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213 Cards in this Set

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Which respiratory structures have stratified squamous epithelium
The oropharynx, laryngopharynx, anterior epiglottis, upper half of the posterior epiglottis, and the vocal folds (True vocal cords)
Which respiratory structures have pseudostratified columnar
mucus secreting epithelium,The nose, paranasal sinuses, nasopharynx, most of the larynx and the tracheobronchial tree
What is shaken baby syndrome?
Characterized by subdural hematoma and bilateral retinal hemorrhages in an infant. Due to vigorous shaking.
What are skull fractures associated with?
Tears of the middle meningeal artery and subsequent epidural hematoma
What is the most common coagulation abnormality in children?
Hemophilia A. Present with soft tissue and joint hemorrhages
What is sildenafil?
A selective inhibitor of the cGMP phosphodiesterase→ increased cGMP levels. Nitric oxide and atrial natriuretic peptide act via the same system.
What is the triad of pericardial tamponade?
Muffled heart sounds, elevated jugular venous pressure, and profound hypotension.
Caused by= rupture of the ventricular free wall as a consequence of an acute transmural MI. Usually occurs 3-7 days after onset of total ischemia.
What is the most effective preventive intervention in almost every patient?
Smoking cessation!
What is a fourth heart sound? And what does it indicate?
Low frequency heart sound at the end of diastole just before S1. Due to decreased left ventricular compliance. Associated with restrictive cardiomyopathy and left ventricular hypertrophy ( the louder the sound, the worse)
What are apocrine glands?
Secrete sweat into hair follicles, and are initially odorless, but can become malodorous secondary to bacterial decomposition on the sin surface.
Not functional until puberty; change through female menstrual cycle.
What are holocrine glands?
Found in association with sebaceous glands
What do merocrine glands secrete?
Watery, fluid rich in sodium and chloride (Sweat) directly to the skin surface
What is secretory form of IgA?
Consists of 2 monomers (J chain and secretory component). Abundant in tears, saliva, mucus, and colostrum (breast milk). Provides infant with passive mucosal immunity
What are anti-inflammatory cytokines?
IL-10 and TGF-B
What are pro-inflammatory cytokines?
IL-1, 4 ,5, 12
What is Thiazolidinediones and how does it act?
Anti-diabetic medication. Binds to peroxisome proliferator-activated receptor-gamma (PPAR-gamma)—acts to increase adiponectin levels which decreases insulin resistance.
How does left ventricular failure present?
Presentation= progressive dyspnea and orthopnea (coughing when lying down).
X-ray= cardiomegaly, pleural effusions (blunting of costophrenic angles), edema, increased vascular shadowing, kerley B lines
What are common triggers for acute heart failure?
Myocardial infarction, severe hypertension, arrhythmias, and drug use (Cocaine)
How does acute respiratory distress syndrome (ARDS) present?
Acute onset, x-ray= bilateral patchy airspace. Caused by an inciting factor such as sepsis, aspiration, pneumonia, or trauma.
DOES NOT have cardiomegaly or jugular venous distention
Describe the innervation of the tongue
Somatic sensory anterior 2/3 of tongue= mandibular division of trigeminal nerve.
Taste sensation to anterior 2/3 of tongue= chorda tympani of facial nerve.
Somatic sensory and taste to posterior 1/3= glossopharyngeal nerve.
Describe the motor innervation of the tongue
All intrinsic muscles EXCEPT palatoglossus muscle = hypoglossal nerve.
Vagus nerve innervates palatoglossus.
What is ticlopidine and what is a serious complication?
Antiplatelet medication. Neutropenia with fever and mouth ulcers.
Useful for prevention and treatment of ischemic strokes, acute coronary syndrome and peripheral vascular disease.
Bell-shaped distribution
68%- 1 standard deviation from the mean
95% within 2 standard deviations
99.7% within 3 standard deviations
What is the relationship between TBG and Thyroid levels?
An increase in TBG leads to an increase in total T4 (bound plus free) and total T3. Level of free thyroid hormone remains normal.
When can thyroid binding globulin increase?
Pregnancy, use of contraceptives, or with hormone replacement therapy. Due to estrogen’s effect on thyroid hormones. (Catabolism of TBG declines with increasing estrogen)
What are the findings associated with congestive heart failure?
Inadequate visceral perfusion causes activation of sympathetics and renin-angiotensin-aldosterone system. Angiotensin converting enzyme is made and released from the endothelium of lung vessels
Sickle cell trait
Asymptomatic and have relative protection from malaria. Be aware that their cells will sickle when sodium metabisulfite is added
What are the components of the Fick principle and why is it used?
Cardiac output is equal to oxygen consumption by the tissues divided by the arteriovenous oxygen difference.
How does Vitamin B12 deficiency occur and how is correctable?
Poor absorption secondary to gastric atrophy, intrinsic factor deficiency, or terminal ileal disease (rarely due to dietary). Corrected with parenteral B12
What is the inheritance pattern of X-linked recessive?
Affected males will always produce unaffected sons and carrier daughters.
Carrier females will have a 50% chance of producing affected sons and carrier daughters. Example= G6PD deficiency
What is the inheritance pattern of X-linked dominance?
Affected males will always produce affected daughters, but none of his sons will be affected
What are actinic keratoses?
Small, erythematous, epidermal lesions with adherent scale. There will be basal cell atypia, hyperkeratosis, and parakeratosis.
Result of chronic sun exposure.
Small percentage will progess to invasive squamous cell carcinoma
What is Karposi’s sarcoma?
Associated with HHV-8. Lesions are found on extremities, head and neck. Palpable and dark brown-violet color
What is Basal cell carcinoma?
Most common skin cancer. Arises on sun-exposed areas and has low tendency to metastasize.
Presents as pearly papules with central depression or ulceration.
How does the IP3 second messenger system work?
Hormone binds and G-protein activated (Gq). Gq activates phospholipase C which then converts lipids into PIP2-→ which breaks into DAG and IP3. IP3 will cause an increase in intracellular Ca, while DAG will increase protein kinase C
What is the presentation for Chlamydia trachomatis?
Serotypes L1-3 will cause painless ulcers with later progression to painful inguinal lymphadenopathy and ulceration.
Histology will show inclusion bodies in cytoplasm.
What is the presentation for Haemophilis ducreyi?
Ulcerative, chancroid. Within a few days there will be a tender, red papule on external genitals that eventually erodes to become painful ulcer. Regional lymph nodes will swell and may become ulcers.
What is the presentation of HSV2?
Most common genital herpes. Vesicles on mucous membranes of the genitalia. Lesions are painful and heal within 10 days.
Histology shows multinucleated giant cells and large pinkish-purple intranuclear inclusions (Cowdry A bodies)
How do you measure renal blood flow?
Divide renal plasma flow by (1-hematocrit).
Renal plasma flow= PAH clearance= (urine [PAH]x urine flow rate)/plasma [PAH]
What is vibrio cholerae?
Oxidase-positive, gram-negative, comma shaped rad. Able to grow on alkaline environment and kills most organisms of normal flora.
DOES NOT cause cell death—will not see blood or pus on stool microscopy
What is lecithinase?
Toxin produced by C. perfringens.
Function= degrade lecithin = component of phospholipid membrane→ destruction and cell death. Widespread necrosis and hemolysis result
What happens after a lesion to the optic tract?
Contralateral homonymous hemianopia and a relative afferent papillary defect (Marcus Gunn pupil) in the contralateral eye.
What is a Marcus Gunn pupil? How can you test it?
Afferent papillary defect in the contralateral eye.
Test with swinging flashlight test; patient’s pupils constrict less (appear to dilate) when a bright light is swung from the unaffected eye to the affected eye
What is Rituximab’s MOA?
Monoclonal antibody directed against the CD20 antigen. Improves prognosis of lymphomas.
What is Infliximab’s MOA?
Chimeric IgG1 monoclonal antibody to TNF-alpha.
- Significant impact on treatment of rheumatoid arthritis. - Also used to treat anklylosing spondylitis and fistulizing crohn’s disease
What does amniocentesis measure at 35 weeks?
Phospholipid content to determine fetal lung maturity. Phospholipids are a major component of surfactant (required to maintain lung airway)
Cardiac presentation of rheumatic fever?
Diffuse fibrous thickening and distortion of mitral valve leaflets→ atrial dilation.
What is the most common cause of mitral stenosis?
Rheumatic fever
What is tardive dyskinesia?
Involuntary perioral movements such as biting, chewing, grimacing, and tongue protrusions.
- Usually arises between 4 months and 4 years of treatment with anti-psychotics.
- May be reversible
What does trisomy 21 mean? What are longterm risks?
Down Syndrome. Patients are at greater risk for developing acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML)
What infection are patients at risk for following lung transplant?
CMV= enveloped double-stranded DNA virus.
Presents with interstitial pneumonia and cytoplasmic inclusion bodies
How does valproic acid work?
Use for myoclonic seizures.
- Suppresses abnormal electric activity by affecting GABA and NMDA receptors, as well as Na and K channels
Describe the findings with atrial myxoma
Constitutional symptoms, mid-diastolic rumbling murmur heard over apex, positional dyspnea and a large pedunculated mass in the left atrium.
What are the histological findings for myxomas?
Scattered cells within a mucopolysaccharide stroma, abnormal blood vessels and hemorrhaging
What are the most common cardiac neoplasms?
Myxoma
Which drug can precipitate opioid withdrawal symptoms in a patient using morphine?
Pentazocine
What is pyloric stenosis
arises secondary to hypertrophy of the pyloric muscularis mucosa.
- Symptoms= projectile non-bilious vomiting after every meal
- more common in male infants
- treatment= surgical splitting of muscle
What is Whipple disease
rare systemic illness that involves small intestine, joints, and central nervous system
Histology= mucosa containing enlarged, foamy macrophages packed with rod-shaped bacilli and PAS-positive.
treatment= antibiotics
typical presentation= middle-aged caucasian males presenting with malabsorption with diarrhea and weight loss
the most common cause of acquired pneumonia in immunocompromised host (HIV patient with CD4 >200)
Streptococcus pneumoniae
Describe the presentation of Huntington's
Dementia and choreiform movement
Characterized by a loss of GABA containing neurons in striatum
Disease is neurodegenerative and autosomal dominant
What is the difference between Type I and II pneumocytes
type I cells are flat and cover the alveolar surface. Type II are cuboidal and serve two roles: produce surfactant and replace alveolar epithelium after injury
What are Clara cells
non-ciliated, secretory constituents of the terminal respiratory epithelium. They inhibit neutrophil recruitment and activation
What are the effects of THC (marijuana)
mild euphoria with laughing behavior, slowed reflexes, dizziness, impaired coordination and short term memory loss.
Physical symptoms= rapid heart rate and conjunctival injection
What are the three etiologies of Hepatocellular carcinoma?
- viral infection with Hep B or C--- when viral DNA is integrated into the genome--> neoplastic changes
- chronic alcoholism (+/- development of cirrhosis)
- consumption of food contaminants
- hemochromatosis
Symptoms of Hepatocellular carcinoma
upper abdominal pain, malaise, fatigue, weight loss and sometimes sensation of abdominal fullness.
Key= Elevated AFP
Describe the etiology and presentation of hepatic adenomas
young and middle-aged women who have used OCPs
Complain of abdominal pain in epigastrium or right upper quadrant.
Serum AFPs are NOT elevated
What is Klinefelter's
47XXY, affects males and is characterized by tall stature, poorly developed secondary characteristics, atrophic testes and infertility
what is Turner's
45X0, common cause of primary amenorrhea. Short stature, webbed neck, shielded crest and "streaked" ovaries. Do Not develop secondary sex characteristics
What is Kallman syndrome
due to diminished synthesis of gonadotropic hormones by the anterior pituitary. Result= primary amenorrhea, absent secondary sex characteristics and an olfactory sensory defect
What is the most important determinant in peak bone mass?
Genetics
What is Splitting
Defense MEchanism: unconscious belief that people are either wholly good or wholly bad. "Black and white" thinking. Common in borderline personality.
What is Reaction Formation
the redirection of unacceptable impulse into its opposite.
What is Sublimation
Mature Defense Mechanism: involves channeling an unacceptable impulse into an acceptable form of behavior.
What is graft-versus-host disease
mediated by T-lymphocytes of the donor tissue
sensitized against: MHC antigens of the recipient
Most commonly affected= skin, liver and GI tract
What is Berkson's bias?
selection bias created by selecting hospitalized patients as the control group
What is the Hawthorne effect
the tendency of a study population to affect an outcome due to knowledge of being studied.
What structure will have increased pressure in alcoholic cirrhosis and why?
Portal vein. Due to hepatocyte death followed by fibrosis. Blood flow will have an increasingly difficult time passing through the liver due to the compromised vasculature
What is the triple test (gestation)
used to determine AFP, hCG and estriol levels. Should be performed between weeks 16-18.
what is the role of the ventromedial hypothalamic nuclei
satiety center and regulation of food intake
Lesion- obesity secondary to hyperphagia and aggressive behavior
What is the role of the lateral hypothalamic nuclei
signal hunger
Bilateral lesions= lose desire to eat
What is the role of the suprachiasmatic nuclei
regulate circardian rhythms
what is the role of the supraoptic and paraventricular nuclei
produce vasopressin (ADH) and oxytocin
What is the difference between the anterior and posterior hypothalamic nuclei
anterior= cooling--- lesion= hyperthermia
posterior= warming-- lesion=hypothermia
Describe the presentation of Giant Cell Arteritis (GCA)
patients older than 50; causes headache, facial pain, jaw claudication, and irreversible vision loss. ESR will be elevated
Must treat immediately with prednisone
What is hereditary pancreatitis? how is it caused?
mutation in the gene that encodes the trypsinogen molecule. The trypsinogen will no longer be susceptible to inhibition. If activated prematurely, it can cause autodigestion of the pancreatic tissue
What is the neurohypophysis
Posterior pituitary
what is Secretin?
a hormone produced by duodenal S-cells in response to increased duodenal H+ concentrations. Stimulates pancreatic ductal cells to increase bicarb secretion.
What is serum sickness
Type III hypersensitivity= fever, urticaria, arthralgias, glomerulonephritis, and lymphadenopathy 5-10 days post-exposure.
Result= low serum C3
What are two ways to maintain plasma glucose between meals
gluconeogenesis and glycogenolysis (glycogen runs out after 12-18 hours)
what is the initial committed step of gluconeogenesis
conversion of pyruvate to oxaloacetate and then oxaloacetate to phosphoenolpyruvate
What are snRNPs
small nuclear ribonucleoproteins. Synthesized by RNA polymerase II. Help remove introns from RNA transcript
What is the myelopathy associated with vitamin B12 deficiency
subacute combined degeneration: ascending (dorsal columns) and descending (corticospinal) pathways --> loss of position and vibration sensation, ataxia and spastic paresis
What is syringomyelia
Cyst within the spinal cord--> destroys lateral spinothalamic tract= bilateral loss of pain and temp
Describe the presentation of amyotrophic lateral sclerosis
upper and lower motor lesions--> spasticity and hyperreflexia (lateral corticospinal tract) ; flaccid paralysis, atrophy and fasciculation (anterior horn)
Which protein outside the nucleosome core facilitates nucleosome packing into a more compact structure?
Histone H1
Describe the pathogenesis of hemochromatosis
mutation of the HFE protein on the basolateral surface of the intestinal cells. Prevents binding to transferrin receptor and endocytosis of transferrin/iron complex.
Result= upregulated expression of iron uptake proteins and excessive iron absorbed
What are patients with hemochromatosis at risk for?
Liver cirrhosis and hepatocellular carcinoma
What does a ring-enhancing lesion in both cerebral hemispheres indicate (in HIV patient)
Toxoplasmosis infection.
first line treatment= pyrimethamine and sulfadiazine
Primary CNS lymphoma's are comprised of what cell response?
B-lymphocytes
What bacteria is responsible for most UTIs in sexually active women?
Staphylococcus saprophyticus. It is catalase +, coagulase -, and resistant to novobiocin
How do you differentiate between Staphylococci and Streptococci?
Catalase test (+= staph)
What is the coagulase test? Use?
measures the ability to clot blood plasma -- separates staphylococci.
Coag += pathogenic species = staph aureus
Coag -= exist as normal flora (s. epidermis or saprophyticus)
What medications increase the risk of gallstone formation?
Gemifibrozil (fibrate) and cholestyramine (bile acid-binding resin).
increase cholesterol excretion by the livery and reduce LDL
What is the MOA of bile acid-binding resins
Bind to bile acid in the GI tract and interfere with its enterohepatic circulation.
Hepatic cholesterol will be consumed to re-synthesize bile acids --> reduced LDL
What is the MOA of "azoles" meds
anti-fungal; inhibit demethylation of lanoesterol into ergosterol (essential component of fungal cell membrane).
They also inhibit P450 cytochrome oxidase
Drug interactions with azoles
cytochrome oxidase inducers= rifampin, phenytoin, carbamazepine, and phenobarbital ---> decrease azole concentration

do not use with other drugs that are metabolized by liver P450 system--> toxicity
What causes right ventricular hypertrophy?
primary pulmonary hypertension due to diseased lung parenchyma
Be suspicious in women ages 20-40
How do sex hormones affect growth?
promote growth and epiphyseal plate closure
- precocious puberty may result in shorter stature.
What is the effect of excess IGF-1
Also called somatomedin C.
gigantism without premature closure of epiphysis
What is Flutamide used for? MOA?
Prostate cancer treatment. It is a non-steroidal anti-androgen that competes with testosterone and DHT for testosterone receptors.
Does NOT affect testosterone production
What medication is used for intermittent claudication and preventing platelet aggregatoin?
Cilostazol
decreases the activity of platelet phosphodiesterase (enzyme responsible for the breakdown of cyclic AMP)
Why use a second generation anti-histamine? And give an example
Fexofenadine. Does not have cross blood brain barrier--> minimal sedation and anti-muscarinic effects (lower side effect profile)
What are direct thrombin inhibitors. MOA?
Hirudin, lepirudin and argatroban. Binds to the thrombin active site (do not require antithrombin III for action)
Treatment of choice for Heparin-induced thrombocytopenia.
What is hemiballism
involuntary flinging movements of one side of the body (contralateral to the subthalamic basal ganglia lesion)
Lesions in the brain and their disease
lentiform nucleus= Wilson disease
substantia nigra= Parkinson's disease
Caudate nucleus atrophy= Huntington disease
how is fructose metabolized in patients with essential fructosuria?
hexokinase
What is leprosy
Disease caused by Mycobacterium leprae
Severity determined by the strength of the cell-mediated immune response
Manifestations= skin thickening, cutaneous hypopigmentation in plaques, hair follicle loss and focally decreased sensation
what is a hallmark of cell injury and death?
Dystrophic calcification --- most common site= damaged cardiac valves
What toxins have superantigen activity?
Enterotoxins, Exfoliative toxins and Toxic Shock Syndrome Toxin
- interact with T cells --> widespread response and release of IL-2 (T cells) and IL-1 and TNF (macrophages)
what cancer has occupational exposures (rubber, aromatic amines) as a risk factor
transitional cell carcinoma of the bladder
- presents with gross hematuria in elderly men
- smoking is another risk factor
What is the differential for mitral valve thickening with vegetations
- infectious endocarditis
- rheumatic valvulitis
-Libman-Sacks endocarditis associated with SLE
- non-bacterial thrombotic endocarditis
What is Isoretinoin used for?
severe acne, refractory to topical therapies.
Adverse effects= hypertriglyceridemia and teratogenicity.
Need monthly pregnancy tests--- B-HCG levels
What are Granulosa cell tumors
estrogen-secreting primary ovarian tumors.
Can cause endometrial hyperplasia and abnormal uterine bleeding. May predispose patient to endometrial adenocarcinoma.
Finding= adnexal mass
Fever, pharyngitis, hepatosplenomegaly and generalized lymphadenopathy are signs of?
Infectious mononucleosis.
Histology= atypical lymphocytes on peripheral smear
caused by EBV infection
What is EBV associated with?
increased incidence of Burkitt's lymphoma and nasopharyngeal carcinoma
How should you treat someone with WBC >100,000, no crystals, but presents with knee pain and swelling
Bacterial joint infection = septic arthritis= Ceftriaxone immediately!
What's associated with low alpha-fetoprotein level in pregnancy
Down's (Trisomy 21)
(no change with Turner's or fetal alcohol syndrome)
What forms the IVC
union of the right and left common iliac veins at the level of L4-5.
Which tissue can use triglycerides to make glycerol-->glucose
Liver
Uses glycerol kinase
What is Autosomal Dominant Polycystic Kidney disease
Occurs in adults
Characteristics= anorexia, hematuria, polyuria, proteinuria, HTN abdo discomfort (asymptomatic until 4th or 5th decade)
Kidney cysts when they're born, liver cysts develop in their 50s
What is Autosomal Recessive polycystic kidney disease
occurs in infants. Die shortly after birth or within the first few years
Examples of mitochondrial diseases
Myoclonic epilepsy (with ragged red fibers)
KEarns-Sayre syndrome
LEber's hereditary optic neuropathy
What is an example of infertility treatment (hormonal)
GnRH administered in pulsatile fashion---> stimulates FSH and LH in the same cyclic pattern

*infusion/constant--> inhibits FSH and LH
A unilateral vesicular rash localized on a single dermatome is...
herpes zoster.
Post-herpetic neuralgia is the most common neurological complaint in VZV infection
NK cells
responsible for the destruction of cells with decreased or absent MHC class I on their surface. Occurs in virus-infected cells and tumor cells
Kill by inducing apoptosis
Use perforin and granzyme
Do express= CD 16 or CD 56
Do not require thymus for maturation
activated by IFN-gamma and IL-12
What is the most common cause of retinitis in HIV+
CMV
treat with ganciclovir when CD4<50
What do you use Leukocyte IFN-alpha for?
treatment of Hep B and C
hairy cell leukemia
condyloma acuminatum
Kaposi'a sarcoma
What are the risks associated with asbestos exposure
most common= Bronchogenic carcinoma of the lung
second most common= mesothelioma

Clinical manifestations usually appear 15-20 years after initial exposure
What fungus can cause chronic pneumonia in immunocompetent
Bastomyces dermatitidis
What causes chronic pneumonia in immunocompromised
Pneumocystis jiroveci
What are Reed-Sternberg cells
Owl eyes
derived from B-lymphocytes
neoplastic cells of Hodgkin Lymphoma
What are the effects of angiotensin II
- systemic vasoconstriction
- preferential constriction of glomerular efferent arteriole
- enhancement of adrenal cortical aldosterone secretion

ACEI= reduce GFR by dilating efferent arteriole
What are granulosa cell tumors
sex-cord stromal tumors
secrete estrogen
often unilateral and variable in size, with lipid content (yellow appearance)
Risk factors for osteoporosis
1. smoking
2. menopause
3. corticosteroid therapy
4. physical activity
5. Caucasian race
6. low total body weight
7. alcohol
What is haptoglobin
plasma protein that binds free hemoglobin in order to prevent renal secretion
When is haptoglobin elevated
Sickle cell disease--> hemolysis
What are the manifestations of sickle cell
1. Hemolysis
2. vasoocclusive symptoms = dactylitis (painful swelling of hands and feet)-- common early in life
3. Infections= prone to infection with encapsulated organisms
What is normal urine osmolality after dehydration
>800 mOsm/L
Test by administering vasopressin
Drinking too much water---> lowers osmolality. Place patient on water restriction
How to treat severe, uncontrolled asthma
First try inhaled steroids and long-acting beta agonists
If related to allergies, try anti-IgE antibodies = Omalizumab
What does the histology of acute myelogenous leukemia (AML) look like?
immature myeloid cells= myeloblasts -- basophilic
presence of Auer rods = stain for myeloperoxidase
What causes typhoid fever
Salmonella typhi and paratyphi
presentation= escalating fever with initial diarrhea or constipation followed by hepatosplenomegaly, "rose spots" on abdomen and possible hemorrhage enteritis
How does Salmonella typhi damage cells
phagocytosed by macrophages (and survive)
cause drastic inflammation within Peyer's patches --> intestinal hemorrhage
also damage liver, spleen and bone marrow
Hep B infection causes....(histology)
Hepatocellular cytoplasm to fill with spheres and tubules of HBsAg = will look finely granular, eosinophilic
"Ground glass"
What is the epidemiology and signs of viral bronchiolitis
children under 2, due to RSV infection
Signs= rhonchi, wheezing
How to treat viral bronchiolitis
Ribavirin (if at risk for disease progression)
What are side effects related to direct arteriolar vasodilators (hydralazine and minoxidil)
reflex tachycardia and edema (sodium and fluid retention)
What is the pathophysiology behind cystic fibrosis
mutation in the chloride channel gene (CFTR), impairs posttranslational processing--> degradation of the regulatory channel before it ever gets transported to the cell surface.

Result= no CFTR protein on apical membrane
How is Listeria monocytogenes destroyed?
via cell-mediated immunity. --> cytokine production--> signals macrophages to ingest listeria
What populations are affected by Listeria monocytogenes
Immunocompromised, elderly, newborns, pregnant women
*can be transmitted transplacentally or during birth
What is a pathognomonic sign for acute pyelonephritis when accompanied by febrile illness
WBC casts
Which cells utilize alternative glycolytic pathway that produces no ATP
Erythrocytes
utilize bisphosphoglycerate mutase-->2,3BPG
don't have mitochondria
Signs of Scleroderma (CREST)
sclerodactyly
Raynaud's syndrome (cold-induced digital vasospasm)
Pulmonary hypertension --- accentuated pulmonary component of 2nd heart sound and signs of right-sided failure
How does scleroderma develop
increased deposition of collagen in tissues
Triggered by increased prolif and accumulation of monoclonal T-cells--> increased cytokine secretion, TGF-beta
Effects the small arterioles and capillaries first
What is Reiter syndrome? Sx?
reactive arthritis --> causes asymmetric inflammatory arthritis of lower extremities in men
Signs=
non-gonococcal urethritis
conjunctivitis
arthritis of knees esp
may also have sacroiliitis (20%-- spondyloarthropathies)
Why perform a cricothyrotomy and what structures do you cut through?
patient needs an emergency airway
skin, superficial cervical fascia, pretracheal fascia and cricothyroid ligament
What enzyme is involved in adenoma progression>
cyclooxygenase-2
Also requires an inactivation of APC tumor suppressor gene
During muscle contraction, what is responsible for the release of the myosin head from actin?
ATP
without ATP= rigor mortis
How can you prevent neonatal tetanus
vaccinate pregnant women with tetanus toxoid --> generate and transfer protective IgG antitoxin to fetus
prolonged PT vs prolonged PTT... what does it mean
prolonged PT= extrinsic pathway (Factor VII)
prolonged PTT= intrinsic pathway (Factor XI, IX, X, VIII)
What is the role of Secretin, where is it secreted
Secreted by the duodenum in response to HCl
Effect= stimulates release of bicarb from exocrine pancreas
What is the result of having a panic attack (pulmonary)
hyperventilation--> respiratory alkalosis and decrease pCO2
Hypocapnia causes cerebral vasoconstriction and decreased cerebral blood flow
Following a MI, using adenosine and dipyridamole has what effect?
vasodilates coronary vessels in nonischemic areas.
Result= divert blood away from the ischemic region

BAD = exacerbates ischemia = coronary steal
What does heme oxygenase do? Why is it important?
converts heme to biliverdin
causes greenish color in bruises following injury
What are signs of hemolytic anemia
anemia
elevated LDH
elevated indirect bilirubin
positive osmotic fragility test = hereditary spherocytosis (RBC cytoskeletal abnormalities)
What is a complication of hemolytic anemia
pigmented gallstones
- increased bilirubin precipitates as calcium bilirubinate
What disease is associated with prominent intracellular sphingomyelin accumulations?
Niemann-Pick disease
What is Niemann-Pick disease, etiology, pathophys
autosomal recessive
Ashenazi-Jewish descent
deficiency of sphingomyelinase that causes accumulation of sphingomyelin in phagocytes = "foamy histiocytes"
Presentation of Niemann-Pick disease
loss of motor skills
hepatosplenomegaly
hypotonia
cherry-red macular spot
Death by age 3
What is orotic aciduria and sx?
disorder of pyrimidine metabolism
Sx:
hypochromic, megaloblastic anemia
neurologic abnormalities
growth redartion
excretion of orotic acid in urine

Rx= uridine supplementation -- inhibits CPSII
Medical conditions influenced by multiple genes (polygenic)
androgenic alopecia
epilepsy
ischemic heart disease
schizophrenia
glaucoma
hypertension
malignancy
type II DM
E.coli O157H7 toxin characteristics
shiga-like
doesn't ferment sorbitol
doesn't produce glucuronidase
MOA= inactivates 60S ribosomal subunit --> inhibition of protein synthesis and eventual cell death
Causes 80% of hemolytic-uremic syndrome (HUS)
What are the characteristics of hemolytic-uremic syndrome (HUS)?
bloody diarrhea
associated with consumption of undercooked beef
What is associated with infective endocarditis caused by Strep bovis
GI lesions (colon cancer)
What is associated with step viridans?
subacute bacterial endocarditis following dental work. Patient must have turbulent blood flow for infection to damage heart
Who can suffer from right sided endocarditis, what bacteria?
IV drug users
typically associated with staph aureus
What is mucicarmine stain used for
detect polysaccharide capsule on cryptococcus neoformans--- will look red
- usually affects immunocompromised
What is an acid-fast stain used to identify
mycolic acid --- Mycobacterium and some Nocardia species
- presence of mycolic acid will prevent decolorization of bacteria
Gastric ulcer vs erosion
Ulcers= penetrate through submucosal layers
Erosions= do not penetrate muscularis mucosa (more shallow than an ulcer)
- can cause melena
- can be related to NSAID use
What are Thiazolidinediones (TZDs), what are they used for, and what to monitor?
Pioglitazone and Rosiglitazone
used for Diabetes type II
Monitor liver functions --- SE= hepatotoxicity
Also at increased risk for heart failure
With what drugs should you monitor thyroid function
lithium
amiodarone
What cells produce InhibinB, how is it regulated, what is its effect
Sertoli cells
released in response to FSH
inhibits anterior pituitary release of FSH

males with one testicle will have elevated FSH due to a low level of inhibin B
What is clavulanic acid, why is it used?
beta-lactamase inhibitor
Used with amoxicillin to prevent its degradation by B-lactamase producing bacteria
What is congenital torticollis
result of malposition of the head in utero or birth trauma
- causes sternocleidomastoid muscle injury and fibrosis

Sx: Child will prefer to hold their head tilted to one side. Noted 2-4 weeks of age
- palpable soft-tissue mass in the inferior 1/3 of the SCM
What is estradiol, where is made
predominant estrogen in the body
converted from androgens in granulosa cells
stimulated by FSH
Where are progesterones and androgens synthesized, from what?
Theca interna cells
stimulated by LH
generated from cholesterol
What is the effect of epinephrine on BP and HR
increases BP and HR (alpha 1, beta 1 agonist)
What's the result of pretreating with propanolol before administering epinephrine
HR stays at baseline, no effect on BP through eliminating B effects of epinephrine ---> only alpha effect remains= vasoconstriction
What should you caution your patient about when taking metronidazole
don't drink alcohol while taking medication--> causes disulfiram-like effect= flushing, nausea/vomiting, headache, abdominal cramps.
What cytokine is involved in cachexia related to cancer
TNF-alpha
suppresses appetite, inhibits lipoprotein lipase and increases insulin resistance in peripheral tissue
What are symptoms of hypothyroidism
fatigue, weight gain, slowed relaxation of deep tendon reflexes, constipation, and dry/coarse skin
What does a uniformly enlarged uterus with normal appearing endometrial tissue within the myometrium indicate?
Adenomyosis
Sx= dysmenorrhea and menorrhagia
What are signs of Vitamin A deficiency
night blindness, xerophthalmia, complete blindness
occasionally Bitot's spots, corneal perforation, keratomalacia, humoral and cell-mediated immune system inhibition
What vitamin can be supplemented in measles' patients to improve condition
Vitamin A
What is the problem with ingesting aflatoxin, what bacteria produce aflatoxins?
Aspergillus strains
Strongly associated with hepatocellular carcinoma
- induces a mutation in the p53 gene
What is amiodarone used for? What are the side effects
Class III anti-arrhythmic agent
SE=
- thyroid dysfunction-- hypothyroidism
- corneal micro-deposits
- blue-gray skin discoloration
- drug-related hepatitis
- pulmonary fibrosis
How do elastin fibers of the alveolar wall stretch during inspiration and then recoil?
Interchain crosslinks involving lysine
doesn't form a triple helix (like collagen)
What is the allosteric activator of the conversion of pyruvate--> oxaloacetate
Acetyl Coa
Required to be able to make glucose from pyruvate
What nerve is damaged if a patient holds their foot in a dorsiflexed and everted position?
Tibial nerve
What nerve delivers sensation to the sole of the foot?
Tibial nerve
what are signs of Rickets? What is it?
Vitamin D deficiency in children
- increase in unmineralized osteoid matrix and widened osteoid seams
- bowed legs
- bone prominence at costochondral junction (Rosary chest)
- Harrison's sulci (indentations in lower ribs)
- Craniotabes
Growth retardation
What stimulates erythropoietin production
Hypoxia -- sensed by the cells in the renal cortex
What do the lung function labs look like in COPD patients
decreased expiratory flow rates
decreased FEV1/FVC ratio
FRC increased
What is endometriosis? What are Sx?
presence of endometrial glands and stroma outside of the uterus
Sx: dysmenorrhea (pain during menstrual period)
dyspareunia (pain with intercourse)
infertility