Upgrade to remove ads
Terms in this set (2000)
inhibits RNA Polymerase 2 and decreases TRANSCRIPTION
alpha amanitin toxicity
Ricin (from castor oil)
cleaves the rRNA on the eukaryotic 60S subunit and inhibits TRANSLATION
inhibits the Na/K ATPase pump by binding to the K-site. (digoxin works the same way!!)
COL1A1 and COL1A2 defects
Osteogenesis Imperfecta (decreased collagen 1) are related to what gene defects?
defective Menkes protein —> Menkes Disease (XR)
Defect in ATP7A
1) G-protein defect
2) cafe-au-alit spots (1 side) with IRREGULAR border
3) polyostotic fibrous dysplasia
4) precocious puberty
5) endocrine abn
Deletion of Dystrophin gene (frameshift mutation)
Non-frameshift mutation in Dystrophin gene
deficiency of neutral amino acid transporters in the prox tubule and in SI
lose the neutral amino acids (tryptophan, etc) in the urine
Low levels of tryptophan can cause low levels of which amino acid?
Low levels of vit. B6 can cause low levels of what amino acid?
Vit. E def.
neurologic symptoms of B12 def. without megaloblastic anemia, hyperhsegmented neutrophils or increase in methylmalonic acid
hemolytic anemia (because vit. E is an antioxidant)
Vit. A def.
increased susceptibility for Measles infection
DysgeuZia + AnoZmia are caused by deficiency to what vitamin?
Ornithine Decarboxylase inhibitor
topical inhibitor of the enzyme
decrease cell growth and stimulates apoptosis
this gene is responsible for long bone growth and is defective in pt. with Turner Syndrome
FabRY Disease eventually leads to what organ failure?
fruit in jamaica has a toxin called hypoglycin
inhibits fatty acyl-CoA dehydrogenase (therefore inhibits Beta oxidation)
inhibits sigma unit of RNA polymerase therefore inhibits TRANSCRIPTION
Inspiratory stridor, visible epiglottis, drooling
found in NORMAL urine.
Prod. by the UMOD gene (chromosome 16)
Xanthochromia (blood in CSF)
Most sensitive test for Subarachnoid hemorrhage
Rhizopus and Mucor sp. / Naegleria
these microbes work through penetration of the cribriform plate
blocks heme polymerase in plasmodium species
Rx of Malaria in chloroquine-resistant areas
for Vivax and Ovale species
toxicity: CAN CAUSE HEMOLYSIS IN PTS. WITH G6PD-DEFICIENCY
Rx for Falciparum species
good prophylaxis before travelling to an area endemic for Malaria
Atovaquone and Proguanil
good for prophylaxis and treatment in Chloroquine resistant areas
Influenza (given IntraNasally)
come see SMALL, YELLOW, ROTAting CHICKENs get vaccinated with SABIN and MMR. its INteresting
2) Influenza (Intravenous) *
More commonly used than the live vaccine
3) Polio (Salk)
4) Hep. A
antibody against Fusion protein of Paramyxovirus
JC virus causing Progressive Multifocal Leukoencephalopathy (PML)
Non enhancing regions of demyelination in MRI
Solitary Ring enhancing lesions in MRI
Multiple Ring enhancing lesions in MRI
Rx for Acute Gout
1) NSAIDs (avoided in patients with renal/hepatic dysfunction, and if patient is at high risk for ulcers)
2) Colchicine (avoided in patients with renal failure and the elderly)
are treatments listed IN ORDER for what condition?
Rx for Chronic Gout
Allopurinol and Uricosuric agents (Probenecid, Sulfapyrizone) are treatment options for what condition?
Artery of Percheron (br. of PCA)
Bilateral Thalamic/Dorsal Midbrain stroke is caused by what artery?
6) Q Fever
(HACEK organisms and Q Fever)
Negative culture endocarditis can be caused by these organisms
Diarrhea of a hospitalized patient
Slit-like vascular spaces in the dermis
Angiosarcoma developing years after breast removal
Do you recognize self-antigens or nah? If yes, then you're good. if no, then you undergo apoptosis
what is Positive selection?
How strongly do you bind to self-MHC. If its too strong, then you die; if its not too strong, you survive
what is Negative selection
Regulatory T cell
FOXP3, CD25 and normal T cell receptors (CD4 and CD3) are expressed on this cell
IPEX syndrome (Immune dysregulation, Polyendocrinopathy, X-linked)
Familiar Mediterranean Fever
mutate MEFV gene (codes for pyrin; pyrin inhibits IL-1)
defective pyrin prod.
inflammation and fever bouts
lasts 6 hrs to 4 days
CAUSES AA Amyloids (seen in chronic inflammation)
granulation tissue formation growth factor
heparin binding epidermal growth factor
GF responsible for keratinocyte replication
Eosinophilic inclusions of damaged Keratin
Eosinophilic inclusions, apoptotic hepatocytes
increase risk for hypersensitivity type 3 because of this complement def.
increased risk for SLE because of this complement def.
Fever is caused by this interleukin
stimulates T cell differentiation
stimulates BONE marrow to prod. myeloid series
stimulates class switching to IgE
stimulates class switching to IgA
aKute phase reactant
1) PERIVASCULAR INFILTRATE OF LYMPHOCYTES, MACROPHAGES, PLASMA CELLS
2) Increased Serum CK
3) Cell mediated/Humoral
INTERSTITIAL FIBROSIS AND PARENCHYMAL ATROPHY
iron chelation (therefore inhibits microbial growth)
Programm Death Receptor 1 (PD1)
1) Binds its ligand (PDL1) and inhibits CD8 cells
2) decreases immune response against tumor cells
3) Similar to CTLA-4
1st = Pilocytic Astrocytoma
2nd = Medulloblastoma (MC malignant)
3rd = Ependymoma
Most common brain neoplasms in kids in order
inactivated Influenza vaccine
DM Type 1
Anti-Glutamic Acid Decarboxylase (GAD-65)
Polymyosits and Dermatomyositis
Anti-Jo1/Anti-Histidyl tRNA Synthetase
Causes of pancreatitis
ERPC (Endoscopic Retrograde Cholangiopancreatography)
Drugs (Sulfa, NRTI's, Protease inhibitors, Valproate, etc.)
I GET SMASHED
Intracellular polyphosphate granules
ACE-I, ARB's, Aldosterone antagonists (Spironolactone), Beta Blockers
drugs that decrease heart remodelling after heart failure
Diabetes Mellitus type 1
HLA-DR3 and DR4
Similar to Primary Biliary Cholangiitis (Lymphocytic infiltrate, destruction of intrahepatic bile ducts and increased Alk. Phosphatase)
Mixed Connective Tissue Disease
Anti-U1 RNP (ribonucleopeptide)
IgA against endomyseum
IgA-anti tissue transglutaminase
1) B cells are present; decrease in level of Plasma cells
2) Nodular lymphoid hyperplasia in GIT
No mature B cells (therefore also no plasma cells)
Hyper-IgE Syndrome (Job Syndrome)
1) mutated STAT3
2) therefore impaired Th17 —> decrease neutrophil recruitment
3) Increased IgE and decreased IFN-gamma
Superficial blanching nests of dilated capillaries
1) binds to Cyclophilin —> calcineurin inhibition
2) toxicity: NEPHROTOXICITY, HYPERLIPIDEMIA, NEUROTOXICITY, HIRSUTISM
Normally stimulates TF causing T cell activation; dephosphorylates NFAT —> enters nucleus and allows IL-2 production
1) binds FKBP (FK506 Binding Protein) —> inhibits Calcineurin
2) toxicity: NEPHROTOXICITY, DIABETES (BECAUSE IT CAUSES HYPERGLYCEMIA)
1) binds FKBP and inhibits mTOR
2) toxicity: Pancytopenia
Ig's that inhibit IL-2 receptor —> decrease intracellular mTOR
drug that inhibits CD20
1) prevents Osteoporosis
2) Binds RANKL and inhibits OSteoclasts
oral thrush, interstitial pneumonia, severe lymphopenia in 1st year of birth
symptoms of SCID and vertical HIV transmission
Drug used prophylaxis or during pregnancy to decrease risk of fetal transmission of HIV
gene that decreases expression of MHC-1 in infected cells of pts. with HIV
gene responsible for viral replication
1) Fragments of DNA in multiples of 180 bp
1) sensitive for apoptosis
VEGF, TGF-Beta, FGF, PDGF (vascular remodelling)
GF's responsible for Angiogenesis
Pure Red Cell Aplasia
Good Syndrome (Hypogammaglobulinemia)
Thymomas are associated with which paraneoplastic syndromes?
1) Cushing Syndrome (Increased ACTH)
2) SIADH (Increased ADH therefore HYPONATREMIA)
3) Paraneoplastic Cerebellar Degeneration (Ig's against Hu, Yo, Tr antigens in Purkinje Cells)
4) Paraneoplastic Encephalomyelitis (Ig's against Hu antigens in Neurons)
5) Lambert-Eaton Syndrome
6) Opsoclonus-Myoclonus Syndrome (Dancing Eyes, Dancing Feet)
Small Cell Lung Cancer can lead to which paraneoplastic syndromes?
Squamous Cell Carcinomas
Hypercalcemia because of elevated PTHrP
Lymphoma and Non-Caseating Granulomas (because they have alpha-1 hydroxylase)
Hypercalcemia because of elevated calcitriol
Renal Cell Carcinoma
Polycythemia is a paraneoplastic syndrome of these neoplasms
this protein encodes for PDGF
Astrocytomas and osteosarcomas
over expression of sis protein can cause these neoplasm
Carcinomas that spread hematogenously
Renal Cell Carcinoma
Follicular Thyroid Carcinoma
Problems in collagen glycOSylation
Acidify urine (Amphetamine is BASIC)
Rx for Amphetamine toxicity
Rx for Copper and Gold tox
DiMERCaprol, Succimer, EDTA (Lead)
Rx for Arsenic, Lead, MERCury tox
St. Johns Warts
Bull Shit CRAP GPS will INDUCE my rage
VICK'S FACE is All Over GQ magazine!
Notochord gives rise to what adult structure?
MediaL umbilical ligaments are derived from what embryologic structure?
MediaN umbilical ligament becomes what in the adult
Round Ligament of the Liver is derived from what embryologic structure?
A-Wave signifies what?
Ventricular Isovolumetric contraction
C-Wave signifies what?
X-Wave signifies what?
TP interval on EKG (AV valves open and PASSIVE flow of blood into ventricles)
Y-wave signifies what?
1) inhibits the FUNNY CURRENT
2) slows HR ONLY!!!!
3) No affect on Ca2+ conductance therefore no affect on contractility
Purkinje > Atria > Ventricles > AVN
what is the speed of conduction in the heart in order
1) Pseudo right bundle branch block, ST elevation in V1 —> V3
2) seen in the Asian population
1) abnormal accessory conduction pathway
2) QRS widening (delta wave) + PR shortened
3) ventricles contract earlier than normal because of additional pathway for conduction
4) sudden cardiac death in a patient with a normal appearing ventricle
MEDIAl calcific sclerosis (Monckeburg)
Calcification of the MEDIA in arterioles
Abd. Aortic Aneurysm
Transmural inflammation of aorta
Cystic Medial Degeneration —> Thoracic Aortic Aneurysm
Myxomatous change in media of arteries
inhibits LYSYL OXIDASE —> Cystic Medial Degeneration —> Thoracic Aortic Aneurysm
Pericardial inflammatory reaction overlying necrotic debris
Pericardial inflammatory reaction due to AUTOIMMUNE REACTION against the necrotic debris
mutations affecting cytoskeletal proteins, mitochondrial enzymes, oxidative phosphorylation
Alcohol abuse, Beriberi, Chagas/Coxsackie Virus, Doxorubicin can cause this heart condition
Hypertrophic Obstructive Cardiomyopathy
1) mutations affecting sarcomeric proteins (beta-myosin chain mutations)
2) anterior displacement of mitral valve leaflet during systole
1) Endocardial thickening and noncompliant ventricles
2) Kussmaul sign +ve
Causes of Restrictive Cardiomyopathy
Sarcoidosis, Amyloidosis, Hemochromatosis can cause this heart condition
1) Endocarditis with a negative blood culture
2) Deposition of STERILE platelet-rich thrombi on valves and strands of fibrin and immune complexes
Causes of NBTE
MC because of malignancy (pancreatic adenocarcinoma is MC!!), hypercoaguabiity, SLE
MVP is MC predisposing valve lesion
Joints —> Migratory Polyarthritis
O —> Pancarditis
Sydenham chorea —> restless, purposeless, jerky motion
Increase JVP during inhalation —> impaired filling of Right Ventricle
1) Hypotension, faint heart sounds, distended neck veins
2) in Cardiac tamponade
1) cells are mixed within a mucopolysaccharide stroma, abnormal vessels and are hemorrhaging
2) increased VEGF —> abnormal vessels and hemorrhage
3) increased IL-6
Transmural inflammation of the arterial wall with fibrinoid necrosis (homogeneous, eosinophilic, wall necrosis)
Skin nodules, sinusitis, peripheral neuropathy (wrist/foot drop), increased IgE, ASTHMA
Hydralazine, Labetalol, Methyldopa
Rx for Hypertension in pregnancy
Calcium Channel blockers, Hydralazine, Potassium channel openers (Minoxidil + Diazoxide)
drugs causing Arteriolar dilation
drugs causing venous dilation
Patient with a H/O Heart Failure, comes with GI problems, Visual disturbances
abnormal AVN conduction/atrail contraction
1) decrease AVN/SAN conduction
2) beta blockers, CCB, Adenosine
Rx for SVT
because of CYSTEINE —> cysteine comes from GLUTATHIONE (because we have limited stores of GSH in our cells)
Tachyphylaxis associated with Nitrates occurs due to?
Fish Oil Supplements
1) increase Bile acid synthesis
2) decrease cholesterol saturation in bile
3) increase GB motility
opposite function to Fibrates
1) activate PPAR-alpha —> LPL and therefore increase TG clearance and decrease VLDL
2) inhibit Cholesterol 7-alpha hydroxylase —> decrease bile acid synthesis —> increase [cholesterol] —> Gallstones
3) Because they also activate PPAR-alpha, increase the insulin response on carbs and fats —> WEIGHT GAIN
opposite function to Fish Oil
this drug inhibits pancreatic LIpase
mutations in NEUROPHYSIN
TNF-alpha and its effect on insulin secretion
activates serine kinase —> P-serine —> inhibits tyrosine autophosphorylation of insulin receptor —> DECREASED INSULIN SIGNALLING
GH and PRL work via this pathway
Jak —> P-tyrosine —> STAT binds to P-tyrosine —> Jak P-STAT —> P-STAT moves to nucleus —> stimulates IGF-1 transcription and translation
1) Make you hunGHRE
2) sleep deprivation and Prader-Willi stimulate it
1) makes you thIN
2) mutations in this gene = congenital obesity
3-beta hydroxysteroid DH
1) CAH with a deficiency in ALL steroid hormones
2) similar to a deficiency in cholesterol desmolase
1) Stimulated by ACTH; inhibited by Ketoconazole
2) def. = accumulation of cholesterol esters in adrenals and gonads
3) cholesterol —> pregnenolone
excess iodine inhibits thyroid peroxidase —> decreased iodination, organification and coupling
inhibits thyroid peroxidase and peripheral 5-deiodinase
Rx for hyperthyroidism causing agranulocytosis
ADH (V2 receptors)
FLAT ChAMP CreGG
which endocrine hormones use cAMP as a signalling pathway
which endocrine hormones use cGMP as a signalling pathway
ADH (V1 receptors)
Histamine (H1 receptors)
which endocrine hormones use IP3 as a signalling pathway
you are wearing a VETT CAP; go INside
INside = INtracellular receptors
which endocrine hormones have Intracellular receptors?
What drug inhibits 11-beta hydroxylase
1) inhibits 11-beta hydroxylase (converts 11-DOC --> Cortisol)
2) results in a decrease in Cortisol, compensatory increase in ACTH, and an increase in 11-DOC --> mb to 17-hydroxycorticoidsteroid (17-OHS) by the liver
What is the MOA of Metyrapone
Creates a hypercoaguable state --> increased risk for thrombus formation
What effect does Cushing Syndrome have on coagulation
hint: same effect as SLE
NSE (neuron-sepcific enolase), Chromogranin A, S-100, Bombesin, n-MYC, Synaptophysin
What gene products are elevated in patients with Neuroblastoma
Proximal muscle weakness and ELEVATED CK
Proximal muscle weakness and NORMAL CK
Muscle stiffness and muscle aches, NO MUSCLE WEAKNESS, and a normal CK
1) mononuclear parenchymal infiltration with well-developed germinal centres in the Thyroid gland
2) painless gland
Granulomatous (de quarvain) thyroiditis
1) mixed, cellular infiltration with occasional multinucleated giant cells within the thyroid gland
2) painful thyroid
1) extensive stromal fibrosis extending beyond the thyroid capsule
2) painless thyroid
2) Iodine def.
3) TSH-secreting pituitary adenoma
**HIT my GRAVE very SMOOTHly
SMOOTH/diffuse enlargement of the thyroid gland can be caused by what conditions?
Tall, crowded follicular cells with scalloped colloid in the thyroid gland
a) Propranolol (beta blockers)
c) Prednisone (corticosteroids)
d) Potassium Iodide (to prevent against radioactive Iodide)
What is the treatment for Hyperthyroidism?
A patient with iodine deficiency is given food replenishing the iodine content and soon develops Hyperthyroidism is considered what?
Exophthalmos (because it is caused by lymphocytic infiltrate, not an adrenergic effect). Rx with high-dose glucocorticoids
What component of hyperthyroidism cannot be corrected via beta-blockers?
Recurrent Laryngeal Nerve
a) Hoarseness of the voice
Ligation of the Inferior Thyroid artery can damage what nerve and present with what symptom?
External br. of Superior Laryngeal Nerve
a) Damage cricothyroid and no cough reflex
Ligation of the Superior Thyroid artery can damage what nerve and present with what symptoms?
Papillary Carcinoma of the Thyroid
1) Branching papillary structures with interspaced calcified bodies (psamomma bodies)
2) Large cells with OVERLAPPING nuclei
Papillary Carcinoma (tall cell variant)
Follicular hyperplasia with tall cells forming intrafollicular papillary projections
pleomorphic and irregular giant cells
What histological feature will you find in anapaestic carcinoma of the thyroid?
Albright Hereditary Osteodystrophy (Pseudohypoparathyroidism 1A)
a) defective Gs alpha-subunit
b) hypocalcemia and high PTH
c) shortened 4th and 5th digits and short stature
Transmembrane G-protein coupled receptors which regulate PTH
How do Calcium sensing channel receptors work?
a) subperiosteal erosions in phalanges (subperiosteal thinning)
b) salt-and-pepper skull
c) osteolytic cystic bone spaces in the long bones with brown fibrous tissue
Stones, bones, abdominal groans, and psychic moans
a) bone pain
c) abdominal disturbances (constipation/peptic ulcers)
d) renal stones (may be recurrent)
e) psychiatric symtoms
Rickets (Vit. D. deficiency in kids)
a) infants only breastfed
b) dark pigmentation to their skin
Vitamin D. Deficiency
a) Osteoid matrix accumulation around trabeculae
b) increased amount of unmineralized osteoid with WIDE osteoid seams
a) in the setting of a pre-existing pituitary adenoma
b) leads to hypopituitarism
Sudden infarction of the pituitary gland
a) low leptin (because of strenuous exercise, weight loss)
b) therefore anorexics dont have periods
DECREASED levels of this hormone causes inhibition of GnRH release
What hormones does Somatostatin inhibit?
a) uniform cells shape and size in ISLANDS
b) eosinophilic cytoplasm with oval/round nucleus
c) dense-core granules in the cytoplasm
Necrolytic Migratory Erythema
a) Associated with glucagonomas
Dermatitis in the groin --> red papule/plaques on the face and perineum that leave a bronze-coloured induration
Necrolytic Migratory Erythema, DM, DVT is possible
Mutation in RET gene
Mutation in RET gene
Mutation in MEN1 gene
a) decreased Menin
b) chromosome 11
What mutation occurs in MEN 1 syndrome?
no LAG for their onset
What are the rapid acting insulin preparations?
inhibits mitochondrial enzymes and therefore increases insulin sensitivity to tissues
a) Patients are EUGLYCEMIC
MOA for Metformin?
GI upset + LACTIC ACIDOSIS
a) Hypoglycaemia, weight gain (because of elevated insulin)
a) Therefore increase insulin sensitivity
a) therefore increase number of insulin-responsive adipocytes
b) increased weight gain because of increased fat storage in adipocytes
what factors do Thiazolidinediones up regulate?
a) Weight gain because of up regulation in Adiponectin
b)Edema because of Na and H2O absorption
a) inhibits glucagon release
b) increases insulin release
MOA of GLP-1
Drug that acts as a long-term GLP-1 agonist
GLP is inactivated by what enzyme?
DDP-4 is inhibited by what drug?
Drug that works similar to Sulfonylureas in Pancreas; binds at a different site on the beta cells
Acarbose and Miglitol
Inhibit alpha-glucosidase and prevent starch breakdown
Rx of hyperthyroidism that is safer in pregnant women
Patient with hyperthyroidism taking appropriate meds develops ANCA-related vasculitis
What drug is responsible?
Hepatotox, Vasculitis, Agranulocytosis, Aplastic Anemia
Toxicity of Thionamides
Perchlorate and Pertechnetate
Drugs that inhibit the Sodium/Iodide pump in the thyroid gland
Hydrochlorothiazide, Amiodarone, Indomethacin
Rx for Nephrogenic DI
Drugs that have the suffix "-vaptan" are classified as what class of drug?
Demeclocycine and ADH antagonists (-vaptan drugs)
Rx for SIADH
synthetic aldosterone agonist with minimal glucocorticoid effects
sensitizes the Calcium Sensing Receptor (CaSR) in parathyroid gland
a) Rx familial hypocalciuric hypercalcemia
**cinacalcet CETS (sets) the CALcium levels
MOA for CinaCALCET?
2 alphas and 2 gammas
Composition for HbF
2 alphas and 2 deltas
Composition for HbA2
Mom with Type O blood
a) no antigens on her RBC
b) Anti-A and Anti-B antibodies (IgG) which cross placenta and enter the neonate
ABO Hemolytic disease of the newborn only occurs with mothers that have what type of blood group?
3) HbS trait
4) HbS disease
5) HbC trait
6) HbC disease
in HbC, glutamate is replaced with Lysine (a +vely charged A.A) --> repels +vs charge and is attracted towards the -vely charged end
in HbS, glutamate is replaced with Valine (neutral charge)
Hb electrophoresis would show which type of hemoglobin closest to the Anode (+ve end)?
precipitation of oxidized Hb
a) nucelar remnants appearing basophilic
b) in patients without a spleen
heme-related pathology because of gene deletions
heme-related pathology because of mutations in splice sites
a) because of VASCULAR OCCLUSION
child with biliary emesis, normal duodenum, absence of a large portion of the jejunum and ileum
a) bowel herniates through the anterior abdominal wall
b) usually to the RIGHT of the umbilicus
Jejunum and Ileum Atresia is MC associated with what condition?
a) Dx for NEC
radio imaging reveals a thin and curvilinear area of lucency parallel to the lumen
Ischemic necrosis of the terminal ileum and colon
Strictures and bowel obstruction
a) secondary to fibrosis
survivors of NEC can go on to develop what?
b) may precipitate early onset for pancreatitis
incomplete/failure in fusion of ventral and dorsal pancreatic buds
abnormal migration of the ventral pancreatic bud
a) uncinate process
b) main pancreatic duct
Ventral Pancreatic Buds give rise to what adult structures?
body, tail, isthmus of the pancreas
Dorsal pancreatic buds give rise to what adult structures?
both Ventral and Dorsal pancreatic buds
what embryological structure does the head of the pancreas derive from?
Transverse part of the duodenum
if the angle between Superior mesenteric artery and Aorta is decreased to less than 20 (normally 45), what structure becomes narrowed?
a) indicates Splenic laceration
Rigid abdomen and left shoulder pain
a) longitudinal tear distal to pectinate line
sharp pain and bleeding on defecation
a) because of poor perfusion
MC location for anal fissures
Superior rectal --> Inf. Mesenteric --> Portal vein
Drainage of Internal hemorrhoids
Internal Pudendal --> Internal Iliac --> Common Iliac --> IVC
Drainage of external hemorrhoids
Internal Spermatic Fascia
Cremasteric Muscle and Fascia
External Spermatic Fascia
Components of the Spermatic Cord and their derivatives
Indirect Hernia or Hydrocele
occurs because of failure of processus vaginalis to close
Scrotal mass that increases in size by applying pressure to the intraabdominal cavity
a) valsava maneuver
Inferior Epigastric Vessels
what are the components of Hasselbachs triangle
a) Reducible midline protrusion of the abdomen covered by skin
a) more pronounced with increased abdominal pressure
a) Down's Syndrome
c) Beckwith-Wiedemann Syndrome
Patients with Umbilical Hernias have what associated conditions?
a) Indirect and Direct hernias occur in MALES
b) FEMoral hernias occur in FEMales
What is the difference between indirect, direct, and femoral hernias?
a) Chronic hemolysis because increased bilirubin from the hemolysis precipitates as calcium bilirubinate (which is pigmented)
b) increased enterohepatic circulation of bilirubin
Causes of Black pigmented gallstones
a) Infections because microbes have beta-glucuronidase which deconjugates bile salts. therefore CB --> UCB increased
Cause of Brown pigmented gallstones
a) TPN inhibits CCK
therefore increased stasis of bile within GB and decreased GB motility --> increased precipitation of cholesterol
Effect of total parenteral nutrition on GB
Parotid gland with cysts and germinal centres
a) benign tumor of parotid
b) mobile and painless mass in the jaw
a) malignant tutor of parotid
b) CN7 involvement
a) Firm swelling around the ear with pain radiating to the jaw/mandible
b) elevated amylase
Alcoholic with PAINFUL hematemesis
PAINLESS hematemesis in a patient with liver failure
esophageal rings and linear furrows
Difficulty swallowing and painful swallowing
what predisposing factor has a VERY STRONG relationship to the development of Mallory-Weiss syndrome?
a) Mucosal erythema, basal zone hyperplasia
b) Elongated lamina propia
c) high Eosinophils
Esophageal tear in the MUCOSA
TRANSMURAL tear in the esophagus
Diffuse Esophageal Spasms
a) Periodic, simultaneous and NON-PERISTALTIC contractions of the esophagus
b) painful and non-propulsive smooth muscle contraction
Biliary Colic = painful, non-propulsive smooth muscle contraction
Esophageal Spasm has a similar pathogenesis to what other condition?
ALCOHOL, SMOKING, and any irritants
(Nitrosamine consumption in Asian populations)
Most important risk factors for developing Squamous Cell Carcinoma of the esophagus
Pre-existing GERD/Barrett's Esophagus, OBESITY
Most important risk factors for developing Adenocarcinoma of the esophagus
a) Achlorhydria (because parietal cell destruction) --> G cell hyperplasia
b) Mucosal atrophy with intestinal metaplasia
What endoscopic findings can be seen in Chronic Gastritis?
Erosions --> Mucosal defect
Ulcers --> extend beyond mucosa and penetrate into submucosa
Differentiate erosion and ulcer
H. Pylori (95%)
Causes of Duodenal ulcers
Causes of Gastric Ulcers
Gastric - may be malignant therefore biopsy required
Duodenal - Benign
Differentiate risk of malignancy of peptic ulcers
Hypertrophy of the brunner glands
a) Hyperplasia of gastric mucosa
b) Hypertrophy of rugae
c) increase mucus production and decrease protein
d) parietal cell destruction
stomach looks like brain gyri
Gastric ulcer (Benign type)
a) punched out lesion in the stomach
b) folds of mucosa surrounding the lesion
Gastric ulcer (Malignant type)
large and irregular with heaped up margins
Gastric Carcinoma (Intestinal type)
gastric carcinoma with the features of a malignant gastric ulcer
Gastric Carcinoma (Diffuse type)
a) signet ring cells in the gastric wall
b) thickening of the stomach
Metastasis from the stomach
Left supraclavicular lymph node enlargement (Virchow's node)
Metastasis with the Intestinal subtype of Gastric Carcinoma
a) Metastasis to the periumbilical region
b) Sister Mary Joseph nodule
villous atrophy and crypt hyperplasia. no response to antibiotics
villous atrophy and crypt hyperplasia. responds to antibiotics
a) foamy macrophages in lamina propia
b) PAS +ve
c) Diarrhea, Arthritis, Fever
a) normal enterocyte architecture
b) foamy cytoplasm because of accumulation of lipids in enterocytes
c) low TG, cholesterol, VLDL and chylomicrons
Autosomal recessive. Loss of fxn in Microsomal TG Transfer Protein (MTP)
Mode of inheritance of Abetalipoproteinemia
increase activity of Th1 cells and Th1-related cytokines
What cells are responsible for damage in Crohn's disease?
increase activity for Th2 cells and Th2-related cytokines
What cells are responsible for damage in UC?
Transmural inflammation in the GIT
Mucosal and submucosal inflammation of lower GIT
1) Transmural inflammation of the GIT
a) SKIP LESIONS
b) terminates by the terminal ileum
c) SPARES THE RECTUM
d) Cobblestones and Creeping Fat
2) the transmural inflammation can result in production of FISTULAS, fissures and ulcers
3) Non-Caseating Granulomas
4) Because of terminal ileum involvement, decrease absorption of fats and bile acids and B12
a) Lose fat in stools --> Ca binds to the fat --> low calcium absorbed --> increased OXALATE absorption --> Oxalate stones!!
Pathogenesis of Crohn's Disease:
Large intestine involvement
Colorectal carcinoma risk
CONTINUOUS (Crohns is SKIP LESIONS)
Extends proximally (backwards from rectum, up)
Red stools (bloody diarrhea)
Sclerosing cholangitis risk
Events of Ulcerative Colitis
Rx for Crohns Dz
Amino salicylic preparations
Rx for UC
Irritable Bowel Disease
a) abdominal pain IMPROVES with defecation
b) constipation and diarrhea cycles
Elderly patient with chronic constipation now presents with PAINLESS hematochezia
Patient with S + S resembling Appendicitis;
a) pain on the LEFT side!!!
Pulsion-related diverticulosis (aka FALSE diverticulum)
a) pouches of intestine with only mucosa and submucosa
b) increased intraluminal pressure --> mucosa and submucosa to outpouch
Traction-related diverticulosis (aka TRUE diverticulum)
a) pouches of intestine with ALL layers out pouching
b) because of inflammation/scarring of the gut wall
a) Meckel's diverticulum
b) Internal Hemorrhoids / Diverticulosis
a) Painless GI bleeding a young/newborn child
b) Painless GI bleeding in an adult
increased uptake of Tc-pertechnetate in RLQ
Dx of Hirschsprung Dz in a child has a strong association for what condition?
Dx of Meconium ileus in a child has a strong association for what condition?
The obstruction in Hirschsprung Dz is located where?
The obstruction in Meconium Ileus is located where?
MCC of death in patients with Hirschsprung Dz:
Pneumonia, Bronchiectasis, Cor Pulmonale
MCC of death in patients with CF
a) bilious vomit, abdominal distension, failure to pass meconium after birth
b) Squirt sign positive (forceful expulsion of stool after rectal exam)
Midgut malrotation around SMA
Fibrous bands extending from cecum and right colon to the retroperitoneum by passing over the 2nd part of the duodenum
Acute Mesenteric Ishemia
a) embolic occlusion of SMA
b) severe abdominal pain, PE inconsistent with the pain
c) currant jelly stools (blood and mucus)
Chronic Mesenteric Ischemia
a) Occlusion of SMA
b) Develops over months
c) Abdominal pain after meals
d) Patient stops eating because of FEAR OF PAIN!!! --> therefore WEIGHT LOSS
a) acute ischemia because of embolic occlusion of blood vessel
Acute mesenteric schema is similar in pathogenesis to what condition?
Angiodysplasia (occurs because of high stress to the RIGHT colon)
a) tortuous dilation of vessels in the GIT
a) polyps in a teenager AFTER PUBERTY
b) mutation in APC gene
Juvenile Polyposis Syndrome
hamartomatous polyps in a CHILD < 5 YEARS OLD
Lynch Syndrome (HNPCC)
LYNCH is the CEO
Mass in the Colon, Endometrium, and Ovary
1) APC mutation --> increases risk
2) COX over expression
3) KRAS mutation --> adenoma
4) Loss of Tumor Suppressor Genes --> Carcinoma
a) younger its
c) early p53 mutation and late APC mutation
Colorectal Carcinoma associated with Ulcerative Colitis:
Panlobular microvesicular steatosis of the liver
Drug-induced liver injury
liver is shrunken, centrilobular necrosis, inflammation of portal tracts and parenchyma
a) Diffuse hepatic fibrosis
b) replacement of normal lobular architecture by fibrous-lined parenchymal nodules
Alcohol, Viral Hepatitis, Non-Alcoholic Fatty Liver, Hemochromatosis
MCC of Cirrhosis
a) Because of alcohol
Macro vesicular fatty change
a) Swollen, necrotic hepatocytes
b) neutrophilic inclusion
c) eosinophilic inclusion of damaged Keratin
a) micro nodular irregularly shrunken liver
b) sclerosis around Zone 3 (central vein)
What cell in the liver is responsible for the fibrosis in cirrhosis?
MC benign tumor in the liver
a) Centrilobular congestion and necrosis
b) Dilation of sinusoids and perivenular hemorrhage
Alpha 1 Antitrypsin Deficiency
PAS +ve globules in the liver
a) mild decrease in UDP Glucuronyltransferase
b) jaundice after stresses (fasting)
c) elevated UCB and normal CB
a) Complete deficiency in UDP glucuronyltransferase
b) present in childhood
Dubin Johnson Syndrome
a) conjugated hyperbilirubinemia
b) absence of biliary transport protein MRP-2
a) no excretion of bile into canaliculi
b) impaired excretion of Epinephrine and therefore it accumulates in the liver --> Black Liver
Cause of black liver in Dubin-Johnson Syndrome
S + S similar to Dubin Johnson, NO BLACK LIVER!
ATP7B mutation on chromosome 13
a) copper becomes bound to ceruloplasmin in the liver
b) ceruloplasmin and excess copper absorbed in GIT excreted in BILE
Major mechanism of copper excretion by the body
a) Patient < 30 years old
b) elevated serum transaminases
c) neurologic symptoms
d) family H/O may/may not be present
a) visualize the Keyser-Fleischer rings in Descent's membrane
Diagnostic study most beneficial for patients with Wilsons Dz
Rx for Copper excess in pts with Wilson Dz
Cardiac manifestations of Hemochromatosis
a) Abnormal HFE gene causing impaired iron sensing --> excessive iron ABSORPTION in the GIT
b) increased DMT-1
c) decreased Hepcidin
What is the pathogenesis of Hemochromatosis
what is the most common liver manifestation in hemochromatosis
C282Y mutation causing cysteine to be replaced by tyrosine
Ferritin - High
TIBC - Low
Serum Iron - High
% Saturation - High
Lab findings in patients with Hemochromatosis
Primary Sclerosing Cholangitis
a) Patient with pre-existing Ulcerative colitis
b) increase IgM
c) p-ANCA +ve
d) bile duct fibrosis
a) tumor of the bile ducts
Patients with Primary Sclerosing Cholangitis are at risk of developing what GB-related condition?
Tree-like mass in the biliary tract
Primary Biliary Cirrhosis (Primary biliary cholangitis)
a) Lymphocytic infiltrate, destruction of intralobular bile ducts and increased Alk. Phosphatase
b) Severe pruritus at NIGHT
c) Bile staining of hepatocytes
Primary biliary cirrhosis (primary biliary cholangitis)
a) anti-mitochondrial antibody
b) increased IgM
c) STRONG ASSOCIATION WITH AUTOIMMUNE DISEASES!!!
d) elevated ALKALINE PHOSPHATASE
Biliary tract disease
c) dark urine
d) light stools
RUQ pain radiating to the scapula
a) RUQ pain with meals --> Rokitansky-Aschoff Sinus
b) Shrunken and calcified GB --> Porcelain GB
Gallstone obstructing the terminal ileum --> small bowel obstruction
air in the biliary tree (pneumobilia)
Complication of gallstone ileum
Pancreatitis with macrocytosis (MCV > 100) because of folate def. due to alcohol
alcoholic with epigastric pain radiating to the back; what will blood smear show?
Drugs (valproic acid, protease inhibitors, NRTI's, SULFA drugs, etc.)
causes of acute pancreatitis
pt. with a prior episode of Pancreatitis WEEKS ago develops a palpable mass in the upper abdomen and cystic lesion is visualized
Granulation and fibrous tissue
walls of the pancreatic pseudocyst are composed of
palpable (enlarged) gallbladder that is NONTENDER. +ve Courvoisier sign
Age > 50
Most important risk factors for Pancreatic Adenocarcinoma
pancreatic enzymes stimulates coag. factors
pancreatic enzymes damage alveolar cap. interface
Complications of Pancreatitis
newborn child without a biliary tract
Jaundice and CIRRHOSIS!!!!
Complications of patients with Biliary Atresia:
Sucralfate. its a prodrug therefore, DONT GIVE WITH ANTACIDS!!
Drug used in GI Dysfunction that requires the presence of an acidic environment
forebrain deformity caused by mutated SHH gene
Meningomyelocele and Syringomyelia
Chari II malformation is associated with what other conditions?
because of atresia to Lusaka and Magendie foramena
why does Dandy-Walker present with non-communicating hydrocephalus
a) patient with loss of pain and temperature sensation
b) preserved FINE TOUCH!!!
What neural cell is responsible for the glutamate-glutamine pathway?
uptake glutamate --> convert it to glutamine --> release the glutamine to be taken up by neurons --> reconvert it to Glutamate for use as NT
what is the Glutamate-Glutamine pathway?
a) swelling of the cell body
b) nucleus moves to periphery
c) dispersed nissl substance
a) decreased size and number of neurons
a) loss of neutrons
b) reactive gliosis
what area in the hypothalamus stimulates HUNGER
what area in the hypothalamus stimulates SATIETY
a) pt has a tremor worsened with motion /anxeity
c) Pts DRINK ALCOHOL to decrease the amplitude of tremor
Rx of essential tremors
sudden, brief and uncontrolled muscle contractions
Away from the lesion
if we damage the PPRF, where do the eyes look?
Towards the lesion
if we damage the Frontal Eye Field (BA #8), where do the eyes look?
1) B/w MCA and Anterior Cerebral Artery
2) B/w MCA and PCA
Watershed zones in the brain
Lacunar infarction (lenticulostriate hemorrhage)
a) contralateral motor and sensory loss
b) in patients with uncontrolled HTN or DM
c) primary scans show NO CHANGE!
d) hypertensive ARTERIOLOAR SCLEROSIS
a) S + S exactly the same as lenticulostriate hemorrhage
b) primary scans reveal intraparenchymal hyperdensity
CN 5, 8 - 10 and sensory tracts
PICA lesion (Wallenburg Syndrome)
CN 5, 7, 8 and sensory tracts
AICA lesion (Lateral Pontine Syndrome)
a) bilateral, wedge-shaped areas of necrosis
b) parallel to the longitudinal fissure
Cerebral Amyloid Angiopathy
Recurrent LOBAR hemorrhages in the occipital and parietal lobes
PROGRESSIVE headache, nausea and vommiting
Intracranial bleeding in CHILDREN
a) caused by shaking baby syndrome (which leads to subdural hematoma in CHILDREN)
Retinal hemorrhage in a neonate is HIGHLY SUGGESTIVE of what condition?
a) CT fails to show them; use Doppler
if a patient survives their initial subarachnoid hemorrhage, what are they at risk of developing?
Basilar Skull Fracture
a) hematoma over the mastoid process (around the ear)
b) periorbital ecchymosis
c) CSF Otorrhea
what is the cause of bleeding in a child with intraventricular hemorrhage?
Rx of a patient with GI bleeding/ulcers due to NSAID therapy
Rx of TIA
4) Vit. A excess
important risk factors for Pseudotumor Cerebrii
a) in woman of child-bearing age
defect in Zinc-Copper Superoxide Dismutase 1
Rx for ALS
a) B12 def. causing Subacute Combined Degen.
b) Vit. E def.
Friedrich's Ataxia has similar manifestations to?
B12 def. - no family history of similar disease
Vit. E def. - no family history again
Friedrich's - Family H/O present; heart problems also seen
Differentiate Friedrich's ataxia, B12 def. and Vit. E def.
a) child with kyphoscoliosis
b) ataxic gait and freq. falls (dorsal column defect)
d) restrictive cardiomyopathy
e) Family H/O of similar disease pattern
a) Loss of Frataxin --> iron buildup
b) GAA trinucleotide repeat
What causes Friedrich's Ataxia
Decorticate (flexor) position
lesion ABOVE red nucleus
Decerebrate (extensor) position
lesion BELOW red nucleus
All nerves moving the eye
a) CN 3, 4, 6
CN3 is MC!!!
* only EXTERNAL Ophthalmoplegia is seen in ischemia; internal is because of aneurysm compressing the nerve
DM neuropathy can lesion what nerves?
Cavernous Sinus Thrombosis
patient with a fever, and signs of CN 3, 4, 5, 6 damage
a) "patient can't move the eyes in any direction"
b) "patient has a -ve corneal reflex"
a) Retinal artery occlusion
b) Hypertensive retinopathy
c) retinitis pigmentosa
painless vision loss
a) painless vision loss
b) dot/flame-shaped hemorrhage
c) cotton wool spots
retinal artery occlusion
a) acute painless vision loss
b) cherry red spot on macula
a) progressive painless vision loss
b) inherited retinal degeneration
a) patient with a H/O HIV now presenting with memory loss
b) CD count now < 200
inflammatory activation of microglia --> from microglial nodules
what will be seen in a brain biopsy of a patient with HIV-associated dementia?
intracellular accumulations of hyperphosphorylated tau protein
what are neurofibrillary tangles?
extracellular deposits of beta-amyloid
what are senile plaques?
a) senile plaques
b) neurofibrillary tangles
c) cortical atrophy with hydrocephalus ex vacuo
Increase the risk
What effect does ApoE4 play on the development of Alzheimer's Dz?
inclusions of TDP-43 in neurons
Lewy Body Dementia
Parkinsons Dz has a late-onset of dementia
Features of Parkinson's Dz with EARLY onset dementia
a) patient with decline in cognitive ability
b) late onset dementia
c) large areas of encephalomalacia
a) Rapidly-progressive dementia
c) Startle myoclonus (sudden, brief, and uncontrolled muscle contractions)
a) intraneural vacuoles and vacuoles in neutrophils
b) elevated 14-3-3 protein in CSF
a) patient with eye pain worsened with movement
c) bowel/bladder incontinence
d) periventricular plaques
a) demyelination and preservation of axons therefore LOW OLIGODENDROCYTES
b) lipid laden macrophages (lipids are the myelin they have consumed)
c) astrocytes (respond to the injury) --> reactive gloss
what are the plaques in MS made of?
MS or MM
oligoclonal bands of IgG
a) Segmental axonal demyelination
b) endoneural inflammatory infiltrate
c) May or may not involve CN7
Antibodies against ganglioside in myelin
the Ig's in GB syndrome are targeting what?
- common perineal nerve is MC involved
a) Demyelination of peripheral nerves
b) leg weakness/atrophy and pes caves
mutation in myelin protein gene
what is the error in Charcot-Marie-Tooth Dz?
a) Rapidly progressive demyelination of CNS (oligodendrocytes)
b) Non enhancing regions of demyelination in MRI
b) buildup of Very long chain FA in arenas, testes
a) sensorineural hearing loss
b) recurrent vertigo
Benign Paroxysmal Positional Veritgo
a) BRIEF EPISODE of vertigo due to head motion
b) NO HEARING LOSS
a) Severe vertigo that LASTS DAYS
b) NO HEARING LOSS
increased pressure and volume in endolymph
what is the cause of Meniere's Dz?
otoliths in semicircular canals
what is the cause of Benign Paroxysmal Positional Vertigo?
inflammation of CN 8
what is the cause of Vestibular Neuritis?
a) Stain/birthmark on the face
b) Tram-track calcifications
c) Unilateral birthmark only
d) mental Retardation
e) GNAQ gene activating mutation
a) Hamartomas in the CNS and skin
b) Angiofibroma (aggressive tumor in the nasal cavity)
c) Mitral regurgitation
d) Ash-leaf spots (hypo pigmentation)
e) cardiac Rhabdomyoma
g) Mental retardation
h) renal Angiomyolipoma
renal, liver, and pancreatic cysts
patients with Tuberous sclerosis can have development of cysts in what organs?
a) cafe-au-alit spots with REGULAR borders
b) optic glioma
c) lisch nodules (pigmented iris)
a) Axillary/inguinal freckles
b) congenital pseudo arthritis
involves chromosome 17
a) hemangioblastomas in retina and cerebellum and spinal cord
a) pseudopalisading tumor cells
b) areas of necrosis and hemorrhage
c) grows along WHITE MATTER tracts
grows PARASAGITTALLY / FALCINE region
a) grows at CEREBELLOPONTINE angle
b) S-100 +ve
"chicken-wire" capillary pattern
a) tumor cells have eosinophilic granular bodies, elongated hair-like processes (rosenthal fibres)
b) in POSTERIOR FOSSA (CEREBELLUM)
a) primitive cells with many mitotic figures
b) Homer-Wright rosettes
c) in the VERMIS of the cerebellum
Metastatic tumor in the CNS
a) multiple at the junction of white and grey mater
b) central necrosis with areas of reactive gliosis
Solitary Ring enhancing lesions in MRI
Cyclophosphamide and ifosfamide cause DNA cross-links at guanine N-7—both require bioactivation by the liver
Which alkylating agent(s) require(s) activation by the liver and might not be effective in a pt with liver failure?
Increased DA; decreased others
What levels of dopamine, GABA, and acetylcholine characterize Huntington disease
ventricular tachycardia and sudden cardiac death. prevented by defibrillator
Patient with Brugada syndrome is at risk for what condition?
MC congenital anomaly of the GIT
Vit. C Def.
Perifollicular and subperiosteal hemorrhages
Doxycycline; it is fecally eliminated and can therefore be used by pts with renal failure
pt with renal failure needs a tetracycline-class drug for a M. pneumoniae infection. What do you prescribe and why
From which fetal structure are the umbilical arteries and veins derived?
Alcohol abuse, diarrhea, aminoglycosides, & diuretics lower Mg2+; mildly/moderately low Mg2+ boosts PTH, while severely low Mg2+ lowers it
alcoholic, hypertensive man with diarrhea recently started taking gentamicin. How could this affect PTH secretion?
- (abnormal penile curvature caused by a tunica albuginea fibrous plaque)
man has pain with intercourse. He is anxious about his performance and notes erectile dysfunction. Which pathology do you consider?
What cofactor does ALT require?
What cofactor does LDH require?
Group A strep erythrogenic toxin,
Name five bacterial toxins coded for in a lysogenic phage
Nadolol and propranolol
Which two β-blockers are commonly prescribed for variceal bleeding
patient with lupus develops lupus nephritis. Which immunosuppressant can be used to treat this new development?
pt who has endocarditis is noted to have round white spots on the retina surrounded by hemorrhage. What is this sign called?
a) normal in females
b) in males = Klinefelter (47 XXY)
blood smear from a male patient, you note a small dumbbell-shaped extension of a cell nucleus (ie, Barr body). What does it represent?
widespread kidney damage associated with granulomatous tissue containing macrophages
stroke affecting multiple vascular territories in the brain
stroke affecting watershed areas
a) Rx GAD
b) Takes 1-2 weeks for onset
5-HT 1A agonist agent
5-HT 1D agonist
because it forms Oxalic acid (oxalate) which precipitates as crystals --> ATN
Why is Ethylene glycol nephrotoxic?
FLashbacks PARalyze SEnior CItizens
List the SSRI's:
b) sexual dysfunction
d) GI abn
S/E of SSRI use
a) alpha 1 blocking activity --> postural hypotension
b) antimuscarinic effects --> urine retention, dry mouth
c) prolonged QT
d) Sexual Dysfunction
S/E of TCA's
a) Cardiotox --> because of Na inhibition therefore wide QRS, prolonged QT
Toxicity of TCA's
Rx for TCA OD:
b) Sexual dysfunction
what class of drug is Venlafaxine and whats it s toxicity?
it can increase seizure threshold in anorexics/bulimics
Rx for depression that does NOT cause sexual side effects
a) Rx = Cryoheptidine
1) Hyperthermia, Hyperreflexia, clonus
2) tremors and seizures
inhibition of 5-HT2 receptors
MOA of cryoheptidine
Neuroleptic Malignant Syndrome
a) Fever, Rigidity, bradykinesia, elevated enzymes
c) NO MYOCLONUS!
b) SEVERE sedation!!!
S/E of Trazodone
involuntary muscular contractions in a patient taking antipsychotic medication
Restlessness, compelling need to move in a patient taking antipsychotic medication
Orofacial chorea in a patient taking antipsychotic medications for CHRONIC period
Acute dystonia and akathisisa
antimuscarinics (Benztropine or diphenhydramine)
**giving the patient Levodopa/DA would worsen the psychosis
Rx of a patient taking antipsychotic medications that develops Acute EPS
switch to atypicals
Rx of a patient taking antipsychotic medications that develops Chronic EPS
Low potency Typical antipsychotics
High Potency Typical antipsychotics
they decrease seizure threshold
Which TYPICAL antipsychotics can cause seizures?
inhibition of COMT in the brain and periphery
a) COMT breaks down levodopa
b) its inhibition will therefore INCREASE levodopa that reaches the brain and INCREASE amount of DA available to the brain
MOA of Tolcapone and Entacapone?
Drugs used for smoking cessation
a) 5-HT 1B/1D agonist
b) inhibit CN5 activation --> decrease pain sensation
MOA of -Triptan drugs
Vigabatrin. It inhibits GABA transaminase --> increase [GABA]
pt with epilepsy not responding to treatment can be given what medication?
a) X-linked dominant --> only in females
a) child with normal development until 5-18 months
b) regression of skills
Atypical antipsychotic drug causing INCREASE in PRL
Do NOT take sofosbuvir or simeprevir MONOTHERAPY!!
Rx for HCV
a) Rx of neurogenic bladder: catheterization, muscarinic antagonists
b) Rx of muscle spasticity: baclofen, GABA-B receptor agonists
woman with longstanding multiple sclerosis has bladder spasticity and muscle spasms. What treatments can you offer for symptom relief?
HIV, sickle cell disease, heroin abuse
disorders that are associated with focal segmental glomerulosclerosis.
a) filtered FREELY
b) secreted by tubular cells --> CARRIER MEDIATED!!
how is PAH excreted by the body?
a) Fanconi Syndrome
b) Bartter Syndrome
c) Gittleman Syndrome
d) Liddle Syndrome
list the Renal Tubular Defects:
Reabsorption defect in the PCT
a) loss of nearly all amino acids, glucose, etc.
a) defective reabsorption in ascending loop of hence
b) the signs and symptoms are SIMILAR TO LOOP DIURETIC USE!!!!
man with an A.R defect presenting with hypokalemia, metabolic alkalosis and HYPERCALCIURIA
a) High calcium in the urine is seen with Bartter syndrome
b) signs and symptoms are SIMILAR TO THIAZIDE DIURETIC USE!!!!
man with an autosomal recessive disorder presents with hypokalemia and a high body pH but a NORMAL URINE CALCIUM level. Diagnosis?
a) gain of fxn mutation in Na reabsorption by the CD
a) patient with elevated serum sodium --> hypertension
b) Low potassium
c) mb alkalosis
d) NO ALDOSTERONE
convert Cortisol --> cortisone
function of 11-beta hydroxysteroid dehydrogenase
Glycyrrhetinic acid (in liquorice)
what substance inhibits 11-beta hydroxysteroid dehydrogenase?
Syndrome of Apparent Mineralocorticoid Excess
a) def. of 11-beta hydroxysteroid dehydrogenase (which normally converts Cortisol --> Cortisone)
b) Cortisol can stimulate Aldosterone receptors --> effects of aldosterone without aldosterone present
a) pt with findings similar to Liddle Syndrome (HTN, hypokalemia, mb alkalosis, no aldosterone)
b) ELEVATED Cortisol!!!!!
Renal Tubular Acidosis
dont be such a HARD ASS, be NORMAL for once
Mb acidosis and a NORMAL anion gap
Omalizumab --> targets immunoglobulin E. prevents IgE from binding to FcεRI
boy has severe asthma and a history of allergies. Which therapeutic antibody can you prescribe, and what does it target?
a) Albumin --> to conserve amino acids for the positive reactants
b) Transferrin --> internalized by macrophages to protect iron from being lost
In a patient with sepsis, what acute-phase reactants will be down regulated?
Blood in the urine without casts suggests an extrarenal process
smoker has painless hematuria. Red blood cells, but no casts, are seen in his urine. Where does this suggest that the bleeding is from?
Acute tubular necrosis; it is self-reversing
most common cause of acute kidney injury in hospitalized pts? What happens if it is left untreated?
Vasospasms + DIC
diffuse cortical necrosis is thought to be a combination of which two pathologic processes?
No --> they are simple cysts
renal cysts that are thin and filled with ultrafiltrate. Are these lesions malignant?
Can be --> remove them
renal cysts that are septated, enhanced, or have solid components. are they malignant?
envelope/dumbbell crystal in urine
coffin-lid crystals in urine
rhomboid/rossette crystals in urine
hexagonal crystals in urine
a) from PCT
b) cells contain lipids and glycogen
a) renal mass with round/polygonal cells
b) clear cytoplasm
What is the origin of the tumor? what are the cells composed of?
a) tumor originating from the CD
b) abundant MITOCHONDRIA
Transitional Cell Carcinoma
a) painless hematuria without any casts
b) exposure to Rubber, Plastic, Leather, Textile in occupation
arises form the Renal Pelvis
what is the origin of Transitional Cell Carcinoma?
a) Detrusor Overactivity
b) in pts. with MS
a) Detrusor Underactivity
b) in pts. with DM causing peripheral neuropathy
c) increased Post-residual volume!!
a) flattened renal tubular cells, loss of brush border
b) denudation of tubular BM
Child with hepatic fibrosis, cystic dilation of kidneys
PKHD-1 mutation. encodes for fibrocystin
what mutation is seen in ARPKD?
Serum. urine becomes positive 14 days after fertilization when hCG > 20
what is more sensitive for pregnancy:
urine or serum test?
Caudal regression syndrome
a) agenesis of sacral spine
b) flaccid paralysis of lower extremities
c) dorsiflexion of toes
d) pt may only have sirenomyelia
uncontrolled diabetes of the mother
MC association of caudal regression syndrome
NO HEARING LOSS
a) abn. formation of 1st and 2nd arches
c) airway obstruction
NO AIRWAY OBSTRUCTION
a) abn. formation of 1st and 2nd arches
b) conductive hearing loss
c) upper vagina
lower vagina comes from urogenital sinus
what structures are derived from the mullerian duct?
b) vas deferens
c) seminal vesicles
what structures are derived from Wolffian duct?
what is the potency of estrogens?
slows its motility --> allows cholesterol to accumulate
what effect does P2 have on the GB?
- all hormones are elevated;
- E2 is LOW
Hormone levels in menopause?
VERY HIGH FSH!!
what is hallmark hormonal response in Menopause?
- low inhibin --> high FSH
- low T2 --> high LH
- high E2
Hormonal status in Klinefelter
low E2 --> high LH and FSH
hormonal status in Turner Syndrome
PAINLESS 3rd trimester bleeding
PAINFUL 3rd trimester bleeding
New onset HTN in a pregnant female > 20 weeks of gestation
Uniformly enlarged uterus
- irregularly enlarged uterus
- E2 responsive mass
- multiple and whorled pattern
- necrotic and hemorrhagic mass in the uterus
- single lesion
- pelvic pain associated with menses
- Fibrocystic change (> 35 years old)
- Intraductal papilloma
- Fibroadenoma (E2 responsive; < 35 years old)
Premenopausal breast masses
- Mammary Duct ectasia
- Papillary Carcinoma
- Phyllodes tumor
Postmenopausal breast masses
stromal proliferation compressing the ducts to slits in the breast
- rock hard mass in the breast
- nests and cords of cells
most lateral bone in the wrist
B/w the tendons of:
- extensor pollicus longus
- extensor pollicus brevis
location of the anatomical snuff box
what bone can be palpated in the snuff box?
persistent wrist pain and tenderness in the snuff box is sign of what bone damage?
- Radial Head Sublaxation
- Child 1-4 years old
- sharp pull to the hand when the arm is EXTENDED and PRONATED
Nursemaid's elbow (radial head sublaxation) causes displacement of what ligament?
- Hemodialysis (beta 2 microglobulin deposition)
other conditions causing Carpal Tunnel Syndrome
Ulnar Collateral Ligament
- Rx = Tommy-John surgery
Baseball players can injure what ligament?
- Radial Nerve
- Deep Brachial Artery
Damage to the mid shaft of the humerus causes damage to
a) What nerve?
b) What artery?
- Axillary Nerve
- Posterior Circumflex Humoral Artery
Damage to the surgical neck of the humerus/ anterior displacement of the humerus can lesion:
a) What nerve?
b) What artery?
- Median Nerve
- Brachial Artery
Supracondylar fracture of the humerus lesions:
a) What nerve?
b) What artery?
- Median nerve and brachial artery
If the supracondylar fracture of the humerus causes an ANTEROMEDIAL displacement of the humerus, what structure(s) are damaged?
if the supracondylar fracture of the humerus causes an ANTEROLATERAL displacement of the humerus, what structure(s) are damaged?
Patients with repetitive rotation of their wrists (mechanics using screwdrivers) can damage what structure?
Lateral Epicondyle --> lateral epicondylitis
- site of insertion of EXTENSOR muscles
Tennis Elbow is damage to what structure?
Medial Epicondyle --> medial epicondylitis
- site of insertion of FLEXOR muscles
Golfers Elbow is damage to what structure?
anterolateral gluteal area
- von Hochstetter triangle
intragluteal injections should be administered in what region?
Osgood Schlatter Dz
overuse injury to the secondary ossification centres of the tibial tuberosity
Patient given epidural anesthesia soon develops sudden back pain and radicular pain
- trabecular thinning and loss in interconnections
- NORMAL serum calcium and phosphate
1) Spongy bone --> vertebral fractures
2) Cortical bones --> long bones --> hip fractures
which bones are effected by osteoporosis in postmenopausal women?
Patient present with fragility fractures (fractures while performing normal activities) is HIGHLY suggestive of what?
- thick and dense bones
- defective osteoclast resorption
bone marrow will be filled with bone --> pancytopenia --> extra medullary hematopoiesis
What might a patient with Osteopetrosis present with?
- primary spongiosa in the medullary cavity without mature trabecular
- accumulation of women bone with diffuse skeletal thickening
- patient with an enlarged forehead
- osteoid deposits at the costochondral junction
- an anterior protrusion of sternum with inward ribs
Paget's Dz of Bone
- dense, hypo vascular mosaic pattern of lamellar bone
- irregular sections separated by cement lines
- patient with chronic progressive hip/groin pain exacerbated by weight bearing
- wedge-shaped zone of affected bone
- dead bony trabeculae and fat necrosis
- NO SWELLING/REDNESS/WARMTH!!!!
insufficiency of medial circumflex femoral artery
what vessel is damaged in a patient with Avascular necrosis of the femur?
- prostatic cancer
- small cell lung cancer
- hodgkin lymphoma
Osteoblastic bone metastases:
- GI cancers
- Breast cancers
Mixed (osteolytic and osteoblastic bone metastases)
- non-small cell lung cancers
- non-hodgkin lymphoma
- renal cell carcinoma
Osteolytic bone metastases
- Ewing Sarcoma
- Osteoid Osteoma
- Fibrous Dysplasia (in spongy bone)
bone tumors in the DIAPHYSIS:
bone tumors in the METAPHYSIS
Giant Cell Tumor
bone tumor in the EPIPHYSIS
cartilage tumor in hands and feet
cartilage tumor in the pelvis and CENTRAL skeleton
bone pain that resolves with aspirin
- PEAK = teens
- elderly (less commonly)
what is the age distribution of Osteosarcomas?
pleomorphic bone cells that produce osteoid is characteristic of?
- Paget's Dz
- Radiation exposure
- Li Fraumeni Syndrome
risk factors for developing Osteosarcomas
< 15 year old BOY with a bone tumor
IgM antibodies reacting against Fc portion of IgG
a) osteoarthritis (degen. joint disease)
a) cartilage DISRUPTION on histology
b) cartilage DESTRUCTION on histology
exacerbation of arginine --> citrulline
anti-cyclic citrullinated peptide antibody
what is a more specific test for RA?
- patient with morning stiffness and SYMMETRIC joint involvement
- AA amyloid
- Sjogren Syndrome
- Pneumoconiosis (Caplan Syndrome)
- Carpal Tunnel
extraarticular manifestations of RA
- needle-shaped crystals
- crystals that are YELLOW under PARALLEL light
- crystals that are BLUE under PERPENDICULAR light
- rhomboid-shaped crystals
- crystals that are YELLOW under PERPENDICULAR light
- crystals that are BLUE under PARALLEL light
monosodium urate deposition
calcium pyrophosphate deposition
- involves spine and sacroiliac joints
- Limits chest expansion --> hypoventilation
extra-articular manifestations of Ankylosing Spondylitis
granulomas containing schaumann and asteroid bodies
Th1 response (IL-2 and IFN-gamma)
what cell type is responsible for the events in sarcoidosis?
- muscle stiffness and muscle aches WITHOUT muscle weakness
- NORMAL CK
- Proximal muscle weakness
- elevated CK
- Endomyseal inflammation
Lung Dz and Myocarditis
What are important associations of Polymyositis?
- Patient with features of polymyositis and a molar rash, gottron papules
muscle biopsy reveals mononuclear perimysial infiltrate, perifascicular atrophy and patchy necrosis
Lung, Ovarian, Colorectal carcinomas and NH Lymphoma
What are important associations of Dermatomyositis?
- Ig's against postsynaptic ACh receptor
- decreased motor end plate potential
Pathophysiology of Myasthenia Gravis
anti-Scl-70 antibody (anti-DNA topoisomerase I antibody)
what Ig is seen in DIFFUSE-type scleroderma?
what Ig is seen in LIMITED-type scleroderma?
increased thickness of stratum corneum
psoriasis and calluses
examples of hyperkeratosis
retention of nucleus in cells within the stratum corneum
example of parakeratosis
increased thickness of stratum granulosum
example of hypergranulosis
accumulation of oedematous fluid between cells in the epidermis
eczematous dermatitis (atopic dermatitis)
example of spongiosis
- seen in Squamous cell carcinoma
premature keratinization of the keratinocytes BELOW stratum granulosum
- defective tyrosinase
poor melanin production in melanocytes
absence of melanocytes in the skin
diminished pigment transfer to keratinocytes
salmon-coloured plaques with silvery scale
neutrophils in stratum corneum
thinning of epidermis above elongated dermal papillae --> bleeding when scale is peeled off
where do we find munro microabscesses and auspitz sign?
- Planar, polygonal, pruritic, purple
- associated with Hep C!!!
- saw-tooth infiltrate of lymphocytes at dermal-epidermal junction
What is the disorder in which you have autoab to hemidesmosomes?
Ig surrounding keratinocytes in a FISH-NET pattern
Ig surrounding BM in a LINEAR fashion
- painful bullae on mucosal sites
- bullae SPREAD LATERALLY when pressure is applied
mutation of valine --> glutamate @ 600th position in BRAF gene
drug that inhibits dihydroorotate dehydrogenase
- rash and alopecia
Toxicity of Leflunomide
drugs that inhibit dihydrofolate reductase
- Stomatitis --> ulcers in the mouth
- Hepatotoxicity --> check LFT's
Toxicity of Methotrexate
Rx for Juvenile Rheumatoid Arthritis
Rx for RA:
6-Mercaptopurine is INACTIVATED by what enzyme?
6-Mercaptopurine is ACTIVATED by what enzyme?
recombinant form of uric acid oxidase
- mb uric acid --> allantoin (water-soluble form)
MOA for Pegloticase
Pegloticase has a similar MOA to what other drug?
- causes Anaphylaxis and Urticaria
Patient taking Rx for gout develops anaphylaxis. what drug was he given?
Patient taking Rx for Gout develops GI abnormalities (pain, diarrhea, etc.) was given what drug?
2) Colchicine (CI in renal failure and elderly)
Rx of ACUTE gout
Rx for CHRONIC gout
Drugs that increase serum calcium by acting as PYROPHOSPHATE analogs
- pyrophosphate analogs
- bind hydroxyapatite
- inhibit OSTEOCLASTS
MOA for bisphosphonates
- osteonecrosis of the jaw
S/E of bisphosphonate usage
It is selective for α1A,D-receptors found on the prostate, rather than the α1B-receptors on systemic vessels
If Tamsulosin is an α-1 antagonist,why does it relax the smooth muscles of the prostate but not the systemic vasculature?
- bone marrow suppression
- GI abnormalities
major toxicities of Hydroxyurea
Androgen insensitivity syndrome (also known as testicular feminization)
MCC of a 46,XY disorder of sexual development
- embryonic (weeks 4-7)
- pseudoglandular (weeks 5-16)
- canalicular (weeks 16-26)
- saccular (week 26-birth)
- alveolar (week 32-8 years)
stages of lung development
how do you diagnose Filovirus?
- sulfapyridine --> anti-bacterial
- 5-ASA --> anti-inflammatory
what is the composition of sulfasalazine?
- HEMOLYSIS IN G6PD DEF. PTS!!!
S/E of Sulfasalazine
Pt. with Crohn's Dz / Ulcerative Colitis taking a medication comes to you complaining of oligospermia.
What drug was he given?
- accumulation of pus in the anterior chamber of the eye
- seen in patients with Uveitis
What is a hypopyon?
CLL has increased peripheral blood lymphocytosis, or bone marrow involvement; SLL does not
What is the difference between small lymphocytic lymphoma (SLL) and chronic lymphocytic leukemia (CLL)?
The frontal lobe (Mature frontal lobes usually inhibit these reflexes.)
Lesions in what lobe of the brain may cause primitive reflexes to reemerge?
Which anti-mite/louse agents can be used?
Na, AChE, GABA inhibition
Treat PML (Pesty Mites and Lice) with PML (Permethrin, Malathion, Lindane), because they NAG you (Na, AChE, GABA blockade)
What is the MOA for anti-mite/louse therapy?
- it inhibits HSL
Which lipid-lowering agent inhibits lipolysis?
- Dx via fundoscopy
A pt reports "curtain-like" vision loss. what does he have?
- Autoimmune pancreatitis
- Retroperitoneal fibrosis
- Noninfectious aortitis (Riedel thyroiditis)
Conditions with IgG4-related systemic disease
woman has sudden painful vision loss and a terrible headache. She is seeing halos around lights. You touch her eye and it feels ROCK-HARD
pt's new glaucoma drug is causing browning of the iris. What is the mechanism of the drug she is taking
woman has multiple painful breast masses bilaterally that fluctuate in size during her menstrual cycle. What is the likely diagnosis?
because their mb yields ONLY acetyl-CoA
- odd-chain FA mb yields propionyl CoA which becomes Succinyl CoA --> can yield Glucose via gluconeogen.
Why are even-chain fatty acids unable to produce new glucose?
Ileus/Hypomobility without obstruction
48-year-old man with many past abdominal surgeries has a distended abdomen with decreased bowel sounds. What does this pt likely have?
Error in the embryonic stage of lung development can lead to what?
Everything up to TERTIARY bronchi
what is formed during the embryonic stage of lung development?
Upto TERMINAL BRONCHIOLES
what is formed during the pseudo glandular stage of lung development?
upto the ALVEOLAR DUCTS
what is formed during the canalicular stage of lung development?
- upto ALVEOLAR SACS
- pneumocytes develop
what is formed during the saccular stage of lung development?
what is formed during the alveolar stage of lung development?
@ 25 weeks
When is respiration capable of occurring in the fetus
alpha 1 antitrypsin
what inhibits elastase in neutrophils?
tissue inhibitors of metalloproteinases (TIMP's)
what inhibits elastase in macrophages?
patient with recurrent pneumonia in the SAME LOCATION
extra nonfunctional lung tissue located within/outside of lung
- dipalmitoyl phosphatidylcholine
what are major components of surfactant?
at the end of tertiary bronchi, just before the start of the bronchioles
where in the lung do cartilage and goblet cells terminate?
in the respiratory bronchioles
where in the lung does cilia terminate?
between the thyroid and cricoid cartilage
where do you perform a cricothyrotomy?
- superior segments of inferior lobes
- posterior segments of upper lobes
aspiration in a SUPINE individual:
1) Intercostal Nerves
2) Phrenic Nerve
sensory innervation of the parietal pleura comes from:
When is Pulmonary vascular resistance at its MINIMUM?
- Taut Form --> de-O2
- Relaxed form --> O2
What different forms does Hb exist in?
- Posterior Ethmoidal Sinus
- Sphenoid Sinus
What does the Superior Meatus drain?
- Frontal Sinus
- Anterior Ethmoidal Sinus
- Maxillary Sinus
What does the Middle Meatus drain?
- Nasolacrimal duct!!
What does the Inferior Meatus drain?
can Rx cyanide poisoning
What drugs can oxidize iron from Fe 2+ --> Fe 3+ ?
a myoglobin-like HYPERBOLIC O2 curve
dissociation of individual Hb chains results in what?
- decreases peripheral tissue O2 consumption --> INCREASED VENOUS O2 concentration
what effect does cyanide have on:
a) Hb concentration
b) % O2 sat
d) Total O2 content
Pts. with CHF exhibit what breathing pattern?
everything causing mb acidosis
When will we see Kussmaul breathing?
- O2 (normally)
What gases are perfusion-limited?
- O2 (in patients with obstructive/restrictive Dz
What gases are diffusion-limited?
- Unintentional injury
- Congenital malformations
top three causes of death in children aged 1 to 14 years?
Which class of GI drugs should not be taken with fluoroquinolones?
headache and constipation
You give a 47-y/o woman a 5-HT3 antagonist for her nausea during chemotherapy. What two main adverse effects should you expect?
facial nerve palsy develops as a result of herpes zoster infection?
Warm agglutinin autoimmune hemolytic anemia
- chronic anemia that is IgG-mediated
What is the cause of hemolytic anemia in pts. with SLE?
- Endothelial damage
What are the components of Virchow's Triad?
- patient with swelling, redness, and pain of their foot
- dorsiflexion of foot --> calf pain (Homan Sign)
Lines of Zahn
interdigitating areas of platelets, fibrin and RBC
patient with lines of zahn had a thrombus form before or after death?
patient with a bone fracture now presenting with dyspnea, neurological symptoms and petechiae
thickened bronchial walls, enlarged mucus glands, patchy squamous metaplasia of bronchial mucosa and NEUTROPHILIC infiltrate
- Centriacinar in UPPER lobes (smoke goes up)
What type of emphysema is seen in patients who smoke?
- Panacinar in LOWER lobes
what type of emphysema is seen in patients with AAT def?
Patient with a NORMAL spirometry, personal/family history of any allergic condition
- Allergic Rhinitis
- Atopic Dermatitis
- Allergic asthma
is at risk for developing?
patients with asthma have high amounts of what interleukin?
What cell is responsible for the effects in asthma?
Type 1 hypersensitivity
what hypersensitivity reaction is seen in asthma?
Shed epithelium forms spiral-shaped mucus plugs
Eosinophil-derived, hexagonal, needle-like crystals in mucus
cells in the lung with LONG SLENDER microvilli and ABUNDANT TONOFILAMENTS
nodular/smooth pleural thickening
long, golden-brown fibres with iron in the lung/pleura
Prussian Blue (because of the iron present in them)
asbestos bodies can be visualized using what stain?
- Non caveating granulomas in hilar lymph nodes
What pneumoconiosis resembles Sarcoidosis
- occurs in patients working in the aerospace industry?
What pneumoconiosis increases the risk for TB?
silica impairs phagolysosome formation in macrophages
How does silica increase risk for TB?
Anergy to skin test with Candida or PPD
Th1 cell (CD4)
What cell type can be seen in bronchoalveloar lavage in pts. with Sarcoidosis?
Amniotic fluid embolism
causes of ARDS
- surfactant is stored and transported to cell surface by lamellar bodies
def. of lamellar bodies in the lungs can cause?
NEC and PDA
Complications of NRDS
1) Retinal injury
2) Bronchopulmonary dysplasia
- because of Free Radical formation
Rx of NRDS with supplemental O2 can result in what complications?
medial hypertrophy and intimal thickening of pulmonary arteries
- Decreased breath sounds
- Dull percussion
- decreased fremitus
- trachea deviates TOWARDS lesion
- Bronchial breath sounds
- Dull percussion
- INCREASED fremitus
- NO TRACHEAL DEVIATION
most important risk factor in developing Primary Spontaneous Pneumothorax
Congestion phase of Lobar pneumonia
Red and HEAVY/BOGGY lobe of the lung
Red Hepatization of Lobar pneumonia
Red and FRIM lobe of the lung
- within DAYS
- aspirate ORAL microbes
- PRODUCTIVE cough and FEVER
- Rx with ANTIBIOTICS
Features of Aspiration PNEUMONIA
- within HOURS
- aspirate GASTRIC contents
- NONPRODUCTIVE cough
- Rx with supportive management
Features of Aspiration PNEUMONITIS
- air-fluid levels on CXR
- Foul-smelling sputum!!!
- destruction of lung parenchyma SECONDARY to neutrophil and macrophage enzyme release
- mass in the lung that displays SHORT and PLUMP microvilli
- no BV invasion
- Large Cell Carcinoma
- Mass in the lung with PLEOMORPHIC GIANT CELLS
- secretes beta-hCG --> gynecomastia and galactorrhea
mass in the lung with SALT-AND-PEPPER pattern on the cells
Expectorant drug that THINS respiratory secretions
Expectorant drug that acts as a mucolytic agent --> liquefies mucus by disrupting disulfide bonds
Toxicity of Zileuton
Cardiotoxicity and Neurotoxicity
Toxicity of theophylline
2) Beta agonist
3) Steroids (IV)
Rx of acute asthma
Rx of chronic asthma
DOC for bronchospasm caused by beta-blockers
painful nodule on labia majora
Condylomas in lower genital tract
Low-risk HPV (6 and 11) an result in?
- epidermal thinning and fibrosis (sclerosis) of the dermis
- parchment-like vulvar skin
Lichen Simplex Chronicus
- thick and LEATHERY vulvar skin
- PAS +ve
- Keratin +ve
- S100 -ve
What are the markers for Paget cells?
- PAS -ve
- Keratin -ve
- S100 +ve
What are the markers for Melanoma?
Mullerian Agenesis --> no uterus, cervix, or UPPER vagina
Cyst on the lateral wall of the vagina
Gartner cysts are remnants of what embryologic structure?
Rhabdomyoblasts have thee characteristic features
What will be stained positive in patients with Embryonal Rhabdomyosarcoma?
- red ulcerations in upper portion of the vagina
- remnants of the mullein glands
- vaginal discharge
- pelvic pain
- red cervical os
- Invasion through the anterior uterine wall --> into BLADDER
- Block ureters --> HYDRONEPHROSIS
What is a long-term risk of Cervical Carcinoma
Secretory (P2) phase
Which phase of the menstrual cycle is the LEAST variable?
the pain associated with ovulation is termed?
Because of the sudden drop in maternal hormones with delivery
Why may newborn baby girls have vaginal bleeding?
- Lymphocytes and PLASMA CELLS in the endometrium
- following retained products of conception, IUD, TB
- endometrial polyp
- endometrial hyperplasia/carcinoma
Causes of uterine bleeding:
LH >>>>>> FSH (FSH is low)
- E2 is HIGH
Hormonal levels in PCOD
- Serous Carcinomas of Ovary and Fallopian Tube
- Medullary Carcinoma of the Breast (Ductal Carcinoma)
- Prostatic Adenocarcinomas (also with BRCA 2)
What cancers can be seen with BRCA 1 mutations?
MC benign germ cell tumor
MC malignant germ cell tumor
Granulose-Theca cell tumor
- feminizing tumor (E2 prod.)
- Call-Exner bodies
Sertoli-Leydig cell Tumor
- masculinizing tumor (T2 prod.)
- Reinke crystals in leydig cells
- Pleural Effusion on the RIGHT side
- Ovarian tumor (Fibroma)
what veins in the embryo give rise to the portal veins in the adult?
Sertoli cell failure --> decreased inhibit --> elevated FSH
mutations in SF1/NR5A1 can cause failure in what cells to develop?
Choriocarcinoma of gestation
p57 -ve on immunochemistry
postpartum bleeding that does NOT respond to uterotonic agents
reprogramming of stem cells
metaplasia occurs through what?
decreased blood flow through an organ
- because of decrease arterial perfusion
- because of decrease venous drainage
- because of shock
decreased partial pressure of O2 in blood
Cherry-red appearance of skin
- brain infarction
liquefactive necrosis is characteristic of what conditions?
fat necrosis of the breast
breast mass with giant cell reaction around the mass
is apoptosis ATP-dependant or indépendant?
Serum Amyloid-Associated protein (SAA protein)
- SAA is an acute phase reactant increased during CHRONIC inflammation
where does AA amyloid originate from?
- abdominal fat pads
tissue biopsy to confirm amyloidosis can be performed at what 2 sites?
Senile Cardiac Amyloidosis
deposits of NON-MUTATED transthyretin can be seen in what condition?
Familial Amyloid Cardiomyopathy
- pts. present with Restrictive cardiomyopathy
deposits of MUTATED serum transthyretin can be seen in what condition?
1, 14, 21
What chromosomes are associated with EARLY-ONSET alzheimers?
What chromosomes are associated with LATE-ONSET alzheimers?
whether a drug is safe or not
- assess the safety, the toxicity, etc.
what does Phase 1 of clinical trials determine?
whether a drug works or not
- assess treatment efficacy, dosing and any S/E
what does Phase 2 of clinical trials determine?
compares the new drug to the old drug(s) being used
what does phase 3 of clinical trials determine?
detects rare or long-term S/E
- may cause the drug to be withdrawn from the market
what does phase 4 of clinical trials determine?
- tail moves to the RIGHT
- MEAN will ALWAYS follow the tail
Mean > Median > Mode
what happens to mean, median, and mode on a POSITIVE SKEW ?
- tail moves to the LEFT
- MEAN will ALWAYS follow the tail
Mean < Median < Mode
what happens to mean, median, and mode on a NEGATIVE SKEW?
- pathogen activeer molecular patterns
TLR's are activated by what?
- CD 14
- recognizes LPS on Gram -ve bacteria
what CD marker is present on macrophages? and what does it recognize?
Phospholipase A2 becomes PG via what enzyme?
Phospholipase A2 becomes LT via what enzyme?
- therefore they result in increased vascular permeability
what arachidonic acid metabolite is responsible for SM DILATION?
- therefore they cause vasoconstriction and bronchoconstriction
what arachidonic acid metabolite is responsible for SM CONSTRICTION?
- smooth muscle constriction of the PERICYTES
how do LT's cause an increase in vascular permeability?
what stimuli activate mast cells?
what do mast cells produce PRIMARILY in inflammation?
- LT's mainly!!
what do mast cells produce as a DELAYED response in inflammation?
- Coagulation cascade
- Kinin pathway --> increased Bradykinin
Hageman Factor activates what pathways?
Selectins on endothelium binding Sialyl-Lewis X on WBC
What substance is responsible for WBC rolling?
CAM's on endothelium bind Integrins on WBC
what substance is responsible for WBC adhesion?
what substance is responsible for WBC transmigration?
Type 1 = No intetgrins (no CD 18 on Neutrophils)
Type 2 = No Sialyl-Lewis X on Neutrophils
Leukocyte Adhesion Deficiency is caused by a def. in what?
NADPH Oxidase def.
pt undergoes Nitroblue Tetrazolium Test and the cells fail to turn blue
1st = MHC binding to TCR
2nd = B7 on APC binds CD28 on T cell
What are the 2 signals required to activate CD4+ T cells?
1st = MHC binding to TCR
2nd = Il-2 from CD4+ Th1 cells
What are the 2 signals required to activate CD8+ T cells?
1st = antigen binds IgM or IgD on surface
2nd = CD40 on B cells binds CD40L on T cells
What are the 2 signals required to activate B cells?
epithelioid histiocytes with a rim of giant cells and lymphocytes
what is the defining feature of a granuloma?
Granulomas WITHOUT central necrosis
- cells HAVE nuceli
Granulomas WITH central necrosis
- cells LOST nuclei
defective gamma-chain in IL-2 receptor
- patient with low platelet count --> bleeding
- skin problems
- elevated IgE and IgA
- found in medullary epithelial cells of the thymus
- helps in CENTRAL tolerance of T cells
what is the function of AIRE?
Autoimmune Polyendocrine Syndrome
- AIRE mutations
patient with Hypoparathyroidism, Adrenal Failure, and Candida infections
Fas-apoptotic pathway defects
Autoimmune Lymphoproliferative Syndrome is caused by a defect in what pathway?
patient has decreased levels of:
Renal disease in patients with SLE
Anti-ds DNA is prognostic for what?
"rim pattern of immunofluorescence"
what component of SLE is responsible for the falsely elevated PTT?
Anti-SSA Ig's (because they CROSS the placenta!!!)
- aka Anti-Ro Ig
what component of Sjogren syndrome is responsible for SLE in neonates?
Marginal Zone Lymphoma
patient with Sjogren syndrome for years now presents with unilateral parotid gland enlargement
anticonvulsant that works by blocking VG calcium channels
- IV Phenytoin
phenytoin has a SLOW axn of onset therefore give Benzo's first
Rx of Status Epilepticus
incomplete closure of the umbilical ring
What is the cause of umbilical hernias?
Neurophysins are carrier proteins for what hormones?
- infections with ENCAPSULATED organisms
Def. of C1 complement has an increased risk for what conditions?
Hyper IgM syndrome
immunoglobulin gene rearrangement is impaired in what disorder?
what enzyme is def. in patients with AIP?
what enzyme is def. in patients with Porphyria Cutanea Tarda?
pt develops LACE-LIKE RASH days after having FLUSHED CHEEKS
intestinal epithelial cells
where does rotavirus replicate?
Neutrophils and Macrophages
what cells can be found in airspaces of patients with emphysema?
- Drug Reaction
- Systemic Symptoms
patient presents with:
- generalized lymphadenopathy
- skin rash
- facial edema
after starting a new medication 2-8 weeks ago
drug-induced reactivation of herpesvirus followed by clonal expansion T-cell that cross react with the drug
Cause of DRESS Syndrome?
- Congenital malformation
MCC of death from age 1-14
arginine and lysine
what amino acids are prominent in histones?
what nucleic acids are methylated on the DNA template strand to differentiate between parent and daughter strands?
DNA Pol. 3
DNA replication in prokaryotes is carried out by?
DNA alpha and delta
DNA replication in eukaryotes is carried out by?
DNA Pol. 1
Primer removal in prokaryotes is carried out by?
Primer removal in eukaryotes is carried out by?
- Splice site
what mutations involve a change in the length of mRNA?
Nucleotide Excision repair
what DNA repair process is def. in patients with Xeroderma Pigmentosum?
Base Excision repair
what DNA repair process is def. in patients with cytosine deamination?
what DNA repair process is def. in patients with Lynch Syndrome (HNPCC)
Non homologous end joining
what DNA repair process is def. in patients with Ataxia Telangiectasia
- anti-Smith Ig
antibody against snRNP's is seen in what pts?
N-oligosaccharides are added to what amino acid?
Serine and Threonine
O-oligosaccharides are added to what amino acid?
N-acetylglucosaminyl 1 phosphotransferase
what enzyme is def. in patients with I Cell disease?
Hyper IgM syndrome
immunoglobulin gene rearrangement is impaired in what disorder?
- 1 isomer is inherited from each parent --> therefore each individual has 2 isomers
- normal ratio between the 2 isomers = 1:1
- 1:1 ratio is maintained in lymphoid reactions
- only 1 isomer is present in neoplasias
how do G6PD isomers help determine clonality?
via Ig light chain phenotype
- kappa or lambda
how is the clonality of B cells determined?
normal ratio of kappa:lambda light chains?
if kappa:lambda ratio = 6:1 or 1:3, is this neoplastic?
- cigarette smoke
where is arsenic found?
- squamous cell carcinoma of the skin
- lung cancers
- angiosarcoma of the liver
what cancers can be caused by arsenic?
deceleration of head growth is a CLASSIC sign in what condition?
Mutations in MECP2 gene result in
where in the GIT are dietary lipids digested?
where in the GIT are dietary lipids absorbed?
Aedes aegypti mosquito
dengue fever is transmitted via what vector?
what part of the circulatory system has a pressure of 25/2?
what part of the circulatory system has a pressure of 25/10?
K = low
HCO3 = high
Na = NORMAL (aldosterone escape)!!!!
patients with primary hyperaldosteronism have what levels of Na, K, and HCO3-?
Complex atypical hyperplasia of the endometrium
chronic E2 exposure without P2 can result in what changes in the endometrium?
inhibit MATURE osteoclast-mediated bone resorption
how do Bisphosphonates Rx osteoporosis?
recombinant form of PTH
MOA of Teriparatide
- patients with DKA have mb acidosis
- undergo resp. alkalosis to compensate (expel CO2)
- if CO2 levels are higher than expected after compensation (use WINTERS formula) --> resp. acidosis
- leads to pull edema and res. failure
Correlate between DKA and respiratory failure
- decreased P50 = increased affinity = left shift curve
- left shift curve = less O2 reaching tissues
- less O2 in tissues = hypoxia
- hypoxia stimulates EPO
any circumstances that cause a DECREASED P50 for Hb can cause what condition?
- Rx = SSRI's (MAO-I's used 2nd line)
pt presents with:
- mood reactivity
- leaden paralysis (arms and legs feel HEAVY)
- rejection sensitivity
- increased sleep and appetite
- disrupt cell membranes
- denature proteins
MOA for Alcohols used as ANTISEPTICS
- disrupt cell membranes
- coagulation of cytoplasm
MOA for Chlorhexidine used as ANTISEPTICS
prod. free radicals
MOA for H2O2 used as an ANTISEPTIC
halogenates proteins and nucleic acids
MOA for Iodine used as an ANTISEPTIC
cross-links proteins and DNA
MOA for Formaldehyde used as an ANTISEPTIC
- breech delivery
- malposition of the head in utero
MCC of congenital torticollis
1) 46 XX
2) 46 XY
MC karyotype for complete moles
NEVER GIVE WITH OTHER SEDATIVE AGENTS
most sedative H1 blocking agents
microsomal monooxygenase (a CYP450 enzyme)
what enzyme converts pro-carcinogens into carcinogens?
Therefore they cause shift INTO the cell
what major ions are located EXTRACELLULARLY?
- therefore it causes shift OUT OF the cell
what major ion(s) are located INTRACELLULARLY?
- GP interna (media)
- Subthalamic nucleus
What areas of the brain can patients with Parkinsons receive high-frequency stimulation?
neuronal shrinkage and intense cytoplasmic eosinophilia in the neurons (IRREVERSIBLE DAMAGE) can can result in?
- Chronic inflammation (SLE)
MCC of NBTE (Marantic Endocarditis)
what oncogenic protein is LOW with APC mutations?
- Renal failure
- Neuro symptoms (lethargy, etc.)
what is the famous PENTAD involved in TTP-HUS?
Focal Segmental Glomerulonephritis
Collapse and sclerosis of glomerular tufts is seen in what condition?
- Poststrep GN
- Membranous Nephropathy (spike-and-dome)
Sub epithelial Ig deposits are seen in what conditions?
- Membranoproliferative GN
- Diffuse proliferative GN
Sub endothelial Ig deposits are seen in what conditions?
diffuse proliferation and sub epithelial Ig deposits:
Patchy necrosis of tubular epithelium and loss of basement membrane
cleaved and non-cleaved follicles in a nodular pattern
Early = hypertrophic muscle fibres
End-stage = fibrofatty muscle replacement
histological features of patients with Duchenne's Muscular Dystrophy:
- Adenomatous (VILLOUS >>>> TUBULAR)
Examples of neoplastic polyps
Examples of non-neoplastic polyps
- Pulmonary Hypoplasia
- Twisted facies
- Twisted skin
- Extremity deformities
- Renal failure
What are the features of POTTER sequence?
- elderly patient with gradual vision loss
- sub retinal inflammation
- ECM formation (thick BM)
Chronic oxidative damage to the retinal epithelium and choriocapillaries
Cause of Dry AMD
Sub retinal Drusen deposits are seen in what condition?
- Grey/Greenish sub retinal discolouration
- adjacent fluid/hemorrhage
overstimulation of VEGF
cause of Wet AMD
Left and Right Gastric arteries
what arteries create anastomoses along the LESSER curvature of the stomach?
Left and Right Gastroepiploic arteries
what arteries create anastomoses along the GREATER curvature of the stomach?
skin patches with ulcerated appearance and necrotic centres
ecthyma gangrenosum is seen in pts with what infection?
painful red plaque with a raised and well-demarcated border
erysipelas are seen in pts with what infection?
distal tubules and collecting ducts
the lowest pH in the nephron is found along what region?
Lesch-Nyhan syndrome is due to a def. in what enzyme?
what enzyme is ELEVATED in Lesch-Nyhan syndrome?
Type 1 = Slow twitch
what type of muscle fibres have high-myoglobin and low-glycogen stores?
Type 2 = Fast twitch
what type of muscle fibres of low-myoglobin and high-glycogen stores?
Frameshift > Nonsense > Missense >>>>> Silent
What is the severity of mutations?
- Aplastic anemia (inherited)
- hypo/hyperpigmentated patches
- short stature
- hypoplastic thumbs
- structures in the cytoplasm that regulate and turnover mRNA
- repress transcription and can store mRNA
- encodes for ALPHA subunit in G-proteins
what is the mutation responsible for McCune-Albright Syndrome?
- PraDer-willi has Paternal Deletion
- AngelMan Syndrome has Maternal Absent
What gene is imprinted in Prader-Willi Syndrome? Angelman Syndrome?
GABA and ACh
what NT's are decreased in Huntington's Dz?
no Wolffian duct --> males have no Vas deferens --> azoospermia
what reproductive consequences occur because of CFTR mutations?
Duchenne's Muscular dystrophy
waddling gait is seen in patients with what disorder?
anchors actin to alpha and beta-dystroglycan (connected to ECM)
what is the function of dystrophin
what is the MCC of death in patients with Duchenne's?
Myotonic Type 1
- muscle wasting
- testicular atrophy
- CAG repeats --> GAIN of fxn
what is the gene mutation in Huntington's Dz?
defect in fusion of prechordal mesoderm results in what condition?
clenched hands and overlapping fingers
- elfin facies
- extreme friendliness with strangers
- affinity towards music
findings in DiGeorge Syndrome
demyelination of peripheral nerves WITHOUT perineurial inflammation
demyelination of peripheral nerves WITH endoneural inflammation
with Rx of Wernicke-Korsakoff, what symptom will remain even after Rx?
what vitamin, if taken in excess, can give a FALSE NEGATIVE stool guaiac test?
excess vit. E in children can cause?
excess vit. E in adults can cause?
E. Coli sepsis in NEONATES
neonate with Galactosemia because of Galactose-1-phosphate uridyltransferase def. is at risk for infection with what organism?
- increased Orotic acid in blood and urine
- NO MEGALOBLASTIC ANEMIA
- patient with signs and symptoms of PKU
- NORMAL Prolactin level. What enzyme is low?
- patient with signs and symptoms of PKU
- ELEVATED prolactin levels
abnormal pallor to the catecholamine regions in the brain
branched chain alpha-keto acid dehydrogenase
what enzyme is def. in Maple-syrup urine disease?
B1 (because the enzyme require TPP as a cofactor)
pts. with Maple-Syrup Urine Disease can be supplemented what vitamin?
patients urine darkens when left in air
fabry disease is because of what enzyme def.?
what substance accumulates in Fabry Disease?
- lipidemia retinalis
benign macrophages with a foamy cytoplasm
- keratin-like coat
- dipicolinic acid
what is the chemical composition of spores?
induces TNF and IL-1
function of lipoteichoic acid
- Strep. Pneumo
- Haemophilus influenza
what microbes undergo transformation?
- group A strep
- Botulinum toxin
- Cholera toxin
- Diphtheria toxin
- Siga toxin
- virus transfers DNA from bacteria --> bacteria
what microbes undergo transDUCtion?
DUC (duck/hide) from the virus
- Exotoxins (EF and LF)
what are the 2 virulence factors for Bacillus Anthracis?
1) Macrophage activation
2) Complement activation
3) Tissue Factor activation --> Coagulation --> DIC
3 functions of Endotoxin:
S. Aureus causing meningitis and CNS abscess formation
what microbe takes the following route:
CNS trauma --> leaking CSF --> meninges
Erythrogenic toxin from Strep. Pyogenes
Scarlett Fever is caused by what toxin?
- patient has history of minor trauma and out-of-proportion pain
- red and swollen overlying skin
symptoms similar to strep progenies infection, NO TONSILLAR EXUDATES
- Pyogenes (Group A Strep)
PYR +ve species
Agalactiae (Group B Strep)
pt. undergoes a GU/GI procedure and develops endocarditis
- Hypertonic solution (6.5% NaCl)
- Bile solutions (therefore bile resistant)
what medium can Enterococci from in?
Calmodulin-mediated Adenylate Cyclase stimulator —> increase cAMP ; inhibits leukocyte phagocytosis
how does Edema Factor function?
what microbe uses the following mode of transmission: wound —> motor axon —> spinal cord?
what microbe uses the following mode of transmission: food —> circulation —> peripheral nerves?
C. perfringens inhibits the release of what NT?
1) Diphtheria antitoxin (targets the toxin)
2) Penicillin and Erythromycin
3) DPT vaccine
Rx of Corynebacterium Diphtheria includes:
targets B-subunit of Diphtheria's exotoxin --> inhibits BINDING of exotoxin to host membrane
how does the DPT vaccine help treat diphtheria and prevent future infections?
Rx of medication repetitive episodes of C.Diff infection
Function of Cord Factor in Tb
inhibits phagolysosome formation --> prevents phagocytosis and allows escape from degradation
Function of Sulfatides in Tb
allow for acid fast staining
Function of Mycolic Acid in Tb
stimulates granuloma formation
Function of Trehalose Dimycolate in Tb
pt. with HIV and CD < 50 presenting with acid-fast infection
Prophylactic rx of MAI in pts. with HIV requires what antibiotic
Provides Factor V (NAD+)
how does S. Aureus help H. Influenzae grow?
- composed of Polyribosylribitol phosphate
main virulence for H. Influenzae is:
what microbe has the following properties:
- Lactose fermenting
- Indole +ve
what test is used to SCREEN for syphilis?
what test is used to CONFIRM syphilis after screening is +ve?
if a Rapid Plasma Reagin test is performed, what microbe is the pt. infected with?
Clue Cells --> Garderella Vaginalis
epithelial cells covered with gram-variable rods
Metronidazole or Clindamycin
Rx of garderella vaginalis
- we MUST rx the partner also!!!
Rx of Trichomonas Vaginalis
- T. Cruzi = painLESS
- T. Brucei = painFULL
T. Cruzi vs. T. Brucei - which has a painful bite and which has a painless bite?
what microbe can cause rectal prolapse and appendicitis like symptoms?
check for LARVAE in the stool
- not eggs, but larvae
how do you Dx for strongyloides?
ones with SEGMENTED genomes
which viruses can undergo reassortment>
in the nucleus
where do DNA viruses replicate?
which DNA virus replicates in the cytoplasm?
in the cytoplasm
where to RNA viruses replicate?
which RNA virus replicates in the nucleus?
plasma membrane of the host cell
where do enveloped viruses get their envelope from?
what is the only virus family that gets its envelope from the nuclear membrane?
- Polyoma virus
- Pappiloma virus
which DNA viruses have circular DNA?
West Nile Virus
culex mosquito can transmit what virus?
what protein, produced by HBV, is responsible for continued transcription of oncogenic genes?
- Atypicals (ones without a cell wall)
- Amphoteracin B
- Echinocandins (Capsofungin)
drugs that release histamine:
Ampicillin vs. Amoxicillin - which has greater biOavailability?
the DON is resistant
what penicillins are resistant to penicillinases (beta-lactamase)?
- Clavulanic Acid
beta-lactamase inhibitors include:
1st gen. Cephalosporins
Drugs used before surgery to prevent wound infections
- Haemophillus influenza
- E. coli
uses of Cephalosporins
- hypersensitivity rxn
- vit. K def.
- autoimmune hemolytic anemia
S/E of cephalosporins
what mb Carbapenems?
What drug inhibits dehydropeptidase 1?
given with Cilastatin
- cilastatin inhibits dehydropeptidase 1 (which inhibits and mb carbapenems)
Carbapenems are given with what other drug to increase their availability?
Van A Ligase
amino acid modification of bacterial cell wall from D-ala --> D-lac occurs via what enzyme?
beta-lactam antibiotics are synergistic with what antibiotics?
bacterial transferase enzymes transfer chemical groups to the antibiotic and decrease its affinity for ribosomes is a mechanism of resistance for which antibiotic?
S/E of aminoglycosides
- Milk (Ca2+)
- Antacids (Mg2+, Ca2+)
- Iron containing preparations
divalent cations decrease absorption of the drug
Tetracyclines should not be taken with what foods?
plasmid-encoded transport pump which decrease influx and increase efflux of the drug
mechanism of resistance towards tetracyclines involves:
bind to 50S and inhibit peptidyltransferase
MOA for chloramphenicol
binds at 50S and inhibit peptide transfer (translocation)
MOA for clindamycin
what antibiotic is known to function by inhibiting initiation of translation by binding to the 30S subunit?
bind to 30S and prevent attachment of aminoacyl-tRNA to the ribosome unit
MOA for tetracyclines
what antibiotics bind to the 23S rRNA of the 50S ribosomal subunit?
- Linezolid inhibits the formation of initiation complex
- Macrolides inhibit translocation (similar to clindamycin)
Linezolid vs. Macrolides - difference in function:
similar to tetracyclines, what antibiotics should not be taken with divalent-cations?
creates transmembrane channels in the cell --> IC ion leakage
MOA for Daptomycin
antibiotic that leaves a metallic taste after taking it
inhibits DNA-dep RNA polymerase
MOA for rifampin
what drug used in the Rx of Tb makes Tb less resistant to decolouration with acid-alcohol agent?
- B6 def.
S/E of INH
catalase peroxide found in mycobacteria
what converts INH into its active form?
pt. taking a drug for Tb develops colour blindness between Red and Green (optic neuropathy). What is the drug?
pt. taking a drug for Tb develops hyperuricemia. what is the drug?
binds to ergosterol in the fungal cell membrane and foes pores that allow for leakage of electrolytes
MOA for Amphoteracin B
- increased tubule permeability to K --> hypokalemia
- decrease EPO --> anemia
- decrease Mg2+
Amphoteracin B toxicity
what drug used to Rx fungal infections is also a nucleotide analog?
- nucleotide analog that inhibits DNA synthesis and causes RNA misreading
- Gets converted to 5-Fluorouracil by cytosine deaminase
MOA for Flucytosine
inhibit CYP450 --> inhibit ergosterol formation
- CYP450 is required to convert Lanosterol --> Ergosterol
MOA for Azole's used to Rx fungal infections
S/E of Azoles
inhibits squalene epoxidase
MOA for terbinafine
hepatotoxicity and taste disturbances
S/E of terbinafine
inhibit the synthesis of beta-glucan (component of fungal cell wall)
MOA for Echinocandins used to Rx fungal infections
Fungal antibiotics that stimulate CYP450
- CYP450 stimulation --> increased Warfarin mb
S/E of griseofulvin
Foscarnet and Cidofovir
antiviral therapy NOT requiring intracellular phosphorylation
- Crystal nephropathy --> renal failure
- BMS (Ganciclovir)
S/E of viral guanosine analogs
Acyclovir, Famciclovir, valacyclovirm ganciclovir
antiviral agents that are Guanosine analogs
inhibit viral DNA polymerase
MOA for guanosine analogs
pt with HIV and CD4 < 50 develops inflammatory vascular sheathing and associated hemorrhage in the eye with full-thickness retinal necrosis and edema
Rx of CMV retinitis
Rx of Herpes Zoster
Rx of Ganciclovir-resistant CMV retinitis
- inhibit viral DNA/RNA polymerase
- inhibit RT of HIV
MOA for Foscarnet
- chelates calcium --> hypocalcemia
- renal wasting of Mg2+
- nephrotoxic --> hypokalemia
S/E of foscarnet
cidofovir is given with what drug to decrease toxicity?
what protein in Influenzae virus helps with uncoating and disassembly of the virus?
inhibits M2 protein
- thus, decreases virus disassembly and uncoating
MOA of Amantidine and Rimantidine?
prevent 3' --> 5' phosphodiester bond formation
MOA of NRTI's
- Lactic Acidosis
Toxicity of NRTI's
hypersensitivity to Abacavir
mutation of HLA-B*5701 can result in what?
- Steven-Johnson Syndrome
- CI in pregnancy --> Teratogenicity
S/E of NNRTI's
S/E of protease inhibitors
Myopathy and increased CK
S/E of integrase inhibitors
Which fusion inhibitors for HIV can be used?
what interferon can be used to Rx HBV and HCV?
interferon Beta can be used for?
inhibits IMP dehydrogenase
MOA for Ribavirin
the RNA-dependant RNA polymerase of HCV requires what non-structural protein?
what drug used to Rx HCV works by inhibiting non-structural protein 5B?
what drug used to Rx HCV works by inhibiting non-structural protein 5A?
What effect do sulfonamides have on neonates?
- produces Biofilms
what bacteria is responsible for the production of an extracellular polysaccharide matrix protecting it from immune system?
fibrinogen and fibronectin that our body produces which coat the prosthetic devices
what does S. Epidermidis attach to on prosthetic devices?
Ig's against the ENVELOPE proteins (gp 120 and gp 41)
- thus, mutations in ENV gene = mutated envelope proteins --> evasion of humeral immunity
humoral response to HIV is targeted against what?
Fab binding portion
what part of the antibody determines its Idiotype?
what part of the antibody determines its isotope (IgM/D, etc.)?
- NK cells
all possess receptors for Fc regions in antibodies
cells that undergo ADCC
- Secretory IgA provides mucosal immunity
- Serum IgA prevents DISSEMINATION of antigen
whats the difference between Secretory IgA and Serum IgA?
- Live = Cell-mediated and Humoral
- Attenuated = ONLY HUMORAL
Live vs. Attenuated vaccines - what immune response is associated with each?
what MHC class is activated with Live vaccines?
Serum sickness and arthus reactions induce what type of hypersensitivity reaction?
Donor T cells recognize host MHC as foreign
- low IFN-gamma --> no giant cell formation
disseminated mycobacterial and fungal infections in childhood
Job Syndrome (Hyper-IgE Syndrome)
steve JOBs was FATED to die
- Facies are coarse
- Abscesses (from S. Aureus)
- Teeth are primary
- igE elevated
- Dermatologic problems (eczema)
Cell-mediated immunity is impaired
if a patient develops an infection after receiving a LIVE vaccine, what immune response is impaired?
- low IgA
- elevated AFP
defect in the LYST gene can result in:
NADOH oxidase def
patients cells fail to fluoresce green upon dihydrorhodamine test
Ribavirin has the same MOA as what immunosuppressive agent?
inhibits PRPP amidotransferase
MOA for 6-MP
- inhibits proteasome by binding to the 26S subunit
- Rx MM
MOA of Bortezomib and uses
- beta 2 stimulates Beta-cells in pancreas --> increase insulin
- insulin fxns to increase K uptake in cells
patient taking beta blockers has hypo/hyperkalemia?
- beta 2
what receptors increase Insulin secretion?
what receptors decrease insulin secretion?
what drugs are used as part of the pharmacological stress test?
vasodilators of normal blood vessels near effected region
- decreased perfusion to ischemic region --> worsens already-present ischema and pain
MOA of pharmacological stress test agents
sub endothelial collagen and GAG's
composition of the fibrous cap of atheromas
child has Transposition of the great vessels. What does the mom most likely have?
Down's Syndrome, Digeorge Syndrome, Maternal Alcohol abuse
child presents with Tetralogy of Fallot. what is the MC extra cardiac manifestation of this disease?
effect of narcotics on cardiac and vascular function curves?
decrease venous return
effect of spinal anesthesia on cardiac and vascular function curves?
effect of AV shunting on cardiac and vascular function curves?
clamping the hepatoduodenal ligament to control bleeding is what maneuver?
Splenic vein thrombosis
gastric varies only in the fundus are caused by what?
patient with a rigid abdomen and left shoulder pain. what sign is this?
Yellow Fever causes jaundice by affecting what zone(s) in the liver?
loss of myenteric plexus
loss of auerbach and meissner plexus
cork-screw appearance of the esophagus
Blood type A
intestinal-type gastric carcinoma is likely in patients with what blood group?
rugae thickening, increased acid production, diarrhea
rugae hypertrophy, decreased acid production, protein loss
improper counterclockwise rotation
cause of midgut malrotation
pts. cecum is located on the RUQ
crampy abdominal pain followed by hematochezia
Watershed areas in the GIT
- Splenic Flexure
- Distal Colon
what is the location for colonic ischema?
progression to advanced fibrosis/cirrhosis
pt. with non-alcoholic liver disease has AST > ALT. This indicates what?
panlobular micro vesicular steatosis
Cysteine is replaced by Tyrosine at position 282
what amino acid mutation occurs in Hemochromatosis?
Primary Sclerosing Cholangitis
"onion-skin" bile duct fibrosis
Primary Sclerosing Cholangitis
intra and extra hepatic bile ducts appear to have a beaded appearance on ERCP
Thrombin and Antithrombin
- forms a ternary complex
in order to inhibit thrombin, what does heparin have to bind to?
- primary = polycythemia vera (LOW EPO)
- secondary = because of chronic hypoxia (HIGH EPO)
primary vs. secondary erythrocytosis - differentiate
cytoplasmic tyrosine kinase
- EPO receptors dont have intrinsic kinases activity and MUST bind to Jak2 to initiate signalling
what intracellular signalling occurs in JAK2Kinase pathways?
- V617F mutation causes JAK2 activation
valine gets mutated to phenylalanine at position 617 in what disorder(s)?
binds plasminogen --> conformational change in its structure --> activates plaminogen
MOA for streptokinase
binds fibrin and activates plasminogen
MOA for Alteplase
- Aminocaproic acid
- Tranexamic Acid
patient takes thrombolytics to help with a clot and begins bleeding profusely. Rx?
- restoration of blood flow can cause ARRHYTHMIAS
S/E of thrombolytic therapy
tearing of the Medial Menisci
pain/popping/clicking of the knee with EXTERNAL rotation of the tibia (externally rotate the foot)
tearing of the Lateral Menisci
pain/popping/clicking of the knee with INTERNAL rotation of the tibia (internally rotate the foot)
pain/popping/clicking of the knee with rotation of the tibia is what test?
Tibial Collateral Ligament
- aka Medial Collateral Ligament
lateral blow to the knee can injure/damage what ligament?
Fibular Collateral Ligament
- aka Lateral Collateral Ligament
medial blow to the knee can damage/injure what ligament?
- medial knee pain (because anserine bursa is located on the medial side of the knee)
- occurs in OBESE patients
features of anserine bursitis
Supra patellar bursitis
what bursitis occurs with repetitive quadriceps use?
Supra patellar bursitis
what bursitis occurs with blows to the distal thigh?
Pre patellar bursitis
what bursitis occurs because of excessive kneeling?
- in pts. who are gardeners/housemaids
Pre patellar bursa
Housemaid's Knee is inflammation of what bursa?
- Medial Menisci
what structures are damaged in Unhappy Triad?
what menisci is more commonly damaged?
rotator cuff muscle(s) that MEDIALLY rotate(s) the arm
- teres minor
rotator cuff muscles that ADDUCT the arm
- fibroproliferative disorder of the palmar fascia
- nodules on palmar fascia creating cords in the palm that flex the fingers
- Superficial branch = sensory innervation of skin
- Deep branch = muscular innervation of extensors
branches of the Radial Nerve and their functions:
patient trying to make a fist presents with claw hand. what is this presentation called?
Pope's blessing involves damage to what nerve?
patellar reflex is elicited from what spinal root?
Achilles reflex is elicited from what spinal root?
what antibody is more specific when testing for RA?
what cells are responsible for the inflammation seen in Gout?
Degenerative joint disease
patient with back pain that is positional and is relieved by rest
- patient with back pain that radiates to the leg
- +ve straight leg test
patient with back pain that is worse with standing and gets better with FLEXING the spine (bending)
patient with back pain that is relieved with EXERCISE
patient with back pain that is constantly present and worse at night
pencil-in-cup deformity of the DIP joints in the FIRST and sometimes the SECOND digits
another name for hindbrain
newborn with macrocephaly, muscle hyperreflexia and hypertonicity
they have stretching of their periventricular pyramidal tracts
why do pts. with congenital hydrocephalus have UMN damage-like symptoms
- Meningomyelocele at LUMBAR level
chiari II malformations are associated with what other conditions?
- responsible for satiety
what area of the hypothalamus is STIMULATED by leptin?
- responsible for hunger
what area of the hypothalamus is INHIBITED by leptin?
lentiform nucleus is atrophied in what disease?
Putamen and Globus Pallidus
Lentiform nucleus is made of what structures?
Putamen and Caudate
Neostriatum is made of what structures?
patient with a re-entry current around the tricuspid valve annulus has?
Wolf-Parkinson White Syndrome
AV conduction tract bypassing the AV node is seen in?
LAD and L-Circumflex Artery
what arteries supply the ANTEROLATERAL papillary muscles?
Posterior Descending Artery
- br. of RCA (if right dominant circulation)
- br. of L-Cicrumflex Artery (if left dominant artery)
what artery supplies the POSTEROMEDIAL papillary muscle?
- jerky and purposeless movements
- low-amplitude involving DISTAL muscles
sudden, brief and uncontrolled muscle contraction
- wild flailing/ballistic movements
- high-amplitude involving PROXIMAL muscles
intracellular eosinophilic inclusions of ALPHA-SYNUCLEIN
- GABA + ACh = LOW
- DA = HIGH
what are the NT levels in Huntington's Dz?
Alexia without agraphia
damaging the splenium of the corpus callosum can cause?
between Posterior communicating and posterior cerebral artery
in the circle of willis, CN3 passes between what arteries?
what gene is mutated in Friedrich's Ataxia?
- encodes for a protein that helps with mitochondrial iron regulation
- mutation causes excessive iron build up
function of the Frataxin gene
3, 4, 6
- MC 3
DM can affect what CN's?
External is affected by ischemia
- therefore DM can cause External Ophthalmoplegia
Internal is affected by compression
External vs. Internal Ophthalmoplegia
- which is affected by ischemia and which by compression?
Grey/White pearly lesion behind the tympanic membrane
desquamated keratin debris
what accumulates in the middle ear in patients with Cholesteatomas?
what HLA is associated with MS?
axonal transmission is reduced in heated environments
why do pts. with MS have fatigue after hot showers?
Ig's against ganglioside in myelin
what do antibodies react with in Guillan-Barre Syndrome?
Hereditary Motor and Sensory Neuropathy
another name for Charcot-Marie Tooth Disease
buildup of galactocerebroside and psychosine in macrophages
JC virus causing PML
progressive neurological findings in immunocompromised patients or patients taking immunosuppressive therapy
Rituximab and Natalizumab
what immunosuppressive agents can lead to PML?
DOC for partial seizures
DOC in pts. with absence and myoclonic seizures
DOC in pts. with Bipolar Dz and seizures
which type of headache may present with Horner Syndrome?
- Acute = Sumatriptan, 100% O2
- Prophylaxis = Verapamil
Rx of cluster headaches:
tumor of the brain with cholesterol cysts in "machine oil"-like fluid
lithium is similar to what element?
- inhibits Gq
- inhibits Gs
- inhibits Gi
What is lithium's effects on G-protein receptors?
- TSH acts via Gs receptors (which are inhibited by Li)
- Li also inhibits 5-deiodinase
Lithium's effects on Thyroid gland:
Nephrogenic Diabetes Insipidus
- ADH acts on V2 receptors via Gs (which are inhibited by Li)
Lithium's effects on the Kidney:
K-channel blockers (MC amiloride)
- Lithium is similar to Na+ and thus, we can increase its clearance via a Diuretic
- Because Li2+ acts on the collecting ducts and inhibits ADH's V2 receptors, we can use diuretics which act on the collecting ducts
Rx of Nephrogenic Diabetes Insipidus caused by Lithium
- Li is similar to Na thus, it can enter cells and depolarize them
thus, it can result in seizures
Lithium's effects on the brain:
DA causes you to cool off
- DA antagonists = Hyperthermia
DA's effect on the temperature control?
- DA ant. effects
- INSOMNIA = selegiline is mb to amphetamines
S/E of Selegiline
which ATYPICAL antipsychotic can cause seizures?
- thus they require a basic environment to be absorbed
are local anesthetics weak acids or bases?
- therefore NO MIOSIS, tachycardia, no GI/GU spasms
Meperidine has features of opioids and what other class of drugs?
opioid that does NOT cause miosis
Rx of opioid-induced constipation
only inhaled anesthetic that does NOT cause respiratory depression:
skeletal muscle relaxant that is structurally similar to TCAs and has similar anticholinergic S/E
Rx of Neonatal Abstinence Syndrome
antidiarrheal opioid related to meperidine
- given with Atropine
- helps prevent abuse because alone, Atropine can cause several S/E that may make pts. decline it.
Diphenoxylate is given with what other drug? Why?
- weak opioid
- Serotonin Syndrome
What is Tramadol and what are its S/E?
- Tetrabenazine + Reserpine
Rx of Huntington's Dz
inhibition of Vesicular MonoAmine Transporter (VMAT)
- decrease DA packing and release
MOA for Reserpine and Tetrabenazine in Rx Huntington's Dz
what cells are involved in type 2 hypersensitivity reactions?
Damage to Meyers Loop
what visual field defects will be seen in pts. with Temporal Lobe masses/damages?
at the Inguinal Crease
what is the most optimal site for a femoral nerve block?
Pudendal Nerve block
the ischial spine tip is a landmark for what nerve block?
Any conditions that cause enlargement of the RA (and also the RV)
what conditions can cause the Coronary Sinus to dilate?
Rx of Restless Leg Syndrome
Pts. may have Iron-def.
What vitamin/mineral can be deficient in pts. with Restless Leg Syndrome?
Rx cataplexy in Narcoleptic pts.
Drug Rx psoriasis that targets IL-12 and IL-23
Drug Rx psoriasis that works by activating a nuclear transcription factor
binds and activates the Vit. D receptor
MOA of Calcipotriene
- hilar LN calcification = eggshell calcification
- calcification of hilar lymph nodes
- birefringent particles surrounded by fibrous tissue
- CRH = Low
- ACTH = Low
- Cortisol = Cannot increase during stressful situations (low)
patients with chronic glucocorticoid use will have what hormonal levels?
transcription factor that increases cytokine production
Function of NF-KB
it has a long half-life
Why is methadone helpful in treating opioid addiction?
injure the prostatic plexus (cavernous nerve br. which innervate the corpora cavernosa and allow erection)
- thus pt. can have Erectile Dysfunction
prostatectomy can injure which nerves? and what can it cause?
Everything in the kindly from Glomerulus --> DCT
what renal structures are formed by the metanephric mesoderm?
- Ureteric bud stimulates differentiation of metanephric mesoderm
- Everything from Collecting ducts --> Ureters
what renal structures are formed by the Ureteric bud (which derives from the mesonephric duct)
most common site of obstruction in fetal kidney:
it's the last place to canalize
why is the ureteropelvic junction the MC place for an obstruction in the fetal kidney?
Chromosomal anomalies associated with Horseshoe kidneys:
defective development of the ureteric bud
- ureteric bud also stimulates differentiation of the metanephric mesoderm
patient with unilateral renal agenesis has a defect in what?
Unilateral renal agenesis
failure of ureteric bud to develop leads to what renal anomaly?
Multi cystic dysplastic kidney
- cysts and CT components in 1 kideny
ureteric bud is present; failure of the ureteric bud to stimulate the differentiation of the metanephric mesoderm:
Duplex Collecting System
patient has Y-shaped bifid ureters. Dx?
1 of 2 possibilities:
a) Ureteric bud splits into 2 before entering the metanephric blastema
b) 2 ureteric buds enter 1 metanephric blastema
What is the defect in Duplex Collecting System?
Posterior urethral valves
- develop from Wolffian Duct
bilateral hydronephrosis occurs because of:
blood supply of the proximal ureters:
anastomoses between Common/Internal Iliac and Superior Vesicle Arteries
blood supply of the distal ureters:
how is glucose reabsorbed at the PCT?
what sites does PTH act on in the kidney?
inhibit Na/PO4 cotransport --> increase PO4 excretion
Functions of PTH at the PCT:
increase Ca reabsorption
Functions of PTH at the DCT:
dilate the afferent arterioles and constrict the efferent arterioles --> Natriuresis
MOA for ANP/BNP:
which type or casts in urine exhibit the Maltese-cross sign?
- because we're losing HCO3- , our body retains Cl- (hyperchloremia)
what is the anion gap in renal tubular acidosis?
- Acute interstitial nephritis
- Acute Pyelonephritis
- Transplant rejection
WBC casts are seen in what conditions:
patient presents with signs of embolism and elevated serum creatinine AFTER undergoing a operative procedure
Needle-shaped clefts obstructing arcuate/intralobular renal arteries
what will be seen in the microscopic evaluation of Postoperative Atheroembolism?
Glomerular source of bleed
RBC casts and acanthocytes indicate that bleeding is where?
HBV and HCV
what diseases are associated with Membranoproliferazive GN Type 1?
Ig against C3 nephritic factor (stabilizes C3)
what Ig's are associated with Membranoproliferazive GN Type 2?
Good pasture Syndrome
Ig's against alpha-3 chain of collagen 4 is seen in what condition?
Rx of Urge Incontinence
- ascending UTI's
- hematogenous spread of bacteria
Causes of Acute Pyelonephritis:
Pt. has the following:
- corticomedullary scarring
- blunted calyces
- Thyroid = Hypothyroidism
- Testes = Decrease T2 production
- Blood = decreases platelet function
- Lungs = ARDS
effect of uremia on various organs:
what gene is responsible for patterning along the anteroposterior axis and CNS development?
- Wnt-7 gene
- FGF gene
what genes are produced at the apical ectodermal ridge?
Homeobox gene (Hox)
what gene organizes the embryo in a cranial to caudal direction?
what vitamin alters the expression of the Hox gene?
synpolydactyly is caused by a mutation in what gene?
Nicotine/CO in CIGARETTE SMOKE
if a neonate dies from SIDS, what substance were they most likely exposed to?
what is the placenta of fraternal twins?
what is the MC placenta of maternal twins?
monochorionic monoamnionic (very rare)
what is the placenta of conjoined twins?
- urine is leaking from the umbilicus
straw-coloured discharge from the umbilicus
- the distal portion of the urachus remains open; the proximal part is obliterated
periumbilical tenderness and purulent discharge from the umbilicus
suspensory ligament of the ovary
- infundibulopelvic ligament
ovarian vessels are contained within what ligament?
Common/External/Internal Iliac Arteries
the ureters pass anterior to what vessels?
- Round ligament of the uterus
- ovarian ligament
what is the derivative of the gubernaculum in females?
what structures are contained within the cardinal ligament?
what type of estrogen indicates a healthy fetus?
- desmin = intermediate filament in muscle cells
- myogenic = nuclear transcription factor in IMMATURE skeletal muscle
how to stain for rhabdomyoblasts:
Hydronephrosis --> Renal Failure
- tumor escapes via anterior wall and compresses the bladder
Common cause of death in patients with Cervical Carcinoma
Ig's against HPV 6 and 11 prevent from the formation of what?
CIN and Carcinomas
Ig's against HPV's 16 and 18 prevent from the formation of what?
1) Hyperplastic = from preexisting endometrial hyperplasia
2) Sporadic = via p53 mutations
Endometrial carcinomas occur via what 2 pathways?
Endometrioid --> resembles normal endometrial tissue
what histology is seen in the hyperplastic endometrial carcinomas?
Serous --> formation of papillary structures that can calcify (psammoma bodies)
what histology is seen in the sporadic endometrial carcinomas?
mobile and marble-like mass in the breast
Medullary Carcinoma of the breast
- subtype of Ductal Carcinoma
soft and fleshy mass in the breast
rock-hard breast mass
sudden testicular pain and absent cremasteric reflex
- Embryonal Carcinoma
- Yolk Sac Tumor
which testicular tutors may have elevated AFP?
- Embryonal Carcinoma
which testicular tumors may have elevated b-hCG?
testes fail to attach to inner lining of scrotum
- because of failure of process vaginalis
what is the cause of testicular torsion?
eosinophilic cytoplasmic inclusions within cells in the TESTES
Leydig Cell Tumor
Reinke Crystals are seen in what condition?
granulosa cells arranged around an eosinophilic fluid
Granulosa-Theca Cell Tumor
Call-Exner bodies are seen in what conditions?
placental Alkaline Phosphatase is elevated in what testicular tumor?
corpora amylacea can be found in what gland?
corpora arenacea can be found in what gland?
PSA > 10
PSA level greater than what is worrisome for any age?
prevents feedback inhibition of FSH and LH --> excessive oocyte growth and ovulation
MOA for clomiphene
- decreases LDL
- NO CHANGE on HDL
effects of Tamoxifen on LDL and HDL
- partial androgen agonist
MOA of Danazol
- binds to androgen receptors and inhibits them
what anti-androgen drug works by impairing the androgen-receptor interaction?
- cholesterol desmolase
- 17-alpha hydroxylase
what enzymes does Spironolactone inhibit?
what enzyme does Ketoconazole inhibit?
- Ketoconazole = inhibits synthesis
- Spironolactone = inhibits binding
ketoconazole vs. spironolactone - which inhibits steroid SYNTHESIS and which inhibits steroid BINDING?
the Her2/neu oncogene targets what GF receptor?
- androgenic effects of virilization
- LOW HDL
S/E of Danazol
- increased Ht
- HIGH LDL
- LOW HDL
androgen abuse effects on the heart
Androgen abuse effects on mental health
upto the end of terminal bronchioles; sparse beyond this point
Airway SM cells extend unto what region in the respiratory tract?
- we lose elasticity
what happens to compliance of lungs as we age?
inspiratory stridor WORSE when supine and gets better when upright
because of destruction of the alveolar walls
why do pts. with Emphysema have a DECREASED diffusion capacity for CO?
pts. with recent infections now presenting with airway obstruction
chronic necrotizing infection of the bronchi
- perfusion is affected by embolisms, not ventilation and the loop measures ventilation
what would happen to the flow-volume loop of the lungs if a patient has a thromboembolism?
Restrictive Lung Dz's
alveolar spaces are collapsed and formation of cystic spaces occurs:
Type 2 pneumocytes
the cystic spaces in restrictive lung Dz are lined by what cells?
- cells with long and slender microvilli
- abundant tonofilaments
nodular/smooth pleural thickening
- birefringent particles surrounded by fibrous tissue (collagen)
- calcification of the hilar LN
- release of toxins from neutrophils
- activation of coag. cascade
cause of damage to the alveolar capillaries in ARDS
- BMPR2 normally inhibits SM proliferation
is the BMPR2 mutation in Pulm. HTN an activating or inactivating mutation?
- air trapped in lung diffuses into blood
- thus, theres a decrease in lung volume because of ALVEOLAR COLLAPSE
why does the trachea deviate to the SAME side in bronchial obstruction/atelectasis
rupture of sub pleural blebs
cause of primary spontaneous pneumothorax
- diseased lung
- mechanical ventilation
cause of secondary spontaneous pneumothorax
focal necrosis of alveolar walls and intra-alveolar hemorrhage
which type of lung cancer is associated with Clubbing (hypertrophic osteoarthropathy)
Large Cell Carcinoma
what type of lung cancer is associated with Gynecomastia and Galactorrhea?
Large Cell Carcinoma
what type of lung cancer can secrete b-hCG?
what oncogene is mutated in Small Cell Carcinoma of the lung?
what genes are upregulated in adenocarcinoma?
it antagonizes NMDA receptors
how does dextromethorphan function as an antitussive?
phosphorylates serine residues which inhibit tyrosine phosphorylation of the insulin receptor --> DECREASED insulin signalling
Effects of TNF-alpha on insulin
Rx of severe hypoglycemia in medical setting
Rx of severe hypoglycemia in non-medical setting
how do you Rx HIV-associated lipodystrophy?
- because of decreased PRL elimination
will a pt. with Renal Failure have increased or decreased PRL?
- thus ADH can increase ACTH
Effect of ADH on CRH
what nucleus in the hypothalamus is ADH synthesized?
glucocorticoids decrease the levels of what cytokine?
what cytokine is elevated in patients with Giant Cell Arteritis?
CN 11 will be damaged in what triangle?
Trauma to the neck above the cricoid cartilage can damage what nerve?
External br. of Superior Laryngeal Nerve
ligation of the superior thyroid artery can lesion what nerve?
Cold agglutinins cause RBC's to aggregate
why will patients with a mycoplasma pneumonia infection develop anemia?
Cold agglutinins disappear
Why does Rx of Mycoplasma pneumonia resolve the anemia?
what is the major virulence factor for Strep Pyogenes?
- activates complement
- inhibits phagocytosis
Function of M Protein in Strep Pyogenes?
- Produces IGF-2 and receptors for IGF-2
- inhibits p53
how does HBx protein form HBV activate cell proliferation?
- anticonvulsants that stimulate CYP450
- Aromatase inhibitors
- Unfractionated Heparin
what medications can result in osteoporosis?
Heterotropy aka Ectopy
presence of normal tissue in an abnormal location
(pancreas found in the ileum)
because in that time, more MAO is being synthesized
why do we wait for 2 weeks after switching between antidepressants before seeing the effects?
competitively binds to Hb
how does CO impair Hb function?
NADH Methemoglobin reductase
what enzyme is def. in pts. with CONGENITAL Methomoglobinemia?
reduces the Ferric to Ferrous iron
function of NADH methemoglobin reductase?
- Cystic Hygroma
- lobulated and compressible tumor of the neck that transilluminates
- consisted of dilated lymphatic spaces
- because pts. with depression and prior history of MANIA will be Dx with bipolar Dz
it is important to obtain history for what medical condition prior to beginning Rx with antidepressants?
thick-walled spherules packed with endospores
ABPA from Aspergillus
pt. with H/O of Asthma/CF now presenting with Eosinophilia and bronchiectasis
whats the embryologic origin of the thymus?
whats the embryological origin of the ultimobranchial body?
abduction of the thigh
function of the superior gluteal nerve
Inferior gluteal nerve
what nerve exits the greater sciatic foramen BELOW the piriformis muscle?
Superior gluteal nerve
what nerve exits the greater sciatic foramen ABOVE the piriformis muscle?
- Lactic Acid
factors responsible for auto regulation of coronary blood flow
baroreceptors cause an increased Vagal influence on the heart --> decreased AV node conduction velocity
what is responsible for the reflex bradycardia when you give a pt. alpha-agonists?
Saphenous Nerve (br. of Femoral)
pt. with loss of sensation on the medial aspect of the leg has what nerve damage?
modification of the ribosomal subunits
resistance to aminoglycosides is achieved via:
nucleotide mismatches that escape repair
what is responsible for the development of colorectal cancer in Lynch Syndrome?
produce TRANSCRIPTION FACTORS
function of the Homeobox gene:
- decrease standard deviation
- increase statistical power (1 - beta value)
how do you increase the precision (aka reliability) of a test?
- negatively charged DNA coils around the positively charged Histones
are histones positively charged or negatively?
- 1 strand is added to each parent strand
How does DNA replication in prokaryotes in eukaryotes occur?
Semi-conservative DNA replication
DNA replication in which two copies that each contain one of the original strands and one new strand
Conservative DNA replication
DNA replication in which replication would leave the two original template DNA strands together in a double helix and would produce a copy composed of two new strands containing all of the new DNA base pairs
fibrous plaque of the tunica albuginea
what chemical is responsible for transmigration of WBC's?
- MHC 1 binding to antigen
- IL-2 from Th1 cells
what are the 2 activation signals for CD8 cells
- generation of regulatory T cells
how does central tolerance occur in the thymus?
- receptor editing
- B cell apoptosis
how does central tolerance occur in the bone marrow?
what phospholipid antibody is responsible for the falsely elevated PTT in SLE pts?
what phospholipid antibody is responsible for the false-negative VDRL screening test?
Perivascular collagen deposition initially
where does collagen deposition INITIALLY occur in pts. with Scleroderma?
in the mucosal crypts
stem cells in the bowel are located where?
components of granulation tissue include:
Propyl and Lysyl hydroxylase
what enzyme is necessary for the CROSS-LINKING of collagen?
what enzyme is necessary to form STABLE collagen?
what collagen is abundant in keloids?
Potassium exchange resins
- excrete Potassium from the body by exchanging it with Sodium
MOA of Sodium Polystyrene Sulfonate
supplying a thiol group to inactivate toxic metabolites is a function of what chemotherapeutic antidote?
PG analogs (Latanoprost)
Glaucoma medications that work by increasing outflow of aqueous humour
- Carbonic Anhydrase Inhibitors
- Beta blockers
- alpha 2 agonists
Glaucoma medications that work by decreasing aqueous humour inflow
- stimulates GLUT-4
What intracellular signalling cascade is stimulated by insulin to increase glycogen synthesis?
what cytokine is the most important mediator for sepsis?
what cytokine recruits WBC's and activates phagocytosis?
1) behavioural therapy
2) short acting benzo
Rx of specific phobias:
- the renal failure and anemia may not be present in every patient
what symptom is essential in Dx TTP?
what organ in the GIT is not a derivative of the foregut yet is supplied by an artery of the foregut?
- Repaglinide and Nateglinide
drugs used to rx DM with the same MOA as Sulfonylureas
Drug used to Rx DM that targets intracellular mitochondrial enzymes
Drug used to Rx DM that targets intracellular nuclear receptors
Meglitinides and Sulfonylureas
Drug used to Rx DM that targets membrane ion channels
Drug used to Rx DM that targets surface adenylate cyclase-coupled receptors
alpha glucosidase inhibitors
Drug used to Rx DM that targets surface membrane-bound enzymes
Drug used to Rx DM that targets surface tyrosine kinase receptors
p < 0.05
what happens to the p-value when 95% of the confidence interval does not include 0?
T cells target viral antigens on the cell surface --> hepatocyte damage
what is the mechanism of liver injury in pts. with Hepatitis?
what microbe grows on VCN agar?
what microbe grows on Thayer-Martin medium?
Rx of detrusor instability
problems involving CERVICAL spine
- sublaxation of the atlantoaxial joint
what vertebral deficits can be seen in pts. with RA?
what tumor suppressor gene is involved in urogenital differentiation?
what tumor suppressor gene is involved in Ubiquitin ligase component?
- Bacteroides are anaerobes that produce beta lactamase
Rx of Bacteroides
- Papilledema (because of pseudotumor cerebri)
Vit. A excess S+S:
Colon cancers on which side tend to bleed?
Colon Cancers on which side cause obstructions?
prevents mucopeptide transfer into growing cell wall
- inhibits bacterial cell wall synthesis
MOA for Bacitracin
unravels helical strands of DNA and breaks its strands
MOA for Metronidazole
pt. with RESPIRATORY or GI infection a few weeks ago now presenting with ascending paralysis
BRCA 1 mutation is on what chromosome?
BRCA 2 mutation is on what chromosome?
Retinoblastoma mutation is on what chromosome?
what vitamin is an essential component of CoA?
what vitamin helps with Iron absorption by converting it to Ferrous iron?
Antimycin A inhibits what complex in ETC?
CCL3- free radicals damage what organelle?
Internal Laryngeal Nerve
if you damage the piriform recess, what nerve can be injured?
Bood cultures and MRI of the spine
what diagnostic tests do you perform on pts. with Osteomyelitis?
Negative Methacholine challenge
what is the most important feature to EXCLUDE the diagnosis of asthma?
What organisms invade Schwann Cells?
what happens to RPF in the first 12 hours after a downstream obstruction?
- Down's Syndrome
- DiGeorge Syndrome
- Maternal alcohol abuse
Tetralogy of Fallot is associated with what other conditions?
- No tissue edema or induration is seen in pts. with contact dermatitis
True or False:
Contact Dermatitis is not associated with Edema
GF's normally target what gene in melanocytes?
Acute = Benzo's
Long-term (most appropriate) = SSRI's
Rx of panic disorder:
Fatty acid synthesis
what metabolic pathway is the citrate shuttle a part of?
what metabolic pathway is the carnitine shuttle a part of?
what ketone body can be detected in urine?
- allows it to come into contact with Chylomicrons and VLDL and break them down
what is LPL bound to in the vascular endothelium?
Heparin causes the dissociation of LPL from endothelium and increases its concentration in blood.
why does Heparin administration decrease plasma Triglyceride levels?
on the plasmid/bacteriophage
where are the genes for Exotoxins located?
on the bacterial chromosomes
where are the genes for endotoxin located?
enzyme that cleaves products in the ECM and allows the spread of infections
MOA of Hyaluronidase
- Group A Strep
- C. Diff
What microbes have hyaluronidase?
- Sickle Cell Disease pts
- Splenic pts
which patients will undergo Sepsis caused by S. Pneumo?
encapsulated bacterial species
Quelling's Rxn positive
Exotoxins of C. Diff affect what signal transduction proteins?
Dapsone and Rifampin
Rx of Tuberculoid form of Leprosy
Clofazimine is added to regimen
Rx of Leprotamous form of Leprosy
inhibits complement deposition on host cells
function of H-Factor of Haemophillus
produces ROS and cause cell damage
action of pyocyanin produced by Pseudomonas
what cell cycle regulator is amplified in Melanomas?
what cell cycle regulator is translocated in Mantle Cell Lymphomas?
IgG against platelet antigens (Gp2b3a)
what are the Ig's directed against in ITP?
- the spleen is responsible for the IgG which attacks platelet antigens
- Ig's bind platelet --> consumed by macrophages in the spleen
the Ig's produced in ITP are produced by what organ?
- vWF deficiency
- Bernard Soulier Syndrome
ristocetin agglutination test is negative in what 2 conditions?
Ristopetin causes vWF on endothelium to bind to Gp1b receptor on platelets
- if either of these is deficient, the platelets will not adhere to the sub-endothelial collagen
why is ristocetin agglutination test negative in Bernard Soulier?
Coagulation Factor Inhibitor
- Ig against factor 8 (MC is against factor 8)
patient with an elevated PTT that does NOT correct when normal plasma is added
it stimulates vWF release from WP bodies
why is Desmopressin used to Rx vWF disease?
its an ADH analog
MOA for DDADP in Rx vWF disease
increases blood volume --> dilutes sodium --> hyponatremia --> SEIZURES!!!
S/E of DDADP use in Rx vWF disease
- destroys Fibrin and Fibrinogen
- destroys coag factors
- blocks platelet aggregation
functions of Plasmin:
- increased PT/PTT
- increased Bleeding time, NORMAL platelet count
- low fibrinogen and fibrin
Lab values after Plasmin use:
alpha 2 antiplasmin
what enzyme inactivates plasmin?
which loop diuretic is more ototoxic?
- seen in UMN palsy
pt. with initial resistance to movement followed by sudden release of tension
- can be at any location (brainstem, internal capsule, spinal cord, motor cortex)
clasp-knife spasticity indicates damage to what structure:
if we damage the INTERNAL globus pallidus, will the pt. experience more or less movement?
if we damage the EXTERNAL globus pallidus, will the pt. experience more or less movement?
pt. with painful genital ulcers that have ragged borders, grey exudate and inguinal lymphadenopathy
- Low mesenteric fat
- recent weight loss
- prolonged bed rest
narrowing of the aortomesenteric angle (angle between the aorta and the superior mesenteric artery) can occur through what circumstances?
pt. presenting with an MI, low BP and HR is given a medication that helps relieve his symptoms and he also develops Glaucoma. What drug was given?
absent P waves
what ECG changes occur in pts. with A. Fib?
if the EKG shows high QRS voltage in the precordial leads, what does this tell us about the heart?
what should you inquire about in medical history of a pt. presenting with Candida Oral Thrush?
- pt. is at risk for Liver Cancer
G --> T mutation in the p53 gene is caused by?
at the lateral border
in relation to the femoral artery, where is the inguinal crease located?
anti fungal that targets the cell WALL
where in the kidney is majority of PAH secreted?
within the Bowman's Space
where in the kidney is the LEAST concentration of PAH?
- Sigmoid colon is affected in 75% of cases
what area of the colon is ALWAYS affected by Hirschsprung Dz?
cells with bilobed/multiple nuclei and prominent/inclusion-li