Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
402 Cards in this Set
- Front
- Back
|
Diagnosis: giant jugular venous "a" wave
|
Pulmonary hypertension/pulmonic stenosis/tricuspid stenosis
|
|
|
Diagnosis: absent jugular venous "a" wave
|
Afib
|
|
|
Diagnosis: absent jugular venous "a" wave
|
Afib
|
|
|
Diagnosis: jugular venous "cv" wave
|
Tricuspid regurgitation
|
|
|
What is the jugular venous "y" wave?
|
Negative wave to due tricuspid opening
|
|
|
Four key neutrophil chemotactic factors
|
C5a
Kallikrein IL-8 LTB4 |
|
|
Transudate or exudate: albumin concentration gradient > 1.2
|
Transudate
|
|
|
Transudate or exudate: albumin concentration gradient < 1.2
|
Exudate
|
|
|
Transudate or exudate: cholesterol < 45
|
Transudate
|
|
|
Transudate or exudate: cholesterol > 45
|
Exudate
|
|
|
Transudate or exudate: high specific gravity
|
Exudate
|
|
|
Transudate or exudate: low LDH
|
Transudate
|
|
|
Which endothelial proteins are involved in leukocyte rolling?
|
E- and P-selectins
|
|
|
Which endothelial protein is involved in tight leukocyte adhesion?
|
ICAM-1
|
|
|
Which endothelial protein is involved in diapedesis?
|
PECAM-1
|
|
|
Which tumor: c-kit mutation
|
GIST
|
|
|
Which tumors: erb-B2 mutation
|
Breast
Ovary Stomach |
|
|
Which tumor: L-myc
|
Small cell lung
|
|
|
Tumor associations BRCA-2
|
Breast
Ovary Prostate Pancreas |
|
|
Tumor association: bombesin
|
Neuroblastoma
Small cell lung Gastric AC |
|
|
Tumor association: tartrate-resistant acid phosphatase
|
Hairy cell leukemia
|
|
|
Tumors most-strongly associated with smoking
|
Laryngeal (SCC)
Lung (SCC and small cell) Kidney (RCC) Bladder (TCC) |
|
|
Tumor association: vinyl chloride
|
Hepatic angiosarcoma
|
|
|
Disease associations: CCl4
|
Fatty liver, cirrhosis
|
|
|
Paraneoplastic syndrome: glucagonoma
|
Necrolytic migratory erythema
|
|
|
Significance of the lecithin:sphingomyelin ratio in amniotic fluid
|
Reflects fetal lung maturity
>2 = definitely mature <1.5 = definitely immature |
|
|
Muscles involved in inspiration during exercise
|
External intercostals
Scalene mm. Sternocleidomastoid |
|
|
Muscles involves in expiration during exercise
|
Internal intercostals + abdominal wall musculature
(Rectus abdominis Int./ext. obliques Transversus abdominis) |
|
|
Formula: collapsing pressure
|
CP = 2T/r
|
|
|
Formula: dead space
|
Vt x ([PaCO2 - PeCO2]/PaCO2)
|
|
|
What gene is implicated in primary pulmonary HTN
|
BMPR2 ---> normally inhibits vascular smooth muscle proliferation
|
|
|
Formula: pulmonary vascular resistance
|
(PA pressure - LA pressure)/CO
|
|
|
Formula: oxygen tissue delivery
|
CO x blood O2 content
|
|
|
5 adaptations to high altitude
|
1. Hyerpventilation ---> respiratory alkalosis
2. ↑ EPO 3. ↑ 2,3-BPG 4. ↑ mitochondria 5. ↑ renal HCO3- excretion |
|
|
Diagnosis: restrictive lung disease with nodular fibroblastic foci
|
IPF
|
|
|
What is the classic history of someone with interstitial lung disease?
|
Dyspnea with exertion
Cough with little/no sputum End-inspiratory crackles Rapid desaturation with exertion |
|
|
Distribution: coal worker's pneumoconiosis
|
Pigment deposition along lymphatic channels
|
|
|
Histology: hypersensitivity pneumonitis
|
Granulomas and lymphocytes
NO eosinophils! |
|
|
How does insulin affect surfactant production?
|
Decreases
|
|
|
Physical exam: bronchial obstruction
|
↓ breath sounds
↓ resonance ↓ tactile fremitus |
|
|
Physical exam: pleural effusion
|
↓ breath sounds over the affected area
Dullness to percussion ↓ tactile fremitus |
|
|
Physical exam: lobar pneumonia with consolidation
|
Bronchial breath sounds
Dullness to percussion ↑ tactile fremitus Egophony |
|
|
Physical exam: pneumothorax
|
Absent breath sounds
Hyperresonance Absent tactile fremitus |
|
|
When would you expect ↑ tactile fremitus?
|
Consolidation = lobar pneumonia
|
|
|
Histology: Bronchi
|
Ciliated pseudostratified columnar epithelium
Smooth muscle Cartilage Submucosal glands Goblet cells |
|
|
Histology: bronchioles
|
Bronchioles = bronchi - cartilage
Ciliated pseudostratified columnar epithelium Smooth muscle Submucosal glands Goblet cells |
|
|
Histology: terminal bronchioles
|
Simple cuboidal ciliated epithelium + Clara cells
NO cartilage, goblet cells, or submucosal glands |
|
|
Histology: respiratory bronchioles
|
Simple low cuboidal epithelium with occasional alveoli
NO adnexal structures (goblet cells, submucosal glands, etc.) |
|
|
As you travel down the respiratory tree, when does cartilage drop off?
|
Bronchioles
|
|
|
As you travel down the respiratory tree, when do goblet cells drop off?
|
Terminal bronchioles
|
|
|
As you travel down the respiratory tree, when do submucosal glands drop off?
|
Terminal bronchioles
|
|
|
Nerve: erection
|
Pelvic n.
|
|
|
Nerve: emission
|
Hypogastric n.
|
|
|
Nerve: ejaculation
|
Pudendal n.
|
|
|
Which ligament contains the uterine arteries?
|
Cardinal ligament
|
|
|
Which ligament contains the ovarian arteries?
|
Suspensory ligament
|
|
|
Which ligament: ovary to uterus
|
Ovarian ligament
|
|
|
Which ligament: cervix to pelvic wall
|
Cardinal ligament
|
|
|
Which ligament: ovary to pelvic wall
|
Suspensory ligament
|
|
|
Which male reproductive structures is testosterone responsible for developing in utero?
|
Epididymis, vas deferens, seminal vesicles
|
|
|
Which male reproductive structures is DHT responsible for developing in utero?
|
Penis, scrotum, and prostate
|
|
|
Key estrogen functions
|
↑ estrogen, LH, and FSH receptors
↑ prolactin production ↑ HDL, ↓ LDL |
|
|
Key functions: progesterone
|
Inhibition of LH, FSH
↓ estrogen receptor expression |
|
|
Classic hormonal changes in menopause
|
↓ estrogen
↑ LH ↑↑↑ FSH |
|
|
Where do postmenopausal estrogens come from?
|
Aromatization of adrenal androgens ---> estrone
|
|
|
Diagnosis: very tall stature, severe acne, antisocial behavior
|
46,YY
|
|
|
Tx: eclampsia
|
ASAP delivery
iv MgSO4 Diazepam |
|
|
When is a woman susceptible to developing pre/eclampsia?
|
20 weeks gestation to 6 weeks postpartum
|
|
|
Which GYN tumor: elevated LDH
|
Ovarian dysgerminoma
|
|
|
Which GYN tumor: Fallopian tube epithelium
|
Serous cystadenoma/adenocarcinoma
|
|
|
Which GYN tumor: looks like colon epithelium
|
Mucinous cystadenoma/carcinoma
|
|
|
Which GYN tumor: lined by urothelium
|
Brenner tumor
|
|
|
Which GYN tumor: bundles of spindle-shaped fibroblasts
|
Fibroma-thecoma
|
|
|
Risk factors: ovarian serous cystadenocarcinoma
|
Family Hx
BRCA1/2 HNPCC |
|
|
Which testicular tumor: painful mass with hemorrhage, necrosis
|
Embryonal carcinoma
|
|
|
Testicular tumor: eosinophilic cytoplasmic crystals
|
Reinke crystals ---> Leydig cell tumor
|
|
|
MOA: anostrazole
|
Aromatase inhibitor
|
|
|
MOA: exemastane
|
Aromatase inhibitor
|
|
|
Use: ritodrine
|
↓ contractions during premature labor
|
|
|
Which cell: granules with heparin, histamine, and leukotrienes
|
Basophil
|
|
|
Which cell: heparin, histamine, and eosinophil chemotactic factor
|
Mast cell
|
|
|
What are in platelet "dense" granules?
|
ADP, Ca2+
|
|
|
What are in platelet "α" granules?
|
vWF, fibrinogen
|
|
|
Which cell: kidney-shaped nucleus and "frosted glass" cytoplasm
|
Monocyte
|
|
|
What converts VIII to VIIIa?
|
IIa
|
|
|
What two reactions does kallikrein catalyze?
|
Plasminogen --> plasmin
HMW kininogen --> bradykinin |
|
|
How is protein C activated?
|
Endothelial cell thrombomodulin changes the substrate specificity of thrombin to protein C ---> APC
|
|
|
Which platelet disease: megakaryocytosis of the bone marrow with large peripheral thrombocytes
|
Bernard-Soulier
|
|
|
Which diseases: acanthocytes
|
Liver disease
Abetalipoproteinemia |
|
|
Which diseases: macroovalocytes
|
Megaloblastic anemia
Bone marrow failure |
|
|
Which diseases: Spherocytes
|
Hereditary spherocytosis
Autoimmune hemolytic anemia |
|
|
Which diseases: target cells
|
Thalassemia
HbC disease Asplenia Liver disease |
|
|
Which diseases: Heinz bodies
|
α-thalassemia
G6PDD |
|
|
Structure of HbH
|
β4
|
|
|
Causes: warm agglutinin disease
|
Associations with SLE, CLL, and drugs (methyldopa and penicillin)
|
|
|
Direct vs. indirect Coombs testing
|
Direct: anti-Ig added to patient RBCs
Indirect: Normal RBCs added to patient serum |
|
|
Manifestations of lead poisoning in kids
|
Paresthesias, wrist/foot drop, and weakness + potential for significant neurocognitive impairment
|
|
|
Manifestations of lead poisoning in adults
|
Abdominal pain, paresthesias, wrist/foot drop, and weakness
|
|
|
MCC of porphyria
|
Porphyria cutanea tarda
|
|
|
How do you treat lead poisoning in a child?
|
Succimer
|
|
|
Classic TTP pentad
|
1. thrombocytopenia
2. microangiopathic hemolytic anemia 3. fever 4. renal failure 5. altered mental status |
|
|
Mnemonic for causes of DIC
|
STOP Making New Thrombi
Sepsis Trauma Obstetric complications Pancreatitis Malignancy Nephrotic syndrome Tranfusion |
|
|
Incidence: Hodgkin's lymphoma
|
Classic bimodal distribution in young adulthood and the elderly
|
|
|
Cell-surface markers: Reed-Sternberg cells
|
CD15+
CD30+ |
|
|
Which tumor: cyclin D1 gene translocation
|
Mantle cell lymphoma
|
|
|
Which tumor: CALLA+, TdT+
|
ALL
|
|
|
Which tumor: massive peripheral neutrophilia and band cells
|
CML
|
|
|
Which leukemia: mild or no anemia/thrombocytopenia
|
CML
|
|
|
Which cytogenetic abnormalities: AML
|
t(15;17)
t(8;21) inv16 |
|
|
Which tumor: "smudge cells"
|
CLL
|
|
|
Diagnosis: ↑ ↑ WBC, ↑ ↑ leukocyte alkaline phosphatase
|
Leukemoid reaction
|
|
|
Classic acute sequela: polycythemia vera
|
Erythromelalgia: sudden, severe bruning pains in hands/feet assoc. with small vessel thrombosis
|
|
|
MOA: enoxaparin
|
LMW heparin with mostly Xa specificity
|
|
|
MOA: lepirudin
|
Direct thrombin inhibitor
|
|
|
MOA: bivalirudin
|
Direct thrombin inhibitor
|
|
|
Antidote: thrombolytics
|
Aminocaproate
|
|
|
Heparin vs. warfarin: pregnancy
|
Heparin
|
|
|
MOA: abciximab
|
GpIIb/IIIa Mab
|
|
|
Which ligament contains the portal triad?
|
Hepatoduodenal
|
|
|
Which ligament contains the gastric arteries?
|
Gastrohepatic
|
|
|
Which ligament contains the gastroepiploic arteries?
|
Gastrocolic
|
|
|
Which ligament contains the splenic vessels?
|
Splenorenal
|
|
|
What is tryptase a marker for?
|
Mast cell degranulation
|
|
|
Tumor marker: BRAF
|
Melanoma
|
|
|
What mutations are associated with glioblastoma multiforme?
|
Growth factors ---> IGF, PDGF, EGF, etc
|
|
|
MOA: pertussis toxin
|
ADP-ribosylation of Gi
|
|
|
Blood/gas partition coefficient is directly proportional to which variable?
|
Arteriovenous gradient
|
|
|
For inhalational anesthetics, the steepness of the arterial tension curve is dependent on which variable?
|
Solubility
Less solubility, higher slope (less solubility = more rapid rise in arterial partial pressure) |
|
|
How does acute rejection manifest after lung transplant?
|
Vascular damage
|
|
|
How does chronic rejection manifest after lung transplant?
|
"Bronchiolitis obliteran" = fibrosis and obstruction of bronchioles
|
|
|
Which amino acids are metabolized to propionate?
|
Isoleucine
Valine Methionine Threonine |
|
|
Diagnosis: "corkscrew esophagus"
|
Diffuse esophageal spasm
|
|
|
MOA: esophageal dysmotility in CREST
|
Fibrosis of esophageal muscles
|
|
|
Glycogen loss: reversible or irreversible?
|
Reversible
|
|
|
Myofibril relaxation: reversible or irreversible?
|
Reversible
|
|
|
Intracellular lipid accumulation: reversible or irreversible?
|
Reversible
|
|
|
Disaggregation of nucelar granules: reversible or irreversible
|
Reversible
|
|
|
Mitochondrial vacuolization: reversible or irreversible
|
Irreversible
|
|
|
Define: acanthosis
|
Stratum spinosum hyperplasia
|
|
|
Define: hyperkeratosis
|
Stratum corneum hyperplasia
|
|
|
Which nerve: passes between hook of the hamate and the pisiform
|
Ulnar n.
|
|
|
Interpretation: "coffee ground" emesis
|
Bloody vomit = GI bleed
|
|
|
List some 1st-gen. antihistamines
|
Diphenhydramine
Chlorpheniramine Hydroxyzine Promethazine |
|
|
Metabolism: diazepam
|
CYP450
|
|
|
Diagnosis: optochin sensitive, bile soluble
|
S. pneumoniae
|
|
|
Diagnosis: optochin-insensitive, bile-insoluble
|
Viridans streptococci
|
|
|
Diagnosis: bacitracin-sensitive
|
S. pyogenes
|
|
|
Diagnosis: bacitracin-resistant
|
S. agalactiae
|
|
|
Diagnosis: cannot be grown in bile OR 6.5% NaCl
|
S. bovis
|
|
|
Diagnosis: can be grown in bile AND 6.5% NaCl
|
Enterococci
|
|
|
What is the "Nef" protein?
|
HIV protein that downregulates host cell expression of MHC 1
|
|
|
Structure: cytokine receptors
|
GPCRs
|
|
|
Which two carpal bones articulate directly with the radius?
|
Scaphoid (lateral)
Lunate (medial) |
|
|
With which carpal bone does the thumb articulate?
|
Trapezium
|
|
|
Which cell type: CNS cell with abundant fibrils and glycogen granules
|
Activated, proliferating astrocyte
|
|
|
What is "aldosterone escape"?
|
Hyperaldosteronemia increases plasma volume, increasing GFR (thus increasing sodium excretion ) and increasing ANP (further accentuating sodium excretion)
The net result is hypervolemia, hypokalemia, and metabolic alkalosis WITHOUT significant hypernatremia |
|
|
Sensory: musculocutaneous n.
|
Lateral forearm
|
|
|
Tx: cryptococcal meningitis
|
Amphotericin + flucytosine
|
|
|
Antifungal spectrum: caspofungin
|
Candida and Aspergillus
|
|
|
Diagnosis: "popcorn calcifications" in the lung
|
Hamartoma
|
|
|
Diagnosis: hemorrhagic patient who receives supportive therapy but develops fever, chills, dyspnea, and renal failure
|
Acute hemolytic transfusion reaction due to ABO incompatibility
|
|
|
Classic precipitating event: hepatic encephalopathy
|
GI bleeding
|
|
|
Which HIV gene is most important in the development of resistance to HAART?
|
pol
|
|
|
Interaction: amiodarone and warfarin
|
Amiodarone inhibits warfarin metabolism ---> excessive anticoagulation
|
|
|
Interaction: metronizadole and warfarin
|
Metronidazole inhibits warfarin metabolism ---> excessive anticoagulation
|
|
|
Interaction: TMP-SMX and warfarin
|
TMP-SMX inhibits warfarin metabolism ---> excessive anticoagulation
|
|
|
Long-term toxicity: hydroxychloroquine
|
Irreversible retinal damage
|
|
|
How does TNFa induce cachexia?
|
Suppress appetite
Inhibit LPL Increase insulin resistance |
|
|
Labs: acute proliferative glomerulonephritis
|
High ASO titer
Low C3 Cryoglobulinema |
|
|
Function: Clara cell secretory protein
|
Inhibits neutrophil recruitment and activation ---> anti-emphysematous
|
|
|
Disease classically associated with cryoglobulinemia
|
HCV
|
|
|
MC cardiac manifestation: rheumatoid arthritis
|
Fibrinous pericarditis
|
|
|
Which CNS structure is most susceptible to global ischemia?
|
Hippocampus
|
|
|
Diagnosis: fulminant liver failure one or two days after surgery
|
Inhalational anesthetic hepatotoxicity
|
|
|
Two diseases: glomerular basement membrane splitting
|
MPGN and Alport's
|
|
|
Indication: ezetimibe
|
High LDL
|
|
|
Formula: Vd
|
Vd = Q/C
|
|
|
Formula: loading dose
|
LD = Vd x Css
|
|
|
Formula: clearance
|
CL = k/C = k x Vd
|
|
|
Formula: t1/2
|
t1/2 = .7Vd / CL
|
|
|
Formula: steady-state concentration
|
Css = FQ/CLT
|
|
|
Formula: maintenance dose
|
MD = (Cp x CL)/F
|
|
|
Which cell: CD14
|
Macrophage
|
|
|
Which complement proteins are important for viral neutralization?
|
C1-C4
|
|
|
Which cytokine promotes Th2 differention?
|
IL-4
|
|
|
Which cytokine promotes Th1 differentiation?
|
IL-12
|
|
|
Which Th1 cytokine inhibits Th2 differentiation?
|
IFNg
|
|
|
Which Th2 cytokine inhibits Th1 differentiation?
|
IL-10
|
|
|
Which cytokines activate NK cells?
|
IL-2
IFNb IFNa |
|
|
What process underlies isotype switching?
|
Heavy chain mRNA alternative splicing
|
|
|
Function: IL-3
|
Functions like GM-CSF: upregulates bone marrow stem cell growth and differentiation
|
|
|
Function: IL-4
|
B cell growth factor
IgE and IgG class switching |
|
|
Function: IL-5
|
Another B cell growth factor
IgA class switching Eosinophil activation |
|
|
Function: IL-12
|
NK and Th1 activation
|
|
|
Classic examples of bacteria that show antigenic variation
|
Salmonella
Borrelia N. gonorrhoeae |
|
|
Which parasite classicaly shows antigenic variation?
|
Trypanosomes
|
|
|
Which rejection: CD8 cells react against foreign MHC
|
Acute
|
|
|
Which rejection: T cell and antibody-mediated vascular damage
|
Chronic
|
|
|
Classic S/Sx: GVHD
|
Rash, HSM, jaundice, colicky abdominal pain with diarrhea
|
|
|
Diagnosis: CD55-, CD59- cells
|
Paroxysmal nocturnal hemoglobinuria
|
|
|
Diagnosis: erythmatous "sand paper" rash with fever and sore throat
|
Scarlet fever
|
|
|
Delirium vs. dementia: onset
|
Delirium: acute
Dementia: gradual |
|
|
Delirium vs. dementia: consciousness
|
Delirium: impaired
Dementia: intact |
|
|
Delirium vs. dementia: course
|
Delirium: fluctuating
Dementia: progressive |
|
|
Delirium vs. dementia: prognosis
|
Delirium: reversible
Dementia: irreversible |
|
|
Delirium vs. dementia: memory impairment
|
Delirium: global
Dementia: remote memory spared |
|
|
Serum Ig levels: Wiscott-Aldrich
|
Isolated low IgM
|
|
|
Collagen synthesis steps inside fibroblasts
|
1. preprocollagen synthesis
2. pro/lys hydroxylation 3. lys glycosylation 4. procollagen triple helix formation |
|
|
Collagen synthesis steps outside fibroblasts
|
1. N- and C-terminal cleavage
2. crosslinking by lysyl oxidase |
|
|
Histology of psoriasis
|
Hyperparakeratosis
Acanthosis Reduced or absent stratum granulosum Some neutrophilic infiltrate |
|
|
Signaling pathway: GLP-1
|
Gs/cAMP
|
|
|
MOA: chlorthalidone
|
Thiazide
|
|
|
Diagnosis: older patient with bone pain and giant cells on biopsy with hundreds of nuclei
|
Paget's disease
|
|
|
Cell lineage: osteoclasts
|
Monocytic cell line
|
|
|
Which two factors are most important in osteoclast differentiation?
|
RANK-L and M-CSF
|
|
|
What is the mechanism of testicular atrophy in cirrhosis?
|
Hypoestinism: impaired hepatic steroid metabolism causes estrogen accumulation
|
|
|
What are the stigmata of hyperestrinism in cirrhosis?
|
Gynecomastia
Testicular atrophy Decreased body hair Spider angiomata |
|
|
Classic toxicity: amphotericin
|
Nephrotoxicity with resultant hypokalemia and hypomagnesemia
|
|
|
Route of infection: rabies
|
Wound ---> neuron axons ---> salivary glands
|
|
|
MCCL: fetal hydronephrosis
|
Inadequate canalization of urinary tract at the ureteropelvic junction
|
|
|
Female derivatives: urogenital sinus
|
Bladder
Urethra Lower vagina Bartholin glands |
|
|
Males derivatives: urogenital sinus
|
Bladder
Urethra Prostate Bulbourethral glands |
|
|
S/Sx: cauda equina syndrome
|
Radiating low back pain
Saddle anesthesia Loss of anocutaneous reflex Bladder/bowel dysfunction Loss of ankle jerk reflex |
|
|
S/Sx: conus medullaris syndrome
|
Flaccid paralysis of bladder and rectum
Impotence Saddle anesthesia |
|
|
Spinal levels: "saddle anesthesia"
|
S3-S5
|
|
|
Which nerve innervates the perineum?
|
Pudendal n.
|
|
|
Which spinal level: paresthesia over the anterior thigh with patellar hyporeflexia
|
L3/L4
|
|
|
Which spinal level: paresthesia over the anterior leg
|
L5
|
|
|
Which spinal level: paresthesia over the posterior leg with Achilles hyporeflexia
|
S1/S2
|
|
|
MOA: fenoldopam
|
Selective DA1 agonist with no α or β activity
Widespread vasodilation, especially in mesenteric, renal, and coronary beds |
|
|
What causes the jugular venous "x" wave?
|
The RA relaxes and the tricuspid valve shifts downward
|
|
|
What condition leads to a "rapid y descent" on jugular venous pressure tracing?
|
Constrictive pericarditis
|
|
|
Which cell: heavy lipid staining after a stroke
|
Microglia with lots of phagocytosed myelin
|
|
|
Which vitamin deficiency: corneal neovsacularization
|
Riboflavin
|
|
|
Which LSD: "foamy histiocytes"
|
Niemann-Pick
|
|
|
Which DNA pol.: 3' -> 5' exonuclease activity
|
Both DNA pol. III and DNA pol. I
|
|
|
Which DNA pol.: 5' -> 3' exonuclease activity
|
Only DNA pol. I
|
|
|
Defect: Tetralogy
|
Neural crest migration
|
|
|
Cell surface markers: B cells
|
CD19, CD20, CD21
|
|
|
Which cell: CD15
|
Neutrophils
|
|
|
Which cell: CD16
|
NK cells
|
|
|
Filtration kinetics: PAH
|
Partly filtered (20-30%) and heavily secreted, but not reabsorbed
|
|
|
Which cell is most-closely associated with expression of tartrate-resistant acid phosphatase?
|
Osteoclasts
|
|
|
Diagnosis: positive straight leg raise test
|
Sciatic nerve root (L4-S3) irritation
Sensitive for disc hernation ---> sciatica |
|
|
Oxidase + pathogens
|
Pseudomonas
V. cholera Campylobacter Helicobacter Neisseria Moraxella Legionella |
|
|
How does the Valsalva maneuver affect the cardiovascular system?
|
Increased positive intrathroacic pressure ---> decreased venous return
|
|
|
Which two left heart murmurs are accentuated by decreased venous return?
|
Hypertrophic cardiomyopathy and MVP
|
|
|
Why does decreasing preload accentuate the murmur of mitral valve prolapse?
|
Decrased EDV allows for more chordae tendinae laxity, allowing the mitral valve to prolapse earlier during LV systole and lenthening the murmur
|
|
|
How does the "hand grip maneuver" affect the cardiovascular system?
|
Increases TPR/afterload
|
|
|
How does the hand grip maneuver influence the murmur of MVP?
|
Increases it: increased afterload favors increased regurgitation
|
|
|
Diagnosis: hyperphenylalaninemia with low catecholamines
|
Dihydrobiopterin reductase deficiency
|
|
|
Which COX isoform is most important for platelet function?
|
COX-1
|
|
|
MOA: entecapone
|
Peripheral COMT inhibitor
|
|
|
MOA: selegiline
|
Selective MAO-B inhibitor
|
|
|
How do eosinophils participate in the immune response to invasive helminths?
|
Helminth becomes coated by IgE, finds IgE Fc receptor on eosinophils ---> degranulation of major basic protein
|
|
|
What is "WDHA syndrome"?
|
Watery Diarrhea, Hypokalemia, and Achlorhydria = VIPoma
|
|
|
Functions: VIP
|
Relaxation GI smooth muscle
Inhibition of gastric H+ secretion Stimulation of pancreatic HCO- secretion |
|
|
Functions: VIP
|
Relaxation GI smooth muscle
Inhibition of gastric H+ secretion Stimulation of pancreatic HCO- secretion Systemic vasodilation Increased glycogenolysis |
|
|
Source: VIP
|
Pancreatic islet cells and GI wall neurons
|
|
|
Which vitamin deficiency is possible in carcinoid syndrome?
|
Excessive serotonin syndrome ---> tryptophan depletion ---> niacin deficiency ---> pellagra
|
|
|
What causes the diarrhea of pellagra?
|
Epithelial atrophy and possibly ulcerations
|
|
|
MOA: trihexyphenidyl
|
Muscarinic antagonist used in Parkinsons
|
|
|
Which are the most abundant amino acids in keratin?
|
Alanine and glycine
|
|
|
Causes of heterophile-negative mononucleosis
|
CMV
HHV-6 Toxoplasma |
|
|
Which portion of the urethra is most susceptible to injury with pelvic fracture?
|
Posterior urethra (prostatic, membranous)
|
|
|
When do the lip and palate fuse during development?
|
6 weeks
|
|
|
What is "hibernating myocardium"?
|
Describes the phenomenon in which chronic ischemic heart disease produces reversible loss of contractility
|
|
|
What is "myocardial stunning"?
|
Similar to hibernating myocardium, but involves short-term, reversible loss of contractility with short ischemic events (<30 minutes)
|
|
|
MCC of E. coli bacteremia
|
UTI
|
|
|
MCC of nosocomial pneumonia
|
GNRs (E. coli, Klebsiella, Pseudomonas, etc.)
|
|
|
MOA: hexamethonium
|
NN nicotinic antagonist
|
|
|
1st-line antihypertensive in CHF
|
ACE inhibitor
|
|
|
What does "pol" code for?
|
Reverse transcriptase
Integrase Protease |
|
|
What does "env" code for?
|
gp160 ---> glycosylated and cleaved to form gp120 gp41
|
|
|
What does "gag" code for?
|
Nucleocapsid proteins p24 and p7
|
|
|
What does "rev" code for?
|
A protein that facilitates HIV protein transport from the nucleus to the cytosol
|
|
|
What does "tat" code for?
|
Codes for a protein that transcriptionally activates other viral genes
|
|
|
What is "opsoclonus-myoclonus syndrome"?
|
Paraneoplastic syndrome of neuroblastoma with non-rhythmic eye movements and myoclonus
|
|
|
Effect: TGFa
|
Potent stimulation of epithelial growth
|
|
|
Diagnosis: eosinophilic casts
|
Myeloma kidney
|
|
|
Risk factors: obstructive sleep apnea
|
Obesity
Tonsillar hypertrophy Hypothyroidism |
|
|
Which growth factors are most important in smooth muscle cell migration and proliferation in atheroscelrosis?
|
PDGF (from platelets!) and TGFb
|
|
|
MOA: diphenoxylate
|
Antidiarrheal opioid agonist ---> decreased peristalsis
|
|
|
MOA: omalizumab
|
Mab against IgE for severe allergic asthma
|
|
|
MOA: pramipexole
|
Non-ergoline DA agonist
|
|
|
Diagnosis: pneumonia with very high fever and diarrhea in a smoker
|
Legionella
|
|
|
Labs: Legionnaire's disease
|
Hyponatremia
|
|
|
MOA: pergolide
|
Ergot DA agonist
|
|
|
MOA: ropinerole
|
Non-ergot DA agonist
|
|
|
Nerve: + Trendelenburg sign
|
Sup. gluteal n.
|
|
|
Classic toxicities: lithium
|
Hypothyroidism
Diabetes insipidus Ebstein's anomaly Nystagmus |
|
|
Classic toxicity: risperidone
|
Hyperprolactinemia
|
|
|
Electron microscopy findings in mesothelioma
|
Tumor cells with numerous long, slender microvilli and abundant tonofilaments
|
|
|
What is "non-typable" H. influenza?
|
Strains that do not produce a capsule and thus are not protected against by Hib immunization
|
|
|
Cardiopulmonary manifestations of obstructive sleep apnea
|
Pulmonary hypertension and right heart failure
|
|
|
Diagnosis: microvesicular hepatic fatty change in a child with fever
|
Reyes syndrome due to aspirin
|
|
|
S/Sx: Reye's syndrome
|
Rash, vomiting, micrvesicular fatty liver, and encephalopathy
|
|
|
MOA: inhalational anesthetic-induced hepatotoxicity
|
Direct liver injury by metabolites and the formation of autoantibodies against liver proteins
|
|
|
Histology: inhalational anesthetic-induced liver injury
|
Massive centrilobular necrosis
|
|
|
What's going on: bluish cells with inclusions in the peripheral blood after correction of iron-deficiency anemia
|
Brisk reticulocytosis with basophilic rRNA inclusions
|
|
|
What are characteristics of drugs that exhibit high hepatic clearance?
|
Lipophilicity
Large Vd High rate of redistribution Good CNS penetration |
|
|
Formula: OR
|
ad/bc
|
|
|
Which CAH: ambiguous genitalia in a female + hypotension
|
21-OH deficiency
|
|
|
Which CAH: ambiguous genitalia in a female + hypertension
|
11-OH deficiency
|
|
|
Which CAH: ambiguous genitalia in a male + hypertension
|
17-OH deficiency
|
|
|
Reaction: 21-hydroxylase
|
Progesterone --> 11-deoxycortisol
|
|
|
MC association: imperforate anus
|
Urogential anomalies
|
|
|
VACTERL association
|
Vertebrae
Anal atresia Cardiac TE fistula Esophageal atresia Renal Limb |
|
|
Major role of glutamine
|
NH3 carrier to the kidney ---> glutaminase ---> urinary NH4+
|
|
|
Which pathogen: subacute endocarditis in a patient without any valvular disease
|
S. bovis
|
|
|
MOA: ergonovine
|
Ergot alkoid; agonist at 5-HT2, alpha, and DA receptors
Vasoconstrictor used to diagnose Prinzmetal's angina |
|
|
What vessels supply the greater curvature of the stomach above the level of the splenic vein?
|
Short gastric aa.
|
|
|
Structure: HAV
|
nonenveloped, linear (+) ssRNA
|
|
|
Structure: HBV
|
enveloped, incomplete circular, dsDNA with reverse transcriptase
|
|
|
Structure: HCV
|
enveloped, linear (-) ssRNA
|
|
|
Structure: HDV
|
enveloped, circular (-) ssRNA
|
|
|
Structure: HEV
|
nonenveloped, linear (+) ssRNA
|
|
|
Which viral hepatitis: water-borne epidemics
|
HEV
|
|
|
Transmission: HBV
|
Parenteral, sexual, or fetal (vertical)
|
|
|
Transmission: HCV
|
Almost exclusively parenteral (blood transfusions and IVDA)
|
|
|
Incubation period: HBV, HCV
|
Several months
|
|
|
Incubation period: HAV, HEV
|
Several weeks
|
|
|
What does + HAVAb IgG mean?
|
Prior, cleared infection or vaccination
|
|
|
What does + HAVAb IgG mean?
|
Prior, cleared infection or vaccination
Also indicates immunity to subsequent infection |
|
|
What does + HBsAg mean?
|
Acute viral hepatitis OR chronic carrier status
|
|
|
What does + HBsAb mean?
|
Either complete recovery from a previous encounter OR prior immunization
|
|
|
If you have been immunized against HBV, what will your serologies look like?
|
All negative except HBsAb
|
|
|
What does + HBcAb mean?
|
Core antibody is elevated in all settings EXCEPT immunization
|
|
|
Diagnosis: intraepithelial acantholysis
|
Pemphigus
|
|
|
Which muscle: sympathetics to the eye
|
Sup. tarsal m.
|
|
|
MOA: clomiphene
|
Binds hypothalamus and prevents estrogen feedback ---> increased GnRH release ---> increase FSH, LH
|
|
|
MOA: lithium-induced diabetes insipidus
|
Interferes with vasopressin action on the collecting ducts ---> nephrogenic
|
|
|
Formula: "accuracy"
|
TP + TN / total # of observations
|
|
|
Toxicity: cyclosporine
|
Nephrotoxicity
|
|
|
Classic drug: avascular necrosis of the femoral head
|
Prednisone
|
|
|
Diagnosis: mild fever, vomiting, and diffuse abdominal tenderness without rebound
|
Gastroenteritis
|
|
|
Contraindication: metoclopramide
|
Parkinson's'
|
|
|
Where is the fundamental lesion of Parkinson's?
|
Substantia nigra (pars compacta)
|
|
|
Diagnosis: high AChE in amniotic fluid
|
Open neural tube defect
|
|
|
What is the "female athlete triad"?
|
Disordered eating
Amenorrhea Osteroporosis |
|
|
Solubility: warfarin
|
Highly lipid soluble
|
|
|
Solubility: heparin
|
Highly water soluble
|
|
|
Why is heparin preferred in pregnancy?
|
Very high water solubility ---> cannot cross placenta
|
|
|
What specific step in viral processing do HIV protease inhibitors block?
|
Cleavage of Gag-Pol
|
|
|
Diagnosis: tented T waves
|
Hyperkalemia
|
|
|
EKG change most specific for hyperkalemia
|
Tented T waves
|
|
|
Possible EKG changes with hyperkalemia
|
Tented T waves
Absent P waves PR prolongation QRS widening |
|
|
EKG changes: hypokalemia
|
U waves
ST depression |
|
|
EKG: hypercalcemia
|
QT shortening
|
|
|
EKG: hypocalcemia
|
QT prolongation
|
|
|
Diagnosis: alcoholic with Parkinsonisms
|
Alcoholic cerebellar degeneration = atrophy of anterior lobes and vermis
|
|
|
Which abx: 50s peptidyltransferase inhibition
|
Chloramphenicol
|
|
|
Which abx: inhibition of translocation by 23S binding
|
Macrolides
Clindamycin |
|
|
List of nonpolar amino acids
|
Glycine
Alanine Valine Leucine Isoleucine Phenylalanine Tryptophan Methionine Proline |
|
|
Common cause of exaggerated lumbar lordosis
|
Excessive tone of hip flexors, weakness of hip extensors
|
|
|
Diagnosis: fetus with oligohydramnios and skull deformities
|
ACE inhibitor fetalopathy
|
|
|
Tx: chlamydia
|
Azithromycin
|
|
|
Diagnosis: neutrophils within the base of intestinal crypts
|
Ulcerative colitis
|
|
|
Which two muscles attach to the lateral aspect of the clavicle?
|
Deltoid and trapezius
|
|
|
MC type of tentorial herniation
|
Uncal
|
|
|
Diagnosis: joint space narrowing
|
Osteoarthritis
|
|
|
Which disease: microsatellite instability
|
HNPCC
|
|
|
Within which tissue do Kayser-Fleischer rings form?
|
Cornea
|
|
|
Define "rhombencephalon"
|
Met- + myelencephalon
|
|
|
Diagnosis: water deprivation test produces serum hyperosmolarity without appropriate concentration of the urine
|
DI
|
|
|
What part of a severed nerve must be recombined for regeneration?
|
Perineurium
|
|
|
Key ACh nucleus within the CNS
|
Nucleus Basalis of Meynert
|
|
|
Supraoptic nucleus =
|
ADH
|
|
|
Paraventricular nucleus =
|
Oxytocin
|
|
|
Function: thalamic VA/VL nuclei
|
motor
|
|
|
Function: lateral cerebellum
|
Voluntary movements of extremities
|
|
|
Function: medial cerebellum
|
Balance
Truncal movements |
|
|
Composition: Lewy bodies
|
α-synuclein
|
|
|
What causes cell death in Huntington's?
|
NMDA-mediated cytotoxicity
|
|
|
S/Sx: PICA stroke
|
Contralateral body pain and temp
Ipsilateral face pain and temp Ispilateral dysphagia Vertigo/diplopia/nystagmus/ataxia |
|
|
Diagnosis: head trauma ---> lucid interval ---> rapid decline
|
Epidural hematoma
|
|
|
Diagnosis: "worst headache of my life"
|
Subarachnoid hemorrhage
|
|
|
Dural venous sinuses run within the...
|
Dura mater, between meningeal and periosteal layers
|
|
|
Which parts of the body are covered by the fasciculus cuneatus?
|
Upper body/extremities
|
|
|
Which parts of the body are covered by the fasciculus gracilis?
|
Lower body/extremities
|
|
|
UMN signs
|
Hyerreflexia
Spasiticity Babinski sign |
|
|
LMN signs
|
Atrophy
Fasciculations Hyporeflexia Hypotonicity |
|
|
Gene: ALS
|
Superoxide dismutase 1
|
|
|
Lesion: Wednig-Hoffman
|
Ventral horn degeneration in an infant ---> "floppy baby"
|
|
|
Diagnosis: stumbling + slurred speech + scoliosis
|
Friedrich's ataxia
|
|
|
Which fibers: Golgi tendon organ
|
Ib
|
|
|
Which fibers: muscle spindle
|
Ia
|
|
|
Foramen: sympathetics to the eye
|
Sup. orbital fissure
|
|
|
What is the most medial structure within the cavernous sinus?
|
Trochlear n.
|
|
|
What happens when the ciliary muscle contracts?
|
Contracts ---> fibers relax ---> lens relaxes ---> lens more convex ---> near vision
|
|
|
What happens when the ciliary muscle relaxes?
|
Relaxes ---> fibers tense ---> lens tenses ---> lens flattens ---> far vision
|
|
|
What is the non-classic cause of a cherry red spot on the macula?
|
Retinal artery occlusion: painless vision loss with cherry red spot on macula
|
|
|
Receptors: ciliary epithelium
|
β → produces aqueous humor
|
|
|
Diagnosis: optic disc cupping with atrophy
|
Glaucoma
|
|
|
What is the pathway for the pupillary reflex?
|
Light activates ipsilateral CN 2 ---> pretectal nucleus in midbrain activates BOTH Edinger-Westphal nuclei ---> bilateral pupillary constriction
|
|
|
Composition: neurofibrillary tangles
|
Abnormally phosphorylated intracellular tau protein
|
|
|
Diagnosis: Parkinsonisms + dementia/hallucinations
|
Lewy body dementia
|
|
|
Distribution: Pick's disease
|
Frontotemporal (only the anterior brain)
|
|
|
Pathophysiology: PML
|
Oligodendrocyte death
|
|
|
Tx: migraines
|
Propanolol, NSAIDs, and triptans
|
|
|
Diagnosis: brain tumor with eosinophilic "corkscrew" fibers
|
Pilocytic astrocytoma
|
|
|
Which vitamin is contraindicated in patients taking levodopa?
|
B6
|
