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128 Cards in this Set
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- 3rd side (hint)
woolsorter's dz
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b.anthracis
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b.anthracis virulence factors (2)
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1) EDEMA FACTOR: adenylate cyclase --> inc cAMP; 2) LETHAL FACTOR: stims macrophages to release TNFa
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Rb normal fxn
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arrest cell at G1
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Sx of endometriosis
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ASx, or: severe dysmenorrhea, dyspareunia (pain during intercourse), and infertility; latter 2 are from adhesions
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genetics of turner syndrome
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classic (but minority) are XO; most are XX with mosaiced monosomic cells
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role of type I vs type II fibers
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TYPE I mainly postural maintenance, work by aerobic metabolism (high myoglobin and mitochondria); TYPE II: rapid, forceful pulses of movements
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typical presentation of serum sickness
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type III hypersensitivity -- arthralgias, pruritic skin rash, vasculitis with fibrinoid necrosis and neutorphil inflam
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lab findings in serum sickness
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decreased C3 -- complement binds immune complexes
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type of allergic reaction provoked by sulfas
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serum sickness (type 3)
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causes of palm and sole rash (4)
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RMSF, syphilis, coxsackie A
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examples of dystonia
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neurological movement disorder involving involuntary muscle contractions and movements; eg CERVICAL DYSTONIA (head turning), BLEPHAROSPASM (rapid blinking --> complete closure of eyelids), WRITER's CRAMP
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shaken baby syndrome
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shaking baby violently --> movement of brain against skull --> tearing of bridging veins --> SUBDURAL HEMATOMA; congested renal veins --> BILATERAL RETINAL HEMORRHAGES; suggests CHILD ABUSE;
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hawthorne effect
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change in behavior of study population because of knowledge that they are being studied
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pygmalion effect
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researcher's beliefs in the efficacy of treatment affects the outcome
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relation of Ca to Phosphorus
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generally, high Ca = low Phosphorus, and vice versa
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steroid-mediated skin changes
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dermal atrophy from inhibition of collagen and GAG production (presents as thinning dry skin, telangiectasias, easy brusiing, and striae -- think cushings)
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mech and use of terbinafine
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MECH: inhibits squalene epoxidase (upstream of ergosterol synth); USED for dermatophytes (often in conjunction with griseofulvin);
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what drugs bind to ergosterol?
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amphotericin B and nystatin
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mech and use of flucytosine
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transformed to 5-FU --> interferes with mRNA->protein; USED in systemic fungal infec (along w/ amphotericin B; like amp/gent, amphotericin B punches holes, allows flucytosine in)
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what does digital clubbing look like and what does it suggest
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thickening of distal phalanges; suggests chronic hypoxic disease (lung dz: cancer, TB, CF, bronchiectasis, pHTN; heart: congenital cyanotic heart diseases, esp tetralogy of fallot)
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mech and use of capsofungin
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inhibits fungal CELL WALL SYNTHESIS (beta-D-glucan, a main component in cell wall of CANDIDA and ASPERGILLUS)
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types of benign breast tumors
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FIBROADENOMA (MCC <25yo, small, mobile, firm, well demarcated, fluctuates with preg); PHYLLODES (leaf-like projections); INTRADUCTAL PAPILLOMA (serous/bloody nipple discharge)
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paget's dz of breast
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eczemtaous patch on nipple; paget cells: large cells w/ c lear halo
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medullary carcinoma of breast
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sheets of cells w/ LYMPHOPLASMACYTIC infiltrate
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post-op persistence of muscle paralysis after AChEi administration
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suggests use of DEPOLARIZING muscle relaxant (not affected by AChEi)
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sx of leptospirosis
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Weil disease: hepatic dysfunction --> conjugated hyperbilirubinemia; renal dysfunction; thrombocytopenia
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receptors for hypothalamic hormones
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all Gq except CRH = Gs (C-RH :: C-AMP)
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receptors for pituitary hormones
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Gs, except oxytocin and V1 of ADH: Gq
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hesselbach's triangle
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direct inguinal hernias; borders: LATERAL: inf epigastric a.; MEDIAL: rectus abdominis m.; INFERIOR: inguinal ligament
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branchial POUCH derivatives
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1: ear; 2: palatine tonsil; 3: thymus (ventral wings) + INFERIOR parathyroid glands (dorsal wings); 4: SUPERIOR thyroid glands
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which part of bone most susceptible to hematogenous osteomyelitis?
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metaphysis; most richly vascularized
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actinic vs seborrheic keratoses
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SEBORRHEIC: "stuck-on" appearance, velvety/greasy surface; ACTINIC: erythematous papules with central scaling due to hyperkeratosis --> SANDPAPER-like;
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common site of RCC met?
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to lungs
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what vitamin needed for methionine synth?
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B12
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what vitamin needed for transamination?
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B6
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what vitamin needed for purine synthesis?
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folate
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what vitamin needed for oxidative decarboxylation of ketoacids
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B1
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which nerve and muscle indicated by positive trendelenburg sign?
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superior gluteal (glut med and min)
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which nerve and muscle implicated by diffifulty rising from seated position / climbing stairs?
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inferior gluteal (glut max)
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which vitamin useful in measles infection?
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Vit A
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lettering of HLA class I vs HLA class II
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Class I: A, B, C; Class II: DR, DP, DQ
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presentation of fibromyalgia vs polymyalgia rheumatica
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POLYMYALGIA rheumatica: >50yo; morning stiffness of neck/shoulder/pelvic girdle; a/w wt loss, fever, inc ESR, and temporal arteritis; FIBROMYALGIA: 20-50yo; widespread MSK pain a/w stiffness, paresthesias, poor sleep, and emotional disturbances, exacerbated by exercise; multiple, symmetric, TENDER SPOTS over muscles/joints/tendons
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fibromyalgia vs ankylosing spondylitis
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can both present with back pain, but FIBROMYALGIA WORSENS with exercise, while ANKYLOSING SPONDYLITIS (along with the other RAs) IMPROVES with exercise
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type of necrosis in most exogenous injuries
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coagulative
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liquefactive necrosis where
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CNS (ischemic strokes)
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Fat necrosis where
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acute pancreatitis
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caseous necrosis where
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TB
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wound w/ fruity odor
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pseudomonas (blue-green)
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hemorrhagic skin lesions by size, ascending
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petechiae, purpura, ecchymoses
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which skin lesions a/w celiac sprue?
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dermatitis herpetiformis (IgA and IgG against gliadin cross-react with reticulin -- anchoring fibril in epidermal BM)
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epi of bullous pemphigoid
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OLD people
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sx of lichen planus
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5Ps: planar, polygonal, purple, pruritc plaques on wrists/hands/trunks/legs
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clinical presentation of rickets
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bowed legs, rachitic rosary, growth retardation
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Call-Exner bodies
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GRANULOSA CELL TUMOR; small follicles filled with eosinophilic secretion; ("CALL EXNER: he'll bring the CEG [Call-exner Estrogen Granulosa]")
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sx of Buerger's disease
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thromboangiitis obliterans -- causes vasoocclusion --> claudication, raynaud's, GANGRENE
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neurotox of bilirubin
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only unconjugated bilirubin (eg Crigler-Najjar) is a threat; conjugated bilirubin gets excreted in the urine
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presentation of chronic mesenteric ischemia
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epigastric / periumbilical abd pain 30-60 mins after meals (atherosclerotic arteries can't meet blood flow demands); weight loss: pain w/ eating; benign physical exam (no physical findings, just sporatic pain)
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duod vs gastric ulcer
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DUOD better linked with acid, gets better after eating/antacids (neutralizes acid) --> a/w wt GAIN; GASTRIC only 70% linked with acid, doesn't get better with food --> a/w weight LOSS
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what does QT interval represent?
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cardica myocyte action potential duration
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changes in coronary blood flow with exercise
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most coronary blood flow during diastole; during exercise, HR inc --> dec diastole --> dec filling time; to compensate, adenosine vasodilates coronary vessels ==> increase flow rate up to 5x;
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relationship of pulmonary trunk to aorta at emergence from base of heart
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anterior-ish and to the left (remember spiral septation)
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what is a derivative of the common cardinal veins?
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SVC
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Beck's triad of cardiac tamponade
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1) Hypotension (dec CO); 2) distended neck veins; 3) distant/muffled heart sounds; (4) tachycardia (reflex)
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pulsus paradoxus
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steep drop in BP with inspiration -- indicates TAMPONADE (decreased LV compliance, inspiration --> increased RH filling --> septal shift --> dec LV filling --> dec CO)
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tamponade vs constrictive pericarditis TIMING
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constrictive pericarditis is a CHRONIC process, tamponade can develop acutely (eg viral pericarditis --> effusion)
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MCC cause of intermittent claudication
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atherosclerosis (almost always)
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Sx of monckeberg arteriosclerosis
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none! Usu asymptomatic; causes medial band-like calcifications, usu of ppl > 50yo
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cause of hyaline arteriosclerosis
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diabetic microangiopathy / essential hypertension
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most reliable indicator of MS severity
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A2-OpeningSnap interval (shorter = more severe)
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bovis in the blood
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cancer in the colon
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what do you do if you find s.INTERMEDIUS in the blood
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INTERMEDIUS --> IMMEDIATELY ASSEESS for ABSCESS
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signs of carcinoid tumor
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wheezing, diarrhea, facial flushing, syncope
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medical tx of carcinoid tumor
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OCTREOTIDE (somatostatin analog with longer half-life; neutralizes 5-HT)
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histologic appearance of abetalipoproteinemia
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lipid taken up by intestinal mucosal cells can't be exported in chylomicrons ==> get foamy cytoplasm filled with lipids
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sequelae of abetalipoproteinemia
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serum lipid deficiency --> membrane damage (RBCs --> ACANTHOCYTES [spiny membrane projections]; neurons --> neuro abnormalities)
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characteristic microscopic finding in Whipple's
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PAS (+) macrophages, rod-shaped T.whippeli bacilli
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what kind of cardiomyopathy in hemochromatosis
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DILATED cardiomyopathy --> CHF signs
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congenital cardiac defects in 22q11
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truncus arteriosus and tetralogy of fallot
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congenital cardiac defects in offspring of diabetic mother
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tranposition of the great vessels
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order of cardiac enzyme elevation after MI
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Troponin, CK-MB, AST, LDH ('i TRIPped CAL and he had a heart attack')
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causes of dilated cardiomyopathy
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ABCD: Alcohol, Beriberi, Chronic Cocaine, Coxsacke B, Chagas, Doxorubicin, Diphtheria
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most common valve affected by bacterial endocarditis
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normally MITRAL valve; in IVDU, TRICUSPID
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vegetations on both sides of valve
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LSE; no embolic risk
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findings in rheumatic fever
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FEVERSS: Fever, Erythema marginatum, Valvular damage, Elevated ESR, Red hot joints (polyarthritis), Subq nodules, Sydenham chrea
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source, activation, and action of pepsin
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secreted by CHIEF CELLS in stomach (as pepsinogen), activated (to pepsin) by LOW PH, involved in PROTEIN DIGESTION
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what GI enzyme elevated in mumps
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amylase (parotits?)
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positional pain in GERD
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increasing pain in recumbent position
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risk of hirschsprung's increases with what dz?
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down syndrome
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which IBD a/w CRC?
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UC
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"apple core" lesion on barium swallow xray
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CRC
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tx for type II crigler najjar
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phenobarbital
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causes of acute pancreatitis
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GET SMASHeD: Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, HyperCa/Hyperlipid, Drugs (sulfas)
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None
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liverbiopsy of pt with alpha-1-antitrypsin deficiency
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oval-to-round intracytoplasmic hepatocyte inclusions that are strongly PAS positive
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pathophys of gallstones in crohn's dz
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ileal involvement of crohns --| bile salt recycling (enterohepatic circulation) ==> increased cholesterol: bilesalt ratio ==> cholesterol precipitation --> cholesterol GALLSTONES
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two forms of gastric adenocarcinoma
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1) INTESTINAL: intestinal glands like colonic ACA; 2) DIFFUSE: signet-ring cells; r/f include: chronic gastritis, barretts, h.pylori, nitrates, cigs
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cushing vs curling ulcers
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CUSHING: stress from head trauma / elev intracranial pressure, located in esophagus/stomach/duod, prone to perf; CURLING: a/w severe trauma / burns, located in prox duod
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cause of bleed in mallory-weiss tears
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increased intra-abdominal / gastric pressure (vom, retching, etc.)
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ras protein
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G-protein; activated by binding to GTP; part of MAP-kinase pathway
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HIV-associated causes of esophagitis (3)
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Candida, HSV, CMV
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morphology of HIV toxo
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ring-enhancing brain lesions + chorioretinitis
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what drugs raise HDL
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Niacin and gemfibrozil
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what are the s/e of HCTZ
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hyperGLUC (glycemia, lipidemia [LDL and chol], uricemia, calcemia)
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tx for s.epidermidis
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VERY resistant -- tx with vancomycin + rifampin
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INH mech and activation
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inhibits mycolic acid synthesis of M.TB; must be ACTIVATED by mycobacterial catalase-peroxidase (intracellularly)
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ethambutol mech
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inhibits synth of mycobacterial cell wall
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"Number Needed To Harm"
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# of ppl that need to be tx for one adverse event to occur = 1/absolute risk increase; = 1/(%incidents1 - %incidents2)
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role or Rb
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regulate G1->S checkpoint; active when hypophosphorylated (stops cell cycle)
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PTH molecular effects
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binds PTH-receptors on OSTEOBLASTS --> upregulats RANK-ligand and M-CSF ==> stims OSTEOCLAST precursos ==> inc OSTEOCLASTS
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what kind of bias with a new screening test
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lead-time
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polyol pathway impoariment in DIABETES
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inc intracel gluc --> sorbitol --> fructose; sorbital + fructose inc osmotic pressure --> water influx --> osmotic cell injury; causes CATARACTS, PERIPHERAL NEUROPATHY
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mechanism of cataract formation in galactosemia
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galactose --> galactitol --> sorbitol --> inc osmotic pressure --> water influx --> osmotic cell injury --> CATARACTS (same mech as polyol pathyway of DM)
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alanine reaction in the liver
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alanine + a-ketogluterate -----ALT+B6-----> pyruvate + glutamate; glutamate then donates NH3 for urea cycle
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"hot tub folliculitis"
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superficial, self-limited pseudomonas infection of hair follicles
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TGF-beta roles
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1) arrests cell cycle (tumor suppressor role); 2) promotes angiogenesis ( ==> tumors resistant to TGF are helped by this); 3) stimulation of fibroblast ECM production (implicated in atherosclerosis and fibroblastic disease)
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endothelin's effect on blood vessels
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constriction
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oseltamivir mech and use
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neuraminidase inhibitor (used to tx influenza A and B); neuraminidase is reqd for relase of virus from infected cells
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amantadine mech and use
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used for INFLUENZA A; blocks viral uncoating inside host cell (diff from oseltamivir which inhibits virion release)
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CMV manifestations in immunocompromised (organ vs HIV)
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organ xplant: CMV pneumonitis; HIV: CMV retinitis
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which cholesterol reducing agents cause hypertriglyceridemia? And what are their other side effects?
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bile acid-binding resins (eg cholestyramine): decreased bile acid recycling --> 10x increase bile acid production, concomitant inc in TG and VLDL as well --> elev TG levels; primarily USED WITH STATINS; (can also cause cholesterol stones b/c of inc chol content)
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TNF's role in hypothalamus
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appetite suppression ==> cachexia
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middle meningeal is a branch of which artery?
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Facial artery (which is a branch of external carotid)
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MCC AFP elevation
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dating error (underestimation of gestational age)
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acute and painless monocular vision loss
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central retinal artery occlusion (CRAO), usu caused by emobolus; fundoscopic findings: pale retina + cherry red macula
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what two growth factors drive angiogenesis?
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VEGF (vascular endothelial GF) and FGF (fibroblast GF)
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main clinical manifestations of acute rheumatic fever (2)
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acute ARTHRITIS and CARDITIS
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what can villous adenomas cause?
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these cauliflower like polyps can cause: BLEEDING, secretory DIARHEA, and partial INTESTINAL OBSTRUCTION
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why give pralidoxime (2-PAM) w/ atropine?
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atropine only reverses muscarinic effects -- not nicotinic; with just atropine, still at risk for muscle paralysis, so give pralidoxime (AChE regenerator) to restore balance
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side effects of giving arterial vasodilator (eg hydralazine) alone?
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vasodilation --> triggers baroreceptor --> sympathetic response --> RAA activation --> sodium / water retention; ==> usu give with sympatholytics + diuretics
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