Last minute from Qs
Terms in this set (2000)
diastolic, decrescendo murmur at L sternum
tx of bacterial vaginosis
bacterial vaginosis histo
dx of gonorrhea/chlamydia
culture and PCR
trichomonas vaginalis histo
motile flagellated trophoizites -- wet mount microscopy
B lactamase inhibitors
clavulanic acid, sulbactam, tazobactam
transmural inflammation of arterial wall with fibrinoid necrosis
MC sx of polyarteritis nodosa
fever, abdominal pain, peripheral neuropathy, weakness and wt loss
what is polyarteritis nodosa associated with and what organ does it spare?
asthma, eosinophilia, granulomatous necrotizing vasculitis
Churg Strauss syndrome
main mechanism of combined OCP
decreased synthesis of gonadotropins (FSH/LH)
flat facial features + excessive skin on neck + duodenal atresia
part of penis most susceptible to damage by pelvic fracture
membranous (posterior) urethra right below prostate
part of penis most susceptible to damage in straddle injuries
bulbar (anterior) urethra
major risk factor for invasive cervical cancer
HPV-- multiple sex partners
most specific marker for dx of acute HBV
marker of active HBV replication and high transmissibility
HBV vaccination seromarkers
anti-Hbs IgG ONLY**
micropthalmia, cleft lip/palate, microcephaly/holoprosencephaly, omphalocele, umbilical hernia, polydactyly
Trisomy 13-- Pautau syndrome
micrognathia, prominent occiput, low set ears, rocker bottom feet, Meckel's diverticulum
Trisomy 18 -- Edwards
tall male, gynecomastia, small testes and infertility -- normal or abnormal intelligence
Klinefelter's (46, XXY)
BRCA genes function
tumor suppressor--> ds DNA breaks REPAIR
mutation--> breast and ovarian cancer
tumor suppressor--> normal protein degradation and genomic stability -- transcription factor
tumor suppressor--> check point--> inhibits G1-->S phase
oncogene--> RTK --> signal transduction
oncogene--> inhibits apoptosis--> follicular lymphoma
mechanism of diphtheria toxin
same as exotoxin A (pseudomonas)
inhibit EF-2 by ribosylation
C. diff toxin mechanism
induces actin depolymerization --> cell death and necrosis
Cholera toxin mechanism and association
E Coli LT toxin
AB5--> activates Gs ADP ribosylation --> increases adenylate cyclase--> increases cAMP--> secretory diarrhea
pertussis toxin mechanism
AB--> ribosylates and INACTIVATES Gi ADP--> increases adenylate cyclase--> increases cAMP-->increases histamine --> cough
E Coli ST toxin
Shiga toxin mechanism and association
shiga-like toxin (E coli)
binds 60S ribosome--> inhibits protein synthesis
botulinum and tetanospasm
both cleave synaptobrevin and block vesicle formation--> inhibiting nt release
tetani--> inhibits GABA and glycine
botulinum--> inhibits ACh
3 proteins-- protective antigen, edema factor, lethal factor
volume of distribution equation
amount of drug in body / plasma drug concentration
high= all in tissues- small lipophilic drugs
low= all in blood-- large/charged molecules or bound to protein
how long does it take a drug to reach steady state?
4-5 half lives
half life equation**
t1/2= o.7* Vd / CL
how many half lives does it take to eliminate a drug totally? (without any effect)
needs to eliminate by 96% --> 5 half lives
MC breast tumor in <35 yo
what does HBV due to HDV to help cause hepatitis?
coats the virus with surface antigen
which hormones is alpha hCG similar to?
FSH, LH and TSH--> hyperthyroidism
increased AFP DDx
neural tube defects or abdominal wall defects
yolk sac tumors
PCOS tx for infertility
SERM--> clomiphene--> blocks estrogen receptors on hypothal/pituitary--> blocks negative feedback--> increases FSH/LH
MCC of septic arthritis in sexually active adults
N. gonorrhea -- assymetric polyarthritis of large joints with fever
MCC of septic arthritis in children and non-sexually active adults
S. aureus - IV drugs
"navir" drugs - mechanism, indication and SE
hyperglycemia and lipodystrophy
"cyclovir" drugs activation
must be phosphorylated by cellular kinases-- intracellular activation
same as zanamivir
--> influenza A and B--> neuraminidase inhibitor
**sialic acid analogue inhibitor
NO INTRACELLULAR ACTIVATION (no activation by kinase)
herpes/CMV -- inhibit DNA polymerase
HIV--> inhibits reverse transcriptase
SE of TMP-SMX
megaloblastic anemia (dihydrofolate reductase inhibitor--> decreased folate)
SJS and TEN
most widely used HIV drug and SE
zidovudine (NTRI)--> BM toxicity and anemia
SE of acyclovir
what is contained in ovarian ligament
where are the ovarian vessels contained?
what is contained in the round ligament of the uterus?
artery of Sampson!
where are the uterine vessels contained?
Cardinal ligament/transverse cervical ligament
single nucleotide deletion causes what kind of mutation?
hPL is similar to what hormones?
prolactin and GH
methylation vs acetylation of DNA
methylation of DNA and histones--> represses DNA transcription (M=Mute)
acetylation of histones--> allows for transcription (A=active)
amino acids in histones
arginine and lysine
enzyme deficient in SCIDs
adenosine deaminase--> build of adenosine--> toxic to B and T cells
due to HPV
dense nuclear staining with perinuclear clearing--> halo
cause of verruca
warts--> HPV 1-4
envelope glycoprotein that makes spheres and tubules of 22 nm diameter that does not correlate with replication
# new cases in specified time period/ pop at risk during time period
**measures disease risk
# of existing cases/pop at risk --> all current cases
= incidence x avg of disease duration
what affects prevalence?
full recovery or death --> both decrease prevalence
mutation of what gives you immunity to HIV?
What does HIV bind to initially?
CCR5 or CXCR4 on CD4 T cells
env--> gp120- attach to CD4cell; gp 41--> fusion
gag--> p24 --> capsid protein
pol--> reverse transcriptase
nef= virulence of virus-->progress to AIDS
tat and rev--> upreg replication
where do chromosomes from a complete molar pregnancy come from?
complete moles= father!
complete--> enucleated egg + 1 or 2 sperm
partial--> 2 sperm + 1 egg -- some from mother
primary amenorrhea in pt with fully developed 2 sex characteristics, cyclic pelvic pain and no other abnormal findings
imperforate hymen--> develop hematocolpos--> forms palpable mass anterior of the rectum
hydatid cyst in liver- cause and contraindications
Echinococcus granulosa--> egg shell calcification with thick fibrous capsule
**DO NOT ASPIRATE--> potential to cause anaphylaxis if spill into peritoneum
drug responsible for majority of OD related deaths?
opioid pain relievers
Zidovudine -- mechanism
*binds reverse transcriptase, but lacks 3 OH group so prevents 3-5 phosphodiesterase bond formation--> chain termination
epithelium of ovary
epithelium of endo and ectocervix
endo--> simple columnar
ecto--> stratified squamous
epithelium of uterus and fallopian tubes
HBeAg is a marker of what?
2 amenorrhea due to loss of basalis and scarring--> from excessive D and C
mechanism of preeclampsia
abnormal placental spiral arteries--> endothelial dysfunction, vasoconstriction and hyperreflexia
K+ sparing diuretics
spironolactone, amiloride, eplerenone, tiamterene
furosemide, ethacrynic acid
where is IVC and aorta on axial CT?
IVC-- on L of image (R of pt)
aorta-- on R of image (L of pt)
**IVC is always bigger than aorta!!!
Tzanck smear + rash
guanosine analog-- activated by viral thymidine kinase to produce acyclovir triphosphate--> INCORPORATED into viral DNA--> inhibits viral DNA polymerase and causes chain termination
**think "CYCLE"-- wants to get INTO cycle
gp 120-- bind CD4 T cell
gp 41-- fusion
protease inhibitors-- "navir"
NRTIs--> nucleoside - inhibit reverse transcriptase (zidovudine-- AZT)
NNRTIs - non nucleoside ("vir" in middle) -- rash and hepatotox
integrase inhibitors -- raltegravir
fusion inhibitors (gp 41) -- enfuvirtide
MOA of interleukins
MOA of heparin and what do you monitor
bind antithrombin and activate it
what are coagulation factors activated by?
exposure to activating substance, phospholipid surface (platelets), Ca++
intrinsic coagulation pathway
collagen/kinin--> XII-->XI-->IX--> VIII-->X--> V--> II--> I + XIII
clotting factor I
clotting factor II
fxn of bradykinin
vasodilation, permeability and pain
factor VIII, X-linked
factor IX, X-linked --> Christmas disease
Extrinsic coag pathway
Tissue factor/thromboplastin--> VII--> X--> V--> II--> I + XIII
vitamin K dependent factors
II, VII, IX, X, Protein C and S
if have vit K deficiency what blood tests are elevated?
PT and PTT
antidote of hep
antidote of warfarin and what must you monitor
fresh frozen plasma
monitor PT and INR
mechanism of antithrombin
main targets: II and X
inhibits factors II, VII, IX, X, XI, XII
what do protein C and S do?
cleaves and inactivates V and VIII
sources of vWF
endothelium and platelets
antidote of thrombolytics
IV vs oral anticoagulants
IV--> inactivates in blood
oral--> decreases synthesis of factors in liver
what tx is used in HIT?
direct thrombin inhibitors--> argatroban
Bernard Soulier syndrome
defect in GpIb--> platelets can't adhere to vWF
defect in GpIIb/IIIa--> platelets can't bind to each other--> decreased aggregation
mech of ASA
inhibits COX--> decreases TXA2--> decreased aggregation
GpIIa/IIIb R inhibitor--> decreased aggregation
deficiency of ADAMS 13
TTP--> get large multimers of vWF --> increased platelet adhesion and aggregation--> thrombosis and thrombocytopenia
- microangiopathic hemolytic anemia (schistocytes)
coag factors with shortest half life??
protein C and VII
**WARFARIN TRANSIENTLY DECREASES PROTEIN C MORE THAN OTHER FACTORS--> get transient increase in coagulation!!! --> must admin with hep at first!!!
effect of cAMP and phosphodiesterase inhibitors on platelets
decreased aggregation and vasodilation
what is the only G2 specific inhibitor cancer drug?
bleomycin --> pulmonary fibrosis
what cancer drug causes hemorrhagic cystitis and what can prevent it?
cyclophosphamide -- covalently X-link DNA at Guanosine
prevented by MESNA
major SE of most cancer drugs
BM suppression--> pancytopenia
affect S phase:
- methotrexate --> folic acid analoge that inhibits dihydrofolate reductase --> inhibits dTMP
- 5-FU --> pyrimidine analog --> complexes folic acid and inhibits thymidylate synthase --> decreases dTMP
- 6-MP/azathioprine --> purine analog--> inhiits purine synthesis
how do you stop myelosuppression of MTX?
how is 6-MP metabolized and what don't you want to take with it?
xanthine oxidase - don't take with allopurinol
dx of brain tumors
nitrosoureas ("-ustine")--> cross BBB
M phase specific cancer drugs
microtubule inhibitors--> vincristine/vinblastine
- vincristine--> CNS tox
- vinblastine--> BM suppression
paclitaxel--> hyperstabilize microtubules
MOA and tox of cisplatin
cross-link DNA-- alkylating
tox- nephrotoxic and CN VIII damage
MOA of hydroxyurea
inhibits ribonucleotide reductase--> inhibits DNA synthesis
MG associated with?
stellar cell in epidermis with granules shaped like a tennis racket and myeloid surface markers
Langerhans cells -- Birbeck granules
macro of liver
mechanism behind tanning
UV light causes increase in melanin production from melanosomes--> NO INCREASE IN MELANOCYTES
normal # of melanocytes with decreased production in melanin (decreased tyrosinase)
normal # of melanocytes with increased melanosomes
abs against melanocytes
fxn of microglial cell in CNS
fxn of mesangial cells in kidney
where is biphosphoglycerate mutase found and what is its function?
convert 1,3 BPG--> 2,3 BPG in hypoxic states--> R shift of Hb-O2 sat curve to deliver more O2 to tissues
what factors cause an R shift in Hb/O2 sat curve?
increase in temp, 2,3-BPG, CO2 and H+ ions (decrease in pH)
PABA sunscreen blocks what?
UV involved in sunburn vs tanning/aging?
recurrent infections, easy bleeding, eczema
Wisckott-Aldrich syndrome = WATER
mutation in WAS gene--> X-linked
**defect in cytoskeleton
cerebellar defects, spider angiomas-- associated with decrease in what?
IgA --> Ataxia-telangiectasia (ATM gene)--> ds DNA breaks --> no repair
what predisposes to recurrent Giardia infections?
albinism + peripheral neuropathy + recurrent pyogenic infections
Chediak Higashi syndrome--> LYST gene
**dysfunction of microtubules--> phagosome and lysosome can't fuse
defect in NADPH oxidase--> decreased ROS
**catalase + orgs -- Pseudomonas
22q11 deletion--> failure of 3rd and 4th pouches (thymus and parathyroid glands)
decreased parathyroid glands--> decreased PTH--> decreased Ca++
chronic diarrhea, mucocutaneous candida + recurrent bacterial/viral infections
recurrent Neisseria infection
abs against sheep RBCs
Abs in SLE
specific--> anti-dsDNA and anti-smith (snRNP)
vasodilation of arterioles and veins and diuresis
ANP and BNP--> increase cGMP
where in kidney is Ca++ reabsorbed??
DCT via PTH
where is fluid most dilute in kidney tubules?
function of descending limb of kidney?
concentrate urine--> hypertonic (>300)
function of ascending limb of kidney?
dilute urine--> hypotonic (<300)
function of DCT?
continue to dilute --> most hypotonic
function of CT of kidney?
ADH--> CONCENTRATE URINE!! (~1200)
function of PCT?
reabsorb everything--> ISOTONIC (~300)
neonate who contracted HBV from mother- what will LFTs be?
mildly elevated--> HBV is not inherently cytotoxic to liver-- all due to inflammatory reaction and neonate's immune system is not fully developed so inflammation will be minimal
Ab against RANKL--> prevents osteoclast activation--> good for osteoporosis or bone mets
gallstone risk factors
4 Fs: fat, fertile, female, forty
gallstone mechanism in preg
estrogen--> hypercholesterol secretion
progesterone--> decreased GB motility
chromosome 3 deletion
VHL --> RCC
WT-1 gene--> Wilms tumor
RB gene--> retinoblastoma and osteosarcoma
Renal cell carcinoma- gene association and chromosome
VHL --> Chrom 3
Von hippel lindau disease
RCC, hemangioblastoma of cerebellum, pheochromocytoma
2 genes associated with renal tumors
VHL--> RCC -- chrom 3 --ADULTS
WT-1 --> Wilm's tumor--> chrom 11 -- KIDS
Wilms tumor, aniridia, geniturinary malformation, retardation
WAGR complex--> WT
Wilms tumor, hypoglycemia, hemihypertrophy, organomegaly (tongue)
which amino acid is NO made from in endothelium?
effects of B-blockers
decrease HR, contractility and RENIN!!
what do you want to vaccinate for in aplenics?
encapsulated bacteria--> S. pneumo, H. flu and N. meningitides
what is main issue of asplenics?
can't clear encapsulated bacteria!!
lactose fermenting gram - bacteria
E. coli, Klebsiella, Enterobacteria and enterococcus
found in cell walls of gram + and - bacteria
**mycoplasma and ureaplasma don't have cell walls!
function and component of capsule in bacteria
polysaccharide--> protects against phagocytosis
function and component of cell wall in bacteria
peptidoglycan--> major surface antigen!!
tx of mycoplasma
macrolides or tetracyclines
minimal change disease biopsy findings
EM-- fused podocytes
LM and IF = NORMAL
renal angiomyolipoma association
tuberous sclerosis--> AD--> brain hamartomas, ash-leaf skin patches, cortical tubers--> seizures and retardation
in a sarcomere, what does actin attach to? Myosin?
actin--> Z line
myosin--> M line
actin= I band
myosin= H band
which nerve courses with the inferior thyroid artery?
which nerve courses with the superior thyroid artery?
E. coli virulence factor involved in sepsis/shock?
Lipid A--> LPS
E.coli virulence factor involved in dysentery?
Shiga-like toxin-- EHEC O157 --> inhibit protein synthesis (60S)
E.Coli virulence involved in watery diarrhea?
LT/ST toxin-- like cholera--> increase cAMP
E. coli virulence in UTI?
fimbriae-- P antigen --> adhesion
E. coli virulence in meningitis?
capsule--> K antigen
GAG in Type 1 collagen in cornea
proteoglycan in ECM--> vascular endothelial cell adhesion to BM
integrin binds to what in the BM??
collagen, laminin, fibronectin
B/L conjunctivitis, fever for 5 days, red tongue and cracked lips, Asian <4, rash, swelling of hands/feet, cervica lymphadenitis --> DX and association
Kawasaki disease--> coronary artery aneurysm
HIV pt with fever, weight loss, diarrhea, anemia, hepatosplenomegaly, clear CXR, increased ALP and LDH-- acid fast org that grows in 41C -- dx and tx
MAC --> macrolides
triplet repeat disorders
HD--> CAG on 4
FA--> GAA on 9
Myotonic dystrophy--> CTG on 19
tingling and numbness in legs with ataxia presenting in male before age 25-- dx and association
HOCM-- ventricular septum hypertrophy
adrenal and cortisol deficiency due to adrenal atrophy
saddle nose and palpable purpura
AD --> B myosin heavy chain mutation
innervation of GB
normal epithelium of distal esophagus
Barrett's esophagus epithelial changes
distal esophagus--> columnar + goblet cells
labs of DIC
decreased platelets and fibrinogen
increased PT and PTT
dx hormone in menopause
increased FSH--> due to decreased estrogen -- no negative feedback
hypotension, JVD, distant heart sounds - dx and tx
pericardial tamponade --> pericardiocentesis
increase in JVD with inspiration --> pericardial tamponade
hx of surgery, fever, dyspnea, absent tactile fremitus and inspiratory lag
obstructive/resorption atelectasis due to mucus plug obstruction
risks for obstructive atelectasis
recent surgery- mucus plug, diaphragm restriction, COPD, foreign body restriction
healthy, asx pt with systolic murmur L sternal border
VSD -- harsh pansystolic
smokes, hemoptysis with central lesion with cavitation and hypercalcemia
squamous cell lung cancer --> secretes PTH --> hypercalcemia and hypophosphatemia
lung CA in non smoker that grows along alveolar septa and does not invade --> thickened septa- may look like pneumo on CXR
MC lung cancer in non-smokers and what is its association
adenocarcinoma --> hypertrophic osteoarthropathy (clubbing)
mutations involved in adenocarcinoma of lung
lung tumor with hyponatremia
small cell--> SIADH
why are Rh- mothers given Rho (D) immunoglobulin
to prevent sensitization of mother's immune system from developing anti-Rh IgG
**if Rh - mother has an Rh+ fetus-- will develop anti-Rh IgG abs and will cause erythroblastosis fetalis in subsequent fetuses. To prevent this- Rho (D) Ig is given with stays in maternal blood and destroys any fetal Rh + RBCs that may enter maternal circulation to prevent Ig formation
seen in aortic stenosis
inspiration--> split goes away because more blood coming back to heart and elongated P sound
expiration--> split present because P sound is shorter and A is delayed
harsh crescendo decrescendo systolic murmur at R 2nd IC space with delayed carotid upstroke
how can you distinguish between aortic stenosis and mitral regurg?
Hand grip--> increases systemic resistance--> decreases AS and increases MR
how does the valsalva maneuver affect heart murmurs
decreases intensity of most murmurs--> decreased venous return
but shortens duration because of a reflex tachy
how does squatting affect heart murmurs?
increases the intensity of most murmurs (except hypertrophic cardiomyopathy) --> because increases venous return and vasc resistance/afterload
flat facies, intel retardation, duodenal atresia, Hirschsprung disease, ASD- primum ostium
Downs- trisomy 21--> nondysjunction in Meiosis I
prominent occiput, micrognathia, low ears, heart defect, death in 1 year
Edwards- trisomy 18
microcephaly/holoprosencephaly, omphalocele, cleft lip/palate, polydactyly
Patau (trisomy 13)-- most severe
high pitched crying, intel disability, microcephaly, VSD - dx and chromosomal abnormality
Cri du chat --> microdeletion of short arm of chromosome 5
very friendly, well developed verbal skills but some intellectual disability, hypercalcemia with sensitivity to vitamin D, long upper lip, big lower lip, small chin, small teeth, wide smile and valvular problems
Williams syndrome-> deletion of long arm of 7
22q11 deletion - which pouches are involved?
3 and 4 --> no thymus, parathyroid glands, truncus arteriosus, cleft palate, hypocalcemia (decreased PTH)
which aa is important for NO synthesis?
conjunctival injection drug
cocaine intox or opiate withdrawal
decreased vit D and increased PO4- (decreased excretion)--> decreased Ca++--> increased PTH--> secondary hyperparathyroidism
what does p value tell you?
statistical significance--> sample size
only DS RNA viruse
DOC for a fib
MOA of digoxin
stimulates vagus n--> decreases HR
inhibits Na/K ATPase--> inhibits Na/Ca++--> increased contractility
alpha blocker--> used for NE extravasation where there is induration and pallor at the IV site due to vasoconstriction
when is BhCG detectable in maternal blood after fertilization? urine?
blood- after 1 week
urine- after 2 weeks
type of collage in scars and MI scars?
type I collegen
bone, skin, cornea, scars, dentin, tendons
type II collagen
cartilage, nucleus pulposus, vitreous body
type III collagen
vessels, granulation tissue, uterus
type IV collagen
decreased absorption of tryptophan--> pellagra like sx due to decreased niacin production
increased filling pressure (mitral regurg, CHF), dilated ventricles
atrial systole against stiff LV wall
assoc with ventricular hypertrophy
best heard: L lateral decubitus in exhalation
isolated a fib precipitating factors
binge drinking, pericarditis, increased sympathetic tone to heart
filtration fraction equation
(GFR= Clearance of creatinine or inulin)
(RPF= clearance of PAH)
clearance of creat or inulin = urine conc*urine flow/plasma conc
clearance of PAH = (Urine conc of PAH)(urine flow)/plasma conc
Chediak Higashi syndrome
oculocutaneous albinism, peripheral neuropathy, microtubule dysfunction in phagosome-lysosome fusion
defect in LYST gene
oculocutaneous albinism, neuropathy, recurrent infection with staph and strep
Chediak-Higashi --> LYST gene
BCR-ABL--> tyrosinase activity--> stimulates granulocytic proliferation
H. influenza growth requirements
chocolate agar--> factors V- NAD and X- hematin
macrolide, isoniazid, grapefruit juice, azoles, cimetidine, cipro
CYP 450 inducers
barbs/alcohol, phenytoin, rifampin, carbamazipine, griseofulvin
warfarin, OCPs, statins
antibiotic that covers anaerobes and aerobes?
antibiotic that covers anaerobes below the diaphragm?
tx of Klebsiella?
cephalo or cipro
tx of aspiration pneumo in alcoholic?
inherited pulmonary HTN gene
2 hit hypothesis--> predisposed to by gene and then a second insult activates the disease
HCC caused by HBV is due to which process?
viral DNA integration into host genome
type IV collagen
IF that shows wire looping
anti-ribosomal P antibodies
which glomerulopathy is associated with HBV and HCV?
MOA of scopolamine and indication?
motion sickness--> M R antagonist
antidote for 5HT syndrome
cryptoheptadine--> 5HT antagonist
MOA of zafirilukast
2nd generation ant-histamines
penicillinase resistant penicillins
nafcillin, oxacillin, dicloxacillin, methicillin
(have bulky R group that blocks access to enzyme)
tx of staph aureus (not MRSA)
MOA of penicillins
block transpeptidase (PBP) --> inhibits cross-linking of peptidoglycan
tx of C. diff
MOA of aminoglycosides
30 S--> inhibit initiation complex formation
MOA of tetracyclines
30 S--> prevent attachment of aminoacyl-tRNA
which antibiotic don't you want to take milk or antacids with?
doxy OR cipro!!--> prevents absorption in gut
MOA of macrolides?
50 S--> blocks translocation
SE of macrolides
GI motility, arrhythmia (prolonged QT), acute cholestatic hep, Rash, eosinophilia
which antibiotic do you not give to someone with Torsades??
toxicity of chloramphenicol
anemia, gray baby syndrome, aplastic anemia
MOA of metronidazole and indication
free radical toxicity of cell that damages DNA
**anaerobes below diaphragm and protozoa
tx of Giardia
what dont you want to drink with metronidazole??
alcohol!-- disulfiram rxn
which antibiotic causes tendonitis and possible rupture?
amoxicillin vs. ampicillin
amoxi have better ORAL availability than ampicillin
ampicillin-- IV (AMPed)
tx of enterococci
ampicillin or amoxi
compares means between 2 groups
(BP between men/women)
means between 3 groups
(BP between 3 diff ethnic groups)
difference in % between 2+ groups--> affected vs. not affected
(% of members in 3 diff ethnic groups who have HTN)
in a normal distribution, what does 1 SD cover?
in a normal distribution what does 2 SD cover?
in a normal distribution what does 3 SD cover?
tail on left, hump on right--> mean<median<mode
tail on right, hump on left-- opening to the right
type I error
alpha--> false + (you sAw something not there)
**correlates with p value-> usually <5% chance
**MC and worse than type II
type II error
beta--> false - (you were BLIND to difference)
**inversely related to statistical power (1-B)
*dont reject null hypothesis when it is false
statistical power and what affects it
1-B --> probability of rejecting null hypothesis when it is false
increase power by:
- increased sample size
- increased expected effect size
- increase precision of measurement
type of HSR in MG
Type II noncytotoxic
type of HSR in DM type I
type of HSR in MS
if antitoxin is delivered and a few days later you get rash, fever and polyarthritis- dx and type of rxn
serum sickness--> T3 HSR
type of rxn you can get from tetanus vaccine
T3 HSR--> arthus rxn
deficiency in what can predispose you to a T3 HSR?
C3 --> normally clears immune complexes
type of rxn in SLE
is OMM contra in pts on mechanical ventilation?
# needed to treat
1/absolute risk reduction
# needed to harm
absolute risk reduction
difference in risk attributable to intervention compared to CONTROL
case control studies --> odds that group with disease was exposed to a risk factor divided by the odds that group w/o disease was exposed
most powerful observational study
PROSPECTIVE--> group with given exposure or risk factor to a group w/o exposure--> looks to see if exposure increases likelihood of disease
RETROSPECTIVE--> compares people with disease to group w/o disease--> prior exposure or risk factor
bright red malar rash on face, with maculopapular rash on arms and trunk that spares palms and soles, fever and coryza
parvo B19 -- fifths --> erythema infectiosum
toxicity of vitamin A
dry skin and arthralgias and myalgias
what is stored in Ito cells of liver
tx of prostatits
TMP-SMX or cipro
tx of S. pyogenes
penicillin first line
macros second line
patient is distant and does not have friends or relationships, content with isolation
patient has odd beliefs or magical thinking, and is awkard with inapropriate affect
schizo sx <6 month
tumor suppressor gene on chrom 17
nts in depression
decreased DA, NE and 5HT
maculopapular rash that starts as small lesion and then spread to rest of body- pruritic
pityriasis rosea--> HHV 7 or 8
calculate compensation of metabolic acidosis
pCO2= (1.5(HCO3-) +8) +/- 2
>15 mm induration
tx of latent TB
SE of aminoglycosides
nephrotoxicity, ototoxicity, neuromuscular blockade
tx of active TB
INH, rifampin, pyrazinamide, ethambutol
SE of rifamin
orange/red body fluids, increase CYP450
what drug causes red-green color blindness?
tx of a fib and v tach
tx of SVT
what do you want to monitor when pt is on amiodarone?
PFTs, LFTs and TFTs and CXR
what is a major SE of procainamide?
SLE like syndrome--> arthralgias and rash
tx of WPW
sx of leiomyoma
abs against centromeres
common cause of Fe deficiency anemia (microcytic) in women
aplastic anemia -- panycytopenia
Fe deficiency anemia lab values
decreased RBC, decreased Hb/Hct, decreased MCV, decreasedMCHC, increased RDW
decreased Fe, ferritin and % sat, increased TIBC
hot tub folliculitis
gram neg rod, non-lactose fermenting, oxidase +
pneumo in CF pts
pneumo in AIDS pts
fungi- histo, coccidio, blasto, and pneumocystis jirovecii
gram - rod, ox - and urease +
pts with UTI following catheter
chronic infection with elevated neuts and L shift
chronic infection with monocytosis or granulocytosis
intracellular bacteria --> TH1 cells (CD8 T cells)
chronic infection with eosinophilia
sporothrix schenckii histo
hyphae with buds off them - like RR tract
a cavitary lesion in the lung in a prior location of granulomatous TB
holosystolic murmur at L sternal border
increase in O2 sat from SVC/IVC to R side of heart indicates what?
L--> R shunt -- VSD
fixed, wide S2 split - cause
ASD--> L--> R shunt-- causes increase of preload of R ventricle vs L ventricle --> delayed emptying regardless of breath
inspiration--> goes away
expiration--> can hear it
calcified cystic mass in brain with cholesterol crystals
craniopharyngioma --> anterior pituitary
sx of craniopharyngioma
h/a, growth failure, bitemporal hemianopsia
histo of terminal bronchioles
simple cuboidal, with clara cells and cilia
**NO cart, glands or goblets
when do cartilage, glands and goblets disappear in respiratory tree?
after BRONCHI--> NOT in bronchioles!!
fxn of interferons alpha and Beta
synthesized by viral infected cells--> antiviral and antitumor props --> primes uninfected cells so they know what to expect
**makes RNAse L --> degrades all mRNA in cell
and protein kinase--> inhibits all protein synthesis --> together cause apoptosis of cell
**these enzymes are activated by dsRNA--> only found in viruses
HBV and HCV, Kaposi sarcoma
MOA of IFN gamma
type II--> made by T cells and NK cells --> promote Th1 cell differentiation and increase MHC II expression --> improves intracellular killing of macros
viral infected cells secrete which IFN?
alpha and Beta
which MHC do IFN alpha and Beta increase?
MHC I --> cytotoxic T cells
what is major immune response to viral infections?
IFN alpha and beta --> innate
dx of sickle cell?
aa switch in sickle cell?
glutamic acid --> valine at position 6
disruption of what promotes metastasis?
E-cadherin--> intermediate jxn
what is most potent vasodilator of cerebral vessels?
main action of nitro
venodilation--> decrease preload--> decrease L ventricular volume
aggression, agitated, disoriented, confused with nystagmus and ataxia--> which drug is he intoxicated with?
mydriasis - drug intox
MOA of cocaine vs amphetamines
cocaine--> NE, DA and 5HT reuptake inhibitor
amphetamine--> increased release of 5HT, DA and NE
conjunctivial injection with increased app, decreased time perception, dry mouth -- drug
miosis with respiratory depression, decreased mental state and constipation
opioids / heroine
categorical data analysis between groups (ex statin tx vs no tx and compared to high fibrinogen vs low fibrinogen
chi squared test
**if gave actual #s (mg/dl) of fibrinogen vs categories-- would be t test
type of rxn of PPD test
what does INH need to be activated?
catalase peroxidase enzyme from bacteria
important for pregnancy--> maturity of lungs of fetus
how do you prevent tumor lysis syndrome?
urine alkalization and hydration
what kind of anemia can B6 deficiency lead to?
microcytic--> cofactor for ALA synthase--> decreased Hb formation --> microcytic, hypochromic
porphyria that leads to photosensitivity and neuropsych sx
late synthesis steps--> uroporphyrinogen decarboxylase and later
**porphyrin cutanea tarda
sx of uroporphyrinogen decarboxylase and disease
porphyrin cutanea tarda--> photosensitivity, neuropsych
fever and sweating every 48 hours with recent travel- dx and tx
P. vivax or ovale --> chloroquine but need primaquine for complete eradication to prevent relapse!!!
MOA of chloroquine
decreases heme polymerase--> can't detox and heme builds up in cells--> toxic to plasmodia
red, capsular organisms on mucicarmine stain with pneumo resistant to antibiotics
findings of cocaine withdrawal
depression and hypersomnolence with no physical signs
findings of nicotine withdrawal
irritable, anxious, increased appetite, with no physical signs
findings of alcohol or benzo withdrawal?
tachy, seizures, palpitations, anxiety
dilated pupils, yawning with excessive lacrimation and diarrhea, muscle aches --> what are they withdrawaing from?
heroine --> depressant
maculopapular rash on palms and soles, with malaise and fever
cardiolipin, lecithin and cholesterol
interacts with MHC on APCs--> increased T cell activation and increased macrophage --> release cytokines (IL-1, IL-2 and TNF)
site of rRNA transcription and assembly of ribosomal subunits
**RNA Poly I
what enzyme transcribes rRNA
RNA poly I
what enzyme transcribes mRNA?
RNA poly II
what enzyme transcribes tRNA?
RNA poly III
decreases Ca++ in blood--> increases osteoblasts
how do osteocytes communicate?
SE of methotrexate and what can prevent them?
apthous ulcers and pancytopenia (death of GI and BM cells)
**folinic acid -- form of THF that doesn't need dihydrofolate reductase
what part of cerebellum do alcoholics typically damage?
anterior lobe--> gait ataxia
what is the major cause of posterior lobe damage?
medulloblastoma or ependymoma--> truncal ataxia
medial lesions of the cerebullum- sx
gait ataxia, wide-based gait, scanning dysarthria, nystagmus, head tilting, truncal ataxia
lateral lesions of cerebellum sx
intention tremor, dysmetria, dysdiadokinesia
lesions of SCA
C/L face and body analgesia
CN V and VII central (lower face only)
lesions of AICA
B/L face analgesia, C/L body
CN V and VII peripheral- whole face
lesions of PICA
C/L body and I/L face analgesia
CN IX and X damage --> hoarseness
cervical motion tenderness-- dx and tx
PID --> cephtriaxone and doxy (gonorrhea/chlamydia)
meningitis sx with change in sense of smell and hx of using Nedi pot or swimming in lakes
primary amebic meningoencephalitis--> Naegleria fowleri
granulomatous amebic encephalitis
acanthamoeba--> standing water or contact solution
CNS sx and seizures with hx of intestinal infection and eating undercooked pork
Neurocysticercosis--> Taenia solium
chorioretinitis + hydrocephalus + intracranial calcifications in new born
ring enhancing brain lesion on CT/MRI in HIV pt
asthmatic wheezing, diarrhea, flushing and R sided valve dysfunction
carcinoid syndrome from neuroendocrine cells
SE of statins
myalgias, rhabdomyolysis and high CK
SE of macros
SE of fluroquinolones
tendon rupture and tendonitis
biggest risk factor of asthma
genetic predisposition to develop IgE against environmental exposure (atopy)
monochorionic diamniotic--> share chorion
teratogenic effects of phenytoin
fetal hydantoin syndrome--> cleft lip, nail hypoplasia, decreased growth and mental, cardiac defects
which drug can predispose to abruptio placenta?
renal damage in an embryo is most likely due to what?
maternal use of ACE I or ARB
MOA of clomiphene
blocks neg feedback of estrogen on GnRH (SERM)
supination of foot
adduction, inversion and plantar flexion
pronation of foot
abduction, eversion and dorsiflexion
DOC to prevent HIV transmission to fetus
zidovudine (AZT) --> comp inhibitor of RNA dep DNA poly --> chain termination
ataxia, telangiectasia, increased infections (IgA deficiency) -- disease and genetic defect
ataxia telangiectasia--> ATM gene--> DNA break repair defect
deficiency in sphingomyelinase--> builds up in monocytic cells--> hepatosplenomegaly, anemia, cherry red spot on macula, foam cells, motor neuropathy
fxn of snRNPs
help spliceosomes--> cut out introns
presentation of androgen insensitivity syndrome
normal appearing female with scant sexual hair, rudimentary vag, NO uterus or fallopian tubes
have testes that are found in labia majora
primary amenorrhea in female with fully developed secondary sexual characteristics
vaginal agenesis or Mullerian aplasia
normal ovaries--> secrete estrogen
ASGN vs IgA Nephropathy
both occur after infection
ASGN-- takes weeks to develop, decreased C3 and no mesangial IgA deposition
IgA -- occurs days after infection, normal C3 and there is prominent mesangial IgA deposition
acute gingivostomatosis in kids 1-3 with fever, lymphadenopathy-- dx and type of genetic material
HSV-1 --> enveloped ds DNA
where do most DNA viruses replicate?
nucleus- except pox virus
where do most RNA viruses replicate?
cytoplasm--> except flue and retro
where does influenza replicate?
DNA viruses mnemonic
"Please pardon papa as he has pox"
parvo - ss --> B19 (erythema infectiosum)
papillomavirus --> HPV
polyomavirus --> JC virus and BK virus
adenovirus -- conjunctivitis, acute hemorrhagic cystitis, pneumo
herpes - HSV, VZV, EBV, SMV, HHV
pox- small pox and molluscum contagiosum
**last 3 = envelope
all cells can generate ribose from F-6-P or glyceraldehyde 3-P if HMP shunt is not active, using what enzymes?
transaldolase and transketolase
if you have a male and female twin, what kind of twins are they?
nucleus of hypothalamus that fxns in sleep?
fxn of alcohol disinfectants ie: isopropanol
disrupt cell membranes and denature proteins
fxn of Fas/Fas L
extrinsic pathway of apoptosis --> play role in autoimmune disease if DEFECTIVE
hypnotic, anxiolytic, muscle relaxant and anti-convulsant medication and MOA
benzo --> increase FREQUENCY of Cl- channel opening--> increase GABA
MOA of TCA
inhibition of 5HT and NE reuptake
MOA of barbs vs benzos
barbs--> increase duration of Cl- channel opening
benzos--> increase frequency of Cl- channel opening
diuretic with hypercalcemic properties?
SE of furosemide
ototoxic, allergy, gout
SE of thiazide
hyperuricemia, hypercalcemia, hyperglycemia, hyperlipidemia
SE of acetazolamide
carbonic anhydrase inhibitor
metabolic acidosis --> lower pH -- lose bicarb
drugs with ototoxicity SE
furosemide, aminoglycosides, cisplatin, salicylates + vanco
SE of vanco
red man syndrome (histamine), nephrotoxic, ototoxic, thrombophlebitis
MOA behind niacin flushing
PG release -- prevented with ASA pre-tx
what is responsible for muscles involuntarily giving out when too much force/tension is occuring?
what is responsible for DTRs?
muscle spindles (intrafusal fibers)
for a screening test is it better to have high sensitivity or specificity?
**sensitivity--> rules OUT
fluctuating lymph node enlargement with painless waxing and waning- dx
Follicular lymphoma --> t (14;18) -- bcl2
T1HSR--> late phase--> release PGs, LTEs and cytokines
parasitic infection--> parasite is coated with IgE and IgG bound to eosinophils--> degranulation of MBP and ROS--> destroy parasite bound with Ab--> Ab dependent cell-mediated cytotoxicity
MCC of aseptic meningitis
viral--> enteroviruses--> coxsackie, echo, entero, polio
MCC of common cold
coronavirus, rhino, adeno
Which vessel has the least O2 content in the body, and that differs the most from the O2 content of the aorta?
coronary sinus--> heart extracts more O2 than any organ
which tx would you give for urinary incontinence due to detrusor instability?
CNS --> memory and cognition
heart --> decrease HR and contractility
bladder, GI, lungs, skin, eyes
alpha 1 location
vessels - peripheral--> increase contraction
alpha 2 location
central --> decrease SNS, insulin and lipolysis
B 1 location
heart and kidneys --> increase HR/contractility and renin
airways , uterus, vessels --> dilation and relaxation
first notch in JVP curve
a= atrial contraction
causes of constrictive pericarditis?
TB, radiation, cardiac surgery
if P50 decreases from 26 mmHg--> 20 mmHg--> L shift of Hb curve--> decreased affinity -- what will be the consequences??
erythrocytosis--> to compensate for decreased O2 affinity
what is responsible for sensory to posterior exterior auditory canal?
if someone is exposed to nitrites, what may occur? and tx?
methemoglobin --> methyene blue
cause of methemoglobin and what is affect on Po2?
nitrites--> increase ROS and oxidation of RBCs--> Fe+2--> Fe+3
mononucleosis with +heterophile (Monospot) dx
mono with -heterophile (- Monospot)
MC manifestation of CMV in immunocompetent?
MC manifestation of CMV in HIV pt?
MC manifestation of CMV after organ transplant?
pathophys and sx of Henoch Schonlein purpura?
pathophys--> after URI (parvo or strep) --> IgA Abs causes IgA complex deposition in vessels--> vasculitis
sx: GI, skin, arthralgias, with IgA nephropathy
swollen lymph nodes and red eyes with strawberry tongue - dx and complications?
Kawasaki disease--> coronary artery aneurysms and thrombosis--> MI
holosystolic murmur that radiates to axilla and what is the best indicator of severity?
mitral regurg --> S3 gallop is best indicator of severity
what is dx if neutrophils fail to turn blue with nitroblue tetrazolium stain?
survival px of <6 months
MOA of enfuvirtide
inhibits ENTRY (Gp41) -- "en" -- "in"
drugs ending with "navir" -- MOA
protease inhibitors (pol gene) --> cleaves polypeptide products into functional parts
MOA nevirapine, efavirenz and delavirdine
"vir" in middle--> NNRTIs--> non-comp inhibition of RNA-dep DNA poly-- do NOT require phosphorylation
SE of verapamil/CCBs?
AV block, constipation, edema and flushing
which AA is a precursor to 5HT?
tryptophan is a precursor for what?
5HT, niacin and melatonin
tyrosine is a precursor for what?
catecholamines, DA, melanin
Serotonin syndrome sx
hyperreflexia, clonus, confusion, tremor, SNS stimulation--> tachy, mydriasis, diaphoresis, vom/diarrhea
tx/antidote of serotonin syndrome
cyproheptadine --> 5HT2 R antagonist
quadruple screen- what is it used for?
trisomy 21, 18 and neural tube defect
decreased AFP, estriol with increased B-hCG and inhibin
decreased AFP, hCG and estriol, with normal inhibin
usually gastrochisis, omphalocele, open neural tube defect
what heart defect is a variant of normal in adults?
patent foramen ovale
where is elastase derived from in lungs?
alveolar macros and neutrophils
what does alpha 1 antitrypsin act on?
elastase derived from neutrophils
MOA of digoxin? effects
vagomimetic --> decreases HR
increases contractility via inhibition of Na/K ATPase--> increases Ca++
source of N in urea cycle?
NH3 and aspartate
FF when given RBF
**MAKE SURE CONVERT RBF TO RPF!!!
converting RBF to RPF
RPF = RBF (1-Hct)
Most effective lipid lowering drug to prevent cardiovascular events?
statins--> HMG-CoA reductase inhibitors
good test for cell-mediated immunity?
Candida skin test--> DHT
cells involved in cell-mediated immunity?
macros, NKs, CD 4 and CD8 T cells
what is responsible for tox of LPS and its mechanism?
Lipid A--> activates macros and granulocytes--> release cytokines/pyrogens (IL-1 and TNF-alpha) --> septic shock
MOA of adenosine
acts like muscarinic R (Gi in nodes)--> decrease cAMP--> decrease Na/Ca and increase K --> hyperpolarize cell
K + blockers names
amiodarone, sotalol, ibutilide, dofetilide
ACA stroke sx
LE > UE hemiparesis
primitive reflexes (frontal lobe)
MCA stroke sx
UE > LE hemiparesis
histo changes of MS
lipid laden macros--> myelin breakdown
astrocytosis-- rxn to injury
lymphs and macros
intracranial lesion with biphasic pattern of growth- dense cellularity interspersed with less dense myxoid --> S-100+
content of what aa best reflects collagen synthesis?
deficiency in hydroxylation of proline and lysine results in what?
deficiency in glycosylation of hydroxylysine residues and formation of procollagen --> decreased triple helix -- dx?
decreased Cu absorption--> decreased lysyl oxidase --> results in what?
Menkes disease--> brittle hair, hypotonia, retardation
pathophys of Ehlers- Danlos
decreased proteolytic cleavage into tropocollagen--> more soluble and does not cross-link(lysyl oxidase) with other fibrils
(disulfide rich globular domains in fibrils--> no proteolytic action)
when is NAD used?
when is NADP used
HMP shunt in glucose met
ex of Type 1 muscle fiber
paraspinals and soleus
course of median nerve
between 2 heads of pronator teres--> then between flexor digitorum superficialis and profundus --> flexor retinaculum
best long term tx of HTN in CHF pt?
ACE-I, ARB, B-blocker or spironolactone--> all prevent remodeling!!!--> protective
HTN tx in preg women
hydralazine and methyldopa
CHF in blacks- tx?
hydralazine and nitrates
SE of hydralazine?
SLE sx and reflex tachy
relationship between Creatinine and GFR? linear or non-linear?
non-linear--> takes significant decrease in GFR to increase Creatinine --> relatively normal up until about 60% decrease in kidney fxn, then curve is very steep
(every time GFR halves, Creat doubles)
pt with severe pneumonia, high fever, GI sx, CNS sx, recent travel/hospital visit - dx and labs
Legionnaire's disease--> hyponatremia, no gram stain, neutrophilia, urine antigen test and BCYE culture (charcoal with cysteine and iron)
if disease is inherited from 2 asx parents-- what is most likely inheritance pattern?
enzyme defiencies are mostly inherited how?
defective non-catalytic proteins are inherited how?
risk factor/contraction of anthrax?
occupation--> WOOL SORTER--> dealing with animal hair, hides, or wool
**GOAT HAIR = MC exposure
"medusa" or serpentine on microscopy?
why do you need to have a nitrate free interval?
to prevent tolerance development
pt has focal neuro sx--> hemiplegia and expressive aphasia-- dx and cells involved
1 day-- red neurons
1 week- neuts (48 hrs) and microglia (3-5 days)
1 month - astrocytes-- gliosis
Last thing to canalize and MC location of obstruction in fetal urinary tract?
ureteropelvic jxn - between kidney and ureter
"greasy" epithelial proliferations that look "stuck on" --> filled with keratin
actinic keratosis and what does it predispose to?
small, rough red or brown papules/plaques--> can lead to SCC
Most important risk factor for developing actinic keratosis?
inherited defect that is associated with macroorchidism?
Fragile X syndrome --> long face, large jaw, large ears, autism
what disease is assoc with Downs?
AD and ALL
long face, sustained grip, muscle wasting, testicular atrophy- dx and genetics?
myotonic dystrophy--> CTG (DMPK gene)-- chrom 19
large jaw, large ears, large testes, intellectual disability? - dx and gene
Fragile X --> FMR1 gene
selective coronary vasodilators?
adenosine and dipyridamole
Abs against Rh are what kind of abs?
IgG -- cross placenta
Abs against A and B are what kind of abs?
IgM - do not cross-- M only stay in MOM
Abs against A and B are what kind of abs in O mothers?
IgG --> can cross!!
Vanco-- indication and mechanism
Gram + orgs
inhibits cell wall peptidoglycan by binding D-ala-D-ala cell wall precursors
medium with vanco, nystatin, colistin and TMP - what does it select for?
Thayer Martin agar--> Neisseria
what are the first cells that contribute to atherosclerosis?
endothelial cells--> damage
pathogenesis of atheroma?
1. endothelial damage--> exposes subendothelial collagen--> macro and lymph migration and platelet adhesion + LDL accumulation (increased permeability) --> macros phagocytose LDL--> foam cells; macros and platelets make GFs (PDGF and FGF)--> stimulate prolif of smooth muscle cells and migration into intima --> ECM deposition--> fibrous plaque
Normal P alveolar O2
Normal A-a gradient
4 causes of hypoxemia
hypoventilation (normal A-a gradient)
R--> L shunt
glutamine --> valine mutation in B globin chain
proteins involved in hereditary spherocytosis?
impaired process in B-thalassemia as a result of a point mutation upstream from AUG codon?
mRNA binding to ribosomes
natural phenomenon where the effect of main exposure on outcome is modified by the presence of another variable?
exons of reconnected in multiple ways during post-transcriptional processing--> makes different proteins -- increases biodiversity
tx of chlamydia?
azithro or doxy
MOA and SE of atropine
muscarinic antagonist--> used for bradycardia
SE: acute closed angle GLAUCOMA!!!
cells involved in forming non-caseating granulomas as in sarcoidosis?
Th1 CD4 T cells--> IL-2 and IFN-gamma
IFN-gamma--> activates macros -- granuloma
IL-2 --> proliferation of Th1 T cells
contraindications of OCP use?
hyperTGs, smoke + >35 yo, pregnant, estrogen dependent tumor, hx of thromboembolic event/stroke, liver disease
n/v, diarrhea, confusion, blurred yellow vision, bradycardia with normal BP
what drug are they on?
digoxin -- CHF or a. fib
tx of digoxin toxicity
charcoal, insulin--> decrease K+
anti-digoxin Fab fragments
what is an indication of the amount of digoxin a person has taken?
K+ in blood--> hyperkalemia
route of infection of N. meningitides?
nasopharynx--> blood--> choroid plexus--> meninges
tx of drug-induced parkinsonism?
anti-muscarinics--> benztropine, trihexyphenidyl
cause of drug induced parkinsonism?
tx of neuroleptic malignant syndrome?
bromocriptine or dantrolene
sx of neuroleptic malignant syndrome?
fever, encephalopathy, unstable vitals, rigidity of muscles
means of 2 groups of subjects-- test
ACE-I effect on bradykinin?
increases it --> ACE normally breaks down bradykinin--> so ACE-inhibitors cause increase in bradykinin--> cough
tx to decrease fetal transmission of HIV during preg?
zidovudine--> NRTI (RNA dep DNA poly inhibitor) -- viral enzyme inhibitor drug
new born presents with shrill crying, tremor, sneezing, rhinorrhea, pupillary dilation, stuffiness, n/v, and jitters that lead to seizures-- dx and tx
dx: acute neonatal opioid withdrawal (from mother)
tx: opium solution
tx of benzo OD
tx of opioid OD
heroine detox or long term maintenance tx
non communicating hydrocephalus
obstruction between ventricals to subarachnoid space --> cause enlargement of ventriclas about obstruction
obstruction of subarachnoid granulations--> cause symmetrical dilation of all ventricals
**usually caused by meningitis
type of hydrocephalus caused via meningitis?
communicating--> blocks subarachnoid granulations
symmetrical enlargement of all ventricles-- what type?
SE of thiazides?
increased glucose, calcium, lipids, uric acid in blood
decreased K+ and Na+ in blood
PAH has decreased extraction ratio after certain concentration due to what?
carrier transport (secretion) is saturated--> active transport
which diuretic causes metabolic acidosis?
acetazolamide--> CA inhibitor --> decreases total bicarb stores in body
do K+ sparing diuretics cause met alkalosis or acidosis??
acidosis--> H+ goes with K+ --> if get increased K+, get increased H+
malignancy associated with EBV?
Burkitt's lymphoma, nasopharyngeal carcinoma, Hodgkin's lymphoma
Kaposi sarcoma is assoc with what virus?
HHV 8 or HIV
glomerulonephritis secondary to bacterial endocarditis is due to what?
circulating immune complexes --> deposition
Homeobox genes- fxn
DNA binding transcription factors--> alter gene expression in morphogenesis (craniocaudal organization)
fever, night sweats, wt loss and cervical lymphadenopathy with Reed sternberg cells
which meningitis agent cause Waterhouse Friderichsen syndrome?
N. meningitidis (S. pneumo can cause this in elderly-- but not likely)
Waterhouse Friderichsen syndrome?
bacterial infection, sepsis, shock and B/L adrenal hemorrhage and insufficiency--> death
gram + diplococci
most important host factor in preventing invasive disease??
IgM and IgG
classical pathway deficiency
encapsulated bacterial infections and AI disorders
C1 esterase inhibitor deficiency
hereditary angioedema due to increased activation of complement--> acute inflammation
MC hereditary complement deficiency?
which complement is important in removing immune complexes?
recurrent pyogenic bacterial infections (capsules) and Type III HSR
sympathetic viscerosomatic reflexes of adrenal glands
sudden anemia and jaundice, malaise and abdominal pain, normal spleen, post infection - dx
G6PD deficiency- triggered by oxidant stressor
anemia, jaundice and splenomegaly
genetic defect in sickle cell anemia?
point mutation at position 6 on B chain--> glutamic acid--> valine
dx of sickle cell anemia
blood smear and Hb electrophoresis
MCC hemolytic anemia
hemolytic anemia w/o Heinz bodies
pyruvate kinase deficiency
oxidized Hb precipitated in RBC-- cross linked
consequences of sickle cell anemia?
aplastic anemia-- B19
autosplenectomy--> Howell jolly and increased encapsulated infections (Salmonella)
vaso-occlusive --> painful, dactylitis, acute chest, AVN, stroke
renal papillary necrosis
destruction of stem cells (radiation/drugs, virus, idiopathic)
pancytopenia with severe anemia- hypocellular BM with fatty infiltration--> DRY BM TAP!!
Dry BM tap - dx
autoimmune hemolytic anemia
cold--> IgM --> ACUTE - CLL, mycoplasma, infectious mono --> intravasc hemolysis (complement)
warm--> IgG --> CHRONIC -- SLE, CLL ,drugs -- >spleen removes membrane bound with IgG--> spherocytes (extravasc)
Direct Coombs test
test for AI hemolytic anemia
*put in anti-Ig Abs--> see if RBCs have IgG on them--> will agglutinate
test for AI hemolytic anemia
*put in normal RBCs and see if pt has anti-RBC Ig--> will agglutinate
consequence of crush injury
hyperkalemia--> due to release from damaged cells
DO NOT ADMIN KCl
tx of hyperkalemia
B adrenergic agonist, insulin, sodium polystyrene sulfonate
what puts K+ IN cells?
B adrenergics agonist (epi)
hypo-osmolarity--> H2O goes in and K+ follows
lab values and histo for Fe deficiency anemia?
histo- microcytic, hypochromic, increased RDW --> anisocytosis
labs--> decreased Fe and ferritin, increased TIBC and apoferritin (ferritin without Fe bound to it in intestine)
increased urine methylmalonic acid and Hcy?
vit B12 deficiency
dx and association with AIDS-dementia complex?
Subacute combined degeneration
Dx: multinucleated giant cells
MC source of rabies virus?
raccoons in US
agitation, photophobia, HYDROPHOBIA, hallucinations--> paralysis, coma--> death
cells affected by HIV
CD4 T cells, macros and microglia
Dx of Tinea versicolor
KOH mount--> spaghetti and meatbolls --> yeast clusters and short curved septate hyphae
Wood lamp--> copper-orange
"blotch sun tan"
pruritic rash with hypopigmentation on chest post tanning/hot and humid weather - dx and tx
Tinea versicolor--> Mallassezia furfur
tx: selenium sulfide
farmer with diarrhea, miosis, bradycardia, bronchospasm, lacrimation, sweating -- dx and tx
organophosphate poisoning (pesticides) --> irreversible cholinesterase inhibitor --> increase ACh and PNS
tx: atropine (musc antagonist) and pralidoxime (regenerates AChE)
acute somatic dysfxn
edema, boggy, fullness, redness, heat, acute tenderness- sharp and severe, hypertonicity, tension
chronic somatic dysfxn
coolness, blanching, dull and achy tenderness, ropiness, thickened skin --> due to vasoconstriction via increased SNS
OMM for acute somatic dysfxn (MVA)
indirect!! -- CS, FPR, indirect MFR, indirect ME
indications for pedal pump
LE lymph congestion-- CHF, nephrotic syndrome, LE chronic dysfxn with edema, venous insufficiency
attachments of dura
foramen magnum, C2, C3, S2 and coccyx (filum terminale)
diplopia when looking down-- which CN is damaged?
CN IV -- superior oblique--> inferior and medial
MOA of edrophonium
very short acting AChE inhibitors--> dx of MG
pathophysiology of MG
may be due to thymoma--> contain myoid cells- have ACh Rs on surface --> prime helper T cells --> autoimmunized T cells attack AChRs on myoid cells --> create infiltrating germinal centers in hyperplastic thymus --> produces Abs that diversify to recognize intact ACh Rs on muscle--> MG
tx and SE of MG
pyridostigmine--> cholinergic effects: diarrhea, bradycardia, hypotension, secretions, nausea, sweating, lacrimation, salivation
observational, retrospective study where subjects are chosen on basis of disease outcome and the risk factors are assessed
case-control study --> measures Odds-ratio
strongest observational study?
TCAs MOA and names
block NE and 5HT reuptake
"ipramines" "iptylines" + doxepin and amoxapine
MAO-Is -- MOA and names
inhibit breakdown of nts
names: tranylcypromine, phenelzine, isocarboxazid, selegiline (MAO-B)
fluoxetine, paroxetine, citalopram, sertraline
SNRIs - MOA and names
block reuptake of NE and 5HT
duloxetine and venlafaxine
MOA of doxetin
TCA - blocks reuptake of NE and 5HT
MOA of sertraline
MOA of duloxetine
MOA of citalopram
MOA of amitriptyline
pathophys of gestational diabetes
increased placental secretion of GH, hPL/hCS, progesterone and CRH
secreted by placenta--> increases pancreatic B cells, lactogenic and GH actions --> increases lipolysis, ketogenesis and decreases glucose utilization--> more for baby
peak of hCG and fxn
peaks at week 10
maintains Corpus luteum to keep secreting progesterone and estrogen in early pregnancy-- until placenta takes over
RPF from PAH concentrations and urine flow
RPF = (urine PAH) / (plasma PAH) * Urine flow rate
RPF from RBF
RPF = RBF (1 - Hct)
arteritis with medial granulomatous inflammation?
Takayasu and Temporal arteritis (giant cell)
Takayasu-- Asian females <40
Temporal -- elderly females >50
sx of PAN
systemically ill-- lots of systems affected: fever, wt loss, malaise, h/a, ab pain and melena (GI), neuro, cutaneous, renal damage, heart
pathology of Giant cell arteritis
granulomatous inflammation (giant cells)
polyangitis nodosa, Wegener's and microscopic polyangitis
sudden onset of focal numbness and tingling in limb that fully resolves within minutes - dx and tx
TIA --> low dose ASA
tinnitus, hearing loss and vertigo-- dx
salicylism - too much ASA
tx of Staph epidermidis?
most are methicillin- resistant so assume that until culture comes back and tx with VANCO**
if susceptible to methicillin-- can tx with NAFCILLIN
Mycobacterium leprae - sx, transmission, dx and tx
transmission- respiratory- nasal
- lepromatous--> due to decreased cell-mediated immunity (Th1) --> with humoral Th2 response --> organisms invade nerves, skin, eyes and testes
- tuberculoid--> intact cell-mediated immunity (Th1) --> forms granulomas due to immune system --> destroys nerves --> self-limited with some hypoesthetic plaques
dx: lepromin test--> tuberculoid
tx: dapsone, rifampin, clofazimine
obligate aerobe, intracell parasite, acid fast with mycolic acid, gram + rod
if have organophosphate poisoning and tx with atropine- what are you still at risk for?
muscle paralysis -- due to nicotinic receptor activation--> can prevent with pralidoxime
tx of Calcium, phosphate and oxalate stones
thiazides--> Ca+ sparing (hypercalcemia but keeps it out of kidneys)
pathophys of CF and effects of respiratory mucosa and sweat glands
respiratory mucosa--> no Cl- secretion, leads to increased Na+ reabsorption and H20 reabsorption--> dehydrated mucosa and more neg transepithelial gradient
sweat glands--> no Cl- secretion--> decreased Na+ reabsorption--> hypertonic sweat
major vasodilators of coronary vessels?
NO and adenosine
what makes NO
arginine + O2
occurs in cardiac tamponade
**inspiration--> decrease amplitude of systolic BP by more than 10 mmHg
**inspiration--> decreased intrathoracic P--> increased venous return--> increase RA and RV P--> push IV septum into LV--> decreased EF and CO --> decreased systolic BP
fused lysosomal granules
seen in AML
AML M3 - chromosomal abnormality
sx of APL
hemorrhage and bleeding tendencies--> DIC**
*due to intravasc coag and increased fibrinolysis--> increased PT/PTT, decreased fibrinogen and increased D dimers
mid diastolic rumble
what is a consequence of Left atrial enlargement due to mitral stenosis?
hoarseness due to recurrent laryngeal impingement
stimulus control tx for insomnia
bedroom is only for sleeping-- dissociate other activities and thoughts
only go to bed when sleepy
leave bed when not sleeping
fixed wake up times
**bed is only for sleeping and sex!!
no naps- set sleep schedule
no caffeine in PM
no alc/smoke/meals near bedtime
exercise reg but not near bedtime
room is dark and quiet
subacute combined deficiency tracts?
LCST and Dorsal columns
DOC for absence + tonic clonic seizures
worst SE of carbamazepine and MOA
MOA-- blocks Na+ channels--> decreases axonal conduction--> simple, complex partial seizures
SE: agranulocytosis and aplastic anemia
consequence of Mycoplasma pneumonia
autoimmune hemolytic anemia--> cold agglutinin (IgM) --> due to immune response Abs and molecular mimicry between M. pneumo and human RBCs
SJS and joint pain
Chlamydia, N. gonorrhea, Rickettsia, Salmonella --> require cell-mediated immunity
in graft vs host disease-- what cells are involved and which organ systems?
graft T cells sensitized against host MHC antigens --> skin, GI and liver commonly affected
change in V/change in P
PTH and Ca+ levels in osteoporosis
which aa is serotonin and niacin derived from?
what molecules is tetrahydrobiopterin needed to make?
BH4 --> serotonin, tyrosine, dopamine, (catecholamines), NO
phenylalanine--> tyrosine--> DA
2 causes of PKU?
phenylalanine hydroxylase deficiency
dihydrobiopterin reductase deficiency (BH4--> BH2)
enzyme in Niemann-picks and sx
sphingomyelinase --> increase sphingomyelin--> accum in macros--> foamy histiocytes, cherry red spot on macula, hepatosplenomegaly and motor neuropathy
enzyme in Fabry disease and sx
alpha- galactosidase A --> build up of ceramide trihexosidase
peripheral neuropathy of hands/feet, angiokeratomas, cloudy cornea, renal failure
enzyme in Gaucher disease
glucocerebrosidase (B-glucosidase)--> increase in glucocerebroside
hepatosplenomegaly, pancytopenia, aseptc necrosis of femur
Gaucher cells--> crumpled tissue paper-- lipid macros
enzyme in Tay Sachs
Hexosaminidase A --> increase in GM2 ganglioside
neurodegeneration, developmental delay
cherry red macula
enzyme in Krabbe disease
galactocerebrosidase--> increase in galactocerebroside
peripheral neuropathy, optic atrophy
enzyme in metachromic leukodystrophy
arylsulfatase A --> increase in cerebroside sulfate
**Central and peripheral demyelination with ataxia and dementia
MOA of methotrexate
similar to folic acid--> dihydrofolate reductase inhibitor
fxn of dihydrofolate reductase
folate--> DHF --> THF --> used as 1 C donor
1 C donor for thymidylate-->DNA
amino acid synth
SE of MTX and tx
myelosuppression (decrease THF) --> tx with folinic acid (prereduced form of folate)-- rescue
marker of mast cell activation
hypotension, urticaria, SOB, after admin of drug (penicillin)
anaphylaxis--> T1HSR --> mast cell degranulation --> histamine and tryptase!!
where is MPO found?
where is ALP found?
liver, kidneys, bones, placenta
where is calcitonin produced?
C cells of thyroid
5 hydroxyindoleacetic acid
breakdown product of 5HT--> screen for carcinoid tumors
mechanism of degranulation of mast cells
has IgE Abs attached to high affinity Rs on mast cell--> when antigen is bound the cross linking causing AGGREGATION of receptors on surface of mast cell--> degranulation
acid fast Gram + orgs
Mycobacteria and Nocardia
acid fast stain
1. aniline dye (carbolfucshin) --> penetrates cell wall and binds with mycolic acid--> red
2. tx with HCl and alcohol--> dissolves outer cell membrane of non-acid fast orgs --> decolorization
**mycolic acid prevents this
3. counterstain- methylene blue is applied and taken up by decolorized bacteria --> blue
Acid fast--> RED
non-acid fast--> BLUE
component of peptidoglycan cell wall of Gram +
thoracentesis locations - midclavicular, mid axillary and paravertebral
midclavicular-- ribs 5-7
midaxillary-- ribs 7-9
paravert-- ribs 9-11
*want to do above the lowest level to prevent damaging abdominal structures
SE of nitrates
throbbing h/a and cutaneous flushing--> due to vasodilation
nocturnal wheezing - DDx
asthma and GERD
what drugs have a SE of "cold extremeties" or Raynauds?
which drugs have SE of constipation?
opioids, CCBs, anticholinergics, Fe supps
Coxsackie A sx
herpangina --> Fever, posterior pharyngeal gray vesicles in children
agglutination of RBCs from other species (horse-Monospot) -- if have Abs
+ --> EBV
- --> CMV
what receptors does NE act on? epi?
NE--> alpha and B1 (not B2)
epi--> alpha and beta receptors
alpha adrenergic inhibitor for sx--> tamsulosin, terazosin
5 alpha reductase inhibitor-- finasteride, dutasteride
pathogenesis of centriacinar emphysema
smoking--> inflammatory rxn in lungs--> recruit NEUTS and MACROS--> release proteases
if given vitamin K and PT is still increased, what is the issue?
factor VII deficiency
liver disease on coagulation
liver produces coagulation factors--> disease will decrease coag factors--> VII has shortest half life so extrinsic pathway will be affected first (PT)
structure affected in NPH?
when an extraneous factor has a correlation with the exposure and disease--> leads to false association of the with the disease (ex: alcohol--> bladder cancer-- muddlied by smoking) -- no sig difference between smokers vs non smokers
when external variable has +/- impact on effect of risk factor --> stratified analysis shows SIG DIFFERENCE between groups (smokers vs non smokers in alc on bladder CA)
when can you discharge a patient against medical advice?
if they are a competent adults
poison ivy-- allergenic substance, type of rxn and cells involved
urushiol--> T4HSR--> CD8 T cells
Xeroderma pigmentosa-- enzyme
endonuclease--> can't release thymine dimers formed by UV light
3-5 exonuclease- fxn
proofreading of normal DNA polymerase during replication
enzyme deficiency in HNPCC
3-5 exonuclease-- accum of mismatched BPs
"I can imagine how the abuse has changed your perspective on life" --> type of technique via psych?
empathy--> trying to walk in their shoes
physician repeats what patient tells them
concern independent of understanding
ie: "yes he really hurt you. A lot of abused children have the same rxns"
Kubler Ross steps of acceptance
tx to prevent PEs and DVT and MOA
Warfarin--> inhibit gamma carboxylation of glutamate of vitamin K dependent clotting factors
MOA of heparin
binds AT III Tightly
direct thrombin inhibitors
argatroban and bivalirudin
prevention of MI and stroke
acute onset of decreased attention, memory and fxn, with fluctuating consciousness and fever
ectopic lens, marfanoid habitus, mental retardation and osteoporosis- dx and enzyme
Homocysteinuria--> cysteine B-synthase
diastolic only CHF-- effects on EF, LVEDV and LVEDP
LV EDV normal (or decreased)
LV EDP increased
systolic only CHF -- EF, LVEDV and LVEDP
LV EDV and LV EDP increased to maintain CO
what type of anemia would you expect to see increased LDH?
grossly pale BM with high lipid content, low Hb and thrombocytopenia
Number needed to harm
(a/a+b) - (c/c+d)
a= risk factor/tx and disease
b= risk factor/tx and no disease
c= no risk factor/tx and disease
d= no risk factor/tx and no disease
Number needed to treat
% of disease in not tx - % of disease in tx
(c/c+d - a/a+b)
(a/c) / (b/d)
% with disease exposed / % with disease unexposed
(a/a+b) / (c/c+d)
topoisomerase II -> release tension
RNA polymerase--> makes 3 OH RNA primer on DNA strand to be replicated
DNA polymerase I fxns
5-3 exonuclease-- remove primer and damaged DNA
muscular and bony products of pharyngeal arches-- derivatives
bony--> neural crest
only sensory tract that does not go through thalamus?
olfactory (CN I)
VPM of thalamus - input and output
trigeminal and gustatory--> to primary sensory cortex
agents of hematogenous osteomyelitis in kids
then S. pyogenes
cause of osteomyelitis in sickle cell patient?
cause of osteomeylitis in DM pt?
granular deposits on IF of PSGN consist of what?
IgG, IgM and C3 --> starry sky
multinucleated giant cells
sarcoptes scabiei mite--> flexor wrist, lateral fingers, webs
**worse at night
best drugs to help prevent cardiac remodeling and maintain ventricular fxn?
Aldosterone inhibitors- spironolactone
vaccine against H. influenza B has decreased what?
MCC of otitis media, sinusitis and conjunctivitis
1. S. pneumo
2. non-typeable (no capsule) H. flu
3. M. catarrhalis
thick bronchial walls, mucus gland enlargement, neutrophilic infiltration, and patchy squamous metaplasia of bronchial mucosa-- dx
chronic bronchitis-- due to environmental cause (ie smoking)
why can a kid get otitis media due to H. influenza even if he's had the vaccine?
b/c otitis media is caused by NON-TYPEABLE H.FLU (NO CAPSULE!!!)
tx of Migraines and MOA
sumatriptan--> 5HT agonist--> inhibits trigeminal nerve activation and prevents vasoactive peptide release, induces vasoconstriction
DA and NE reuptake inhibitor
NE and 5HT reuptake inhibition (like SNRIs)
pathophys of migraine
afferent trigeminal nerve activated--> meninges--> release vasoactive peptides (dilate), substance P and CGRP
SE of metformin?
SE of TCA
anticholinergic-- urinary retention
convulsions, coma, cardiotoxicity
high seizure threshold
impaired vision in HIV pt
tx of CMV retinitis
gancyclovir --> neutropenia
foscarnet --> seizures (hypomag and calcemia)
cidofovir --> nephrotoxicity
T4 HSR cells
CD8 T cells
SE of valproate
hypoparathyroid, D.I., tremor
tx of DM neuralgia
1st line tx for acute gout?
(colchicine-- 2nd line due to SE)
(glucocorticoids in elderly and renal failure pts)
histo of PSGN
LM --> enlarged, hypercellular glomeruli
IF--> subepithelial humps with IgG and C3-- lumpy/bumpy
EM--> electron dense deposits on BM
initial tx of septic arthritis?
how do you prevent acyclovir induced crystalline nephropathy?
cytokeratin is in what type of cells?
epithelial -- make up cytoskeleton
marker for mesenchymal tissue?
185 kD glycoprotein that spans the membrane and has intracellular tyrosine kinase activity- associated with breast, ovarian and endometrial cancer
HER2/neu--> oncogene --> cell proliferation
white pupillary reflex -- indicates what and what is the most common 2nd malignancy associated with it?
Retinoblastoma --> Rb tumor suppressor gene
2nd malignancy: osteosarcoma
Rb gene - type and hypothesis
**2 hit hypothesis -- sporadic or familial
effects of DA on ANS
low doses--> D Rs--> vasodilation of renal and mesenteric vessels
higher doses--> B1 Rs--> increase HR and BP
highest doses--> alpha 1 Rs--> vasoconstrict--> decrease RBF and CO
what is responsible for causing a miscarriage within the first 5-8 weeks of pregnancy?
progesterone from the corpus luteum
Berger disease vs PSGN
Berger disease-- occurs 1-2 days after a URI or GI infection (IgA) --> hematuria and IC in mesangium
PSGN-- at least 1 week after infection -- usually 1-3 weeks --> hematuria, proteinuria, RBC casts, edema
viscerosomatic reflex of prostate?
viscerosomatic reflex of adrenals?
viscerosomatic reflex of T6-T9?
liver and GB
PKU- causes and tx
phenylalanine hydroxylase OR BH4 deficiency (worse)
(tyrosine hydroxylase--> decreased DOPA)
tx: decrease phenylalanine and increase tyrosine in diet
intellectual disability, decreased growth, seizures, fair skin and musty body odor
deficiency in homogentisate oxidase -- black everything
may get arthrlagias
Glucose 6 phosphatase deficiency?
von Gierkes disease
acid maltase deficiency?
Pompe disease (lysosomal- 1,4 glucosidase)
liver glycogen phosphorylase deficiency?
muscle glycogen phosphorylase deficiency? dx and tx?
McArdles --> increase sucrose intake before exercise
muscle phosphofructokinase deficiency--> exercise myalgia and hemolytic anemia
deficiency of branching enzyme --> get linear glycogen --> cirrhosis, hyponatremia and death
what disease do you eat a ketogenic diet??
PDH deficiency--> want to evade the TCA cycle
what are sensitive markers for muscle injury?
CK and myoglobin--> both increased in serum
what are the effects of CK and myoglobin in McArdles?
increased in serum
#1 cause of mitral stenosis?
tryptophan is the precursor to what?
diarrhea and dermatitis - disease and aa involved
Hartnup disease--> tryptophan (niacin)
aa precursor to hemoglobin?
phenylalanine is essential for making what?
tyrosine--> thyroxine and Dopa (BH4 required)
DOPA--> melanin and DA (B6)
DA--> NE (vit C) and Epi (SAM)
anti-citrullinated peptide - disease
first phenotypic sign of puberty?
thelarche-- breast buds
deletion on long arm of chrom 22?
DiGeorge's syndrome--> defective 3rd and 4th pouches--> thymus and PTH glands--> hypocalcemia and immune deficiency
inheritance of alopecia?
polygenic with variable penetrance
Strep able to grow in bile and 6.5% NaCl
MC port of entry for enterococci to invade the body?
kinesin and dynein are part of what structure?
fxn of kinesin and dynein
kinesin--> anterograde transport down axon
dynein--> retrograde transport back toward nucleus and also ciliary and flagellar motion
effects of valsalva and standing on the heart and murmurs?
decrease venous return to heart--> increase MVP and HCM murmurs
decrease all other murmurs
effects of squatting on murmurs?
increase preload and afterload--> increase MOST murmurs
hand grip on murmurs?
increase afterload--> increase AR, MR and VSD
decrease AS and HCM
CF pts sweat
excessive Na and Cl -- due to not reabsorbed by CFTR
normal sweat tonicity
most specific marker for RA?
anti-citrullinated peptide abs (Anti-CCP)
PRPP synthetase- fxn
Ribose 5 P--> PRPP ---------> IMP--> AMP + GMP
*if this enzyme is upregulated--> increase purine synth--> increase risk of gout
tx of acute angle glaucoma that causes alkalinization of urine?
acetazolamide--> Carbonic anhydrase inhibitor--> acts in PCT
SE of ACE-I and mechanism?
cough and angioedema-- due to increased bradykinin
hyperkalemia and hypotension
**AVOID IN B/L RAS --> will vasodilate renal arterioles (specifically efferent) and cause further decrease in GFR)
pathophys of achondroplasia?
activating mutation at FGFR3--> inhibits chondrocytes
why is the Cl- content greater in venous blood compared to arterial?
due to CHLORIDE SHIFT caused by carbonic anhydrase action that converts CO2 from tissues to HCO3- to be carried to lungs
*HCO3- diffuses out of RBC in exchange for Cl-
age related changes cause what 2 major processes?
wrinkles and presbyopia--> structural changes
which organism is associated with eating custard and or mayo?
antidepressant associated with priapism??
TRAZADONE!!! -- inhibits 5HT2 and alpha 1 receptors
bacteria that undergo transformation
(uptake extracellular DNA)
S. pneumo, H. flu, Neisseiria
how can non-capsule forming strains of S. Pneumo acquire genes for a capsule?
which pain med is not anti-inflammatory?
acetaminophen -- antipyretic and analgesic ONLY
which pain medication spaces platelet functions?
COX2 selective inhibitors-- celecoxib
tx of hyperpyrexia?
COOL PATIENT-- cooling blanket, etc
then antipyretics (ASA or acetaminophen)
injection into which quadrant of the buttocks will result in injury to the superior gluteal nerve and cause Trendelenburg gait?
sleeping meds that are nonaddictive?
zolpidem (Ambien) , zaleplon, esZopiclone
HTN medication that causes flushing and edema??
amlodipine/ dihydropine CCBs
SE of verapamil?
constipation and gingival hyperplasia
which glands are responsible for smelly sweat??
apocrine--> arm pits, etc --> become maloderous due to bacteria
which glands are present all over body-- sweat?
which type of glands are sebaceous glands?
partially ds circular DNA in capsid with RNA dep DNA poly -- causes fever, joint pain and atypical lymphs
only viruses to get envelope from budding from the nuclear membrane?
CMV and EBV
where is COX 1 and 2 located?
COX 1 --> platelets and GI
COX 2 --> inflammatory sites--> BETTER!!
risk of celecoxib?
COX 2 selective inhibitor--> increased coagulation! --> don't affect platelets and may leave them unopposed
also COX2 normally makes PGI2 --> anti-coagulant
tumors with psammoma bodies?
papillary thyroid carcinoma
papillary ovarian adenocarcinoma
characteristics of Glioblastoma multiforme?
Pseudopalisading pleomorphic cells -- lined up around necrosis or hemorrhage
cross corpus callosum--> butterfly
characteristics of oligodendroglioma?
fried egg cells-- round nuclei
chicken wire capillary pattern
cancers assoc with EBV?
Burkitt's (8;14) -- cmyc
Reed Sternberg cell markers?
CD 15 and CD30
Diffuse large B cell lymphoma--> 14;18
Waldeyer ring, GI
Mantle cell lymphoma translocation and gene?
t(11;14) - cyclin D1 --> allows cell cycle to continue
Follicular lymphoma translocation and gene?
bcl-2 --> inhibits apoptosis
waxing and waning lymphadenopathy??
lymphoma associated with lytic bone lesions and hypercalcemia?
adult T cell lymphoma-- HTLV1
CD4+ T cells--> cutaneous patches/plaques/tumors --> can spread to LN and viscera (Sezary syndrome)
multiple myeloma- everything you know
monoclonal M spike on electrophoresis
Bence jones proteins in urine (light chain)
amyloidosis (AL) --> renal problems
lytic bone lesions
Rouleaux formation of RBCs
"fried egg appearance"
impaired hematopoeisis--> anemia and weakness
M spike of IgM and hyperviscosity syndrome
but NOT bone lesions!!
precursor of mutliple myeloma?
hemidesmosomes-- not as severe
no Nikolsky sign -- do not form new bullae with traction
tenser bliesters that do not rupture easily
desmosomes-- severe blistering that rupture easily--> skin AND mucosa (oral)
Nikolsky and Asboe Hansen sign
- make NEW ones with traction and spread laterally with pressure
fishnet appearance on IF
non linear DNA viruses?
papilloma, polyoma and hepadna (HBV)--> circular
replication of HBV vs HIV
HBV: dsDNA--> ssRNA--> dsDNA (reverse transcriptase)
HIV: +ssRNA --> dsDNA--> +ssRNA (RT)
hemoptysis + hematuria - dx
chronic sinusitis, mucosal ulcers and hematuria- dx
what kind of cancer is pernicious anemia associated with?
what cancer is H. pylori associated with?
megaloblastic anemia with increased methylmalonic acid?
glomerulopathy assoc with heroine abuse, HIV or sickle cell disease?
what test do you do to dx post-strep glomerulonephritis
anti-streptolysin O ab (ASO)
thermoregulatory center of body?
anterior hypothalamus (cool- PNS)
what is responsible for warming up the body?
posterior hypothalamus--> shivering and increase TSH
what is responsible for fever and cooling down the body?
infliximab - MOA, indication and SE
MOA: TNF alpha monoclonal ab
Indication: RA, AS, psoriasis, IBD
SE: can predispose to infection--> reactivate TB
adalimumab-MOA, indication and SE
MOA: TNF alpha monoclonal ab
Indication: RA, AS, psoriasis, IBD
SE: can predispose to infection--> reactivate TB
what do you want to do before starting infliximab?
TB test! -- can predispose to infection/reactivation
MOA of etanercept
TNF decoy receptor-- binds to TNF and takes out of blood
sore throat, fever, vesicles on buccal mucosa, pharynx, mouth, tongue, gums, as well as hands, groin, maybe feet etc -- dx and virus
hand foot and mouth disease--> coxsackie A (Picornavirus--> naked icosahedral, +ssRNA virus)
SE of opioids?
constipation, miosis, NAUSEA, decreased RR
if baby is startled, they abduct and extend arms and then adduct-- which reflex?
lateral flexion of hips when stroked one side of spine- which reflex?
fencing reflex is also known as what?
assymetrical tonic neck reflex
"ovoid nodules" in glomerular periphery of someone with glomerulonephropathy?
Diabetic nephropathy--> Kimmelstiel Wilson lesions
URI sx (cough, rhinorrhea) then LRI sx and tachypnea/wheezing -- dx and bug?
bronchiolitis -- RSV
inspiratory stridor, barking cough, hoarseness and SOB --dx and bug?
croup (laryngotracheobronchitis)-- parainfluenza
xanthomas on achilles and accelerated atherosclerosis, corneal arcus-- dx and deficiency?
Type II familial cholesterolemia--> LDL R deficiency --> increased LDL and cholesterol
eruptive xanthomas, hepatosplenomegaly, pancreatitis and abdominal pain-- dx and deficiency?
Type I hypercholesterolemia--> LPL or apo-CII deficiency
**no increased risk of atherosclerosis
do you need to get parental consent to do an abortion on a minor? STD tx? pregnancy?
NO!!! unless state/local laws
h/a, ab pain, wt loss, muscle pain, palpable purpura, hematuria, no granulomas and no URI sx, high ESR -- dx and monitor test?
microscopic polyangitis-- P-ANCA
Wegner's vs microscopic polyangitis
Wegner's-- URI (sinusitis, saddle nose), LRI (hemoptysis, cough), renal- hematuria --> granulomas --> C-ANCA
Microscopic polyangitis-- dermato-pulmonary-renal --> systemic sx with palpable purpura-- same as Wegners but no URI sx and no granulomas --> P-ANCA
potential consequences of HELLP syndrome?
HELLP= preeclampsia with hemolysis, elevated LFTs and low platelets
can lead to DIC with hepatic rupture, vision loss, seizures and heart failure
sx of shock
describe HOCM murmur
systolic crescendo-decrescendo (similar in path to aortic stenosis)
apex and L sternal border--> suprasternal notch
*decreases with increased preload/afterload (squatting, hand grip, etc) -- m'ore blood-- bigger the space it has to pass through because it dilates--> decreases murmur
*increases with decreased preload/afterload (standing, valsalva)
what is Sheehan disease and which drug is contraindicated in it?
Sheehan-- postpartum pituitary necrosis secondary to hemorrhage or severe bleeding during birth--> lack of blood to pituitary--> infarcts--> problems with lactation
DO NOT USE BROMOCRIPTINE (DA agonist--> will further suppress prolactin)
what is MOA and use of bromocriptine
DA agonist--> used in hyperprolactinemia to inhibit prolactin
**DON'T USE IN HYPOPROLACTINEMIA
which vaccines have eggs in them?
flu and yellow fever
SE of TCAs?
anticholinergics-- dry mouth, tachy, dilated pupils , urinary retention
Tri-Cs: Convulsions, cardiotox, coma
tx of cardiotoxicity of TCAs?
toxicity of mercury?
nephrotoxicity-- acute renal injury--> oliguria, high creat
falling spots, lethargy, ataxia, speech changes, metabolic acidosis- dx?
tinnitus, gastric ulceration, interstitial nephritis-- cause?
ASA effect on respiration?
increase--> resp alkalosis
scanning speech/dysarthria, intention tremor, nystagmus- dx?
MS -- damage of oligodendrocytes
association of HLA with MS?
tx of UTI in pregnant patient??
what do you use vanco for? and SE?
MRSA (and C. diff)
**RED MAN SYNDROME
Nephrotoxic, ototoxic and thrombophlebitis--> flushing
location of broca's aphasia?
inferior frontal gyrus
location of wernicke's aphasia?
superior temporal gyrus
the only deficit is can't repeat "no ifs, ands or buts" -- dx and location?
conduction aphasia --> arcuate fasciculus
contraindications for using IV steroids in acute asthma attack?
VZV or herpes simplex keratitis
what infectious or disease process can produce high vit D?
if a patient makes a decision not in their own best interest, what is the first thing you should do?
assess their capacity!
which innominate dysfunction causes a relatively longer leg on the affected side?
which innomniate dysfunction causes a relatively shorter leg?
if someone has a shorter leg, what will happen to their innominates?
the affected side will be anterior
the unaffected side posterior
Dx of MS?
oligoclonal bands in CSF
increased IgG in CSF (oligolonal)
MRI-- gold standard*** --> periventricular plaques (oligodendrocyte loss and reactive gliosis)
punched out bone lesions, IgG spike on electrophoresis, fried egg cells, hypercalcemia?
plasma cells (fried eggs) produce lots of IgG or IgA --> M spike
lytic bone lesions (OAF)--> hypercalcemia
renal insufficiency --> Bence jones proteins in urine
primary amyloidosis (AL -- light chain)
M spike with IgM?
Waldenstrom macroglobulinemia--> hyperviscosity but no lytic bone lesions
what is the precursor to mutliple myeloma?
MGUS-- monoclonal gammopathy of undetermined significance
worst itch of life after swimming in Africa (swimmer's itch), fever, hives, hepatosplenomegaly- dx and tx
Schistosoma (snails--> water--> penetrate skin)-- dx by eggs in stool or urine
Hematobium-- terminal spine--> bladder -- hematuria
Mansoni-- subterminal spine-- liver --> bloody diarrhea
MOA of praziquantal
increase Ca++ --> spastic paralysis of fluke
cause of elephantitis? and tx?
Wuchereria bancrofti -- mosquito bite
causes of secondary hyperparathyroidism?
chronic renal failure--> decreased Ca++
low vit D--> decreased Ca++
tetany, cardiac sx, psych sx
Chvostek sign--> tap facial nerve
Trousseau sign--> occlude brachial a with BP cuff at triceps--> carpal spasm
MOA of chloramphenicol?
blocks peptidyltransferase at 50S
MOA of clindamycin?
inhibits translocation at 50S -- anaerobic above diaphragm -- aspiration pneumo
tx of aspiration pneumo or lung abscess?
MOA of metronidazole
free radical toxic metabolites in cell--> damage DNA
use of metronidazole?
anaerobes BELOW DIAPHGRAM
tx of vaginitis?
SE of metronidazole?
don't drink alc--> disulfiram rxn -- flushin, tachy, hypotension
MOA and use of praziquantal?
increase Ca++ --> spastic paralysis
MOA and use of ivermectin?
increases glutamate Cl channels--> paralysis
Onchocerca (river blindness)-- hyperpigmented skin and blindness via black fly
MOA of bendazole and use?
inhibits beta tubulin polymeraization--> structural integrity damaged
used for enterobius vermicularis (MC-- anal pruritis-- Scotch tape test)
which parasite do you do the Scotch tape test for?
enterobius vermicularis--> bendazole
risk factors for endometrial CA?
if postmenopausal woman has persistent vaginal bleeding with normal physical, what is first dx test?
endometrial biopsy - if they can handle it
MOA of doxorubicin?
generate free radicals--> breaks in DNA
tx of brain cancer?
nitrosureas-- cross BBB-- cross link DNA
ex: carmustine, lomustine, semustine, etc)
tx of CML?
busulfan -- cross links DNA
chemo drug that causes nephrotoxicity and neurotoxicity (CN VIII and wrist drop)?
tx of melanoma?
hydroxyurea-- inhibits ribonucleotide reductase-- inhibits DNA synthesis
SE of trastuzumab?
MOA and use of rituximab?
MAB against CD 20 --> used in NHL
tx against solid tumors?
bevacizumab --> MAB against VEGF
MAB against VEGF and SE?
bevacizumab --> hemorrhage and wound healing
chemo drug that causes pulmonary fibrosis?
bleomycin and busulfan (CML)
chemodrug that causes hemorrhagic cystitis?
chemodrug that causes cardiotoxicity?
chemodrug that causes dilated cardiomyopathy?
chemodrugs that cause BM suppression?
almost all do but MTX, 6MP and 5FU especially
cancer drug that causes pulmonary fibrosis and hyperpigmentation?
cancer drug that causes peripheral neuropathy?
innervation and fxn of teres major?
internal rotation and adduction
contents of triangular space? and borders?
teres minor, major and triceps
circumflex scap artery
contents of quadrangular space and borders?
both teres, triceps and humerus
contents: axillary n and posterior circumflex artery
triangular interval- borders and contents?
teres major, long head and humers
contents: radial and profundus brachii
psych disorder in child where there is a hostile defiant behavior towards authority but no actual violations?
oppositional defiant disorder
what is Tourette's associated with?
OCD and ADHD
what personality disorder is associated with conduct disorder?
personality disorder of a loner who doesn't care about social interactions and little expression?
personality disorder with no interpersonal relations and weird thinking?
personality disorder where they are afraid of rejection and desire relationship with others but dont really have one?
cyclical pelvic pain that peaks with onset of menses, dyspareunia?
endometriosis--> need visualization of ovaries
catalase - bacteria that is soluble in bile?
S. pneumo (vs. S. viridans)
catalase - bact that grows in bile but not hypertonic saline?
S. bovis (vs. enterococcus faecalis)
causes of impetigo?
S. aureus >> S. pyogenes
catalase negative, PYR +, beta hemolytic that cannot grow in hypertonic saline?
indicators of previous S. pyogenes infection?
spreading factors of S. pyogenes?
catalase neg, PYR + that can grow in hypertonic saline?
tx of S. pyogenes?
penicillin or macros
tx of S. agalactiae?
S. pyogenes characteristics?
tx of Status epilepticus?
tx of tonic- clonic seizures?
valproate -- inhibit Na, increase GABA
carbamazepine -- inhibit Na --> decrease conduction
phenytoin-- inhibit Na
seizure DOC in preg and neonates?
SE of ethsuximide?
SE of phenytoin
gingival hyperplasia, megaloblastic (folate), nystagmus, ataxia, periph neuropathy
SLE syndrome, increases CYP450
fetal hyndrantoin syndrome -- cleft lip, nail hypoplasia, mental, heart, growth
agranulocytosis, aplastic anemia
diplopia, ataxia, teratogenesis
valproic acid SE?
hepatotox, thrombocytopenia, GI
SE of lithium
nephrogenic DI -- ADH antagonist
MOA and SE of methimazole?
inhibits thyroid peroxidase
rash, agranulocytosis, aplastic anemia
MOA of B blockers on the heart?
decrease cAMP and decrease Ca++ currents--> decrease slope of phase 4 and decrease SA and AV nodal activity
where on an EKG do B blockers affect?
slow nodal activity--> increase PR interval
what does the clearance of PAH measure?
how do you get RBF from clearance of PAH?
RBF= RPF / (1-Hct)
amenorrhea, osteoporosis, hypotension, bradycardic, lanugo hair, enlarged parotid glands
anorexia nervosa-- binging/purging type
(Vs bulemia--> will have normal BMI and no sx of starvation!!!)
what effect will ureteral constriction have on GFR?
decrease it--> increase hydrostatic P in Bowman's
causes of accelerated bone loss?
estrogen deficiency (prolactinoma, menopause)
vit D deficiency
effects of prolactinoma on estrogen?
prolactin--> inhibits GnRH --> inhibits FSH and LH --> inhibits estrogen--> osteoporosis, amenorrhea, anovulation, vag dryness, hypogonadism
consequences of prolactinoma?
amenorrhea, infertility, anovulation
a study where exposure and an outcome are measured at a particular point of time -- snap shot
cross-sectional study -- measures prevalence
if aspirate supine- where is it most likely to go?
posterior R upper lobe OR superior R lower lobe
MCC of aseptic meningitis
enteroviruses (picornaviruses--> + ssRNA) -- polio, echo, coxsackie
fever, h/a, malaise, photophobia, painful eye movements, with weakness and hyporeflexia, with viral RNA from CSF-- dx, agent and characteristics?
aseptic meningitis--> poliovirus --> picornavirus (+ssRNA virus) -- enterovirus-- fecal/oral
histo of Rheumatic fever
Aschoff bodies-- granuloma with giant cells
Anitschkow cells--> enlarged macros with ovoid, wavy, rod like nucleus
which process is responsible for the degradation of misfolded proteins? and if not present can lead to PD
ubiquination--> marks for degradation
**if not present--> PD and AD
what is acetylation important for?
histone acetylation--> makes euchromatin--> active DNA for transcription
what is gamma carboxylation imp for?
activating vit K clotting factors- II, VII, IX and X and C and S
what is glucuronidation important for?
metabolism of bilirubin-- conjugation
UDP glucuronysyl transferase
2 common drugs used for abortion and their MOAs?
mifepristone (Plan B) -- competitive progesterone inhibitor
misoprostol -- PGE-1 analogue
MOA of acarbose
surface membrane bound enzyme inhibitor (alpha-glucosidase at brush border)
DM drug that affects membrane ion channels?
sulfonylureas (close K+ -- depolarize-- release insulin)
ex: chlorpropamide and tolbutamide, glyburide
DM drug that acts on G protein receptor?
GLP-1 --> increases insulin, decreases BG and increases satiety
DM drug that acts on intracellular enyzymes?
2 causes for exacerbation of MG sx - how to tell them apart?
myasthenic crisis-- not enough doseage--> do edrophonium test and get improvement-- need higher dose of neostigmine
cholinergic crisis-- too high dose-- do edrophonium test and get NO improvement-- temporarily stop meds!!
MOA of pralidoxime
regenerates AChE if given early --> need to give with atropine for organophosphate poisoning-- tx nicotinic receptors!!
MOA of atropine
muscarinic antagonist-- tx muscarinic sx of organophosphate poisoning
what is anterior pituitary derived from
what is posterior pituitary derived from?
neuroectoderm or neural tube
what is the spleen derived from?
what are the kidneys derived from?
what is the liver and pancreas derived from?
what are the lungs derived from?
what are they thymus and parathyroid glands dervied from?
what is the adrenal medulla and parafollicular cells of thyroid derived from?
adrenal cortex derived from?
thyroid follicular cells derived from?
what are the salivary, sweat and mammary glands derived from?
what are the bones of the skull derived from?
what is the nucleus pulposus derived from?
which enzyme does heme inhibit in the pathway of heme synthesis to aid in tx or acute intermittent porphyria?
S-aminolevulinic acid synthase
sx of acute intermittent porphyria and tx?
deficiency of porphobilinogen deaminase--> build up of s-aminolevulinic acid and porphobilinogen
sx: 5Ps: painful abdomen, port wine urine, polyneuropathy, psych disturbance, precipitated by drugs, alc or starvation
tx: heme or glucose--> inhibit S-aminolevulinic acid synthase!!!
which enzymes do lead inhibit in the heme metabolism pathway?
which enzyme is deficiency in sideroblastic anemia
S-ALA synthase --> Fe builds up in mito in erythroid precursor--> get ringed sideroblasts
what gives elastin it's elastic properties??
desmosine cross linking with lysine -- lysyl hydroxylase
proline, glycine and lysine
**CROSS LINKING OF DESMOSINE WITH LYSINE!!!
no hydroxylation, triple helices or disulfide bridges!!
1. Synthesis (RER)--> preprocollagen-- glycine, proline and lysine
2. hydroxylation (RER)--> proline and lysine (vit C) -- scurvy
3. Glycosylation (RER) --> procollagen-- hydrogen and disulfide bonds (triple helix) -- osteogenesis imperfecta
4. exocytosis--> Extracellular space
5. proteolytic processing--> cleave disulfide rich end--> make tropocollagen
6. Cross-linking--> lysin-hydroxylysine cross-linkage (Cu lysyl oxidase) --> Ehlers-Danlos and Menkes
spasmodic dystonia- with arching of back, opthistonic posturing of head, back, neck and UE
or hiatal hernia
precursor of thyroxine?
DOC for acute bacterial sinusitis?
amoxi + clauvulanate
sudden erruption of seborrheic keratosis --flat greasy, pigmented epithelial proliferation with horn cysts-- sign and indication?
Leser-Trelat sign-- GI malignancy (get colonoscopy)
seborrheic keratosis path
intraepidermal horn cysts with cornified cells of melanin
atypia or dysplasia of keratinocytes in basal layer of epidermis?
actinic keratosis--> precursor to SCC of skin
what does xeroderma pigmentosa predispose to?
basal cell carcinoma
what does actinic keratosis predispose to?
large uniform, palisading nuclei with hyperchromatic and little cytoplasm-- on skin
basal cell carcinoma
fever, anemia, thrombocytopenia, renal failure, purpura, neuro sx -- with large vWF multimer
pathophys and gene of TTP?
ADAMTS13 --> decreased degradation of vWF multimers (no protease)-- large multimer--> increased platelet adhesion and aggregation
frontal bulging with nasal bridge, circumoral rash and lesions, anterior bowing of shins, sensorineural hearing loss (CN VIII deafness), fissuring of mouth/lips- dx
newborn with hydrocephalus, chorioretinitis, intracranial calcifications and mental retardation-- dx
congenital toxoplasma gondii
newborn with PDA, deafness and cataracts as well as rash- dx
MOA and indication of danazol
synthetic testosterone--> acts on pituitary--> neg feedback--> decrease LH and FSH--> decrease estrogen
MOA and indication of ketoconazole
inhibits cholesterol desmolase in adrenals--> inhibits steroid syntehsis
used in PCOS!
MOA and indication of leuprolide
GnRH analog--> can be given pulsatile or continuous
used for infertility (pulsatile)
prostate CA, uterine fibroids, endometriosis, precocious puberty (continuous)
fxn of Rb gene and diseases if lacking?
Rb inhibits G1--> S phase progression
if lacking--> osteosarcoma and retinoblastoma
microcephaly, thin upper lip, smooth philtrum, 10th percentile of ht/wt, small palpebral fissures and slowed CNS development
effects of ACE-inhibitors on fetus?
effects of warfarin on fetus?
chondrodysplasia, bone deformities, fetal hemorrhage, abortion
effects of thalidomide on fetus?
limb defects-- phocomelia, micromelia
PCT unresponsiveness to PTH -- dx
Albright's hereditary osteodystrophy (pseudohypoparathyroidism) - short stature, short 4th/5th metacarpals, rounded facies, mental retardation
tinnitus (ocean), hearing loss, vertigo and feeling of fullness -- dx and pathophys
Meniere's disease--> due to hydropic dilation and distention of fluid in cochlea from excess endolymphatic fluid in cochlea
cause of BPPV?
Ca++ otolith deposition in semicircular canal
U/L SNHL, ataxia and tinnitus- dx
vertigo, n/v, ataxia and nystagmus with no changes in hearing?
enlarged, very tender LNs with fever, chills and generalized weakness, also painful ulcer with dark hemorrhagic purpura at area of bite - dx and tx
bubonic plaque-- Yersinia pestis (fleas)
fever and anemia post tick bite- malaria like sx -- dx and tx?
Babesiosis --> atovaquone and azithromycin
when do you see a palms and soles rash?
Rocky Mountain spotted fever
really high fever with Lyme?
Ehrlichiosis -- morulaes in monocytes
spiking fever, abdominal pain/distention, hepatosplenomegaly, weight loss, sore at site of bite-- dx and transmission? tx?
Leishmania donovani--> sandfly
tx: sodium stibogluconate
changes in pregnancy
increased CO, decreased TPR
increased HR, plasma vol, RBC, decreased Hct
increased TV and RR--> decreased CO2 and increased plasma pH
decreased GI motility--> increased reflux and prolonged emptying
increased GFR and RPF, increased size of kidneys--> decreased Bun and creatinine
increased RAAS--> increased aldosterone--> increased Na+ retention-- but GFR increased to so plasma stays same
increased estrogen--> increased binding globulins
when do sleepwalking, bed wetting and night terrors occur?
Stage 3 sleep--> delta waves (slow waves)
when do nightmares and dreams occur?
REM sleep--> beta waves
study of choice to determine prevalence of a disease in a population?
totaly caloria malnutrition with muscle wasting and loss of fat
protein malnutrition with skin lesions and edema-- child with swollen belly
sx of hyperkalemia?
palpitations, arrhythmias- high T waves
sx of vit E toxicity?
hemolytic anemia due to decreased vit K dependent factors, acanthatosis, weakness, posterior columna and spinocerebellar tract demyelination
seizures, increased ICP, papilledema, liver damage with high LFTs, GI sx, skin changes and arthralgias-- what is this a toxicity of ?
toxicity of ASA?
gastric ulceration, tinnitus (CN VIII), acute renal failure, metabolic acidosis
can stimulate resp center--> hyperventilation
Reye syndrome in children with virus
causes of ATN?
ischemia-- shock, sepsis, hypotension, CHF, hemorrhage
nephrotoxic -- aminoglycosides, radiocontrast, lead, cisplatin, rhabdomyolysis (statins), hemoglobinuria
regions most susceptible to injury of kidney?
PCT and thick ascending limb
what is the most important risk factor contributing to development of cervical dysplasia??
HPV 16 or 18
asthma, sinusitis, granulomas, palpable purpura and eosinophilia -- can also get peripheral neuropathy-- dx
patho phys of pulmonary HTN due to CHF
L CHF--> increased pulmonary vascular congestion--> endothelial damage--> increased endothelin, decreased NO--> vasoconstrict and remodeling--> pulm HTN
which receptors do CMV and EBV bind to?
CMV-> cellular integrins
EBV--> CR2 (CD21)
what R does rabies bind to in host?
nicotinic ACh R
what R does rhinovirus bind to in host?
the chances that someone really does not have a disease if the test is negative
negative predictive value-- varies with prevalence
the chances that someone really does have the disease if a test is positive?
positive predictive value -- varies with prevalence
the probability that a test detects disease when disease is present?
the probability that a test indicates non-disease when disease is absent?
when offspring receives 2 copies of chromosome from 1 parent and none from other
heterodisomy--> Meiosis I error
isodisomy-- meiosis II error
fragile X genetics
triplet repeats CGG on X chromosome
chrom associated with Prader-Willi and AngelMann syndrome
chromosome 15-- imprinting and gene deletions
genetics of Turner's syndrome
45 XO --> meiotic nondysjunction of paternal chrom
meiotic nondysjunction syndromes
trisomy 13, 18, 21
which nts are affected in tetanus?
GABA and glycine
best test to confirm menopause?
when viruses with SEGMENTED genomes exchange segments (influenza)
crossing over of 2 chromosomes-- exchange of genes
simultaneous infection of cell with 2 viruses-- one is coated with the other
if 2 defective viruses that cannot infect a cell on their own are put together and can now infect the cell -- what is that called?
schizoaffective disorder vs bipolar or depressive with psych sx?
schizoaffective-- crazy all the time - always has psych sx-- do not correlate with mood sx
BP/MDD with psych sx-- psycho sx are only present during mood disturbances
Flight of ideas
which artery supplies the inferior wall of the heart/diaphragmatic surface?
ovarian tumor marker?
what decreases risk of ovarian cancer?
decreased reparative processes of surface of ovaries (ie ovulation -- every time woman ovulates there needs to be a surface repair on the ovary -- may be irregularities)
**OCPs decrease this risk--> decreased # of ovulations in woman's lifetime
MOA of canagliflozin? and what should be monitored before starting?
SGLT2 inhibitor (inhibits glucose reabsorption from PCT
**CHECK RENAL FXN FIRST!!!
when should thyroid fxn tests be done? before which drugs?
amiodarone -- check LFTs, thyroid and PFTs
SE of metformin
lactic acidosis -- contra in renal failure!!
which drugs bind PPAR-gamma nuclear transcription regulator and what affect does it have?
increases insulin sensitivity in peripheral tissues
MOA of acyclovir
it is phosphorylated by viral thymidine kinase (only in infected cells) and then inhibits viral DNA polymerase--> chain termination
MOA of nystatin
binds ergosterol and forms membrane pore--> leakage of electrolytes--> swelling and bursting
(same as AMPH B)
MOA of azoles
inhibit ergosterol synthesis via cyto P40 enzyme inhibition
(ketoconazole--> inhibits cholesterol desmolase)
MOA of griseofulvin and indication
used for dermatophytes -- superficial infections
MOA: interferes with microtubule fxn-- disrupts mitosis
MOA of terbinafine and indication?
MOA: inhibits squalene epoxidase
fxn of sertoli cells
analogous to granulosa cells
secrete MIF, inhibin
**inhibin--> inhibits FSH at anterior pituitary
fxn of inhibin
which cells in a male are temperature sensitive?
lung abscesses and parenchymal damage is due to what?
lysosomal enzymes from macros and neuts
Ca++ efflux in myocyte relaxation is due to what?
Ca++ ATPase on SR and Na/Ca++ exchanger on sarcolemma
effects of leukotrienes?
vasoconstriction, vasc permeability, bronchospasm
effects of platelet activating factor?
vasoconstriction, platelet aggregation, bronchoconstriction, increased leukocyte adhesion to endothelium
what is responsible for granuloma formation?
Th1 cells--> IFN-GAMMA!! IL-12 and TNF-alpha
effects of bradykinin
vasodilation, permeability, smooth muscle contraction and pain
what is responsible for anemia of chronic disease?
ferritin -- scavanges Fe to prevent microbes from getting it
hepcidin-- prevents release of Fe from ferritin
what is responsible for ESR?
fibrinogen (coagulation) --> Rouleaux formation
**ACUTE PHASE REACTANT-- IL-6
what is the fxn of CRP?
opsonin and fixes complement
major control of ventilation?
central chemoreceptors in medulla--> responding to increased CO2
**EXCEPT in dramatic hypoxia -- then peripheral takes over
what is TMP-SMX used for?
UTIs, GI or skin lesions
ex: Pneumocystis jiroveci, toxoplasma, Nocardia
tx of Pseudomonas
anti-pseudomonal penicillins: ticarcillin and piperacillin
cefepime (4th gen)
gentamycin, cipro, levofloxacin, carbapenems can also work too
MOA and use of vanco?
inhibits cell wall peptidoglycan formation by binding D-ala-D-ala portion of cell wall precursors
used for Gram + only -- Serious infections (MRSA and C.diff)
stages of lobar pneumonia
1. congestion (24 hrs)-- edema, red, boggy-- dilated vessels --> exudates with bacteria
2. red hepatization (2-3 days)-- red, firm lobe-- exudate with RBCs, neuts and fibrin
3. gray hepatization (4-6 d)-- pale, firm lobe-- RBC disintegrate-- exudate has neuts and fibrin
4. resolution-- restoration of normal architecture-- enzymatic degradation of exudate
where does T cell positive selection occur?
Thymic cortex--> with thymic cortical epithelial cells
where does T cell negative selection occur?
thymic medulla--> with thymic medulla epithelial cells
aldolase B deficiency
fructose intolerance-- cirrhosis, jaundice, vom, lethargy, hypoglycemia, renal damage
what is responsible for cataract formation in galactose met disorders?
deficiency of riboflavin- sx?
glossitis, stomatitis, dermatitis, cheilosis, corneal vascularization, ariboflavinosis
which vitamin is the cofactor for hepatic gamma carboxylation of glutamic residues?
MOA of 5-FU
pyrimidine analoge--> when activated it inhibits thymidylate synthase
*cannot be reversed with leucovorin/folinic acid--> actually potentiates it's toxicity
tx of HOCM?
B blockers or CCBs
dx of HOCM
echo-- SAM (systolic anterior motion of mitral valve) and early closure and then reopening of the aortic valve; L ventricular hypertrophy
heart sound of HOCM
systolic ejection murmur
accentuated by exercise or standing
lessened by squatting or lying down
what drug shifts a curve to the right but does not cause a change in efficacy?
what drug shifts a curve down and cannot be overcome by increasing the agonist substrate?
what drug shifts a curve to the left, but parallel?
indirect agonist-- potentiation
MOA of cocaine?
blocks monoamine reuptake--> NE, DA and 5HT
MOA of prazosin?
competitive alpha 1 blocker
MOA of phenoxybenzamine?
noncompetitive alpha 1 blocker -- used for pheo
the only noncompetitive alpha 1 blocker used clinically?
chemo drug that causes peripheral neuritis-- tingling in hands and feet
severe pruritis after shower, h/a, dizzy, flushing- with increased WBCs, platelets, RBCs and Hct
Polycythemia vera-- due to mut in JAK2 -- makes hematopoeitic stem cells more sensitive to growth factors (EPO)
MOA and resistance to Rifampin?
MOA- DNA dep RNA polymerase inhibitor
- resistance by changing that enzyme-- rapid resistance if used alone
red orange body fluids
ramps up CYP450
MOA and resistance of isoniazid?
MOA - inhibits synthesis of mycolic acids
resistance by downreg bacterial catalase-peroxidase-- needed to activate INH
fever, throat pain, dyspnea, tachypnea, stridor, dysphagia for solids, and hematopoeitic blasts in blood smear
T cell ALL -- ALL is most common malig in kids, and T cells cause mediastinum mass--> dysphagia, throat pain, etc
if have blasts in blood smear?
fever, bleeding, bone pain, hepatosplenomegaly with blasts
B cell ALL
MC malignancy in children?
MOA of celecoxib
COX 2 selective inhibitor-- good for people with GI issues
how does TNF-alpha and glucagon mediate insulin resistance? and FFAs?
they activate serine kinases which phosphorylate the B component of insulin receptors (TK) --> can not be phosphorylated by insulin and inhibits the downstream effects
what is needed for hydroxylation of proline in collagen synthesis?
hypotonia, feeding difficulties, cardiomegaly and polysaccharides in lysosomes-- dx and enzyme
Pompe disease--> lysosomal/acid alpha-glucosidase (acid maltase)
severe fasting hypoglycemia, increased lactate, hepatosplenomegaly, growth retardation, hyperlipidemia
Von Gierkes disease-- Glucose 6 phosphatase
chronic hemolytic anemia, splenomegaly and poor exercise intolerance
Pyruvate kinase deficiency
hepatosplenomegaly, hypoglycemia, muscle weakness, growth retardation but NO increased lactate!!
Cori disease--> debranching enzyme (alpha-1,6-glucosidase)
most abundant AA in collagen?
if have elevated AChE in amniotic fluid-- dx?
dx of NTD?
elevated AChE and AFP
MOA of isopreterenol
non selective B agonist
what causes insulin resistant in obese people?
FFAs and TGs
tx of atonic bladder?
hydrocephalus, intracranial calcifications and chorioretinitis?
h/a, irritable, short term memory
periph neuropathy-- wrist drop
microcytic anemia, basophilic stippling and sideroblasts
2. resolution temporarily
3. hepatic dysfxn, decreased BG and met acidosis
4. GI scarring
alkaline mucous secretion
Brunner's glands--> duodenum
what makes up the portal vein?
SMV + Splenic v (IMV drains into splenic)
2 consequences of malrotation of midgut?
the tendency for certain alleles at 2 linked loci to occur together more often than is expected by chance
when 1 gene contributes to multiple phenotypic effects?
what is the urease breath test (C-urea) used to screen for?
H. pylori--> duodenal ulcers
neutrophil chemotactic factors
LTB4, IL-8, C5a, bacterial products
what is aztreonam used for?
gram neg rods
what is MOA of pertussis toxin and what are the sx?
inhibits Gi via ADP ribosylation --> increases cAMP
- increases insulin secretion--> hypoglycemia
- hyperactivity of resp system
- block immune effector cells
- increased histamine sensitivity
sudden onset dyspnea, resp distress refractory to O2 tx, b/l crackles and b/l infiltrates on CXR, acute pancreatitis -- dx and pathophys
ARDS--> alveolar hyaline membrane
- diffuse alveolar damage --> increased cap permeability--> exudate leakage and noncardiogenic pulmonary edema--> intra-alveolar hyaline membrane
proximal muscle weakness with CD8+ lymphocyte infiltration and MHC I on sarcolemma
polymyositis-- endomysial inflammation with CD8 T cells
anti-Jo-1 abs -- associated with what?
polymyositis and dermatomyositis
same as poly- except rash and CD4+ T cells in perimysium
prox muscle pain but NO weakness-- dx
excessive daytime sleepiness, brief periods of sudden muscle tone loss-- dx and low CSF compound?
narcolepsy with cataplexy
low orexin/hypocretin-1 in CSF
when are psychiatrist relationships with patient ethical?
NEVER- not current OR former!!
most posterior surface of heart- closest to esophagus for TEE?
TEE- anterior and posterior
anterior--> L atrium
posterior--> descending aorta
failure of maxillary prominence to fuse with medial nasal prominence
failure of lateral palatine prominences to fuse
when is work minimal for pts with elastic resistance (pulmonary fibrosis)?
at higher RR--> decreased tidal volume--> decreased elastic resistance
when is work minimal for pts with air way resistance (asthma, emphysema, obstruction) ?
at lower RR--> decreased RR --> decreased resistance to air flow
tx of CMV?
what are the MOAs of "cyclovirs" and what is required of them?
MOA- inhibit viral DNA poly
NEED TO BE PHOSPHORYLATED! (nucleosides)
what are the 2 nucleotide viral DNA polymerase inhibitors?
**do NOT need phosphorylation!
what DNA polymerase inhibitors (anti-virals) do not need to be phosphorylated?
fxn of a pilus?
to mediate attachment of bacteria to cell surface
bacteria that have a pilus?
chromosome abnormality in AML
t(15,17) -- APL
where is t(9;22)?
anion gap metabolic acidosis with increased lactate, hyperventilation-- dx and enzyme decreased
hypoxia-induced lactic acidosis
**PDH decreased--> pyruvate shunted to lactate
what poisoning are nitrites used to tx?
CN --> binds cyto complex IV in ETC--> inhibits met
nitrites--> Hb--> MetHb--> high affinity for CN so takes it out of system
what do nitrites do in blood?
form methemoglobin --> high affinity for CN
what is the most important contributor to peak bone mass?
GENETICS!!! - 80%
Drugs that cause SLE sx with anti-histone Abs-- how are they metabolized?
liver acetylation-- slow vs fast acetylators
drugs that trigger an SLE syndrome?
drugs metabolized by liver acetylation cause what SE?
retinitis in HIV pt- cause and tx?
when combined effect is equal to sum of 2 drugs
when combined effect is greater than sum of 2 drugs
when a drug allows another drug to reach its full potential?
wt gain, fatigue, HTN, with intrasellar microadenoma and increased ACTH- dx and path changes of adrenal gland?
Cushing's disease--ACTH pituitary tumor
causes b/l hyperplasia of adrenal gland-- F and R
fxn of free ribosomes
make cytosolic/structural proteins
fxn of bound ribosomes (RER)
make secretory, membrane and lysosomal proteins
fxn of SER
problem with Scurvy?
vit C--> decreased hydroxylation of collagen
problem with osteogenesis imperfecta?
AD--> problem with triple helix of collagen-- glycosylation -- type I collagen
problem with Ehler's Danlos?
problem with cross-linking collagen (type V)
tx of absence seizures?
SE of valproic acid?
thrombocytopenia (decreased folic acid)
SE of lamotrigine
SE of ethosuxamide
fatigue, GI, h/a, itching, SJS
MOA of valproic?
increases Na+ channel inactivation--> increases GABA
tx of status epilepticus?
benzo- diazepam, lorazepam
DOC for tonic clonic seizures in preg or neonates?
tx of tonic clonic seizures?
prophylaxis of status epilepticus?
SE of carbamazapine?
agranulocytosis, aplastic anemia
tx of trigeminal neuralgia?
hyperorality, hypersexuality and disinhibited behavior-- dx and where is lesion?
Kluver Bucy --> amygdala
*assoc with HSV 1
how many hours can an intern work? resident?
intern-- 80 hr week with 16 hr shifts
resident-- 80 hr week with 24 hr shift
HLA assoc of DM?
DR3 + DR4
HLA assoc of Celiac?
DQ2 + DQ8
dyspnea, chest pain and tachy, 1 week after surgery?
HLA assoc with Hashimotos?
radioactive iodine-- in Graves? in carcinoma?
increased in Graves/toxic multinodular--> hyperthyroid
decreased in adenoma/carcinoma
what is the cholesterol in hyperthyroid?
hypo--> clears cholesterol
germinal centers in thyroid?
2 major sx of Graves due to ABs?
proptosis-- infiltrative opthalmolopathy-- fibroblasts
pretibial myxedema-- dermal fibroblasts-- infiltration of lymphs and GAGs in dermis
SE of propylthiouracil? MOA?
MOA- peroxidase and 5-deiodinase inhibitor-- for hyperthyroid
SE: rash, hepato, agranulocytosis/aplastic anemia
enzyme levels of Klinefelter's?
decreased Leydig cells and sertoli cells--> decreased testosterone and inhibin--> increased FSH and LH --> increased estrogen
enzyme levels of Kallmann? sx?
decreased GnRH--> decreased all hormones
*anosmia (decreased olfactory bulb) and infertility
enzyme levels of Turners?
decreased estrogen--> increased FSH and LH
hyperphagia, early obesity, hypogonadism, hypotonia, developmental delay, small hands/feet and eyes
Prader-Willi--> maternal imprinting of chrom 15 with paternal deletion
what do testicular choriocarcinomas secrete? and what is its effects?
B-HCG--> similar to LH and TSH--> gynecomastia and hyperthyroidism
major SE of bupropion? and MOA?
seizures-- in bulimics
major SE of TCAs?
3 Cs- coma, convulsions and cardiotox-- arrhythmias (increase QRS)
major SE of SSRIs?
what SE besides EPS do typical antipsychotics cause?
hyperprolactinemia--> galactorrhea (DA antag)
MOA and use of baclofen?
GABA agonist--> muscle spasticity
bromocriptine, cabergoline, quinagoline
fxn of leptin?
decreases appetite-- get resistance in obesity because increased leptin--> decreased responsiveness--> increased appetite--> further increases obesity
leptin--> decreases NPY (app stimulant) and increases POMC--> increases alpha-MSH (decreases app)
tx of gastroparesis?
metoclopramide--> DA antagonist
type of organism of Naegleria fowleri and disease?
primary amebic meningoencephalitis
type of rxn of GBS?
type of rxn of MS?
what does the a wave correspond to in a JVP curve?
atrial systole (a)--> ventricular contraction (c)--> relaxation (x)--> atrial filling (v)--> RA to RV (y)
what can cause an increased a wave?
stenosis -- AS, PS, TS, MS, pulm HTN or R vent hypertrophy
how does tricuspid regurg affect the JVP curve?
decreases the X descent--> blood is coming back in to atrium
SE of Li
D.I. -- ADH antagonist
tremor, sedation, heart block, hypothyroid!
SE of MAO-Is
HTN crisis with tyramine
blood smear of Sickle cell
Howell Jolly bodies
African American, painful legs and hands of boy who spent day outside in heat playing soccer and not drinking water-- this has happened before -- dx
tx of painful crisis in sickle cell?
IV fluids and narcotics to tx pain-- very painful
liquid hallucinogen that causes perceptual distortion and synesthesia?
ANS hyperactivity, change in mental status and neuromuscular abnormalities?
belligerence, impulsiveness and nystagmus, aggression-- drug
PCP - ketamine
continued pain, with spasm, stiffness, decreased ROM, increased hair growth and edema after an injury-- with no nerve damage? if there is nerve damage?
Complex regional pain syndrome I
chromsome affected in sickle cell
chromosome 11, AR
mutation of sickle cell
point mutation on B chain--> glutamic acid--> valine
CHROMOSOME 11-- AR
SNS innervation to LE?
when is a PPD >5 mm considered positive?
recent contact with TB
when is PPD >10 mm considered positive?
high risk occupations
kids <4 yo
difficult breathing, acute chest pain, joint pain and splenomegaly in African American
Sickle cell- vaso-occlusive crisis-- painful
anemia--> difficult breathing
what brings on a vaso-occulsive crisis in sickle cell?
which other disease does sickle cell share a chromsome with?
B-thalassemia--> chromsome 11
inheritance of hemophilia?
inheritance of thalassemias?
initial tx for B thalassemia?
tx of vaso-occlusive crisis in sickle cell caused by infection?
hydration- keep hydrated
resp source-- keep O2 Sat >92%
potential for transfusion
diseases assoc with chromosome 21?
nucleus in medulla responsible for PNS to thorax and gut organs?
DMV-- dorsal motor nuc of vagus
nucleus responsible for sensory from VII, IX and X -- gut and taste?
nucleus responsible for motor to IX and X
nucleus ambiguus-- sytlopharyngus, palate, laryngeal, pharyngeal
nucleus ambiguus- fxn
motor of IX and X --> palate, pharynx, larynx
superior salivatory nucleus
submandibular and sublingual--> VII
inferior salivatory nucleus
fxn of solitary nucleus
sensory of VII, IX and X
fxn of dorsal motor nucleus of vagus?
ANS fxn of thorax and gut
pure motor stoke- hemiparesis-- where is lesion?
internal capsule--> lenticulostriate artery (MCA)-- HTN
damage to nucleus ambiguus indicates what??
PICA -- lateral medullar syndrome
infarct of what artery can cause locked in syndrome?
which primary CA causes a paraneoplastic syndrome of polycythemia?
RCC--> increases EPO
paraneoplastic syndromes of small cell lung CA?
paraneoplastic syndromes of squamous cell lung CA?
paraneoplastic syndromes of RCC?
nonsense mutation producing a stop codon for B globulin
osteomyelitis in DM or IVDU?
osteomyelitis in sickle cell?
tx of salmonella osteomyelitis?
what are crescents in RPGN composed of?
fibrin and macros/monos
loading of MHC I vs MHC II?
MHC I--> peptides loaded in RER after delivery via TAP peptide transporter
MHC II--> antigen loaded after release of invariant chain in ACIDIFIED LYSOSOME
costimulatory signal of T cell activation?
B7 (APC) and CD28 (on T)
polydipsia/polyuria, decreased serum Na and decreased urine osmlarity-- dx and tx
primary polydipsia-- psych
tx: water restriction
polydipsia/polyuria, increased serum Na, decreased urine osmolarity and robust (>50%) response to vasopressin -- dx and tx
complete central DI
tx: hydration and vasopressin
polydipsia/polyuria, increased serum Na, decreased urine osmolarity and minor response to vasopressin -- dx and tx
tx: hydration, HCTZ, indomethacin
cause of ecthyma gangrenosum
hot tub folliculitis or swimmer's ear?
virulence factors that cause ecthyma gangrenosum?
exotoxin A--> EF-2 inhibitor--> chain termination
MC association with imperforate anus?
urogenital tract malformation
bacterial DNA polymerase III fxn
3-5 exonuclease--> base excision and mismatch repair
bacterial DNA poly I fxn
exonuclease 5- 3--> removes primase and replaces with DNA
also removes nucleotide sequences
what causes secretion of HCO3- in the GI system and where does it come from?
secretin--> increases HCO3-
from S cells in duodenum
what kind of Hb has decreased 2,3-BPG and what does it do to it?
Fetal hemoglobin--> increases Hb-O2 affinity (R shift) -- so can extract more O2 from mother
the effects of inspiration on heart murmurs?
increases RIGHT SIDED murmurs (TR)
causes of hyper-estrogen in cirrhosis?
mitochondrial inherited diseases
MELAS= mito encephalopathy lactic acidosis stroke like sx
Leber hereditary optic neuropathy--> B/L vision loss
Myoclonic seizures with red ragged fibers
MC location of schwannoma?
cerebellopontine angle-- between cerebellum and lateral pons
B/L acoustic neuromas associated with what?
obstructive hydrocephalus and Parinaud's syndrome-- where is tumor? what part of brain?
pineal gland--> dorsal MB
MC location of a meningioma?
convexities of cerebral hemispheres
papillary thyroid carcinoma
papillary serous carcinoma of the endometrium and ovary
MC location hemangioma?
Homer wright rosettes
(blue cells wrap around pink neuritis processes)
DDx of HIV pt with brain lesions? - multiple ring enhancing
2. CNS lymphoma
3. primary CNS tumor
5. bacterial/fungal abscess
ring enhancing brain lesions in HIV pt that is toxoplasma negative and EBV positive?
Primary CNS lymphoma--> B CELLS!!!
compare means between 3 or more groups?
ANOVA-- null= all groups are random samples of same population-- rejected if sig diff between groups
test to compare between gender vs smoking status - if there is an affect?
compare means between 2 groups
what has best action on inhibiting antithrombin?
MOA of heparin?
inhibit factor Xa
antidote of heparin?
factor Xa inhibitors?
thrombin direct inhibitors?
tx of CHF and HTN?
tx of hyperthyroid and HTN?
effects of propanolol on RAAS?
inhibits renin secretion (B1 Receptor)
major SE of thiazolidinedions ("glitazone")
weight gain and edema, heart failure
MOA and SE of fibrates?
activates PPAR-alpha--> increase HDL
upreg LPL--> increase TG clearance
SE: myositis, GALLSTONES
which cholesterol drug increases HDL most?
niacin--> flushing, pruritis, hepatotox
what do you do when starting statin tx?
anti-Scl-70 Ab (anti-DNA toppoisomerase I ab)
retrosternal burning/regurg, when supine, Raynaud's and non-pitting edema of hands?
causes of drug induced SLE?
MOA and use of penicillamine?
chelator and immunosuppressant
deficiency in IFN gamma signaling pathway predisposes to what?
disseminated mycobacterial disease--> can't form granulomas
delayed umbilical cord separation
leukocyte adherence deficiency
fever, chills, malaise and arthralgias after renal transplant with increased creatinine?
Acute rejection--> cell mediated and humoral --> lymphocytic infiltration around vessels!
type of receptor for glucagon?
cAMP --PKA (Gs/Gi)
FSH, LH, ACTH, TSH, CRH, hCG, ADH, MSH, PTH, GHRH, glucagon, calcitonin, Epi/NE
ANP, NO -- vasodilators
GnRH, oxytocin, ADH, TRH, Histamine (H1), AT II, Gastrin, Epi
cortisol, vit D, estrogen, testosterone, T3/T4, aldosterone, progresterone
type of R for AT II?
steroids--> cortisol, aldo, estro/testo, prog, vit D3, T3/T4
due to abnormal migration of the ventral panc bud
#1 tx for GAD?
buspirone--> 5HT1a agonist
cause of narcolepsy?
decreased orexin/hypocretin-1 production
associations of narcolepsy?
hypnagogic (going to sleep)
hypnopompic (post) hallucinations
start with REM sleep
tx of narcolepsy?
day time stimulants-- amph,*
night-- sodium oxybate
skin/tissue necrosis when first start warfarin is due to what?
decrease in protein C synthesis (short half life)
toxin and fxn of C. perfringens?
alpha toxin--> lecithinase (PLC)
where are enhancers located within a gene?
VARIABLE (same with repressors)
where are promoters located within a gene?
25-70 bps upstream
immune rxn to TB
macros engulf them--> present to T cells and release IL-12 to activate CD4 T cells--> release IFN-gamma --> activate macros to kill TB and form Langerhans giant cells
Langerhans giant cell
caseating granuloma-- peripheral nuclei in horseshoe shape
changes in post synaptic muscle cell in MG?
decreased end plate potential (decreased # of ACh Rs)
MOA of scopolamine?
Muscarinic antagonist--> motion sickness
(can use if have SE of AChE-inhibitors)
MOA of pilocarpine and use?
cholinomimetic-- contracts ciliary eye muscle, pupillary sphincter, salvia/tears
proteins that can be radiolabeled by DNA must be able to bind DNA- those include:
Transcription factors (n-Myc)
vit D Rs
retinoic acid Rs
DNA trans/rep proteins
long standing unilateral renal artery stenosis-- what will happen to kidney?
hypertrophy/hyperplasia of juxtaglomerular cells (renin)-- modified smooth muscle cells that secrete renin
juxtaglomerular cells-- modified smooth muscle in afferent arteriole
macula densa-- DCT
EXTRAglomerular mesangial cells
fever with postauricular rash that starts at head and moves to feet, lymphadenopathy and polyarthralgia-- dx and class?
Rubella--> togavirus--> +ssRNA, envelope, icosahedral
deafness, cataracts and PDA in newborn?