• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/481

Click to flip

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;

481 Cards in this Set

  • Front
  • Back
conn's syndrome
-primary hyperaldosteronism
-most often due to benign adenoma in zona glomerulosa
drugs causing transcellular K shift
-stimulate Na/K ATPase
-insulin, B2 agonists
determine how many half-lives of a drug it takes before it reaches steady-state concentration in the serum
-with each half life, the serum concentration increases by half of remaining % yet to be achieved:
one T1/2=50% of steady state
two T1/2=75% of steady state
three T1/2=87.5% of steady state
four T1/2=93.75% of steady state
five T1/2=96.87% of steady state
congenital infections
1) toxoplamosis
2) rubella
3) cmv
4) hsv-2
5) syphillis
6) parvovirus b19
7) varicella
congenital syphilis
-peg teeth, perforate palate, saddle nose, hepatitis, jaundice, saber shins, deafness, blindness, rhinitis, cutaneous lesions
-infection after 20 weeks gestation
congenital toxoplasmosis
-chorioretinitis/blindness, basal ganglia calcifications, hydrocephalus
-may be asx at birth
congenital HSV-2
-transmission via birth canal
-encephalitis, conjunctivitis, vesicular skin lesions
-often asx at birth
congenital varicella
limb defects, mental retardation, blindness
congenital cmv
deafness, IUGR, basal ganglia calcification, petechial rash, microcephaly/mental retardation, hepatosplenomegaly, jaundice
-90% asx at birth
congenital rubella
deafness, patent ductus arteriosus, pulmonary stenosis, cataracts, microcephaly/mental retardation, purpura
blueberry muffin baby
petechial rash, seen with congenital CMV or rubella infections
congenital parvovirus B19 infection
fetal death in 1st trimester, hydrops fetalis after that
which herpes causes encephalitis in whom?
1) congenital/neonatal encephalitis--HSV2
2) immunocompetant adults--HSV1
what to monitor when treating with Li or valproate?
-Li; serum creatinine, TSH
-valproate; liver transaminases, platelet count
how can staph epidermidis infect prosthetic devices?
produces a biofilm to stick on them
HLA types associated with DM1
-HLA DR3/DR4 heterozygotes have 33x risk
-either DR3 or DR4 in combo with another subtype has increased risk
-homozygous HLA-DR2 individuals have a decreased risk
HLA-A3
hemochromatosis
HLA-B27
-psoriasis
-ankylosing spondylitis
-inflammatory bowel disease
-reiter's syndrome
reiter's syndrome
classic triad:
1) conjunctivitis & uveitis
2) urethritis
3) arthritis
-post-GI or chlamydia infection
-strong association with HLA-B27
HLA-B8
graves' disease
HLA-DR2
MS, hay fever, SLE, goodpasture's
HLA-DR3
DM1, when heterozygous with DR4 have a 33x risk
HLA-DR4
rheumatoid arthritis, DM1 (when heterozygous with DR3 have 33x risk)
HLA-DR5
pernicious anemia, hashimoto's thyroiditis
HLA-DR7
steroid-responsive nephrotic syndrome
lecithinase
-aka alpha toxin
-produced by clostridium perfringens
-causes myonecrosis (gas gangrene) and hemolysis
-dx with growth on egg agar
germ tube test
-used to dx candida infection
-demonstration of pseudohypha formation in animal serum
weil-felix test
-used to distinguish between rickettsial diseases
-assay serum for antirickettsial Abs that cross react with proteus Ag
-positive for typhus (r. typhi, r. prowazekii) and rocky mt spotted fever (r. rickettsii)
-negative for Q fever (coxiella burnetii)
epithelial cell junctions, from superficial-->deep
1) zona occludens/tight junctions--prevents paracellular diffusion, claudins+occludins
2) zona adherens/intermediate junction--cadherins+actin
3) macula adherens/desmosome--cadherins (like desmoglein) + intermediate filaments
4) gap juntions--connexons
5) hemidesmosomes--connect cells to underlying ECM, integrins+lamin in BM
bullous pemphigoid
-autoimmune disorder, anti-hemidesmosome IgGs produced
-hemidesmosomes attach epithelium to underlying basement membrane
-Abs are below the epidermis, linear IF
-lesions begin on lower abdomen, groin, flexors, generally spare oral mucosa
-subepidermal blisters
-nikolsky sign negative (pressure on skin does not separate epidermis)
-similar but less severe than pemphigus vulgaris
pemphigus vulgaris
-autoimmune skin disorder with IgG Ab against desmosomes (specifically, the cadherin desmoglein)
-IF throughout the epidermis
-intraepidermal bullae involving skin and oral mucosa
-lesions usually begin in oral mucosa
-positive nikolsky sign (pressure to skin separates epidermis)
-similar to bullous pemphigoid but life threatening
CML translocation
t(9,22), philadelphia chromosome, bcr-abl
burkitt's translocation
t(8,14), c-myc activation
follicular lymphoma translocation
t(14,18), bcl-2 activation
M3 AML translocation
t(15,17), retinoic acid receptor-PML fusion protein
ewings' sarcoma translocation
t(11,22)
mantle cell lymphoma translocation
t(11,14)
hypokalemic periodic paralysis
-genetic disease causing periodic muscle weakness and paralysis
-episode triggers; strenuous exercise, high-carb meal, anxiety
-often presents in 1st or 2nd decade, family hx
-tx: K supplementation during episodes and K-sparing diuretics for prophylaxis
vasculature of gonads
-ovarian and testicular arteries originate directly from the abdominal aorta, inferior to renal arteries
-right ovarian/testicular vein empties into IVC
-left ovarian/testicular vein drains into left renal vein, which then drains into IVC
-lymphatic drainage into para-aortic LNs
ligamentous derivatives of ventral mesentary
1) falciform ligament--contains ligamentum teres
-together comprising the lesser omentum:
2) gastrohepatic ligament--contains gastric arteries
3) hepatoduodenal--contains portal triad
ligamentous derivatives of dorsal mesentary
1) splenorenal ligament--contains splenic artery and vein
-together comprising the greater omentum:
2) gastrosplenic ligament--contains short gastric arteries
3) gastrocolic ligament--contains gastroepiploic arteries
falciform ligament
-connects liver to ventral body wall
-ventral mesentary derivative
-contains ligamentum teres
hepatoduodenal ligament
-connects liver to duodenum
-contains the portal triad
-comprises the free edge of the lesser omentum
-together with the gastrohepatic ligament comprises the lesser omentum
-ventral mesentary derivative
gastrohepatic ligament
-connects liver to lesser curvature of the stomach
-contains the gastric arteries
-along with hepatoduodenal ligament comprises the lesser omentum
-ventral mesentary derivative
splenorenal ligament
-connects spleen to posterior body wall
-contains splenic artery and vein
-dorsal mesentary derivative
gastrosplenic ligament
-connects greater curvature of stomach to spleen
-contains short gastric arteries
-part of greater omentum
-dorsal mesentary derivative
gastrocolic ligament
-connects greater curvature of stomach to transverse colon
-contains gastroepiploic arteries
-comprises the greater omentum along with gastrosplenic ligament
-dorsal mesentary derivative
HNPCC
-aka lynch syndrome
-mutation of dna mismatch repair genes (MLH or MSH) causes microsatellite instability (ex: dinucleotide repeat instability)
-80% progress to CRC
-proximal colon always involved
-increased risk of endometrial, ovarian, gastric and pancreatic cancers
familial adenomatous polyposis
-AD mutation of APC on 5q
-all pts develop cancer by 35-40 so need prophylactic colectomy
-thousands of polyps
-pancolonic
-always involves rectum
1) gardner's syndrome= FAP + osseous and soft tissue tumors, retinal hyperplasia
2) turcot's syndrome= FAP + brain involvement (astrocytoma, medulloblastoma)
peutz-jeghers syndrome
-AD benign polyposis syndrome (polyps themselves dont transform to malignant)
-increased risk of CRC and some visceral malignancies
-hamartomous polyps especially in SI, but may have some in stomach and colon
-hyperpigmented mouth, hands, lips, genitalia
li-fraumeni syndrome
-inactivation of p53 TSG on 17p
-increased risk for sarcomas, leukemia, carcinomas
gardner's syndrome
-subtype of familial adenomatous polyposis (thousands of pancolonic polyps, always involving rectum, cancer by 35-40, AD inactivation of APC on 5q)
-FAP + retinal hyperplasia, osseous and soft tissue tumors
turcot's syndrome
-subtype of familial adenomatous polyposis (thousands of pancolonic polyps, always involving rectum, cancer by 35-40, AD inactivation of APC on 5q)
-FAP + malignant brain tumors
microscopic findings at different times following MI
1-2 hours; contraction bands
4-12 hours; initial coagulation necrosis
2-4 days; extensive coag necrosis, muscle shows total loss of striations and nuclei, neutrophil emigration, hyperemia (dilated vessels)
-5-7 days; granulation tissue, beginning of fibrosis
-7 weeks; contracted scar complete
post-MI complications and most likely time post MI
-LV CHF and pulmonary edema; first 24 hours
-arrhythmia; first fews days
-ventricular free wall rupture, tamponade, papillary muscle rupture, ventricular septal supture; 3rd-7th day
-fibrinous pericarditis; 1-7 days
-aneurysm formation; 4-6 weeks
-dressler's syndrome; 6-8 weeks
hypnagogic vs hypnapompic hallucinations
-hypnapompic: hallucination upon waking
-hypnagogic: hallucination upon sleeping
ecg abnormalities in hypo- and hyperkalemia
-hypo: u wave, a positive wave following the t wave, that looks like another t wave basically
-hyper: peaked tall t waves
meckel's diverticulum
-congenital persistence of vitelline duct (originally connects gut to yolk sac)
-can cause bleeding, intussusception, volvulus, terminal ileum obstruction
-present in 2% of population
-found in distal ileum, 12 inches from ileocecal valve
-may contain heterotopic rests of gastric mucosa (causing mucosal ulceration from acid production) or pancreatic tissue
minimal change disease
-altered cell-mediated immune response with abnormal secretion of lymphokines by t cells
-reduces production of anions in glomerular BM, increasing permeability to albumin but not to Igs
-aka lipoid nephrosis
-normal LM but foot process fusion or effacement on EM
-most common cause of childhood nephrotic syndrome (peak incidence at 2-3 yo)
-no hypertension, unlike other nephrotic dzs
sx of hydrocephalus
1) gait problems
2) urinary incontinence
3) confusion/dementia
azotemia
increased serum BUN and creatinine
serum BUN:creatinine in different forms of azotemia
1) prerenal >20
2) renal <15
3) post renal is greater than 15
fractional excretion of Na
-FENa: (amount of filtered Na)/(amount of excreted Na)
-FENa= [(UNa x PCr)\(PNa x UCr)] x 100
-FENa <1% indicates good tubular function, excludes ATN as cause of azotemia
-FENa> 2% is highly suggestive of ATN as cause of azotemia
Uosm in evaluation of azotemia
-Uosm>500mosm/kg--> good tubular concentrating ability, prerenal azotemia
-Uosm<350mosm/kg---> tubular dysfunction, renal or postrenal azotemia
UNa in evaluation of azotemia
-UNa < 20mEq/L --> intact tubular function, prerenal azotemia
-UNa>40mEq/L--> tubular dysfunction, renal azotemia
labs in prerenal azotemia
1) BUN:Cr > 20
2) Uosm > 500
3) UNa < 10
4) FENa <1%
5) high ADH secretion
labs in renal azotemia
1) BUN:Cr < 15
2) Uosm <350 FENa>2%
4) UNa > 20
5) low ADH secretion
alopecia areata
-caused by autoimmune attack on hair follicles, with antibodies against anagen-phase follicles
-HLA DQ3
HLA DQ3
alopecia areata
what needs cold for culture?
listeria
hemophilus influenzae culture needs
-factor V (NAD) and X (hematin)
-can either culture with factors added or co-culture on blood plate with S. aureus, which will lyse the RBCs to release the necessary factors
mycobacteria special culture needs
cholesterol
calculate half-life from Vd and CL
T1/2= (0.7 x Vd)/CL
uricosuric agents
probenecid, sulfinpyrazone, increase urinary excretion of uric acid
tx acute attacks of gout with
colchicine, --| MT formation, leukocyte migration and phagocytosis of monosodium urate crystals
agnosia
-inability to recognize, despite adequate sensation
-can be visual, auditory, etc
-prosopagnosia: inability to recognize faces
alexia
inability to read, can understand words spelled out-loud
apraxia
loss of ability to carry out certain movements correctly in response to the stimuli that normally elicit them
agraphia
loss of writing ability
anosognosia
loss of recognition of own dz
aphonia
loss of sound production
components of seminal fluid
1) prostate (25%)--acid phosphatase, citric acid, calcium, clotting enzymes, profibrinolysin, zinc
2) bulbourethral/cowper's glands (5%)--thick alkaline mucus
3) epididymis (5%)--carnitine, acetylcarnitine
4) seminal vesicles (60%)--fructose
actions of insulin on target enzymes
-insulin (via TK receptor) decreases cAMP;
1) dephosphorylates glycogen synthase, activating it
2) dephosphorylates glycogen phosphorylase, deactivating it
actions of glucagon on target enzymes
-increases cAMP
-phosphorylates glycogen synthase, deactivating it
-phosphorylates glycogen phosphorylase, activating it
ito cells
-fat-containing mesenchymal cells in the space of disse in the liver
-the site of vit A storage
SEs and toxicity of TCAs
-anticholinergic SEs; sedation, tachycardia, dry mouth, visual disturbances, urinary retention, constipation
-tox: Convulsions, Coma, Cardiotoxicity (arrhythmias), hyperpyrexia (high fever), confusion/hallucination in elderly who are susceptible to anticholinergic effects
what causes alexia w/out agraphia?
-infarction of the left PCA (dominant hemisphere)
-affects anterior occipital cortex= right homonymous hemianopsia with macular sparing
-affects splenium of corpus callosum=cant read but can write
SC nerve/vertebrae anatomy
-31 pairs of spinal nerves
-C1-C7 nerves exit above the corresponding vertebra
-C8 nerve exits below C7 vertebra, there is no C8 vertebra
-from T1 nerve onward, all spinal nerves exit below corresponding vertebra
how to measure extracellular fluid volume?
=inulin space, because inulin disperses throughout the ECF and doesnt enter cells
serum osmolality equation
= 2[Na] + [glu]/18 + [BUN]/2.8
wernicke's encephalopathy vs. korsakoff syndrome
Wernicke's
1) reversible
2) ataxia
3) ophthalmoplegia/ocular movement palsies
4) confusion

Korsakoff:
1) not reversible
2) antero & retrograde amnesia
3) confabulation
-both caused by thiamine (B1) deficiency, usually in alcoholics
wet beriberi
-high output HF, dialated cardiomyopathy, edema
-caused by thiamine deficiency
wet beriberi
-symmetric demyelination of peripheral nerves, polyneuritis, symmetrical muscle wasting
-caused by thiamine deficiency
mutation in sickle cell
-substitution of valine for glutamate in beta globin chain
eqn for sensitivity
= TP / (TP + FN)
= 1 - false negative rate
= positive in disease
eqn for specificity
= TN / (TN + FP)
= 1 - false positive rate
= negative in health
implication of high sensitivity of test
highly sensitive--> low false negatives, can rule disease out, good for screening test
implication of high specificity of test
highly specific--> low false positive rate, used to rule dz in, use as confirmatory test after a positive screening test
PPV
-proportion of ppl testing positive that actually have the dz
= TP / ( TP + FP )

-even if test is specific and sensitive, if prevalence of dz is low test will have low PPV
NPV
-proportion of ppl testing negative who really dont have the dz
= TN / ( TN + FN )
risk factor for calcium oxalate renal stones
strict vegetarianism (lots of spinach and nuts)
what tumor causes hyperthyroidism?
-monodermal teratoma, containing functional thyroid tissue called struma ovarii
meig's syndrome
triad of:
1) ovarian fibroma-thecoma
2) ascites
3) right-sided pleural effusion (hydrothorax)
drugs causing gynecomastia
"some drugs create awesome knockers"
-spironolactone
-digitalis
-cimetidine
-alcohol
-ketoconazole
acanthamoeba
severe keratoconjuntivitis in dirty contact lens wearers
ophthalmia neonatorum
-conjunctivitis in newborns
-1st week; n. gonorrhoeae
-2nd week; chlamydia trachomatis
causes of bacterial conjunctivitis
-s. aureus (most common)
-s. pneumoniae
-h. influenzae
-h. aegyptius=pink eye
causes of viral conjunctivitis
-adenovirus (+ preauricular lymphadenopathy)
-HSV-1 (+ dendritic ulcers on fluorescein staining)
chlamydia trachomatis
-leading cause of preventable infectious blindness
-A, B, Ba, C
-intracellular bacteria staining only with iodine and giemsa
-transmission via elementary bodies
leptospira interrogans
-gram-neg spirochete with hooks, questionmark shaped
-found in water contaminated by animal urine, esp hawaiian or tropical waters
-infxs range from:
1) ax
2) flulike, with rash and vomiting
3) weil dz: jaundice, hemorrhage, renal failure, skeletal muscle necrosis
legionella pneumophila
-gram-neg rod, poor gram stain, use silver stain
-facultative intracellular
-charcoal yeast agar + cysteine and iron
-two diseases:
1) legionnaire's dz: severe pneumonia, esp in elderly smokers or alcoholics
2) pontiac fever; mild flu
-aerosolized water transmission, no person-to-person
-tx: erythromycin
anion gap eqn
= [Na] - [Cl-] - [HCO3-]
-normal gap= 8-16
albinism
-AR defect in copper-dependent tyrosine hydroxylase
-cant tyrosine--->melanin
-prone to squamous cell carcinoma and melanoma
medial medullary syndrome
-occlusion of the anterior spinal artery, lesion of:
1) cst in pyramid: contralateral hemiparesis
2) medial lemniscus: contralateral loss of touch/proprioception
3) XII nucleus: ipsi tongue weakness, protruded tongue points to side of lesion
lateral medullary syndrome
-aka wallenberg
-occlusion of vertebral artery/PICA
-lesion of:
1) solitary nucleus; ipsi taste
2) nucleus ambiguus; hoarseness, dysphagia
3) sans fibers; ipsi horner's
4) inferior cerebellar peduncle; ipsi ataxia
5) VIII nuclei; vertigo, nausea, nystagmus
6) spinal nucleus of V; ipsi face pain/temp
7) ascending spinothalamic tract; contra body pain/temp
weber's syndrome
-caused by occlusion of paramedian branches of PCA
-damage of ventral/medial midbrain, lesion of:
1) CN III: ipsi eye down and out, ptosis, pupil blown
2) cerebral peduncle (corticospinal + corticobulbar tracts); contra hemiparesis
locked-in syndrome
-ventral pontine lesion caused by basilar artery thrombosis
-bilateral pyramidal tract infarction
-complete paralysis except vertical eye movements and blinking, which are controlled in the midbrian
-intact sensation and cognition
PCA occlusion
-homonymous hemianopsia of contra visual field with macular sparing
-paramedian branch occlusion can produce weber's syndrome (CNIII palsy + contra hemiparesis)
AICA occlusion
-lateral inferior pontine syndrome
1) VII nucleus; ipsi face paralysis
2) VIII; vertigo, nystagmus, vomiting, sensorineural deafness
3) spinal tract of V; ipsi face pain/temp
4) inferior/middle cerebellar peduncles; ipsi ataxia
eqn for alveolar ventilation
=(tidal volume - deadspace volume) x RR
thiazides
-ex: hydrochlorothiazide, indapamide, metolazone
-inhibit the Na/Cl symport in DCT
-increase excretion of Mg, Cl, K, H, and Na
-decrease excretion of Ca!!!!!
-may result in alkalosis, hyperuricemia, hypercalcemia, hypokalemia, hyponatremia
-effects on Ca absorption benefit use in post-menopausal women and ppl with hx of Ca stones
-SE: sulfonamide allergy, alkalosis
-contraindicated in diabetes b/c decrease insulin release
which are sulfonamide diuretics?
-all CA inhibitors
-all thiazides
-all loop diuretics except ethacrynic acid
loop diuretics
---|Na/Cl/2K transporter in TAL
-ex: bumetanide, ethacrynic acid (only non sulfa!!!), furosemide, torsemide
-increased excretion of Na, H, K, Mg, Ca
-decreased excretion of uric acid
-tox: OH DANG! ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis (interstitial), gout
K-sparing diuretics
-ex: spironlactone and eplerenone (aldosterone receptor antagonists in CT)
-ex: triamterene and amiloride (Na channel inhibitors in CT)
-SE: hyperkalemia (possible causing acidosis from K/H transcellular shift), spironolactone causes gynecomastia
m. pneumoniae dx and tx
-dx: serology to find one or both Abs:
1) cold agglutinins, autoAb against O+ RBCs in cold
2) strep MG agglutinins, Abs against strep salivarius strain MG
-TX: macrolide, no cell wall so dont use a penicillin!
menetrier dz
-hypertrophic gastritis
-superthick rugal folds
-hyperplasia of mucous glands
-protein-losing enteropathy
-atrophy of parietal cells
-increased risk of carcinoma
i cell disease
-inherited deficiency of the enzyme UDP-N-acetylglucosamine, making golgi bodies incapable of marking lysosomal-intended enzymes with a mannose 6-P marker
-primary lysosomes dont contain hydrolytic enzymes
-undigested stuff accumulates large cytosolic inclusions
-dx: lysosomal enzymes will be present in the blood (without mannose phosphorylation they get mid-addressed to exocytosis)
-sx: congenital deformities, gingival hypertrophy, psychomotor retardation, early death
orlistat
---| pancreatic lipases
-tx for obesity, causes steatorrhea
sibutramine
-sympathomimetic seratonin and NE reuptake inhibitor
-used for obesity
-se: htn and tachycardia
megestrol
-progesterone derivative
-used to stimulate appetite in old ppl
name 2 opioids used as antidiarrheal agents
1) loperamide
2) diphenoxylate
SEs of platin alkylating agents
-nephrotoxic
-ototoxic
-peripheral neuropathy
doxorubicin antidote
-dexrazoxane, an Fe-chelator that prevents formation of free radicals to avoid cardiomyopathy
doxorubicin, MOA and SEs
-MOA; intercalates dna, -| topoisomerase II, dsDNA breaks
-SEs; cardiomyopathy, radiation recall reaction toxic extravasation
-prevent cardiomyopathy with dextrazoxane or dexferoxamide (Fe-chelator)
penicillamine
-a broad-range chelator
-tx for wilsons dz b/c chelates copper
-tx for lead or arsenic poisoning
CN poisoning antidote
1) nitrate to induce metHb formation, metHb will bind CN and prevent it from inhibiting cytochrome oxidase
2) thiosulfate to convert the CN into a renally-excretable form
posterior interosseous nerve
-branch of radial nerve
1) thumb extension via extensor pollicis longus
2) thumb abduction via abductor pollicis longus
3) index finger extension via extensor indicis
thenar muscles
1) opponens pollicis (opposition)
2) flexor pollicis brevis (flexion)
3) abductor pollicis brevis (abduction)
-all innervated by medial nerve
lumbricals
-flex at MCP, extend at DIP and PIP
-fingers 2 and 3 lumbricals innervated by median nerve (distal median lesion has fingers 2/3 curled)
-fingers 4 and 5 lumbricals innervated by ulnar nerve (ulnar nerve lesion has pope hand, 4th and 5th fingers curled)
interosseus muscles
-all innervated by ulner nerve
-dorsal interosseus abduct fingers
-palmar interosseus adduct fingers
ulnar nerve hand muscles
1) 4th and 5th lumbricals
2) adductor pollicis
3) all interosseus
4) all digiti minimi (hypothenar eminence muscles)
median nerve hand muscle
1) all thenar eminence muscles; opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
2) 2nd and 3rd lumbricals
radial nerve hand muscles
1) abductor pollicis longus (brevis=median n)
2) extensor indicis
3) extensor pollicis longus
general muscles of thenar & hypothenar eminences
-"OAF"
-opponens
-abductor
-flexor
only bacterial membrane w/cholesterol
mycoplasma
HPV oncogenesis
-virus proteins E6 an E7 inhibit cell TSGs p53 and p110
retinoblastoma
-loss of Rb TSG on 13q
-also increased chance of osteosarcoma
oncogenesis of HTLV-1
-causes adult t-cell leukemia/lymphoma
-viral gene products (tax) alter host protein function
kaposi sarcoma caused by
-HHV8 infxn in AIDS pts
winged scapula caused by
-damage to long thoracic nerve
-arises from C5, 6, 7 in the neck and doesnt travel through the axilla with the rest of the brachial plexus
-serratus anterior
axillary sheath contains
1) axillary artery
2) cords of brachial plexus (lateral, posterior, medial)
CN III can be squashed by aneurysm of adjacent...
-posterior cerebral artery rostral to it (from bifurcation of basilar)
-superior cerebellar artery (last branch off basilar before it bifurcates) caudal to it
-CN III emerges from midbrain
trochlear nerve
-innervates superior oblique which depresses adducted eye
oslers nodules
-red/purple subQ macules on pads of fingers and toes
-side of infective endocarditis
janeway lesions
-hemorrhagic, painless plaques on palms and soles
-sign of infective endocarditis
celecoxib contraindications
-sulfonamide allergy
-coronary artery dz b/c it increases risk of thrombosis
dysthymia
mild depression lasting at least 2 years
describe relationship of digoxin and K
-digoxin binds to Na/K ATPase at the K binding site
-hyperkalemia decreases digoxin effect
-hypokalemia, for example due to concurrent diuretic use, increases digoxin effect and toxicity
C3 deficiency causes
1) recurrent encapsulated organism infections cause cant opsonize
2) risk of type III hypersensitivity dz because cant clear immune complexes
pulmonary wedge pressure corresponds to
LA pressure
where is the chemoreceptor trigger zone, and where does it project to?
located in the area postrema in floor of 4th ventricle, projects to lateral reticular formation of medulla to activate vomiting center
fibroblast growth factor receptor deficiency causes
-achondroplasia, dwarfism
MEN
-all are AD, II and III are associated with ret gene
1) MEN I aka wermer's syndrome; parathyroid tumors, pituitary tumors, pancreatic endocrine tumors (insulinoma, gastrinoma, VIPoma), commonly presents with kidney stones and gastric ulcers
2) MEN II/IIA aka sipple's syndrome; parathyroid tumors, pheochromocytoma, medullary carcinoma of the thyroid (secretes calcitonin)
3) MEN III/IIB; pheochromocytoma, medullary carcinoma of the thyroid (secretes calcitonin), oral/intestinal neuromas, marfanoid habitis
wermer's syndrome
-MEN I
-parathyroid tumors
-pituitary tumors
-pancreatic tumors (gastrinoma, VIPoma, insulinoma, etc)
-common presentation= kidney stones with gastric ulcers
sipple's syndrome
-aka MEN II/IIA, associated with ret gene, AD
-parathyroid tumors
-pheochromocytoma
-medullary carcinoma of the thyroid (calcitonin secreting)
MEN IIb aka III
-AD, associated with ret gene
-pheochromocytoma
-medullary carcinoma of the thyroid (calcitonin-secreting)
-oral/GI neuromas
-marfanoid habitus
associate the gene with the cancer:
1) bcl-2
2) L-myc
3) erb-B2
4) C-myc
1) follicular lymphoma
2) small cell lung carcinoma
3) breast, ovarian, gastric carcinoms
4) burkitt lymphoma
tx of klebsiella pneumonia
-3rd generation cephalosporin (cefotaxime, ceftriaxone, ceftazidime)
tumor marker for what?
1) CEA
2) CA-125
3) AFP
4) PTH-rP
5) calcitonin
1) CEA-colorectal, pancreatic, gastric, breast (very nonspecific)
2) CA-125-ovarian
3) AFP-hepatocellular carcinomas, nonseminomatous germ cell tumors of the testes (ex: yolk sac tumor)
4) PTH-related peptide-small cell carcinoma of the lung
wegener's granulomatosis triad
1) necrotizing granulomas of upper airway tissue
2) small vessel vasculitis
3) renal dz

+ cANCA
macrophages in granulomas
called epithelioid histiocytes, may also form multinucleated giant cells, but not necessary for granuloma dx
aprepitant
-antagonist of neurokinin-1 receptors, which control the emetic reflex
-used to tx chemo-induced nausea and vomiting
why are chlamydia obligate intracellular bacteria?
they cant make ATP
urease-positive organisms
PUNCH
proteus
ureaplasma
nocardia
cryptococcus
helicobacter
congenital lipoid adrenal hyperplasia
-mutation in the steroidogenic acute regulatory protein (StAR), which is necessary to transport cholesterol from outer to inner mito membrane in adrenals and gonads
-complete steroid hormone deficiency in adrenals and gonads with enlargement of the adrenals
-causes male pseudohermaphroditsm and adrenal insufficiency
tx for borrelia burgdorferi
doxycycline
notching/scalloping of undersurface of ribs on CXR indicates
aortic coarctation
eisenmenger syndrome
-when a L-->R shunt shifts to R-->L because pulmonary HTN developed
cytoplasmic inclusions in epidermal cells
molluscum contagiosum (poxviridae)
broad-based budding
blastomyces dermatitides
narrow-based budding, encapsulated
cryptococcus neoformans
budding yeast that looks like a captain's wheel
paracoccidiomycosis
septate hyphae, 45 deg angle branching
aspergillus
nonseptate hyphae, wide-angle branching
mucormycosis or rhizopus
macrophage with intracellular yeast
histoplasmosis
meningitis in aids pt
cryptococcus neoformans, encapsulated narrow-budding yeast, india ink stain, pigeon droppings, latex agglutination test detects polysaccharide capsular antigen, soap bubble lesions in brain
abetalipoproteinemia
-AR deficiency of apoB100 and apoB-48, or microsomal transfer protein (MTP) which transfers triglycerides onto apoB
-w/out apoB48 cant make chylos, w/out apoB100 cant make VLDL
-low serum levels of chylos, VLDL, LDL, cholesterol, and triglyceride
-presents in infancy with steatorrhea, failure to thrive, acanthocytosis
-later, ataxia, nightblindness (due to fat-soluble vit absorptions)
focal segmental glomerulosclerosis
-primary, or secondary to HIV or IVDU
-EM shows focal damage of visceral epithelial cells
-loss of foot processes and pronounced focal detachment of epithelial cells
-nephrotic
-poor prognosis, commonly progresses to CRF
acute epididymitis and orchitis is caused by
gonorrhoeae or chlamydia
goodpasture's renal dz
rapidly progressive glomerulonephritis
electron dense subepithelial humps
poststreptococcal glomerulonephritis
podocyte foot process fusion
minimal change dz aka lipoid nephrosis
necrotizing enterocolitis
-GI mucosal necrosis and possible perforation in a neonate
-most common in premmies
accumulation of valine and isoleucine
maple syrup urine dz
causes of elevated anion gap met acidosis
Methanol
Uremia
Diabetic KA
Phenformin/Paraldehyde
Iron pills
Lactic acidosis
Ethylene glycol
Salicylic acid
achondroplasia
-AD mutation in FGFR-3, resulting in constant receptor activation and --| of chondrocyte proliferation
-short limbs, normal trunk
ocular muscles, action and innervations
1) MR -medial movement, III
2) LR -lateral movement, VI
3) IO -elevation from adducted position, III
4) SO -depression from adducted position, IV
5) SR -elevation from abduction, III
6) IR -depression from abduction, III
oblique vs rectus eye muscles
rectus muscles:
-move eye in the direction of their name (ex: superior rectus moves eye up)
-move eye from ABducted position
-both innervated by III
oblique muscles:
-move eye in opposition direction of their name (ex: superior oblique moves eye down)
-move eye from ADDucted position
-IO innervated by III, SO innervated by IV
only dna virus that is ss
parvovirus (B19)
which dna viruses are enveloped?
-hepadnavirus (hep b)
-herpesvirus
-pox virus (only dna virus not icosahedral)
which dna viruses are naked?
-papovavirus (papilloma, polyoma)
-adenovirus (adenovirus)
-parvovirus (B19)
which dna viruses are circular?
-hepadnavirus
-papovavirus (papilloma+polyoma)
describe different GLUTs
1) GLUT1
-RBCs, brain vessels, kidney, colon
2) GLUT2;
-liver, pancreatic beta cells, basolateral SI
-bidirectional
3) GLUT3;
-neurons, placenta, testes
-low Km
4) GLUT4;
-fat, skeletal muscle, heart
-insulin translocates GLUT4 to membranes
5) GLUT5
-SI, testes, sper
-fructose transporter
parinaud's syndrome
-lesion of DORSAL midbrain, often due to pineal tumor
-compression of superior colliculi-> paralysis of conjugate vertical gaze, pupillary light reflexes
-compression of cerebral aqueduct-> noncommunicating hydrocephalus, papilledema
liquefactive necrosis results from
release of hydrolytic enzymes from dying (neural) tissues
coagulative necrosis characterized by
protein denaturation
CCK
-released from I cells in duodenum and jejunum in response to FAs and AAs
-inhibits gastric acid secretion and gastric emptying via afferent vagal stimulation of SS secretion
-stimulates contraction of gallbladder
-increases production of hepatic bile
-increases pancreatic secretion
-relaxes sphincter of Oddi
bicornuate uterus
-congenital y-shaped uterus
-results from incomplete fusion of paramesonephric ducts
-results in spontaneous abortions, urinary tract abnormalities
CD3 present on
all t cells, mediates intracellular signal transduction
CD 14 present on
macros, endotoxin receptor
CD20 present on
B cells
CD56 present on
NKCs
CD16 present on
macros and NKCs, Fc IgG receptor
pralidoxime
AchE reactivating agent used in cases of organophosphate AchE poisoning (ex: parathion)
why are rickettsiae obligate intracellular?
need CoA and NAD
fast-twitch vs slow-twitch muscle fibers
1) slow twitch, type I fibers
-smaller MN diameter, slower response
-endurance
-high mitochondrial concentration for oxidative phosphorylation
-high myoglobin concentration for oxygen supply to oxidative phosphorylation
-red due to myoglobin
2) fast-twitch, type II fibers
-larger MN diameter, fast response
-sprint not endurance
-high glycogen concentration for anaerobic metabolism
-low myoglobin concentration makes them white
-low mito concentration
what molecular technique used to test for CF?
-pcr amplification of the region with the single AA mutation and then sequencing
muscles of mastication and action
1) temporalis- backward movement
2) lateral pterygoid- forward movement, only muscle that opens mouth
3) medial pterygoid- elevates lower jaw
4) masseter- elevates lower jaw
5) digastric- depresses lower jaw
6) mylohyoid- depresses lower jaw
choanal atresia
bone maldevelopment causing obstruction of one or both nasal passages
classic triad of congenital rubella
1) cataracts
2) deafness
3) PDA
how to differentiate partial vs complete central DI
-administer vasopressin
-if urine osmolarity increases by >50%, complete, if by <50%, partial
thayer martin media
-a chocolate agar based medium with antibiotics to suppress the growth of other bacteria
-used to grow the fastidious n. gonorrheae
-often use vancomycin to --| gram positives, colistin (a polymyxin) to --|gram negs except neiserria meningitidis or gonorrhoeae, and nystatin to --| yeast
ebstein's anomaly
-congenital heart defect
-apical displacement of tricuspid valve leaflets, increased volume of RV, atrialization of RV
-associated with maternal Li use
mycoplasma pneumoniae is associated with what Abs?
-cold IgM agglutinins, Abs against the surface P1 protein that mycoplasma uses to attach to respiratory epithelial cells
downs syndrome associated w/what cancer/
ALL
macroorchidism in pubertal males seen in
fragile x syndrome
high arginine levels in spastic child
-arginase deficiency
-arginase normally produces urea and ornithine from arginine in the urea cycle
-tx with low protein diet devoid of arginine
anti-collagen IV Abs
goodpastures
immune mech of rheumatic heart dz
Abs against strep M proteins cross react with antigens in heart and joints
immune mech of post-strep glomerulonephritis
deposition of circulating immune complexes, sub-epithelial humps
pauci-immune rapidly progressive glomerulonephritis
-caused by wegeners, pauci immune because no antibody deposition in glomerulus
anticentromere Abs
CREST syndrome
anti-smith Abs
SLE
CA-19-9 is tumor marker for
pancreatic carcinoma
bombesin is a tumor marker for
-neuroblastoma
-lung and gastric cancer
TRAP is a tumor marker for
hairy cell leukemia (b cell)
placental alkaline phosphatase is a tumor marker for
seminoma
I band, A band, H band in contraction
1) I band is the space between A bands, decreases width
2) A band, composed mostly of myosin, does not change length
3) H band-in the middle of the A band, the part with only myosin and no actin, shortens during contraction
S-100 is tumor marker for
-melanoma
-neural tumors
-astrocytoma
probenecid
-used as prophylaxis against gout
-inhibits PT reabsorption of urate
-also inhibits the secretion of many acidic drugs like cephalosporins and fluoroquinolones
-can cause uric acid stone formation if urine concentration gets too high
most common cause of neonatal meningitis and dx tests
-strep agalactiae
-beta hemolytic, bacitracin resistant, CAMP test positive
genetic basis of cystic fibrosis
-deletion of phenylalanine at position 508 on the CFTR gene on chromosome 7
leigh disease
-aka subacute necrotizing encephalopathy
-one of the few examples of dzs involving defects in MITO dna
-defect in cytochrome oxidase
-pts present as young adults with progressive intellectual deterioration, weakness, ataxia, seizures
adrenoleukodystrophy
-XR deficiency of beta FAs in peroxisomes
-accumulation of long chain FAs
-brain demyelination and adrenal insufficiency
ear nerves and region supplied
1) auricotemporal nerve= ant. half of external ear canal
2) auricular branch of vagus= post. half of external ear canal
3) greater auricular nerve= lower auricle
4) lesser occipital nerve= upper auricle
5) vestibulocochlear nerve= hearing and motion
psoriasis sx worsened by what med?
chloroquine
anticentromere Ab associated with
crest syndrome
anti-ro Ab associated with
-sjogren syndrome
-aka anti-SS-A
anti-la AB associated with
-sjogrens syndrome
-aka anti-SS-B
anti-Scl 70 Ab associated with
-systemic sclerosis
-aka anti-DNA topoisomerase
anti-DNA topoisomerase associated with
-systemic sclerosis
-aka anti-Scl 70
anti-ribonuclearprotein Abs associated with
-sjogrens syndrome
-include anti-SS-A (Ro) and anti-SS-B (La)
antihistone Abs associated with
-drug-induced SLE
pseudomonas antibiotic resistance via
mutation of porin, restricting entry of antibiotics into the bacteria
anti-IgG IgMs associated with
rheumatoid arthritis
tay sachs dz
-caused by insertion of 4 bases in the coding region for the hexosaminidase A gene, producing a frameshift mutation and premature stop codon
-motor retardation, cherry-red macula and blindness, deafness, death by four years
alpha and beta receptor blocker
labetalol
location of brachial plexus lesion resulting in 1) erb's palsy, 2) klumpke's total claw hand
1) upper trunk; C5, C6
2) lower trunk; C8, T1
drug induced lupus
-phenytoin
-hydralazine
-procainamide
-INH
anti Jo-1 Abs
polymyositis/dermatomyositis
anti-U1RNP Abs
mixed connective tissue dz
purple malar rash
-lupus pernio
-sarcoidosis
pruritic purple papules on wrists
-aka lichen planus
-hep C
-sawtooth infiltrate of lymphocytes at dermal-epidermal junction
S-100 marker for
melanoma
how does staph aureus evade phagocytosis?
-protein A, binds Fc region of Ig and disrupts opsonization and phagocytosis
acute intermittent porphyria
-AD, late onset
-episodic variable expression
-anxiety, confusion, paranoia
-acute abdominal pair
-no photosensitivity (unlike in congenital erythropoietic porphyria and porphyria cutanea tarda)
-port wine urine in some pts
-never give barbiturates
whats unusual about meperidine?
-its an opiate, full mu agonist, but has anticholinergic effects
-wont cause sphincter contraction, for example like morphine, and therefore can be used to tx pain of cholecystitis
-in OD, wont cause pinpoint pupils due to antimuscarinic effect, if anything would see mydriasis
what tumor produces placental alkaline phosphatase?
seminoma
antimitochondrial Abs seen with
primary biliary cirrhosis
renal plasma flow=
clearance of PAH
through which muscles do these nerves pass, and may be compressed by?
1) median
2) musculocutaneous
3) radial
4) ulnar
1) pronator teres
2) coracobrachialis
3) supinator
4) flexor carpi ulnaris
this drug --| Ca release from SR
dantrolene
hemicholinium
-inhibits the choline uptake transporter that takes up choline from degraded Ach in synapses
pseudomonas exotoxin mechanism
-exotoxin A
-ADP-ribosylates/inactivates EF-2, which is a g protein involved in protein translation
-therefore pseudomonas inhibits protein synthesis
tetanus toxin mechanism
-protease that blocks release of inhibitory NTs GABA and glycine, causing spastic paralysis
-lockjaw, risus sardonicus
major steps of collagen synthesis
1) translation in RER
2) vit C-dependent hydroxylation of proline and lysine residues in RER
3) glycosylation and formation of procollagen triple helix in RER/golgi
4) exocytosis of procollagen triple helix
5) extracellular cleavage of terminal regions of procollagen makes insoluble tropocollagen
6) extracellular cross-linking of lysine/hydroxylysine by lysyl oxidase/copper makes collagen fibrils
defect in type IV collagen
-alports syndrome
-XR
-hereditary nephritis, deafness, vision problems
-type IV collagen is found in basement membranes
defect in type III collagen
-ehlers-danlos syndrome
-variable inheritance, faulty collagen III synthesis
-hyperextensible joints, hyperextensible skin, easy brusing
-may be associated with joint dislocations, berry aneurysms, colon rupture, aortic dissection
-type III collagen is found in skin, blood vessels, uterus, fetal tissue, granulation tissue
defect in type I collagen
-osteogenesis imperfecta, AD
-multiple fractures, blue sclerae, deafness due to abnormal middle ear bones
-jacked up teeth due to abnormal dentin
-type I collagen is found in bones, teeth, skin, tendons, dentin, fascia, cornea, late wound repair
mechanism of scurvy, sx
-vit c deficiency inhibiting lysine and proline hydroxylation on preprocollagen alpha chains in the RER
-sx: loose teeth, bleeding gums, bruising, poor wound healing, etc
name some causes of polycythemia
-primary: polycythemia vera
-secondary: RCC, renal transplant, living at high altitudes, lung dz, heart failure
in what tissues will you have positive stains for:
1) vimentin
2) desmin
3) cytokeratin
4) GFAP
5) neurofilaments
1) vimentin in connective tissue
2) desmin in muscle
3) cytokeratin in epithelial cells
4) GFAP in neuroglia
5) neurofilaments in neurons
trastuzumab
-HER2 epidermal growth factor receptor blocker
ARF, rash, eosinophilia, fever
-acute (drug induced) interstitial nephritis
-main culprits: NSAIDS, methicillin, rifampin, diuretics, sulfonamides
mccune albright syndrome
-unilateral cafe-au-lait spots
-precocious puberty
-polyostotic fibrous dysplasia with multiple body defects containing unmineralized whorls of connective tissue
-somatic mutation of a Gs protein
what lymph nodes drain the penis vagina and anal canal?
-medial side of horizontal chain of superficial inguinal LNs
-may be a site of metastasis of neoplasm from these primary sites
what lymph nodes drain the penis vagina and anal canal?
-medial side of horizontal chain of superficial inguinal LNs
-may be a site of metastasis of neoplasm from these primary sites
pyriform cortex is
primary olfactory cortex
insula is
primary gustatory cortex
postcentral gyrus
primary sensory cortex
precentral gyrus
primary motor cortex
antimitochondrial Abs
primary biliary sclerosis
what is bumetanide
a loop diuretic
how does primary hypothyroidism cause amenorrhea?
-primary hypoT (for ex: hashimotos), causes increased TRH release from the hypothalamus
-TRH stimulates both TSH and prolactin release from the pituitary
-excess prolactin then inhibits GnRH
-decreased GnRH decreases FSH and LH, resulting in anovulation
sotalol is
class III antiarrhythmic, blocks K channels
name class IB antiarrhythmics
-lidocaine, tocainide, mexiletine, phenytoin
omalizumab
-monoclonal Ab against IgE, inhibits IgE binding to Fc region on mast cells and basophils, thus limiting release of mediators
-used in pts w/moderate-severe asthma
beclomethasone
-glucocorticoid used in asthma
-inhibits COX2 and phospholipase A2
nedocromil
-inhibits mast cell degranulation
-tx: asthma
-another ex: cromolyn
formeterol
-long acting B2 agonist used in asthma prophylaxis
ipratropium
-muscarinic antagonist with minimal systemic side effects because it is a quaternary amine
-used in asthma/COPD
name dz causes unconjugated and conjugated hyperbilirubinemias
1) unconjugated
-gilberts
-crigler najjar
2) conjugated
-dubin johnson (black liver)
-rotor's syndrome (no black liver)
location of lesion in UMN vs LMN lesion of CNVII
-umn: lesion of contralateral motor cortex, sparing of forehead with receives ipsi UMN innervation too
-LMN; lesion of ipsi CNVII in pons
cetirizine
2nd generation H1 blocker (nonsedating allergy med)
ketotifen
-ophthalmic antihistamine that noncompetitively blocks H1 receptors and stabilizes mast cells
-used to tx allergic conjunctivitis
myasthenic syndrome
-neoplastic myasthenia gravis, caused by either
1) thymoma
2) bronchogenic carcinoma
eaton lambert syndrome
-autoimmune dz caused by autoAbs against presynaptic calcium channels on Ach neuron on NMJ
-lack of Ach release causes weakness like myasthenia
-proximal muscle weakness of the limbs
-improves with use
-paraneoplastic cause is small cell carinoma
compare/contrast myasthenia gravis and eaton lambert syndrome
MG:
-Abs against Ach receptor on postsynaptic neurons in NMJ
-worsens with use (more sx in evening)
-weakness of facial muscles
-neoplastic cause is thymoma or bronchogenic carcinoma

EL:
-Abs against presynaptic Ca channels in NMJ
-weakness improves with muscle use
-starts with proximal muscle weakness
-paraneoplastic cause is small cell carinoma
kulchitsky cells
small dark blue cells of small cell/oat cell lung carcinoma, neuroendocrine cells
name the paraneoplastic effects of;
1) small cell lung carcinoma
2) squamous cell carcinoma
3) RCC
4) hemangioblastoma
5) breast carcinoma
6) thymoma
1) ADH, ACTH, lambert-eaton syndrome
2) PTH
3) Epo, PTH
4) Epo
5) PTH
6) lambert eaton, myasthenia gravis
what is the macrophage endotoxin receptor?
CD14
cytokine causing cancer cachexia
TNF
fredericks ataxia unique b/c
-recessive trinucleotide repeat expansion dz
-so can see it in a young child in who's fam there is no hx of dz
small jaw birth abnormality...
trisomy 18 (edwards)
roth's spots
-pale retinal spots surrounded by hemorrhage
-seen in endocarditis
mutation implicated in hypertrophic cardiomyopathy
myosin beta chain
what causes granulomatosis infantiseptica
-listeria monocytogenes ifxn in pregnant women
-high mortality due to disseminated fetal granuloma formation
electrolyte imbalances caused by ACE-i
-hyperK, hypoNa
sulfonylureas
-stimulate endogenous insulin release in DMII pts by closing beta-cell K channels, depolarizing the cells, triggering insulin release via calcium influx
-1st generation; tolbutamide, chlorpropamide, both can cause disulfiram-rxn, chlorpropamide can cause SIADH
-2nd gen; glyburide, glimepiride, glipazide, SE are hypoglycemia
other than insulin, what drug class is only other used in DMI pts
-biguinides: metformin, phenphormin
-insulin sensitizers, mech unknown, may decrease gluconeogenesis, increase glycolysis
-se: lactic acidosis
nitrite test
-can distinguish members of enterobacter family from other organisms
-enterbacter are gram neg rods that form nitrite from nitrate
-exs of enterbacters; ecoli, klebsiella, pseudomonas, proteus, etc
glucosuria appears when serum [glu] > ??
200
technetium scan
concentrates in gastric mucosa, can be used to find ectopic gastric mucosa in a meckel diverticulum, for ex in a child presenting with massive painless rectal bleed
OCD commonly associated with what other disorder?
tic disorders, like tourettes
trendelberg gait
-waddling gate or drop of pelvis when standing on one foot
-caused by weakness of gluteus medius or minimus muscles which abduct the thigh, innervated by superior gluteal nerve
anticentromere Abs
CREST syndrome
riluzole
-extends the survival of ALS pts
-glutamate release inhibitor, glutamate receptor blocker, Na channel blocker
-may prevent excitotoxicity to neurons
baclofen
-symptomatic tx of ALS
-GABA agonist
name 2 ALS drugs
-riluzole prolongs survival
-baclofen tx sx
CML blood smear shows
-increased neutrophils but decreased leukocyte alkaline phophatase (LAP)
-low LAP distinguishes neutrophilia of CML from neutrophilia of acute inflammation
CLL blood smear
-increased lymphocytes
what NT important for REM sleep?
Ach
anti-Scl-70 Abs
scleroderma
what artery is frequently injured in knee dislocations?
popliteal artery
cause of endocardial cushion defect in downs syndrome
inadequate migration of neural crest cells
cherry red spot seen on fundoscopic exam with
-niemann pick dz
-tay sachs
deficiency of sphingomyelinase
niemann-pick dz
deficiency of iduronate sulfatase
hunter syndrome
deficiency of n-acetyleglucosamine-1-phosphotransferase
i cell dz
esophagus lies behind/may be compressed by what portion of the heart?
left atrium
sumatriptan
seratonin 5HT 1D/1B agonist used to tx migraines and cluster headaches
describe site of latency of
1) EBV
2) HSV 1/2
3) VZV
1) b cells
2) sacral/trigeminal ganglia
3) dorsal root ganglia
WT1 gene
-wilm's tumor TSG on 11p
mallory bodies
-tangled bundles of cytokeratin intermediate filaments forming eosinophilic cytoplasmic inclusions in alcoholic hepatocytes
describe superior and recurrent laryngeal nerves
1) superior laryngeal nerve:
-external branch innervates cricothyroid muscle
-internal branch carries sensation from larynx above the vocal folds
2) recurrent (inferior) laryngeal nerve
-motor to all the muscles of the larynx except the cricothryoid
-sensation from larynx below the vocal folds
contents of the carotid sheath
1) vagus nerve
2) carotid artery
3) internal jugular vein
name the 2 main defects in fructose metabolism
1) fructokinase deficiency: benign deficiency in fructokinase, just get fructose in blood and uring
2) fructose-1-P aldolase B deficiency; AR, results in accumulation of f-1-P which sequesters all the phosphate, causing a shortage of P necessary for gluconeogenesis/glycogenolysis. infants present after 6 months (when they start eating fructose) with severe hypoglycemia, along with liver damage, etc.
name the steps of development at which oocytes are arrested at different times
-primordial oocytes; diplotene (last stage) of meiosis 1
-ovulation triggers resumption of meiosis, and ovulated oocytes are arrested in metaphase of meiosis II until fertilization
what is the only GI hormone released by carbs, fats, or proteins?
gastric inhibitory peptide
tx for syphillis
penicillin
guarnieri bodies
cytoplasmic inclusions characteristic of smallpox
tx for borriella or rickettsia
doxycycline
what antibiotics prevent initiation complex formation?
-linezolid, from 50s side (mostly for VRE staph or enterococci)
-aminoglycosides, from 30s side, and which also cause misreading of the mRNA (for gram - aerobes)
MOA of macrolides
inhibit translocation, bind 50s
MOA of chloramphenicol
-inhibits ribosomal peptidyl transferase
which antibiotic is used for tx of acne?
tetracycline
MOA of tetracycline
--| binding of aminoacyl-tRNA to ribosomes
what develops into the medial umbilical ligament?
umbilical arteries
what develops into the median umbilical ligament?
urachus/allantoic duct
cause of:
1) widened splitting
2) widened and fixed splitting
3) narrowed splitting
4) paradoxic splitting
1) pulmonic stenosis
2) ASD
3) pulmonary HTN
4) aortic stenosis
LDL receptors bind what apoprotein?
Apo B-100
churg-strauss syndrome
vasculitis+eosinophilia+asthma
buproprion
-antidepressant, smoking cessation
-DA reuptake inhibitor, nicotine antagonist
-toxicity is stimulant effects
-contraindicated in anorexics/bulimics, in whom it causes seizures
window period
-middle period of HepB infxn when HBsAbs have begun to be made and equal the amount of HBsAg, so neither are seen in serum
-HBcAb will be positive
lysosomal alpha glucosidase deficiency
pompe disease
glucose-6-phosphatase deficiency
von gierke dz
myophosphorylase deficiency
mcardle dz
loffler's syndrome
-endomyocardial fibrosis with a prominent eosinophilic infiltrate
-eosinophil granule proteins damage heart causing restrictive cardiomyopathy
-most common in tropical areas
endocardial fibroelastosis
-restrictive cardiomyopathy of children
-thick fibroelastic tissue in endocardium of young children
HIV ELISA is looking for what?
p24
test to detect viral load in HIV pts
rt-pcr
early marker of HIV infection
p24
PCWP estimates
LA pressure
cardiac malformation associated with maternal diabetes
-transposition of great vessels due to failure of the AP septum to twist
cause of tetralogy
failure of AP septum to align
endocardial cushion defect caused by
failure of neural crest cells to migrate, common in downs
cyclobenzaprine
-spasmolytic used to tx muscle spasms
-antimuscarinic SEs, like TCAs
probability of type II error
-error that you didnt reject null when you should have
=1-power
type I error
-rejecting the null hypothesis when its actually true
=p value
muscle and nerve for tongue protrusion
-genioglossus muscles protrude tongue and push towards the opposite side
-CN XII lesion will result in tongue pointing towards side of lesion due to ipsi genioglossus weakness
what viral families have semented genomes?
-reovirus (rota + reo)
-orthomyxovirus (influenza)
-arenaviruses (LCMV + lassa fever)
-bunyaviruses (california encephalitis, sandfly/rift valley fever, crimean-congo hemorrahgic fever, hanta)
enzyme deficiency in hurler's dz
alpha-L-iduronidase
enzyme deficiency in gauchers
beta-glucocerebrosidase
enzyme deficiency in tay sachs
hexosaminidase A
histo finding in dermatitis herpetiformis
IgA deposits on the basement membrane
drug to tx onychomycosis
terbinafine
medical tx of cholelithiasis
-ursodiol, a primary bile acid that reduces cholesterol secretion into bile and can dissolve cholesterol gallstones
tangiers dz
-deficiency of ABCA1 leading to severely reduced serum HDL
-ABCA1 protein transport cholesterol and phospholipids out of cells for pickup by ApoA1
-orange/yellow tonsils, hand neuropathy and muscle atrophy, enlarge LNs, hepatomegaly, atherosclerosis
lesion of cerebellar vermis
-truncal ataxia wide-based drunken sailor gait, but normal finger nose and heel-shin tests
cause of xeroderma pigmentosum
mutation in nucleotide excision repair gene
CD56
NKC marker
CD14
macrophage marker, endooxin receptor
enzyme deficient in alkaptonuria
homogentisate oxidase
legionella special media is...
charcoal-yeast agar, enriched with iron and cysteine
Ki-67
a nuclear factor whose expression correlates with neoplastic replicative activity
amylin
a type of amyloid protein associated with DM2, deposits in the pancreas
AF
senile cardiac amyloid aka transthyreitin, aka ATTR
drugs known to cause lupus
-hydralazine
-chlorpromazine
-isoniazid
-methyldopa
-quinidine
name 3 MAO-inhibitors
-phenelzine
-tranylcypromine
-iproniazid
-isocarboxazid
baby with rash/cutaneous hemorrhages, deafness, periventricular calcifications
CMV
triad of congenital CMV ifxn
1) deafness
2) cutaneous hemorrhage
3) periventricular calcifications
ehrlichia phagocytophilia
-intracellular bacteria transmitted by ixodes tick (same vector as borriella and babesia)
-berry-like clusters of organisms inside granulocytes
-leukopenia, low platelets
other than cough, what does b. pertussus cause?
-lymphocytosis
-hypoglycemia
nucleolus
site of rRNA synthesis, contains RNA polymerase I, because it synthesizes the bulk of ribosomal rRNA
main functions of rna poly I, II, and III
I-rRNA synthesis
II-mRNA synthesis
III-tRNA synthesis
macrophages containing amastigotes is a sign of
-leishmania donovani infection (kala-azar)
-characterized by spiking fevers, hepatosplenomegaly, pancytopenia
lymphatic drainage of testes/ovaries
-para-aortic LNs, near the origin of the testicular/ovarian artery from the abdominal aorta
-its so high up because gonads originate from high in the abdomen and then descend
name the dzs associated with conjugated- and unconjugated- hyperbilirubinemias
-conjugated: dubin-johnson, rotor's
-unconjugated: crigler-najjar, gilberts
downey cells
atypical reactive lymphocytes in EBV CBC (which shows lymphocytosis)
spinal levels for patellar and achilles reflexes
-patellar; L4
-achilles; S1
spinal levels for biceps and triceps reflexes
-biceps; C5-C6
-triceps; C7-C8
what kind of diuretics to avoid in renal insufficiency/failure?
-K-sparing ones
-with renal insufficiency tend to have hyperkalemia, so use of spironolactone can cause arrhythmia
2 most common causes of maternal death in preeclampsia
-cerebral hemorrhage
-pulmonary complications/ARDS
hairy cell leukemia
-chronic b cell leukemia in midaged/old men
-only leukemia w/out lymphadenopathy
-panycytopenia, splenomegaly
-leukemic cells are "hairy"
-positive TRAP stain
-autoimmune vasculitis and arthritis
riedel thyroiditis
-chronic hypothyroidism characterized by dense fibrosis that destroys thyroid and extends into adjacent structures (largyngeal nerve-hoarseness, tracheal obstruction, dysphagia, dyspnea, etc)
-fixed, hard, painless goiter
name the essential amino acids
-lysine
-leucine
-isoleucine
-threonine
-valine
-phenylalanine
-methionine
-histidine
-arginine
sleep stages an EEG waveforms
1) awake, eyes open-beta
2) awake, eyes closed-alpha
3) light sleep- theta
4) deeper sleep/bruxism-sleep spindles and k complexes
5) deepest sleep/ sleepwalking/ bedwetting- delta
6) REM- beta
muscle and nerve in foot dorsiflexion
-muscle: tibialis anterior
-nerve: deep peroneal nerve
foot eversion muscles
-peroneus longus and brevis
-superficial peroneal nerve
tibialis posterial
-inversion and plantar flexsion
-supplied by tibial nerve
positively skewed distribution
-mean > median > mode
-tail on the right
negatively skewed distribution
- mode > median > mean
- tail on the left
layers of the anterior abdominal wall
1) skin
2) superficial fascia (camper, then scarpa)
3) external oblique
4) internal oblique
5) transversus abdominus
6) transversalis fascia
7) parietal peritoneum
hereditary angioedema is caused by
deficiency of C1 esterase inhibitor, results in edema of mucosal surfaces
points of insertion of
1) psoas major
2) gluteus maximus
3) gluteus medius
4) gluteus minimus
5) piriformis
1) lesser trochanter of femer
2) gluteal tuberosity
3-5) greater trochanter
basal lamina
-extracellular matrix, part of basement membrane
-composed of collagen type IV and glycoproteins (laminin), and proteoglycans (heparan sulfate)
name two beta blockers with intrinsic sympathomimetic activity
-acebutolol and pindolol
-ISA means they are partial agonists and have a weak cardiostimulatory effect
-dont use these drugs in pts with angina because they can increase myocardial O2 demand, instead of decreasing it
transition
purine replaces a purine, or pyrimidine replaces a pyrimidine
transversion
purine replaced by pyrimidine, or vice versa
describe 4 kinds of immunity
1) natural active- you were infected, made ur own Abs
2) natural passive- baby takes moms Abs
3) artificial active- vaccine
4) artificial passive- pooled Ig
pyruvate carboxylase
-converts pyruvate ---> oxaloacetate for use in the CAC
-biotin is cofactor
arthus reaction
-type III hypersensitivity reaction
-local swelling/inflammation 24-48 hours after injection of an Ag the person has been previously exposed to (like tetanus vaccine)
-preexisting Abs react with Ag and deposit immune complexes
source of transmission for campylobacter jejuni
poultry
smoked fish may be a source for what bacteria?
clostridium botulinum
campylobacter jejuni
-enterocolitis
-frequent antecedent to guillain-barre (acute ascending demyelinating neuromuscular paralysis caused by Abs against campylobacter cross-reacting with neural Ags)
-curved gram neg microaerophilic oxidase positive rods
-associated with poultry, puppies with diarrhea in children
-bloody or watery diarrhea
what bacterial infxn mimics appendicitis?
yersinia enterocolitica mesenteric adenitis
pick's dz is aka...
frontotemporal dementia
why are CF pts infertile?
congenital bilateral absence of vas deferens
crewcut appearance on xray is associated with
extramedullary hematopoesis in sickle cell anemia
case series study
-collection of detailed info about ppl who are all believed to have the same dz
-point is to have a clear description of the common defining aspects of a particular dz
-no control group/nondzed group
-critical first step in generating a profile by which a new dz can be recognized
risk ratio and odds ratio used to analyze which types of studies?
-RR= cohort study
-OR= case control study
define case control vs cohort study
-case control; subjects grouped into dz or not dzed categories, then look retrospectively for the presence or absence of suspected risk factors. analyze with odds ratio.
-cohort study; subjects grouped into categories of +/- risk factors and then look prospectively for development of dz. analysis with relative risk.
cross over study
interventional study where all subjects are in both tx and placebo groups at some point in the study
recA gene
-bacterial gene that encodes the enzyme recombinase A, which mediates homologous recombination between linear pieces of DNA with chromosome DNA
-a bacteria lacking recA can still undergo F+ to F- conjugation, but no other mechanism of DNA exchange
reid index
-ratio of mucous gland depth to total thickness of bronchial wall
-increased in patients with chronic bronchitis
curschmann spirals
-mucus casts of small airways
-found in asthmatics
selegiline
MAO-B inhibitor (mao-a preferentially metabolizes NE and 5HT, whereas mao-b preferentially metabolizes DA)
pergolide
DA receptor agonist
anti-Jo-1
polymyositis/dermatomyositis
anti-U1RNP Ans
mixed connective tissue dz
anti-Scl 70
-diffuse systemic sclerosis
-aka anti-DNA topoisomerase
what autoAb associated with drug-induced SLE?
antihistone
cushings dz vs cushings syndrome
dz= ACTH-dependent hyperadrenalism
syndrome= hypercortisolism from any cause
craniopharyngiomas associated with what endocrine disorder?
neurogenic DI
name 4 bacterial pathogenic traits acquired by lysogeny
OBED
1) O Ag of salmonella
2) botulinum toxin
3) erythrogenic exotoxin of s. pyogenes (scarlet fever)
4) diptheria toxin
protein A
surface virulence factor of s. aureus, binds Fc region of IgG and prevents activation of complement
which bacteria has a polypeptide capsule?
b. anthracis
proplythiouracil
-inhibits the thyroid enzyme peroxidase, which catalyzes most of the thyroid hormone synthesis reactions, most importantly organification of iodide and coupling of DIT/MIT
-also inhibits conversion of T4-->T3 in the periphery
methimazole
inhibits organification and coupling of thyroid hormone synthesis
what artery supplies the femoral head?
medial femoral circumflex artery
retinopathy of prematurity
-accelerated neovascularization in the inner layers of the retina
-occurs in preterm infants, esp. when their respiratory compromise is txed with high FiO2
why is creatinine clearance a slightly inaccurate estimate of GFR?
-because although it is freely filtered, about 10-15% is also secreted in the PT, slightly overestimating GFR
where does an aspirated peanut go when sitting up or supine?
-sitting up; inferior segment of right lower lobe
-supine; superior segment of right lower lobe
cowdry bodies
intranuclear inclusions of HSV infxn
diptheroids
-gram positive rods that are normal flora of the oropharynx
-similar to diptheria, but diptheria has a lysogenized diptheria toxin, which makes it pathogenic
-diptheroids and diptheria are distinguished from one another with the ELEK test
which lung cancers are central, which peripheral?
-central: squamous cell, small cell
-peripheral: adenocarcinoma, bronchioalveolar carcinoma, large cell
which lung cancer associate with previous pulmonary injury/inflammation?
adenocarcinoma
describe histology of a large cell carcinoma cell
pleomorphic giant cells with leukocyte fragments in cytoplasm
L-myc
oncogene associated with small cell lung carcinoma
N-myc
oncogene associated with neuroblastoma
c-kit
oncogene associated with gastrointestinal stromal tumor (GIST)
bcl-2
oncogene associated with follicular lymphoma, inhibits apoptosis
name three "myc" genes and the cancers they are associated with
-c-myc: burkitts lymphoma
-l-myc: small cell lung carcinoma
-n-myc: neuroblastoma
Tdt
-a cell surface marker present only in extremely primitive cells of lymphocyte lineages
-present on neoplastic cells of ALL
-involved in VDJ rearrangement of the heavy chain
in what conditions do you find target cells?
1) hemoglobinopathies (thalassemia, HgC dz, SS)
2) liver dz
3) asplenia
isoniazid, MOA and method of resistance
-MOA: decreases synthesis of mycolic acids
-must be activated by mycobacterial catalase-peroxidase
-resistance via:
1) decreased activity of the catalase-peroxidase enzyme
2) modification of the isoniazid-binding site of the mycolic acid synthesis enzyme
paraneoplastic cerebella degeneration
a autoimmune paraneoplastic syndrome where Abs against tumor cells cross react with cerebellum, seen mostly in cancers of ovary, uterus, breast, and small cell of lung
splitting common among ppl w/
borderline personality
fibromyalgia
-chronic disorder w/widespread musculoskeletal pain, stiffness, paresthesias, poor sleep, emotional disturbances
-on PE find multiple symmetrically distributed spots of tenderness
-mostly women, some sort of pain misperception or something
bile and strep
-strep pneumonia is "bile soluble" meaning it CANT be cultured in bile
-gamma hemolytic entercocci and nonenterococci can grow in bile (enterococci also can grow in NaCl)
which artery most commonly involved in atherosclerosis?
abdominal aorta