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374 Cards in this Set
- Front
- Back
What in cancer precipitates NBTE (nonbacterial thrombotic endocarditis)?
|
Marantic Endocarditis: Hypercoagulability due to procoagulant circulating cancer products
|
|
What is Trousseau's Sx?
|
Migratory Thrombophlebitis due to disseminated cancer causing Hypercoagulability
|
|
Actions of ANP (atrial natriuretic peptide)?
(2) |
-Peripheral vasodilation
-Increased urinary excretion of Na and H20 |
|
Dx
Clubbing and cyanosis of toes but not fingers |
Patent Ductus Arteriosus
|
|
How to make LVOT obstruction (e.g. HCOM) louder?
Quieter? |
Louder:
1) Decrease preload (e.g. sudden stand or Valsalva) Quieter: 1) Increase preload (squatting, lying supine) 2) Decrease pressure gradient across valve by increasing SVR with hand grip or vasoconstriction |
|
S/e of Hydralazine
How to avoid |
Arterial vasodilation --> relfex sympathetic tachycardia and salt retention
Give with Diuretics and sympatholytics |
|
Ion that causes Phase 0 depolarization in
Pacemaker cells: All other heart cells: |
Pacemaker cells: Ca (voltage gated)
All other heart cells: Na (voltage gated) |
|
Collagen type in scars replaces what in granulation tissue?
|
Type I scar replaces Type III granulation tissue
|
|
Which antiarrythmic class slows K efflux prolonging repolarization and prolonging refractory period?
|
Class III
|
|
Fick's Eq
|
O2 consumed/ (SaO2-SvO2)
|
|
Nitrate signalling pathway
|
Nitrate converted to NO by vascular smooth muscle --> Inc cGMP --> Dec Ca --> Myosin dephosphorylation
|
|
Dosing concern re: Nitrates
|
Must have nitrate-free period every day to avoid TOLERANCE
|
|
Which artery occluded
II, III, AVF elevations |
RCA
|
|
Etio of Senile Aortic Stenosis
|
Calcium deposits in leaflets
|
|
Causes of Aortic Valve problems
1) AS, 70s or older 2) AS, 50s-60s 3) AS + AI, younger 4) AR only |
1) AS, 60s or more --> Senile calcific AS
2) AS, 50s or younger --> Congenital bicuspid AV valve 3) AS + AI --> Chronic Rheumatic Heart Disease 4) AR only --> Acute Infectious Endocarditis |
|
Channel problem in Long QT
|
Decreased outward K current prolongs repol --> polymorphic VT (e.g. Torsades)
|
|
What happens to baroreceptor firing when hypertensive?
|
Increased firing
|
|
Cardiac injury to low perfusion
|
Chronic low perfusion or repetitive low grade ischemia --> Myocardial stunning --> Repetitive stunning --> Myocardial hibernation
|
|
Dx
Mitral regurg in underdeveloped country |
Rheumatic fever
|
|
ANP production by ventricles (vs atria) is caused by what?
(2) |
1) Ventricular hypertrophy
2) Volume overload |
|
Light microscopy after MI:
0-4 hrs = 4-12 hrs = 12-24 hrs = 1-5 days = 5-10 days = 10-14 days = 14+ days = |
0-4 hrs = minimal change
4-12 hrs = edema, wavy fibers 12-24 hrs = coag necrosis, contraction band necrosis 1-5 days = coag necrosis with neutros 5-10 days = Macro phagocytosis of dead cells 10-14 days = granulation tissue and neovascularization 14+ days = collagen deposition/scar |
|
Effect of nitrates on Pressure Volume Loop
|
Nitrates cause venous and arterial vasodilation decreasing both Preload and Afterload maintaing SV
|
|
Dx
Endocarditis following GU manipulation (foley etc) |
Enteroccocal endocarditis
|
|
Which structures dilate in
VSD? ASD? |
VSD - LA
ASD - RA and RV (+/- PAs Eisenmenger) |
|
Prognostic (and cyanotic) determinant of TOF
|
Degree of Pulmonary Stenosis
|
|
Dx
Early diastolic murmur |
AI
|
|
Dx
Facial rash, proteinuria, CP worse with inspiration |
Pericarditis
(Serosal inflammation of Lupus) |
|
Causes of Pulm HTN in congestive HF
(2) |
1) Back pressure log from L heart
2) Reactive vasoconstriction 2/2 VENOUS Congestion |
|
Histologic sign in Acute Graft Rejection
|
Dense interstitial Lymphoyctic infiltrate
|
|
Ischemic changes to heart
0-1 min: 1-30 min: 30+ min: |
0-1 min = Loss of contractility w/in 60 seconds
1-30 min = Reversible injury with reperfusion 30+ min = Irreversible injury |
|
What is the only GI ulcer NOT associated with malignancy?
|
Duodenal
|
|
What microorgnaism destroys myenteric plexus leading to achalasia, megacolon, or megaureter
|
Trypansoma cruzi = Chagas Disease
|
|
MOA
VIPoma Tx |
Somatostatin --| VIP which itself would otherwise inhibit Gastrin
|
|
Where is H pylori most concentrated in GI tract?
|
Prepyloric area
|
|
Dx
Palpable but non-tender Gallbladder (courvoisier sign), weight loss, jaundice, dark urine, pale stool |
Pancreatic cancer
|
|
Dx
Colon: Numerous discrete flask shaped ulcerative lesions on endoscopy, Trophozoites containing RBCs on biopsy |
Entamoeba Histolytica
|
|
Dx
Colon: Spindle shaped tumor cells with small vessel proliferation on biopsy |
Kaposi Sarcoma
|
|
Dx
Oxidase positive, gram negative, comma shaped rods on ALKALINE media, in gut |
Cholera
|
|
Dx
Diarrhea, mucus and some epithelial cells on microscopy (2) |
Cholera or ETEC
|
|
Dx, Mech
Abdominal pain and distension, vomiting, air in GB and biliary tree |
Gallstone ileus after Cholecystenteric Fistula
(Gallstone crosses fistula and blocks ileocecal valve) |
|
How to get B12 after gastrectomy
|
IV B12 for life
|
|
Tx
Giardia |
Metronidazole
|
|
Dx
Stool sample shows ellipsoidal cysts with smooth walls and 2+ nuclei |
Giardia
|
|
S/e of Opioids on Biliary system
|
Sphincter of Oddi contraction --> Biliary colic (pain)
|
|
Which cell does Shigella first invade?
|
M cells in Peyer's Patches
|
|
Most likely adenoma tupe to progress to colon cancer?
|
Villous adenoma
|
|
Dx
Mucin producing, signet ring neoplatic cell in ovarian stroma |
Krukenberg tumor (Gastric cancer metastasized to ovary)
|
|
Dx
Postprandial pain 30-40 min after meal, hx of atherosclerosis |
Atherosclerotic mesenteric ischemia
|
|
Most common structural abnormality if imperforate anus
|
UG tract defects
|
|
Dx
Longitudinal mucosal tears at GE junction |
Mallory Weiss tear
|
|
Activators of HCl production
(3) |
1) ACh
2) Hisatmine 3) Gastrin |
|
Structure trapped in Superior Mesenteric artery sx
|
Transverse duodenum between SMA and Aorta
|
|
Most likely organism in intraabdominal infxn
(2) |
B Fragilis > E. coli
|
|
Mech of Vancomycin resistance in Enterococcus
|
D-Lactate substitution for D-Ala in peptidoglycan wall
|
|
Dx
Garlic odor on breath |
Arsenic poisoning
|
|
Tx
Arsenic poisoning |
Dimercaprol
|
|
Dx
Foamy macrophages packed with rod shaped baccili and PAS positive granules |
Whipple's Disease (Tropheryma whippeli)
|
|
What 3 things increase oxygen affinity?
|
1) Increased pH
2) Decreased 2,3-BPG 3) Decreased temperature |
|
Tx
Heparin overdose |
Protamine
|
|
Dx
Leukemia, mediastinal mass causing respiratory sx, dysphagia, and superior vena cava sx |
T cell Acute Lymphoblastic Leukemia
|
|
S/e of AZT (zidovudine)
|
Neutropenia
|
|
Lab values in HUS
RBC Plt Bleeding Time LDH Coags |
RBC - Lo
Plt - Lo Bleeding Time - Long LDH - Hi Coags - nL |
|
Dx
Subretinal fluid, gray subretinal membrane or neovascularization |
Wet Age Related Macular Degeneration
|
|
Tx
Wet Age Related Macular Degeneration |
Anti VEGF
|
|
Steroid effect on Hct
|
Increased independent of concurrent EPO usage
|
|
DIC vs TTP in HUS
Bleeding: What is activated? Coags: Fibrinogen: |
DIC
Bleeding: Yes What is activated? Coag cascade Coags: PT and PTT long Fibrinogen: Low fibrinogen TTP-HUS Bleeding: No What is activated? Only plts Coags: nL Fibrinogen: nL |
|
Dx
Gingival bleeding, epistaxis, menorrhagia |
von Willebrands
|
|
Dx
Decreased plt aggregation with RISTOCETIN |
von Willebrands
|
|
What supplement can mitigate Folate/B12 deficiency?
|
Thymidine
|
|
Labs in Abnormal bleeding due to lack of dialysis
|
Uremia --> QUALITATIVE plt disorder so:
1) nL plts 2) nL PT 3) nL PTT 4) LONG Bleeding time |
|
How does Nitrite poisoning work?
*NB NOT NitrAtes |
Oxidize heme iron causing Methemoglobinemia
|
|
Which organ senses hypoxia for increasing Hct?
|
Kidney's Renal cortical cells
|
|
Dx
t(15;17) --> PML/RARalpha |
Acute Promyelocytic Leukemia
|
|
Which enzyme can synthesize ribose from fructose-6-phosphate?
|
Transketloase
|
|
What cells regulate total body iron?
|
Hepatic parenchymal cells via Hepcidin
|
|
Translocation in AML
|
t(15;17)
|
|
Dx
Many immature cells (band forms, metamyelocytes, myelocytes) and few blasts, Leukocyte Alk Phos low |
CML
If Alk Phos nL or High = Leukemoid reaction |
|
Dx
Elderly patient with chronic anemia without identifiable underlying cause |
Usually B12 malabsorption
|
|
Heme and Glucose inhibit poryphyrin synthesis where?
|
delta-ALA synthase (first step)
|
|
What causes the power stroke?
|
First 40 degrees of deflection - Pi dissociation
Next 5 degrees of deflection - ADP dissociation |
|
What products are released during Labor to induce uterine tone?
|
PGE2 and PGF2
Effin'/******' labor |
|
How do NSAIDs and ASA cause renal damage?
|
Block Prostaglandin production which normally dilates Afferent Arterioles --> Renal ischemia --> Renal failure
|
|
Defense mechanism
Redirection of emotion from person or object causing negative emotion to more acceptable but still inappropriate person or object |
Displacement
|
|
Defense mechanism:
Redirection of emotion from person or object causing negative emotion to more Acceptable AND Appropriate person or object |
Sublimation
|
|
Defense mechanism:
Unacceptable or personally disagreeable impulses or drives are attributed to others |
Projection
|
|
Defense mechanism:
Unacceptable feelings are ignored and the opposite sentiment is expressed |
Reaction Formation
(Ben) |
|
Prescreen for use of TNF-alpha inhibitor (e.g. etarnecept)
|
PPD for latent TB
|
|
Prescreen for use of Methotrexate or Leflunomide
|
LFTs
|
|
Lab monitoring while on Hydroxychloroquine
|
Ophthalmologic vists for Irreverisble retinal damage
|
|
Dx
Sudden upward stretching of arm at the shoulder, hand clumsiness |
Lower trunk of Brachial nerve plexus injury
|
|
Dx
Shoulder dislocation, weak deltoid and teres minor |
Axillary n. injury
|
|
Dx
Midshaft humerus fracture |
Radial n. injury
|
|
Dx
Violent stretching of head from shoulder, weakness of forearm flexion |
Upper brachial n plexus injury --> Musculocutaneous n. injury
|
|
Dx
Nerve damage during axillary lymph node dissection |
Long thoracic n.
|
|
Positive externality of this drug is to increase Ca resorption within nephron for women with comorbid osteoperosis
|
HCTZ
|
|
Tx
Acute Gout 1st 2nd Alternative |
1st - NSAIDs
2nd - Colchicine Alternative - Glucocorticoids for contraindications to NSAIDs |
|
Dx
Wound with fruity odor |
Infection with Pseudomonas Aeruginosa
|
|
Mech of Hypokalemia in antihypertensives
|
IF NOT K sparing:
Decreased blood volume --> Inc Aldosteron --> Na keeping/K wasting |
|
A. acid composition of Collagen
|
Gly-X-Y
X and Y are usually proline and lysine but not as commonly as Glycine |
|
Dx
Necrotic skin wound with erythematous border and necrotic center |
Anthrax
|
|
Which IL causes Antibody Istoype Switching?
|
IL-4
|
|
Dx
Recurrent otitis media, chronic diarrhea, FTT, and pneumocystis infxn |
SCID
|
|
Dx
Child with recurrent otitis media, bronchitis, and sinusitis |
Immmotile Cilia Syndrome
|
|
Dx
Recurrent cutaneous abscesses |
Chronic Granulomatous Disease
|
|
What does Candida Skin Test test?
|
Cell mediated immune response
(Macros, NK cells, CD4+, CD8+) |
|
Dx
Subperiosteal hematomas, painful gums |
Vit C def
|
|
Dx
Cheilosis, stomatitis, glossitis, corneal vascularization |
VitB2 (Riboflavin) def
|
|
Dx
Acrodermatitis enteropathica, growth retardation, infertility |
Zinc def
|
|
Dx
Cheilosis, glossitis, dermatitis, and peripheral neuropathy |
VitB6 (Pyridoxine) def
|
|
Dx
Erythematous, pruritic papules, vesicles and bullae that appear bilaterally symmetrically on flexor surfaces |
Dermatitis Herpetiformis
|
|
Dx
Mental retardation, eczema, "mousy" odor |
PKU (Phenylketonuria)
|
|
Inheritance of PKU
|
Autosomal Recessive
|
|
Cause of Peau d'orange
|
Tumor blocks Lymphatic drainage --> lymphedema, pitting and thickening of skin
|
|
What causes nipple/skin retraction in breast ca?
|
Infiltration of Suspensory (Cooper's) Ligament
|
|
S/e
Topical corticosteroid cream |
Dermal atrophy
|
|
Dx
BRAF V600E mutation |
Melanoma
|
|
Dx
Intranuclear inclusions and Multinucleated inclusion-bearing giant cells |
Shingles
|
|
Only Antiviral that doesn't need phosphorylating enzymes to work
|
Cidofovir
|
|
Which RNA polymerase makes rRNA?
mRNA? tRNA? |
rRNA = RNA Pol I
mRNA = Pol II tRNA = Pol III |
|
Dx
Basal cell layer atypia, hyperkeratosis, and parakeratosis |
Actinic Keratosis (small percentage progress to SCC)
|
|
Dx
Nests of Basaloid cells and Peripheral Palisading of nuclei |
Basal Cell Carcinoma
|
|
Dx
Thin stratum granulosum, prominent parakeratotic stratum corneum with occasional foci of neutrophil accumulation |
Psoriasis
|
|
Tx
Male pattern baldness |
Finasteride
|
|
What is a 90 nt RNA sequence with pseudouridien and acetylcytosine?
|
tRNA
|
|
What is at 3' end of tRNA
|
CCA where a. acids attach
|
|
S/e
Pseduolymphoma |
Phenytoin
|
|
S/e
Agranulocytosis (2) |
1) Carbamazepine
2) Clozapine |
|
S/e
Steven Johnson Sx |
Lamotrigine
|
|
What enables E Coli to cause meningitis
|
K-1 antigen in capsule
|
|
MOA
Tetradotoxin |
Antagonizes Voltage Gated Na Channels in nerve and cardiac tissue
|
|
Dx
Confusion, agitation, tremor, tachycardia, HTN, clonus, hyperreflexia, hyperthermia and diaphoresis |
Serotonin Syndrome
|
|
Tx
Serotonin Syndrome |
Cyrpoheptadine
|
|
Which fatty acids cannot be beta oxidized as is by mitochondria?
Where are they metabolized |
Very long chain fatty acids
and Fatty acids with branch points at odd-numbered carbons Metabolized in PEROXISOMES |
|
Schizophrenia spectrum by time:
|
0-1 mo = Brief Psychotic Disorder
2-6 mo = Schizophreniform Disorder 6+ mo = Schizophrenia |
|
Tx
Heat induced seizure |
Cooling blankets
|
|
Meningococcal meningitis prophylaxis
|
Rifampin
|
|
Neurofibromatosis is a tumor of what cells?
What are their embryological origin? |
Schwann cells
From Neural crest |
|
What accounts for Alpha helical or Beta pleated sheet structure
|
Hydrogen bonds
|
|
How does thiopental allow such short unconscious periods when used as anasthetic?
|
Rapid redistribution of the lipid soluble substance allows awakening within 5-10 minutes of administration
|
|
MOA
Ethosuximide |
Blocks T-type Ca channels in Thalamus
|
|
What causes Meningoencephalitis in HIV pts?
|
Cryptococcus neoformans
|
|
Dx
Polysaccharide capsule antigen |
Cryptococcus neoformans
|
|
Histology of
Cryptococcus neoformans |
Round or oval budding yeast
|
|
What has happened when neurons have enlargement of cell body, eccentric nucleus, big nucleolus, and dispersion of Nissl substance?
|
Axonal injury to the neuron
|
|
What has happened to neuron:
Shrinkage of cell body, loss of Nissl substnace, eosinophilic cytoplasm. |
Cell death or Irreverisble injury (Red Neuron)
|
|
What has happened to neuron:
Loss of neurons and functional groups of neurons, Reactive gliosis |
Neuronal atrophy
|
|
Dx
Encephalopathy with lactic acidosis and stroke like episdoes |
MELAS (it's in the name!)
A mitochondrial disease |
|
Dx
Down and out Eye BUT PERRLA |
Ischemia of CNIII (sparing PS fibers on outside of nerve)
|
|
Dx
Behavioral disinhibition, progressive dementia, dysarthria, echolalia or aphasia |
Pick's Disease
(The last 3 are types of speech difficulty they present with) |
|
Rule for language barrier pts:
|
If NON-emergent always wait for a trained Objective interpreter
|
|
Autonomic effect on Insulin secretion
|
Alpha - inhibit insulin secretion
Beta - Stimulate insulin secretion |
|
Function of pilus in Meningococci
|
Epithelial attachment to the Pharynx
|
|
What does blood anesthetic concentration tell us?
Arteriovenous concentration gradient ? Significance? |
in Blood = Solubility
AV gradient = Tissue solubility In both, the higher the slower the onset of action |
|
Dx
Child with brain tumor, sheets of small blue cells, often in vermis |
Medulloblastoma
|
|
Dx
Brian tumor in child, rosettes |
Ependymoma
|
|
Tx
Absence + Tonic clonic seizures |
Valproic acid
|
|
Tx
EtOH withdrawal If Liver disease: |
1st line: Long acting Benzos (Diazepam)
Advanced Liver disease: Short acting Benzos (Lorazepam, oxazepam) |
|
Advantage of Buspirone for anxiety
|
Non-sedating
|
|
Elevated in Klinefelter's
Why? |
FSH due to gonadal failure (lack of negative feedback
|
|
CA-125 is a biomarker specifically for what?
|
Ovarian EPITHELIAL tumor cells
|
|
Loss to follow up is what kind of bias?
|
Selection bias
|
|
In the ovary
Androstenedione is produced by what? Estrogen is produced by what? |
Androgens by Theca INTERNA
Estrogen by Granulosa cells |
|
Triad of Preeclampsia
|
1) HTN
2) Proteinuria 3) Edema |
|
What are the 5 types of DCIS?
1) Solid sheets of pleomorphic high grade cells with central necrosis |
1) Comedocarcinoma
2) Solid 3) Cribiform 4) Papillary 5) Micropapillary |
|
What prevents lactation DURING pregnancy
|
High levels of Progesterone and Estrogen
|
|
What type of Ig is Rhogam?
|
IgG
(hence dosed to small amount of fetal blood in mom, bc too much cause immune reaction after crossing placenta) |
|
Why is Rhogam IgG?
|
Fc region of IgG has highest affinity for phagocytic cells
|
|
Dx
Pregnant mother with maculopapular rash that begins on head and neck and moves to chest, postauricular lymphadenopathy |
Maternal Rubella (German measles)
|
|
Birth defects with Maternal Rubella (German Measles)
(3) |
Sensorineural deafness, cataracts, and cardiac malformations
|
|
Cell type in ovary?
|
Simple cuboidal
|
|
What hormone is mainly responsible for Gestational Diabetes?
|
hPL (Human Placental Lactogen)
|
|
Histology of Endometrius by place in menstrual cycle:
1) Glycogen rich mucus, edematous endometrial stroma, tortuous spiral arteries 2) Coiled glands with occasional cytoplasmic vacuoles 3) Compact, non-edematous stroma, endometrial glands long but straight, coiled arteries are deep 4) Eroded, hemorrhagic endometrial surface with disintegrating stroma and glands |
1) Luteal phase
2) Ovulation 3) Proliferative phase 4) After menses |
|
How long after fertilization to detect hCG?
|
8 days
|
|
Draw the Internal external genitalia tree for males!
|
SRY, TDF, Testes, Sertoli cells, MIF, Paramesonephric ducts, Leydig cells, Testosterone, internal genitalia, DHT, external genitalia
Notebook 66 |
|
Which stage of Meisosis arrestment?
Egg in ovary - Egg selected for ovulation - Ovulated egg waiting for fertilization - |
Egg in ovary - Prophase I
Egg selected for ovulation - between the two Ovulated egg waiting for fertilization - Metaphase II |
|
Lymph drainage
Testes - Scrotum - |
Testes - Paraoartic lymph nodes
Scrotum - Superficial Inguinal lymp nodes |
|
Dx
Uterus filled with large, edematous, vesicular structures that look like a bunch of grapes |
Complete molar pregnancy
|
|
What to treat
Gonorrhea - Chlamydia - |
Gonorrhea - 3rd gen Cephalosporing
Chlamydia - Azithromycin or Doxy |
|
Dx
33 yr old woman, not pregnant, vaginal bleeding, right adnexal mass, endometrial hyperplasia |
Granulosa cell tumor
|
|
Which nerve is blocked at the ischial spine in childbirth?
|
Pudendal nerve
|
|
Which nerves can be blocked for completeblockage of perineal and genital anethesia in addition to Pudendal?
(2) |
Genitofemoral
and Illioinguinal |
|
Tx
Infertility in PCOS |
Estrogen receptor modulator (e.g. Clomiphene)
|
|
Why is PaO2 in L atrium less than in Pulmonary capillaries?
|
Bronchial arteries mix their deoxygenated blood into the oxygenated pulmonary veins
|
|
Which bug causes Chronic PNA in ImmunoCOMPETENT hosts?
|
Blastomycosis dermatitidis
|
|
Abx consideration in Mycoplasma
|
NO CELL WALL so cant' use penicillins, cephs, penems, or vanc
USE Tetracycline or Erythromycin |
|
Dx
Frequent infxns from all 3 types of bugs, no Ig, no thymus |
SCID
|
|
Dx
Fungus ball in lung |
COLONIZING Aspergillus
|
|
Dx
Lung infection with 45 degree hyphae |
Aspergillus
|
|
MOA of Vareniclin
(2 effects) |
Partial Agonist of Nicotinic ACh receptors
1) Decreases cravings 2) Makes nicotine less pleasurable |
|
Dx
Lung sputum, germ tubes (aka true hyphae) |
Candida Albicans
Contaminant, NOT a true INFXN |
|
What makes up R border of heart on CXR
|
Right Atrium
|
|
Dx
In lung histology, enlarged centrally located epithelial cell |
CMV
|
|
What type of virus is CMV
|
Enveloped, dsDNA virus
|
|
Acid fast stain tests for what component?
|
Mycolic acid
|
|
Which astham drugs works on vagally mediated bronchoconstriction
|
Ipratropium
|
|
How far does lung pleura go superiorly?
|
Past the clavicle
|
|
Dx
Lung infection, endospores packed inside spherules |
Coccidioides immitis
|
|
Mech of ARDS
|
Damage to Endothelial cells --> Pulmonary capillary leakage of fluid into alveoli
|
|
Dx criteria of ARDS
|
1) Acute onset lung dysfunction
2) Pulmonary edema 3) Normal L Atrial pressure 4) PaO2/FIO2 <200 |
|
Dx
Nodular glomerular sclerosis |
Diabetic Nephropathy (Kimmelstiel-Wilson) lesion
|
|
Which bone tumor is most associated with Paget's disease?
|
Osteosarcoma
|
|
Dx
Bone shows crescent sign with subchondral collapse |
Avascular necrosis
|
|
Dx
Osteophytes and joint space narrowing |
Osteoarthritis
|
|
Dx
Generalized osteosclerosis and pathologic fractures |
Osteopetrosis
|
|
Dx
Bone area of myixed lysis and sclerosis with focal periosteal elevation |
Osteosarcoma
|
|
Dx
Lump in throat without medical evidence of obstruction |
Globus Hystericus
|
|
What normally coats urate crystals in gout keeping them from being immunogenic/inflammatory?
|
ApoE and ApoB
|
|
Dx
Fibrous-walled cysts within the subchondral bone, joint mice |
Osteoarthritis
|
|
Which Vitamin can be highly teratogenic?
|
Vitamin A
|
|
Dx
Fetal microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation or spontaneous abortion |
VitA toxicity in utero
|
|
MOA
Oseltamivir |
Neuraminidase inhibitor of Influenza A and Influenza B
Only effective if taken within first 48 hrs |
|
What does Neuraminidase do?
|
It allows flu virions to cleave themselves away from membrane to infect other cells
|
|
Dx
180 base pair DNA segments |
DNA laddering = Apoptosis
|
|
Action on Muscarinic smooth muscles:
Atropine = Phytostigmine = |
Atropine = Relaxation
Physostigmine = Contraction |
|
What does Pralidoxime do?
|
Antidote to Organophosphate Anticholinesterase inhibitor
It reactivates Cholinesterases by dephosphorylating them |
|
How are Benzos metabolized?
Diazepam - Midazolam - Lorazepam - |
Diazepam - Hepatic oxidation
Midazolam - Hepatic oxidation Lorazepam - Hepatic glucoronidation |
|
Dx
Confusion, blurred vision, dry mucous membranes, intense thirst |
Anticholinergic toxicity
Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter |
|
Word for when one gene has many phenotypic results
|
Pleiotropy
|
|
Dx
Rare genetic disease in children, but in no earlier family members |
Germline mutation or mosaicism
|
|
Indication for Fish Oil
|
Refractory Hypertriglyceridemia
|
|
Physical exam frequency for Diabetics
Foot inspection - Pinprick sensation - |
Foot inspection - Daily
Pinprick sensation - Yearly |
|
Translocation in Auer rods
|
t(15;17) in AML
|
|
Who makes IL-2 and what does it do?
|
-IL-2 is made by T cells
-It stimulates differentiation of T cells, B cells, NK cells, and Macros |
|
Who makes IL-1 and what does it do?
|
-Made by Mononuclear phagocytes?
-Activates lymphocytes and promotes fever, lethargy, and anorexia |
|
Who makes TNF-alpha and what does it do?
|
-Made by Macros
-Induces systemic inflammatory response and ultimately septic shock and cachexia |
|
Who makes IFN-alpha and what does it do?
|
-Made by basically all cells except T cells
-Antiviral function |
|
Who makes GM-CSF and what does it do?
|
-Made by many cells
-Promotes stem cell production of granulocytes and monocytes |
|
Characteristics of cadherins
(3) |
1) In desmosomes
2) Between cells 3) Ca dependent |
|
Dx
Multiple firm, flesh-colored, dome shaped papules on on the skin, filled with pruritic material and umbilicated |
Molloscum contagiosum
|
|
Dx
Multiple blue violet dermal plaques on feet and legs before spreading proximally, also on mucosal membranes and genitals |
Kaposi's sarcoma
|
|
Trigger for Bile and Pancreatic juice
|
Duodenal acidity
|
|
Which structure is frequently damaged in anterior and posterior tibial dislocations at the knee?
|
Popliteal artery
(pinned by surrounding muscles) |
|
Which structure is injured with Penetrating trauma to Popliteal fossa?
|
Tibeal nerve
|
|
Bug in Endometritis
|
Bacteroides (most common amongst mixed flora)
|
|
Can 2 yr olds get shingles?
|
Apparently
|
|
How do Tyrosine Kinase receptors transmit into cell?
|
Via Dimerization
|
|
Interview technique:
1) Vicarious understanding of patient's feelings 2) Expression of concern for patient's experiences 3) Drawing the patient's attention to discrepancies in the story 4) Encouraging the patient to talk more about their experienvce 5) Repeating what the patient said in order to cofirm understanding show hearing |
1) Empathy
2) Support 3) Confrontation 4) Facilitation 5) Reflection |
|
Dx
Chronic nasal congestion that worsens with abrupt changes in temperature or humidity or exposure to odors or alcohol, HA, anosmia, sinusitis |
Vasomotor rhinitis
|
|
Dx
Chronic nasal discharge, atrophic nasal mucosa, thinning of the nasal septum, oropharyngeal ulcers |
Chronic Cocaine insufflation
|
|
What does GFR increase to after nephrectomy?
|
80%
|
|
Where in penis do phosphodiesterase inhibitors work?
|
Corpus cavernosum
|
|
What stimulates pancreas to secrete bicarb?
|
Secretin
|
|
Dx
Flashbacks, hypervigilance, irritability and poor concentration following an event Less than 4 weeks = More than 4 weeks = |
Less than 4 weeks = Acute Stress Disorder
More than 4 weeks = PTSD |
|
Difference between Adjustment Disorder and Acute Stress Disorder
Timeline: Sx: Trigger: |
Timeline: Adjustment is within 3 months of stessor, Stress d/o is quick but cannot last past 4 weeks --> PTSD
Sx: Share many (Sleep problems, irritability, poor concentration) but Adjustment doesn't have flashbacks or nightmares. Trigger: Adjustment is emotional (e.g. divorce), Stress d/o is generally life threatening |
|
Dx
HIV pt, fever, HA, seizures, personality changes, and psychosis |
Herpes virus Encephalitis
|
|
Defect in porphyria that causes intermittent abdominal pain and neurologic manifestations after exposure to medication.
|
HMB Synthase in Acute Intermittent Porphyria
|
|
What do the numbers next to pedigree mean?
|
Their ages
|
|
Inheritance of Hemophilias A and B?
|
Both X linked Recessive
|
|
Characteristics of Exudate lab findings
(2) |
1) Pleural protein/serum > 0.5
2) Pleural LDH/serum > 0.6 (or 2/3 of upper limit of normal LDH) |
|
What is myasthenia gravis associated with?
|
Thymoma
|
|
Most common bugs in Setic Joint:
(2) |
1) Nisseria gonorrhea
2) Staph aureus |
|
Which embryologic structures do not form well in DiGeorge
|
3rd and 4th Pharyngeal pouches
|
|
Lab abnormalities in DKA
K - Na - Anion Gap - Ammonia - |
K - Hi
Na - Low Glucose - Hi Anion Gap - Hi Ammonia - Hi |
|
Dx
Downward displacement of elongated cerebellar tonsils through the foramen magnum |
Arnold-Chiari malformation
|
|
Dx
Enlarged posterior fossa, midline cyst representing expanded fourth ventricle replaces vermis |
Dandy-Walker syndrome
|
|
Dx
Fluid filled cavities within the medulla |
Syringobulbia
|
|
Dx
Blind vaginal pouch, Testosterone Hi, LH Hi, FSH normal |
Androgen insensitivity
(-Testosterone high because Tests present, and leydig cells makes but hypothalamus doesn't respond to it so LH hi too. -FSH normal because sertoli cells present and make nl FSH with normal feedback. -Female phenotype bc Testesterone eventually converted to estradiol. -No uterus bc MIF made by Sertoli cells. |
|
Long lasting alpha receptor blockers used for Pheos
|
Phenoxybenzamine
|
|
Dx
Premie with brain injury |
Intraventricular Hemorrhage in Germinal Matrix
|
|
Ototoxic chemotherapy agent
|
Cisplatin
|
|
S/e of Antiarrhytmic
Delayed onset interstitial pneumonitis |
Amiodarone
|
|
MOA
Misoprostol on stomach |
Binds Prostaglandin receptor to
1) Increase mucus production 2) Decrease parietal cell acid secretion |
|
What is Aspirin Intolerant Asthma?
|
Asthmatics who get Nasal Congestion and Bronchospasm from ASA via Leukotrienes
|
|
What post-translational modification can anchor proteins to cell membrane?
|
Palmitoylation
|
|
What is the purpose of Glucoronidation?
|
Generally to detoxify or metabolize substances in the liver
|
|
MOA
Nitroglycerin |
Systemic Venous dilation --> Decerased pre load and SV --> Reduced CO --> Reflexive tachycardia and contractility inc --> Ultimately PVR remains unchanged with slight dec in preload, afterload, and CO
Ultimately reducing myocardial oxygen consumption relative to coronary perfusion |
|
Dx
Short stature, short metacarpal and metatarsal bones, lo Ca, Hi PTH |
Albright Hereditary Osteodystrophy
(a type of Pseudohypoparathyroidism, i.e. end organ PTH resistance) |
|
Different mutations in the same genetic locus cause similar phenotypes
|
Allelic heterogeneity
(e.g. Becker's and Duchenne's both at same locus) |
|
What induces bronchospasm in Asthma?
|
Leukotriene D4
|
|
What causes hyperpigmentation in Hemochromatosis
|
Hemosiderin deposits w/in the dermis
|
|
Dx
Hepatomegaly, skin hyperpigmentation, the sugar, impotence, arthropathy, cardiac dysfunction |
Hemochromatosis
|
|
Does the IVC experience increased pressure during Portal HTN?
|
Despite increased volume/pooling NO inc in pressure
|
|
Bugs in Impetigo
(2) |
1) Staph aureus
2) Group A Strep |
|
Bug in: Ecthyma gangrenosum, hot tub folliculitis, pyoderma, and green nail syndrome
|
Pseudomonas Aeruginosa
|
|
Acidifying the bacterial medium inhibits which antibiotic resistance mechanism?
|
Pumping out the abx
|
|
Biochem Mech of Achondroplasia
|
Arg for Gly in FGFR-3 on c'some 4
|
|
Gene involved with fused digits
|
FGFR-2
|
|
Gene in Osteogenesis Imperfecta
|
COL1A
|
|
Which c'some is Bruton's Agammaglobulinemia on?
|
X c'some
|
|
What is the purpose of the hydrophobic amino acids for membrane bound proteins?
|
Signals the SRP to move the growing strand from Cytosol into RER
|
|
Dx
Branched chain ketoaciduria |
Maple syrup urine disease
(defect in Alpha-keto acid dehydrogenase) |
|
Which vitamin is necessary for Alpha-keto acid dehydrogenase (as in maple syrup urine disease)?
|
VitB1 (thiamine)
|
|
Dx
Infant is pale and edematous, massively enlarged liver, fhx of hemoglobinopathy |
Infant is Hb Bart's (i.e. complete alpha thalassemia)
|
|
Glucagon works with which 2 messenger system?
|
Gs --> Adenylate cyclase --> cAMP
|
|
What does Red Safranin O stain?
|
Cartilage
|
|
Which parts of the pheo pathway can be methylated before they become VMA?
|
Norepi --> Normetanephrine --> VMA
Epi --> Metanephrine --> VMA |
|
What are ABG changes in Pulmonary Embolism?
(3) |
Hypoxemia --> Respiratory Alkalosis
pO2 Low pCO2 Low pH High |
|
Platelet Aggregating Factor (PAF) is stimulated through which 2 messenger system?
|
Gq --> IP3 --> Ca from RER
|
|
Why do Peptic ulcers get Abx?
|
To prevent H pylori RECURRENCE
(apparently not to eradicate infxn) |
|
Dx criteria for NF-1
|
2 or more of:
1) 6 or more Cafe au lait spots 2) Freckling 3) 2 or more Neurofibromas or 1 Plexiform neurofibroma 4) Optic nerve glioma 5) Irish Lisch nodules 6) 1st degree relative with NF-1 |
|
What are soft, flesh colored non tender papules in NF-1?
|
Neurofibromas (benign tumors)
|
|
What is inheritance of NF-1?
|
Autosomal dominant with 100% Penetrance but Variable Expressivity
|
|
Which Abx can cause widespread release of histamine from mast cells?
|
Vancomycin
(i.e. Red Man syndrome) |
|
Which cell is screwed up in Idiopathic Pulmonary HTN?
|
Pulmonary endothelial cell
|
|
Dx
Bloody diarrhea, mucosal hemmorhage and patchy areas of necrosis in bowel --> Edematous transmural infarctions |
Ischemic colitis
|
|
Dx
Hypoglycemia after prolonged fast with imparied ketogenesis |
Beta oxidation defect
Usually a Medium Chain acyl CoA dehydrogenase deficiency |
|
Which proto-oncogene is a GTP membrane protein?
|
Ras
|
|
MOA
Rosiglitazone |
Increases GLUT4 expression on Adipocytes
|
|
MOA
Glyburide |
Closes K channel on Beta cells promoting Insulin secretion
|
|
MOA
Metformin |
Decreases gluconeogenesis and increases glycolysis
|
|
Dx
Mouth ulcers, perineal abscess |
Crohn's disease
|
|
What does Cimetidine due to PT on warfarin?
|
Increases it Gradually
|
|
How is Warfarin gotten rid of?
|
Hepatic P45o system
|
|
Complete MOA
Albuterol |
Gs --> Adenyl cyclase --> cAMP --> Inhibits myosin phosphorylation in bronchial smooth muscle --> Dilation
|
|
Deposit in Osteomalacia
|
Oseoid
|
|
What is Li-Fraumeni Syndrome?
Inheritance |
Familal cancer syndrome of Breast and Soft tissue Sarcomas
Inherited as One allele deletion in tumor supressor (usually p53) |
|
Dx
Fever, cough, hemoptysis, Southwest USA |
Coccidioides immitis
|
|
Dx
Lymphocytic infiltration of thryoid gland with germinal center formation |
Hashimoto's Thyroiditis
|
|
Inheritance of Muscular dystrophies
|
X linked recessive
|
|
Dx
Bird's beak on barium swallow |
Achalasia (aka Lack of peristalsis from lack of relaxing)
|
|
Which efferent neurons are not myelinated?
|
Postganglionic autonomic neurons
|
|
Which HLA II component is degraded by macros before presentation?
|
Invariant chain
|
|
Dx
Glossal pain, dry mouth, atrophy of the tongue papillae, alopecia |
Iron deficiency
|
|
MOA
Fungal -Conazoles |
Impair lipid (Egestrol) synthesis in Fungal Cell Membrane
|
|
Dx
Vaginal pain and pruritis, white atropic patches of skin on labia |
Lichen Sclerosus
|
|
Leukoplakia can affect only what surfaces?
|
Mucosal
|
|
Dx
Conjunctivitis, urethritis, and seronegative arthritis |
Reactive Arthritis (Reiter's sx)
|
|
Of Celiac Disease
Skin Manifestation - Bowel Histology - |
Skin Manifestation - Dermatitis Herpetiformis
Bowel Histology - Atrophy of intestinal wall |
|
What layer is a skin callus in?
|
Stratum corneum (the top layer)
|
|
What hormone is high in perncious anemia?
|
Gastrin (due to hypochlorhydria)
|
|
Which testicular tumor regresses with lying down?
|
Varicocele
|
|
Acanthosis nigricans NOT in diabetes indicates what?
|
GI tract cancer
|
|
Tx for Mechanical heart valve
|
Lifelong Warfarin + ASA
|
|
Embyrologic cardiac structure affected in DiGeorge
|
Truncus arteriosus
|
|
Which Ig need isotype switching
|
IgG, IgA and IgE
M and D don't |
|
Dx
Macrophages that look like wrinkled tissue paper |
Gaucher's Disease (Glucocerebrosidase deposition)
|
|
Epinephrine has which 2nd messenger pathway?
|
Phospholipase C --> IP3 --> Ca
|
|
MOA
Infliximab |
Anti TNF-alpha agent
(a monoclonal antibody against TNF-a) |
|
Dx
"Broom"like structure on silver stain |
Aspergillus
|
|
Bacteria take up naked DNA
|
Transformation
|
|
Phages insert new nuclear material into Bacteria
|
Transduction
|
|
Dx
HIV pt with renal disease |
FSGS
(Focal Segmental Glomerulosclerosis) |
|
What is erB2?
|
(HER2/neu) growth factor over-expressed in breast cancer
|
|
Dx
Sudden onset back pain, hematuria, and oliguria with Anion Gap acidosis |
Ethylene glycol poisoning
(Ethylene glycol metabolites cause Ca oxalate crystal deposition and renal failure) |
|
Which lymph node is sentinel for abdominal malignancy?
|
Left Supraclavicular (Virchow's node)
Bc that's where thoracic duct empties |
|
Inc or Dec will Increase contraction velocity of muscle:
Preload - Afterload - Extracellular Ca - Passive Tension - |
Preload - Inc
Afterload - Dec Extracellular Ca - Inc Passive Tension - Inc |
|
What does Aspergillus do (special)?
|
Vascular invasion
|
|
Which part of spleen is bigger in Splenomegaly due to congestion?
|
Red Pulp
|
|
Tx
Acute variceal bleeding |
Somatostatin (octreotide) bc it reduces splanchnic blood flow by inhibiting Glucagon and VIP
|
|
MOA
Colchicine |
Inhibits microtubule polymerization --> inhibiting Leukocyte migration and phagocytosis
|
|
Most comm S/e of Thiazolidinedione tx
|
Fluid retention/edema --> Weight gain
|
|
Sex Hormone levels in anorexia
|
All down
|
|
Signal that acts on Adrenal Medulla
|
ACh
|
|
Dx
Diabetes, immunocompromise, fever, back/flank pain, inguinal mass, Difficulty WALKING and Extending at Hip |
Psoas abscess
|
|
Dx
Carpopedal spasms soon after birth, aortic arch abnormaliity |
DiGeorge
|
|
Dx
Over-expression of MHC I on sarcolemma and inflitration of CD8+ T cells |
Polymyositis
|
|
Dx, and localize lesion
Motor vehicle collision, CP, back pain, SOB |
Aortic rupture
at Aortic Isthmus (most commonly) |
|
S/e (3)
And Mechanism of Amphotericin B |
MOA: Binds membrane steroids (Ergosterol in fungi, less affinity in human membranes)
S/e: 1) Nephrotoxicity 2) Hypokalemia 3) Hypomagnesemia |
|
What reaction does sunlight exposure catalyze in Vit D production?
|
Step 1: 7-Dehydrocholesterol to Cholecalciferol
|
|
S/e of these 3 drugs is decreasing Seizure Threshold
|
1) Bupropion
2) Isoniazid 3) Imipenem |
|
What is the medium that contains Vanc, Colistin, Nystatin, and Trimethoprim?
Significance? |
Thayer-Martin media selects for Neisseria species
|
|
Dx
1) High Aldosterone, Low Renin 2) High Aldosterone, High Renin |
1) Primary Hyperaldosteronism
2) Secondary Hyperaldosteronism |
|
Causes of
Hyperaldosteronism with High Renin (4) |
Secondary Hyperaldosteronism
1) Renovascular JTN (e.g. renal a. atherosclerosis) 2) Diuretic use 3) Malignant HTN 4) Renin secreting tumor |
|
Tx
Acute DKA |
Regular Insulin
|
|
Duration of action of regular Insulin
|
Peaks 2-4 hrs, duration 5-8 hrs
|
|
What allows Ca levels to decrease after muscle cell fires?
(2) |
1) Ca ATPase
2) Na/Ca exchange Both on Sarcoplasmic reticulum |
|
When is Pulmonary vascular resistance lowest in Spirometry
|
At the end of quiet expiration.
(Functional Residual Capacity) |
|
Dx
UTI, hematuria in children |
Adenovirus
causing Hemorrhagic cystitis |
|
Dx
Maternal virilization during pregnancy and masculinization of fetus |
Aromatase deficiency
|
|
Dx
Ambiguous genitalia, salt wasting neonate |
21-Hydroxylase deficiency
|
|
Dx
Ambiguous genitalia, salt retention |
17-Hydroxylase deficiency
|
|
Dx
DIC, bilateral hemorrhagic destruction of adrenal glands |
Meningococcal sepsis
|
|
What is the purpose of the HMP shunt?
|
To create NADPH to make Steroids and FAs
|
|
Mechanism
Macrosomia and hypoglycemia in Gestational diabetes |
High BG crosses placenta --> Beta cell hyperplasia --> Hypoglycemia and growth
|
|
Dx
Child with tarry stool, Tc scan localizes to RLQ |
Meckel's Diverticulum (failure of Omplahlomesenteric closure)
|
|
What innervates Anterior 2/3s of Tongue
Sensation = Gustatory = |
Sensation = Mandibular CN V
Gustatory = Chorda Tympani CN VII |
|
What innervates Posterior 1/3 of Tongue?
Taste, pain, temperature, touch = |
CNs 9 and 10
|
|
What is activated in Acute Necrotizing Pancreatitis?
|
Trypsin
|
|
Associated with EBV that isn't mono
(2) |
1) Burkitt's lymphoma
2) Nasopharyngeal carcinoma |
|
Mech of Factor V Leiden Hypercoagulability
|
Mutated Factor V is not inactivated by Protein C
|
|
Dx
Transaminitis, trouble speaking and standing |
Wilson's Disease
|
|
Dx study
Normocytic anemia, with v low retics, normal anemia work up, normal lymph and plts |
Chest CT for Thymoma for
Pure Red Cell Aplasia (PRCA) |
|
Pickwickian sx vs OSA
|
Pickwickian is due to obesity so is all the time so Hypoxemia and Hypercapnia on ABG even during day.
OSA has normal ABG when awake. |
|
Pathognomonic Trisomies
Dec AFP = Inc Beta = Dec PAPP-A = |
Dec AFP = 18
Inc Beta = 21 Dec PAPP-A = 13 |