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Cosas
| Question | Answer |
|---|---|
| Replication cycle of the Virus infecting HBV, DNA into bloodstream and development of IgM, against HBc. | Converts viral reverse transcriptase into partially ss-mRNA template to viral DNA. HBV contains ds DNA genome a viral DNA polymerase with reverse transcriptase |
| Essential step in replication of HCV and HIV for viral protease into individual proteins. | Cleavage of precursor polyprotein by viral protease. |
| Integration of viral DNA into the host genome | HIV insert genome into host chromosome (hepatocarcinogenesis) HIV must integrate into the host to replicate. Integrase Inhibitor (dolutegravir) target HIV replication. |
| Pustular skin lesions, thick scabs, urine sediment with red blood cell cast. Organism responsible? | Pyrrolidonyl arylamidase positivity (PYR), gram +, catalase -, Hemolysis Beta complete clear, bacitracin sensitive + group A Strep pyogenes (cellulitis, pharyngitis, erysipelas, impetigo). |
| Nonsuppurative complication of GAS group A Strep pyogenes | ARF acute Rheumatic fever and Glomerulonephritis. Elevated streptococcal antibodies (anti-streptolysin, anti-DNaseB, and anti-hyaluronidase). |
| Trip to Brazil, pruritic eruptions between toes, attribute to barefoot walking in fields, stool reveal smooth thin walled eggs if untreated leads to? | Microcytic anemia (iron deficiency anemia) due to chronic blood loss. Human hookworm (Necator americanus and Ancylostoma duodenale) serpiginous rash, can live in GI for 14 yrs and cause blood loss. Peripheral eosinophilia diagnostic clue |
| Nonproductive cough, wheezing after traveling, resolved after several days and begin with Abdominal discomfort, anorexia, stool shows OVAL egg with thick outer shell and single interior ovum larvae penetrate small intestine wall. | Ascaris lumbricoides (roundworm). Transpulmonary migration of larvae. Can migrate to alveoli and mature. Individual developed LOEFFLER Sx a transient eosinophilic pneuminitis. Transmitted via contaminated water or food. |
| Scarlet fever (group A Strep pyogenes) sandpaper like rash that begins on the neck and upper trunk, associated with fever and sore throat. Complication with RF and Glomerulonephritis 1-5 days treatment | Penicillin V. Group A Strep pyogenes produces pyrogenic exotoxins. Gram + catalase - Hemolysis Beta complete clear, PYR +, bacitracin sensitive, ERYTHROGenic Toxin. |
| Febrile neutropenia fever with Absolute neutrophil <500. They are risk for viral and fungal infections | Invasive pulmonary aspergillosis (chest pain, fever, cough, dyspnea, hemoptysis) chest consolidation nodules or cavitary lesions. Septate NARROW hyphae 45 degrees |
| Chest x Ray diffuse bilateral interstitial infiltrates, fulminant respiratory failure. Lack peptidoglycan no cell wall | Pneumocystis pneumonia(mycoplasma pneumonia) gliding motility ⬆️IgM, cold aggluttinins |
| Ring and cross (Maltese) shape intraerythocytic inclusions, ⬆️Lactate Dehydrogenase ⬇️haptoglobin, | Borrelia burgdorferi (Lyme disease) and Babesiosis(babesia microti) both transmitted by IXODES tick. |
| Mulberry shaped intracytoplasmic inclusions (morulae)in monocytes, transmitted by tick bite (lone star) | Ehrlichia Chaffeensis. Harbored by white tailed deer. Tx doxycycline |
| Tender regional lymphadenopathy and single papulo ulcerative lesión with eschar. Infected by rabbits | Francisella tularensis gram - bacteria |
| Silent or subclinical (anicteric) in young children. It present as acute, self limited characterized by Jaundice, malaise, fatigue, anorexia, vomiting, right upper quadrant pain, aversion to smoking. | Hepatitis A virus, IgG against HAV prior infection |
| HIV with anal Squamous cell carcinoma, Rectal bleeding, hard mass, is a precursor of intraepithelial neoplasias of Cervix, penis, vulva, and anus. | HPV 16, 18 |
| Transformation process take up exogenous DNA into its genome and express encoded proteins. | Streptococcus pneumonia is able to undergo TRANSFORMATION which allows bacterium to take up exogenous DNA. Strep pneumonia do not form a capsule it gain virulence. |
| Inhibits host protein ADP ribosylation EF-2 causes systemic Toxin mediated effects. IgG against circulating proteins against exotoxins B | Diphtheria corynebacterium local(pseudomebranous pharyngitis, cervical lymphadenopathy laryngotracheitis) Systemic(myocarditis, HF, neurologic Toxicity) |
| Tumor necrosis alpha TNF a inhibitors (adalimumab) increases risk of infection with intracellular bacteria and Granulomatous fungi | HISTOPLASMA capsulatum replicates within intracellular space of macrophages and spread from lungs to lymph nodes and reticuloendothelial system (liver, spleen, bone marrow). |
| Invades VILLOUS Epithelium blunting (loss of absorptive capacity) of villi in duodenum and Proximal Jejunum | Rotavirus ds RNA non enveloped segmented fecal oral watery diarrhea |
| Ring form throphozoites, Africa, malaria Plasmodium, erythocytic parasite maybe treated with | Chloroquine (non resistant) atovaquine proguanil and artemisin. Primaquine is required to KILL P. Vivax and P. Ovale Liver hypnozoites. |
| Thick, viscous, clogging secretions, CF includes pancreatic insufficiency, chronic sinusitis, Neal Polyps, chronic bronchitis (barrel chest, hyper inflated lungs, productive cough) | Pseudomonas aeroginosa, forms a biofilm to prevent full elimination from the body, gram -, bacilli rods, lactose -, white colonies Oxidase + |
| Flatulence, foul smelling stools, giarda lamblia, contaminated water. Treatment p | Metronidazole for protozoan flagellate use also for Helicobacter pylori, amebiasis, thrichomoniasis. |
| Erythematous Inguinal swelling indicates bubonic plague. Transmitted by rodents, flea bite. Resembles a closed safety pin | Yersinia pestis gram neg coccobacillus exhibits bipolar staining |
| Pregnant women with febrile gastroenteritis (vomiting, fever, diarrhea) gram + rods | Listeria monocytogenes, motile facultative intracellular. Listeriolysin O (pores in phagosomes escape into cytoplasm avoid lysosomal destruction). Actin based transcellular spread(hijacks actin based cellular motility) third trimester higher risk. |
| Lactose índole positive(ability to convert Tryptophan to índole) gram neg rods | E. Coli UTI |
| Diphtheria Toxin AB exotoxin mechanism | Inactivated EF-2, inhibits protein synthesis and leads to cell death, intracellular protein ribosylation. |
| Coagulase and catalase negative PYR pyrrolidonyl arylamidase positive (necrotizing fasciitis) | Streptococcus pyogene |
| Tzanc positive multinucleated giant cells, infection within S2, S3 and S4 Dorsal root sensory ganglia. | Herpes simplex virus treatment continuous daily valacyclovir. Acyclovir, famciclovir |
| Esophageal Varices and splenomegaly indicate PORTAL hypertension, eosinophilia or bladder cancer sub saharan, Africa, Middle East, Japan | Schistosomiasis a parasitic blood fluke |
| Early Neonatal sepsis, Hemolysis clear, production of CAMP test, Beta Hemolysis enhances with strains of staph aureaus. | Streptococcus agalactiae |
| Gene exchange that occurs through crossing over 2 ds DNA molecules | Recombination |
| Mixing describes the genome segments viruses that infect the SAME host cell | Reassortment |
| Uptake of NAKED DNA by a Prokaryotic or Eukaryotic cell. Alters the genetic composition of host cell | Transformation |
| Thayer Martin medium (chocolate sheep agar contains vancomycin, colistin, thrimethropin, nystatin) | Nasopharynx, Neisseria meningitidis |
| N. Meningitidis transmitted respiratory secretions, treatment | Rifampin penetrates and eliminates nasopharyngeal colonization. |
| Non motile non hemolytic gram positive forms multiple curls that resembles medusa head | Bacillus anthracis, antiphagocytic D-glutamate capsule, also produces exotoxin complex composed of edema Factor, lethal. |
| Pseudohyphae with blastonidia, mucocutaneous infections, candidemia due to Vascular catheter | Candida |
| Yeast with broad based budding, inhaled skin and bone | Blastomyces |
| Spherules with endospores, transient pulmonary syndrome, meninges bone | Coccidiodes |
| Encapsulated yeast, meningitis in AIDS | Cryptococcus |
| Small oval yeast within macrophages, pneumonia | HISTOPLASMA |
| Cephalosporins (cefotaxime, ceftriaxone) resistant organism | Listeria monocytogenes, MRSA , Enterococci ( reason is resistant to Penicillin Binding protein) Atypical (mycoplasma and chlamydia ( reason no CELL Wall) Listeria treatment is Ampicillin |
| Double stranded DNA dsDNA viruses replicate in cytoplasm | Herpesviruses(VZV, EBV, Cytomegalovirus, HHV-6, HHV-8 kaposi), Poxvirus, hepadnavirus, Adenovirus, Papillomavirus, Polyomavirus, Parvovirus(ss DNA replicate in nucleus smallest DNA) |
| Shiga toxin producing bacteria. E. coli 0157:H7 Enterohemorragic E. coli EHEC Shigella. Bloody diarrhea, schistocytes, thrombocytopenia, acute kidney injury | Hemolytic uremic syndrome reservoir contaminated undercooked beef |
| Canned food consumption of preformed botulism toxin | Clostridium botulinum |
| Consumption of dairy (custard), produce, meats, eggs (mayonnaise) salads. Causes abdominal cramping 1-6 hours after ingestion | Staph aureus heat stable enterotoxin |
| Consumption of raw oysters causes voluminous watery diarrhea similar to cholera | Vibrio parahemolyticus |
| Consumption of raw eggs, incomplete cooked poultry causes watery diarrhea abdominal cramping, vomiting and fever | Salmonella gastroenteritis |
| Synthesize fungal CELL WALL polysaccharide | Caspofungin. Most active against candidates abs aspergillosis |
| Synthesizing a fungal cELL membrane abs leads to pore formation lysis | Amphotericin B |
| Bind ergosterol in the fungal cell membrane | Amphotericin B and Nystatin (inhibit synthesis of ergosterol) |
| Binds microtubules and inhibit mitosis. Effective against dermatology te fungi as it accumulates keratin | Griseofulvin |
| SS RNA, mc onset resolves 2-3 days. Vomiting, diarrhea no blood or mucus due to lack of small bowel inflammation | Norovirus is a Calcivirus family linear non enveloped ssRNA |
| Inhibition of bacterial DNA dependent RNA polymerase Side effects GI, rash, red orange body fluids | Rifampin |
| AR, F208 mutation, impairs CFTR function, decreased water content causes thick viscous mucus. Chronic airway obstruction, GI malabsorption. Clinical : recurrent sino pulmonary infections (staphylococcus aureus, pseudomonas aeruginosa & Burkholderia cepa | ⬆️sweat chloride levels, nasal potential difference measurement, genetic testing for CFRT mutations . Male infertility bilateral absence of VAS deferens |
| DNA viruses replicate in cytoplasm | Enveloped : Hepadna (hepB), Herpes (varicella, HSV-1 and HSV-2), pox (smallpox) Non-enveloped : Adenovirus, Papova (HPV), Polyoma (JC, BK) |
| Multinucleated giant cells, vesicles on lips, ds DNA enveloped, fluid between dermis and epidermis | HSV-1 |
| SS-RNA virus | Negative sense Arena(lassa), Bunya (hantavirus), delta (hep D), filo (Ebola, Marburg), orthomyxo (influenza ) paramyxovirus (RSV, mumps, measles), rhabdo (rabies ) |
| Early viral infection before serologic response | Window period HIV p24 positive but negative HIV |
| Papules and pustules with honey crusted lesions, involves face in young children, complication causes facial puffiness, dark urine (poststreptoccocal glomerulonephritis) damages basement membrane | Nonbullous impetigo (staphylococcus aureaus mc. group A Strep pyogenes |
| Microscopic hematuria, proteinuria tea or cola colored urine, periorbital facial swelling, ⬆️creatinine, ⬇️complement C3, damages basement membrane | PSGN Poststreptococcal Glomerulonephritis several weeks after impetigo caused by GAS |
| Antiphagocytic microbial capsule has the ability to cause lung infection, colonized Nasopharynx, has a thick polysaccharide capsule impedes phagocytosis and complement Binding. | Streptococcus pneumonia gram +, lancet shaped organism grows in pairs (diplococci) |
| Alveolar hyaline membranes fibrinous deposits in alveoli and inhibit gas transfer, respiratory collapse | Respiratory distress syndrome and acute respiratory distress syndrome |
| Associated with Diabetic ketoacidosis, immunosuppresion (solid organ transplant, hematologic malignancies, glucocorticoid therapy) affects paranasal sinuses, facial periorbital pain, purulent nasal discharge. | Mucormycosis, rhizopus, absidia are saprophytic fungi, nonseptate 90 degree angle broad hyphae |
| Late tertiary syphilis, vulvar painless indurated module, white rubbery lesion may Ulcerated, involves ascending aortic aneurysm calcification on x rays. High pitched tambour S2 | Gumma |
| Painless ulceration with raised indurated borders, treponema pallidum inoculation (penis or vulva) 3-6 weeks resolved | Chancre primary syphilis |
| Secondary syphilis bacteremic stage following chancre resolution 5-10 wks presents with diffuse macular rash, large gray wartlike growths in genital perineal | Condylomata lata |
| Encodes for major HIV enzymes protease reverse transcriptase and integrase | Pol gene |
| Rocky Mountain spotted fever caused by rickettsia rickettsi, maculopapular rash Appalachian mountains, malaise 3-5 days | Doxycycline inhibits protein synthesis by binding 30s bacterial ribosomal |
| Prevent DNA gyrase and topoisomerase from unwinding bacterial ds circular DNA, treat typhoid fever, Salmonella. | Fluoroquinolones(ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, Enoxacin ⬇️topoisomerase II DNA gyrase |
| Bacterial folate metabolism, inhibits dihydrofolate reductase | Trimethoprim sulfamethoxazole |
| Large, painful coalesced Inguinal lymph nodes (buboes) intracytoplasmic chlamydial inclusion bodies | Agent chlamydia Trachomatis Disease : lymphogranuloma vererum. |
| Multiple ring enhancement | Toxoplasma gondii . Handling cat litter box |
| Seizures, Intracraneal HTN, eosinophilia, ⬆️ESR, exposure to infected stool, taenia solíamos pork eggs | Neurocystercosis Tx albendazole |
| Transplacental transmission to fetus, targets neural progenitor cells, microcephaly, craniofacial disproportion, spasticity, ocular abnormalities, cortical thinning, ventriculomegaly, arthrogryposis(contractures). | Zika virus ssRNA flavivirus |
| Antibiotic resistance causes beta lactamase, ESBL. Mutated Penicillin Binding protein, mutated porin protein | Penicillins |
| Vancomycin is a glycopeptide used to treat MRSA, binds D-Alanine D-alanine | Antibiotic resistance causes mutated peptidoglycan cell wall, impaired influx/increased efflux, D-alanine is replaced by D-lactate leading to resistance of antibiotic |
| Antibiotic mechanism of resistance is the Methylation and binding of the ribosome | Aminoglycoside is a aminoacyl binding 30s ribosomal the cell misread mRNA, interferes with protein translation. |
| Without Haemophilus influenza vaccine that contains PRP polyribosylribitol Phosphate conjugated the child is at risk for | Invasive disease caused by Hib (Haemophilus influenza type b) causes meningitis, bacteremia, pneumonia, epiglottitis. |
| Curved gram negative, free living in salt water, ingestion of raw oysters or wound infection, high risk in those with liver disease and iron overload. | Vibrio vulnificus |
| Decreased osteoclasts reducing bone resorption | Biphosphonates |
| Found in osteoblasts it's activation triggers osteoclasts and stimulates bone resorption | RANK-L |
| Most common cause of hematogenous osteomyelitis in children | Staph aureaus |
| Most frequent cause of osteomyelitis in patients with sickle cell anemia, ⬆️CRP | Salmonella occur in long bones, painful crisis vaso occlusive |
| Alpha agonist nasal spray and oral medication | Phenylephrine |
| Alpha-1 adrenergic Receptor antagonist work by relaxing bladder neck muscles in the prostate helps to urinate | Tamsolusin (flomax) |
| 5-alpha antagonist Inhibitor inhibits the conversion of testosterone to DHT use in BPH and male hair baldness | Dutasteride and finasteride |
| Rare form of chronic pyelonephritis specially associated with proteus, tumor like growth, upper urinary tract infection, lipid laden foamy macrophages | Xanthogranulomatous pyelonephritis |
| Cause peripheral neuropathy due to its depletion of pyridoxine Vit B6. Can also cause drug induce lupus.. required Vit B6 supplement | Isoniazid |
| Respiratory, GI, caused by innefective chloride transport and consequently thick exocrine secretions which clog up the airways and the pancreatic ducts | Cystic fibrosis |
| ⬆️hematocrit >55% mutation V617F in JAK2 gene, pruritus with exposure to hot water, ⬇️EPO | Polycythemia Vera |
| Age child understand the finality of death, preschool kids think death is irreversible | Age 6 |
| Stimulate sebaceous glands and causes acne | Androgens |
| Lancet shaped, gram passive cocci in pairs, nuchal rigidity, confusion fever (meningitis), alcoholics, sickle cell anemia, asplenic (have high risk ) | Streptococcus Pneumoniae mcc bacterial meningitis in ADULTS |
| Bean shaped gram negative cocci in pairs | Neisseria meningitidis second mcc of meningitidis < 60 yrs |
| Motile gram positive rods is a facultative intracellular, 3rd mcc of meningitis in NEONATES after group B streptococcus and E. coli | Listeria monocytogenes |
| Moa similar to that Adenylate Cyclase Toxin increases intracellular cyclic AMP, leading to neutrophil and macrophage dysfunction and tissue edema? | Bacillus anthracis and Bordetella pertussis. |
| Corkscrew shaped pathogen, flu-like illness (fever, myalgia, rigors) conjunctival suffusion, noninflammatory conjunctivitis. | Leptospirosis causednby exposure to water contaminated with animal urine, kayaking, freshwater swimming |
| Free living motile, protozoan parasite that lives in warmth water and soil worldwide. Motile TROPHOZOITES, exposure to recreational water activities, penetration cribriform plate, ⬆️protein, ⬆️neutrophils | Primary amoebic encephalitis, Tx amphotericin B |
| Lifelong latent infection of the sensory ganglion. Latent infection within neuronal cell bodies | Herpes simplex virus |
| Multiple and deep ulcers. Base may have gray to yellow exudate, long parallel strands school of fish. It's painful, sub Saharan, Latin America Asia | Chancroid. Haemophilus ducreyi. |
| Multiple small grouped ulcers. Shallow with erythematous base. Multinucleated GIANT cells and intranuclear inclusions (cowdry type A), sexually transmitted painful initially | Genital herpes HSV 1 and HSV 2 |
| No lymphadenopathy, base may have granulation like tissue. Deeply staining gram negative INTRACYTOPLASMIC cyst Donovan bodies, no pain initially | Granulomatis Inguinal (Donovanosis) Klebsiella granulomatis |
| Single, indurated well circumscribed ulcer, nonexudative base, painless Inguinal lymphadenopathy. Thin, delicate corkscrew shaped organism on dark field. Nonpainful | Syphilis Treponema pallidum agent |
| Small shallow ulcers, large painful coalesced Inguinal lymph nodes (buboes). INTRACYTOPLASMIC CHamydial inclusión bodies in epithelial cells | Lymphogranuloma venereum Chlamydia trachomatis agent |
| Human pubic louse, transmitted sexually via skin to skin, intense pruritus, skin excoriation marks | Phthirus pubis. Treatment topical PERMETHRIN cream block parasite sodium ion in nerve cell membrane |
| Child <3 yr with high fever, rapidly progressive respiratory distress (retraction, stridor) with swollen epiglottis (thumbprint sign) on neck X-ray. | Epiglottis, Haemophilus influenza type B |
| Several needle marks (IV drug users), multiple lung opacities (septic emboli), it can cause perforations in heart valves, rupture chordae tendinae | Staphylococcus aureus causes RIGHT endocarditis |
| Preeclampsia (>20 wks gestation, HTN, 140/90, proteinuria. Spiral arteries remain narrow and tortuous the fetal response to inadequate oxygenation is to slow its GROWTH (fetal growth restriction) and shunt blood from periphery (kidney) to the brain. | Results in ⬆️placental vascular resistance , ⬇️uteroplacental perfusion(hypoxia). ⬇️umbilical vein oxygen delivery. Leads to decreased ⬇️fetal urine output and oligohydramnios. |
| Ischemic (hypotension)nor toxic (radiocontrast) injury to the renal tubular cells. Urinalysis shows muddy brown granular cast NO pyuria. Ischemic injury in PCT and thick ascending limb of henle. | Acute tubular necrosis |
| Rash, fever, acute kidney injury and PYURIA following antibiotics, proton pump inhibitors, NSAIDS (indomethacin) diuretics. Inflammatory infiltration of renal interstitium due to IgE and T cell mediated hypersentivity . Urine show pyuria, WBC cast | Acute interstitial nephritis |
| Produced by Neisseria Meningitidis, N Gonorrheae, Strep Pneumoniae, Haemophilus Influenzae. Is composed of a dimer (joined by a Peptide J chain) | IgA protease, secretory IgA exist in mucosal surfaces bind and inhibit the action of PILI and other cell surface antigens mediate mucosal ADHERENCE and penetration |
| Oral thrush, severe lymphopenia during first year of life (vertical transmission HIV-1 mother to child) | ANtiretroviral therapy in regardless of CD4 count must be given in HIV pregnant Infants receive ZIDOVUDINE as prophylaxis for several weeks |
| Medial Hypertrophy and fibrointimal proliferation, endothelial damage, narrowed arteriolar lumens cause progressive decrease in glomerular ischemia and fibrosis. | Chronic HTN results in hypertensive nephrosclerosis |
| Product of serotonin metabolism and elevated 24 hr urinary level are helpful in diagnosing Carcinoid syndrome, which presents with episodic flushing, wheezing, plaque like deposits of fibrous tissue on the right sided endocardium, causing tricuspid REg | 5-hydroxyindoleacetic Acid (5-HIAA) |
| Occur in older individuals due to atherosclerosis. Narrowed renal Artery causes HYPOPERFUSION of the affected kidney with subsequent ischemic damage (tubular atrophy, interstitial ischemia, glomerular crowding) | Unilateral renal Artery Stenosis (RAS). Contralateral kidney is exposed to ⬆️high BP and show changes of hypertensive nephrosclerosis (arterial wall thickening due to hyaline). |
| HYPOPERFUSION of the stenotic kidney stimulates ? | RENIN release by juxtaglomerular cells |
| Myocardial damage hours to days post MI, neutrophils and macrophages remove necrotic tissue and release cytokines and growth factors that initiate tissue proliferation | Inflammation |
| Days to weeks port MI, transforming growth factor beta (TGF-B) and other anti inflammatory cytokines downregulate the inflammatory response and stimulate FIBROBLAST migration and proliferation. Causing extensive type I and III Collagen deposition. | Proliferation |
| Weeks to months post MI, TGF-B also stimulates production of matrix mettaloproteinase that facilitate Collagen remodeling and crosslinking to form dende SCAR tissue. | Remodeling |
| Released by a variety of cells including macrophages and function as anti-inflammatory cytokines that reduces the formation of FIBROTIC tissue. | INF-B |
| Noncaseating granulomas, transmútalas inflammation, paneth cell Metaplasia, heme positive stool | Chrohn disease |
| Abdominal pain and bleeding mc in older patients, necrosis, thrombus formation and Hemorrhage | Ischemic colitis |
| Infection present with watery diarrhea, abdominal pain, fever. Mucopurulent exudate composed of fibrin, bacteria and neutrophils. | Pseudomembranous colitis due to Clostridium difícile |
| Inflammatory bowel disease, continuous superficial inflammation affecting the mucosa and submucosa with crypt abscesses (neutrophil collection within glandular lumen) and crypt atrophy NO granulomas. | Ulcerative colitis |
| Neutrophil chemotactic agents | C5a, IL8, LTB4, Kallikrein, Platelet activation factor |
| Primary target of HIV | CD4 + T cell MHC II |
| HbF alpha 2 gamma2 (a2 y2). Histidine positive charges binds ONLY Deoxy Hb. HbF has ⬆️affinity for oxygen | ⬇️2,3 BPG because SERINE instead of Histidine LEFT shift on oxygen binding curve. |
| ⬇️synthesis of factors 1972/ C, S protein, splinter hemorrhages, hematuria, melena, ⬆️PT (11-15 sec) ⬆️PTT (25-40) | Vit K Deficiency |
| ⬇️susceptibility to cleavage by activated protein C | Factor Va Leiden |
| ⬇️Ferrochelase, ⬇️ALA dehydratase, ⬇️HEME synthesis, basophilic stippling | Lead poisoning |
| X-linked defect in o-ALa synthase aminolevulinic acid synthase. Prussian blue stained mitochondria Tx pyridoxine Vit B6 | Sideroblastic anemia |
| CD4 cell mediated destruction of parietal cells, loss of intrinsic factor. Do not respond to Vit, cause Megaloblastic anemia, ⬇️K⬇️Hb ⬆️MCV ⬆️Methylmalonic Acid, ⬆️ gastrin | Pernicious anemia |
| Bone marrow shows hypercellular erythroid and granulocytes hyperplasia ⬆️Homocysteine normal methylmalonic Acid | Folate Deficiency |
| Degeneration of the DORSAL columns of spinal cord, causing loss of vibration and position sense, Romberg + ⬆️Homocysteine ⬆️methylmalonic acid | Vit B 12 Deficiency |
| X linked Recessive, ⬇️NADPH ⬇️Glutathione⬆️destruction of RBC, indirect bilirubinemia (jaundice)hemoglobinurua (dark urine) HEINZ bodies, bite cells | G6PD Deficiency |
| DAF decay accelerating factor CD55/CD59 neg COOMBS, spherocytes on peripheral smear | Paroxysmal nocturnal hemoglobinuria |
| Direct Xa inhibitors (Apixaban, Rivaroxaban) | ⬆️PT phrothrombin (11-15) ⬆️ partial thromboplastin tune aPTT but do NOT affect thrombin time TT |
| Have shorter half lives than clotting factors II, VII, IX, X | Protein C and S |
| GpIIb/IIIa inhibitors | Abciximab is from monoclonal antibody Fab fragments Abciximab, epitifibatide, tirofiban |
| Has a LONG half life of factor II | PT (11-15) prothrombin |
| Used to monitor unfractioned heparin | aPTT activated partial tromboplastin time |
| BCL-2 adults (14,18) centrocytes (small cleaved cells) or centroblast, B cell tumor, mc indolent NON hid kin lymphoma | Follicular lymphoma |
| >60 yrs old, mc adult leukemia, SMUDGE cells, CD20, CD5, B cell neoplasm, oncogene BCL-2, ⬇️hypohammaglobulinemia. | CLL chronic lymphocytic leukemia |
| Adult males, mature B cell tumor, TRAP+ cells with cytoplasmic projections, splenomegaly. | Hairy cell leukemia |
| ⬇️Vit D, ⬇️Ca, ⬆️PTH, ⬇️PO4. Soft bones, ⬆️ALP, hyperactivity of Osteoblast, osteoid matriz and widened osteoid rachitic rosary rickets.. | Osteomalacia |
| Provide the majority of the blood supply to femoral head and neck | Medial femoral Circumflex Artery |
| >40 yrs age female, improves with rest, asymmetric joint, <2000 WBC involves DIP (Heberden nodes) and PIP (Bouchard nodes), Hard bony enlargement of joints | Osteoarthritis |
| Female HLA-DR4, anti IgG antibody, anti-cyclic citrullinated peptide antibody (anti-CCP), +RF, +C-reactive, ⬆️ESR >2000 WBC, swan neck, boutonnière, morning stiffness >30 min | Rheumatoid Arthritis |
| ⬇️C3 ⬇️C4, ⬆️Creatinine ⬆️Proteinuria | LES... induced drugs Phenytoin, hydralazine, Procainamide, Isoniazide, Sulfas |
| ⬆️Prolactin, ⬆️1,25 dihydroxy vit D, ⬆️Ca, ⬆️ALP, ⬆️hypercalciuria (urine calcium) IL-2, lysozyme, amyloid A, ⬆️ ACE serum, ⬆️CD4/CD8, noncaseating granulomas, CXR bilateral adenopathy and coarse reticular opacities. CT hilar and mediastinal adenopathy | Sarcoidosis |
| ⬆️CK, +ANA, +anti-Jo-1 (anti-histidyl tRNA synthetase), +anti-SRP, +anti-Mi-2 antibodies. | Polymyositis /dermatomyositis |
| CD8 + T cells, ⬆️anti Jo-1, ⬆️aldolas, ⬆️CK, symmetrical Proximal muscle weakness, ⬆️difficult to climb stairs, getting up from chair. Endometrial mononuclear infiltrate, patchy necrosis | Polymyositis |
| Gottron papules, perimysial inflammation and atrophy with CD4 + Tcells. Associated with cancers, ovarian, lung, colorectal and non hodgk | Dermatomyositis |
| Origin S2-S4 function sensory (perineum) motor (urethral and anal sphincter). | Pelvic innervation - pudental nerve |
| L1-L2 sensory (scrotum/labia majora) Medial thigh | Genitofemoral |
| C5-C6 fracture surgical neck, Anterior dislocation of humerus. Loss arm abduction. | Axillary nerve |
| C5-T1 midshaft fracture of humerus, compression of axila due to crutches. Deep brachial Artery passes inferior to the TERES major muscle and courses posteriorly along the HUMERUS in close | Radial nerve |
| Arises from basilar Artery aneurysm from LEFT ... will cause NON pupil sparring, CN III oculomotor palsy of left. | PCA posterior cerebral Artery |
| Supply Medial portions of 2 hemispheres (frontal/parietal) occlusion of ... can cause contralateral motor and sensory deficits of lower extremities. Behavioral changes and urinary incontinence. | ACA anterior cerebral artery |
| Affect motor control of the hand (gripping) face/mouth (whistling) throat (swallowing) Broca aphasia due to dominant frontal lobe damage. | MCA Occlusion Medial cerebral Artery |
| JAW deviates towards the side of lesion | CN V lesion |
| Uvula deviates AWAY from side of lesion | CN X vagus |
| Impairment shoulder, shrugging (trapezius, SCM) | CN IX glossopharyngeal lesion |
| Shoulder drop on side of lesion (trapezious) | CN XI accessory lesion |
| LMN lesion, tongue deviate TOWARD side of lesion | CN XII lesion hypoglossal |
| ⬆️TLC ⬇️FEV1/FVC ⬇️FVC ⬆️RV ⬇️lung elasticity (from destruction of interalveolar walls), ⬇️limitation of Tidal volume due to hyperinflation | Obstructive lung disease |
| COPD, chronic bronchitis, emphysema | Obstructive lung disease |
| ⬇️lung volume ⬇️lung compliance ⬇️total and residual volumes ⬆️Expiratory flow rate (but ⬇️ reduce in compare to normal ) | Restrictive defect lung disease (alveolar hyaline membrane, pulmonary fibrosis, atelectasis, diffuse Intraalveolar hemorrhage. |
| Abnormally shaped or tear drop shaped RBC, immature RBC (nucleated erythrocytes), WBC (myelocytes), DRY bone Tap marrow (due to fibrous tissue replacement of bone marrow) bone biopsy shows thicknened trabeculae with increased reticulum | Myelofibrosis is a chronic myeloproliferative disorder |
| Is an acute leukocytosis in response to infection, presents with bands (due to left shift fast production of WBC and neutrophils) immature leukocytosis, ⬆️elevated leukocyte alkaline phosphatase Difference between leukemoid has ⬆️LAP and CML has ⬇️LAP | Leukemoid reaction |
| Child with diffuse eczema (seborrheic) type rash, lytic lesions on X-ray. Tennis racket shaped granules, bilamellar granule in cytoplasm | Cells are derived from DENDRITIC cells. Langerhans histiocytes. |
| Holosystolic murmur similar to MR/AR, loudest at tricuspid region, harsh, increase with inspiration, ⬆️overload handgrip, usually a young child. | VSD |
| Best heard at APEX with radiation towards the axilla, | Mitral regurgitation |
| Loudest at tricuspid with radiation to the RIGHT sternal border. Usually a IV drug abuser | Tricuspid regurgitation |
| ⬆️tryglicerides, lipid lowering agent that has greatest effect on triglycerides. Fasting only affects TG measurement. It also ⬇️lower cholesterol and ⬆️raise HDL, upregulate lipase. | FIBRATES (fenofibrate, gemfibrozil, clofibrate, bezafibrate) first line treatment |
| RENIN is released from the kidney.. RENIN ⬆️increases angiotensin II and ⬆️ Aldosterone which can cause ⬇️K hypokalemic metabolic alkalosis. Angiotensin I is converted to angiotensin II in the LUNG. Aldosterone promotes Na absorption and K excretion. | Renal Artery Stenosis is due to a release of RENIN from kidney. |
| Increased in RENIN and shuts OFF angiotensin II and BP will drop⬇️, then PLASMA renin feedback increases ⬆️and help promote ⬆️increase blood flow to the kidney. | ACE-I captopril, enalapril, ramipril |
| Promotes Na absorption and K excretion, promotes excretion of H+ for which every H+ excreted, bicarbonate HCO3 is absorbed. (Explains hypokalemia metabolic alkalosis. | Aldosterone |
| Unable to flex index fringed and the flexora of the fingers. Flexion of the wrist, MCP and interphalangeal joints (2-5 digits) is controlled by? | Flexor Digitorum Profundus tendon comes from flexor digitorum muscle. |
| HAART therapy for HIV started with 3 antiretroviral medications that include? | 2 nucleoside Reverse Transcriptase inhibitors (NRTI) plus either 1 non-nucleoside Reverse transcriptase inhibitor or 1 protease inhibitor or 1 integrase Inhibitor. Viral resistance can occur when there are 2 or more mutations of the target proteins. |
| Anyone diagnosed with HIV, triple therapy always begun to prevent resistance. 2 nucleoside reverse transcriptase Inhibitor and I protease inhibitor or integrase. | Reverse transcriptase and Protease |
| Randomization of pts into study group in randomized control trials is done to improve study quality and control differences between 2 groups. | Two groups with similar underlying characteristics |
| Placenta is near or overlies the CERVICAL OS, and can lead to painless bleeding during any trimester during pregnancy. | Placenta Previa |
| Vaginal bleeding with pain, occurs during THIRD trimester only. | Abruptio Placentae. |
| Ethanol is metabolized by alcohol dehydrogenase to acetaldehyde, which is then metabolized to acetaldehyde Dehydrogenase to acetate. Is telling variant enzyme K487 is much slower than native variant so efficacy of the enzyme.. | Decreased catalytic efficiency of K487 |
| Alcohol dehydrogenase in cytosol of the hepatocyte. Then acetaldehyde dehydrogenase in mitochondria. NAD limited reagent. | Ethanol 2 metabolized enzymes.. |
| Deficiency of enzyme acetaldehyde dehydrogenase, acetaldehyde builds up and causes | Facial flushing and ⬆️increase HR (also a bad hangover) |
| Post infection and inflammatory states leads to FIBROBLAST proliferation and increase.... deposition. Within 2-3 days of infection inflammatory process into peritoneal cavity, fibroblast and myofibroblast join neutrophils and macrophages to laying down? | FIBRIN. |
| Chronic pancreatitis the enzymes that causes inability to digest triglycerides? | Pancreas secretes enzymes Lipase, Phospholipase A and Colipase to digest FAT. |
| Pancreas for starch digestion secretes? | Alpha Amylase |
| For Protein the pancreas secretes | Protease andnTrypsinogen |
| First and second most common cause of LOWER GI bleeding? | Diverticulosis and Angiodysplasia |
| Dilation and tortuosity of blood vessels in the mucosal layer of the colon that can easily bleed. Is associated with Aortic stenosis, Von Willebrand factor Deficiency. Due to prone bleeding in weak areas exposed to blood vessels in the colon. | Angiodysplasia. |
| Diffuse Scleroderma and CREST (C calcinosis, T telangiectasia) are progressive fibrosis and Collagen disorders. Scleroderma can lead to | Pulmonary hypertension |
| Skin tightening that disappear wrinkles, causes claw like formation on hands (inability to extend fingers), esophageal dysmotility manifest as esophageal reflux, associated with slc-70 anti DNA topoisomerase I, CREST associated with anticentromere. | Diffuse Scleroderma |
| During 3rd trimester manifest as painful vaginal bleeding, blood appears DARK RED due to venous blood. Risk factors: trauma, HTN, smoking, preeclampsia, cocaine abuse, uterine fibroids. | Abruptio placentae (placental abruption) |
| Placenta attaches to myometrium without penetrating it. Curettage shows FIBROUS nodule of placental tissue firmly adherent to wall. Incomplete separation after delivery. Risk severe Hemorrhage. | Placenta accreta |
| Placenta penetrates INTO myometrium | placenta increta |
| Placenta penetrates (perforates) through myometrium and into uterine serosa invades ENTIRE uterine wall. | Placenta percreta |
| Hypopituitarism is less severe. Failure postpartum lactation and failure to resume menses, anorexia, fatigue, ⬇️GH, ⬇️Prolactin, ⬇️ACTH, ⬇️TSH, ⬇️Gonadotropin, ⬆️Aldosterone. | Sheehan Sx |
| Auer rods (intracytoplasmic)are deformed azurophilic granules found in cytoplasm. APL (acute promyelocytic leukemia) formerly M3 AML, ⬆️⬆️myeloblast, transient proliferationof myeloid. High risk for DIC. | Acute myeloid leukemia t(15:17) |
| BCR-ABL result in FUSION protein gene, that inhibits apoptosis while promoting mitogenesis and increase TIROSINE KINASE Receptor that promotes malignant cell proliferation in .... clinical splenomegaly, excessive sweating, band forms, ⬇️⬇️LAP Leuko alkali | Chronic myeloid leukemia t(9,22) Philadelphia BCR-ABL |
| Associated with V617F JAK2 mutation, substitutes phenylalanine resulting in tyrosine phosphorylation then cytokine activation of JAK-STAT | Myeloproliferative disorders : polycythemia Vera, essential thrombocytopenia, myelofibrosis and CML. |
| Intense itching after hot shower, erythromelalgia (severe burning pain red blue coloration) due to blood clots on extremities. Carcinoma associated with... ⬆️RBC mass | Polycythemia Vera known as primary erythrocytosis |
| Tortuous dilation of vessels, hematochezia. Found in cecum, terminal ileum, ascending colon. Right colon. | Angiodysplasia |
| Small bowel necrosis causes acute abdominal pain out of proportion, currant jelly stools, bloody, hx of atherosclerotic ⬇️BP HF, shock (hypovolemic tachycardia, ⬇️urine output, ⬇️BP cold clammy, ⬇️CO⬆️systemic vascular resistance afterload | Acute mesenteric ischemia |
| Associated with adenovirus rotavirus vaccine enteric bacteria , in children terminal ILEUM invaginates into cecum. Sausage like palpable mass at the UPPER quadrant, current jelly stools, Peyer patch Hypertrophy, bulls eye appearance on usg. P | Intussusception it can be a complication of Henoch Schonlein púrpura obstruction ileoileal. |
| A complication is hypocalcemia may be caused by sequestration via intraperitoneal saponification of calcium and later sepsis. Hypocalcemia causes excitability of nerve and muscle cells ECG shows QT prolongation, Chvostek sign by facial CN VII tapping over | Acute pancreatitis |
| ⬇️⬇️LDL, prevent cholesterol absorption at small intestine brush. Inhibits cholesterol uptake by intestinal by blocking specific transporters | Ezetimibe side effect ⬆️LFT ⬆️hepatotoxicity if given with statins (lovastatin, simvastatin, rosuvastatin) |
| Inhibits CHOLESTEROL 7-a-Hydroxylase which catalyze rate limiting in bile acid synthesis, activates peroxisome proliferator activated receptor alpha (PPAR-a) ⬇️⬇️⬇️TG ⬇️VLDL | FIBRATES (gemfibrozil, bezafibrate, fenofibrate) Fibrate + statin = myopathy. Fibrate + bile resin(colestipol, colesevelam,cholestyramine) = gall stones |
| Inhibits lipolysis (hormone sensitive Lipase) in adipose tissue, reduces hepatic VLDL ⬇️fatty acids release, ⬇️HDL clearance.. side effect red flushed face with NSAID or long term use, hyperglycemia hyperuricemia | Niacin(Vit B3) |
| Binds M3 muscarinic Receptors and leads to an increase intracellular calcium | ACh |
| Binds H2 Receptors and increase cAMP | Histamine |
| Inhibits gastric and pancreatic Lipase, helps breakdown and absorption of dietary fats. Use in weight loss suppresses appetite | Orlistat |
| Release by juxtaglomerular cells (kidney) AFFERENT arterioles. Secreted in response to sympathetic stimulation, ⬇️BP⬆️Na in tubular mácula densa. B1 effect | Renin |
| ⬆️central blood volume (combined volume of blood in heart cavities, lungs, central arterial) ⬆️sympathetic stimulation/quick response, ⬇️ADH (vasopressin) responds to low⬇️blood volume, ⬆️ANP(release from atria in response to ⬆️volume check on RAA | Physiologic changes in COLD water <60 degrees |
| ⬆️ANP ⬇️RENIN ⬇️aldosterone ⬇️angiotensin ⬇️ADH | Healthy individual with transient increase of BP after rapid load of 2 liters of saline 0.9% infusion causes? |
| Released by interstitial cells in peritubular capillary in response to hypoxia. Is a pro-erythroblastic growth factor produced in kidney. CKD can be ANEMIC secondary to la know it. Can stimulate Erythrocyte production,stimulate RBC production | Erythropoietin... side effect: ⬆️BP, ⬇️ferritin, ⬇️serum iron, edema (Darbepoetin) |
| Large dose of anticoagulant CITRATE with the blood manifest as muscle cramps, tetany, perioral paresthesia, Chvostek sign produces ipsilateral contraction of muscle | Massive blood transfusion has a risk of hypocalcemia |
| Causes of HTN ⬇️K hypokalemia ⬇️renin ⬇️aldosterone | Non aldosterone causes : Congenital adrenal hyperplasia, deoxycorticosterone producing adrenal tumor, Cushing syndrome, exogenous mineralcorticoids |
| Causes of HTN ⬇️K hypokalemia ⬆️renin ⬆️aldosterone | Secondary HYPERaldosteronism: renovascular hypertension, malignant Hypertension, renin secreting tumor, diuretic use, renal Artery Stenosis (metabolic alkalosis) |
| Paroxysmal ⬆️BP with tachycardia, pounding headache, palpitations, diaphoresis adrenal incidentaloma | Pheochromocytoma |
| Foul smelling stool, steatorrhea, colicky abdominal pain after solid food, blunting villi and crypt hyperplasia in small intestine | Celiac sprue. Is a DYSFUNCTION of Enterocyte |
| Serves as primary site for nutrient digestion and mucosal absorption, synthesize and secretes mucus in superficial Epithelium | Goblet cells |
| Secretes hydrochloric Acid HCI and intrinsic factor. Located in gastric glands of fungus and cardia | Parietal or oxyntic cells |
| Región underventilated but well perfumed will lead to an increase in? Is created when ventilation decreases and perfusion remains constant or high. V/Q mismatch(if you have obstructed airway) | Physiologic shunt, with 100% oxygen back to the heart oxygen won't improve oxygenation in case of shunt |
| When perfusion goes ⬇️down and ventilation remains the same, gas exchange doesn't take place such as trachea. | Dead space is created meaning oxygen is in the alveoli but no blood taking away oxygen with 100% oxygen improves oxygenation in dead space due to less perfusion in lungs |
| V alveolar ventilation , Q pulmonary blood flow (perfusion) normal | V/Q = 0.8 |
| Pharyngeal pouch associated with superior parathyroid glands, ultimobrachial body. Associated with superior laryngeal branch of vagus CNX. Aortic arch TRUE Aortic arch, subclavian arteries. | 4th pharyngeal pouch migration of endoderm |
| Pharyngeal pouch associated with thymus, inferior parathyroid migration from endoderm. Associated with glossopharyngeal CN IX Aortic arch common carotid artery, Proximal internal carotid artery. | 3rd pharyngeal pouch |
| Pharyngeal pouch associated with Epithelium of middle ear and auditory tube, associated with trigéminal V | 1st pharyngeal pouch |
| Neck mass MIDLINE | Thyroid |
| Neck mass ANTERIOR sternocleidomastoid, | Brachial cleft CYST |
| Neck mass POSTERIOR a sternocleidomastoid | CYSTIC Hygroma |
| Neck mass within sternocleidomastoid | Hematoma and Torticollis |
| Teratogens (valproic acid) place the fetus a the highest risk of birth defects | 3-8 weeks of pregnancy which is when organogenesis occurs. |
| Interstitial nephritis occurs days to weeks after starting a drug (ibuprofen,acetaminophen(Tylenol ) diuretics, Penicillin, cephalosporins, sulfa drugs, rifampin) a renal biopsy shows? UA shows protein levels, ⬆️WBC eaoninophils | Inflammatory infiltrates in the interstitium. If overdose can cause fulminant hepatic failure |
| NSAID the onset can be MONTHS after taking the NSAID to induce a kidney reaction | Interstitium inflammation with sparing of the glomerulus |
| Kidney exhibit uneven scarring along with blunting and dilation of the calyces | Chronic pyelonephritis |
| Histology shows infiltrative nest and islands of pleomorphic Squamous epithelial cells, keratin pearl, risk factor schistosomiasis haematobium. | Squamous cell carcinoma of bladder |
| Histopathology shows increased number of epithelial cell layers within the papillary folding of the mucosa. | Transitional cell carcinoma |
| Composed of nest and sheets of dark blue cells under hematoxylin, childhood 2-4 yrs, loss of function WT1 or WT2 on chromosome 11, flank mass | Wilms tumor nephroblastoma |
| Glomerular basement thickening eosinophilic nodular glomerulosclerosis kimmelstein Wilson lesions, damage to podocytes result in albuminuria, mesangial expansion | Diabetic glomerulonephopathy. |
| Granular deposits IgG and C3, when statin with silver spike and dome with sub epithelial deposits in capillary wall, right sided varicocele indicates renal vein thrombosis, diffuse capillary | Membranous nephropathy membranous Glomerulonephritis |
| Segmental sclerosis and hyalinosis, deposits of IgM, C3, C1 effacement of foot process | Focal segmental glomerulosclerosis |
| Lipid seen in PCT, effacement podocytes, no staining, children 2-8 disorder in glomerular capillary loops, proteinuria >3.5, hyperlipidemia hypoalbuminemia, urinary sediment acellular. Overproduction of IL-13 causes damage to podocyte | Minimal change disease (lipoid nephrosis) |
| SUBPERIOSTEAL ⬆️ resorption with cortical thinning, ⬆️Ca, ⬆️1,25 dihydro vit D ⬆️bone resorption ⬆️PTH ⬆️ALK ⬆️cAMP in urine, ⬇️P04 hypophosphatemia | Primary hyperparathyroidism |
| Prominent cement lines hypovascular, bone specific alkaline phosphatase ALP! Osteocalcin propeptides of type I Collagen. Bone forming cells, lay down bone matrix and later calcified | Osteoblast |
| ⬆️increases the replication of Osteoblast leading to increased formation of mature Osteoblast also ⬆️increases Collagen and decreases ⬇️bone resorption by ⬆️Osteoblast apoptosis | TGF-Beta |
| Dissolves by secreting H+ and collagenases. Differentiates from a fusion of monocytes, macrophages lineage, bone resorbing cells, Tartrate resistant Acid phosphatase, urinary hydroxyproline and urinary deoxypyridinoline reflect the activity. | Osteoclasts |
| ⬆️IL-1 production and ⬇️osteoprotegrin and these drive osteoclasts activation | PTH Binding to Osteoblast |
| Macrophage colony stimulating factor (M-CSF) and the receptor for activated nuclear factor kappa B ligand (RANK-L) stimulate the development of mature | 2 most important factors in OSTEOCLASTS |
| Causes osteoporosis y ⬇️osteopretegerin production ⬆️RANK-L production and ⬆️RANK expression in osteoclasts | ⬇️low ESTROGEN |
| Contractile mechanism in skeletal muscle depends on proteins | Myosin II, actin, tropomyosin and troponin and calcium ions |
| Prevents crosslinking between actin and Myosin. | Tropomyosin |
| Cross bridge ADP phosphate complex | Myosin |
| Inhibits osteoclast activity to ⬇️bone resorption. Secreted by parafollicular C cells of the thyroid | Calcitonin |
| Binding to troponin C shifts tropomyosin away from the myosin binding site on actin | Calcium |
| In men is released from SERTOLI cells of testes to inhibit FSH production | INHIBIN B |
| In women stimulates secretion of INHIBIN B from granulosa cells of the ovary which then suppress... the release from anterior pituitary | FSH |
| Do not provide adequate NEGATIVE feedback on FSH secretion thus FSH tend to elevate in males who have ONLY One testicle (⬆️FSH) | ⬇️LOW inhibin B |
| Inhibit both GnRH and LH but INHIBIN B only inhibit FSH | Testosterone |
| ⬆️increases synthesis of ANDROGENS due to LH stimulation which gets converted into ESTRADIOL within granulosa cells | THECA Cells |
| Positively feedback (activation) on anterior pituitary at MIDCYCLE in response to LH surge causes | ⬆️FSH ⬆️LH |
| Increase hepatic cholesterol uptake, ⬆️HMG-CoA reductase which increase ⬆️cholesterol formation. BOTH causes increase cholesterol GALLSTONES | Estrogen |
| Catalizes conversion of androstenedione to 17 beta Estradiol | Aromatase |
| Acts on theca cells, ⬆️ activity of cholesterol desmolase | LH |
| Acts on granulosa cells ⬆️activity of aromatasa ⬆️secretion of 17 beta Estradiol | FSH |
| Made in testicles by Aromatase in leydig cells that secrete testosterone | Estradiol |
| Yellow thecal cells, presents as meigs syndrome (ovarian mass, ascites, pleural effusion) is an ovarian cell tumor | Fibroma |
| Ovarian cell tumor that shows pink Sertoli cells with tubules or cords same as testes. Hyperandrogenism (amenorrhea, hirsutism, deepening voice, male pattern baldness, acne, clitoromegaly). | Sertoli-Leydig |
| Tumors are unilateral and large, they secrete estrogen and present with hyperestrogenism, postmenopasual bleeding with thickened endometrium. Call exner bodies (cells in rosette pattern) | Granulosa theca |
| During luteal phase secretory day 14-28 causes | ⬆️progesterone, ⬆️estrogen, ⬇️fsh ⬇️LH due to NEGATIVE feedback |
| Glands are dilated and coiled and contain wide lumen, stroma volume (edema) | Mid secretory (luteal) phase endometrium day 21 |
| Responsible to EXTERNAL rotation innervated by syprascapular nerve | Infraspinatus and teres minor |
| Treatment of choice for oral candidiasis, tongue thrush, pharyngeal esophageal, inhaled corticosteroids used without chamber | Nystatin mouthwash |
| Inhibits the release of acetylcholine which activates the Nicotinic Receptors necessary for skeletal muscle contraction | Botulinum toxin |
| Acid base pH with severe acidosis (⬇️pH (7.35-7.45), ⬇️PaCO2 (33-45), ⬇️HCO3(22-28) and alkalosis with acidosis. Respiratory alkalosis and ANION GAP metabolic acidosis | Aspirin (salicylate) intoxication |
| Varicose veins, incompetent valves allow reflux of blood into the dependent feet and legs. | Blood ⬆️increases HYDROSTRATIC pressure causing edema. |
| Electrical alternans (usually cardiac tamponade) heart cannot fill properly, preload decreases, hypotension, tachycardia, fluid back up ⬆️JVP | Big pericardial EFFUSION (electrical alternan) |
| Characterized by immune destruction of platelets by anti Platelet antibodies, ⬇️platelets, ⬆️bleeding time (2-7 min), antibodies against glycoprotein IIb/IIIa complex, petechia, epistaxis easy bruising in childhood develops after VIRAL infection. | Idiopathic Thromcocytopenia Púrpura (ITP) |
| Pt don't bleed only ⬆️platelets, normal PT, PTT and fibrinogen. Inhibition or Deficiency of ADAMS13 (vWF metalloproteinase) schistocytes (helmet no central pallor RBC), ⬆️LDH, ⬆️creatinine | Thrombotic Thrombocytopenic Purpura TTP |
| Thrombocytopenia (low platelet count), microangiopathic hemolytic anemia (spherocyte (round pink no central pallor) splenomegaly, negative COOMB, ⬆️Bilirrubin indirect, ⬇️haptoglobin), altered mental status, renal failure and fever | Pentad TTP thrombotic thrombocytopenic Purpura |
| Sore throat, adenopathy, positive HETEROPHILE antibody test means | Mononucleosis by Epstein Barr Virus |
| Inhibit rate limiting beta oxidation of fatty acids. Resting muscle requires less energy for acid breakdown than active muscle. | Malonyl CoA |
| Low ST elevation, pleuritic chest pain, alleviated by sitting up and leaning forward, distant heart sound | |
| Pericarditis | |
| Distributed Purpura as a result of extramedullary hematopoiesis | Congenital rubella. |
| Lots of exercise followed by renal failure, dark urine, can cause false positive urine dipstick | Rhabdomyolysis |
| Superior rectal Varices cause | Internal hemorrhoid |
| Periumbilical Varices can cause | Caput medusa |
| First reverse transcriptase Inhibitor associated with anemia secondary to red cell aplasia, reactivación parvovirus B19 after treatment can cause aplastic anemia. | AZT zidovudine |
| Continuous mucosal involvement starting in the rectum and extending proximally, more likely extra GI symptoms such as uveitis, risk for colon cancer. | Ulcerative Colitis |
| Complicated by fístulas, and abscess formation, marked transmural involvement with skip lesions that can extend from mouth to anus. | Chrohn disease |
| Inherited lysosomal defect enzyme glucocerebrosidase, accumulation of glucocerebroside, reticuloendothelial cells cannot perform their function, accumulates foamy macrophages | Gaucher |
| When physician makes decision for patients instead of providing them with options. | Paternalism |
| Lymph nodes from TESTES drain | Para Aortic lymph nodes |
| Lymph nodes from scrotum drains | Superficial Inguinal lymph node |
| Originates BELOW dentate line, Squamous Epithelium innervated from the INFERIORrectal nerve where Pain is mediated | External hemorrhoids |
| Sweating, piloerection, dilated pupil, fever, rhinorrhea, diarrhea | Opioids withdrawal |
| Mercury poison treatment | Dimercaprol |
| Delirium tremens, crawling bugs on skin | Alcohol withdrawal symptoms |
| Use for control of AF, ⬇️conduction velocity, ⬆️ERP, ⬆️PR interval side effect: constipation, gingival hyperplasia | Verapamil, diltiazem (anti arrhythmic Ca blockers class IV) |
| ⬆️serum ammonia, ⬆️urinary orotic acid, ⬇️blood urea nitrogen | Orotic acid crystals |
| ⬇️calcium ⬆️phosphorus ⬇️PTH, it causes QT prolongation, Chvostek facial CN VII tapping, Trosseu sign | Hypoparathyroidism |
| ⬇️ calcium , ⬆️phosphorus ⬆️PTH characteristics of | Retail failure |
| ⬆️Calcium, ⬇️phosphorus ⬆️PTH, short stature, round facies, shirt 4th/5th digits | Primary Hyperparathyroidism |
| ⬇️calcium, ⬆️phosphate⬆️PTH | Albright hereditary Osteodystrophy |
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