows it to move in corkscrew watery diarrhea which becomes dysenteric fecal-oral from 1. domestic animals 2. contaminated/undercooked/unpasturized food Most common infectious agent assoc. with Guillaine-Barre |
#microbiology
|
|
DOC: Methotrexate OD
|
Leucovorin aka Folinic Acid
Functional Derivative of THF which does not req dihydrofolate reductase to become biologically active |
#pharm #toxicology
|
|
Leucovorin
|
aka Folinic Acid
DOC: Methotrexate OD Functional Derivative of THF which does not req dihydrofolate reductase to become biologically active |
#pharm #toxicology
|
|
Folinic Acid
|
aka Leucovorin
DOC: Methotrexate OD Functional Derivative of THF which does not req dihydrofolate reductase to become biologically active |
#pharm #toxicology
|
|
Filgrastim
|
recombinant G-CSF
↑ granulocyte proliferation |
#pharm #toxicology
|
|
recombinant G-CSF
|
Filgrastim
↑ granulocyte proliferation |
#pharm #toxicology
|
|
Fomepazole
|
competitive antagonist of alcohol dehydrogenase
DOC: methanol or ethylene glycol poisoning (high anion gap + high osmolar gap metabolic acidosis) |
#pharm #toxicology
|
|
DOC: ethylene glycol poisoning
|
Fomepazole: competitive antagonist of alcohol dehydrogenase
also for methanol poisoning |
#pharm #toxicology
|
|
DOC: methanol poisoning
|
Fomepazole: competitive antagonist of alcohol dehydrogenase
also for methanol poisoning |
#pharm #toxicology
|
|
Dexrazoxane
|
iron-chelating agent used to reduce anthracycline induced (ie doxorubicin) cardiotoxicity
|
#pharm #toxicology
|
|
DOC: doxorubicin cardiotoxicity
|
Dexrazoxane: iron-chelating agent used to reduce anthracycline induced (ie doxorubicin) cardiotoxicity
|
#pharm #toxicology
|
|
Amifostine
|
free-radical scavenging agent used to ↓ nephrotoxicity 2° to platinum containing agents (cisplatin)
|
#pharm #toxicology
|
|
DOC: cisplatin nephrotoxicity
|
Amifostine + aggressive hydration
establish chloride diuresis: cisplatin stays in a non-reactive state when in higher chloride concentration |
#pharm #toxicology
|
|
Insulin Types Durations
|
Long Acting
--Glargine 1/d, no peak (provides basal levels) --NPH 2/d [neutral protamine hagedorn--not important] Short acting Regular insulin: peaks in 3 hours, lots of problems with post-prandial hypoglycemia [delayed onset due to unwanted polymerization at injection site] Rapid Onset: lispro, aspart: best for postprandial hypoglycemia |
#pharm
#diabetes |
|
Insuline Glargine
|
1/d no peak
provides basal levels |
#pharm
#diabetes |
|
NPH Insulin
|
2/d no peak, provides basal levels
replaced by long acting Insuline Glargine (1/d) |
#pharm
#diabetes |
|
Regular insulin injx
|
peaks in 3 hours, lots of problems with post-prandial hypoglycemia
[delayed onset due to unwanted polymerization at injection site] |
#pharm
#diabetes |
|
Lispro
|
rapid onset insulin: 15 min
1h duration good for post-prandial needs on top of 1/d insulin glargine similar to aspart [regular insulin forms unnatural polymers at injx site, delays onset to 3 h] |
#pharm
#diabetes |
|
Aspart
|
rapid onset insulin 15 min
1h duration good for post-prandial needs on top of 1/d insulin glargine similar to lispro [regular insulin forms unnatural polymers at injx site, delays onset to 3 h] |
#pharm
#diabetes |
|
How does a cholecystectomy affect lipid digestion/absorption
|
it does not affect where lipids are digested (duodenum) or absorbed (jejunum)
bile acids are still produced by the liver and released into entero-hepatic circulation what changes is a ↓ tolerance for eating a lot of fat at one sitting because there is no storage |
#physiology
#gastrointestinal |
|
Lipid Digestion and Absorption: Locations
|
Digestion: Dudoenum
Absorption: Jejunum |
#physiology
#gastrointestinal |
|
Losartan
|
ARB: Angiotensin Receptor Blocker
all end in -artan NB: similar effects to ACEI's w/o angioedema or dry cough |
#pharmacology
#cardiovascular |
|
-artan
|
ARB: Angiotensin Receptor Blocker
all end in -artan (eg Losartan) NB: similar effects to ACEI's w/o angioedema or dry cough |
#pharmacology
#cardiovascular |
|
ARB's
|
ARB: Angiotensin Receptor Blocker
all end in -artan (eg Losartan) NB: similar effects to ACEI's w/o angioedema or dry cough |
#pharmacology
#cardiovascular |
|
Gluconeogenesis:
Converting Pyruvate to Fructose 1,6 Bisphosphate |
Unidirectional Enzyme: Pyruvate Kinase: Phosphoenolpyruvate (PEP) → Pyruvate + ATP
Circumventing Process: Pyruvate Carboxylase + Biotin: Pyruvate → Oxaloacetate Mitochondrial of Liver & Kidneys Allosterically activated by Acetyl-CoA Mitochonrial Malate Dehydroganase: Oxaloacetate → Malate Transport to Cytosol Cytosolic Malate Dehydrognase: Malate → Oxaloacetate PEPCK (PEP Carboxykinase) → GTP dependent Oxaloacetate → PEP Reversible Reactions back to Fructose 1,6 Bisphosphate |
#biochemistry #energymetzm
|
|
Gluconeogenesis:
Phosphoenolpyruvate → Glucose-6-Phosphate |
PEP → Fructose-1,6-Bisphophate via reversible reactions of glycolysis
Unidirectional Enzyme: Phosphofuctoskinase 1 Reverse Enzyme: Fructose Bisphosphatase 1 Regulation via both ATP/AMP levels and Glucagon No Glucagon → no cAMP → no PKA activity → dephosphorylated PFK-2/FBP-2 enzyme: PFK2 active state on → promotes Phosphofructose Kinase Glucagon → cAMP → PKA activity → phosphorylated PFK-2/FBP-2 enzyme: FBP-2 in active state → promotes Fructose Bisphosphatase 1 So Fructose 1,6 Bisphosphate → Fructose 6 P conversion to Glucose 6 P via reversible process |
#biochemistry #energymetzm
|
|
Gluconeogenesis
Fructose 6 Phosphate to Extracellular Glucose |
F6P → G6P via reversible process in cytosol
G6P translocate moves it into ER Glucose-6-Phosphatase removes phosphate NB: deficiency of Glucose 6 Phosphatase = Von Gierke Dz |
#biochemistry #energymetzm
|
|
negatively birifringent cyrstals in synovial fluid
|
Monosodium Urate
NB: not uric acid/urate alone |
#pathology
|
|
Cytoplasmic inclusions in oligodendrocytes
|
histology of progressive multifocal leukoenceophalopathy (PML)
|
|
|
Microglial Nodules and Multinucleated Cells within the CNS
|
characteristic for viral CNS infections esp HIV encephalopathy
|
|
|
Spongiform Transformation of Grey matter
|
Prion Dz: Cruetzfelt-Jakob, Bovine Spongiform Encephalopathy
PrP prior protein found in normal neurons has α helix. Conversion to β sheet = prion dz. |
|
|
Histology of PML
|
progressive multifocal leukoenceophalopathy:
Cytoplasmic inclusions in oligodendrocytes |
|
|
Histology of Crutzfelt-Jakob
|
PrP prior protein found in normal neurons has α helix. Conversion to β sheet = prion dz.
Spongiform Transformation of Grey matter (like mad cow) |
|
|
Differentiate the MEN Sros
|
MEN1: diamond
Pituitary Adenoma, Parathyroid Tumors, Pancreatic Tumor MEN2a: Square: Parathyroid Tumors and Pheos MEN2B: Tall Thin Pentagon: Parathyroid Tumors, Oral Neurofibromas, Pheos, plus marfanoid habitus |
#pathology #syndromes
|
|
Thyroid Mass + Marfanoid Habitus
|
MEN1: diamond
Pituitary Adenoma, Parathyroid Tumors, Pancreatic Tumor MEN2a: Square: Parathyroid Tumors and Pheos MEN2B: Tall Thin Pentagon: Parathyroid Tumors, Oral Neurofibromas, Pheos, plus marfanoid habitus |
#pathology #syndromes
|
|
Histones
|
5 histones
2x of (H2A, H2B, H3 & H4) create 8 molecule nucleosome core H1 bind segments between nucleosome cores and facilitate packing into more complex cois |
#biochemistry #DNA
|
|
Dermatitis herpetiformis 2° to GI pathology
|
Celiac Dz
Small pruritic vesicles on extensor surfaces 2° to IgA deposition at tips of dermal papillae |
#pathology #gastrointestinal #skin
|
|
Small pruritic vesicles on extensor surfaces in pt w/ GI problems
|
Dermatitis herpetiformis of Celiac Dz
Staining will demonstrate IgA deposition at tips of dermal papillae |
#pathology #gastrointestinal #skin
|
|
Ventral Spinothalamic Tract
|
Light Touch and Pressure Sensation
|
#neurology
|
|
Part of Spinal Cord Responsible for Light Touch and Pressure Sensation
|
Ventral Spinothalamic Tract
|
#neurology
|
|
Lateral Spinothalamic tract
|
Pain and Temperature Sensation
|
#neurology
|
|
Pain and Temperature Sensation in the Spinal Cord
|
Lateral spinothalamic tract
|
#neurology
|
|
cystic hygroma
|
posterior neck mass of cystic spaces separated by connective tissue in lymphoid aggregates
Turner's Sro |
#pathology #syndromes
|
|
posterior neck mass of cystic spaces separated by connective tissue in lymphoid aggregates
|
cystic hygroma of Turner's Sro
|
#pathology #syndromes
|
|
Hemicholinum
|
blocks choline uptake into nerve terminal
|
#pharm #drugs
|
|
Rx: blocks choline uptake into nerve terminal
|
blocks choline uptake into nerve terminal
|
#pharm #drugs
|
|
Pt being treated for Tuberculosis has ataxia and ↓ pain sensation
|
B6 deficiency
INH is B6 analog, competes in the processes of neurotransmitter production and also ↑ renal excretion of B6 Treat with B6 supplementation |
#pharm #toxicities
|
|
Physiologic Pulmonary Dead Space Formula
|
Vd =
Vtotal x (PaCO2 - PexpiredCO2) / PaCO2 |
#physiology
#pulmonology |
|
Hereditary Angioedema: Contraindicated Rx
|
AD C1 esterase inhibitor deficiency
ACEI's (Captopril) worsens angioedema |
#pharmacology #sideeffects
|
|
Liver Damage from Inhaled Anesthetics
|
Massive Liver Necrosis, centrilobular
rare but existant complication of Halothane Use Halothane metabolites toxic to liver → autoantibodies against liver proteins |
#pharmacology #sideeffects
|
|
PABA
|
para-aminobenzoic acid
folic precursor in prokaryiotes sulfas are PABA analogues humans lack abilityt o convert PABA to folic acid, thus require folate |
#microbiology
#pharmacology #antibiotics #biochemistry #molecules |
|
CREST Sro
|
Calcinosis
Raynauds (may present with ulceration) Esophageal Dysmotility Sclerodactyly Telangeictasia CD4 mediated hyperreactivity to unknown antigen → excessive tissue fibrosis Barium swallow: dilated esophagus absent peristalsis. Risk for barret's Esophagus → adenocarcinoma |
#pathology #syndromes
|
|
Barium Swallow: dilated esophagus, no peristalsis
|
Calcinosis
Raynauds (may present with ulceration) Esophageal Dysmotility Sclerodactyly Telangeictasia CD4 mediated hyperreactivity to unknown antigen → excessive tissue fibrosis Barium swallow: dilated esophagus absent peristalsis. Risk for barret's Esophagus → adenocarcinoma |
#pathology #syndromes
|
|
OTC Rx resitant heartburn + finger ulceration
|
CREST Sro
Calcinosis Raynauds (may present with ulceration) Esophageal Dysmotility Sclerodactyly Telangeictasia CD4 mediated hyperreactivity to unknown antigen → excessive tissue fibrosis Barium swallow: dilated esophagus absent peristalsis. Risk for barret's Esophagus → adenocarcinoma |
#pathology #syndromes
|
|
Duiretic whose efficacy is decreased by NSAIDs
|
furosimide
(Na-K-2Cl symporter inhibitor) additionally stimualtes prostaglandins which ↑ renal blood flow and ↑ GFR |
|
|
Stroke: ataxia-hemiplegia
|
base of pons
|
#neurology #strokes
|
|
Stroke: dysarthria, clumsy hands
|
base of parns, or genu of internal capsule
|
#neurology #strokes
|
|
Stroke: base of pons
|
ataxia-hemiplegia
or dysarthria, clumsy hands (may be genu of internal capsule) |
#neurology #strokes
|
|
Stroke: genu of internal capsule
|
dysarthria, clumsy hands (may be base of pons)
|
#neurology #strokes
|
|
Tissue Presentation Based on Time Since MI
|
0-4h: no change
4-12: early coagulation necorsis, edema, hemorrhage, wavy fibers 12-24: coagulation necrosis and marginal contraction band necrosis 1-5d: PMN infiltrate 5-10: M∅ phagocytosis 10-14: granulation ts and neovascularization 2 wks -2 mo: collogen deposition |
#pathology
|
|
Drugs likely to produce SLE
|
Hydralazine
Procainamide Isoniazid likely to have anti-histone antibodies but not anti-dsDNA antibodies |
#pathology
#pharmacology #toxicities |
|
The carnitine shuttle
|
long chain fatty acids cannot enter the inner mitochondrial matrix alone
Short and Medium Chain Fatty Acids just diffuse into to inner mitochondrial membrane In Cytosol Fatty Acids → Fatty Acyl-CoA by Thiokinase Translocate to outer mitochondrial lumen NB: inner mito membrane impermeable to CoA Carnitine Palmitoyltransferase 1 (CPT1) removes CoA group and transfers Fatty-Acyl to Carnitine Fatty Acyl-Carnitine Shuttled Across membrane by Translocase CPT2 switches Carnitine back for a CoA inside the inner mitochondrial lumen malonyl CoA inhibits CPT1 preventing β-oxidation of fatty acids while fatty acids are being synthed in the cytosl carnitine may be synthed in liver and kidney, but all muscular carnitine must be dietary, from meat. |
#biochemistry #energymetzm
|
|
β-Oxidation of Fatty Acids
|
each removal of 2 carbons requires the addition of a CoA group but produces 2FADH2, 1 NADH, and Acetyl CoA (which may enter TCA cycle and produce 12 equivalents of ATP or become ketones)
Odd chained fatty acids end as Propionyl CoA → methylmalonyl coA → Succinyl CoA by proprionyl-CoA-carboxylase + biotin and methylmalonal CoA racemase/mutase with B12 respectively |
#biochemistry #energymetzm
|
|
Ketones
|
Produced by siphoning off Acetyl CoA
Thiolase (Acetyl-CoA + Acetyl-CoA → Acetoacetyl-CoA + CoA) HMG CoA Synthase (Acetoacetyl CoA + Acetyl-CoA --> HMG CoA + CoA) HMG CoA Lyase (HMG CoA → Acetyl CoA + Acetoacetate) Acetoacetate is a Ketone which may spontaneously degrade to Acetone (another ketone) or be upgraded via NADH to 3 hydroxybutryate (another ketone) |
#biochemistry #energymetzm
|
|
What is the HBVsAg
|
22 nn glycoprotein componenet of the envelope
NB: not the nucleocapsid |
#microbiology #virology
|
|
Distinguishing Neuroleptic Malignant Sro from Serotonin Sro
|
Serotonin Sro: Myoclonus
NMS: Rigidity s Myoclonus |
#pharmacology #toxicity
#neurology |
|
Renal Papillary Necrosis
|
Assoc. w/
--Sickle Cell --Analgesics (NSAIDs ↓ renal blood flow) --DM --Acute Pyelo or UT Obstrx Infarct Necrosis Acute onset hematuria and colicky flank pain |
#pathology #nephrology
|
|
α glucosidase inhibitor
|
α glucosidase inhibitors
acarbose, miglitol ↓ fnx of intestinal brush border disaccharidases create osmotic bloating & malabsorption |
#pharmacology #diabetes
#energymetzm |
|
acarbose
|
α glucosidase inhibitors
acarbose, miglitol ↓ fnx of intestinal brush border disaccharidases create osmotic bloating & malabsorption |
#pharmacology #diabetes
#energymetzm |
|
miglitol
|
α glucosidase inhibitors
acarbose, miglitol ↓ fnx of intestinal brush border disaccharidases create osmotic bloating & malabsorption |
#pharmacology #diabetes
#energymetzm |
|
route of median nerve
|
C6-T1
with brachial artery between biceps brachii and brachialis muscle medial aspect of antecubital fossa crosses between humeral and ulnar heads of pronator teres muscle between flexor digitorum superficialis and flexor digitorum profundus muscles enters hand within flexor retinaculum denervation → thenar atrophy, ape hand deformity lost sensation on palmar surface of first 3.5 digits |
#anatomy #neurology
|
|
route of the ulnar nerve
|
between olecranon and medial epicondyle "funnybone" injury
between flexor carpi and flexor digitorum profundus injury paralyses intrinsic muscles of hand → claw hand |
#anatomy #neurology
|
|
99mmTc-pertechnetate accumulation
|
detects presence of gastric mucosa
|
#pathology #diagnostics
|
|
test to identify presence of gastric mucosa
|
99mmTc-pertechnetate scan
accumulates in gastric mucosa |
#pathology #diagnostics
|
|
Pathogenesis of Polyhydramnios
|
~1000 ml
either ↓ fetal swallowing or ↑ fetal urination ↓ swallowing from GI obstrx/atresia, anenecephaly (no brain → no swallowing) ↑ urination: high cardiac output 2° to anemia or twin-to-twin transfusion |
#pathology #embryology
|
|
the histology of chronic graft rejection of a kidney
|
years in delay
antibody mediated → obliterative vascular fibrosis |
#pathology #kidney
|
|
in which direction is mRNA transcribed
|
5' to 3'
|
#biochemistry #DNA
|
|
Production, Storage and Secretion of Thyroid Hormones
|
Active Import of I- by Iodine Pump
--inhibited by thiocyanate, perchlorate anions and extremely high [I-] Oxication of I- to I2 (dimer, not 2+ ion) by peroxidase enzyme --inhibited by propylthiouracil Tyrosine incorporated into thyrobluline by ribosomes, thyroglobulin packaged in golgi secretory vesiscle and excreted into lumen Organifciation of I2: same peroxidase enzyme catalyzes formation of either Monoiodotyrosine or diiodotyrosine at jnx of follicular cells and lumen MIT + DIT = T3 DIT + DIT =T4 When stimulated by TSH lysosomal enzymes digest thyroglobulline and release T3 and T4 leftover MIT and DIT deiodintated by thyroid deiodinase (deficiency mimics I2 deficiency) NB: TSH upregulates all processes |
#physiology #endocrine
|
|
Thyroid Deiodinase
|
breaks I2 off of leftover MIT and DIT allowing for I2 recycling
deficiency of Thyroid Deiodinase mimics I2 deficiency |
#physiology #endocrine
|
|
Thyroid Peroxidase
|
Responsible for both conversion of I- into neutral I2 dimer and also for organification of I2 dimers into MIT or DIT at jnx of thyroid follicular cells and thyroglobulin containing lumen
|
#physiology #endocrine
|
|
T3 v T4
|
more T4 is produced
T3 is more active T4 converted to T3 or rT3 in peripheral tissues T3 serves as feedback inhibition to pituitary [rT3 is inactive] |
#physiology #endocrine
|
|
Thyroid Binding Globulin
|
Transports T3 and T4 in peripheral blood
hepatic failure ↓ TBG pregnancy ↑ TBG because any free T3 inhibits pituitary TSH prodxn, Δ TBG will ↑↓ total Thyroid Hormone in blood but does not ↑↓ Free Thyroid hormone in blood |
#physiology #endocrine
|
|
Systemic Mastocytosis
|
↑ Histamine Secretion leads to manifestations
↑ Gastric secretion inactivates pancreatic and intestinal enzymes → diarrhea & malabosprtion ↑ vasodilation → flushing, hypotension, tachycardia, syncope urticaria/, pruritis, dematographism |
#pathology #hematology
|
|
Neonate born to HepB+ mother
|
HBeAg presence in serum indicative of virulence
usually acquired through birth canal 25% transmission from HBeAg- moms almost 100% from HBeAg+ moms Viral replication proceeds at high rate and almost all progress to chronic hepatitis However, minimal changes in Liver because HepB not directly hepatotoxic and neonatal immune system not capable of responding |
#microbiology #virology
|
|
Preventing Thyroid Toxicity upon exposure to Radioactive materal
|
administer overwhelming amts of K+I- potassium iodide
competitively inhibit uptake of radioactive iodide into thyroid gland |
#pharmacology #toxicology
|
|
[CRH], [ACTH] c prednisone Tx
|
both ↓ ↓
|
#physiology #endocrineology
|
|
Constrictive Pericarditis vs Cardiac Tamponade
|
Constrictive Pericarditis takes months to produce tamponade
Tamponade is an acute onset |
#physiology #cardiology
|
|
Amlodipine
|
Dihydropyridine calcium channel blocker
more selective for vasculature relaxes arterioles to reduce TPR in angina pectoris |
#pharmacology #cardiology
|
|
Drugs which increase lithium levels
|
Li+ treated just like Na+
Thaizide Diuretics (NB: not loop) Kidney attempts to compensate for Na+ loss by increasing uptake in proximal tubule, ends up reabosrbing Li+ ACEI's -unknown mech NSAID's -unknown mech |
#pharmacology #toxicity
|
|
72 kD enzyme only present in inflammatory cells during inflammation
|
COX2
selectively upregulated during inflammation |
#biochemistry #pharmacology #inflammation
|
|
Depolarizing NMJ blocker
|
Succinylcholine
|
#pharmacology #drugs
|
|
Non-depolarzing NMJ blocker
|
d-turbocurare
anything -curium or -curonium |
#pharmacology #drugs
|
|
Enzymatic Rxns which Require biotin
|
Acetyl-CoA carboxylase
acetyl-CoA → malonyl CoA in fatty acid prodxn Pyruvate Carboxylase pyruvate to oxaloacetate (gluconeogenesis) Propionyl Carboxylase Proprionyl CoA → methylmalonyl-CoA [→ Succinyl CoA] methylcrotonyl CoA Carboxylase part of breakdown of branched chain amino acidsinto acetoacetate Leu Phe Tyr Trp, Lys deficiency from eating raw egg whites |
#biochemistry #energymetzm
|
|
Gram positive rods found in CSF tap
|
Listeria monocytogenes
|
#microbiology #neurology
|
|
Gram negative rods found in CSF tap
|
E coli
|
#microbiology #neurology
|
|
DOC: preventing Ca2+ nephrolithiasis
|
Thiazide diruetics
inhibition of Na+/Cl- cotransporter in distal convoluted tubule ↑ Na+ charge in lumen and forces Ca2+ out |
#pharmacology #drugs
|
|
Normal molecular progression to colon cancer
|
Normal Epithlium
mutated APC → Early Adenoma mutated K-RAS → late adenoma mutation of p53 & DCC → malignant trnasformation adenomas <1 cm unlikely to undergo malifnant transformation >4cm likely → adenocarcinoma |
#pathology #neoplasia
|
|
Precocious puberty + Paralysis of Upward Gaze
|
Paralyzis of upward gaze = parinaud sro aka dorsal midbrain sro
consistent with tumor in pineal region and germinomas are most common tumor of pineal gland precocious puberty induced by βHCG prodxn may proceed to obstructive hydrocephalus |
#pathology #neoplasia #neurology
|
|
Pineal Tumor
|
germinomas are most common tumor of pineal gland
precocious puberty induced by βHCG prodxn Paralyzis of upward gaze = parinaud sro aka dorsal midbrain sro consistent with mass occupying lesion may proceed to obstructive hydrocephalus |
#pathology #neoplasia #neurology
|
|
Spontaeous Intraranial Hemorrhage in a young adult
|
likely cocaine (or sympatheticomimetics)
coarctation of aorta → berry aneurysm (htn) [AV malformation] |
#pathology #cardiovascular #neurology
|
|
Hypervariable Pili
|
Virulence factor of Neisserias
|
#microbiology
|
|
IgG binding outer membrane protein
|
protein A virulence factor of Staph aureus binds Fc region
|
#microbiology
|
|
Antiphagocytic acpsule
|
Pneumococcosu
H influenzae Neisseria |
#microbiology
|
|
Characterize eosinophil fnx
|
Antibody-dependent cytotoxicity
Eosinophils have an IgE Fx degranulation releases major basic protein eosinophils also contain histaminase which degraes histamine and decreases severity of atopy also leukotrienes and peroxidases which ↑ inflammation |
#immunology
|
|
Which strx are associated with which parts of the duodenum (specifically at risk for cancer invasion)
|
1st part: horizontal over L1, only part not retroperitoneal
2nd part: L1-L3 vertical; ampulla of vater 3rd: horizontal along L3 abromainal aorta and IVC close association with uncinate process and SMA/V high risk for invasion 4th superiorly L3 → L2 Ligament of Treitz defines Duodenum from jejunum |
#anatomy
|
|
Most common Cancers in Women and Men
Highest Death causing Cancers in women and men |
Incidence
--Women: Breast > Lung > Colon/Rectum --Men: Prostate > Lung > Colon/Rectum Mortality --Men: Lung > Prostate --Women: Lung > Breast |
#pathology #neoplasia
|
|
Psammoma bodies
|
"Sand Bodies" laminated concentric calcific spherules seen in:
Papillary adenocarcinoma of Thyroid Serous papillary cystadenocarcinoma of ovary Meningioma Malignant mesotheliuma Mn: PSaMMoma Pappilary, Serous, Meningioma, Mesothelioma |
#pathology #neoplasia
|
|
Vitamin D deficiency
[Ca2+], [Phosphorus], [PTH] |
↑ PTH
↓ both Ca2+ and Phosphorus vitamin D ↑ absorption of both bones will release both in response to PTH, but not enough |
#physiology #endocrine
|
|
enoxaprin
|
LMW heparin
|
#pharmacology #drugs
|
|
"Chloride Shift"
|
HCO3 produced in blood from CO2 diffuses out into blood, negative charge drives Chloride into RBC
|
#phsyiology
|
|
late onset food poisoning
transient waterry diarrhea |
c perfringes
toxin formed after ingestion & germination of spores |
#microbiology #toxins
|
|
how do cells die during menstraution
|
apparently apoptosis though I still think it's reperfusion injury
|
#physiology #endocrine
|
|
Radial Traction in lungs means what
|
pulling inwards
|
#pathology #pulmonology
|
|
Why is sputum green during pneumonia?
|
Myeloperoxidase is a blue green heme based pigmented molecule within the azurophilic granules of PMN's which catalyzes the prdxn of HOCl from h2O2
|
#immunology
|
|
Ristocetin
|
activates GP Ib-IX receptors on platelets which bind vWF
good test to see if vWF deficient |
#pathology #diagnostics #hematology
|
|
prolonged PTT c prolonged bleeding time, same pathology
|
vWF deficiency
vWF binds Factor8 and marketly ↑↑ λ |
#pathology #hematology
|
|
Henoch Shonen Purpura
|
IgA immune complex deposition
affects: GI tract:severe abdominal pain risk bleeding and intussicception Kidneys: Burger's leukocytoclastic nephritis Skin: Purpura Joints: migratory arthirits |
#pathology #syndromes
|
|
Where is the urethra damaged in a pelvic fx
|
between prostatic urethra and pelvic diaphragm becasue it is firmly attached to both
|
#anatomy
|
|
where is the urethra damaged 2° to blunt trauma to perineum w/o pelvic fx
|
blubous urehtra immediately after pelvic diaphragm
|
#anatomy
|
|
Extremity Edema
↑ Cardiac Output ↓ Extremity Sensation |
Wet Beriberi
neuropathy + cardiac involvement usually high output CHF Thiamine deficiency |
#pathology #nutrition
|
|
Wet Beriberi
|
Wet Beriberi
neuropathic sensory-motor loss in distal extremities + cardiac involvement usually high output CHF Thiamine deficiency dry beriberi does not include Cardiac invovlement |
#pathology #nutrition
|
|
tRNA strx
|
acceptor stem includes
--5' terminal phosphate and --3' CCA w/ terminal hydroxyl, this is added post transcriptionally in eukaryotes and then loaded with aminoacid by aminoacyl tRNA synthetase T arm with TΨC Loop (Thymidine, Pseudouridine, Cytidine) necessary for binding to Ribosomes D arm: numerous dihydrouracil residues faciliatates correct recognition by aminoacyl tRNA synthetase anticodon site opposite acceptor stem |
#biochemistry #DNA
|
|
Primary Limitation of BZD's
|
Falling
|
#pharmacology #toxicities
|
|
statins + fibrates
|
statin: HMG coA reductase inhibitor
potential toxicity: myopathy and hepatitis simvastatin is worst fibrates: ↑ LPL --gemfibrozil increases the concentration of statins --fenofibrate itself casues myopathy |
#pharmacology #toxicities
|
|
statin + bile acid resins
|
statin: HMG coA reductase inhibitor
potential toxicity: myopathy and hepatitis simvastatin is worst bile acid resins: cholestyramine, colestipol, colesevelam ↓ absorption of statins 4 hour separation |
#pharmacology #toxicities
|
|
fibrates + bile acid resins
|
fibrates: ↑ LPL
--gemfibrozil & fenofibrate bile acid resins: cholestyramine, colestipol, colesevelam combo: ↑ cholesterol concentration in bile → ↑ gallstones |
#pharmacology #toxicities
|
|
Main cause of sudden cardiac death in previously healthy young adults
|
Hypertrophic Cardiomyopathy
Autosomal Dominant: disoriented tangled cardiomyocytes Dilated septum obstructs outflow tract → systolic murmur ↑ by ↓ venous return (standing, valsalva) Main cause of sudden cardiac death in previously healthy young adults assoc. c Friederick's ataxia Tx: βblocker or non-dihydropyridine Ca2+ channel blocker, eg verpamil |
#pathology #cardiovascular
|
|
Hypertrophic Cardiomyopathy
|
Hypertrophic Cardiomyopathy
Autosomal Dominant: disoriented tangled cardiomyocytes Dilated septum obstructs outflow tract → systolic murmur ↑ by ↓ venous return (standing, valsalva) Main cause of sudden cardiac death in previously healthy young adults assoc. c Friederick's ataxia Tx: βblocker or non-dihydropyridine Ca2+ channel blocker, eg verpamil |
#pathology #cardiovascular
|
|
The only microbe which causes epiglottitis
|
Hib
|
#microbiology
|
|
Amphotericin B
what should you monitor |
Serum K+ and Mg++
nephrotoxicity is Amphotericin's limitation, most pts will need K+ and Mg++ supplementation decreased EPO production may also lead to normocytic normochromatic anemia |
#pharmacology #toxicity #chemotheraputics
|
|
pancytopenia s hepatosplenomegaly
|
aplastic anemia
--severe B12 or folic deficiency --aleukemic leukemia --myelodysplastic sro "dry tap" hypocellular marrow filled with fat & fibrotic stroma |
#pathology #hematology
|
|
Clue Cells
|
Gardenlla vaginalis
grey vaginal discharge c "fishy odor" Tx: metronidazole |
#microbiology #genitalia
|
|
grey vaginal discharge c "fishy odor"
|
Gardenlla vaginalis
Clue Cells tx: metronidazole |
#microbiology #genitalia
|
|
foamy yellow-green vaginal c foul smell
|
Trichomonas vaginalis
flagellated protozoan |
#microbiology #genitalia
|
|
purulent vaginal discharge
|
Gonorrhea or Chlamydia
|
#microbiology #genitalia
|
|
Partial Mole v Complete Mole
|
Partial Mole: one ovum + 2 or more sperm → 69XXX or 69 XXY
Complete Mole: one sperm enters egg, duplicates its chromosomes while maternal chroms eliminated "androgenesis" almost always 46XX |
#pathology #embryology #neoplasia
|
|
From whence is saphenous vein harvested for a CABG
|
surgeons access the vein in the femoral triangle just below the pubic tubercle
why? because fuck you that's why. quit asking questions. |
#anatomy #clincial
|
|
When is pulmonary vascular resistance lowest
|
at the low volume end of normal tidal volume
above this the stretch in the wall squeezes the vasculature below this muscular is placing pressure on the system |
#physiology #pulmonology
|
|
What will ↓ proptosis in graves dz?
|
only glucocorticoids by ↓ inflam
antithyroid drugs do not fight exopthalmos |
#pharmacology #pathology #endocrine
|
|
Post MI Ventricular WallRupture
|
10% of cases 3-7 days after MI when coagulative necrosis and PMN infiltrate have weakened most
LV hypertrophy prior to MI is rupture-protective |
#pathology #cardiovascular
|
|
Multiple Myeloma
|
Plasma Cell Neoplasia
Anemia → infx Bone Resorption → hypercalcemia AL amyloid "apple green" birefringence → renal failure → Bence Jones light Chains |
#pathology #neoplasia
|
|
Cladribine
|
Adenosine analogue, resistent to Adenosine deaminase → reaches high concentrations in cells
DOC for hairy cell leukemia → complete remissions good CNS penetration, urinary excretion |
#pharmacology #chemotheraputics #neoplasia
|
|
Adenosine Deaminase Resistant Adenosine Analogue
|
Cladribine
Adenosine analogue, resistent to Adenosine deaminase → reaches high concentrations in cells DOC for hairy cell leukemia → complete remissions good CNS penetration, urinary excretion |
#pharmacology #chemotheraputics #neoplasia
|
|
DOC Hairy Cell Leukemia
|
Adenosine analogue, resistent to Adenosine deaminase → reaches high concentrations in cells
DOC for hairy cell leukemia → complete remissions good CNS penetration, urinary excretion |
#pharmacology #chemotheraputics #neoplasia
|
|
Fludrabine
|
Purine analogue used in CLL
|
#pharmacology #chemotheraputics #neoplasia
|
|
Sickle Celler Dies of Septic Shock
|
Pneumococcus or Hemophilus Influenzae
(no spleen, esp susceptible to encapsulated organisms) Salmonella important for osteomyelitis, not for septicemia |
#pathology #microbiology
|
|
Charcot-Bouchard pseudoaneurysms v Berry Aneurysms
|
Charcot-Bouchard
Hypertension Small arteries of basal ganglia & internal capsule <1mm sudden onset of focal deficits from intracerebral hemorrhage in basal ganglia, itnernal capsule, thalamus, and pons Berry (saccular aneurysms) ADPKD, Marfan, Ehlrs-Danlos sros Circle of Willis, APC, or middle cerebral artery Size variable 2-25 mm sudden onset of headache and AMS from subarachnoid hemorrhage |
#pathology #neurology #strokes
|
|
CD14
|
Monocyte-M∅ lineage
|
#immunology
|
|
Stop Codons
|
UAA UGA UAG
|
#biochemistry #DNA
|
|
Aseptic Meningitis in Children
|
Most commonly Enteroviruses:
Coxsackie virus, echovirus, poliovirus and enterovirus |
#microbiology #neurology
|
|
PMH: Blunt Trauma to Abdomen c Emergent Surgery presents with Bacteremia
|
Splenectomy
vulnerable to encapsulated organisms Pneumococcus Meningococcus H influenzae |
#microbiology #immunology
|
|
Hydroxyzine
|
First Generation Anti-histamine
blackade M, 5HT and α pathways 5HT blocakde stimualtes appetite α: postural dizziness lipophilic ✓xBBB → sedation |
#pharmacology #drugs
|
|
Promethazine
|
First Generation Anti-histamine
blackade M, 5HT and α pathways 5HT blocakde stimualtes appetite α: postural dizziness lipophilic ✓xBBB → sedation |
#pharmacology #drugs
|
|
Fexofenadine
|
2nd Generation Anti-Hitstamine do not have anti-muscarinic, anti-alpha or anti-5HT problems
∅xBBB → ∅sedation |
#pharmacology #drugs
|
|
Chlorpheniramine
|
First Generation Anti-histamine
blackade M, 5HT and α pathways 5HT blocakde stimualtes appetite α: postural dizziness lipophilic ✓xBBB → sedation |
#pharmacology #drugs
|
|
Diphenhydramine
|
First Generation Anti-histamine
blackade M, 5HT and α pathways 5HT blocakde stimualtes appetite α: postural dizziness lipophilic ✓xBBB → sedation |
#pharmacology #drugs
|
|
Electrolyte Balance in 1° Adrenal Insufficiency
|
↓Na, Cl, HCO3
↑K NB: pts w/ 2° or 3° adrenal insufficiency ∅ → mineralcorticoid deficciency |
#physiology #endocrine
|
|
Baroreceptor Reflex Physiology
|
CN9
pressure ↑ firing rate → vagal discharge → ↑ AV reffractory preriod Stimualtion good for Superventricular Tachycardia (AV reenterant tachycardias) |
#physiology #cardiology #autonomics
|
|
Factor V Leiden mutation
|
glutamine for arginine substrition near protein C cleavage site → not degraded
hypercoagulative [activated protein C (APC) responsible for inactivating factors V & 7] |
#pathology #hematology
|
|
glutamine for arginine substrition near protein C cleavage site on Factor V
|
Factor V Leiden mutation → not degraded
hypercoagulative [activated protein C (APC) responsible for inactivating factors V & 7] |
#pathology #hematology
|
|
Cidofovir
|
a nucleoside monophosphate
unlike acyclovir, vaalacyclocir, famciclovir or ganiciclovir (only nucleaoside analogues) Cidofovir does not need to be phosphorylated by infected cells to be effectve good for thymidine kinase deficient (acyclovir resistent) herpesvirus often found in AIDS pts |
#pharmacology #chemotheraputics
|
|
DOC: acyclovir resistant herpes
|
Cidofovir: a nucleoside monophosphate
unlike acyclovir, vaalacyclocir, famciclovir or ganiciclovir (only nucleaoside analogues) Cidofovir does not need to be phosphorylated by infected cells to be effectve good for thymidine kinase deficient (acyclovir resistent) herpesvirus often found in AIDS pts |
#pharmacology #chemotheraputics
|
|
Acute Infective Endocarditis
|
Staph aureus is most common cause
predisposed by undelrying host endotheial damage & fibrin/platelet deposition |
#microbiology #pathology #cardiovascular
|
|
Otherwise healthy pt unable to tolerate everyday sounds?
Which cranial nerve has been injured? |
Faical: stapedius muscle paralysis → no mitigation of sound "hyperacusis"
|
#pathology #neurology
|
|
Reed Sternberg Cells
|
ample cytoplasm
double/bi-lobed nuclei indicative of Hodgkin's Lymphoma |
#pathology #neoplasia #hematology
|
|
Cell with double/bi-lobed nuclei and ample cytoplasm
|
Reed Sternburg Cells
pathognomic for Hodgkin's Lymphoma |
#pathology #neoplasia #hematology
|
|
Normal Location of Great Vessels
Transposition |
Normal: aorta anterior and to the left of the pulmonary artery
Transposition: aorta lies anterior and to the right of the pulmonary artery |
|
|
two cardiovascular abnormalities which present with cyanosis at birth
|
Tetrology of Fallot
Transposition of the Great Vessels: --right side of heart + pulmonary = closed loop --left side + systemic = closed loop compatible with life via abnormal patency: PFO, VSD, PDA, |
|
|
renal mass
3p deletion |
renal cell carcinoma
assoc w/ 3p deletion = VHL KO → constitutive HIF expression (hypoxia induced factor ↑ VEGF) half of all spontaneous RCC's ( & VHL Sro incl RCC) Micro: "polygonal cells with abundant clear cytoplasm" Grossly: CHO & Lipids = golden mets to lungs & bones, (prefers lungs) Wide Range of PNPSro's: -EPO → polycythemia -ACTH → cushing's -PTHrP → hypercalcemia -Prolactin → HPG suppression |
#pathology #syndromes #neoplasia
|
|
cerebellar hemangioblastomas
renal cell carcinomas & pheocytochromas |
Von Hippel Landau Sro
usually 3p delection AD Sro (Knudsons) VHL KO → constitutive HIF expression (hypoxia induced factor ↑ VEGF) allso accts for half of all spontaneous RCC's |
#pathology #syndromes #neoplasia
|
|
Most common laboratory abnormality of Legionella pneumonia
|
hyponatremia
|
#microbiology
|
|
Scopolamine
|
selective muscarinic antagonist
primarily used vs. motion sickness 2ndary to Dramamine/Antihistamines may be used to reduce the ANS side effects of cholinesterase inhibitors prescribed for myasthenia gravis. |
#pharmacology #drugs #toxicities
|
|
TAG metzm
|
Glucagon, Epinephrine → Gs → cAMP → cAMP dpt Protein Kinase → activates Hormone Sensitive Lipase
Hormone Sensitive Lipase: TAG → Glycorol and Fatty Acids Fatty Acids undergo β Oxidation Glycerol diffuses to Liver (Hepatic) Glyrocerol Kinase: Glycerol → Glycoerol 3 Phosphate May be used to build another TAG or G3P dehydratase (unimportant): G3P → DHAP DHAP in equilibrium with both Glyceraldehyde-3-P and Fructose 1,6 Bisphosphate, may participate in either glycolysis of gluconeogenesis |
#biochemistry #energymetzm
|
|
Acetyl CoA Carboxylase
|
biotin dpt enzyme: first comitted step in Fatty Acid Synth
Acetyl CoA --> malonyl CoA |
#biochemistry #energymetzm
|
|
Drugs which may cause seizures
|
Buproprion- NE + DA reuptake inhibitor
Isoniazid (if given w/o B6) Imipenem (Antibiotic) |
#pharmacology #toxicities
|
|
Gram positive rods found in CSF tap
|
Listeria Monocytogenes
Facultatively Intracellular β hemolytic gram potisive Tumbling Motility via "Actin Rockets" Opportunistic Infection of Neonates and Immunocomp --Septicemia or Meningitis Access via Contaminated/Unpasturized Food, for neonates transplacental or vaginally Uniquely able to grow at 4*C |
#microbiology
|
|
Listeria Monocytogenes
|
Listeria Monocytogenes
Facultatively Intracellular β hemolytic gram potisive Tumbling Motility via "Actin Rockets" Opportunistic Infection of Neonates and Immunocomp --Septicemia or Meningitis Access via Contaminated/Unpasturized Food, for neonates transplacental or vaginally Uniquely able to grow at 4*C |
#microbiology
|
|
Gram Positive Rod with Tumbling Motility
|
Listeria Monocytogenes
Facultatively Intracellular β hemolytic gram positive Tumbling Motility via "Actin Rockets" Opportunistic Infection of Neonates and Immunocomp --Septicemia or Meningitis Access via Contaminated/Unpasturized Food, for neonates transplacental or vaginally Uniquely able to grow at 4*C |
#microbiology
|
|
Gram Positive Rod Grows in Refridgerator
|
Listeria Monocytogenes
Facultatively Intracellular Tumbling Motility via "Actin Rockets" Opportunistic Infection of Neonates and Immunocomp --Septicemia or Meningitis Access via Contaminated/Unpasturized Food, for neonates transplacental or vaginally Uniquely able to grow at 4*C |
#microbiology
|
|
Suppression
(Defense Mechanism) |
Mature Defense Mechanism
Intentional with-holding of distressing thoughts. |
#ethics
|
|
BZD's vs Barbituates
|
BZD's ↑ freq of GABAa opening
Barbituates ↑ duration of GABAa opening |
#pharmacology #drugs #mechanisms
|
|
Inhibits DA + NE Reuptake
|
Burproprion "Wellbutrin"
NB: Risk Seizures |
#pharmacology #drugs #toxicities
|
|
Inhibits NE + 5HT Reuptake
|
TCA's
Also Venlafaxine and Desvenlafaxine (SIADH, ↑ BP) |
#pharmacology #drugs #mechanisms
|
|
Lecithinase
Agent, Mechanism |
aka Phospholipase C aka α toxin
Produced by C perf |
#microbiology #toxins
|
|
Genetics of Type 1 Diabets
|
HLA-DQ and HLA-DR
|
#pathology #genetics
|
|
Why amyloid in T2DM islets?
|
Islet Amyloid Polypeptide ie Amylin cosecreted with insulin.
|
#pathology
|
|
anti-hyperlipidemic agent produces cutaneous flushing
|
niacin/nicotinic acid
prostaglandin mediated flushing may be inhibited by aspirin mech: inhibits VLDL secretion, ↑ HDL secretion & LPL fnx |
#pharmacology #drugs #cardiovascular
|
|
Caspacin
|
topical analgesic which ↓ substance P
|
#pharmacology #drugs #mechanism
|
|
Complete Mole v Partial Mole
Genetics, Sx, Appearnce, Risks |
Partial Mole: one ovum + 2 or more sperm → 69XXX or 69 XXY
Sx: vaginal bleeding, abd cramping Grosss: fetus, cord, amniotic membrane, enlarged villi Risks: low rate conversion to malignancy Complete Mole: one sperm enters egg, duplicates its chromosomes while maternal chroms eliminated "androgenesis" almost always 46XX Sx: many: vaginal bleeding, enlargement, hyperemesis, pre-eclampsia, hyperthyroidism, theca-lutein cysts Gross: Trophoblast only "bunch of grapes" enlarged villi Risks: 1/4 → malignant trophoblast dz |
#pathology #reproductive
|
|
Lipoate Deficiency
|
Cofactor for 3 enzymes: Pyruvate Dehydrogenase, αKGDHC & branched chain ketoic acid dehdyrogenase (maple syrup dz)
Pyruvate Dehydrogenase: Pyruvate → Acetyl-CoA All 3 have the same cofactors: NAD, FAD, Thiamine, CoA & Lipoate Lipoate deficiency blocks things up at pyruvate → lactic acidosis |
#biochemistry #energymetzm #vitamins
|
|
Maple Syrup Urine Dz
|
↓ α ketoacid dehydrogenase
→ ∅ AminoAcid debranching Leucine, Isoleucine, Valine (esp Leu) Involved in both the pathway which converts Leu to Acetyl-CoA &the pathway that converts Ile & Val to Proprionyl-CoA Severe CNS defects → MR and Death NB: cofactors same as Pyruvate dehydrogenase and αKGDHC |
#biochemistry #pathology #syndromes
|
|
α ketoacid dehydrogenase
|
AminoAcid debranching: Leucine, Isoleucine, Valine (esp Leu)
Involved in both the pathway which converts Leu to Acetyl-CoA &the pathway that converts Ile & Val to Proprionyl-CoA ↓ α ketoacid dehydrogenase → Severe CNS defects → MR and Death NB: cofactors same as Pyruvate dehydrogenase and αKGDHC |
#biochemistry #pathology #syndromes
|
|
Mesna
|
antidote for hemorrhagic cystitis 2° to nitrogen mustard based chemothreapeutics eg cyclophosphamide or analoges (ifosfamide)
normally nitrogen mustards → acrolein → uroepithelial toxicity mesna binds and inactivates metabolites |
#pharmacology #drugs #toxicities
|
|
Prophylaxis vs Hemorrhagic Cystitis in Anti-neoplastic chemotherapy
|
Mesna
hemorrhagic cystitis 2° to nitrogen mustard based chemothreapeutics eg cyclophosphamide or analoges (ifosfamide) normally nitrogen mustards → acrolein → uroepithelial toxicity mesna binds and inactivates metabolites |
#pharmacology #drugs #toxicities
|
|
Ondansetron
|
5-HT3 inhibitor used for nauesa/vomitting following chemoRx
|
#pharmacology #drugs
|
|
5-HT3 inhibitor used for nauesa/vomitting following chemoRx
|
Ondansetron
|
#pharmacology #drugs
|
|
CD31+ Tumor
|
PECAM1 used for leukocyte migration
tumor of vascular endothelial cells |
#pathology #neoplasia
|
|
Describe the neurologic pathway by which the eyes accomodate to light
|
optic nerve branches branches to ispilateral pretectal nucleus in superior colliculus
fibers project to both ipsilateral and cotnralateral Edinger-Westphal nuclei, the site of preganglionic PSNS neurons neurons project out within CN3 to ciliary ganglion and then into the eye |
#neurology
|
|
Trypanosoma cruzi
neurologic sequelae |
trypanosome (parasite) carried by Reduviid "Kissing" bug which lives in the walls of rural huts
destroys myenteric plexus & causes PSNS denervation |
#microbiology
|
|
16S rRNA
|
peice of the prokaryotic 30S which contains the Shine-Delagarno complememntnary sequence necessary for for binding
|
#biochemistry #DNA
|
|
23S rRNA
|
part of 50S rRNA which facilitates peptide bind formation
|
#biochemistry #DNA
|
|
APP gene on Chrom 21
|
Amyloid Precursor Protein
one of 3 genes assoc w/ early onset (<60) familial Alzheimers (APP + Presenilin 1 on chrom 14 and Presenilin 2 on Chrom 1) |
#pathology #genetics
|
|
Genes assoc w/ Early Onset Alzheimers
|
Amyloid Precursor Protein (APP) on Chrom 21
Presenilin 1 on chrom 14 Presenilin 2 on Chrom 1) NB: Late onset assoc. w/ ε4 allele of ApoE |
#pathology #genetics
|
|
ε4 ApoE
|
ε4 allele of Apolipoprotein E associated with late onset (>60 yo) Alzheimers
|
#pathology #genetics
|
|
Genes assoc w/ Late Onset Alzheimers
|
ε4 allele of Apolipoprotein E associated with late onset (>60 yo) Alzheimers
|
#pathology #genetics
|
|
Hypertrophic Cardiopmyopathy
|
Hypertrophic Cardiomyopathy
Autosomal Dominant: disoriented tangled cardiomyocytes, mostly from β-myosin heavy chain mutation Dilated septum obstructs outflow tract → systolic murmur ↑ by ↓ venous return (standing, valsalva) Main cause of sudden cardiac death in previously healthy young adults assoc. c Friederick's ataxia Tx: βblocker or non-dihydropyridine Ca2+ channel blocker, eg verpamil |
#pathology #syndromes #genetics
|
|
β-Myosin Heavy Chain Mutation
|
Hypertrophic Cardiomyopathy
Autosomal Dominant: disoriented tangled cardiomyocytes, mostly from β-myosin heavy chain mutation Dilated septum obstructs outflow tract → systolic murmur ↑ by ↓ venous return (standing, valsalva) Main cause of sudden cardiac death in previously healthy young adults assoc. c Friederick's ataxia Tx: βblocker or non-dihydropyridine Ca2+ channel blocker, eg verpamil |
#pathology #syndromes #genetics
|
|
Interactions between HPG and HPT axes
|
Estrogen ↑ Thyroglobulin Production
Δ[thyroglobulin] → stepwise Δ[T3, T4] w/o Δ[free T3, T4] ↑ in thyroid hormones thus seen in pregnancy, OCPs & HRT |
#physiology #endocrine
|
|
Hematologic/poietic Effects of Glucocorticoids
|
lyses lymphocytes, eosinophils and basophils, ↓ monocyte differentiation into M∅ (thus decreasing antigen presentation)
"↑" PMN's on CBC via demargination, does not actually ↑ # PMN |
#pharmacology #physiology #hematology
|
|
Dyspniac Lung Biopsy
|
Metastatic Renal Clear Cell Carcinoma
Most Common Renal Cell Carcinoma assoc w/ 3p deletion = VHL KO → constitutive HIF expression (hypoxia induced factor ↑ VEGF) half of all spontaneous RCC's ( & VHL Sro incl RCC) Micro: "polygonal cells with abundant clear cytoplasm" Grossly: CHO & Lipids = golden mets to lungs & bones, (prefers lungs) Wide Range of PNPSro's: -EPO → polycythemia -ACTH → cushing's -PTHrP → hypercalcemia -Prolactin → HPG suppression |
#pathology
#neoplasia |
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Normal Fractional Excretion of Sodium, Inulin, PAH, Urea
|
Sodium = <1%
NB: majority ALWAYS resporbed in proximal tubule Urea: 55% consistently Inulin: 100%, neither secreted nor resorbed PAH: 100% secreted, secretion rate correlates to blood flow not filtration rates |
#physiology #renal
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Uptake and Secretion of Bilirubin: which is ATP dependent
|
Organic Anion Transporting Peptide OAPT bring unconjugated bilirubin in via facilitated diffusion
MRP2 is ATP dependent excretion impaired MRP2 will allow diffusion back out OATP |
#physiology #renal
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Dubin Johnson vs Rotor Sro
|
Both have defective MRP2 excretion of conjugated bile
DJ: black pigmented liver, no (?) jaundice Rotor: no pigmentation, definitely jaundiced |
#pathology #renal
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DOC: narcolepsy
|
Modafinil
non-amphetamine stimulant not sympatheticomimetic, lower risk for dependency |
#pharmacology #drugs #neurology
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Modafinil
|
DOC: narcolepsy
non-amphetamine stimulant not sympatheticomimetic, lower risk for dependency |
#pharmacology #drugs #neurology
|
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DOC: Trigeminal Neuralgia
|
carbapamazine
|
#pharmacology #drugs #neurology
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CXR: pulmonary infiltrates far worse than expected from clincial presentation
|
M pneumoniae "walking pneumonia"
|
#microbiology #pulmonology
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Positive VLDR, Negative FTA Absorption
|
circulating anti-phospholipid antibodies
indicative of SLE w/ Lupus Anticoagulant, present in 1/4 of SLE results in recurrent thromboemboli and fetal loss |
#pathology
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SLE w/ ↑PTT
|
Lupus Anticoagulant present in 1/4 of SLE
results in recurrent thromboemboli and fetal loss |
#pathology #rheumatology
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The pathology of heart failure cells
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↑ Pulmonary BP → RBC extravasation → M∅ Hemoglobin ingestion → Hemosiderin Laden M∅
|
#pathology #pulmonology
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Artery Damaged with non-displaced crushing fx of femoral neck (eg 2° to osteoporosis)
|
Medial Circumflex Artery supplies majority of blood to the region and is vulnerable as it is closely associated with posterior neck
|
#anatomy
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DOC: Absence + Tonic-Clonic
|
Valproate
Ethosuximide DOC for Absence, but does not help Tonic CLonic |
#pharmacology #neurology
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Meiosis Events and Non-Disjunction
|
Meiosis 1: Chromosomes separate by homologous pairings
Non-disjunction: trisomy with 3 different chromosomes Meisosis 2: those separate Non-disjunction: trisomy with 2 types of chromosomes: 1 from one parent and two identical chroms from other parent Oocytes arrest at prophase of Meiosis I LH surge induces Meiosis I to conclude Enters Meiosis II but arrests at metaphase Meiosis II completes upon fertilization |
#embryology
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How do β-Blockers interact with Thyroid Hormones
|
Beta Blockers do 2 things:
1. block thyroid mediated SNS upregulation 2. ↓ peripheral T4 → T3 NB: β blockers do not prevent new thyroid hormone synthesis, thyroid hormone release or decrease immediate cellular responsiveness to thyroid hormene ( ↑ cellular metzm) |
#physiology #pharmacology #endocrinology
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|
What is:
Sucrose, Lactose, Maltose |
Sucrose: Glucose & Fructoose
Lactose: Glucose & Galactose Maltose: 2 Glucoses |
#biochemistry #energymetzm
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|
Number Needed To Harm
2 drugs |
1/(difference in absolute risk)
|
#biostats
|
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What drugs will halt the progression of diabetic nephropathy
|
ACEI's & ARBs
--far beyond anything else |
#pharmacology #diabetes
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What Drugs/Hormones/Molecules use cGMP as a 2nd messenger
|
ANP, NO, the Eye, [Embryonic Polarization of Pyramidal Cells], Olfactory Cells
Phosphodiesterase inhibitors (sildenafil) |
#pharmacology #physiology #biochemistry
|
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Gut does not absorb cystine
|
shares common transporter with ornithine, lysine and arginine (dibasic amino acids)
cysteine can be produced from homocysteine, not deficient (unlike homocysteinuria) same transporter in gut in kidney → no renal cysteine absorption → cystinuria: AR disorder with recurrent renal stones |
#pathology #nephrology
|
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Cystinuria
|
cysteine can be produced from homocysteine, not deficient
(unlike homocysteinuria) same transporter in gut in kidney → no renal cysteine absorption → cystinuria: AR disorder with recurrent renal stones [Cystine shares common transporter with ornithine, lysine and arginine (dibasic amino acids)] will show ↓ gut absorption of ornithine, lysine, arginine and cystine |
#pathology #nephrology
|
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Calculate A-a gradient
|
Normal Aa gradient <15
(Not 0 because ventilation better in apex and perfusion better in lower lobes = ventilation perfusion mismatch) >15 means that the problem is definitely in the lungs: air is not exchanging appropriately A-a = PAO2 - PaO2 and PAO2 ≈ 150 - (PaCO2/0.8) Deriving the formula is complicated but the formula is not so just memorize this: |
#physiology #pathology #pulmonology
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Recurrent Lobar Hemorrhagic CNS Strokes
|
Lobar = cerebral hemispheres ie not lacunar
most common presentation of cereberal amyloid angiopathy low mortality rate 2° to β amyloid deposition, not related to systemic amyloidosis NB: β amyloid is from amyloid precursor protein, cause of late onset alzhemiers |
#pathology #neurology #rheumatology
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AL protein
|
Bence Jones Ig light chain of multiple myeloma
Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain Mn: aL = Light chain |
#pathology #rheumatology
|
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AA protein
|
derived from Serum Associated Amyloid (SAA) protein
Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain |
#pathology #rheumatology
|
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Transthyretin
|
derived from AF protein
Senile Cardiac Amyloidosis Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain Mn: aF = auld Farts |
#pathology #rheumatology
|
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Amylin
|
Derived from AE
Amyloid 2° to T2DM Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain Mn: aE = Endocrine |
#pathology #rheumatology
|
|
A-CAL deposition
|
derived from calcitonin
= amyloidosis 2° to medullary carcinoma of the thyroid Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain |
#pathology #rheumatology
|
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β2 microglobulin deposition
|
derived from MHC class I proteins
dialysis associated amyloidosis Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain |
#pathology #rheumatology
|
|
Senile Cardiac Amyloidosis
|
Transthyretin amyloid deposition derived from AF protein
Senile Cardiac Amyloidosis Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain Mn: aF = auld Farts |
#pathology #rheumatology
|
|
Amyoid 2° to TD2M
|
Amylin amyloid protein deposition Derived from AE
Amyloid 2° to T2DM Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain Mn: aE = Endocrine |
#pathology #rheumatology
|
|
Amyloidosis 2° to Cancer
|
A-CAL deposition, derived from calcitonin
= amyloidosis 2° to medullary carcinoma of the thyroid Amyloidosis: β pleated sheet w/ apple green birfringence under polarized light with Congo red stain |
#pathology #rheumatology
|
|
Cystic Fibrosis vs. SCID
|
CF presents with recurrent infx (strep, Hib, Morax), but not opportunistic pathogens (fungi, pneumocysticis)
|
#pathology #microbiology
|
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ACL vs PCL
|
ACL:
Tibia anterior midline → Femur Posterior Lateral PCL: Think Straight up and Down on the posterior aspect of both femur and tibia |
#anatomy
|
|
Budd Chairi Sro
|
Occlusion of IVC 2° to any of multiple causes
congestive liver dz → failure portal hypertension |
#pathology #liver
|
|
Occlusion of the IVC
|
Budd Chiari Sro
Sro 2° to any of multiple causes congestive liver dz → failure portal hypertension |
#pathology #liver
|
|
What kind of vaccine is the rabies vaccine?
|
Killed
|
#microbiology
|
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Osteocalcin
|
non-collagenous protein secreted by osteoblast used as a marker of bone formation
|
#physiology
|
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Nephrotic Sro:
sequence of events |
1. ↑ glomerular permeability
2. massive protein loss in urine 3. edema 4. Both ADH & RAAS activated → sodium and water retention which exacerbates edema 5. Compensatory ↑ in Hepatic Protein Prodxn, including lipoproteins 6. Lipiduria |
#pathology #nephrology
|
|
ACEI's vs Cr
|
ACEI's block AT2 from constricting the efferent arteriole
normal for Cr to increase 1/3 in first week |
#pharmacology #nehprology
|
|
URI's s Croup
Causes by Freq |
1. Rhinovirus
2. Influenza 3. Coronavirus 4. Adeno etc |
#microbiology #pulmonology
|
|
Eythrocyte transketolase
|
↑ activity after thiamin infusion diagonistic of thiamin deficiency
|
#vitamins #molecules
|
|
Parkinsoner on levodopa carbidopa
some good days some lock ups wants better medicine routine |
on-off phenomenon
unpredictable and dose independent higher doses have no benefit, nor do drug holidays best prevention: maintaining a constant dose |
#pharmacology #neurology
|
|
Parkinsoner
medicine not working as well as before |
continued destruction of striatonigral DA neurons
|
#pharmacology #neurology
|
|
DOC: Meningococcal Prophylaxis
|
Rifampin
NB: orange secretions & ↑ p450 |
#pharmacology #chemotheraputics #microbiology
|
|
Lady treated for MI now has severe eye pain
|
glaucoma treated with atropine
|
#pathology #pharmacology
|
|
Night Blindness DDx
|
Most common cause: hereditary retinitis pigmentosa
Acquired: 1. toxic retinopathy 2° phenothiazines or chloroquine 2. vitamin A deficiency 3. Congenital rubella, syphilis, or infx 4. diabets |
#pathology #neurology
|
|
Thiazide side effects
|
1. RAAS activation → hypokalemia & acidosis
2. hyponatremia 3. hypovolemia → ↑ metabolite absoprtion → hyperuricemia 4. ↑ plasma cholesterol & LDL 5. ↓ insulin & ts glucose hyptake → hyperglycemia |
#pharmacology #sideeffects
|
|
Severe hypothermia and oxygen dyssociation curve
|
left shift (does not release O2 into ts as well)
this is because the lungs are normally cooler than the tissues, helpful in normal physiologic state to load with more o2 |
#biochemistry #hemoglobin
|
|
Dz: Fabry's Dz
|
(Lysosomal Storage Dz)
Presentation: Peripheral Acorneuropathy, angiokeratomas, Cardiovascular/Renal Dz Deficiency: alpha galactosidase A Accumulation: Ceramide tihexose Inheritance: XR --NB the only X linked lysosomal storage dz |
#pathology #molecules #geneticdzs
|
|
Dz: Gaucher's Dz
|
(Lysosomal Storage Dz)
Presentation: HSM, Asepptic necorsis of femur; Gaucher's cells: macorphages that look like crumpled ts paper Deficiency: Glucocerebrosidase Accumulation: Glucocerebroside Inheritance: AR (all but Fabry's & Hunters AR) NB: most common Lysosomal stroage Dz |
#pathology #molecules #geneticdzs
|
|
Dz: Neimann-Pick
|
(Lysosomal Storage Dz)
Presentation: progressive neuodegeneration, cherry red spot on macula, foam cells, HSM (defining feature vs. Tay-Sach's) Deficiency: sphingomyelinase Accumulation: sphingomyelin Inheritance: AR (All but Fabry's & Hunters AR) Mn: Neiman picks his nose with hi-sphinger |
#pathology #molecules #geneticdzs
|
|
Dz: Tay-Sach's
|
(Lysosomal Storage Dz)
Presentation: Prgoressive neurodegeneration, cherry red spot on macula, lysosomes with onion skin, no HSM (defining feature vs. Niemann Pick) Deficiency: Hexosaminidase A Accumulation: GM2 ganglioside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Dz: Krabbe's Dz
|
(Lysosomal Storage Dz)
Presentation: Peripehral neuropathy, dvlptl delay, optic atrophy, globoid cells Deficiency: beta galactocebrosidase Accumulation: galactoserebroside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Dz: Hurler's
|
(Lysosomal Storage Dz)
Presentation: Dvlpt delay, gargolylism, ariway obstrx, corenal clouding, HSM Deficiency: alpha L iduronidase Accumulation: heparan sulfate, dermatan sulfate (same as Hurler's) Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Dz: Hunter's
|
(Lysosomal Storage Dz)
Presentation: aggressive behavior mild dvlpt delay, HSM Deficiency: Iduronidate sulfatase Accumulation: heparan sulfate, dermatan sulfate (same as Hurler's) Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Ashkenazi Jews
|
Dz: Gaucher's Dz
(Lysosomal Storage Dz) Presentation: HSM, Asepptic necorsis of femur; Gaucher's cells: macorphages that look like crumpled ts paper Deficiency: Glucocerebrosidase Accumulation: Glucocerebroside Inheritance: AR (all but Fabry's & Hunters AR) NB: most common Lysosomal stroage Dz Dz: Neimann-Pick (Lysosomal Storage Dz) Presentation: progressive neuodegeneration, cherry red spot on macula, foam cells, HSM (defining feature vs. Tay-Sach's) Deficiency: sphingomyelinase Accumulation: sphingomyelin Inheritance: AR (All but Fabry's & Hunters AR) Mn: Neiman picks his nose with hi-sphinger Dz: Tay-Sach's (Lysosomal Storage Dz) Presentation: Prgoressive neurodegeneration, cherry red spot on macula, lysosomes with onion skin, no HSM (defining feature vs. Niemann Pick) Deficiency: Hexosaminidase A Accumulation: GM2 ganglioside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Deficiency: alpha galactosidase A
|
Dz: Fabry's Dz
(Lysosomal Storage Dz) Presentation: Peripheral Acorneuropathy, angiokeratomas, Cardiovascular/Renal Dz Deficiency: alpha galactosidase A Accumulation: Ceramide trihexose Inheritance: XR --NB the only X linked lysosomal storage dz |
#pathology #molecules
|
|
Deficiency: Glucocerebrosidase
|
Dz: Gaucher's Dz
(Lysosomal Storage Dz) Presentation: HSM, Asepptic necorsis of femur; Gaucher's cells: macorphages that look like crumpled ts paper Deficiency: Glucocerebrosidase Accumulation: Glucocerebroside Inheritance: AR (all but Fabry's & Hunters AR) NB: most common Lysosomal stroage Dz |
#pathology #molecules
|
|
Deficiency: sphingomyelinase
|
Dz: Neimann-Pick
(Lysosomal Storage Dz) Presentation: progressive neuodegeneration, cherry red spot on macula, foam cells, HSM (defining feature vs. Tay-Sach's) Deficiency: sphingomyelinase Accumulation: sphingomyelin Inheritance: AR (All but Fabry's & Hunters AR) Mn: Neiman picks his nose with hi-sphinger |
#pathology #molecules
|
|
Deficiency: Hexosaminidase A
|
Dz: Tay-Sach's
(Lysosomal Storage Dz) Presentation: Prgoressive neurodegeneration, cherry red spot on macula, lysosomes with onion skin, no HSM (defining feature vs. Niemann Pick) Deficiency: Hexosaminidase A Accumulation: GM2 ganglioside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Deficiency: beta galactocebrosidase
|
Dz: Krabbe's Dz
(Lysosomal Storage Dz) Presentation: Peripehral neuropathy, dvlptl delay, optic atrophy, globoid cells Deficiency: beta galactocebrosidase Accumulation: galactoserebroside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Deficiency: alpha L iduronidase
|
Dz: Hurler's
(Lysosomal Storage Dz) Presentation: Dvlpt delay, gargolylism, ariway obstrx, corenal clouding, HSM Deficiency: alpha L iduronidase Accumulation: heparan sulfate, dermatan sulfate (same as Hurler's) Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Deficiency: Iduronidate sulfatase
|
Dz: Hunter's
(Lysosomal Storage Dz) Presentation: aggressive behavior mild dvlpt delay, HSM Deficiency: Iduronidate sulfatase Accumulation: heparan sulfate, dermatan sulfate (same as Hurler's) Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Accumulation: Ceramide trihexose
|
Dz: Fabry's Dz
(Lysosomal Storage Dz) Presentation: Peripheral Acorneuropathy, angiokeratomas, Cardiovascular/Renal Dz Deficiency: alpha galactosidase A Accumulation: Ceramide trihexose Inheritance: XR --NB the only X linked lysosomal storage dz |
#pathology #molecules
|
|
Accumulation: Glucocerebroside
|
Dz: Gaucher's Dz
(Lysosomal Storage Dz) Presentation: HSM, Asepptic necorsis of femur; Gaucher's cells: macorphages that look like crumpled ts paper Deficiency: Glucocerebrosidase Accumulation: Glucocerebroside Inheritance: AR (all but Fabry's & Hunters AR) NB: most common Lysosomal stroage Dz |
#pathology #molecules
|
|
Accumulation: sphingomyelin
|
Dz: Neimann-Pick
(Lysosomal Storage Dz) Presentation: progressive neuodegeneration, cherry red spot on macula, foam cells, HSM (defining feature vs. Tay-Sach's) Deficiency: sphingomyelinase Accumulation: sphingomyelin Inheritance: AR (All but Fabry's & Hunters AR) Mn: Neiman picks his nose with hi-sphinger |
#pathology #molecules
|
|
Accumulation: GM2 ganglioside
|
Dz: Tay-Sach's
(Lysosomal Storage Dz) Presentation: Prgoressive neurodegeneration, cherry red spot on macula, lysosomes with onion skin, no HSM (defining feature vs. Niemann Pick) Deficiency: Hexosaminidase A Accumulation: GM2 ganglioside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Accumulation: galactoserebroside
|
Dz: Krabbe's Dz
(Lysosomal Storage Dz) Presentation: Peripehral neuropathy, dvlptl delay, optic atrophy, globoid cells Deficiency: beta galactocebrosidase Accumulation: galactoserebroside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Accumulation: heparan sulfate, dermatan sulfate
|
Dz: Hurler's
(Lysosomal Storage Dz) Presentation: Dvlpt delay, gargolylism, ariway obstrx, corenal clouding, HSM Deficiency: alpha L iduronidase Accumulation: heparan sulfate, dermatan sulfate (same as Hunter's) Inheritance: AR (All but Fabry's & Hunters AR) Dz: Hunter's (Lysosomal Storage Dz) Presentation: aggressive behavior mild dvlpt delay, HSM Deficiency: Iduronidate sulfatase Accumulation: heparan sulfate, dermatan sulfate (same as Hurler's) Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Presentation: Peripheral Acorneuropathy, angiokeratomas, Cardiovascular/Renal Dz
|
Dz: Fabry's Dz
(Lysosomal Storage Dz) Presentation: Peripheral Acorneuropathy, angiokeratomas, Cardiovascular/Renal Dz Deficiency: alpha galactosidase A Accumulation: Ceramide trihexose Inheritance: XR --NB the only X linked lysosomal storage dz |
#pathology #molecules
|
|
Presentation: HSM, Aseptic necorsis of femur; macorphages that look like crumpled ts paper
|
Dz: Gaucher's Dz
(Lysosomal Storage Dz) Presentation: HSM, Asepptic necorsis of femur; Gaucher's cells: macorphages that look like crumpled ts paper Deficiency: Glucocerebrosidase Accumulation: Glucocerebroside Inheritance: AR (all but Fabry's & Hunters AR) NB: most common Lysosomal stroage Dz |
#pathology #molecules
|
|
Presentation: progressive neuodegeneration, cherry red spot on macula, foam cells, HSM
|
Dz: Neimann-Pick
(Lysosomal Storage Dz) Presentation: progressive neuodegeneration, cherry red spot on macula, foam cells, HSM (defining feature vs. Tay-Sach's) Deficiency: sphingomyelinase Accumulation: sphingomyelin Inheritance: AR (All but Fabry's & Hunters AR) Mn: Neiman picks his nose with hi-sphinger |
#pathology #molecules
|
|
Presentation: Prgoressive neurodegeneration, cherry red spot on macula, lysosomes with onion skin
|
Dz: Tay-Sach's
(Lysosomal Storage Dz) Presentation: Prgoressive neurodegeneration, cherry red spot on macula, lysosomes with onion skin, no HSM (defining feature vs. Niemann Pick) Deficiency: Hexosaminidase A Accumulation: GM2 ganglioside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Presentation: Peripehral neuropathy, dvlptl delay, optic atrophy, globoid cells
|
Dz: Krabbe's Dz
(Lysosomal Storage Dz) Presentation: Peripehral neuropathy, dvlptl delay, optic atrophy, globoid cells Deficiency: beta galactocebrosidase Accumulation: galactoserebroside Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Presentation: Dvlpt delay, gargolylism, ariway obstrx, corenal clouding, HSM
|
Dz: Hurler's
(Lysosomal Storage Dz) Presentation: Dvlpt delay, gargolylism, ariway obstrx, corenal clouding, HSM Deficiency: alpha L iduronidase Accumulation: heparan sulfate, dermatan sulfate (same as Hunter's) Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|
|
Presentation: aggressive behavior mild dvlpt delay, HSM
|
Dz: Hunter's
(Lysosomal Storage Dz) Presentation: aggressive behavior mild dvlpt delay, HSM Deficiency: Iduronidate sulfatase Accumulation: heparan sulfate, dermatan sulfate (same as Hurler's) Inheritance: AR (All but Fabry's & Hunters AR) |
#pathology #molecules
|