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292 Cards in this Set
- Front
- Back
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thymic hypoplasia
ovarian dysgenesis decreased IgA normal calcium levels |
Ataxia Telangiectasia
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What causes the damage in pancreatitis?
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trypsin activation
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Why are we susceptible to gonoccal infections so often?
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gonoccal bacteria can undergo high frequency antigenic variation
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what hormone levels would you see with klinefelter's?
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decreased testosterone
increased LH and FSH |
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vampire enzyme deficiency?
porphyria cutanea tarda |
urobilinogen decarboxylase
see blistering, red urine, nocturnal |
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What is Vitamin B6?
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Pyridoxal phosphate
cofactor necessary in the synthesis delta ALA succinyl CoA plus Glycine (along with B6 and ALA synthase) |
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What are the most common brain mets?
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LUNG
BREAST MELANOMA |
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Erythema Infectiousum
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Parvovirus
B19, predilection for erythroid precursors, replicates in bone marrow |
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How do you test for Hep C?
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Cryoglobulins
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Somatostatinoma
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produced by the delta cells of the pancreas
may result in decreased CCK production, resulting in gallstones Somatostatin inhibits insulin, glucagon, secretin, gastrin, and CKK secretion |
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umbilical hernia, hypotonia, lethargic infant
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hypothyroidism
may also see congenital heart defects, macroglossia, prolonged jaundine and constipation |
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Where are melanocytes derived from?
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neural crest
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What does reliable mean?
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reproducible
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What does the aortic sinus measure?
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pressure, mediated by the glossopharyngeal-- can sense increased pressure (tight collar) as increased blood pressure, and stimulate a decreased heart rate, decreased blood pressure, and sometimes, even syncope
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In what conditions do you see target cells?
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Liver Disease (alcoholics)
Asplenia HbC disease Thalassemia |
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Bradykinin
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increased venoconstriction, arteriole vasodilation. make sure the kidneys are perfused
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BNP and ANP
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counteracts the sympathetic, endothelin and ang II vasoconstriction to decrease preload
Nesiritide is a recombinant form of BNP |
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angiogensis in neoplastic and granulation tissue
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mediated by vEGF and FGF
proinflammatory cytokines like IL-1 and IFN gamma may indirectly promote angiogensis via VEGF expression |
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telomerase
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reverse transcriptase. adds TTAGG to 3' ends, RNA dependent DNA polymerase
active in cancer cells, and stem cells |
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What are the killed vaccinations?
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RIP Always
Rabies Influenza salk Polio HAV |
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What viruses are infectious?
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Most double stranded DNA (except Pox and HBV) and positive stranded ssRNA (because it's like mRNA)
Naked nucleic acids of negative strand ssRNA and dsRNA are not infectious |
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What are the live attenuated vaccines?
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Measles, Mumps, Rabies, Yellow Fever, Small Pox,
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Bloom Syndrome
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Premature Aging because of shortened telemeres
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What does dobutamine do for the heart?
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Increase Contractility
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Left Sided Heart Murmurs
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INCREASE on expiration
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Right sided heart murmurs
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INCREASE on inspiration
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Iron Poisoning
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Causes peroxidation of membrane lipids; symptoms include acute gastric bleeding, metabolic acidosis and scarring leading to GI obstruction
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What is the antidote for theophylline?
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beta blocker
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What is the antidote for tPA or streptokinase?
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Aminocaproic Acid
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What do you do if your patient overdoses of TCAs?
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NaHCO3 for serum alkalinization
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PCL
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attachs to the lateral condyles of the femur, and the posterior part of the tibia
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ACL
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attaches to the lAteral condyles of the femur, to the anterior part of the tibia
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Thayer Martin Media
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Contains Vancomycin (get rid of gram +) Colistin (polymixin) and TMP to get rid of the gram negatives, and nystatin to get rid of fungi
Chocolate (heated blood) media cultures for Neissierria Gonorrhea |
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Acute Renal Failure
prerenal azotemia |
in a normal nephron, BUN is reabsorbed for countercurrent multiplication, but Creatinine is not
ARF: increased Serum Creatinine and BUN Prerenal Azotemia: decreased RBF (hypotension) leads to decreased GFR, Na+ and H20 and Urea are retained by the kidney. So BUN and Creatinine INcrease in an attempt to conserve volume Serum BUN/Creatinine: more than 20 Renal: less than 15, and postrenal more than 15 |
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Renal azotemia
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Intrinsic, generally due to acute tubular necrosis or ischemia/toxins. patchy necrosis lead to debris obstructing tubules and fluid backflow across the necrotic tubule: decreased GFR
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Thaizides
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Inhibit the Na+/Cl- cotransport
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Gonorrhea Infection and Chalmydia infection in males predisposes to
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epidydimitis
generally seen in males under 35 males over 35, you see E.Coli and P. Aeruginosus Also, TB begins in the epipdymis, spreads to the seminal vesicles, prostate and testicles |
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Hydrocele
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persistant tunica vaginalis
this is the most common cause of scrotal enlargement. Ultrasound distinguishes fluid versis a testicular mass causes the enlargement hematocoele is blood, spermatocele contains sperm |
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variococele
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bag of worms; most common left sided scrotal enlargement in an adult
blockage of the left renal vein can cause this (any time you've got a hypercoaguable state--> could see this) or if you have renal cell carcinoma invading the renal vein |
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Epipdydimitis
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scrotal pain with radiation into the spermatic cord or flank
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Malignant testicular tumors
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95% are germ cell in origin--> 40% are germ cell--> seminoma
60% are mixtures--(embryonal, teratoma, choriocarcinoma, yolk sac tumor) |
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Torsion of the testicles
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Surgery is imperative, occurs with trauma most commonly, or cyptocorchid testis or atrophy of the testis. twisting of the spermatic cord cuts off venous supply and there is a danger for hemorrhagic infacrcation
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What is the most common site for prostate CANCER?
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peripheral zone, palpated on DRE
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What does PSA do?
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proteolytic enzyme that increases sperm motility and maintains that seminial secretions are in the liquid state
PSA is more sensitive than specific in prostate CANCER |
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BPH
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NOT a risk factor for prostate cancer
advanced age is the biggest risk factor for prostate cancer |
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Sex Hormone Binding Globulin
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Binding protein for estrogen and testosterone
estrogen increases the synthesis of SHBG; SHBG has a higher affinity for testosterone than estrogen--> Estrogen Amplifier androgens, insulin, obestity and hypothyroidism all decrease synthesis of SHBG |
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Estrogen and SHBG
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SHBG has a higher affinity for testosterone than estrogen
estrogen increases the synthesis of SHBG in the liver increased SHBG means less free testerone--> less sex drive |
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Sildenafil
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most common drug to treat erectile dysfunction
inhibits the breakdown of cGMP by type 5 phosphodiesterase so increased levels of cGMP causes vasodilation in the corpus cavernosum and the penis |
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what lung cancers occur peripherally?
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adenocarcinoma and large cell carcinoma
adenocarcinoma: most commonly occur lung cancer, especially in women and non smokers large cell: see gynecomastia and galactorrhea (removed surgically) |
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What lung cancers occur centrally?
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small cell and squamous. both associated with smoking
small cell is the worst cancer, never resect, always chemo/radiation. small cell si often associated with ectopic production of ACTH or ADH. May lead to lambert eaton syndrome (autoantibodies against Ca++ channels) |
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Squamous Cell Carcinoma
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cavitation, clearly linked to smoking. see central necrosis and cavitation. see parathyroid like activity.
occurs centrally |
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VIPoma
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treat with octreotide or somatostatin
causes WDHA-- watery diarrhea, inhibits gastrin secretion, hypokalemia and achlorydia |
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Erb-B2
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EGF tyrosine kinase receptor associated with 25-50% breast cancers
predicts responsiveness to trastuzumab |
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N-myc
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associated with neuroblastoma and small cell carcinoma
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Bcl-2
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associated with follicular lymphoma, facilitates neoplastic cell survival
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Kawasaki's Disease
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vasculitis of little kids, strawberry red tongue, fever, conjunctivitis, associated with coronary aneurysms-- cutaneous involvement
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how is mRNA read?
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5-> 3, with protein synthesis occuring from N-->C
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what is an operon
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a DNA sequence with a promotor, a regulator, and an operator, along with structural genes
culturing E. Coli in the presence of glucose will supress the lac operon, decrease adenylate cyclase, decrease cAMP levels |
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how can you tell central diabetes insipidus from nephrogenic?
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central (usually a problem with the hypothalamus--> where ADH is made) will respond to ADH, and increase osmolarity of the urine, nephrogenic will not
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how does theophylline cause bronchodilation?
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inhibits phospodiesterase, thereby decreasing the cAMP hydrolysis
overdose of theophylline presents as seizures |
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Fanconi's Anemia
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Inherited aplastic anemia
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Charcot's Triad for MS
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Scanning speech, intention tremor and nystagmus
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Charcot's Triad for Cholangitis
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Jaundice, RUQ pain and fever
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What is elevated in Klinefelter's?
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Increased FSH and LH, increased estrogen
dysgenesis of semiferous tubules causes decreased inhibin, and dysgenesis of leydig cells cause decreased testosterone, leading to high LH will stimulates estrogen production |
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What is common between klinefelter's and turner's?
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increased levels of LH and FSH
turner's: low estrogen klinefelter's: high estrogen |
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What do you see in 5alpha reductase deficiency?
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penis at 12
unable to convert test to DHT, ambigous genitalia until puberty when increased testosterone causes masculinization, and increased growth of external genitalia |
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What is an epoxide reductase inhibitor?
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warfarin
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tubrous sclerosis
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hamartomas. see ash leaf spots, shagreen patches, and HAMARTOMAS everywhere
hamartomas in the CNS, skin, organs, cardiac rhabdomyoma and renal angiomyolipoma. MR and seizures |
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Why are you susceptible to gallstones with TPN?
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decreased CCK stimulation without any enteral action
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Folic Acid
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Alcohol inhibits folic acid absorption, and the reduced version of folic acid is needed for nucleotide synthesis to make DNA
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Chronic Granulomatous Disease
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X linked recessive
lack of NADPH oxidase, so no O2- is around. Catalase positive organisms are ingested, but not killed because the catalase neutralizes the H202. myeloperoxidase is present, but no peroxide is formed because there isn't any H202 around. Catalase negative organisms are killed when the myeloperoxidase combines H202 with Cl- and forms HOCl Classic Test: Nitroblue Tetrazolium Test |
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Myeloperoxidase Defiency
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AUTOSOMAL recessive (not X linked recessive like CGD) both O2- and H202 are produced, but there is not HOCl formed without myeloperoxidase around
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Lyme Disease
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treated with Doxycycline or penicillin like antibiotics
early stage: flu-like, erythema chronicum migrans early disseminated: AV heart block, Bell's Palsy late: assymetric arthritis of the large joints, memory loss, somnolence and mood changes |
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Bacteria that grows dextrans from glucose
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Strep Viridans (s. mutans and S. sanguis)
mouth can cause SBE, deep wound infections, abdominal abscesses, septicemia |
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Moraxella Catarrhalisis
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part of the normal flora of the Upper Respiratory Tract
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Verapamil
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slows down the depolarization during diastole, by blocking the Ca++ channels in the SA and AV nodes
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What should you NOT take when you are on Levodopa/Carbidopa
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Multivitamin
V B6 increases peripheral metabolism of levidopa, so there is less to get into the CNS |
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Epinephrine
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Works on alpha 1,2, beta 1 and 2
at low doses, has higher affinity for beta 1 receptors (B1OW) used for: glaucoma, anaphylaxis, asthma and hypotension |
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Norepinephrine
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Has selectivity for alpha 1, alpha 2 and beta 1, but NOT for beta 2
used for situations of hypotension, but it will not increase renal perfusion |
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Dopamine
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used in shock and heart failure
ionotropic and chronotropic D1=D2>beta>alpha |
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phenylephrine
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activates alpha1>alpha2
net vasoconstrictor |
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Wilson's Disease Symptoms
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Asterixis
Basal Ganglia Degeneration Cirrhosis, Copper Deposition, Corneal Deposits, Carcinoma (hepatocellular) Choreiform Movements Dementia Hemolytic Anemia autosomal recessive inheritance |
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HEV
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associated with Expectant Mothers, Enterics, and Epidemics
RNA virus |
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Circular DNA viruses
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Papillomavirus, Polyomavirus
partially duplexed: Hepadna (Hep B) |
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Absent UDP gluconryl Transferase
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Crigler Najjar Syndrome, type I
presents early in life, and patients die within a few years |
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Dubin Johnson Syndrome
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problem with excreting conjugated bilirubin
rotor's syndrome is similar, but even milder, not causing a black liver |
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Reye Syndrome
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see microvesicular steatosis, no necrosis or inflammation.
hepatic failure and encephalopathy |
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Pompe's Syndrome
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see enlarged liver, heart
missing alpha 1,4 glucosidase |
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Cartinine Deficiency
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can't make ketone bodies
beta hydroxybutyric acid or acetoacetate get myoglobinemia, weakness following exercise, elevated muscle triglycerides and hypoketonemia can't use Long Chain Fatty Acids, and toxic accumulation |
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Most common benign tumor of the liver?
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cavernous hemangioma
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most common cause of angiosarcoma?
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exposure to vinyl chloride, arsenic or thorium dioxide
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Glomus Body
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afferent arteriole connected to an efferent vein via an AV anastamosis. The role of the glomus body is thermoregulatory, to shunt blood away from the skin surface during cold temperatures
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What are the toxins that work by ADP ribosylation?
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Diptheria and P. Aeruginosus
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Sphingomyleinase defieciency
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Neimann Pick
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Lack of galatcocerebrosidase
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Krabbe's
see a build up of galatcocerebroside |
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Alpha Galactosidase deficiency
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Fabry's-- this is X linked Recessive
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BMPR2 gene
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normally inhibits vascular smooth muscle proliferation. Leads to primary pulmonary hypertension
has a poor prognosis may treat with bosentan |
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what lab values would you see in a pulmonary embolism?
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respiratory alkalosis
decreased PaCO2 and decreased P02 |
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Obstruction to what vein would cause symptoms similar to SVC syndrome?
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braciocephalic (only ipsilateral)
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Dinoprostone
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PGE2 analog causing cervical dilation and uterine contraction, inducing labor
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What would you use to RELAX the uterus, and prevent labor?
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terbutaline or ritodrine
beta 2 agonists to reduce premature contractions |
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exposure to DES in utero
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clear cell adenocarcinoma of the vagina
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how would you check Vit B12 levels?
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you'd have elevated methylmalonyl CoA
you'd have a build up of methylmalonyl CoA because colbalamin is needed to convert it to succinly CoA |
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What kind of conditions would lead to B12 deficiency, since you do have such a large reserve pool
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Sprue, Enteritis, Diphyllobothrium latum, perinicious anemia, and atropic gastritis, crohn's disease
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What is the function of folic acid?
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it is converted to THF, a coenzyme for 1 carbon methylation reactions
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Cystathionine Synthase
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Missing in homocystinuria
ectopia lentis, osteoporosis, MR, hypercoagulable states, early atherosclerosis |
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What else is needed for dopamine Beta hydroxylase to convert dopamine to norepinephrine?
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Vitamin C
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AZT
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inhibits DNA chain elongation, it's a nucleoside reverse transcriptase inhibitor
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lipofuschin
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yellow-brown pigment accumulates in aging cells. The end product of lipid peroxidation. Free radical injury
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siderophages
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iron deposits in macrophages, congestive heart cells
pulmonary congestion |
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hwo does lead poisoning lead to microcytic anemia?
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lead inhibits ferrochetalase and ALA dehydratase
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intravascular hemolysis
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hemoglobinuria
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extravascular hemolysis
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jaundice
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autoimmune anemias
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warm: IgG-- chronic anemia seen in SLE, CLL or with certain drugs (methyldopa) this is mostly extravascular hemolysis
cold: IgM it is an acute anemia triggered by cold; seen in mycoplasma pneumonia infections or in EBV Erythroblast fetalis |
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top 3 childhood brain tumors and ways to distinguish
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1. pilocytic astrocytoma: both cystic and solid. cerebellar ataxia and HA. good prognosis
2. Medulloblastoma: cerebellar, solid, (not any part cystic) rosette, small blue cells. PNET. cerebellar ataxia and HA 3. Ependymoma: causes hydrocephalus, see perivascular pseudorosettes. |
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What is the difference between a simple partial and a complex partial seizure?
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Simple partial: no loss of consciousness, one part of the body is impaired
Complex Partial: almost always in the temporal lobe, mood changes, illusions, hallucinations. Impaired consciousness Treat both with carbamazepine! (increases Na channel inactivation) |
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what activates and what inhibits ALA synthetase?
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Alcohol, barbiturates and hypoxia activate ALA synthetase to take glycine and succinyl CoA and make aminolevulinic acid
heme and glucose inhibit ALA synthase |
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primary hyperparathyroidism
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has subperiosteal thinning, whereas osteoporosis you see trabecular thinning
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mycoplasma
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contain sterols, and have no cell wall
not susceptible to any penicillin acting antiobiotic |
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bugs that don't gram stain
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These Rascals May Microscopically Lack Color
Treponoma (too thin) Rickettsia (intracellular) Mycobacteria (acid fast, high lipid content) Mycoplasma (no cell wall) Legionella (intracellular) Chlamydia (intracellular parasite, lacks muramic acid in the cell wall) |
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what is the treatment for nephogenic diabetes insipidus?
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hydrochlorothiazide
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How do you calculate free water clearance?
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CH20= V-Cosm
with loop diuretics, you see isotonic urine with ADH, you see concentrated urine without ADH, you see diluted urine |
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Where does PTH act in the kidney?
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Proximal Convuluted Tubule: it inhibits the Na+/Phosphate cotransport to excrete Phosphate
In the distal convoluted tubule: stimulates the Ca+/Na+ exchange to increase Calcium reabsorption |
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What is a helpful test when you've got metabolic alkalosis?
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urine chloride
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What is a helpful test if you have metabolic acidosis?
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urine ketones, glucose
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What happens in high altitude?
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Increased 2,3 DPG (right shift) to unload O2 to the tissues
Increased ventilation (resp alkalosis) so kidneys will increase HCO3 excretion to get rid of bases cellular changes like increased mitochondria |
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How is carbon dioxide transported in the blood?
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Bicarbonate (90%)
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What is penicillin a structural analogue of?
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D-ALA-ALA
penALAcillin |
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What activates a macrophage?
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Gamma Interferon from the Th1 cell
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What are the hereditary Thrombosis Syndromes?
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Factor V Leiden
Prothrombin Gene Mutation ATIII deficiency Protein C or S deficiency |
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What is the factor V Leiden Deficiency?
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you produce a mutant factor V that cannot be degraded by protein C
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What is the prothrombin gene mutation?
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Mutation in the 3' untranslated region associated with venous clots
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How would you diagnose an ATIII defiency?
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Heparin administration will lower the (before) prolonged PTT
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What is the role of protein C and S?
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Enhance fibrinolysis by inactivating Factors V and VIII
with a defiency, you wouldn't inactivate V and VIII following a warfarin administration you have an increased risk of hemorrhagic skin necrosis |
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Heparin
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enhances Antithrombin III, which will neutralize 12, 11, 9 and 10
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Vincristine
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often associated with peripheral neuropathy
M phase specific alkaloid, binds to tubulin and blocks microbtubule polymerization |
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Gleevec
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used for CML and stromal tumors, side effect is fluid retention
inhibits bcr abl |
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Trastuzumab
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monoclonal antibody against HER-2. helps kill breast cancer cells that overexpress HER-2
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carcinoma
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derive from epithelial tissue
squamous, glandular, or transitional |
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sarcoma
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derive from connective tissue
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hamartoma
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benign
non-neoplastic overgrowth of disorganized tissue indigenous to a particular site |
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Peutz Jehger's Syndrome
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Bening Polyposis Syndrome, associated with an increased risk of CRC and other visceral malignancies (pancreas, breast, stomach, ovary)
hamartomas polyps of the colon and small intestine, hyperpigmented mouth, lips, hands and genitalia |
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Amylase
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marker of acute pancreatitis, mumps, seen with bulemia
lipase is more specific for the pancreas |
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GGT
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seen with various liver disease, increased with heavy alcohol consumption
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Alkaline Phosphatase
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Seen with obstructive liver disease (hepatocellular carcinoma)
bone disease and bile duct disease |
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CRC cancer on the left_________ and on the right _________?
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On the left, it obstructs
On the right, it bleeds CEA tumor marker must screen patients over 50 with stool occult and colonscopies |
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tension pneumothorax
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mediastinal and trachea shift away from the collapsed lung
hyperlucent lung field compresses the diaphragm |
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glioblastoma multiform
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pseudopalisading malignant tumor cells
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chicken wire capillary pattern
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oligodendroglioma-- fried egg appearance
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c-myc
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Burkitt's Lymphoma (8, 14) cmyc gene moves next to heavy chain Ig gene (14)
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You have hep C, what is the most likely outcome?
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Chronic, stable hepatitis
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How do you treat status epilepticus?
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1st with lorazepam because it's fast acting
2nd use phenytoin |
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What lipid drugs are sued to decreased LDLs?
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Statins ans Ezetimibe
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Ezemtibibe
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decreases absorption of LDLs from the GI tract
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what are the structural genes for HIV?
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gag-- g24 and g7
pol-- reverse transcriptase env-- gp120 and gp41 |
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abetalipoproteinemia
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no apoB100 and no aopB48
Autosomal Recessive, sx appear in the first few years of life failure to thrive, steatorrhea, acanthocystosis, ataxia and night blindness |
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What happens if you have a lipoprotein lipase deficiency or altered apolipoprotein C-II?
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you would have increased chylomicrons, and elevated blood levels of TG and cholesterol
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What is familial hypercholesterolemia?
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Absent LDL receptors
Autosomal Dominant increased LDL levels |
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What is familiarl hypertriglyceridemia?
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increased VLDL and elevated serum levels of triglycerides
this is caused by a hepatic overproduction of VLDL |
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From what are the parafollicular (C cells) of the thyroid derived?
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neural crest
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Where are the thyroid follicular cells derived from?
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The Endoderm
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What are the VACTERL mesodermal defects?
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vertebral defects
anal atresia cardiac defects (unless the aortopulmonary septum-- neural crest) Tracheo-esophageal fistula renal defects limb defects |
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What are teratogens effects, and when are they most injurious?
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before week 3, all or none
after week 8: growth and function are affected ACE inhibitors: cause renal damage DES: vaginal clear cell adenocarcinoma Cocaine: abnormal fetal development, and fetal addiction, placental abruption Vitamin A: birth defects: cleft palate, cardiac abnormalities Thalidomide: flipper limbs Smoking: preterm labor, placental problems, IUGR, ADHD X rays or anticonvulsants: multiple anomalies Warfarin: bone deformities, fetal hemorrhage, abortion alkylating agents: absence of digits Folate Antagonists (TMP, MTX) neural tube defects aminoglycosides: VIII toxicity |
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When is the chorion formed? When is the amnion formed?
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Chorion: 3 weeks
Amnion: 8 weeks amnion surrounds the baby-- what they drink, pee |
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What is the difference between monozygotic and dizygotic twins?
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Mono: one placenta (2 amnions)
Di: two placentas (2 amnions) |
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Where do the fetal umbilical arteries derive from the in the fetus??
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Internal Iliac arteries to the placenta
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What is the urachus?
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Removes nitrogenous waste from the fetal bladder, like a urethra, connects to the allantois
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Where are the umbilical arteries and veins derived from?
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the allantois
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Vitelline fistula
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fistual between umbilicus and terminal ileium--> fecal discharge
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Urachal Fistula
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Fistula between the umbilicus and the bladder--> urinary disharge
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Truncus Arteriousus
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Gives rise to the pulmonary arteries and the ascending aorta
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Bulbus Cordis
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Gives rise to the smooth parts of the left and right ventricle
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Primitive Ventricle/Atria
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Trabeculated part of the left and right ventricle/atria
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What is the left horn of the sinus venosus
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becomes the coronary sinus
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What does the right horn of the SV give rise to?
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Smooth part of the right atrium
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Where does the SVC come from embryologically?
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the right common cardinal vein and the right anterior cardinal vein
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Where does the deoxygenated blood from the SVC go to in the fetus?
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Diverted into the pulmonary artery, through the Ductus Arteriosus to the lower body of the fetus through the internal iliac arteries, and then to the umbilical artery to bring to the placenta
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What decreases the prostaglandins causing the PDA closure in a baby?
|
the increased O2 causes a decreased PGE
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What is the postnatal derivative of the umbilical arteries? the allantois?
|
the mediaL umbilical ligaments
the allantois becomes the mediaN umbilical ligament |
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What are the aortic arch derivates?
|
1 Five-- 1st part of the maxillary artery
2 Seven Stapedial artery and hyoid artery 3 Nine common carotid artery and the proximal part of the internal carotid 4/6 Ten (4th arch, 4 limbs, SYSTEMIC) so it becomes the aortic arch on the left side, and on the right, the proximal part of the right subclavian artery The 6th arch: pulmonary and the pulmonary to systemic shunt (ductus arteriosus) |
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chiari type 2
|
cerebellar herniation through the foramen magnum--> aqueductal stenosis, hydrocephalus and often seen with a synringomyelia and thoracolumbar myelomeningocele
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|
treacher collins syndrome
|
1st neural arch fails to migrate, mandibular hypoplasia and facial abnormalities
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What branchial arch is the stylopharyngeus derived from?
|
so it's CN IX, which means it's branchial arch 3
the stylopharnygeus is innervated by the glossopharyngeal nerve |
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What branchial arches make up the posterior tongue?
|
branches 3 and 4 make the posterior 1/3
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What are the intrinsic muscles of the larynx innervated by?
|
Ten, except the cricothyroid
so the 4th arch (IX) is good for swallowing and the 6th arch (x-- recurrent laryngeal) is good for talking |
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what fails to fuse in a cleft palate?
|
the lateral palatine process, the nasal septum and or the median palatine process
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What happens in a cleft lip?
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failed fusion of the medial nasal processes to fuse with the maxillary process
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What does the diaphragm form from?
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Several
Parts Build Diaphragm SEptum Transversum (central tendon) Pleuroperitoneal folds Body wall Dorsal Mesentary of the esophagus |
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Gastrochisis
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failure of the lateral body folds to fuse--> extrusion of the abdominal contents through the abdominal folds
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Omphalocele
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persitence of herniation of abdominal contents through the umbilical cord
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Tell me about the spleen embryology
|
arises from the dorsal mesentary, thus it's derived from the mesoderm
but it is supplied by the artery of the foregut, the celiac artery |
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What is the embryological origin of the nephron-- from the glomerulus to the distal convulted tubule
|
metanephros
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What does the ureteric bud give rise to?
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The pelvis, collecting duct, calyces, ureter
it is derived from the mesonephros this is what doesn't form in potter's syndrome |
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paramesonephric duct
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the mullerian ducts--> develops into the fallopian tubes, uterus, and upper 1/3 of the vagina
Where does the lower 2/3 of the vagina come from? the UG sinus |
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What does the mesonephric ducts form?
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The male internal structures, except prostate
So, the seminal vesicles, the epididymis, the ejaculatory duct, and the ductus deferens |
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What secretes the MIF?
|
sertoli cells
the leydig cells secrete testosterone which helps the development of the mesonephric ducts (SEED) |
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What is the female and male counterparts of the genital tuburcle?
|
the penis and the clitoris
epispadias are abnormal openings of the penile urethra on the dorsal side, from a faulty positioning of the genital tuburcle |
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What is hypospadia from?
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more common than epispadias, and they are a failed urethra folds closure
what is the female counterpart to the urethral fold? the labia minora |
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What are the embryological origins of the female and male sex glands?
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urogenital sinus
females have bartholin and skene glands males have cowpers and prostate glands |
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techoic acid
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in gram positive cell walls and cell membranes-- induces IL-1 and TNF alpha
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|
what are the intracellular parasites?
|
chlamydia and rickettsia
chlamydia lacks muramic acid in the cell wall--> needs a giemsa stain |
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What needs Giemsa Stains?
|
Chlamydia, Borrelia, Plasmodium and trypanosomes
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What needs silver stains?
|
fungi and legionella
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What must you use to grow borderella pertussis?
|
Bordet Gengou (potato) agar
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What makes Clostridium, Bacteroides and Actinomyces obligate anaerobes?
|
they lack catalase and or superoxide dismutase, thus they are susceptible to oxidative damage
|
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what antibiotics require O2 to enter the cell?
|
aminoglycosides
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|
endotoxin
|
are stable at 100 degrees C for 1 hour whereas exotoxins are NOT heat stable, they are rapidly destroyed 60 degrees C except for staph
|
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|
What cytokines are released with superantigens?
|
bind directly to TCR and MHC II causing the release of IFN gamma and IL-2 (which come from the Th1 cell to activate the cytotoxic T cell)
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|
how does C. tetani work?
|
blocks the release of inhibitory neurotransmitters GABA and Glycine
lock jaw-- this is a TOXIN |
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Which bacteria have their endotoxins coded for in lysogenic phages?
|
ABCDE
shigA-like toxin Botulinum toxin (certain strains) Cholera Diptheria Erythrogenic toxin of GAS |
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alpha hemolytic
|
Strep Pneumo and Strep Viridans
pneumo is optochin senstive, bile soluble viridans is optochin resistant, bile insoluble pneumo has a capsule, viridans doesn't |
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|
beta hemolytic strep
|
GAS: bacitracin sensitive
GBS: bacitracin resistant beta hemolysis means its clear |
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gamma hemolytic strep
|
E faecalis and peptostreptococcus
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|
ASO titers
|
indicate a recent GAS infection
Strep PHaryngitis: gives rheumatic PHever and glomerulonePHritis JONES--O is a heart for myocarditis |
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D-glutamate
|
anthrax
|
|
|
what organisms produce IgA proteases?
|
the encapsulated ones-- that would have a postive Quellung reaction
H. influenza Strep Pneumo Neisseria Meningitidis |
|
|
pyruvate kinase deficiency
|
you can't convert PEP into pyruvate to generate ATP, because RBCS rely on glycolysis for ATP, pyruvate kinase deficiency
|
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|
Drugs to treat Alzhemiers
|
Vit E
Memantine (NMDA antagonist) Donepezil |
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|
Isoniazid
|
inhibits mycolic acid synthesis
|
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|
What do you give to treat cholinesterase inhibitor overdose (like organic phosphates)
|
atropine + pralidoxime
|
|
|
What are the direct agonists of the cholinomimetics?
|
bethanechol
carbachol-- glaucoma, pupil constriction, releases the intraocular pressure pilocarpine-- stimulates sweat and tears methacholine-- challenge test for asthma |
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What do you give for atropine overdose?
|
phyostigmine
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|
What is deficient in PKU?
|
phenylalanine hydroxylase--> don't get to tyrosine
can also be seen if you don't have Tetrahydrobiopterin, the cofactor for this makes tyrosine an essential amino acid |
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|
Where does cortisol play a role in the generation of catecholamines?
|
stimulates PNMT in the adrenal gland to make epinephrine from norepinephrine
|
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|
What is the first artery affected with atherosclerosis?
|
abdominal aorta
|
|
|
What is a side effect of first generation sulfonureas?
|
SIADH
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|
what is vWD associated with?
|
angiodyslplasia of the right colon
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Where do you see an IgG antibody against the IIa/IIIb receptors?
|
ITP, you get a peripheral destruction of platelets
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|
metryapone
|
Inhibits cortisol
|
|
|
What do you treat Tourette's Syndrome with?
|
Haloperidol-- antipsychotic
tourette's is associated with OCD onset is younger than 18 |
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schizophrenia
|
increased dopamine levels
decline over 6 months diagnosis requires 2 or more of the following 1. delusions (paranoid type) 2. hallucinations 3. disorganized speech (loose associations) 4. disorganized or catonic behavior 5. negative symptoms (flattened affect, social withdrawal, lack of motivation) genetic factors outweigh the environmental factors brief psychotic disorder (less than 1 month) 1-6 months: schizophreniform schizoaffective disorder: at least 2 weeks of stable mood, plus major depressive, manic or mixed (depressed, or bipolar) presents earlier in men than women (20-30) |
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What do you treat benzodiazepine overdose with?
|
flumazenil
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|
Patient having delirium tremens, what do you give him?
|
benzodiazepine
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What are the opoids?
|
heroin, morphine, methadone
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|
|
What are the depressants?
|
alcohol (overdose give supportive care)
Benzodiazepines (overdose give flumazenil) Barbiturates (overdose give support) Opoids (overdose give nalozone/naltrexone) |
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|
What are the stimulants?
|
amphetamines
cocaine caffeine nicotine cocaine and amphetamine see pupillary dilation |
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|
what are the hallucinogens?
|
PCP--belligerence
THC LSD-- flashbacks |
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antipsychotics (typical)
|
haloperidol + -azines
Used for the positive symptoms of schizophrenia, also used for tourette's, psychosis and acute mania D2 blockers, (also block alpha and histamine receptors-- leading to sedation and dry mouth as additional side effects) remember, schizophrenia has elevated dopamine levels lower potency: thioridazine and chloropromazine (have no neurological side effects) |
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atypical antispychotics
|
also block the 5-HT receptors, along with D2, alpha and histamine receptors
can treat the negative sx of schizophrenia It's not Atypical for OLd CLOSets to RISPER QUIETly risperidone has the highest liklihood for EPS symptoms, and clozapine may cause agranulocytosis olazapine can be used to treat psychosis, OCD, anxiety disorder, depression, mania |
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|
lithium
|
toxicity
LMNOP movement disorder nephrogenic diabetes insipidus hypOthyroidism pregnancy problems |
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|
mirtazapine
|
antidepressent that is an alpha 2 antagonist, along with a 5HT 23 antagonist that causes weight gain
|
|
|
drugs that may cause seizures?
|
you better stand BII for the seizures!
Buproprion Imipenem Isoniazid (if given w/out B6) |
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|
struma ovarii
|
teratoma of the ovary that contains thyroid tissue
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|
|
pseudomyxoma peritonei
|
intraperitoneal acculumaltiong of mucinous material from ovarian or appendiceal tumor
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|
|
call exner bodies
|
small follicles filled with eosinophilic secretions
seen in granulosa cell tumor precocious puberty in a little kid-- premature estrogen stimulation of the granulosa cell tumor |
|
|
sarcoma boitryoides
|
vaginal carcinoma (rhabdomyosarcoma) that is desmin postive
seeen in little girls under 4 |
|
|
ovarian fibroma
|
Meigs Syndrome
ovarian fibroma ascites hydrothorax pulling sensation in the groin |
|
|
serous or bloody discharge
|
intraductal papilloma
small tumor that grows in the lactiferous ducts, typically below the areola |
|
|
phyllodes tumor
|
LARGE, leaf like projections
most common in the 6th decase, some may become malignant |
|
|
acute mastitis
|
breast abscess during feeding, increased risk of bacterial infection through cracks in the nipple. S. aureus is the most common pathogen
|
|
|
fibrocystic disease
|
most common cause of breast lumps from age 25 to menopause--> occurs in the reproductive peroid of life
1. fibrosis 2. cystic: blue cystic domes 3. sclerosing adenosis (often confused with inflitrating ductal) 4. epithelial hyperplasia (increased risk of carcinoma with atypical cells) |
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|
ductal carcinoma in situ
|
non invasive
patterns: cribiform, comedo--> dilated ducts |
|
|
prostate adenocarcinoma
|
increased total PSA with decreased fraction of FREE PSA
tx: GNRH agonists (leuprolife and goserlin) |
|
|
Testicular Tumors
|
95% are germ cell; and malignant
seminoma: most common, fried egg appearance embryonal carcinoma choriocarcinoma: increased hCG teratoma: mature in males, is often malignany |
|
|
Testicular Seminoma
|
testicular tumor, germ cell
most common tumor, painless, late metastasis, excellent prognosis |
|
|
Reinke Crystals
|
Leydig cell tumor, causes gynecomastia in males and precocious puberty in boys
|
|
|
Michaelis Gutmann Bodies
|
yellow plaques in the bladder due to chronic cystis
foamy macrophages filled with laminated minerliazed concretions |
|
|
squamous cell carcinoma of the bladder
|
associated with schistoma hematobium-- common cancer in Egypt
eggs are surrounded by eosinophils, IgE antibodies are attached to the eggs. Eosinophils have Fc receptors for IgE, the eosinophils attach to the IgE and release major basic protein which destroys the egg--> type II hypersensitivity reaction |
|
|
torsion of the testicles
|
usually from trauma
twisting of the spermatic cord cuts off the venous/arterial blood supply sudden onset of testicular pain absent cremasteric reflex (the scrotum usually retracts when stroking the inner thigh) the testicle is drawn up into the inguinal canal |
|
|
prostatitis
|
acute (e.coli, k. pneumo, p. aeruginosa) or chronic (generally abacterial)
|
|
|
what role does testosterone play in impotence?
|
testosterone is only involved in psychic desire, no role for the ability to sustain an erection
impotence is the mosy common manifestation of hypogonadism |
|
|
beta 2 agonists that relax the uterus
|
ritodrine and terbutaline
|
|
|
obligate anaerobes
|
Nagging Pests Must Breathe
Nocardia Pseudomonas Aeruginosus Mycobacterium Tuberculi Bacillus |
|
|
obligate anaerobes
|
Can't Breath Air
Clostridium Bacteroides Actinomyces they lack catalase or superoxide dismutase, thus susceptible to oxidative damage |
|
|
intracellular bugs
obligative vs facultative |
obligative: stay inside when it's really cold
rickettsia and chlamydia facultative: Some Nasy Bugs May Live FacultativeLY Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia |
|
|
IgA protease as virulence factor?
|
Neisseria, Strep Pneumo and H Influenza
|
|
|
What does protein A of staph aureus do?
|
binds the Fc region of IgG, disrupting opsonization and phagocytosis
|
|
|
What does the M protein of GAS do?
|
prevents phagocytosis
|
|
|
shiga toxin
|
by shigella and by e coli
cleaves the host cell rRNA and inactivates the 60S ribosome and enhances cytokine release causing HUS |
|
|
what are the superantigens?
|
TSS-1 from staph aureus
GAS-- scarlet fever these bind the MHCII and TCR activating large numbers of T cells to stimulate the release of IFN gamma and IL-2 |
|
|
ADP ribosylating toxins
|
AB toxins
Diptheria--Ef-2 elongation Cholera-- ADP ribosylation of G protein stimulates adenylate cyclase, increase Cl- pumped into the gut and decreased Na+ absorption E. coli (lable stimulates adenylate cyclase and heat stable does guanyl cyclase) Pertussis: increase cAMP by inhibiting G alpha inhibitory |
|
|
Clostridium Perfringens
|
alpha toxin causes gangrene; gets double zone of hemolysis on blood agar
lecinthinase splits phospholipids |
|
|
endotoxin
|
part of the gram negative wall
Lipid A activates macrophages (IL1, TNF, NO) activates the alternative pathway (C3a and C5a) Activates Hagemann Factor (DIC) |
|
|
Genes for these bacteria are encoded in a lysogenic phage
|
shigA
Botulinum Cholera Diptheria Erythrogenic toxin of GAS |
|
|
enterobacteria
|
COFFEe
Capsule O antigen Flagellar antigen Ferments Glucose Enterobacteri includes: E. coli, Salmonella, Shigella, Klebsiella, Serratia and Proteus they all ferment glucose and they are all oxidase negative |
|
|
pneumonia in an alcoholic?
|
Klebsiella-- red currant jelly sputum
klebsiella may also cause nosocomial UTIs |
|
|
what bug mimics chrohn's or appendicitis?
|
yersina enterocolitis
|
|
|
what are the sequela of lyme's disease?
|
Bell's palsy
Arthritis Kardiac block Erythema chronica migrans |
|
|
Yaws
|
infection of skin, bone and joints--> healing with keloids cause severe bone deformities
not an STD, but VDRL positive |
|
|
brucellosis
|
undulant fever, from unpasteurized dairy
|
|
|
headache, fever, vasculitis
|
Rickettsia
they all require CoA and NAD treatment for all rickettsias are tetracycline Q Fever is Queer, no rash, no vector, negative Weil Felix reaction |
|
|
palm and sole rashes
|
CARS
Coxsackie A Rocky Mountain Spotted Fever (rickettsia) Syphillus |
|
|
campylobacter
|
causes bloody diarrhea
comma shaped oxidase positive growth at 42 degrees |
|
|
shigella and salmonella
|
both lactose negative
shigella: very low ID50 Salmonella has flagellar motility and produce H2S salmonella can remain in the gallbladder indefinitely |
|
|
yersinia enterocolitica
|
can mimic appenditicis or crohn's
causes a bloody diarhea |
|
|
what are the watery diarrheas?
|
cholera
ETEC viruses (adenovirus, rotavirus, norwalk) protozoan (giardia and cryptosporidium) c. perfringens |
|
|
viral causes of meningitis?
|
enteroviruses (coxsacckie)
HSV HIV west nile virus VZV |
|
|
meningitis in HIV patients?
|
cryptococcus
JC polyoma virus CMV toxoplasmosis |
|
|
pneumonia in HIV patients?
|
pneumocystis jirovecii
|
|
|
pneumonia post-viral infection
|
staph, H influenza
|
|
|
atypical pneumonia
|
mycoplasma
legionella chlamydia |
|
|
pneumonia in kids
|
Runts May Cough Sputum
RSV Mycoplasma Chlamydia Pneumonia Strep Pneumo |
