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1437 Cards in this Set
- Front
- Back
often precedes squamous cell carcinoma
|
actinic keratosis
|
|
primary adrenocortical deficiency
|
Addison's disease
|
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polyostotic fibrous dysplasia, precocious puberty, cafe-au-lait spots, short stature, young girls - diagnosis?
|
Albright's syndrome
|
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hereditary nephritis with nerve deafness
|
Alport's syndrome
|
|
anti-basement membrane antibodies - diagnosis?
|
Goodpasture's syndrome
|
|
anticentromere antibodies - diagnosis?
|
scleroderma (CREST)
|
|
anti-double-stranded DNA antibodies (ANA antibodies) - diagnosis?
- what hypersensitivity type? |
SLE - type III hypersensitivity
|
|
anti-epithelial cell antibodies - diagnosis?
|
pemphigus vulgaris
|
|
antigliadin antibodies - diagnosis?
|
celiac disease
|
|
antihistone antibodies - diagnosis?
|
drug-induced SLE
|
|
anti-IgG antibodies - diagnosis?
|
rheumatoid arthritis
|
|
antimitochondrial antibodies - diagnosis?
|
primary biliary cirrhosis
|
|
antineutrophil antibodies - diagnosis?
|
vasculitis
|
|
antiplatelet antibodies - diagnosis?
|
idiopathic thrombocytopenic purpura
|
|
arachnodactyly - diagnosis?
|
Marfan's syndrome
|
|
Argyll-Robertson pupil - diagnosis?
|
neurosyphilis
|
|
Arnold-Chiari malformation
|
cerebellar tonsillar herniation
|
|
Aschoff bodies - diagnosis?
|
rheumatic fever
|
|
atrophy of the mammillary bodies - diagnosis?
|
Wernicke's encephalopathy
|
|
Auer rods - diagnosis?
|
acute myelogenous leukemia (especially promyelocytic type)
|
|
autosplenectomy - diagnosis?
|
sickle cell anemia
|
|
Babinski's sign is associated with what?
|
UMN lesion
|
|
"bamboo spine" on x-ray
|
ankylosing spondylitis
|
|
basophilic stippling of RBCs - diagnosis?
|
lead poisoning
|
|
defective dystrophin, less severe than Duchenne's
|
Becker's muscular dystrophy
|
|
LMN CN VII palsy
|
Bell's palsy
|
|
Bence Jones proteins - possible diagnoses?
- in each case, what are the proteins? |
multiple myeloma - kappa or lambda light chains
Waldenstrom's macroglobulinemia - IgM |
|
IgA nephropathy - diagnosis?
|
Berger's disease
|
|
Bernard-Soulier disease - what is the defect?
|
defect in platelet adhesion
|
|
bilateral hilar adenopathy, uveitis - diagnosis?
|
sarcoidosis
|
|
Birbeck granules on EM - diagnosis?
|
histiocytosis X (eosinophilic granuloma)
|
|
bloody tap on LP - diagnosis?
|
subarachnoid hemorrhage
|
|
"blue bloater"
|
chronic bronchitis
|
|
blue-domed cysts - diagnosis?
|
fibrocystic change of the breast
|
|
blue sclera - diagnosis?
|
osteogenesis imperfecta
|
|
boot-shaped heart on x-ray - possible diagnoses?
|
tetralogy of Fallot or RVH
|
|
Bouchard's nodes - diagnosis?
- where are they located? - why do they occur? |
osteoarthritis - on PIP secondary to osteophytes
|
|
boutonniere deformity - diagnosis?
|
rheumatoid arthritis
|
|
branching rods in oral infection - diagnosis?
|
Actinomyces israelii
|
|
"brown tumor" of bone - possible diagnoses?
- what causes the brown color? |
hyperparathyroidism or osteitis fibrosa cystica (von Recklinghausen's disease)
- color is due to hemorrhage in cysts |
|
X-linked agammaglobulinemia
|
Bruton's disease
|
|
posthepatic venous thrombosis - diagnosis?
|
Budd-Chiari syndrome
|
|
Buerger's disease - what size arteries does it affect?
|
small or medium-artery vasculitis
|
|
Burkitt's lymphoma - what is the translocation?
- what virus is it associated with? - appearance on histology? |
8:14 translocation
EBV starry sky appearance |
|
Burton's lines - diagnosis?
|
lead poisoning
|
|
what types of ANCA are associated with Wegener's granulomatosis and microscopic polyangiitis?
|
Wegener's - c-ANCA
MPA - p-ANCA |
|
cafe-au-lait spots on skin - diagnosis?
|
neurofibromatosis
|
|
calf pseudohypertrophy - diagnosis?
|
Duchenne's muscular dystrophy
|
|
Call-Exner bodies - diagnosis?
|
granulosa-theca cell tumor of the ovary
|
|
cardiomegaly with apical atrophy - diagnosis?
|
Chagas' disease
|
|
trypanosome infection - diagnosis?
|
Chagas' disease
|
|
painless chancre - diagnosis?
|
primary syphilis
|
|
painful chancroid - cause?
|
Haemophilus ducreyi
|
|
Charcot's triad of multiple sclerosis
|
nystagmus, intention tremor, scanning speech
|
|
Charcot's triad of cholangitis
|
jaundice, RUQ pain, fever
|
|
Charcot-Leyden crystals - diagnosis?
- what are they? |
bronchial asthma - eosinophil membranes
|
|
what is the defect in Chediak-Higashi disease?
|
phagocyte deficiency
|
|
cherry-red spot on macula - possible diagnoses?
|
Tay-Sachs or Niemann-Pick disease
|
|
what are Cheyne-Stokes respirations, and in what circumstance do they occur?
|
central apnea in CHF and increased intracranial pressure
|
|
"chocolate cysts"
|
endometriosis
|
|
what does chronic atrophic gastritis predispose to?
|
gastric carcinoma
|
|
Chvostek's sign - what is it, and what does it indicate?
|
facial muscle spasm upon tapping - sign of hypocalcemia
|
|
DES exposure in utero predisposes to what?
|
clear cell adenocarcinoma of the vagina
|
|
clue cells - diagnosis?
|
Gardnerella vaginitis
|
|
Codman's triangle on x-ray - diagnosis?
|
osteosarcoma
|
|
cold agglutinins - possible diagnoses?
|
Mycoplasma pneumonia or infectious mononucleosis
|
|
cold intolerance - sign of what?
|
hypothyroidism
|
|
condylomata lata - diagnosis?
|
secondary syphilis
|
|
continuous machinery murmur - indicates what?
|
patent ductus arteriosus
|
|
what is the defect in Cori's disease?
|
debranching enzyme deficiency
|
|
cough, conjunctivitis, coryza, fever - diagnosis?
|
measles
|
|
Councilman bodies - diagnosis?
|
toxic or viral hepatitis
|
|
Cowdry type A bodies - caused by what?
|
herpesvirus
|
|
crescents in Bowman's capsule - diagnosis?
|
rapidly progressive crescentic glomerulonephritis
|
|
what is Crigler-Najjar syndrome?
|
congenital unconjugated hyperbilirubinemia - due to absent UDP glucuronyl transferase
|
|
acute gastric ulcer associated with severe burns
|
Curling's ulcer
|
|
currant-jelly sputum - diagnosis?
|
Klebsiella
|
|
Curschmann's spirals - diagnosis?
- what are they? |
bronchial asthma - whorled mucous plugs
|
|
acute gastric ulcer associated with CNS injury
|
Cushing's ulcer
|
|
D-dimers - diagnosis?
|
DIC
|
|
depigmentation of neurons in substantia nigra - diagnosis?
- where is the defect? - symptoms? |
Parkinson's disease - basal ganglia disorder
- rigidity, resting tremor, bradykinesia |
|
dermatitis, dementia, diarrhea - diagnosis?
|
pellagra (niacin/vitamin B3 deficiency)
|
|
dog or cat bite - infected with?
|
Pasteurella multocida
|
|
what is Dressler's syndrome?
|
post-MI fibrinous pericarditis
|
|
what is Dubin-Johnson syndrome?
- what is the defect? - what is the pathologic consequence? |
congenital conjugated hyperbilirubinemia - due to defective liver excretion of conjugated bilirubin, causing black liver
|
|
what is the defect in Duchenne's muscular dystrophy?
- what is the inheritance pattern? |
deleted dystrophin gene - X-linked recessive
|
|
eburnation - diagnosis?
|
osteoarthritis
|
|
trisomy 18 associated with rocker-bottom feet, low-set ears, heart disease
|
Edwards' syndrome
|
|
what is Eisenmenger's complex?
|
late cyanosis shunt (reversal of an uncorrected L-R shunt to an R-L shunt)
|
|
elastic skin - diagnosis?
|
Ehlers-Danlos syndrome
|
|
where and what is Erb-Duchenne palsy?
|
superior trunk injury to brachial plexus (C5-6) - "waiter's tip"
|
|
erythema chronicum migrans - diagnosis?
|
Lyme disease
|
|
genetically inherited aplastic anemia
|
Fanconi's anemia
|
|
what is Fanconi's syndrome?
|
proximal tubular reabsorption defect (causes excretion of many things - leads to, among other things, rickets, metabolic acidosis, hypokalemia)
|
|
"fat, female, forty, and fertile" - at risk for?
|
acute cholecystitis
|
|
fatty liver - associated with?
|
alcoholism
|
|
ferruginous bodies - diagnosis?
|
asbestosis
|
|
colon polyps with osteomas and soft tissue tumors - diagnosis?
|
Gardner's syndrome
|
|
what is the defect in Gaucher's disease?
|
glucocerebrosidase deficiency
|
|
Ghon focus - diagnosis?
|
primary TB
|
|
what is Gilbert's syndrome?
- what is the deficiency? |
benign congenital unconjugated hyperbilirubinemia - due to mildly decreased UDP-glucouronyl transferase or decreased bilirubin uptake by liver
|
|
what is the defect in Glanzmann's thrombasthenia?
|
defect in platelet aggregation (defect in GPIIb/IIIa)
|
|
autoantibodies against alveolar and glomerular basement membrane proteins - diagnosis?
|
Goodpasture's syndrome
|
|
Gowers' maneuver - diagnosis?
- what is the maneuver? |
Duchenne's - use of patient's arms to help legs pick self off floor
|
|
idiopathic peripheral polyneuritis - diagnosis?
|
Guillain-Barre syndrome
|
|
"hair on end" (crew cut) appearance on x-ray - possible diagnoses?
- why does this happen? |
beta-thalassemia or sickle cell anemia - due to extramedullary hematopoiesis
|
|
what is Hand-Schuller-Christian disease?
|
chronic progressive histiocytosis (Langerhans cell histiocytosis)
|
|
lots of HbF - diagnosis?
|
thalassemia major
|
|
HbS - diagnosis?
|
sickle cell anemia
|
|
conditions in which hCG is elevated
|
choriocarcinoma, hydatidiform mole
|
|
Heberden's nodes - diagnosis?
- where are they located? - why do they occur? |
osteoarthritis - DIP swelling secondary to osteophytes
|
|
Heinz bodies - diagnosis?
|
G6PD deficiency
|
|
hypersensitivity vasculitis associated with hemorrhagic urticaria and upper respiratory tract infections - diagnosis?
|
Henoch-Schonlein purpura
|
|
heterophil antibodies - diagnosis?
- caused by what? |
infectious mononucleosis - caused by EBV
|
|
high-output cardiac failure (dilated cardiomyopathy) is associated with what vitamin deficiency?
- what is the disease called? |
vitamin B1 (thiamine) deficiency - wet beriberi
|
|
HLA-B27 - associated with what diseases?
|
Reiter's syndrome, ankylosing spondylitis, psoriasis, inflammatory bowel disease
|
|
disease associated with HLA-DR3 or DR4
- what causes it? |
diabetes mellitus type 1 - autoimmune destruction of beta cells
|
|
Homer Wright rosettes - diagnosis?
|
neuroblastoma
|
|
honeycomb lung on x-ray - diagnosis?
|
interstitial fibrosis
|
|
symptoms of Horner's syndrome
|
ptosis, miosis, anhidrosis
|
|
Howell-Jolly bodies - caused by what?
|
splenectomy or nonfunctional spleen
|
|
caudate degeneration - diagnosis?
- what is the inheritance pattern? |
Huntington's disease - autosomal dominant
|
|
hyperphagia, hypersexuality, hyperorality, hyperdocility - diagnosis?
- what is the affected organ? |
Kluver-Bucy syndrome - affects amygdala
|
|
hyperpigmentation of skin - diagnosis?
|
primary adrenal insufficiency (Addison's disease)
|
|
hypersegmented neutrophils - diagnosis?
|
macrocytic anemia
|
|
hypertension and hypokalemia - diagnosis?
|
Conn's syndrome (aldosterone-secreting tumor)
|
|
hypochromic microcytosis - possible diagnoses?
|
iron deficiency anemia, lead poisoning
|
|
increased alpha-fetoprotein in amniotic fluid/maternal serum - possible diagnoses?
|
neural tube defects (anencephaly, spina bifida)
|
|
increased uric acid levels - possible diagnoses?
|
gout, Lesch-Nyhan syndrome, myeloproliferative disorders, use of loop and thiazide diuretics
|
|
Janeway lesions - diagnosis?
|
endocarditis
|
|
what disease is the Jarish-Herxheimer reaction associated with, and what is it?
|
syphilis - overaggressive treatment of an asymptomatic patient that causes symptoms due to rapid lysis
|
|
what is the defect in Job's syndrome?
|
neutrophil chemotaxis abnormality - due to failure of IFN-gamma production by helper T cells
|
|
Kaposi's sarcoma - associated with?
|
AIDS in MSM
|
|
what is the defect in Kartagener's syndrome?
|
dynein defect
|
|
Kayser-Fleischer rings - diagnosis?
|
Wilson's disease
|
|
keratin pearls - diagnosis?
|
squamous cell carcinoma
|
|
Kimmelstiel-Wilson nodules - diagnosis?
|
diabetic nephropathy
|
|
bilateral amygdala lesions - diagnosis?
|
Kluver-Bucy syndrome
|
|
koilocytes - diagnosis?
|
HPV
|
|
Koplik spots - diagnosis?
|
measles
|
|
gastric adenocarcinoma with ovarian metastases
|
Krukenberg tumor (Puneet, this one is for you)
|
|
Kussmaul hyperpnea - diagnosis?
|
diabetic ketoacidosis
|
|
lens dislocation, aortic dissection, joint hyperflexibility - diagnosis?
- what is the defect? |
Marfan's syndrome - defect in fibrillin
|
|
what is the defect in Lesch-Nyhan syndrome?
|
HGPRT deficiency
|
|
Lewy bodies - diagnosis?
|
Parkinson's disease
|
|
what is Libman-Sacks disease?
|
endocarditis associated with SLE
|
|
lines of Zahn - diagnosis?
|
arterial thrombus
|
|
Lisch nodules - diagnosis?
|
neurofibromatosis (von Recklinghausen's disease)
|
|
low serum ceruloplasmin - diagnosis?
|
Wilson's disease
|
|
lucid interval - associated with what head pathology?
|
epidural hematoma
|
|
"lumpy-bumpy" appearance of glomeruli on immunofluorescence - diagnosis?
|
poststreptococcal glomerulonephritis
|
|
lytic bone lesions on x-ray - diagnosis?
|
multiple myeloma
|
|
Mallory bodies - diagnosis?
|
alcoholic liver disease
|
|
esophagogastric lacerations - diagnosis?
|
Mallory-Weiss syndrome
|
|
what is the defect in McArdle's disease?
|
muscle phosphorylase deficiency
|
|
McBurney's sign - diagnosis?
|
appendicitis
|
|
MLF syndrome (internuclear ophthalmoplegia) - diagnosis?
|
multiple sclerosis
|
|
monoclonal antibody spike - possible diagnoses?
- what makes up the spike in each? |
multiple myeloma (IgG or IgA)
MGUS Waldenstrom's macroglobulinemia (IgM) |
|
myxedema - diagnosis?
|
hypothyroidism
|
|
necrotizing vasculitis of the lungs (hemoptysis) and necrotizing glomerulonephritis - possible diagnoses?
|
Wegener's or Goodpasture's
|
|
needle-shaped, negatively birefringent crystals - diagnosis?
|
gout
|
|
Negri bodies - diagnosis?
|
rabies
|
|
nephritis, cataracts, hearing loss - diagnosis?
- what is the defect? |
Alport's syndrome
- type IV collagen defect |
|
neurofibrillary tangles - diagnosis?
|
Alzheimer's disease
|
|
what is the defect in Niemann-Pick disease?
|
sphingomyelinase deficiency
|
|
no lactation postpartum - diagnosis?
- what causes it? |
Sheehan's syndrome - due to pituitary infarction
|
|
nutmeg liver - diagnosis?
|
CHF
|
|
occupational exposure to asbestos - associated with?
|
malignant mesothelioma
|
|
"Orphan Annie" nuclei - diagnosis?
|
papillary carcinoma of the thyroid
|
|
Osler's nodes - diagnosis?
|
endocarditis
|
|
owl's eye inclusion bodies - diagnosis?
|
CMV
|
|
eczematous dermatitis of nipple or areola - diagnosis?
- what is it a sign of? |
Paget's disease of breast
- sign of underlying neoplasm |
|
increased osteoblastic and osteoclastic activity - diagnosis?
|
Paget's disease of bone (osteitis deformans)
|
|
painless jaundice - diagnosis?
|
pancreatic cancer (of head)
|
|
palpable purpura on legs and buttocks - diagnosis?
|
Henoch-Schonlein purpura
|
|
bronchogenic apical tumor associated with Horner's syndrome
|
Pancoast's tumor
|
|
pannus - diagnosis?
|
rheumatoid arthritis
|
|
nigrostriatal dopamine depletion - diagnosis?
|
Parkinson's disease
|
|
periosteal elevation on x-ray - diagnosis?
|
pyogenic osteomyelitis
|
|
benign polyposis - diagnosis?
|
Peutz-Jeghers syndrome
|
|
penile fibrosis - diagnosis?
|
Peyronie's disease
|
|
Philadelphia chromosome (bcr-abl) - diagnosis?
|
CML
|
|
Pick bodies - diagnosis?
|
Pick's disease
|
|
progressive dementia, similar to Alzheimer's - diagnosis?
|
Pick's disease
|
|
"pink puffer" - diagnosis?
- what are the two types, and what causes them? |
emphysema
- centroacinar - due to smoking - panacinar - due to alpha1-antitrypsin deficiency |
|
esophageal webs with iron deficiency anemia - diagnosis?
|
Plummer-Vinson syndrome
|
|
podagra - diagnosis?
- where is it located? |
gout - MP joint of hallux
|
|
podocyte fusion - diagnosis?
|
minimal change disease
|
|
polyneuropathy, cardiac pathology, and edema - diagnosis?
- what causes it? |
wet beriberi (vitamin B1 deficiency)
|
|
polyneuropathy preceded by GI or respiratory infection
|
Guillain-Barre syndrome
|
|
what is the defect in Pompe's disease?
- what significant finding is it associated with? |
lysosomal glucosidase deficiency
- cardiomegaly |
|
port-wine stain - diagnosis?
|
hemangioma
|
|
positive anterior "drawer sign" - diagnosis?
|
anterior cruciate ligament injury
|
|
what is Pott's disease?
|
vertebral tuberculosis
|
|
pseudopalisade tumor cell arrangement - diagnosis?
|
glioblastoma multiforme
|
|
pseudorosettes - diagnosis?
|
Ewing's sarcoma
|
|
ptosis, miosis, anhidroisis - diagnosis?
- often associated with what? |
Horner's syndrome
- Pancoast's tumor |
|
rash on palms and soles - possible diagnoses?
|
secondary syphilis, Rocky Mountain Spotted Fever, coxsackie A virus
|
|
recurrent vasospasm in extremities - diagnosis?
|
Raynaud's syndrome
|
|
RBC casts in urine - diagnosis?
|
acute glomerulonephritis
|
|
recurrent pulmonary Pseudomonas and S. aureus infections - associated with?
|
cystic fibrosis
|
|
red urine in the morning - diagnosis?
|
paroxysmal nocturnal hemoglobinuria
|
|
Reed-Sternberg cells - diagnosis?
|
Hodgkin's lymphoma
|
|
increased Reid index - diagnosis?
|
chronic bronchitis (gland depth/total thickness of bronchial wall)
|
|
Reinke crystals - diagnosis?
|
Leydig cell tumor
|
|
what are the symptoms of Reiter's syndrome?
|
urethritis, conjunctivitis, arthritis
|
|
renal cell carcinoma, cavernous hemangiomas, adenomas - diagnosis?
|
von Hippel-Lindau disease
|
|
renal epithelial casts in urine - diagnosis?
|
acute toxic/viral nephrosis
|
|
rhomboid crystals, positively birefringent - diagnosis?
|
pseudogout
|
|
rib notching - diagnosis?
|
coarctation of aorta
|
|
Roth's spots in retina - diagnosis?
|
endocarditis
|
|
what is Rotor's syndrome?
- what is the defect? - similar to what disease? |
congenital conjugated hyperbilirubinemia
- defective liver excretion of bilirubin (similar to Dubin-Johnson, but milder) |
|
rouleaux formation of RBCs - diagnosis?
|
multiple myeloma
|
|
S3 - possible diagnoses?
|
left-to-right shunt (VSD, PDA, ASD), mitral regurgitation, CHF (LV failure)
|
|
S4 - possible diagnoses?
|
aortic stenosis, hypertrophic subaortic stenosis
|
|
Schiller-Duval bodies - diagnosis?
|
yolk sac tumor
|
|
senile plaques - diagnosis?
|
Alzheimer's disease
|
|
what is Sezary syndrome?
|
cutaneous T-cell lymphoma
|
|
what is Sheehan's syndrome?
|
postpartum pituitary necrosis
|
|
Schwartzman reaction - associated with?
|
Neisseria meningitidis
|
|
signet-ring cells - diagnosis?
|
gastric carcinoma
|
|
simian crease - diagnosis?
|
Down syndrome
|
|
Sipple's syndrome - also known as?
|
MEN IIa
|
|
dry eyes, dry mouth, arthritis - diagnosis?
|
Sjogren's syndrome
|
|
skip lesions - diagnosis?
|
Crohn's
|
|
slapped cheeks - diagnosis?
|
erythema infectiosum (fifth disease)
|
|
Smith antigen - diagnosis?
|
SLE
|
|
"smudge cell" - diagnosis?
|
CLL
|
|
soap bubble on x-ray - diagnosis?
|
giant cell tumor of bone
|
|
spike and dome on EM - diagnosis?
|
membranous glomerulonephritis
|
|
what is a Spitz nevus?
|
benign juvenile melanoma
|
|
splinter hemorrhages in fingernails - diagnosis?
|
endocarditis
|
|
starry-sky pattern - diagnosis?
|
Burkitt's lymphoma
|
|
"strawberry tongue" - diagnosis?
|
scarlet fever
|
|
streaky ovaries - diagnosis?
|
Turner's syndrome
|
|
string sign on x-ray - diagnosis?
|
Crohn's disease
|
|
subepithelial humps on EM - diagnosis?
|
poststreptococcal glomerulonephritis
|
|
suboccipital lymphadenopathy - diagnosis?
|
rubella
|
|
sulfur granules - diagnosis?
|
Actinomyces israelii
|
|
swollen gums, bruising, poor wound healing, anemia - diagnosis?
- what is this due to? - why do these symptoms occur? |
scury - vitamin C (ascorbic acid) deficiency
- vitamin C is needed for hydroxylation of proline and lysine in collagen synthesis |
|
systolic ejection murmur (crescendo-decrescendo) - diagnosis?
|
aortic valve stenosis
|
|
t(8;14) - diagnosis?
- gene involved? |
Burkitt's lymphoma
- c-myc activation |
|
t(9;22) - diagnosis?
- gene involved? |
CML
- Philadelphia chromosome - bcr-abl hybrid |
|
t(14;18) - diagnosis?
- gene involved? |
follicular lymphoma
- bcl-2 activation |
|
tabes dorsalis - diagnosis?
|
tertiary syphilis
|
|
tendon xanthomas (classically Achilles) - diagnosis?
|
familial hypercholesterolemia
|
|
thumb sign on lateral x-ray - diagnosis?
- caused by what? |
epiglottitis - due to Haemophilus influenzae
|
|
thyroidization of kidney - diagnosis?
|
chronic bacterial pyelonephritis
|
|
tophi - diagnosis?
|
gout
|
|
"tram-track" appearance on LM - diagnosis?
|
membranoproliferative glomerulonephritis
|
|
what is Trousseau's sign of malignancy?
- possible diagnoses? |
migratory thrombophlebitis
- visceral cancer or pancreatic adenocarcinoma |
|
what is Trousseau's sign of latent tetany?
- diagnosis? |
carpal spasm
- hypocalcemia |
|
what is Virchow's node?
- what is it a sign of? |
left supraclavicular node enlargement
- from metastatic carcinoma of the stomach |
|
what is Virchow's triad?
- predilection for what? |
blood stasis, endothelial damage, hypercoagulation
- pulmonary embolism |
|
neurofibromatosis with cafe-au-lait spots - diagnosis?
|
von Recklinghausen's disease
|
|
what is von Recklinghausen's disease of bone?
|
osteitis fibrosa cystica ("brown tumor")
|
|
adrenal hemorrhage associated with meningococcemia - diagnosis?
|
Waterhouse-Friderichsen syndrome
|
|
waxy casts in urine - diagnosis?
|
chronic end-stage renal disease
|
|
WBC casts in urine - diagnosis?
|
acute pyelonephritis
|
|
WBCs in urine - diagnosis?
|
acute cystitis
|
|
Wermer's syndrome - also known as?
|
MEN type I
|
|
what is Whipple's disease?
- caused by what? |
malabsorption syndrome caused by Tropheryma whippelii
|
|
hepatolenticular degeneration - diagnosis?
|
Wilson's disease
|
|
"wire loop" appearance on LM - diagnosis?
|
lupus nephropathy
|
|
"worst headache of my life" - rupture of what?
- associated with what syndrome? |
rupture of berry aneurysm
- associated with adult polycystic kidney disease |
|
xanthochromia of CSF - diagnosis?
|
subarachnoid hemorrhage
|
|
xerostomia, arthritis, keratoconjunctivitis sicca - diagnosis?
|
Sjogren's syndrome
|
|
upper GI diverticulum
|
Zenker's diverticulum
|
|
gastrin-secreting tumor associated with ulcers - diagnosis?
|
Zollinger-Ellison syndrome
|
|
most common bacteremia/pneumonia among IV drug abusers
|
S. aureus
|
|
most common bacteria associated with cancer
|
H. pylori
|
|
most common bacteria found in GI tract
- 2nd most common? |
Bacterioides
- E. coli |
|
4 most common brain tumors in adults
|
mets > astrocytoma (including glioblastoma multiforme) > meningioma > schwannoma
|
|
most common brain tumor in kids
- location? |
medulloblastoma - in cerebellum
|
|
most common supratentorial brain tumor in kids
|
craniopharyngioma
|
|
most common breast cancer
|
infiltrating ductal carcinoma
|
|
most common breast mass
- most common in post menopausal women? |
fibrocystic change
- carcinoma |
|
most common benign breast tumor
|
fibroadenoma
|
|
most common bug in debilitated, hospitalized pneumonia patient
|
Klebsiella
|
|
most common cardiac primary tumor in adults
- usual location and appearance? |
myxoma
- "ball and valve" in left atrium |
|
most common cardiac primary tumor in kids
|
rhabdomyoma
|
|
most common cardiac tumor in adults
|
mets
|
|
most common cardiomyopathy
|
dilated cardiomyopathy
|
|
most common chromosomal disorder
- what other disorders is it associated with? |
Down syndrome
- associated with ALL, Alzheimer's dementia, endocardial cushion defects |
|
most common chronic arrhythmia
- what is the patient at high risk for? |
atrial fibrillation - high risk of emboli
|
|
most common congenital cardiac anomaly
|
VSD
|
|
most common cause of constrictive pericarditis
|
tuberculosis
|
|
most common coronary arteries involved in thrombosis
|
LAD > RCA > LCA
|
|
most common causes of early cyanosis
|
tetralogy of Fallot, transposition of great vessels, truncus arteriosus
|
|
most common causes of late cyanosis
|
VSD, ASD, PDA
|
|
how do you close a PDA?
- how do you keep it open? |
close with indomethacin
open with misoprostol |
|
most common demyelinating disease
|
multiple sclerosis
|
|
most common dietary deficit
|
iron
|
|
most common cause of epiglottitis
|
Haemophilus influenzae type B
|
|
most common esophageal cancer
|
squamous cell carcinoma
|
|
most common gene involved in cancer
|
p53 tumor suppressor gene
|
|
most common group affected by cystic fibrosis
- what dietary deficiency is associated with CF? - what lung problems occur? |
Caucasians
- fat-soluble vitamin deficiencies - mucous plugs and lung infections |
|
most common gynecologic malignancy
|
endometrial carcinoma
|
|
most common heart murmur
|
mitral valve prolapse
|
|
most common heart valve involved in bacterial endocarditis
|
mitral
|
|
most common heart valve involved in bacterial endocarditis in IV drug abusers
|
tricuspid
|
|
most common heart valve involved in rheumatic fever
- which is 2nd most common? |
mitral valve
- aortic is 2nd |
|
most common helminth infection in the U.S.
- 2nd most common? |
Enterobius vermicularis
- Ascaris lumbricoides is 2nd most common |
|
most common hereditary bleeding disorder
|
von Willebrand's
|
|
most common kidney stone
- 2nd most common? - are they each radiopaque or radiolucent? - how are the 2nd most common formed? |
calcium - radiopaque
2nd is ammonium - radiopaque - formed by urease-positive organisms like Proteus vulgaris or Staphylococcus |
|
most common leukemia in adults
|
AML
|
|
most common liver disease
|
alcoholic liver disease
|
|
most common location of brain tumors in adults
|
supratentorial
|
|
most common location of brain tumors in kids
|
infratentorial
|
|
most common lysosomal storage disease
|
Gaucher's disease
|
|
most common male cancer
|
prostatic carcinoma
|
|
most common malignancy associated with noninfectious fever
|
Hodgkin's disease
|
|
most common malignant skin tumor
- does it metastasize? |
basal cell carcinoma
- only very rarely metastasizes |
|
most common mets to bone
|
breast, lung, thyroid, testes, prostate, kidney
|
|
most common mets to brain
|
lung, breast, skin (melanoma), kidney (renal cell carcinoma), GI
|
|
most common mets to liver
|
colon, gastric, pancreatic, breast, lung carcinomas
|
|
most common motor neuron disease
|
ALS
|
|
most common neoplasm in kids
- 2nd most common? |
ALL
- cerebellar medulloblastoma is 2nd |
|
most common nephrotic syndrome
|
membranous glomerulonephritis
|
|
most common obstruction of male urinary tract
|
BPH
|
|
most common opportunistic infection in AIDS
|
Pneumocystis jiroveci pneumonia
|
|
most common organ receiving mets
- why? |
adrenal glands
- rich blood supply |
|
most common organs sending mets
|
lung > breast, stomach
|
|
most common benign ovarian tumor
|
serous cystadenoma
|
|
most common malignant ovarian tumor
|
serous cystadenocarcinoma
|
|
most common pancreatic tumor
- which part of pancreas is affected? |
adenocarcinoma of the head of the pancreas
|
|
most common age of patient with ALL
|
child
|
|
most common age of patient with CLL
|
adult >60
|
|
most common age of patient with AML
|
adult >60
|
|
most common age of patient with CML
|
adult 35-50
|
|
most common patient with Hodgkin's
- exception: nodular sclerosis type - what patient? |
young male
- nodular sclerosis type - female |
|
most common patient with minimal change disease
|
young child
|
|
most common patient with Reiter's
|
male
|
|
most common pituitary tumor
- 2nd most common? how does it stain? |
prolactinoma
- somatotropic adenoma is 2nd - acidophilic |
|
most common preventable cancer
|
lung cancer
|
|
most common primary bone tumor in adults
|
multiple myeloma
|
|
most common cause of primary hyperparathyroidism
- other causes? |
adenomas
- also hyperplasia and carcinoma |
|
most common primary liver tumor
|
hepatoma
|
|
most common renal tumor
- what diseases is it associated with? - what paraneoplastic syndromes is it associated with? |
renal cell carcinoma
- von Hippel-Lindau and acquired polycystic kidney disease - erythropoietin, renin, PTH, ACTH |
|
most common cause of secondary hyperparathyroidism
|
hypocalcemia of chronic renal failure
|
|
most common sexually transmitted disease
|
Chlamydia
|
|
most common site of diverticula
|
sigmoid colon
|
|
most common site of metastasis
- 2nd most common? |
regional lymph nodes
- liver is 2nd |
|
most common sites of atherosclerosis
|
abdominal aorta > coronary > popliteal > carotid
|
|
most common skin cancer
|
basal cell carcinoma
|
|
most common stomach cancer
|
adenocarcinoma
|
|
most common testicular tumor
|
seminoma
|
|
most common thyroid cancer
|
papillary carcinoma
|
|
most common tumor in men
|
prostate carcinoma
|
|
most common tumor in women
|
leiomyoma (estrogen dependent)
|
|
most common tumor of infancy
|
hemangioma
|
|
most common tumor of the adrenal medulla in adults
- benign or malignant? |
pheochromocytoma - benign
|
|
most common tumor of the adrenal medulla in kids
- benign or malignant? |
neuroblastoma - malignant
|
|
most common type of Hodgkin's
|
nodular sclerosis
|
|
most common type of non-Hodgkin's
|
follicular (small cleaved)
|
|
most common type of pituitary adenoma
|
prolactinoma
|
|
most common vasculitis
- poses risk for? - what causes this? |
temporal arteritis
- risk of ipsilateral blindness - due to thrombosis of opthalmic artery |
|
most common cause of viral encephalitis
|
HSV
|
|
most common vitamin deficiency in the U.S.
- how long do body stores last? - what patient population is most at risk? |
folic acid - stores last 3-4 months
- pregnant women at high risk |
|
most common cause of Addison's
- 2nd most common? |
autoimmune
- infection is 2nd |
|
most common cause of dissecting aneurysm
|
hypertension
|
|
most common cause of descending and abdominal aortic aneurysm
|
atherosclerosis
|
|
most common cause of ascending aortic aneurysm
|
tertiary syphilis
|
|
most common cause of bacterial meningitis in adults
|
Streptococcus pneumoniae
|
|
most common cause of bacterial meningitis in the elderly
|
S. pneumoniae
|
|
most common cause of bacterial meningitis in kids
|
S. pneumoniae or Neisseria meningitidis
|
|
most common cause of bacterial meningitis in newborns
|
group B streptococcus
|
|
most common cancer associated with AIDS
|
Kaposi's sarcoma
|
|
most common cause of congenital adrenal hyperplasia
|
21-hydroxylase deficiency
|
|
most common cause of cretinism
|
iodine deficit/hypothyroidism
|
|
most common cause of Cushing's syndrome
- 2nd most common? |
corticosteroid therapy
- excess ACTH secretion by pituitary is 2nd |
|
most common cause of death in CML
|
blast crisis
|
|
most common cause of death in SLE
|
lupus nephropathy
|
|
most common cause of dementia
- 2nd most common? |
Alzheimer's
- multi-infarct is 2nd |
|
most common causes of DIC
|
Gram-negative sepsis, obstetric complications, cancer, burn trauma
|
|
most common cause of ejection click
|
aortic/pulmonic stenosis
|
|
most common cause of food poisoning
|
S. aureus
|
|
most common cause of glomerulonephritis in adults
|
IgA nephropathy (Berger's disease)
|
|
most common cause of epidural hematoma
- is bleeding fast or slow? |
rupture of middle meningeal artery - fast bleeding
|
|
most common cause of subdural hematoma
- is bleeding fast or slow? |
rupture of bridging veins due to trauma - slow bleeding
|
|
most common cause of hemochromatosis
- causes risk of? |
multiple blood transfusions
- can cause CHF and increased risk of hepatocellular carcinoma |
|
most common cause of hepatic cirrhosis
|
alcohol
|
|
most common cause of hepatocellular carcinoma
|
cirrhotic liver, often due to hepatitis B and C
|
|
most common causes of holosystolic murmur
|
VSD, tricuspid regurgitation, mitral regurgitation
|
|
most common cause of secondary hypertension
|
renal disease
|
|
most common cause of hypoparathyroidism
|
thyroidectomy
|
|
most common cause of hypopituitarism
|
adenoma
|
|
most common infection in blood transfusion
|
hepatitis C
|
|
most common infection in burn victims
|
Pseudomonas
|
|
most common cause of "machine-like" murmur
|
PDA
|
|
most common cause of mental retardation
- 2nd most common? |
Down syndrome
- fragile X is 2nd |
|
most common cause of MI
|
atherosclerosis
|
|
most common cause of mitral valve stenosis
|
rheumatic heart disease
|
|
most common cause of myocarditis
|
coxsackie B
|
|
most common cause of nephrotic syndrome in adults
|
membranous glomerulonephritis
|
|
most common cause of nephrotic syndrome in kids
- how do you treat it? |
minimal change disease
- treat with corticosteroids |
|
most common cause of opening snap
|
mitral stenosis
|
|
most common cause of osteomyelitis
|
S. aureus
|
|
most common cause of osteomyelitis in patients with sickle cell disease
|
Salmonella
|
|
most common cause of osteomyelitis in IV drug abusers
|
Pseudomonas
|
|
most common causes of acute pancreatitis
|
alcohol and gallstones
|
|
most common cause of chronic pancreatitis in adults
- in kids? |
alcohol in adults
cystic fibrosis in kids |
|
most common cause of peau d'orange
|
carcinoma of the breast
|
|
most common cause of PID
|
Neisseria gonorrhoeae
|
|
most common cause of hospital-acquired pneumonia
|
Klebsiella
|
|
most common cause of pneumonia in cystic fibrosis or burn infection
|
Pseudomonas aeruginosa
|
|
most common cause of preventable blindness
|
Chlamydia
|
|
most common cause of primary amenorrhea
- what is the abnormality? |
Turner's - XO
|
|
most common cause of primary hyperaldosteronism
|
adenoma of adrenal cortex
|
|
most common cause of primary hyperparathyroidism
|
adenoma
|
|
most common cause of pulmonary hypertension
|
COPD
|
|
most common cause of right heart failure due to a pulmonary cause
|
cor pulmonale
|
|
most common cause of right-sided heart failure
|
left-sided heart failure
|
|
most common cause of Sheehan's syndrome
|
postpartum pituitary infarction secondary to hemorrhage
|
|
most common cause of SIADH
|
small cell carcinoma of the lung
|
|
most common cause of UTI
|
E. coli
|
|
most common causes of UTI in young women
|
E. coli and Staphylococcus saprophyticus
|
|
heterochromatin vs. euchromatin
|
HeteroChromatin = Highly Condensed (transcriptionally inactive)
euchromatin = less condensed, transcriptionally active ("truly transcribed") |
|
what nucleotides are purines?
|
A,G (PURines = PURe As Gold)
|
|
what nucleotides are pyrimidines?
|
C,U,T (PYrimidines = CUT the PY)
|
|
what functional group does thymine have?
|
THYmine has a meTHYl
|
|
what amino acids are needed for purine synthesis?
|
Glycine, Aspartate, Glutamine (A and G are purines)
|
|
hydroxyurea - mechanism of action?
|
inhibits ribonucleotide reductase (converts ribonucleotides to deoxyribonucleotides)
|
|
6-mercaptopurine - mechanism of action?
|
blocks de novo purine synthesis
|
|
5-fluorouracil - mechanism of action?
|
inhibits thymidylate synthase (makes dTMP from dUMP)
|
|
mechanism of action of methotrexate and trimethoprim
|
inhibit dihydrofolate reductase (makes THF, which is needed for dTMP synthesis)
|
|
transition vs. transversion
|
transition - substituting purine for purine, e.g. (transItion = Identical type)
transversion - substituting purine for pyrimidine, e.g. (transVersion = conVersion between types) |
|
nonsense mutation
|
change resulting in an early stop codon (Stop the nonsense!)
|
|
fluoroquinolones - mechanism of action?
|
inhibit DNA gyrase
|
|
what is the defect in xeroderma pigmentosum?
|
mutated endonucleases (for nucleotide excision repair) - prevents repair of thymidine dimers
|
|
what is the defect in hereditary nonpolyposis colorectal cancer?
|
mutated mismatch repair genes
|
|
what are the 3 types of RNA, and what are their distinguishing characteristics?
|
rRNA - most abundant (Rampant)
mRNA - longest (Massive) tRNA - smallest (Tiny) |
|
mRNA start codon
|
AUG (inAUGurates protein synthesis)
|
|
mRNA stop codons
|
UGA (U Go Away)
UAA (U Are Away) UAG (U Are Gone) |
|
which types of RNA do the different types of RNA polymerase make?
|
RNA polymerase I - rRNA
RNA polymerase II - mRNA RNA polymerase III - tRNA (numbered in order as products are used in protein synthesis) |
|
exons vs. introns
|
exons are coding segments
introns are non-coding segments that are spliced out (INtrons stay IN the nucleus, whereas EXons EXit and are EXpressed) |
|
tetracyclines - mechanism of action?
|
bind 30S subunit and prevent attachment of aminoacyl-tRNA
|
|
subunits that make up the eukaryotic vs. prokaryotic ribosome
|
Eukaryotes: 40S + 60S = 80S (Even)
prOkaryotes: 30S + 50S = 70S (Odd) |
|
function of ribosome sites in protein synthesis
|
going APE:
A site - incoming Aminoacyl-tRNA binds here P site - accommodates growing Peptide E site - holds Empty tRNA as it Exits |
|
functions of ATP and GTP in protein synthesis
|
ATP - for tRNA charging (Activation)
GTP - for tRNA binding to ribosome and translocation (Gripping and Going places) |
|
aminoglycosides - mechanism of action?
|
inhibit formation of initiation complex in protein synthesis and cause misreading of mRNA
|
|
chloramphenicol - mechanism of action?
|
inhibits 50S peptidyltransferase (which catalyzes peptide bond formation)
|
|
mechanism of action of macrolides and clindamycin?
|
bind 50S subunit and block translocation
|
|
function of G1 and G2 phases in cell cycle
|
Gap or Growth (duplication of cell contents, cell growth)
|
|
function of S phase in cell cycle
|
DNA Synthesis
|
|
what is the defect in I-cell disease?
|
lysosomal storage disorder - failure of addition of mannose-6-phosphate to lysosome proteins (normally targets proteins to lysosomes)
- so enzymes are secreted from cell instead of going to lysosomes |
|
name 5 drugs that act on microtubules (and what they're used for)
|
mebendazole/thiabendazole (antihelminthic)
griseofulvin (antifungal) vincristine/vinblastine (anti-cancer) paclitaxel (anti-breast cancer) colchicine (anti-gout) |
|
what is the defect in Chediak-Higashi syndrome?
- symptoms? |
defect in microtubule polymerization, causing decreased phagocytosis
- symptoms: recurrent pyogenic infections, partial albinism, peripheral neuropathy |
|
what is the defect in Kartagener's syndrome?
- symptoms? |
dynein arm defect, causing cilia to be immotile
- symptoms: infertility, bronchiectasis, recurrent sinusitis, situs inversus |
|
mechanism of action of cardiac glycosides (digoxin and digitoxin)?
|
inhibit Na+/K+-ATPase, causing decreased Na+/Ca2+ exchange
- more Ca2+ in cell causes increased cardiac contractility |
|
location of the different types of collagen
|
Be (So Totally) Cool, Read Books
type I: Bone, Skin, Tendon (type I: bONE) type II: Cartilage (carTWOlage) type III (Reticulin): blood vessels, uterus, fetal tissue type IV: Basement membrane (type IV: under the floor) |
|
what is the defect in scurvy?
|
vitamin C deficiency, so can't hydroxylate proline and lysine residues in collagen
|
|
what is the defect in Ehlers-Danlos syndrome?
- which type of collagen is most affected? - symptoms? |
faulty collagen synthesis, especially type III collagen
- symptoms: hyperextensible skin, tendency to bleed, hypermobile joints |
|
what is the defect in osteogenesis imperfecta?
- which type of collagen is most affected? - symptoms? |
abnormal type I collagen synthesis
- symptoms: multiple fractures with minimal trauma (brittle bones), blue sclerae, hearing loss, dental imperfections |
|
what is the defect in Alport's syndrome?
- which type of collagen is most affected? - symptoms? |
abnormal type IV collagen synthesis
- symptoms: hereditary nephritis, deafness, ocular disturbances (type IV collagen found in kidney, ears, and eyes) |
|
what is the defect in Marfan's syndrome?
|
mutation in fibrillin (component of elastin)
|
|
what disease can be caused by alpha1-antitrypsin deficiency?
- why does this occur? |
emphysema - due to excess elastase activity (alpha1-antitrypsin normally inhibits elastase)
|
|
what blotting procedures are used to probe for DNA, RNA, and protein?
|
SNoW DRoP:
Southern = DNA Northern = RNA Western = Protein |
|
Prader-Willi vs. Angelman's syndrome - inactivation of which parent's allele?
|
Prader-Willi - deletion of Paternal allele
AngelMan's - deletion of Maternal allele |
|
what is the defect in hypophosphatemic rickets (vitamin D-resistant rickets)?
- what is the inheritance pattern? |
phosphate wasting at proximal tubule
- X-linked dominant |
|
what is the primary symptom in Leber's hereditary optic neuropathy?
- what causes this? - what is the inheritance pattern? |
loss of central vision due to degeneration of retinal ganglion cells and axons
- mitochondrial inheritance |
|
what gene is mutated in achondroplasia?
|
fibroblast growth factor receptor 3
|
|
what gene is mutated in ADPKD?
- what chromosome is it on? |
APKD1 gene
- on chromosome 16 (16 letters in "polycystic kidney") |
|
what gene is mutated in familial adenomatous polyposis?
- what chromosome is it located on? |
APC gene
- chromosome 5 (5 letters in "polyp") |
|
what is the defect in familial hypercholesterolemia?
|
defective or absent LDL receptor
|
|
what is Osler-Weber-Rendu syndrome?
|
hereditary hemorrhagic telangiectasia - disorder of blood vessels
|
|
what is the defect in hereditary spherocytosis?
|
defect in spectrin or ankyrin
|
|
what chromosome is the mutation in Huntington's disease located on?
|
chromosome 4 (hunting 4 food)
|
|
what chromosome is the mutated gene in neurofibromatosis type 1 (von Recklinghausen's disease) located on?
- symptoms? |
chromosome 17 (17 letters in von Recklinghausen)
- symptoms: cafe-au-lait spots, neural tumors, Lisch nodules (iris hamartomas) |
|
what gene is mutated in neurofibromatosis type 2?
- what chromosome is it on? - symptoms? |
NF2 gene on chromosome 22 (type 2 = 22)
- symptoms: bilateral acoustic neuromas, juvenile cataracts |
|
what are some symptoms of tuberous sclerosis?
|
facial lesions, hypopigmented "ash leaf spots" on skin, cortical/retinal hamartomas, renal cysts, cardiac rhabdomyomas
|
|
what are some symptoms of von Hippel-Lindau disease?
- what gene is mutated? - what chromosome is it on? |
hemangioblastomas, bilateral renal cell carcinomas
- VHL gene (tumor suppressor) on chromosome 3 (von Hippel-Lindau = 3 words) |
|
what gene is mutated in cystic fibrosis, and how?
- treatment? how does it work? |
CFTR - deletion of Phe 508
- N-acetylcysteine cleaves disulfide bonds in mucus |
|
name 10 X-linked recessive disorders
|
Be Wise, Fool's GOLD Heeds False Hope:
Bruton's agammaglobulinemia Wiskott-Aldrich syndrome Fragile X G6PD defiency Ocular albinism Lesch-Nyhan syndrome Duchenne's/Becker's muscular dystrophy Hemophilia A and B Fabry's disease Hunter's syndrome |
|
what is the gene defect in Duchenne's muscular dystrophy?
- what is the defect in Becker's? |
Duchenne's = Deleted Dystrophin (frameshift mutation)
- Becker's = mutated dystrophin |
|
what are the symptoms of fragile X syndrome?
|
macro-orchidism, long face, large jaw, large everted ears (fragile X = eXtra-large testes, jaw, ears)
|
|
name 4 trinucleotide repeat expansion diseases
- what are the repeated segments for each? |
Try (trinucleotide) hunting for my fried eggs (X):
Huntington's disease - CAG myoTonic dystrophy - CTG Friedreich's ataxia - GAA fraGile X syndrome - CGG |
|
name the 3 most common autosomal trisomies
- which chromosome? - symptoms? |
Down syndrome - 21 (Drinking age) - flat facies, prominent epicanthal folds, simian crease
Edward's syndrome - 18 (Election age) - micrognathia, low-set ears, clenched hands with overlapping fingers Patau's syndrome - 13 (Puberty) - cleft lip/Palate, holoProsencephaly, Polydactyly |
|
symptoms of 22q11 deletion syndromes
- what is the cause? - 2 examples of syndromes? |
CATCH-22:
Cleft palate Abnormal facies Thymic aplasia (causes T cell deficiency) Cardiac defects Hypocalcemia due to parathyroid aplasia - due to aberrant development of 3rd and 4th branchial pouches - examples: DiGeorge syndrome, velocardiofacial syndrome |
|
vitamin A - other name?
- function? |
retinol
- constituent of visual pigments (retin-A) |
|
vitamin B1 - other name?
- what cofactor does it make? - what types of reactions does this assist in? - what diseases are caused by deficiency? |
thiamine
- TPP - for dehydrogenase reactions - beriberi (Ber1Ber1) and Wernicke-Korsakoff syndrome |
|
vitamin B2 - other name?
- what cofactors does it make? how many ATP? - symptoms of deficiency? |
riboflavin
- FAD and FMN (derived from riboFlavin) - FAD makes 2 ATP (B2) - 2 C's: Cheilosis, Corneal vascularization |
|
vitamin B3 - other name?
- what cofactor does it make? how many ATP? - what disease is caused by deficiency? symptoms? |
niacin
- NAD (derived from Niacin) - 3 ATP (B3) - pellagra - 3 D's: Diarrhea, Dermatitis, Dementia |
|
vitamin B5 - other name?
- what cofactor does it make? |
pantothenate
- CoA (from pantothen-A) |
|
vitamin B6 - other name?
- what types of reactions does it participate in? |
pyridoxine
- transamination and decarboxylation reactions |
|
vitamin B12 - other name?
|
cobalamin
|
|
source of folate
|
green leaves (FOLate from FOLiage)
|
|
function of S-adenosyl-methionine
|
transfers methyl units (SAM the methyl donor man)
|
|
biotin - cofactor in what kind of reactions?
- cause of deficiency? |
carboxylation reactions
- ingestion of raw eggs, which contain avidin (AVIDin in egg whites AVIDly binds biotin) |
|
vitamin E - function?
|
antioxidant that protects erythrocytes and membranes from damage (E for Erythrocytes)
|
|
vitamin K - function?
|
needed for proper function of clotting factors II, VII, IX, and X and proteins C and S (K is for Koagulation)
|
|
disulfiram - mechanism of action?
|
inhibits acetaldehyde dehydrogenase, causing accumulation of acetaldehyde
|
|
kwashiorkor vs. marasmus - what are the causes and symptoms of each?
|
kwashiorkor - protein malnutrition
- results from a protein-deficient MEAL: malnutrition, edema, anemia, liver fatty change marasmus - energy malnutrition - Marasmus results in Muscle wasting |
|
cell processes that take place in both mitochondria and cytoplasm
|
HUGs take two:
Heme synthesis Urea cycle Gluconeogenesis |
|
hexokinase vs. glucokinase
- what do they do? - where are they each located? - high or low affinity? - high or low Vmax? |
both convert glucose to glucose-6-phosphate
- hexokinase is everywhere and has high affinity and low Vmax - glucokinase is in liver and beta cells of pancreas - has low affinity and high Vmax |
|
cofactors involved in pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase reactions
|
TPP (B1), FAD (B2), NAD (B3), CoA (B5), lipoic acid
|
|
purely ketogenic amino acids
|
Lysine and Leucine
|
|
substrates in TCA cycle
|
Citrate Is Krebs' Starting Substrate For Making Oxaloacetate:
Citrate - Isocitrate - alpha-Ketoglutarate - Succinyl-CoA - Succinate - Fumarate - Malate - Oxaloacetate |
|
enzymes unique to gluconeogenesis (all irreversible)
|
Pathway Produces Fresh Glucose:
Pyruvate carboxylase PEP carboxykinase Fructose-1,6-bisphosphatase Glucose-6-phosphatase |
|
purposes of HMP shunt
|
produce NADPH (for fatty acid/steroid biosynthesis and glutathione reduction to prevent oxidative damage)
produce pentose sugars (for nucleotide synthesis) |
|
what are Heinz bodies?
- what disease do they occur in? |
Heinz bodies = denatured Hemoglobin that precipitates within RBCs
- occur in G6PD deficiency (oxidative damage) |
|
what is the defect in fructose intolerance?
|
deficiency of aldolase B (converts fructose-1-P to DHAP and glyceraldehyde)
|
|
what is the defect in essential fructosuria?
|
deficiency of fructokinase (converts fructose to fructose-1-P)
|
|
what is the defect in classic galactosemia?
- symptoms? |
absence of galactose-1-phosphate uridyltransferase (converts galactose-1-P to glucose-1-P)
- failure to thrive, infantile cataracts (galactitol accumulates in eye) |
|
substrates in urea cycle
|
Ordinarily, Careless Crappers Are Also Frivolous About Urination:
Ornithine - Carbamoyl phosphate - Citrulline - Aspartate - Argininosuccinate - Fumarate - Arginine - Urea |
|
what is the defect in phenylketonuria?
- symptoms? |
decrease in phenylalanine hydroxylase (converts Phe to Tyr) or in THB cofactor
- mental/growth retardation, fair skin, musty body odor (disorder of aromatic aa metabolism causes musty body odor) |
|
what is the defect in alkaptonuria?
- symptoms? |
deficiency of homogentisic acid oxidase (involved in Tyr degradation)
- dark connective tissue, pigmented sclera, urine turns black on standing |
|
what is the defect in albinism?
|
deficiency of tyrosinase or defective tyrosine transporters (so can't make melanin from tyrosine)
|
|
what is the defect in homocystinuria?
|
defect in cystathionine synthase (in pathway converting homocysteine to cysteine) or in homocysteine methyltransferase (converts homocysteine to methionine) - both cause excess homocysteine
|
|
what is the defect in cystinuria?
- what can result? |
defect of renal proximal tubule transporter for cysteine
- excess cystine in urine can cause precipitation of cystine kidney stones |
|
what is the defect in maple syrup urine disease?
- symptoms? |
defect in alpha-ketoacid dehydrogenase, which degrades branched amino acids (Ile, Leu, Val - I Love Vermont maple syrup from the branches of maple trees)
- urine smells like maple syrup, CNS defects |
|
what enzyme deficiency is a major cause of SCID?
- what patient population gets SCID? |
adenosine deaminase deficiency (excess ATP imbalances nucleotide pool and prevents DNA synthesis)
- SCID happens to kids |
|
what is the defect in Lesch-Nyhan syndrome?
- symptoms? |
absence of HGPRT (He's Got Purine Recovery Trouble) - enzyme of purine salvage pathway, so block leads to excess uric acid
- retardation, self-mutilation, gout |
|
what is the defect in orotic aciduria?
- findings? |
inability to convert orotic acid to UMP (in de novo pyrimidine synthesis pathway)
- orotic acid in urine, megaloblastic anemia |
|
function of insulin with regard to glucose
|
Insulin moves glucose Into cells
|
|
tissues that don't need insulin for glucose transport
|
BRICK L:
Brain, RBCs, Intestine, Cornea, Kidney, Liver |
|
what are glycogen storage diseases types I-III and V?
- what enzymes are deficient in each? - what specific organs do types II and V affect? |
Very Poor Carbohydrate Metabolism:
I = Von Gierke's disease - glucose-6-phosphatase II = Pompe's disease - lysosomal alpha-1,4-glucosidase - heart (cardiomegaly) - Pompe's trashes the Pump III = Cori's disease - debranching enzyme V = McArdle's disease - skeletal muscle glycogen phosphorylase - muscle (McArdle's = Muscle) |
|
what is the defect in Fabry's disease?
- what substrate accumulates? |
deficient alpha-galactosidase A
- ceramide trihexoside accumulates |
|
what is the defect in Gaucher's disease?
- what substrate accumulates? |
deficient beta-glucocerebrosidase
- glucocerebroside accumulates |
|
what is the defect in Niemann-Pick disease?
- what substrate accumulates? |
deficient sphingomyelinase - no man picks (Niemann-Pick) his nose with his sphinger (sphingomyelinase)
- sphingomyelin accumulates |
|
what is the defect in Tay-Sachs disease?
- what substrate accumulates? |
deficient hexosaminidase A (Tay-SaX lacks heXosaminidase)
- GM2 ganglioside accumulates |
|
what is the defect in Krabbe's disease?
- what substrate accumulates? |
deficient galactocerebrosidase
- galactocerebroside accumulates |
|
what is the defect in metachromatic leukodystrophy?
- what substrate accumulates? |
deficient arylsulfatase A
- cerebroside sulfate accumulates |
|
what is the defect in Hurler's syndrome?
- what substrates accumulate? |
deficient alpha-L-iduronidase
- heparan sulfate and dermatan sulfate accumulate |
|
what is the defect in Hunter's syndrome?
- what substrates accumulate? - what is the inheritance pattern? |
deficient iduronate sulfatase
- heparan sulfate and dermatan sulfate accumulate - X-linked recessive (hunters aim for the X) |
|
Hunter's vs. Hurler's - which has corneal clouding?
|
Hurler's
(hunters see clearly - no corneal clouding) |
|
citrate shuttle vs. carnitine shuttle - what metabolic pathways are they involved in?
|
citrate - fatty acid synthesis (SYtrate = SYnthesis)
carnitine - fatty acid degradation (CARnitine = CARnage of fatty acids) |
|
statins - mechanism of action?
|
inhibit HMG-CoA reductase
|
|
functions of apolipoproteins A-I, B-100, C-II, B-48, and E
|
A-I - activates LCAT
B-100 - Binds LDL receptor and mediates VLDL secretion C-II - Cofactor for lipoprotein lipase B-48 - mediates chylomicron secretion E - mediates remnant (Extra) uptake |
|
direction of transport of LDL and HDL
|
LDL - from liver to tissues (LDL is Lousy)
HDL - from periphery to liver (HDL is Healthy) |
|
what is the defect in hyperchylomicronemia?
|
lipoprotein lipase deficiency or altered apolipoprotein C-II
|
|
what is the defect in familial hypercholesterolemia?
|
absent or decreased LDL receptors
|
|
what is the defect in hypertriglyceridemia?
|
hepatic overproduction of VLDL
|
|
what is the defect in abetalipoproteinemia?
|
deficiencies of apoB-100 and apoB-48 - unable to synthesize lipoproteins
|
|
landmarks of 2nd week of fetal development
|
rule of 2's:
- 2 germ layers (epiblast, hypoblast) - 2 cavities (amniotic cavity, yolk sac) - 2 components to placenta (cytotrophoblast, syncytiotrophoblast) |
|
landmark of 3rd week of fetal development
|
rule of 3's:
- 3 germ layers (ectoderm, mesoderm, endoderm) |
|
landmarks of 4th week of fetal development
|
rule of 4's:
- 4 heart chambers - 4 limb buds grow |
|
what germ layer are odontoblasts derived from?
|
neural crest (Crest toothpaste)
|
|
symptoms of mesoderm defects
|
VACTERL:
Vertebral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal defects Limb defects |
|
at which days in fetal development do the amnion and chorion form?
|
chorion forms at day 3
amnion forms at day 8 |
|
what are the components of the umbilical cord?
|
2 umbilical arteries
1 umbilical vein urachus all surrounded by Wharton's jelly |
|
structures that perform fetal erythropoiesis during development, in order
|
Young Liver Synthesizes Blood:
Yolk sac (3-8 wk) Liver (6-30 wk) Spleen (9-28 wk) Bone marrow (28+ wk) |
|
what is the adult derivative of the umbilical arteries?
|
umbiLical arteries become mediaL umbilical ligaments
|
|
what is the adult derivative of the allantois/urachus?
|
allaNtois becomes mediaN umbilical ligaments
|
|
what is the adult derivative of the 1st aortic arch?
|
part of the MAXillary artery (1st arch is MAXimal)
|
|
what are the adult derivatives of the 2nd aortic arch?
|
Stapedial artery (Second arch) and hyoid artery
|
|
what are the adult derivatives of the 3rd aortic arch?
|
common Carotid artery and internal Carotid artery (C is 3rd letter of alphabet)
|
|
what are the adult derivatives of the 4th aortic arch?
|
aortic arch and right subclavian artery (4th arch = 4 limbs = systemic circulation)
|
|
what is the defect in spina bifida occulta?
- in meningocele? - in myelomeningocele? |
bony spinal canal fails to close, but no herniation
- meninges herniate through - meninges and spinal cord herniate through |
|
what is Chiari type II?
|
cerebellar tonsils herniate through foramen magnum
|
|
what is Dandy-Walker?
|
large posterior fossa, absent cerebellum, enlarged 4th ventricle
|
|
what is the defect in holoprosencephaly?
|
cerebral hemispheres do not separate across midline
|
|
what is the defect in syringomyelia?
- symptom? |
enlarged central canal of spinal cord - damages crossing fibers of spinothalamic tract
- so bilateral loss of pain and temperature sense |
|
what germ layers are the different parts of the branchial apparatus derived from?
|
CAP covers outside from inside:
Clefts = ectoderm Arches = mesoderm Pouches = endoderm |
|
innervations and general functions of derivatives of each branchial arch
|
arch 1 - CN V2 and V3 - chewing
arch 2 - CN VII - facial expression arch 3 - CN IX - stylopharyngeus arch 4 - CN X - swallowing arch 6 - CN X - speaking |
|
name some derivatives of branchial arch 1
|
Meckel's cartilage (Mandible, Malleus, incus, sphenoMandibular ligament)
Muscles of Mastication (temporalis, Masseter, lateral and Medial pterygoids) Mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini, anterior tongue |
|
what is the defect in Treacher Collins syndrome?
- symptoms? |
1st arch neural crest fails to migrate
- mandibular hypoplasia, facial abnormalities |
|
name some derivatives of branchial arch 2
|
Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
muscles of facial expression, Stapedius, Stylohyoid, posterior belly of digastric |
|
name some derivatives of branchial arch 3
|
greater horn of hyoid, stylopharyngeus (innervated by glossopharyngeal nerve)
|
|
what are the derivatives of the 3rd branchial pouch?
|
3rd pouch contributes to 3 structures:
thymus and inferior parathyroids |
|
what is the defect in DiGeorge syndrome?
- symptoms? |
aberrant development of 3rd and 4th branchial pouches (form thyroid and parathyroids)
- T-cell deficiency and hypocalcemia |
|
what ear bones and muscles derive from the 1st branchial arch?
- from the 2nd? |
1st: Malleus/incus, tensor tyMpani
2nd: Stapes, Stapedius |
|
embryologic components of diaphragm
|
Several Parts Build Diaphragm:
Septum transversum Pleuroperitoneal folds Body wall Dorsal mesentery of esophagus |
|
innervation of diaphragm
|
C3,4,5 (keeps the diaphragm alive)
|
|
what is the defect in gastroschisis?
|
failure of lateral body folds to fuse, causes extrusion of abdominal contents
|
|
what is the defect in Potter's syndrome?
- symptoms? |
bilateral renal agenesis in utero (due to malformed ureteric bud) causes oligohydramnios (babies with Potter's can't Pee in utero)
- limb deformities, face deformities, pulmonary hypoplasia |
|
adult derivatives of the mesonephric (wolffian) ducts
|
SEED:
Seminal vesicles Epididymis Ejaculatory duct Ductus deferens |
|
what is the defect in hypospadias?
|
failure of urethral folds to close - causes abnormal opening of penile urethra on inferior side of penis (hypo is below)
|
|
what is the defect in epispadias?
- what condition is associated with epispadias? |
faulty positioning of genital tubercle - causes abnormal opening of penile urethra on superior side of penis (Epispadias - you hit your Eye when you pEE)
- Extrophy of the bladder is associated with Epispadias |
|
only bacteria with a protein capsule
|
Bacillus anthracis
|
|
bacteria that do not Gram stain well
|
These Rascals May Microscopically Lack Color:
Treponema Rickettsia Mycobacteria Mycoplasma Legionella pneumophila Chlamydia |
|
what does PAS stain for?
- what does it diagnose? |
glycogen and mucopolysaccharides (PASs the sugar)
- Whipple's disease |
|
name 4 obligate aerobes
|
Nagging Pests Must Breathe:
Nocardia Pseudomonas aeruginosa (P. AERuginosa is an AERobe) Mycobacterium tuberculosis Bacillus |
|
name 3 obligate anaerobes
|
anaerobes Can't Breathe Air:
Clostridium Bacteroides Actinomyces |
|
what type of bacteria are aminoglycosides ineffective against?
|
anaerobes (aminO2glycosides require O2 to enter bacterial cell)
|
|
name 2 obligate intracellular bacteria
|
stay inside cells when it's Really Cold:
Rickettsia Chlamydia |
|
name 8 facultative intracellular bacteria
|
Some Nasty Bugs May Live FacultativeLY:
Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia |
|
what does a positive quellung reaction indicate?
|
bacteria is encapsulated (quellung = capsular swellung)
|
|
name 4 encapsulated bacteria
|
Some Nasties Have Kapsules:
Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae Klebsiella pneumoniae |
|
name 4 urease-positive bacteria
|
Particular Kinds Have Urease:
Proteus Klebsiella H. pylori Ureaplasma |
|
what bacteria produce a yellow pigment?
|
S. aureus (aureus = yellow)
|
|
what bacteria produce a blue-green pigment?
|
Pseudomonas aeruginosa (AERUGula is green)
|
|
what bacteria produce a red pigment?
|
Serratia marcescens (red maraschino cherries)
|
|
function of Corynebacterium diphtheriae toxin
|
inactivates elongation factor (EF-2)
|
|
function of Vibrio cholerae toxin
|
activates Gs, stimulating adenylyl cyclase - increases Cl- in gut and decreases Na+ absorption
|
|
E. coli heat-labile toxin vs. heat-stable toxin
|
heat-labile stimulates Adenylate cyclase, heat-stable stimulates Guanylate cyclase
("labile like the Air, stable like the Ground") |
|
function of Bordetella pertussis toxin
|
inhibits Gi, causing increased cAMP
|
|
function of C. tetani toxin
|
blocks release of GABA and glycine
|
|
function of C. botulinum toxin
|
blocks release of acetylcholine
|
|
function of Shigella toxin
|
Shiga toxin cleaves host rRNA and enhances cytokine release
|
|
location of endotoxin
|
Gram-Negative cell wall
(N-dotoxin) |
|
name 5 bacterial toxins that are encoded in a lysogenic phage
|
ABCDE:
ShigA-like toxin Botulinum toxin Cholera toxin Diphtheria toxin Erythrogenic toxin of Streptococcus pyogenes |
|
how do you distinguish between Staph. epidermidis and Staph. saprophyticus?
|
NOvobiocin - Saprophyticus is Resistant, Epidermidis is Sensitive (on the office's staph retreat, there was NO StRES)
|
|
how do you distinguish between Strep. pneumoniae and viridans?
|
Optochin - Viridans is Resistant, Pneumoniae is Sensitive (OVRPS - overpass)
|
|
how do you distinguish between group A and B strep?
|
Bacitracin - group B strep are resistant, group A are Sensitive (B-BRAS)
|
|
how do you distinguish between Staphylococci and Streptococci?
|
catalase (Staph make catalase because they have more staff)
|
|
what diseases does Streptococcus pneumoniae cause?
|
MOPS (Most OPtochin Sensitive):
Meningitis Otitis media Pneumonia Sinusitis |
|
what species of viridans group Strep causes subacute bacterial endocarditis?
|
S. sanguis (blood - there is lots of blood in the heart)
|
|
normal location of viridans Streptococci
|
in the mouth (not afraid of-the-chin - op-to-chin resistant)
|
|
sequelae of Strep pharyngitis
|
rheumatic fever (PHever), glomerulonePHritis (due to PHaryngitis)
|
|
symptoms of rheumatic fever
|
no rheum for SPECCulation:
Subcutaneous nodules Polyarthritis Erythema marginatum Chorea Carditis |
|
what patients does Streptococcus agalactiae infect?
|
babies (group B is for Babies)
|
|
characteristics of Corynebacterium diphtheriae
|
ABCDEFG:
ADP ribosylation (by toxin) Beta-prophage (encodes toxin) Corynebacterium Diphtheriae Elongation Factor 2 (ribosylated by toxin) Granules |
|
main symptom of Clostridium tetani infection
|
TETanic paralysis (TETanus)
|
|
what are the sources of C. botulinum?
|
BOTulinum - from bad BOTtles of food and honey
|
|
what does C. perfringens infection cause?
|
gas gangrene (PERFringens PERForates a gangrenous leg)
|
|
what does C. difficile infection cause?
|
DIfficile - causes DIarrhea and pseudomembranous colitis
|
|
what is the only Gram-positive bacteria with endotoxin?
|
Listeria monocytogenes
|
|
what are the treatments for Actinomyces israelii and Nocardia asteroides?
|
SNAP:
Sulfamethoxazole for Nocardia Actinomyces gets Penicillin |
|
lepromatous vs. tuberculoid leprosy - which is worse?
- what causes the difference? |
LEpromatous is worse (LEthal)
- due to failed cell-mediated immunity |
|
what type of bacteria grow pink colonies on MacConkey's agar?
- name 5 examples |
lactose fermenters (lactose is KEE)
- MacConKEE's agar: Citrobacter, Klebsiella, E. coli, Enterobacter, Serratia |
|
how do you distinguish between Neisseria gonorrhoeae and meningitidis?
|
MeninGococci ferment Maltose and Glucose
Gonococci ferment only Glucose |
|
what diseases does Haemophilus influenzae cause?
|
HaEMOPhilus causes Epiglottitis, Meningitis, Otitis media, Pneumonia
|
|
what special culture is needed to grow Haemophilus influenzae?
|
chocolate agar with factors V (NAD) and X (hematin)
(when a child has the "flu", mom goes to the five (V) and dime (X) to buy some chocolate) |
|
how do you stain Legionella pneumophila?
- what special culture is needed to grow it? |
silver stain
- charcoal yeast extract with iron and cysteine (French legionnaire with silver helmet sitting around charcoal fire with an iron dagger - he is no sissy/cysteine) |
|
what diseases does Pseudomonas aeruginosa cause?
|
PSEUDOmonas - Pneumonia, Sepsis, External otitis, UTI, Diabetic Osteomyelitis
|
|
antigen types found in Enterobacteriaceae
- are they glucose fermenters or nonfermenters? |
COFFEe:
Capsular (K) antigen O antigen Flagellar (H) antigen Ferment glucose Enterobacteriaceae |
|
what diseases does Klebsiella cause?
- what patients does it affect? |
4 A's:
Aspiration pneumonia Abscess in lungs Alcoholics di-A-betics |
|
Salmonella vs. Shigella - which is motile?
- how are they transmitted? |
Salmonella (salmon swim)
- Food, Fingers, Feces, Flies |
|
name the spirochetes
- which is the biggest? |
BLT: Borrelia, Leptospira, Treponema
- Borrelia (B is Big) |
|
what is Weil's disease?
|
icterohemorrhagic leptospirosis (severe infection with Leptospira interrogans)
|
|
symptoms of Lyme disease
|
BAKE a Key Lyme pie:
Bell's palsy Arthritis Kardiac block Erythema migrans |
|
which stage of syphilis is characterized by systemic disease?
|
Secondary syphilis = Systemic
|
|
what is the Argyll Robertson pupil?
|
sign of tertiary syphilis - constricts with accommodation but is not reactive to light (prostitute's pupil - accommodates but doesn't react)
|
|
which treponeme test is more specific and remains positive longest: FTA-ABS or VDRL?
|
FTA-ABS (Find The Antibody ABSolutely)
|
|
causes of VDRL false positives
|
VDRL:
Viruses (mono, hepatitis) Drugs Rheumatic fever Lupus/leprosy |
|
name 6 zoonotic bacteria
|
Big Bad Bugs From Your Pet named Ella:
Bartonella henselae Borrelia burgdorferi Brucella Francisella tularensis Yersinia pestis Pasteurella multocida |
|
what is the source of Brucella, and what does it cause?
|
Unpasteurized dairy products - causes Undulant fever
|
|
triad of symptoms caused by rickettsiae
|
headache, fever, rash
|
|
what distinguishes rickettsial rash from typhus rash?
|
rickettsial rash starts on hands and feet and spreads inward
typhus rash starts centrally and spreads outward (Rickettsia on the wRists, Typhus on the Trunk) |
|
what causes Q fever, and what distinguishes it from other rickettsiae?
|
Coxiella burnetii
Q fever is ***** - no rash, no vector (transmitted by aerosol), negative Weil-Felix reaction, organism can survive outside for a long time |
|
what infections cause a palm and sole rash?
|
drive CARS using palms and soles:
Coxsackievirus A Rocky Mountain spotted fever Syphilis |
|
Chlamydia elementary body vs. reticulate body - what is the function of each?
|
Elementary body Enters the cell
Reticulate body Replicates in the cell |
|
what do the different serotypes of Chlamydia trachomatis cause?
|
types A, B, C - in Africa, cause Blindness and Chronic infection
types L1-3 - cause Lymphogranuloma venereum types D-K - cause everything else |
|
treatment for C. difficile
|
metronidazole
|
|
treatment for leprosy
- side effects? |
dapsone
- hemolysis, methemoglobinemia |
|
treatment for H. influenzae meningitis
- prophylaxis for close contacts? |
ceftriaxone
- rifampin prophylaxis |
|
treatment for Legionella
|
erythromycin
|
|
treatment for Pseudomonas
|
aminoglycoside + extended-spectrum penicillin
|
|
treatment for H. pylori
|
triple therapy: bismuth, metronidazole, and tetracycline/amoxicillin
|
|
treatment for Lyme disease
|
doxycycline
|
|
treatment for syphilis
|
penicillin
|
|
treatment for Gardnerella
|
metronidazole
|
|
treatment for Rickettsiae
|
tetracycline
|
|
treatment for Chlamydia
|
erythromycin or tetracycline
|
|
treatment for Mycoplasma pneumoniae
|
tetracycline or erythromycin
|
|
histoplasmosis - where is it contracted?
- microscopic appearance? |
Mississippi/Ohio river valleys
- macrophage filled with intracellular oval bodies |
|
blastomycosis - where is it contracted?
- microscopic appearance? - preferred form at different temperatures? |
east of Mississippi river
- Blastomycosis = Big Broad-Based Budding - cold = mold, heat = yeast |
|
coccidioidomycosis - where is it contracted?
- microscopic appearance? |
southwestern US
- spherule filled with endospores |
|
paracoccidioidomycosis - where is it contracted?
- microscopic appearance? |
Latin America
- budding yeast looks like captain's wheel |
|
treatment for local mycotic infection
- for systemic infection? |
fluconazole or ketoconazole
- amphotericin B for systemic |
|
what causes tinea versicolor?
- treatment? |
Malassezia furfur
- miconazole, selenium sulfide |
|
treatment for superficial Candida albicans infection
- for systemic infection? |
nystatin
- amphotericin B for systemic |
|
treatment for Pneumocystis jiroveci
|
trimethaprim-sulfamethoxazole
|
|
treatment for Sporothrix schenckii
|
itraconazole or potassium iodide
|
|
symptoms of Chagas' disease
- what causes it? - what transmits it? - treatment? |
dilated cardiomyopathy, megacolon, megaesophagus
- Trypanosoma cruzi transmitted by reduviid bug - nifurtimox |
|
treatment for African sleeping sickness
|
SURamin for blood-borne disease
MELArsoprol for CNS penetration (it SURe is nice to go to sleep; MELAtonin helps with sleep) |
|
how is Leishmania transmitted?
- treatment? |
sandfly
- treat with sodium stibogluconate |
|
treatment for malaria
|
chloroquine + primaquine to prevent relapse by dormant species in liver
|
|
what organisms does the Ixodes tick transmit?
|
Borrelia burgdorferi and Babesia
|
|
what is the main symptom of Entamoeba histolytica infection?
|
bloody diarrhea
|
|
what are three main drugs used to treat nematode (roundworm) infections?
|
meBENDazole (worms are BENDy), pyrantel pamoate, diethylcarbamazine
|
|
what disease does Onchocerca volvulus cause?
- treatment? - how is it transmitted? |
rIVER blindness
- IVERmectin - blackflies |
|
what is the main drug used to treat cestode (tapeworm) and trematode (fluke) infections?
|
praziquantel
|
|
Taenia solium - what are the two types of infection?
- ingestion of which form causes each? |
intestinal tapeworms - caused by ingestion of larvae
cysticercosis - caused by ingestion of eggs |
|
infection by what causes cysts in liver?
- what happens if the cysts burst? |
Echinococcus granulosus
- anaphylactic reaction |
|
what parasite is associated with squamous cell carcinoma of the bladder?
|
Schistosoma haematobium
|
|
what parasite is associated with cholangiocarcinoma?
|
Clonorchis sinensis
|
|
what nematodes are spread by ingestion?
|
you'll get sick if you EAT these:
Enterobius Ascaris Trichinella |
|
nematodes that spread cutaneously
|
these get into your feet from the SANd:
Strongyloides Ancylostoma Necator |
|
what parasite can cause vitamin B12 deficiency?
|
Diphyllobothrium latum
|
|
what parasites can cause microcytic anemia?
|
Ancylostoma and Necator
|
|
what parasite can cause perianal pruritis?
|
Enterobius
|
|
what organism causes typhoid fever?
|
Salmonella typhi
|
|
name 3 organisms that cause typhus (and what kind of typhus they cause)
|
Rickettsia prowazekii (epidemic)
Rickettsia typhi (endemic) Rickettsia tsutsugamushi (scrub typhus) |
|
live vs. killed vaccines - what type of immunity is induced?
|
live - humoral and cell-mediated immunity
killed - only humoral immunity |
|
which viral vaccines are killed vaccines?
|
RIP Always:
Rabies Influenza Salk Polio HAV |
|
Sabin vs. Salk polio vaccines - which is killed, and which is live?
|
Sabin - live
SalK - Killed |
|
are DNA viruses single-stranded or double-stranded?
- exception? |
double-stranded
- parvovirus is exception ("part-of-a-virus") |
|
are DNA viruses linear or circular?
- exceptions? |
linear
- exceptions: papilloma, polyoma, hepadna are circular |
|
are RNA viruses single-stranded or double-stranded?
- exception? |
single-stranded
- exception: reovirus ("repeatovirus") is double-stranded |
|
are viruses haploid or diploid?
- exception? |
haploid
- exception: retroviruses are diploid |
|
where do DNA viruses replicate?
- exception? |
nucleus
- exception: poxvirus replicates in the cytoplasm |
|
where do RNA viruses replicate?
- exceptions? |
cytoplasm
- exceptions: influenza virus and retroviruses replicate in the nucleus |
|
name the nonenveloped viruses (and whether they are DNA or RNA)
|
naked CPR and PAPP smear:
RNA: Calicivirus, Picornavirus, Reovirus DNA: Parvovirus, Adenovirus, Papillomavirus, Polyomavirus |
|
name the DNA viruses
|
HHAPPPPy:
Hepadna Herpes Adeno Pox Parvo Papilloma Polyoma |
|
do DNA viruses have icosahedral or complex nucleocapsids?
- exception? |
icosahedral
- exception: pox (complex) |
|
name the herpesviruses
|
get herpes in a CHEVrolet:
CMV HSV EBV VZV |
|
what does the Tzanck test look for?
- what does it test for? |
multinucleated giant cells
- HSV-1, HSV-2, VZV (Tzanck heavens I don't have herpes) |
|
what viruses are paramyxoviruses?
|
PaRaMyxovirus:
Parainfluenza RSV Measles (rubeola) Mumps |
|
what is the treatment for RSV?
|
ribavirin
|
|
what RNA viruses are negative-stranded?
|
Always Bring Polymerase Or Fail Replication:
Arenavirus Bunyavirus Paramyxovirus Orthomyxovirus Filovirus Rhabdovirus |
|
what RNA viruses are segmented?
|
BOAR:
Bunyavirus Orthomyxovirus Arenavirus Reovirus |
|
what viruses are picornaviruses?
- RNA or DNA viruses? |
PERCH on a peak (pico):
Poliovirus Echovirus Rhinovirus Coxsackievirus HAV - RNA viruses (picoRNAvirus) |
|
what disease does rhinovirus cause?
|
common cold (rhino has a runny nose)
|
|
what virus causes yellow fever?
|
flavivirus (flavi = yellow)
|
|
what disease does rotavirus cause?
|
infantile gastroenteritis (ROTA = RIght Out The Anus)
|
|
genetic drift vs. genetic shift - which causes epidemics and which pandemics of influenza virus?
|
drift - epidemics
shift - pandemics (Sudden Shift is more deadly than graDual Drift) |
|
what are the main symptoms of measles?
|
3 C's:
Cough, Coryza, Conjunctivitis + Koplik's spots |
|
what are the main symptoms of mumps?
|
Parotitis, Orchitis, aseptic Meningitis
(make your parotid glands and testes as big as POM-poms) |
|
name 3 arboviruses
- what are arboviruses? |
ARBOvirus = ARthropod-BOrne virus
- Flavivirus, Togavirus, Bunyavirus (Fever Transmitted by Bites) |
|
what type of infection does hepatitis A cause?
|
hep A:
usually Asymptomatic, Acute |
|
how is hepatitis B transmitted?
|
hep B:
Blood-borne |
|
what type of infection does hepatitis C cause?
- what are possible sequelae? |
hep C:
Chronic infection can cause Cirrhosis and Carcinoma |
|
what does hepatitis D require to infect?
|
HBV
(hep D is Defective and Dependent on HBV) |
|
how is hepatitis E transmitted?
- what patient population is particularly at risk? |
hep E:
Enteric (can cause Epidemics) Expectant mothers (pregnant women) have high mortality |
|
which hepatitis viruses are transmitted by fecal-oral route?
|
hepatitis A and E ("the vowels hit your bowels")
|
|
what does ABcAb indicate?
|
IgM HBcAb - recent disease
IgG HBcAb - chronic disease |
|
what does HBeAb indicate?
|
HBeAb = low transmissibility
(HBeAg = high transmissibility - Beware!) |
|
what receptors does HIV virus bind on T cells?
- on macrophages? |
T cells - CD4 and CXCR4
macrophages - CD4 and CCR5 |
|
4 stages of HIV infection
|
1 - Flulike (acute)
2 - Feeling fine (latent) 3 - Falling CD4 count 4 - Final crisis (AIDS) |
|
what is Bacillus cereus contracted from?
|
reheated rice (food poisoning from reheated rice? Be serious/B. cereus!)
|
|
4 most common causes of pneumonia in children
|
Runts May Cough Sputum:
RSV Mycoplasma Chlamydia pneumoniae Streptococcus pneumoniae |
|
most common cause of pneumonia in hospitalized and immunocompromised patients
|
Staphylococcus
|
|
most common cause of aspiration pneumonia
|
anaerobes
|
|
most common cause of osteomyelitis in diabetics and drug addicts
|
Pseudomonas aeruginosa
|
|
most common cause of osteomyelitis in sickle cell patients
|
Salmonella
|
|
name 7 bacteria that cause UTIs
|
SSEEK PP:
Serratia marcescens Staphylococcus saprophyticus Escherichia coli Enterobacter cloacae Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa |
|
name 6 infections that are transmitted in utero or during birth
|
ToRCHeS:
Toxoplasma gondii Rubella CMV HIV HSV-2 Syphilis |
|
what organism causes a painful genital ulcer?
|
Haemophilus ducreyi (it's so painful, you do cry)
|
|
what is Fitz-Hugh-Curtis syndrome a complication of?
- what are the characteristics? |
PID
- infection of liver capsule with "violin string" adhesions to parietal peritoneum |
|
what is the most common nosocomial infection caused by respiratory therapy equipment?
|
Pseudomonas AERuginosa (involves AIR)
|
|
name 6 bacteriostatic antibiotics
|
we're ECSTaTiC about bacteriostatics:
Erythromycin Clindamycin Sulfamethoxazole Trimethoprim Tetracyclines Chloramphenicol |
|
name 6 bactericidal antibiotics
|
Very Finely Proficient At Cell Murder:
Vancomycin Fluoroquinolones Penicillin Aminoglycosides Cephalosporins Metronidazole |
|
penicillin - mechanism of action?
- toxicity? |
blocks transpeptidase cross-linking of cell wall
- hypersensitivity reaction |
|
what class of drugs are methicillin, nafcillin, and dicloxacillin?
- what bacteria are they used for? - side effect of methicillin? |
penicillinase-resistant penicillins
- S. aureus (but not MRSA) - interstitial nephritis |
|
what class of drugs are ampicillin and amoxicillin?
- which has greater oral bioavailability? - what Gram-negative rods do they kill? |
aminopenicillins - extended spectrum (AMPed up penicillin)
- amOxicillin has greater Oral bioavailability - HELPS kill enterococci: Haemophilus influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella |
|
name 3 antipseudomonal penicillins
|
Ticarcillin, Carbenicillin, Piperacillin (TCP = Takes Care of Pseudomonas)
|
|
what Gram-negatives are covered by 1st generation cephalosporins?
- by 2nd generation? |
1st: PEcK = Proteus mirabilis, E. coli, Klebsiella pneumoniae
2nd: HEN PEcKS = Haemophilus influenzae, Enterobacter aerogenes, Neisseria, Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens |
|
side effect of cephalosporins
|
disulfiram-like reaction with ethanol
|
|
beta-lactamase-resistant monobactam
- what does it treat? - who is it used for? |
aztreonam
- Gram-negative rods - penicillin-allergic patients |
|
what is imipenem always administered with?
- why? |
cilastatin - inhibits renal dihydropeptidase I and decreases renal inactivation of imipenem (with imipenem, the kill is LASTIN with ciLASTATIN)
|
|
side effects of carbapenems
|
seizures, GI distress, rash
|
|
vancomycin - mechanism of action?
- side effects? |
binds D-Ala-D-Ala on cell wall and blocks cell wall mucopeptide formation
- NOT many: Nephrotoxicity, Ototoxicity, Thrombophlebitis, red man syndrome |
|
what antibiotics block 30S and 50S ribosomal subunits?
|
buy AT 30, CCELL at 50:
30S: Aminoglycosides, Tetracyclines 50S: Chloramphenicol, Clindamycin, Erythromycin, Lincomycin, Linezolid |
|
name 5 aminoglycosides
- mechanism of action? - anaerobe coverage? - side effects? |
mean GNATS: Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin
- inhibit formation of 30S initiation complex - no anaerobe coverage - canNOT kill anaerobes: Nephrotoxicity, Ototoxicity, Teratogen |
|
uses of demeclocycline
|
antibiotic
ADH antagonist (Demeclocycline = Diuretic in SIADH) |
|
tetracyclines - mechanism of action?
- what are they used for? - side effects? |
block attachment of aminoacyl-tRNA to 30S
- VACUUM THe BedRoom: Vibro cholerae, Acne, Chlamydia, Ureaplasma Urealyticum, Mycoplasma pneumoniae, Tularemia, H. pylori, Borrelia burgdorferi, Rickettsia - discolor teeth and inhibit bone growth, photosensitivity |
|
which tetracycline can be used in patients with renal failure? why?
|
doxycycline - fecally eliminated
|
|
chloramphenicol - mechanism of action?
- use? - side effects? |
blocks 50S peptidyltransferase activity
- meningitis - aplastic anemia, gray baby syndrome |
|
what two drugs are mainly used to treat anaerobes, and where?
|
clindamycin - for anaerobes above the diaphragm
metronidazole - for anaerobes below the diaphragm |
|
clindamycin - mechanism of action?
- use? - side effect? |
blocks 50S peptide bond formation
- anaerobes - pseudomembranous colitis |
|
sulfonamides - mechanism of action?
- side effects? |
inhibit dihydropteroate synthetase (involved in folate synthesis)
- hemolysis in G6PD deficiency, nephrotoxicity, photosensitivity |
|
trimethoprim - mechanism of action?
- side effect? how can it be alleviated? |
inhibits dihydrofolate reductase (folate synthesis)
- bone marrow suppression (TMP = Treats Marrow Poorly) - alleviate with folinic acid |
|
fluoroquinolones - mechanism of action?
- side effects? |
inhibit DNA gyrase
- damage to cartilage, tendonitis, tendon rupture (fluoroquinoLONES hurt attachments to your BONES) |
|
what bacteria are treated with metronidazole?
- side effects? |
GET GAP on the metro:
Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes, H. Pylori - disulfiram-like reaction with alcohol, metallic taste |
|
polymyxins - mechanism of action?
- side effects? |
act like detergents - bind and disrupt cell membranes of bacteria ('MYXins MIX up membranes)
- neurotoxicity, acute renal tubular necrosis |
|
solo prophylaxis against M. tuberculosis
|
isoniazid
|
|
anti-TB drugs
- side effect for all? - side effect of ethambutol? |
INH-SPIRE: Streptomycin, Pyrazinamide, Isoniazid, Rifampin, Ethambutol
- hepatotoxicity - ethambutol causes red-green color blindness |
|
isoniazid - mechanism of action?
- side effects? |
blocks synthesis of mycolic acids
- neurotoxicity, hepatotoxicity (INH Injures Neurons and Hepatocytes) |
|
rifampin - mechanism of action?
- side effects? |
4 R's:
RNA polymerase inhibitor Revs up microsomal P-450 Red/orange body fluids Rapid resistance if used alone |
|
treatment of MRSA
|
vancomycin
|
|
treatment of vancomycin-resistant enterococcus
|
linezolid and streptogramins (quinupristin/dalfopristin)
|
|
amphotericin B - mechanism of action?
- side effects? |
binds ergosterol and forms membrane pores (amphotericin "tears" holes in the membrane)
- fever/chills, nephrotoxicity, arrhythmias, anemia, IV phlebitis |
|
nystatin - mechanism of action?
|
binds ergosterol and disrupts fungal membranes
|
|
azoles - mechanism of action?
- side effects? |
inhibit fungal ergosterol synthesis
- gynecomastia, inhibit cytochrome P-450 |
|
what drug is used to treat cryptococcal meningitis? why?
|
fluconazole - can cross blood-brain barrier
|
|
flucytosine - mechanism of action?
- use? - side effect? |
blocks DNA synthesis
- systemic fungal infections - bone marrow suppression |
|
caspofungin - mechanism of action?
|
blocks synthesis of beta-glucan (part of fungal cell wall)
|
|
terbinafine - mechanism of action?
|
inhibits fungal squalene epoxidase (part of ergosterol synthesis)
|
|
griseofulvin - mechanism of action?
|
blocks mitosis by interfering with microtubule function
|
|
amantadine - mechanism of action?
- used to treat? - side effects? |
blocks viral uncoating (a man to dine takes off his coat), increases dopamine release
- Amantadine - used to treat influenza A and rubellA and Parkinson's - ataxia, slurred speech (causes problems with the cerebellA) |
|
zanamavir/oseltamavir - mechanism of action?
|
inhibit influenza neuraminidase
|
|
ribavirin - mechanism of action?
- used for? - side effect? |
inhibits IMP dehydrogenase (blocks nucleotide synthesis)
- RSV, chronic hepatitis C - hemolytic anemia |
|
acyclovir - mechanism of action?
- used for? |
GTP analog - inhibits viral DNA polymerase
- HSV, VZV, EBV |
|
ganciclovir - mechanism of action?
- used for? - side effects? |
GTP analog - inhibits viral DNA polymerase
- CMV - leukopenia, neutropenia, thrombocytopenia |
|
foscarnet - mechanism of action?
- how is it unlike acyclovir and ganciclovir? - side effect? |
pyrophosphate analog (FOScarnet = pyroFOSphate analot) - viral DNA polymerase inhibitor
- does not need to be activated by viral kinase to work - nephrotoxic |
|
what class of drugs are saquinavir, ritonavir, indinavir, etc.?
- side effects? |
HIV protease inhibitors (NAVIR TEASE a proTEASE)
- hyperglycemia, lipodystrophy |
|
what class of drugs are zidovudine, didanosine, zalcitabine, stavudine, etc.?
|
HIV nucleoside reverse transcriptase inhibitors (have you dined/vudine with my nuclear/nucleoside family?)
|
|
name 3 HIV non-nucleoside reverse transcriptase inhibitors
|
Never Ever Deliver nucleosides:
Nevirapine Efavirenz Delavirdine |
|
side effects of HIV reverse transcriptase inhibitors
|
bone marrow suppression, peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia
|
|
name an HIV fusion inhibitor
- mechanism of action? |
enfuvirtide - binds viral gp41 and blocks conformational change necessary for fusion with CD4
|
|
antibiotics to avoid in pregnancy
|
SAFE Moms Take Really Good Care:
Sulfonamides Aminoglycosides Fluoroquinolones Erythromycin Metronidazole Tetracyclines Ribavirin Griseofulvin Chloramphenicol |
|
where do T cells and B cells mature?
|
T cells = Thymus
B cells = Bone marrow |
|
what HLA genes encode MHC I?
- MHC II? |
MHC I - A, B, C (HLA I letter)
MHC II - DR, DP, DQ (HLA II letters) |
|
location of MHC I vs. II
|
MHC I - on all nucleated cells
MHC II - only on APCs |
|
cytotoxic vs. helper T cells - which has CD4 and which has CD8?
- which MHC class do they each bind to? |
cytotoxic T cells - CD8 (binds MHC I)
helper T cells - CD4 (binds MHC II) (product of CD and MHC = 8) |
|
what are the 2 signals needed for Th cell activation?
|
1. MHC II presents antigen to TCR
2. B7 on APC binds CD28 on T cell |
|
what are the 2 signals needed for Tc cell activation?
|
1. MHC I presents antigen to TCR
2. IL-2 from Th cell signals Tc cell to kill |
|
what are the 2 signals needed for B cell class switching?
|
1. IL-4, IL-5, or IL-6 from Th2 cell
2. CD40 receptor on B cell binds CD40 ligand on Th cell |
|
characteristics of Fc portion of antibody
|
Constant
Carboxy terminal of heavy chain Complement-binding area Carbohydrate side chains |
|
3 functions of antibodies
|
1. opsonization
2. neutralization 3. complement activation (enhances opsonization and lysis of antigen) |
|
which immunoglobulin is found in mucous membrane secretions?
|
IgA
|
|
which immunoglobulin can be a dimer?
- which a pentamer? |
dimer: IgA
pentamer: IgM |
|
which immunoglobulin mediates type I hypersensitivity?
|
IgE
|
|
what is an Ig allotype?
- isotype? - idiotype? |
allotype - epitope that differs among members of the same species (ALLotypes = different ALLeles)
isotype - epitope common to a single class of Ig idiotype - epitope determined by antigen-binding site |
|
what is a thymus-independent antigen?
- what type of Ig is secreted in response? |
no peptide component
- IgM only (can't be presented on MHC to T cells, so no T cell activation of B cells for class switching) |
|
what are the functions of IL-1-5?
|
hot T-Bone stEAk:
IL-1 - inflammatory response, fever (hot) IL-2 - stimulates T cells IL-3 - stimulates Bone marrow IL-4 - stimulates IgE production IL-5 - stimulates IgA production |
|
what is the function of IL-8?
- what is it secreted by? |
recruits neutrophils to clear infections (clean up on aisle 8)
- secreted by macrophages |
|
what activates the classic complement pathway?
|
IgG or IgM (GM makes classic cars)
|
|
what is the function of decay-accelerating factor (DAF) and C1 esterase inhibitor?
- what does deficiency of each cause? |
prevent complement activation on self-cells
- deficiency of C1 esterase inhibitor - hereditary angioedema - deficiency of DAF - paroxysmal nocturnal hemoglobinuria (complement-mediated lysis of RBCs) |
|
what is the function of C3b?
|
opsonization (C3b Binds Bacteria)
|
|
what is the function of C3a and C5a?
|
C3a, C5a - Anaphylaxis
|
|
what does deficiency of C5-C8 predispose to?
|
Neisseria bacteremia
|
|
what are the functions of interferons?
|
interferons interfere with virus activity in uninfected cells:
- alpha- and beta-interferons cause production of viral protein-inhibiting ribonuclease - gamma-interferons stimulate MHC I and II expression - also activate NK cells |
|
with what infections are patients given preformed antibodies (passive immunity)?
|
given antibodies To Be Healed Rapidly:
Tetanus toxin Botulinum toxin HBV Rabies virus |
|
what cytokine plays a major role in granulomas?
- what secretes it? - what does it do? |
IFN-gamma
- secreted by Th1 cells - stimulates macrophages |
|
what are the 4 types of hypersensitivity reactions?
|
ACID:
I - Anaphylactic and Atopic II - Cytotoxic (antibody-mediated) III - Immune complex IV - Delayed (cell-mediated) |
|
what is serum sickness?
- what type of hypersensitivity reaction? - how is the Arthus reaction different? |
antibodies to foreign serum protein or drug form - immune complexes deposit in tissues and fix complement - tissue damage
- type III hypersensitivity - Arthus reaction - local intradermal injection of antigen, so complexes formed locally in skin |
|
what initiates type IV hypersensitivity reactions?
- give 3 examples |
4 T's:
T lymphocytes - Transplant rejections, TB skin tests, Touching (contact dermatitis) |
|
what is the defect in Bruton's agammaglobulinemia?
- what is the major symptom? - what is the inheritance pattern? |
defect in tyrosine kinase gene - causes decreased production of B cells
- recurrent Bacterial infections after maternal IgG levels decline - X-linked recessive (affects Boys) |
|
what is the defect in severe combined immunodeficiency?
|
defect in early stem-cell differentiation - decreased production of B and T cells
|
|
what causes hyper-IgM syndrome?
|
defect in CD40 ligand on Th2 cells - inability to class switch
|
|
what is the defect in Wiskott-Aldrich syndrome?
- what are the main symptoms? |
defect in ability to mount IgM response - low IgM, high IgE and IgA (Aldrich)
- WIPE: recurrent Infections, thrombocytopenic Purpura, Eczema |
|
what is the defect in Job's syndrome?
- symptoms? |
failure of IFN-gamma production, so no neutrophil chemotaxis
- FATED: coarse Facies, cold staphylococcal Abscesses, retained primary Teeth, increased IgE, Dermatologic problems |
|
what is the defect in Chediak-Higashi syndrome?
|
defect in microtubule function and thus lysosomal emptying of phagocytic cells
|
|
what is the defect in chronic granulomatous disease?
|
lack of NADPH oxidase - defect in microbicidal activity of neutrophils
|
|
what is the defect in chronic mucocutaneous candidiasis?
|
T-cell dysfunction, specifically against Candida albicans
|
|
what is the defect in ataxia-telangiectasia?
|
defect in DNA repair enzymes with associated IgA deficiency
|
|
what is the defect in common variable immunodeficiency?
|
defect in B cell maturation - normal number of circulating B cells, but decreased plasma cells
|
|
what diseases are associated with HLA-B27?
|
PAIR:
Psoriasis Ankylosing spondylitis Inflammatory bowel disease Reiter's syndrome |
|
cyclosporine - mechanism of action?
- side effects? |
inhibits calcineurin, preventing production of IL-2 (blocks T cell activation)
- susceptibility to infection, nephrotoxic |
|
tacrolimus - mechanism of action?
- side effects? |
binds FK-binding protein, inhibiting IL-2 secretion (blocks T cell activation)
- nephrotoxic, peripheral neuropathy |
|
azathioprine - mechanism of action?
- side effects? - what is the effect of simultaneous allopurinol? |
blocks nucleic acid synthesis - toxic to proliferating lymphocytes
- bone marrow suppression - increased toxicity (since drug is metabolized by xanthine oxidase) |
|
muromonab - mechanism of action?
|
binds CD3 on T cell surface and blocks T cell signal transduction
|
|
sirolimus - mechanism of action?
- side effects? |
binds mTOR and blocks T cell proliferation in response to IL-2
- hyperlipidemia, thrombocytopenia, leukopenia |
|
mycophenolate mofetil - mechanism of action?
|
inhibits de novo guanine synthesis - blocks lymphocyte production
|
|
daclizumab - mechanism of action?
|
binds IL-2 receptor on activated T cells
|
|
loading dose equation
- maintenance dose equation |
loading = Cp x Vd/F
maintenance = Cp x Cl/F |
|
name 3 zero-order elimination drugs
|
PEA (pea is round, like 0):
Phenytoin Ethanol Aspirin |
|
therapeutic index equation
|
TILE:
TI = LD50/ED50 (LD50 = median lethal dose, ED50 = median effective dose) |
|
what G-protein class is associated with each receptor type?
|
qiss and qiq till you're siq of sqs:
qiss = alpha1, alpha2, beta1, beta2 qiq = M1, M2, M3 siq = D1, D2, H1 sqs = H2, V1, V2 |
|
bethanechol - mechanism of action?
- used for? |
muscarinic agonist
- used for postoperative ileus and urinary retention - activates Bowel and Bladder smooth muscle (Beth Anne, call me if you want to activate your Bowels and Bladder) |
|
pilocarpine - mechanism of action?
- used for? |
muscarinic agonist
- stimulates sweat, tears, saliva (PILocarpine - PILE on the sweat and tears) |
|
methacholine - mechanism of action?
- used for? |
muscarinic agonist
- challenge test for diagnosing asthma (bronchoconstricts) |
|
neostigmine and pyridostigmine - mechanism of action?
- used for? - CNS penetration? |
anticholinesterases
- myasthenia gravis - NO CNS penetration (NEO CNS) |
|
physostigmine - mechanism of action?
- used for? |
anticholinesterase
- glaucoma (PHYS is for EYES) |
|
echothiophate - mechanism of action?
- used for? |
anticholinesterase
- glaucoma |
|
symptoms of cholinesterase inhibitor poisoning
- what is the antidote? |
DUMBBELSS:
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, Salivation - antidote: atropine + pralidoxime (regenerates cholinesterase) |
|
benztropine - mechanism of action?
- used for? |
muscarinic antagonist
- PARKinson's disease (PARK my BENZ) |
|
scopolamine - mechanism of action?
- used for? |
muscarinic antagonist
- motion sickness |
|
ipratropium - mechanism of action?
- used for? |
muscarinic antagonist
- asthma, COPD (I pray/ipra- I can breathe soon) |
|
oxybutynin, glycopyrrolate - mechanism of action?
- used for? |
muscarinic antagonists
- reduce bladder urgency/spasms |
|
methscopolamine, pirenzepine, propantheline - mechanism of action?
- used for? |
muscarinic antagonists
- peptic ulcer treatment |
|
atropine - mechanism of action?
- side effects? |
muscarinic antagonist
- hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter |
|
hexamethonium - mechanism of action?
|
nicotinic antagonist (put a HEX on smokers/nicotine) - ganglionic blocker
|
|
what are low doses of epinephrine selective for?
|
beta1 receptors (Blow - low = beta1)
|
|
what is norepinephrine selective for?
|
alpha > beta1 (NO beta2 activity)
|
|
what is isoproterenol selective for?
|
beta receptors only
|
|
dobutamine - mechanism of action?
|
beta1 agonist
|
|
phenylephrine - mechanism of action?
|
alpha1 agonist
|
|
albuterol and terbutaline - mechanism of action?
|
beta2 agonists
|
|
ritodrine - mechanism of action?
- used for? |
beta2 agonist
- reduces premature uterine contractions |
|
amphetamine and ephedrine - mechanism of action?
|
indirect sympathetic agonists - release stored catecholamines
|
|
cocaine - mechanism of action?
|
indirect sympathetic agonist - catecholamine uptake inhibitor
|
|
clonidine and alpha-methyldopa - mechanism of action?
- used for? |
alpha2 agonists
- hypertension |
|
name 4 selective beta2 agonists
|
MAST:
Metaproterenol Albuterol Salmeterol Terbutaline |
|
phenoxybenzamine and phentolamine - mechanism of action?
- used for? - what is the difference? |
nonselective alpha blockers
- pheochromocytoma - phenoxybenzamine is irreversible, phentolamine is reversible |
|
prazosin, terazosin, doxazosin - mechanism of action?
|
selective alpha1 blockers
|
|
mirtazapine - mechanism of action?
- used for? |
selective alpha2 blocker
- depression |
|
name 5 selective beta1 antagonists
|
A BEAM of beta1 blockers:
Acebutolol Betaxolol Esmolol Atenolol Metoprolol |
|
name 2 non-selective alpha and beta antagonists
|
carvedilol, labetalol
|
|
name 2 partial beta agonists
|
Partial beta Agonists:
Pindolol Acebutolol |
|
antidote for methemoglobin toxicity
|
METHylene blue (for METHemoglobin), vitamin C
|
|
symptoms of lead poisoning
- treatment? |
LEAD:
Lead Lines on gingivae (Burton's lines) Encephalopathy, Erythrocyte basophilic stippling Abdominal colic, sideroblastic Anemia Drops (wrist and foot drop) - treatment: dimercaprol and EDTA, succimer for kids (it sucks to be a kid with lead poisoning) |
|
drugs that cause atropine-like side effects
|
tricyclics
|
|
name 2 drugs that cause coronary vasospasm
|
cocaine, sumatriptan
|
|
drugs that cause cutaneous flushing
|
niacin, calcium channel blockers, adenosine, vancomycin
|
|
name 2 drugs that cause dilated cardiomyopathy
|
doxorubicin, daunorubicin
|
|
drugs that cause torsades de pointes
|
class III (sotalol) and IA (quinidine) antiarrhythmics, cisapride
|
|
name 5 drugs that cause agranulocytosis
|
clozapine, carbamazepine, colchicine, propylthiouracil, methimazole
|
|
drugs that cause aplastic anemia
|
chloramphenicol, benzene, NSAIDs, propylthiouracil, methimazole
|
|
what drug causes a direct Coombs-positive hemolytic anemia?
|
methyldopa
|
|
what drug causes gray baby syndrome?
|
chloramphenicol
|
|
drugs that cause hemolysis in G6PD deficient patients
|
hemolysis IS PAIN:
Isoniazid Sulfonamides Primaquine Aspirin Ibuprofen Nitrofurantoin |
|
drugs that cause megaloblastic anemia
|
having a blast with PMS:
Phenytoin Methotrexate Sulfa drugs |
|
what drugs cause thrombotic complications?
|
OCPs (estrogens/progestins)
|
|
what drugs cause cough?
|
ACE inhibitors
|
|
name 3 drugs that cause pulmonary fibrosis
|
bleomycin, busulfan, amiodarone
|
|
what drugs cause acute cholestatic hepatitis?
|
macrolides
|
|
name 3 drugs that cause hepatic necrosis
|
halothane, valproic acid, acetaminophen
|
|
what drug causes hepatitis?
|
isoniazid
|
|
name 2 drugs that cause pseudomembranous colitis
|
clindamycin, ampicillin
|
|
name 6 drugs that cause gynecomastia
|
Some Drugs Create Awesome Knockers:
Spironolactone Digitalis Cimetidine Alcohol Ketoconazole estrogens |
|
name 2 drugs that cause hot flashes
|
tamoxifen, clomiphene
|
|
what drug causes gingival hyperplasia?
|
phenytoin
|
|
what drugs cause gout?
|
furosemide, thiazides
|
|
what drugs cause osteoporosis?
|
corticosteroids, heparin
|
|
what drugs cause photosensitivity?
|
SAT for a photo:
Sulfonamides Amiodarone Tetracycline |
|
what drugs cause Stevens-Johnson syndrome?
|
ethosuximide, lamotrigine, carbamazepine, phenobarbital, phenytoin, sulfa drugs, penicillin, allopurinol
|
|
name 4 drugs that cause SLE-like syndrome
|
it's not HIPP to have lupus:
Hydralazine Isoniazid Procainamide Phenytoin |
|
what drugs cause tendonitis, tendon rupture, and cartilage damage?
|
fluoroquinolones
|
|
what drug causes Fanconi's syndrome?
|
expired tetracycline
|
|
what drugs cause interstitial nephritis?
|
methicillin, NSAIDs, furosemide
|
|
name 2 drugs that cause hemorrhagic cystitis
- how can you prevent this? |
cyclophosphamide, ifosfamide
- prevent with mesna |
|
name 2 drugs that cause cinchonism
|
quinidine, quinine
|
|
name 2 drugs that cause diabetes insipidus
|
lithium, demeclocycline
|
|
name 4 drugs that cause a Parkinson-like syndrome
|
haloperidol, chlorpromazine, reserpine, metoclopramide
|
|
name 3 drugs that cause seizures
|
bupropion, imipenem/cilastatin, isoniazid
|
|
what drugs cause tardive dyskinesia?
|
antipsychotics
|
|
what drugs cause a disulfiram-like reaction?
|
metronidazole, 1st generation sulfonylureas, certain cephalosporins, procarbazine
|
|
what drugs are nephrotoxic and neurotoxic?
|
polymyxins
|
|
what drugs are nephrotoxic and ototoxic?
|
aminoglycosides, vancomycin, loop diuretics, cisplatin
|
|
name 7 drugs that are P-450 inducers
|
Queen Barb Steals Phen-phen and Refuses Greasy Carbs:
Quinidine Barbiturates St. John's wort Phenytoin Rifampin Griseofulvin Carbamazine |
|
name 6 drugs that are P-450 inhibitors
|
inhibit yourself from drinking from a KEG because you'll get SICk:
Sulfonamides Isoniazid Cimetidine Ketoconazole Erythromycin Grapefruit juice |
|
transudate vs. exudate
|
transudate is hypocellular and protein poor
exudate is cellular and protein rich |
|
what receptors mediate tight neutrophil binding to endothelium?
|
ICAM-1 on endothelium binds integrin on leukocyte
(hold on tight to your CAMera) |
|
what is AL amyloid derived from?
- AA amyloid? - A-CAL amyloid? |
AL = Light chains (multiple myeloma)
AA = Acute-phase reactant (chronic inflammatory disease) A-CAL = calcitonin (medullary carcinoma of the thyroid) |
|
tumor grade vs. stage
- which is more prognostic? |
grade = degree of differentiation
Stage = degree of Spread - stage is more prognostic |
|
what tumor type is l-myc gene associated with?
|
L-myc = Lung tumor
|
|
what tumor type is n-myc gene associated with?
|
N-myc = Neuroblastoma
|
|
what gene is associated with melanoma? what chromosome is it on?
|
p16 on 9p (melaNoma is on Nine)
|
|
what chromosome is NF2 on?
|
22q (type 2 = 22)
|
|
what cancer is DPC gene associated with?
|
pancreatic cancer (Deleted in Pancreatic Cancer)
|
|
what cancer is DCC gene associated with?
|
colon cancer (Deleted in Colon Cancer)
|
|
what tumor types are associated with elevated beta-hCG?
|
HCG:
Hydatidiform moles Choriocarcinomas Gestational trophoblastic tumors |
|
what does TRAP stain test for?
|
hairy cell leukemia (TRAP the hairy animal)
|
|
name 4 tumors that have psammoma bodies
|
PSaMMoma:
Papillary adenocarcinoma of thyroid Serous papillary cystadenocarcinoma of ovary Meningioma Mesothelioma |
|
what primary tumors metastasize to brain?
|
Lots of Bad Stuff Kills Glia:
Lung, Breast, Skin, Kidney, GI |
|
what primary tumors metastasize to liver?
|
Cancer Sometimes Penetrates Benign Liver:
Colon, Stomach, Pancreas, Breast, Lung |
|
what primary tumors metastasize to bone?
- are lung, prostate, and breast tumors osteoblastic or osteolytic? |
P.T. Barnum Loves Kids:
Prostate, Thyroid, Testes, Breast, Lung, Kidney - Lung = Lytic - prostate = blastic - Breast = Both |
|
case-control vs. cohort study
- do they use odds ratio or relative risk? |
case-control - compare group with disease to those without (retrospective)
- odds ratio cohort - compare group with risk factor to those without (prospective) - relative risk |
|
sensitivity vs. specificity
|
sensitivity - how well a test identifies truly ill people (SNOUT - rules OUT)
specificity - how well a test identifies truly well people (SPIN - rules IN) |
|
positive predictive value vs. negative predictive value
|
PPV - proportion of positive tests that are true positives
NPV - proportion of negative tests that are true negatives |
|
prevalence vs. incidence
|
prevalence = percent of people affected in a population
incidence = new incidents in a given time period/total population at risk |
|
type I vs. type II error
|
type I (alpha) - saying that there is a difference when none exists (you "saw" a difference)
type II (beta) - saying there is not a difference when one exists (you did not "see" a difference) |
|
t-test vs. ANOVA vs. chi-squared
|
t-test - difference between 2 means
ANOVA - difference between 3+ means chi-squared - difference between percentages or proportions of categorical outcomes (not means) |
|
types of disease prevention
|
PDR:
primary - Prevent disease occurrence secondary - Detect disease early tertiary - Reduce disability from disease |
|
name some reportable diseases
|
Hep Hep Hep Hooray, the SSSMMART Chick is Gone:
Hep A, Hep B, Hep C HIV Salmonella, Shigella, Syphilis Measles, Mumps AIDS Rubella Tuberculosis Chickenpox Gonorrhea |
|
4 things required for a malpractice claim to be valid
|
4 D's:
Duty of physician to patient Dereliction - physician breached duty Damage to patient Direct - breach of duty caused harm directly |
|
what does Apgar score evaluate?
|
Appearance, Pulse, Grimace, Activity, Respiration
|
|
what are the verbal milestones at age 2?
|
200 words and 2 word sentences at age 2
|
|
at what age does toilet training take place?
|
age 3 (pee at age 3)
|
|
how many blocks can be stacked at 1, 2, and 3 years?
|
3 at age 1, 6 at age 2, 9 at age 3 (age in years x 3)
|
|
at what age can a child ride a tricycle?
|
age 3 (3-cycle)
|
|
what are the Kubler-Ross grief stages?
|
Denial, Anger, Bargaining, Grieving, Acceptance
(Death Arrives Bringing Grave Adjustments) |
|
what EEG waveforms are associated with the different sleep stages?
|
BATS Drink Blood:
Beta - awake, eyes open Alpha - awake, eyes closed Theta - stage 1 (light sleep) Sleep spindles/K complexes - stage 2 (deeper) Delta - stage 3-4 (deepest) Beta - REM |
|
name 5 causes of eosinophilia
|
NAACP:
Neoplastic Asthma Allergic processes Collagen vascular diseases Parasites |
|
what is the defect in factor V Leiden?
|
mutant factor V that cannot be degraded by protein C - thrombosis
|
|
functions of von Willebrand factor
|
mediates linking of platelet Gp1b receptor to subendothelial collagen
carries and protects factor VIII |
|
function of GpIIb/IIIa receptor on platelets
- what upregulates it? |
platelet cohesion - binds fibrinogen and links platelets together
- ADP binding to platelet |
|
function of protein C
|
with protein S, cleaves and inactivates factors V and VIII
|
|
name 4 diseases that have target cells
|
"HALT," said the hunter to his target:
HbC disease Asplenia Liver disease Thalassemia |
|
name 4 diseases that have basophilic stippling:
|
TAIL:
Thalassemias Anemia of chronic disease Iron deficiency Lead poisoning |
|
what are Howell-Jolly bodies?
- when are they seen? |
nuclear remnants in RBCs
- asplenia or hyposplenia |
|
what enzymes are affected in lead poisoning?
|
ferrochelatase and ALA dehydratase
|
|
what enzyme is affected in acute intermittent porphyria?
|
uroporphyrinogen I synthase
|
|
what enzyme is affected in porphyria cutanea tarda?
|
uroporphyrinogen decarboxylase
|
|
what are the symptoms of porphyria?
|
5 P's:
Painful abdomen, Pink urine, Polyneuropathy, Psychological disturbances, Precipitated by drugs |
|
warm and cold agglutinins - which Ig type are they each associated with?
|
warm = IgG (warm weather is Great)
cold = IgM (cold ice cream - MMM) |
|
name 7 causes of DIC
|
STOP Making New Thrombi:
Sepsis Trauma Obstetric complications acute Pancreatitis Malignancy Nephrotic syndrome Transfusion |
|
what is the defect in ITP?
|
anti-GpIIb/IIIa antibodies cause platelet destruction
|
|
what is the defect in TTP?
|
defect in vWF-cleaving enzyme - large vWF multimers increase platelet aggregation
|
|
what is the defect in hemophilia A?
|
factor VIII deficiency
|
|
what is the defect in hemophilia B?
|
factor IX deficiency
|
|
extrinsic vs. intrinsic coagulation cascade - which bleeding time test is used to test each?
|
extrinsic = PT
intrinsic = PTT |
|
what is the defect in Glanzmann's thrombasthenia?
|
decreased GpIIb/IIIa
|
|
what is the defect in Bernard-Soulier disease?
|
decreased Gp1b
|
|
which type of Hodgkin's lymphoma is associated with very high numbers of Reed-Sternberg cells?
|
mixed cellularity type
|
|
symptoms of multiple myeloma
|
CRAB:
hyperCalcemia Renal insufficiency Anemia Bone/Back pain |
|
which leukemia is TdT+?
|
ALL (marker of pre-T and pre-B cells)
|
|
which leukemia response to all-trans retinoic acid?
- why? |
AML - induces differentiation of myeloblasts
|
|
which leukemia has smudge cells?
|
CLL
|
|
what distinguishes leukemoid reaction from leukemia?
|
leukocyte alkaline phosphatase level (only secreted by normal benign leukocytes - so only in leukemoid reaction)
|
|
what is the defect in Langerhans cell histiocytoses?
- what is a characteristic EM finding? |
proliferative disorder of dendritic cells (Langerhans cells)
- Birbeck granules (look like tennis rackets) |
|
what condition are teardrop cells found in?
|
myelofibrosis
|
|
heparin - mechanism of action?
- side effects? - use what to rapidly reverse? |
activates antithrombin III
- bleeding, HIT - protamine sulfate |
|
what tests are used to monitor heparin and warfarin?
|
heparin - PTT
warfarin - PT (the EX-PresidenT went to WAR) |
|
lepirudin and bivalirudin - mechanism of action?
- used for? |
directly inhibit thrombin
- HIT (heparin alternative) |
|
warfarin - mechanism of action?
- side effects? - use what to rapidly reverse? |
inferferes with gamma-carboxylation of vitamin K-dependent clotting factors
- teratogenic, skin/tissue necrosis - vitamin K and fresh frozen plasma |
|
name 3 thrombolytics
- mechanism of action? - treat toxicity with what? |
streptokinase, urokinase, tPA
- aid conversion of plasminogen to plasmin - aminocaproic acid |
|
clopidogrel and ticlopidine - mechanism of action?
- side effect of ticlopidine? |
block ADP receptors, preventing GpIIb/IIIa expression
- neutropenia |
|
abciximab - mechanism of action?
|
binds and blocks GpIIb/IIIa
|
|
methotrexate - mechanism of action?
- used for? - side effect? reverse with? |
inhibits dihydrofolate reductase, blocking nucleotide synthesis
- cancer, abortion, autoimmune diseases - myelosuppression - reverse with leucovorin |
|
5-fluorouracil - mechanism of action?
- side effect? reverse with? |
inhibits thymidylate synthase, blocking nucleotide synthesis
- myelosuppression - reverse with thymidine |
|
6-mercaptopurine - mechanism of action?
- metabolized by? |
blocks purine synthesis
- xanthine oxidase |
|
cytarabine - mechanism of action?
|
inhibits DNA polymerase
|
|
cyclophosphamide and ifosfamide - mechanism of action?
- side effects? reverse with? |
alkylating agents (cross-link DNA)
- myelosuppression, hemorrhagic cystitis - reverse latter with mesna |
|
carmustine, lomustine, semustine - class?
- mechanism of action? - used for? |
nitrosoureas
- alkylate DNA - brain tumors (cross blood-brain barrier) |
|
cisplatin and carboplatin - mechanism of action?
- side effects? |
cross-link DNA
- nephrotoxic and ototoxic |
|
busulfan - mechanism of action?
- side effect? |
alkylates DNA
- pulmonary fibrosis |
|
doxorubicin and daunorubicin - mechanism of action?
- side effect? |
intercalate in DNA
- dilated cardiomyopathy |
|
dactinomycin - mechanism of action?
- used for? |
intercalates in DNA
- childhood tumors (kids ACT out - dACTinomycin) |
|
bleomycin - mechanism of action?
- side effect? |
forms free radicals, causing DNA breaks
- pulmonary fibrosis |
|
hydroxyurea - mechanism of action?
- used for? |
inhibits ribonucleotide reductase, blocking DNA synthesis
- cancer, sickle cell anemia |
|
etoposide - mechanism of action?
|
blocks topoisomerase II
|
|
prednisone - side effects?
|
Cushing-like symptoms
|
|
tamoxifen and raloxifene - mechanism of action?
- used for? - side effect of tamoxifen? |
estrogen receptor antagonists in breast
- estrogen-positive breast cancers - increased risk of endometrial carcinoma (partial agonist effect) |
|
trastuzumab - mechanism of action?
- used for? |
monoclonal antibody against HER-2
- HER-2-positive breast cancer |
|
imatinib - mechanism of action?
|
bcr-abl tyrosine kinase inhibitor
|
|
vincristine and vinblastine - mechanism of action?
- side effects? |
block microtubule polymerization, blocking mitotic spindle
- vincristine - neurotoxic - vinBLASTine - myelosuppression (BLASTs Bone marrow) |
|
paclitaxel - mechanism of action?
|
block microtubule depolymerization (mitotic spindle can't break down)
|
|
structures in carotid sheath
|
internal jugular vein
common carotid artery vagus nerve |
|
relationship between resistance and viscosity, length and vessel radius
|
directly related to viscosity and length
inversely related to radius^4 |
|
what is wide S2 splitting associated with?
|
pulmonic stenosis (delayed RV emptying)
|
|
what is fixed S2 splitting associated with?
|
ASD (increased flow through pulmonic valve)
|
|
what is paradoxical S2 splitting associated with?
- what occurs on inspiration? |
aortic stenosis (delayed LV emptying)
- P2 and A2 move closer together, eliminating the split |
|
murmur increases in intensity on inspiration - which side is the defect?
|
right side (more blood flows into RA)
|
|
murmur increases in intensity on expiration - which side is the defect?
|
left side (more blood flows into LA)
|
|
what causes U wave in EKG?
|
hypokalemia, bradycardia
|
|
what is the characteristic EKG finding in Wolff-Parkinson-White syndrome?
- what causes it? |
delta wave
- ventricles begin to depolarize early due to accessory bundle of Kent that bypasses AV node |
|
treatment for atrial fibrillation?
|
warfarin
|
|
1st degree AV block
|
prolonged PR interval
|
|
2nd degree AV block - Mobitz type I and II
- which is Wenckebach? |
type I = Wenckebach - progressive lengthening of PR interval until a QRS is dropped
type II - no lengthening of PR interval, but occasional dropped beats |
|
3rd degree AV block
|
atria and ventricles beat independently of each other
(P waves have no relation to QRS waves) |
|
Cushing triad
- what is it a sign of? |
hypertension, reflex bradycardia, respiratory depression
- sign of increased intracranial pressure (constricts arterioles - cerebral hypoperfusion - sympathetic response causes HTN) |
|
name the 5 right-to-left congenital shunts in the heart
|
5 T's:
Truncus arteriosus Transposition of the great vessels Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return |
|
left-to-right shunts and right-to-left shunts in the heart - which has early vs. late cyanosis?
|
right-to-left - early cyanosis
left-to-right - late cyanosis |
|
what is Eisenmenger's syndrome?
|
reversal of a left-to-right shunt due to progressive pulmonary hypertension
|
|
what are the elements of tetralogy of Fallot?
|
PROVe:
Pulmonary stenosis Right ventricular hypertrophy Overriding aorta VSD |
|
location of infantile vs. adult coarctation of the aorta
|
INfantile = proximal to ductus arteriosus (IN close to heart)
aDult = Distal to Ductus arteriosus |
|
what is Prinzmetal's angina?
|
angina at rest due to coronary artery spasm
|
|
what causes red infarcts?
|
hemorrhagic - occur in tissues with collateral circulation (liver, lungs, etc.) or due to REperfusion injury (REd)
|
|
what is the most specific and long-lasting marker of MI?
|
troponin
|
|
what is Dressler's syndrome?
|
autoimmune fibrinous pericarditis several weeks post-MI
|
|
causes of dilated cardiomyopathy
|
Alcohol abuse
Beriberi Coxsackie B Cocaine use Chagas' disease Doxorubicin toxicity |
|
which type of dysfunction (systolic or diastolic) does each type of cardiomyopathy cause?
|
dilated - systolic
hypertrophic - diastolic restrictive - diastolic |
|
name 6 types of emboli
|
FAT BAT:
Fat Air Thrombus Bacteria Amniotic fluid Tumor |
|
what causes acute vs. subacute endocarditis?
- normal or previously damaged heart valves? |
acute - S. aureus, affects previously normal valves
subacute - viridans strep, affects abnormal or diseased valves |
|
symptoms of bacterial endocarditis
|
FROM JANE:
Fever Roth's spots Osler's nodes Murmur Janeway lesions Anemia Nail-bed hemorrhage Emboli |
|
what is Libman-Sacks endocarditis?
|
verrucous, sterile endocarditis associated with lupus (SLE causes LSE)
|
|
symptoms of rheumatic heart disease
|
FEVERSS:
Fever Erythema marginatum Valve damage ESR increased Red-hot joints (migratory polyarthritis) Subcutaneous nodules (Aschoff bodies), St. Vitus' dance (chorea) |
|
pulsus paradoxus (Kussmaul's pulse) - what is it, and what is it a sign of?
|
pulse decreases during inspiration
- due to compression of heart by cardiac tamponade, pericarditis, etc. |
|
triad of findings in Wegener's granulomatosis
- marker of disease? - treatment? |
vasculitis, granulomas in lung, glomerulonephritis
- c-ANCA - cyclophosphamide and corticosteroids |
|
what are the p-ANCA vasculitides, and what are their characteristics?
|
microscopic polyangiitis - like Wegener's, but no granulomas
Churg-Strauss syndrome - granulomatous with eosinophilia |
|
what are the symptoms of Sturge-Weber disease?
|
port-wine stain on face
leptomeningeal angiomatosis |
|
what is the distinguishing feature of Henoch-Schonlein purpura?
- what organs are affected? |
IgA
- affects skin, joints, GI |
|
what size vessels are affected by Buerger's disease?
- what patients does it affect? |
small and medium vessels
- heavy smokers |
|
what patients are affected by Kawasaki disease?
- what is a common sequela? |
kids, Asians
- coronary aneurysm |
|
what is polyarteritis nodosa?
- what disease is it associated with? |
immune complex inflammation of medium-sized muscular arteries
- hepatitis B |
|
what is Takayasu's arteritis?
- symptoms? |
granulomatous thickening of aortic arch/proximal great vessels ("pulseless disease")
- FAN MY SKIN On Wednesday: Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, Weak pulses |
|
reserpine and guanethidine - mechanism of action?
- used for? |
decrease norepinephrine release
- hypertension |
|
losartan - mechanism of action?
|
angiotensin II receptor blocker
|
|
hydralazine - mechanism of action?
- affects arterioles or veins more? - used for? - side effects? |
increases cGMP, causing smooth muscle relaxation
- arterioles - hypertension - lupus-like syndrome, compensatory tachycardia |
|
minoxidil - mechanism of action?
- used for? - side effect? |
opens K+ channels, hyperpolarizing and relaxing smooth muscle
- hypertension - hypertrichosis |
|
name 3 calcium channel blockers
- mechanism of action? - which has strongest effect on vasculature, and which on heart? - side effects? |
nifedipine, verapamil, diltiazem
- block voltage-dependent calcium channels of cardiac and smooth muscle - vasculature = nifedipine, heart = verapamil - cardiac depression, peripheral edema, constipation |
|
nitroglycerin - mechanism of action?
- does it affect arteries or veins more? |
releases NO in smooth muscle, increasing cGMP and relaxing
- veins (decreases preload) |
|
nitroprusside - mechanism of action?
- used for? |
releases NO, increasing cGMP and relaxing smooth muscle
- malignant hypertension |
|
fenoldopam - mechanism of action?
- used for? |
D1 receptor agonist - relaxes renal vascular smooth muscle
- malignant hypertension |
|
diazoxide - mechanism of action?
- used for? |
K+ channel opener - hyperpolarizes and relaxes vascular smooth muscle
- malignant hypertension |
|
statins - mechanism of action?
- side effects? |
HMG-CoA reductase inhibitors
- increased LFTs, rhabdomyolysis |
|
niacin - mechanism of action?
- side effect? |
inhibits adipose tissue lipolysis, reduces hepatic VLDL secretion
- flushing |
|
cholestyramine, colestipol, colesevelam - mechanism of action?
- side effects? - contraindicated in whom? |
prevent intestinal reabsorption of bile acids, so liver must use cholesterol to make more
- GI discomfort, decreased absorption of fat-soluble vitamins - patients with gallstones |
|
ezetimibe - mechanism of action?
|
prevent cholesterol reabsorption in small intestine
|
|
gemfibrozil, clofibrate, fenofibrate - mechanism of action?
- side effects? |
upregulate LPL, which degrades triglycerides in VLDL
- myositis, increased LFTs |
|
digoxin - mechanism of action?
- effects increased by? - antidote? |
blocks Na+/K+-ATPase, causing increased Ca2+ in the cell (indirect inhibition of Na+/Ca2+ exchanger)
- renal failure, hypokalemia, quinidine - normalize K+, lidocaine, anti-digoxin Fab fragments, Mg2+, cardiac pacer |
|
class IA antiarrhythmics - name 3
- mechanism of action? - effect on action potential duration? - side effects? |
Quinidine, Procainamide, Disopyramide (the Queen Proclaims Diso's pyramid)
- Na+ channel blockers - increase AP duration - quinidine - cinchonism, torsades de pointes - procainamide - SLE-like syndrome |
|
class IB antiarrhythmics - name 3
- mechanism of action? - effect on action potential duration? |
Lidocaine, Mexiletine, Tocainide (I'd Buy Lidy's Mexican Tacos)
- Na+ channel blockers - decrease AP duration |
|
class IC antiarrhythmics - name 3
- mechanism of action? - effect on action potential duration? |
flecainide, encainide, propafenone
- Na+ channel blockers - no effect on AP duration |
|
class II antiarrhythmics - mechanism of action?
- side effects? |
beta-blockers, so block phosphorylation and activation of calcium channels
- asthma exacerbation, cardiovascular slowing, CNS sedation |
|
class III antiarrhythmics - name 3
- mechanism of action? - effect on action potential duration? - side effects? |
sotalol, ibutilide, amiodarone
- K+ channel blockers - increase AP duration - torsades de pointes; amiodarone - pulmonary fibrosis, hepatotoxicity, photodermatitis, blue corneas, hypo/hyperthyroidism (check PFTs, LFTs, and TFTs when using amiodarone) |
|
class IV antiarrhythmics - name 2
- mechanism of action? - side effects? |
verapamil, diltiazem
- Ca2+ channel blockers - constipation, CV slowing |
|
adenosine - mechanism of action?
- used for? |
increases K+ efflux from cells, hyperpolarizing
- AV nodal arrhythmias |
|
spatial relationship of pulmonary artery to bronchus in each lung hilum
|
pulmonary artery is RALS - Right Anterior, Left Superior
|
|
spinal levels of structures perforating diaphragm
|
T8: IVC
T10: esophagus, vagus T12: aorta, thoracic duct, azygous vein (I 8 10 eggs at 12) |
|
innervation of diaphragm
|
C3,4,5 (keeps the diaphragm alive) - phrenic nerve
|
|
muscles of inspiration during exercise
|
inSpiration = external intercostals, Scalene muscles, Sternomastoids
|
|
which form of hemoglobin has higher O2 affinity?
|
R (relaxed) form
(when you're Relaxed, you do your job better - carry O2) |
|
left and right shifts in the oxygen hemoglobin curve are associated with what changes in O2 affinity?
|
left shift = increased affinity
right shift = decreased affinity |
|
what gene is mutated in primary pulmonary hypertension?
- what does it normally do? |
BMPR2 - normally inhibits vascular smooth muscle proliferation
|
|
in which situation does 100% O2 improve PO2 - airway obstruction or blood flow obstruction?
|
blood flow obstruction
|
|
what is the defect in chronic bronchitis?
|
increased Reid index (hypertrophy of mucus-secreting glands in bronchioles)
|
|
chronic bronchitis vs. emphysema - which has early and which has late-onset hypoxemia?
|
chronic bronchitis - early-onset (due to shunting because of mucus obstruction)
emphysema - late-onset (due to eventual loss of capillary beds) |
|
obstructive vs. restrictive lung disease - high or low FEV1/FVC ratio?
|
obstructive - low FEV1/FVC
restrictive - high FEV1/FVC |
|
what is the defect in neonatal respiratory distress syndrome?
|
surfactant deficiency
|
|
what is the defect in acute respiratory distress syndrome?
|
alveolar damage by many different causes leads to protein-rich leakage into air spaces
|
|
bronchial obstruction vs. tension pneumothorax - which way does the trachea deviate?
|
bronchial obstruction - toward lesion
tension pneumothorax - away from lesion |
|
complications of lung cancer
|
SPHERE of complications:
Superior vena cava syndrome Pancoast's tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal symptoms (hoarseness) Effusions (pleural or pericardial) |
|
squamous cell carcinoma of lung - location?
- major risk factor? - paraneoplastic syndrome? |
central (Squamous = Sentral)
- Smoking - PTH-related peptide |
|
most common lung cancer in females and nonsmokers
|
adenocarcinoma
|
|
small cell carcinoma of lung - location?
- paraneoplastic syndromes? |
central (Small = Sentral)
- ACTH or ADH, Lambert-Eaton syndrome |
|
what do carcinoid tumors secrete?
|
serotonin
|
|
Pancoast's tumor - location?
- consequence? |
apex of lung
- compresses cervical sympathetic plexus, causing Horner's syndrome |
|
name 3 1st generation H1 blockers
- side effects? |
diphenhydramine, dimenhydrinate, chlorpheniramine
- sedation, antimuscarinic, anti-alpha-adrenergic |
|
name 3 2nd generation H1 blockers
- advantage over 1st generation? |
loratadine, fexofenadine, cetirizine
- less sedating - decreased entry into CNS |
|
which beta2-agonist is used in acute asthma attacks vs. long-term control?
|
albuterol - acute
salmeterol - long-acting |
|
theophylline - mechanism of action?
- side effects? |
inhibits phosphodiesterase, decreasing cAMP hydrolysis - so increased cAMP leads to bronchodilation
- cardiotoxic, neurotoxic |
|
cromolyn - mechanism of action?
- used for? |
prevents release of mast cell contents
- asthma prophylaxis (not acute attacks) |
|
zileuton - mechanism of action?
- used for? |
blocks conversion of arachidonic acid to leukotrienes
- asthma |
|
zafirlukast, montelukast - mechanism of action?
- used for? |
block leukotriene receptors
- asthma |
|
guaifenesin - used for?
|
expectorant - removes excess sputum
|
|
what is secreted by each layer of the adrenal glands?
|
zona glomerulosa - aldosterone (salt)
zona fasciculata - cortisol (sugar) zona reticularis - sex hormones (sex) medulla - catecholamines |
|
name the hormones secreted by the anterior pituitary
- which are secreted from basophils? |
FLAT PiG - FSH, LH, ACTH, TSH, prolactin, GH
- B-flat - FSH, LH, ACTH, TSH are secreted by basophils |
|
what hormones are secreted by the different pancreatic islet cells?
- where is each cell type located? |
alpha - glucagon (peripheral)
beta - insulin (central - INSulin INSide) delta - somatostatin (interspersed) |
|
prolactin regulation - what upregulates it, what inhibits it, and what does it upregulate and inhibit?
|
upregulated by TRH
inhibited by dopamine prolactin upregulates dopamine and inhibits GnRH |
|
what does somatostatin do?
|
inhibits GH and TSH
|
|
what is secreted in 17-alpha hydroxylase deficiency?
- symptoms? |
aldosterone
- hypertension, hypokalemia, pseudohermaphroditism (due to lack of testosterone) |
|
what is secreted in 21-alpha hydroxylase deficiency?
- symptoms? |
sex hormones
- masculinization, hypotension, hyperkalemia |
|
what is secreted in 11-beta hydroxylase deficiency?
- symptoms? |
sex hormones
- masculinization, hypertension (since 11-deoxycorticosterone can act like aldosterone) |
|
what substances alter phosphate levels, and how?
|
PTH - increases phosphate excretion in kidney (Phosphate Trashing Hormone)
vitamin D - increases phosphate absorption in gut |
|
what ions regulate PTH secretion, and how?
|
low Ca2+ - increased PTH
low Mg2+ - decreased PTH |
|
where is calcitonin secreted from?
- function? |
parafollicular (C) cells of thyroid
- decreases bone resorption (opposite of PTH) - calciTONin TONes down calcium levels |
|
functions of T3
|
4 B's:
Brain maturation Bone growth Beta1-adrenergic effects Basal metabolic rate increased |
|
which endocrine hormones signal via cAMP?
|
FLAT CHAMP:
FSH, LH, ACTH, TSH CRH, hCG, ADH, MSH, PTH (+ calcitonin and glucagon) |
|
which hormones signal via IP3?
|
GGOAT:
GnRH, GHRH Oxytocin ADH (V1 receptor) TRH |
|
treatment for Conn's syndrome
- why? |
spironolactone - acts as an aldosterone antagonist
|
|
what is the defect in Sheehan's syndrome?
|
enlargement of anterior pituitary during pregnancy (increased lactotrophs) without increased blood supply - infarction of pituitary after severe bleeding of delivery
|
|
treatment for pheochromocytoma
|
phenoxybenzamine (irreversible alpha-antagonist)
|
|
symptoms of pheochromocytoma
|
5 P's:
elevated blood Pressure Pain (headache) Perspiration Palpitations Pallor |
|
rule of 10's for pheochromocytoma
|
10% malignant
10% bilateral 10% extra-adrenal 10% calcify 10% kids 10% familial |
|
tumors of MEN 1, 2A, and 2B
|
MEN 1: Parathyroid, Pituitary, Pancreatic (3 P's)
MEN 2A: medullary thyroid carcinoma, Pheochromocytoma, Parathyroid (2 P's) MEN 2B: medullary thyroid carcinoma, Pheochromocytoma, oral/intestinal ganglioneuromatosis (1 P) |
|
what gene is mutated in MEN 2A and 2B?
|
ret oncogene
|
|
what diseases are associated with a tender and a non-tender thyroid?
|
tender - subacute thyroiditis (de Quervain's)
nontender - Hashimoto's thyroiditis |
|
what is the defect in Riedel's thyroiditis?
|
thyroid replaced by fibrous tissue - hypothyroidism
|
|
Jod-Basedow phenomenon
|
thyrotoxicosis upon iodine replenishment in a patient with an iodine deficient goiter
|
|
characteristics of papillary thyroid carcinoma
|
ground-glass nuclei (Orphan Annie), psammoma bodies
|
|
what cell do medullary thyroid carcinomas derive from?
- what hormone do they produce? |
parafollicular (C) cells
- calcitonin |
|
symptoms of hyperparathyroidism
|
stones, bones, and groans:
hypercalcemia and hypercalciuria (renal stones) bone resorption and increased alkaline phosphatase (bones) weakness and constipation (groans) |
|
what is the other name for osteitis fibrosa cystica?
- defect? |
von Recklinghausen's syndrome
- cystic bone spaces filled with brown fibrous tissue |
|
renal osteodystrophy - what is the defect?
|
renal disease causes secondary hyperparathyroidism, which causes bone lesions
|
|
what are the signs of hypoparathyroidism?
|
Chvostek's sign - tapping of facial nerve causes facial spasm
Trousseau's sign - occlusion of brachial artery causes carpal spasm |
|
what is pseudohypoparathyroidism?
|
kidney is unresponsive to PTH
|
|
causes of hypercalcemia
|
CHIMPANZEES:
Calcium ingestion, Hyperparathyroid, Hyperthyroid, Iatrogenic, Multiple myeloma, Paget's disease, Addison's disease, Neoplasms, Zollinger-Ellison syndrome, Excess vitamin D or A, Sarcoidosis |
|
treatment for prolactinoma
|
bromocriptine (dopamine agonist)
|
|
which HLA genes are associated with diabetes mellitus type 1?
|
HLA-DR3 and DR4
|
|
what is the cause of central vs. nephrogenic diabetes insipidus?
|
central - lack of ADH
nephrogenic - kidney is unresponsive to ADH |
|
treatment for SIADH
|
demeclocycline (ADH antagonist)
|
|
rule of 1/3s for carcinoid tumors
|
1/3 metastasize
1/3 present with a 2nd malignancy 1/3 multiple |
|
treatment for carcinoid syndrome
|
octreotide
|
|
what is the defect in Zollinger-Ellison syndrome?
|
gastrin-secreting tumor - causes recurrent ulcers
|
|
name 2 sulfonylureas
- mechanism of action? - used for? - side effects? |
glyburide, glipizide
- close K+ channel in islet beta cell, depolarizing the cell and triggering insulin secretion - type 2 diabetes - hypoglycemia, disulfiram-like effect (1st generation) |
|
metformin - used for?
- side effect? |
type 1 and 2 diabetes
- lactic acidosis |
|
pioglitazone and rosiglitazone - mechanism of action?
- side effects? |
increase target cell's response to insulin
- edema, hepatotoxicity, CV toxicity |
|
acarbose and miglitol - mechanism of action?
|
inhibit intestinal alpha-glucosidases, decreasing glucose absorption
|
|
pramlintide - mechanism of action?
|
decreases glucagon
|
|
exenatide - mechanism of action?
|
GLP-1 mimetic - increases insulin and decreases glucagon release
|
|
orlistat - mechanism of action?
- used for? |
inhibits pancreatic lipases, decreasing fat metabolism (orlistat gets rid of fat)
- obesity |
|
sibutramine - mechanism of action?
- used for? |
serotonin and norepinephrine reuptake inhibitor
- obesity |
|
propylthiouracil and methimazole - mechanism of action?
- used for? - side effects? |
inhibit organification and coupling of thyroid hormone synthesis (propylthiouracil also decreases conversion of T4 to T3)
- hyperthyroidism - rash, agranulocytosis, aplastic anemia |
|
levothyroxine and triiodothyronine - used for?
|
thyroxine replacement in hypothyroidism
|
|
demeclocycline - mechanism of action?
- used for? - side effects? |
ADH antagonist
- SIADH - photosensitivity, abnormalities of bone and teeth (like all tetracyclines), diabetes insipidus |
|
what nerve plexus is in the intestinal submucosa?
- in the muscularis externa? - what do they each control? |
Submucosa = Submucosal plexus (Meissner's)
- controls Secretions Muscularis = Myenteric plexus (Auerbach's) - controls Motility |
|
structures that derive from foregut
- from midgut? - from hindgut? |
stomach to proximal duodenum + liver, gallbladder, pancreas
- distal duodenum to proximal 2/3 of transverse colon - distal 1/3 of transverse colon to upper rectum |
|
where are varices seen in portal hypertension?
|
gut, butt, and caput:
esophageal, internal hemorrhoids, and caput medusae |
|
which liver zones are affected first in viral hepatitis vs. alcoholic hepatitis?
|
viral - periportal zone (virus reaches here from blood first)
alcoholic - centrilobular zone (most sensitive to toxic injury) |
|
organization of vessels in femoral region
|
you go from lateral to medial to find your NAVEL:
femoral Nerve - femoral Artery - femoral Vein - Empty space - Lymphatics |
|
what patients get indirect inguinal hernias?
- why? |
infants - due to failure of processus vaginalis to close
|
|
what are the boundaries of Hesselbach's triangle?
- which type of hernia protrudes through here? |
inferior epigastric artery, rectus abdominis, inguinal ligament
- direct inguinal hernias |
|
indirect vs. direct inguinal hernias - what is the spatial relationship to the inferior epigastric vessels?
|
MDs don't LIe:
Medial to vessels = Direct Lateral to vessels = Indirect |
|
where do femoral hernias protrude?
- what patients get them? |
below inguinal ligament lateral to pubic tubercle
- women |
|
what do B/plasma cells in Peyer's patches secrete?
|
IgA - the Intra-gut Antibody
|
|
which salivary glands secrete most serous vs. most mucinous saliva?
|
parotid = Serous (on the Sides)
sublingual = Mucinous (in the Middle) |
|
what is the function of cholecystokinin?
- what cells secrete it? |
increased pancreatic secretion and gallbladder contraction
- secreted by I cells in small intestine |
|
what is the function of secretin?
- what cells secrete it? |
increased bicarbonate and bile secretion, decreased gastric acid secretion
- secreted by S cells in duodenum |
|
what is the function of somatostatin?
|
inhibitory - decreases secretion of all GI fluids (anti-GH)
|
|
what is the function of glucose-dependent insulinotropic peptide?
- what cells secrete it? |
decreases gastric acid secretion, increases insulin release
- secreted by K cells in small intestine |
|
what is the function of vasoactive intestinal polypeptide (VIP)?
- where is it secreted from? |
increased intestinal fluid secretion, relaxation of sphincters
- secreted from parasympathetic ganglia |
|
what is the function of motilin?
|
produces migrating motor complexes in the fasting state
|
|
what is the defect in achalasia?
|
loss of myenteric plexus leads to failure of lower esophageal sphincter to relax
|
|
what is Boerhaave syndrome?
|
transmural esophageal rupture due to violent retching (Boerhaave = been-heaving)
|
|
what are the symptoms of Plummer-Vinson syndrome?
|
triad:
- dysphagia (esophageal webs) - glossitis - iron-deficiency anemia |
|
risk factors for esophageal cancer
|
ABCDEF:
Alcohol, Achalasia Barrett's esophagus Cigarettes Diverticula Esophageal webs, Esophagitis Familial |
|
causes of Curling's vs. Cushing's ulcer in stomach
|
Curling's - burns lead to sloughing of mucosa (burned by the Curling iron)
Cushing's - brain injury leads to increased vagal stimulation and increased H+ production (always Cushion the brain) |
|
chronic gastritis type A vs. type B - causes and location in stomach?
|
type A - Autoimmune (pernicious Anemia), affects Body
type B - due to H. pylori Bacteria, affects Antrum |
|
what is the defect in Menetrier's disease?
|
gastric hypertrophy with atrophy of parietal cells (rugae look like brain gyri)
|
|
gastric vs. duodenal ulcers - associated with weight gain or weight loss? why?
|
Gastric ulcer - pain is Greater with meals, leading to weight loss
Duodenal ulcer - pain Decreases with meals, leading to weight gain |
|
what are the features of Crohn's that distinguish it from ulcerative colitis?
|
old crone and a fat granny (creeping fat, granulomas) skipping (skip lesions) down a cobblestone road (cobblestone mucosa) away from the wreck (rectal sparing)
|
|
what is intussusception?
|
telescoping of 1 bowel segment into a distal segment
|
|
what is the defect in Hirschsprung's disease?
|
failure of neural crest cell migration causes lack of enteric nerve plexuses and leads to congenital megacolon proximal to aganglionic segment
|
|
what is the defect in meconium ileus?
- what patients does it affect? |
meconium plug obstructs intestine
- cystic fibrosis patients |
|
which type of colon polyps are more likely to be malignant?
|
villous (so villainous)
|
|
what is Gardner's syndrome?
|
FAP with osseous and soft tissue tumors and retinal hyperplasia
|
|
what is Turcot's syndrome?
|
FAP with brain involvement (TURcot = TURban)
|
|
alcoholic vs. viral hepatitis - which has higher ALT and which AST?
|
alcoholic - AST (toASTed)
viral - ALT |
|
causes of micronodular vs. macronodular cirrhosis
|
micronodular - toxic insult (alcohol, iron, copper)
macronodular - significant injury and necrosis (infectious or drug-induced) |
|
symptoms of Wilson's disease
- treatment? |
ABCD:
Asterixis Basal ganglia degeneration (parkinsonian) Ceruloplasmin decreased, Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma of liver, Choreiform movements Dementia - treat with penicillamine |
|
symptoms of hemochromatosis
- treatment? - which HLA is it associated with? |
Hemochromatosis Can Cause Deposits:
Cirrhosis (micronodular) CHF Diabetes mellitus (bronze diabetes due to skin pigmentation) - treat with phlebotomy and deferoxamine - HLA-A3 |
|
Charcots triad of cholangitis
|
jaundice, fever, RUQ pain
|
|
causes of acute pancreatitis
|
GET SMASHeD:
Gallstones, Ethanol, Trauma Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/lipidemia, Drugs |
|
what tumors are associated with CEA and CA-19-9 markers?
|
CEA - colorectal cancer
CEA and CA-19-9 - pancreatic cancer |
|
what is Trousseau's syndrome, and what is it a sign of?
|
migratory thrombophlebitis (redness and tenderness in extremities)
- sign of pancreatic adenocarcinoma |
|
what is Courvoisier's sign, and what does it indicate?
|
obstructive jaundice with a palpable gallbladder - sign of pancreatic adenocarcinoma
|
|
cimetidine, ranitidine, famotidine, nizatidine - mechanism of action?
- side effects of cimetidine? |
H2 blockers - decrease H+ secretion by parietal cells
- P-450 inhibitor, antiandrogenic, decreased renal creatinine excretion |
|
omeprazole, lansoprazole - mechanism of action?
|
gastric parietal cell proton pump inhibitors
|
|
bismuth, sucralfate - mechanism of action?
|
bind ulcer base and allow bicarbonate to reestablish pH gradient (protection)
|
|
triple therapy of H. pylori ulcers
|
metronidazole, amoxicillin/tetracycline, bismuth
|
|
misoprostol - mechanism of action?
- used for? |
PGE1 analog - increases secretion of gastric mucus barrier
- prevent NSAID-induced peptic ulcers, maintain patent ductus arteriosus, induce labor |
|
name 2 muscarinic antagonists used to treat peptic ulcers
|
pirenzipine, propantheline
|
|
aluminum hydroxide - used for?
- side effects? |
antacid
- constipation (aluminimum amount of feces), proximal muscle weakness |
|
magnesium hydroxide - used for?
- side effects? |
antacid
- diarrhea (Mg = Must go to the bathroom), hyporeflexia, cardiac arrest |
|
sulfasalazine - mechanism of action?
- used for? - side effects? |
antibacterial and anti-inflammatory
- IBD (both forms) - malaise, sulfonamide toxicity, oligospermia |
|
ondansetron - mechanism of action?
|
serotonin antagonist - anti-emetic
|
|
metoclopramide - mechanism of action?
- used for? - side effect? |
D2 receptor antagonist - increases contractility, sphincter tone, and motility in gut
- post-surgical gastroparesis - parkinsonian symptoms |
|
layers of epidermis
|
Californians Like Girls in String Bikinis:
stratum Corneum stratum Lucidum stratum Granulosum stratum Spinosum stratum Basale |
|
unhappy triad knee injury
|
damage to medial collateral ligament, medial meniscus, and anterior cruciate ligament
|
|
what does positive anterior drawer sign indicate?
|
damage to ACL
|
|
what does abnormal passive abduction of the knee indicate?
|
damage to MCL
|
|
rotator cuff muscles
- what do they each do? |
SITS:
Supraspinatus - abduction Infraspinatus - lateral rotation Teres minor - adduction and lateral rotation Subscapularis - medial rotation and adduction |
|
damage to which nerve causes "Saturday night palsy"?
|
radial nerve (compression of axilla)
|
|
proximal median nerve lesion causes what?
|
ape hand (can't oppose thumb)
|
|
distal median nerve lesion causes what?
|
Pope's blessing (median claw) when asked to bend fingers and ulnar deviation of wrist upon flexion
|
|
proximal ulnar nerve lesion causes what?
|
radial deviation of wrist upon flexion
|
|
distal ulnar nerve lesion causes what?
|
ulnar claw hand (Pope's blessing) when asked to straighten fingers
|
|
musculocutaneous nerve lesion causes what?
|
inability to flex arm at elbow
|
|
axillary nerve lesion causes what?
|
inability to abduct arm (deltoid muscle)
|
|
what causes Erb-Duchenne palsy?
|
lesion to upper trunk of brachial plexus (C5,6)
|
|
what causes Klumpke's palsy?
- what is the motor deficit? |
lesion to lower trunk of brachial plexus (C8,T1)
- loss of lumbrical function - total claw hand (MCP joints extended, PIP and DIP flexed) |
|
function of radial nerve
- what muscles does it innervate? - what is the sign of a lesion? |
great extensor nerve
- BEST: Brachioradialis, Extensors of wrist and fingers, Supinator, Triceps - wrist drop |
|
what muscles are contained in the thenar and hypothenar eminences?
|
OAF:
thenar - Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis hypothenar - Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi |
|
function of dorsal vs. palmar interosseous muscles
|
PAD DAB:
Palmars ADduct Dorsals ABduct |
|
motor function of obturator nerve
|
thigh adduction
|
|
motor function of femoral nerve
|
thigh flexion and leg extension
|
|
motor function of common peroneal vs. tibial nerve
- what are the signs of damage? |
PED:
Peroneal Everts and Dorsiflexes foot (if damaged, foot droPED) TIP: Tibial Inverts and Plantarflexes foot (if damaged, can't stand on TIPtoes) |
|
motor function of superior gluteal nerve
- what symptom occurs if damaged? |
thigh abduction
- positive Trendelenburg sign |
|
type 1 vs. type 2 muscle fibers - what are the characteristics?
|
type 1 - slow twitch, red fibers, oxidative phosphorylation ("one slow red ox")
type 2 - fast twitch, white fibers, anaerobic glycolysis |
|
what is the defect in osteopetrosis?
|
failure of normal bone resorption (abnormal osteoclasts) due to carbonic anhydrase deficiency
|
|
what is the defect in polyostotic fibrous dysplasia?
|
bone replaced by fibroblasts, collagen, irregular bony trabeculae
|
|
what is McCune-Albright syndrome?
|
polyostotic fibrous dysplasia + endocrine abnormalities (precocious puberty) and cafe-au-lait spots
|
|
giant cell tumor of bone - what cell type?
- located where? - appearance on x-ray? |
osteoclastoma
- epiphyseal ends of long bones - soap bubble/double bubble |
|
Ewing's sarcoma - what is it?
- appearance? - chromosome translocation? |
small blue cell tumor of bone
- onion-skin appearance (Ewings and onion rings) - t(11;22) |
|
what HLA type is rheumatoid arthritis associated with?
|
HLA-DR4
|
|
what are the symptoms of Sjogren's syndrome?
- diagnostic autoantibodies? - how is Sicca syndrome different? |
xerophthalmia (dry eyes), xerostomia (dry mouth), arthritis
- SS-A (Ro), SS-B (La) - Sicca syndrome - dryness, but no arthritis |
|
symptoms of Reiter's syndrome
|
conjunctivitis/uveitis, urethritis, arthritis ("can't see, can't pee, can't climb a tree")
|
|
what disease is associated with "pencil-in-cup" deformity?
|
psoriatic arthritis
|
|
symptoms of lupus
|
I'M DAMN SHARP:
Immunoglobulins (anti-dsDNA, anti-Sm), Malar rash Discoid rash, ANA, Mucositis, Neurologic disorders Serositis, Hematologic disorders, Arthritis, Renal disorders, Photosensitivity |
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characteristics of sarcoidosis
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GRAIN:
Gammaglobulinemia Rheumatoid arthritis ACE increase Interstitial fibrosis Noncaseating granulomas |
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what is the defect in polymyositis?
- dermatomyositis? - significant findings? |
CD8+ T-cell injury to myofibers - progressive symmetric proximal muscle weakness
- dermatomyositis = polymyositis + malar/heliotrope rash, Gottron's papules - increased CK, ANA, anti-Jo-1 |
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what is the defect in myasthenia gravis?
- Lambert-Eaton syndrome? - for each, do symptoms improve or worsen with muscle use? |
autoantibodies to postsynaptic ACh receptors - worsens with muscle use
- autoantibodies to presynaptic Ca2+ channels - improves with muscle use |
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what disease is associated with anti-Scl-70 antibody (anti-DNA topoisomerase)?
|
diffuse scleroderma
|
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symptoms of CREST syndrome
- what marker is it associated with? |
Calcinosis
Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia - antiCentromere antibody |
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what is Auspitz sign, and what is it associated with?
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psoriasis - bleeding when scales are scraped off
|
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what is the defect in albinism?
|
defect in tyrosinase, so unable to make melanin (normal number of melanocytes)
|
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what is the defect in vitiligo?
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patches with decreased number of melanocytes
|
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what is melasma?
|
hyperpigmentation associated with pregnancy
|
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honey-colored crusting - diagnosis?
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impetigo
|
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white painless plaques on tongue - diagnosis?
- caused by what? |
hairy leukoplakia
- EBV |
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what is the defect in pemphigus vulgaris?
- what sign is associated with it? - how is it different from bullous pemphigoid? |
IgG auto-antibody against desmosomes
- Nikolsky's sign - separation of epidermis upon manual stroking - bp = auto-antibodies against hemidesmosomes (Ab's are "bullow" the epidermis), negative Nikolsky |
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pruritic papules with deposits of IgA at the tips of the dermal papillae - diagnosis?
- associated with what disease? |
dermatitis herpetiformis
- celiac disease |
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symptoms of lichen planus
- what disease is it associated with? |
Pruritic Purple Polygonal Papules, Wickham's striae
- hepatitis C |
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main symptom of pityriasis rosea
|
herald patch followed by "Christmas tree" distribution
|
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what is actinic keratosis a precursor to?
|
squamous cell carcinoma
|
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function of LTB4
- what do other leukotrienes do? |
neutrophil chemotaxis (neutrophils arrive B4 others)
- bronchoconstriction |
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function of PGI2
|
inhibits platelet aggregation, vasodilation (all opposite TXA2)
|
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aspirin - mechanism of action?
- side effects? |
irreversible COX inhibitor
- GI upset, Reye's syndrome, renal failure |
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NSAIDs - mechanism of action?
- use? |
reversible COX inhibitors
- antipyretic, analgesic, anti-inflammatory |
|
celecoxib - mechanism of action?
|
COX2 inhibitor, so less GI toxic than other NSAIDs
|
|
acetaminophen - mechanism of action?
- side effect? why? antidote? |
reversible COX inhibitor
- hepatic necrosis (metabolite depletes glutathione) - antidote is N-acetylcysteine (regenerates glutathione) |
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activity of aspirin and acetaminophen, as compared to NSAIDs
|
acetaminophen = NSAID - anti-inflammatory
aspirin = NSAID + antiplatelet |
|
etidronate, pamidronate, alendronate, risedronate - mechanism of action?
- used for? |
bisphosphonates - inhibit osteoclast activity
- osteoporosis, Paget's disease of bone |
|
colchicine - mechanism of action?
- used for? |
depolymerizes microtubules, impairing leukocyte chemotaxis
- acute/chronic gout |
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probenecid - mechanism of action?
- used for? |
inhibits uric acid reabsorption in proximal tubule
- chronic gout |
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allopurinol - mechanism of action?
- used for? |
inhibits xanthine oxidase
- chronic gout, tumor lysis syndrome |
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etanercept - mechanism of action?
|
recombinant TNF receptor that sequesters TNF
(etanerCEPT is a TNF decoy reCEPTor) |
|
infliximab - mechanism of action?
|
anti-TNF Ab
(INFLIXimab INFLIX pain on TNF) |
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what structures do ureters pass under?
|
uterine artery, ductus deferens
|
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fluid compartments in body
|
60-40-20 rule:
60% total body water 40% intracellular 20% extracellular |
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clearance calculation
|
Cx = UxV/Px
|
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how is GFR estimated?
- effective renal plasma flow? |
GFR = inulin clearance (or creatinine clearance)
EPRF = PAH clearance |
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free water clearance calculation
|
CH2O = V-Cosm
Cosm = UosmV/Posm |
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does angiotensin II cause acidosis or alkalosis?
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alkalosis - stimulates Na+/H+ exchange in proximal tubule, so H+ is excreted
|
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effect of aldosterone in collecting tubules
|
inserts more Na+ channels to increase Na+ reabsorption
|
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which segments of the kidney does PTH act on?
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proximal tubule - inhibits Na+-phosphate cotransport
distal tubule - increases Ca2+/Na+ exchange |
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effect of prostaglandins on kidney
|
vasodilate afferent arterioles - increase GFR (this is why NSAIDs can cause acute renal failure
|
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causes of anion gap metabolic acidosis
|
MUD PILES:
Methanol, Uremia, Diabetic ketoacidosis Paraldehyde/Phenformin, Iron tablets/INH, Lactic acidosis, Ethylene glycol, Salicylates |
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what is the defect in type 1 renal tubular acidosis?
- type 2? - type 4? |
type 1 - defect in H+/K+-ATPase of collecting tubules, so can't secrete H+
type 2 - defect in proximal tubule bicarbonate absorption type 4 - hypoaldosteronism |
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nephritic vs. nephrotic syndromes
|
nephrItic = Inflammatory (hematuria)
nephrOtic = massive prOteinuria |
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diffuse proliferative glomerulonephritis - associated with what?
- appearance on microscopy? |
SLE
- wire looping of capillaries |
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membranous glomerulonephritis - associated with what?
- appearance on EM? |
SLE
- spike and dome appearance |
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GBM splitting is associated with what diseases?
|
Alport's syndrome (nephritic)
membranoproliferative glomerulonephritis (nephrotic) |
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what disease is associated with subendothelial deposits in glomerulus?
|
lupus glomerulonephritis (diffuse proliferative glomerulonephritis)
|
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mesangial deposits - diagnosis?
|
IgA nephropathy (Berger's disease)
|
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what are struvite kidney stones caused by?
|
infection with urease-positive bacteria
|
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are uric acid stones radiolucent or radiopaque?
|
Uric acid = radiolUcent
|
|
WAGR complex
|
Wilms' tumor
Aniridia Genitourinary malformation Retardation |
|
risk factors for transitional cell carcinoma
|
Pee SAC:
Phenacetin Smoking Aniline dyes Cyclophosphamide |
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conditions that cause renal papillary necrosis
|
diabetes mellitus
acute pyelonephritis chronic phenacetin use sickle cell anemia |
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does renal failure cause acidosis or alkalosis?
|
acidosis - failure to secrete H+ and reabsorb bicarbonate
|
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what are the EKG findings in hyper- and hypokalemia?
|
hyperkalemia - peaked T waves
hypokalemia - U waves, flattened T waves |
|
mannitol - mechanism of action?
|
osmotic diuretic - increases tubular fluid osmolarity, causing increased urine flow
|
|
acetazolamide - mechanism of action?
- used for? - side effects? |
carbonic anhydrase inhibitor - decreases bicarbonate reabsorption in proximal tubule
- glaucoma, metabolic alkalosis, altitude sickness - metabolic ACIDosis (ACIDazolamide), sulfa allergy |
|
furosemide - mechanism of action?
- side effects? |
loop diuretic - inhibits Na+-K+-2Cl- cotransport in thick ascending limb, increases calcium excretion (Loops Lose calcium)
- OH DANG: Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis, Gout |
|
ethacrynic acid - mechanism of action?
- used for? |
same as loop diuretics - inhibits Na+-K+-2Cl- reabsorption in thick ascending limb
- diuresis in patients with sulfa allergies |
|
hydrochlorothiazide - mechanism of action?
- side effects? |
thiazide diuretic - inhibits NaCl reabsorption in distal tubule, decreases calcium excretion
- hypokalemia, metabolic alkalosis, hyperGLUC (hyperGlycemia, Lipidemia, Uricemia, Calcemia) |
|
name 3 K+-sparing diuretics
- mechanisms of action? - side effects? |
Spironolactone, Triamterene, Amiloride (K+ STAys)
- spironolactone - aldosterone receptor antagonist in collecting duct - triamterene and amiloride - block Na+ channels in collecting duct - hyperkalemia, antiandrogen effects (spironolactone) |
|
captopril, enalapril, lisinopril - mechanism of action?
- side effects? |
ACE inhibitors
- CAPTOPRIL: Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower angiotensin II, hyperkalemia |
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embryologic origins of CNS, PNS, and microglia
|
CNS - neuroectoderm
PNS - neural crest Microglia - Mesoderm (like Macrophages) |
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function of Meissner's corpuscles, Pacinian corpuscles, and Merkel's disks
|
Meissner's corpuscles - dynamic fine touch (adapt quickly)
Pacinian corpuscles - vibration and pressure Merkel's disks - static touch (adapt slowly) |
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functions of hypothalamus
|
TAN HATS:
Thirst/water balance Adenohypophysis control Neurohypophysis control Hunger Autonomic regulation Temperature regulation Sexual urges |
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what does lateral area of hypothalamus control?
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hunger (if lateral area is damaged, you shrink laterally - anorexia)
|
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what does ventromedial area of hypothalamus control?
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satiety (if ventromedial area is damaged, you grow ventrally and medially - hyperphagia)
|
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what does anterior hypothalamus control?
- posterior hypothalamus? |
cooling, pArasympathetic (A/C - anterior cooling)
- heating, sympathetic |
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what does septal nucleus of hypothalamus control?
|
Septal nucleus = Sexual urges
|
|
what does suprachiasmatic nucleus of hypothalamus control?
|
circadian rhythm
|
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what do LGN and MGN of thalamus control?
|
LGN - vision (Lateral = Light)
MGN - auditory (Medial = Music) |
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what do VPL and VPM of thalamus control?
|
VPL - body sensation
VPM - facial sensation (you put Make-up on your face) |
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what do VA/VL nuclei of thalamus control?
|
motor (anterior to sensation, just like in cortex)
|
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functions of limbic system
|
5 F's:
Feeding, Fleeing, Fighting, Feeling, and sex |
|
functions of superior, middle, and inferior cerebellar peduncles
|
middle - receives contralateral cortical input
inferior - receives ipsilateral proprioceptive input superior - output to contralateral cortex |
|
name the cerebellar deep nuclei, from lateral to medial
|
Don't Eat Greasy Foods:
Dentate, Emboliform, Globose, Fastigial |
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which pathway in basal ganglia does each type of dopamine receptor act on?
|
D1 receptors stimulate the excitatory pathway
D2 receptors inhibit the inhibitory pathway |
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what is the defect in Parkinson's disease?
- symptoms? - characteristic pathology? |
degeneration and depigmentation of the substantia nigra pars compacta (loss of dopaminergic neurons - so decreased stimulation of basal ganglia)
- TRAP: Tremor at rest, cogwheel Rigidity, Postural instability - Lewy bodies |
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what is the defect in hemiballismus?
|
contralateral subthalamic nucleus lesion - so loss of inhibition of thalamus
|
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what is the defect in Huntington's disease?
|
expansion of CAG repeats - atrophy of caudate nucleus
|
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what is athetosis?
- what is it characteristic of? |
slow writhing movements of fingers
- basal ganglia lesion (Huntington's disease) |
|
what is the cause of intention tremor?
|
cerebellar dysfunction
|
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major symptom of frontal lobe damage
|
Damage = Disinhibition
|
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what is the consequence of a parietal lobe lesion?
|
contralateral spatial neglect
|
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what is the consequence of a lesion to the reticular activating system?
|
reduced levels of arousal and wakefulness
|
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cerebellar hemispheres vs. vermis - which affects limbs vs. trunk?
- does damage affect contralateral or ipsilateral side? |
hemispheres - laterally located, so affect lateral limbs
vermis - centrally located, so affect central body - damage affects ipsilateral side |
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damage to paramedian pontine reticular formation vs. frontal eye fields - what is the major symptom?
|
PPRF - eyes look away from side of lesion
frontal eye fields - eyes look toward side of lesion |
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what is the result of damage to the hippocampus?
|
anterograde amnesia (unable to make new memories)
|
|
what causes Wallenberg's syndrome?
- symptoms? |
PICA infarct
- nystagmus, ipsilateral ataxia, Horner's syndrome |
|
what causes locked-in syndrome?
|
basilar artery infarct
|
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what disease are Charcot-Bouchard microaneurysms associated with?
- what part of circulation do they affect? |
chronic hypertension
- small deep vessels (basal ganglia, thalamus, etc.) |
|
bloody or yellow spinal tap - diagnosis?
|
subarachnoid hemorrhage
|
|
what connects lateral ventricles to 3rd ventricle?
|
foramen of Monro
|
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relative locations of foramina of Luschka and Magendie
|
Luschka = Lateral
Magendie = Medial |
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symptoms of hydrocephalus
|
dementia, gait problems, urinary incontinence
|
|
lower extent of spinal cord
- lower extent of subarachnoid space - where should lumbar puncture be performed? |
L1-L2
- S2 - between L3 and L5 (to keep the spinal cord alive) |
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organization of spinal tracts with respect to legs and arms
|
corticospinal and spinothalamic - Legs are Lateral
DC-ML - legs are medial, arms are lateral (peel off as you move down spinal cord) |
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lower muscle mass and tone, decreased reflexes, downgoing toe - UMN or LMN lesion?
|
LMN - everything lowered
|
|
what is the defect in poliomyelitis and Werdnig-Hoffman disease?
|
destruction of anterior horns of spinal cord - lower motor neuron lesion
|
|
what part of the spinal cord is spared in occlusion of the anterior spinal artery?
|
dorsal columns
|
|
what part of the spinal cord is affected in tabes dorsalis?
|
dorsal columns
|
|
what part of the spinal cord is affected in syringomyelia?
|
crossing fibers of spinothalamic tract (so bilateral loss of pain and temperature sense)
|
|
symptoms of Werdnig-Hoffman disease
|
floppy baby, tongue fasciculations (early death)
|
|
dermatome of the neck
|
C3
|
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dermatome at the nipple
|
T4 (teat pore)
|
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dermatome at the umbilicus
|
T10 (belly butTEN)
|
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dermatome at the inguinal ligament
|
L1 (IL = inguinal ligament)
|
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dermatome of the kneecaps
|
L4 (down on L4s)
|
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innervation of the penis
|
S2,3,4 (keeps the penis off the floor)
|
|
function of muscle spindles vs. Golgi tendon organs
|
muscle spindles monitor muscle length - activate motor neurons when stretched
Golgi Tendon organs monitor muscle Tension - inhibit motor neurons |
|
spinal levels of arm and leg reflexes
|
ankle - S1,2
knee - L3,4 biceps - C5,6 triceps - C7,8 |
|
cranial nerves that lie medially at brain stem
|
III, VI, XII
|
|
function of superior and inferior colliculi
|
superior - vertical gaze
inferior - auditory (eyes are above ears) |
|
what is the defect in Parinaud syndrome?
|
lesion in superior colliculi - so paralysis of conjugate vertical gaze
|
|
are CN I-XII sensory, motor, or both?
|
I, II - Sensory (Some Say)
III, IV - Motor (Marry Money) V - Both (But) VI - Motor (My) VII - Both (Brother) VIII - Sensory (Says) IX, X - Both (Big Brains) XI, XII - Motor (Matter Most) |
|
what are the functions of the three vagal nuclei?
|
nucleus Solitarius - visceral Sensory information
nucleus aMbiguus - Motor innervation of pharynx, larynx, and esophagus dorsal motor nucleus - autonomics to thorax |
|
what openings in the skull do CN V divisions exit through?
|
CN V must exit due to Standing Room Only:
V1 - Superior orbital fissure V2 - foramen Rotundum V3 - foramen Ovale |
|
what cranial nerves exit through the superior orbital fissure?
|
CN III, IV, V1, VI (all eye nerves except CN II)
|
|
what cranial nerves exit through the internal auditory meatus?
|
CN VII, VIII (ear nerves)
|
|
what cranial nerves exit through the jugular foramen?
|
CN IX, X, XI
|
|
what cranial nerves pass through the cavernous sinus?
- what are the symptoms of cavernous sinus syndrome? |
CN III, IV, V1, V2, VI
- opthalmoplegia, ophthalmic and maxillary sensory losses (due to nerve compression) |
|
symptoms of UMN vs. LMN facial lesion
|
UMN - contralateral paralysis of lower face only (upper face gets bilateral innervation)
LMN - ipsilateral paralysis of whole face |
|
what is Bell's palsy a complication of?
|
ALexander graHam Bell with STD:
AIDS Lyme disease Herpes zoster Sarcoidosis Tumors Diabetes |
|
what muscles close the jaw?
- what muscle opens it? |
close - Masseter, teMporalis, Medial pterygoid (M's Munch)
open - Lateral pterygoid (Lowers) |
|
perilymph vs. endolymph - what is the predominant ion in each?
|
perilymph = Na+ (outside cell)
endolymph = K+ (inside cell) |
|
which parts of inner ear detect linear vs. angular acceleration?
|
utricle and saccule - linear (contain maculae)
semicircular canals - Angular (contain Ampullae) |
|
open vs. closed angle glaucoma - what is the difference, and which is painful?
|
open - obstructed outflow through canal of Schlemm (painless)
closed - obstruction of flow between lens and iris (painful) |
|
down and out eye - diagnosis?
|
CN III damage
(since lateral rectus and superior oblique still functional) |
|
what is strabismus?
|
misalignment of eyes
|
|
what is amblyopia?
|
reduction of vision due to disuse in critical period
|
|
innervation of pupillary constriction vs. dilation
|
constriction - CN III (parasympathetic)
dilation - T1 sympathetics |
|
what is the Marcus Gunn pupil?
|
afferent pupillary defect, so decreased bilateral constriction when light is shone in affected eye
|
|
what are the functions of the outer and inner parts of CN III, and what can damage each part?
|
inner - carries output to ocular muscles (affected by vascular disease)
outer - carries parasympathetic output (affected by compression) |
|
what is the defective protein in Lewy body dementia?
- symptoms? |
alpha-synuclein defect
- parkinsonism + dementia and hallucinations |
|
what is the defect in progressive multifocal leukoencephalopathy?
- what causes it? |
demyelination of CNS
- JC virus |
|
what is the defect in Charcot-Marie-Tooth disease?
|
hereditary defect in production of proteins needed for peripheral nerves/myelin sheath
|
|
stain for astrocytes (and astrocytomas)
|
GFAP
|
|
microscopic appearance of oligodendroglioma
|
fried egg cells with chicken-wire capillary pattern
|
|
Rosenthal fibers - diagnosis?
|
pilocytic astrocytoma
|
|
latanoprost - used for?
- mechanism of action? - side effect? |
glaucoma
- increases outflow of aqueous humor - darkens iris |
|
butorphanol - mechanism of action?
- what distinguishes it from other drugs in its class? |
partial agonist at opioid mu receptors, agonist at kappa receptors
- less respiratory depression |
|
tramadol - mechanism of action?
|
weak opioid agonist, inhibits serotonin and NE reuptake (works on multiple receptors - "tram it all" in)
|
|
phenytoin - mechanism of action?
- used for? - side effects? |
Na+ channel inactivation
- tonic-clonic seizures, prophylaxis of status epilepticus - ataxia, gingival hyperplasia, hirsutism, teratogenic, megaloblastic anemia, SLE-like syndrome, P-450 induction |
|
carbamazepine - mechanism of action?
- used for? - side effects? |
Na+ channel inactivation
- tonic-clonic seizures, partial seizures, trigeminal neuralgia - agranulocytosis, aplastic anemia, liver toxicity, teratogenic, P-450 induction |
|
lamotrigine - mechanism of action?
- side effect? |
blocks voltage-gated Na+ channels
- Stevens-Johnson syndrome |
|
gabapentin - mechanism of action?
- used for? - side effects? |
increases GABA release
- seizures, peripheral neuropathy - sedation, ataxia |
|
topiramate - mechanism of action?
- side effects? |
blocks Na+ channels, increases GABA action
- sedation, kidney stones |
|
phenobarbital - mechanism of action?
- what patients is it used for? - side effects? |
increases GABA action by increasing DURATion of Cl- channel opening (barbiDURATe)
- pregnant women, children - sedation, P-450 induction |
|
valproic acid - mechanism of action?
- used for? - side effects? |
Na+ channel inactivation, increases GABA concentration
- tonic-clonic seizures, myoclonic seizures - hepatotoxicity, neural tube defects |
|
ethosuximide - mechanism of action?
- used for? - side effects? |
blocks thalamic T-type Ca2+ channels
- absence seizures - EFGH: Ethosuximide - Fatigue, GI distress, Headache, Stevens-Johnson syndrome |
|
benzodiazepines - mechanism of action?
- used for? - side effects? - treat overdose with? |
increase GABA action by increasing FREquency of Cl- channel opening (FREnzodiazepines)
- acute status epilepticus, seizures of eclampsia - sedation, dependence - flumazenil |
|
name the short-acting benzodiazepines
- what is the problem with them? |
TOM thumb: Triazolam, Oxazepam, Midazolam
- highest addictive potential |
|
side effects of inhaled anesthetics
|
hepatotoxicity, nephrotoxicity, malignant hyperthermia
|
|
what drugs are used as intravenous anesthetics?
|
B.B. King on OPIATES PROPoses FOOLishly:
Barbiturates Benzodiazepines Ketamine Opiates Propofol |
|
ketamine - mechanism of action?
- used for? - side effects? |
blocks NMDA receptors
- IV anesthetic - hallucinations, bad dreams |
|
what IV anesthetics are used for short surgical procedures?
|
thiopental, propofol
|
|
with anesthetics, what qualities do solubility in blood and lipids determine?
|
low blood solubility - rapid induction and recovery
high lipid solubility - high potency |
|
name 3 ester-type and 3 amide-type local anesthetics
- mechanism of action? - side effects? |
esters - procaine, cocaine, tetracaine
amides - lIdocaIne, mepIvicaIne, bupIvacaIne (amIdes have 2 I's) - block Na+ channels - CNS excitation, CV toxicity, arrhythmias |
|
order of loss of sensation types with local anesthetics
|
pain > temperature > touch > pressure
|
|
name 1 depolarizing neuromuscular blocker and 2 nondepolarizing neuromuscular blockers
|
depolarizing: succinylcholine
nondepolarizing: tubocurarine, pancuronium |
|
dantrolene - used for?
- mechanism of action? |
malignant hyperthermia, neuroleptic malignant syndrome
- prevents Ca2+ release from sarcoplasmic reticulum |
|
name 3 dopamine agonists used in Parkinson's
|
bromocriptine, pramipexole, ropinirole
|
|
amantadine and L-dopa - mechanism of action?
- used for? - side effect of L-dopa? what drug is given to reduce this? |
increase dopamine in CNS
- Parkinson's - arrhythmias from peripheral conversion to dopamine - carbidopa inhibits peripheral conversion of L-dopa to dopamine |
|
selegiline - mechanism of action?
- used for? |
MAO-B inhibitor, preventing dopamine breakdown
- Parkinson's |
|
entacapone, tolcapone - mechanism of action?
- used for? |
COMT inhibitors, preventing dopamine breakdown
- Parkinson's |
|
benztropine - mechanism of action?
- used for? |
antimuscarinic
- Parkinson's - curbs excess cholinergic activity, improving tremor and rigidity |
|
sumatriptan - mechanism of action?
- used for? - side effect? |
serotonin agonist - inhibits trigeminal activation and vasoactive peptide release
- migraines, cluster headaches - coronary vasospasm |
|
memantine - mechanism of action?
- used for? |
NMDA receptor antagonist
- Alzheimer's |
|
donepezil - mechanism of action?
- used for? |
acetylcholinesterase inhibitor
- Alzheimer's |
|
mature defense mechanisms
|
mature women wear a SASH:
Sublimation Altruism Suppression Humor |
|
what is conduct disorder?
- difference from oppositional defiant disorder? |
repetitive behavior violating social norms in a child <18
- defiance toward authority, but no serious violations of social norms |
|
autistic disorder vs. Asperger's disorder
|
autism - language and social impairment, below-normal intelligence
Asperger's - milder, no language impairment, normal intelligence |
|
characteristics of Rett's disorder
|
loss of development, mental retardation, stereotyped hand-wringing
|
|
major characteristic of childhood disintegrative disorder
|
regression in multiple areas of functioning after at least 2 years of normal development
|
|
hypnagogic vs. hypnopompic hallucinations
|
hypnaGOgic - occur while GOing to sleep
hypnopompic - occur while waking from sleep |
|
progression of schizophrenic diseases
|
<1 month - brief psychotic disorder
1-6 months - schizophreniform disorder >6 months - schizophrenia |
|
what is dissociative identity disorder?
|
2+ distinct identities or personalities (multiple personality disorder)
|
|
what is depersonalization disorder?
|
feelings of detachment from self
|
|
what is a dissociative fugue?
|
abrupt change in geographic location with inability to recall past, confusion about identity, or assumption of a new identity
|
|
characteristics of manic episode
|
maniacs DIG FAST:
Distractibility, Irresponsibility, Grandiosity Flight of ideas, goal-directed Activity, Agitation, decreased need for Sleep, Talkativeness |
|
mood stabilizers used in bipolar disorder
|
lithium, valproic acid, carbamazepine
|
|
symptoms of major depressive episode
|
SIG E CAPS:
Sleep disturbance, loss of Interest, Guilt loss of Energy loss of Concentration, Appetite changes, Psychomotor retardation or agitation, Suicidal ideations depressed mood |
|
symptoms of panic disorders
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PANICS:
Palpitations, Paresthesias Abdominal distress Nausea Intense fear of dying or losing control, lIghtheadedness Chest pain, Chills, Choking, disConnectedness Sweating, Shaking, Shortness of breath |
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what is malingering?
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consciously faking a disorder in order to attain a specific gain
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what is factitious disorder?
- 2 examples? |
consciously creating symptoms in order to assume "sick role" and get medical attention
- Munchausen's syndrome and Munchausen's syndrome by proxy |
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what is conversion?
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motor or sensory symptoms following an acute stressor
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name the cluster A personality disorders
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paranoid
schizoid schizotypal |
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schizoid vs. schizotypal personality disorder?
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schizoid - voluntary social withdrawal, limited emotional expression
schizotypal - eccentric appearance, magical thinking, interpersonal awkwardness |
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name the cluster B personality disorders
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antisocial
borderline histrionic narcissistic |
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name the cluster C personality disorders
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avoidant
obsessive-compulsive dependent |
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name 4 types of depressant
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alcohol, opioids, barbiturates, benzodiazepines
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treatment for delirium tremens
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benzodiazepines
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name 4 stimulants
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amphetamines, cocaine, caffeine, nicotine
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name 3 hallucinogens
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PCP, LSD, marijuana
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treatment for heroin overdose
- for heroin detoxification? |
naloxone/naltrexone
- methadone or suboxone (fewer withdrawal symptoms) |
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treatment for ADHD
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methylphenidate
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haloperidol, fluphenazine, thioridazine - mechanism of action?
- side effects? |
typical antipsychotics - block D2 receptors
- extrapyramidal side effects (akinesia, akathisia), tardive dyskinesia, neuroleptic malignant syndrome |
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symptoms of neuroleptic malignant syndrome
- treatment? |
FEVER:
Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles - treat with dantrolene |
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name 3 atypical antipsychotics
- mechanism of action? - side effect of clozapine? |
olanzapine, clozapine, risperidone (it's not atypical for old closets to risper)
- block serotonin, alpha, H1, and dopamine receptors - agranulocytosis |
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side effects of lithium
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LMNOP:
Lithium side effects - Movement (tremor) Nephrogenic diabetes insipidus (ADH antagonist) hypOthyroidism Pregnancy problems |
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buspirone - mechanism of action?
- used for? |
stimulates serotonin receptors
- generalized anxiety disorder |
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name 2 tricyclic antidepressants
- mechanism of action? - side effects? |
imipramine, amitriptyline
- block reuptake of NE and serotonin - tri-C's: Convulsions, Coma, Cardiotoxicity |
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name 4 SSRIs
- side effects? |
fluoxetine, paroxetine, sertraline, citalopram
- sexual dysfunction, serotonin syndrome |
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bupropion - used for?
- side effects? - why is it a good substitute for SSRIs? |
smoking cessation, depression
- stimulant effects, seizure in bulimic patients - no sexual side effects |
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venlafaxine and duloxetine - mechanism of action?
- used for? |
inhibits serotonin and NE reuptake
- depression |
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mirtazapine - mechanism of action?
- used for? - side effects? |
alpha2 antagonist, serotonin receptor antagonist
- depression - sedation, weight gain, dry mouth |
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maprotiline - mechanism of action?
- used for? - side effects? |
blocks NE reuptake
- depression - sedation, hypotension |
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trazodone - mechanism of action?
- used for? - side effects? |
blocks serotonin reuptake
- insomnia - sedation, priapism, hypotension |
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phenelzine and tranylcypromine - mechanism of action?
- used for? - side effect? |
MAO inhibitors - increase levels of amine neurotransmitters
- depression - hypertensive crisis with tyramine ingestion |
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what vessels are contained within:
- suspensory ligament of ovaries? - transverse cervical ligament? - round ligament of uterus? |
SLO - ovarian vessels
TCL - uterine vessels RLU - none (round = 0) |
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pathway of sperm during ejaculation
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SEVEn UP:
Seminiferous tubules - Epididymis - Vas deferens - Ejaculatory duct - Urethra - Penis |
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what are Sertoli and Leydig cells stimulated by, and what do they secrete?
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Sertoli - stimulated by FSH to secrete ABP and inhibin (and MIF in utero)
Leydig - stimulated by LH to secrete testosterone |
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which estrogen increases the most in pregnancy?
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estriol (1000x - marker of fetal well-being)
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what are theca and granulosa cells stimulated by, and what do they secrete?
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theca - stimulated by LH to secrete androstenedione
granulosa - stimulated by FSH to secrete estrogen |
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which parts of meiosis are oocytes arrested in, and when?
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meiosis I arrested in prOphase until Ovulation
meiosis II arrested in METaphase until fertilization (an egg MET a sperm) |
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what is the defect in 5-alpha-reductase deficiency?
- major symptom? |
unable to convert testosterone to DHT
- ambiguous genitalia until puberty, when increased testerone causes growth of penis |
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symptoms of preeclampsia
- eclampsia? |
hypertension, proteinuria, edema
- eclampsia also has seizures |
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what is the major marker of ovarian cancer?
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CA-125
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what is a Brenner tumor?
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Brenner = Benign ovarian tumor that looks like Bladder
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what is Meigs' syndrome?
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triad of ovarian fibroma, ascites, hydrothorax
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microscopic appearance of seminoma
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fried egg cells in lobules with watery cytoplasm
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yolk sac tumors in both men and women are associated with what tumor marker?
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AFP
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characteristics of Bowen's disease vs. erythroplasia of Queyrat
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Bowen's - gray solitary crusty plaque on shaft of penis or scrotum
Queyrat - red velvety plaques on glans penis |
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finasteride - mechanism of action?
- used for? |
5-alpha-reductase inhibitor (decreased conversion of testosterone to DHT)
- BPH, male-pattern baldness |
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flutamide - mechanism of action?
- used for? |
competitive inhibitor of testosterone receptor
- prostate carcinoma |
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leuprolide - mechanism of action?
- used for? |
GnRH analog (agonist when pulsatile delivery, antagonist when continuous) - leuprolide can be used in lieu of GnRH
- infertility (pulsatile), prostate cancer (continuous) |
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sildenafil and vardenafil - mechanism of action?
- side effect? |
inhibit cGMP phosphodiesterase, so increased cGMP - causes smooth muscle relaxation and increased erection (sildenafil/vardenafil fill the penis)
- impaired blue-green color vision |
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mifepristone - mechanism of action?
- used for? |
progesterone receptor inhibitor
- termination of pregnancy |
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dinoprostone - mechanism of action?
- used for? |
PGE2 analog
- induce labor (dilates cervix and uterine contraction) |
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ritodrine and terbutaline - mechanism of action?
- used for? |
beta2 agonists
- relax uterus and reduce premature contractions |
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anastrozole, exemestane - mechanism of action?
- used for? |
aromatase inhibitors
- breast cancer |
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clomiphene - mechanism of action?
- used for? |
partial agonist of estrogen receptors in pituitary gland - prevents normal feedback inhibition and promotes LH and FSH release
- infertility, PCOS |
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tamoxifen - mechanism of action?
- used for? |
estrogen receptor antagonist in breast
- ER-positive breast cancer |
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raloxifene - mechanism of action?
- used for? |
estrogen receptor partial agonist in bone
- osteoporosis |