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429 Cards in this Set
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Systemic mastocytosis
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mast cell proliferation in bone marrow and other organs
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leads to increased histamine secretion (increased gastric acid secretion)
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Opioid side effects
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cause contraction of smooth muscle cells, such as the sphincter of Oddi, leading to constriction and spasm
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Growth factor signal transduction
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GF binds RTK -> auto-phosphorylation of receptor ->interaction w/ SOS protein -> Ras activation (GTP necessary) -> MAP kinase activation -> gene transcription
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Osteoclasts
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large, multinucleated cells that originate from the phagocytic cell lineage in the marrow
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stain w/ TRAP and stimulated by M-CSF
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Bronchial lavage w/ increased CD4 and high CD4:CD8 ratio
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sarcoidosis
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compare to AIDS or hypersensitivity pneumonitis which has a low CD4:CD8 ratio
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polymyositis
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CD8 infiltrate and MHC I protein overexpression on muscle cells
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rT3
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peripheral thyroid hormone that is converted from T4. Therefore, it is not seen if T3 is given exogenously
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Ureteropelvic junction
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last site in GU to canalize, also most common site of obstruction
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SCID
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also has absence of thymic shadow
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compared to DiGeorge, SCID has more bacterial infections, more common hypogammaglobulinemia, and no facial abnormalities or cardiac defects
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Prepatellar bursa
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chronic trauma from repeated kneeling can cause bursitis (housemaid's knee)
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Attributable risk percent (ARP)
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represents the excess risk in a population that can be explained by exposure to a particular risk factor
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ARP = (RR-1)/RR
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Male sexual differentation
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MIF inhibits development of the uterus and the fallopian tubes and testosterone induces the formation of the epididymis, vas deferens, seminal vesicles
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therefore, if only sertoli cells are deficient, the patient will have internal male and female genitals and external male genitals
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Two tissues that are resistant to cancer cell infiltration
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elastic tissue and cartilage
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Antibody site that binds complement
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complement binds to the Fc portion closer to the hinge region
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Surgery to thyroid may damage this nerve
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external branch of the superior laryngeal nerve, which travels with the superior thyroid artery and vein
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loss of innervation to the cricothyroid
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imperforate anus
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most commonly associated w/ genitourinary tract malformations (renal agenesis, hypospadias, epispadias, bladder extrophy)
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also associated w/ VACTERL, but not as commonly as with GU problems
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VACTERL
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vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula, esophageal atresia, renal anomlaies, limb anomalies
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associated w/ imperforate anus
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Conductivity of heart muscle
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Purkinje > atria > ventricles > AV node
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Elastin
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compared to collagen, it has less prline and lysine residues that are hydroxylated, no triple helix is formed
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elastin's plasticity and abiliyt to recoil upon release of tension is due to desmosine crosslinking between lysine residues on different chains (crosslinking is done by lysyl hydroxylase)
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Female tract epithelium
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ovary (simple cuboidal), fallopian (simple columnar), uterus (simple pseudostratified columnar), cervix (simple columnar and stratified squamous), vagina (stratified squamous non-keratinized)
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Tuner syndrome
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short stature, webbed neck, low posterior hair line, streak ovaries
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most commonly associated w/ monosomy (45, XO), but also seen w/ mosaicism where there was a mitotic error early in development
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IL-12 deficiency
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lack of IL-12 prevents differentation of TH0 cells into TH1 cells. Thus, TH1 cells won't be around to make IFN-gamma. Low IFN-gamma then prevents activation of macrophages
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treatment for this would be giving IFN-gamma
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Lecithin:sphingomyelin ratio
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cortisol has the greatest effect on increasing this ratio
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prolactin, and thyroxine also increase the ratio, but not as much as cortisol
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Helicotrema
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the helicotrema is at the apex of the cochlea. The apex is large and flexible and responds best to low-frequency sounds (large and flexible enough so that low energy waves can move it). The base responds to high frequency sounds (thin and rigid)
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transmission of sound: tympanic membrane -> vibration of ossicles -> oval window -> movement of perilymph in scala vestibuli -> scala tympani -> basilar membrane -> hair bending
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Ehlers-Danlos syndrome
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heritable connective tissue disease assoicated w/ abnormal collagen
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clincally manifests as over-flexible joints, over-elastic skin, fragile tissue susceptible to bruising, wounding, hemarthrosis
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Neurophysin
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carrier proteins for oxytocin and vasopressin from paraventricular and supraoptic nuclei, respectively
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They are coupled to the hormones, packaged into neurosecretory vesicles, and secreted by the posterior pituitary
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ADH effect on kidney
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primarily exerts its effect on the medullary collecting duct
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Killed virus vaccine mechanism
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decreases virus entry into cells
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as opposed to a live-attenuated vaccine that sensitizes T-cells to infected cells
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Nasal transepithelial potential difference
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CF patients have a more negative potential difference than normal due to increased luminal sodium resoprtion
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CFTR is responsible for chloride secretion and an inhibitory effect on opening of apical sodium channels. Defect in CFTR leads to increase sodium resorption
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Anterior Urethral injury
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commonly due to pelvic fractures, which cause a hematoma below the prostate w/ upward displacement of the gland (damage to the posterior urethra)
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this leads to a full bladder sensation, blood if a foley catheter is placed, and pain
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Posterior urethral injury
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most commonly due to a saddle injury, where the bulbous urethra is injured
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Respiratory tract cells
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mostly pseudostratified, columnar, mucus-secreting (paranasal sinuses, laryngeal vestibule, false vocal cords, tracheal bifurcation)
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the true vocal cords are stratified squamous epithelium
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plaque rupture in acute coronary syndrome
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fibrous cap holds the plaque together and enzymes like metalloproteinases (produced by inflammatory macrophages) can break the cap down
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Patient information
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cannot be disclosed to others, even a wife, without explicit consent of the patient
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Cryoglobulinemia
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think HCV and multiple myeloma
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Metyrapone test
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Metyrapone blocks cortisol synthesis by inhibiting 11-B-Hydroxylase, leading to a buildup of 11-deoxycortisol. Thus, serum cortisol levels are reduced and feedback to ACTH is lost, leading to increased ACTH release
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11-deoxycortisol metabolites are measured as 17-hydroxycorticosteroids in the urine
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Superior orbital fissure
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carries CN III, IV, V1, VI, superior ophthalmic vein
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DNA replication
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Okazaki fragments are synthesized 5' -> 3', but DNA ligase then constructs them 3' -> 5'
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GTP production in TCA cycle
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occurs when succinyl-CoA is converted to Succinate by succinyl-CoA synthetase
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this GTP can be used for a bunch of things, such as the conversion of PEP to oxaloacetate by PEP carboxykinase in gluconeogenesis
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Carotid massage
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pressure on carotid leads to increased afferent baroreceptor firing rate -> decreased sympathetic action on heart and increased parasympathetic action -> slower conduction through AV node
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Parasympathetic nervous system primarily functions to slow the heart rate by slowing conduction through the AV node
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Femoral neck fractures
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medial femoral circumflex artery makes the largest contribution to blood supply of this region and is vulnerable to damage from femoral neck fractures
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Lung parenchyma
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extends to the level just above the clavicle
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anti-D Rh immuneglobulin
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IgG type because Fc receptors on phagocytic cells have the greatest affinity for the Fc fragments of IgG
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multivalent IgM antibodies are generally more effective than IgG antibodies at promoting agglutination of foreign cells
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COX-2
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undetectable in most tissues except inflammatory cells
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COX-1, on the other hand, is expressed in all cells
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Effect modification
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effect of a main exposure on the outcome is modified by the presence of another variable. It's not the same as confounding
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Here's an example: a test was done to see the effects on a drug on DVT. Smokers who took the drug had a decreased rate vs. smokers who didn't. Non-smokers who took the drug were the same as non-smoker who didn't. This looks like confounding at first, but it's actually effect modification
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MYC proteins
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mammalian transcription factors that bind to DNA
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Bypass grafting for coronary artery disease
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usually the LAD is replaced by the left internal mammary artery (left internal thoracic)
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when multiple coronary arteries or vessels other than the LAD need fixing, the great saphenous vein is used, usually accessed just below the pubic tubercle
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Osteoporosis
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Decreased bone density that involves cancellous bone and presents w/ fractures of vertebral column, distal radius, hip, and neck of femur
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serum calcium and PTH levels are within the normal range
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Supraspinatus
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abduction of the humerus
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Small bowel atresia in neonate
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usually due to vascular accidents in utero, most commonly the SMA
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leads to "apple peel" atresias where the mesentery of the bowel is absent
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Glycogen metabolism
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glycogen is broken down by glycogen phosphorylase, which is active in the phosphorylated state and inactive in the dephosphorylated state. Phosphorylase kinase regulates the phosphorylation.
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Phosphorylase kinase itself is phosphorylated by PKA in response to increased cAMP (increased due to epinephrine or glucagon). Phosphorylase kinase activity can also be increased directly by Ca2+
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Hyperparathyroidism effect on bone
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subperiosteal thinning is characteristic with cystic degeneration
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may also have renal stones, GI upset, and psychiatric disorders
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Glucose stores
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glucose level is achieved through gluconeogenesis after 24 hours
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Pathways requiring NADPH
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cholesterol and fatty acid synthesis (both anabolic pathways)
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Croup
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usually due to paramyxovirus (MCC parainfluenza, followed by RSV)
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Tuberculosis containment
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CD4+ cells and macrophages
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Mental retardation, eczema, mousy/musty body odor
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PKU
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BUN in cirrhosis
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Decreased liver function leads to impaired urea cycle -> decreased BUN levels
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Hepatic encephalopathy is likely precipitated by hematemesis, which led to increased ammonia and nitrogen absorption in the gut. Other causes include GI bleed, hypovolemia, hypokalemia, sedative, and infection.
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Treatment of acute mania
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Lithium, valproate, carbamazepine
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Treatment of asthma
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Fibrous cap holds the plaque together and enzymes like metalloproteinases (produced by inflammatory macrophages) can break the cap down
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Bastomyces dermatitidis
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can cause pulmonary disease in immunocompetent people
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Elimination of counfounding in an experiment
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matching can eliminate confounding
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Obstructive sleep apnea
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associated w/ systemic hypertension and can eventually lead to pulmonary hypertension and right heart failure
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FAS gene
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regulates deletion of autoreactive T lymphocytes
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a defect in the FAS gene may lead to an increase in T lymphocytes that are autoreactive. FAS gene mutation is thought to be a posisbly etiology for SLE
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Insuline resistance
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thought to be due in part to increased FFA and serum triglycerides
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Innervation of the submandibular and sublingual gland
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parasympathetic fibers originating in the superior salivatory nucleus carried on the facial nerve via the chorda tympani
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Course of the ureter
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exit the kidney, move inferiorly, cross over the common/external iliac vessels and under the gonadal vessels, then pass lateral to the internal iliac vessels and medial to the gonadal vessels as they enter the true pelvis
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Natriuretic peptide
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ANP is secreted by the atria in response to volume overload, while BNP is predominantly secreted by the ventricles in volume overload
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Propionyl CoA
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derived from amino acids (Val, Ile, Met, and Thr), odd-numbered fatty acids, and cholesterol side chains
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congenital deficiency of propionyl CoA carboxylase, leads to development of propionic acidemia
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Pyruvate dehydrogenase deficiency
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ketogenic diet is required, consisting of leucine and lysine, as well as phenylalanine, isoleucine, and tryptophan (although these 3 are also glucogenic)
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the disease can present w/ neonatal death to mild episodic symptoms in adulthood
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pulmonary embolism
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causes acute hypoxemia, hyperventiliation (hypocapnea), and respiratory alkalosis
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Bloom syndrome
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generalized chromosomal instability that leads to susceptibility to neoplasms
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Methylmalonic aciduria
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defect in isomerization of methylmalonyl CoA into succinyl CoA
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Mu Opioids
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activate G-protein receptors and lead to increased potassium efflux from the cell, leading to hyperpolarization of postsynaptic neurons and blocking pain transmission
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Peroxisomal disease
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inborn error where perioxisomes are either absent or nonfunctional
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Normally, very long chain fatty acids (VLCFA) and branched chain fatty acids cannot undergo mitochondrial beta-oxidation and are instead broken down via a specialized form of beta-oxidation or alpha oxidation in the perioxisomes. Zellweger and Refsum disease are examples of this.
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Caudal regression syndrome
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neonates are born w/ agenesis of the sacrum and occasionally lumbar spine w/ paralysis of legs, dorsiflexed feet, and urinary incontinence
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usually associated w/ uncontrolled maternal diabetes
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Myocardial hiberation
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persistent or repetitive low flow state in the heart causes hibernation of myocardium that can be reversed by reperfusion
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Myocardial stunning is a similar concept, but it on a short term basis, as opposed to hibernation, which is due to chronic low flow.
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Ischemic preconditioning of myocardium
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development of resistance to infarction by cardiac myocytes previously exposed to repetitive non-lethal ischemia
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Loss to follow-up
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creates a potential for selection bias
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Fragile X Syndrome
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increased CGG trinucleotide repeats leads to hypermethylation of the FMR1 gene, which leads to the constellation of symptoms in Fragile X
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Abnormal migration of neural crest cells through the primitive truncus and bulbus cordis
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Tetralogy of Fallot, transposition of the great vessels, and persistent truncus arteriosus
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Serum sickness
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type III hypersensitivity reaction w/ fever, urticaria, arthralgias, glomerulonephritis after exposure to an antigen
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sulfonamides are a common cause of this that cause immune complex formation w/ IgG or IgM and resultant complement fixation, leading to a decrease in serum C3
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Gift accepting
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don't accept gifts of more than $10 value, if preferential treatment is expected, or if the patient is demented. Except to this would be a one time gift of a small or token value
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Acid excretion from body
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occurs in the form of free hydrogen ions and titratable acids (NH4+ or H2PO4-)
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mitochondrial myopathy
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presence of lactic acidosis and ragged red skeletal muscle fibers. Include disorders like myoclonic epilepsy w/ ragged red fibers (MERRF), leber optic neuropathy, mitochondrial encephalopathy w/ stroke like episodes and lactic acidosis (MELAS)
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mitochondrial disorder with variable expression due to heteroplasmy
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Loss of myocyte contractile function
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occurs within 60 seconds of total ischemia
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after 30 minutes of total ischemia, ATP levels have dropped to 15% and irreversible ischemic injury is likely
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Hereditary angioedema
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inherited autosomal dominant condition that causes episodes of painless, non-pitting, well-circumscribed edema
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due to a lack of C1 esterase inhibitor, which normally suppresses C1 classic complement pathway and also inactivates kallikrein. Kallikrein normally catalyzes conversion of kininogen to bradykinin, which increases vascular permeabiltiy and edema
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Midshaft facture of humerus
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injury to deep brachial artery and radial nerve
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Supracondylar fracture of humerus
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injury to brachial artery
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Most common reason for elevated AFP
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dating error, where the fetus's age is underestimated and therefore, AFP is thought to be too high
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date is confirmed using ultrasound
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Treatment of staph epidermidis endocarditis
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vancomycin, because S. epidermidis is usually resistant to penicillin G and many other antibiotics
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Adrenal crisis
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immediately treat w/ corticosteroids
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Breast milk contents
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contains proteins, carbs, fat, vitamins, trace minerals and immunoglobulins. The only thing that is missing is vitamin D and K
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Cisplatin treatment
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MOA: form reaction oxygen species that can form DNA crosslinks. S/E: nephrotoxicity
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Drug induced parkinsonism
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can be due to antipsychotic treatment. Treat with centrally-acting antimuscarinic agents. Do NOT treat w/ levodopa, because that can induce psychosis
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Dihydrobiopterin reductase deficiency
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most common cause for deficiency of BH4 and results in atypical or malignant phenylketonuria. BH4 is used in the synthesis of tyrosine, DOPA, serotonin, and NO
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Verapamil's effect on diastolic depolarization
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Slows diastolic depolarization (slope of phase 0). The reason why it's diastolic is because the electrical impulse is traveling through the heart when the heart is relaxed, and this will eventually lead to contraction/systole
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Lesch-Nyhan syndrome
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deficiency in HGPRT/salvage pathway means that de novo purine synthesis must be upregulated, and PRPP synthetase and amidotransferase are both enzymes in this pathway
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Carboxyhemoglobin
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Hemoglobin bound w/ CO, thus preventing O2 binding
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in contrast to methemoglobinemia, where the Fe2+ is oxidized to Fe3+ due to drug exposures and some enzyme deficiencies
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Neonatal tetanus
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can be prevented by ensuring that the pregnant mother is vaccinated to allow transfer of protective IgG antitoxin antibodies across the placenta
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Airway resistance
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majority of resistance is located in the medium and small-sized bronchi greater than 2mm in diameter. Resistance is maximal in the second to fifth generation airways including segmental bronchi, and minimal in the bronchioles (because they are parallel)
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Fastest metabolized sugar
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Fructose-1-phosphate: only sugar that can bypass PFK-1
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Parvovirus replication
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occurs in the bone marrow
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N-acetylglutamate
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essential activator of carbamoyl phosphate synthase I and is formed by N-acetylglutamate synthetase from acetyl-CoA and glutamate
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space constant
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measure of how far along an axon an electrical impulse will travel
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demyelination decreases the space constant
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Gamma-glutamyl transferase (GGT)
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when liver enzymes are reved up, there is a GGT elevation
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Common cardinal veins
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derive the SVC and other constituents of the systemic venous circulation
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Amphotericin B treatment
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can cause renal toxicity, so it's important to monitor serum potassium and magnesium
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Thyroglobulin synthesis
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TSH induces gene transcription of thyroglobulin, leading to thyroglobulin synthesis
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thyroglobulin is later attached to iodide by thyroid peroxidase. Thyroid peroxidase also catalyzes the breakdown of iodinated thyroglobulin into MIT and DIT
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Craniopharyngioma
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calcified cystic tumor of rathke pouch derivative that can commonly have yellow, cholesterol rich fluid in the cysts
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Auditory canal innervation
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posterior external canal is innervated by the vagus, and touching it may produce a vasovagal syncopal episode
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the rest of the auditory canal is innervated by CNV3
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Superior gluteal nerve
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found in the superomedial quadrant of the buttock
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damage can lead to trendelenberg gait because it innervates the gluteus medius
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GLUT transport
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facilitated diffusion where glucose moves down its gradient into cells with the help of a carrier protein
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Reperfusion injury
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occurs secondary to oxygen free radical generation, mitochondrial damage, and inflammation
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in muscle, this can lead to cell membrane damage and release of creatine kinase
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Diptheria
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neural and cardiac toxicity are serious potential sequelae. immunization leads to circulation of IgG against the circulating exotoxin B protein, preventing the disease
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Bile acid-binding resins + fibrates
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increase cholesterol excretion by the liver, leading to an increased risk of gallstone formation
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Propranolol and thyrotoxicosis
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decreases the sympathetic adrenergic impulses caused by increased thyroid hormones and also decreases the peripheral conversion of T4 -> T3
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Coronary steal phenomenon
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collateral microvessels are arterioles that form adjacent pathways for blood flow to areas that are distal to occluded vessels. Blood flow is redistrubuted from ischemic areas to non-ischemic areas through vasodilated collateral microvessels and this can worsen the ischemia of the occluded artery
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Human multidrug resistance gene (MDR1)
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produces a P-glycoprotein that is a transmembrane ATP-efflux pump that pumps cancer drugs out of cells. THis is a mechanism of resistance
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Muromonab-CD3
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anti-CD3 antibody that inhibits T-lymphocytes and is used for transplant therapy
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Fat embolism syndrome
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triad: acute-onset neurologic abnormalities, hypoxemia, and petechial rash
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usually occurs after long bone fractures when fat globules dislodge and travel into pulmonary microvessels. The rash is due to FFA toxic damage and platelets coating the fat globules, leading to thrombocytopenia and petechiae
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Actinic keratoses
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appear on chronically sun-exposed areas of skin and are erythematous papules w/ central scale and "sandpaper-like" texture
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Sorbitol dehydrogenase
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found in lens, converts sorbitol into fructose. In states of high glucose, sorbitol builds up, leading to increased osmotic pressure and influx of water, leading to cataract formation
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Nitroglycerin
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rapidly acting agent that venodilates, leading to decreased preload in the ventricles, leading to decrease O2 consumption and alleviation of angina symptoms
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Maple syrup urine disease (MSUD)
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defect in branched chain alpha-keto acid dehydrogenase. Urine has a distinctive sweet odor, much like burned caramel. Supplementation w/ thiamine might be beneficial
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Urea composition
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NH3 from aspartate
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Aqueous humor production
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produced by the ciliary epithelium and is sensitive to Beta-adrenergic block. This is why timolol blocks aqueous humor production and improved glaucoma
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Shigella infection
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mucosal invasion is the essential pathogenic mechanism for Shigella and is the most important factor of disease. The shiga toxin can cause further disease by destroying cellular protein synthesis, but is considered less important in teh pathogenesis of shigellosis
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Neuroleptics
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high potency drugs are more likely to produce extrapyramidal symptoms and less likely to produce anticholingergic and antihistamine symptoms, while low potency drugs are the exact opposite
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Atrial fibrillation
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the heart rate is due to the AV nodal refractory period, leading to an HR of about 120 bpm
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Inhaled-anesthetic hepatotoxicity
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type 1: associated w/ aminotransferase elevation and mild to no symptoms. Type 2: severe of fulminant hepatits leading to rapid atrophy and a shrunken liver.
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Labs: marked AST levels, prolonged prothrombin time, and eosinophilia. Albumin would be normal because the liver injury is acute
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Induced mania in bipolar disorder
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TCAs/antidepressents
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Distal duodenal ulcer
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suggests zollinger-ellison (most PUD ulcers are found in the duodenal bulb). In ZE, there is an increased basal:maximal gastric acid secretion
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Latent period (in reference to experiments)
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defined as the time elapsed from initial exposure to clinically apparent disease.
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example: a prospective study is done to determine the effects of vitamins on heart disease. It is shown that heart disease is decreased in people who took the vitamins for more than 5 years, but not for those who took the vitamins for <5 years.
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Creutzfeld jakob disease
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rapidly progressive dementia and myoclonic jerks. on microscopic examination, multiple vacuoles are seen in gray matter (spongiform encephalopathy)
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Endothelium-derived relaxing factor (EDRF), aka NO
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cholinergic agonsts bind to muscarinic receptors on endothelial cells and promote release of NO, which leads to vasodilation
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Antidepressent in patients who don't want sexual side effects
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Buproprion
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Pentazocine
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opioid narcotic specifically designed to produce analgesic effects w/ little to no abuse potential. As a result, if given to someone who is dependent on opioids, it will induce withdrawal
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vitamin B6 effect on levodopa
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increases the peripheral metabolism of levodopa, decreasing its effectiveness
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vitamin A overdose
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acute: nausea, vomiting, vertigo, blurred vision. Chronic: alopecia, dry skin, hepatotoxicity, hepatosplenomegaly, papilledema
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Global cerebral ischemia
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hippocampus is the first area to be damaged during global cerebral ischemia
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Parkinson's tx
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amantadine increases synthesis, release, and EFFECT of endogenous domaine; Entacapone/tolcapone are COMT inhibitors that increase levodopa availability to the brain
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lacunar infarcts
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result of hypertensive changes in arterioles that leads to liphyalinosis and microatheromas. Also seen in diabetes
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seen in infarcts of the posterior limb of internal capsule, VPL/VPM, base of bons
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Cerebral amyloid angiopathy
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most commonly causes hemorrhaging within the cortex and subcortical white matter and is not associated w/ ischemic stroke
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Rabies
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restlessness, agitation, dysphagia progressing to coma in 30-50 days after exposure to caves/bats.
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Vaccination (killed virus) for individuals at high-risk is preventative
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Bradycardia tx after inferior MI
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Atropine is indicated b/c it decreases vagal influence on the SA node. Side effects are increased intraocular pressure and may precipitate closed angle glaucoma
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Mycoplasma genus
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lack a cell wall (includes mycoplasma and ureaplasma)
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Rapid plasma decay of thiopental
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due to redistribution of the drug to other tissues of the body (skeletal muscle and adipose tissue), NOT metabolism
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Treatment of concurrent tonic-clonic and absence seizures
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valproic acid
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Theophylline intoxication
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moa: decrease cAMP levels, possibly by activating phosphodiesterase. Intoxication results in abdominal pain, vomiting, diarrhea, cardiac arrhythmias, and seizures. Seizures are most important.
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Tx of intoxication includes giving Beta blockers and benzos for the seizures
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Atypical depression
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MAOi are first line treatment (phenelzine, tranylcypromine)
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Atypical depression is characterized by mood reactivity, leaden fatigue, rejection sensitivity, increased sleep and apetite
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polycistronic bacterial mRNA
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means that one mRNA can code for several proteins, which is how the lac operon can upregulate 2 proteins at the same time
|
|
|
Calcineurin
|
an essential protein in IL-2 activation which promotes growth and differentiation of T cells
|
|
|
alpha-galactosidase
|
membrane-bound disaccharidases on the intestinal brush border that break down disaccharides into monosaccharides for absorption. Acarbose and miglitol are taken by diabetes to prevent absorption of glucose
|
|
|
Intrapleural pressure at FRC
|
-5 mmHg H20
|
|
|
Hepatocyte injury in viral hepatitis
|
diffuse swelling termed "ballooning degeneration". Hepatocyte death is characterized by lobular architectural disruption and confluent hepatocyte necrosis, a process called "bridging necrosis." Fever and dark urine would be seen in the patient
|
|
|
Thrombin time (TT)
|
increased by drugs that directly inhibit thrombin formation, such as heparain
|
Factor Xa inhibitors (idraparinux, rivaroxaban, apixaban, ultralow weight heparin) increased PTT and PT, but don't affect TT
|
|
Severity of mitral regurgitation
|
presence of S3 indicates severe regurg and left ventricular volume overload and is a predictor of the severity of the MR
|
a presence of S4 may indicates late stage decompensation of severe MR
|
|
Adenosine effect on heart
|
reduces the rate of spontaneous depolarization in cardiac pacemaker cells, slowing the heart rate
|
|
|
Membranous glomerulopathy
|
associated w/ systemic diseases, solid tumors, drugs, and infections. Diffuse thickening of the glomerular capillary wall on LM w/o cellularity and dense subepithelial deposits
|
|
|
Mycobacterium tx
|
pyrazinamide works best in an acidic environment and thus works best against intracellular bacteria that are within phagolysosomes. Isoniazid, rifampin, and ethambutol have better activity against extracellular MTB
|
|
|
Senile cardiac amyloidosis
|
atrial natriuretic peptide is the precursor protein
|
|
|
ACEi + beta blockers
|
beta blockers already decrease renin levels, so giving ACEi wouldn't alter ATII levels much and wouldn't have a compound effect on BP
|
|
|
Recurrent hemorrhagic stroke
|
most commonly caused by cerebral amyloid angiopathy, which leads to lobar hemorrhage
|
compared to lobar hemorrhage associated w/ hypertension, lobar hemorrhage assoicated w/ amyloid angiopathy has a more benign course and lower mortality
|
|
Artery posterior to the duodenal bulb
|
gastroduodenal artery. ulceration into this artery can lead to life-threatening hemorrhage
|
|
|
TCA side effects
|
presynaptic NE release (tremor, insomnia), cardiac fast Na+ channels (conduction defects, arrhythmias, hypotension), central and peripheral muscarinic AChR (hyperthermia, flushing, dilated pupils, intestinal ileus, urinary retention, sinus tachycardia), peripheral alpha-1 receptors (orthostatic hypotension), H1 receptors (sedation)
|
|
|
Pituitary hypoplexy
|
acute bleeding in a patient w/ preexisting pituitary adenoma. Cardiovascular collapse occurs because of ACTH deficiency
|
|
|
Salicylate poisoning time frame
|
Respiratory alkalosis is the first disturbance because the medullary center is directly stimulated resulting in hyperventilation. A few hours after ingestion, an anion gap metabolic acidosis begins to develop, making it a mixed respiratory alkalosis/metabolic acidosis.
|
Late stage salicylate poisoning becomes metabolic acidosis
|
|
Drugs that cause seizures
|
buproprion, isoniazid, imipenem
|
|
|
Pathogenesis of Strep. viridans endocarditis
|
viridans can produce dextran from sucrose. dextrans facilitate strep adherence to fibrin. Therefore, viridans can bind to fibrin-platelet aggregates deposited at the site of endothelial trauma
|
dextrans can also aid viridans in formation of dental carries
|
|
Cyanide poisoning
|
binds to iron-containing enzymes (cytochrome complex in oxphos). Nitrites are given as a rescue because they induce the formation of methemoglobin, which has a high affinity for CN, and can sequester it. Sodium thiosulfate is then given, which combines w/ CN to make thiocynate (less toxic), which can be excreted
|
symptoms include rapidly-developing cutaenous flushing, tachypnea, headache, and tachycardia, w/ nausea, confusion and weakness
|
|
Incidence of esophageal SCC:adenocarcinoma
|
0.5:1
|
|
|
Orotic aciduria
|
due to deficiency in orotate phosphoribosyl transferase and OMP decarboxylase (these two enzymes represent separate active domains on a single polypeptide, which is why a single mutation causes dysfunction of both)
|
treat w/ uridine supplementation
|
|
Villous adenoma
|
large, sessile w/ cauliflower or velvety projections. May secrete large amounts of mucus, leading to mucus diarrhea and may lead to hypovolemia or electrolyte imbalances
|
|
|
Antiphospholipid antibody (APLA) syndrome
|
due to lupus anticoagulant may occur in SLE and is associated w/ venous thromboembolism, arterial thromboembolism, and increased fetal loss
|
lupus anticoagulant is the most common cause of prolonged PTT and false positive VDRL in patients with lupus
|
|
HIV proteins
|
gag gene (p24, p7), env gene (gp120, gp41), pol gene (important enzymes). gp120 aids in binding to the cell surface and gp41 aids in fusing to the cell membrane and entry of the virus
|
polyprotein precursors are encoded for by the structural genes (gag, pol, and env). gp160 is formed from the env gene and then cleaved to form gp120 and gp41
|
|
Ca2+ channel blocker S/E
|
dihydropyridine (amlodipine, nifedipine): peripheral edema, flushing, dizziness. NO AV NODE BLOCK
|
non-dihydropyridine (verapamil): constipation, gingival hyperplasia
|
|
Abetalipoporteinemia
|
inability to synthesize apolipoprotein B. Microscopically, you see lipids piled up in the small intestines because they can't get out
|
|
|
Corticosteroid effect on tissues
|
skeletal muscle (proteolytic -> weakness), bones (decreases bone mass), liver (increases gluconeogenesis)
|
|
|
Marked one sided kidney atrophy
|
suggestive of renal artery stenosis (RAS) that occurs in elderly individuals due to atherosclerotic changes in the arterial intima. Hypertension and abdominal bruit are present
|
The atrophy is most likely due to lack of oxygen and nutrients
|
|
Graft-versus-host disease (GVHD)
|
occurs after allogenic bone marrow transplantation where the graft T-cells sensitize against the host MHC antigens within 1 week of transplantation. SIgns include liver damage, jaundice, diarrhea, intestinal bleeding, abdominal cramping, skin desquamation
|
|
|
BRCA gene
|
tumor supressor genes that function in gene repair and regulation of the cell cycle
|
|
|
HIV esophagitis
|
caused by candida (patches of adherent, grey pseudomembranes), HSV-1 (small vesicles that evolve into punched out ulcers), and CMV (linear ulceration)
|
|
|
amiodarone S/E
|
thyroid dysfunction (check TSH), corneal micro-deposits, blue-gray skin discoloration, drug-related hepatitis, pulmonary fibrosis
|
|
|
c-jun
|
transcription factor proto-oncogene
|
|
|
Sickle-cell dactylitis
|
painful swelling of hands and feet seen in young children. Hemolysis occurs, leading to a decrease in serum haptoglobin levels
|
|
|
Cell swelling due to ischemia
|
ischemia leads to decreased ATP, which leads to ion pump failure, which leads to an increase in intracellular Ca2+ and Na+
|
|
|
Gestational diabetes treatment
|
insulin
|
|
|
Cidofovir
|
a nucleoside monophosphate that doesn't require action by cellular kinases for conversion to active nucleoside triphosphate form and is thus a good tx for viruses w/o phosphorylation activity
|
acyclovir, valacyclovir, famciclovir, and ganciclovir all require a herpesviral kinase
|
|
Erythrocyte sedimentation rate (ESR)
|
IL-1, IL-6, and TNF-alpha mediate systemic inflammatory response and stimulate secretion of acute-phase proteins (such as fibrinogen). High levels of fibrinogen increase ESR, which is a nonspecific marker of inflammation
|
|
|
Treatment of peripheral neuropathy
|
TCAs
|
|
|
Long QT syndrome
|
unprovoked syncope in a previously asymptomatic young person. The two congenital syndromes associated w/ long QT are Romano-Ward syndrome and Jervell an Lange-Nielsen syndrome. Both of these are thought to be results of mutations in K+ channel protein that contributes to the delayed rectifier current of the cardiac action potential
|
may predispose to torsades de pointes. agents that prolong QT include procainamide, sotalol, amiodarone, disopyramide, dofetilide, phenothiazines, and TCAs
|
|
Coronary sinus dilation
|
MCC is elevated right-sided heart pressures secondary to pulmonary artery hypertension
|
|
|
Digitalis (digoxin) overdose
|
AV block, vTach, nausea, vomiting, anorexia, confusion, blurry vision, changes in color perception, hyperkalemia
|
Example: patient w/ CHF presents w/ disturbed color perception, anorexia, nausea, vomiting, and diarrhea. What is the most likely complication? Answer: Arrhythmias
|
|
Dystrophic calcification of aortic valve
|
hallmark of cell injury and death, occuring all types of necrotic tissue. Aged or damaged cardiac valves and atheromatous plaques are a favorite
|
|
|
anovulation
|
common in the first 5-7 years after menarche and last ten years before menopause, and manifests with marked menstrual cycle variability
|
|
|
Idiopathic pulmonary hypertension
|
autosomal dominant w/ variable penetrance. abnormal bone morphogenic protein receptor type 2 (BMPR2) as first insult, which predisposes to pulmonary vascular disease. A second insult activates the disease process, resulting in proliferation of vascular smooth muscle
|
|
|
Treatment of hypertension + chronic ischemic myocardial failure
|
ACEi. Prevents remodeling and deterioration of ventricular contractile function, in addition to reducing BP. Beta blocker would also be beneficial
|
|
|
Pick's disease
|
destruction of the frontal and temporal lobes, Pick bodies (cytoplasmic tau inclusions), behavioral abnormalities like socially inappropriate behavior, speech and language decline, urinary incontinence (this is in contrast to AD, which has slow, progressive memory loss)
|
|
|
Toxoplasmosis in neonate
|
Early infection is usually asymptomatic, but can lead to necrotizing encephalitis or disseminated disease. When organism infects mother in later trimesters, there is a greater likelihood of infection and it will have the classic triad of toxo
|
|
|
Hypothyroidism
|
can see elevated creatinine phosphokinase (CPK) because there is atrophy of the type II muscle fibers
|
|
|
RANK and RANKL mechanism
|
differentiation of osteoclasts is mainly governed by RANKL and GM-CSF, both of which are produced by osteoblasts. RANKL binds to RANK on osteoclasts. Osteoblasts also secrete osteoprotegerin (POG) and this acts as a decoy receptor for RANKL and inhibits its action.
|
lack of estrogen leads to overexpression of RANK, which causes an increase in osteoclast activation and increased bone resportion.
|
|
Exercise in diabetics
|
lowers blood glucose by teh following mechanism: increases muscle uptake by sensitizing muscle cells to action of insulin, and increases insulin-independent glucose uptake
|
To prevent hypoglycemia in DM1 treated w/ insulin: eat 15-40g carbs immediately before exercise, check blood sugar before, during, and after exercise, time dosage so that insulin peak doesn't occur during exercise, do not inject insulin in limbs that will be exercised
|
|
Germinoma of the pineal gland
|
similar to testicular seminomas. classic symptoms: precocious puberty, Parinaud syndrome (paralysis of upward gaze), obstructive hydrocephalus
|
|
|
Hyaline arteriolosclerosis
|
caused by diabetes mellitus and NONmalignant hypertension
|
malignant hypertension causes hyperplastic arteriolosclerosis
|
|
Chronic mesenteric ischemia
|
most often caused by atherosclerotic narrowing of celiac trunk leading to "angina-like" symptoms of the bowel
|
|
|
Marantic endocarditis
|
small, sterile, non-destructive fibrinous vegetations along the lines of the closure of cardiac valve cusps. Due to a appendix or pancreas tumor that leads to a hypercoagulable state, which leads to the endocarditis
|
|
|
DIffuse medium-sized lymphocytes w/ high proliferation index (high Ki-67)
|
Burkitt lymphoma
|
|
|
Malignant melanoma pathogenesis
|
BRAF, a protein kinase involved in signaling pathways in melanocytes, can be mutated leading to greatly increased risk of activation of signaling pathways for melanocyte growth, survival, and metastasis
|
|
|
Colon adenocarcinomas and COX-2
|
recent studies have shown an increased activity of COX-2 w/ colon adenocarcinomas and in inherited polyposes syndromes. Patients taking NSAIDs regularly have been shown to have lower incidence of adenomas compared to general population
|
|
|
Normal aging of the heart
|
decreased left ventricular chamber size, particularly in the apex to base dimension, causing the basal septum to bulge into the outflow tract (sigmoid septum). Atrophy of cardiac myocytes results in increased interstitial connective tissue and in some cases, deposition of amyloid
|
|
|
Anaplastic characteristics
|
loss of cell polarity, significant variation in shape and size (pleomorphism), deep staining of nuclei (hyperchromatism), larger nuclei, abnormal mitoses, giant-multinucleated tumor cells
|
|
|
Kidney segments most dependent on blood flow
|
PCT and ascending loop of Henle already have low blood flow and are highly dependent on ATP, so decreased blood flow will damage them first, leading to acute tubular necrosis
|
|
|
Jurvell and Lange-Nielsen syndrome
|
congenital long-QT syndrome w/ neurosensory deafness
|
|
|
bisphosphoglycerate mutase
|
converts 1,3-BPG into 2,3-BPG in erythrocytes. Increased concentration of 2,3-BPG leads to right shift of Hb curve and dumping of O2 to tissues
|
|
|
Cauda equina syndrome
|
saddle anesthesia and loss of anocutaneous reflex due to damage to S2-S4 nerve roots
|
|
|
Protease inhibitor S/E
|
hyperglycemia, lipodystrophy, drug-drug interactions due to inhibition of cytochrome P-450
|
|
|
Cladribine
|
purine analog that is the drug of choice for hairy cell leukemia. resistant to degradation by adenosine deaminase
|
|
|
Diphtheria treatment
|
diphtheria antitoxin, antibiotics (streptomycin) and immunization. Antitoxin is the most important and has the greatest effect on prognosis
|
MC COD is cardiomyopathy
|
|
Gibbs free energy (G)
|
G is negative in a spontaneous reaction. If G is negative, the equilibrium constant, K, will have to be greater than 1 (G = -RTlnKeq). If G is positive, K will have to be less than 1
|
|
|
Neuron degeneration/damage
|
irreversible damage seen w/ red neurons (first 48 h), followed by neutrophils and macrophages. Three to five days after onset of ischemia, neurons disintegrate and their fragments are phagocytized by macrophages (lipid filled because they are eating up myelin). Within 2 weeks, astrocytes migrate in and begin gliosis and scar formation
|
|
|
Drugs that are excreted by liver as opposed to the kidney
|
high lipophilicity (since high lipophilicity means they rapidly cross tubular cell membranes after filtration and reenter tissues and allows them to cross cellular barriers and enter hepatocytes) as well as high volume of distribution.
|
|
|
Difference between superior vena cava syndrome and brachiocephalic syndrome
|
SVC syndrome affects both sides of the face, neck chest, and both arms. Brachiocephalic obstruction only affects the right face, right arm and right side of the neck.
|
|
|
Chronic treatment of asthma
|
inhaled glucocorticoids are most effective anti-inflammatory agents
|
|
|
Types of necrosis
|
coagulative necrosis: most common, preserved cell outlines (spider bites, organ ischemia), pyknosis, karyorrhexis, and lysis. Liquefactive necrosis: CNS, ischemic strokes, cells undergo fragmentation and are phagocytized by macrophages and form a cystic cavity
|
|
|
Anorexia nervosa and amenorrhea
|
loss of pulsatile secretion of GnRH from the hypothalamus
|
|
|
Topical decongestants (phenylephrine, xylometazoline, oxymetazoline)
|
characterized by rapid decline of effectiveness after a few days (tachyphylaxis). This is due to decreased production of endogenous NE. This leads to exacerbation of nasal congestion symptoms (rebound rhinorrhea)
|
|
|
Organophosphate rescue
|
atropine for all symptoms except muscle paralysis, pralidoxime for muscle paralysis
|
|
|
Polyribosyl-ribitol-phosphate (PRP)
|
a component of the Hib capsule that is conjugated to diphtheria or tetanus toxoid for a vaccine.
|
|
|
Mucicarmine stain
|
used to detect polysaccharide of Cryptococcus neoformans. Cryptococcus is the only pathogenic fungus w/ a polysaccharide capsule
|
|
|
Prevention of TIA
|
low dose aspirin
|
|
|
Samter's triad
|
triad of asthma, aspirin hypersensitivity: nasal symptoms, bronchospasm, facial flushing. Nasal polyposis can occur in 10%
|
|
|
Hypocalcemia after whole blood transfusions
|
due to calcium chelation by citrate anticoagulant
|
|
|
hypertriglyceridemia in patients on bile acid-binding resins
|
cholestyramine causes the liver to have to make 10x more bile, and it also upregulates the formation of VLDL and triglycerides
|
cholestyramine is usually given with statins. However, because cholestyramine decreases the absorption of statins, the drugs have to be taken 4 hours apart
|
|
Anesthetic pharmacokinetics
|
inspired air (lower MAC = higher potency), lungs (rate of rise of gas tension in alveoli and the blood is directly proportional to both the rate and depth of ventilation), blood (high solubility aka blood/gas partition coefficient = slow onset of action), target tissues such as the brain (higher arteriovenous concentration gradient = slower onset of action)
|
|
|
Amino acids w/ 3 titratable protons
|
histidine, arginine, lysine, aspartic acid, glutamic acid, cysteine, tyrosine
|
|
|
Primary vs. reactivation HSV infection
|
Primary: fever, vesiculoulcerative gingivostomatitis, and cervical lymphadenopathy
|
Reactivation: targets the face w/ perioral blisters and "cold sores"
|
|
Blood supply of ureter
|
proximal 1/3 is supplied by the renal artery, which is why in a kidney transplant, the proximal ureter is preserved and fused to the recipients bladder
|
|
|
Ether's effect on viruses
|
ether and other organic solvents can inactivate the enveloped viruses, which leads to a loss of viral infectivity
|
|
|
Receptor tyrosine kinases vs. tyrosine-kinase associated receptors
|
Receptor tyrosine kinase: cytosolic domain has enzymatic activity, leads to activation of MAP-kinase, phosphorylation of Ras protein, and downstream second messengers. Includes Growth factor receptors (EGF, PDGF, FGF, insulin)
|
Tyrosine-kinase associated receptors: cytosolic domain lacks enzyme activity. JAK/STAT pathway is involved. Includes cytokines, GH, prolactin, IL-2
|
|
Maternal hyperglycemia
|
fetus is likely subjected to relatively high blood glucose levels during gestation. This leads to increased fetal release of insulin and transient hypoglycemia once the infant is born
|
|
|
Biliary sludge
|
usually caused by gallbladder hypomotility. This leads to bile precipitation and the formation of biliary sludge
|
gallbladder hypomotility can be seen w/ pregnancy, rapid weight loss, parenteral nutrition, or octreotide
|
|
Fenoldopam
|
D1 agonist that vasodilates the renal vessels and also leads to sodium and water excretion
|
|
|
Neutrophil margination w/ corticosteroid therapy
|
Neutrophil counts increase following glucocorticoid administration as a result of "demargination" of leukocytes previously attached to vessel wall
|
|
|
Chloride shift
|
to maintain electrical neutrality, chloride ions diffuse into RBCs to take the place of bicarb as it moves out. Since venous blood has increased CO2 levels, that means it is more acidic, and bicarb must leave the RBC to act as a buffer. This causes chloride to come in, leading to low chloride levels in venous blood
|
|
|
Digoxin MOA
|
increases cardiac contractility by blocked Na-K-ATPase and also decreases AV nodal conduction by increasing vagus nerve/parasympathetic activity
|
|
|
Oral bioavailability
|
determined on a graph by taking the area under the curve of the oral divided by the area under the curve of the IV dose
|
F = (AUC oral x IV dose) / (AUC IV x oral dose)
|
|
Reticulocytes
|
larger than RBCs, have bluish cytoplasm and reticular precipitates of residual rRNA
|
|
|
Bicuspid aortic valve
|
becomes aortic stenosis in patient's sixties
|
|
|
Anti-phospholipase A2 receptor antibodies
|
seen in membranous nephropathy
|
|
|
Fructose metabolism in patients w/ essential fructosemia
|
fructose is metabolized by hexokinase to fructose-6-phosphate. This pathway is not significant in normal individuals
|
|
|
HCL + EtOH + carbolfuchsin
|
this describes an acid-fast stain that stains mycobacteria w/ mycolic acid in their cell walls. Carbolfuchsin is an aniline dye
|
|
|
HbC disease
|
caused by a missence mutation where lysine is substituted for glutamate at the 6th position in the beta globin chain. Since lysine is positively charged, the HbC molecule will travel further than the HbS molecule on a gel
|
|
|
Hypercalcemia in Sarcoidosis
|
due to activation of macrophages, which leads to intrinsic activity of 1alpha hydroxylase, which increases calcitriol formation, leading to hypercalcemia
|
|
|
Chronic rejection in lung transplant
|
results in bronchiolitis obliterans, where the bronchiolar walls are narrowed, obstructed, inflamed, and fibrotic
|
|
|
Diphenoxylate
|
opiate anti-diarrheal that binds mu opiate receptors in the GI tract and slows motility
|
octreotide is helpful for secondary diarrhea
|
|
Conjunctival injection
|
aka red eye
|
|
|
P bodies
|
cytoplasmic proteins that play an important role in mRNA transcription regulation and mRNA degradation
|
|
|
Argatroban
|
similar to lepirudin, argatroban is a direct thrombin inhibitor that is used in patients with heparin-induced thrombocytopenia (HIT)
|
|
|
Protein structure
|
Primary (peptide bonds), secondary (hydrogen bonds), tertiary (ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds)
|
|
|
Why verapamil doesn't work on skeletal muscle
|
skeletal muscle is not dependent on extracellular calcium influx and thus, a Ca2+ channel blocker wouldn't do anything to it
|
|
|
Ethambutol
|
antimycobacterial agent that inhibits carbohydrate polymerization, thereby preventing peptidoglycan synthesis. Optic neuritis is a side effect
|
Man walks in w/ TB and decreased visual activity. Once drug is eliminated from regimen, his vision improves
|
|
Gestational hyperglycemia
|
may be due to decreased activity of the glucokinase enzyme. Glucokinase acts as a glucose sensor in the liver and pancreas and deficiency of this enzyme may lead to mild hyperglycemia that can be exacerbated by pregnancy
|
|
|
Wet AMD
|
Ophth exam: eye reveals a gray subretinal membrane. Patient has blurry and distorted vision
|
treat w/ VEGF inhibitors
|
|
Inflammatory breast carcinoma
|
skin retraction is due to infiltration of cooper ligaments. Can also invade the lymphatics and cause a peau d'orange look
|
|
|
Mast Cell degranulation
|
When antigen binds IgE, multiple IgEs aggregate and cross-link, leading to mast cell degranulation. Mast cells release histamine, tryptase, and other chemotactic/vasoactive peptides. Tryptase is relatively specific to mast cells and is used as a marker for mast cell activation
|
|
|
Macrocytosis in Sickle cell anemia
|
classic cause of megaloblastic anemia is folate deficiency. Sickle patients have increased RBC turnover and thus, a higher demand for folate.
|
|
|
Colon adenocarcinoma location and presentation
|
Left-sided: infiltrate the intestinal wall and encircle the lumen, manifests w/ partial intestinal obstruction.
|
Right-sided: grow exophytic masses that manifest w/ iron deficiency anemia, fatigue, and weight loss
|
|
Blood supply to heart during exercise
|
vasodilation is the primary way the heart gets more oxygen, and the actual blood flow is dependent on the duration of diastole
|
|
|
Sample size effect on P
|
if two studies both get the same RR, but one study has a slightly higher p-value, then chances are that that study didn't have a large enough population
|
|
|
Cilostazol, Dipyridamole
|
decrease activity of platelet phosphodiesterase. Cilostazol also inhibits platelet aggregation. The result is direct arteriolar vasodilation, as well as inhibition of platelet aggregation
|
|
|
Pulsus alternans
|
seen in patients w/ left ventricular dysfunction. Defined as beat to beat variation in magnitude of the pulse pressure in the presence of a regular cardiac rhythm
|
|
|
7alpha hydroxylase
|
estrogenic influence during pregnancy facilitate biosynthesis of choleterol by increasing the activity of HMG-CoA reductase. If 7alpha hydroxylase activity is reduced, then cholesterol isn't converted to bile acids, resulting in excess cholesterol secretion in bile and the formation of cholesterol stones
|
|
|
Phenytoin S/E
|
generalized lymphadenopathy (psuedolymphoma)
|
|
|
Mycobacterium avium (MAC)
|
causes disseminated disease in HIV+; weekly azithromycin is used as prophylaxis in patients at high risk for MAC. Treatment for MAC is clarithromycin/azithromycin + rifabutin + ethambutol
|
presents w/ nonspecific symptoms, fever, weight loss, diarrhea. Blood cultures are usually positive for acid-fast bacteria that grow best at 41C
|
|
Fibronectin
|
part of the extracellular matrix (long w/ collagen and laminin), bind integrins. Involved in the formation of granulation tissue
|
integrins can also bind to collagen or laminin
|
|
Chronic topical corticosteroid therapy
|
leads to atrophy/thinning of the dermis w/ loss of dermal collagen, drying, cracking, and or tightening of the skin, telangiectasias, ecchymoses
|
|
|
Somatomedin C
|
peptide that is structurally similar to insulin and is released in response to GH and stimulates growth in target cells
|
|
|
Proopiomelanocortin (POMC)
|
polypeptide precursor that goes through enzymatic cleavage and modification to produce beta-endorphins, ACTH, and MSH
|
|
|
Reserpine
|
MOA: VMAT inhibitor that prevents packaging of presynaptic vesicles of monoamines. Has been used as a cheap and old antihypertensive drug
|
S/E: predisposes to depression because it depletes NE and 5-HT
|
|
Course of the median nerve
|
arises from lateral and medial cords of the brachial plexus, courses with the brachial artery in the groove between the biceps and brachialis, crosses the medial aspect of the antecubital fossa, between the humeral and ulnar heads of the pronator teres, between the flexor digitorum superficialis and digitorum profundus, through the flexor retinaculum and into the hand
|
|
|
Treatment for measles infection
|
vitamin A
|
|
|
Insulin profiles
|
the best basal, long-acting insulin is glargine insulin. THe best short-acting insulin is aspart and lispro
|
|
|
Most common antibody in the US
|
anti-CMV antibody
|
|
|
Jaundice of the newborn
|
Day 1: ABO incompatibility. Day 2: Jaundice of the newborn
|
|
|
Rhogam
|
anti-Rh-IgG
|
IgG is used because the Fc receptors on phagocytic cells have the greatest affinity for Fc fragments of IgG antibodies. These specific IgGs also don't cross the placenta
|
|
Chlamydia pneumoniae
|
some relationship w/ atherosclerosis
|
|
|
Difference between superior vena cava syndrome and pancoast tumor
|
superior vena cava syndrome is due to a mediastinal mass, most commonly a bronchogenic carcinoma. Pancoast tumor is seen in the superior sulcus of the lung and leads to Horner's syndrome, not SVC syndrome.
|
|
|
Differentiating complete and partial diabetes insipidus
|
central DI has a more than 10% increase in urine osmolality after administration of desmopressin. Partial DI has a more moderate response, indicating that some vasopressin is present, but not enough to allow normal kidney function
|
|
|
Treatment of hypertriglyceridemia
|
First line: fibrates (activate PPAR-alpha and increases LPL activity). Second line: Niacin (decrease synthesis of hepatic VLDL and triglycerides)
|
|
|
Nephrotic syndrome and hypercoagulable state
|
Nephrotic syndrome, many important substances are lost in the urine, such as anticoagulant factors, especially antithrombin III. THis may lead to renal vein thrombosis and a hypercoagulable state. A varicocele may be a sentinel marker for this
|
|
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Lipofuscin
|
a product of lipid peroxidation, it accumulates in aging cells (especially in patients w/ malnutrition and cachexia).
|
Example: patient dies from esophageal cancer. On autopsy, the heart is small and has no atherosclerosis. However, the cardiac cells have prominent intracytoplasmic granules that are tinged yellowish-brown
|
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Abnormal bleeding in patients w/ uremia
|
uremia (seen in patients on dialysis) can cause a qualitative platelet disorder w/ normal PT, PTT, and platelet count
|
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|
Myoglobin
|
the individual subunits of hemoglobin are structurally analogous to myoglobin. if separated, their graph will look like a myoglobin graph
|
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Her2/neu
|
transmembrane glycoprotein that has intracellular tyrosine kinase activity. It is an epidermal growth factor that plays a role in growth and differentiation. Overexpression of the oncogene is seen in 30% of invasive cancers
|
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|
Cough, low grade fever, malaise after trip to the Great Lakes
|
blastomyces dermatitidis
|
|
|
Facial pain, headache, black necrotic eschar in nasal cavity + DKA
|
mucormycosis. Best to take a biopsy to confirm diagnosis, not blood culture
|
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|
Ricketsia MOA
|
invades endothelial cells, leading to vasculitis
|
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|
Megestrol acetate
|
for patients who are taking chemotherapy and have lost their appetite, megestrol acetate increases appetite
|
|
|
Acute viral hepatitis histology
|
ballooning degeneration, hepatocyte necrosis, portal inflammation. Hepatitis B shows cytoplasm filled w/ spheres and tubules of HBsAg and the cytoplasm takes on a finely granular, eosinophilic "ground glass" appearance
|
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|
Prokaryotic rRNA/ribosomes
|
16s rRNA sequence is found in the 30S ribosomal unit and contains a sequence that is complementary to the Shine-Dalgarno sequence on mRNA. The 23S rRNA of the 50S subunit facilitates peptide bond formation. Elongation factor G facilitates translocation, with energy supplied by GTP
|
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|
Androgenic alopecia (male pattern baldness)
|
demonstrates polygenic inheritance w/ variable penetrance. Circulating androgens are thought to be correlated w/ severity
|
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|
HBsAg facts
|
component of the HBV envelope, it's a noninfective glycoprotein that forms spheres and tubules 22 nm in diameter. Infected hepatocytes secrete enormous amounts of HBsAg, considerably exceeding the amount needed. This is why HBsAg levels are not indicative of virus replication
|
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|
Fenfluramine, dexfenfluramine, phentermine (phen phen)
|
associated w/ secondary pulmonary hypertension
|
Example: 35 year old obese female presents w/ progressive dyspnea and dizziness w/ exertion. She follows a diet and has taken appetite suppressant medications in the past.
|
|
Acyclovir crystalline nephropathy
|
acyclovir crystals can precipitate if the patient is not adequately hydrated
|
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|
Fatty oxidation inhibitors
|
newer agents that inhibit fatty acid oxidation and shift energy production to glucose oxidation. Glucose oxidation is thought to be more oxygen efficient and for this reason, fatty oxidation inhibitors are good for angina
|
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Atheroembolic disease of the renal arteries
|
cholesterol-containing debris gets pushed from larger arteries and lodges in smaller vessels, causing ischemia. Renal biopsy shows needle-shaped cholesterol crystals that partially or completely obstruct the renal arterioles
|
73-year old male develops cyanotic toe discoloration following coronary angioplasty w/ elevated serum creatinine
|
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Risk factors for bone mass
|
Low BMI, smoking history, glucocorticoid therapy, early menopause
|
Black race has higher bone density than caucasian race
|
|
Diuretics w/ maximum amount of diuresis in a short period of time
|
Loop diuretics (furosemide)
|
|
|
How to increase HDL levels
|
Niacin is the best agent for increasing HDL. Lifestyle modifications also increase HDL, but only 5-10%, whereas Niacin can increase it 25-35%. Statins (2-15%), fibrates (10-25%) are also helpful, but not first line
|
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|
Cystinuria and sodium cyanide-nitroprusside test
|
defect in renal proximal tubules (COAL). This leads to aminoaciduria and precipitates stone formation. Kidney stones at a young age!
|
cyanide-nitroprusside test detects sulfhydryl groups and is a rapid qualitative determinant of the presence of urine cystine. Purple discoloration indicates amino acids in the urine
|
|
Mycobacterium w/ twisted, serpentine cords
|
this indicates "cord factor." Cord factor is a mycoside, meaning it is composed of two mycolic acid molecules bound to a disaccharide. The presence of cord factor correlates w/ virulence. Cord factor inactivates neutrophils, damaging mitochondria, and induce release of TNF
|
|
|
Difference between dysplasia and carcinoma
|
dysplasia is reversible, whereas carcinoma is irreversible
|
|
|
PABA containing sunscreens
|
widely used to prevent UVB damage. DO NOT block UVA wavelength range
|
Avobenzone can be added to PABA agents to absorb UVAI and UVAII. Many zinc oxide containing sunscreens provide base braod spectrum protection against UVB, UVAI, UVAII
|
|
Huntington Disease pathogenesis
|
alteration of gene expression in HD is thought to occur due to hypermethylation of histones. These hypermethylated histones bind DNA and prevent transcription of certain genes (such as a decrease in BDNF)
|
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|
Diseases w/ elevated CPK
|
hypothyroidism, autoimmune disease (polymyositis/dermatomyositis), muscular dystrophies, and HMG-CoA reductase inhibitors
|
|
|
Bioavailability of nitrates
|
isosorbide mononitrate has the highest oral bioavailability (100%). Isosorbide dinitrate has a lower oral bioavailability because it undergoes first pass metabolism. Nitroglycerin is placed under the tongue and is absorbed systemically, but if it were to be swallowed, it would have a low bioavailability
|
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|
LPS
|
Three regions: O antigen, core polysaccharide, and Lipid A. Lipid A is responsible for toxic properties of LPS that lead to sepsis and shock. O antigen is used to classify bacteria
|
LPS is released from bacterial cell membranes with cell-death or during cell division. It is not actively secreted by bacteria
|
|
Ethical issue of telling someone if someone is a patient of yours
|
it's unethical to discuss information regarding a patient's diagnosis, treatment, prognosis. The physician should neither confirm nor deny whether the person of interest is even a patient.
|
|
|
Candida and the human immune system
|
Local defense against candida is performed by T-cells, whereas systemic infection is prevented by neutrophils. For this reason, localized candidiasis is common in HIV-positive patients, while neutropenic individuals are more likely to have systemic disease
|
|
|
Lactase-deficient individuals
|
increased stool osmotic gap, increased breath hydrogen content, decreased stool pH upon lactose challenge
|
|
|
Berkson's bias
|
selection bias created by selecting hospitalized patients as the control group
|
|
|
Acute gingivostomatitis
|
think HSV-1
|
example: 1-3 year old comes in w/ fever, irritability, decreased oral intake, swollen gums w/ ulcerative lesions, enlarged, tender cervical lymph nodes. Oral scrapings demonstrate cells w/ intranuclear inclusions
|
|
Serum sodium less than 120
|
SIADH
|
|
|
Ristocetin test
|
activates GP Ib-IX receptors on platelets and makes them available for vWF binding. When vWF levels are decreased, there is poor platelet aggregation in the presence of ristocetin
|
|
|
Anti-inflammatory cytokines
|
IL-10 and TGF-B. TGF-B inhibits Th2 lymphocyte differentiation, cytotoxic T-cell activities, and B-cell immunoglobulin secretion.
|
IL-10 is produced by a variety of cells (mostly Th2) and inhibits IL-2 and IFN-gamma production by Th1 cells, while enhances Th2 activity. It also inhibits TNF-alpha and IL-12 production
|
|
Amiodarone and Long QT
|
Amiodarone increases the QT interval, but it has a low associated w/ torsades de pointes
|
|
|
Bosentan
|
oral endothelin-receptor antagonist recently approved for treatment of pulmonary hypertension. Since endothelin is a potent vasoconstrictor, bosentan prevents vascular and right ventricular hypertrophy by decreasing pulmonary arterial pressure
|
|
|
Foscarnet
|
induces renal wasting of magnesium and may lead to hypomagnesemia. Hypomagnesemia may reduce release of PTH, leading to hypocalcemia. Both of these electrolyte abnormalities may lead to seizure.
|
Example: 43 yo male w/ HIV comes in w/ impaired vision (supposed to know that this is CMV). Third day of hospitalization, he develops generalized seizures and is found to be hypocalcemia and hypomagnesemic
|
|
Hemorrhagic cystitis in a kid
|
adenovirus: small urinary infection outbreak among children in a daycare center. several boys develop acute onset dysuria and hematuria. Urine detects viral fragments
|
|
|
Fibromyalgia
|
chronic disorder of unclear etiology w/ diffuse musculoskeletal pain, insomnia, and emotional disturbances
|
contrast to polymyalgia rheumatica, where the patient is usually over 50, has pain and stiffness w/ fever, malaise, and weight loss, and is associated w/ temporal cell arteritis
|
|
Liver and glycerol metabolism
|
only the liver can utilize glycerol produced by the degradation of triglycerides by hormone sensitive lipase. In the liver, glycerol is used for tiacylglycerol synthesis, gluconeogenesis, and as an intermediate in glycolysis. The liver specific enzyme glycerol kinase converts glycerol into glycerol-3-phosphate
|
|
|
"On-Off" phenomenon in Parkinson's
|
unpredictable and dose-independent, where the levodopa effects are lost and hypokinesia and rigidity come back
|
The "wearing off" phenomenon of Parkinson's is due to progressive destruction of striatonigral dopaminergic neurons over a period of time
|
|
D-xylose
|
monosaccharide whose absorption is not affected by pancreatic insufficiency. Oral administration can be used to differentiate between malabsorption of pancreatic insufficiency and gastrointestinal mucosal etiology
|
|
|
Glomus tumor (glomangioma)
|
tender, small red-blue lesion under the nail bed. Originates from the modified smooth muscle cells that control thermoregulatory functions of dermal glomus bodies
|
|
|
Increase in staphylococcal infections over the past 20 years
|
due to increase in intravascular devices
|
|
|
Penicillin structure
|
structural analogs of D-ala-D-ala that bind to transpeptidases and inhibit them
|
|
|
Treatment of bacteroides fragilis
|
Piperacillin-tazobactam
|
|
|
Janeway lesions
|
due to microemboli to cutaneous blood vessels
|
|
|
Multiple myeloma
|
Easy fatigability (anemia), constipation (hypercalcemia), back pain (bone lesions), and azotemia (renal failure). On kidney biopsy, large eosinophilic casts composed of Bence-Jones proteins are seen
|
|
|
Cheat sheet on antiarrhythmics
|
Class IA: slow phase 0, prolonged phase 3, prolonged action potential. Class IB: little effect on phase 0, shortens phase 3, shortened action potential. Class IC: Drastic slowing of phase 0, no effect on phase 3. Digoxin, Adenosine, Ca2+ blockers: no changes to action potential
|
|
|
Bronchioalveolar carcinoma
|
arises from alveolar cells, represents 10% of all lung cancers. On light microscopy, the tumor is composed of tall columnar cells that line the alveolar space and secrete mucus into the alveoli. No evidence of stromal or vascular invasion
|
|
|
Trigeminal nerve anatomy
|
arises at the level of the middle cerebellar peduncle
|
don't confuse w/ facial nerve, which arises at the cerebellopontine angle
|
|
HIV prophylaxis in pregnant women
|
Nucleoside analog zidovudine reduces the risk of perinatal transmission by about 2/3
|
|
|
Secretin and pancreatic juice composition
|
as secretin increases and flow rate increases, HCO3- increases and Cl- decreases
|
|
|
E. coli neonatal meningitis
|
capsule (K-1 antigen) is the most important virulence factor
|
|
|
C. difficile toxins
|
toxin A (enterotoxin): neutrophil chemoattractant leading to mucosal inflammation, loss of water in gut lumen, and mucosal death. Toxin B (cytotoxin): causes actin depolymerization, loss of cellular cytoskeleton integrity, cell death, and mucosal necrosis
|
|
|
What to do if a patient doesn't want to know the results of a biopsy
|
asks if he or she has a family member who could make further decisions about health care
|
|
|
BH4 cofactor
|
used in hydroxylase enzymes for the synthesis of tyrosine, dopa, and serotonin, and NO
|
|
|
Reid index
|
ratio of thickness of mucous gland layer in the bronchial wall submucosa to teh thickness of the whole bronchial wall (bronchial epithelium, submucosa, don't include cartilage)
|
|
|
Chronic interstitial nephritis
|
chronic renal injury due to NSAID in patients with chronic pain
|
|
|
Pancreatitis
|
destruction of blood vessel walls can cause hemorrhage into necrotic areas. areas of white chalky fat necrosis are visible in pancreatic tissue. they can spread into the mesentery, omentum, and other parts of the abdominal cavity
|
|
|
strawberry hemangioma
|
first increase in size w/ the baby, then spontaneously regress
|
|
|
Allosteric activator of gluconeogenesis
|
Acetyl-CoA acts on pyruvate carboxylase to increase its activity
|
|
|
Treatment of status epilepticus
|
Infusion of benzodiazepine to stop current seizures and simultaneous administration of phenytoin to prevent recurrence of seizures
|
|
|
Bromodeoxyuridine uptake
|
indicates that a tumor has a high number of cells in the S phase and that they are preparing to divide, indicating a high grade tumor
|
|
|
Type of insulin used for DKA tx
|
Regular insulin, not lispro or aspart. Regular insulin is a short-acting insulin that takes action in 30 minutes, peaks at 2-4 hours, and lasts for six to eight hours
|
|
|
Neuropathy in Diabetes mellitus
|
caused by diabetic microangiopathy which leads to nerve ischemia. Sorbitol can also lead to osmotic nerve injury
|
|
|
Pathogenesis of alcohol induced hepatic steatosis
|
decrease in FFA oxidation secondary to excess NADH production
|
|
|
Pro-carcinogens
|
metabolized by cytochrome P450 monooxygenase, an enzyme system present in hepatic microsomes and the ER of varied other tissues. This system metabolizes steroids, alcohol, toxins, and other foreign substances by rendering them soluble and easier to excrete. However, this system also converts some pro-carcinogens, such as benz(o)pyrene into carcinogens
|
|
|
Eosinophil defense against parasites
|
stimulated by IgE bound to a parasitic cell, they destroy the parasite via antibody-dependent cellular cytotoxicity
|
|
|
Niacin effets on hypertensives and diabetic treatments
|
Niacin potentiates the effects of some anti-hypertensives medications, such as vasodilators and ganglion blocking agents, because of its vasodilatory effects (must decrease dose of antihypertensives). Niacin also increases insulin resistance, which sometimes manifests as acanthosis nigricans. Therefore, the dose of diabetic treatment should be increased
|
|
|
Lac operon
|
Lactose present in the cell binds the repressor protein, removing it from the operator, and allowing transcription of the lac genes. If glucose is present, it will inhibit adenylate cyclase, leading to a decrease in cAMP. cAMP will therefore not be around to bind CAP. cAMP-CAP is normally an activator of the lac operon. So with glucose, the lac operon is inhibited
|
|
|
How to differentiate galactosemia and fructosemia
|
Galactosemia presents w/ problems right when you start breastfeeding, whereas fructosemia starts after you start eating real food
|
|
|
Adiponectin
|
Increased by pioglitazone, leading to decreased insulin resistance
|
|
|
Lobar pneumonia stages
|
Congestion (first 24h): affected lobe is red, heavy, boggy w/ vascular dilation, alveolar exudate that contains mostly bacteria. Red hepatization (2-3 days): red, firm lobe w/ alveolar exudates that contain RBCs, neutrophils, and fibrin.
|
Gray hepatization (4-6 days): gray-brown firm lobe w/ RBCs disintegrate, alveolar exudate that contains neutrophils and fibrin. Resolution: restoration of normal architecture w/ enzymatic digestion of the exudate
|
|
Bile transport in hepatocytes
|
The liver takes up indirect bilirubin through a passive process (OATP organic anion transporting polypeptide) and secretes direct bilirubin through an active process (MRP2 organic anion transporter, a specific ATP powered pump). Thus, inhibiting the MRP2 pump would lead to decreased conjugated bilirubin in the bile ducts, but conjugated bilirubin would still leak out of the hepatocytes via the OATP and into the serum, resulting in a conjugated bilirubinemia
|
|
|
Holiday heart syndrome
|
alcohol binge consumption may lead to episodes of atrial fibrillation
|
|
|
Pulmonary vascular resistance
|
PVR is lowest at functional residual capacity (FRC). Inhalation increases PVR due to pressure placed on pulmonary vessels by the expanding alveoli. Forced exhalation increased PVR as well due to collapsing positive pressure placed on the lung parenchyma
|
|
|
Biliary atresia
|
occurs due to complete obstruction of extrahepatic bile ducts. Patients develop jaundice, dark urine, white stool, and a conjugated hyperbilirubinemia. Liver biopsy shows marked intrahepatic bile duct proliferation, portal tract edema and fibrosis, and parenchymal cholestasis
|
|
|
Aortic rupture due to MVA
|
most common site of injury is the aortic isthmus, which is the connection between the ascending and descending aorta distal to where the left subclavian artery branches off the aorta
|
|
|
Xanthelasma and primary biliary cirrhosis
|
Biliary cirrhosis can produce cholestasis, which can lead to hypercholesterolemia, which can lead to xanthelasma
|
|
|
Wallerian degeneration
|
occurs in the segment of the axon that has lost connection with the cell body. First, there is swelling and irregularity is noted in teh distal segment of the axon. Within a week, Schwann cells and macrophages begin digesting the axon.
|
Changes in the neuronal body after the axon is severed is called axonal reaction. It becomes swollen, rounded, with teh nucleus displaced to the periphery. Nissl substance becomes fine, granular and dispersed throughout the cytoplasm. These changes reflect an increased synthesis of protein by the cells in order to regenerate the severed axon
|
|
Cortisol control of catecholamines
|
Cortisol regulates PNMT, which is responsible for the production of epinephrine from NE
|
|
|
Dobutamine effects
|
Positive inotropic effect, weak chronotropic effect, increased cardiac conduction velocity
|
|
|
Endometrium changes w/ ectopic pregnancy
|
Endometrial biopsy would reveal decidual (gestational) changes without chorionic villi. This is due to the hormonal changes that occur during pregnancy (even though it's ectopic)
|
|
|
Side effects of levodopa even with carbidopa
|
Adding carbidopa reduces most peripheral side effects except for behavioral changes such as anxiety and agitation. In fact, they can get worse w/ carbidopa because carbidopa will increase levodopa going to the brain
|
|
|
NF-kB
|
Transcription factor responsible for cytokine production in the immune response to infectious pathogens. Crohn's disease is associated w/ an increased activity of NF-kB protein.
|
|
|
Angiogenesis
|
driven by 2 substances: VEGF and FGF. IL-1 and IFN-gamma can also be involved, but indirectly, because they stimulate the release of VEGF.
|
|
|
Acute Chest Syndrome
|
vaso-occlusive crisis localized to the pulmonary vasculature that can occur in patients w/ sickle cell anemia.
|
|
|
Inactivation of Hep A
|
chlorinated water, bleach, formalin, UV irradiation, or boiling at 85C for one minute
|
|
|
Native valve bacterial endocarditis (NVBE)
|
mitral valve prolapse is the most common cardiac abnormality predisposing to NVBE in 15-60 year olds. Rheumatic valvular disease is also a potential, although less common, precipitant of NVBE
|
|
|
Transmural inflammation w/ fibrinoid necrosis of arteries
|
Polyarteritis nodosa. Associated w/ HBV!
|
|
|
Anal fissure
|
longitudinal tear in the mucosa of the distal anal canal. Majority of fissures occur at the posterior midline of the anal verge
|
|
|
Prognostic factor in poststreptococcal glomerulonephritis
|
Age. 95% of children resolve completely, whereas only 60% of adults do. The rest lead to chronic GN or RPGN
|
|
|
Fatty streaks
|
earliest lesion of atherosclerosis and are present in individuals after age 10. Composed of intimal, lipid-filled foam cells, derived from macrophages and SMC that have engulfed lipoproteins
|
Although some may progress to athersclerotic plaques, in general their occurrence and location in a child do not predict the occurrence of atheromatous plaques later in life
|
|
Endometriosis facts
|
Nodularity of the uterosacral ligaments and fixed retroversion of the uterus are commonly seen. Painful intercourse is a result of retroversion of the uterus and endometrial implants on the uterosacral ligaments
|
|
|
Paraneoplastic cerebellar degeneration
|
most commonly associated w/ cancers of the lung, breast, ovary, and lymphoma. Antibodies seen: anti-Yo (ovary and breast), anti-P/Q (lung), and anti-Hu (lung). These antibodies react against tumor cells and also cross react w/ cerebellar Purkinje neurons, leading to ataxia, dysarthria, and nystagmus.
|
|
|
Rituximab
|
Monoclonal antibody against CD20 antigen and is used to treat some lymphomas
|
|
|
Thiamine dependent enzymes
|
Pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase, branched chain ketoacid dehydrogenase
|
|
|
Zolpidem
|
short-acting hypnotic agents structurally unrelated to benzos. Used for short-term treatment of insomnia and has less potential for tolerance and addiction, no anticonvulsant properties, and no muscle relaxing properties
|
|
|
Cell that has long, branched lipids within its bacterial wall
|
Mycobacterium. This is referring to mycolic acids, which are long branched saturated fatty acids
|
|
|
Liver biopsy w/ dense pigment composed of epinephrine within lysosomes
|
Dubin-Johnson syndrome
|
|
|
Sweat glands
|
Apocrine: secretion is initially odorless but can become malodorous secondary to bacterial decomposition on the skin surface. Eccrine (merocine): present throughout the body and secrete watery fluid rich in sodium and chloride. Holocrine: found in association w/ sebaceous glands
|
|
|
Zenker's diverticulum
|
Can be due to cricopharyngeal muscle dysfunction. This will increase intraluminal pressure in the oropharynx and cause the mucosa to herniate through the wall and the point of weakness, forming the diverticulum
|
|
|
Pancytopenia in SLE
|
due to warm-hemolytic anemia
|
|
|
Drug Combos
|
Permissive: when one drug has an effect and the other doesn't, but when given together, the combined effect is increased. Synergistic: when two drugs have effects, but when added together, it's more than their sum. Additive: when two drugs have effects, and when added together, it's the sum of them.
|
|
|
Post-herpetic neuralgia
|
most common neurological complication of VZV
|
|
|
Radiation effect on cells
|
induces DNA damage through DNA double-strand fractures and the formation of oxygen free radicals
|
|
|
Congenital developmental abnormalities
|
Malformation: primary defect in cells or tissues that form an organ (Holoprosencephaly). Disruption: secondary destruction of a previously well-formed tissue or organ (amniotic band syndrome). Deformations: secondary to extrinsic compression (hip dislocation, clubbed feet). Sequence: single primary defect leads to a number of abnormalities (Potter syndrome)
|
|
|
Serine and threonine phosphorylation and relationship w/ insulin resistance
|
aberrant serine and threonine residue phosphorylation by serine kinase leads to insulin resistance. These aberrant phosphrylations can occur in the presence of TNF-alpha, catecholamines, glucocorticoids, and glucagon
|
|
|
Colonization of MRSA on human
|
asymptomatic colonization of the nasopharynx is the most common. This increases the risk of infections following surgery, peritoneal dialysis, and hemodialysis
|
|
|
Leuprolide treatment
|
initial increase in DHT and T levels, then a concordant decrease in DHT and T levels
|
This is in contrast to finasteride, which causes a concordant decrease in DHT levels
|
|
Treatment of neonatal meningitis
|
Ceftriaxone for Group B, HiB, Strep pneumo, and ampicillin for Listeria!
|
|
|
Chronic lithium side effects
|
Because it is exclusively excreted by the kidneys, anything that leads to increased PCT sodium absorption will lead to increased lithium levels. NSAIDs, thiazides, and ACEi are examples of drugs that do this
|
Example: woman w/ bipolar disorder comes in w/ involuntary movements, ataxia, and tremor that started 2 weeks ago.
|
|
Renal stones that aren't seen on plain films
|
Uric acid stones: only radiolucent stones, so they can't be visualized on plain films.
|
|
|
Kozak consensus sequence
|
found on eukaryotic mRNA 3 bases upstream of the AUG start codon. It serves as the initiator for translation. If a G replaces a C, then thalassemia intermedia is the result
|
|
|
Subclinical hepatitis infection
|
Most often HAV, where the patient is infected but never knows it, and then the infection resolves.
|
|
|
Crohn's disease and kidney stones
|
most often calcium oxalate kidney stones. This is due to impaired bile acid absorption in the terminal ileum, which leads to increased fat malabsorption. Lipids then bind calcium ions, and the resulting soap complex is excreted. Free oxalate can now be absorbed in the intestines, and this forms urinary calculi.
|
|
|
Pure red cell aplasia
|
rare form of marrow failure characterized by marked hypoplasia of marrow erythroid elements in the setting of normal granulopoiesis and thrombopoiesis.
|
Associated w/ thymoma and parvovirus B19 infection
|
|
Carpal tunnel syndrome
|
caused by median nerve compression. Most commonly associated w/ repetitive wrist movements, but also seen in hypothyroidism, DM, RA, and dialysis associated amyloidosis.
|
Hemodialysis MOA: may develop deposition of B2-microglobulin/amyloid deposition that can lead to median nerve compression and often manifests as BILATERAL carpal tunnel syndrome
|
|
Treatment of hyperthyroidism w/ radioactive iodine
|
Pretreatment w/ potassium perchlorate or pertechtenate will decrease the effects of the therapy because these compounds competitively inhibit the sodium-iodine transporters (NIS) at the basolateral membrane of the follicular cell
|
|
|
First pass metabolism bypass
|
Can be bypassed via IV, sublingual, or rectal administration of a drug
|
|
|
Phases of ATN
|
Initiation: injury to renal tubules. Maintenance: decreased urine output, fluid overload, hyperkalemia, metabolic acidosis. Recovery: gradual increase in urine output, hypokalemia
|
|
|
Porcelain gallbladder
|
bluish, brittle, calcium-ladden gallbladder wall that can develop in patients w/ chronic cholecystitis. Patients are often symptomatic. 11-33% of this patient population will eventually develop gallbladder carcinoma
|
|
|
Non-rhythmic conjugate eye movements w/ myoclonus (opsoclonus-myoclonus)
|
Neuroblastoma. MC extracranial childhood cancer, most commonly in the adrenal medulla. The opsoclonus-myoclonus part is a paraneoplastic syndrome. N-myc association
|
|
|
Anastrozole
|
selective aromatase inhibitor used in the treatment of breast cancer
|
|
|
Location of colon cancer
|
rectosigmoid > ascending colon
|
|
|
Isoniazid S/E
|
hepatotoxic: can cause acute mild hepatic dysfunction, or, in a small percentage of cases, cause frank hepatitis w/ fever, anorexia, and nausea
|
|
|
Pancreatic pseudocyst epithelium
|
Epithelium consists of granulation tissue and fibrotic tissue. Unlike a true cyst, pseudocysts are not lined by epithelium
|
|
|
EPO production
|
endothelial cells of the peritubular capillaries of the kidneys
|
|
|
Primidone
|
antiepileptic that is metabolized to phenobarbital and phenylethylmalonamide (PEMA)
|
Clinical scenario: 24 year old with a history of seizures comes into the ER sedated and not oriented. Labs show an elevation of phenobarbital levels (answer choices don't show any obvious barbiturates)
|
|
Workup of metabolic alkalosis
|
check urine chloride: decreased indicates loss of HCl from stomach (vomiting or nasogastric suction), diuretic use shows increased urine Cl, increased aldosterone secretion which increases Cl concentration in the urine (this one, unlike the first 2, is saline-resistant because giving saline will not fix the metabolic alkalosis)
|
|
|
Spongiosis
|
primary histologic finding in patients w/ eczematous dermatitis (contact dermatitis)
|
|
|
Pulsion
|
constant pressure in a hollow organ that leads to things like diverticuli in the colon (false since the mucosa and submucosa punch out of the muscularis)
|
|
|
Pulmonary hamartoma (pulmonary chondroma)
|
Most common benign lung tumors that present in the periphery. They are composed of disorganized cartilage, fibrous and adipose tissue
|
|
|
Presence of erythroid percursors in organs such as the liver and spleen
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indicative of extramedullary hematopoiesis, a condition characterized by EPO-stimulated, hyperplastic marrow cell invasion of extramedullary organs. Seen in severe chronic hemolytic anemias, such as B-thalassemia, and myelofibrosis
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Monitoring for symptoms in patients w/ ankylosing spondilitis
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Enthesopathies (inflammation at sites of tendon insertion) are common in ankylosing spondylitis. Involvement of the costcovertebral and costrosternal junctions may cause limitation of chest movements, resulting in hypoventilation, which is why the chest expansion should be checked often
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Tracheal deviation clues in a smoker
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Towards side of lesion: most
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