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914 Cards in this Set

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What kind of infarction is a hospitaltized, severely hypotensive patient typically having?
Subendocardial infarction; usually occurs in a setting of shock and affects most ECG leads
Elevated serum cardiac enzymes, patient borught in with typical mycocardial pain and ST elevation in a few leads
Most likely transmural infarction due to occlusion of a coronary artery
Compares CSF and serum glucose
CSF glucose is normally 2/3 serum glucose
T or F, viral meningitis alters CSF glucose
False, viral meningitis does not alter CSF glucose
Congenital encephalities due to HSV-1 usually involves this part of the brain
Temporal lobe bilaterally
CREST syndrome is also know as
Limited scleroderma
Plexogenic pulmonary arteriopathy
Prominent in primary pulmonary hypertension
ARDS
Rapid onset of respiratory insufficiency secondary to diffuse alveolar damage
Sarcoidosis
Interstitial pneumonia, noncaseating giant cell granuloma's
Parasites that may cause suppurative cholangitis due to biliary tract obstruction
Roundworm: Ascaris lumbricoides, Liver flukes: Clonorchis Sinensis and Fasciola hepatica
Homan's sign
Pain due to extension of foot in one with DVT
Virchow's triad
Endothelial cell injury, alteration of blood flow and hypercoagulability
Drug of choice for N. gonorrhea
Ceftriaxone
Has a non-immunogenic capsule
Streptococcus pyogenes
Episome
Plasmid that has been stably inserted into a chromosome by specific recombination
Give examples of traits given to bacteria by stable integration of bacteriphages to bacterial chromosomes
O antigen of salmonells, erythrogenic toxin of S. pyogenes, botulinum exotoxin & diptheria toxin
Apraxia
Deficit of purposeful movement caused by a central lesion
Dysarthria
Deficit of speech articulation despite normal word finding & normal grammar
Drug used in mercuric and arsenic poisoning
Dimecaprol
Drug used in Lead poisoning
Edetate calcium sodium (EDTA)
When do Sickle cell disease patients present with symptomts?
98% present with symptoms before the age of 8years old
This infection precipitates aplastic crises in sickle cell patients
Parvovirus B19
How can you temporarily control bleeding esophageal varices?
Sclerotherapy or esophageal balloon
Achalasia
Motor difficulty of the esophagus, difficulty swallowing
Plummer-vinson syndrome
Causes hypochromic microcytic anemia, atrophic glossities and esophageal webs - is due to the deficiency of iron
Schatzki rings
Found in squamocolumnar juntion of esaophagus just below the aortic arch. May be asymtpomatic, complete blockage may be caused uf food is not chewed properly - steakhouse syndrome - sensation of food "sticking"
Zenker diverticulum
Evagination of esaphagus at the junction of the esophagus and pharynx
Definitive test of candida
Germ tube test - formation of pseudohyphae on samples grown in tissue cultures
MOA of Terbinafine
Inhibits the synthesis of ergosterol by inhibiting the synthesis of squalene epoxidase - used to treat dermatophyte infections
MOA of nystatin
Complexes with ergosterol and causes the membrane to become leaky - treat candida
MOA of Griseofulvin
Inhibits microtubule formation and is used to treat dermatophyte infections
Why is flucytosine contraindicated in HIV patients
Flucytosine is a thymidylate synthetase inhibitor that is used to treat crytpoccocis, may cause bone marrow suppresion in HIV patients and is therefore contraindicated
Tartrate resistant acid phosphatase
Marker for Hairy cell leukemia -a B lymphocyte leukemia
Histaminase
Eosenophils make this to regulate inflammatory reactions due to the release of histamine by Mast cells
Histamine
Mast cells and basophils
Major Basic Protein
In eosenophilic cell granules - destroy parasites
Lactoferrin
Specific granules of neutrophils - they intefere with iron metabolism needed by bacteria
Myeloperoxidase
Azurophilic granules of neutrophils - handling bacteria - holes in their cell walls
Where is hCG made during the first trimester of pregnancy?
Syncytiotrophoblast lining the placental villi, maintains the corpus luteum
Enzyme released by corpus luteum
Estrogen, progesterone and relaxin
Role of progesterone during pregnancy
Progesterone maintains pregnancy
Where are endotoxins and cholera toxin genes found
Bacterial chromosomes, most exotoxins are encoded on plasmids
Vancomycin resistant enterococci
Form new cell wall bridges D-lactic acid instead of D-ala and can therefore not be recognized by vancomycin
These enzymes are inactivated by B-lactamases
penicillins and cephalosporins
Give examples of drugs that are inactivated by acetylation, adenosylation
Aminoglycans, sulfonamides and chloramphenicol
Give examples of antibiotics that inhibit protein synthesis - resistance to this drugs may be due to modified ribosomes
Tetracyclines and macrolide antibiotics
Layer of epithelium affected by HPV
Stratum basale
Level of epidermis where HPV maturation takes place
Stratum lucidum and granulosum. Genome duplication takes place in stratum spinosum
Preeclampsia onset before the 20th week is indicative of
hydatiform mole
Conditions that increase the risk of pre-eclampis but at 6 months
Anencephaly, NT defects and twin gestations
Cause of pseudohepatitis in children
Yersinia enterolitica - ingestion of milk or pork - found in cooler climates
Chromosome with mutation in Becker and Ducheme musculodystrophy
X-linked recessive; In frame mutations with Beckers and Frame shift mutations with Duchemes : Gene affected: dystrophin
Medial calcification of small arteries
Monckenberg calcification
Hyperplastc arteriosclerosis.
Laminated thickening of arterial walls - onion skinning phenomenon
What part of cell are inclusion bodies due to molluscum contagiosum?
Cytoplasm
This carcinoma has S-100 positivity
Melanoma
Viruses implicated in atherosclerosis
Chlamydia pneumoniae and CMV
Immunoglobulin markers thay could be used in paternity test
Kappa light chains and IgG1 IgG2 IgG3 - genetic allotypic markers
Idiotypes
Immunoglobulins made in response to certain antigens that one has been exposed to
Isotypes of Immunoglobins
5 major classes: IgM, IgD, IgG, IgA, IgE
Inherited disorder due to trinucleotide repeat in myotonin protein kinase
Myotonic dystrophy
Pseudomonas mallei
Causes glanders
Psuedomonas psuedomalle
Causes melioidosis
streptobacillus molliform
Rat bite fever in the US
Spirillum minus
Sodoku rat bite fever in Japan
Muscle supplied by the recurrent laryngeal nerve
all laryngeal muscles except cricothyroid
Toxocariasis
Visceral larva migrans due to dog roundworm
The only family of double stranded RNA viruses
Reovirus: Rotavirus and reovirus, naked and segmented with 10-11 segments
Circumvallate placents
Extrachorial portion outside the insertion of amniotic membranes
Bipartite Placenta
Placenta has two equal segments
Anemia, atrophic glossitis and esophageal webs are associated with
Plummer-vinson syndrome
Hour glass shaped stomach within the thoracic cavity
Sliding hiatial hernia, incidence increases with age, most are not symptomatic on their own
What GI tract organs may be affected in Chaga's disease
May see massively dilated esophagus and dilated colon, cause dby trypanosoma cruzii
Sequence of arteries and veins in the femoral region
NAVEL (Lymphatics are most medial)
Hormones needed for luteal maintenance
Progesterone and estrogen, both are secreted by the corpus luteum during the secretery phase of the menstrual cycle
What happens to hormone levels fertilization takes place
Progesterone levels remain high to maintain the pregnancy
Explain the inrease in estradiol levels in preovulatory stages
Due to positive feedback from estradiol to anterior pituitary causing increase in FSH and LH secretion
GnRH is usually released in a pulsatile manner, what is observed in it is given continuously?
Downregulated receptors in the anterior pituitary leading to decreased levels of FSH and LH
Level of FSH and LH during the luteal phase of the ovarian cycle
Reduced, negative feedback from progesterone and estrogen
EBNA
A molecule found on the membrane of EBV, may be presented to CD8+ T-Cells on MHC-type 1
Specific gravity of transudates
<1.012
Specific gravity of exudates
>1.012
Chylous ascites
Accumulation of lymph within the pleural cavity
What kind of effusion is associated with blocked lymphatics
Exudate - usually will have cells and protein either secondary to infection eg filariasis or postop for auxillary lymph nodes
Two main mechanisms by which liver cirrhosis results in the accumulation of fluid in the peritoneal cavity
Increased portal hypertension and resudec osmotic pressure
Motilin
Hormone released by the small intestine during the fasting stage, the levels of this hormone in the blood vary with the MMC (Migrating Motor Complex)
What interrupts the MMC
Eating a meal
What evokes the release of CCK during the intestinal phase of the digestive period?
Fat and protein digestion products in the duodenum
This hormone induces the contraction of the gallbladder and relaxation of the sphincter of oddi
CCK
Function of gastrin
Released during gastric phase of digestion - increased motility of stomach - DECR. Rate of empyting due to contraction of the pyloric sphincter - increase in ileal molitily (gatroileal reflex - increase in colonic motility (Gastrocolic reflex)
Where in the stomach are the cells that release Gastrin-releasing Peptide
Antrum: Vagal efferents or local reflexes activate antral enteric neurons to release GRP which stimulate G cells to secrete gastrin
This hormone is released by delta cells in the stomach mucosa when the PH < 3, inhibits gastric acid production and also acts directly on parietal cells to decrease production of H+
Why would you see an increase in VEGF MRNA in skeletal within one hour of exercising?
Angiogenesis, growth of new capillaries, to decrease diffusion distance for nutrients and waster products
How do we estimate left atrial pressure
Pulmonary wedge pressure, catheter via pulmonary artery, inflate balloon - decrease blood flow distally - pressure due to events in left atrium.
Most likely cause of miscarriage in first trimester
Chromosomal abnormalities
Abruptio placentae
Placenta detatches prematurely from implantation site, usually occurs in the third trimester. Char by retroplacental hemorrhage betweem the placental and uterine wall
Placenta previa
Implanted in lower segment of uterus, may bleed profusely in late pregnancy
What percentage of patients with ischemic heart disease present with death?
25%
Repair mechanisms deficient in patient with HNPCC?
Have microsatellite instability, have problems with mismatch repair genes
Xeroderma pigmentosus is due to deficiency in
Nucleotide excision repair proteins
MOA of Epoprostenol
It stimulates PGI2, used to treat pulmonary htn
PGE1 agonist used to treat gastric induced peptic ulcer and is an abortifacient
Misoprostol
PGE1 agonist used to maintain patency of PDA and treat male impotence
Alprostadil
PGE2 agnost used for cervical ripening and as abortifaceant
Dinoprostone
PGF2alpha agonist used to treat glaucoma
Latanoprost
PGF2alpha agonist used to as abortifaceant
Carboprost
Virchow's node is associated with which tumors if no primary can be found in lung and neck?
Gastric carcinoma
Which electrolyte is raised in the following conditions? Addison's disease, hyperparathyroidsm, hyperthyrodism, multiple myeloma, chronic renal failure, metastatic carcinoma,
Hypercalcemia
Why is hypercalcemia seen in leukemia, multiple myeloma, metastatic carcinoma?
Due to bone destruction
A neoplastic disease of C-cell lineage which would be linked with high levels of calcitonin
Medullary carcinoma of the thyroid
What is the role calcitonin?
Decreasing calcium absortpion in intestine, decreasing osteoclast activity in bones and decr. Reabs. Of calcium in the renal tubules
Factors that may predispose a woman tro vaginal candida infection
High pH, diabetes (high glucose) and antibiotics
This disease can predispose for fistulas involving the vagina
Crohns disease
Drugs thar cause drug induced SLE:
Procainamide, INH, quinidine, methyldopa, hydralazine and chlropromazine
Indications for Digoxin
CHF, atrial fibrillation and atrial flutter
Disopyramide
Class Ia antriarrhythmic - Rx of ventricular arrhythmias
Flecainide
Class Ic antiarrhythmic - Rx of life threatening ventricular arrhythmias
Trousseaus sign
Migrating thrombophlebitis that is associated with pancreatic carcinoma, also carcnimina of the lung & colon
This disease is highly associated with IBD and presents with liver failure, preogressing biliary cirrhosis
Primary sclerosing cholangitis
Splenic infarction is usually associated with:
arterial thromboembolic events
How does hyperprolactinemia lead to infertility in males?
Leydig cells have receptors that bind prolactin and LH, synergy betw the two. High prolactin causes down regul of LH receptors in the testis on the leyding cells, decrease pulsatile nature of LH and inhibits intracellular events cause by LH
Oral cancer due to chewing tobacco most often involves
Lower lip
Oncogene associated with Neueoblastoma?
N-myc
2 year old, has tumor of adrenal medulla - Homer-wright psuedorossetes
Nueroblastoma
Organ most likely to be involved in neuroblastomas
Adrenal medulla
Homer-wright pseudorosettes
Circles of tumor cells - central young nerve fibers arise from the tumor cells - Seen in Neuroblastoma
What cancers is erb-B2 gene associated with?
Breat, ovarian, gastric carcinomas
What cancers is c-myc gene associated with?
Burkitt's lymphoma
What cancers is L-myc gene associated with?
Small cell carcnoma of the lung
What cancers is ret gene associated with?
MEN II and MEN III
6/14/2007
Latest test
Continue from question # 36 up to 1
2nd Latest test
Continue from question #10
3rd latest test
Continue from question #11
4th latest test
Continure from question 11
6/7/2007
Causes cervitis - infection is established in subendothelial space
N. gonorrhea
Causes cervitis - obligate intracellular parasite
Chlamydia
Drugs of choice for chlamydia
Has an altered cell wall devoid of muramic acid - treat with Quionolones, macrolides or tetracycline - not B-lactams
Owl's eye
Basophilic intranuclear inclusion - CMV
Double stranded, naked, Icosahedral virus
Reovirus - Rotavirus is in this group, is associated with diarrhea in children
The only cells in the body devoid of class I MHC
RBC's
The cytotoxic cell that kills in the absence of MHC I
NK cells
CD16
Receptor for the Fc portion of Immunoglobulin G
Common valves damaged due to carcionoid disease
Pulmonic and tricuspid valves
Which Staph exotoxin is associated with food poisioning whose onset is 3-4hrs - presents with nausea & vomit?
Enterotoxin A
Gram positive spore forming bacteria in rice that causes food posioning
Bacillus cereus
T. cruzii is an intracellular parasite that localizes in:
nerve cells & myosites
Main organs affected by Borrelia burgdorferi
Skin, CNS and heart
T or F: plasmodium parasites can invade the myocardium leading to myositis
TRUE
Symptoms of infection by Gp B coxcaskie virus
pleuritis, myocardities
Drugs that can induce hemolytic anemia in patients with G6PD
Quinine, Nitrofurantoin, dapsone, sulfonamides, primaquine
How is Strep pyogenes differentiated from other beta hemolytic strep
It is bacitran sensitive
Test used to differentiate staph aureus from other staph
S. aureus is coagulase positive
Test used to differentiate Staph epidermidis from Staph saprophyticus - both are alpha hemolytic
S. epidermidis is sensitive to novobioicin
Test used to differentiate strep pneuomonia from strep viridans -
strep pneuomonia is sensitive to optochin
Common examples of heterophile tests
Monospot test, Weil-Felix tests and VDRL - Where ab from patient cross-react with unrelated substances - the causative agents are usually hard to id in culture
Weil-Felix tests
Used to diagnose rickestial diseases: cross-reaction between heterophiles produced by ricketsial diseases and Ox strain of proteus vulgaris
What ailment has autoantibodies againts histones
drug induced lupus
What ailment has autoantibodies againts ribonucleoprotein
Mixed connective tissue disease
Virus that is a major cause of bonchiolitis in children
RSV - a paramyxovirus
Interferon alpha
Product of leukocytes - inhibits viral replication
Interferon beta
Product of fibroblasts - inhibits viral replication
TNF-alpha
Given off by macrophages and NK cells, is cytotoxic to tumor cells and causes cachexia of chronic disease
The cause of Q fever
Coxiella burnetii
Gram negative normal flora implicated in Sub acute endocarditis following oral procedures
HACEK (Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis (resistant to erythromycin), Eikenella corrodens, Kingella kingae)
Antibody associated with systemic scleroderma
Anti-Scl 70
Cause of swelling and inflammation for 1-2 days after vaccine?
Due to secondary immune reactions, happens if individual has seen this immunogen before, ie is now getting a booster shot to a vaccine he has had before
Treatment and cure of Wiskott Aldrich syndrome
Bone marrow transplant from a HLA identical sibling
What is the defect in Wiskott Aldrich syndrome?
Defective gene that codes for a protein WASP that is responsible for the reorganization of hematopoietc cytoskeleton in response to external stimuli. Hence cells cannot migrate in response to stimuli.
Bacterial causes of hepatic abcess include
E. coli, Klebsiella, Streptococcus, Staph, Bacteroides, pseudomonas
How do you treat flaccid paralysis due to Clostridium botulinum
Supportive
How does D. latum cause megaloblastic anemia
Sists in ileum and absorbs Vitamin B12 making it unavailable for absorption
These bacteria obstruct the biliary tract or pancreatic duct and are associated with cholangiocarcinoma
Clonorchis sinensis
Shepherd with dog, has unilocular cyst in liver
Echinochoccus granulosus larvae
Guarnieri bodies
Molluscum contagiousm, pox viruses diff, replicate in the cytoplasm, they need to carry their own enxymes - DNA dependent RNA polymerase
Bacteria with drug resistance due to mutation of porin pore protein
Psuedomonas aeruginosa
Bacteria with drug resistance due to mutation of PBP - chromosomally mediated
Staph aureus, Strep pneuomina, N. gonorrhea and H. influenza
Bacteria with drug resistance due to mutation of topoisomerase - chromosomally mediated
Pseudomonas and E. coli
Bacteria with drug resistance due plasmid mediated acetyltransferase
Enterobacter and klebsilla to gentamicin and Salmonella to Chloramphenicol
This toxin inactivates elongation factor 2 in eukaryotic cells via ADP ribosylation affecting translation elongation
Diptheria toxin
FTA-Abs
Anti treponema test
Symptoms of later syphyllis - neurosyphillis
Personality change, Affect - no facial expressions, Reflexes - Argyll Robertson pupils, Eye defects, Sensorium, Intellectual decline, Speech is deficient.
Next common pool of peeps after Hiv patients at risk of Pneumocystis carinii infections
Premature infants
Crytpococcus neoformans
Profound problem in HIV - causes cryptococal meningitis, is urease positive test, india ink stain, best dx testm latex particle agglutination test for capsular antigen
Medium of choice to diagnose meningococcal meningitis
Chocolate agar
CMV
Aseptic encephailits, not meningitis
Infectious agent of H. pylori is
CagA gene and type III secretory system that injects CagA into host genes
6/8/2007
Cross tolerance
Tolerance to one drug occurs as a result of exposure to another drug
Physiologic dependence
Copmulsive drug using behavior for passive satisfaction
Physical dependence
When one has signs and symptoms when they stop taking a drug
Form of drug that is rapidly absorbed in the stomach
Uncharged
Treatment generally indicated with organophosphate intoxication
Atropine
What is the function of teichoic acids found on gram +ve bacteria
To attach on body surfaces
Efficacy
The maximum effect that can be produced by a drug regardless of its dose
Potency
Dose of drug needed to achieve 50% of the drugs effect
Cocaine
Local anesthetic, blocks monoamine reuptake of NE, DA and 5HT
Fluoxetine
Serotonin reuptake blocker
Levothyroxine
Thryoid replacement hormone used to treat hypothyroidsm
A patient with EBV is given Ampicillin, how will he present in a few days?
maculopapular rash, he should not be given ampicillin because this is a viral infection
Symmptoms of EBV infection
Sorethroat, headache, ferer, malaise, palat enanthem, lymphadenopathy, hepatosplenomegaly, periorbital edema, rash, tonsillitis and pharyngitis
Congenital pyloric stenosis
This is due to a hypetrophied pylorus, diagnosed at 3 -4 wks life, can be corrected by pyloromyotomy in which the pylorus causing the obstruction is cut.
The two most common agents used to treat Clostridium dificille
Vancomycin and metronidazole, Bacitran may also be used
Caused by a necrolitic toxin produced by Clostridium dificille
Pseudomonas colitis - you may not see anything grow on cultures - NOTE THAT THIS IS CAUSED BY TOXINS
Vibrio parahemolyticus
Food poisoning due to ingestion of sea food that has the toxin
What is the physiology behind gastric ulcers due to stress
Increase pepsin or gastric acid production due to stress may also be low gastric defenses due to stress
Define isometric muscle contraction or relaxtion
Contraction or relaxation without change in muscle length
define isotonic muscle contraction or relaxtion
There is a change in muscle length but no change in muscle tone
Viruses that cannot complete their life cycles without their own polymerases
Retrovirus, Reovirus, all -ve sense RNA viruses
How do tetenus toxins cause disease?
They block the release of GABA/ Glycine
How do bordetella pertusis toxins cause disease?
Cause ADP ribosylation of Gi leading to increase in CAMP
Dysfunctional uterine bleeding
Uterine bleeding occuring at irregular intervals
Menorrhagia
Abnormal uterine bleeding occuring at regular intervals
A diagnostic prerequisite for endometriosis
Inflammation of the endometrium - Plasma cells must be present
Cramps during ones period are due to
Local prostaglandin release
Left parasternal heave
This is due to right ventricular hypetrophy
Rupture of papillary muscles after MI manifests with
Valvular insufficiency, patient may have signs of mitral regurgitation and signs of acute congestive heart failure
What happens to oxygen content in an anemic individual
Goes down
Narcissitic personality disorder
Grandiose personality disorder, fantasies of glory, exploitative behavior, sense of entitlement, lack of empathy and concern for others
Histrionic personality dirsoder
Attention seeking behavior and labile emotions, tend to dress to be noticed and to be seductive
Genes for synthesis of heavy chains - immunoglobulins are on chromosome
14
Genes for the synthesis of kappa light chains
Chromosome 2
Genes for the synthesis of lambda light chains
Chromosome 22
This bacteria leads to granulomatosis infantiseptica in baby infected in utero
Listeria monocytogenes - mum hardly has any symptoms, except pershaps diarrhea
Causes granuloma inguinale that looks like syphyllis infection
Klebsiella granulomatis
Why is histoplasmosis usually not communicable from person to person?
It is intracellular organism - yeast form - in the RES and lungs. Hence not communicable from person to person
How is infection of histoplasma capsulatum acquired
By inhaling spores: in the body histo is in form of yeast but at lower temperature is in hyphal form with microconidia and macroconidia
6/10/2007
Entamoeba hystolitica
15 -40 micron ameoba with ingested erythrocytes, small nuclei and tiny distinctivecentral karyosomes, like the cecum and ascending colon, caused flask shaped ulcerations, may be asymtpomatic or vary from mild diarrhea to severe purging dysentery. May also get to liver and cause liver abscesses. Causes bloody diarrhea
Acanthomoeba
Free living emoeba that causes amoebic meningoencephalitis
Balantidium coli
A large ciliated intestinal parasite that causes damage that resembles E. histolytica
Giardia lamblia
Small distinctive protozoa that looks like it has a face, it has suckers at the bottom
Naegleria fowleri
Free living emoeba that causes amoebic meningoencephalitis
Wilsons diseases
Failure of copper to enter the circulation in the form cerulopasmin. Have accumulation of cooper in the brain, eyes (Kayser-Flesicher rings) and liver. Sxs seen in the patient: asterexis - parkinsonian symptoms due to basal ganglia degeneration -
Pathogenesis of varicose veins
Increase in venous pressure in veins, seen in men as they age and seen in women rlt to pregnancy, puberty and menopause
When can htn cause exacerbation of varicose veins
Right heart failure - increase in venous pressure in the veins
Pathogenesis of polio
Loss of motor neurons from the anterior horn of the spinal cord
What is the disease: lack of sensation in cool parts of body, have nodular lesions - biopsied, show granulomatous infection with acid fast bacilli
Leprosy
How are multinucleated cells formed
From fusion of activated macrophages, these are in no way related to giant cells seen in anaplastic neoplasms, or osteoclast like or virus-induced syncitia
Vestibular adenitis
tender posterior introitus with focal ulcerations
Vaccines associated with benign paracortical expansion that is associated with scattered multinucleated giant cells with eosnophilic cytoplasm, and nuclear inclusion bodies (the giant cells are composed of lymphocuyts - Warthin- finkeldy giant cells
Measles
Most common tumors in women
Leiomyomas
Marker for seminomas
Placental alkaline phosphatase
S100 marker can be useful in determining which cancers
Melanoma and schwannomas, S-100 is expressed by different types of cells and not entirely specific
Predominating WBC in patient infected with mono
CD8+ cells, B cells are destroyed by the virus
Which cells are infected by CMV
Monocytes, CM?V causes heterophile negative mononucleosis
6/14/2007
New born baby presents with triad of: cutaneous hemorrhages (Blueberry muffin baby), deafness, periventricular calcifications are due to what infection
CMV
Most common intrauterine fetal viral infection
CMV
New born babby has vessicles around the skin and encephalitis
Herpes viral infection during vaginal birth
Mentally retarded baby, with heart malformations, is blind, cataracts, hearing loss, retinopathy and has some motor abnormalities: No antiviral treatment works, just supportive
Congenital rubella infection
Baby born with abnormal teeth, bones and CNS
Congenital syphillis - will probably die in utero
Severe congenital infections cause intracerebral calcifications
Toxoplasmosis
How do mumps virus attach to host cells?
Via hemagluttinin-Neuraminidase glycoprotein
The F glycoprotein is responsible for the formation of multinucleated giant cells, by allowing these viruses to move from one cell to another
Measles virus and RSV
Glutamate receptors
NMDA receptor (ligand and voltage gated) & Ligand gated cation channels (AMPA and Kainate receptors)
NMDA receptor (N-methyl-D-Aspartate)
Let's Ca++ and Na++ thru, requires glutamate as ligand to activate and also depolarization (voltage-gated) that expels Mg2+ that plugs the channel at resting potential
Give an example of a pure voltage gated channel
Sodium channel involved in action potential down the axon of the neuron
A child is exposed to a grandmother with shingles, what will this child present with if they have never been exposed to either shingles or chicken pox
Chickenpox
Prokaryote without a cell wall
Ureaplasma or mycoplasma
Prokaryote without muramic acid in its cell wall
Chlamydia
Major cardiac effects seen in children born to alchoholic mums
Atrial and ventricular septal defects
Diethylstilbestrol
Clear cell adenocarcinoma
What teratogenic effects does maternal lithium have
Ebsteins anomals and tricuspid atresia
What teratogenic effects does maternal thalidomide have
Phocomelia and cardiac manifestations
Contraction alkalosis
This is seen with loop diuretics -> Have loss of Na+ Cl- and water, but very little HCO3- is contained in this volume lost and hence the concentration in the body increases with decrease in water. Leads to alkalosis
List hormones that can be secreted by bronchogenic carcinomas
ADH, ACTH, MSH, PTH, VIP. hCG, prolactin and calcitonin
On what gene is the tumor suppressor gene BRCA1 that is associated with breast cancer located?
17q
What cancer should you associate with the following genes APC (5q), DCC (18q), p53 (17p)
Colon cancer
What cancer should you associate with the following gene DPC (18q)
Pancreatic cancer
What cancer should you associate with the following gene NF-1 (17q)
Neurofibromatosis type I - associated with peripheral nerve tumors
DCC (18q)
Stomach cancer
Physiological calcification of this structure is known to produce "phantom lung" lesions
Costal cartilage
Drug used to treat visceral leishmaniasis
Sodium stibogluconate and meglumine antimonate
Vector that spreads leishmaniasis
Female phlobotomine sandfly
Annular pancreas
Rare- condition where head of pancreas circles the second part of the duodenum and may cause obstruction
Increased activity of this enzyme is seen in patients with alpha-1 antitrypsin deficiency. It is a serine protease closely linked to emphysema
Elastase, the one in the liver has some residula capacity and therefore the effects are not as severe as in the lung
IL3
Hematopoietic colony stimulating factor
Permanent non-dividing cells
Have left the cell cycle and can no longer undergo mitotic division again : neurons and cardiac myosites
Labile cells (Continuously dividing cells)
eg. epithelial lining
Stable cells
Quiescent - divide in response to injury - liver and glandular organs in body
The gastroepiploic nodes drain
Greater curvature of the stomach
Internal iliac nodes drain
bladder and male internal genitalia
Subpyloric nodes
Drain distal stomach, pancrease and duodenum
Superficial inguinal nodes drain
Perinium, vagina and rectum
Which beta blockers are not recommended for patients with angina and why?
Acetabulol and pindolol, they both have sympathomimetuc activity and may exacerbate the angina
Peutz-jeghers syndrome
An AD hereditary disease, three main criteria for dx: Family hx, Mucocutaneous lesions - patches of hyperpogmentation in hand, mouth and feet, and Harmatomatous polyps in the GI tract
Gardner syndrome
AD - have mouth lesions - impacted and supernumerary teeth, multiple jaw osteomas. Multiple polyps in colon and extracolonic tumors
Typical response of renal vasculature to increased blood pressure is
Affterent arteriolar constriction
Typical response of renal vasculature to decreased arterial pressure is
You see brown murky amniotic fluid, what do you suspect?
Neonatal listeriosis - causing amnionitis
Antibody Dependent Cytotoxic Cells ADCC
NK cells, find virally infected cells and tumor cells coated with antibody and kill them
LAK cells
Superactivated NK cells, activated by IL2
Aprepitant
NK1 antagonist apporved for chemo induced nausea and vomiting, NK1 and NK2 receptors are closely related to substance P
Dronabinol
orally active carnabinoid - approved from chemo induced nausea and vomiting
Prochloperazine
Dopamine antagonist used to treat nausea and vomiting sx
Agent useful in the treatment of anticipatory emesis and vertigo
Lorezapam and diazepam - Bind to GABA A Receptors and enhance GABAergic transmission
Scopolamine
Muscarinic antagonist - used to treat motion sickness and preop nausea
Digoxin is mainly used to treat
A-fibrillation and flutter
What do these drugs treat: Amiodarone, Quinidine. Disopyramide, Adenosine
Supraventricular tachycardias
Drug you would use to prevent ventricular tachycardia/ fibrillation
Amiodarone and Disopyramide
In case or rapid hemolysis what is the change seen in haptoglobin and bilirubi
Inc. unconjugated bilirubin (Indirect) and decrease in haptoglobin cause it binds free hemoglobin
A non-hemolytic cause of indirect hyperbilirubinemia
Criggler-Najjar syndrome
Stimulation of vagal afferents by CCK leads to inhibition of what secretions
Serotonin inhibition of gastric acid secretion
Apocrine metaplasia of breat
Benign seen in normal breast and fibrocystic changes
Florid epithelial hyperplesia of breast tissue
Associated with increased risk of carcinoma
Adenosis in breast tissue
Increase in the number of acinii - seen in pregnant women
What kind of motility does Giardia lamblia have
Falling leaf motility - has flagella on both ends - jerky back and forth movement
Guanfacine
Central acting alpha 2 receptor agonist
6/17/2007
Sturge-weber syndrome
port-wine stain, purple and flat telangiectasia, lie in distribution of trigeminal nn, grow with the body, other symptoms include mental retardation, seizures, hemiplegia
Milroy's disease
Congenital lymphatic malformation
Osler-Weber-Rendu syndrome
Multiple small telangiectasia's
Von-Hippel-Linadua
Have carvenous hemangiomas
Minoxidil MOA
It is a potassium channel agonist that is used to treat htn, causes hyperpolarization of endothelial cells, leads to vasodilation. Also binds to receptors n beta pancreatic iselt cells --> hyperpolarize --> reduced insulin production
Atenolol is selective for which receptos
B1
MOA of Clonidine used as antihtn drug
Binds a2 receptors --> decr release of NE from presynpatic terminal
Phentolamine
Non-selective alpha adrenergic antagonist - can be used to treat pheochomocytoma or normal htn if other drugs such as beta blockers and calcium channel blockers have failed
MOA of Digoxin
Digixon inhibit the Na/K pump. Inhibition of the pump directly --> increase in intracellular Na. The rise in intracellular Na also results in a rise in intracellular Ca due to the Na/Ca exchange mechanism.
MOA of diptheria toxin
Toxin Causes inhibition of protein synthesis by acting on EF-2, main target is the heart and nerve
MOA of alpha toxin - P. aeruginosa
Toxin Causes inhibition of protein synthesis by acting on EF-2, main target is the liver
MOA of anthrax toxin
An adenylate cyclase - causes fluid loss from cells
MOA of Botox
Neurotoxin - binds presynaptic vessicles and decr. Release of Ach
MOA of cholera toxin
Ribosylates GTP binding protein --> activate adenylate cyclase --> fluid loss
MOA of clostridium prefringerens alpha toxin
This is a lecithinase (a phospholipidase)
MOA of Ecoli labile toxin
Ribosylates GTP binding protein --> activate adenylate cyclase --> fluid loss
Pertussis toxin
Ribosylates Gi, causes fluid loss
Shiga toxin
Decr. Protein synthesis by inhibiting 60S ribosome subunit
Streptococcal erythrogenic toxins
Inhibit protein synthesis by increasing cytokine production
Tetenus toxin
neurotoxin - inhibits neurotransmitters that have glycine and GABa as NT
Gram -ve, lactose -ve, and oxidase positive (only enterobacteriacae that is ox +ve) causing UTI
P. aeruginosa, seen in patients with chronic indwelling catheters
UTI in diabetics
Candida albicans
UTI infections in older men with prostate problems
E. Faecalis
Lactose +ve, oxidase -ve, gram -ve rod that is the most common cause of community acquired urinary tract infections
E. coli
Lactose +ve, oxidase -ve, gram -ve rod that can cause UTI in poorly controlled diabetics
Klebsiella pneumoniae
Patients with kidney stones predisposed to UTI by this bacteria that is lactose -ve and urease positive
UTI in young women, catalase +ve, cocci, coagulase -ve
S. saprophyticus
Cause of tumor necrosis
Ischemia - sometimes gwo too fast, blood supply can't keep up.
Extramammary Paget's disease
Non-invasive adenocarcinoma of the skin, usually in areas rich in apocrine glands - eg genital areas, Skin itchy, may mistake for excema, biopsy to dx - mucin rich cells
Invasive squamous cell carcinoma of the vulvar may have been preceeded by
VIN (less differentiated) or condyloma (better differentiated)
Markers for vulvar melanoma
S100 or HMB-45
The Hib vaccine is composed of
It is has the polyribitol phosphate capsule polysaccharides coupled to a protein carrier molecule. Children betw 2 - 15 months are vaccinated
Drug given for the prophylaxis of Hib
Rifampin is given to family members
Which bacteria have mycolic acid in their cell wall?
Acid fast bacteria: Mycobacterium. Nocardia is slightly acid fast
Protein A
Anti-phagocytic - Staph aureus
35F : abdominal pain, flushing, diarrhea, and elevated 5H-IAA in urine
Carcinoid syndrome
MOA of octreotide used to treat carcinoid syndrome
A somatostatin analog that binds carcinoid tumors and reduces the release of hormones that cause diarrhea and flushing
Alosetron MOA
5HT3 analog - used to treat IBS - diarhea predominat
Domperidone MOA
D2 R agonist - prokinetic - constipation
Dronabinol MOA
Orally active cannabinoid - antiemetic for nausea causeb by chemo
Famotidine MOA
H2 antagonist - reduce gastric acid secretion
Lansoprazole MOA
PPI - reduce gastric acid secretion
Phentermine MOA
Amphetamine - decrease. apetite
What is sulfasalazine used to treat
Mild - mod Ulcerative collitis
Ursodiol
Dissolve cholesterol gallstones and reduce cholesterol in bile
Bence-jones proteins
Light chains found in urine - monoclonal - indicative of multiple myeloma
Percentage of downsyndrome children that have cardiac problems
1/5, have Atrial septal defects (ostium primum) or VSD
What needs to be presnt in boipsy for a dx of chronic endometritis to be made?
Plasma cells
NMDA receptor
Ligand gated ion channel, lets in Na and Ca ions leading to depolarization of neurons when bound
GABA and Glycine receptors
Ligand gated ion channels that let in cl-
Most prominent cells found in where have a positive PPD
Macrophages (activated with lots of vessicles - called epithelioid) --> stain positively for CD14
A defect in this enzyme causes congenital methemoglobinemia
NADH-methemoglobin reductase
True or false: Partial pressure of oxygen in an individual is determined by solution of oxygen in combination with hemoglobin
False - determined by solution of oxygen in plasma
What determines oxygen content?
How much oxygen is bound to hemoglobin
Hepatic cirrhosis
Sites of fibrosis and disorganization of hepatic parenchyma
Focal nodular hyperplasia of live
Benign, disorganized nests of normal hepatic cells
Artery that is injured in epidural hematoma
Middle meningeal artery
Patient - hemotypmanum, battle sign (echymossis over the masotid process, periorbital echymosse (racoon sign)
Basilar skull fractures
Which bones are usually affected in a basilar skull fracture
Sphenoid bone & petrous bone
Causes of intracerebral hemorrhage
Most often due to htn, blood anticoagulants, cocaine use, cerebral amyloid angiopathy and methamphematime use
Patient complaining of setting off metal detectors probably suffers from
Hemochromatosis
Arygria
Blu-gray skin coloring due to silver poisoning
Wilsons disease
Copper accumulation in the liver and brain
Hutchinson's triad
Seen in congenital syphillis - deaf, notched incisors and interstitial keratitis
Sulfadiazine
Used to treat toxoplasmosis
Thiazodilinedione
Drug that can be used to treat metabollic syndrome, causes decrease in glucose, decr. C protein levels, Decr. In Triglycerides and increase in HDL
Niacin
Drug that can be used to treat metabollic syndrome, causes increases in glucose, Decr. In Triglycerides and increase in HDL
Statins
Drug that can be used to treat metabollic syndrome, causes decr. C protein levels, Decr. In Triglycerides and increase in HDL
How does Protein A in S. aureus prevent opsonization
Binds to the Fc portion of IgG
What role does IgA protease play in the bacteria that have them
Prevent shedding of bacteria from mucocal surfaces
Bacteria that have IgA proteases
S, penumoniae, N. meningitidis, N. gonorrhea and H. influenza
How does strep pneumoniae prevent opsonization
Inactivation of complement
Describe the pain of biliary colic
Right upper quadrant pain of the abdomen that radiates to the scapular area
Colicky pain without jaundice ->
Obstriction of cystic duct - still have bile flowing via hepatic and common duct
Bacterial forms containing dipicolinic acid
Bacteria with spores
How would you remove endotoxin from surfaces
Scrub with detergents - they can withstand really high temperatures therefore autoclaving may not work for them
Diphenoxylate
A drug that is used with atropine to treat diarrhea
Infliximab
Monoclonal ab to TNF-alpha used to treat crohns disease
Octreotide
somatostatin analog used to treat diarrhea in a variety of endocrine disorders such as carcinoid syndrome, gastrinoma, also treat VARICEAL BLEEDING & ACROMEGALY
Omeprazole
Inhibits H+/K+ pump, used to treat gastric ulcers
Tizanidine
Spasmolytic used in cerebral palsy, MS and stroke
Role of CD3 on T cells
Signal transduction
HLA alleles found in patients with lyme disease that get monoarticular arthritis more frequently
HLA-DR4
Maintains patency of PDA
Prostaglandin E
Effects of NSAIDS on PDA
Promote closure eg indomethacin
Effect of insulin on surfactant production in neonates
Inhibit surfactant production
LAK cells
NK cells that have been activated in vitro by IL-2
Complications of Plasmodium falciparum infection
(Fever spikes at 48 hr intervals) - Renal failure, pulmonary edema, hypoglycemia, cerebral malaria, shock
T or F: Babesia microti causes a self limiting disease
TRUE
Periodicity of malaria caused by P. malariae
72 hours - mild
Most common cause of malaria
P. vivax
Vasodilator metabolites
Adenosine, carbon dioxide, lactic acid
Predisposing risk factors for eclampsia
First pregrancy, diabetic, SLE, htn
You may find chloramphenicol used in developing countries to treat
Typhoid fever and salmonella
MOA of chloremphenicol
Inhibits ribosomal peptidyl transferase
MOA of linezolid
Block the formation of initiation complex - used in vancomycin resistant cases
Class IB antiarrhythmics MOA
They block sodium channels, shorten AP duration and refractory period, also reduce SA node automaticity and AV node conduction
Class IB antiarrhythmics
Tocainide, mexiletine and lidocaine. Mexiletine & tocainide may be given orally. Lidocaine is given via IV -has a first pass metabolism
Esmolol
Ultra short acting B1 blocker to treat arrythmias
Class IV antiarrythmics
Slow conduction via AV and SA node: Diltiazem and verapamil
Most common breast mass in men under 25
Gynecomastia, generally idiopathic related to hormonal changes
Robertsonian translocations involving chromosome 14 and 21 may lead to
Down syndrome & recurrent first trimester spontaneous arbotions
Antidote for treating OD of fibrinolytic agents
Aminocaproic acid
The transmitter that is of primary important in REM sleep
Ach
Role of Dopamine as NT
Voluntary movement, mood, Prolactin release inhibitor,
NE in CNS
Involved in attention, mood and arousal
Serotonin in CNS
Mood & sensation
Serotonin in the periphery
Vascular regulation and digestive function
Gingival hyperplasia is a side effect ot this drug used to treat epilepsy
Phenytoin
MOA of phenytoin
Blocks Na+ channels and is actually a class IB antiarrhythmic drug
Which class of antiarrhythmics is sometimes used to block digitalis-induced arrhythmias
Class IB
Sotalol MOA
Class III antiarrhythmic - acts by blocking K+ channels
Malignant otitis externa is most common in
Diabetics
Most common causes of meningitis (bacterial)
S.pneumonia (elderly), H. influence (unvaccinated youngins) + S. agalactiaie and E. coli & N. meningitidis (young adults)
Most common cause of otitis media
S. pneumonia and H. influenza
Most patients with syringomyelia have congenital protrusion of the cerebellum and the medulla through the foramen magnum
Arnold Chiari syndrome
What is the purpose of coupling H. influenza capsule with diphtheria toxoid?
Diptheria toxoid - peptides are presented on MHC type II and this can bing T cells - T cell response is importance in class-switching so that other types of immunoglobulins are made
Patient presents with epilepsy, mental retardation, ash-leaf spots of the trunk (ovoid hypopigmented areas), red yellow papules on face (adenoma sebaceum), cortical hamartomas (large white nodules)
Tuberous sclerosis: AD
Acoustic Neuromas
NF-2
Capillary hemangioblastomas
Von-Hippel Lindua - also likely to have renal carcinoma
Herniation of cerebellar tonsils
Arnold Chiaris malformation
Leptomeningial angiomatosis
Sturge-Weber disease
Acute mastitis in breast feeding mum
Staph most common, strep also possible culprit
Paget disease is associated with which carcinoma of the underlying breast?
Ductal carcinoma
Sucralfate
Coats ulcers in stomach and promotes healing
Droperidol
butyrophenone dopamine antagonist - used as antiemetic
Granisentron
5HT3 antagonist - antiemetic
Metoclopramide
dopamine antagonist - prokinetic and antiemetic
Misoprostol
PGE1 agonist - decreases gastric acid secretion, promotes bicarcabonate and mucus production
What do you need to diagnose chronic bronchitis
Chronic productive cough for atleast 3 months over a period of 2 successive years
Clinical characteristic of neuroleptic malignant syndrome
Hyperprexia, muscle rigidity, altered mental status, autonomic instability (tachycardic, diaphoresis) - seen with antipsychotics and antidepressant amoxapine. Treat with dantrolene and dopamine afonists
Important associated abnormalities seenin Arnold -Chiari malformations
Lumbar meningocoele and Sphingomyelia
Difference between Arnold-Chiari Malformations type 1 and 2
Type due to herniation of cerebellar tonsils, less symptomatic. Type 2 is due to a small posterior fossa leading to herniation of cerebellar vermis and medullar through the foramen magnum
Anencephaly
Most severe neural tube defect due to failure of the neural tube to close rostrally
Dandy-walker malformation
Have abnormally large posterior fossa and missing cerebellar vermis, instead replaced by a large cyst lined by ependyma - this is an enlarged 4th ventricle.
Holoprosencephaly is often associated with trisomy
13 ( less with trisomy 18)
Side effects of lithium
Movement disorder (tremor), Nephrogenic diabetes insipidus, hypOthyroidsm - (transient - should monitor TSH levels), Pregnancy problems (LMNOP)
What lab values should be monitored when treating a patient with valproate - to stabilize their mood
Plaletet count (causes thrombocytopenia), liver transaminase,
Most common cause of IE in drug users
S. aureus
S. epidermidis and IE seen in individuals with
Prosthetic valves
Drug used to treat Hepatitis B and C
Interferon
Most common side effect associated with interferon
Depression
Delta agent
Antigen associated with hepatitis B
Red man syndrome is seen in patients treated with
vancomycin
Stevens-johnson
antineoplastics
SLE - like syndrome - name drugs
Hydralazine, procainamide, quinidine, some cephalosporins
Tuberculin
An outer surface protein found on mycobacteria tuberculosis
Sclerodermal patients with these antibodies are more likely to have limited skin involvement
Anticentromere antibodies - CREST
Sclerodermal patients with these antibodies are more likely to have systemic disease such as pulmonary fibrosis
Antitopoisomerase antibody
Methenamine silver stain
Used to detect fungi
Masson's trichome
Connective tissue stain
Zeihl-Neelsen stain
Acid fast organisms eg. Mycobacterium. Nocardia is slightly acid fast
Stopped at Q 20.
Biochem
Pyruvate kinase deficiency
AR - would cause right shift of hemoglobin dissociation curve because of accumulation of 2,3 BPG due to lack of pyruvate kinase needed for reaction og PEP to pyruvate
Thiamine - Vitamin B1 is a cofactor for which enzymes
Pyruvate dehydrogenase and transketolase.
Thiamine deficiency is characterized by
heart failure, peripheral neuropathy, memory problems
Vitamin A
Required for adequate vision and proper keratinization - if deficient char by dry skin and night blindedness
Lesch-Nyhan syndrome
X linke reccessive disorder, completely deficient in HGPRT - Hypoxanthine-guanine phosphoribosyltransferase. HGPRT is responsible for the salvage of purines by converting hypoxanthine amd guanine to their monophopshorylated forms. Leads to accumul of hypoxanthine n guanine -> increase in uric acid levels and mental retardation. Also self mutilation and gout may be seen.
Deficiency of Adenosine demaninase
Severe combined immunodeficiency disease
Phosphoribosylpyrophosphatase synthase
Rate limiting enzyme in the synthesis of purine nucleotides. U sually it is overactive leading to overprod of purines --> hyperuricemia and gout
Thymidine kinase
Enzyme in the salvage pathway for pyrimidines. Acyclovir inhibits this enzyme
Xanthine oxidase
terminal enzyme --> degradation of purines --> uric acid. Inhibited by allopurinol
Type I hyperlipoproteinemia
Mostly children - deficient in capillary lipoprotein lipase or apolipoprotein C-II in VLDL - accumulate chylomicrons; float when left in refrigerator o/n
Type IIa hyperlipoproteinemia
Deficient in LDL receptors - increase in plasma LDL - Early dvpt of atherosclerosis & CAD
Type IIb hyperlipoproteinemia
Cause is uknown - Elevated plasms LDL & TG - Early dvpt of atherosclerosis & CAD
Type III hyperlipoproteinemia
Deficient in apolipoprotein E - accum IDL & chylomicron remnants - form xanthomas and atherosclerosis & CAD
Type IV hyperlipoproteinemia
Overproduction or reduced clearance of VLDL -
Which of the enzymes: glucokinase and hexokinase is regulated by insulin?
Glucokinase - in liver
Rate limiting enzyme in ketogenesis
HMG CoA synthase
This vitamin deficiency can lead to hemolytic anemia
Vit E - prevent lipid peroxidation of cell membranes
Vitamin A overdose or Vitamin D deficiency
Bone pain in the long bones
Debranching enzyme deficiency leads to
Cori's disease; hepatomegaly, hypoglycemia. Treat by avoidance of fasting, access to dietary protein for gluconeogenesis
Deficiency of branching enzyme
Andersens disease - cirrhosis of liver, patients fail to thrive in first 18 months of life, they die by 5yrs
Von Gierke's disease
Glucose-6-phosphatase --> liver and kidneys are affected --> present at 3 or 4 months - hepatosplenomagly n fasting hypoglycemia
Pompe's disease
Deficiency of alpha-glucosidase - generalized to all tissure - heart most vulnerable - lysosomal storage disease
Her's disease
Liver phosphorylase deficiency - children show hepatosplenomegaly n fasting hypoglycemia - sx better with age and disappear by puberty
Benefits of treating sickle cell patient with hydroxyurea
HbF - gamma globin chains --> prevent formation of linear aggregates - do not have valine substitution that attaches to the sticky spot on adjacent tetraments.
Oligodendrocytes may be infected by two viruses:
JV virus - Progressive multifocal leukoencephalopathy & Measles virus - Subacute sclerosing panencephalitis
Which cells are importance reservoirs of HIV in lymph nodes
Follicular dendritic cells
Medullary carcinoma of the thyroid
Neoplastic thyroid C cells - producing calcitonin
Parathyroid chief cells and Oxyphil cells secrete:
PTH
Auer Rods
Acute Myelogenous leukemia , M3
What do Auer rods contain
Azurophilic granules
Rapid treatment of AML with chemotherapy
This can lead to DIC - due to release of enzymes normally found in azurophilic granules
Rouleaux formation
Multiple myeloma
Poultry
Salmonella and campylobacter
Cream - unpasteurized milk
Brucella and Listeria
Most sensitive indicator for alchohol abuse
Serum GammaGlutamyltranspeptidase
Duchenes muscular dystrophy
Large deletion of a single gene
B1 selective blockers
A BEAM: Acebutolol Betaxolol Esmolol Atenolol Metoprolol
Labetalol
Block a1, B1, B2 - used to treat hypertensive emergencies + pheochromocytoma
Timolol
Blocks B1 and B2 - used to treat open-angle glaucoma
Effeciency of a screening test
Percentage of people who are truly classified in a test
Deficiency of lysosomal glucosidase
Pompe's disease
Decreased ability to phosphorylate tyrosine may be associated with
Diabetes and dwarfism
ACTH deficiency
Would affect the whole adrenal cortex, but aldosterone is mainly regulated by angiotensin II and potassium - its levels do not change that much - infact almost normal
This drug is used as an adjunt to treat diabetes and is associated with lactic acidosis
Metformin
Clonidine
Centrally acting antihtn drug - used for refractive htn
Glyburide
Sulfonylurea antidiabetic agent - adjunt to diet to lower blood glucose levels
Hereditary angioedema
Inadequate C1 esterase antibody
Serum sickness
Circulating immune complexes
RA
Immune complexes
Hypothalamic somatostatin inhibits
TSH and GH release
Pancreatic somatostatin inhibits
Insulin, Glucagon and gastrin release
Contraction of this muscle duricng mastication contributes to the backward movement of the lower jaw during mastication
Temporalis muscle
These two muscles help to depress the lower jaw during chewing
Digastric muscle and mylohyoid muscle
This muscle helps to move lower jaw forwad during chewing
Lateral pterygoid muscle
This muscle helps to elevate the lower jaw during chewing
Medial pterygoud
Salmeterol
Long acting beta agonist
MOA of ipratropium
Bronchodilator - acts by antagonizing M3 - reducing IP3
Selenium deficiency
Cardiomyopathy and skeletal muscle degradation
Zinc deficiency
Rash, impaired mentation, wound healing and night vision, growth retardation
Most common cause of acute pancreatitis
Impacted gallstones and alchoholism
Gastrulation
A process that establishes the three germ cell layers
Abnormal gastrulation
Usually mesoderm layer is affected: May present with Caudal dysplasia, sirenomelia. Fused limbs - mermaid syndrome
Notochord
Nucleus propulsus
Mesoderm
Muscle, connective tissue, bone, heart, spleen, kidney, cartilage
Endoderm
Biliary tree, urinary bladder, vagina, parencyma of liver, pancreas
Hyaline arteriosclerosis
Thickening of media secondary to benign htn due to deposition of proteins in the media
Hyperplastic arteriosclerosis
thickening of media secondary to benign htn due to hyperplasia of myocytes - concentrically -> onion skinning
Bowen's disease
Grey-white relatively flat penile plaque --> could become SCC --> insitu penile carcinoma
Erythroplasia of Queiyrat
Redish penile plaque - multiple - insitu penile carcinoma
Giant condyloma
Uncommon variant of condyloma acuminatum - locally aggressive on male penis
What type of hypersensitivity rx is: MS, Guillain-Barre syndrome and MS
Type IV
What type of hypersensitivity rx is: Lupus erythematosus, RA and polyarteritis nodosum
Type III
A newborn infant has numerous light brown macules on skin - what is this associated with?
Neuroblastoma
Tumor that usually presents as an abdominal mass
Neurofibroma
AD - Café au Lait spots, neurofibromas, multiple neural tumors
Thoracic duct
Arises from the cisterna chyli at levels L1 and L2, enters thorax via aortic hiatus, in posterior mediastinum - if injures - chylothorax
Formation of junctional complexes relies on the formation of homotypic connections bewteen two adjacent cells via this molecule
E-cadherin - lack of it seen in various familial breast and gastric cancers
C-myc
Burkitt lymphoma
L-myc
Small cell carcinoma of the lung
Hurler syndrome
Causes dwarfism and skeletal changes, hepatosplenomegaly, mental retardation and corneal clouding: Alpha -L-irudonidase deficiency
TCA drug that has been used to treat migraines
Amitryptiline
Pseudodementia
A major depressive disorder
The most important chemotactic factors for neutrophils are
C5a and IL8
Menkes disease
X-linked deficienct in Copper - symtpoms include kinky hair. Sz, failure to develop milestones
Dupuytren contracture
contraction of palmar fascia - pathoge = interaction of myofibroblasts with the collagen fibrils in the collagen fibrils of the fascia - Falls under fibromatosis and is associated with alchoholism
What does the first pharyngeal pouch develop into
Middle ear and eustacian tube
Exemestane
Androstenedione analogue - inhibits aromatase - used to treat breast cancer
Tamoxifen
Estrogen receptor antagonist
Limiting factor of amphotericin B usage
Nephrotoxicity
Cold temperature is needed to grow this bacteria
Listeria
Deficiency of C5
Susceptible to Neisseria infections
Most common immunodeficiency
IgA deficiency - allergic to milk, lots of respiratory infections
From what is the neurohypophysis derived?
Derived from the evagination of the diencephalonic neuroectoderm
What kind of bone lesions does prostate cancer cause
Osteoblastic bone lesions - would see an increase in alkaline phosphatase
Lytic tumor metastasis of lung, kindey and Gii tumors in lungs can be monitored by testing for
Tartrate-reistant acid phosphatase that is released by osteoclast cells
Which diseases are associated with buboes?
Lymphogranuloma venereum, bubonic plague and chancroid
Budd-Chiari syndrome
A condition that obstructs renal blood flow from the liver
PiZZ allele
Affected in alpha -1- antitrypsin deficiency
Hypnopompic hallucinations
Occur when waking up
Hypnagogic hallucinations
Take place when going to sleep
Megestrol
Progesterone derivative that increases appetite - used to increase appetite or people who need to gain weight
Orlistat
Drug used to manage obesity: inactivate enzymes whose funtion is to digest dietary fats
Waterhouse Friderichsen syndrome
N. meningitidis
Ophthalma neonatorum
N. gonorrhea
Bacterial myocarditis
S. aureas and Corynebacterium diphtheriae
What area is weakended in indirect inguinal hernia
Transversalis fascia
Secretin
Stimulates the release of bicarbonate- containing fluid from the pancrease and bile duct
VIP
Relaxes smooth muscle and stimulates the secretion of water and electrolytes
Increases blood flow to the intestines after a fatty meal
CCK
Elevation of the tongue is carried out by:
Styloglossus (CN XII) and palatoglossus (Pharyngeal plexus nn)
Diarrhea
Isotonic contraction
Sweating
Loose more water than salt - hypertonic contraction
Most common cause of hypothyroidism
Chronic thyroiditis
Used to treat methemoglobinemia
Methylene blue or ascorbic acid
Portal vein
Splenic vein + SMV
Foster Kennedy Syndrome (FKS)
ipsilateral anosmia, ipsilateral optic atropy, contralateral edema due to anterior fossa meningioma
CN1
SVA
CNII
SSA, not a true peripheral nn, but a tract of the diencephalon
CN III
GSE & SVE
Muscles innervated by CN III
Extraocular muscles, levator palpebrae muscl, also constricts pupil, accomodates and converges
Which muscles intort the eye?
SIN - superior rectus and superior oblique {SR & IR - adduct, IO & SO - abduct]
Explain origins of GVE in CNIII
pre ganglionic parasympathetic fibers from Edinger-Westphal nucleus --> CNIII --> Ciliary ganglion --> eye (miosis- sphincter muscles & accomodation-ciliary muscle)
Conditions that can lead to CN III impairment
Oculomotor palsy (tuor, epidural or subdural hematoma) -- Transtentorial uncal herniation - pupilloconstrictor r on periphery of nn, affected first followed by SVE -- aneurysms (post communicating and internal carotid) peripheral first victims -- DM , damages central nn first, spares the pupilloconstrictors
These nn enter the orbit through the Superior orbital fissure
CN III & IV and V-1, VI, postganglionic sympathetic fibers that dilate iris
Idiopathic torticollis
Sx of CN IV palsy
Extorsion of eye, weak downward gaze, vertical diplopia with vertical eye movements and head tilting to compensate for diplopia.
Results in bilateral CN IV palsy
Head trauma injuring superior medullary velum or causing herniation of the free border of the tentorium
Muscles innervated by CN V - SVE
Muscles of mastication (lateral and medial pterygoid muscles, temporalis and masseter), myelohyoid, anterior belly of digastric, tensori tympani and veli palatini
Most common isolated CN palsy due to long course of nn
CN VI
Bells palsy
Peripheral facial paralysis and involves the upper and lower face -LMN lesion
Crocodile tears
Lacrimation after eating and is due to abberant regeneration of CN VII after injury
Bilateral facial nn palsy
Guillian-Barre
Supranuclear facial palsy
Lower facial muscles affected, contralateral. Spare the upper
Mobius syndrome
Congenital facial diplegia (CNVII) and convergent strabismus (CN VI), a genetic disorder, these two nerves fail to develop
CN IX
Taste, salivation, swallowing, input from the carotid sinus, input from the carotid body
Carotid sinues
Baroreceptors
Carotid body
chemoreceptors
NN of pharyngeal arch 1
Trigemminal
nN of pharyngeal arch 2
Facial
NN of pharyngeal arch 3
Glossopharyngeal
CN IX exits the skull via
jugular foramen, along with X and XI
CN VII exits skull via
Stylomastoid foramen
Central gustatory pathway
CN VII, IX, X project thru the solitary tract and nucleus --> Central tegmental tract --? VPM --> gustatory cortex of parietal lobe.
Glossopharyngeal neuralgia
Stabbing pain in the root of the tongue due to lesion of CN IX
Paralysis of tensori tympani inn by CN V
Hypoacusis
paralysis of stapedius inn by CN VII
hyperacusis
Nn of pharyngeal arch 4 & 6
Vagus
CN X - what tastes buds does this innervate
Taste buds in the glottis
Components of gag reflex
CN IX - afferent limb and CN X - efferent limb
Muscles inn by CN X - SVE
Levator veli palatini -- palatoglossus muscles -- uvula -- striated muscle of upper esophagus -- muscles of larynx and pharynx
CN XI - accesory nn - muscles innerv
Intrinsic muscles of the larynx through the recurrent laryngeal nn {inferior laryngeal nn] except the cricothyroid muscle
CN XI - spinal division nn - muscles innerv
C1 - C6, goes back through the foramen magnum and innervates: SCM (C2) and trapezius (C3 C4)
Paralysis of SCM
problem turning head on the contralateral side
MLF syndrome (a pontine lesion)
Often seen in Multiple sclerosis patients - internuclear ophthalmoplegia
Facial colliculus syndrome
Could see LMN lesion of CN VII and UMN lesion of CN VI - due to pontine glioma
Lesions of medulla
Medial medullary syndrome (ASA), lateral meduallry syndrome (PICA)
Lesions of pons
Medial pontine inferior syndrome (paramedian branches of Basilar), Lateral inferior pontine syndrome (AICA), facial colliculus syndrome, MLF syndrome
NF2
Bilateral acoustic neuromas
Lesions of the midbrain
Parinauds (Dorsal midbrain - pineal gland tumor - Superior colliculus & central duct); Paramedian midbrain - Benedikt syndrome - red nucleus, medial lemnisus and dentothalamic tract
Glomus jugulare tumor
Most common inner ear tumor -- compresses CN IX, X, XI
What part of brainstem is affected in locked in syndrome
Base of pons - affect corticospinal and corticobulbar tracts but CNIII and IV are ok!
Central pontine myelinosis
Alchoholisc - hyponatremia -- corticobulbar n corticospinal tracts are affected : spastuc quadriparesis, pseudobulbar changes and mental changes
Top of the basilar syndrome
Occlusion of rostral basilar artery ( balint's syndrome + Anton's syndrome)
Balint's syndrome
Damage to posterior watershed areas -- optic ataxia (inability to reach for items accurately)
Anton's syndrome
Brain damage to occipital lobe - blind but affirm that can still see
Sublavian steal syndrome
Occlusion of subclavian artery proximal to vertebral artery
5 cerebellopontine tumors
Schwannoma, Arachnoid, Meningioma, Epidermoid and Ependymoma
Hemispheric syndrome
brain tumor (astrocytoma) or brain abscess -- arm, leg & gait dystaxia and ipsilateral cerebellar signs - involves one side usually
Anterior vermis syndrome
leg dystaxia - ETOH
Posterior vermis syndrome
Flocular nodular lobe involev - medulloblastoma and ependymoma - trunk dystaxia
Name arteries that irrigate the thalamus
PCA, Posterior communicating artery and anterior choroidal artery (lateral geniculate body)
Fibers contained in the genu of the internal capsule
Corticobulbar fibers
Arteries that perfuse the posterior limb of the internal capsule
Branches of anterior choroidal artery and lenticulostriate branches from middle cerebral artery
Genu of internal capsule is irrigated by
branches from the anterior choroidal artery and internal carotid artery
Cause of binasal hemianopia
bilateral calcification of internal carotid arteries
At what level of the vetebral column is the ciliospinal center of budge located
T1 - T2
What structures are affected in parinauds
Posterior commissure and rostral interstitial nucleus of vertical gaze - paralyzed upward gaze and convergence
One and a half syndrome
MLF is gone and so is one abducens nerve
Argyll Robertson pupil
See in syphillis and diabetes, no direct or consensual miosis, but capable ot converges and miosis during convergence (caudal Edinger westphal nucleus intact)
Marcus Gunn pupil
Lesion of an optic nn, seen in MS (relative afferent pupil)
Ipsilateral hemiparesis, ipsilateral eye down and out, pupil fixed and dilated, ptosis, contralateral homonymous hemianopia
transtentorial uncal herniation
cause of papilledema
incre. Intracranial pressure --> bigger blind spot, is non inflammatory cause.
Adies pupil
CN with parasympathetic components
III (Ciliary ganglion), VII (Pterygopalatine ganglion, submandibular ganglion), IX (Otic ganglion), X (mural ganglia)
True of false: sympathetic neurons have ganglia
True - Small intensely fluorescent cells - Dopamine is their NT
T or F: NO is a neurotransmitter
True - smooth muscle relaxation and penile erection
Which ANS stimulates renin secretion by the kidney?
Sympathetic
Cause of Hirschprungs disease
neural crest cells do not migrate to colon - lead to dilation and hypetrophy of colon proximal
Familial dysautonomia (Riley-Day syndrome)
Jewish children - too much sweat, poor feeding (GI tract not enough tone), unstable blood pressure -- eventual loss of autonomic and sensory ganglia
Preganglionic sympathectomy may be used to treat
Raynauds
Shy-Dragger syndrome
affects preganglionic neurons from the intermediolateral cell column. Char by orthostatic hypotension, anhidrosis, Impotence
This part of the brain helps to maintain homeostasis
Hypothalamus subserves - endocrine, ANS and limbic system.
This nucleus of hypothalamus makes dopamine- PIF
Arcuate nucleus
Lesion of this nucleus of the hippocapus results in hyperthermia
Anterior, lesions of posterior - poikilothermia
This fiber system interconnects: amygdala, hypothalamus and septal area
What effect does th eposterior hypothalamus have on the ANS
Stimulates the sympathetic nervous system
The best know hypothalamic syndrome
Diabetes insipidus
Name two drugs that can cause SIADH
Carbamezapine and Chlorpromazine
What tumors can cause bitemporal hemianopsia
Cranipharyngioma and pitutary adenoma. The two may also cause hypothalamic syndrome due to pressure on the hypothalamus
Limbic system
Behavioral and emotional expression
Through which two systems is the limbic system expressed
Hypothalamus and ANS
A telencephalic structure that has reciprocal connection with the hypothalamus and hippocampus
Septal area
What are the functions of the hippocampal formation
learning, memory and recognition of novelty
Limbic lobe
subcallosal area -- paraterminal gyrus -- cingulate gyrus -- isthmus -- parahippocampal gyrus n uncus
Major structures of the hippocampal formation
Dentate gyrus (granule cells) --> Hippocampus (Cornu ammonis - pyramidal cells) form fornix --> subiculum -- forms MTT
Amygdala
Fear and sympathetic activity
Name 3 limbic midbrain nucleir and their neurotransmitters
ventral tegmental area (dopamine), raphe nuclei (serotonin) and locus cereules (NE)
Kluver-Bucy syndrome
Bilateral ablation of anterior temporal lobes including amygaloid nuclei. --No fear of natural enemies, High rage threshold "make love not war" visual agnosia, hyperphagia, hypersexual, docility
Amnestic (confabulatory) syndrome
bilateral infarction of the hippocampal formation (irrigated by posterior cerebral and anterior choroidal) - ANTEROGRADE AMNESIA - UNABLE TO LEARN, MEMORY LOSS, HIPPOCAMPAL PATHOLOGY
Most epileptic part of the cerebrum
Hippocampus - sommer's sector is very sensitive to ischemia
Strachan's syndrome
Too much B1 - optic atrophy, spinal ataxia and nerve deafness
Bilateral removal of cingulate gyrus
Loss of initiative and inhibition, a dulling of emotions
Components of the basal ganglia
Caudate nucleus, putamen and globus pallidus
Striatum
caudate nucleus and putamen
Lentiform nucleus
GP and putamen
Corpus striatum
lentiform nucleus and caudate nucleus
Role of striatum
Extrapyramidal motor system - initiation and execution of movement and automatic stereotyped postural movements such as swing hands when walk
List structures included in the striatal extrapyramidal motor system
Neocortex -- striatum -- GP -- Substancia nigra -- subthalamic nuclues and thalamus
How does methylphenyltetrahydropyridine induce parkinsonism
destroys dopaminergic neurons in the pars compacta of substancia nigra
What chromosome is involved in huntingtons disease?
chromosome 4
Which lobes are atrophied in huntingtons
frontal and temporal (sommers area ) - in huntingtons have loss of GABAergic and cholinergic neurons in the striatum
How does glutamate toxicity lead to death
A lot of glutamate, astrocytes cannot manage to take them out of the system -- bind to NMDA receptors -- calcium influx and subsequent cell death. Glutamate toxicity is seen in huntingtons patients
Clinical signs of huntingtons
choreiform movements, dementia and hypotnoia
Syndenhams chorea
St vitus dance - seen in girls after bout of RA
Chorea gravidum
2nd trimester of pregnancy, may have history of syndenhams chorea
Hemiballism
vascular lesion of subthalamic nucleus -- have contralateral findings -- violent flinging of one or both extremities
How do you treat wilson's disease
penicillamine
Hepatolenticular degeneration
Wilsons disease - AR - chromosome 13 - wing beating tremor - choreiform movements, Kayser-Flescher ring, may have dementia and personality disorders
Tardive dyskinesia
repetitive choreic movement that affects face and trunk -- from treatment with phenothiazines, butyrophenones or metoclopramide
Xeroderma pigmentosa
The deficiency in excinuclease - inability to remove thymidine dimers
Buerger disease
segmental necrosis of arteries and veins of extremities
Behcet
multisystem disorder presenting with aphthous ulcers in mouth and genitalia and uveitis
In what condition is electromechanical dissociation of ECG and pulse reading seen
Pulmonary infarction - heart continues to fire - depolarize but no pusle is felt cause of embolus; myocardial toxity; pericardial tamponade
What nodes drain the testicles?
para-aortic nodes - think of the origin of the testicles and where they descend from
Where nodes does rectal cancer first metastasize to?
If tumor is below the pectineal line --> inguinal nodes, if above --> iliac nodes
Superficial inguinal nodes drain:
Lower limbs, buttocks, perinium, anterior abdomen
Internal iliac nodes drain:
Bladder, male genital organs, some parts of uterus and cervix
External iliac nodes drain:
deep inguinal nodes, some parts of uterus and cervix
Whipples disease
Small intestine malabsoprtion caused by Treponema whippeli
Leydig cell tumor
Golden brown testicular tumor - large polygonal cells - rod shaped crystals or reinke - gynecomastia - 20 - 60yrs old - give off estrogens or androgens
Sertoli cell tumors
Grey white to normal color and form tube like structures
CA-125
Marker elevated in breast cancer
Medullary carcinoma of thyroid produces this hormone
calcitonin
Which cancer is associated with PTH-like protein
Squamous cell carcinoma of the lung
Marker that is non-specific but can be used to monitor colon cancer
CEA
Name two diseases in which VWF is messed up and can lead to prolonged bleeding and prolonged partial thromboplastin time
VWD and Bernad-Souiler disease
Thrombasthenia
Defective platelet aggregation - GPIIb-IIIa is defective
What cancer is S. hematobium associated with
Bladder cancer
Predisposing factors for meningiomas
Von Recklinghausen disease, trauma to meninges
What kidney defects are seen in RA
Mesangial proliferation, membranous nephropathy that may progress to Rapid glomerular glomerulonephritis
What type of receptors are GHRH receptors
Gs - Adenylate cyclase
What type of receptors are GH receptors
Tyrosine kinase
This nucleus is found in the brain, produces ACH - projects to the rest of the brain - degenerates in Alzheimers disease
Basal nucleus of Meynert
Two organs that are innervated by postganglionic sympathetic fibers whose NT is Ach
Sweat glands and some blood vessels
Describe the permissive serotonin hypothesis
States that when 5HT levels are low & catecholamine levels low --> depression and insomnia; when 5HT levels are high and catecholamine levels are high --> mania
Which NT may be involved in oOCD
5HT - dysfunction
Fluoxetine
SSRI
What 5HT receptors do antidepressants target?
5HT1 - agonists & 5HT2 antagonists
Dopamine receptors
D1 (postganglionic - excitatory) & D2 (Pre and post ganglionic) excitatory - adenylate cyclase downstream for both
Where in the brain are endorphins found
Exclusively in the hypothalamus
Enkephalins - where are they in CNS
Globus pallidus - coexist with GABA and others - pain suppression
Opioid peptides in the CNS
Dynorphins, endorphins and enkephalin
What do you know about substance P
NT - pain transmission - found in SN (most conc), DRG cells, substancia gelatinosa, with GABA in striatonigral tract - role in movement disorders. Substance P reduced in patients with Huntington's chorea
Somatostatin controls the release of these two hormones from the pituitary gland
GH and TSH
These cells of the cerebellar are GABA-ergic
Purkinje, basket, stellate, golgi cells
Difference betw MOA of GABA-A and GABA-B receptors
GABA-A - open chloride channels and GABA-B are on neurons that have other NT and when bound they reduce the release of the other NT
Glycine is the major NT in the spinal cord and is used by
Renshaw cells
NT of climbing cells found in the cerebellum
Aspartate
Glutamate receptors
N-Methyl D-Aspartate receptors, involved in long term potentiation (hippocampus - a memory process), kindling and Sz, may be neurotoxic
Effects of glutamat excitotoxicity
As in huntingtons - Glut binds to NMDA receptors, influx of calcium - cell death
NO as a NT
longterm potentiation in the hippocampus
Huntingtons chore
Loss of Ach and GABA neurons in the Striatum --> reduction of GABA in striatum and substancia nigra
Edrophonium and neostigmine injections
Used to diagnose myasthenia gravis
Deficits in Gerstmann syndrome
Inferior parietal lobe of the dorminant side - Finger agnosia, dyscalculia, Right and left confusion, dyslexia, dysgraphia, contralateral hemianopia or lower quadrantanopia
Defects seen in lesions of inferior parietal lobe - non dorminant side
Topographic memory loss, Anosognosia, construction apraxia, dressing apraxia, contralateral sensory neglect, contralateral hemianopia or quadrantopia
Patient has gait apraxia, what lobe in his brain is affected
Frontal lobe - seen in normal pressure hydrocephalus: dementia, gait apraxia and incontinence. Gait apraxia is inability to use lower limbs properly
Dysprosody
Nondominant hemispheric language deficit - serves emotion, melody, expressivity
Hydrocephalus ex vacuo
Hydrocephalus due to decrease cerebral mass - eg ischemic injury. Not caused by blockage or overproduction of CSF
Internal hydrocephalus
External hydrocephalus
Communicating hydrocaphalus
noncommunicating hydrocephalus
Characteristics of fetal alchohol syndrome
Abnormal facies - microcephaly - atrial septal defects - mental retardation
The most frequent sites of thrombotic occlusion in the brain
Bifurcation of carotid and middle cerebral artery
The most frequent sites of embolism in the brain
Middle cerebral artery
Pure motor lacunar strokes are most likely from lesions affecting
Internal capsule
Pure sensory lacunar strokes are most likely from lesions affecting
Thalamus
Charcot-Bourchard aneurysms
Minute dilations of small arteries at their bifurcations - a complication of longstanding htn
In the brain, intracraneal hemorrhages are most common in
Basal ganglia and thalamus
Causes of SAH
Berry aneurysm at the circle of willis - arteriovenous malformations - trauma - hemorrhagic diasthesis
Picks disease -degenerating disease of the cerebral cortex and is associated with pick bodies - intracellular aggregated tau protein
Broca'a aphasia
Brodmann area 44
Wernicke's aphasia
Broadmann area 22
Gerstmann syndrome sxs
Lesions of dominant parietal lobe: Agrapghia, acalculia, finger agnosia, right - left disorientation, accounts for a proportion of learning disabilities
Anosognosia
Denial of illness - injury of non dominant parietal lobe, patient also neglects the opposite side
Part of the brain affected in individual with problems with longterm memoru
Hippocampus. If individual is having problems with learning new things then problem is with both hippocampuse and medial temporal lobe
What part of the brain is affected in korsakoff syndrome
Thalamus
Fahr disease
Affects basal ganglia - rare hereditary - calcification of basal ganglia - onset 30 - demented by 50 - sx - like negative sx in schizo
Disease that affect basal ganglia
Parkinsons, huntington chorea, wilson, fahr disease
What part of brain does the NE pathway start
Pons - important for REM sleep
Haloperidol
Antipyschotic most used for acute sx - has high extrapyramidal sxs.
Thioridazine
Retinitis pigmentosa and retrograde ejaculation
Atypical antipsychotics with 5HT and DA antagonism
Clozapine, risperidone and olanzapine
Antidepressants used to treat OCD
Fluoxetine and clomipramine
antidepressants used to treat enuresis
Imipramine
Antidepressants used to treat panic disorder
Imipramine
Antidepressants used to treat chronic pain with or without depression
Amitrytptiline
Symptoms of serotonin syndrome
delirum, sweating, cramps, nausea, insomnia, restless
Trazodone
Antidepressant - 5HT1 antagonist and alpha1 blocker - sedating and priapism, no Ach effects
Mirtapazine
Stimulates realease of NE and 5HT, block 5HT2 and 5HT4 - weight gain and somnolence
Bupoprion
used to treat depression - weak inhibitor of dopamine
Causes cervitis - infection is established in subendothelial space
N. gonorrhea
Causes cervitis - obligate intracellular parasite
Chlamydia
Drugs of choice for chlamydia
Has an altered cell wall devoid of muramic acid - treat with Quionolones, macrolides or tetracycline - not B-lactams
Owl's eye
Basophilic intranuclear inclusion - CMV
Double stranded, naked, Icosahedral virus
Reovirus - Rotavirus is in this group, is associated with diarrhea in children
The only cells in the body devoid of class I MHC
RBC's
The cytotoxic cell that kills in the absence of MHC I
NK cells
CD16
Receptor for the Fc portion of Immunoglobulin G
Common valves damaged due to carcionoid disease
Pulmonic and tricuspid valves
Which Staph exotoxin is associated with food poisioning whose onset is 3-4hrs - presents with nausea & vomit?
Enterotoxin A
Gram positive spore forming bacteria in rice that causes food posioning
Bacillus cereus
T. cruzii is an intracellular parasite that localizes in:
nerve cells & myosites
Main organs affected by Borrelia burgdorferi
Skin, CNS and heart
T or F: plasmodium parasites can invade the myocardium leading to myositis
TRUE
Symptoms of infection by Gp B coxcaskie virus
pleuritis, myocardities
Drugs that can induce hemolytic anemia in patients with G6PD
Quinine, Nitrofurantoin, dapsone, sulfonamides, primaquine
How is Strep pyogenes differentiated from other beta hemolytic strep
It is bacitran sensitive
Test used to differentiate staph aureus from other staph
S. aureus is coagulase positive
Test used to differentiate Staph epidermidis from Staph saprophyticus - both are alpha hemolytic
S. epidermidis is sensitive to novobioicin
Test used to differentiate strep pneuomonia from strep viridans -
strep pneuomonia is sensitive to optochin
Common examples of heterophile tests
Monospot test, Weil-Felix tests and VDRL - Where ab from patient cross-react with unrelated substances - the causative agents are usually hard to id in culture
Weil-Felix tests
Used to diagnose rickestial diseases: cross-reaction between heterophiles produced by ricketsial diseases and Ox strain of proteus vulgaris
What ailment has autoantibodies againts histones
drug induced lupus
What ailment has autoantibodies againts ribonucleoprotein
Mixed connective tissue disease
Virus that is a major cause of bonchiolitis in children
RSV - a paramyxovirus
Interferon alpha
Product of leukocytes - inhibits viral replication
Interferon beta
Product of fibroblasts - inhibits viral replication
TNF-alpha
Given off by macrophages and NK cells, is cytotoxic to tumor cells and causes cachexia of chronic disease
The cause of Q fever
Coxiella burnetii
Gram negative normal flora implicated in Sub acute endocarditis following oral procedures
HACEK (Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis (resistant to erythromycin), Eikenella corrodens, Kingella kingae)
Antibody associated with systemic scleroderma
Anti-Scl 70
Cause of swelling and inflammation for 1-2 days after vaccine?
Due to secondary immune reactions, happens if individual has seen this immunogen before, ie is now getting a booster shot to a vaccine he has had before
Treatment and cure of Wiskott Aldrich syndrome
Bone marrow transplant from a HLA identical sibling
What is the defect in Wiskott Aldrich syndrome?
Defective gene that codes for a protein WASP that is responsible for the reorganization of hematopoietc cytoskeleton in response to external stimuli. Hence cells cannot migrate in response to stimuli.
Bacterial causes of hepatic abcess include
E. coli, Klebsiella, Streptococcus, Staph, Bacteroides, pseudomonas
How do you treat flaccid paralysis due to Clostridium botulinum
Supportive
How does D. latum cause megaloblastic anemia
Sists in ileum and absorbs Vitamin B12 making it unavailable for absorption
These bacteria obstruct the biliary tract or pancreatic duct and are associated with cholangiocarcinoma
Clonorchis sinensis
Shepherd with dog, has unilocular cyst in liver
Echinochoccus granulosus larvae
Guarnieri bodies
Molluscum contagiousm, pox viruses diff, replicate in the cytoplasm, they need to carry their own enxymes - DNA dependent RNA polymerase
Bacteria with drug resistance due to mutation of porin pore protein
Psuedomonas aeruginosa
Bacteria with drug resistance due to mutation of PBP - chromosomally mediated
Staph aureus, Strep pneuomina, N. gonorrhea and H. influenza
Bacteria with drug resistance due to mutation of topoisomerase - chromosomally mediated
Pseudomonas and E. coli
Bacteria with drug resistance due plasmid mediated acetyltransferase
Enterobacter and klebsilla to gentamicin and Salmonella to Chloramphenicol
This toxin inactivates elongation factor 2 in eukaryotic cells via ADP ribosylation affecting translation elongation
Diptheria toxin
FTA-Abs
Anti treponema test
Symptoms of later syphyllis - neurosyphillis
Personality change, Affect - no facial expressions, Reflexes - Argyll Robertson pupils, Eye defects, Sensorium, Intellectual decline, Speech is deficient.
Next common pool of peeps after Hiv patients at risk of Pneumocystis carinii infections
Premature infants
Crytpococcus neoformans
Profound problem in HIV - causes cryptococal meningitis, is urease positive test, india ink stain, best dx testm latex particle agglutination test for capsular antigen
Medium of choice to diagnose meningococcal meningitis
Chocolate agar
CMV
Aseptic encephailits, not meningitis
Infectious agent of H. pylori is
CagA gene and type III secretory system that injects CagA into host genes
6/8/2007
Cross tolerance
Tolerance to one drug occurs as a result of exposure to another drug
Physiologic dependence
Copmulsive drug using behavior for passive satisfaction
Physical dependence
When one has signs and symptoms when they stop taking a drug
Form of drug that is rapidly absorbed in the stomach
Uncharged
Treatment generally indicated with organophosphate intoxication
Atropine
What is the function of teichoic acids found on gram +ve bacteria
To attach on body surfaces
Efficacy
The maximum effect that can be produced by a drug regardless of its dose
Potency
Dose of drug needed to achieve 50% of the drugs effect
Cocaine
Local anesthetic, blocks monoamine reuptake of NE, DA and 5HT
Fluoxetine
Serotonin reuptake blocker
Levothyroxine
Thryoid replacement hormone used to treat hypothyroidsm
A patient with EBV is given Ampicillin, how will he present in a few days?
maculopapular rash, he should not be given ampicillin because this is a viral infection
Symmptoms of EBV infection
Sorethroat, headache, ferer, malaise, palat enanthem, lymphadenopathy, hepatosplenomegaly, periorbital edema, rash, tonsillitis and pharyngitis
Congenital pyloric stenosis
This is due to a hypetrophied pylorus, diagnosed at 3 -4 wks life, can be corrected by pyloromyotomy in which the pylorus causing the obstruction is cut.
The two most common agents used to treat Clostridium dificille
Vancomycin and metronidazole, Bacitran may also be used
Caused by a necrolitic toxin produced by Clostridium dificille
Pseudomonas colitis - you may not see anything grow on cultures - NOTE THAT THIS IS CAUSED BY TOXINS
Vibrio parahemolyticus
Food poisoning due to ingestion of sea food that has the toxin
What is the physiology behind gastric ulcers due to stress
Increase pepsin or gastric acid production due to stress may also be low gastric defenses due to stress
Define isometric muscle contraction or relaxtion
Contraction or relaxation without change in muscle length
define isotonic muscle contraction or relaxtion
There is a change in muscle length but no change in muscle tone
Viruses that cannot complete their life cycles without their own polymerases
Retrovirus, Reovirus, all -ve sense RNA viruses
How do tetenus toxins cause disease?
They block the release of GABA/ Glycine
How do bordetella pertusis toxins cause disease?
Cause ADP ribosylation of Gi leading to increase in CAMP
Dysfunctional uterine bleeding
Uterine bleeding occuring at irregular intervals
Menorrhagia
Abnormal uterine bleeding occuring at regular intervals
A diagnostic prerequisite for endometriosis
Inflammation of the endometrium - Plasma cells must be present
Cramps during ones period are due to
Local prostaglandin release
Left parasternal heave
This is due to right ventricular hypetrophy
Rupture of papillary muscles after MI manifests with
Valvular insufficiency, patient may have signs of mitral regurgitation and signs of acute congestive heart failure
What happens to oxygen content in an anemic individual
Goes down
Narcissitic personality disorder
Grandiose personality disorder, fantasies of glory, exploitative behavior, sense of entitlement, lack of empathy and concern for others
Histrionic personality dirsoder
Attention seeking behavior and labile emotions, tend to dress to be noticed and to be seductive
Genes for synthesis of heavy chains - immunoglobulins are on chromosome
14
Genes for the synthesis of kappa light chains
Chromosome 2
Genes for the synthesis of lambda light chains
Chromosome 22
This bacteria leads to granulomatosis infantiseptica in baby infected in utero
Listeria monocytogenes - mum hardly has any symptoms, except pershaps diarrhea
Causes granuloma inguinale that looks like syphyllis infection
Klebsiella granulomatis
Why is histoplasmosis usually not communicable from person to person?
It is intracellular organism - yeast form - in the RES and lungs. Hence not communicable from person to person
How is infection of histoplasma capsulatum acquired
By inhaling spores: in the body histo is in form of yeast but at lower temperature is in hyphal form with microconidia and macroconidia
Where does electron transport system occur in bacteria?
Ctyoplasmic membrane
Mesosomes
Complex invaginations of bacterial cell membranes that have a role in cell division
Polyribosomes
Where bacteria protein synthesis takes place
Erysipelothris rhusiophathiae
Gram negative rod that causes localized skin infection
Trichinella spiralis
Ingest undercooked meat: sxs. - periorbital edema, myositis, fever and eosenophilia
Wermer syndrome (MEN I)
parathyroid hyperplasia, adenoma (hyperparathyroidsm - hypercalcemia): Pancreatic neoplasms (gastrinoma ZE)- multiple peptic ulcers, Pituitary adenoma : rarely
Shy-Drager syndrome
Failure of the ANS leading to: orthostatic hypertension and parkinsonianism
Sipple syndrome
MEN II, Medullary thyroid carcinoma, pheochromocytoma and parathyroid disease
Turcot syndrome
Very rare: have adenomas of gastric tract and CNS gliomas- astrocytoma and medulloblastoma
M3 receptors
Found on smooth muscle of brocnhioles, when stimulated they cause bronchoconstriction. Are also on blood vessels and cause vasodilation of the blood vessels
17 alpha hydroxylase deficiency
Leads to deficiency in sex hormones