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481 Cards in this Set
- Front
- Back
conn's syndrome
|
-primary hyperaldosteronism
-most often due to benign adenoma in zona glomerulosa |
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drugs causing transcellular K shift
|
-stimulate Na/K ATPase
-insulin, B2 agonists |
|
determine how many half-lives of a drug it takes before it reaches steady-state concentration in the serum
|
-with each half life, the serum concentration increases by half of remaining % yet to be achieved:
one T1/2=50% of steady state two T1/2=75% of steady state three T1/2=87.5% of steady state four T1/2=93.75% of steady state five T1/2=96.87% of steady state |
|
congenital infections
|
1) toxoplamosis
2) rubella 3) cmv 4) hsv-2 5) syphillis 6) parvovirus b19 7) varicella |
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congenital syphilis
|
-peg teeth, perforate palate, saddle nose, hepatitis, jaundice, saber shins, deafness, blindness, rhinitis, cutaneous lesions
-infection after 20 weeks gestation |
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congenital toxoplasmosis
|
-chorioretinitis/blindness, basal ganglia calcifications, hydrocephalus
-may be asx at birth |
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congenital HSV-2
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-transmission via birth canal
-encephalitis, conjunctivitis, vesicular skin lesions -often asx at birth |
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congenital varicella
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limb defects, mental retardation, blindness
|
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congenital cmv
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deafness, IUGR, basal ganglia calcification, petechial rash, microcephaly/mental retardation, hepatosplenomegaly, jaundice
-90% asx at birth |
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congenital rubella
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deafness, patent ductus arteriosus, pulmonary stenosis, cataracts, microcephaly/mental retardation, purpura
|
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blueberry muffin baby
|
petechial rash, seen with congenital CMV or rubella infections
|
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congenital parvovirus B19 infection
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fetal death in 1st trimester, hydrops fetalis after that
|
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which herpes causes encephalitis in whom?
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1) congenital/neonatal encephalitis--HSV2
2) immunocompetant adults--HSV1 |
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what to monitor when treating with Li or valproate?
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-Li; serum creatinine, TSH
-valproate; liver transaminases, platelet count |
|
how can staph epidermidis infect prosthetic devices?
|
produces a biofilm to stick on them
|
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HLA types associated with DM1
|
-HLA DR3/DR4 heterozygotes have 33x risk
-either DR3 or DR4 in combo with another subtype has increased risk -homozygous HLA-DR2 individuals have a decreased risk |
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HLA-A3
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hemochromatosis
|
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HLA-B27
|
-psoriasis
-ankylosing spondylitis -inflammatory bowel disease -reiter's syndrome |
|
reiter's syndrome
|
classic triad:
1) conjunctivitis & uveitis 2) urethritis 3) arthritis -post-GI or chlamydia infection -strong association with HLA-B27 |
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HLA-B8
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graves' disease
|
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HLA-DR2
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MS, hay fever, SLE, goodpasture's
|
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HLA-DR3
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DM1, when heterozygous with DR4 have a 33x risk
|
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HLA-DR4
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rheumatoid arthritis, DM1 (when heterozygous with DR3 have 33x risk)
|
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HLA-DR5
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pernicious anemia, hashimoto's thyroiditis
|
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HLA-DR7
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steroid-responsive nephrotic syndrome
|
|
lecithinase
|
-aka alpha toxin
-produced by clostridium perfringens -causes myonecrosis (gas gangrene) and hemolysis -dx with growth on egg agar |
|
germ tube test
|
-used to dx candida infection
-demonstration of pseudohypha formation in animal serum |
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weil-felix test
|
-used to distinguish between rickettsial diseases
-assay serum for antirickettsial Abs that cross react with proteus Ag -positive for typhus (r. typhi, r. prowazekii) and rocky mt spotted fever (r. rickettsii) -negative for Q fever (coxiella burnetii) |
|
epithelial cell junctions, from superficial-->deep
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1) zona occludens/tight junctions--prevents paracellular diffusion, claudins+occludins
2) zona adherens/intermediate junction--cadherins+actin 3) macula adherens/desmosome--cadherins (like desmoglein) + intermediate filaments 4) gap juntions--connexons 5) hemidesmosomes--connect cells to underlying ECM, integrins+lamin in BM |
|
bullous pemphigoid
|
-autoimmune disorder, anti-hemidesmosome IgGs produced
-hemidesmosomes attach epithelium to underlying basement membrane -Abs are below the epidermis, linear IF -lesions begin on lower abdomen, groin, flexors, generally spare oral mucosa -subepidermal blisters -nikolsky sign negative (pressure on skin does not separate epidermis) -similar but less severe than pemphigus vulgaris |
|
pemphigus vulgaris
|
-autoimmune skin disorder with IgG Ab against desmosomes (specifically, the cadherin desmoglein)
-IF throughout the epidermis -intraepidermal bullae involving skin and oral mucosa -lesions usually begin in oral mucosa -positive nikolsky sign (pressure to skin separates epidermis) -similar to bullous pemphigoid but life threatening |
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CML translocation
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t(9,22), philadelphia chromosome, bcr-abl
|
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burkitt's translocation
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t(8,14), c-myc activation
|
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follicular lymphoma translocation
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t(14,18), bcl-2 activation
|
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M3 AML translocation
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t(15,17), retinoic acid receptor-PML fusion protein
|
|
ewings' sarcoma translocation
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t(11,22)
|
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mantle cell lymphoma translocation
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t(11,14)
|
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hypokalemic periodic paralysis
|
-genetic disease causing periodic muscle weakness and paralysis
-episode triggers; strenuous exercise, high-carb meal, anxiety -often presents in 1st or 2nd decade, family hx -tx: K supplementation during episodes and K-sparing diuretics for prophylaxis |
|
vasculature of gonads
|
-ovarian and testicular arteries originate directly from the abdominal aorta, inferior to renal arteries
-right ovarian/testicular vein empties into IVC -left ovarian/testicular vein drains into left renal vein, which then drains into IVC -lymphatic drainage into para-aortic LNs |
|
ligamentous derivatives of ventral mesentary
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1) falciform ligament--contains ligamentum teres
-together comprising the lesser omentum: 2) gastrohepatic ligament--contains gastric arteries 3) hepatoduodenal--contains portal triad |
|
ligamentous derivatives of dorsal mesentary
|
1) splenorenal ligament--contains splenic artery and vein
-together comprising the greater omentum: 2) gastrosplenic ligament--contains short gastric arteries 3) gastrocolic ligament--contains gastroepiploic arteries |
|
falciform ligament
|
-connects liver to ventral body wall
-ventral mesentary derivative -contains ligamentum teres |
|
hepatoduodenal ligament
|
-connects liver to duodenum
-contains the portal triad -comprises the free edge of the lesser omentum -together with the gastrohepatic ligament comprises the lesser omentum -ventral mesentary derivative |
|
gastrohepatic ligament
|
-connects liver to lesser curvature of the stomach
-contains the gastric arteries -along with hepatoduodenal ligament comprises the lesser omentum -ventral mesentary derivative |
|
splenorenal ligament
|
-connects spleen to posterior body wall
-contains splenic artery and vein -dorsal mesentary derivative |
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gastrosplenic ligament
|
-connects greater curvature of stomach to spleen
-contains short gastric arteries -part of greater omentum -dorsal mesentary derivative |
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gastrocolic ligament
|
-connects greater curvature of stomach to transverse colon
-contains gastroepiploic arteries -comprises the greater omentum along with gastrosplenic ligament -dorsal mesentary derivative |
|
HNPCC
|
-aka lynch syndrome
-mutation of dna mismatch repair genes (MLH or MSH) causes microsatellite instability (ex: dinucleotide repeat instability) -80% progress to CRC -proximal colon always involved -increased risk of endometrial, ovarian, gastric and pancreatic cancers |
|
familial adenomatous polyposis
|
-AD mutation of APC on 5q
-all pts develop cancer by 35-40 so need prophylactic colectomy -thousands of polyps -pancolonic -always involves rectum 1) gardner's syndrome= FAP + osseous and soft tissue tumors, retinal hyperplasia 2) turcot's syndrome= FAP + brain involvement (astrocytoma, medulloblastoma) |
|
peutz-jeghers syndrome
|
-AD benign polyposis syndrome (polyps themselves dont transform to malignant)
-increased risk of CRC and some visceral malignancies -hamartomous polyps especially in SI, but may have some in stomach and colon -hyperpigmented mouth, hands, lips, genitalia |
|
li-fraumeni syndrome
|
-inactivation of p53 TSG on 17p
-increased risk for sarcomas, leukemia, carcinomas |
|
gardner's syndrome
|
-subtype of familial adenomatous polyposis (thousands of pancolonic polyps, always involving rectum, cancer by 35-40, AD inactivation of APC on 5q)
-FAP + retinal hyperplasia, osseous and soft tissue tumors |
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turcot's syndrome
|
-subtype of familial adenomatous polyposis (thousands of pancolonic polyps, always involving rectum, cancer by 35-40, AD inactivation of APC on 5q)
-FAP + malignant brain tumors |
|
microscopic findings at different times following MI
|
1-2 hours; contraction bands
4-12 hours; initial coagulation necrosis 2-4 days; extensive coag necrosis, muscle shows total loss of striations and nuclei, neutrophil emigration, hyperemia (dilated vessels) -5-7 days; granulation tissue, beginning of fibrosis -7 weeks; contracted scar complete |
|
post-MI complications and most likely time post MI
|
-LV CHF and pulmonary edema; first 24 hours
-arrhythmia; first fews days -ventricular free wall rupture, tamponade, papillary muscle rupture, ventricular septal supture; 3rd-7th day -fibrinous pericarditis; 1-7 days -aneurysm formation; 4-6 weeks -dressler's syndrome; 6-8 weeks |
|
hypnagogic vs hypnapompic hallucinations
|
-hypnapompic: hallucination upon waking
-hypnagogic: hallucination upon sleeping |
|
ecg abnormalities in hypo- and hyperkalemia
|
-hypo: u wave, a positive wave following the t wave, that looks like another t wave basically
-hyper: peaked tall t waves |
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meckel's diverticulum
|
-congenital persistence of vitelline duct (originally connects gut to yolk sac)
-can cause bleeding, intussusception, volvulus, terminal ileum obstruction -present in 2% of population -found in distal ileum, 12 inches from ileocecal valve -may contain heterotopic rests of gastric mucosa (causing mucosal ulceration from acid production) or pancreatic tissue |
|
minimal change disease
|
-altered cell-mediated immune response with abnormal secretion of lymphokines by t cells
-reduces production of anions in glomerular BM, increasing permeability to albumin but not to Igs -aka lipoid nephrosis -normal LM but foot process fusion or effacement on EM -most common cause of childhood nephrotic syndrome (peak incidence at 2-3 yo) -no hypertension, unlike other nephrotic dzs |
|
sx of hydrocephalus
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1) gait problems
2) urinary incontinence 3) confusion/dementia |
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azotemia
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increased serum BUN and creatinine
|
|
serum BUN:creatinine in different forms of azotemia
|
1) prerenal >20
2) renal <15 3) post renal is greater than 15 |
|
fractional excretion of Na
|
-FENa: (amount of filtered Na)/(amount of excreted Na)
-FENa= [(UNa x PCr)\(PNa x UCr)] x 100 -FENa <1% indicates good tubular function, excludes ATN as cause of azotemia -FENa> 2% is highly suggestive of ATN as cause of azotemia |
|
Uosm in evaluation of azotemia
|
-Uosm>500mosm/kg--> good tubular concentrating ability, prerenal azotemia
-Uosm<350mosm/kg---> tubular dysfunction, renal or postrenal azotemia |
|
UNa in evaluation of azotemia
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-UNa < 20mEq/L --> intact tubular function, prerenal azotemia
-UNa>40mEq/L--> tubular dysfunction, renal azotemia |
|
labs in prerenal azotemia
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1) BUN:Cr > 20
2) Uosm > 500 3) UNa < 10 4) FENa <1% 5) high ADH secretion |
|
labs in renal azotemia
|
1) BUN:Cr < 15
2) Uosm <350 FENa>2% 4) UNa > 20 5) low ADH secretion |
|
alopecia areata
|
-caused by autoimmune attack on hair follicles, with antibodies against anagen-phase follicles
-HLA DQ3 |
|
HLA DQ3
|
alopecia areata
|
|
what needs cold for culture?
|
listeria
|
|
hemophilus influenzae culture needs
|
-factor V (NAD) and X (hematin)
-can either culture with factors added or co-culture on blood plate with S. aureus, which will lyse the RBCs to release the necessary factors |
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mycobacteria special culture needs
|
cholesterol
|
|
calculate half-life from Vd and CL
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T1/2= (0.7 x Vd)/CL
|
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uricosuric agents
|
probenecid, sulfinpyrazone, increase urinary excretion of uric acid
|
|
tx acute attacks of gout with
|
colchicine, --| MT formation, leukocyte migration and phagocytosis of monosodium urate crystals
|
|
agnosia
|
-inability to recognize, despite adequate sensation
-can be visual, auditory, etc -prosopagnosia: inability to recognize faces |
|
alexia
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inability to read, can understand words spelled out-loud
|
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apraxia
|
loss of ability to carry out certain movements correctly in response to the stimuli that normally elicit them
|
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agraphia
|
loss of writing ability
|
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anosognosia
|
loss of recognition of own dz
|
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aphonia
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loss of sound production
|
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components of seminal fluid
|
1) prostate (25%)--acid phosphatase, citric acid, calcium, clotting enzymes, profibrinolysin, zinc
2) bulbourethral/cowper's glands (5%)--thick alkaline mucus 3) epididymis (5%)--carnitine, acetylcarnitine 4) seminal vesicles (60%)--fructose |
|
actions of insulin on target enzymes
|
-insulin (via TK receptor) decreases cAMP;
1) dephosphorylates glycogen synthase, activating it 2) dephosphorylates glycogen phosphorylase, deactivating it |
|
actions of glucagon on target enzymes
|
-increases cAMP
-phosphorylates glycogen synthase, deactivating it -phosphorylates glycogen phosphorylase, activating it |
|
ito cells
|
-fat-containing mesenchymal cells in the space of disse in the liver
-the site of vit A storage |
|
SEs and toxicity of TCAs
|
-anticholinergic SEs; sedation, tachycardia, dry mouth, visual disturbances, urinary retention, constipation
-tox: Convulsions, Coma, Cardiotoxicity (arrhythmias), hyperpyrexia (high fever), confusion/hallucination in elderly who are susceptible to anticholinergic effects |
|
what causes alexia w/out agraphia?
|
-infarction of the left PCA (dominant hemisphere)
-affects anterior occipital cortex= right homonymous hemianopsia with macular sparing -affects splenium of corpus callosum=cant read but can write |
|
SC nerve/vertebrae anatomy
|
-31 pairs of spinal nerves
-C1-C7 nerves exit above the corresponding vertebra -C8 nerve exits below C7 vertebra, there is no C8 vertebra -from T1 nerve onward, all spinal nerves exit below corresponding vertebra |
|
how to measure extracellular fluid volume?
|
=inulin space, because inulin disperses throughout the ECF and doesnt enter cells
|
|
serum osmolality equation
|
= 2[Na] + [glu]/18 + [BUN]/2.8
|
|
wernicke's encephalopathy vs. korsakoff syndrome
|
Wernicke's
1) reversible 2) ataxia 3) ophthalmoplegia/ocular movement palsies 4) confusion Korsakoff: 1) not reversible 2) antero & retrograde amnesia 3) confabulation -both caused by thiamine (B1) deficiency, usually in alcoholics |
|
wet beriberi
|
-high output HF, dialated cardiomyopathy, edema
-caused by thiamine deficiency |
|
wet beriberi
|
-symmetric demyelination of peripheral nerves, polyneuritis, symmetrical muscle wasting
-caused by thiamine deficiency |
|
mutation in sickle cell
|
-substitution of valine for glutamate in beta globin chain
|
|
eqn for sensitivity
|
= TP / (TP + FN)
= 1 - false negative rate = positive in disease |
|
eqn for specificity
|
= TN / (TN + FP)
= 1 - false positive rate = negative in health |
|
implication of high sensitivity of test
|
highly sensitive--> low false negatives, can rule disease out, good for screening test
|
|
implication of high specificity of test
|
highly specific--> low false positive rate, used to rule dz in, use as confirmatory test after a positive screening test
|
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PPV
|
-proportion of ppl testing positive that actually have the dz
= TP / ( TP + FP ) -even if test is specific and sensitive, if prevalence of dz is low test will have low PPV |
|
NPV
|
-proportion of ppl testing negative who really dont have the dz
= TN / ( TN + FN ) |
|
risk factor for calcium oxalate renal stones
|
strict vegetarianism (lots of spinach and nuts)
|
|
what tumor causes hyperthyroidism?
|
-monodermal teratoma, containing functional thyroid tissue called struma ovarii
|
|
meig's syndrome
|
triad of:
1) ovarian fibroma-thecoma 2) ascites 3) right-sided pleural effusion (hydrothorax) |
|
drugs causing gynecomastia
|
"some drugs create awesome knockers"
-spironolactone -digitalis -cimetidine -alcohol -ketoconazole |
|
acanthamoeba
|
severe keratoconjuntivitis in dirty contact lens wearers
|
|
ophthalmia neonatorum
|
-conjunctivitis in newborns
-1st week; n. gonorrhoeae -2nd week; chlamydia trachomatis |
|
causes of bacterial conjunctivitis
|
-s. aureus (most common)
-s. pneumoniae -h. influenzae -h. aegyptius=pink eye |
|
causes of viral conjunctivitis
|
-adenovirus (+ preauricular lymphadenopathy)
-HSV-1 (+ dendritic ulcers on fluorescein staining) |
|
chlamydia trachomatis
|
-leading cause of preventable infectious blindness
-A, B, Ba, C -intracellular bacteria staining only with iodine and giemsa -transmission via elementary bodies |
|
leptospira interrogans
|
-gram-neg spirochete with hooks, questionmark shaped
-found in water contaminated by animal urine, esp hawaiian or tropical waters -infxs range from: 1) ax 2) flulike, with rash and vomiting 3) weil dz: jaundice, hemorrhage, renal failure, skeletal muscle necrosis |
|
legionella pneumophila
|
-gram-neg rod, poor gram stain, use silver stain
-facultative intracellular -charcoal yeast agar + cysteine and iron -two diseases: 1) legionnaire's dz: severe pneumonia, esp in elderly smokers or alcoholics 2) pontiac fever; mild flu -aerosolized water transmission, no person-to-person -tx: erythromycin |
|
anion gap eqn
|
= [Na] - [Cl-] - [HCO3-]
-normal gap= 8-16 |
|
albinism
|
-AR defect in copper-dependent tyrosine hydroxylase
-cant tyrosine--->melanin -prone to squamous cell carcinoma and melanoma |
|
medial medullary syndrome
|
-occlusion of the anterior spinal artery, lesion of:
1) cst in pyramid: contralateral hemiparesis 2) medial lemniscus: contralateral loss of touch/proprioception 3) XII nucleus: ipsi tongue weakness, protruded tongue points to side of lesion |
|
lateral medullary syndrome
|
-aka wallenberg
-occlusion of vertebral artery/PICA -lesion of: 1) solitary nucleus; ipsi taste 2) nucleus ambiguus; hoarseness, dysphagia 3) sans fibers; ipsi horner's 4) inferior cerebellar peduncle; ipsi ataxia 5) VIII nuclei; vertigo, nausea, nystagmus 6) spinal nucleus of V; ipsi face pain/temp 7) ascending spinothalamic tract; contra body pain/temp |
|
weber's syndrome
|
-caused by occlusion of paramedian branches of PCA
-damage of ventral/medial midbrain, lesion of: 1) CN III: ipsi eye down and out, ptosis, pupil blown 2) cerebral peduncle (corticospinal + corticobulbar tracts); contra hemiparesis |
|
locked-in syndrome
|
-ventral pontine lesion caused by basilar artery thrombosis
-bilateral pyramidal tract infarction -complete paralysis except vertical eye movements and blinking, which are controlled in the midbrian -intact sensation and cognition |
|
PCA occlusion
|
-homonymous hemianopsia of contra visual field with macular sparing
-paramedian branch occlusion can produce weber's syndrome (CNIII palsy + contra hemiparesis) |
|
AICA occlusion
|
-lateral inferior pontine syndrome
1) VII nucleus; ipsi face paralysis 2) VIII; vertigo, nystagmus, vomiting, sensorineural deafness 3) spinal tract of V; ipsi face pain/temp 4) inferior/middle cerebellar peduncles; ipsi ataxia |
|
eqn for alveolar ventilation
|
=(tidal volume - deadspace volume) x RR
|
|
thiazides
|
-ex: hydrochlorothiazide, indapamide, metolazone
-inhibit the Na/Cl symport in DCT -increase excretion of Mg, Cl, K, H, and Na -decrease excretion of Ca!!!!! -may result in alkalosis, hyperuricemia, hypercalcemia, hypokalemia, hyponatremia -effects on Ca absorption benefit use in post-menopausal women and ppl with hx of Ca stones -SE: sulfonamide allergy, alkalosis -contraindicated in diabetes b/c decrease insulin release |
|
which are sulfonamide diuretics?
|
-all CA inhibitors
-all thiazides -all loop diuretics except ethacrynic acid |
|
loop diuretics
|
---|Na/Cl/2K transporter in TAL
-ex: bumetanide, ethacrynic acid (only non sulfa!!!), furosemide, torsemide -increased excretion of Na, H, K, Mg, Ca -decreased excretion of uric acid -tox: OH DANG! ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis (interstitial), gout |
|
K-sparing diuretics
|
-ex: spironlactone and eplerenone (aldosterone receptor antagonists in CT)
-ex: triamterene and amiloride (Na channel inhibitors in CT) -SE: hyperkalemia (possible causing acidosis from K/H transcellular shift), spironolactone causes gynecomastia |
|
m. pneumoniae dx and tx
|
-dx: serology to find one or both Abs:
1) cold agglutinins, autoAb against O+ RBCs in cold 2) strep MG agglutinins, Abs against strep salivarius strain MG -TX: macrolide, no cell wall so dont use a penicillin! |
|
menetrier dz
|
-hypertrophic gastritis
-superthick rugal folds -hyperplasia of mucous glands -protein-losing enteropathy -atrophy of parietal cells -increased risk of carcinoma |
|
i cell disease
|
-inherited deficiency of the enzyme UDP-N-acetylglucosamine, making golgi bodies incapable of marking lysosomal-intended enzymes with a mannose 6-P marker
-primary lysosomes dont contain hydrolytic enzymes -undigested stuff accumulates large cytosolic inclusions -dx: lysosomal enzymes will be present in the blood (without mannose phosphorylation they get mid-addressed to exocytosis) -sx: congenital deformities, gingival hypertrophy, psychomotor retardation, early death |
|
orlistat
|
---| pancreatic lipases
-tx for obesity, causes steatorrhea |
|
sibutramine
|
-sympathomimetic seratonin and NE reuptake inhibitor
-used for obesity -se: htn and tachycardia |
|
megestrol
|
-progesterone derivative
-used to stimulate appetite in old ppl |
|
name 2 opioids used as antidiarrheal agents
|
1) loperamide
2) diphenoxylate |
|
SEs of platin alkylating agents
|
-nephrotoxic
-ototoxic -peripheral neuropathy |
|
doxorubicin antidote
|
-dexrazoxane, an Fe-chelator that prevents formation of free radicals to avoid cardiomyopathy
|
|
doxorubicin, MOA and SEs
|
-MOA; intercalates dna, -| topoisomerase II, dsDNA breaks
-SEs; cardiomyopathy, radiation recall reaction toxic extravasation -prevent cardiomyopathy with dextrazoxane or dexferoxamide (Fe-chelator) |
|
penicillamine
|
-a broad-range chelator
-tx for wilsons dz b/c chelates copper -tx for lead or arsenic poisoning |
|
CN poisoning antidote
|
1) nitrate to induce metHb formation, metHb will bind CN and prevent it from inhibiting cytochrome oxidase
2) thiosulfate to convert the CN into a renally-excretable form |
|
posterior interosseous nerve
|
-branch of radial nerve
1) thumb extension via extensor pollicis longus 2) thumb abduction via abductor pollicis longus 3) index finger extension via extensor indicis |
|
thenar muscles
|
1) opponens pollicis (opposition)
2) flexor pollicis brevis (flexion) 3) abductor pollicis brevis (abduction) -all innervated by medial nerve |
|
lumbricals
|
-flex at MCP, extend at DIP and PIP
-fingers 2 and 3 lumbricals innervated by median nerve (distal median lesion has fingers 2/3 curled) -fingers 4 and 5 lumbricals innervated by ulnar nerve (ulnar nerve lesion has pope hand, 4th and 5th fingers curled) |
|
interosseus muscles
|
-all innervated by ulner nerve
-dorsal interosseus abduct fingers -palmar interosseus adduct fingers |
|
ulnar nerve hand muscles
|
1) 4th and 5th lumbricals
2) adductor pollicis 3) all interosseus 4) all digiti minimi (hypothenar eminence muscles) |
|
median nerve hand muscle
|
1) all thenar eminence muscles; opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
2) 2nd and 3rd lumbricals |
|
radial nerve hand muscles
|
1) abductor pollicis longus (brevis=median n)
2) extensor indicis 3) extensor pollicis longus |
|
general muscles of thenar & hypothenar eminences
|
-"OAF"
-opponens -abductor -flexor |
|
only bacterial membrane w/cholesterol
|
mycoplasma
|
|
HPV oncogenesis
|
-virus proteins E6 an E7 inhibit cell TSGs p53 and p110
|
|
retinoblastoma
|
-loss of Rb TSG on 13q
-also increased chance of osteosarcoma |
|
oncogenesis of HTLV-1
|
-causes adult t-cell leukemia/lymphoma
-viral gene products (tax) alter host protein function |
|
kaposi sarcoma caused by
|
-HHV8 infxn in AIDS pts
|
|
winged scapula caused by
|
-damage to long thoracic nerve
-arises from C5, 6, 7 in the neck and doesnt travel through the axilla with the rest of the brachial plexus -serratus anterior |
|
axillary sheath contains
|
1) axillary artery
2) cords of brachial plexus (lateral, posterior, medial) |
|
CN III can be squashed by aneurysm of adjacent...
|
-posterior cerebral artery rostral to it (from bifurcation of basilar)
-superior cerebellar artery (last branch off basilar before it bifurcates) caudal to it -CN III emerges from midbrain |
|
trochlear nerve
|
-innervates superior oblique which depresses adducted eye
|
|
oslers nodules
|
-red/purple subQ macules on pads of fingers and toes
-side of infective endocarditis |
|
janeway lesions
|
-hemorrhagic, painless plaques on palms and soles
-sign of infective endocarditis |
|
celecoxib contraindications
|
-sulfonamide allergy
-coronary artery dz b/c it increases risk of thrombosis |
|
dysthymia
|
mild depression lasting at least 2 years
|
|
describe relationship of digoxin and K
|
-digoxin binds to Na/K ATPase at the K binding site
-hyperkalemia decreases digoxin effect -hypokalemia, for example due to concurrent diuretic use, increases digoxin effect and toxicity |
|
C3 deficiency causes
|
1) recurrent encapsulated organism infections cause cant opsonize
2) risk of type III hypersensitivity dz because cant clear immune complexes |
|
pulmonary wedge pressure corresponds to
|
LA pressure
|
|
where is the chemoreceptor trigger zone, and where does it project to?
|
located in the area postrema in floor of 4th ventricle, projects to lateral reticular formation of medulla to activate vomiting center
|
|
fibroblast growth factor receptor deficiency causes
|
-achondroplasia, dwarfism
|
|
MEN
|
-all are AD, II and III are associated with ret gene
1) MEN I aka wermer's syndrome; parathyroid tumors, pituitary tumors, pancreatic endocrine tumors (insulinoma, gastrinoma, VIPoma), commonly presents with kidney stones and gastric ulcers 2) MEN II/IIA aka sipple's syndrome; parathyroid tumors, pheochromocytoma, medullary carcinoma of the thyroid (secretes calcitonin) 3) MEN III/IIB; pheochromocytoma, medullary carcinoma of the thyroid (secretes calcitonin), oral/intestinal neuromas, marfanoid habitis |
|
wermer's syndrome
|
-MEN I
-parathyroid tumors -pituitary tumors -pancreatic tumors (gastrinoma, VIPoma, insulinoma, etc) -common presentation= kidney stones with gastric ulcers |
|
sipple's syndrome
|
-aka MEN II/IIA, associated with ret gene, AD
-parathyroid tumors -pheochromocytoma -medullary carcinoma of the thyroid (calcitonin secreting) |
|
MEN IIb aka III
|
-AD, associated with ret gene
-pheochromocytoma -medullary carcinoma of the thyroid (calcitonin-secreting) -oral/GI neuromas -marfanoid habitus |
|
associate the gene with the cancer:
1) bcl-2 2) L-myc 3) erb-B2 4) C-myc |
1) follicular lymphoma
2) small cell lung carcinoma 3) breast, ovarian, gastric carcinoms 4) burkitt lymphoma |
|
tx of klebsiella pneumonia
|
-3rd generation cephalosporin (cefotaxime, ceftriaxone, ceftazidime)
|
|
tumor marker for what?
1) CEA 2) CA-125 3) AFP 4) PTH-rP 5) calcitonin |
1) CEA-colorectal, pancreatic, gastric, breast (very nonspecific)
2) CA-125-ovarian 3) AFP-hepatocellular carcinomas, nonseminomatous germ cell tumors of the testes (ex: yolk sac tumor) 4) PTH-related peptide-small cell carcinoma of the lung |
|
wegener's granulomatosis triad
|
1) necrotizing granulomas of upper airway tissue
2) small vessel vasculitis 3) renal dz + cANCA |
|
macrophages in granulomas
|
called epithelioid histiocytes, may also form multinucleated giant cells, but not necessary for granuloma dx
|
|
aprepitant
|
-antagonist of neurokinin-1 receptors, which control the emetic reflex
-used to tx chemo-induced nausea and vomiting |
|
why are chlamydia obligate intracellular bacteria?
|
they cant make ATP
|
|
urease-positive organisms
|
PUNCH
proteus ureaplasma nocardia cryptococcus helicobacter |
|
congenital lipoid adrenal hyperplasia
|
-mutation in the steroidogenic acute regulatory protein (StAR), which is necessary to transport cholesterol from outer to inner mito membrane in adrenals and gonads
-complete steroid hormone deficiency in adrenals and gonads with enlargement of the adrenals -causes male pseudohermaphroditsm and adrenal insufficiency |
|
tx for borrelia burgdorferi
|
doxycycline
|
|
notching/scalloping of undersurface of ribs on CXR indicates
|
aortic coarctation
|
|
eisenmenger syndrome
|
-when a L-->R shunt shifts to R-->L because pulmonary HTN developed
|
|
cytoplasmic inclusions in epidermal cells
|
molluscum contagiosum (poxviridae)
|
|
broad-based budding
|
blastomyces dermatitides
|
|
narrow-based budding, encapsulated
|
cryptococcus neoformans
|
|
budding yeast that looks like a captain's wheel
|
paracoccidiomycosis
|
|
septate hyphae, 45 deg angle branching
|
aspergillus
|
|
nonseptate hyphae, wide-angle branching
|
mucormycosis or rhizopus
|
|
macrophage with intracellular yeast
|
histoplasmosis
|
|
meningitis in aids pt
|
cryptococcus neoformans, encapsulated narrow-budding yeast, india ink stain, pigeon droppings, latex agglutination test detects polysaccharide capsular antigen, soap bubble lesions in brain
|
|
abetalipoproteinemia
|
-AR deficiency of apoB100 and apoB-48, or microsomal transfer protein (MTP) which transfers triglycerides onto apoB
-w/out apoB48 cant make chylos, w/out apoB100 cant make VLDL -low serum levels of chylos, VLDL, LDL, cholesterol, and triglyceride -presents in infancy with steatorrhea, failure to thrive, acanthocytosis -later, ataxia, nightblindness (due to fat-soluble vit absorptions) |
|
focal segmental glomerulosclerosis
|
-primary, or secondary to HIV or IVDU
-EM shows focal damage of visceral epithelial cells -loss of foot processes and pronounced focal detachment of epithelial cells -nephrotic -poor prognosis, commonly progresses to CRF |
|
acute epididymitis and orchitis is caused by
|
gonorrhoeae or chlamydia
|
|
goodpasture's renal dz
|
rapidly progressive glomerulonephritis
|
|
electron dense subepithelial humps
|
poststreptococcal glomerulonephritis
|
|
podocyte foot process fusion
|
minimal change dz aka lipoid nephrosis
|
|
necrotizing enterocolitis
|
-GI mucosal necrosis and possible perforation in a neonate
-most common in premmies |
|
accumulation of valine and isoleucine
|
maple syrup urine dz
|
|
causes of elevated anion gap met acidosis
|
Methanol
Uremia Diabetic KA Phenformin/Paraldehyde Iron pills Lactic acidosis Ethylene glycol Salicylic acid |
|
achondroplasia
|
-AD mutation in FGFR-3, resulting in constant receptor activation and --| of chondrocyte proliferation
-short limbs, normal trunk |
|
ocular muscles, action and innervations
|
1) MR -medial movement, III
2) LR -lateral movement, VI 3) IO -elevation from adducted position, III 4) SO -depression from adducted position, IV 5) SR -elevation from abduction, III 6) IR -depression from abduction, III |
|
oblique vs rectus eye muscles
|
rectus muscles:
-move eye in the direction of their name (ex: superior rectus moves eye up) -move eye from ABducted position -both innervated by III oblique muscles: -move eye in opposition direction of their name (ex: superior oblique moves eye down) -move eye from ADDucted position -IO innervated by III, SO innervated by IV |
|
only dna virus that is ss
|
parvovirus (B19)
|
|
which dna viruses are enveloped?
|
-hepadnavirus (hep b)
-herpesvirus -pox virus (only dna virus not icosahedral) |
|
which dna viruses are naked?
|
-papovavirus (papilloma, polyoma)
-adenovirus (adenovirus) -parvovirus (B19) |
|
which dna viruses are circular?
|
-hepadnavirus
-papovavirus (papilloma+polyoma) |
|
describe different GLUTs
|
1) GLUT1
-RBCs, brain vessels, kidney, colon 2) GLUT2; -liver, pancreatic beta cells, basolateral SI -bidirectional 3) GLUT3; -neurons, placenta, testes -low Km 4) GLUT4; -fat, skeletal muscle, heart -insulin translocates GLUT4 to membranes 5) GLUT5 -SI, testes, sper -fructose transporter |
|
parinaud's syndrome
|
-lesion of DORSAL midbrain, often due to pineal tumor
-compression of superior colliculi-> paralysis of conjugate vertical gaze, pupillary light reflexes -compression of cerebral aqueduct-> noncommunicating hydrocephalus, papilledema |
|
liquefactive necrosis results from
|
release of hydrolytic enzymes from dying (neural) tissues
|
|
coagulative necrosis characterized by
|
protein denaturation
|
|
CCK
|
-released from I cells in duodenum and jejunum in response to FAs and AAs
-inhibits gastric acid secretion and gastric emptying via afferent vagal stimulation of SS secretion -stimulates contraction of gallbladder -increases production of hepatic bile -increases pancreatic secretion -relaxes sphincter of Oddi |
|
bicornuate uterus
|
-congenital y-shaped uterus
-results from incomplete fusion of paramesonephric ducts -results in spontaneous abortions, urinary tract abnormalities |
|
CD3 present on
|
all t cells, mediates intracellular signal transduction
|
|
CD 14 present on
|
macros, endotoxin receptor
|
|
CD20 present on
|
B cells
|
|
CD56 present on
|
NKCs
|
|
CD16 present on
|
macros and NKCs, Fc IgG receptor
|
|
pralidoxime
|
AchE reactivating agent used in cases of organophosphate AchE poisoning (ex: parathion)
|
|
why are rickettsiae obligate intracellular?
|
need CoA and NAD
|
|
fast-twitch vs slow-twitch muscle fibers
|
1) slow twitch, type I fibers
-smaller MN diameter, slower response -endurance -high mitochondrial concentration for oxidative phosphorylation -high myoglobin concentration for oxygen supply to oxidative phosphorylation -red due to myoglobin 2) fast-twitch, type II fibers -larger MN diameter, fast response -sprint not endurance -high glycogen concentration for anaerobic metabolism -low myoglobin concentration makes them white -low mito concentration |
|
what molecular technique used to test for CF?
|
-pcr amplification of the region with the single AA mutation and then sequencing
|
|
muscles of mastication and action
|
1) temporalis- backward movement
2) lateral pterygoid- forward movement, only muscle that opens mouth 3) medial pterygoid- elevates lower jaw 4) masseter- elevates lower jaw 5) digastric- depresses lower jaw 6) mylohyoid- depresses lower jaw |
|
choanal atresia
|
bone maldevelopment causing obstruction of one or both nasal passages
|
|
classic triad of congenital rubella
|
1) cataracts
2) deafness 3) PDA |
|
how to differentiate partial vs complete central DI
|
-administer vasopressin
-if urine osmolarity increases by >50%, complete, if by <50%, partial |
|
thayer martin media
|
-a chocolate agar based medium with antibiotics to suppress the growth of other bacteria
-used to grow the fastidious n. gonorrheae -often use vancomycin to --| gram positives, colistin (a polymyxin) to --|gram negs except neiserria meningitidis or gonorrhoeae, and nystatin to --| yeast |
|
ebstein's anomaly
|
-congenital heart defect
-apical displacement of tricuspid valve leaflets, increased volume of RV, atrialization of RV -associated with maternal Li use |
|
mycoplasma pneumoniae is associated with what Abs?
|
-cold IgM agglutinins, Abs against the surface P1 protein that mycoplasma uses to attach to respiratory epithelial cells
|
|
downs syndrome associated w/what cancer/
|
ALL
|
|
macroorchidism in pubertal males seen in
|
fragile x syndrome
|
|
high arginine levels in spastic child
|
-arginase deficiency
-arginase normally produces urea and ornithine from arginine in the urea cycle -tx with low protein diet devoid of arginine |
|
anti-collagen IV Abs
|
goodpastures
|
|
immune mech of rheumatic heart dz
|
Abs against strep M proteins cross react with antigens in heart and joints
|
|
immune mech of post-strep glomerulonephritis
|
deposition of circulating immune complexes, sub-epithelial humps
|
|
pauci-immune rapidly progressive glomerulonephritis
|
-caused by wegeners, pauci immune because no antibody deposition in glomerulus
|
|
anticentromere Abs
|
CREST syndrome
|
|
anti-smith Abs
|
SLE
|
|
CA-19-9 is tumor marker for
|
pancreatic carcinoma
|
|
bombesin is a tumor marker for
|
-neuroblastoma
-lung and gastric cancer |
|
TRAP is a tumor marker for
|
hairy cell leukemia (b cell)
|
|
placental alkaline phosphatase is a tumor marker for
|
seminoma
|
|
I band, A band, H band in contraction
|
1) I band is the space between A bands, decreases width
2) A band, composed mostly of myosin, does not change length 3) H band-in the middle of the A band, the part with only myosin and no actin, shortens during contraction |
|
S-100 is tumor marker for
|
-melanoma
-neural tumors -astrocytoma |
|
probenecid
|
-used as prophylaxis against gout
-inhibits PT reabsorption of urate -also inhibits the secretion of many acidic drugs like cephalosporins and fluoroquinolones -can cause uric acid stone formation if urine concentration gets too high |
|
most common cause of neonatal meningitis and dx tests
|
-strep agalactiae
-beta hemolytic, bacitracin resistant, CAMP test positive |
|
genetic basis of cystic fibrosis
|
-deletion of phenylalanine at position 508 on the CFTR gene on chromosome 7
|
|
leigh disease
|
-aka subacute necrotizing encephalopathy
-one of the few examples of dzs involving defects in MITO dna -defect in cytochrome oxidase -pts present as young adults with progressive intellectual deterioration, weakness, ataxia, seizures |
|
adrenoleukodystrophy
|
-XR deficiency of beta FAs in peroxisomes
-accumulation of long chain FAs -brain demyelination and adrenal insufficiency |
|
ear nerves and region supplied
|
1) auricotemporal nerve= ant. half of external ear canal
2) auricular branch of vagus= post. half of external ear canal 3) greater auricular nerve= lower auricle 4) lesser occipital nerve= upper auricle 5) vestibulocochlear nerve= hearing and motion |
|
psoriasis sx worsened by what med?
|
chloroquine
|
|
anticentromere Ab associated with
|
crest syndrome
|
|
anti-ro Ab associated with
|
-sjogren syndrome
-aka anti-SS-A |
|
anti-la AB associated with
|
-sjogrens syndrome
-aka anti-SS-B |
|
anti-Scl 70 Ab associated with
|
-systemic sclerosis
-aka anti-DNA topoisomerase |
|
anti-DNA topoisomerase associated with
|
-systemic sclerosis
-aka anti-Scl 70 |
|
anti-ribonuclearprotein Abs associated with
|
-sjogrens syndrome
-include anti-SS-A (Ro) and anti-SS-B (La) |
|
antihistone Abs associated with
|
-drug-induced SLE
|
|
pseudomonas antibiotic resistance via
|
mutation of porin, restricting entry of antibiotics into the bacteria
|
|
anti-IgG IgMs associated with
|
rheumatoid arthritis
|
|
tay sachs dz
|
-caused by insertion of 4 bases in the coding region for the hexosaminidase A gene, producing a frameshift mutation and premature stop codon
-motor retardation, cherry-red macula and blindness, deafness, death by four years |
|
alpha and beta receptor blocker
|
labetalol
|
|
location of brachial plexus lesion resulting in 1) erb's palsy, 2) klumpke's total claw hand
|
1) upper trunk; C5, C6
2) lower trunk; C8, T1 |
|
drug induced lupus
|
-phenytoin
-hydralazine -procainamide -INH |
|
anti Jo-1 Abs
|
polymyositis/dermatomyositis
|
|
anti-U1RNP Abs
|
mixed connective tissue dz
|
|
purple malar rash
|
-lupus pernio
-sarcoidosis |
|
pruritic purple papules on wrists
|
-aka lichen planus
-hep C -sawtooth infiltrate of lymphocytes at dermal-epidermal junction |
|
S-100 marker for
|
melanoma
|
|
how does staph aureus evade phagocytosis?
|
-protein A, binds Fc region of Ig and disrupts opsonization and phagocytosis
|
|
acute intermittent porphyria
|
-AD, late onset
-episodic variable expression -anxiety, confusion, paranoia -acute abdominal pair -no photosensitivity (unlike in congenital erythropoietic porphyria and porphyria cutanea tarda) -port wine urine in some pts -never give barbiturates |
|
whats unusual about meperidine?
|
-its an opiate, full mu agonist, but has anticholinergic effects
-wont cause sphincter contraction, for example like morphine, and therefore can be used to tx pain of cholecystitis -in OD, wont cause pinpoint pupils due to antimuscarinic effect, if anything would see mydriasis |
|
what tumor produces placental alkaline phosphatase?
|
seminoma
|
|
antimitochondrial Abs seen with
|
primary biliary cirrhosis
|
|
renal plasma flow=
|
clearance of PAH
|
|
through which muscles do these nerves pass, and may be compressed by?
1) median 2) musculocutaneous 3) radial 4) ulnar |
1) pronator teres
2) coracobrachialis 3) supinator 4) flexor carpi ulnaris |
|
this drug --| Ca release from SR
|
dantrolene
|
|
hemicholinium
|
-inhibits the choline uptake transporter that takes up choline from degraded Ach in synapses
|
|
pseudomonas exotoxin mechanism
|
-exotoxin A
-ADP-ribosylates/inactivates EF-2, which is a g protein involved in protein translation -therefore pseudomonas inhibits protein synthesis |
|
tetanus toxin mechanism
|
-protease that blocks release of inhibitory NTs GABA and glycine, causing spastic paralysis
-lockjaw, risus sardonicus |
|
major steps of collagen synthesis
|
1) translation in RER
2) vit C-dependent hydroxylation of proline and lysine residues in RER 3) glycosylation and formation of procollagen triple helix in RER/golgi 4) exocytosis of procollagen triple helix 5) extracellular cleavage of terminal regions of procollagen makes insoluble tropocollagen 6) extracellular cross-linking of lysine/hydroxylysine by lysyl oxidase/copper makes collagen fibrils |
|
defect in type IV collagen
|
-alports syndrome
-XR -hereditary nephritis, deafness, vision problems -type IV collagen is found in basement membranes |
|
defect in type III collagen
|
-ehlers-danlos syndrome
-variable inheritance, faulty collagen III synthesis -hyperextensible joints, hyperextensible skin, easy brusing -may be associated with joint dislocations, berry aneurysms, colon rupture, aortic dissection -type III collagen is found in skin, blood vessels, uterus, fetal tissue, granulation tissue |
|
defect in type I collagen
|
-osteogenesis imperfecta, AD
-multiple fractures, blue sclerae, deafness due to abnormal middle ear bones -jacked up teeth due to abnormal dentin -type I collagen is found in bones, teeth, skin, tendons, dentin, fascia, cornea, late wound repair |
|
mechanism of scurvy, sx
|
-vit c deficiency inhibiting lysine and proline hydroxylation on preprocollagen alpha chains in the RER
-sx: loose teeth, bleeding gums, bruising, poor wound healing, etc |
|
name some causes of polycythemia
|
-primary: polycythemia vera
-secondary: RCC, renal transplant, living at high altitudes, lung dz, heart failure |
|
in what tissues will you have positive stains for:
1) vimentin 2) desmin 3) cytokeratin 4) GFAP 5) neurofilaments |
1) vimentin in connective tissue
2) desmin in muscle 3) cytokeratin in epithelial cells 4) GFAP in neuroglia 5) neurofilaments in neurons |
|
trastuzumab
|
-HER2 epidermal growth factor receptor blocker
|
|
ARF, rash, eosinophilia, fever
|
-acute (drug induced) interstitial nephritis
-main culprits: NSAIDS, methicillin, rifampin, diuretics, sulfonamides |
|
mccune albright syndrome
|
-unilateral cafe-au-lait spots
-precocious puberty -polyostotic fibrous dysplasia with multiple body defects containing unmineralized whorls of connective tissue -somatic mutation of a Gs protein |
|
what lymph nodes drain the penis vagina and anal canal?
|
-medial side of horizontal chain of superficial inguinal LNs
-may be a site of metastasis of neoplasm from these primary sites |
|
what lymph nodes drain the penis vagina and anal canal?
|
-medial side of horizontal chain of superficial inguinal LNs
-may be a site of metastasis of neoplasm from these primary sites |
|
pyriform cortex is
|
primary olfactory cortex
|
|
insula is
|
primary gustatory cortex
|
|
postcentral gyrus
|
primary sensory cortex
|
|
precentral gyrus
|
primary motor cortex
|
|
antimitochondrial Abs
|
primary biliary sclerosis
|
|
what is bumetanide
|
a loop diuretic
|
|
how does primary hypothyroidism cause amenorrhea?
|
-primary hypoT (for ex: hashimotos), causes increased TRH release from the hypothalamus
-TRH stimulates both TSH and prolactin release from the pituitary -excess prolactin then inhibits GnRH -decreased GnRH decreases FSH and LH, resulting in anovulation |
|
sotalol is
|
class III antiarrhythmic, blocks K channels
|
|
name class IB antiarrhythmics
|
-lidocaine, tocainide, mexiletine, phenytoin
|
|
omalizumab
|
-monoclonal Ab against IgE, inhibits IgE binding to Fc region on mast cells and basophils, thus limiting release of mediators
-used in pts w/moderate-severe asthma |
|
beclomethasone
|
-glucocorticoid used in asthma
-inhibits COX2 and phospholipase A2 |
|
nedocromil
|
-inhibits mast cell degranulation
-tx: asthma -another ex: cromolyn |
|
formeterol
|
-long acting B2 agonist used in asthma prophylaxis
|
|
ipratropium
|
-muscarinic antagonist with minimal systemic side effects because it is a quaternary amine
-used in asthma/COPD |
|
name dz causes unconjugated and conjugated hyperbilirubinemias
|
1) unconjugated
-gilberts -crigler najjar 2) conjugated -dubin johnson (black liver) -rotor's syndrome (no black liver) |
|
location of lesion in UMN vs LMN lesion of CNVII
|
-umn: lesion of contralateral motor cortex, sparing of forehead with receives ipsi UMN innervation too
-LMN; lesion of ipsi CNVII in pons |
|
cetirizine
|
2nd generation H1 blocker (nonsedating allergy med)
|
|
ketotifen
|
-ophthalmic antihistamine that noncompetitively blocks H1 receptors and stabilizes mast cells
-used to tx allergic conjunctivitis |
|
myasthenic syndrome
|
-neoplastic myasthenia gravis, caused by either
1) thymoma 2) bronchogenic carcinoma |
|
eaton lambert syndrome
|
-autoimmune dz caused by autoAbs against presynaptic calcium channels on Ach neuron on NMJ
-lack of Ach release causes weakness like myasthenia -proximal muscle weakness of the limbs -improves with use -paraneoplastic cause is small cell carinoma |
|
compare/contrast myasthenia gravis and eaton lambert syndrome
|
MG:
-Abs against Ach receptor on postsynaptic neurons in NMJ -worsens with use (more sx in evening) -weakness of facial muscles -neoplastic cause is thymoma or bronchogenic carcinoma EL: -Abs against presynaptic Ca channels in NMJ -weakness improves with muscle use -starts with proximal muscle weakness -paraneoplastic cause is small cell carinoma |
|
kulchitsky cells
|
small dark blue cells of small cell/oat cell lung carcinoma, neuroendocrine cells
|
|
name the paraneoplastic effects of;
1) small cell lung carcinoma 2) squamous cell carcinoma 3) RCC 4) hemangioblastoma 5) breast carcinoma 6) thymoma |
1) ADH, ACTH, lambert-eaton syndrome
2) PTH 3) Epo, PTH 4) Epo 5) PTH 6) lambert eaton, myasthenia gravis |
|
what is the macrophage endotoxin receptor?
|
CD14
|
|
cytokine causing cancer cachexia
|
TNF
|
|
fredericks ataxia unique b/c
|
-recessive trinucleotide repeat expansion dz
-so can see it in a young child in who's fam there is no hx of dz |
|
small jaw birth abnormality...
|
trisomy 18 (edwards)
|
|
roth's spots
|
-pale retinal spots surrounded by hemorrhage
-seen in endocarditis |
|
mutation implicated in hypertrophic cardiomyopathy
|
myosin beta chain
|
|
what causes granulomatosis infantiseptica
|
-listeria monocytogenes ifxn in pregnant women
-high mortality due to disseminated fetal granuloma formation |
|
electrolyte imbalances caused by ACE-i
|
-hyperK, hypoNa
|
|
sulfonylureas
|
-stimulate endogenous insulin release in DMII pts by closing beta-cell K channels, depolarizing the cells, triggering insulin release via calcium influx
-1st generation; tolbutamide, chlorpropamide, both can cause disulfiram-rxn, chlorpropamide can cause SIADH -2nd gen; glyburide, glimepiride, glipazide, SE are hypoglycemia |
|
other than insulin, what drug class is only other used in DMI pts
|
-biguinides: metformin, phenphormin
-insulin sensitizers, mech unknown, may decrease gluconeogenesis, increase glycolysis -se: lactic acidosis |
|
nitrite test
|
-can distinguish members of enterobacter family from other organisms
-enterbacter are gram neg rods that form nitrite from nitrate -exs of enterbacters; ecoli, klebsiella, pseudomonas, proteus, etc |
|
glucosuria appears when serum [glu] > ??
|
200
|
|
technetium scan
|
concentrates in gastric mucosa, can be used to find ectopic gastric mucosa in a meckel diverticulum, for ex in a child presenting with massive painless rectal bleed
|
|
OCD commonly associated with what other disorder?
|
tic disorders, like tourettes
|
|
trendelberg gait
|
-waddling gate or drop of pelvis when standing on one foot
-caused by weakness of gluteus medius or minimus muscles which abduct the thigh, innervated by superior gluteal nerve |
|
anticentromere Abs
|
CREST syndrome
|
|
riluzole
|
-extends the survival of ALS pts
-glutamate release inhibitor, glutamate receptor blocker, Na channel blocker -may prevent excitotoxicity to neurons |
|
baclofen
|
-symptomatic tx of ALS
-GABA agonist |
|
name 2 ALS drugs
|
-riluzole prolongs survival
-baclofen tx sx |
|
CML blood smear shows
|
-increased neutrophils but decreased leukocyte alkaline phophatase (LAP)
-low LAP distinguishes neutrophilia of CML from neutrophilia of acute inflammation |
|
CLL blood smear
|
-increased lymphocytes
|
|
what NT important for REM sleep?
|
Ach
|
|
anti-Scl-70 Abs
|
scleroderma
|
|
what artery is frequently injured in knee dislocations?
|
popliteal artery
|
|
cause of endocardial cushion defect in downs syndrome
|
inadequate migration of neural crest cells
|
|
cherry red spot seen on fundoscopic exam with
|
-niemann pick dz
-tay sachs |
|
deficiency of sphingomyelinase
|
niemann-pick dz
|
|
deficiency of iduronate sulfatase
|
hunter syndrome
|
|
deficiency of n-acetyleglucosamine-1-phosphotransferase
|
i cell dz
|
|
esophagus lies behind/may be compressed by what portion of the heart?
|
left atrium
|
|
sumatriptan
|
seratonin 5HT 1D/1B agonist used to tx migraines and cluster headaches
|
|
describe site of latency of
1) EBV 2) HSV 1/2 3) VZV |
1) b cells
2) sacral/trigeminal ganglia 3) dorsal root ganglia |
|
WT1 gene
|
-wilm's tumor TSG on 11p
|
|
mallory bodies
|
-tangled bundles of cytokeratin intermediate filaments forming eosinophilic cytoplasmic inclusions in alcoholic hepatocytes
|
|
describe superior and recurrent laryngeal nerves
|
1) superior laryngeal nerve:
-external branch innervates cricothyroid muscle -internal branch carries sensation from larynx above the vocal folds 2) recurrent (inferior) laryngeal nerve -motor to all the muscles of the larynx except the cricothryoid -sensation from larynx below the vocal folds |
|
contents of the carotid sheath
|
1) vagus nerve
2) carotid artery 3) internal jugular vein |
|
name the 2 main defects in fructose metabolism
|
1) fructokinase deficiency: benign deficiency in fructokinase, just get fructose in blood and uring
2) fructose-1-P aldolase B deficiency; AR, results in accumulation of f-1-P which sequesters all the phosphate, causing a shortage of P necessary for gluconeogenesis/glycogenolysis. infants present after 6 months (when they start eating fructose) with severe hypoglycemia, along with liver damage, etc. |
|
name the steps of development at which oocytes are arrested at different times
|
-primordial oocytes; diplotene (last stage) of meiosis 1
-ovulation triggers resumption of meiosis, and ovulated oocytes are arrested in metaphase of meiosis II until fertilization |
|
what is the only GI hormone released by carbs, fats, or proteins?
|
gastric inhibitory peptide
|
|
tx for syphillis
|
penicillin
|
|
guarnieri bodies
|
cytoplasmic inclusions characteristic of smallpox
|
|
tx for borriella or rickettsia
|
doxycycline
|
|
what antibiotics prevent initiation complex formation?
|
-linezolid, from 50s side (mostly for VRE staph or enterococci)
-aminoglycosides, from 30s side, and which also cause misreading of the mRNA (for gram - aerobes) |
|
MOA of macrolides
|
inhibit translocation, bind 50s
|
|
MOA of chloramphenicol
|
-inhibits ribosomal peptidyl transferase
|
|
which antibiotic is used for tx of acne?
|
tetracycline
|
|
MOA of tetracycline
|
--| binding of aminoacyl-tRNA to ribosomes
|
|
what develops into the medial umbilical ligament?
|
umbilical arteries
|
|
what develops into the median umbilical ligament?
|
urachus/allantoic duct
|
|
cause of:
1) widened splitting 2) widened and fixed splitting 3) narrowed splitting 4) paradoxic splitting |
1) pulmonic stenosis
2) ASD 3) pulmonary HTN 4) aortic stenosis |
|
LDL receptors bind what apoprotein?
|
Apo B-100
|
|
churg-strauss syndrome
|
vasculitis+eosinophilia+asthma
|
|
buproprion
|
-antidepressant, smoking cessation
-DA reuptake inhibitor, nicotine antagonist -toxicity is stimulant effects -contraindicated in anorexics/bulimics, in whom it causes seizures |
|
window period
|
-middle period of HepB infxn when HBsAbs have begun to be made and equal the amount of HBsAg, so neither are seen in serum
-HBcAb will be positive |
|
lysosomal alpha glucosidase deficiency
|
pompe disease
|
|
glucose-6-phosphatase deficiency
|
von gierke dz
|
|
myophosphorylase deficiency
|
mcardle dz
|
|
loffler's syndrome
|
-endomyocardial fibrosis with a prominent eosinophilic infiltrate
-eosinophil granule proteins damage heart causing restrictive cardiomyopathy -most common in tropical areas |
|
endocardial fibroelastosis
|
-restrictive cardiomyopathy of children
-thick fibroelastic tissue in endocardium of young children |
|
HIV ELISA is looking for what?
|
p24
|
|
test to detect viral load in HIV pts
|
rt-pcr
|
|
early marker of HIV infection
|
p24
|
|
PCWP estimates
|
LA pressure
|
|
cardiac malformation associated with maternal diabetes
|
-transposition of great vessels due to failure of the AP septum to twist
|
|
cause of tetralogy
|
failure of AP septum to align
|
|
endocardial cushion defect caused by
|
failure of neural crest cells to migrate, common in downs
|
|
cyclobenzaprine
|
-spasmolytic used to tx muscle spasms
-antimuscarinic SEs, like TCAs |
|
probability of type II error
|
-error that you didnt reject null when you should have
=1-power |
|
type I error
|
-rejecting the null hypothesis when its actually true
=p value |
|
muscle and nerve for tongue protrusion
|
-genioglossus muscles protrude tongue and push towards the opposite side
-CN XII lesion will result in tongue pointing towards side of lesion due to ipsi genioglossus weakness |
|
what viral families have semented genomes?
|
-reovirus (rota + reo)
-orthomyxovirus (influenza) -arenaviruses (LCMV + lassa fever) -bunyaviruses (california encephalitis, sandfly/rift valley fever, crimean-congo hemorrahgic fever, hanta) |
|
enzyme deficiency in hurler's dz
|
alpha-L-iduronidase
|
|
enzyme deficiency in gauchers
|
beta-glucocerebrosidase
|
|
enzyme deficiency in tay sachs
|
hexosaminidase A
|
|
histo finding in dermatitis herpetiformis
|
IgA deposits on the basement membrane
|
|
drug to tx onychomycosis
|
terbinafine
|
|
medical tx of cholelithiasis
|
-ursodiol, a primary bile acid that reduces cholesterol secretion into bile and can dissolve cholesterol gallstones
|
|
tangiers dz
|
-deficiency of ABCA1 leading to severely reduced serum HDL
-ABCA1 protein transport cholesterol and phospholipids out of cells for pickup by ApoA1 -orange/yellow tonsils, hand neuropathy and muscle atrophy, enlarge LNs, hepatomegaly, atherosclerosis |
|
lesion of cerebellar vermis
|
-truncal ataxia wide-based drunken sailor gait, but normal finger nose and heel-shin tests
|
|
cause of xeroderma pigmentosum
|
mutation in nucleotide excision repair gene
|
|
CD56
|
NKC marker
|
|
CD14
|
macrophage marker, endooxin receptor
|
|
enzyme deficient in alkaptonuria
|
homogentisate oxidase
|
|
legionella special media is...
|
charcoal-yeast agar, enriched with iron and cysteine
|
|
Ki-67
|
a nuclear factor whose expression correlates with neoplastic replicative activity
|
|
amylin
|
a type of amyloid protein associated with DM2, deposits in the pancreas
|
|
AF
|
senile cardiac amyloid aka transthyreitin, aka ATTR
|
|
drugs known to cause lupus
|
-hydralazine
-chlorpromazine -isoniazid -methyldopa -quinidine |
|
name 3 MAO-inhibitors
|
-phenelzine
-tranylcypromine -iproniazid -isocarboxazid |
|
baby with rash/cutaneous hemorrhages, deafness, periventricular calcifications
|
CMV
|
|
triad of congenital CMV ifxn
|
1) deafness
2) cutaneous hemorrhage 3) periventricular calcifications |
|
ehrlichia phagocytophilia
|
-intracellular bacteria transmitted by ixodes tick (same vector as borriella and babesia)
-berry-like clusters of organisms inside granulocytes -leukopenia, low platelets |
|
other than cough, what does b. pertussus cause?
|
-lymphocytosis
-hypoglycemia |
|
nucleolus
|
site of rRNA synthesis, contains RNA polymerase I, because it synthesizes the bulk of ribosomal rRNA
|
|
main functions of rna poly I, II, and III
|
I-rRNA synthesis
II-mRNA synthesis III-tRNA synthesis |
|
macrophages containing amastigotes is a sign of
|
-leishmania donovani infection (kala-azar)
-characterized by spiking fevers, hepatosplenomegaly, pancytopenia |
|
lymphatic drainage of testes/ovaries
|
-para-aortic LNs, near the origin of the testicular/ovarian artery from the abdominal aorta
-its so high up because gonads originate from high in the abdomen and then descend |
|
name the dzs associated with conjugated- and unconjugated- hyperbilirubinemias
|
-conjugated: dubin-johnson, rotor's
-unconjugated: crigler-najjar, gilberts |
|
downey cells
|
atypical reactive lymphocytes in EBV CBC (which shows lymphocytosis)
|
|
spinal levels for patellar and achilles reflexes
|
-patellar; L4
-achilles; S1 |
|
spinal levels for biceps and triceps reflexes
|
-biceps; C5-C6
-triceps; C7-C8 |
|
what kind of diuretics to avoid in renal insufficiency/failure?
|
-K-sparing ones
-with renal insufficiency tend to have hyperkalemia, so use of spironolactone can cause arrhythmia |
|
2 most common causes of maternal death in preeclampsia
|
-cerebral hemorrhage
-pulmonary complications/ARDS |
|
hairy cell leukemia
|
-chronic b cell leukemia in midaged/old men
-only leukemia w/out lymphadenopathy -panycytopenia, splenomegaly -leukemic cells are "hairy" -positive TRAP stain -autoimmune vasculitis and arthritis |
|
riedel thyroiditis
|
-chronic hypothyroidism characterized by dense fibrosis that destroys thyroid and extends into adjacent structures (largyngeal nerve-hoarseness, tracheal obstruction, dysphagia, dyspnea, etc)
-fixed, hard, painless goiter |
|
name the essential amino acids
|
-lysine
-leucine -isoleucine -threonine -valine -phenylalanine -methionine -histidine -arginine |
|
sleep stages an EEG waveforms
|
1) awake, eyes open-beta
2) awake, eyes closed-alpha 3) light sleep- theta 4) deeper sleep/bruxism-sleep spindles and k complexes 5) deepest sleep/ sleepwalking/ bedwetting- delta 6) REM- beta |
|
muscle and nerve in foot dorsiflexion
|
-muscle: tibialis anterior
-nerve: deep peroneal nerve |
|
foot eversion muscles
|
-peroneus longus and brevis
-superficial peroneal nerve |
|
tibialis posterial
|
-inversion and plantar flexsion
-supplied by tibial nerve |
|
positively skewed distribution
|
-mean > median > mode
-tail on the right |
|
negatively skewed distribution
|
- mode > median > mean
- tail on the left |
|
layers of the anterior abdominal wall
|
1) skin
2) superficial fascia (camper, then scarpa) 3) external oblique 4) internal oblique 5) transversus abdominus 6) transversalis fascia 7) parietal peritoneum |
|
hereditary angioedema is caused by
|
deficiency of C1 esterase inhibitor, results in edema of mucosal surfaces
|
|
points of insertion of
1) psoas major 2) gluteus maximus 3) gluteus medius 4) gluteus minimus 5) piriformis |
1) lesser trochanter of femer
2) gluteal tuberosity 3-5) greater trochanter |
|
basal lamina
|
-extracellular matrix, part of basement membrane
-composed of collagen type IV and glycoproteins (laminin), and proteoglycans (heparan sulfate) |
|
name two beta blockers with intrinsic sympathomimetic activity
|
-acebutolol and pindolol
-ISA means they are partial agonists and have a weak cardiostimulatory effect -dont use these drugs in pts with angina because they can increase myocardial O2 demand, instead of decreasing it |
|
transition
|
purine replaces a purine, or pyrimidine replaces a pyrimidine
|
|
transversion
|
purine replaced by pyrimidine, or vice versa
|
|
describe 4 kinds of immunity
|
1) natural active- you were infected, made ur own Abs
2) natural passive- baby takes moms Abs 3) artificial active- vaccine 4) artificial passive- pooled Ig |
|
pyruvate carboxylase
|
-converts pyruvate ---> oxaloacetate for use in the CAC
-biotin is cofactor |
|
arthus reaction
|
-type III hypersensitivity reaction
-local swelling/inflammation 24-48 hours after injection of an Ag the person has been previously exposed to (like tetanus vaccine) -preexisting Abs react with Ag and deposit immune complexes |
|
source of transmission for campylobacter jejuni
|
poultry
|
|
smoked fish may be a source for what bacteria?
|
clostridium botulinum
|
|
campylobacter jejuni
|
-enterocolitis
-frequent antecedent to guillain-barre (acute ascending demyelinating neuromuscular paralysis caused by Abs against campylobacter cross-reacting with neural Ags) -curved gram neg microaerophilic oxidase positive rods -associated with poultry, puppies with diarrhea in children -bloody or watery diarrhea |
|
what bacterial infxn mimics appendicitis?
|
yersinia enterocolitica mesenteric adenitis
|
|
pick's dz is aka...
|
frontotemporal dementia
|
|
why are CF pts infertile?
|
congenital bilateral absence of vas deferens
|
|
crewcut appearance on xray is associated with
|
extramedullary hematopoesis in sickle cell anemia
|
|
case series study
|
-collection of detailed info about ppl who are all believed to have the same dz
-point is to have a clear description of the common defining aspects of a particular dz -no control group/nondzed group -critical first step in generating a profile by which a new dz can be recognized |
|
risk ratio and odds ratio used to analyze which types of studies?
|
-RR= cohort study
-OR= case control study |
|
define case control vs cohort study
|
-case control; subjects grouped into dz or not dzed categories, then look retrospectively for the presence or absence of suspected risk factors. analyze with odds ratio.
-cohort study; subjects grouped into categories of +/- risk factors and then look prospectively for development of dz. analysis with relative risk. |
|
cross over study
|
interventional study where all subjects are in both tx and placebo groups at some point in the study
|
|
recA gene
|
-bacterial gene that encodes the enzyme recombinase A, which mediates homologous recombination between linear pieces of DNA with chromosome DNA
-a bacteria lacking recA can still undergo F+ to F- conjugation, but no other mechanism of DNA exchange |
|
reid index
|
-ratio of mucous gland depth to total thickness of bronchial wall
-increased in patients with chronic bronchitis |
|
curschmann spirals
|
-mucus casts of small airways
-found in asthmatics |
|
selegiline
|
MAO-B inhibitor (mao-a preferentially metabolizes NE and 5HT, whereas mao-b preferentially metabolizes DA)
|
|
pergolide
|
DA receptor agonist
|
|
anti-Jo-1
|
polymyositis/dermatomyositis
|
|
anti-U1RNP Ans
|
mixed connective tissue dz
|
|
anti-Scl 70
|
-diffuse systemic sclerosis
-aka anti-DNA topoisomerase |
|
what autoAb associated with drug-induced SLE?
|
antihistone
|
|
cushings dz vs cushings syndrome
|
dz= ACTH-dependent hyperadrenalism
syndrome= hypercortisolism from any cause |
|
craniopharyngiomas associated with what endocrine disorder?
|
neurogenic DI
|
|
name 4 bacterial pathogenic traits acquired by lysogeny
|
OBED
1) O Ag of salmonella 2) botulinum toxin 3) erythrogenic exotoxin of s. pyogenes (scarlet fever) 4) diptheria toxin |
|
protein A
|
surface virulence factor of s. aureus, binds Fc region of IgG and prevents activation of complement
|
|
which bacteria has a polypeptide capsule?
|
b. anthracis
|
|
proplythiouracil
|
-inhibits the thyroid enzyme peroxidase, which catalyzes most of the thyroid hormone synthesis reactions, most importantly organification of iodide and coupling of DIT/MIT
-also inhibits conversion of T4-->T3 in the periphery |
|
methimazole
|
inhibits organification and coupling of thyroid hormone synthesis
|
|
what artery supplies the femoral head?
|
medial femoral circumflex artery
|
|
retinopathy of prematurity
|
-accelerated neovascularization in the inner layers of the retina
-occurs in preterm infants, esp. when their respiratory compromise is txed with high FiO2 |
|
why is creatinine clearance a slightly inaccurate estimate of GFR?
|
-because although it is freely filtered, about 10-15% is also secreted in the PT, slightly overestimating GFR
|
|
where does an aspirated peanut go when sitting up or supine?
|
-sitting up; inferior segment of right lower lobe
-supine; superior segment of right lower lobe |
|
cowdry bodies
|
intranuclear inclusions of HSV infxn
|
|
diptheroids
|
-gram positive rods that are normal flora of the oropharynx
-similar to diptheria, but diptheria has a lysogenized diptheria toxin, which makes it pathogenic -diptheroids and diptheria are distinguished from one another with the ELEK test |
|
which lung cancers are central, which peripheral?
|
-central: squamous cell, small cell
-peripheral: adenocarcinoma, bronchioalveolar carcinoma, large cell |
|
which lung cancer associate with previous pulmonary injury/inflammation?
|
adenocarcinoma
|
|
describe histology of a large cell carcinoma cell
|
pleomorphic giant cells with leukocyte fragments in cytoplasm
|
|
L-myc
|
oncogene associated with small cell lung carcinoma
|
|
N-myc
|
oncogene associated with neuroblastoma
|
|
c-kit
|
oncogene associated with gastrointestinal stromal tumor (GIST)
|
|
bcl-2
|
oncogene associated with follicular lymphoma, inhibits apoptosis
|
|
name three "myc" genes and the cancers they are associated with
|
-c-myc: burkitts lymphoma
-l-myc: small cell lung carcinoma -n-myc: neuroblastoma |
|
Tdt
|
-a cell surface marker present only in extremely primitive cells of lymphocyte lineages
-present on neoplastic cells of ALL -involved in VDJ rearrangement of the heavy chain |
|
in what conditions do you find target cells?
|
1) hemoglobinopathies (thalassemia, HgC dz, SS)
2) liver dz 3) asplenia |
|
isoniazid, MOA and method of resistance
|
-MOA: decreases synthesis of mycolic acids
-must be activated by mycobacterial catalase-peroxidase -resistance via: 1) decreased activity of the catalase-peroxidase enzyme 2) modification of the isoniazid-binding site of the mycolic acid synthesis enzyme |
|
paraneoplastic cerebella degeneration
|
a autoimmune paraneoplastic syndrome where Abs against tumor cells cross react with cerebellum, seen mostly in cancers of ovary, uterus, breast, and small cell of lung
|
|
splitting common among ppl w/
|
borderline personality
|
|
fibromyalgia
|
-chronic disorder w/widespread musculoskeletal pain, stiffness, paresthesias, poor sleep, emotional disturbances
-on PE find multiple symmetrically distributed spots of tenderness -mostly women, some sort of pain misperception or something |
|
bile and strep
|
-strep pneumonia is "bile soluble" meaning it CANT be cultured in bile
-gamma hemolytic entercocci and nonenterococci can grow in bile (enterococci also can grow in NaCl) |
|
which artery most commonly involved in atherosclerosis?
|
abdominal aorta
|