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what is the defect in osteogenesis imperfecta
type 1 collage
what findings will you see in osteogenesis imperfecta
can be mistaken for child abuse
multiple fractures
may have teeth issue
blue sclera due to exposure of chorodial veins
hearing loss
genetics with osteogenesis imperfecta
AD
COLA1A1 and COL1A2
what is celecoxib
selective cox 2 inhibitor, has anti-inflammation without impaired platelet function becuase the platelets express cox 1
how does adapative immunity prevent us from getting influenza
anti- hemagglutin
what does hemagglutin do
promote influenza viral injury
what does neuramindase do
promote progeny virion release
what is akathisia
extrapyramidal symptom of antipsychotic that present with inability to sit or stand sill in one position
what is in the cavernous sinus
CN III, IV, V1, V2, V1
what is germinal martrix hemorrhage
happen when baby born young, present with altered level of consciousness, hypotonia, bulging anterior frontanelle with a lot of bleeding
how does phase 4 depolarizarion in cardiac pacemaker work
closure of repolarizing K channel, slow influx of Na through funny channel, opening of T type Ca channel
what is the action of timolol
non selective beta blocker
effect of timolol on the eye
antagonize beta 2 receptor on ciliary epithelium which decrease aqueous humor
how do beta blocker help with hyperthyroidism
hyperthyroidism cause an upregulation of beta adrenergic receptor, hence we wanna block that
beta blocker also block the conversion of T4 to T3
Medulloblastoma- who is it seen most in and what are the histology
seen in kids
really malignant, affect cerebellum
histology show small blue cell
warfrin can cause what skin effect
skin necrosis via the thrombotic occlusion in the microvassculature
Neutrophils have...
name 2 things
myeloperoxidase and beta glucuronidase
neutrophil chemotactic agents are
C5a
IL5
LTB4
kallikrein
platelet activating factor
what can happen after chronic use of antipsychotic
tardive dyskinesia
involuntary movement after chronic use, lip smacking
what is important to regenerate in the anaerobic cycle, what does this do
we need to regenerate NAD+do we have convert glyceraldehyde 3 phos to 1,3 BPG
How do we regenerate NAD+
lactate dehydrogenase converting pyruvate to lactate
what is treacher collins pathology
issue with the first and 2nd arch
what are the mediators for fever
IL1, IL6, TNF, prostaglandin
what is seen with a diagnositic test for nontreponemal syphillus
antibody to cardiolipin-cholesterol lechtin antigen
what will be seen on midgut malrotation
formation of Ladd bands
6th week herniate through umbilical ring
10th week return to abdominal cavity and rotate around SMA
what does a mitral regurg sound like?
holosystolic blowing murmur
loudest at apex and radiates to the axilla
what does tricuspid regurg sound like
holosystolic murmur
radiates to the right sternal boarder
left dominant circulation of the heart
posterior descending/ interventricular artery arise from the left circumflex coronary artery
right dominant circulation
posterior descending/ interventricular artery arise from right coronary artery
what are the strep virdins bacteria
streptococcus mitis
streptococcus mutans
where are the baroreceptors
in the aortic arch and carotid sinus
what does the baroreceptor in the aortic arch respond to
increase in blood pressure, transmit info via vagus nerve to solitary nucleus
what does the baroreceptor in the carotid sinus respond to
increase and decrease in BP, transmit info via glossopharyngeal nerve to the solitary nucleus
what happen to barorecpetor in low blood pressure
decrease in atrial pressure -> decrease stretch-> decrease afferent baroreceptor firing -> increase in efferent sympathetic firing (via alpha 1` vasoconstrictrion and beta 1 contractility) and decrease efferent parasympathetic (via vagus nerve) stimulation -> vasoconstriction, increase in HR, increase in BP, increase in contractility
cohort study
look at person with an exposure and see if they get disease
LOOK AT EXPOSURE
case control study
compare people with and without disease and see if they have certain exposure
LOOK AT DISEASE
type 1 error
p value, significance levels
stating that there is an effect or difference when none exist
null hypothesis incorrectly rejected in favor of alternative hypothesis
type 2 error
statistical power is 1-beta
beta is the probability of making a type II error
stating that there is not an effect or different when one exist; null hypothesis is not rejected when it is in fact false
how do you decrease beta error
increase sample size
increase expected effect size
increase in precision of measurement
what is affected in wenicke

speech fluidity? comprehension? repetition?
speech fluidity- fluent
comprehension- impaired
repetition- impaired

the area affected in the superior temporal gyrus of temporal lobe
what is affected in conduction aphasia?

speech fluidity?
comprehension?
repetition?
speech fluidity- fluent
comprehension- intact
repetition- impaired

due to damage arcuate fasciculus
what is I cell disease
inherited lysosomal storage disease, issue with the signaling of proteins to the lysosomes. instead they secreted extracellulary.

defect in N acetlyglucosaminyl-1 phoaphotransferase
what is the presentation of I cell disease
high plasma level of lysosomal enzymes
coarse facial features
restricted joint movement
clouded corneas
what is the antibody associated with pemphigus vulgaris
IgG antibody against demoglobin
what is the antibody associated with bullous pemphigoid
IgG antibody against hemidesmosomes
what is the presentation of pemphigus vulgaris
type of blister
involve oral mucosa
immunofluorescence
nikolsky sign
flaccid blisters
involve the oral muscoa
immunofluorescence is net like/ reticular pattern
positive nikolsky sign- seperation of epidermis upon manual stroking of skin
what is the presentation of bullous pemphigoid
type of blister
involve oral mucosa
immunofluorescence
nikolsky sign
tense blister
does not involve the oral mucosa
immunofluorescence is linear pattern at epidermal- dermal junction
niklosky sign is negative- no seperation of epidermis upon manual stroking of skin
antibody for RA
IgM antibody against Fc portion of IgG
MORE specific- anti-cyclic cirtullinated peptide antibody
what innervate the Inferior pharyngeal constrictor muscle
vagus nerve (superior laryngeal branch)
what muscle does CN 9 innervate (glossopharyngeal nerve)? What does this do?
stylopharyngeus
elevation of pharynx and larynx
what happens to amcetaminophin when we take too much of it?
create toxic NAPQI and deplete glutathione
why is glutathione important?
it allows for the conversion of reactive oxygen specific to water so less damage is done to issue
Glutathione needs to be in its reduced state to do this, once oxidized it will be reduced with NADPH
what is the presentation of acute intermittant porphyria?
painful abdomen
port wine colored urine
polyneuropathy
worse with p450 inducers, alcohol, and starvation
psychological issues
how do you treat acute intermittant porphyria
glucose and heme (inhibits aminolevulionic acid dehydrogenase)
what mutation can cause sideroblastic anemia? mode of transmission?
aminolevulinic acid synthase
x linked
what is that pathway for ubiquination
ubiquinated proteins get degraded via proteasome
what happens when we treat salmonella
prolong duration of bug in poop
what happens when we treat shigella
lessen duration of bug in poop
what type of response for live attenuated vaccine give
induce cellular (T cell) and humoral response (B cell)
what type of response for inactivated/ killed vaccine
humeral response (mostly B cell)
what are the toxoid vaccine
C. diptheriae toxoid
C. tetani toxoid
B. pertussis toxoid
how are very long fatty acid chains broken down
via peroxisome
what is the point of pulmonary surfactance
decrease alveolar surface tension- which prevents alveolar collapse
decrease lung recoil
increase compliance
what is slipped strand misreading
there are repeated sequences of a certain nucleotide and the copies of homologous chromosome bind out of registry and then cause excision of part of the DNA and future alternation of the protein.
this would shorten the protein and cause a frame shift mutation
what is underdeveloped in digeorges
3rd and 4th brachial pouch
what is mosaicisim
presence of genetically distinct cell lines in the same person
what causes a transesophageal hernia aka hiatal hernia
the fundus of the stomach protruding out of the diaphragm
what is the function of glucokinase
convert glucose to glucose 6 phosphate in the liver and beta pancreatic cell
what is the function of hexokinase
convert glucose to glucose 6 phosphate in most tissue minus the liver and beta pancreatic cell
what gene mutation is asssociated with maturity-onset diabetes of the young
glucokinase
what is michaelis menten constant
concentration of s substrate that is found when the reaction has reached half its maximum velocity
what is on the first pharyngeal arch
maxillary process-> maxilla and zygomatic bone

mandibular process -> meckel cartilage -> mandible, malleus and incus, sphenomandiular ligament

can also result in periauricular skin tags
what is the function of IkB on NF-kBb
releases NF-kB after undergoing phosphorylation
what happens if the posterior communicating artery is damaged
contralateral hemianopia with macular sparing
what can an aneurysm of the posterior communicating artery result in
occulomotor nerve palsy
what is complex seizures
impaired consciousness
symptoms are dependent on where the anatomical location of the seizure is
simple partial seizures
consciousness is spared
symptoms are dependent on the anatomical location of the seizure
myoclonic seizures
patients present with quick and repeitive jerks
tonic clonic
usually begins in tonic phase where there is a contraction of all muscles, the clonic phase is then followed and results in rhythmis jerking of the bilateral extremities
what is the difference between avoidant and schizoid personality disorder
avoidant- desires relationship with others

schizoid- content with social isolation
what can smoking do to stomach acid
increase stomach acid and decrease the amount of mucus made. bad if you want to reduce ulcers
what is an adverse effect to inhaled anesthetics and succinylcholine
malignant hyerperthermia
induced fever with severe muscle contractions
mutation in voltage sensitive ryanodine receptor cause increase Ca release from sacroplasmic reticulum, casing increase ATP and heat
antisocial
disregard for and violation of rights of others, criminality, impulsivity
before the age of 18 this is called conduct disorder
lentigo maligna
mole that is assymetrical, differ in color, change in time

proliferation at epidermonal and dermal junction, good prognosis
what are the types of melanoma
superficial spreading
nodular
lentigo maligna
acral lentiginous
seborrheic keratosis
flat, greasy, pigmented squamous epithelial proliferation with keratin filled cyst
what is leser trelat sign
a sudden appearance of seborrheic keratosis, indicate a malignancy
what is the pathology associated with sarcoidosis
widespread noncaseating granulomas and elevated CD4/CD8 ratio
what hematological issue can happen with lupus
cytopenias
what are rouleaux formations and what are their significance
high ESR and multiple myeloma
what are the functions of oxytocin
stimulate labor
uterine contractions
milk let down
controls uterine hemorrhage
western blot
can look at protein
southern blod
look at DNA
northern blot
look at RNA
southwestern blot
look at DNA binding proteins
what type of pain is seen with diabetic neuropathy
burning
what is a common site of fetal hydronephrosis that is obstructive
ureteropelvic junction
what is the function of C3b
Opsonization
inactivated influenza vaccine will do what
neutralizing antibodies against hemagglutinin antigen, which prevent virus from entering the cell
what are the functions of setroli cell
create anti-mullerian hormone which results in inovulation of parameonephric duct
also provides nutrients for spermatogenesis
what is the functoin of leydig cell
creates testosterone (which can be used to convert the wolffian duct to male internal genitalia
Also creates DHT via 5a reductase to allow for male external genitalia
what can coxiella burnetii cause
Q fever
high suspected if person works on farm
will have pneumonia and hepatitis
no rash
what will be seen on gross anatomy of primary TB
Gohn complex
affects 2 sites- lower lobe and ipsilateral lymph node
will become calcified overtime
what is the gross anatomy of secondary TB
simon focus-
apex of the lung, gets there via primary TB spreading by blood
can be calcified
how do you convert glucose 6 phosphate to 6 phosphogluconate
via G6PD
what is G6PD that rate limiting step for
pentose phosphate pathway
what are the quads attached to
tibial tuberosity
what would we see in gallstone ileus
small bowel obstruction with air in the gallbladder and biliary tree
what happens to our skin as we age
increased collagen crosslinking- however does not help overall because you are not making that much collagen
decrease collagen fibril and increase of collagen and elastin degradation
placenta accreta
placenta is atached to the myometrium
will present as postpartum hemorrhage that does not improve with medication or uterine massage
what never innervates the subprapubic area
illiohypogastric nerve
what does the ilinguinal nerve provide
sensation to upper and medial thigh and part of the external genitalia
what does the genitofemoral nerve do
provide cremasteric reflex and sensation to upper anterior thigh
what type of bladder issue will people with MS have
hypertonic bladder, due to lack of descending inhibitory control from upper motor neuron
what mediators cause systemic inflammatory response
IL-1, IL-6, TNF-a
what are the antibodies in goodpasture
alpha 3 chain type IV collagen
what organ is spared in polyarteritis nodosa
lungs
how do we test for a primary thyroid issue
TSH
what is the function of bcl-2
inhibits apoptosis and promotes survival of cell
what increases when we have oral glucose vs iv glucose
oral glucose will have a higher response to insulin level due to incretins glucagon like peptide and gastric inhibitory peptide

incretins are secreted in response to sugar containing meals
NF 2 chromosome issue and mode of inheritance
chromsome 17
AD
NF 2 presentation
cataracts
bilateral schwannoma
schwannoma is a
adult primary brain tumor
what is the marker for schwannoma
S 100
what stain can we use for glioblastoma multiforme
GFAP
Glioblastoma can cross the....
corpus callosum
what done is most commonly fractured when fall on outstretch hand
scaphoid
xray of carpal bones
what is a transamiation reaction
a reaction between amino acids and alpha keto acid
what is the co factor for transamination
vitamin B6- pyridoxal phosphate
what is tetrahydrobiopterin a cofactor for
the synthesis of tyrosine, dopamine, and serotonin
what is inhibited in the diphtheriae vaccine
exotoin B via IgG
how do we do glycogenesis
take pyruvate and go to oxaloacetate then phosphenolpyruvate then back to glucose
what does the external branch of superior laryngeal nerve innervate
cricothryoid muscle
what nerve and muscle are at risk of injury in a thyroidectomy
external branch of superior laryngeal never and the cricothryoid muscle
what are neoplastic polyp with a high risk of malignancy transformation
serrated and adenomatous polyp
which adenomatous polyp type is more dangerous for malignancy- villous or tubular
villous
what muscle is innervated by the thoracodorsal nerve
latissimmus dorsi
how do we screen the stool for fat
sudan III stain
where are anal fissure below pectinate line located
posterior midline due to lack of perfusion
what does a high grade cervical intraepithelial neoplasia mean
immature basal cells go to epithelial surface
what does cervical carcinoma make
atypical cell invade basement membrane
what does low grade cervical intraepithelial neoplasia mean
atypical cell in the lower 1/3 of epithelium
atherosclerotic plaques predominate what type of arteries
large elastic artery
large to medium size muscular artery
what is the most affected location is atherosclerosis, name the rest of the affected vessels in descending order
abdominal aorta
coronary artery
popliteal artery
carotid artery
what is the site of b cell development in the lymph node
follcile
what is the site of T cell development in the lymph node
paracortex
what is the cell marker for monocyte macrophage lineage
CD 14
what is the cause of cleft lip
failure of fusion of the maxillary and medial nasal process
what is the cause of cleft palate
failure of fusion of the lateral palatine shelves

failure of fusion of lateral palatine shelf
what is the presentation of treacher collins
mandibular hypoplasia, facial abnormalities
what is the Pierre robin sequence
micrognathia, glossoptosis, cleft palate, airway obstruction
Pierre Robin sequence pathology
issue with 1st and 2nd brachial arch
how does the EBV virus infect the body
infects B cells through CD 21
what does EBV show on blood smear
atypical lymphocytes on peripheral blood smear will show reactive cytotoxic T cell
what mononucleosis will have a negative monospot test
CMV
what is the monospot test
heterophile antibodies detected by agglutination of sheep or horse RBCs
what is meigs syndrome
triad of ovarian fibroma (bundle of spindle shaped fibroblast), ascities, hydrothorax
choriocarcinoma
malignancy of trophoblastic tissues
no chorionic villi
increase in beta- hCG
shortness of breath, hemoptysis
hematogenous spread of lung
why do we have calicium oxalate stones with Chrons disease
there is impaired bile acid reabsorption in the terminal ilium, which means that the bile salts will bind to calcium in the small intestine and create soap which go out in the poop
the oxalate will get absorb and we have oxalate kidney stone
what are the characteristic of calcium oxalate
x ray
CT
shape
xray- radiopaque
CT- radiopaque
shape- envelope/ square
what are the characteristic of calcium phosphate stone
x ray
CT
shape
xray- radiopaque
CT- radiopaque
shape- wedge shaped prism
what vitamin issue can result in calcium oxlate stone
vitamin C abuse
what pH changes are associated with calcium oxlate stones
hypocitrauria
decrease in pH
what effect does prolong ACTH exposure on the adrenal gland
hyperplasia of the fasiculata and reticularis
what does the brachiocephalic vein drain to
jugular and subclavian vein
what does a blockage in brachiocephalic vein show
arm and face swelling
what swelling will be in SVC syndrome
bilateral facial and arm swelling
what is the function of pilli in N, meningitis
colonization of the nasopharyngeal epithelium
what provides cutaneous innervation to the lateral foreman
musculocutaneous nerve
what provides cutaneous innervation of the medial forearm
medial antebrachial cutaneous nerve
what do T tubules do
transmit depolarization signal to trigger the release of calcium and induce muscle contraction

uniform distribution allows for coordinated muscle contraction
how do we get horner syndrome
compression of the superior cervical ganglion
what is buspirone mechanism of action
stimulates 5-HT 1a receptors
what is buspirone used for
generalized anxiety disorder
what is the benefits of buspirone
lack muscle relaxant or anti-convulsant properties
slow onset of action
carries no risk of dependence
what is the earliest manifestation of diabetic nephropathy
albumin in pee
what is the immunology seen with primary sclerosing cholangitis
p ANCA
what is the immunology seen with primary biliary cirrhosis
AMA
what is the pathology of primary sclerosing cholangitis
onion skin bile duct fibrosis
alternating strictures and dilation
what is the pathology of primary biliary cirrhosis
lymphocytic infiltration and granuloma
what will activation of nicotinic cholinergic receptor result in
immediate influx of Na and Ca and outflux of K
how do we treat cardiotoxicity of TCA
sodium bicarb
where are muscarinic receptors found
parasympathetic nervous system
where are nicotinic receptors found
sympathetic nervous system
nicotinic receptors are....
all excitory
muscarinic receptors are...
inhibtory and excitory
overactive bladder syndrome is caused by
uninhibited bladder contractions
why do we get mallory weiss syndrome
due to increased abdominal pressure
what happens with mallory weiss syndrome
mucosal lacerations at gastroesophageal junction due to severe vomiting
fructose intolerance
hereditary deficiency of aldolase B
cause a buildup of fructose-1- phospate in liver
what is the presentation of fructose intolerance
hypoglycermia, jaundice, cirrhosis, vomiting
what is the presentation of essential fructosuria
fructose in blood and urine
other than that the symptoms are asymptompatic
what is the enzyme affected in essential fructosuria
fructokinase
what arteries do charcot bouchard aneurysm affect
small vessels of the brain
what are the risk factors of charcot bouchard aneurysm
chronic hypertension
is charcot bouchard seen on angiogram
no
what are the symptoms of charcot bouchard
progressive neurological symptoms
what are the symptoms of saccular aneurym
sudden severe headache
how do you treat otitis media
amoxicillin and clavulante
when does central pontine myelinolysis happen
when we do a rapid correction of severe hyponatremia
what will be the presentation of central pontine myelinolysis
para and quadriparesis, dysarthria (issue speaking), dysphagia (issue swallowing)
which renal artery does the ACE inhibitor affect
efferent arteriole, causes vasodilation
Increase renal blood flow and decrease GFR
what does angiotensin II do on the renal artery
constrict efferent arteriole
what happens when we constrict efferent arteriole
increase in GFR
Decrease RBF
what happens when we contrict afferent arteriole
Decrease GFR
Decrease RBF
What drugs constrict afferent arteirole on kindey
NSAIDS
What drugs dilate afferent arteriole on kidney
prostaglandins
What bacteria are removed by the spleen
streptococcus pneumonia
haemophilus influenzae
neisseria meningitis
Down syndrome markers in newborn screening
decrease in alpha fetoprotein
increase in beta- hCG
Edward syndrome marker in newborn screening
decrease in alpha fetoprotrin
decrease in beta- hCG
What would indicate cancer metastasis on the brain
multiple masses on brain in junction of white and gray junction
due to region high vascularity and narrow diameter vessel
What is the marker for medullary carcinoma of the thyroid
calcitonin
What is the marker of epithelial tumor of the ovary
CA125
What is the marker of pancreatic andrenocarcinoma
CA 19-9
What is the the pathology of Paget Disease of Bone
increase osteoclastic activity followed by increased osteoblastic activity
Describe the bone quality in paget disease of bone
poor bone quality. increased bone density and alternating band of cortical thickening
What is the histological findings will be seen in basal cell carcinoma
palisading nuceli
What is the precursor to squamous cell carcinoma
Actinic keratosis- a scaly plaque
where are the cyst in ADPKD
cortex and medulla
where are the cyst in ARPKD
collecting duct
what is the mutation with ADPKD
chromosome 16- PKD1
chromosome 4- PKD2
where is the foramina of monro located
between lateral ventricle and 3rd ventricle
where is the lateral foramina of lushchka located
between 4th ventricle and CSF
where is the median foramen of magendie
between 4th ventricle and CSF
how do we absorb phosphate from the kidney
Na-phosphate cotransporter
what is the potential complications of MI between 0-24 hours
ventricular arrhythmia
heart failure
cardiogenic shock
what is the potential complications of MI between 1-3 days
post infection fibrosis pericarditis
what is the potential complications of MI between 3-14 days
free wall rupture -> tamponade
papillary muscle rupture -> mitral regurgitation
interventricular septal rupture
LV pseudoaneurysm
What is the complication of MI 2 weeks and out
Dressler syndrome- pericarditis, autoimmune
heart failure
arrhythmia
true ventricular aneurysm
What type of seizures can be treated with phenobarbital
focal/partial
tonic-clonic
status epilepticus
What is the chromosome is affected VHL?
3q
What chromosome is affected in NF1
chromosome 17
aortic arch- 1st
part of the maxillary artery
aortic arch-2nd
stapedial artery and hyoid bone
aortic arch- 3rd
common carotid artery and proximal part of internal carotid
aortic arch-4th, left
aortic arch
aortic arch-4th, right
right subclavian artery
aortic arch-6th
proximal part of pulmonary artery and ductus arteriosis (on left)
What is the embryological issue with patent ductus arteriosis
6th brachial arch
What murmur is heard with patent ductus arteriosis
machine like murmur
what abdominal finding is seen with downs
omphalocele
what is covering the omphalacele
peritonium
what is the population at risk for buerger disease
heavy smoker who start smoking early
what is the pathology of buerger
segemental thrombosis in arteries and vein
what is the presentation of buerger
peripheral ischemia, pain, faint pulse in small/medium artery, and gangrene in toe and finger
what are the side effects of TCA
anticholinergic effects- dry mouth, urinary retention
QT prolongation
what is the signs of PCP intoxication
tachycardia, dilation of pupil (mydriasis), nystagmus
what are the signs of amphetamine intoxication
tachycardia, dilation of pupil, NO nystagmus
how does TCA cause QT prolongation
inhibit fast Na channel in cardiac myocytes
what is the long term complication of rubeola virus
subsacute sclerosing panencephalitis- dementia and personality
what part of the pancreas is made by ventral pancreatic bud
precursor of uncinate process
inferior/ posterior portion of the head
major pancreatic duct
what part of the pancreas is made by the dorsal pancreatic bud
body, tail, and most of the head
what is the triad of plummer vinson syndrome
1. esophageal web
2. dysphagia
3. iron deficiency anemia
what is the weight is anorexia nervosa
low weight
what is the weight in bulimia nervosa
normal body weight
what causes enlarged coronary sinus
pulmonary hypertenison
what are class III anti-arrhythmic drugs
amiodarone
sotalol
dofetilide
what is the MOA of class III anti-arrhythmic drug
block potassium channel and inhibit the outward potassium currents during phase 3 of the cardiac action potential
what are the 3 things that are degenerated in Friedreich atxia
1. spinocerebellar tract degeneration
2. dorsal column
3. dorsal root ganglia
what happens when the spinocerebellar tract is damaged
cerebellar ataxia
what does damage to the dorsal column/ dorsal root ganglia degeneration
position/ vibration sensation
what hormones use cAMP as a second messenger
FSH
LH
ACTH
TSH
CRH
hCG
ADH- V2 receptor
MSH
PTH
calcitonin
GHRH
glucagon
way to remember second messengers that use cAMP
FLAT ChAMP
what does cAMP activated in the second messenger pathway
protein kinase A
rationalization
making an excuse for unacceptable feelings about an exam
example of rationalization
claiming the job was not important when we get fired
example of supression
not worrying about a big game until it is time to play
what is regression
intentionally withholding an idea or feeling from conscious awareness
what does the CFTR protein do
transmembrane ATP gated Cl channel
what are the signs of vit D overdose
hypercalcemia, loss of appetite, not really consciousness
what disease can cause vit D excess
granulomatous disease
why do granulomatous disease cause increase Vit D
increased activation of vit D by epitheloid macrophage

they express a-1 hydroxylase
where is the AV node located
endocardial surface of the right atrium, near the septal leaflet of the tricuspid valve
what can injury above the clavicle result in
damage to the lung pleura
boundary of the posterior triangle of the neck

what can be damage here
sternocleidomastoid muscle
trapezius muscle
clavicle

accessory nerve
how do we get esophageal varices in portal hypertension
shunting of blood to left gastric vein
what can cause caput medusae in portal hypertension
shunting of blood to periumbilical veins
what can cause splenomegaly in portal hypertesion
shunting of blood to splenic RED pulp
where do aortic dissections type A happen
ascending aorta, at the sinotubular junction
where do aortic dissection type 2 happen
descending aorta
at the left subclavian artery
what leads to increase expiratory flow rates
increase elastic recoil and increased radial traction
what will Dubin Johnson syndrome present as
black liver
what is the histology of Dubin Johnson syndrome
dense pigment within lysosome
what is the defect in Dubin Johnsn
cannot excrete conjugated bilirubin
what is the defect in crigler-najjar
absent UDP- glucuronosyltransferse
severe
what is the defect in gilbert syndrome
mildly decreased UDP-glucuronosyltransferase

may present in times of stress
what does UDP- glucuronosyltransferase do
conjugate bilirubin
why is there selective loss of albumin in minimal change disease
loss of foot process- loss of neg charge on basement membrane
what unwinds the DNA
helicase
what relaxes the tension of the DNA as it is being unwind
topoisomerase
what coagulase bacteria are novobiocin sensitive
S. epidermidis
what coagulase negative bacteria is novobiocin resistant
S. saprophyticus
what is indicated in the treatment of alcohol withdrawl
benzodiazapine
what are the benzodiazepine
-epam
chlordiazepoxide
alprazolam
what is the mechanism of action of benzodiazepines
facilitate GABAa action by increasing the frequency of Cl channel opening
how to treat benzo overdose
flumaxenil
flumenazil and its relation to benzo
competitive antagonist
mechanism of action of barbiturates
facilitate GABAa action by increase duration of Cl channel opening
what enzyme is affected in acute intermittent prophyria
prophoblinogen deaminiase
what enzyme is affected in polyporphyria cutanea tarda
uroporphyrinogen decarboxylase
what is the presentation of polyprophryia cutanea tarda
blistering cutaneous photosensitivity
what is the presentation of acute intermittent porphyria
painful abdomnet, port wine colored pee, polyneuropathy, psychological issues

worse with P450 inducer,alcohol,starvation
what is diagnostic for 21 hydroxylase deficiency
elevated 17-hydroxyprogesterone
what type of seizure is lamotrigine not used for
status epilepticus
what is the mechanism of action for lamotrigine
block voltage gated Na channel
what should you worry about with lamotrigine
Steven johnson sydnrome
which is more selective- spironolactone or epleronone
eplerenone
which would result in gynecomastia- spironolactone or eplerenone
spironoloactone
what is thiazide diuretic
chlorthalidone
what are status epilepticus
seizure lasting more than 5 minutes
how do you treat acute status epilepticus
benzodiazepines
how do you prevent status eplipticus
phenytoin
what is the mechanism of action of phenytoin
block Na channel
what cellular structures are affected in malignant tumors that result in their malignant spread
integrin
what do integrin bind to
fibronectin, collagen, laminin
what does IL 2 do
class switch to IgE and IgG
what does IL 5 do
eosinophil chemotaxis
class switch IgA
maturation of B cell to plasma cell
what does IL2 do
T cell growth factor and CD8 T cell activator
what does Th1 make
IFN gamma and IL 2
what does Th2 make
IL4, IL5, IL 10
light microscope for membranous glomerulopathy
diffuse thickness of the glomerular basement on light microscopy without increase cellularity
what is the EM appearance of membranous nephropathy
spike and dome appearance with subepithelial deposits
what is the appearance of membranoproliferatie disorder
tram track appearance
what is the immune complex deposition of membranoprolierative glomerulonephritis
granular
what are the fat soluble vitamins
ADEK
what are the igns of Vit A deficiency
night blindness
dry, scaley skin
corneal ulceration
what are the diagnostic approach for strongyloides stercoralis
rhabditiform larvea in stool
how do you diagnose schistosoma infection
detect parasite egg in the stool
what diagnostic test use to ID enterobius vermicularis
perianal egg deposition
what is the diagnosis for flatworm infection
proglottids in the stool
what is the diagnosis for giardia lamblia and entameoba histolytica
trophozoites and cyst in the stool
what artery supplies the majority of the blood for the femoral head and neck
medial circumflex femoral artery
ACL attaches
lateral femoral condyle to anterior tibia
PCL attaches
medial femoral condyle to posterior tibia
what is seen in wold-parkinson-white syndrome
antrioventricular conduction tract bypassing the atrioventricular node
how do you treat wolff- parkinson-white syndrome
procainmide- Na blocker
amiodarone- K channel blocker
will ectopic ACTH production from small cell lung cancer be suppressed with high dose dexamethasone administration
no
will high ACTH from a pituitary adenoma be suppressed with high dose dexamethasone
yes
what is the mechanism of action of tamsulosin
alpha 1 selective
what cell takes up bacteria from the ileum and present antigen to immune cells
M cell on peyer patch that will then secrete IgA
malassezia will cause...
a hypopigmented rash
what is the presentation of renal papillary necrosis
gross hematuria
acute flank pain
passage of tissue fragments in pee
high altitude exposure will result in what type of metabolic compensation
respiratory alkalosis
why do we get edema is nephrotic syndrome
we are peeing out protein, so there is less plasma oncotic pressure so there is an increase in plasma filtration in capillary bed
how do you treat C diphtheriae from order of importance
1. diphteria antitoxin
2. penicillin or erythromycin
3. DPT vaccine
how do you treat acute migraine
SSRI
NSAID
sumatropitan
how do you prevent migraine
beta blocker
Ca blocker
how do you treat cluster headache
O2, ergotamine, sumatriptan
how do you prevent cluster headage
vermpil
how you treat tension tension headache
NSAIDS
what is the genetic issue with follicular lymphoma
t14;18
what is the genetic issue with mantel cell lymphoma
t11;14
what is the pentad of thrombotic thrombocytopenic purpura
1. neurological symptoms
2. renal symptoms
3. fever
4. thrombocytopenia
5. microangiopathic hemolytic anemia
what initiates transcription
CAAT box
TATA box
how do we get epispadias of penis
issue with genital tubercle
hepatocellular carcinoma is most strongly associated with which hepatitis
Hep B
what is the defect in hyper IgM syndrome
CDL on Th cell
what is the defect in chronic granulomatous disease
defect in NADPH oxidase
what will the nitroblue tetrazulium dye reduction test show in chronic granulomatous disease
fail to turn blue
what bug spreads chagas disease
triatomie
what is budd chiari
thrmobosis or compression of hepatic vein with centrilobular congestion and necrosis
what are the potential cause of budd chiari
hypercoagulable, polycythemia vera, post partum state
what do fibrates inhibits
7-a- hydroylase
what do you want to give prior to surgury of pheochromocytoma
alpha antagonist followed by beta blocker
what is the target or rituximab
CD20
what are the lab findings the hemochromatosis
increase serum iron
increase ferritin
decrease transferriton
increase in transferin saturation
what does the parvoviris B 19 infect
erythrocyte precurosis
which group will have diarrhea with HUS- kids or adults
kids get diarrhea
which leukemia will have a dry tap on aspiration
hairy cell leukemia
what is the staining for hairy cell leukemia
positive TRAP
What is folinic acid also known as
leucovorin
how do you reverse toxicity of methotrexate
folinic acid aka leucovorin
what the congenital reasons for QT prolongation
mutation in K channel that delays
what is Romano Ward Syndrome
AD
congenital long QT syndrome
NO DEAFNESS
What is Jervell and Lange-Nielsen syndrome
AR
congenital long QT syndrome
sensorineural deafness
what is the mechanism of action of opiods
agonist at opiod receptor
open K channels and close Ca channels
what is in the marginal zone of a B cell lymphona
most outer part of the lymphome
contains memory B cell
what does opiods do for synaptic transmission
decrease in synaptic transmission
what do opiods inhibit the release of
ACh
NE
5-Ht
glutamate
Substance P
what is the excess collagen in keloid
collagen 3
what does collagen 3 make in terms of wound healing
granulation tissue
what does TGF beta cause in excess in wounds
keloid and hypertrophic scarring
TGF beta functions include
fibroblast migration, proliferation, and connective tissue synthesis
TGF beta can convert helper T cell to what type, what other factor does it need
TGF-beta and IL 6 to make Th17 cell
what is the first area to get damage by global cerebral ischemia
hippocampus- specifically the pyramidal cells
in general, what are the are the neurons to be worried in global cerebral ischemia
pyramidal cells of hippocampus and neocortex

purkinje cell of the cerebellum
where does positive selection happen in the thymus
cortex
where does negative selection happen in the thymus
medulla
what should be used to reduce chronic kidney disease in patients with hypertension and diabetes
ACE
ARBs
what type of glands cause acne
sebaceous glands
what are the examples of holocrine glands
sebaceous glands
meibomian gland
what are the example of apocrine glands
mammary glands
what are the examples of merocrine glands
salivary gland
eccrine sweat glands
apocrine sweat glands
what is the mechanism of merocrine glands
cells secrete via exocytosis
what is the mechanism of apocrine glands
cells secrete via membrane bound vesciels
what is the mechanism of action of holocrine glands
cell lysis releases entire contents of the cytoplasm
what cells make glucagon
alpha cell of the pancreas
can you tell someone if a patient is stable if you cannot get their consent to do so
yes- only that they are stable
desmopressin can increase the levels of...
vWF from endothelial cell
factor 8
what are the signs of vitamin B 2 def aka riboflavin
inflammation of lips, fissures at corner of the mouth, corneal vascularization
what is riboflavin used for
redox reactions
what are the components of ribaflavin
FAD and FMN
what part of the cirtric acid cycle require FAD
succinate dehydrogenase to convert succinate to fumarate
when can we get a Hep D infection
with hep B
bipolar II will have...
hypomanic and depressive episode
bipolar I will have
at least one manic episode with or without a hypomanic or depressive episode
borderline personality disorder will have
unstable mood and relationships
erratic behavior
may have splitting
what are fetal hydrops
pleural effusion with secondary pulmonary hypoplasia, and ascites
what can parovirus B 19 present in adults
arthralgia aka joint pain
what is the function of Rb protein
prevents the damage cell from preceding G1 to S checkpoint via the inactivation of transcription factor E2F
when is Rb activated
hypophosphorylated- inactivates transcription factor E2F
when is Rb inactivated
hyerphsophorylated
what will happen if there is vagina lateral geniculate body
temporal hemiretina
what amino acid is needed for the excretion of acid
glutamine
what happens when ATP binds to mosin
release of mysoin head from its binding site on the actin filament
what can be the result of increased urinary pressure on the kindey
renal parenchymal atrophy
what is the main muscle used in the valsalva maneuver
rectus abdominis
what will happen if there is injury to the meyer's loop in the temporal lobe
contralateral superior quadratanopia
what will be seen on blood smear of a babesiosis infection
intraerythrocyic organisms
what spreads babesiosis
ixodes tick
where is babesia infection hapen
northeastern US
what does an S4 sound mean
stiffness in ventricle wall
what does S3 sound mean
sudden cessation of passive ventricular filling
what do we called milder major depressive disorder lasting at least 2 year
persistent depressive disorder
alzheimer can happen with down syndrome because...
chromosome 21 has amyloid precursor protein
Alzheimer's disease involve in intracellular....
neurofibrillary tangles
Alzheimer's disease involve in extracellular....
AB amyloid beta plaque
AB amyloid plaques are...
abnormal fragments of amyloid precursor protein
neurofibrillary tangles compose of...
hyperphosphorylated tau protein
what happens when we have weight loss or a lot of exercise when it comes to periods
functional hypothalamic amenorrhea....results in loss of pulsatile GnRH
what is the mechanism of action of rifampins
inhibition of DNA- dependent RNA polymerase
what is the mechanism of action of isoniazid
inhibition of mycolic acid synthesis
what is the mechanism of action of pyrazinamide
hepatotoxicity and hyperuricemia
what is the mechanism of action of ethambutol
inhibition of arabinosyl transferase
what is the most common presentation of cryptococcus neuformans
meningoenephalitis
what are the withdrawl symptoms of heroin
dialated pupils, yarning, lacrimation
what are the withdrawal signs of stimulants
increased appetite
hypersomnia
intense psychomotor reterdation
what is an imperforate hymen
incomplete degeneration of the central portion of the fibrous tissue band connection that walls of the vagina
what is the presentation of imperforate hyman
normal secondary sexual characteristics
cyclic abdominal or pelvic pain due to accumulate of periods blood
primary amenorrhea
where is angiotensin I converted to angiotensin II
small vessels of the lung
what causes isolated systolic hypertension
age related stiffness and decrease in compliance of the aorta and major peripheral arteries
both alleles contribute to the phenotype of the heterozygote
codominance
phenotype varies amount people of the same genotype
variable expressivity
what are examples of codominance
blood groups
a1- antritrypsin deficiency
what are the example of variable expressivity
NF 1 patients
not all people with a mutant genotype show the mutant phenotype
incomplete pentrance
what are examples of incomplete penetrance
BRAC1 gene mutation do not always get cancer
one gene contributes to multiple phenotypic effects
pleiotropy
what is an example of pleiotropy
PKU- which results in light skin, intellectual disability, and musty order
increased severity or earlier onset of disease in succeeding generations
anticipation
patients inherits or develops a mutation in a tumor suppressor gene, the complementary allele must be deleted/mutated before cancer develops
loss of heterozygosity
what are examples of loss of heterozygosity
retinoblastoma
two hit hypothesis Lynch syndrome
Li-Fraumeni syndrome
a heterozygote produces a nonfunctional altered protein that also prevents the normal gene product from functioning
dominant negative mutation
tendency for certain alleles at 2 link loci to occur together more or less often than expected by chance
linkage disequilibrium
presence of genetically distinct cell lines in the same person
mosaicism
mutation at different loci produce a similar phenotype
locus hererogeneity
different mutations in the same locus produce the same phnotype
allelic heterogeneity
presence of normal and mutated mitochondrial DNA
heteroplasmy
what are an example of allelic heterogeneity
beta- thalassemia
what is the gene issue in beta thalassemia
beta gene on chromosome 11
gene mutation
what is the gene issue in alpha thalassemia
alpha gene on chromosome 16
gene deletion
what is an example of locus heterogeneity
albinism
achondroplasia chromsome affected
4- FGFR3
what is the inheritance for achondorplasia
AD
what chromosome is affected in familial adenoamatous polyp
5
what is mutated in familial andenomatous polypsis
APC tumor suppressor gene
how do we get sporadic colorectal cancer
mutation in APC gene
what in the syndrome where a person is really friendly to stranger
williams syndrome
what are the facial feature of williams syndrome
elfin facies
what are the Ca issue in willaims syndrome
hypercalcemia due to increase sensitivity to vitamin D
what in the genetics behind williams syndrome
microdeletion of long arm of chromosome 7
what is the genetics behind cri-du-chat
microdeletion of short arm of chromosome 5
what 4 things cause activation of the intrinsic pathway
collagen, basement membrane, activated platelets, and high molecular weight kininogen/ kallikrein
what is the pathophysiology of myasthenia gravis
autoantibodies to posy synaptic ACh receptor
what is type II hypersensitvity
antibody bind to cell surface, result in cell destruction
what is type III hypersensitvity
antibody-antigen complex, activate complement and release neutrophil
what is type I hypersensitvity
anaphylactic shock, antigen cross link with IgE on presensitized mast cell, result in degranulation
what is type IV hypersenstivity
direct CD 8 kill or
CD 4 ID antigen and induce cytokine
what are the antibody against lambert- eaton myasthenic syndrome
autoantibodies to presynaptic Ca channel which decrease ACh release
what is the drug used to test for myasthenia gravis
edorphonoium- anticholinesterase increase ACh
how do you treat myasthenia gravis
pyridostigmine- anticholinesterase, increase ACh
what stool type is seen wiht acute mesenteric ischemia
currant jelly
what is the sign of chronic mesenteric ischemia
food aversion and weight loss
what artery is most affected in mesenteric ischemia
SMA
sarcoidosis presentation with x-ray presentation
shortness of breath
enlarged lymph nodes
immune mediated, widespread noncaseating granulomas
x-ray presentation will show bilateral adenopathy
what are the lab values for scaroidosis
elevated ACE
elevated CD4/CD8 ratio in bronchoalveolar lavage fluid
what are the calcium findings is sarcoidosis
hypercalcemia due to increase 1a hydroxylase mediated vitamin D activation in macrophages
what is the issue with osteopetrosis
failure of bone resorption due to defective osteoclast
what is the presentation of osteopetrosis
bone fractre, thrombocytopenia and leukopenia and anemia (due to bone taking up medullary space), vision and hearing issue due to skull being think impinge on nerve
why do we get osteopetrosis
mutations in carbonic anhydrase that impair osteoclast from generating acidic environment needed to reabsorb bone
what is the prophylaxis for osteoporosis- in terms of exercise
regular weight bearing exercise
what are AChE inhibitors used in alzhimers
donepezil
galantamine
rivastigmine
tacrine
what is mematine used for
alizhimers
what is the mechanism of action of metamine
NMDA receptors antagonist- reduce excitoxicity
what is clozapine used for
second generation antipsychotics
what are the first generation antipsychotics target
D2 antagonism
what is the mechanism of 2nd generation antipsychotics
D2 antagonist and blocks serotonin receptors
what symptoms can 1st generation anti-psychotics target
positive symtpoms
what symptoms can second generation anti psychotics target
positive and negative symptoms
why can 2nd generation antipsychotics cause drowsiness
block H1 receptors
what are metabolic issues associated with second generation antipsychotic
end in -pines
weight gain
diabetes
hyperlipidemia
what cardiac issue can 2nd generation antipsychotics cause
QT prolongation
what are the unique side effect of clozapine
agranyloytosis- monitor WBC regularly
what is the unique side effect of resperidone
prolactinemia- due to blockaged of D2 inhibition
what is a endocrine side effect 1st gen antipsychotics
hypeprolactinemia due to dopamine receptor antgonism
what medication will we see neuroleptic malignant sydrome and tardive dyskinesia
first generation anti-psychotics
why do we see tardive dyskinesia
after chronic use of 1st generation antupsychotics
what is the MOA of trazadone
blocks 5-HT2, a1- adrenergic, H1 receptors
what is the MOA of bupropion
increase in NE and dropmine
what is bupropion used for
smoking cessation
what is the MOA of varenicline
nicotinic ACh receptor partial agonist
what is the varenicline used for
smoking cessation
what is secreted in response to hypoglycemia
glucagon
what is the effect of glucagon
stimulate hepatic glucose production
why does hyperammonemia result in coma
cerebral edema
what is the equation for flow rate
Q= VA
Q- flow rate
V- velocity
A- cross sectional area
what is the difference between costrochondritis and pleuirsy
costrochondritis will have pain with palpation of chest-hurts when there is pressure between the rib and cartilage
what is the first step in intracellular killing
create radical oxygen with NADPH oxidase
what is the stages of O2 dependent killed
O2 converted to O2- via NADPH oxidase
O2- converted to H2O2 via superoxide dumitase
H2O2 converted to HOCl radical via myeloperoxidase
HOCl will then destroy phagosome
what will damage in the posterior communicating artery result in
blown out pupil, down and out eye
due to damage to CN III
how do we treat salmonella typhi
ceftriaxone or fluoroquinolone
what is the time criteria for brief psychotic disorder
less than 1 month
will have delusions, hallucination, ect
what is the time criteria for schizophreniform disorder
1-6 months
will have delusions, hallucination, ect
what is the time criteria for schizoaffective disorder
more than 2 weeks
will have delusions, hallucination, ect
what is clonidine
a2 agonist
what is guanfacine
a2 agonist
what is clonidine/ guanfacine used for
hypertensive urgency, ADHD, tourette syndrome
what is phenoxybenzamine
irreversible alpha 1 blocker
what is VIPoma, what are the action of VIP
non alpha and non beta islet cell pancreatic tumor

increase intestinal water and electrolyte secretion and increase relaxaion of intestinal smooth muscle and spincters
what is the signs of VIPoma
watery diarrhea, hypokalemia, low secretion of acid
what do we think a patient has if they have buring abdominal pain that does not get that much better with PPI
gastrinoma, zollinger ellison syndrome
what is the presentation of a patient with tuberous sclerosis
hamartomas in CNS and skin
angiofibroma
ash leaf spot
cardiac rhabdomyoma- most common primary cardiac tumor in children
renal angiomylopoma
seizure
shagreen patchines
increase incidence of subependymal astrocytoma
what is the presentation of neurofibromatosis 1
cafe au lait spot
lisch nodules
cutaneous neurofibroma
pheochromocytomas
optic gliomas
what are some biological agents that can be used to treat RA
TNF-a inhibitors
what intestinal nematode aka round worn is associated with respiratory symptoms
ascaris lumbricoides
what ligament has to be cut to get to the spinal cord
ligamentum flavum
what will be seen on gram stain of candida
peseudohypea- yeast form
in the cold
what will canidida show in the heat
germ tubes
what is dead space
area that is ventilated but not perfused
what is the presentation of IgA nephropathy
episodic gross hematuria that occurs concurrently with respiratory of GI tract infections
what is the presentation of acute interstitial nephritis
fever
rash
hematuria
CV tenderness
what is the cause of acute interstitial nephritis
after getting drugs
what cancer is associated with lambert-easton myasthenic syndrome
small cell lung cancer
the central retinal artery is a branch of....
opthalmic artery
how do we cool down the body
exaporation of sweat
what is the pathology of polyarteritis nodosa
transmural inflammation of the arterial wall and fibrinoid necrosis
segmental ischemic necrosis
why do we not want to mix alcohol with acetaminophen
.Alcohol induces the synthesis of CYP2E1 isoenzyme aka a cytochrome p450 enzymes, causing a higher percentage of acetaminophen to be converted to NAPQ1
what happens to LH:FSH and fasting insulin in PCOS
increase
things from this place will be sent to the golgi apparatus
endoplasmic reticulum
what is the function of COPI
golgi to golgi- retrograde
back aka cis of golgi to endoplasmic reticulum
what is the function of COPII
endoplasmic reticulum to back aka cis golgi
what is the function of clatherin
trans-golgi to lysosome
plasma membrane to golgi
what is the histology of small cell lung cancer
small dark blue cell
positive chromogranin
neuron-specific enolase positive aka neural cell adhesion molecule
what can be made from small cell lung cancer
ACTH
SIADH
Antibodies against presynaptic Ca channels
what is the presentation of klinefeler syndrome
testicular atrophy
gynecomastia
eunuchoid body shape
what is the patho-physiology of klinefelter syndrome
dysgenesis of seminiferous tubule- inhibin B- increase FSH

abnormal leydig cell function- decrease in testosterone increase LH increase estrogen
what is the treatment in atropine overdose
physostigmine- anticholinesterases increase ACh
what is transformation
ability for bacteria to take up naked DNA from environment
will not work if DNase is present
what will be seen in chronic inflammation
mononuclear cell like macrophages, lymphocytes lymphocytes, plasma cell
fibroblast mediated and collagen deposition
what will be seen in granuloma formation
epithelioid macrophage and giant cell
where do we secrete EPO from
kidney
what is the function of vitamin E
antioxidant, protect RBC and membrane from free radical damage
what vitamin def can have neurologic presentation similar to vitamine B12 def wihtout the megaolblastic anemia, hypersegmented neutrophils, and increase in serum methlymalonic acid
vitamin E
what does CN V1 and V2 exit out of
foramen rotundum
what does CN V3 exit out of
foramen ovale
what comes out of the internal auditory meatus
CN 7 and 8
what comes out of the foramen spinosum
middle meningeal artery
what is damaged in epidural hematoma
middle meningeal artery
what will be seen on CT of epidural hematoma
lens pool of blood
does not cross suture lines
does subdural hematoma cross suture lines
yes
what is wrong with subdural hematoma
rupture of bridging vein
what is the signs of syringomyelia
sensory loos of pain and temperature
fine touch and position is spared
what is the pathophysiology of syringomyelia
cystic cavity aka syrinx within central canal of spinal cords
damage to anterior white commissure
what thing is at risk of getting injured in removal of protate
pelvic parasympathetic nerves
what is sildenafil
inhibit PDG5, increase cGMP, increase NO and prolong smooth muscle relaxation
what is the presentation of goodpasture
coughing up blood
issue breathing
hematuria
pretty much renal and lung issue
what will be seen on IF of goodpasture
linear IF
what parts of the kindey are most susceptible to renal ischemia
PCT and thick ascending limb
what happens to the lungs after we smoking
mucus production and secretion go up
activity of airway cilia for down
alveolar macrophages function go down
what does the left circumflex artery come off of
left main coronary artery
what is the cause of albinism
decrease in melanin production due to decrease in tyrosinase activity or defective tyrosine transport
what is the gene affected in Li-Fraumeni syndrome
TP53
what is the gene product of TP53, what does it do
p53, activates p21 which blocks G1 to S phase
what is the sign of rupture of intervertebral disc
pain that radiates after lifting something heavy
what is the metabolite of morphine, is it active
morphine-6-glucuronide, it is active and more potent than morphine
why do we get issues with morphine ADR when we take too much
morphine is metabolized to more potent metabolites aka morphine-6-glucuronide that accumulates in the body
what muscle in the rotator cuff lateral rotate arm
teres minor and intraspinatus
what muscle in the rotator cuff medially rotates arm
subscapularis
what muscle in the rotator cuff initially abducts the arm
supraspinatus
what is the strongest risk factor for pancreatic adenocarcinoma
smoking
what is delusional disorder
fixed, persistent, false belief system lasting more than 1 month
what is the lysosomes
digestion of cellular debris and pathogens
what is peroxisomes
oxidation of very long and branched chain fatty acids
hydrogen peroxide degeneration
what is proteasomes
degradation of ubiquitinated proteins
what is the function of rough endoplasmic reticulum
synthesis of integral membrane and secretory proteins
what is the function of smooth endoplasmic reticulum
drug detoxification
lipid, phospholipid, and steroid synthesis
what is the equation for filtration fraction
filtration fraction = Glomerular filtration rate/Renal plasma flow
what is the equation for renal plasma flow
renal plasma flow= renal blood flow * (1-hematocrit)
what microbe should you be worried about if CD4 is below 200
pneumocystis jirovecii
what microbe should you be worried about if CD4 is below 100
toxoplasma gondii
what microbe should you be worried about if CD4 is below 50
mycobacterium avium
what microbe should you be worried about if CD4 is below 150
histoplasma capsulatum
how do you treat pneumocystis jirovecii
trimethoprim-sulfamethoxazole
how do you treat toxoplasma gondii
trimethoprim sulfamethoxazole
how do you treat mycobacterium avium
azithromycin
how do you treat histoplasma capsulatum
itranconazole
what presents with a palpable abdominal mass- aortic abdominal aneurysm or aortic dissection
aortic abdominal aneurysm
what causes aortic aneurysm
chronic transmural inflammation
what type of emphysema does alpha 1- antitrypsin deficiency happen
panacinar emphysema
what does steroids do to the liver
increase in hepatic gluconeogenesis and glycogenesis
why do we have stria with steroids
inhibition of fibroblast proliferation and collagen formation in skin- results in thinking of skin aka stria and impaired wound healing
what does nonbacterial thrombotic endocarditis indicate
nonbacterial thrombotic endocarditis- deposition of sterile platelet thrombi on cardiac valves
seen with advanced malignancy and chronic inflammatory disorders such as antiphospholipid syndrome, systemic lupus erythematosus
what type of lymphadenopathy does a lesion in the medial lower extremity cause
inguinal lymphadenopathy
what type of lymphadenopathy does a lesion in the lateral lower extremity cause
popliteal and inguinal lymphadenopathy
what is seen in bacterial endocarditis
fever
roth spots- on retina
osler nodes- painful
murmur
janeway lesions- painless
anemia
nail-bed hemorrhage
emboli
what is the pathogenesis of osler nodes
seen in bacterial endocarditis
immune complex deposition in skin
what is the pathogenesis of janeway lesions
microemboli to skin vessels
what is myasthenia gravis associated with
thymoma and thymic hyperplasia
what is made by the 3rd pharyngeal pouch
thymus and inferior parathyroid gland
where is ADH made
in the paraventricular and supraoptic nuclei of the hypothalamus
what is the first sign of alcohol withdrawl
anxiety, insomnia, tremors, diaphoresis aka sweating a lot, GI upset
happen 6-24 hours after last drink
when do we get seizures in alcohol withdrawl
12-48 hours after last drink
what are delirium tremens
happens with alcohol withdrawal
confusion, agitation, fever, tachycardia, hypertension, sweating, hallucinations
when do delirum tremens after last drink
48-96 hours
what type of antibiotics have a MOA of interfering in aminoacyl-tRNA binding
tetracyclines
what antibiotic has a mechanism of action of binding to the 23S rRNA of the 50S ribsomal subunit and block translocation
macrolides
how do macrolides work
bind to 50S ribosomal subunit- block translocation
what is the presentation of mucoymycosis and rhizopus
seen in diabetic ketoacidosis
necrotic eschar on face
possible nerve injury
penetrate brain via cribriform plate
what are the steps for base excision repair
glcosylase cleaves the altered base
endonuclease cleaves the 5' end and lyase cleaves the 3' sugar phosphate
DNA polymerase fills the single nucleotide gap and ligase seals the nick
what is the function of glycosylase
cleaves the altered base
what is the function of endonuclease
leaves the 5' end of damaged DNA
what is the function of lyase
cleaves the 3' sugar phosphate
what is the function of ligase
seals the nick on DNA
what will be seen on electromyograhy in a patient with clostridium botulinum
decrease in muscle response following stimulation of a motor nerve
what is the pathophysiology of C. botulism
produce a heat labile toxin that inhibits ACh release in the neuromuscular function
what endometrial process cause menstration
apoptosis
what is the MOA of a rash after taking a drug
IgE independent mast cell activation
how does IgE independent mast cell activation degranulate
via activation of protein kinase A and PI3 kinase
what does angiotensin II cause to arteries
vasoconstriction
what supplies blood to the proximal ureter
renal artery
what supplies blood to the distal ureter
superior vesical artery
what is the MOA to an axillary nerve injury
anterior humerus dislocation
what is damages in a spinal fracture of the midshaft humerus
radial nerve
what is seen in acute respiratory distress syndrome
endothelial damage which results in increase alveolar capillary permeability which result in protien rich leakage into the alveoli which reuslt in diffuse alveolar damage
what is the function of thrombin
convert fibrinogen to fibrin
what is needed in bacterial cell wall synthesis
peptidoglycan
what is the enzyme needed for peptidoglycan synthesis that will result in a bacterial cell wall
glycosyltransferase
which bacteria lack a cell wall
mycoplasma bacteria
what is the presentation of inflammatory breast cancer
dermal lymphatic invasion by breast carcinoma
breast look like orange pell
what is the pathophysiology of inflammatory breast cancer
neoplastic cells block lymphatic drainage
what will be seen in selective IgA def
airway and GI infections
autoimmune disease
anaphylaxis to IgA containing products such as in blood products
what part of the urethra is most commonly damaged in pelvic fracture
membranous urethra
what part of the urethra is damaged in straddle injuries
penile and bulbous segment of the urethra
what eye condition is very painful
acute closure glaucoma
what medication can precipitate acute closed angle glaucoma
atropine
what does heme oxygenase do
converts heme to biliverdin
what causes a bruise to have color
what will aortic regurg result in
left ventricular dilation and eccentric hypertrophy
will result in increase stroke volume
what is the light microscopy of acute poststreptococcal glomerulonephritis
glomeruli enlarged and hypercellular
what is the IF in acute poststreptococcal glomerulonephritis
granular appearance due to IgG, IgM, and C3 deposition along glomurular basement membrane
why do we get graves ophthalmopathy
immune mediated, activated T cells increase fibroblast secretion
what is the MOA of graves
thyroid stimulating immunoglobulin IgG stimulates TSH receptors
what is the triad for fat emboli PE
hypoxemia, neurological abnormalities, petechial rash
what will be normal in ARDS
pulmonary capillary wedge pressure
what is the presentation of hyperadosteronism
hypertension hypokalemia, and metabolic alkalosis
why do we not see high sodium in hyperaldosteronism
aldosterone escape
the increased intravascular volume caused increased renal blood flow and therefore more natriuresis and loss of sodium
chancroid is a...
deep painful ulcer with raged borders that are associated with a grey exudate and inguinal lymphadenopathy
what is the microorganism that cause chancroid
haemophilius ducreyi
what does the mullerian/ paramesonephic duct make
female internal structures and part of upper vagina
pharmacokinetic formula for half life
Vd x 0.7 / clearance
pharmacokinetic formula for maintenance dose
steady state plasma concentration x clearance / bioavaliability factor
pharmacokinetic formula for loading dose
steady state plasma concentration x volume of distribution / bioavailability fraction
what is seen with phenotypic mixing
host cell has 2 viral strains
the virus will have nucleocapsid protein from one strain and unchanged parental genome from the other strain
will the next generation in phenotypic mixed virus revert back to the original
yes- because the underlying viral genome was not changed
what is the first line medication for ADHD
stimulant drugs that increase the availability of norepinephrine and dopmaine
what are the stimulant drugs used in ADHD
methlypheidate, dextroamphetamine, methamphetamine
what is associated with polyhydramnios
gastrointestinal obstruction and anencephaly
does nitroprusside affect stroke volume
no
what is a glomangioma
tender, small red blue lesion under the bail bed
what is the origination of glomangioma
modified smooth muscle cells that control thermoregulatory function
what blood supply is posteromedial papillary muscle supplied by
posterior descending
what does the glossopharyngeal nerve provide to the tounge
posterior 1/3 taste and sense
what nerve supplies sensation to the tonsillar lining
glossopharyngeal nerve
what gland does the glossopharyngeal nerve supply
parotid gland secretion
what provides sensation to the anterior 2/3 of tounge
V1
what provides taste to the anterior 2/3 of tounge
VII
what is the typical presentation of primary biliary cirrhosis
fatigue and pruritus in a middle age women
what is the typical presentation of a patient with primary sclerosing cholangitis
middle age man with IBD
elevated alk phos
what is the ophthalmic artery a branch of
internal carotid artery
why do we get guillian barre syndrome
molecular mimicry, antibodies formed against infectious agents cross react with myelin and schwann cell
what can be a measurement for renal plasma flow
PAH clearance
what can Vit A def cause
keratinizing epithelium
what is the function of Vit A
maintain mucus secreting columnar epithelia of the ocular conjunctiva, respiratory and urinary tract, and pancreatic and other exocrine duct
when will we see wide and fixed S2 splitting
ASD
what is mifepristone
progesterone antagonist
glucocorticoid antagonist
what is misoprostol
prostaglandin E1 agonist
what will damage to the lower trunk of the brachial plexus result in
damage to median and ulnar nerve
where does isotype switching in the B cells happen
germinal center
when does insulin peak once injected
2-4 hours after
what pathway do antipshycotics target
tuberoinfundibular pathway
mesocorticol pathway
mesolimbic pathway
nigrostrial pathway
what does decrease activity in the mesocorticol pathway result in
negative symptoms, flat affected and limited speech
what does increase activity in the mesolimbic pathway result in
positive symptoms, delusions and hallucinations
what does decrease activity in the nigrostrial pathway result in
extrapyramidal symptoms- parkinsonism, tardive dyskinesia, dystonia
what does decrease activity in the tuberinfundibular pathway result in
increase prolaction
what does buprenorphine target
partial opioid receptor agonist that binds with high affinity but has low instrinsic activity
what can buprenorphine do in patients on long term opioid therapy
precipitate withdrawl
what is a partial agonist
act at same sight as full agonist but has lower maximal effect
what does a noncompetitive antagonist do
decrease efficacy by shifting curve down
cannot be overcome by increase agonist substrate concentration
what does a competitive antagonist do
shift curve to the right and decrease potency
can be overcome by increasing the concentration of agonist substrate
what are the findings in uremic platelet dysfunction
normal PT, PTT, platelet count
increase bleeding time
what are the signs of marijuana intoxication
conjunctival injection, tachycardia, increased appetite, and dry mouth
what are the first line medications for bipolar
lithium, valproate, 2nd generation quetiapine
how can you calculate cardiac output with the fink principle
rate of consumption/ arteriovenous O2 content difference
what is the issue with systemic primary carnitine deficincy
inherited defect in the transport of long chain fatty acids into the mitochondria
what is the result of systemic primary carnitine deficiency
weakness, hypotonia, hypoketotic hypoglycemia
what is needed for the infection of shigella
mucosal infection of the M cell that overlie Peyer's patch
what are the non lactose fermenting organism
shigellea
salmonella
proteus
pseudomonas
what muscle is at the anterior midaxillary line of the chest
serratus anterior
what does a chest tube go through for pleural effision at the midaxillary line
serratus anterior muscle, intercostal muscle, ad parietal pleura
what is the presentation of gaucher disease
pancytopenia
osteoporosis
lipid laden macrophages resembling crumpled tissue/lipid laden macrophages
bone crisis
hepatosplenomegaly
what is the enzyme deficient in gaucher disease
glucocerebrosidase
what neuro tracts are affected in vitamin B 12 def
spinocerebellar tracts
lateral corticospinal tracts
dorsal column
how does neisseria meningitidis transfered
pharynx to blood to choroid plexus to meninges
what creates a pearly substance in the ear and has conductive hearing loss
cholesteatoma
what is the treatment for fructose intolerance
deficiency of aldolase B
decrease intake in fructose and sucrose
sucrose is glucose and fructose
what is choesteatoma in the ear due to
squamous cell debris, overgrowth of desquamated keratin debris within the middle ear space
what is the enzyme is affected in galactokinase deficncy
defect in galacotokinase
what is the mechanism of action of amphotericin B and nystatin
bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis
what is the mechanism if action of azole
inhibit the synthesis of ergosterol
what is congenital torticollis
child prefers to hold head tilted to one side
what is the common cause of congenital torticollis
malposition of the head in utero
what does tropheryma wipplei cuase
whipple disease
what is the pathology of whipple disease
PAS positive foamey macrophage in intestinal lamina propria
what are the symptoms of whipple disease
fat malabsorption, cardiac symptoms, arthalgias which affects the joint and lymph node, neurological symptoms
what is abetalipoproteinemia
inherited inability to make apolipoprotein B
lipids accumulate in the small intestine
what brain cancer will have rosenthal fiber
pilocytic astrocytoma
what will be seen in ependymomas
hydrocephalus because the enendymal cell in 4th ventricle is affected
at what level do we do a lumbar puncture
L3/L4 or L4/L5
at what level of the iliac crest
L4 verebral body
what are the signs of pheochromocytoms
paraoxysamal hypertension, flushing, diaphoresis, and headache
what happens to our lungs as we age
TLC unchange
FRV decreased
RV increased
what do we see with crohn disease with ileal resection
bile acid malabsorption
cannot absorb fat soluble vitamins
cannot get Vit K- impaired coagulation
where is the issue in broca aphasia
where is the SA node location
junction of the right atrium and superior vena cava
what antifungal targets the cell wall
caspofungin
where is the edinger-westhphal nuclei located
upper midbrain
how do youtreat drug induced parkinsonism
muscarinic antagonist- benztropine
what is the issue with galactose deficiency
issue with galactokinase
what are the symptoms of glactokinase deficiency
glalactose in blood, infantile cataracts
what are signs of iron def anemia
spoon shape nails aka koilonychia
shiny red tounge
what is the triad for pulmmer vinson syndrome
dysphagia
esophageal web
iron deficiency anemia
how can direct arteriolar vasodilator lower blood pressure but have tachycardia
activation of sympathetic activity
how can direct arteriolar vasodulator lower blood pressure but have edema
activation of RAAS
What is fidaxomicin
macrocyclic antibody that inhibit RNA polymerase
used against C. diff
what breast cancer will have microcalcidications
ductal carcinoma in situ
what happens to the heart as we age
decrease in left ventricular chamber apex to base
development of sigmoid shaped ventricular septum
myocardial atrophy with increased collagen deposition
accumulation of cytoplasmic lipofuscion pigments
what is the different in first and second fever in Dengue virus
first is usually self limited and the secondary infection is due to a different viral serotype that cause a more severe illness
what is the genetics behind hypertrophic cardiomyopathy
beta myosin heavy chain mutation
what is the pathology of papillary thyroid crcinma
large cell with finely dispersed chromatin- results in an empty or ground glass appearance
intranuclear inclusions or grooves
what is the pathology of follicular carcinoma
psammoma bodies
what is the genetics behind heritable pulmonary arterial hypertension
BMPR2
what is the function of BMPR2
inhibits vascular smooth muscle proliferation
what is affected in RTA type I
defect in ability of alpha intercalated cell to secrete H
what is urine pH and K level in RTA type I
urine pH greater than 5.5
hypokalemia
what is affected in RTA type II
defect in proximal convoluted tubule HCO3- re-absorption
what is the pH and K level in RTA type II
urine pH less than 5.5
hypokalemia
what is affected in RTA type 4
hypoaldosteronism
what is the pH and K level in RTA type 4
hyperkalemia
urine pH less than 5.5
what is seen with angiomyolipoma
tuberous scelerosis
can we see paraneoplasic syndrome in renal cell carcinoma
yes
ectopic EPO, ATCH, PTHrP, renin
what can schistosoma haematpobium cause
squamous cell carcinoma of the bladder