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Terms in this set (106)
right gastric artery
supplies the lesser curvature of the stomach, the left gastric artery supplies the proximal lesser cruvature and the right and left gastric anastomose
Mortality in pregnant women is high
Belongs to the hepevirdae family which has make, single stranded positive sense RNA
Diarrhea that resolves when nutrition is provided IV rather than orally suggests a malabsorption syndrome. Unabsorbed solutes in the GI tract draw water into the intestine, producing and osmotic diarrheaq
Located in duodenum and jejunum release CCK.
Primary stimulus for release is FA and AA in food
CCK causes gall bladder contraction which can contribute to biliary colic when the outlet is obstructed by gallstone disease
Proper hepatic artery, portal vein, Common bile duct. Cystic artery
Is STRATIFIED squamous epithelium - not keratinized
Is a 5ASA analog that is used to treat mild to moderate UC. It's used for maintenance purposes so you dont have to keep them on long dose steroids
Gram negative, oxidase positive, urease positive rod
Amoebic dysentery most often acquired in the tropics
Invades the colonic mucosa and creates shallow ulcers.
Symptoms include loos stools with mucus an blood. It can lead to fulminant colitis.
Severe colitis, perforation, localized ameboma, and LIVER ABCESS
Primary biliary cholangitis
Conjugated hyperbillirubinemia and increased Alk Pho's
Chronic granulomatous inflammation around medium sized intrahepatic bile ducts is seen
Associated with Anti mitochondrial antibodies
Is a synthetic analog of somatostatin and decreases portal blood flow which decreases variceal bleeding
It inhibits the vasodilator hormones thus causing splanchnic vasoconstriction
Used to treat diarrhea in various endocrine disorders such as carcinoid syndrome, gastronomy, and glucogaonama.
Causes the migrating motor complexes to occur during fasting
Calcium bilirubin stones
Bilirubin or pigment stones are typically seen in patients with chronic hemolytic disorders such as hereditary spherocytosis, sickle cell, and biliary tract infection
Cytoskeleton membrane protein defect. Abnormal red cells are removed from circulation from the spleen.
Angiosarcoma of the liver
Highly aggressive tumor that arises from blood vessels. Risk factor is vinyl chloride
Is caused by mitochondrial dysfunction that leads to impairment of oxidative phosphorylation and fatty acids beta oxidation in a virus infected, sensitized host
Consists of enchepatlopathy and hepatic failure that typically occurs in children younger than 15
Gram negative oxidase positive curved rod
Transmission is fecal oral and primarily occurs via contamination of poultry
Endothelial cells - chylomicrons
Chylopmicrons are lipoproteins that primarily carry dietary TG from the intestine to the tissues
LPL is found on the luminal surface of endothelial cells lining the capillaries and is required for the metabolism of chylomicrons form VLDL and LDL
Calcification of the pancreas seen on CT
Chronic pancreatitis can cause calcification of the pancrease that are visible radiologically as opacities or opaque lesions. Up to 30% of patients with chronic pancreatitis eventually develop DM2
2 cm mass in pancreas and increased acid levels
Means zollinger ellinosson. Which can arise in the pancreas or in the duodenum. The tumor does not respond to secretin and increases acid secretion with secretin. See gastric cell hyperplasia and one or more duodenal ulcers.
Germ tube test
HIV positive patient with oral exudate: Candida albicans
Germ tube test distinguishes candida from normal flora
Is a H1 antagonist used to treat motion sickness and true vetigo
Is an antiemetic that blocks dopamine receptors in the chemoreceptors trigger zone
Is number one cause of painless rectal bleeding in the elderly. Andiodysplasia is number two (thin and fragile blood vessels)
most common type of non-neoplastic polyps; small and more often multiple; found in left colon and rectum.
Sawtooth glandular epithelium composed of proliferated goblet cells and columnar epithelium. No malignant potential. HAVE NO DYSPLASIA so cant be adenoma
Oral rehydration therapys
Glucose absorption across intestinal epithelium occurs in association with Na+. Cl, bicarbonate, and water accompany Na and glucose leading to rehydration
Primary preventative measures
Decrease both incidence and mortality of the diseases.
Diphenhyrdamine(anithistamine with anticholinergic effects)
can percipitate narrow angle glaucoma
can cause cognitive impairment and delirium in the elderly, urinary retention, constipation, dry mouth, and tachycardia
anti cholinergics relax the pupillary constrictor muscle
alpha 1 agonists stimulate the radial dilator muscle
result from a single fertilized egg that divides into two at the blastocyst stage
which receptor is stimulated to allow ca2 into smooth muscle cells
Alpha-1 adrenergic receptor leads to production of IP3 and DAG. IP3 release ca from the Sarcoplasmic reticulum. DAG stimulates Protein kinase C.
Stimulation of Alpha-1 receptors causes constriction of peripheral blood vessels, pupillary dilation, contraction of sphincters in GI tract and bladder, and pilomotor smooth muscle contration.
nicotinic receptors on skeletal muscles work by allowing sodium into cells through Gs. Alpha 1 is Gq. M2 is Gi.
Familial hypercholesterolemia type IIa
mutation of Apo100 receptor in the liver. Pts accumulate LDL cholesterol in the bloodstream which can lead to early atherosclerosis. Pts can develop xanthomas. The most severe from of the disease causes disease pts to die from MI before 20 years of age.
Gallstones are a side effect of what type of qualitative anemia
Herediatry spherocytosis which is due to seeing spheres on RBC smear that is due to defect in ankyrin or spectrin. Splenic destruction of the spherocytes can lead to extravascular hemolytic anemia, jaundice, splenomegaly, and pigmented gallstones.
see a normocytic mormochromic anemia. high unconjugated bilirubin leads to pigmented black gallstones. and osmotic fragility test is positive.
if a failed terminated pregnancy then where could complications arise
rectouterine pouch: lowest part of the female peritoneal cavity
posterior fornix of the vagina is in close relation to this space and can be penetrated in attempts to induce abortion
is a MAO inhibitor and is treatment for atypical depressant.
barbituates, alcohol, phenothiazines, and MAO inhibitors decreases the amount of REM sleep. When pts stop the disease they get a rebound amount of REM sleep and REM rebound develops with an increased number and intensity of dreams.
what type of infection causes dead birds and occurs during summer seasons?
viral encephalitis caused by an arthropod, mosquito vector. encephalitis causes abnormalities in brain function including altered mental status and ataxia and sensory deficits. Meningitis causes a lethargic patient but their brain function remains normal
doxy and tetracyline
bind to the 30S ribosome subunit. Azithromycin is a macrolide which binds to 50s
lyme disease tx?
doxycycline is used for tx along with tetracycline. tetra is eliminated renaly and doxy is primarily excreted by non renal routes.
The most common gastrointestinal emergency occurring in neonates; may progress to intestinal perforation, peritonitis, and sepsis. around when infant is started on oral foods. abdominal distention and air in the bowel wall or portal vein.
Atrioventricular septal defects of osteum primum
associated with DS cuz its an endocardial cushion defect.
22q11 deletion and failure of the 3and 4th arch to develop so u get truncus arteriosis and tetrology of fallot
is the transposition of the great vessels
misfolding of fibrillin-1 which causes defects in elastin causing dissecting aortic aneurysm.
XO has coarctation of the aorta.
serology of acute HBV
positive HBsAg, HBeAG, anti-HBc-IgM but the ansence of HBsAB and HBeAB. Persistance of HBsAg beyond 6 months means a chronic infection
Bucket analogy for RPF and GFR
Afferent (AA) and Efferent arteriole (EA) can be thought of as tubes that fill AA and empty EA a bucket(glomerulus). the fuller the bucket, the greater GFR. Dilating either tube will increase flow through the bucket. Dilating the input fils the bucket (increases GFR), dialating the outflow empties the bucket (lower GFR). Constricting the input lower the bucket level, constricting the output raises bucket level
elevated epo levels and history of alcohol abuse indicate what
alcohol abuse, nodular cirrhosis, elevated bilirubin all suggest that liver pathology. Elevated epo= hepatocellular carcinoma. Other epo secreting tumors are renal cell carcinoma, hemangioblastoma, and pheochromocytoma
source stays the same, target changes. Associated with redirected emotion, phobias, scapegoating
what is ASD defined by?
prominent right ventricular cardiac impulse, mid systolic ejection murmur heard in the pulmonic area and along the left sternal border, and FIXED SPLITTING OF THE SECOND HEART SOUND. right atrial and ventricular hypertrophy due to increased preload on the right side from the left to right shunt.
injury at mid humerus affects which nerve
radial nerve innervates the posterior mm of the arm and forearm and injury leads to loss of extension of the elbow, wrist, and fingers, and weakened supination of the forearm. There is also sensory loss over the posterior arm, forearm and dorsum of the hand.
Induction of REM sleep
Serotonin: helps to initiate sleep
ACh: induces REM sleep
NE: lower during REM sleep
Dopamine; produces arousal and wakefulness: dopamine rises with waking
SANDman = mnuemonic
G-, oxidase neg rod with large polysaccharide capusle that causes pneumonia in alcoholics
Klebsiella, which forms lobar cavitations in the lobes. use 3rd generation cephlasporins and fluoroquinolones to treat
a patient with anemia and Hbn of 6
would have a decreased mixed venous SaO2 and venous p02 will also be reduced. cuz theres not as much hbn to carry the oxygen around. The tissues will still extract the same amount so the venous blood will be left with a lot less.
pt unable to close eyelid and lips and cant make facial expressions after blow to side of face
VII courses superficially through the parotid gland and causes paresis and paralysis of ipsilateral face.
normally acetoacetate and 3-hydroxybutrate are produced at equal levels. When this ratio decreases is when you know that youre in ketoacidosis.
Congenital syphilis symptoms
as saddle nose(flattening of the nose), Hutchinson teeth(notched incisors), mulberry molars(deformed molars), or saber shins(bowed out shins), interstitial keratitis(vascularization of the cornea), sensorineural deafness
USE PENCILLIN TO TREAT T.Pallidum infections
vitamin B12 causes by which tapeworm?
fish tapeworm - D. latum - humans get infection by ingesting undercooked or raw fish that are contaminated with the tapeworm, adult worm attaches to small intestine and release eggs. adult tapeworm absorbs vitamin B12 from intestinal lumen and also interferes with ileal vitamin B12 absorption. ID eggs in stool for daignosis. Tx with niclosamide or praziquantel.
note: clonorchis causes cholangiocarcinoma
If uti has positive leukocyte esterase and negative nitrite...
think G+ enterococcus faecalis or staphlococcus saprophyticus cuz The G- enterobacteriacie family (E.coli, enterobacter, klebsiella , and proteus) all take nitrate to nitrite.
coagulopathy caused by endothelial cell injury that triggers a cyclic process of thrombosis and fibrinolysis
characterized by presence of thrombi within organs, bleeding from mucosal surfaces, thrombocytopenia, prolonged PT and PTT, decreased fibrinogen levels and elevated fibrin split products.
Helmet cells are seen in DIC, HUS, TTP or mechanical heart valves
associated with thymomas, Type II hypersensitivity reaction to Ach receptors. Symptoms get worse as the day goes on
Antibodies agaisnt presynaptic calcium channels of the NMJ, are associated with small cell carcinoma of the lung. These pts in contrast to MG pts get weak at beginning of day and it gets better with more movement.
obstructive sleep apnea systemic issues
arousal from sleep in response to asphyxia keeps the SNS active = HTN and increased risk of stroke
Hypoxic pulmonary vasoconstriction = pulmonary HTN
CNS hypoexmia = increased sympathetic output = systemic vasoconstriction, increased afterload and preload = increased risk of HR and cardiac output
graft versus host disease
is due to the donor leukocytes affecting the foreign host tissue. These donor T cells can cause apoptosis through Fas Ligand binidng and CD8 release of perforin and granzyme
tumor is derived from primitive streak remnants and often contains bone, hair, or other tissue types so comes from all germ layers. Most common tumor in US neonates.
Right lower quadrantanopia
parietal lobe issue. Upper retina receives info from lower eye fields and travels to the parietal lobe while those in the upper eye fields end up in meyers loop and then temporal lobe. LGN causes a hemianopia.
ACE inhibitor MOA
Prevent Na+ and H2O reabsorption by inhibiting aldosterone secretion (diuresis results)
promotes na excretion by kidneys and potassium retention but have no effect on phosphate handling
primitive defense mechanism where objects or people are viewed as either ALL GOOD or ALL BAD
28yo male Pt comes with bilateral ptosis and distal muscle weakness. States father and brother have it but his symptoms seem to be worse. What is it?
He had myotonic dystropy 1 an adult onset form of MD. AD disorder with CTG repeat>50. Symptoms start in 20-40s and frontal balding, eyelid and facial muscle atrophy, cataracts, distal muscle weakness, infertility, and insulin resistance. HISTOLOGICALLY SEE RING FIBERS AND CENTRAL NUCLEI ARE PRESENT.
Lymph nodes in the groin region
superficial LN = penis, skin of the labia, scrotum (not testes) and anal canal drain to superficial inguinal LN
tumors above dentate line = ano, peri rectal and paravertebral LN
tumors below dentate line = superficial inguinal lymph nodes
which part of the renal tubule has a brush border?
PCT is the only portion with abundant microvilli because its incharge of all the reabsorption.
what is the main source of glucose in a dieting obese person ie eating a very low carb diet?
glycerol liberated from the breakdown of fats. gylcerol is phosphorylated by glycerol kinase to form Glycerol-3-phosphate which enters the glucooneogenic pathway via oxidation to become dihydroxyacetone phosphate.
Can fatty acids produce glucose?
kinda. odd numbered FA leave a final propronyl coa which can be made into a succinyl CoA which equals 1/2 of a glucose molecule
Mutations in N-Myc seen in which cancer
most common tumor in adrenal medulla in kids <4.
arises from NCC and is an asymptomatic abdominal mass crossing the midline that is rough and irregular. Wilms tumor does not cross the midline.
see small blue cells forming pseudorosettes
binding to activated lymphocyte IL2 receptor alpha chains, antagonizing IL-2. Kidney transplant rejection prophylaxis
binds to and inhibits CD3 T-lymphocyte antigen.
mTOR inhibitor (a growth factor); binds FKBP. Blocks T-cell actvaiton and B-cell differenation by preventing response to IL-2. Used in kidney tranplants (the kidney sirvives).
Tox: anemia, thrombocytopenia, leukopenia. INsulin resitance, hyperlipidemia.
synergistic with cyclosporine
via inhibit CALCINEURIN, blocks T-cell proliferation. Remember that sirolimus does this via the mTOR pathway blockage
older woman with headache, muscle aches, jaw claudication, tenderness of temples or unilateral HA and normal labs except elevated ESR
temporal arteritis- see granulomatous lesion with giant cells. If left untreated can lead to blindness.
how does vascular resistance with cardiogenic shock
MI impairs the ability of the LV to pump, thereby decreasing stroke volume and reducing cardia output. A resultant drop in arterial pressure can lead to cardiogenic shock
compensatory baroreflex-mediated increase in sympathetic vascular resistance
how are ascaris lumbercoides dealt with by the immune system
Ascaris penetrate intestinal mucosa and can cause fever and respiratory issues.
Immune system reacts by coating with IgE antibodies which trigger eosinophil mediated cytotoxicity. TH2 response causes Fc receptors on mast cells causing them to degranulate.
rectal tumor that has glandular structure?
Colorectal adenocarcinoma. risk factor is UC. also polyps. This is the one with adenoma polyposis sequence and polyposis syndrome
most frequent benign intracranial neoplasm.
middle aged females are most often affected
arise from arachnoidal cells of the meninges
slow growth and no invasion.
reactive arthritis - reiter syndrome
"Cant pee, can't see, can't climb up a tree"
conjuctivitis, urethritis, arthritis.
associated with chyamydial infections in 70% of cases and HLA-b7. no crystals seen on aspiration of the knee.
weakness in the ability to protract the scapula
affected muscle is the serratus anterior. innervation by the long thoracic nerve (C5,C6,C7)
Continuous "machine-like" heart murmur
PDA. PDA risk factors = prematurity, birth and high altitude, and maternal rubella infection.
fried egg appearance; tumor cells with round nuclei and cleared cytoplasm
Oligodendroglioma. tend to occur in the cerebral hemispheres of middle aged patients of both sexes
bradykinesia, a resting tremor, gait difficulty, and rigidity. Due to degeneration of nigrostriatal dopamine and Ach in the striatum.
Tx: increase dopaminergic tone. (levadopa and carbidopa)
decrease Ach with muscarinic antagonists which is trihexyphenidyl and benztropine. Amytriptiline is another antidepressant that can produce antimuscarinic effects.
posterior limb of the internal capsule lesion
pure motor deficit stroke.
Contralateral hemiplegia with involvement of the face (lower face, sparing in the forehead)
Lacunar strokes commonly involve the lenticulostriate arteries
HTN and DM are risk factors
a gram postive anaerobic bacteria taht causes oral-cervicofacial abcesses
Actinomyceses israelii - long, branching filamentous rods when cultured
Tx with penicillin
short term reflex in diabetes pts to increase blood glucose
Type 1 DM pts dont have insulin or glucagon to alter glucose levels so what they use is epinephrine secretion to increase blood glucose in case of hypoglycemia.
how to diagnoses MEN1 tumors that have increased gastric secretion
Zollinger ellison syndrome is diagnostic with a positive secretin test. .
Gastring is normally produced by G cells and IS NEGATIVE FEEDBACK TO SOMATOSTATIN AND SECRETIN.
secretin stimulation test
Secretin production inhibits gastrin production in normal people, but in those with gastrinoma it markedly INCREASES GASTRIN PRODUCTION
PKU is an AR disease and phenyalanine is a teratogen to the developing fetus
treatment for nausea during cancer that also increases apetite
dronabinol - THC agonist
ia potassium sparing diuretic that acts primarily as a competitive inhibitor of aldosterone receptors in the distal segments. may cause gynecomastia by displacing androgen from the androgen receptor and by clearing testosterone faster
first stages of healing of open wound
macrophages dominate in the first 3-5 days. they play an essential role in formation of granulation tissue and phagocytosis of inflammatory cells, bacteria, and damaged tissue
cough, coryza, conjunctivitis, and cephalocaudal spreading rash are the 4 c's of what viral exanthem - koplik spots
What is a gram positive, (coagulase positive and catalase positive bacteria that clumps in grapes) what is the virulence factor?
Protein A is the opsonin that is found on staph auerus
Muscle fiber shortening and lengthening
A band is ALWAYS the same and I band contacts.
A band is from sarcomere delineated by myosin filaments.
I band is the space between the A bands, and shortens with contraction
In a gun shot wound to the armpit, what will you hit?
axillary artery, axillary vein, and all the cords. ALL THE CORDS ARE IN THE AXILLA.
If you fracture the surgical neck of humerus, what nerve do you hit?
the axillary nerve!
substantia nigra loss of dopaminergic neurons
why does oral glucose have more of an effect on insulin levels than IV glucose?
because of GASTRIC DEPENDENT INSULINOTROPIC PEPTIDE secreted by the K cells of the duodenum and jejunum
is hilar lymphadenopathy and granuloma in middle and lower lobe.GHON complex means primary TB. Reactivation is the upper lobes lol.
When the heme portion of hemoglobin has oxidant damage (Fe3+) which results in the loss of the RBC's oxygen carrying capacity. (Drugs etc). Fe2+ is the normal binding form. Can be caused by cyanide poisoning and NO2. nitrites can also do this through dietary intake or poluttion.
Normal PaO2, low SaO2
Tx: methylene blue
how do you increase muscle contractile force
by increasing frequency of motor nerve firing units through summation. Summation is either sending out consequetive quick APs to the same muscle causing a twitch or by Multiple fiber twitch by adding more muscle fibers to the AP.
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