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Usmle Step 1

light amyloid chain (seen in which type of amyloidosis: systemic or local?) systemic amyloidosis
heavy amyloid chain deposition in which type of amyloidosis (systemic or local)? localized ie heart amyloidosis, kidney
hib vaccine mixed with what toxoid component, what is its formal name, and why is this done? diptheria toxiod or tetanus toxoid -> T cell stimulation -> further b cell stimulation by T cells -> Class switching from IgM to IgG -> much better immunity. protein is PRP polyribiose ribitol phosphate
HIb vaccine schedule? 2, 4, 6, 15 months
kawasaki disease is associated with which cardiac complication myocardial infarction, and coronary artery aneurysm
pulmonary hypertension seen most commonly in which autoimmune disease? Scleroderma
which systemic vasculitis causes hepatic necrosis PAN (also viral hepatitis)
MHC 1 consists of ? B2 Microglobulin and HEAVY chain only - heavy chain is highly polymorphic
MHC 2 consists of ? alpha and beta polypeptides
Argatroban use, montior with, MOA? use:anticoagulant, use in thrombosis in pts with Heparin Induced Thrombocytopenia, and percutaneous coronary intervention. monitor: PTT MOA : direct thrombin inhibitor. DOES NOT REQUIRE ANTITHROMBIN III, therefore used in patients already on heparin.
most common cause of thrombocytopenia in hospitalized patients is? heparin (mostly with unfractioned heparin ,vs low molecular weight heparin>)
how to treat thrombosis in Heparin Induced Thrombocytopenia patients? argatroban (direct thrombin active site inhibitor), lepirudin , hirudin, bivaliruden
all normal females are mosaic at x chromosome : T or F - What is the Mechanism and the microscopic result True - all females with 46 xx - one x is deactivated by LYONIZATION - randomly - makes all normal females MOSAIC. Mechanism is formation of heterochromatin (low transcriptional activity) and BARR BODY is result.
euchromatin formed by ? Heterochromatin formed by ? (MOA) Euchromatin is HISTONE ACETYLATION -> high transcriptional activity Heterochromatin - condensed via methylation - > CYTOSINE -> MethylCYTOSINE.
standard rx for CHF and one extra drug which improves overal survivability - what is the mechanism of this - (low or high dose required) Standard rx = Ace Inhibitor, Diuretic (not spiro) and Digoxin. extra drug is spiro /epleronone -> blocks ALD - (aldosterone increases cardiac remodeling -> fibrosis)
process and intracellular locations of insulin production starts in beta pancreatic cell - proinsulin forms -> RER - > packaged and sent to GOGI apparatus here, convertase cleaves it into 1)insulin 2)C-peptide 3) 2 pairs of BASIC amino acids. C pep+insulin packed secretory granules- >equimolar release
common presentations of neurofibromatosis type 1 , genetic defect and chromosome, tumor, and origin vonrecklinghausen disease - NF1 , ch 17 cafe au lait spots, rubbery tumors -> neurofibromas -> tumor of schwann cells -> neuroectoderm. buttonholing
Ectoderm develops into? skin, appendages, nasal, oral epithelium, anal to dentate line, lens and cornea
Neuroectoderm gives rise to? all neurons, neurohypophysis, retina, pineal gland, pregant autonomic fibers, astrocytes, ependymal cells, choroid plexus.
mesoderm - dived into? gives rise to? 3 sections - para-axial, intermediate, lateral leads to muscles bones blood genitals, dermis and most organs - not liver, pancreas, lungs, outpouching of gut, or thyroid (base of tongue)
endoderm - thyroid (base of tongue), epithelial lining of GIT, lung, urethra, ear. also LIVER, PANCREAS, LUNG becuase these are all outpouching of privitive gut tube
Notocord- regreses but leaves vestigal structure nucleus pulposus (vertebrae form form paraaxia mesoderm)
organophosphorous poisoning - symptoms and MOA MOA - anticholinestrase at both N and M rec. symptoms are : DUMBELS d-diarrhea&diaphroesis, U-urination, M-miosis (pupillary sphincter), B-bronchospasam and + secretions, E - emesis, L - lacrimation and S - salivation
type 1, alpha error reject null when null is really true ie - seeing a difference when no differece is there - convicting an innocent man of being guilty. alpha is the probability of this happening. depends on p=0.05 ~ 5% chance that you will get thiserror type 1 = b/(b+d)
type 2, beta fail to reject null but null was truly false. ie seeing NO effect, but there was one. declaring a guilty man innocent. beta is the probability - set at 0.2 there 80% chance of rejecting null when null is truly false.
how is trypsinogen activated? where? what ezyme? trypsinogen from pancreas -> trypsin by duodenal epithelial cells - enteropeptidase. trypsin -> breaks down protein to dipeptide and AA's. activates other proteases ie carboxypeptidase, elastase, and chymotrypsin.
what enzyme allows usage of glycerol in liver? glycerol kinase - TG is broken down into Glycerol and Fatty Acid FA -> beta oxid or ketogenesis, Glycerol -> GLYCEROL KINASE (liver only) to glycerol3p->Dhap->glycolysis/neogenesis. TG stored in adipose-mtblz to FFA+glycerol by hormone sensitive lipase
hepatic angiosarcoma - which carcinogens? which marker? true origin cells? polyvinyl chloride (plastic), thorotrast (radioisotope), arsenic (pesticide) express CD 31 AKA PECAM 1 (seen on vascular endothelial cells for WBC migration - thus true origin is vascular endothelial cells
injury to axillary nerve caused by what injury and what symptoms ? anterior dislocation on shoulder -> paralysis of deltoid and teres minor and sensory loss to upper lateral arm.
violent stretch between head and shoulder causes? symptoms? upper trunk -> erb duchenne palsy -> adducted, pronated extended elbow.
mastectomy or any axillary surgery - damaged nerve? symptoms? long thoracic nerve -> serratus anterior paralysis -> winging scapula and inability to abduct arm beyond 90 degrees.
hepatic angiosarcoma - which carcinogens? which marker? true origin cells? polyvinyl chloride (plastic), thorotrast (radioisotope), arsenic (pesticide) express CD 31 AKA PECAM 1 (seen on vascular endothelial cells for WBC migration - thus true origin is vascular endothelial cells
injury to axillary nerve caused by what injury and what symptoms ? anterior dislocation on shoulder -> paralysis of deltoid and teres minor and sensory loss to upper lateral arm.
violent stretch between head and shoulder causes? symptoms? upper trunk -> erb duchenne palsy -> adducted, pronated extended elbow.
mastectomy or any axillary surgery - damaged nerve? symptoms? long thoracic nerve -> serratus anterior paralysis -> winging scapula and inability to abduct arm beyond 90 degrees.
defective CFTR transmembrane protein gating of Cystic Fibrosis? ATP-gated! pumps cl- out of epithelial cells against [] gradient using ATP - drawing water and Na along with it - hydrating and promoting secretion (airways, gut, pancreas)
why high chlordie in sweat of Cystic Fibrosis patients? in eccrine sweat glands, sweat starts as isotonic to plasma but in transportation, salt is removed by CFTR but the defect prevents this thus high sweat chloride - good screening test
antibiotics causing hearing and vestibular function loss aminoglycosides and vancomycin rarely also cause neuromuscilar blockade (aminoglycosides)
hepatic function monitoring required with whhich anti TB drugs iNH, rifampin, pyrazinamide
complete blood count monitoring with which antibiotics? chloramphenicol, dapsone, TMPSMX
most renal toxic AB's? AM-B and aminoglycosides -> ATN
optic neuritis, scotoma, colorblindness, decrease visual acuity caused by which AB? ethambutol
forcarnet - details about it - activation? use? MOA? administration. pyrophosphate analog, no activation required . inhibits DNA pol in HERPES and RTase in HIV. IV admin, rx advanced Advanced sids w/ acyclovir resistant herpes and gancyclovir resistnt CMV
Acyclovir MOA nucleoside analog.activated intracellularly to MONOPHOSPHATE by viral THYMIDINE KINASE, convert monophosphate THEN is converted to TRIphosphate by CELLULAR KINASE - which is active - inhibits herpesvirus DNA polymerase mediated replication .
Lamivudine cytosine analog -NRTI - must phosphorylate by cellular kinase. inhibits HIV rev transcription through viral DNA CHAIN TERMINATION.
Saquinavir no intracelluar activation required- is a PROTEASE INHIBITOR binds catalytic site of HIV ASPARTIC PROTEASE - prevents cleavage of polyprotein precursors necessary for generation of functional viral proteins.
Gancyclovir guianine nucleoside analog - structurally simiar to acyclovir. requires conversion to monophosphate - has GREATER ACTIVITY THAN ACYCLOVIR VS CMV Dna Polymerase.
Amantadine - antiviral agent - no activation - bind and INHIBITS M2 ion channel protein of Influenza A, blocking viral UNCOATING after host cell endocytosis.
oseltamivir no activation required, sialic acid analogue - inhibits influenza A and B (vs amantadine ONLY A)
platelets release what factors to cause proliferation of atherosclerotic plaques PDGF, TGF-b, SMC. these stimulate smooth muscle cell migration from media into intima as well as SMC proliferation.
beta lactamase producing bacteria list how to make penicillins work against these? S.aureus, H.influenza, bacteroides, gram - bactera. rx with sulbactam, tazobactam, clavulinic acid.
CEA -> ? AFP -> ? ACID Phosphatase-> CA-125 -> AFP - liver DZ, cirrhosis, yolk sac tumor CA-125 - not effective screener - ovarian ca, endometrial, lung, breast, pancreas ca - benign also ie endometriosis , PID, cirrhosis. Acid Phosphatase - prostate esp osteoclastic bone activity. CEA - ca colon
alzheimers MRI what is atrophied ON MRI hippocampal atrophy is first to be seen and better seen on MRI - later its generalized cortical atrophy
Idiopathic Membranous Nephropathy - common in what group, exactly pathophysiology elderly - find serum AB's vs PLA2R phospholipase A2 Receptor IgG4 -> immune complex deposition. PLA2R mostly found in GLOMERULAR Podocytes - is the major antigen in IDIOPATHIC memb glom neph.
Mixed cryoglobulinemia ? assx what disease, what Ig? , what thickens? HEP C - IgM deposition in GLOMERULUS -> BM thickens + cellular proliferation.
Mesothelioma vs adenoca lung Hemorragic pleural effusion, nodular or smooth pleural thickening on xray - lung parenchyma intact - EM gold standard - tumor cells with numberous long slender microvilli with abundant TONOFILAMENTS (vs adenoca has short, plump microvilli)
ALL - T all vs B all - presentation and immunohistochemical staining difference? IHC - both Tdt - B ALL - 10, 19, 20 T-all 2, 3, 4, 5, 7, 8 T all presents as mediastianl mass -> esophageal compression and dyphagia, stridor, dyspnea. - more RESP symptoms.
some viruses are polycistronic - entire mrna transcript gets translated and then the proteins are cleaved by proteases to make functional proteins. which viruses have this type of replication? name a virus like this single stranded, positive sense, linear non-segmented RNA virus, SS+ - these have genome that is independently infective if transferred into a host cell and that functions as its own mRNA. ECHOVIRUS has a SS+ RNA genome so exhibits this characteristic.
pleura innervation , pain felt where? pleura = visceral (lung) and parietal (other) visceral-pain felt by phrenic, but referred to c3-c5 area, on neck and shoulder. (diaphramatic, mediastinal and visceral pleura) parietal pleura -> somatic sensory nerves- capable of sharp localized pain.
99mmTc pertechnetate scan detecs? gastric mucosa - thus Meckel's Diverticulum. (right lower abdominal area)
Meckels Diverticulum - failure to obliterate what? presentation? omphalomesenteric duct. Lower GIT Bleeding in young patient due to acid secretion by ectopic gastric mucosa in diverticulum. -> Melena, and right lower quadrant pain. looks like appendicitis. red currant jelly stool.
failure of veneral and dorsal pancreatic buds to FUSE leads to? pancreas divisum (asymptomatic, incidental finding)
Hindgut is part of primitive gut, gives rise to distal 1/3 transverse colon, descending colon, rectum and upper part of anal canal. failure of proper descent leads to ? Descends along what artery? anal agenesis or imperforate anus DESCENDS along Inferior Mesenteric Artery
abnormal midgut ROTATION AROUND ________ artery, leads to ___________? pathophys? superior mesenteric artery - intestinal MALROTATION - fixed fibrous adhesive bands -> intestinal obstruction.
Dihydrotestosterone comes from what precursor and what enzyme and results in development of what in male embryo, and adult testosterone -> 5 alpha hydroxylase -> DHT P P S - penis prostate scrotum. facial hair, baldness, muscle mass, libido.
2 types of 5 alpha reductase. type 1 in postpubescent SKIN type 2 in GENITALS deficiency of type 2 -> diminished conversion of testosteroneto DHT in tissues . if male fetus has this defect, internal genitalia normal development under testosterone but? external does not develop due to low DHT -> pseudohermaphrodism. genitalia at birth is either small penis + hypospadias, or female type. may be raised as female until puberty then masculinization and testis descent occurs.
Pancoast tumors cause which syndromes Horner Syndrome, SVC syndrome, Arm weakness, arm paresthesia, and haorsness - due to invasion of paravertebral sympathetic chain.
Meissners plexus , layer of GIT and other name Meissners Submucosa
Auerbach plexus muscular layer , myentric plexus.
Corticosteroid rx can increase which cell type and why? neutrophils increase due to demargination (release of all neutrophils which were attached to vessel walls) Note - lymphocytes are decreased t>b, within minutes by redistributing them into spleen, bone marry and lymph nodes.
what is + trendelenberg test and why does it happen - muscles and nerves involved? when patient walks away from examiner, hip dips to the opposite side - ie pt stands on right leg, hip sinks to left side. due to paralysis of gluteus medius and minimus - supplied by superior gluteal nerve
obturator nerve injury causes? weak thigh adduction and medial thigh sensory loss
sciatic nerve innervates which muscle group -- except ? innervates all hamstrings except SHORT HEAD of biceps femoris.
thiazide diuretics cauase what HYPER problems and what HYPO problems HYPER - hyperuricemia, calcemia, glycemia, lipidemia (INCREASE CHOLESTEROL and LDL - BAD IN HYPERTENSIVES because trying to lower cardiac risk) HYPO problems:hypokalemia, hypotension-reduce BP via blood volume and decrease vascular resistance.hyponatremi
drugs causing DISULFIRAM like rxn disulfiram, metronidazole, cephalosporins,chloramphenicol, ritonavir, sulfonylureas (chlorpropamide etc)
neurtal protesases (elastase) come from what cells in lung. how is their activity counterbalanced? what diseases result from overactivity/under balace? neutrophils (azurophil/primary granules) and alveolar macrophages/ alpha 1 antitrypsin in SERUM centriacinar and panacinar emphysema.
lung transplant patient comes with pneumonia - what virus is implicated commonly and what does the histo look like CMV - enveloped double stranded, DNA Virus -intranuclear and cytoplasmic inclusion bodies.
bilateral acoustic neuromas are associated with what disease - chromosomes? Neurofibromatosis type 2 - autosomal dominant, NF2 gene on ch 22.
Strep Pyogenes - classification and major virulence factor? Group A, Beta hemolytic - B-BrAs - bacitracin- group B resistant (S.agalactiae) group A sensitive (s.pyogenes.) M-protein is important virulence factor. it is antiphagocytic, anticomplement, cytotoxic to neutrophils AND mediates bacterial attachment
Streptolysin O - oxygen labile, extracelular protein from S.pyogenes - what does it do? lyses RBC (b-hemolytic) and PMN's is the antigen responsble for AB's - ASO. Does NOT convey phagocytosis resitance.
DNase - enzyme in Streptococcus - what does it do> depolymerizes viscous DNA in Pus and disintegrates PMN's allowing the bactera to move freely in dissue.
Streptokinase is an extracellular enzyme - catalyzes what? why? plasminogen ---> Plasmin -> fibrin digestion facilitating spread of streptococci in infected tissue - used as a thrombolytic.
Aspirin binds what enzymes? WHich enzyme is always present in cells, and which is inducible? when is it inducible? what is the molecular of weight of the inducible enzyme - contrast with INFLIXIMAB COX 1 & COX 2 - Cox 1 is always expressed but 2 is undetected except in inflammation. COX 2 is INDUCIBLE - blocked by NSAIDS - molecular wt is 72kD. Infliximab also binds to an inflammatory protein but COX 2 is an ENZYME but TNF is a PROTEIN.
Infliximab targets what?, used for what dieases? TNF alpha crohns, Rheumatoid arthritis toxicity is REACTIVATION OF LATENT TB
Trastuzumab herceptin monoclonal AB vs HER2 (erb-b2) kills breast cancer cells which overexpress her2 - use in metastatic breast cancer.
Imatinib (gleevec) vs philadelphia chromosome brc abl tyrosine kiase inhibitor use in CML, GI stromal tumors.
Rituximab: monoclonal ABs vs CD20 found in b cell neoplams - use in NHL, Rheumatoid arthritis w/ Methotrexate.
omalizumab used in which patients severe asthma with high IgE, or triggered by special allergic trigger - is AB vs IgE - useful in patients resistnat to steroids or trying to get off steroid.
penicillins inhibit which enzyme. what does this enzyme do? structural analog of ? transpeptidase enzyme - catalyzes final crosslink step in peptidoglycan cell wall formation - joining of the amino acid in 3rd pos of peptidoglycan to terminal d ala-d ala , penicillins are structural analogs of D-ala-D-ala. inhibits cell wall synth.
most important test to work up cushings syndrome? dexamethasone suppression test. normal: suppress ACTH+cortisol if ACTH high, and cortisol is <50% suppressed -> Pituitary adenoma. if ACTH high but no suppression of cortisol, ->ectopic ACTH low baseline ACTH and no suppression -> primary adrenal tum
ACTH stimulation test is used in? adrenocortical deficiency.
antiepileptic drugs using NA channels phenytoin, carbamezapine, valproic acid.
ethosuximide MOA? side effects calcium T type channels blocked. EFGH + stevens johnson Ethosuximide Fatigue GI upset Headache
phenytoin side effects nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsuitism, megaloblastic anemia, fetal Hydantoin syndrome, SLE like syndrome, inducer of P450
carbamezapine side effects dipolpia, ataxia, blood dyscrasia,s - agranulocytosis, aplaistic anemia, liver toxicity, teratogenic, induce p450, siadh, SJS aka exfoliative dermatitis
Valproic acid side effects - GI disress, hepatotoxic *measure LFT* NEURAL TUBE DEFECTS SPINA BIFIDA
dexrazoxane? iron chelating agent prevents anthracycline induced doxorubicin cardiotoxicity.
amifostine? cytoprotective free radical scavenger agent used to decrease cuymuative nephrotoxicity associated with platinum contaiing alkylating chemotherapeutics
mesna used to block hemorragic cystis caused by what? cyclophosphamide or ifosfamide - blocks toxicity to uroepithelial cells caused by ACREOLIN which is the metabolic product formed in KIDNEY
how does TNF a, catecholamines, glucocorticoids and glucagon and high free fatty acids induce insulin resistance? activation of SERINE KINASES - this leads to phosphorylation of Insulin Receptor Serine 1 IRS1 serine residues. this inhibits IRS1 tyrosine phosphorylation by insulin (of beta subunits). phospohorylation of THREONINE resides do the same.
Serine and Threonine Residue phosphorylation by SERINE kinases leads to what?? INSULIN RESISTANCE - tNFa, catecholamines, glucocorticoids, glucagon, high FFA.
Pagets disease of bone - what is the progress of disease first - osteoCLAST breakdown bone. then osteoblasts regenerate it. net result is increased bone resorption and formation of abnormal bone. new collagen deposits haphazardly(not linear) -> mosaic pattern w/ cement lines represent previous areas of reabx.
acetaminophen metabolism? toxicity? treatment? 90% metabolized in liver by sulfatin and flucuronide conjugation, 10% by p450 enzymes ->NAPQI which is toxic and dangerous. at low doses, NAPQI is metabolzed by hepatic glutathione . if toxicity, then glutathione exhausted -> centrilobular necrosis.
rx acetaminophen poisoning. N acetyl Cysteine which is a sulfylhydryl donor, glutathione substitute in liver. enhances non toxic sulfation elimination of acetaminophen.
vagal stimulation on lungs causes what ? what receptors mediate this? where are the receptors located in the histology how does this affect work of breathing? bronchial smooth muscle contraction, and increase mucus secretion mediated by m3 receptors in Submucosa. this overall INCREASES WORK OF BREATHING
difference between wallerian degeneration and axonal reaction? timeframes? wallerian degen is in SEVERED part of axon distal to injury - swelling, irregularity, destruction by schwann cells and macrophages. de3generatoin of PROXYMAL segment occurs to node of ranvier.
what happens to proxymal axonal part of severed axon injury? axonal reaction 0 cellular edema in cell body, swoled , round, nucleus displaces to periphery of cell and dispersion of NISSIL substance - with fine , granular changes -> central chromatolysis. 1 day -12 days after injury.
degenerative disesae of neurons characterized by what on histology/ reactive glial changes - neuronal loss is selective - affects well definded neuronal groups - alz, picks, huntingtons etc
which cardiac drugs slow AV conduction> digoxin, CCHB's B-blockers
hyper parathyroid bone changes? subperiosteal thinning on medial side of 2 and 3 phalanxes of hand and salt and pepper appearance of the skull. appendicular skeleton is mostly involved (pectoral, pelvic and limbs)
hyperparathyroid presentation? bone loss, renal stones, gastrointestinal GIT ulcers and psychiatric disorders. 85% parathyroid ademona 15% hyperplasia
vitamin D deficiency bone changes? unmineralized osteoid with widened osteoid seams. low bone mineral density, high fracture risk
trabecular thinning with fewer interconnections is characteristic of? osteoporosis total bone mass is decreased and normal bone architecture is disrupted.
mosaic pattern of lamellar bone with irregular sections of lamellar bone with cement lines (representing previous resorption) ? Pagets DZ bone
Osteopetrosis histological bone changes? marble bone disease - decreased osteoclastic bone resorption - persistence of primary unmineralized spongiosa in medullary canals . in NORMAL people, the bone marrow replaces spongiosa.
metalloproteinases are enzymes secreted from macrophages - what are they notorious for ? remodeling the fibrous cap of atherosclerotic plaques, making MI more likely.
embolus in which artery produces hemorragic infarct in lungs and which produce wedge shaped infarcts? wedge shaped - peripheral branches of pulmonary artery. other infarcts cause hemorrhagic infarcts because of dual blood supply from pulmonary and bronchial arteries.
brown gallbladder pigment stones caused by? infections of biliary tract
black gallbladder stones caused by? intravscular hemolysis
cysteine stones develop dude to? autosomal recessive transmembrane cystine transport in intestine and kidney/.
uric acid stones psoriasis, leukemia.
gallbladder hypomotility leads to ? biliary sludge - contains cholesterol monohydrate crystals, calcium bilirubinate, mucus . pregnancy, rapid wt loss, long use of TPN or OCTREOTIDE and high spinal cord injuries.
paramesonephric ducts (mullerian ducts) become? inhibited by? stage of development? beome uterine tubes, uterus, cervix and upper vagina. inhibited in males by Mullerian Inhibiting Factor MIF from SERTOLI CELLS DUCTAL stage develop under ESTROGEN from mother
Wolffian Ducts - Mesonephric Ducts become epididymis , ductus deferns, seiminal vesicles.
GENITAL STAGE - genital tubercle - ? urogenital folds - ? Genital Swellings - ? Urogenital Sinus - ? Genital Tubercle -> glans penis, clitoris Urogenital folds -? venteral aspect penis, labia minora Genital Swellings - scrotum and labia majora. Urogenital Sinus -> bladder, urethra, prostate, bulbourethral glands , or lower vagina and bartholin glands.
3 stages of genital development in embryo? GONADAL STAGE, DUCTAL STAGE, GENITAL STAGE
primary biliary cirrhosis has what immunological markers? Anti Mitochondrial AB(vs pyruvate dehydrogenase complex E2),ANA=prognostic anti-actin Ab,and Anti-centromere antibody (prognostic for portal HTN)Interlobar bile duct dmg+intra epithelial wbc+periductal granuloma w/ epitheloid cells ANA (prognostic)
rx primary biliary cirrhosis use GGT test check gluten sensitivity (differentiate pagets dz) rx ursodeoxycholic acid + cholestyramine, vit ADEK and Calcium.
Primary sclerosing cholangitis image ducts w/ MRCP - beading of intra+extrahepatic bile ducts. P ANCA+ assx 80% churg strauss, ulcerative colotis, HLA dr3, HLA B8
alkaline phosphatase also comes from (other than osteoclastic bone activity) > bile duct cells -> obstructive jaundice high ALP
Budd Chiari Syndrome - occlusion of IVC or hepatic veins with centrilobular congestion and necrosis(acetaminophen tox) leading to congestive liver disease -> hepatomegaly, ascites, abd pain, liver failure. varicies, abd and back veins, ABSENT JVD cuased by the following conditions - hypercoagulability (polycythemia, OCP, pregnancy) Hepatocellular carcinoma.
differentiate budd chiari vs rt heart failure - HIGH JVD in RT HEART
alcoholic hepatitis - liver finidngs? hepatitis - swollen necrotic hepatocytes with neutrophilic infiltration . Mallory odies (intracytoplasmic eosinophilic inclusions) AST>ALT ration >1.5
alcoholic cirrhosis irreversible micronodular, shrunken, hobnail, sclerosis around CENTRAL VEIN = ZONE III, liver failure, portal HTN, hepatocellular CA
methacholine muscarinc cholinergic agonist
scopolamine is antagonist of muscarinic cholinergic receptrs used for motion sickness
phenoxybenzamine is a non selective ? alpha adrenergic antagonist used in rx pheochromocytoma.
isoproterenol is nonspecific beta adrenergic agonist - alpha = beta ? CHECK used in asthmatics - bronchodilator
ipratopium bromide like scopolamine - antagonist of muscarinic cholinergic receptors.
all betablockers and drugs that decrease av conduction in heart increase WHAT INTERVAL PR interval ONLY
type 3 hypersensitivity rxn example SERUM SICKNESS caused by what common antibiotic? serum findings? Trimethoprim/sulfonamides. - fever, skin rash, itching, arthralgia, glom-neph, lymphadenopathy - 5-10 days pst exposure. immune complex deposits -> compliment activation -> HYPOCOMPLEMNTEMiA low serum c3
Sulfonamides cause what kinds of hypersensitivity rxns/ type 3 - serum sickness 5-10 days after type 2 - thrombocytopenia
transcription factors and DNA enhancers bind to what to increase TRANSCRIPTION - how many bases upstream? to the 5' or 3' end? what enzyme binds this area? Pro or Eukaryote? Promotor regions - two of importance in EUKARYOTES - CAAT box 60-80 bases upstream (5') and TATA Box 25 bases upstream. enzyme is RNA POLYMERASE 2
rubella caused by what virus? what lymphnodes are classically involved TOGAVIRUS - german measles - rubella - post auricular and occipital nodes
rubeola caused by what virus? paramyxovirus
appetite suppressants like fenfluramine, dexfenfluramine and phentermine used for 3 months or more cause what? secondary pulmonary hypertension -> dyspnea weakness, dizziness, syncope) -- eventually becomes cor pulmonale so RV hypertrophy.
causes of bilateral upper lobe pulmonary fibrosis coal worker, silicosis, tuberculosis, histoplasmosis, sarcoidosis, allergic bronchopulmonary aspergillosis, ankylosing spondylitis.
tzanck smeark herpes mostly HSV 2
side effects of SSRI's like sertaline. contrast with side effect of TCA's (imipramine, doxepin, amitriptyline, clomipramine. SSRI - sexual dysfunction most common TCA - urinary retention (anticholinergic effect, worse in BPH) arrhythmia rare but feared -quinidine like, prolnged QRS and QT seizures, orthostatic hypotension a1 antagonism, sedation (histamine block)
most common cause of aseptic viral meningitis? enterovirus - coxsackie, echo, polio. polio can cause LMN and meningitis.
sexually transmitted viruses -> meningitis HIV HSV1 2 EBV CMV
resp secretion viruses -> meningitis? varicella, mumps, adenovirus.
Arboviruses - insect bites -> meningitis examples? togavirus (east, west and venezuelan equine encephalitis), flaviviridae (st lous encephalitis) bunyaviridae (california encephalitis)
lactase deficient patients have what findings ? increased stood osmotic gap, increased breath hydrogen content, decreased stool pH.
Stool osmotic gap - number? constituents? diseases? maximum is 290 mOsm/kg (same as blood) normally its much lower closer to 50. constituents are mostly Sodium and Potassium. if electrolytes are the main component, ~50mOsm. if poorly absorbed substances, then osmotic gap goes up ~100mOSM ie Lactose intol.
lactose intolerance test- describe. 50g lactose w/ blood level measured at 0 60 120 min. if blood glucose increase <20 mg/dl and there are symptoms (bloating, flatulence diarrhea etc) then the dx is confirmed.
d xylose test? what it is and why d-xylose is a monosaccharide. its abx does not require pancreatic enzymes - not affected by pancreatic insufficiency or pancreatectomy. orad admin fixed dose used to differentiate MALABSORPTION Gi vs pancreat.
Apocrine sweat glands apocrine (dermis and subcutaneous fat of breast areolae, axillae, genitals) membrane bound sweat vesicles into hair follices (not directly to skin surface. adrenergic fibers of SYMP system - not functional until puberty. smell comes from bacterial action.
Holocrine glands ? associated with sebaceous glands. holocrine secretion entails discharge of entire secretory CELLS that undergo breakdown to release secretory product.
eccrine / Merocrine glands skin of most of the body not lips, glans penis etc. secrete watery na cl solution directly to skin surface.
paracrine sweat glandsq similar to endocrine glands by secretions reach target cells by DIFFUSION through EXTRACELLULAR SPACE
how does heptatitis B virus increase chance of hepatocellular carcinoma? 2 mechanisms. 1 - incorporation of HBV DNA into host genome causes chronic liver cell injury and regenerative hyperplasia increasing mutational probablity. second, HBV codes for HBx protein activated MULTIPLE GROWTH PROMOTING GENES and p53 inactivation.
urticaria - 2 types what are they, MOA 1 antigen induced>IgE>mast cell 2 NO IgE - direct mast cell stim by opiates, antibiotics, radiographic contrast media. BOTH cause microvasculature hyperpermeability , resolve hours, days weeks. may coalesce>annular, linear, acriform.
HISTOLOGY of urticaria mild superficial infiltrate composed of mononuclear cells and some EOSINOPHILS around dermal VENULES. Superficially - COLLAGEN BUNDLES PARTED by dermal edema and lymphatic channels dilate with TRANSUDATE. No epidermal changes.
acanthosis ? increased thickness in stratum SPINOSUM (prickle cell layer) between granular cell layer and basal layer. Psoriasis - acanthosis.
spongiosis INTERcelluar epidermal edema histo:increase width of space between cells. assx spongiotic dermatitis which includes eczema.
acantholysis loss of cohesion between keratinocytes of epidermis or adnexal structures. assx spongiotic dermatitis, incl eczema.
dyskeratosis abnomal premature keratinization of keratinocytes . dyskeratotic cells are EOSINIPHILIC and have small basophilic nuclear remnant. dyskeratosis found in Squamous Cell Ca.
which colon cancer type involves PROTO Oncoges, ANTI oncogenes, and DNA Mismatch repair genes? how many of these dna mismatch repair genes exist. names?> SPORADIC COLON CA=PROTO/ANTI oncogenes APC, k-ras, p53 DCC.Polyp type. LEFT SIDE, older than 50 HNPCC involves DNA mismatch repair genes MLH1 MSH2 MSH6 PMS2. NO POLYPS, RIGHT SIDE, younger than 50
lynch 1 family predisposition to COLON ADENOCARCINOMA
lynch 2 predisposition to colon cancer with similar features to lunch 1, AND extraintestinal cancers, endometrial, ovarian, stomach, pancreas, urothelial.
APC gene is responsible for intercellular ATTACHMENT. mutation leads to formation of? polyps from norml mucosa. APC mutation detected in most sporadic colon cancers and all familial .
Polymyalgia Rheumatica is associated with what disease in more than 50% cases neck torso shoulder pelvic girdle pain and morning stiffness, with fever fatigue and weight loss temporal arteririts / GCA
protein C - vitamin K dpenedent factor , syth in liver, anticoagulant degrading factor Va and VIIIa
Factor XII hageman - synth in liver, activated by? triggers? endothelial injury. triggers intrinsic pathway
Urokinase is thrombolytic for MI and PE, MOA? plasminogen to plasmin, which degrades fibrinogen to fibrin and FDP.
to decrease GFR by 50 %, what % of renal glomeruli need to be involved? 75% septic emboli from endocardial vegetations CANNOT DO THIS MUCH DAMAGE, more likely to be IMMUNE COMPLEX disease
nonpolar hydrophobic AA's? valine alanine isoleucine, methionine, phenylalanine
where are nonpolar hydrophobic AA's like alanine, valine isoleucine , methionine, phenylalanine located and for what? interiorly on globular proteins where they are shielded from direct contact with water. classic plasma membrane spanning proteins are executors for glycoprotein hormones TSH.LH.FSH-gProt-coupled memb bound recptrs
why is Creatine Kinase elevated in hypothyroidism/ muscle biopsy in hypothyroid shows - pale fibers with decreased striation and deposition of mucinous material. atrophy of type 2 fibers .
other causes of elevated CPK are Statins, autoimmune polymiositis dermatomyositis, muscular dystrophy like duchenne
hypertrophic cardiomyopathy - genetics? genes involved? how many cases are genetic? defect? nearly ALL cases due to Auto DOM mutations in CARDIAC SARCOMERE PROTEIN. MOST COMM IS BETA-MYOSIN HEAVY CHAIN. single point MISSENSE mutation in beta myosin heavy chain MHC (50%), Myosin binding protein C (25%) or Tropomyosin (5%)
Dilated cardiomyopathy - how many cases are genetic? mutation? 1/3 cases are genetic, AUTO DOM, cardiac myocyte CYTOSKELETAL PROTEINS DYSTROPHIN OR MITOCHONDRIAL ENZYMES. recall dystrophin mutation also seen in duchenne and becker muscular dystrophy.
what % of erythroid precursors are destroyed in b12 / folic acid deficiency? is the bone marrow hyper or hypo cellular? can neuropathy of b12 occur in absence of anemia? - which senses / tracts go first. MCV >? , other causes of MCV ? hypercellular marrow, 90% erythroid precursors are destroyed before release. MCV >80 usually around 100. >110 is highly indicative of b12/folate def. other causes: liver dz hypothyroid, alcoholism. >6 lobes neutrophil. degen post and lateral column
mannitol - what kind of diuretic? where does it act in kidney? common s/e? serious s/e? use? osmotic diuresis - used to decrease ICT act in PROX TUBULE AND LOOP OF HENLE. s/e volume deprletion and hypernatremia pulm edema, and RISE IN PLASMA VOLUME -> triggers viscious cycle>release of K and h20 release from celle>rise>hypoNA met acid, hypoK.
bumetanide is a loop diuretic - inhibits nak2cl in asc loh. blocks na cl transport so increases their secretion.
osteoclasts come from what cell lineage? how are they stimulated and controled? relationship b/w osteoblasts and clasts clasts are from monocyte phagocytic cells. they are controlled by MCSF and RANK L which come from osteoblasts. interaction b/w rankL and clasts is inhibited by BLAST secreted osteoprotegrin OPG. bone turnover + if rankL + and OPG -.
Arsenic Poisoning - MOA? Rx? blocks Sulfhyldryl groups on multiple enzymes -> cellular metabolism shut down -> GIT symptoms + garlic breath. USE DIMERCAPROL or penicillamine (also for mercury, copper, gold) displases arsenic form SH groups.
ulcerative colotis rectum always involved, imflammation is limited to mucosa and submucosa only, mucosal damage is continuous. complications megacolon -> perforation. high risk of adenoca colon.
crohns disease noncaseating granuloma, perianal fistulae, transmural inflammation
most common CNS metastasis comes from? lung , breast and melanoma
melanocytes are what embryological cell lineage? neural crest cells. -
melanomas metastasize commonly to ? brain, GIT, bone, liver and lungs.
surface ectoderm - epidermis, appendages, mammary glands (modified sweat glands), lens , adenohypophysis.
irregularly irregular tachyarrhyphmia in conscious patient? atrial fibrillation - most common chronic arrhythmia. ABSENT P WAVES, irregularly spaced ventricular contractions=(variable R R interval)
QT interval ventricular depolarizaiton and repolarization . QT prolonged in ventricular tachycardia aka torsades de pointes - heart rate is usually regular.
high QRS voltags in precordial leads ventricular htphy - usually from untreated hypertension. does not usually cause irregular rhythm
QRS prolonged interval - ventricular dyssynchrony or slowed intraventricular impulse conduction. BBB - regular HR.
b6 cofactor in transamination and decarboxylation of aminoacids for gluconeogenesis and other processes.
b1 thiamine cofactor for transketolase, alphaketoglutarate dehydrogenase and pyruvate dehydrogenase
b2 Riboflavin dehydrogenases using FMN and FAD
b3 dehydrogenases using NAD and NADP assx pellagra
biotin carboxylases - 4 of them. pyrivate carboxylasse, acetyl coa carboxylase, propionyl coa carboxylase and 3 methylcrotonyl coa carboxylase.
blood transfusion - relatinship with calcium and potassium? whole blood is mixed with citrate anticoagulant before storage. this CHELATES serum CALCIUM > HYPOCALCEMIA (normal 8-10) -> PARESTHESIA, tingling toes and fingers. stored blood cells lose intracelular K -> hyperkalemia
HIV1 protease inhibitors resembles cushings syndrome
cave exploration, mississippi and ohio? hisOHIOplasMISSISSIPPI CAVEuslatum lives in macrophages, RESEMBLES RESPONSE TO TB includes granulomas
6th position, beta globin gene , GA -> Valined sickle cell trait
delta 508 deletion in CF what is deleted? phenylalanine
peroxisomes - where in cell? what enzymes? where are they most abundant? function? cytoplasmic - oxidative enzymes Catalase, D-amino acid oxidase oric acid oxidase. ubiquitious in eukaryotes, most in Liver and kidney where detox happens. in liver, also break down fatty acids.
etoposide and podophyllin - MOA, Use? topoisomerase 2 causes chromosome breaks and then reseals them to relieve + super coiling. these drugs block that : etoposide testicular and small cell ca lung. podophyllin for genital warts
5FU and 5Deoxyuridine block thymidylate synthase methotrexate blocks dihydrofolate reductse
irinotecan, topotecan inhibit topoisomerase 1, induces single strand breaks to relieve negative supercoiling. vinca alkaloids like vincristine and vinblastine build TUBULIN monomers, disrupting microtuble necessary for separating chromosome strands during mitosis.
Taxanes like paclitaxel cause microtubular dysfunction like vinca alkaloids
renal PLASMA flow = renal art pressure - renal vein pressure / renal vascular resistance OR? RBF=PAH clearance=urinePAHxurine flow/plasmaPAH
rheumatoid arthritis, cardiac involvement? Fibrinous pericarditis
tertiary syphilis cardiac involvement aortitis, aortic aneurysm, aurtoic regurg. rare mitral valve lesions.
glucagonoma presentation? rare pancreatic tumor with necrolytic migratory erythema, elevated erythematous rash in groin, hyperglycemia, stomatitis, cheilosis,, abdominal pain. measure serum glucagon.
somatostatin inibits what? presentation? abdominal pain, gall stones, constipation and steatorrhea due inhib of insulin, glucagon, gastrin, cholecystokinin, and secretin and inhibit directly GIT motility.
which toxins are superantigens? enterotoxins, exfoliative toxins, and TSST, cross link MHC 2 to TCR -> huge recruitment of T cells and macrophages -> release of IL2 and TNF -> Toxic shock syndrome.
trochlear nerve palsy causes ? vertical diplopia like walking down stairs, reading or looking toward nose.
auer rods are deformed azurophilic granules found in cytoplasm of myeloblasts staning positively for myeloperoxidase. abundant in AML M3 stain with MYELOPERXOIDASE
hairy cell leukemia stains + for what? TRAP tartarate resistant acid phosphatase. neoplasts b lymphocytes are precursors and are cd20+ - splenomegaly, fatigue, pancytopenia.
normal aging of heart? deposition of lipofuscin, shrinking left ventricle and sigmoid shaped septum - bulges into left ventricular outflow tract!
light microscope finding in GBS, presentation? segmental demyelination and endoneural inflammatory infiltrate. ascending weakness, loss of DTR's even bells palsy and resp paralysis.
werdnig hoffman syndrome pathophys? anterior horn cell dmage, LMN - flaccid weakness, areflexia, atrophy and fasciculation - floppy child syndrome.
Thiamine deficiency demyelination unlike GBS, no PERINEURLA INFLAMMATION IS SEEN. pain and parestheisa, weakness, afrelexia, and distal lower limb weakness is seen.
duchenne muscular dystrophy - inheritance, type of mutation? frameshift mutation, x linked
spherocytosis incareas risk of what kind of gall stones? what virus precipitates aplastic crisis parvovirus b19 pigment gallstones
Lithium toxicity presentation? how it is handled in the kidney? what drugs for what conditions increae the reabx of lithium -> toxicity? presents as tremors, twitching, agitation, ataxia and delerium. handled by kidnye like SODIUM - in PT >60% reabx. dehydration, CHF, volume depletion - body increases NA reabx, and LI too -> tox. ACE INHIB, NSAID, THIAZIDE DIURETICS (not loop)
1st line RX for isolated systolic HTN - in regular pt and in diabetic pt? normal: thiazide diuretic or dihydropyridine CCB diabetic - ACE inhibitor or ARB
acid fast uses what dye and what decolorizer? carbolfuschin and alcohol stains for MYCOLIC acid.
SLE assiciated with what part of T lymphocyte mutation? what function of CTL's is lost with this mutation? FAS mutation -> failure of CLONAL DELETION of autoreactive TL's
primidone is an antiepileptic drug metabolized to what? metabolized into phenobarbital and phenylethylmalonamide PEMA, which are also anticonvulsants.
h influenza - 2 types . capsulated and non-capsulated. type B has was unique feature? do non capsulated strains cause disease? what disease do they cause? type B has RIBOSE instead of hexose. its pathogenic because capsule protects vs phagocytosis.
hyaluronidase is used by which bacteria? staph, strep group A, and clostridium difficle
adenovirus is common in people living in close quarters - pharyngoconjunctival fever - pharyngitis, cough, nasal congestion, conjunctivitis and lymph nodes calcivirus = norwalk virus - Gastroenteritis paramyxovirus = parainfluenza (croup),RSV (bronchiolitis in infants), measles and mumps parvovirus = b19 aplastic crisis in sickle cell anemia, spherocytosis and fifths disease, hydrops fetaliss
arenavirus = lymphocytic choriomeningitis virus (LCV) febrile aseptic meningoencephalitis or influenzalike illness from HAMSTERS AND MICE poxviruses = smallpox, vaccinia, cowpox, monkeypox and molluscum contagiousm.
base excision repair - types of DNA damage that is corrected by this defect in single bases - spontaneous, chemical (depurination), thymine dimer formation UV rays - breaks in DNA chain/oxidative dmg (ionizing radiation), cross links, intercalation, alkylation - chemical/drugs.
base excision repair -order of enzymes glycosylase - removes BASE endonuclease - removes SUGAR-PHOSPHATE LYase assists in this (endonuclease ->5', lyase 3') DNA polymerase -replaces missing nucleotide, ligase reconnects strands glycosylase-endonuclease-lyase-dna polymerase - ligase.
ACE inhib's do what to renal filtration fraction? who is this dangerous is? what is the lab test that reflects this/ creatinine rises transiently. filtration fraction is decreases due to decrease efferent constriction because of angiotensin 2, dangerous in renal artery stenosis - in whom blood flow is low , the effernt constriction is maintaining GFR -> renal failure.
most common thyroid cancers? 1) papillary thyroid cancer 2) follicular thyroid cancer both arise from follicle epithelium.
papillary thyroid cancer histology most common thyroid cancer. FNAC ->thyroidectomy. branching papillae with bibrovascular stalk lined by single or multiple layers of cuboidal epithelium, GROUND GLASS NUCLEI, psammoma bodies. good prognosis.INTRANUCLEAR GROOVING. also a tall cell variant
follicular thyroid cancer - hiso? 2nd MCC. well differentiated, simulating normal thyroid, or less well differentiated with sheets of follicular cells or large cells with eosinophilic cytoplasm HURTHLE CELLS. different from PTC:ground glass nuclei and pasmmoma body.
anaplastic thyroid carcinoma aggresive poor prog. 2 yr mortality 100%, invades locally and mets. large pleomorphic cells, large multinucleated osteoclast like cells, and small cells mixed in with spindle cells. no psamm, or ground glass nuclei.
medullary thyroid cancer from parafollicular C cells, 20% familial MEN 2a 2b, bilateral, preceded by c cell hyperplasia. uniform polygonal or spindle shaped cells CALCITONIN STAIN + extracellular amyloid deposits from calcitonin are present - CONGO RED STAIN.
follicular adeonma benign thyroid tumors difficult to differentiate from follicular thyroid cancer. look for ABSENT CAPSULAR and VASCULAR INVASION.
hashimotothyroiditis MONONUCLEAR infiltrate Lymphocytes+plasma cells, GERMINAL CENTERS. METAPLASIA of thyroid follicluar epithelium -> large oxyphilic cells with granular cytoplasms = hurthle cells (follicluar thyroid ca also) anti TPO ab's
hurthle cells seen in ? large oxyphilic cells eosinophilic cytoplasm) hashimoto thyroiditis (metaplastic change) medullary carcinoma thyroid.
riedels thyroiditis extensive fibrosis extending into surrounding structures. hard fixed gland simulates malignancy. anti antithyroid peroxidase maybe + (autoimmunity possible)
antithyroid peroxidase + hashimoto and ridel
de quervain thyroiditis mixed cellular infiltration with occasional multinuclear giant cell aka granulomatous thyroiditis. maybe virally triggered -> thyrotoxicosis, painful tender gland - then hypothyroid, finally euthyroid.
thyroid follicular cells arise from? outpouching of pharyngeal epithelium. they then migrate to lower neck and fise with parafollicular C cells from 4th pharyngeal pouch and form the thyroid. follicular cell cancers are Papillary and Follicular.
capillary endothelial cells arise from? Von Hippel Lindau disease? primitive endothelium. VHL - capillary rich hemangioblastomas. VHL gene regulates transcription of Hypoxia inhibitive factor 1 HIF1 (++VEGF and erythropoetin) ->mutation = hemangioma.
EF2 is necessary for what exactly process? translation : ef2 is necessary for tRNA to insert NEW amino acid into growing protein chain .
clostridium perfringens releases what special toxin causing cell destruction? cytolytic toxin aka alpha toxin or phospholipase C -> degrades cell membrane phospholipids and destroying the cell.
what is ebsteins anomaly? what drug causes it? Atrialization of right ventricle aka apical displacement of tricuspid valve Lithium causes it - rx manic / bipolar.
valproic acid is used as? (2 specific differnt functions) anticonvulsant AND mood stabilizer - use in epileptics with bipolor / depression also in absence(2nd after ethosuximide), myoclonic(DOC), GTC. as mood stabilizer:prevents mania in rapid cycling bipolar disorder(<4 episodes/yr), and mania.
sertraline is SSIR used in what disorders/ depression, OCD, panic.
S.aureus is the usual cause of of soft tissue infections. which drug is empirically used to rx this NAFCILLIN - used for folliculitis, abscesses. treats S. aureus (usually produces b-lactamase) nafcillin is not effective vs MRSA
lung abscesses in alcoholic pts is usually treated with clindamycin
causes of AVASCULAR NECROSIS OF FEMORAL HEAD 4 causes: Sickle cell DZ -embolic SLE - vessel wall vasculitis Steroid Therapy - unknown Alcoholism - unknown no swelling or erythema - MRI most sensitive.
micicarmine stain for what fungus? cryptococcus neoformans
nonseptate hyphae that branch at wide angles are from what fungi? Micor and Rhizopus.
Candida albicans forms germ tubes (sprouts of true hyphae from yeast cells) in incubated in 37 deg C for 3 hours. this differentiates C. Albicans from what other fungi? other candidal fungi.
Spherules (round with endosores) found in coccidioides immitus causing what disease? lung disease - meningitis is not common.
Sporangium is a structure that contains spores - present in MOLD fungi.
does cryptococcus have mold, yest or dimorphic yeast ONLY NOT DIMORPHIC
protamine sulfate used for? counteract OD heparin think PROTAHEP protamine sulfate comes form salmon sperm!
VItamin K reveresed OD WARFARIN
Aminocaproic acid (comes form lysine)and tranexamic acid inhibit what? used in OD of what drugs? streptokinase. inhibit plasminogen activation
Shigella is NON motile vs salmonella is motile. Shigella is non lactose fermenting and produces ACID instead of GAS like Ecoli. Shigella does not produce H2S compared to salmonella which does. Salmonella mechanism is Mucosal invasion. via M cells in peyers patches . after entering M cells, shigella lyses into containment vacuole and enter CYTOSOL. causes APOPTOSIS and spread into adjacent cells w/ ACTIN POLYMERIZATION
shigella releases shiga toxin ->inhibits protein synthesis. is AB toxin 1A binds 5Bs. A inactivtes 60s rib -> no prot synth, cell death. toxin is less important than mucosal invasion. non toxigenic strains cause disease also. Prolferation in lymph nodes is not characteristic of shigella - but is seen in yersinia enterocolitica and salmonella typhi. yersinia enterocolitica causes lymph node infection - inflamed mesernteric nodes - pseudoappendicitis.
pseudoappendicitis is caused by? enlarged lymphnodes in yersinia enterocolotica.
distended macrophages in intestnal lamina propria seen in what disease Whipple Disease
collections of neutrophils in crypt lumina in intestine seen in ? ulcerative colotis.
intestinal inflammation with scatered non-caseating granulomas crohns disease
massive infiltration of intestinal lamina propria with atypical lymphocytes seen in? GIT LYMPHOMAS.
lactose deficiency patients have what mucosal changes? none
bullous pemphigoid - disease of elderly - ABs vs ? Hemidesmosomes - AB's attack these along dermal epidermal junction at basement membrane - compliment fixation -> tissue injury. SUBEPIDERMAL NONACANTHOLYTIC blister appers w/ edema and perivasc lymphocytic infiltrate. vacuolations in basal layer >blister.
young woman with skni rash, arthralgia, and POSITIVE VDRL TEST SLE - antiphospholipid AB's make VDRL +, reactive vs cardiolipin. APLA -venous thrombosis, arterial thrombosis, miscarriage. Lupin anticoaglant 10-30% SLE pts. MISCARRIAGE bc inhib tPA activity necessary for trophoblastic invasion of uterus.
trophoblastic invasion of uterus , blocked by antiphospholipid antibodies of SLE, physiologically requires what substance? tPA
transmural infarct has what ECG finding ST elevation.
rupture of ventricle post MI happens after how long/ 4-5 dyas , range 1-10 days. at this time coagulative necrosis, neutrophil infiltration and enzymatic lysis of connective tissue has weakened the infarcted myocardium.
if ventricle wall ruptures, how does patient die? what will ECG show? profound hypotension due to cardiac tamponade. ECG shows electrical activity but body is pulseless -> hypotension, shock, death.
gram + actinomycete T.Whipelli involves small intestine, joints and CNS. what are the histo findings? Mucosa of Small intenstive with ENLARGED FOAMY MACROPHAGES packed with 1) Rod shaped bacilli 2) diastase resistant, PAS + granules.
relative risk is in COHORT studies. what is the equivalent in CASE CONTROL studies?> Exposure odds ratio
blastomycosis dermatitidis is dimorphic fungus causing pulmonary infection in what immune status host? immunoCOMPETENT.
bastomycosis is seen in what area? what other fungi is seen in this area? OHIo/Mississippi valley, great lakes also see histohioplasmississippi cauess asymptomatic or flylike illness with cough and sputum, hemoptysis and pleuritic chest pain. maybe chronic. granuloma +++
transverse cervical ligament is also known as cardinal ligament -extends from where to where? cervix and lateral fornix of vagina to lateral pelvic wall.
transverse cervical ligament aka cardinal ligament contains what artery and should be ligated during what procedure.? UTERINE artery - ligate in radical hysterectomy/
nerves and vessels to OVARY are delivered through what ligament. when shoudl this ligmanent be ligated? suspensory ligament of ovary. shoudl be ligated in any surgery involving ovary.
broad ligament of uterus is formed by mesovarium which covers the ovaries.
ovarian arteries are branch of? abdomainal aorta bilaterally. left ovarian VEIN drains into left renal vein, right directly into IVC. parasymp innervation of ovary - VAGAL.
common complication of ovarian surgery causing bleeding? accidental ligation of ureter instead of suspensory ligament.
etanercept (enbrel) is an anti TNF a drug used in rheumatoid arthritis esp in those who have failed with methotrexate. what screen needs to be done before using this drug? it causes immunosuppression therefore PPD test for latent TB must be done. cannot use in any patient with infection.
make sure to do what test when using Methotrexate and Leflunomide? Liver Function tests.
acellular pertussis vaccine contains what immunogenic material? purified components of B pert and detoxified pert toxin. toxoid
hep b vaccine contains? purified inactivated hbsag particles from YEAST through recombinant DNA tech
varicella vaccine contains? line attenuated varicella virions
bcg vaccine contains live attenuated strain of m.bovis.
salk (sulks cause it sucks) = IPV dead inactive killed virus
sabin - OPV - live attenuated virus
wiskott aldrich syndrome presentation : mutation? eczema, infection, thrombocytopenia(petichae, hematemesis, epistaxis. X chrom mutuation (males only) B and T disorder - esp pyogenic inf(failed humoral vs polysaccharide capse, h.inf, s.pneum.) opportunistic.p.jirovec.esp after maternal igg iga @6
rx wiskott aldrich syndrome hla matched bone marrow trx.
tzanck smear uses what stain? what tissues are tested with this smear? what viruses does it identify? Herpes Simplex or VZV virus. uses Wright Giemsa Stain. Scrapings from oral ulcer base.
herpetic gingivostomatitis is the most common manifestation of PRIMARY HSV1 infection - at what age is this commong? 1-3 years, fever, vesicoulcerative lesions in oral membranes and localized lymphadenopathy.
secondary reactivation of hsv1, 2, vsv, cmv like orolabial herpes. confined to one side, 1/10 involvement of initial infection
hsv 1 remains latent where vzv ? CMV? hsv in trigeminal ganglia vzv in dorsal root ganglia cmv many tissues. - interstitial pneymonitis, retinitis, hepatitis, colitis and generalized disease
patient with anaphylaxis - what can be used as marker alternative to histamine? tryptase - comes from mast cells only therefore is a good serum marker for mast cell activation
primary cns lymphomas esp those in immunosuppressed are associated with EBV, what are common markers found on these cells? CD 20, CD 79A may present with mental status change, seizures, progressive focal neurologic deficit. high grade anaplasia, poor response to chemo.
von hippel lindau syndrome presentation? genetic inforamation? autosomal DOM. VHL gene, chromosome 3p DELETION. presentation cerebellar hemangioblastoma, clear cell RCC, pheochromocytoma. rcc in 40% pts. strong assx 3p . rcc only assx with this deletion.
rb oncogene is located on ch 13. mutations lead to? retinoblastoma and osteosarcoma
NF 1 is on ch 17 mutations causes vonrecklinghausens diseae
WT1 anti-oncogene ch 11, assx? wilms tumor.
BRCA 1 - breast and ovarian ca
when to use colchicine?q in gout pts with contraindications to NSAIDS like renal faiure, peptic ulcer dz
drugs highly CLEARED by liver (bile feces) (not 'metabolized or biotransformed' by liver) have what characteristics/ high lipophilicity! high volume of distribution. these same drugs tent to be poorly cleared by kidney as they can cross tubular cell membranes after filtration and enter tissues again. high lipid soluble allows drug to enter hepatocytes - excreted.
low volume of distribution drugs are confined to bloodstream and do not diffuse readily through hepatocytes into bile. low Vd is highly plasma prot bound and hydrophilic, excreted unchanged in urine.
what are epitheloid cells? activated macrophages/
what is the essential cofactor for hepatic microsomal carboxylase that converts glutamyl residues into gamma carboxyglutamates. required for functioning of factors vii, ix, x - allows for calcium binding sites that interact with phospholipid surface -> Vitamin K - calcium binding sites interact with PL surface to produce THROMBIN.
enoxaparin is a low molecular wt heparin MOA? potentiates antithrombin 3 therefore mostly inhibiting factor xa which prevents prothrombin -> thrombin.
enoxaparin is a low molecular wt heparin MOA? potentiates antithrombin 3 therefore mostly inhibiting factor xa which prevents prothrombin -> thrombin.
tissue plasminogen activator tPA converts plasminogen to plasmin, breaking down fibrin, -> thrombolysis. CLOT SPECIFIC thrombolysis plasminogen is bound by thrombolytic agents streptokinase urokinase and tPA, these agents assist in cleavage to plasminogen to plasmin
prothrombin factor II is vit K dependent. along with 7 9 10 - all of these are therefore depleted by? warfarin.
prothrombin factor II is vit K dependent. along with 7 9 10 - all of these are therefore depleted by? warfarin.
methotrexate enters cells and gets polyglutamated, which keeps it in the cell along with ? dihydrofolate reductate. thus these 2 are increased in cell in MTX use.
methotrexate enters cells and gets polyglutamated, which keeps it in the cell along with ? dihydrofolate reductate. thus these 2 are increased in cell in MTX use.
presentation of mutiple myeloma easy fatigue (anemia) constipation (hypercalcemia) bone pain (back and ribs, due osteoCLAST activating factor from myeloma cells -> bone lysis) renal failure
what causes renal failure in multiple myeloma multifactoria : hypercalcemia, hyperuricemia, kidney infiltration by myeloma cells, AL amyloidosis , infections.
what is classic myeloma kidney aka myeloma cast nephropathy due to excess excretion of FREE LIGHT CHAINS - bence jones protein (light chains) filtered in glom, then reabx into tubules. when exceeds reabx capacity, then appear in urine. precipitate with TAMM HORSFALL protein ->eosinophilic casts NOT EOSINOPHILS
what do bence jones light chain do in tubular epithelium and tubules? obstruction and compression -> renal failure. B J Prot is directly toxic to tubular epithelium causing atrophy - > see large glassy eosinophilic casts
ischemic tubular necrosis presents how? muddy brown granular and epithelial cell casts along free tubular epithelia cells.
acute pyelonephritis would present with ? pyuria, WBC casts
hypersensitivity interstitial nephritis manifests as? sterile pyuria and history of some drug . peripheral eosinophilia and eosinophiluria is non specific but suggests hypersensitivity interstitial nephritis.
NSAID causes what kind of nephritis? papillary necrosis and chronic interstitial nephritis.
aminoglycosides renal damage? accumulates in CORTEX, acute tubular necrosis.
chronic lead exposure , what effect on kidney? chronic tubulointerstitial nephritis -> renal failure.
failed fusion results in ? endocardial cushoin defect - ostium PRIMUM ASD
failed proliferation -> unilateral aplasia of fibula
apoptosis failure in embryo? autoimmune DZ and persistecnce of autoreactive T/B immune cells.
obilteration branchial cleft cyst
migration hirschprung dz - neural crest cells
fusion hypospadias (failed urethral FOLDS)
TGA failure? septation (spiralling) of aorticopulmonary septum
if you see GOBLET cells in esophageal epithelium is this normal? if not, what does it represent. it is not normal, it represents adenocarcinoma / barrets esophagus
most common eshophageal benign tumor leiyomyoma
ronchi and wheezing in a neonate / child indicates closing airways - either asthma or bronchiolitis. most common cause of bronchiolitis is RSV - what is the management of rSv supportive - if very severe, then add aerosolized ribavirin
MOA of ribavirin and viruses it works on RSV and hepatitis C is a nucleoSide analog, inhibits guanine nucletides
ganciclovir is anti herpes virus guanine nucleoside analog (other guanine nucleoside analog is ribavirin) .. ganciclovir is different from acyclovir how> ganciclovir is more active vs CMV Dna
Oseltamivir is a sialic acid analogue inhibits what parts of influenza virus? neuraminidases of both type A and B influenza. this can cause bronchiolitis in children but RSV is more commo
amantadine impairs what part of influenza infectivity> uncoating of influenza A ONLY - this uncoating happens after endocytosis
what is the most importnat part of abscess formation on a biochemical immunology level? spilling of lysosomal enzymes from macrophages and neutrophils. this creates further chemotaxis and damages surrounding lung tissue making abscess possible.
interferon gamma - what is its function> phagolysosome formation, inducible nitric oxide synthase release and development of granulomas and caseous necrosis.
interleukin 12 does stimulates NK cells to destroy target, is responsible for T helper cell seretion of IFN gamma.
selegiline is an inhibitor of MAO B. pretreatment with this prevents what/ progression of parkinsons.
dopamine is a d2 agonist, stimulates central d2 receptors - only helps early parkinsons but may delay introduction of ldopa by years
use of carbidopa (blocks peripheral conversion of l-dopa to dopamine) l dopa is abx in small intestine by large NEUTRAL amino acid transporter system then converted to dopamine by enzyme dopa decarboxylase. the peripheral conversion causees all the side effects (GI effects) carbidopa does not cross BBB so prevents it.
picornaviruses/ echo, rhino, hepatitis a, enterovirus, polio
which picornaviridae are acid stable acid labile labile - rhinovirus - no GI disease stable - enterovirus (all are but notably entero)
fetal defects and their mechanism? malformation, deformation, disruption, sequence, agenesis.
malformation defects/ primary defect in cells, holoprosensephaly(5th wk, trisomy 13, 18) anencephaly, congenital heart disease, poly/syndactyly
deformation - fetal anomales due to extrinsic mechanical forces ie uterine constraint -> hip dislocation/breech presentation. (not potters synd which is a SEQUENCE)
disruption / amniotic band syndrome secondary breakdown of previously normal tissue / structure - rupture of amnion during development leads to band formation which compresses or amputates limbs.
sequence occurs when a number of abnormalities results from single primary defect ie? oligohydramnios -> potters syndrome
how do cancer cells become resistant to chemotherapy drugs/ multidrug resistance genes ie MDR1
describe MDR 1 gene transmembrane protein P-glycoprotein which is ATP DEPENDENT EFFLUX pump. p-gly. is normally on intestinal and renal tubular epithelial cells and eliminates foreign compounds.also in capilly endothelium of BBB. prevents penetraion. removes drugs if mutated
function of p glycoprotein (as seen on MDR1 gene giving resistance to turmor cells from drugs) found on intestinal and renal tubular epithelial cells - eliminates toxins found on capillary endo in BBB - prevents penetration of toxins into brain found on tumor cells , eliminates drugs from cancer cells as toxins - gives resistance. ATP dependen
process of apoptosis is separated into what 2 phases initiation and execution - initiation brings protein hydrolyzing caspases . execution ; the caspases bring about cell death by cleaving cellular proteins and activating DNAses
initiation phase of apoptosis signals from 2 pathways -mitochochondrial or death receptor (extrinsic). mito becomes permeable to pro-apoptotics, antiapoptotic bcl2 bclx finish and bax bim cause release of cytochrome C
proapoptotic factors bax bim anti-apoptotic, bcl2 bclx once anti finish, then pro cause mito permiability and release of cytochrome c -> apoptosis
extrinsic pathway : death receptor engaged on cell surface (tumor necrosis factor receptor family) TNFr1 and FAS cd95 - multiple bound fas receptors come together and make a binding site for death domain containing adapter FADD>binds caspase and activates it.
mechanism of opioid tolerance involves phosphorylation of opioid receptors by protein kinase. chronic tolerance may involve increased adenylyl cyclase or NO levels.
morphine tolerance shows what Neurotransmitter to interact with opioid pathway ? glutamate (normally excitatory) binds NMDA receptors -> phopshorylates NMDA receptors (activate) DEXTROMETHORPHAN reverses opioid tolerance through nmda antagonist properties. glutamate plays a role in morphine tolerance
what neurotransmitter specifically plays a role in morphine tolerance NMDA receptors and glutamate action.
glycine is a co - binder for glutamate. what do the 2 do in the cns? allow for activation of nmda receptors. it does not play a role in morphine tolerance however.
vasovagal syncope from ear canal is still mediated by vagus x
posterior part of external auditory canal is innervated by small auricular branch of vagus nerve. remainder is supplied by mandibular trigemianl through auriculotemporal..
inner surface of tympanic memb supplied by what nerve ix glossopharyngeal. via typanic branch.
what is the most common arrhythmia in myocardial ischemia as in heart attack? therefore most common cause of sudden cardiac death ventricular fibrillation
most lethal arrhythmias in acute MI patients are? vent fibrillation or vent tachycardia.
most common cause of MI death after actute prehospital phase (which was vent fib, or vent tach) ventricular failure
wall rupture or ventricular septal rupture occurs how long after MI/ 3-7 days
adenosine and acetylcholine act on what part of the cardiac myosite depolarization? phase 4 which is the slow upward automaticity part before 0 spike then 3 repolarization . phase 4 mechnaism - slow na+ leak + closing of k+ channels. then at -50, T-type ca channels open and speeds up depol to -40 after which depolarization happens
adenosine mechanism of acting on phase 4 of cardiac depolariation ? activates K+ channels - preveents depolarization. also inhibits L type calcium chanels - which are active in phase 0, prolongs time to threshold.
mechanism of acetyl choline on cardiac myosite - opens specific k_ channels and increase k conductance and at the same time, slows inward Ca influx. - slows the heart.
norepinephrine effect on cardiac myocites/ acts in L type ca channels and na channels in phase 4. - increase ca and na influx, rapid depolarization incrased heart rate.
which drugs are anti TNF a action -(synovitis, joint erosion, rheumatoid arthritis, slow disease progression) etanercept, adalimumab, infliximab. increase infection risk, esp TB - do PPD skin test First.
purine pyrimidine agents - are tey used in rheumatoid arthritis? yes - methotrexate is 1st line agent.
what immune complex vasculitis assx igA, c3, presenting with leukocytoclastic angiitis in SMALL vessels of dermis and GIT - abdominal pain, purpuric rash, polyarthralgia and complicated by glomerulonephritis , in males mosly 3-11 yrs HSP
GCA and takayasu do not have iga or c3. may present with weakened pulses in extremities . TAO is not assx iga or c3 either.
hypersensitivity myocarditis presentation and cause? due to a new drug with cross reacting atopic response - periVASCULAR infiltrate with abundant eosinophls
s100 protein is a protein seen in melanoma, schwannoma, inflammation, clear cell sarcomas, has antimicrobial activity.
reed sternberg cells seen in what disease hodgkins lymphoma
follicular lymphoma sows what kinds of cells? what age group? 2 important cells - centrocytes (small cleaved cells) , centroblasts, large, non cleaved cells. older adults
burkitt lymphoma presentation? high grade lymphoma - mass in abdomen pelvis or jaw, starry sky apparance due to monotonous population of medium sized lymphocytes with a few tingible macrophages.
b12 neuropathy = dorsal columns (position and vibration, gait abnormal, sensory ataxia) lateral corticospinal tract - UMN sign - spastic, hyper refflexia, babinski sign axonal degen, can cause numbness or paresthesia
syringomyelia - cyst within spinal cord destroys central portion of spinal cord - lateral spinothalamic tracks are affected, bilateral loss of pain and temp - involvement of motor neurons of AHC' >flaccid paralysis and atrophy of intrinsic muscles of hand.
damage to dorsal column and dorsal roots are? tabes dorsalis - unlike combined degen of b12, later tract is not involved.
ALS - upper and lower motor neuron lesion
anterior spinal artery syndrome - result of compression / occlusion of artery in front of spinal cord. compression from bone fragments or disc herniation - complete loss of strength below level of injury and loss of pain and temp sens but PRESERVED VIBRATION.
thiazolidinediones TZD - like pioglitazone, rosaglitazone act how? stimulate NUCLEAR RECEPTOR PPAR gamma which is transcriptional regulator of genes involved in glucose and lipid metabolism. -> TRANSACTIVATION
most important gene regulated by PPAR gama (stimulated by TZD"s like pioglitazone) Adiponectin (its levels are LOW in dm 2) rx wx TZD's increases adiponectin to N levelx.
sulfonylureas bind to what? Katp channels on beta cells
insulin acts by? binding cell surface receptors . receptor is tetrameric with 2a and 2b subunits - a is extracellular and is binding site. b is intracellular w/ tyrosine kinase domains.
enzyme inactivation is an important mechanism for action of metformin and alpha glucosidase inhibitors . metformin decreases enzyme activity responsible for gluconeogenesis in hepatic microsomes . alpha glucosidase inhibitors decrease enzyme activity of? membrane bound disaccharidases on intestinal brush border.
2 classes of dopamine agonists: ergot compounds - bromocriptine and pergolide NOn ergot compounds - pramipexole and ropinerole
bromocriptine is ergot dopaminergic - used to treat parkinsons or hyperprolactinemia.
role of amantadine in parkinsons indirect and direct dopaminergic , alleviates motor symptoms. enhances endogenous dopamine.has some anticholinergic so reduces tremors.
decreased central dopamine degradation by what drug selegiline MAO B inhibitor prevents degradation of dopamine in brain
COMT and dopadecarboxylase inhibitors decrease breakdown of levodopa in peripheral tissues, increasing the amount available to briain.
most common urea cycle defect? ornithine transcarbamoylase deficiency - increase ammonium and carbamoyl phosphate -> neurological damage. major cases present in children, minor may present in adults.
propylthiouracil vs methimazole PTU - safe in Pregnancy and decreases Peripheral conversion
antithyroid drug pneumonics propylthiouracil, methimazole, thiocyanate, perchlorate THIroid peroxidase inhibitors I- -> I2 block meTHImazole, propylTHIouracil Na->I PUMP Blockers - thiocyaNAte and perchlorate.
patient on antithyroid drug - agranulocytosis is complication - presentation and appropriate test? WBC count with differential is the right test, presents with fever and sore through 0.5% ppl have this side effect, usually in early rx, but may be at any time.
why not use aspirin or ibuprofen for thyroid patients with fever and sore throat? first suspect agranulocytosis - so symptomatic management is not enough. also thes drugs displace thyroid hormones from binding sites - worsening thyrotoxic state , use ACETAMINOPHEN.
pulm HTN definition >25 mmhg
causes of Pulm Artery Htn? Major: sporadic or idiopathic - MCC left heart failure chronic hypoxia - COPD, sleep apnea, chronic thromboembolism, HIV
genetics of PAH? auto DOM with variable penetrance. abnormal BMPR2 bone morphogenetic protein receptor type 2. this predisposes to pulm vasc disease., then, infections drugs, ion channel defects>DZ begins-++ endothelin (vasoconstr), inhib NO, PGi2
pathophysiology of pulm artery htn vasoconstriction, vasc smooth muscle proliferation , fibrosis, thrombosis of pulm art/ateriole, endothelial cell growth, elevated pulm pressure. -> right vent hypertrophy, failure, dyspnea, pain, distended neck veins. increases p2 and holosystolic tricusp
murmur of pulmonary art hypertension accentuated p2 at left sternal border. holosystolic tricuspid insufficiency accentuated with inspiration,
rx pulmonary artery hypertension epoprostenol
pantothenic acid b5 becomes CoA. where is Coenzyme A required many reactions but importantly TCA CYCLE where it binds oxaloacetate + coA -> citrate -> succinyl coA. also imp in vit A, D, cholesterol, steroid, heme, fatty acid, Amino Acid, and protein synth.
how does pantothenic acid become coA actively transported into cells, ATP dependent phosphorylation -> coA.
symptoms of b5 pantothenic acid deficiency burning feed, numbness, paresthesia/dysestheisas.
rx neisseria meningitis? ceftriaxone for minimum 2 weeks.
FF = gfr / rpf normal FF = 20% filtered load = GFR x plasma concentration rpf best estimate with PAH gfr estimate with creatinine why use renal PLASMA flow instead of renal BLOOD flow for filtration equations? because
mycobacterium avium intracellularae - infects immunosuppressed and competent hosts. more comming in hiV with CD4 counts BELOW 50 - diagnose with blood culture of AFB - prevention and treatment? weekly azithromycin prevents treat with clarithromycin/azithromycin + rifabutin/ethambutol - must use combo and use HIV rx to bring counts above 200
isoniazid used prophylactically in HIV pts exposed to M. TB with POSITIVE PPD what is cosidered + PPD in HIV pts? induration of 5mm or more.
rifampin is used in those exposed to? N.meningitidis, and H.influenzae. not useful against mycobacterium avium intracellularae.
penicillin rx classically in waht dz treponemal, neisseria, and gram+
TMPSMX used in HIV for prevention of what diseases? when do those disesases become especially likely? cd4 count 200 -Pneumocystin jiroveci cd4 100 - toxoplasma gondi
maternal insulin does not cross placenta but sugar does so fetal hyperglyemia results in diabetic mothers causing hyperinsulinemia (transient) but also excess calorie storage as fat. fetus has hypoglycemia for how long? 1 week or so.
treatment of toxoplasmosis pyremethimine and sulfadiazine
if you see EBV on spinal tap of hiv patient with cns manifestions , think of> b cell lymphoma
mycoplams requires what nutrient to grow on media cholesterol
narrow zone of b hemolysis on sheep blood agar (resembles b hemolytic strep) and has tumbling motility at 22 deg c, and cultured at low temps even 4 deg c listria monocytogenes eliminiated by cell mediated immunity (intracellular)
bupropion causes agitation insomnia and seizures acts on NE but not SE, ach, or histamine. bupripion used for depression assx psychomotor retardation (because it is stimulatory) also treats nicotine dependency, used in depression where ssris cause sexual dysfunction
crohns dz predisposes to gall stones by what mechanism increased bile acid wasting, not because of increased delivery to liver
screen all newborns for? hypothyroid, phenylketonuria and galactosemia
frontal lobe syndrome (possible due to injury) 3 categories disinhibited, disorganized, apathetic - all 3 characteristics are present but one will dominate.
arb's block AT 1 receptors and therefore what what effects/. increased renin, increased AT1 increased AT 2 DECREASED ALDOSTERONE (due to vasc smooth muscle relaxation) and NO CHANGE in bradykinin levels.
some drugs that can be used in early rheumatoid arthritis usual management of it is methotrexate, add leflunomide and TNF a inhibitors if needed. sulfasalazine, hydroxychloroquine, minocycline
side effects of minocycline photosensitivity and autoimmune hepatitis.
naproxen is an NSAID works by blocking PG synth side effecs. gi bleed, fluid retention, hypertension becomes WORSE, elevation of liver enzymes.
side effects of methotrexate stomatitis(oral ulcers), hepatotoxic - hepatitis, fibrosis and cirrhosis. myelosuppression -> infection. b cell lymphoma, pulmonary fibrosis. folinic acid reduces stomatitis.
patients with CHF - what drug can reduce all cause mortality and slowing progress of heart failure? BETA BLOCKERS, especially CARVEDILOL which blocks a1 b1 b2 also remember SPIRO does similar by preventing cardiac remodeling though blocking aldosterone actions.
positive osmotic fragility test is seen in spherocytosis, not sickle cell anemia
formation of pigment gallstones in hemolytic anemia? increased bilirubin from rbc precipitates as calcium bilirubinate forming pigmented stones. mature pigmented stones combine calcium bilirubinate, bilirubin polymers and calcium salts.
copper management? wilsons disease affects what wilsons AutoRec-copper liver brain eye. 60% ingested copper (.6-3mg/day) abx stomach duod, bound albumin->liver>binds a2globulin = ceruloplasmin->secreted to plasma=95%circulating copper) normal body copper 50-150mg. extra secreted bile>stool, 10% renal.
septic arthritis usually due to ? gonococcus. use ceftriaxone empirically to cover this in any inflamed monoarthrotis while waiting for confirmation. - complications of waiting -0 joint destruction, osteomyelitis, sepsis
first step in screening for malabsorption is stool test with which stain? sudan III - testing for quantitative fat analysis. >7gm/day fot excreted is malabx
what can be diagnosed by duodenal aspiration or jejunal biopsy - too invasive to use early in a workup but help to establish diagnosis of crohns, whipple, celiac sprue and others
panacinar emphysema a1 antitrypsin deficiency - is a form of copd, affects LOWER LOBES (vs centriacinar - smoking - afects upper lobes) caused by neutrophil elastase in alveoli, lower lobes worse because greater perfusion
centriacinar emphysema upper lobes, assx smoking, destructive proteases from macrophages and neutrophils cause acinar wall destruction. reflects lower perfusion in upper lobes, and low presnece of a1 antitrypsin in serum
diastolic pressures >120 cuase hyperplastic arteriosclerosis onion like concentric thickening of walls of arterioles of laminated SMC's and reduplicated basement membranes - malignant nephrosclerosis - retinal hge, exudate, pappiledema = malignant hypertension.
homogenous deposition of hyaline materia in intima and media of small arteries and arterioles characterizes hyaline arteriosclerosis - assx LOWER levels of hypertension
pyruvate to lactate uses NADH and turns it back into NAD, which is used by? glyceraldehyde 3p -> 1,3 BPG turns NAD+ into NADH
3 types of colonic adenomatous polyps tubular , villous, tubulovillous
tubuar - d dysplastic colonic mucosal cells with tubular shaped glands - smaller, pedunculated
villous dysplastic epithelial cells form villi like projections extending from polyp surface down to stroma . look like cauliflower, lower gi bleeding - guaiac+, anemia, intestinal obstr, mucus secretion, secretory diarrhea, high risk of adenocarcinoma.
what hco3 level is normal and what is 'compensated' renally? 25 is normal, 30+ is compensated renally recall too many H+ = acidosis , we try to excrete the excess h+ which causes retention of hco3
contraction alkalosis - overuse of diuretics cause volume loss, causes increased aldosterone - causes na h20 retention and loss k and h+ renally. loss of h+ produces met alk, aka contraction alk . lab: high ph, high hco3 and high pco2
diabetic ketoacidosis low ph, low hc03 and low pco2 (due resp kussmaul)
SaO2 less than what is required to cause hypoxic secondary polycythemia (increased rbc mass) less than 92% a pao2 of 70mmhg corresponds to sao2 of 94%
erythrocytosis is defined as? what do you need to look at to determine if it is relative or absolute erythrocytosis >52% male >48% female hematocrit Look for RBC MASS - if normal, then RELATIVE erytyrocytisis
gout occurs in patients with ACTIVATING MUTATIONS in PRPP synthetase - due to? increase purine production -> hyper uricemia
small 5mm cavities in basal vang, post limb int capsule, pons, cerebellum are lacunar infarts. what are the primary causes of lacunar infarcts/ lipohyalinosis and microatheromas
lipohyalinosis destructive vessel lesion w/ loss of normal architecture, muram foam cells and fibrinoid necrosis.
microatheromas accumulation of lipid laden macrophages in intimal layer of vessel. - they occur near the branch off from feeding artery
mitral valve disease and carotid atherosclerosis can cause cerebran infarction secondary to embolism - also release microemboli but are not as common as the main 2, which aree? lipohyalinosis and microatheroma
oligodendrocyte apoptosis occurs in multiple sclerosis
cystic fibrosis patients with mild cftr mutations may have normal sweat chloride test in them what other test can you do> nasal transpeithelial potential difference -(between surface of resp epithelia and interstitial fluid). CF pts have more NEGATIVE baseline nasal potential than normal due to increase luminal sodium resorption. see pic. this abx in all gland but sweat no.
s4 gallop is presystolic sound, before s1. left sided s4 hear best at apex with pt in left lateral decubitus. rt sided s4 heart along lower left sternal border (tricuspid area) s4 hear when sudden rise in end diastolic ventricular pressure caused by atrial contraction against ventricle that is maximally full. s4 in any condition causing stiff ventricle ie LVH
5 year old, bounding pulse , thrill on upper left sternal border, continuous machinery murmur =? what aortic arch? patent ductus arteriosus - embryonically allows fetal blood from pulm into systemic circuluation , bypassing lungs. closes at birth w/ pgE2 and O2. after closing = ligamentum arteriosum. 6th aortic arch!!!!
PDA comes from what aortic arch 6th arotic arch
sinus venosus embryologic structure in heart gets blood from vena cavae - in adult, becomes smooth portion of FA canned sinus venarum
bulbus cordis beginning of ventricular outflow tract in embryo - is the smooth part of left and right ventricle
primitive atrium gets blood from sinus venosus , transmits to ventricle - becomes the rough part of RA and LA.
VCN thayer martin for neisseria (esp colistin does this) nystatin for fungi, vancomycin for gm + - what type of medium selective medium
enrichment media have sepcial factors XV factors for haemophilus or anaerobic conditions for clostridia
differential media for differentiating based on metabolic properties like Macconkey and EMB agar CKEE
reducing media culture organisms that reduce iron or sulfur
PSVT rx - valsalva increases refractory period in AV node prevents reentrant circut - due to increased vagal tone . if this failed then what rx? adenosine
hyper IgM is inability of b cells to class switch - due to? HEAVY CHAIN CONSTANT REGION that wont change, deficeint CD40 Ligand - recurrent sinopulmonary infection (differentiate CF) see lymphiod hyperplasia due to too much IgM. rx IvIg
pulmonary finding in CHF (ie post MI) decreased lung compliance due to pulm edema -> TRANSUDATE in interstitium.
drug of choice in gonoccal urethritis ceftriaxone
failed rx with ceftriaxone for urethritis = NGU, commonly c.trachomatic or ureaplasma urealyticum, also mycoplasma or trichomonas. azithromycin is rx.
chlamidya trachomatis is intracelular has cell wall but NO :PEPTIDOGLYCAN . considered gram - , difficult to stain. has PBP's!!? this is called chlamidyal anomaly what is chlamidyal anomaly - chlamidya has penicillin binding protins but no peptidoglycan
ureaplasma urealyticum lacks cell wall, does not stain and is not susceptible to ceftriaxone, so rx with? macrolides or tetracyclines
how to treat chlamidya or ureaplasma? antiribosomal antibiotics macrolides or tetracyclines
chlamidya requires what from its host cell that it cannot produce on its own, but ureaplasma cAN produce ATP - is required for growth and replication
how does tetanus vaccine protect from tetanus does NOT prevent bacterial growth rather gives immunity to bacterial product through cirulating antibodies
pro-carcinogens are metabolized by cytochrome p450 monooxygenase, prensent in ? hepatic microsomes and endoplasmic reticulum of other tissues.
cytochrome p450 monooxygenase metabolizes steroids, alcohol, toxins and other substances by rendering them soluble and easier to excrete. this process can cause what HARMFUL effect turning procarcinogens into carcinogens and causing mutations > cancer
chemicals can induce cancer, most of these chemicals start in harmless PRO-carcinogenic state and must be made into active carcinogens. what system in the body does this? cytochrome p450 monooxygenase, from hepatic microsomes and endoplasmic reticulum of other tissues.
glutathione s transferase is involved in? DETOX, inactivates carcinogens.
mitochondrial cytochrome oxidase cytochrome a+a3 is part of ETC, reacts with what to produce what? reacts with oxygen to produce water -
difference between mitochondrian cytochrome oxidase cytochrome a+a3 vs microsomal monooxygenase cytochrome p450 cytochrome a+a3 mitochondrial cytochrome oxidase is part of ETC - turns o2 into water cytochrome p450 microsomal monooxygenase turns procarcinogens into carcinogens. (hepatic microsomes and endoplasmic reticulum)
superoxide dismutase converts what into what superoxide into oxygen and hydrogen peroxide during phagocytosis
space constant is? measure of how far along an axon , an electrical impulse will travel.
what is space constant used for reflects increased charge dissipation if decreased - results in impaired stimulus transmission along axon.
what is purpose of myelin to increase space constant therefore increase the distance traveled by impluse down axon
demyelination has what effect on space constant - decrease and therefore decreased signal transduction.
temporal summation vs spatial summation temporal refers to sequential impulses frm same neuron over time spatial summation refers to impulses from several different neurons
neisseria gonorrhea - infection does not provide lasting immunity becuse? 1 high antigenic variation - and immunity only against single epitope 2 poor antibody response to gonococcus (IgG, IgM) and very low titre is released.
resistance of n.gonorrheae to what antibiotics? mostly penicillin, partly fluoroquinolones still sensitive to 3rd gen cephalosporins.
gonorrhea is frequently co infected with what infection? therfore rx shoudl include what drugs/ chlamydia trachomatis - include 3rd gen cephalosporin ceftriaxone and azithromycin/doxycycline
repeated neisseria infectino can be caused by what deficiency of the complement system? terminal complement deficiency ->inability to form MAC
best place to harvest gret saphenous vein for CVS procedures? ie bypass surgery in atherosclerosis just below pubic tubercle
if left anterior descending artery alone is occluded by atherosclerotic plaque, what is the best replacement vessel for bypass grafting? left internal mammary artery aka left internal throacic artery - why? becuase superior short and long term patency rate compared to saphenous vein graft.
if multiple coronary artery grafts are required, where to harvest the vessels from> great saphenous vein - longest in body, superficially located.
course of great saphenous vein. medial malleolus, medial leg, thigh, drains into femoral vein at femoral triangle. graft here, below pubic tubercle - sartorius muscle laterally, adductor longus medially.
short/small saphenous vein course? lateral aspect of foot, goes posteriorly drains into popliteal fossa.
parvovirus b19, erythrovirus aka fifth disease (is the 5th on the list of childhood viral exanthems) replicates WHERE int he body and why there? how is it transmitted? transmission is respiratory droplets AND blood bourne infection. replicates in BONE MARROW why? becuase blood group P antigen = globoside is a b19 virus receptor expressed on RBC, rbc precursors, megakaryocytes, endothelial cells, placenta, and fetus
parvovirus b19 causes arthritis in adults, fifth disease in children aplastic crisis (no new rbc production and this is dangerous in those with existing hemolysis ie spherocytosis or sickel cell) complication in HIV hydrops fetalis in first trimester
treatment for hodgkins lymphoma - vinca alkaloids, vincristine most likely
how do vinca alkaloids work inhibit microtubule formation - bind b tubulin prevent polymerization of microtubule proteins. inhibition of microtubule causes cell cycle specific cytotox in M PHASE .
what is the toxicity to arresting in M phase of cell cycle. inhibition of microtubules as in vinca alkaloids causes replicated chromosomes to be unable to align and then separate into daughter cells.
vincristine assx neurotoxicity, peripheral neuropathy. - disruption of microtubule formation - transports cellular products from neuron body down axon
why does microtubule inhibiton cause neuropathy, what drug is characteristic of this vinca alkaloids - vincristine - microtubules transport cellular nutrients from neuronal body down axon. vincristine disrupts neuronal microtubuls.
patients with COPD, asthma , what beta blockers to give? selective beta blocker is required - metoprolol, atenolol, acebutolol, esmolol
why not to give propranolol in copd / asthma nonselective beta blockers cause bronchoconstriction and peripheral vasospasm and predispose diabetics to hypoglycemia by blunting hypoglycemic symptoms
nitrates are vasodilators and decrease BP, how can this paradoxically increase myocardial o2 demand and how can this be prevented vaso dilation, decrease BP - body sympathetic system kicks in >catecholamines > beta 1 stimulation, REFLEX TACHYCARDIA - prevent by blocking beta 1 = metorprlol, esmolol, atenolol
n-acetyl cysteine is medication used in? acetaminophen tylenol od also renal protective prior to administration of iv iodine contrast for radiological studies.
hydralazine causes arteriolar dilation ->what is the negative effect of this? how do we overcome this reflex tachycardia - overcome with coadmistration beta blockers.
nifedipine is a peripherally acting CCB - causing reflex tachycardia due to arteriolar effect. how to overcome? use cardioselective CCB's like diltiazem or verapamil - slow av nodal conduction but beta blockers blunt tachycardia if required.`
drugs causing reflex tachycardia nitrates, hydralazine, non cardioselective CCB's like nifedipine
ischemic colitis due to systemic hypotension happens where first and presents how? why? splenic flexure and sigmoid colon are watershed areas between sources of perfusion. splenic flex is between SMA and IMA. presents with pain and bloody diarrhea
what drugs act on PPAR ? what do they do? ppar gamma is glitazones for diabeties , increases sensitivty to insulin - hepato and cardio toxic PPAR Alpha - FIBRATES used to decrease TG's, upregulate LPL causing increased TG clearance.never give with statins (more muscle liver tox)
most common Congenital adrenal hyperplasia cause 21 alpha hydroxylase deficiency - decrease cortisol, aldosterone, increases sex hormones, salt wasting and hypOtension. a NON SALT DEPLETING FORM ALSO EXISTS
what is the genetic inheritance of 21 alpha hydroxylase deficiency chromose 6, autosomal recessive
treatment of CAH? deficiency enzymes cause failed ACTH regulation so ACTH goes way up, Rx is administer minimum effective dose of cortisol to keep acth suppressed.
omphalomesenteric duct connects midgut lumen with yolk sac cavity. it obliterates at 7th week. if it is abnormal, what defects can result? persistent duct aka vitteline fistula is complete failure to close>intestine to umb>meconium leak - diverticulum mcc, partial closure patent part on ileum, fibrous band to umb. sinus=partial close, patent part at umb. duct cust (enterocyst)
what is enterocyst umbilical and ileal part of omphalomesentric duct obliterate as normal by central patent part remains.
Li Fraumeni is autosomal dominant mutation in 1 allele of p53 gene predisposing to cancers at young age after second allele mutates. p53 produces p53 protein arresting cell in g1/s until dna damage is repaired, or else inducing apoptosis. what cancers? breast, brain, adrenal cortex, sarcoma, leukemia - all before age 45
Rb gene regulats g1 S check point w/ rb protein tumor suppressor. what cancers if mutated? retinoblastoma and osteosarcoma
brca 1 tumor suppressor gene what cancers breast and ovary
NF2, tumor suppressor gene - bilateral acoustic neuroma (schwann cells) in cerebello pontine angle - hearing loss vertigo tinnitus
APC gene - familial polyposis syndrome, sporadic colon cancer, and melanoma. what does the gene do? maintains low levesl of b catenin (which is oncogenic) and for intracelllar adhesion.
how to explain neurological and rash findings that are associated with fat embolus? fat globules escape lungs through precapillay av sungs that open due to increased pulm art pressure>fat to CNS, confusion etc. thrombocytopenia and petechiae are b/c platelet adherence and coating of fat microglobules
focal necrosis of alveolar wlls with intralaveolar hemorrage seen in/ goodpasture, vasculitis ass hge, pulmonary hemosiderosis - basically pulm hemorrhage syndromes
red thrombus vs fat embolus? red thrombus in pulm artery is DVT or deep veinous source. - no rash or CNS involvement in
mechanism of alcohol withdrawal ethanol binds inhibitory gabaA and potentiates effects of GABA>sedation .long use>downregulation of gaba recepotrs.also block NMDA(excitatory), so upregulates also increased synth excitatory mediators ie NE,5ht, dopamine>TOLERANCE and withdrawl
alcohol w/d happens 10 hrs after last drink, maximum intensity in 3 days, subsides 5 days presentation/ shakes, tremor, autonomic dysfunction - tachycardia, high resp, temp, nausea vomiting, insomnia, agitation, anxiety. seizures at 48 hours (GTC)
delrium tremens begins 2-3 days after drink, possibly fatal, sympathetic hyperactivity, high bp, temp, perspiration, hallucinations, confusion , formication=bugs under skin
ischemic infarcts of brain look cystic!, coaused by atherosclerosis commonly - necrosis takes place - neurons become red then die - macrophages clean up, stay there for months, lastly what cell comes and walls off the cavity/ astrocytes in proces called gliosis
wht are the 3 distributions of pneumonia patch, involving a number of lobules = broncho/lobular inflam infiltrate confined to alveolar walls - interstitial entire lobe = lobar
4 stages of lobar pneumonia congestion 24 hours red hepatization 2-3 days gray hepatization 4-6 days resolution
congestion 24 hrs lobe is red, heavy and boggy vascular dilation, alveolar exudate his mostly bacteria
red hepatization 2-3 days red, firm, liver like!hepatization. exudate contains neutrophils and rbs and fibrin
gray hepatization, 4-6 days gray brown firm lobe, rbc disentigrated, edudate contains neutrophils and fibrin - note RBC Disintegrated
difference between red and gray hepatization time frame red, then gray - rbcs are broken down in gray - therfore gray, not red
resolution restoration of normal - enzymatic digestion of exudate
porcelain gallbladder seen on x ray, bluish, brittle, calcium laden GB on outline. ca deposits intramurally due to irritation or natural progression , may be asymptomatic - assx callbladder carcinoma 30%! cholecystectomy recomended
findings in gallbladder with fluke infection is? NOT porcelain GB, find brown pigment stones
most common benign lung tumor , finding? hamartoma. peripherally located - appear as COIN LESION 50-60 yrs pts. consisnt of disorganized cartilage , fibrous and adipose tissue disorganized cartilage! fibrous and adipose tissue.
neuroendocrine markers are seen in what lung tumor small cell ca and carcinoid tumors
celecoxib is a sulfa drug, inhibits reversibly cox 2, but spares cox 1. why is this useful cox 2 blocks inflammation , cox 1 spared leaves gi mucosa intact , use in patients who need NSAIDs but have GIT problems toxicity thrombosis, sulfa allergy.
rituximab is monoclonal AB vs what? used for what? rx lymphomas , vs cd20
ADH acts where? PRINCIPAL cells (think adh=vasopressin=principal) in medullary collecting duct. v1 + > vasoconstriction and increased protaglandin release. v2+>antidiuretic response
sunscreen contains what active ingredient? active against what wavelengths? what time of UV? PABA paraaminobenzoic acid esters - used vs UVB 290-320 nm, do not absorb UVA (320-400) uvb causes sunburn, immunosuppression, photo aging, and carcinogenesis. UVA is not as harmful but compounds are added ie avobenzone for uva1 uva2 zinc oxide vs all
probenecid decreasees renal clearance of penicillins by? inhibiting tubular organic acid secretion system. prolongs action of penicillin.
clavulinic acid, sulbactam and tazobactam all inhibit BETA LACTAMASES
non-dihydropyridine CCBs (verapamil and dildiazem) + beta blockers cause what bad effect significant sinus bradycardia, even sinus arrest and severe hypotension
why do fibrates predispose to gallstones? suppression of cholesterol 7alpha hydroxylase, reduces conversion of cholesterol into bile acids -> more cholesterol in bile - precipitates, gallstones.
drugs predisposing to cholesterol stones AND any other factors? fibrates (7a hydroxylase), octreotide, ceftriaxone
what antibiotic causes increased risk of gallstones (cholesterol) ceftriaxone
SAH>rupture berry aneurysm or AV malformation - what causes morbidity a week after. prevent? vasospasm due to impaired brain autoregulation - rx NIMODIPINE selective CCB
anti Ro SSA and LA SSB seen in sjogren syndrome increaed risk of what cancer/ non hodgkin lymphoma
when to suspect legionella> pneumonia and diarrhea
how to test for legionella sputum is UNRELIABLE use uRINE ANTIGEN test
another bacteria like legionella that inhabits water systems - mycobacterium kansasii
ace inhibitor allergy reaction is characterized by what tongue, eyelid, face lips swelling, due to BRADYKININ, not anaphylaxis
what is non immune mediated mast cell degranulation - what causes it? non IgE stimuli ie drugs, chemicals heat etc. = pseudoallergic reaction - similar to hypersinsitivity but no ige involvement. - VANCOMYCIN
why do fungi mucor absidia mostly rhizopus have affinity for DKA patients? presence of KETONE REDUCTASE ENZYME gives affinity for ketones and high sugar. proliferate in blood vessel walls, cause necrosis downstream. - spreads to CNS, death.
microscope findings in mucormycosis broad nonseptate hyphae with RIGHT ANGLE BRANCHING , tissue invasion of Blood vessels , thrombosis and tissue necrosis.
what to differentiate mucormycosis from? aspergillus - also affects sinuses in immunocompromised and has similar sx, seen with v shaped 45 degree branching hyphae
diagnosis of bronchopulmonary allergic aspergillosis vs paranasal aspergillus - ABPA - high IgE and antibodies to aspergillus fumigatus. skin hypersensitivty is also +
carbon tetrachloride causes what kind of hepatic injury? free radical injury - CCL4 is oxidised by p450 oxidase -> CCL3 freeradical forms -> lipid degredation and h202 = lipid peroxidation. hepatocyte necrosis ensues
place an IVC filter in patients contraindicated for anticoagulation prevents DVT reaching lungs or other parts of body
adrena gland tumor, yellowish most commonly is aldosterone secreting = conn syndrme. presentation? hyperaldosterone = na retention, k secretion = hypertensionand hypokalemia, also metabolic alkalosis. hypokalemia causes muscle weakness (hypokalemic paresis) and alkalosis causes paresthesias
age related macular denge leading caues of blindness in usa - degen of central retina, dry: subretinal drusen or pigment change. wet: neovasc + hge/gray mebm rx? dry: vitamins and zinc wet: vgef inhib + laser phototherapy. RX ranibizumab and pegaptanib
anti epidermal growth factor receptors used in non small cell lung ca erlontinib, getitinib
anti-interleukin 2 is for immunosuppression in gvhd or transplant pts
why use methadone in heroin addiction rx potent, long acting opiate with good oral availability - key is it has a very long half life so it suppresses withdrawal long as to break addiction.
how does head and neck of femur get blood supply? what vessel is most likely injured in femoral neck fracture trochanteric anastomosis = medial and lateral femoral circumflex arteries. medial circumflex femoral makes the largest contribution and is most likely to be injured
HAART has what effect on the HIV virus resistance via POL mutations (reverse transcriptase)
what kind of genome on hiv virus diploid genome 2 molecules of RNA
p24 is? capsid protein, GAG
gp41 is for fusion and entry = envelope protein
gp120 is for attachment to t cells = envelope protein
env gene is for ? gp 120, and gp41
reverse transcriptase synthesizes dsDNA from rna. the ds dna then integrates into host genome RECOMBINATION is posisble due to 2 same RNA strands present
hiv binds to? cxcr4 cd4 on t cells ccr5 and cd4 on macrophages homoczygouls ccr5 mutation gives immunity, heterozygous ccr5 gives delayed infection time
how do get immunity to HIV? homozygous ccr5
presumptive diagnosis of hiv with eliza - highly sensitive good for seeing positives, so rule out , then what test to confim western blot - specific, high fasle negative rate- use to rule IN
what is use of hiv pcr/viral load in hiv? monitoring drug therapy with viral load.
aids diagnosis <200cd4, normal 500-1500. or cd4/cd8 ration less than 1:1.5
babies are false positive HIV due to what? maternal IgG vs gp120
hiv infections at cell count #'s 400-candida, tenia, shingles, TB, bacterial 200 - HSV, cryptosporidiosis, isospora, coccidiodiomycosis, pneumocystis j. 100 candida esophagitis, toxoplasmosis, histoplasmosis 50 CMV retinitis, esophagitis, MAC, cryptococcal meningoencephalitis.
hiv assx neoplasms - kaposi sarcoma, hhv 8, cervical ca hpv, cns lymphoma b cell, NHL
eggshell calcification seen in hydatid cyst
empty can test with sensitivity in shoulder or weakness is specific for what ? supraspinatus tendon injury
why is supraspinatus most commonly injured? friction on acromion, most superior position
muscles of rotator cuff anterior - subscapularis superior supraspinatus posterior infraspinatus, teres minor
what collagen related process is responsible for aging and wrinking skin collagen fibril production decreases NOT proline hydroxylation or collagen corss linking or fibrillin synth or collagenase. only decreased collagen production.
how does 2 3 BPG bind to HB? pocket formed my 2 BETA chains (only HBA not HBF) the pocket has +charge AA's binding to negative phosphates in 23 dPg. it does not bind oxyHB, only deoxy.
why can fetal hb not bind to 2.3 bpg and therefore has higher affinity for o2? becuase hbf has 2 gamma chains instead beta chains and the beta chains form a pocket for 23BPG and also HISTIDINE is very important.
what happens if the histidine on beta chain of HB mutates cannot bind to 23BPG then and increaes affinity for o2
can 2,3bpg bind all kinds of HB? no only DE OXY HbA
sexually active adult with polyarthralgia , swollen, and aspirate w/ neutrophils and intracellular organisms neisseria gonorrheae.
potassium iodide blocks thyroid uptake of radioactive iodine how? competitive inhibition
first dose hypotension is an adverse effect when starting ace inhibitors. what drugs coadministered make this phenomenon more likely? diuretics causing hypovolemia or hyponatremia etc
phenoxybenzamine has what unique characteristics irreverisble and a1 and a2
why is inhibin low in undescended testes becuase inhibin comes from semineferous tubules which involute in undescended testes. - atrophic and hyalinized. FSH is elevated due to loss negative inhibition by inhibin.
leydig cells are not sensitive to temperature therefore what will be the finding in undescended testes normal testosterone, sexual dvelopment but undescended testes, low sperm and inhibin and high FSH
why do reticulocycets appear blue compared to RBC. what stains bring this about and what component are staining blue. why is this especially noticable after iron therapy. anemic gets iron therapy ++erythropoiesis , high reticulocytes also. stain with WRIGHT GIEMSA, see bluish RETICULAR MESH LIKE NETWORK OF RESIDUAL RIBOSOMAL RNA. after 24 hours in blood stream they mature.
non bacterial thrombotic endocarditis is not caused by bacteria or calcium! it is caused by HYPERCOAGULABLE STATE. if NBTE is caused by hypercoagulability is is caused marantic or marasmic endocarditis. what other syndrome is this similar pathology to? Trousseau's syndrome - migratory thrombophlebitis also caused by malignancy and hypercoagulability pancreas and lung
which cancers are NBTE and trousseaus syndrome closely associated with mucinous adenocarcinoma pancreas adenocarcinoma lung.
HIV what are NEf and Tat? Tat - viral replication Nef - decreases expression of MHC class 1 on infected cells.
precocious puberty definition and causes/ males <9 females <7 CAH, ovarian and adrenal tumors if neurologic abnormalities ie gaze problem(parinaud) then brain tumor
parinaud syndrome aka dorsal midbrain syndrome - paralysis of upward gaze. MCC Germinoma of pineal gland
germinoma originate from what cell line embryonic germ cells -
symptoms of pineal germinoma precocous puberty due -b-hcg production aqueductal compression ->obstr hydrocephalus parinaud syndrome - paralysis of upward and convergence - due to compression of tectal midbrain
heme oxygenase plays what role in bruises heme -> biliverdin (green bruise)
axillary lymph node dissectin is a risk for chronic lymphedema of the arm. what cancer does this predispose to?> multiple violaceous nodules on the arm - angiosarcoma.
LM of shingles shows? intranuclear inclusion in keratinocytes and multinucleated giant cells (tzanck smear). skin biopsy shows - acantholysis (loss of intracellular connections) and keratinocytes and intraepidermal vesicles. dermal inflam, and wbc vasculits.
what is extrahepatic biliary atresia congential obstr of extrahepatic bile ducts. - total obstr by 3rd wk of like - obstr jaundice picture, enlarged liver. high direct bili, ask phos, ggt.
liver biopsy findings in biliary atresia? diagnostic : 1 marked intrahepatic bile ductule proliferation 2 portal tract edema, and fibrosis 3 parenchymal cholestasis rx? surgical release or else biliary cirrhosis by 6 month
non-caseating granuloms in sarcoidosis and chrons
sarcoidosis has elevated ACE levels.
sarcoidosis GRAIN? gammaglobulinemia, rheumatoid arthritis, ace incre3ase, interstitial fibrosis, noncaseating granuloma
epithelial granulomas of sarcoidosis contain schaumann and steroid bodies
elevated vit d of sarcoidosis is due to increase 1 alpha hydroxylase activity
injury to fibular neck injures what nerve - what loss is seen common peroneal nerve also called common fibular nerve foot drop, and sensory loss on dorsum of foot and lateral aspect of knee
common causes of metabolic alkalosis are loss of hydrogen from body ie vomiting , stomach suction. this causes decreased cl- (less than 10 meq/l) this is saline responsive 2 thiazide diuretic use increase loss of na cl and reabx hco3-> ++aldosterone >save na but still lose cl - contraction alk
third common cause of metabolic alk continued from previous slide conn syndrome -hyper aldosterone secretion - save na, save hco3, lose h but lose cl and k. urinary cl is elevated (20=meq/l) this is saline resistant metabolic alkalosis.
treatment of the common causes of met alk 1 stomach / hydrogen loss type - saline rx 2 diuretic thiazide esp - rx saline 3 aldosterone type - saline resistant
what test is very important when suggestiv of met alk - always check URINE CL findings vomiting / hcl loss - serum cl low, urine cl low thiazide dirutetic, urine cl high serum cl low aldosterone type, urinary cl high (20+)
met alk is characterized by what findings on lab high ph, high hco3 high pco2
bleeding time and and PTT elevation suggests vWD - because platelets are inhiited and factor viii also. differ from hemophilia - only viii involved so ptt elevated but not BT
factor xiii def causes what findings it is a transglutaminase that corss links fibrin polymers and stabilizes clots - xiii def causes delayed bleeding but not PT PTT oR BT
mitral stenosis has opening snap due to abrupt halting of motion of stenotic mitral valve leaf during mitral valve opening . most commonly due to prior rheumatic carditis
xeroderma pigmentosum deficient enzyme is UV specific ENDONUCLEASE not 3'5' exonuclease
what disease is associated with dna exonuclease 3' 5' proofreading failure - defective repair of mismatched bases = hnpcc
in alzheimers disease , where does amylod deposit and what is it derrived from. what is its specific name deposition in parenchyma and blood vessels of the brain of (congo red +) amyloid = A beta amyloid comes from cleavage of APP amylod precursor protein. - 2 places senile plaques (core is a beta) and amyloid angiopathy-media and BM of cerebral vessels
where can krukenberg tumors originate stomach, breast, pancreas and gallbladder
what do ovarian tumor cells look like in krukenberg tumor signet ring cells mucin producing in ovarian stroma
stomach is most common source of krukenerg tumor - breast in 5-20% - how does seeding occur> peritoneal seeding
what characteristic nodes are enlarged in GIT malignancy sister mary joseph nodule (paraaortic ) and virchows node
aortic regurg causes widened pulse pressure and therfore head bobbing.
lacunar infarcts are ISCHEMIC infarts and thus do not show up immediately on CT but show up weeks later as LAKE LIKE - why do they happen> Hypertension -> hyaline arteriosclerosis _> narrowing of lume -> occlusion
where do lacunar infarcts occur and what do they cause there pure motor hemi - post limb int cap pure sensory VPL VPM thalamus ataxia hemiplegia syndrome - base of pons dysarthria clumsy hand synd-base of pons or genu of int cap
charcot buchard aneurysms are microaneurysms less than 1 mm (vs 15 mm of lacunar) - small penetrating arterioles of basal gang, pons, subcortifcl white matter due to hypertension also but not causing hyaline arteriosclerosis these are hemorrhagic strokes and will be evident on CT
COAL amino acids cystine ornithine lysie and arginine are dibasic amino acids that share a comon transport mechanism in kidney and intestinal lumen. in GIT, these AA's are reabx w. high affinity transporter on JEJUNAL cells. in kidney? substances are filtered at glomerulus and reabx by similar transmemb channel on PROX TUB - the defect causes failure of this so there is excessive excretion of COAL AA's into urine (failure to reabx)
the pka of coal aa's is ? 8.3 but urine is acidic so they precipitate - esp CYSTEINE -> cysteine stones lifelong urolithiasis and cystinuria
cystinuria is inborn error of transporter of COAL aa's . AUTO RECESSIVE, only clinical problem is recurrent nephrolithiasis , how to diagnose? hexagonal cystine crystals. (rhomboid calcium, needule urate)
mycolic acid is in cell wall of mycobacterium , makes it acid fast - can be treated with what analog of vit b6 inh - is similar to b6 - causes what side effects - neuropathy hepatoxicity 450 inhibit
in cerebral hypoperfusion like shock or decreased co, what parts of the brain are injured first pyramidal cells of hippocampus = sommers sector purkinje cells of cerebellum. if continued ischemia, then watershed zones - border between ant and mid cerebral arteries - wedge shaped areas of necrosis over cerebral convexitie, laterla to fissure.
cyclosporine and tacrolimus act on calcineurin - what is it? in normal t cells, it is a protein phosphatase activated by + of receptor. once activated, it dephosphorylates NFAT, allowing it to enter nucleus , binds IL2promotor -> IL2
Neurofibromin is a tumor suppressor protein on NF1 gene ch 17 - protects vs cancer becuase it suppresses? RAS gene - which activates cell growth and proliferation
BCL2 (bcell leukemia / lymphoma 2) is an apoptosis inhibitor. if overexpressed, cell death delayed- follicular cell lymphoma (t 14:18, q32;q21 ) p53 is a tumor suppressor causing cell cycle arrest and apoptosis. ineffective in most cancers and li fraumeni syndrome
choriocarcinoma and moles are associated with what kind of cyst theca leutin cysts (bilateral and multiple)
yolk sac tumors have 50% what bodies? schiler duval bodies - resemble glomeruli
grnulosa cell tumor has call exner bodies hcg secreting tumors are dysgerminoma and horiocarcinoma
granulosa theca cell tumors secrete estrogen and have call exner bodies - present? fenizing - precocious puberty but more commonly seen in post menopausal women causing endometrial hyperplasia - small gland like structures with acidophilic material is call exner body - is immature follice
using hands to raise from squat or from chair (proxymal muscle weakness) is called> gowers sign -
why is distal muscle hypertrophy seen in those with proxymal muscle weakness to compensate for proxymal muscle weakness.
gower sign and calf enlargement in child 3-6 = duchenne - deletion of gene coding for dystrophin - located on x chromosome , also recessive only males are affected but females are carriers. - dystrophin is a structural compoent of skeletal muscle fibers , links cytoskeleton actin to transmembrane proteins alpha and beta dystrophiglycans - loos results in myonecrosis.
histology of duchennes widespread muscle necrosis , on LM, variation of muscle fiber size and angulated fibers seen . some fibers have centrally located internalized nuclei
charcot marie tooth disease is caused by mutation of genes responsible for synthesis of myelin - abnormal myelin is made , decreased nerve conduction velocity - presents as weakness of dorsiflexion due to common peroneal nerve involvement
endomysial inflammation is seen in polymyositis perifascicular inflammation is seen in dermatomyositis. both cause prox musc weak but no distal hypertrophy
endoneural inflammatory infiltrate seen in GBS
tuberous sclerosis Skin - sebaceous adenoma, seizure, shagreen patch 4 tubes- CVS rhabdomyoma, Renal tube angiomyolipoma, CSF ependymoma(astrocytoma), skin tube - sebaceous adenoma, shagreen, ash leaf
achalasia failure of what plexus myentric / auerbach think achalasiauerbach , and cardia (muscle) so myentric)
metronidazole uses? get gap on the metro gardenrella, entameba, trichomonas giardia anaerobes pylori
dresseler syndrome weeks after MI - fibrinous pericarditis , autoimmune
wagr complex wilms tumor - renal , mcc in early childhood 2-4 yrs aniridia genitourinary malformation retardation
km= km=[s] @1/2 Vmax is a substrate concentration allowing the enzyme to do its thing. if you need less substrate then it means the enzyme has high affinity , if you have to have lots of substrate, then it means the enzyme has a low affinity.
lineweaver burke plot what is eq for slope? km/Vmax
verapamil or quinidine toxic effect with digoxin why/ digoxin and and furosemide >? they displace it from its plasma protien causing digoxin toxicity furosemide causes hypokalemia - causes digitalis tox.
what drugs make lithium toxicity more likely? what is the teratogenic effect of lithium? Li behaves like sodium. it crosses BBB freely. anything causing increased sodium retention , also acts on Li ie ace inhibitors, thiazides, NSAIDS! ebstein anomaly
what is ebstein anomaly associted with li? ventriculization of right atrium and atrialization of right ventricle - ie displacement of tricuspid valve to apex.
low therapeutic index drugs phenobarbital, digoxin, warfarin, heparin, lithium
3 kinds of antagonism pharmalogical, chemical, physiological.
physostigmine fixes atropine poisoning , crosses BBB, use in glaucoma too
why is dopamine beta hydroxylase used in stains? what does it do? catalyzes dopamine to NE in the brain. it is unique to NE containing areas of the brain therefore it can be stained for to find NE containing areas.
differnt shocks with appropriate treatment anaphylactic shock - epinephrine septic shock - nor epinephrine (only alpha action but less heart action) septic shock aslo use dopamine for d1 effect on renal perfiusion cardiogenic shock - want heart only so b1 - dobutamine
why is dobutamine used in cardiac stress testing specific to beta1 - increased action so increased o2 demand
b2 receptors in uterus prevent contraction ritodrine and terbutaline
which two beta blockers reduce mortality after MI? metoprolol and carvedilol
thyroid storm propranolo
non selective beta blockers ; how to remember which ones letters p-z except labetalol (has Alol, means it also blocks Alpha - is a nonselective a and b.)
labetalol and carvedilol Alol and I lol -> have alpha activity also
alll beta blockers a-m are ? b1 selective
propranolol use migraine prophylaxis (also lithium, and one more - refer to flash cards??), phobia, anxiety, danger with alcohol use in essential tremor and thyroid storm and prevents t4-t3 conversion
how do beta blockers decrease renin secretion - beta receptor blockade on renal JGA cels
antihypertensive effects of beta blcokers decrease heart beta 1 stim, decrease TPR and blod volume due to JGA blockade and decrease aldosterone
which beta blockers are goodin patients with pulmonary disease A BEAM - acebutolol, betaxolol, esmolol, atenolol ,metoprolol these are selective beta 1, do not affect b2 - no broncho constr
which beta blockers have ISA intrinsic sympathetic activity , mimicing NE ie is a partial agonist, (also do not increase blood lipids) acebutolol and pindolol.
what is beta blocker of choice in portal HTN patients with esophageal variceal bleeding>> NADOLOL
never give a beta blocker to patient on beta blocker why? cocaine raises BP due to a1 but is a b2 action is slightly there - si moderately high BP. if added beta blocker, then no b2 effect so only a1 -> massive increase in BP
beta blockers are drug of choice in pateints with aortic dissection they not only decrease the bp but decrease the SLOPE OF THE RISE OF THE BP , and high slope rise of BP increases the tearing of aortic dissection
review interactions on page 247 review beta blcokers 242 and graphs on 241 and earlier.
admin of analgesics like morphine (less so meperidine have what pain causing effect in upper GIT spasm of sphincter of oddi -> biliary colic
hypokalemia findings on ECG (as caused by amphotericin B) T wave FLAT U wave PROMINENT ST DEPRESSION premature atrial and ventricular contraction. ventricular tachycardia or fibrillatoin .
oseltamivir is a neuraminidase inhibitor used in inf A B. neuraminidase is required for release of virus from infected cells and spread w/in resp tract. neuraminidase inhibitora cause newly synth virions to adhere to cell surface>aggregate, no spread. muyst be taken w/in 48 hrs, slows viral penetration of mucous secretions protecting resp epithelium, preventing infection.
amantidine operates how? impairs uncoating or disassembly of virus (inf A only) after endocytosis.
ototoxic diuretics? furosemide (oh dang) ethacrynic acid
NITRATE DRUGS causes muscle relaxation how? simulate nitric oxide (EDRF) NO->guanylate cyclase which turns GTP-->cGMP this incases the cGMP in cell, causing DECREASED CALCIUM, decreasing activity of MLCK, and then dephosphorylation, then smooth muscle relaxation.
glanzmann thrombasthenia and the drug which mimics it glanzmann is congenital def of GP2b3a receptor. ABCIXIMAB is AB vs GP2b3a
anastrozole is an aromatase inhibitor that blocks estrogen production. where does most estrogen come from ? androstendione from adrenal, to estrone in liver/muscle/fat used in post menopausal women with breast ancer
CMV rx in AIDS? ganciclovir, foscarnet, cidofovir.
foscarnet is a pyrophospahate analog, and chelates calcium and wasting of MAGNESIUM . so Low MG and Ca cause? PTH -> even more low ca -> SEIZURES.
in morphine addicted patients, what drug will precipiate withdrawal ? pentazocine - is a mu agonist but only partial agonist. is an analgesic with low abuse potential
what is the drug of choice for listeria - ampicilin - ceftriaxone does NOT cover it
risperidone is good rx for schizophrenia but caues what side effect in women/ hyperprolactinemia, causing amoenorrhea prl is inhibited by dopamine. dopamine acts on D2 lactotrophs - resperidone is anti dopamine, loss of feedback inhib,more prl>hypogonadism due inhibis gnrh
verapamil CCB + beta blocker very low BP, rate and heart block
1 non depolarizing neuromuscular blocker 2 depolarizing N M blocker 1 vecuronium 2 ONLY ONE is succinyl choline
3 c's of measles cough coryza conjunctivitis
pregnancy bHCG + when? fertilization ->implantation 6 days Blood serum hcg 6-8 days after implantation urine 14 days after
conjugation sex pilus, f plasmid e coli first, most bacteria are capable
transduction (recall transversion is substitution of purine for pyrimidine) movement of DNA material from one species to another through bacteriophage. - AB resitance, and virulence factors
transformation non pathogenic straings can take up DNA from other lysed bacteria around, express their virulence factors and become pathogenic. S.pneumoniae, H.influenzae, N. Meningitidis. (all encapsulated) is the example of 2 non pathogenic strains mixed>lethal
what gram+ bacteria secrets ENDO toxin Listeria
ecoli - toxigenic ETEC - has cholera like toxin - ST and LT segments what does LT do and why is ST not inactivated by heat? LT ++ what receptor ? St ++ what receptor? LT ++ Gs-adenylyl cyclase ST is not inactivated beacuse it is very small! ST++ cGMP through guanylyl cyclase on apical membranes of gut mucosal cells. pili are responsible for adhesion to GIT mucosa, kidney/bladder. K capsule for meningitis.
Stacked Brick Intestinal Adhesion is? EAEC - enteraggregative e.coli. adhere to jejenum and ileum in aggregative stacked brick pattern but do NOT invade->persistent diarrhea in 3rd world
Shiga like toxin from? EHEC inactiavtes 60S
Fick's principle (fuck principle) = CO = Rate of O2 Consumption / (art o2 content - venous o2 content)
local defense vs candida what cells?> systemic defense vs candida is by? Local - T CELLS Systemic NEUTROPHILS HIV -> Local candida Neutropenic ->systemic candida
renal cell carcinoma originates from what cells? proxymal tubule renal EPITHELIAL CELLS
hypertrophic cardiomyopathy, which valve is pressing against the hypertrophic septum? MITRAL VALVE NOT AORTIC
eukaryotic gene transcription - RNA pol 2 uses DNA to crease mrna associated with ENHANCERS AND PROMOTERS 1) Promotors are bindings sites for transcription factors and RNA pol 2 - TWO TYPES OF PROMOTORS TATA/hogness box 25 bases upstream and CAAT box 80 bases upstream.
ENHANCERS increase rate of transcription initiation through protein binding and interaction with trasncription factors bound to promotor sequences. enhancers are located upstream OR DOWNSTREAM OR IN THE GENE ITSELF - ie vARIABLE LOCATIONS.
Repressor elements similar to enhancers , but DECREASE instead of increase transcription rates.
resistance in SERIES just add them all up
resistance in PARALELL 1/total = 1/r1+1/r2+1/r3 etc add the FRACTIONS and then INVERT THE ANSWER remember 1/2+1/2+1/2+1/2 = 4/2 (denominator stays same)
goodpasture syndrome is caused by antiGBM vs? alpha 3 chain of collagen type 4 attacks lungs and kidneys, glomnephritis+pulm hge - CRESENT FORMATION w/ fibrin. - LINEAR IgG and C3 , rbc casts and mild proteinuria , hypertension.
Wegeners - involves upper and lower resp tract, and kidneys RPGN - granulomatosis and polyangiitis, C-Anca+ (anti NEURTOPHIL CYTOPLASMIC antibody. RPGN of wegeners is Pauci Immune - no anti GBM antibodies or immune complex deposition (compare to goodpasture syndrome.
cardiac cell cytoskeletal protein or mitochondrial enzymes defect leads to what condition Dilated Cardiomyopathy
mutation in Cardiac Cell sarcomere proteins (beta-myosin heavy chain) underlie hypertrophic cardiomyopathy syncope of HCM is onset with exertion, no ECG abnormalities.
unprovoked syncope with congenital prolonged QT interval is defect in Potassium channels - what 2 syndromes? Romano Ward, Jarvell Lange Neilsen syndrome
dexrazoxane is what? iron chelating agent prevents anthracycline induced (doxorubicin) cardiotoxicity
cisplatin (platinum) based chemotherapy causes nephrotoxicity - how to prevent this/ aggressive Nacl hydration (drug remains inactive in high cl solution) and drug AMIFOSTINE thiol based cytoprotective free radical scavenging agent used to decrease cumulative nephrotox of platinum agents.
follicular lymphoma is most indolent NONHODGKINS lymphoma in adults, origin, defect etc? Waxing and Waning lymphadenopathy t14;18, characteristic and results in overexpression of bcl2
hairy cell leukemia presents with splenomegaly and pancytopenia in older men LN's are not enlarged , leukemic cells have hair like cytoplasmic projections , + for TRAP tartarate resistant acid phosphatase Mycosis Fungoides: cutaenous T cell lymphoma - proliferating cd4+ infiltrate skin->pautrier microabscesses - plaques like eczema/psoriasis.erythroderma
ALL - MCC in children - lymph nodes, liver spleen enlarged, fever, bleeding, bone pain. neoplastic cells are pre b or pre t burkitt assx ebv , aggressive very susceptible to chemo
what tissues cannot use ketones and why/ any tissue w/o mitochondria - RBC's and liver cannot becuase it lacks Succinyl Coa Acetoacetate Coa transferase (thiophorase)
SHiN ? strep pneumo, HiB, N.Meningitis - IgA Protease + Meningitis + TRANSFORMATION +
spore forming bacteria bacilus (cereus, anthracis) Clostridium (perfringens, botulinum, tetani) Coxiella Brunetti
clostridium perfringens toxin alpha toxin is Lecithinase - acts as phospholipase , destroys cell membranes test with NAGLER REACTION in egg yolk gets DOUBLE ZONE HEMOSYSIS on BLOOD agar
dangerous infections in neonates? Groub B strep (Agalactiae) (beta hemolytic) Ecoli Listeria
diptheria toxin is coded by what> ? what medium? what is volutin? beta prophage, loeffler coagulated serum medium volutin are metachromatic ble and red granules . RECALL ELEK TEST distinguishes diptheria from other diptherioids
mechanisms of AB resitance vancomycin chnage in peptidoglycan later penicilin binding protein d-ala d-ala to d-ala d-lac, PBP2, protein 2a replaces transpeptidase sulfonamides decrease affinity of enzyme mutations and active transport of AB out of cell
mechanism of tetracycline and gram - bacterial resistance> tetracycline - active export out of cell gram - bacteria , conjugation plasmids give AB resistance - especially VRE enterococcus , gamma hemolysis) - get resistance very quickly and pass on plasmid.
tetanus toxin blocks gaba and glycine release causing spastic paralysis from what cells, and where renshaw cells in spinal cord remember toxin is transported INTRAAXONALLY and binds GANGLIOSIDE RECEPTORS
recall vancomycin is normally given IV becuase of very poor oral abx - when can you give oral vancomycin> c diff colotis
c diff and c botulinum both have double zone hemolysis c diff has stormy fermentation of milk media .
listeria and d diff polymerize actin filaments - actin rockets
only bacteria to have poly peptide capsule with d glutamate is anthrax
vaginal transmission during birth strep agalactiae (swap , if + at 36 rx penicillin and ampicillin) Listeria monocytogenes
listeria has what kind of motility and what other special movement trait actin rockets (like c diff) and tumbling motility no spors can cause amnionitis , septicemia, abortion and granulomatosis infantiseptica rx ampicillin gentamycin - has listeriolysin o
nocardia vs actinomyces abscess in brain/ actinomyces 1 single brain abscess nocardia, multiple abscesses
TNF alpha blockers all are antibodies - adalimumab, etanercept, infliximab - all used for same purpose - INFLIXIMAB PREDISPOSES TO TB REACTIVATION etanercept is a TNF DECOY RECEPTOR
type 1 diabetes is what kind of hypersensitivty rxn> type FOUR not type two
pallegra is 3d's caused by what niacin deficiency , OR b6 deficiency recall tryptophan --> niacin THROUGH b6 isoniazid also blocks this
when calculating incidence, dont forget what important point/ those currently with or those previously + for it are NOT CONSIDERED AT RISK
what diseases is ESR important in? polymyalgia rheumatica polyarteritis nodosa rheumatic fever OSTEOMYELITIS!! high esr should raise clinical suspicion tuberculosis, malignancy
fluoroquinolones work on what enzymes? what 2 steps does it block? what genes code for these enzymes? what genes mutate to give resistance to FQ's? topoisomerase 2 and 4 - come from genes PARC and PARE 2-positive supercoils 4-separation of daughter dna chromosome before cell division (recall semiconservative replication) resist by mutation in gyrA gyrB genes , altered affinity of binding.
DsDNA antibody is specific to RENAL involvement in SLE
what disease are + ANA (antinuclear antibody) lupus, sjogrens, scleroderma, polymyositis , dermatomyosits rheumatoid arthritis
what type f hypersensitivity reaction is Polyarteritis Nodosa , what type is eczema PAN - III Eczema type I
anti microsomal antibody SLE sjogren, rheumatoid arthritis, hashimoto, others
ANA is progrnostic in what diseae primary biliary cirrhosis
anticentromere antibody is prognostic for what - portal hypertension
histo finding in primary biliary cirrhosis - periductal granulomas, intra epithelial lymphocytes,, epitheloid cells associated with gluten sensitivty , rx ursodeoxycholic acid and cholestyramine and vitamin adek
primary sclerosing cholangitis - assx churg strauss p anca +, 80% assx ulcerative colitis - image ducts with MRCP see BEADING of intra and extra hepatic bile ducts.
what is ANCA igG vs cytoplasmic antigens in neutrophil granulocytes, measured with elisa and immunflouresence. pANCA is perinuclear staining - c ANCA is cytoplasmic staining
c anca is cytoplasmic staining p anca is perinuclear staining.
coefficient of determination? r2 , r is pearsons coefficient
is chlamidya reportable? no - but gonorrhea, syphilis and hiv are
what is the basic ADDICTION pathway in the brain DOPAMINERGIC - ++->positive reinforcement, medial forebrain bundle, -> nucleus accumbens -> venteral tegmental area inverse relationship - dopamine is like gas pedal serotonin in forebrain is like brakes.
cravings come from insular cortex through its projections to thalamus and amygdala (emotional anticipation and conditioned response)
when in apgar given? whats the best score given at 1 min and 5 min - thus given twice total best score is 10 apgar - appearance pulse grimace activity respiration
treatment for restless leg syndrome dopaminergic agents - like roperinole and premipaxole , levo carbi dopa avoid caffeine, clonazepam gabapentin or opiods in extreme
what is secreted from suprachiasmatic nucleus NorEpinephrine - controls ACTH prolactin, melatonin and nocturnal NE.
what is the pathway of circadian rhythm Retina _> suprachiasmatic nucleus,- NE release , Pineal gland , melatonin.
what drugs can reduce risk of hiv transmission from mother to child azathiaprine reduces breast milk risk by half. (risk was 50% with breast feeding) Nevirapine - given around labor , reduces risk of delivery trasnmission by half also high compliance required for AZT rx
what are the risks associated with transmission of HIV uncircumcised at higher risk, risk of sex with low risk male is 1/5 million, high risk make i 1/20-1/2. needle stick injury 1/250 , blood transfusion 2/3 vertical - 20% with no intervention - recall all infants test + due maternal AB:S. after 1 year, 20
what is fanconi syndrime proxymal tubular defect of resorption - leads to polyuria, acidosis, electrolyte imbalance, and growth failure
von hippel lindau syndrome - chromosome, type of transmission and associated malignancies chromosome 3, autosomal dominant and 4 cacners IS A TUMOR SUPPRESSOR GENE MUTATION 3 systemsn - BLOOD VESSELS - hemangioblastoma and angiomatosis RENAL RCC , ADRENAL - pheochromoctoma.
fanconi anemia genetic dz , short stature, high incidence of tumors, leukemia, aplastic anemia - p53 mutation - AML COMMON
Wilsons disease - autosomal RECESSIVE, mutation of ATP7B on chromosome 13. reduced formation and secretion of CERULOPLASMIN and hinders copper metabolism reducing formation and decreasing copper secretion into biliary system. -copper free radical damage to liver, then blood, gets to basal gang and cornea.
liver involvement in wilsons disease asymptomatic liver function tests chronic hepatitis, fulminant hepatitis, protal hypertesniion liver cirrhosis
neurological sequela of wilsons disease parkinsonian like tremor (resting and pill rolling) common due to both in basal ganglia rigidity, catatonia, ataxia, slurring speech, personality changes, depression or paranoia.
how to diagnose wilsons disease - liver biopsy showing quantitative hepatic copper level higher than 250 mcg/gram dry wt. - or, low serum ceruloplasmin (<20 mg/dl)+keyserflecher rings CT of head can show the degenerative changes but not specific to wilsons disease and not part of diagnosis
lymph node malignancy is MONOCLONAL as assessed by GENE REARRANGEMENT ON T CELL RECEPTOR GENES. see single allele for V REGION of TCR. similar is true in B cells = clonal rearrangement of HEAVY CHAINS is b lymphoma
viral infections associated with intracytoplasmic inclusion herpes virus and measles (differentiate with koplik spots of measles)
rx ADHD methylphenidate ritalin atomoxitine, nonstimulant SNRI = dexedrine
rett disorder is x linked dominant ! only seen in females because males die in utero seen in girls - apparently normal for 6 months.years then loss of development, retardation, loss of communication, ataxia and stereotyped handwriting. - midline hang wringing deceleration of head growth!
why does purging, vomiting cause hypokalemic, hypochloremic alkalosis? loss of H+ and Cl- in vomiting = hypochloremic alkalosis - low K because - body tries to compensate by dumping H+ from cells into serum in EXCHANGE for k + leading to low K in serum
how do anorexics and starvation patients get LANUGO> low fat -> low fat based hormones ie GnRh - > low sex hormones -> lanugo, amenorrhea - same mechanism
neurotransmitters in psychiatric disease:
anxiety : +NE - GABA (rx benzo) - 5HT (ssris , flluvoxamine also in OCD)
depression - NE - 5HT - Dopamine
alzheimers - ACH
Huntingtons - ACH - GABA therefore never give anticholinergics in alzheimers and huntingtons patients
schizophrenia + dopamine
parkinsons - dopaine + serotonin + ach recall benztropine - muscinic atagonist is used
differentiate dementia vs pseudodementia dementia , patients may not be aware of memory loss - pseudodementia - usually depression in elderly - and they are away are irritated by their dementia
mini mental status exam used for what dementia diagnosis
genetics associted with alzheimers disease presinilin 1, 2 on chromosomes 1, 14. APP gene (amyloid precursor protein) on chromome 21 seen in DOWN SYNDROME apolipoprotein E gene on ch 19
lewy bodies are seen in > lewy body dementia ( parkinsonism with visual halucinations and repeated falls) , parkinsons disease and lewy body type alzheimers
hirano bodies seen in? intracellular aggregate of ACTIN , rod shaped cryatals, eosinophilic. CJD
oligclonal band of igG seen in CSF in what diseasee? gamma portion of electrophoresis MS (igG vs oligodendrocytes) syphilis, SLE, sarcoidosis
high potency neruoleptics haloperidol, flufenazine
medium potency neuroleptis trifluperazine, molindone
low potency thioridizine, chlorpromazine
what is dantrolene used for malignant hyperthermia (caused by inhalational agents and succinyl choline) in people with RYR1 gene mutation. Neuroleptic malignant syndrome (antipsychotics)(dopaminergic) mechanism - prevents release of calcium from sarcoplasmic ret. in SKEL MUSCLES
C C T T chlorpromaine causes? thioridizine causes? corneal deposits for cpz reTinal deposits for Thioridizine (also retrograde ejaculation)
EPS high in high potency antipsychotics anticholinergic SE's high in low potency antipsychotics
if rx of schizophrenia makes the symptoms worse? organic brain lesion in dominant temportal hemisphere
antipshychotic use presents with what dental complication cavities because it produces metalic tase in mouth and patients eat candy
Tardive dyskinesia vs cerebelar disease cerebellar disease - tremor present always , TD tremor REDUCES while reaching for an object)
RYR1 gene mutation is for what? fever and hyperthermia when use of succinylcholene and antipsychotics -, neuroleptic malignant syndrome and malignant hyperthermia are very similar RYR1 gene codes for ryanodine receptors of skeletal muscles.
typical antipsychotics vs atypical = typical block d2 atypical block d2 and 5ht - prevents a lot of side effects becuase 5ht is also blocked. h2 and alpha is blocked in both causing hypotension, and weight gain from h2
olanzapine OCD, depression, anxiety, mania , bipolar, tourettes also use other atypical antipsychotics
olanzapine and quietapine cause major gain of weight -> diabetes
respiridone how does it cause amenorrhea through increasing prolactin also causes agranulocytosis like clozapine
diphenhydramine and antihistamines worsen what? espeially in what dangerous age group? extrapyrimidal side effects in elderly like delerium. use bezos instead.or TRAZODONE
trazodone is used in rx depression or insomnia in demented patients less potency, and anticholinergic side effects than TCA's itself is a serotonin modulator.
patient with dementia needs help sleeping or to reduce agitation , what antipsychotic to use/ use HIGH potency becuase has less anticholinergic side effects (worsen delerium) do not use low potency because it has high anticholinergic side effects
manic episode lasts how long signs? 1 week DIG FAST distractable, irresponsible (hedonistic), grandiosity, flight of ideas Agitation/activity Sleep reduction Talkativeness
one manic episode =? bipolar 1
one hypomanic episode bipolar 2
rx bipolar lithium valproic acid carbamezapine
lithium used for what acts through phosphoinositol pathway -> IP3 bipolar, aggression, cluster headaches, causes NEphrogenic Diabetes insipidius so used in rx siadh.
side effects of lithium LMNOP lithium, movement (tremors)(replaces sodium -> tremors ) nephrogeic DI hypOthyroid, pregnancy problems ie fetal cardiac defect EBSTEIN ANOMALY
uses of streptomycin and mechanism of action tuberculosis (blocks 30s ribosome, halts protein synth) plague yersinia pestis tularemia - francisella tularensis
What anti TB drug causes it to lose acid fastness the stain is taken up by mycolic acid int he cell wall of TB INH acts by inhibiton of mycloic acid synth - thus is specific to mycobacteria. recall INH is toxic to Neurons and Hepatocytes
parkinsons patient therapy is losing effectiveness, why? multivitamin with b6 - increases peripheral metabolism of levodopa decreasing its effectiveness.
cimetidine causees gynecomastia and inhibits cytochrome p450 causing increase in what drugs warfarin, phenytoin, propranolol metoprolol quinidine and theophylline
retrolental fibroplasmia is mediated through what growth factor vgef stimulated by high concentration o2
phylloquinone is plan baesd vitamin k menoquinone is flora based vit k
breast milk has all vitamins except vit d and k
increased diagnostic accuracy (lead time bias) increases what incidence AND prevlaence contrast with improving survival of patients which only increases prevalence
which genes are on apical ecdodermal ridge (ectodermal thickening at the end of the developing limb) wnt 7 and fgf.
what does sonic hedgehog gene do at base of limbs in zone of polarizing activity ZPA, involved in patterning , along Ant Post axis -- determines correct location of limbs. is ECTODERMAL - deficiency causes holoprsencephaly
wnt 7 - at apical ecodermal ridge necessary for proper organization along dorsal ventral axis
FGF gene achondroplasia - also on apical ectodermal ridge - stimulated mitosis of mesoderm causing limb lengthening
homeobox gene - skelegtal organization in cranio caudal direction - codes for transcirption regulators,
hox d13 synpolydactylyl between 3-4th digit retinoic acid mutates it.
smudge cells seen in b - cll
platelets have dense bodies alpha granules dense bodies - ADP, Ca(vit K), alpha granules - vWF and fibrinogen and PF 4 - TXa2 is not preformed - rather synthesized
affinity is binding strength IgG avidity - mullti point binding IgG>IgA
cisapride is a promotility agent that was removed from market for causing arrhythmias - which? Torsades De Pointes
foregut from where to where, what artery supplies pharynx to duodenum celiac artery
midgut ? duodenum to splenic flexure SMA
hindgut splenic flexure to rectum IMA
developmental anomalies of ROSTRAL FOLD Sternal defects
failure of Lateral fold omphalocele and gastroschiesis
Caudal fold bladder extrophy
what is the covering in omphalocele amnion on peritoneum other anomalies are associated 50%
gastroschiesis is extruding viscera NOT covered by sac. other anomalies not common, liver is never found protruding
how do we activate the dehydrogenase complex exercise higher NAD/NADH ration high ADP and high calcium
arsenic blocks lipoic acid
3 different dehydrogenase complexq akG pyruvate branched amino acid dehydrogenase
branches of internal pudedal artery I love going places in my very own underwear I L G P I M V O U iliolumbar, lateral sacral, gluteal (sup inf), pudendal (int), inf vesical, middle rectal, vaginal, obdurator, umbilical
causes of mitral valve prolapse MVP may occur with greater frequency in individuals with Ehlers-Danlos Syndrome, Marfan syndrome [9] or polycystic kidney disease.[10] Other risk factors include Graves' disease.[11] and chest wall deformities such as Pectus Excavatum [12]
what is the result of untreated congenital hip dislocation EROSIVE arthropathy
primordial germ cell migration from yolk sac failure results in extragonadal germ cell tumor = teratoma.
achondroplasoia (autosomal dominant) FGFr3 - membranous ossification is NORMAL so normal head. vs endochondral ossification defect is constituitive ACTIVATION of FGFR3, causing causing INACTIVATION of chondrocytes
duodenal atresia - failure to recanalize assx trisomy 21 apple peel atresia is jejunal, ileal, or colonic atresia is due to VASCULAR ACCIDENT
Tracheo esophageal fistula is a MESODERMAL problem foregut midgut hindgut all endoderm developmental defects of ant abdominal wall ECTODERMAL
midgut development is herniation at 6 weeks reenters abdominal cavit at 10 weeks, rotates around SMA - volvulus summary - malrotation of midgut causes = omphalocele, intestinal atresia or stenosus, voluvlus.
coelom is the embryonic cavity in mesoderm (middle layer) gives rise to? pleura, pericardium and peritoneum
most common location of obstruction in fetus causing hydronephrosis is uretropelvic junction - why? by 10 weeks, before metanephros ->kidney starts making urine, the uterters are fully canalized. failure at uretropelvic junction is most common abnormality
amniocentesis showing acetylcholinestrace is indicative of wht defect failure of FUSION - NTDs
NTDs happen at whta time frame, and where 4th week failure of fusion of anterior or posterior neuropores. anterior is encephalocele or anencephaly posterior is more common, spina bifida, menengocele or meningomyelocele
mesonephric ducts - what do they do in both genders in males, they become epidydamus, ductus deferns, seminal vesicles and ejaculatory ducts, in females they become gartners ducts they never fuse.
paramesonephric ducts in males? vestigial testicular appendix
fusion of urethral folds forms urethra in both males and females failure of fusion of urethral folds = hypospadias
Pagets disease of bone is osteoCLASTIC these osteoclasts are multinucleated 100+ (normal is 2-5) what is this stimulated by? ++ by osteoblasts RANK L and M-csf macrophage colony stumlating factor receptor for activated nuclear factor kappa - beta ligant
alkaline phosphatase increased in all osteoCLAST diseases stress fractures, pagets
gastric bypas surgery complication dumping syndrome - (stomach food storage function is lost) - accelerated dumping -> sugary food especially - anxiety /bloating, diarrhea, "butterflies"
DLco is diffusion limited carbon monoxide (rate of diffusion) what does this measure? surface area and thickness of membrane - reason is because is ALways is diffusion, we can therefore predict the rate of diffusion. emphysmea and fibrosis DECREASE exercise increase!
resolved ARDS usually becomes? interstitial fibrosis - look for decreased DLCO
what does the cresent consisit of in RPGN plasma proteins c3, fibrin, parietal cells, monocytes, macrophages
metastatic prostate cancer to bone looks like?> pleomorphic cells arranged into duct like structures (remember its ADENOcarcinoma)
somites are what cell lineage? mesoderm - somites are masses of mesoderm give rise to muscles.
basophils are never present in cancer cells
if children dont talk by 18 months, then check? or just general crying and babbling hearing.
findings in DIC (common cause retained fetus) prolnged PT PTT thrombocytopenia low fibrinogen elevtaed FBP's fibrin split producsts aka d dimerslow factor v and viii levels.
which clotting factors are low in DIC V VIII
site of attachment of renal stones in kidney is renal papilla which is junction b/w pyramids (cortex) and the minor calyx ->major calyx -> renal pelvis -> ureter
all renal stones (calcium, oxalate, phosphate and uric acid PRECIPITATE in ACIDIC ph. Ca can precipitate in Neurtal Ph ONLY ONE KIND OF STONE PRECIPITATES IN ALKALI? STRUVITE
urease positive bugs are PARTICULAR KINDS HAVE UREASE P K H U proteus, Klebsiella, h pylori, ureaplasma
bacterial toxins that inhibit protein synthesis EHEC vero/shiga toxin, shigella toxin - both act through inhibition of 60s ribosome unit diptheria and pseudomonas toxins work though EF2 mechanism
lysine instead of glutamic acid at 6th postio on beta globin gene causes HBC - this lysine is BASIC so on electrophoresis HbC travels SLOWEST recall valine for glutamic acid is the sickle cell mutation
sickle cell train Valine for glutamic acid at 6 causes what kind of interaction, making it so dangerous of a disease hydrophobic interaction - recall valine is NON polar but glutamic ACID is POLAR so LOSS OF CHARGE/polarity
normal folding of the globin chains - alpha? beta? secondary ? tertiary? 8 alpha helical stretches is secondary folding 8 beta bends is tertiary structure - sickle cell or hbc does not cause major change in the structure. however PROLINE substitution would do this
HbM disease is formation of methemoglobin - prevents formation of ferrous iron - remains in ferric form - this is due to HISTIDE -> TYROSINE in heme binding pocket of alpha or beta chain
rapid induction of anaesthesia , or truth serum is done with sodium thiopental - ultra short acting barbiturate - acts on gaba and increases inhibition. - why is it ultra short acting> very quickly redistributes into skel muscle and fat tissues
best rx in MI arrhythmias , why? lidocaine and amiodarone - specific to depolarized and depolarizing rapidly cells - which describes MI - so these drugs are specific to infarcted types of tissue , treatment of choixe
verapamil is used to treat atrial tachyarrhythmia - why is it important to not give in ventricular tachyarrhythmia because it cauess vent fibrillation and death
digoxin is used as an antriarrhythmic, why? slows AV nodal conduction -> use in atria tachyarrhythmias
atypical phenylketonuria causes what symptoms and what is the deficiency tetrahydrobiopterin reductase , requred for phenylalanine>tyrosine and tyrosine>dopa - , also required for Nitric oxide and serotonin - symptoms are then high prolactin because no dopamine so no inhibition of prolactin. also neurological abnormalities
reed sternberg cells hodgkins lymphoma
differential for heart valve thickening with vegetations SLE - libman sacchs-most common, involves coronaries also bacteria nonbacterial NBTE rheumatic
dermatomyositis - autoimmune so perivascular ischemic necrosis, associated with? myocarditis, interstitial lung disease , vasculitis
churg strauss - necrotizing vasculitis commonly seen in ATOPIC patients coronary artery necrotizing vasculitis is seen but NOT cardiac valve defects - assx asthma, eosinophilia. Necrotizing GRANULOMAS
hiv p24 and p 7 - what gene gp41 gp120 -? enzymes? replication regulation? p7 p21 - GAG gp41 gp120 - ENV enzymes - Pol regulation of replication TAT and REV
MS see lipid laden macrophages and OLIGODENDROCYTE depletion - loss of white matter astrocyte PROLIFERATION oligoclonal bands of IgG also see oligodendrocyte depletion in progressive multifocal leukoencephalopathy
chloramphenicol inhibits ? 50s subunit and peptidyl transferase so inhibits protein synth
homeobox genes code for? DNA TRANSCIPTIONAL FACTORS which regulate expression of genes and location of organts and tissues called morphogenesis
reserpine is a cheap antihypertensie used globally causing what symptoms? blocks packaging of NE, dopamine and serotonin, at the stage of packaging into vesicles. they are not vesicated, therefore get broken down by MAO. this causes depression! and suicidal ideation, also nasal congestion and hypersecretion of gastric acid
granulomatous vasculitis of MEDIA, arterial only takayasu - mostly aortic arch but also temporal - women less than 40 temporal arterititis , mostly temporal , greater than age 50
luekocytoclastic vasculitis, hypersensitivity vasculitis, microscopic vasculitis preesnt in small arterie with FIBRINOID necrosis , arterioles, capillaries, veinules. similar to PAN, igA
PAN - immune complex vasculitis causing what kind of necrosis? affects medium and small arteries FIBRINOID necrosis - immune complex goes into vessel wall, brings complement and plasma proteins making an eosinophilic fibrinoid smudge
rheumatoid arthritiis vasculitis similar to PAN - fibrinoid type, causing infarcts of organs in long time rheumatic arthritis patients
orthostatic hyptension phenelzine (mao inhibitor) and TCAs
drugs causing seizure imipenem !! bupropion isoniazid IF GIVEN WITHOUT PYRAZINAMIDE
skin brusises petichae less than 5 mm purpura 5mm - 1cm ecchumosis 1cm + do NOT blanche - unlike telangiectasias
apc gene -> adenomatous polyps are premalignant. adenoma to carcinoma sequence involves kras p53 and DCC gene
what enzyme increased causes increase chance of colon cancer COX - therefore cox2 inhibitors are shown to DECREASE colon cancer.
cardiac tamponade can occur in relation to viral illness how? viral pericardidtis -> serous fluid accumulation , tamponade. jugular distension, pulsus paradoxus and low blood pressure are seen. recall constrictive pericarditis is a chronic process
becks triad of cardiac tamponade is? 1) distended jugular 2) distant muffled heart sounds 3) hypotension
myocardial infarction can cause signs similar to becks triad however it would also present with PULMONARY EDEMA - remember you must HEAR SINGS oF edema - dyspnea and fatigue will be signs in both so cannot be assumed to be caused by pulm edema
HSP is a IgA mediated LEUKOCYTOCLASTIC vasculitis affecting young boys after infection the IgA is vs the infecting organism and then deposit in small vessels causing JOINT PAIN, PALPABLE PURPURA and ABDOMINAL PAIN can be hematuria and tarry black stool
joint pain in HSP is in what joints why? knees and ankles, because of dependent location - > more immune complex deposition
pinealoma is not originating from pineal gland, rather just in the area of the pineal gland. tey are most commonly what ? germinomas - cause perinaud syndrome, obstructive hydrocephalus and precocious puberty
size of adenomatous polyps increases risk of malignancy less than 1 cm - 0% more than 4cm - 50%
which gene converts normal mucosa to polyp - is APC which gene makes the cells proliferate in existing poyps so they become larger and more likely malignany - K RAS
final malignant transformation of a large polyp into cancer cells requires DCC and p53 K ras is a proto-oncogene , after mutation is becomes an oncogene. normally it codes for a protein that regulates cell cycle. after mutation , loss of function makes it oncogenic.
enfurvitide is an HIV fusion inhibitor MOA? binds gp41 prevents entry into genome of uninfected CD4+ T cells
ritonavir is a protease inhibitor prevents maturation and assembly of virions makes them uninfective zidovudine is an NRTI - requires activation by thymidine kinase before it can be in its functional triphosphate form
nevirapine, efavirenz and delaviridine are NNRTI's , prevent RNA -> Dna, no activation required. most dangerous s/e is life threatening hepatic failure with encephalopathy - preceeded by flu like symptoms with abdominal pain, jaundice - this happens within 6 wekks. stevens johnsons within 18 wks
erythema nodosum most common in strep pyogenes pharyngitis, also s aureus, sarcoidosis, fungal infections, chlamidya
anterior uveitis causes herpes, syphilis, lyme disease and hla b7 assx reactive arthritis
bilateral absence of vas deferens seen in cystic fibrosis
lipofuschin is due to lipid peroxidation and free radical damage seen in heart and liver of aged or malnourised, diseased patients.
transciption, regulation and degradation of mRNA in cytoplasm is mediated by what cytoplasmic P bodies
what are the post transcriptional modifications done to mrna to turn it form hnRNA into mRNA poly A tail, cap on 5' end, intron splicing
hepatic adenomas are seen in young women especially after using OCP's epigastric or RUQ pain, asymptomatic or incidentally discovered. may rupture and cause life threatening bleeding.
granulomas in lung, other than TB fungi, berrylium, foreign body, sarcoidosis, histiocytosis wegeners
fanconi syndrome of kidney is due to chronic NSAID - chronic interstitial nephritis loss of k, p, amino acids and glucose
pathophys of chronic nsaid interstitial nephritis medullary concentration+vasa recta ischemia due to inhib PG's+cellular damage due to mitochondria oxidative decoupling -> reversible interstitial inflammation, calyceal architecture distruction, tubular atrophy.
duodenum breaks down lipids, jejenum absorbs it. this remains true in cholecystectomy patients
valine leucine threonine methionine cholesterol and odd chain fatty acids catabolized to propionyl coa through what enzyme branched chain alpha keto acid dehydrogenase
porpionyl coa > methylmalonyl coa through biotin dependent carboxylation > succinyl coa through ISOMERIZATION and b12 defeciencty of methylmalonyl coa isomerase causes increased methyl malonyl coa in serum and urine
PRIMIDONE is metabolized to? phenobarbital - patient with overdose symptoms who is epileptic but shows high blood levels of phenobarbital - it was primidone overdose , metabolized into this. used in rx seizures and epilepsy but avoided for lethargy
what type of cell predominates in sarcoidosis patients bronchoalveolar washings cd4+t cells look for high cd4 : cd8 ratio in bronchioalveolar lavage 5:1 - 20:1 this ratio is DECREASED in hiv, hypersensitivty pneumonitis
foscarnet is a pyrophosphate analog that does not require activation it inhibits directly dna polymerase in herpes and reverse transcriptase in HIV used in HIV patients with herpes virus not responding to acyclovir and CMV not responding to gancyclovir
drugs that are metabolized and excreted by liver tend to be highly lipophilic and have a HIGH VOLUME OF DISTRIBUTION highly lipophilic drugs with high VD are poorly renally excreted becuuse they pass lipid membranes easily and are reabsorbed by kidney
histo of pilocytic astrocytoma - most common cerebellar tumor in children, can also arise in brainstem, hypothalamus, or optic pathway cystic, micro-cysts, well differentiated spindle cells with hairy proceses. eosinophilic granular bodies and rosenthal fibers present
Glioblastoma multiforme subcortical white matter, butterfly has ASTROCYTES (keep straight with pilocytic astrocytoma which has WELL DIFFerentiated SPINDLE CELLS) this tumor has POORLY DIFFERENTIATED cells pleomorphic marked nuclear atypia and brisk mitotic activity NECROSIS, VACULARITY
medulloblastoma - second most common posterior fossa tumor of children small poorly differntiated cells with high mitotic activity SCANT CYTOPLASM, LITTLE STROMA AND HOMER WRIGHT ROSETTES
ependymoma pseudorosettes, gfap + roof of 4th vent in children spinal in adults
neuroblastoma is most common extracranial tumor in children. renal medulla small round blue cell tumors, neuritic process called NUEROPIL is pathognomonic. NSE,chromogranin,s100,synaptophysin all +. GFAP NEGATIVE HVA VMA high and CH 2, N-MYC gene (transcription factor)
splenic findings in sickle cell children - sequesteration which is congestion and hypovolemia where all RBC clumps get stuck in spleed. repeated sequesteration / congestion leads to atrophy and fibrosis in years so adults do not present with sequesteration, they present with fibrosis
muromonab is ? vs cd3 - use in kidney transplant having rejection
rituximab vs cd 20 use in b cell lymphoma or severe rheumatoid arthritis
omalizumab anti IgE used in refractory asthma
anti epidermal growth factor is? CETuximab vs cancers like pancreating, NON SMALL CELL lung
bevacizumab is vs VEGF used in colon cancer and GIT cancers
leukemoid reaction vs CML both have myelocytes, metamyelocytes, promyelocytes and band cells differentiate with ALKALINE PHOSPHATASE LOW IN CML , (philadelphia BCR ABL 9:22) HIGH IN Leukemoid reaction
cml - blasts must be less than 10 %
rank L high osteoprotegrin (decoy receptor) Low -> bone resprotion by osteoclasts rank l and m csf come from osteobasts . PTH works through this mechanism - BLASTS ++ rank L/mcsf > ++ rankL : osteoprotegrin ratio >resorption
Rifampin inhibits DNA dependent RNA synth causing so preventing transcription therefore no mrna so no protein resistance is through modification of rifampin binding site on dna dependent rna polymerase
INH needs to be activated by enzyme Catalase Peroxidase !!! then it inhibits mycolic acid synthesis alteration of this catalase peroxidase enzyme is resistance mechanism vs INH
30 s subunit aminoglycosides (gentamycin, streptomycin) tetracycline doxycycline
50 s subunit chloramphenicol, clindamycin, linezolid, macrolides (azythromycin erythromycin clarithromycin)
alkaline phosphatase reflects osteoBLASTS comes also from placenta, liver, intestines tartarate resistant ACID phosphatase, urinary hydroxproline and urinary deoxypyridinoline are for osteoCLASTS - urine deoxypyridinoline is most sensitive
differentiate between alkaline phosphatase elevated due to intestine or liver? bone = boil bone specific ALP is easily denatured by heat also can use electrophoresis or monoclonal ABs
calcitonin marker in medullary carcinoma thyroid from parafollicular c cells
post auricular lymph nodes german measles rash face to trunk togavirus
aorta riding anterior and to the right of pulm art is ? TGV failure of Septum to SPIRAL NORMALLY during SEPTATION
embryological failure:
fusion failureof urethral folds to FUSE is HYPOspadias
aptosis autoimmune diseses due to failure of slection process
obliteration branchial cleft cyst - lateral! 3rd differentiate from thyroglossal (endodermal) base of tongue, central, moves with swallowing, surgically remove the track
migration neural crest -> hirschprung
proliferation unilateral aplasia of fibula
pda machinery murmur, bounding pulse, thrill at left upper sternal border 6th aortic arch derivative
triple test done 16-18 wks tests for afp, hcg and estrIOL if high, then do ultrasound. if dates are correct and ultrasound abnormal, do amniocentesis
afp from fetal liver, git and yolk sac if high, wrong dates!!!, NTD, abdominal wall defects (gastroscheisis or omphalocele) multiple gestation LOW IN DOWNS
decreased estriol means placental insufficiency
herieditary hemorrhagic telangiectasia on skin and mucosa , present with melena and epistaxis is osler weber rendu
leptomenengial angioma + facial port wine stain sturge weber
retinal hemorrhage , bilateral renal cell carcinoma liver cyst and hemangioblastomas on cerebelum von hippel lindau
aneuploidy is chromosomal nondysjunction during meiosis or mitosis
meiotic nondysjunction is a type of aneuploidy
pleitropy is one gene that affects many outcomes
definitive dx of downs first triple test (confirm dates) see low AFP , then do amniocentesis and karyotype for final diagnosis
polyploidy 2 or more complete chromosomes in 1 cell ie partial mole
law of separation - mendels first law parent chromosomes split so child gets half from each parent
downs patients are at increased risk of what cancer ALL AML
chromosomal instability syndrime are NOT fragile x syndrme - consisint of xeroderma, bloom sydrome, ataxia telangiectasia , fanconi anemia
fragile x syndrom hypermethylation of FMR 1 gene on long arm chromosome x results in profound mental retardation due to CGG trinucleotide repeats. remember hypermethylation of cytosine , deactivating the gene is the mechanism
mantle cell lymphoma - b cell 11:14 results in? ACTIVATION OF CYCLIN D GENE
15:17 apml M3 (recall 8:21 is m2) - many auer rods, peroxidase + -> DIC
8:14 burkitts lymphoma - c-myc , next to immunoglobulin heavy chain gene, gets heavy expressed , so increased prodction of ONCOGENE
9:22 bcr abl has what ckind of activity tyrosine kinase
retinoblastoma RB gene - requires 2 hits to become malignant is a tumor suppressor gene on ch 13
clara cells are nonciliated and in terminal resp epithelium secrete clara cell secretory protein CCSP, which does 2 things - 1) surfactant 2) contains p450 enzymes, helps metabolize
myoclonus obsoclonus (is paraneoplastic) is uncoordinated random eye movements seen in children associated with? neuroblastoma - N myc gene also see orbital metastasis (proptosis, diplopia) brain mets - EPIDURAL SPACE = dumbell tumor - compresses spinal tissue
low c1 estrase is Hereditary Angioedema (auto dom) do not give captopril
enveloped viruses are destroyed by ether and other organic solvents. these have a lipid bilayer coming from host cell nuclear or plasma memb non-enveloped viruses are resistant to ether
proteus mirabilis has what kind of flagella peritrichous flagella
serpiginous chains with caput medusae appearance on LM is what bacteria anthrax
listeria the only gram + bacteria with endotoxin
vitamin e def leads to oxidative stress of all lipid bilayers , especially RBC and neurons - long neurons and axons becuase they have more surface areas>more oxidative damage. loss of vibraration and proprioception seen ie cystic fibrosis, abetalipoproteinemia
cholecystitis - x ray is not helpful becuase most stones dont have enough calcium to be opaque , ultrasound finds stones in most asymptmatic individuals diagnosis with HIDA SCAN - give radio dye, watch for liver filling, then direct excretion into duodenum and bypass of gallbladder is diagnostic
bcl -2, 14 translocates to 18 near IgG heavy chain gene - overexpression - excessive protein is synthesized from bcl 2 causing? inhibition of apoptosis - follicular lymphoma find cd 19, 20, 21, 79a in B cells
subdural hge between dura and arachnoid -due to tearing of bridging cortical veins
Subarachnoid hge between arachnoid and pia due to rupture berry aneurysm, ant communicating, post communicating and middle CEREBRAL artery (not middle MENINGIAL)
Papillary necrosis caused by? Sickle cell, diabetes (not enzymatic glycosylation->vasc wall compromise>ischemia), acute pyelonephritis and urinary obstruction NSAID's
the true ischemia diseases or kidney cause? PAPILLARY NECROSIS, NOT ischemic tubular necrosis
papillary necrosis see yellow tips of renal pyramids distal 2/3 sloughing papillae, COAGULATIVE INFARCT, with tubular outlines preserserved. pain, hematuria and passage of clumps
cd 40 is on B cell binds with Cd 40LIGNAD on activated T cells. CD? cd 154 is cd 40 L
ethosuximide works on t type calcium channels especially in thalamic neurons use in absence seizures
benzo barbiturates and alcohol act on GABA A it is a ligand gated CL channel . these POTENTIATE gaba and INCRESE CHLORODIE CURRENT
valproate acts on NMDA, POTASSIUM and SODIUM AND GABA
gallbladder fluke infection leads to what kind of stone brown pigment stones
homocystineuria develops because of cystatione synthase deficiency - conversion of homocysteiine into cystathione and cystine requires b6. if the enzyme is deficiency ,then b6 offers relief by converting some homocysteine to cysteine PRESENTS LIKE MARFANS SYNDROME !! arachnodactyly , scoliosis, elongated limbs and ectopia lentis
homocystinuria presents like marfans syndrome rx b6
ALS is umn and LMn degen - thinning of anterior horn cells and loss of corticothalmaic tract - see SPASTICITY along with LMN . see loss of cranial nerve nuclei and precentral gyrus atrophy . find mutations of SOD 1 gene -for copper zinc superoxide dismutase rx with RILUZOLE which decreases gaba release
reason for decreased chest expansion in hla b27 ank spond? costochondral enthesitis
group a strep (pyogenes) causes rheumatic FEVER , see? myocarditis with granulomas are aschoff bodies - contain mostly binuclear cells also find caterpillar cells aka anitsckow cells=plump macrophages with slender bodies inside - these are chromatin Ribbons . overtime these become aschoff giant cells.fibroti
in diptheria toxin myocarditis, find ? no granulomas (ARF) see MACROPHAGES and PLEOMORPHIC BODIES
aortic stenosis is assx atrial fibrillation. cardiac output is already low, if at fibb starts, it goes even lower due to loss of 'atrial kick' (ejection from atria) what symptoms are seem profound hypotension
amantadine acts how on dopamine? increases synth, release and reuptake
which drugs CENTRALLY prevent BREAKDOWN OF LEVODOPA selegeline (through MAO B) Tolcapone through COMT
anterior cerebral arteries suppy medial side of hemispheres - damage here causes contralateral loss of sensation, and motor deficits of legs, genitals and personality changes
von willerbands disease causes poor platelet aggregation (gp1b IX) and shorter life of VIII (antihemophelic factor) (halflife w/ vwf 12 hr, w/o 2 hr) so see both clotting abx and PTT abx. platelet bleeding is mucocutaneous, and menorrhagia post surgical/dental is VIII def
hegeman factor XIII causes PTT deficiency but is usually asymptomatic and discovered accidnetally
riboflavin deficiency -> less FMN/FAD - TCa cycle inhibited at succinate dehydrogenase -RECALL DEHYDROGENASE COMPLEX b1-TPP, b2-FMN b3_NAD b5/6? and lipoic acid also affects electron reception in ETC - metabolic changes to b2 are made in heart, liver and kidney
classic galactosemia is most common - def of? galactose 1 p uridyl transferase causes lethargy, failure to thrive, hyprchloremic metabloic ACIDOSIS amino aciduria - rx no lactose (galactose and glucose)- galactitol through galactitol reductase -> liver and lens damage
galactokinase is less severe, less common - most common effect is cataract
diptheria becomes dangerous when it aquires TOX gene - how does it get this lysogeny - from coryneyphage beta
what is the role of 16s subunit of 30 s in ribsosomes 16s contins 'complementary base pairs to mrna" to the shine dalgaro sequence which is 10 bases upstream from AUG. this 16s is the first ribosome to bind and initiated protein translation
which ribosome created peptide bonds between the amino acids? 23s of the 50 s
translocation is movement of ribsosome complex along mrna strand - how is this powered elongation factor G, powered by GTP
verapamil is a non dihydropyridine CCB, selective for heart and used in atrial fibrillatin angina and hypertension causes constipation, has negative inotropic effect do not give in CHF causes AV block - this is the MOA but also causes most side effects GINGIVAL HYPERPLASIA AND BRADYCARDIA
amilodipine is selective on vasc smooth muscle. cause reflex tachycardia - increases myocardial workload , do not use in heart failure, or coronary syndromes
lidocaine is used in ventricular arrhythmias especially after MI digoxin also slows AV nodal conduction like verapamil , both are rx for atrial tachycardia
raloxefene is a SERM , blocks estrogen in breast and uterus but SIMULATeS estrogen in bone and blood decreases breast cancer risk but also increses bone mineral density preventing osteoporosis
cancer cells can : 1) detach from existing area due to loss of E Cadherins 2) bind to new basement membranes and invade due to laminin and fibronectin 3) destroy and invade healthy tissue with metalloproteinaes - using zinc to melt tissues
dubin johnson is "defect in excretion of bilirubin glucuronides across canalicular membrane" - so dubie isnt letting out smoke liver becomes black.see pigment granules composed of 'epinephrine metabolite polymers' (making the liver black) on electron spin resonance. see NORMAL liver function + conjugated jaundice (>50% vs unconj or else N liver. URINE COPROPORPHYRIN 1!
reason for increased lipid profile in nephrotic syndrome find increased synth of lipoporteinsto compensate decrease COP (cholesterol, TH, VLDL, LDL, Lipoprotein a, apolipoprotein, apoprotein), LOW Lipoprotein lipse so no destruction, and abnormal carrier proteins carrying lipids. ,
Muscular atrophy can be caused by corticosteroids - what other drug can have a similar presentation chloroquine
PAN typically spares pulmonary circulation and very rarely involves bronchial circulation. commonly involves? all organs especially heart kidney liver and mesenteric vessels - creates BEAD LIKE aneurysms on mesenteric vessels PAN is segmental, transmural and necrotizing - can rupture leading to hemorrhage
defective growth hormone receptor -> LARON dwarfism serum high growth hormone with low igf1 (liver)
growth hormone works through JAK STAT (janus kinase and stat 5)
igf 1 comes from 2 places - central (hypothalamus ) causes BRAIN growth, does not affect body growth liver - affects body growth
crohns renal stones? calcium oxalate-ileum doesnt absorbe bile acids - so cholesterol is free to bind calcium - soap - this is unabsorbable - calcium oxalate stones form
rheumatic heart disease and mitral valve prolapse (more common) are most common predisposers to bacterial native valve endocarditis -> give emboli causing strokes
sphrocytes seen in spherocytosis, hemolytic anemia, old blood samples and BURNS
global cerebral ischemia -> hypocammpus .pyramidal cells. neocortex cerebellum .purkinje cells.]
transmural arterial inflammation with FIBRINOID NECROSIS - PAN
large amounts of fat and lysosomal enzymes cause LIQUIFACTIVE NECROSIS seen in brain and fat
most common type of necrosis in other organs other than fatty organs is coagulative necrosis
PAS+ granules on liver biopsy look for pulmonary signs - panacinar emphysema - this is alpha 1 anti trypsin granules
N-acetyl cysteine in CF patient breaks down disulfide bridges - releasing mucous
SPINOCEREBELLAR AND DORSAL COLUMN INVOLVED IN freidrich ataxia OR VITAMIN E DEF -(LBW babies, fat malabx, abetalipoproteinemia
tnf alpha causes what paraneoplastic syndrome cachexia - is released by tumor cells and macrophages therefore tnf a is aka cachetin increases insulin resistance, decreases appetite and action of lipoprotein lipase
abciximab - vs 2b3a , causes significant neutropenia in 24 hours used in stent placenent and acute coronary sydromes
ticlopidine is alternative to clipidogrel and aspirin - blocks ADP preventing 2b3a . rarely used if others can be used due to serious side effects - NEUTROPENIA AND MOUTH ULCERS IN 1%- MONITOR BLOOD COUNT / 2 WKS
cavernous hemangioma is most common benign tumor of liver - spontaneous regress, or surgical removal. usually less than 5 cm, no immediate risk but do bleed after biopsy and not diagnostically helpful - do not biopsy . these GROW BY ECTASIA NOT HPL/HPTHY not related to OCP (that is hepatic ADENOMA)
mycoplasma pneumoniae causes hemolysis how cold agglutinins produced as defensive ABs produce hemolysis. when immune rxn goes down as infection is cleared, then hemolysis stops. also see STEVENS JOHNSONS SYNDROME
opening snap - S2 time difference is best guage of severity of mitral STENOSIS AKA a2 os interval less time is more severe more time is less severe
EBV binds on CD21
cd 21 present on b cells espeically in nasopharyngeal epithelium EBV binds to cd 21 via its GP350. it binds on the C3D portion.
vitmain c - > scurvy - deficiency takes place in RER
cholestasis causes elevated alkaline phosphatase - ie primary biliary cirrhosis
Created by: tpryl



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