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-dronates analogue of, MOA
pyrophsophate (important component of hydroxyapatitie). Make hydroxyapatite more insol, and dec bone reab by interfering w/ osteoclasts. Tx: osteoporosis, pagets, malig induced hypercalcemia.
3.
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4.
% of sickle cell traite. Aggregate with what?
ie. HbA 60%, HbS 40%. nml peripheral smears, indices, retic count and MCHC. sicle w/ Na metabisulfite
5.
1,3-beta-D-glucan
major polysaccharide component of fungal cell wall
6.
1° hypothyroidism
feat: fatigue, weight gain, constipation, slow relaxation of DTR, and dry, coarse skin
1. 2.
TSH rise occurs well before low thyroid hormone level seen=>best marker for Dx *exception in cases of central hypothyroidism (deficiency in TSH) but cases are rare 7.
2 factors that contribute to angiogenesis?
VEGF and FGF
8.
2 factors that contribute to angiogenesis?*
VEGF and FGF
9.
2 sample t test
compare means of 2 populations: with 2 mean values, variances and sample sizes. Then calculate the p value.
2 sx specific for hyperthyroidism due to grave's
Infiltrative dermopathy (pretibial myxedema) and exophthalmos T cell->cytokines>Fibroblast and sec of glycoasminoglycans TSH R in adipocytes and fibroblasts
3-hydroxy-3-methylglutaryl-CoA (HMG CoA) lyase
mitochondrial enzyme
10.
11.
responsible for ketogenesis from HMG CoA HMG CoA results from degradation of leucine, a strictly ketogenic AA, and also from synthesis by HMG CoA synthase an intermediate in the formation of cholesterol 12. 13.
7a-hydroxylase
concerts cholesterol to bile acids
24hr urinary cortisol and dexmethasone suppression test screening
tests for Cushing syndrome feats: central obesity, skin striae, rounded facies, deposition of supraclavicular fat, and proximal weakness
14.
15.
69y female no identifiable cause of anemia. Cx?
B12 def. cx: Gastric atrophy intrinsic factor deficiency terminal ileal disease (dietary far less common).
99mm Tc-pertechnetate scan
detects presence of gastric mucosa accumulation in the RLQ of the abdomen is Dx of Meckel diverticulum that contains ectopic gastric mucosa
16.
abdominal CT
useful for detecting calcification of chronic pancreatitis
17.
abnormal midgut rotation around SMA
leads to intestinal malrotation=>intestine fixed by fibrous adhesive bands can cause to intestinal obstruction
18.
Abx that causes pancytopenia
chloramphenicol
19.
20.
ACE I can cause dec renal filtration fraction in what pts?
Pts with renal artery stenosis (CAD).
acetylcholine and coronary autoregulation
neurotransmitter released from parasympathetic neurons acts on muscarinic receptors=>inhibitory effects on heart *nervous input has very little effect on coronary blood flow
21.
22.
acetylcholinesterase in amniotic fluid indicates
neural tube defect: AFP and ACHE appear if neurpore doesn't fuse (opening b/w neural tube and amniotic cavity)
achalasia
classically present with dysphagia for liquids and difficulty belching in assoc with dilated esophagus and absent paralysis in smooth muscle portion of esophagus most often congenital disorder always caused by dysfxn of ganglion cells of myenteric plexus *if seen in pt from Central or South America suspect infxn by Trypanosoma cruzi
Acholic stools (no BR pigment) and bone pain
chronic cholestatic prcoess (primary biliary cirrhosis)
action of ANP
inc peripheral vasodilation, inc urinary excretion of Na and water.
action of atropine, cimetidine, lansoprazole, sucralfate, bethanechol, lansoprazole
block parietal cell M3 Ach R block gastric parietal cell H2 R Binds base of mucosal uclers to protect form acid cholinomimetic muscarinic agonist to treat ileus and urinary retention. PPI
Active TB never treated with drug monotherapy because:
fast emergence of mycobacterial antibiotic resistance form rapid, selective gene mutations.
27.
acute adrenal insufficiency
characterized by mineralcorticoid deficiency=hyperkalemia and mild hyperchloremic acidosis
28.
acute appendicitis
classically present with periumbilical pain that migrates to RLQ, nausea, vomiting, diarrhea, and fever
23.
24. 25.
26.
occurs in all age groups with peak incidence in children 6-10 caused by obstruxn of appendicular lumen *most commonly by fecaliths=>other causes include: hyperplastic lymphoid follicles, foreign bodies, nematodes, and carcinoids retained mucus causes appendicular wall to distend=>impairs venous outflow=>hypoxia=>ischemia and assoc bacterial invasion inflamm and edema of appendicular wall cause further distention **necrosis of wall with rupture may follow=>peritonitis 29.
acute chest syndrome in Sickle cell dz
...
30.
Acute effects of corticosteroidson CBC:
inc neutrophil count (from demargination of neutrophils previously attached to vessel wall) Dec lymphocyte, monocyte, basophil, and eosinophil counts.
31.
32.
Acute intermittent porphyrias: d ALA and phorphobilinogem responsible for acute abdominal pain and neurological sx. Regulated by
dec heme-->inc hepatic ALA synthase -->inc d AlA and porphobilinogen. Administration of heme relieves symptoms.
acute lymphocytic leukemia (ALL)
predominantly affects children blast cells positive for CD10 antigen (CALLA) suggest good prognosis
33.
acute marginal branches
arise from right coronary artery supplies wall of right ventricle=>provides collateral circulation in pts with LAD occlusion
34.
acute MI and ventricular remodeling
involves expansion, thinning, and fibrous healing of infarcted zone regional dysfxn of infarct causes vol overload for remaining viable myocardium=>hypertrophy of remaining myocardium=>compensation for loss of contractile fxn *net result: dilated ventricular hypertrophy with enlargement of LV cavity
35.
36.
Acute pancreatitis -->pancreatic pseudocyst which consist of :
collection of fluid rich in enzymes, and infl debris. Walls have granulation tissue, and fibrosis.
acute promyelocytic leukemia (APL)
M3 AML subtype have WBCs that produce aberrant protein with affinity for retinoic acid results from t(15;17) mutation where gene for retinoic receptor alpha (RAR-alpha) is transferred from c'some 17 to c'some 15 where it fuses with the PML gene=>PML/RARalpha=>abnormal receptor unable to signal for differentiation for myeloid precursors Tx with all-trans-retinoic acid stim differentiation of myeoblasts to mature granulocytes and induces remission in about 90% of pts with APL
37.
acute pyelonephritis
present with pyuria WBC casts=>indicate renal origin of pyuria
38.
acute transplant rejection
occurs weeks following transplantation primarily cell-mediated process histopathologic analysis: dense mononuclear lymphocytic infiltrate primarily Tlymphocytes against MHC Ag with cardiac myocyte damage Tx: immunosuppressive drugs *chronic rejection would show scant inflammatory cells and interstitial fibrosis months to years after transplantation
39. 40.
41.
acute tubular necrosis
characterized by increased serum Cr
Adaptive immune mx that prevents reinfect w/ influenza virus:
anti-hemagglutinin IgG (circulation) mucosal anti-hemaglutinin IgA (nasopharynx)
Addison's disease
autoimmune condition=>adrenal glands bc markedly atrophic *assoc with diffuse atrophy of adrenal cortex
42.
Addison's disease
assoc with atrophic adrenal glands
Adenosine Use, SFX
Rapidly acting antiarrhythmic used to convert people out of PSVT (DRUG OF CHOICE). rapidly clearted (Th 10s). sfx: chest burning (bronchospasm), flushing, high grade block (adverse reactions).
44.
Adenosine effect on pacemaker cell? Similar rx?
Open K channel (slow I funny), inhibit Ca influx (inc Th). Ach similar.
45.
ADPKD
destroy kidney parenchyma Flank pain, hematuria, HTN, urinary ifxn, progressive renal failure. PKD1 (ch16) or PKD2 (Ch4) Assoc: berry aneurysm, MVP, benign hepatic cysts.
Adrenal crisis presentations. Treatment?
Px: hypotensive, tachycard, hypoglycemic, hx (vomiting, abdominal pain, weight loss, hyperpig). Tx: corticosteroids
Adrenal crisis: MCC
depression of entire hypothal-pit-adrenal axis by glucocorticoid therapy mcc of adrenal insufficiency. Precipitated under stressful sit (infxn, surg)
adrenergic receptors and coronary autoregulation
alpha 1 cause constriction of blood vessels among other effects
43.
46.
47.
48.
alpha-2 centrally located and cause inhibition of SNS ß-1 cause excitation of heart ß-2 cause vasodilation (NOT stim by NE) 49.
adrenergic sx of hypoglycemia
sweating, tremor, palpitations, hunger, nervousness (due to Epi, NE release) CNS sx develop later and at lower gluocse levels. (behavioral changes, confusion, visual distrub, stupor, seizures).
50.
Adverse effects of succinylcholine
malignant hyperthermia (w/ halothane) in genetically susceptible Severe hyperK in pts w burns, myopathies, crush injuries, denervation (quadrepleg, Gullane) Bradycardia from parasymp stim or tachy from symp anglionic efeects.
51.
affinity maturation
process of enhancing hypervariable region of Ag binding affinity that occurs after initial binding of Ag to membrane-bound immunoglobulin on naïve B lymphocyte and subsequent migration of that B-lymphocyte to a lymph node within germinal center of lymph node affinity maturation accomplished by process of somatic hypermutation where DNA coding for new immunoglobulin variable region is mutated randomly at a very high rate=>results in new immunoglobulins with similar, better, or worse affinity for the Ag only B cells expressing Ab with enhanced affinity for Ag will be selected for *does not occur in T-lymphocyte maturation
52.
African american given prophylactic tx before trip to africa. Returns 4d later w/ jaundice, dark urine. Labs: anemia, reticulocytosis, and indiret hyeprbilirubinemia. Smear: dark inclusions w/ crystal violet.
cx: Hemolytic anemia from oxidative stress (antimalarial drugs) G6PD def. Crysatl violet : stains heinz bodies. X recessive.
53.
African form of Burkitt lymphoma
primarily effects children; typically presents as a maxillary or madibular mass; strongly assoc with EBV infxn light microscope: monomorphic, intermed-sized lymphocytes with round nuclei, multiple prominent nucleoli, and vacuolated basophilic cytoplasm; high mitotic index and high cell death rate commonly seen; benign MØ that phagocytize the resulting cellular debris ("tingible body MØ) are diffusely distributed thruout malignant tissue; clear spaces that surround MØ contribute to "starry sky" appearance demonstrate translocation of c-myc oncogene on long arm of c'some 8 with the Ig heavy chain region of c'some 14 [t(8;14)] *product of c-myc is nuclear phosphoprotein that fxns as a transxn activator controlling cell prolif, differentiation, and apoptosis
54.
55. 56.
57.
58.
Age of presentation of ADPKD and ARPKD
40-50; and birth to 1 year of life.
akathesia
inner restlessness due to anti-psychotic tx
alcohol toxicity and cardiomyopathy type
dilated CMP
alcoholic low in folate or b12?
folate.
aldolase B deficiency
life-threatening disorder bc aldolase B needed for metabolism of fructose-1-phosphate to generate dihydroxy acetone phosphate (DHAP) and glyceraldehyde
systolic dysfxn the main mech of heart failure
pts bc symptomatic only after ingesting fructose-containing foods *infants commonly present with FTT, hepatomegaly, and cirrhosis Tx: eliminating dietary fructose 59.
aldose reductase
enzyme that concerts glucose to sorbitol plays role in development of chronic complications of diabetes has low affinity for glucose; *in normal indiv very little glucose metabolized by this enzyme but in diabetics glucose metabolism by this enzyme is high due to chronically high blood glucose concentrations
60.
61.
62.
63.
Alendronate:
Synthetic biosphosphonate analog of pyrophosphte. bone resorption inhibitor prevents osteoporosis in post menopausal women.
Allergic bronchopulmonary aspergillosis
May complicate asthma. --> transient recurrent pulm infiltrates and eventually proximal bronchiectasis.
alphaketoglutarate dehydrogenase complex
converts alpha-ketoglutarate to succinyl-CoA
amenorrhea in nervosa and atheletes
low hypothal-pit gonadotropin secretion.
coenzymes required: thiamine lipoic acid CoA, FAD, NAD+
64.
65.
66.
amino acids with three titratable protons
histidine arginine lysine aspartic acid glutamic acid cysteine tyrosine
aminocaproic acid, tranexamic acid
inhibits fibrinolysis
amlodipine
dihydropyridine Ca2+ channel blocker=>selective for vascular smooth muscle most common adverse effects: peripheral edema reflex tachycardia=>avoid in pts with acute coronary syndrome
67.
amphotericin B
polyene antifungal that binds ergosterol in fungal membrane=>pore formation and cell lysis
68.
amyl nitrite
effective in Tx of cyanide poisoning forms methemoglobin that binds cyanide ions and forms non-toxic compound cyanomethemoglobin=>prevents cyanide from binding to mitochondrial enzymes in tissues
anaplastic tumors
undifferentiated tumors: dont' resemble tissue of origin. composed of pleomorphic cells w/ large, hyperchromatic nuclei , disorganized growth. Numerous abnl mitosis and giant tumor cells.
anatomy of middle mengial artery branch off
branch of maxillary artery, branch of ext carotid
angiotensin II and coronary autoregulation
very pwrfl vasoconstrictor=>acts to regulate systemic (NOT local) blood flow
72.
annular pancreas
abnml migration of ventral pancreatic bud. encircles teh descending part of duodenum and may lead to sx of duodenal obtxn in neonates.
73.
anthracycline
chemotherapeutic agents (doxorubicin, daunorubicin, epirubicin, idarubicin)
69.
70.
71.
form free radicals in myocardium most severe side effect is cumulative dose-related dilated cardiomyopathy *presents with Sx of L and R ventricular CHF=>dyspnea on exertion, orthopnea, peripheral edema; swelling of sarcplasmic reticulum is the morphologic sign of early stage of doxorubicin-associated cardiomyopathy=>followed by loss of cardiomyocytes *most effective method of preventing doxorubicin cardiomyopathy is dexrazoxane anti-psychotics low and high potency.
low pot: non neuro SFX (sedation, antichol, ortho hypoTN) high pot: extrapyr sx
Antibodies prevalent in Hashimoto's Thyroiditis?
Anti-thyroid Peroxidase (TPO) and Anti-thyroglobulin antibodies.
76.
Antibody types for A, B, and O
IgM, IgM and IgG
77.
anticoagulant protein C
neg reg of blood coagulation=>prevent XS coagulation
74.
75.
activated protein C deactivates factor V and VIII by proteolysis actions of protein C are increased in presence of protein S 78.
antiepileptic that casues elevated phenobarbital and phenylethylmalonamide
Primidone
79.
80.
81.
Antiepileptic that is metabolized to phenobarbital and phenylethylmalonamide (PEMA)
Primidone
Antithyroid drugs and complications
Agranulocytosis. Need WBC coutn and differential (methimazole or PTU presentign with fever)
antiviral medications that cause StevensJohnson syndrome
nevirapine efavirenz
82.
aortic dissection
chest scans usually show widened "double barrel" descending thoracic aorta primary even is intimal tear=>give rise to hematomas as more blood creeps behind medial wall can extend both proximally and distally *HTN is the single most imp risk factor for development of intimal tears leading to aortic dissections **cystic medial degen (seen in Marfan syndrome) also predisposes pts but relatively infrequent ***3° syphilis known for thoracic aortic dissections but not common in US
83.
aortic regurgitation hemodynamics
murmur of AR diastolic decrescendo murmur *heard loudest in early diastole=>press gradient greatest btwn aorta and left ventricle maximal=>typically best heard at L sternal border with pt leaning forward and at end expiration
84.
aortic stenosis
harsh crescendo-decrescendo systolic ejection murmur=>classic auscultatory finding=>heard best in R 2nd intercostal space with radiation to carotids *pts usually aSx for prolonged time and first present with exertion and can include syncope, dizziness, angina or heart failure *bicuspid aortic valve common cause of aortic stenosis in US
85.
AP and verapamil
Ca2+ channel blocker and class IV antiarrythmic drug=>slows phase 0 depol=>↓ rate of SA node and slows AV node conduction *phase 0 depol of cardiac conduction system occurs during diastole=>slows diastolic depol clinical use: angina HTN SVT
86.
APC mutations progression:
nml epi-(APC)->early adenoma -(KRAS)->late adenoma-(p53)->adenoCA
87.
Aplastic Anemia
Radio ->Fanconi (Idiopath) using Drugs and Viruses (b19, EBV, HIV, HCV)
88.
aplastic anemia
classically present with decreased reticulocyte count in presence of anemia
Aplastic crisis Example
sickle cell anemia pt with infection (ie parvovirus-nonenveloped ssDNA). Anemia and no reticulocyte response (aplastic). Cx: destruction of erythroid precursor cells.
90.
Apolipoprotein E4 associated w/
late-onset familial alzheimer dz. early onset: APP (ch21) presenilin 1 and 2.
91.
ards abnl and nml :
anml: inc pulm cap perm, dec compl, inc work of breathing, worse V/Q. Nml: PCWP
89.
92.
aromatase
expressed in ovarian tissue and present in subcutaneous fat, normal breast tissue, and cancerous breast tissue *in postmenopausal state, extraovarian aromatase maintains a low level of estrogen in peripheral circulation
93.
aromatase
catalyzes conversion of androgens to estrogens
94.
aromatase inhibitors
anastrazole, letrozole, exemestane aromatase inhibitors that inhibit synthesis of estrogen from its androgenic substrate=>suppressing estrogen to postmenopausal levels *in Tx of metastatic cancer aromatase inhibitors are equivalent or superior to tamoxifen **3rd generation are highly selective and potent
95.
arsenic poisoning
inactivates numerous enzymes in cellular metabolism acute poisoning commonly occurs due to ingestion of arsenic-containing insecticides present: GI Sx-nausea, vomiting, abdominal pain, and dirrrhea; decreased level of consciousness, hypotension, tachycardia, and garlic odor breath Tx: dimercaprol
96. 97.
98.
AS murmor heard
@ peak of Aortic pressure between Ao, Ac.
Aseptic meningitis presentations
fever, ha, photophobia, painful extraocular movements. -->myalgias, asymmeteric paralysis.
aspirin
irreversibly acetylates platelet COX-I=>decreased formation fo TXA2 used as 1° and 2° prevention of MI and strokes
99.
aspirin inhibits:
cox-1 and cox-2 cox-2 is not nmly expressed in cells.
100.
Association with MG, LE?
MG: thymoma LE: pre-existing malignancy (ie lugn cancer)
At which is HPV recommended?
Both males and females only between ages 9-26
102.
atheromas
lipid-filled intimal plaques that bulge into arterial lumen
103.
atherosclerosis risk factors
HTN, smoking, diabetes, hypercholesterolemia
101.
predisposes to aneurysm formation=>esp abdominal aortic 104.
atrial septal defect
wide, fixed splitting of the 2nd heart sound is characteristic finding in ASD can prod chronic pulmonary HTN as result of L=>R intracardiac shunting Eisenmenger syndrome is the late-onset reversal of L=>R shunt due to pulmonary vascular sclerosis resulting from chronic pulmonary HTN
105.
atrial septal defect and ventricular remodeling
shunting of blood from L to R atrium=>↑ pulmonary blood flow *net result: vol overload of RV=>right-sided dilated ventricular hypertrophy
106.
atropine and parietal cell
blocks gastric parietal cell at M3 acetylcholine receptor
107.
Atropine poisoning:
blind as a bat, mad as a hatter, red as a beet, hot as hare, dry as a bone, bowel and bladder lose their tone and heart runs alone. Reverse with physosotigmine.
108.
autoimmune hypophysitis
inflammation of pituitary sometimes seen during late pregnancy or early postpartum present: acute with headaches, visual field defects, and cortisol deficiency
109.
autosomal and sex chromosomal inherited disorders associated with CV developmental defects and/or pathology
Down syndrome: endocardial cushion defects (ostium primum ASD, regurgitant AV valves) DiGeorge syndrome: tetralogy of Fallot and interrupted aortic arch Friedreich's ataxia: hypertrophic cardiomyopathy Marfan's syndrome: cystic medial necrosis of aorta Tuberous sclerosis: valvular obstruction due to the cardiac rhabdomyomas
110.
avitaminosis A
squamous metaplasia can keratinize
111.
avitaminosis E
infertility, dec serum phospholipids
112.
azoles
ketoconazole, fluconazole, itraconazole, voriconazole antifungal meds that inhibit demethylation of lanosterol into ergosterol (essential component of fungal cell membrane) *also inhibit P450 cytochrome oxidase system=>increases toxicity of drugs metabolized by liver P450 system (e.g., warfarin, cyclosporin, tacrolimius, phenytoin, isoniazid, rifampin, oral hypoglycemics) cytochrome oxidase inducers (rifampin, phenytoin, carbamazepine, phenobarbital) increase azole metabolism=>lower their concen in serum
113.
B6 effects on levidopa, carbidopa
increase metabolism and dec effectiveness.
114.
Babesia divergens
endemic on northeaster coast of US transmitted by tick bites and causes babesiosis=>malaria-like illness with predilection for asplenic pts
115.
116.
117.
118.
bacteria associated with PID
N gonorrhoeae, c trachomatis can cx ectopic preg if sex act.
bacteria G+ rod: narrow zone beta hemolysis. motile. can grow at 4c.
Listeria monocytogenes. cell mediated immunity needed.
bacteria that can cause infection with low counts?
shigella, campylobacter (500), Entamoeba histolytica (1), giardia (1)
bacteria that proliferate in lymph nodes
Salmonella typhi Yersinia enterocolitica *when cause lymph node infxn mesenteric nodes can enlarge and bc inflamed=>RLQ pain confused clinically with appendicitis=>"pseudoappendicitis"
119.
bacterial casues of anterior uveitis
herpes, syphillis, lyme dz
120.
base excision repair
removal of abnormal bases and replacement with correct base abnormal bases recognized and removed by specific glycosylases without disruption of phosphodiester backbone removal prod apurinic and apyridimidic sites that are cleaved by specific nucleases=>gap then filled by DNA polymerase and joined by ligase
121.
Benzos and sfx
...
122.
Beriberi
infantile: appears between ages 2-3 months with fulminant cardiac syndrome with cardiomegaly, tachycardia, cyanosis, dyspnea, and vomiting adult dry: symmetrical peripheral neuropathy accompanied by sensory and motor impairments, esp distal extremities adult wet: neuropathy with cardiac involvement high-output congestive heart failure and neurological Sx strongly suggest wet beriberi (thiamine deficiency)
123.
124.
125.
126.
127.
128.
129.
Berksons pygmalion hawthorne
Selection bias (hops pts) researcher's beliefs Knowledge of study (study affects pop)
best drugs for tx of hypertryglycerdiemia
Fibrates and niacin.
Best imaging study to work up someone with NF type 2?
MRI of the head
Best test to asses damage of liver?
Elevated PT
Best test to preform when suspecting an Aortic dissection?
Transesophageal Echocardiogram
Beta blocker action in thyrotoxicosis
Dec sympathetic adrenergic impulses @ target organs. Dec rate of peripheral conversion of T4 to T3.
bethanechol
cholinomimetic muscarinic agonist clinical use: ileus and urinary retention somewhat selective for M2 muscarinic receptor=>can increase gastric acid secretion
130.
bile acid
prod in liver=>excreted with bile=>reabsorbed in terminal ileum as micelles with fat droplets *can be lost with feces if terminal ileum is inflamed (as in Crohn's dz)=>less bile acid present in bile=>ratio of cholesterol/bile acid increases=>cholesterol precipitates in bile of gallbladder and forms gallstones
131.
bile acid-binding resins
bile acid sequestrants=>bind bile acids in GI=>excretion of bile acids=>increase hepatic synthesis of new bile acids that consumes liver cholesterol stores *hepatic cholesterol reduction is activating factor for HMG CoA reductase=>increased hepatic cholesterol synthesis=>increased risk of prod gallstones
132.
bile acid-binding resins
bind bile acids in GI tract=>interfere with enterohepatic circulation of bile acids primarily used in combo with statins for Tx of hypercholesterolemia increase hepatic TG prod=>can cause elevations in serum TG
133.
bilobed (malignancy)
reed sternberg; hodgkin
134.
Bioavail
F= AUC oral x dose IV/ AUC IV x dose oral
Black pt with frequent visits to the hospital for painful crisis: what is she treated with and what does she have?
Painful, vaso-occlusive crises. Respond well to oxygen, IV fluids, and high dose narcotics.
135.
136.
blot procedures
southern: DNA fragments western: proteins northern: mRNA southwestern: DNA-bound proteins (transxn factors, nucleases, histones, etc.)
137.
BRCA1, BRCA2
DNA repair enzymes mutations assoc with breast cancer, ovarian cancer, Lynch syndrome, xeroderma pigmentosum, Fanconia anemia
138.
Broken 12th rib
kidney. pain radiates to back (11 and 12 are floating)
139.
bromodeoxyuridine
thymidine analog used for grading tumors uptake is consistent with high-grade tumor and a poor prognosis
140.
bronchoalveolar carcinoma
subtype of lung adenocarcinoma uncommon, 10% of all lung cancers; occurs in non smokers tumor arises from alveolar epithelium and located at periphery of lung and often multifocal microscope: tumor is well-diff, composed of tall, columnar cells that line alveolar septa without evidence of vascular stromal invasion imaging: pneumonia-like consolidation
141.
Brucella melitensis
acquired by drinking infected milk or by direct contact with infected sheep and goats present: fever, malaise, lymphadenopathy, and hepatosplenomegaly *extremely rare in US
142.
143.
144.
145.
146.
Buerger's histo
acute and chronic inf of arterial walls / thrombosis Can extend into contiguous veins and nerves.
Bupropion CI in what patiens
patients with seizure d/o and bulimia, anorexia.
C diph culture Sx?
in cysteine-tellurite agar. septiciemia, UTI, erythrasma, endocarditis in IC. gray pharyngeal exudate in not vacc.
c tetani vaccicination
Toxin can cross placenta, developing countries can vaccinate young adults. It is formalin -inactivated toxin (toxoid)
cAMP
2nd messenger in G-protein/adenylate cyclase 2nd messenger system utilized by hormone receptors including ß-adrenergic receptors, V2 ADH receptors, and calcitonin, glucagon, TSH, ACTH, and HCG receptors, among many others
147.
Campylobacter fetus
opportunistic pathogen that infects immunocompromised persons infxn can cause septicemia in newborns, women in 3rd trimester of pregnancy, and debilitated elderly pts
148.
149.
campylobacter transmission
domestic animals or contaminated food.
CaNa2EDTA
chelating agent of choice for Tx of acute lead and mercury poisoning acts by forming complexes with mono-, di- and trivalent ions
150.
candida albicans
component of normal human skin and mucous membrane flora exists as single-celled budding yeast with pseudohyphae (formed from yeast cells) does not cause disseminated infxns in healthy ppl=>can induce serious dzs when immune system weakened *opportunist pathogen host antifungal defense is T-lymphocytes and neutrophils 1. T-lymphocytes (in particular T(H) cells) are imp for prevention of superficial Candida infxn *why localized candidiasis common in HIV+ pts 2. neutrophils prevent hematogenous spread of Candida; can cause R-sided endocarditis, liver and kidney abscesses, and candidemia *why neutropenic indiv more likely to have systemic dz
151.
capsaicin
reduces pain by reducing susbtance P
152.
capsofungin
echinocandin antifungal that blocks glucan synthesis
153.
Carbon tetrachloride effects on liver
p450 microsomal oxidase --detoxifies. poisoning -->produces free radicals that lead to liver necoriss and fatty change.
154.
cardiac output
use Fick principle to calculate CO=O2 consumption/arteriovenous O2 diff
155.
156.
Carpal tunnel syndrome associated with what d/z
hypothyroidism, DM, RA, dialysis assocaited amyloidosis
carvedilol
ß-blocker nonspecifically antagonizes: ß-1 ß-2 alpha-1
157.
Catalase + organisms
PLACESS Pseudomonas, Listeria, Aspergilus, Candida, E.coli, S. aureus, Serratia CGD: recurrent infxns
158.
Caudal regression syndrome: cx and sx
maternal diabetes; sacral agenesis w/ lower exteremity paralysis and urinary incontience.
159.
Cause of AAA
atherosclerosis which starts as a fatty streak. Then weakens underlying media of aortic wall.
160.
cause of adding carbidopa to levidopa only tx
inc anxiety, agitation
161.
cause of gout (mt)
mt in PRPP synthetase-->inc pdtn of purines-->hyperuricemia
162.
cause of lynch syndrome (AD)
abnml nucleotide mismatch repair. MSH2, MLH1 genes.
cause of paraneoplastic sydrome of hypercoagulability (trousseau's syndrome):
cancer (adenocarcinoma of panceas, colon, lung). visceral cancer.
164.
Cause of trisomy 13
secondary to non dsjxn of maternal meiosis I. associated w/ cleft lip, palate, polydactyly, rocker bottom, holoprosencephaly
165.
Causes of Down syndrome? %
DS due to meiotic non dysjxn > robertsonian t14:21 t21:22 (3-4%)
166.
causes of megaloblastic anemia
deficiencies of vit B12 and/or folate
163.
assoc with number of drugs (methotrexate and phenytoin) and some inborn metabolic errors
167.
168.
Causes of normotensive hypokalemia alkalosis?
1. vomiting 2. diuretic abuse 3. Bartter's 4. Gitelman's **Vomiting is the only with decreased urinary chloride levels.
cavernous hemangiomas
consist of dilated vascular spaces with thin-walled endothelial cells soft blue compressible masses up to a few cm; appear on skin, mucosa, deep tissues and viscera; when appears on skin most frequently based in dermis less likely to regress spontaneously than capillary hemangiomas *assoc with Hippel-lindau dz w hen found in brain and viscera
169.
CCl4 effect on liver
free radical injury=>oxidized by p450 whchi forms CCl3.-->reacts w/ lipids in cell membrane (degradation and H2O2 formaiton)..Lipid peroxidation.. hepat nec
170.
celiac disease
gluten-sensitived enteropathy *gluten a component of wheat and some other related grains characterized by Sx of malabsorption: diarrhea, weight loss, and deficiencies of vitamins and minerals *Sx subside with exclusion of gluten-containing products from diet may manifest early or later in life Dx when flattening of mucosa with loss of villi and chronic inflamm infiltration of lamina propria seen on small intestine biopsy; IgA anti-tissue transglutaminase and IgA endomysial Ab are very sensitive and specific for Dx *most pronounced changes seen in duodenum and proximal jejunum bc concentration of gluten higher there
171.
celiac disease mechanism
occur by immune-mediated mech in genetically-susceptible indiv abnormal response to tissue transglutaminase, a enzyme that participates in metabolism of gluten IgA Ab to gliadin (mixture of polypeptides extracted from gluten) typical finding in pts other Ab frequently found in pts with celiac dz are anti-endomysial and anti-reticulin
172.
cell adhesion molecules
proteins located on cell surface that mediate binding with other cells or with ECM ex) selectins, integrins, and cadherins *usually downreg in malignant tumors=>allows cells to spread from their site of origin
173.
174.
cells causing swelling in acute gout? tx and MOA
neutrophils. Colchicine inhibits chemotaxis of neutrophils by preventing microtubule formation.
central chemoreceptors
located in medulla indirectly sensitive to changes in PaCO2=>directly sensitive to pH changes *NOT sensitive to PaO2
175.
cervix epithelium
simple columnar (endocervix); stratified squamous (ectocervix) charac: contains cervical glands; secretion undergoes cyclic changes allowing for less viscous mucus at time of ovulation assoc tumors: condyloma acuminatum, squamous cell CA, adenocarcinoma
176.
characeristics of aktinic keratosis
hyperkeratosis and parakeratosis
177.
Characteristics of Blastomycosis?
Found in soil or rotting wood. CXR will reveal multiple nodules or dense consolidation. Can cause skin lesions, osteolytic bone lesion, and prostate involvement. Not usually seen in immunocompromised hosts.
178.
Characteristics of Histoplasmosis?
Found in Ohio river valley. Palatal ulcers, hepatosplenomegaly, and pancytopenia. CXR will reveal interstitial pneumonitis.
179.
characteristis of turner
primary amenorrhea, high arched palate, widely spaced nipples, ovarian dysgenesis (streaked), short.
chemotherapeutic agents and cardiomyopathy type
dilated CMP
180.
systolic dysfxn main mech of heart failure ex) doxorubicin *dose-dependent cardiotoxicity 181.
cherry hemangiomas
small, vascular, bright-red, papular lesions; always cutaneous and not found on mucosa or deep tissues most common benign vascular tumors in adults; do not regress spontaneously; # often increases with age=>why referred to as senile hemangiomas *appear during 3rd or 4th decade of life **maraschino cherries are in cocktails histo: sharply circumscribed areas of congested capillaries and post-capillary venules in papillary dermis
Chi square test
2x2: test association b/w variable and effect (+/-)
child presents with barking cough, hoarseness and respiratory distress. what is the dx?
Croup- 2/2 parainfluenza
Child with history of trauma to soft palate then develops s/s of stroke. what is the dx?
Internal Carotid Artery Dissection
185.
child with hyperpyrexia is treated by:
cooling blankets first, then acetaminophen which takes longer to act.
186.
child with meningtis + petechial rash?
meningococcemia
Child, fever, painful gingival ulcers, swollen gums, cervical lymphadenopathy. Oral ulcer base scraping---> interpretation.
Oral ulcer base scraping--Tzanck test (look for multinucleated giant cells). HSV, VZV: present w/ fever, vesiculoulcerative (herpatic) gingivostomatitis, cervical lymph for PRIMARY INFXN. Reactivation: limited perioral blister.
188.
Cholecystitis
acute or chronic infl of GB. cx: mc cholelithiasis; (block->2nd ifxn) inc ALP (if bile duct involved) Dx: US or HIDA
189.
Cholinergic crisis
lack of response from edrophonium. Need to stock cholinesterase inhibitors. if positive response--> continue or inc dose of neostigmine
190.
chronic lymphedema disposes to:
angiosarcoma (stewart-treves syndrome)
191.
chronic lymphocytic leukemia
frequently seen in elder pts
182. 183.
184.
187.
presents with lymphadenopathy, hepatosplenomegaly, and anemia has an indolent course neoplastic cells resemble mature B-lymphocytes
192.
chronic myelogenous leukemia (CML)
translocation of c-able gene from c'some 9 to c'some 22 [t(9;22)]=>philadelphia c'some bcr-abl the resulting fusion gene=>encodes protein that inhibits apoptosis while promoting mitogenesis and increased tyrosine kinase activity
193.
chronic pancreatitis
often caused by alcoholism=>exocrine insufficiency present: severe abdominal pain, stool that floats in toilet bowel (due to XS fat content), and weight loss
194.
Churg-Strauss
vasculitis linked to asthma lesions typically occur in small vessels and characteristically accompanied by granulomas and eosinophilic necrosis
195.
CI for OCP
prior hx of thromboembolic event or stroke hx of estrogen-dependent tumor >35 who smoke heavily hypertriglyceridemia Decompensated or active liver disease (steroid met is impaired) Pregnancy.
196.
CI for OCP*
prior hx of thromboembolic event or stroke hx of estrogen-dependent tumor >35 who smoke heavily hypertriglyceridemia Decompensated or active liver disease (steroid met is impaired) Pregnancy.
197.
cimetidine and parietal cell
blocks gastric parietal cell histamine H2 receptor
198.
Cimetidine use and sx
H2 r antagnoist for ulcers. SFX: gynecomastia. also inhib p450.
Cimetidine: Use, moa, sfx
H2 R antagonist dec hydrochloric gastric aci production. SFX: Gynecomastia.
200.
circulatory regulation
IV fluid infusions ↑ intravascular vol=>↑ preload=>↑ ventricular myocardial sarcomere length=>↑ stroke vol and CO
201.
cirrhosis and albumin
classically present with decreased serum albumin levels from decreased prod
202.
citrullemia
urea cycle disorder
199.
results from deficiency of arginosuccinate synthetase ATP is the cofactor required 203.
204.
cleft lip: Cleft palate:
maxillary prominenece fail to properly fuse w/ intermaxillary segment. Palatine shelves of maxiallary prominence fail to properly fuse w/ one another or primary palate.
clinical manifestations of Wilson disease
liver involvement: aSx liver fxn abnormalities chronic hepatitis fulminant hepatitis portal HTN liver cirrhosis neuropsychiatric sequela: parkinsonian-like tremor rigidity and/or catatonia ataxia slurred speech personality changes depression or paranoia
205.
clomiphene
selective estrogen receptor modulator=>prevents neg feedback inhibition on hypothalamus by circulating estrogen=>increased gonadotropin prod common Tx for PCOS and women who want to get preggo=>induces ovulation
206.
clomiphene
antiestrogen=>interferes with neg feedback of estrogens on hypothalamus and pituitary increases synthesis of GnRH=>increases gonadotropins used to Tx infertility esp when assoc with anovulation
207.
Clostridium difficile
colonizes colonic mucosa and releases toxins that cause mucosal inflamm, cell damage, and ultimately cell death with mucosal necrosis present in 2-3% of healthy adults and in about 70% of healthy infants as part of gut's normal microbial flora dz results when pt uses antibiotics that kill large portion of commensal organisms in gut (what normally keeps the C. difficile in check) pathogenic strains prod AB toxin: A-enterotoxin; acts as neutrophil chemoattractant=>mucosal inflamm, loss of water into gut lumen (prod diarrhea), and mucosal death B-cytotoxin=>actin polymerization, loss of cellular cytoskeleton integrity, cell death and mucosal necrosis toxins bind to specific receptors on intestinal mucosal cells and are internalized where they exert their intracellular effects
208.
Clostridium perfringens
alpha toxin lecithinase causes cell membrane integrity loss frequently assoc with clostridial myonecrosis and gas gangrene (rapidly progressive form of fasciitis assoc with penetrating injury by soil-contaminated objects *can also cause transient watery diarrhea
CML and CLL causes neutropenia which can lead to what fungal infection:
invasive aspergillosis. (lung MC affected). Hemoptysis, lung granulomas. + Aspergillus has predilection for blood vessels--> spread hematog and cx infarcts in skin, paranasal sinuses, kdiney, endocard, brain.
co
...
Coarctation of aorta : eventually leads to death by
hypertension associated complication. LVF, rupture dissecting Ao aneurysm, IC hemorrhage
212.
Colchicine sfx
diarrhea, N/V MOA: inhibit tubulin polymerization
213.
Cold agglutinins infxn and dz
Mycoplama pneumoniae, EBV, hematologic malignancy
214.
colonoscopy
used to Dx ulcerative colitis and Crohn's dz involving large intestine
209.
210. 211.
also used to screen for colon cancer 215.
common causes of liver cirrhosis
alcoholism chronic hepatitis B and C
Common causes of primary amenorrhea in female w/ secondary sexual characteristics :
imperforate hymen or mullerian duct anamoly. undx imperforate hymen presents w/ cyclic abdominal or pelvic pain and hematocolpos.
217.
Common cx for inc prevalence?
improved quality of care.
218.
Common cx of atypical DVT?
factor V leiden mut. Pt given Protein C and PTT doesn't change (Nml)--due to Va resistance.
216.
219.
220.
221.
222.
Common findings seen in Paget's disease?
Due hyperfunctioning Osteoclasts. Elevated Alk. Phosph., femoral bowing on x-ray, and loss of CN VII activity due to enlarging cranial bones.
common side effects of digoxin?
GI : nausea, vomiting, anorexia
Common sx of infectnious mono cx:
sore throat, high fever, cervical lymphadenopathy, splenomegaly cx: 90% EBV (CMV, HIV, toxo are non-EBV mono)
complement deficiency
deficiency of C1, C2, and C4 leads to increased susceptibility to infxns and SLE-like dz low levels of C5, C6, C7, C8, and C9 predispose indiv to infxns with Neisseria gonorrhea and Neisseria meningitidis
223.
concentric ventricular hypertrophy
uniformly thickens ventricular wall while other dimensions of ventricle remain virtually unchanged=>narrowed ventricular cavity *often seen in pts with longstanding HTN bc ↑ LV afterload
224.
congenital adrenal hyperplasia
encompasses a group of disorders that stem from various defects in enzymes involved in cortisol biosynthesis=>increased cortisol precursors proximal to enzyme deficiency 21-hydroxylase deficiency the most common cause=>90%; converts 17-hydroxyprogesterone to 11deoxycortisol in zone fasciculata; converts progesterone to deoxycorticosterone in zona glomerulosa *accum cortisol precursors diverted towards adrenal androgen biosynthetic pathway=>increased adrenal androgens **low cortisol levels stim ACTH prod=>further increases adrenal androgens production ***female infants get masculinized and males look normal
congenital pyloric stenosis
infant: RUQ mass (hypertrophy of SM) Projectile vomit *non bilious
226.
Congenital rubella
cataracts, deaf, PDA
227.
Congenital torticollis
noted by 2-4wks of age. hold head tilted to one side. Cx: malposition of head in utero or birth trauma. Tx: conservative therapy and stretching exercises.
228.
Conn's syndrome
increased aldosterone secretion=>hypertrophy of glomerular layer of adrenal cortex
Consequences of reduced hemoglobin p50?
reduced release of O2-->renal hypoxia, inc Epo, inc erythrocytosis.
control of respiration
PaCO2 in healthy indiv major stim of respiratory drive=>CO2 readily crosses BBB and forms H+ ions that directly activate medullary respiratory center *PaO2 and pH are of secondary imp except when abnormalities are present (e.g., COPD)
225.
229.
230.
PaO2 sensed in carotid and aortic bodies; plays little role when >70mmHg but in profound hypoxemia (<60mmHg)=>mech plays more imp role in maintaining respiratory drive *chronic and profound hypercapnia =>high [CO2] cease to stim respiratory center=>O2 bc the only stim=>bad if rapidly increase O2 bc pt loses respiratory drive stim=>respiratory failure 231.
coronary occlusion and collaterals
rate of occlusion=>major determinant of whether or not coronary artery plaque will cause ischemic myocardial injury *slowly developing occlusion allows formation of collaterals=>could prevent myocardial necrosis
232.
coronary steal syndrome
paradoxical ↓ in blood flow to an area of ischemic myocardium bc blood will preferentially flow thru pharmacologically dilated arteries of the heart not obstructed by atherosclerotic coronary vessel narrowing
233.
Corynebacterium diptheriae
causes diptheria: acute bacterial dz that initially affects oropharynx spread by respiratory droplet transmission and causes dzs via AB exotoxin; B subunit allows penetration of A subunit into cell to inhibit ribosome fxn=>transfers a ribose residue from NAD to a histidine on EF2=>essential for peptide chain translocation on ribosome in process of translation=>causes cell death by inhibiting protein synthesis thru EF-2 inactivation neural and cardiac toxicity are serious potential sequelae immunization with diptheria toxoid induces production of circulating IgG against exotoxin B subunit=>effectively prevents dz
CPx of choriocarcinoma
Arises from trophoblast. MC from evacuated hydatidiform mole, but also abortion, nml preg, ectopic preg. Px: vag bleeding, uterine enlargement, inc hCG. Met hematogenously (lungs). Tx: chemo sensitive. Macro: soft, yellow white. Necrosis and hemorrhage. Cytotrophoblast and syncytiotrophoblast. No villi
CPx of glucagonoma
DM, necrolytic erythema, and anemia.
craniopharyngioma (histo, origin,
calcified cyst, w/ squamous epithelium, kertain pearls, viscious fluid rich in xol. Derived from Rathke's pouch
crescents in glomerulonephritis consists of:
parietal cells, monocytes, macrophages, fibrin.
238.
CREST : pathophys
CD4 lymph -->secretions-->fibroblast -->collagen-->tissue fibrosis. LES muscle replaced by fibrous tissue.
239.
CREST syndrome
Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
234.
235. 236.
237.
assoc with anti-centromere Ab 240.
cricopharyngeal muscle dysfunction
due to diminished relaxation of pharyngeal muscles during swallowing=>more force required to move food bolus down more intense contractions of pharyngeal muscles increase oropharyngeal intraluminal press *with time pharyngeal mucosa will herniate thru muscle fibers in zone of weakness (post hypopharynx)=>form Zenker diverticulum (false diverticulum) Sx: "high dysphagia"-difficulty swallowing felt "at the throat," coughing, choking, and sometimes even nasal regurgitation present: oropharyngeal dysphagia, coughing, choking, and recurrent aspiration
241.
242.
cricothyrotomy cuts through
superficial cervical fascia and crycothyroid membrane.
cryptorchidism
incomplete descent of the testes into the scrotum undescended testes are usually found in abdominal cavity or in inguinal canal can lead to sterility and increases risk of testicular carcinoma
243.
cryptorchidism
seminiferous tubules are damaged interstitial Leydig cells are preserved
244.
Cushing's dz
assoc with hyperandrogenism and obesity
245.
Cushing's sydrome
XS cortisol production
cx and presentation of cricopharyngeal muscle dysfxn
diminsed relaxation of pharyngeal muscle during swallowing. Inc intralum pressure causes mucosa to herniate leading to zenker diverticulum. Present with dysphagia, coughing, chokcing, recurrent aspiration.
247.
cx of apple peel in GI:
SMA obtxn. Intestinal atresia distal to duodenum due to vascular accidents in utero.
248.
cx of charcot bouchard
small and pts w/ hypertension (longstanding).
249.
cx of clubbing
prolonged hypoxia: large cell lung ca, tuberculosis, CF, empyema, bronchiectasis, chronic lung abscesses
250.
cx of delirium
infection, electrolyte disbalance.
251.
cx of DS
nondysjxn>robertsonian translocation>mosaicism
252.
cx of frothy urine
proteinuria. due to nephrotic syndrome.
253.
cx of gallstones in crohn's
dec bile acid reabs and lost in feces inc lithogenicity of bile. xol precipitates and forms gallstones.
cx of green sputum in bacterial infection in lungs?
Myeloperoxidase (neutrophil azurophilic granules).. used to produce HCOL for resp burst.
cx of hyperosmotic vol contraction isoosmotic vol contxn vol exp and hypoosm hypoosmotic vol ctxn hypertonic vol exp
DI or sweating (hypotonic) diarrhea or hemorrhage Psychogenic polydypsia Adrenal insuff (Na wasting) hypertonic saline infus
Cx of insulin resistance in overweight individuals
high free fatty acids and serum triglycerides
cx of pancytopenia and glomerulonephritis in SLE
AutoAb vs blood cells (TII HS). immune complex deposition w/in glomerulus (TIII HS)
Cx of recurrent lobar hemorrhages and association
cerebral amyloid angiopathy due to age (associated w/ HTN)
Cx of reperfusion injury?
1. oxygen free radical (parenchymal, endothelial, leukocytes), 2. mito damage 3. inflamm (neutrophil recruit) 4. complement
cx of subarachnoid hemorrhage?
AV mal and saccular aneurysm
Cx of tissue damage in lung abscess:
lysosomal enzyme released from neutrophils or macrophages.
262.
cystic fibrosis
present: recurrent respiratory infxn with Pseudomonas aeruginosa, chronic diarrhea, weight loss *P. aeruginosa common pulmonary pathogen in CF **diarrhea and weight loss occur as result of malabsorption due to obstructive fibrosis and progressive insufficiency of exocrine pancreas
263.
cystic hygromas
lymphatic cysts lined by thin endothelium
246.
254.
255.
256.
257.
258.
259.
260.
261.
benign tumors often present at birth; most commonly located on neck and lateral chest wall *frequently found in neonates with Turner syndrome and Down syndrome
264.
cystitis
common organisms: E. coli, S. saprophyticus, P. mirabilis, Klebsiella, Enterococci Sx: may be aSx or Sx; suprapubic pain and tenderness, frequent urination labs: UA and micro show +leukocyte esterase, +nitrites, +bacteria, +WBC, +RBC occasionally
265.
cytochrome P450 monooxygenase
enzyme present in hepatic microsomes and endoplasmic reticula of varied other tissues metabolizes steroids, alcohol, toxins, and other foreign substances *renders them soluble and easier to excrete **converts pro-carcinogens into carcinogens capable of causing mutations in human DNA
266.
cytomegalovirus
causes "heterophil-negative" mononucleosis in immunocompetent hosts in immuocompromised pts it casues various systemic infxns: pneumonia, hepatitis, retinits, esophagitis, and diarrhea
267.
D-glutamate
B anthracis capsule instead of polysacch
268.
D-xylose test
monosaccharide. differentiate malab of pancreatic vs GI mucosal etiology
Damage of scleroderma on pulm vessels
Pulmonary hypertension due to damage of pulmonary vasculature. prolif and accum of monoclonal T cells in affected tissues secrete cytokines (TGF-beta) that inc pdtn of colalgen and ECM protein by fibroblasts.
danazol
synthetic androgen
269.
270.
clinical use: endometriosis, hereditary angioedema side effects: hirsutism, masculinization, fluid retention, and weight gain 271.
272.
Daptomycin: use, sfx , moa
G+ inc MRSA. depolarization of bacterial cellular membrane and inhibition of DNA, RNA, protein sythesis. INc CPK and incidence of myopathy
deamination of bases
can occur spontaneously or 2° to exposure to certain chemicals cytosine=>uracil adenine=>xanthine guanine=>hypoxanthine
273.
274.
275. 276.
277.
278.
279.
Death by TCAs mech
refractory hypotension and cardiac arrhythmias. Inhibit fast Na ch in cardiac myocytes. Tx: nml saline + hypertonic Na bicarb
Dec glomerular pressure with ACE I occurs in:
pts with renal artery stenosis.
decreased BUN
associated with liver dz bc less ammonia converted to urea
def in late complement comp
No MAC--> neiss infetions
Def in Propionyl CoA carboxylase leds to:
propionic acedemia, Poor feeding, vomiting, hypotonia, lethargy, dehydration, anion gap acidosis.
defect terminal compleent casacade infxsn
nisseria
deferoxamine
chelating agent used to Tx iron poisoning in pts receiving multiple blood transfusions for conditions such as thalassemia and in pts who consume large amounts of supplemental iron binds iron in bloodstream and facilitates urinary excretion
280.
deglutition
3 phases: oral-voluntary; food bolus collected at back of mouth and lifted upwards to post wall of pharynx=>initiates pharyngeal phase pharyngeal phase-involuntary pharyngeal muscle contractions=>propel food bolus to esophagus esophageal phase-food enters esophagus and stretches walls; peristalsis begins juts above site of distention and moves food downward; relaxation of LES follows=>allows food bolus enter stomach
281.
dermatomyositis
autoimmune disorder presents: proximal muscle weakness and skin involvement including a violaceous discoloration of upper eyelids (heliotrope rash), and a raised, violaceous, scaling eruption on the knuckles (Gottron's sign) CPK levels are typically elevated
Describe 2nd stage of syphillis?
condylamata lata and maculopapular rash invovling entire trunk and extremities. rash also on palms and soles
283.
Describe an essential tremor?
Tremor that is suppressed at rest but exacerbated toward the end of a goal directed activity.
284.
Describe Cystinuria?
1. recurrent kidney stones 2. stones are hard and radioopaque 3. crystals are hexagonal 4. urinary cyanide nitroprusside test is positive
Describe Diffuse Esophageal Spasm?
Spontaneous pain and discomfort with hot or cold food. Best to proceed with Esophageal motlitiy study will reveal non-peristaltic, high amplitude contractions.
286.
Describe Homocystinuria?
Marfan's syndrome + Mental retardadtion + thromboembolic events+ downward dislocation of the lens TXT: Vitamin B6
287.
Describe polymyostitis?
characterized by weakness and difficulty arising from chair and or stair climbing.
Describe post-operative cholestatis?
Commonly seen after seizures with 1. hypotension 2. Extensive blood loss into tissues 3. Massive blood replacement Pt will have jaundice few days after surgery and mildly elevated AST and ALT, with elevated bilirubin levels.
Describe Prader Willi Syndrome?
Deletion in chromosome 15 Hypogonadism, hypotonia, macrophagia mental retardation, small down turned mouths,diamond shaped eyes
Describe renin-angtiotensinaldosterone pathway?
1. Renin produced by JGA in kidney 2/2 hypoperfusion 2. Renin cleaves angiotensinogen into angiotensen I 3. angio. I is converted to angio. II by ACE (released by lungs) 4. Angio. II: vasocontrictor, promotes ADH release from pituitary, and aldosterone production in adrenal cortex.
Describe saline responsive metabolic alkalosis?
Metaoblic alkalosis with urine chloride less than 20. Due to : 1. Vomiting 2. volume depletion 3. diuretic abuse txt with isotonic saline
Describe the pattern of esophageal dysmotility in scleroderma?
decreased peristaltic contractions in lower 2/3 of esophagus. decreased LES tone "food gets stuck in throat"
Describe the symptoms of Pancoast tumor?
2/2 lung tumor in superior sulcus compress brachial plexus and cause shoulder pain radiating to arm in ulnar nerve distribution tumor invades CN 8 and T1
282.
285.
288.
289.
290.
291.
292.
293.
294. 295.
296.
Describe the two sample t-test?
used to compare the mean of two groups of subjects
Describe what imaging studies of invasive aspergilliosis would look like?
CXR: rapidly progressive dense consolidation CT: Pulmonary nodules with "Halo" signs or lesions with air crescent.
desmolase
catalyzes formation or destrxn of carbon-carbon bonds within a molecule plays sig role in respiration and fermentation
297.
dexrazoxane
iron-chelating agent that ↓ formation of oxygen free radicals by doxorubicin and other anthracyclines
298.
Diamond-Blackfan anemia?
congenital hypoplastic anemia macrocytic anemia, low reticulocyte count, and congenital anomalies: webbed neck, triphalangeal thumb, shielded chest
299.
diastolic heart failure
characterized by ↓ ventricular diastolic compliance BUT normal ventricular contractile performance=>LVEDP must be ↑ to achieve near-normal LVEDV and stroke vol *only see ↑ in LVEDP
300.
diastolic HF vs Systolic HF:
Diastolic: dec ventricular diastolic compliance but nml ventricle contractility SHF: dec ventricular contractil performance (dec EF)-->inc LVEDP, LVEDV
301.
didanosine side effects
pancreatitis
302.
Diff b/w brachiocephalic and SVC obstruction?
SVC bilateral. brachiocephalic drains ipsilateral jugular and subclavian vein.
303.
Diff b/w central and partial DI?
less than 10% change: nephrogenic Complete central: >50%
304.
Diff b/w hepatocyte injury and death
injury: diffuse swelling (ballooning degeration) Death: lobular architectural disruption and confluent hepatoyte necrosis (bridging necrosis).
305.
Diff b/w HSV, syphilis, and Chlam
HSV ulcers -painful, heal in 10 days S: ulcer heals in weeks. Chlam - painless, heal few days.
306.
diff b/w LMWH and unfract
both bind antithrombin to inc activity against Xa. but Unfract binds both antithrombin and thormbin
307.
Diff b/w MEN2A and 2B
2A: Parathyroid hyperplasia, medullary CA, pheochromocytoma 2B: medullary CA, pheochromocytoma, oral/intest mucosal neuromas.
Diff b/w myocardial hibernation, stunning, remodeling..?
hibernation: reversed by reperfusion adn more serious than stunning (ischmeia-induced reversibel loss of contractile fxn). Ischemia preconditioning: resistance to infarction due to repetitive nonletha isch. Ventricle remodeling: change in mass, vol, shape, myocyte comp of heart.
difference between comma shaped gram - bacteria that cause diarrhea, ox + :
campylobacter cannot grow in alkaline rich medium while cholera can.
Difference between malignant HTN and long standing non malig HTN on arterioles? Assoc with other disease?
Hyaline arteriolosclerosis w/ longstanding nonM and diabetes. Malignant HTN--> homogenous, onion-like, concentric thickening of walls.
Difference between malignant HTN and long standing non malig HTN on arterioles? Assoc with other disease?*
Hyaline arteriolosclerosis w/ longstanding nonmalignant and diabetes. Malignant HTN--> homogenous, onion-like, concentric thickening of walls.
Difference between persistant granulomatous inflammation and excessive granulation tissue
1: chronic inflammation from activated MO (may be due to presence of foreign antigen/suture). 2: keloid.
308.
309.
310.
311.
312.
313.
314.
315.
316.
317.
Difference of mycoplasma and mycobacteria walls?
Mycoplasma has mycolic acid (long brached chain sat. FA). Mycobacteria has no wall.
differentiate between Toxolplasmosi, CNS lymphoma, and PML in HIV pt?
Toxo: multiple ring enhancing lesions in basal ganglia CNS lymphoma: Solitary ring enhancing lesion. presence of EBV DNA in CSF PML: multiple non enhancing lesions with no mass effect
Differentiate false labor?
1. No cervical changes seen on exam 2. lower abdominal pain relieved by sedation 3. irregular contractions
differentiation between erosion and ulcer: border?
muscularis mucosa (not penetrated by erosion)
digoxin
clinical use: impaired left ventricular fxn AFib common adverse side effects: nausea vomiting diarrhea
318.
dimercaprol
chelating agent used in Tx of arsenic poisoning displaces arsenic ions from sulfhydryl groups and enzymes and facilitates their excretion
319.
diphenoxylate
opiate anti-diarrheal structurally related to meperidine binds to mu opiate receptors in GI tract and slows motility lower therapeutic doses allow for potent anti-diarrheal effects w/o sig opiate effects (euphoria and physical dependence) higher doses can produce morphine like euphoria and physical dependence=>usually combined with atropine to discourage abuse common side effects: bloating and mild sedation
320.
321.
Diphenoxylate: use, moa, sfx
anti-diarrheal opiate (related to meperidine), binds mu to slow motility. Euphoric at high dose
diphtheritic myocarditis and cardiomyopathy type
ultimately progresses to dilated CMP systolic dysfxn the main mech of heart failure
322.
direct arteriolar vasodilators
effective antihypertensives can cause sig arterial vasodilation=>reflex sympathetic activation=>tachycardia and edema to counteract compensatory effects prescribe with sympatholytics and diuretics
323.
direct thrombin inhibitors
directly inhibit thrombin-mediated fibrin formation *mainly prolong TT lepirudin and argatroban are primarily used for management of heparin-induced thrombocytopenia
324.
DNA cross-linking
induced by numerous chem and physical agents *most notably caused by alkylating agents used in Tx of cancer
325.
DNA methylation
epigenetic phenomenon used to silence or reduce expression of certain genes only template strand is methylated early in course of DNA replication=>enzymes can differentiate between template and daughter strand=>adenine methylation guides DNA repair in newly synthesized DNA *how tumor suppressor genes frequently silenced in malignant cells
326.
Dominant hemoglobin in infants
HbF. begins to switch during frist 6 mo
327.
Dopamine no effect on CNS due to:
tight jxns in BBB. (levodopa, however, can cross).
328.
Down and out lesion with
PCA damage
329.
Down sydrome
most common c'somal abnormality 2nd most common cause of mental retardation assoc with advanced maternal age and can be Dx prenatally indicated by low AFP=>indicates amniocentesis=>karyotyping of fetal cells contained in amniotic fluid can Dx Down syndrome 90% have trisomny 21; parents are normal and abnormality from meiotic non-dysjunction (failure of c'some 21 to divide during meiosis); occurs in ovum, explaining assoc of Down syndrome with increased maternal age
330.
331.
332.
333.
334.
335.
336.
Drug for sickel cell anemia to increase HbF. other drugs
hydroxyurea. Gardos channel blocker to prevent dehydration
Drug induced lupus drugs metabolized by:
N acetylation in liver. (hydralazine and procainamide).
Drug of choice for human and dog bites?
Amoxicillin + Clavulunate
drug to reduce tobacco withdrawal cravings and attentuate reward efects of nicotine
Varenicline : partial agonists of nicotine Ach R.
Drugs for motion sickness:
1st gen antihistaminic drugs (meclizine, dimenhydrinate) Scopolamine (antimusc seffects). SFX: blurry vision, dry mouth, palpitations, urinary retention, constipation.
Drugs met by p450 Drugs that induce or inhibit p450 enzyme
...ie: phenytoin inc met by phenobarb, carbama, rifampin.
drugs that target secretory diarrhea
bismuth subsalicylate probiotics octreotide
337.
338.
Drugs treat what Oseltamivir, ganciclovir, lamivudine, amantidine
oseltamivir: inhib Influ A, B viral neuroaminidases. Ganciclovir: HSV (guanine nucleoside analogue), CMV (HIV) Lamivudine: anti-retroviral nucloside RT (HIV) Amantidine: impair uncoat of influe A virion after endo Ribavirin: RSV bronchiolitis
Drugs treat what Oseltamivir, ganciclovir, lamivudine, amantidine
oseltamivir: inhib Influ A, B viral neuroaminidases. Ganciclovir: HSV (guanine nucleoside analogue) Lamivudine: anti-retroviral nucloside RT (HIV) Amantidine: impair uncoat of influe A virion after endo Ribavirin: RSV bronchiolitis
339.
340.
341.
342.
drugs with antimuscarinic effects: (flushed skin, mydriasis)
atropine, TCA (amitryptiline), H1 r AA (diphenhydramine), neuroleptics, antiparkinsonian drugs
Ductus arteriosus corresponds to what embryonic counterpart
6th embryonic arch.
DUMBELS (CPx of organophosphate poisoning);
Diarrhea, Urination, Miosis, Bronchospasm/Bradycardia, Emesis, Lacrimation, Salivation
DVT drugs of choice
vit K inhibitors (warfarin) direct factor Xa inhibitors: idraparinux rivaroxaban apixaban ultralow molecular weight heparin
direct thrombin inhibitors: argatroban dabigatran 343.
DVT prevention short and long term
short: heparin (bind antithrombin tightly) long: warfarin (block glutamate residue carboxylation)
344.
dx of Candida endopthalmitis
Opthalmoscopy
345.
Dx of Wilson disease
gold standar: liver biopsy demonstrating quantitative hepatic copper level >250 mcg/gram dry weight confirmed by presence of low serum ceruplasmin (<20 mg/dL) in conjunction with increased urinary copper or Kayser-Fleischer rings *almost all neuropsychiatric involvement will also have Kayser-Fleischer rings=>can be identified on slit lamp examination
346.
347.
Dx: mild hypochromatic microcytic anemia, inc HbF, hemoglobin A2, target celsl
Beta-thalassemia minor cx: mut -->defective txn, processing, tln of b-globin mRNA.
dysplasia
abnormal cell growth confined to epithelium often pleomorphic (differing in size and shape) may lose alignment along BM and often cease to group together in organized fashion dysplastic nuclei typically stain very intensely bc more chromatin is present (hyperchromatism) # of mitoses of dysplastic epithelium may increase or appear very bizzare nucleus to cytoplasm ratio (N:C) is elelvated reversible process and doesn't necessarily proceed to cancer low-grade dysplasia does not involve entire thickness of epithelium=>high grade does but doesn't penetrate BM; AKA carcinoma in situ *once penetrate BM no longer considered reversible
348.
dz assoc w/ impaired DNA repair
fanconi anemia (AR, hypersen to DNA x linking agents, bloom syndrome (AR HS to UV damage and Chemotx agents), xeroderma pig(AR UV light).
349.
350.
351.
352.
early menarche, nullparity and obesity are risk factors for
endometrial cancer.
EBV associated with what malig
Burkitt lymphoma, nasopharyngeal CA (chinese) IC: CNS lymphoma, post transplant lymphoprolif disorder
EBV mononucl like symptoms caused by:
CMV, HHV-6, toxo
eccentric ventricular hypertrophy
caused by vol overload=>leads to dilatation of ventricle *associated with ↑ in chamber size=>also seen in dilated CMP and after MI
353.
354.
355.
356.
357.
358. 359.
360.
361.
362.
363. 364.
365.
366.
Ecoli not able to ferment sorbitol or produce glucuronidase
EHEC
Ecthyma gangrenosum
cutaneous necrotic dz (pseudomonas aeruginosa bacteremia and septicemia). It invades perivascularly and releases tissue destructive exotoxins causing vasc destxn and resultant insuff of BF to patches of skin that beocme edematous and subseq necrose. (common in neutropenia, hosp. pts,, burns, chronic indewll)
Effect of beta hemoglobin chains being very similar to myoglobin?
"isolated" beta globin chains will have diss curve like myoglobin
Effect of epi on diastolic BP
depends on dose (a1 or b2 predominates).
effect of steroids on erythrocytes
causes erythrocytosis.
effect potentiation
drug's ability to increase pharmacologic effect of another agent
effects of epinephrine on insulin release
Dec release (alpha action)> inc release (beta action). Alpha blocker causes inc release. (ie phenoxybenzamine)
Effects of muscarinic agonist on endothelial surface R?
release of NO, and endothelium-derived relaxing factor (EDRF). NO -->inc GC-->inc cGMP-->Ca efflux ->vascular wall sm relax
Effects of niacin other than nml use:
POtentiate anti-hypertensive meds (vasodilatory effects); insulin resistance
Effets of human placental lactogen
inc Insulin resistance, stim proteolysis, and inhibits gluconeogenesis.
EHEC cannot make:
ferment sorbitol, or produce glucuronidase
Ehler's Danlos syndrome
heritable CT disorder characterized by skin hyperextensibility, joint hypermobility, tissue fragility, poor wound healing, and easy brusing
Electrophresis and hemoglobin problems
HbS-- mut in both beta chains HbC-- mut in both beta chains (Missense Glu->lys) neg Hb Sc: 1Hbs 1 HbC (2 bands) thalassemias-- non fxnl globin chains (alpha- frameshift
endometrial hyperplasia
presents clinically as dysfxnal uterine bleeding caused by elevated estrogen unopposed by progesterone acting on endometrial lining XS estrogen can be exogenous as in HRT that does not contain progesterone or it can be endogenous such as with an estrogen-secreting ovarian tumor or with increased aromatization of androgens to estrogens in adipose tissue of obese women
367.
energy supply from metabolism of protein, fat, and carbohydrates
1 g protein/carb=4 cal of NRG 1 g ethanol=7 cal of NRG 1 g fat=9 cal of NRG
368. 369.
370.
Enzyme responsible for green color of bruises
Heme oxygenase turns heme to biliverdin then to bilirubin.
Epi effects Epi and Propanolol
Epi: inc SBP (a1,B1), inc HR (b1). inc or dec DBP (a1 or b2) pro: elimin vasodil and tachy-->only a effect-->vasoctxn
epinephrine and glucose metabolism
increases glucose by multiple mech: 1. liver-increased glycogenolysis and gluconeogenesis 2. skeletal muscle-decreases glucose uptake; increases alanine released from skeletal m.=>serves as source of gluconeogenesis in liver 3. adipose tissue-increases breakdown of TG=>increasing FA and glycerol in circulation=>utilized as gluconeogenetic substrates *glucagon has insig effect on adipose tissue and skeletal m.
371. 372.
373.
Equation for filtration fraction
GFR/RPF
erythroblastosis fetalis, hemolytic anemia presentation:
infant w/ anemia, hepatosplenomegaly, jaundice, death. Maternal Ab (IgG) to fetal RBC ... Rh- mother and Rh+ infant @ 2nd birth. Type II HS
essential fructosuria
in pts with essential fructosuria=>metabolism of fructose by hexokinase to fructose-6-phosphate is 1° method of metabolizing dietary fructose *this pathway not sig in normal indiv
374.
essential fructosuria
benign rare autosomal recessive aSx disorder due to fructokinase deficiency detected through clinitest tablets=>nonspecific test for presence of reducing sugar * will have neg urine dipstick bc it utilizes glucose oxidase=>specific for glucose reducing sugars: glucose, galactose, fructose
375.
ether sensitivity of viruses depends on:
presence of lipid bilayer enveoope
376.
Euchromatin vs heterochromatin
euchro : acetylation (high txn) hetero: methylation (low txn)
377.
extramedullary hematopoesis
chronic hemolytic anemias
378.
Extramedullary hematopoiesis
cx by severe chronic hemolytic anemias (b thalassemia)
379.
extrapyramidal sx due to psych drugs
haloperidol, fluphenzine: acute extrapyr sx (spasmotic torticollis) are dystonic reactions, akathisia, parkinsonism
380.
ezetimibe
selectively inhibits intestinal absorption of cholesterol primarily used in conjunction with statin causes modest reductions in serum TG and modest elevations in serum HDL
381.
382.
F pt with anemia. Hgb 9.2, MCV 72 , low ferritin. Heavy menstrual period, epistaxis. Cx
von willebrand dz (AD-- lifelong hx of gingival bleeding, epistaxis, mucosal bleeding, menorrhagia.
fabry
...
383.
factors that ↓ stability of atheromatous plaques
thin fibrous cap rich lipid core active inflammation *potentially promote rapid coronary occlusion via superimposed thrombosis if plaque ruptured
384.
failure of hindgut descent
failure of proper descent can lead to different degrees of anal agenesis or imperforate anus
385.
fallopian tube epithelium
simple columnar charac: ciliated cells: help transport the egg/embryo; peg cells: secrete nutrients assoc tumors: rare
Familial retinoblastoma at risk for secondary tumor..?
Osteosarcoma
387.
Fanconi's anemia?
autosomal recessive disorder pancytopneia and macrocytosis average age at diagnosis is 8 cafe au lait spots, microcephaly, horseshoe kidneys, absent thumbs
388.
Fatty streaks seen in :
pts of all ages. As early as 1, and commonly in 10 and up.
389.
Features of ataxia telangiectasia
cerebellar ataxia, telangiectasia, inc risk of sinopulm infxns, AR inheritance. defect in gene ATM - role in DNA break repair. IgA deficicency and predisposes to ifnx of upper and lower airways.
390.
Features of chronic bronchitis
thickened bronchial walls, neutrophil infiltration, mucous gland enlargement, patchy squamous metaplasia of bronchial mucosa cx: environmental exposure and smoking.
391.
Features of HEV
unenveloped, ssRNA, transmitted fecal-oral rout. high mortality in infected pregnant women.
392.
fenoldopams action
d1 dopamine agonist: vasodilator and natriuretic.
A Fib drug that inc QRS duration in a rate-dependent manner.
class Ic (ie flecainide) Class III antiarr are reverse use-dependent (slow HR the more the QTc interval is prolonged).
fibrates
1st line therapy for hypertriglyceridemia=>decreases serum TG by 20-50%
386.
393.
394.
mech: activate PPAR-alpha 395.
filtration fraction
FF=GRF/RPF increases in hypovolemia as RPF drops proportionately more than GFT due to compensatory mechanisms of RAA system
396.
397.
398.
findings of DIC
prolonged PTT, PT thrombocytopenia and microangiopathic hemolytic anemia low fibrinogen Elevated fibrin split pdts (d -dimer) Low factor V, VIII
First dose hypotension: drug associated and risks
ACEI: predisposing risks: hyponatremia, hypovelemia (diuretics), low baseline BP, high renin, or aldos, renal impairment, heart failure.
First step in the management of Epiglottitis?
Endotracheal intubation with a set up for tracheostomy
399.
fish oils (omega-3 FA)
used to Tx hypertriglyceridemia decrease hepatic VLDL prod and decrease serum TG by 20-30%
400.
flutamide
inhibit testosterone and DHT binding
401.
flutocytosine
inhibits both DNA (replication) and RNA (protein synthesis) in fungal cells *mainly used as synergistic agent with amphotericin B=>particularly imp in Tx of cryptococcal meningitis
402.
focal myocardial scarring
commonly results from MI
403.
folate deficiency
inhibits formation of dTMP=>limits DNA synthesis promotes megaloblastosis and erythroid precursor cell apoptosis in bone marrow
404.
follicular lymphoma
translocation of IgH heavy chain gene for c'some 14 to 18 [t(14;18)] on c'some 18 the gene located near the bcl-2 gene=>apoptosis inhibitor protein Bcl-2 is expressed
405.
406.
407.
408.
formation of pyrimidinepyrimidine dimers
DNA damage from exposure to UV radiation
foscarnet side effects
electrolyte abnormalities: hypocalcemia hypokalemia hypomagnesemia hypophosphatemia
Friedrich's ataxia is mimicked by:
Vit E def
functional regurgitation
acute hemodynamic changes prod fxnal heart murmurs in absence of fixed valve lesion dilatation of LV in response to ↑ preload=>fxnal mitral regurgitation=>eliminated by preload reduction and reduced by afterload reduction
409.
410.
411.
412.
Fungal infections: Local and systemic disseminations
T lymphocytes local Neutrophils: systemic. example candida.
Fxn and dz associated with : Mesolimbic-mesocortical Nigrostriatal Tuberoinfundibular
MM: behavior (schizoprenia) NS: coord voluntary movmnt. parkinsonism TI: Prolactin release. Hyperprolactinoma
Fxn of Vit C Epid of def?
hydroxylation of proline and lysin residues in pro-colagen. (prolyl, lysyl hydroxylases) homeless, alcoholic, drug user. Px: perifollicular hemorrhages, easy bruising, gum dz
galactosemia
autosomal recessive disorder characterized by neonatal jaundice, bleeding diasthesis, feeding intolerance, hypotension and death if unTx caused by absent fxn of galactose-1-phosphate uridyl transferase Tx: elimination of all milk products from diet and feeing with soy-based infant formula
413.
ganciclovir
interferes with human host cell DNA synthesis than acyclovir clinical use: CMV *commonly administered to pts with advanced HIV major adverse effects: neutropenia, anemia, thrombocytopenia, and impaired renal fxn
414.
415.
GAS: RF and acute poststrep GN..
RF follows strep throat only. APSGN can follows impetigo or pharyngitis.
gastric ulcers
majority occur at the lesser curvature at border btwn acid-secreting and gastrin secreting mucosa left and right gastric arteries run along lesser curvature and are likely to be damaged=>cause gastric bleeding
416.
417.
Gene transfer via conjugation
sex pilus: pili in E.coli, ABx resistance
genetic hemochromatosis
defect in intestinal absorption of dietary iron=>storage of .5-1.0 g of iron each year *storage primarily in the parenchymal organs typically silent until early adulthood when at least 20g of iron have been accumulated present: abdominal pain, skin pigmentation, hepatomegaly, deranged glucose homeostasis, cardiac dysfxn, atypical arthritis, hypogonadism *men typically present after 40 years of age; women present after menopause but accumulate iron at a faster rate **women present later due to physiologic iron loss thru menstruation and pregnancy
418. 419.
420. 421.
422.
GFR estimation
estimated by calculating the clearance of innulin
glomerular nephritis and deposits
C1q: MPGN type 1(subendothelial) Ige: SLE confined to cap wall. poor prog IgG, IgM, C3 in mesangium PSGN
Glucagon has effects on
Liver.. Insignificant on skeletal and adipocytes.
Glucocorticoid effects on liver and other enzymes:
Potent stimulator of liver gluconeogenesis. also peripheral antagonism of insulin contributing to hyperglycemia.
glucose-6-phosphatase
converts glucose-6-phosphate to glucose *only found in liver
423.
glucose-6-phosphate metabolism
can be metabolized 3 ways: 1) conversion to G1P by phosphoglucomutase=>used for glycogen synthesis 2) conversion to glucose by glucose-6-phosphatase *this enzyme absent in muscle 3) conversion to 6-phosphogluconolactone by glucose-6-phosphate dehydrogenase in first step of PPP
424.
glucuronide transferase
converts bilirubin into soluble bilirubin diglucuronide in hepatocytes
425.
glutathione-S-transferase
involved in detoxification of some chem carcinogens converts toxic substances into inactive metabolites
426.
Goodpasture's syndrome
caused by anti-GBM that targets alpha3-chain of collagen type IV path: develop RPGN=>ARF with crescentic formation (fibrin deposition) on light microscopy; RBC casts; mild proteinuria; anti-GBM cross react with BM in lung alveoli=>pulmonary hemorrhage IF: "linear" IgG and C3 deposition
427.
grading
degree of tumor differentiation low grade: well-differentiated and resemble tissue of origin; likely to be benign high grade: less-differentiated; lost features of primary tissue; likely to be malignant; display cellular and nuclear pleomorphism (variations in shape and size); high # of mitoses; tend to be invasive; usually radiosensitive
428.
Gram negative cocci?
Neisseeria
429.
Gram negative rods?
Heamophillus, Pseudomonas, Klebsiella and legionella
430.
Gram positive rods?
Listeria and Bacillus
Gram stain with gram positive cocci in clusters?
Staph.
Gram stain with gram positive diplococci?
Strep. Pneumoniae
Greatest prognostic factor of liver function:
Serum albumin level and prothrombin.
griseofulvin
enters fungal cells and binds microtubules=>inhibits mitosis
Group A streptococcal pharyngitis
can lead to rheumatic fever via antigenic mimicry
431.
432.
433.
434. 435.
GAS and cardiac myocytes have similar antigenic protein sequences=>immune system mounts response against GAS=>can cause myocarditis and valve destrxn over time 436.
H. pylori
gram- spiral shaped bacteria assoc with formation of duodenal ulcers due to increased gastric acidity increased gastric acidity caused by decreased somatostatin-secreting cells in gastric mucosa=>unchecked gastrin prod *strongly assoc with gastric ulcers, gastritis, gastric adenocarcinoma, and gastric lymphoma
437.
H. pylori
strongly assoc with peptic ulcer dz and gastric adenocarcinoma
438.
HACEK organisms
Hameophilus Actinobacillus Cardiobacterium Eikenella Kingella *can cause endocarditis and do not grown on standard blood culture
439.
hamartomas
most common benign lung tumors usually aSx and detected incidentally on CXR as peripheral "coin lesion" histo: areas of mature hyaline cartilage mixed with CT, smooth muscle, and fat
440.
haptoglobin
serum protein that binds free Hb promotes excretion via reticuloendothelial system will be decreased in intravascular hemolysis
441. 442.
HAV inactivation via:
Water chlorination, bleach (1:100), formalin, UV irr, boiling 85C for 1 min.
Hb in newborns, For how long?
a2gamma2. switches in first 6mo of life.
443.
HbA2 elevation
in b thalassemia minor (trait) an intermedia because b globin chain underproduction dec synth of HbA1.
444.
HbS problem and aggregation occurs w/
Val->glut: aggregates with loss of O2, low pH, high 2,3DPG
445.
HCG
secreted by placenta to support CL early phases-->secretes progesterone which maintains endometrium.
Heart defects due to abnml migration of neural crest cell through the primitive truncus arteriosus and bulbus cordis.
TOF, Transp of great vessels, Truncus arteriosus
Heat killed bacteria Recomb bacterial outer sruface protein inactivated toxin Live-attenuated org
bordetella pertussis, v cholerae, yersinia pestis Borrelia burgdorferi (recomb bact outer surface protein) c dpigh, clostridium tentani (inactivated toxoid) BCG vaccine (TB), francicella, salmonella typhi.
Hemadsorption
hemagglutinins, glycoproteins aff to RBC (influenza, parainfluenza)
Hematogenous osteomyeltitis: childhood Sickle cell Pott DM recumbent, impaired mob ortho surg, trauma
S aureus (bacteremia) Salmonella, S aureus (infarcted bone) M TB (lung)--vertebrae Polymicrobial (foot ulcer)-- feet bones Polymicrobial (contiguous pressure sores)-- sacrum, heels polymicrobial (direct)
hemochromatosis
classically see increased serum irons
446.
447.
448.
449.
450.
assoc with cirrhosis, increased incidence of hepatocellular cancer, skin darkening, and insulin resistance 451.
hemochromatosis and ventricular remodeling
can result in accumulation of iron in myocardium as hemosiderin *net result: dilated CMP with ↑ LV cavity=>pts present with signs and Sx of CHF
452.
Hemolysin and superantigens.
not in cell wall of staph.
453.
hemolytic anemia
characterized by: decreased haptoglobin level increased LDH increased bilirubin schistocytes
hemolytic anemia, hypercoag state (thrombosis) and dec blood counts
paroxysmal nocturnal hemoglobinuria. Def in CD55, CD 59.
hemoperitoneum
free blood in peritoneal space
454.
455.
can be caused by lacerations or rupture of intraperitoneal organs: transverse colon, liver, and spleen 456.
hemosiderin-laden macrophages
"heart failure cells" presence in macrophages in alveoli indicate chronic elevation of pulmonary capillary hydrostatic press=>usually result of LHF
457.
heparin
unfractionated heparin is the most commonly used anticoagulant in hospital setting mech: increases effect of naturally occurring anticoagulant antithrombin-III *activated partial thromboplastin time (aPTT) is meas to monitor therapeutic effect of heparin complications: bleeding; heparin-induced thrombocytopenia *Tx is with protamine
458.
459.
Hepatic abcess:
protal vein, arterial supply ascending biliary tract infection, directin invasion from adjacent source, penetrating injury. IE. Staph aureus through hematogenous seeding of liver. Enteric GN bacilli, and enterococci.
hepatic encephalopathy
reversible decline in neurologic fxn precipitated by hepatic damage=>increased levels of ammonia in circulation due to failure of liver to metabolize waste prod ammonia initially enters circulation thru GI tract after having been created during enterocytic catabolism of glutamine and bacterial catabolism of dietary protein in the colon=>goes to liver thru portal vein for detoxification to urea precipitants of hepatic encephalopathy: GI bleeding, hypovolemia, hypokalemia, metabolic alkalosis, hypoxia, sedative usage, hypoglycemia, and infxn *any stressor that alters ammonia balance Tx: lactulose
460.
hepatic encephalopathy: CPx , labs
alcoholic, vomiting, delirium, asterixis, gynecomastia. Altered mental status due to: -inc load of nitrogenous subs abs in gut. (bleed) Inc NH3 pdtn (diet protein, GI bleed, constip, ifxn) Dec NH3 removal (renal failure, diuretics, post-TIPS) Tx: lactulose (inc NH4+), low protein diet, rifaximin (kill intestinal bacteria)
461.
hepatitis C
virus has 6 or more genotypes and multiple subgenotypes=>genetic differences in two envelope glycoproteins=>hypervariable region of envelop glycoprotein prone to frequent mutation *production of host Ab lags behind prod of new mutant strains no proofreading 3'-->5' exonuclease acivity=>RNA polymerase makes erros during replication=>several subspecies of HCV present in blood at any one time
462.
HER2/neu
many pts with breast cancer overexpress this protein involved in cell prolif=>assoc with worse prognosis inhibition of epidermal growth factor and HER2/neu pathways can lead to apoptosis of breast cancer cells *monoclonal Ab against HER2/neu receptors (e.g., trastuzumab) have been successful in Tx of breast cancer
463.
hereditary pancreatitis
rare disorder that results from mutation in gene that encodes trypsinogen gene=>leads to synthesis of abnormal trypsinogen that is not susceptible to inhibition by either trypsin or PSTI pts experience recurrent attacks of acute pancreatitis
464.
465.
466.
467.
Hereditary pancreatitis cx/
mutation in trypsinogen resulting in no trypsin
herpesvirus
acquires lipid bilayer from host cell nuclear membrane *most enveloped nucleocapsid viruses acquire lipid bilayer envelopes from budding thru plasma membrane of host cell
Heterophile Ab test
sens and spec for EBV assoc infectious mono
heteroplasmy.
coexistance of mt and wild type mit genomes
468.
Hib vaccination not good against
nontypable strains of H influenza that cause otitis media, sinusitis, bronchitis.
469.
high AFP levels
assoc with abdomina wall defects (omphalocele), gastroschisis, multiple gestation, and neural tube defects (spina bifida, anencephaly)
High bomodeoxyuridine uptake by tumor reflects:
its a thymidine analog: so many tumors in S phase-->high grade -->poor prognosis
high waist to hip ratio associations
insulin resistance metabolic syndrome DM II
470.
471.
*meas visceral obesity 472.
highly active retroviral therapy (HAART)
includes inhibitors of HIV reverse transcriptase and protease assoc HIV drug resistance bc high mutation rate of HIV genome and selective press exerted by antiretroviral drugs
473.
hindgut
part of primitive gut that gives rise to: distal third of transverse colon descending colon sigmoid colon rectum uppar part of anal canal
474.
Hirschsprung disease
failure of neural crest migration to bowel wall=>submucosal and myenteric plexi do not develop manifests with intestinal obstrxn in first days of life: failure to pass meconium bilious vomiting abdominal distention
475.
hirsutism
male-like pattern terminal hair (coarse, curly, and pigmented) growth in females idiopathic: increased conversion of testosterone into DHT by 5-alpha-reducatase or due to higher sensitivity of hair follicles to DHT *occurs due to increased testosterone secretion or increased conversion of testosterone to DHT causes: idiopathic (most likely cause if reg menses and no Sx of virulization), PCOS, Cushing syndrome, ovarian and adrenal tumors Tx: spironolactone (blocks androgen receptors), flutamide (testosterone receptor antagonist), finasteride (5-alpha-reductase inhibitor) *should be distinguished from virilization
476.
histamine and coronary autoregulation
potent vasodilator released primarily from mast cells when there is tissue damage ↑ capillary permeability=>local edema
477.
histidinemia
rare autosomal disorder that causes increased histidinemia=>pts deficient in histidase=>required for catabolism of histidine clinical manifest: speech defects, pschomotor and gen retardation, emotional disturbance *most frequent inborn metabolic disorder in Japan
478.
Histo: Chlamydia and HSV
C: intracyto inclusion bodies HSV: multinucl giant cells % intranuclear inc
479.
HIV env gene mutations
code for structural glycoproteins responsible for viral escape from host neutralizing Ab
480.
481.
482.
HIV gene polyprotein that is glycosylated and cleaved
env gene: gp160 and cleaved in ER to make gp120 and gp41.
HIV gene that undergoes further processing:
Env->glycosylated to gp160, cleaved w/in ER, and GA to form envelope glycoprotein gp120, gp41.
HIV pol gene mutations
responsible for acquired resistance to HIV reverse transcriptase inhibitors and HIV protease inhibitors responsible for emergence of: 1. HIV protease variants that are resistant to standard protease inhibitors 2. structural changes in HIV-1 reverse transcriptase that render enzyme resistant to standard nucleoside and non-nucleoside reverse transcriptase inhibitors
483. 484.
485.
486.
487.
488.
489.
Homobox genes code
DNA binding txn factors : role in morphogenesis
How can MGUS be differenetiated from multiple myeloma?
with the absence of renal insuffeicieny, hypercalcemia, anemia and lytic bone lesions
How can you differentiate the uterus in adenomyosis and fibroids?
adenomyosis: symetrically enlarged fibroids: irreguarly
How do pts with 5 alpha reductase def. present?
46 XY 1. can't convert testosterone to DHT. have female external genitalia but show virilization at puberty.
How do pts with Androgen Insensitivity present?
46 XY 1. Mullerian inhibiting factor secreted by testes prevents development of internal female organs
How do pts with Mullerian Agensis present?
46 XX 1. Blind ended vaginal pouch 2. No uterus
How do you calculate an APGAR score?
Appearance: 0= body and extremities are blue 1= body pink, extremities blue 2= body and exttremitis are pink Pulse: 0=No heart activity 1= pulse < 100 2= pulse > 200 Grimace ( reaction to nasal stimulation) 0=no response 1= grimace to 2= active cough Activity 0= no activity 1= some flexion 2= full flexion Respiration 0= completely absent 1= slow and irregular 2= full respiratory effort
490.
491.
How do you differentiate between a pt that presents with dementia and gait problems?
Can be either Alzheimer's or Normal pressure: It depends on when it started. Gait abnormality is an EARLY finding in Normal pressure.
How do you differentiate between Gastroischisis and Omphalocele?
Gastroschiasis: Bowel WITHOUT protective covering. Ompahlocele: Bowel without protective covering, associated with other congenital abnormalities
492.
How do you differentiate between the oral ulcers of HSV and CMV and what are txt options?
HSV: Small, multiple and well circumscribed with bx showing ballooing degernation and eosinophilic intranuclear inclusions. TXT: Acyclovir CMV: Large, shallow and superficial with bx showing intranuclear and intracytoplasmic inclusion. TXT: IV Ganciclovir
How do you differentiate chlamydia pnemonia from RSV bronchilitis?
Chlamydia doesn't have fever or wheezing
How do you differentiate Transient Synovitis from Septic Arthritis?
If pt has 3 of the following - Septic Arthritis: 1. WBC > 12000 2. Fever Temp > 39 3. ESR > 40 4. Refusal to bear weight
495.
How do you distinguish DVT from cellulitis?
Cellulitis has lymphadenopahty
496.
How do you treat Stress (hairline) fractures?
Rest, analgesia and hard soled shoe
497.
How do you txt a pancreatic pseudocyst?
It spontaneously resolves
How does a pt with Neurocardiogenic (vasovagal) syncope present?
Have the following prior to passing out: 1. Nausea 2. Diaphoresis 3. Tachycardia 4. Pallor 2/2: pain, stress, and situations like needles or urination dx with tilt table test
499.
How does Achlasia present?
Dx: LES does not relax, muscles with absent neurons in myenteric plexus, manometry shows absent peristalsis.
500.
How does Adenomyosis present?
dysmenorrhea and menorrhagia enlarged, symmetrical painful tender uterus
501.
How does Diabetes affect CN III function?
Causes nerve ischemia. Only affects the somatic function of CN III- eye is down and out. Parasympathetic function remains unaffected- normal light and accommodation reflexes.
How does Diffuse Esophageal Spasm present and what is the txt?
Dx: chest pain and dysphagia, manometry demonstrates high amplitude peristaltic contractions. barium enema reveals corkscrew esophagus txt: antispasmodics, supportive care
How does disseminated gonococcal infection present?
1. polyarthraligsas 2. tenosynovitis 3. vesiculopustular lesions
How does esophaeal dysmotility 2/2 scleroderma present?
Dx: Loss of peristatlis in esophagus, fibrosis and atrophy of smooth muscle, LES is incompetent leads to reflux and strictures
How does metastatic spine cancer present?
The pain is worse with rest, when the patient is sleeping
how does N-acetylcysteine loosen mucus glycoproteins
cleaves disulfide bonds
493.
494.
498.
502.
503.
504.
505. 506.
How does one define status epilepticus and what is the txt?
seizure activity greater than 5-10 minutes that does respond to antiseizure activity. txt: 1. Benzo's- first line 2. Phenytoin (phenobarbital)- second line
How does one differentiate between ligamentous tear and meniscal tear?
Both can have "popping" sounds: Ligamentous: immediate swelling 2/2 hemarthrosis. immediate inability to bear weight menisceal: gradual joint swelling,
How does one differentiate CML from Leukomoid reaction?
Check Leukocyte Alkaline Phosphatase (LAP) it is elevated in leukomoid reaction
510.
How does one txt duodenal hematomas?
Nasogastric suction Parenteral nutrition
511.
How does one txt mucoormycosis?
1. Surgical debridement 2. Systemic chemotherapy + IV amphotericin
How does pregnancy cause the compensated metabolic alkalosis?
Stimulatory effect of progesterone on the medullary respiratory system.
513.
how does vitamin c def. present?
1. ecchymosis 2. petechiae 3. bleeding gums 4. hperkeratosis
514.
How does Vitreous hemorrhage present?
Sudden loss of vision with floaters, **Fundus hard to visualize
How does Zenker's diverticilum present and what is the txt?
Dx: food sticking in throat, halitosis, regurgitation, NO pain Txt: Surgery
How is Herpes Simplex keratitis characterized and what do you txt it with?
DX: corneal vesicles and dendritic ulcers TXT: Antiviral therapy (oral or topical)
How long should Clopidogrel be continue for pt after UA/NSTEMI?
12 months
How long should Clopidogrel be continue if pt got drug eluting stent vs bare metal stent?
bare metal: 30 days drug eluding: one year
how long should Warfarin be continued in pt with idiopathic cause of DVT?
6 months
how long should warfarin be continued in pt with reversible cause of DVT?
for 3 month
How should one txt a pregnant pt with syphillis but is allergic to penicillin?
First confirm allergy Must txt with penicillin so desensitizes patient.
522.
How would a pt with a small bowel obstruction present?
nausea, vomiting, abdominal distention
523.
hyaline arteriosclerosis
marked by homogenous deposition of hyaline material in intima and media of small arteries and arterioles
507.
508.
509.
512.
515.
516.
517.
518.
519.
520.
521.
underlying structure of vessel wall is maintained but intima is thickened and the arterial lumen narrowed *usually component of diabetic microangiopathy 524.
hydatidiform mole
usually presents early in pregnancy with vaginal bleeding and fundal size greater than dates
525.
hydatidiform mole
form of gestational trophoblastic dz classified as: 1. complete-no fetal structures; composed entirely of large edematous and disordered chorionic villi that appear grossly as clusters of vesicular structures with a "bunch of grapes" appearance; always have 46 XX karyotype; all C'somes paternally derived 2. partial-shows formation of some fetal structures grossly; typically results from fertilization of ovum by two or more sperm=>karyotypes 69XXY or 69XXX
526.
hyperplastic arteriosclerosis
onion-like concentric thickening of arteriolar walls due to laminated smooth muscle cell and reduplicated BM can result from malignant HTN (diastolic press > 120 mm Hg) most commonly affected areas: kidneys, retinas, and intestinal arterioles *can affect arterioles in all tissues and muscles less likely to be symptomatically involved
Hypertensive depressed patient came back froma wine and cheese party: drug cx ie Pizza restaurant
MAO I
528.
hypertorphic cardiomyopathy
autosomal dominant disorder caused by mutation of ß-myosin heavy chain
529.
hypertriglyceridemia Tx
niacin and fibrates are the most effective Tx
Hypervariability of HCV is due to what cellular component ?
lacks 3-5 proofreading exonuclease in RNA polymerase.
531.
Hypocretin 1 -2
promote wakefulness
532.
hypogammaglobulinemia
predisposed pts to bacterial infxns
533.
hypoglycemia
initially manifests with pallor and sweaty skin=>worsens with bizarre behavior, convulsions, and unconsciousness can develop
527.
530.
caught early can be self-Tx with consumption of 15-30 g of fast-acting carbs (e.g., glucose tablets, sweetened fruit juices, milk, soft drinks, or hard candy) when severe enough to induce unconsciousness parenteral Tx is required=>intramuscular glucagon injection in non-medical setting =>correct hypoglycemia by increasing hepatic glycogenolysis and gluconeogenesis=>return to consciousness within 10-15min *in medical-setting Tx with IV dextrose hypoglycemic agent that inc insulin release in DM2
Glyburide
535.
idiopathic pulm fibrosis
...
536.
IgA
the Ab most strongly assoc with antigenic mucosal contact
IgA protease seen in what organism?
N meningitidis, gonorrhea
IM infection shows increased proliferation of what cells?
Tc 8 cells. Used to kill infected B cells.
Imaging study for child with developmental dysplasia of the hip?
If < 4 months - Ultrasound if > 4 months - X-ray
Immunocom (HIV) patients at risk for developing reactivation of what infections? leads to waht?
latent EBV-->NH diffuse B cell lymphoma
implication of testicular mass on Thyroid?
hCG structural similarities to TSH. High concenstration seen in testicular tumors and can stimualte TSH receptors and cause hyperthyroidism
534.
537.
538.
539.
540.
541.
in A fib, ventricular contraction rate is determined by:
the AV node refractory period
In which condtions does one see Vitamin B3 def (niacin)?
1. alcoholics 2. long term isoniazid therapy 3. carcinoid syndrome 4. hartnup disease
In which disease does one see sharp, triphasic and synchronus discharges?
Cretzfeuldt-Jakob disease
In which renal condition does one see Broad or Waxy casts?
Chronic renal faliure
in which renal condition does one see fatty casts?
Nephrotic syndrome
In which renal condition does one see muddy brown casts?
ATN
In which renal condition does one see RBC casts?
Glomerulonephritis
In which renal condition does one see WBC casts?
1. Interstitial Nephritis 2. Pylonephritis
In which situations will one see torsades de pointes?
1. Alcoholics (hypomagensia) 2. Meds. ( TCA's, anti-fungals, amiodaraone, sotalol) txt with MgSO4
551.
increased BUN
suggests renal failure, heart failure, or dehydration
552.
increased GABA
thought to be directly responsible for altered mental status seen in hepatic encephalopathy
553.
Indications for aortic valve replacement?
1. Symptomatic patient with AS 2. Patients with severe AS undergoing CABG or other valvular surgery 3. Asymptomatic patients with severe AS with either severe LV dysfunction, LV hypertrophy > 15mm, valve area < 0.6 cm2 or abnormal response to exercise
554.
indications for Tx with cortisol
used as immunosuppressive drug in Tx of allergic rxns
542.
543.
544.
545.
546.
547.
548.
549.
550.
can be injected or applied topically 555.
indications for Tx with desmopression
used to Tx central diabetes insipidus and nocturnal enuresis also increases circulating levels of von Willebrand factor (factor VIII:R) and promotes coagulant activity of factor VIII:C
556.
557.
558.
559.
560. 561.
562.
indications for Tx with subcutaneous epinephrine
indicated primarily for Tx of anaphylaxis
Infarct at anterior portion of medial pons :
dysarthria, contralateral ataxic hemiparesis. Trigeminal arises here.
infective endocarditis vs rheumatic fever heart dz
1st is destructive. latter is fibrotic.
Inferior thyroid artery travels close to __ nerve
recurrent laryngeal.
Influenza virus antibodies against:
hemagglutinin - IgA and IgG
infxn with capsulated organisms can occur in pts
that dont' have spleen or defective complement pdtn. no spleen in pts with sickle cell or removal from trauma.
infxns due to x linked agammaglobulinenma of bruton
strep, staph but good response by clel medated immun to listeria, viruses, and fungi
563.
inhaled glucocorticoids
most commonly used prophylaxis for persistent bronchial asthmas well tolerated and rarely cause systemic side effects; most common one is oropharyngeal candidiasis=>avoided with spacer and rinsing one's mouth after inhalation; systemic effects can be seen with higher doses=>increased intraocular press, cataracts, growth retardation in children, bone loss, suppression of HPA axis
564.
565.
Inheritance of achondroplasia
AD: 50% inheritance of an affected parent.
insulin
acts via tyrosine kinase that also has cytosolic tyrosine kinase activity=>*activates protein phosphatase=>dephosphorylates (activates) glycogen synthase=>glycogen synthesis *protein phosphatase dephosphorylates and inactivates F16BP=>inhibits gluconeogenesis anabolic hormone that promotes synthesis of glycogen (in liver and skeletal m.), TG, nucleic acids, and proteins inhibits glycogenolysis and gluconeogenesis
566.
insulin vs. glucagon
insulin opposes glucagon action glucagon stim insulin secretion from pancreas, glycogenolysis, gluconeogenesis, lipolysis, and ketone body prod insulin increases glucose, AA and K+ uptake by cells, inhibits ketoacid formation and inhibits lipolysis
567.
568.
insulins:
long: glargine, detemir NPH: 18hr (2/day) Short: lispro, aspart, glulisine (3/day w/ meals) rapid onset
intermittent claudication
muscle pain with exercise that remits with rest almost always result of atherosclerosis of larger named arteries=>obstrxn of flow results from fixed stenotic atheromatous lesions=>prevents sufficient increase in blood flow to muscles during exercise=>ischemic muscle pain pain rapidly relieved by rest bc residual blood flow adequate to meet metabolic demands of resting, but not exercising, muscle
569.
interstitial pneumonia
usually caused by Mycoplasma pneumoniae usually affects young pts CXR: area of patchy infiltration light microscope: inflamm infiltrate confined to interstitium
570.
ischemic acute tubular necrosis
most common cause of intrinsic renal failure (ARF) in hospitalized pts triggers hypoxic changes in tubular epithelial cells=>decreasing their fxnal capacity proximal tubules and thick ascending limb of Henle's loop located in outer medulla of kidney=>more susceptible to hypoxia in conditions of low blood supply and will suffer first histo: flattening of epithelial cells, loss of brush border in PCT, cell necrosis and denudation of tubular BM *muddy brown casts=>pathognomonic
571.
572.
Isolated systolic hypertension
stiffening of aorta (age related) ie 180/90
Isoniazid effects on vitamins and px
similar to B6. inc excretion of pyridoxine. and competes for binding sites -->defective synth of GABA. need suppl. Px: sensory ataxia, dec pain sensation
573.
Isospora belli
causes chronic, water, profuse diarrhea in immunocompromised pts *esp those with AIDS
574.
isotype switching
switching is a process that occurs in naïve B-lymphocytes upon initial exposure to Ag this process does not occur in T-lymphocyte maturation
575.
ITP
...
576.
janus protein kinase (JAK)
2nd messenger system for peptide hormones in JAK-STAT pathway *signal transducers and activators of transxn JAK has tyrosine kinase activity
577.
jejunal, ileal, colonic atresia (apple atresia)
result of vascular accidents in utero *not congenital malformations diminished intestinal perfusion leads to ischemia of a segment of bowel=>subsequent narrowing or obliteration of lumen **ileum is affected most often if major vessel occluded (such as SMA), area of wall necrosis is large=>apple peel atresia=>mesentery of bowel is absent and assoc bowel segment forms a spiral around the affected blood vessel common cause of intestinal obstruction
578.
579.
Jimson weed poisoning: belladonna alkaloids
Strong anticholinergic properties. (similar to atropine) Block visceral muscarinic R. Reverse by giving physostigimine which inc acetylcholine.
jun
DNA-binding protein=>binds DMa for transcriptional control gene that codes for jun is is a proto-oncogene *proto-oncogenes are genes that can bc an oncogene following a mutation or with constitutive expression
580.
581. 582.
583.
K concentrations along nephron?
100% at capsule-->reabs along tubule (2/3 in PT, 1/4 in TAL). a-interalated cells of late distal and cortical CT are primary mediators of K regulation.
Kallman's syndrome
congenital absence of GnRH-secreting neurons
ketoconazole and estrogen production
antifungal agent that decreases androgen synthesis by inhibiting multiple enzyme pathways involved in synthesis of androgens
Klinefelter syndrome
typical genotype: 47 XXY; most clinical manifestations result of extra X c'some; can occur whe there is "non-disjunction" of sex c'somes during meiotic division in either parent presentation: hypogonadism, small firm testes, elongated limbs, gynecomastia seminiferous tubules progressively destroyed and hyalinized=>testes small and firm; serum inhibin decreased, decreased Leydig cells=>low testosterone, ED, increased LH and FSH *hypogonadism causes delayed epiphyseal fusion=>elongated limbs **most are infertile
584. 585.
586.
knee bursa
...
Kozak sequence and the consequence
Plays a role in inititation of translation. gccRccAUGG. Mt in Guanin replacing Cytosine 3rd position upstream causes thalassemia intermedia.
Lab findings associated with Anti-phospholipid Syndrome?
1. Will have positive VDRL but negative FTA-ABS 2. Prlonged PTT 3. Thrombocytopenia
587.
588.
labs after Iv hydration w/ nml saline and insulin in DKA
dec serum glucose, osmolality, potassium. Inc serum bicarb, and sodium.
lactase deficiency
most common cause of selective carbohydrate malabsorption lactase a mucosal enzyme responsible for digestion of lactase pts typically complain of GI Sx including gaseous distention and diarrhea after the ingestion of dairy products
589.
lactulose and ammonia
used to lower blood ammonia levels bacterial action on lactulose=>acidification of colonic contents=>converts absorbably ammonia into nonabsorbable ammonium ion *ammonia trap
Langerhan cell histiocytosis (Px, marker)
tennis racker (birbeck granules monocyte linease child: lytic bone lesions and skin rash or reccurent otitis media w/ mass (mastoid bone) S-100 and CD1a
591.
Langhans cell
giant cell (MO and horseshoe nuclei). activated by Th1
592.
Lead time bias buzz words
new screening test test for poor prognostic dz (lung, pancreatic)
593.
lecinthinase
exotoxin released by Clostridium perfringens=>degrades membrane phospholipids (including lecithin)=>leads to cell membrane destrxn and cell death
590.
C. perfringens causes gas gangrene 594.
lecithin/sphingomyelin (L/S) ratio
commonly used to meas fetal lung maturity from amniotic fluid; ratio 1:1 until middle of 3rd trimester then type II pneumocytes begin secreting surfactant=>lecithin concen increases sharply while sphingomyelin remains unchanged *by 35wks gestation ratio averages 2:1 or higher=>indicating lung maturity phosphatidylcholine (lecithin): component of pulmonary surfactant sphingomyelin: common membrane phospholipid
left anterior descending artery/anterior interventricular branch
supplies: anterior 2/3 of interventricular septum anterior wall of left ventricle part of anterior papillary muscle
596.
left circumflex coronary artery
supplies lateral and posterior superior walls of left ventricle via obtuse marginal branches
597.
left main coronary artery
gives rise to LAD and left circumflex coronary arteries
598.
lesion at jugular foramen
jugular foramen (vernet) syndrome: dysfxn of CN IX,X,XI
Lesion in optic tract can give contralat homonymous hemianopia and relative aff pupillary defect in contral eye. How?
Marcus Gunn pupil: nasal portion of retina contributes more input to pretectal nucleus than temporal portion of retina.
600.
leukamoid vs cml
both have inc WBC count. but enzyme neutrophil alkaline phosphatase is nml or elevated in leukemoid rxn and dec in CML.
601.
Leukemia with Vit A association:
acute myeloid leukemia (M3 FAB variant- acute promyelocytic leukemia assc w/ 15;17.) retinoic acid R alpha for ch 17 transferred to chromosome 15.
602.
Leukemia with Vit A association:
acute myeloid leukemia (M3 variant- acute promyelocytic leukemia assc w/ 15;17.) retinoic acid R alpha for ch 17 transferred to chromosome 15.
595.
599.
Leukocyte adhesion def (AR) absense in
CD18.. inability to synth integrins necessary for leuk to exit bloddstream.
lidocaine
clinical use: ventricular arrhythmias=>esp after acute MI
Ligament injured with radial head subluxation:
annular ligament tear
Linear regression vs correlation coeff
LR: relationship b/w dependent variable and independent. CC: single number to report strength and magniuted b/w two things.
Lipohyalinosis and microatheromas
destructive vessel lesion characterized by loss of nml aterial architecture, mural foam cells; accum of lipid-laden MO w/ in itimal layer of vessel . Assoc with lacunar infarct.
608.
lipoprotein lipase deficiency
chylomicrons aren't hydrolyzed to release triglycerides. -->inc serum chylomicrons. Hyperlipidemia, pancreatitis, lipemia retinalis, eruptive skin xanthomas, hepatosplenomegaly. Heparin releases endothelium-bound lipases, but reduced in these pts.
609.
lipoxygenase
enzyme involved in arachidonic acid metabolism
603.
604. 605.
606.
607.
responsible for pathway that synthesizes leukotrienes 610. 611.
liver biopsy
useful for evaluation of chronic hepatitis and cirrhosis
local factors influencing coronary blood flow
*adenosine prostaglandins serotonin ANS neurotransmitters bradykinin mechanical sheer stress thrombin *NO (endothelium derived relaxation factor) *most important
612.
location of esophagus
between trachea and vertebral bodies in superior thorax typically collapsed with no visible lumen on CT images of the chest
613.
614.
Long term neurlogic sequelae associated with bacterial meningitis?
1.) Hearing Loss 2.) Loss of cognitive functions ( neuronal loss of the dentate gyrus in the hippocampus) 3.) seizures 4.) mental retardation 5.) spacticity or paresis
loop diuretic
inhibit NaK2Cl symporters in TAL of Henle=>block Na and Cl transport and increase Na, Cl, and fluid excretion commonly used to Tx pulmonary edema, venous and pulmonary congestion 2° to CHF, and peripheral edema common side effects: hypokalemia, hypomagnesemia, and hypocalcemia
615.
616. 617.
Low freq detected @ High freq
LF: apex of cochlea, near helicotrema HF: base of cochlea, near oval and round window
low haptoglobin
hemolytic anemia
Low serum Na found in what organism causing pneumonia?
legionella.
618.
low-grade non-Hodgkin lymphoma
usually effects middle aged and elderly pts present: fever, malaise, anorexia, and lymph node enlargement lymph node biopsy reveals prolif of atypical lymphocytes
619.
620.
621.
Lxn of enhancer, repressors, promoters
enhancer and repressors: anywhere Promotors: 25-70b upstream of assoc gene
Lxn of neonatal intraventricular hemorrhage? RF
fragile germinal matrix inc ferq w/ dec age and birth weight.
lymph node drainage below umbilicus
retroperitoneal (paraaortic) lymph nodes: testes superficial inguinal lymph nodes: all cutaneous structures inf to umbilicus, including external genitalia and the anus up to the pectinate line *located on ant thigh inf to inguinal ligament deep inguinal nodes: receive afferents from superficial inguinal nodes and deep lymphatic trunks along femoral vessels; lymphatics from glans penis and clitoris also drain here **located under fascia lata on medial side of femoral vein external iliac nodes: superficial and deep inguinal nodes, and deep lymphatics of abdominal wall below umbilicus common iliac nodes: internal and external iliacs ***located alongside common iliac artery
622.
lysogenization
c dipth gains tox gene via bacteriophage infecting host bacterium and integrating genome to cause AB exotoxin productiong
623.
lysogenization*
c dipth gains tox gene via bacteriophage infecting host bacterium and integrating genome to cause AB exotoxin productiong
624.
Lytic vs lysogenic phage
Lytic: phage infects bacterium-->cleavage of bact DNA-->some parts packed in viral capsid Lysogenic: infects bacterium-->incorp into bacterial chrom. Excised w/ flanking gene. ABCDE: ShigA-like, Botulinum, Cholera, Dipth, Erythrogenic (strep pyogenes)
625.
major defense of s pneumo
polysach capsule
major determinant for bladder cell carcinoma?
penetration of bladder wall.
Major determinant for viral tropism to spec tissues of specific hosts -->
surface glycoprotein (attaches host cell plasmalemma R)
Male 1-2week old child px w/ vomiting, hypotension, hypoNa, hyperK. Dx
salt wasting 21 hydroxylase def. Deficient cortisol and aldosterone synth w/ adrenal androgen overpdtn. M: nml genitelia, F: ambiguous.
malformation deformation disruption sequence agenesis
1. primary defect in cells or tissue that form an organ (intrinsic dev abnml) 2. extrinsic mechanical forces(ie. pressure in uterus) 3. 2ndary breakdown of prev nml tissue structure. (amniotic band syndrome) 4. # of abnl from single primary defect (potter syndrome) 5. complete absence of organ
malignancy in child presenting with resp sx, dysphagia, SVC syndrome.
ALL (T cell)- mediastinal mass
Malignant otitis externa in diabetes pts
Pseudomonas
Mallory-Weiss syndrome
describes mucosal tears that occur around the esophagogastric-squamocolumnar junction
626.
627.
628.
629.
630.
631.
632.
these tears caused by increased intraluminal press in stomach that occurs during retching or vomiting
633.
management of ACE inhibitor
the best Tx of chronic cough caused by an ACE inhibitor is replacement with an ARB like losartan ARBs are beneficial for both HTN and diabetic neuropathy; they do not interfere with catabolism of bradykinin as ACE inhibitors do
634.
mannitol
osmotic diuretic used in management of cerebral edema and increased ICP mech: rapidly increases plasma or tubular fluid osmolality=>water moves from interstitial space into vascular space or tubular lumen *in brain water redist from tissues to plasma helps reduce cerebral edema and ICP common side effects: headache, nausea, vomiting overaggressive Tx: XS vol depletion and hypernatremia, vol expansion, dilutional hyponatremia, metabolic acidosis, hyperkalemia, pulmonary edema from increased hydrostatic press
635.
mannitol use and tox
Cerebral edema. SFX: pulmonary edema.
636.
mantle cell lymphoma
translocation between cyclin D1 locus on c'some 11 and immunoglobulin heavy chain (IgH) locus on c'some 14 [t(11;14)]=>increased prod of cyclin D1 a promoter of G1 to S-phase transition during the cell cycle
Marfan's syndrome murmur and heart disease
associated with aortic root dz=>aneurysmal dilatation, aortic regurgitation, and aortic dissection
637.
*aortic regurgitation causes diastolic murmur 638.
639.
640. 641.
642.
643.
644.
645.
Marfanoid habitus
tall slender disproportionately long arms, legs, fingers
Marker of osteoblast activity osteoclast activity?
Osteoblast: ALP Osteoclast: TRAP, urinary hydroxyproline, deoxypyridinoline*
Marker seen in MS?
IgG in CSF
markers for breast tumor tx and px
ER/PR+: tamoxifen ERB-B2+ (aggressive): trastuzamab
MC aseptic meningitis infections?
enteroviruses: coxsackie, echo, entero, polio
MC bacterial cx of acute otitis media, sinusistis, conjunctivitis?
strep pneumo, nontyp H influ, moraxella.
MC SFX of inhaled glucocorticoids:
oropharyngeal candidiasis. dysphonia
McArdle's disease
type 5 glycogen storage disease=>myophosphorylase deficiency=>failure of glycogenolysis *glycogenolysis provides immed NRG for strenuous muscle contraction clinical manifest: decreased exercise tolerance, myoglobinuria, muscle pain with physical activity
646.
647. 648.
MCC of hydronephrosis in fetus:
Uretopelvic jxn. Last to canalize.
MCC of pneumonia in adults?
S penumoniae, followed by N .meningetitis.
MCC of thrombocytopenia in hospitalized patients
Heparin: heparin induced thrombocytopenia tx: direct thrombin inhibitors (hirudin, lepirudin, argatroban)
649.
MDRI gene
codes for P-glycoprotein=>transmembrane ATP-dependent efflux pump that has broad specificity for hydrophobic compounds can both reduce influx of drugs into cytosol and increase efflux from cytosol=>prevent action of chemo drugs *in tumor cells it actively removes chemo agents=>particularly hydrophobic agents like anthracyclines normally expressed in intestinal and renal tubular epithelial cells=>eliminate foreign compounds from the body
650.
Meckel diverticulum
occurs due to failure of obliteration of omphalomesenteric duct present: lower GI bleeding, melena, RLQ pain *lower GI bleeding is most common manifestation and occurs due to acid secretion by ectopic gastric mucosa present in diverticulum=>ulceration and bleeding **when inflamed clinical appearance almost impossible to differentiate from acute appendicitis can predispose intestine to intussesception=>manifests as a colicky abdominal pain and "currant jelly" stools
Meckel diverticulum presentations and dx
lower gi bleed, RLQ location. Ectopic gastric mucosa -->acid ->ulceration, bleed. Pertechnetate scan dx RLQ. adn gastric epith .
medium sized tumor cells, basophilic cytoplasm, proliferation farction (ki-67 fraction) of >99%.
burkitts (EBV)
653.
medroxyprogesterone (Depo Provera)
progesterone-only OC administered as intramuscular injection once every 12wks
654.
meds causing seizures
bupropion, clozapine, isoniazid, ciprofloxacin
Medullary CA of thyroid gland characterized by: and assoc w/
extracell deposits amyloid formed by calcitonin secreted form neoplastic parafollicular C cells. Assoc w/ MEN 2(A&B)
megaloblastic anemia
most frequently caused by folate or vit B12 deficiency
651.
652.
655.
656.
will see increased MCV peripheral blood smear will reveal hypersegmented neutrophils (>5 lobes) and enlarged ovoid erythrocytes (oval macrocytes) 657.
MEN 1
autosomal dominant condition characterized by: parathyroid gland tumors of pituitary gland tumors of pancreas
658.
MEN 2B
characteristics: Marfanoid habitus, mucosal neuromas, medullary thyroid carcinoma, pheochromocytoma
659.
Met potential of metastatic prostate cancer:
bone (axial skeleton).. sclerotic punched out lesions. presents w/ back pain
660.
metab of drugs that cause lupus like sx :
N-acetylation (hyralazine, procainamide)
661.
metabolic syndrome
group of risk factors: HTN abdominal obesity atherogenic dyslipidemia insulin resistance
662.
metaclopramide
dopamine AA w/ central and peripheral fx. Prokinetic and antiemetic prop to treat Gi mot d/o l(gastroparessis to prevent N/V.
663.
metaloproteinase
degrade components of ECM and Basement membrane composed of laminin and collagens IV, VII
664.
Metformin CI in
renal failure (d/t risk of lactic acid accumulation). And lactic acidosis situations (liver dyxfxn, CHF, alcoholism, sepsis
665.
Methenamine silver
crypto
666.
Methotrexate use, sfx
RA. SFX: stomatitis (ulcers), hepatotox (hepatitis, fibrosis, cirrhosis). Folic acid supp to red stomatitis.
667.
Methotrexates side effect?
First line agent for rheumatoid arthirits ( anti-metabolite agent) 1. stomatitis 2. abdominal pian 3. nausea 4. hepatotoxicity 5. anemia to prevent this give with folic acid
668.
methylene blue
indicated for Tx of methemoglobinemia reducing agent that converts iron heme from Fe3+ to Fe2+ state
669.
670.
Methylmalonic acid and homocysteine elevated in what def?
elevated in B12 def due to dec metabolism. homocysteine elevated in folate def only.
methylmalonic aciduria
due to increased circulating levels of methylmalonic acid due to deficiency of vit B12-dependent enzyme methylmalonate mutase imp in metabolism of isoleucine, valine, methionine, thymine, threonine, oddchain FA, cholesterol
671.
microscopic polyangiitis (leukocytoclastic angiitis or hypersensitiity angiitis)
most common vasculitis from antibiotic use affects small vessels only pathogenesis: type III immune rxn; Ag is often a medication (commonly penicillin)
672.
mifepristone (RU-486)
synthetic steroid with anti-progestin and anti-glucocorticoid effects used primary as abortifacient
673.
Milrinone in cardiac adn vesels
PDE inhibitor : inc contractility and inc vasodilation
674.
misoprostol use
PDE1 analog used to prevent NSAID- induced ulcer dz
675.
missense mutation
when mutations alter AA sequence can be conservative where new AA is similar in chem structure
676.
mitochondrial cytochrome oxidase
component of electron transport chain reacts with molecular O2 to produce water
677.
mitochondrial dz
myoclonic epilepsy w/ ragged red fibers leber optic neuropathy mitochondrial encephalopathy with stroke-like episodes and lactic acidosis
678.
mitotane
andrenocorticolytic drug clinical use: adrenocortical carcinoma
679.
mitral annular calcification
degen calcific deposits in fibrous ring of mitral valve=>rarely assoc with regurgitation or stenosis most common: women > 60 Hx of myxomatous degen of mitral valve chronically elevated LV press *mitral valve radius is fixed
680.
mitral insufficiency and ventricular remodeling
↑ LVEDV=>LV dilatation and hypertrophy from ↑ load from regurgitant flow *net result: dilated left ventricular hypertrophy and ↑ LV mass
681.
mitral stenosis hemodynamics
mitral stenosis due to abnormal valves may have an opening snap in early diastole shortly after the aortic component of the second heart sound (A2) the opening snap occurs shortly after the mitral valve opens due to tensing of the valves leaflets after the valve cusps have completed their opening excursion the A2-OS interval is inversely correlated with the severity of mitral stenosis
682.
mitral valve prolapse
prod mid-systolic click and late systolic murmur=>heard best over cardiac apex *most common anatomical abnormality producing mitral regurgitation
683.
MOA for colchicine and use
acute gouty arthritis and prophylaxis of reccurent gouty arthritis; inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization. Chemotaxis of neutrophils! SFX: nausea, diarrhea
684.
MOA of BNP
activate GC-->inc intracel cGMP
MOA of cromolyn and nedocromil
stabilize mast cell DEGRANULATION independent of stimulation.
686.
MOA of DDAVP for bleeding
induce endothelial procoagulatory protein release (including vWF); used in hemophilia A
687.
MOA of entacapone
block COMT which stops conversion of L DOPA to w/e in the periphery-->more L-DOPA entering.
688.
MOA of leuprolide
GnRH agonist -->first transient inc and then dec in T and DHT
689.
MOA of nitrate drugs
transformed to NO at vascular SM cell membrane. Inc cGMP-->dec intracell Ca--> myosin dephosp
Mockenberg's medial calcific sclerosis
medial calcinosis characterized by calcified deposits in muscular arteries
685.
690.
typically affect indiv >50 years of age visible radiologically and often times palpable on physical exam clinically aSx bc don't narrow vessel lumen 691.
692.
693.
694.
695.
mode of infection by staph epidermidis
synthesis of extracell polysaccharide matrix
monitor muscle length, and muscle force
muscle spindle system Golgi tendon
Most common cause of hypertension in children?
Fibromuscular Dysplasia Angiogram reveals "string of beads" sign
Most common cause of NASH?
1. Obesity 2. Diabetes 3. Hypertryglyceridiemia
Most common inciting factor for asthma
allergen. cold air has non immune mx and is related to exercise.
Most common reasons behind post cholecysteomy pain?
1. Functional pain 2. Sphincter of oddi dysfunction 3. Bile duct obstruction both 2 and 3 would present with elevated liver enzymes and ultrasound would show dilated ducts
Most common solid organ injured in blunt abdominal trauma?
Spleen
698.
Mt in xeroderma pigmentosum
defect in DNA excisional repair.
699.
Mt that causes HNPCC
DNA mismatch repair gene mt
700.
multiple myeloma
present: easy fatiguability (due to anemia), constipation (due to hypercalcemia), bone pain=>most commonly in back and ribs (due to prod of osteoclast activating factor by myeloma cells and subsequent bone lysis), renal failure *esp seen in elderly pts
696.
697.
histo: large eosinophilic casts composed of Bence-Jones proteins (light chains) seem in tubular lumens risk factors: hypercalcemia, hyperuricemia, infiltration of kidney by myeloma cells, AL amyloidosis, frequent infxn mut in pol gene mut in env gene
assoc w/ HIV RT inhibitors and HIV protease inhib resistnace assoc w/ hos neutralizing Ab
702.
mutation in polycythemia vera
JAK2 (non-R tyrosine kinase)
703.
Mx of Fondopiranoux
inhibit Xa --> inc Pt, PTT. no effect on TT
704.
myc proteins
txn factors
705.
Mycobact resistance to isoniozid
non expression of catalase-peroxidase enzyme or genetic modification of isoniazid binding site
Mycoplasma pneumoniae pathophys
no cell wall, but has cell membrane. Antigenic similarity b/w cell walls of host and bacteria->cold aglutinin destruction of host rbc-->anemia. tx w/ erythro or tetra corrects infxn and anemia resolves. C can also cause stevens-johnson
myocardial contractility (inotropy) slope of pressurevolume curve for left ventricle
↑ slope=>↑ inotropy
myoglobin
monomeric protein
701.
706.
707.
708.
↓ slope=>↓ inotropy
primary O2-carrying protein of skeletal muscle of skeletal and cardiac muscles has much higher affinity for O2 than does Hb=>has hyperbolic oxygen-dissociation curve *each subunit of Hb has similar O2 binding physiology as myoglobin 709.
710.
711.
712.
Myotonic dystrophy
AD d/o. Inc # of trinucleotide repeats on myotonia-protein kinase gene. Myotonia w/ weakness and atrophy. cataracts, frontal balding, gonadal atrophy.
nasal transepithelial potential diff measurement use: more neg than nml value indicates
used along with sweat test. Neg value -->reduced luminal cl secreiton and inc Na and net water abs. -->dehydrated mucus.
Nasal ulcer with glomerulonephritis:
Granulomatosis with polyangiitis (wegeners) C-ANCA (Ab to neutrophil)
NE IV causing blanching and induration. Prevention?
Phentolamine (alpha 1 blocker).
713.
714.
Negative predictive value, and positive predictive value
NPV: prob that pt doesn't have dz PPV: prob that pt does have dz
negative selection in T cell maturation
essential for eliminating T cells that bind to self MHC or self Ag with overly high affinity=>if permitted to survive would likely induce immune and inflamm rxns against self Ag leading to autoimmune dz occurs in thymic medulla and involves interaction of developing T cells with thymic medullary epithelial an dendritic cells serves to eliminate T cells that may be overly autoreactive against self Ag and therefore my place a role in autoimmunity if not destroyed=>results in a population of T cells that have only an appropriately low affinity for self MHC molecules
715.
nephrotic syndrome and albumin
classically present with decreased serum albumin due to protein-wasting enteropathy
716.
neural tube defects
assoc with increased AFP levels and acetylcholinesterase levels in amniotic fluid
717.
neurofibromatosis type 2
more "central" form characterized by: bilateral acoustic neuromas brain meningiomas shwannomas of the dorsal roots in spinal cord
718.
neurofribromatosis type 1
characterized by: café-au-lait spots cutaneous neurofibromas, axillary or inguinal freckling optic glioma iris hamartomas osseous lesions
719.
Neuron changes in MS:
length constant (signal travels a shorter distance due to dec myelination)
Next step for workup of someone with anklyosing spondylitis?
X-ray of sacro-iliac joints. to demonstrate fusion.
Next step in management of patient with subclavin vein thrombosis ( warm, swollen, pale with pulses)?
1. Remove catheter 2. Duplex of vein to determine if anti-coagulation is needed.
Next step when patient presents with Alkali ingestion?
Upper GI endoscopy
NF-kB is associated with production of:
cytokines. Overexpression in crohn's.
NF1 has neurofibromas that arise from what celLS
Schwann cells --which arise form neural crest
725.
niacin
improves hyperlipidemia by decreasing synthesis of hepatic TGs and VLDL
726.
Niacin def
pellagra, dermatitis, dementia, diarrhea
727.
niacin deficiency
characterized by pellagra: dementia dermatitis diarrhea
728.
nitrate action
act primarily as venodilator=>↓ cardiac work by ↓ left ventricular filling vol/preload
Nitrate bioavailability orally? (Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate, amyl nitrite)
Isosorbide mononitrite >> others No 1st pass met. Na Nitroprusside (IV) Amyl nitrite (Inhaled)
720.
721.
722.
723.
724.
729.
730.
731.
Nitrate bioavailability orally? (Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate, amyl nitrite)
Isosorbide mononitrite >> others No 1st pass met. Na Nitroprusside (IV Amyl nitrite (Inhaled)
nitrate drug action
mimic action of endothelial derived relaxing factor transformed to NO at vascular smooth muscle cell membrane=>leads to ↑ cGMP, ↓ intracellular Ca2+ and myosin dephosphorylation
732.
nitrates and phosphodiesterase inhibitors
PDE inhibitors used for ED and pulmonary HTN=>if used in combo with nitrates cause profound systemic hypotension=>both ↑ intracellular cGMP=>vascular smooth muscle relaxation *use together is absolutely contraindicated
733.
734.
Nitrates can cause paradoxycal myocardial o2 demand. Prevented with use of
metoprolol
nitric oxide
created and released from endothelial cells in coronary vasculature synthesized from arginine and oxygen by endothelial nitric oxide synthase (eNOS) released from coronary endothelium in response to neurotransmitters (ACh, NE), platelet products (serotonin, ADP), thrombin, histamine, bradykinin, and endothelin also released in response to pulsatile stretch and flow shear stress in coronary arteries=>major regulator of flow-med vasodilation in large arteries and pre-arteriolar vessels acts w/i vascular smooth muscle cells via soluble guanylate cyclase enzyme to ↑ prod of cyclic GMP and cause smooth muscle relaxation
Nitroblue tetrazolium fail to turn blue
CGD nml neutrophils reduce nitroblue -->dark blue pigment
norepinephrine and coronary autoregulation
neurotransmitter released from sympathetic neurons that stim adrenergic receptors
Normal light microscopic findings in a patient with Nephrotic syndrome suggest what?
Minimal Change disease
738.
octreotide
somatostatin analogue=>decreases gut motility, gut blood flow, and gut endocrine and exocrine fxn *decreases secretion of pancreatic enzymes into intestine
739.
Opioid drug that causes withdrawl sx?
Pentacozin ***
740.
Opioids and RUQ pain
Opioids act on smooth muscle (contraction) at sphincter of Oddi -->inc pressures in bile duct and gall bladder.
741.
ornithine transcarbamoylase
catalyzes 2nd step of urea cycle where ornithine and carbamoyl phosphate are combined to form citrulline
735.
736.
737.
occurs within mitochondria deficiency in this enzyme leads to hyperammonemia and mental retardation 742.
orotic aciduria
due to defective pyrimidine synthesis resulting from deficiency of enzyme orotate phosphoribosyl transferase *this enzyme requires glutathione as a coenzyme
Oseltamivir
neurominidase inhib -->tx and prevent inf A and B. impairs release of new form virions, impairs penetration of mucus secretions
osteocytes remain connected to each other by
gap jxns.
745.
Osteogenesis imperfecta?
autosomal dominant type 1 collagen defect 1. hearing loss 2. opalescent teeth-discolored 3. blue sclera
746.
ovary epithelium
simple cuboidal
743.
744.
charac: also known as germinal epithelium; transitions to peritoneum at the broad ligament of the uterus assoc tumors: serous, mucinous, endometrioid, clear cell, Brenner (urothelial) *site of origin for many benign and malignant ovarian neoplasms 747.
P bodies
Foci w/in eukar cells that suppress translation of mRNA by binding it in the cytoplasm.
748.
Painful ulcers on genetilas
haemophilus ducrey, HSV 1,2
749.
painless ulcers on genitals
Klebsiella inguinale, trepobema pallidum, Chlamidia trachomatis
750.
pancreas divisum
failure of ventral and dorsal buds to fuse usually aSx and only found incidentally
751.
pancreatic secretory trypsin inhibitor (PTSI)
prevents trypsin-mediated activation of other proteolytic enzymes and autodigestion of pancreatic tissue secreted by pancreatic acinar cells inhibits any trypsin abnormally activated within the pancreas *inhibitory capacity can be exceeded by large amounts of active trypsin which can act as its own inhibitor
752.
papillary necrosis
assoc with: DM analgesic nephropathy sickle cell dz
753.
parietal cell stimulation
acetylcholine histamine gastrin *proton pump inhibitors block final common pathway of gastric acid secretion from parietal cells
754.
755.
756.
parkinson on off and wearing off
on off is unpredictable moments where pts gains mobility w/out restriction. wearing off is dyign off of dopamenergic neurons -->dec response to drug
Particles of what size can reach alveoli?
<2uM
Parvovirus and aplastic anemia
non-enveloped single stranded DNA virus most common viral cause of an aplastic crisis in pts with sickle cell anemia or other chronic hemolytic disorders mech: infects erythroid precursor cells in bone marrow *dimishes number of reticulocytes available to replace deformed and/or removed erythrocytes
757.
Parvovirus B19 in children and adults
children: erythema infectiosum (fifth disease) Adults: arthritis that mimics RA
758.
PAS stains
glycoprotein in cell walls of G+ actinomycete Tropheryma whippellii
759.
patent ductus arteriosus and Tx
associated with prematurity and congenital rubella infxn *large shunts can cause dyspnea, cyanosis, and frequent respiratory infxns therapy with indomethacin and ibuprofen (NSAIDS) successfully closes defect *in neonates prostaglandins help maintain PDA
Path of biventricular pacemaker lead 2
coronary sinus (in AV groove of posterior aspect of heart)
761.
Path of infection of tetanus
wound-->retrograde motor neuron-->spinal cord: inhibit inhibitory interneurons
762.
Patho in osteoporosis
loss of total bone mass resulting in trabecular thinning.
763.
patho of thromboangiitis obliterans
vasculiitis of arteries, veins and extension to surrounding tissue
pathogen associated with cryoglobulins
Hep C vrius
765.
pathogenesis of cushing ulcers?
INC ICP-> vagus activation-->inc HCl release
766.
Pathogenesis of MG
AI against skeletal muscle Receptors (Type II HS)
767.
pathogenicity of H influenzae
capsule.
Pathophys is diffuse scleroderma esophageal hypomotility:
Atrophy and fibrous replacement of muscularis leading to incompetence of lower esoph sphincter. Dilation -->reflux -->barrett and esoph adenoCA
pathophys of insecticidse
organophosphates -->irreversible binding to cholinesterase-->stim nicotinic and muscarinic. Cholinergnic excess -->salivation, diaphoresis, urinary incont, diarrhea, emesis, miosis, bradycardia.
pathophys of kidney stones in chron's iliocolitis
crohn's-->oxalage kidney stones Impaired bile acid abs @ terminal ileum--> loss of bile acid in poop (fat malab). lipids bind Ca and soap complex is excreted. Free oxalate (nmly bound by Ca to form unabs complex) is abs and froms urinary calculi.
771.
pathophys of temporal arteritis
Granulomatous inflammation of media
772.
pathways exclusive to mitochondria
ß-oxidation of FA
760.
764.
768.
769.
770.
ketogenesis citric acid cycle parts of urea cycle (carbamoyl phosphate synthetase 1 and ornithine transcarbamoylase) pyruvate carboxylase 773.
Patients with recurring giardia infxns?
a gammaglobulinemia, other immune def : no IgA which fights giardia.
774.
PCOS (Stein-Leventhal syndrome)
characterized by: elevated estrogen, androgen, and LH hyerandrogenisms chronic anovulation=>infertility oligomenorrhea multiple ovarian cysts common features: obesity insulin resistance dyslipidemia *increase risk of diabetes and CV dz
775.
776.
pericardial fibrosis
usually follows: cardiac surgery radiation therapy viral infxns of the pericardium
pericardial tamponade and pulsus
combo of: JVD hypotension pulsus paradoxus *if previously healthy and suffered penetrating/blunt chest trauma to pericordial region=>high suggestive of tamponade *breath sounds will be normal
777.
pertussis toxin
AB exotoxin released by Bordetella pertussis=>stim intracellular G-proteins to increase cAMP prod leads to: increased insulin prd lymphocyte and neutrophil dysfxn increased sensitivity to histamine
pharmacodynamic drug interaction
ability of drug, as part of its MOA, to antagonize/prevent the effect of another drug or endogenous substance
pharmacokinetic drug interaction
how drugs used together in a patient affect the absorption and elimination of each other
780.
phosphatidylglycerol
major component of surfactant and its levels in amniotic fluid increase after 36wks (lecithin after 30wks) gestation in parallel with increased surfactant production by maturing fetal lung
781.
phospholipase C
active in G-protein/IP3/Ca2+ 2nd messenger system
778.
779.
hormone binds receptor and activates G-protein=>activates PLC=>degrade phospholipids to IP3 and DAG *both DAG and increased intracellular Ca2+ caused by IP3 will activate PKC 782.
Pictures with enlarged ventricles: TB meningitis. condition related to impaired fxn of :
arachnoid granulations
783.
PID
mucopurulent cervicitis with cervical motion tenderness is frequent indicator of PID manifested as endometritis, salpingitis, tubo-ovarian abscesses or pelvic peritonitis most serious risk is permanent damage to repro system=>infertility *can lead to ectopic pregnancy and infertility due to scarring of fallopian tubes if not Tx appropriately assoc with N. gonorrhoeae and Chlamydia occurrence of infertility as sequela of PID est to be 15-20% for women who have single episode of PID and 5085% for women with multiple episodes
784.
pigment stones
common in rural asian populations with increased incidence in women and elderly brown pigment stones usually arise 2° to infxn of biliary tract=>release of ß-glucuronidase by injured hepatocytes and bacteria=>increases hydrolysis of bilirubin glucuronides and increases amount of unconjugated bilirubin in bile *biliary infxn with E. coli, Ascaris lumbricoides, or liver fluke Opisthorcis sinesis sig elevates risk of developing brown pigment stones
785.
pituitary cancer
1° cancer is extremely rare=>more prone to metastases due to rich vascular supply present: tumor mass effects *infiltrative lesions involving suprasellar space typically compress the pituitary stalk=>decreased hypothalamic dopamine and loss of inhibition of pituitary lactotrophs=>increased prolactin
786.
pituitary hypoplexy
hemorrhage into preexisting pituitary adenoma=>medical emergency present: acute, severe headache, ophthalmoplegia, and altered sensorium Tx: urgen neurosurgical consultation and stress doses of glucocorticoids
787.
788.
pol gene mut and HIV
HIV RT inhibitors and HIV protease inhibitors
polyarteritis nodosa
*transmural inflamm of the arterial wall with fibrinoid necrosis is characteristic of polyartertitis nodosa (PAN); inflamm can occur in any organ except lung segmental, transmural, necrotizing inflamm of med to small sized arteries Sx: fever, abdominal pain, melena, peripheral neuropathy, malaise, weakness, weight loss, diffuse muscular aches and pains *assoc with HBV (10-30% cases; peak incidence in young adults; not linked to cigarette smoking
789.
polycystic kidney disease
inherited condition with juvenile and adult forms present: HTN flank pain recurrent UTI hematuria abdominal mass causes thickened endometrium due to XS estrogen=>risk of developing endometrial hyperplasia and carcinoma
790.
polycystic ovary syndrome (SteinLevanthal)
characterized by young females with infertility, acne, hirsutism, insulin resistance, and central obesity as well as characteristic bilateral ovarian cysts
791.
polyethelene glycol
osmotic laxitive
792.
Polyribosyl-ribitol-phosphate
component of Hib capsule. (conjugated in dipth or tet toxoid)
793.
Pompe disease
acid alpha glucosidase deficiency or acid maltase deficiency glycogen storage dz II presents with hepatomegaly, cardiomegaly and increased risk for cirrhosis
794.
795.
porcelain gallbladder: cx, px
cx: chronic cholecystitis Tx: prophylactic cholecystectomy (high risk of GB CA)
positive selection in T cell maturation
process by which only T cells expressing TCR that is able to bind self MHC are allowed to survive=>those not specific for self MHC are signaled for elimination by apoptosis occurs after TCR DNA rearrangement and prior to negative selection occurs in thymic cortex and involves interaction of T cells with thymic cortical epithelial cells expressing self MHC responsible for development of a T cell repertoire that can recognize self
post op urinary retention
Involves dec micturition reflex activity: dec contracitlity of bladder detrusor and inc vescle vesicle sphincter tone. Tx w/ muscarinic agonist (bethanachol) or a1 blocking.
Posterior urethra injuries Anterior urethra injuries
Pelvic fracture-: inab to void w/ full bladder sensation Straddle injury
798.
Potency =
higher affinity for receptor
799.
Potter syndrome
bilat renal aplasia, oligohydraminos, facies, hypoplas.
Presentation and labs for pt w/ halothane associated lethal fulminant hepatitis:
elevated aminotransferase , prolonged PT time, eosinophilia. Shrunken liver Centrilob hepatocell necrosis and inflammation off portal tracts adn parenchyma. present with: fever, anorexia, nausea, myalgia, arthralgias, rash.
801.
Presentation of acute hepatitis: (HAV
Fever, malaise, fatigue, anorexia, nausea, vomitting Mid abd pain, dark urine (inc serum bilirubin). Hepatomeg and jaundice. Inc AST, ALT followed by inc BR, ALP.
802.
Presentation of Alkaptonuria
AR d/o. def of homogentisic acid oxidase (breakds down tyrosine bypdt homogentisic acid (alkapton)) ->pigment deposits in connective tissue
803.
Presentation of HUS:
young children acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia. labs: dec RBC count, hematocrit, platelet count, inc BT, LDH, BUN and creatinine.
presentation of wiskott-aldrich syndrome
Triad: eczema, thrombocytopenia, combiend B and T deficiency. Onset early in life w/ thrombotycotpenia present at brith and eczema and repeated infx (capsulated) at 6-12mo.
presentations of congenital toxoplasmosis
transplacental infection. Hydrocephalus, intracranial calcifications, chorioretinitis. (tell expectant mother sto avoid cat feces)
Presentations of intestinal malrotation embryology?
cecum in RUQ. Ladd's bands. midgut fixed to SMA. compl: intestinal obxtn, midgut volvulus.
807.
Presentations of pulmonary HTN?
second heart sound, signs of RHF.
808.
Prevalance affects
PPV, and NPV
796.
797.
800.
804.
805.
806.
809.
prevention of DVT
heparin is the DOC unfractionated and low molecular weight heparins most commonly used for prevention of DVT in inpatient settings=>esp in pts undergoing elective surgery increases effect of naturally occurring anticoagulant antithrombin-III unfractionated heparin bind to antithrombin-III by pentasaccharide in heparin chain=>conformational change of antithrombin-III=>increases antithrombin binding and neutralization of thrombin
primary biliary cirrhosis Labs, Assoc
AI rxn -->lymphoycte infiltrate + granulomas. dxtn of intralob bile ducts. Labs: inc conj bili, inc xol and inc ALP. addtl: inc serum mito Ab (IgM). associated with CREST, Sjogren, RA, celiac.
811.
problem with fragile x syndrome
hypermethylation of cytosine bases
812.
problems in pts with ankilosing spond
Back; Enthesopathies (inflammation at sites of tendon insertion). involves costovertebral and costoternal jxn (can limit chest mvmvts -->hypoventilation Other problems: anterior uveitis, asc aortitis.
Problems with benzos and other drug that may cause sedation:
1st gen H1 histamimne R antagonists (diphenhydramine, chlorpheniramine).
814.
problems with dna mismatch repair
HNPCC or lynch syndrome.
815.
producers of endotoxin
gram neg organisms organisms
816.
prolactin inhibition
inhibited by dopamine=>acts on D2 dopamine receptor of lactotrophs *dopamine secreted by hypothalamus
817.
Prolonged pruritis and fatigue
primary sclerosing cholangitis (inf and fibrosis of biliary tract).
Properties of cancer resistant cell membrane protein?
human multidrug resistance (MDR1) gene codes -->P-glycoprotein (ATP-dependent efflux pump). specificity for hydrophobic compounds.
propyl hydroxylase lysyl oxidase procollage peptidase metalloproteinases
first three streghten collagen, last one breaks it down --leading to thrombus and MI. procollagen peptidase deficient in ehler danlos.
protamine sulfate
peptide antagonist of heparin
810.
813.
818.
819.
820.
binds to heparin forming a complex that has no anticoagulant activity not very effective in Tx toxicity caused by molecular weight heparin 821.
protein kinase A
primary intracellular affector enzyme in G-protein/adenylate cyclase 2nd messenger system increased levels of cAMP stim PKA
822. 823.
824.
825.
PRPP synthase mut that inc Vmax-->
gout
Pt on chemo. Develops renal problems. Best prevented with:
Allopurinol or Rasburicase (urate oxidase)-->no allantoin
Pt presents with acute motor and sensory loss, loss of rectal tone and urinary retention?
Cauda Equina Syndrome Surgical Emergency!!
pt presents with blurred vision, constipation and vomiting, what type of medication would cause this?
Anti-cholinergics: Trihexyphenidyl
pt presents with dull ache over eye with swollen eyelid, edematous conjunctivae, and exudates in anterior chamber, after recent eye surgery?
Post-op endophthalmitis
Pt presents with iron deficiency, foul smelling stool, easy bruising. What could it be?
Think Celiac's disease decreased iron, vitamin K and A
Pt presents with lobar pneumonia and vomiting and diarrhea?
Think of Legionella pneumonia txt with Azithromycin or Levofloxacin
pt presents with pain in MCP and PIP joints, but no redness or swelling, only 15 min. stiffness in am, what do you suspect?
Viral arthritis, commonly seen in adults around children Most likely Parvovirus, symmetric, multiple joints Check Anti-B19 IgM
pt presents with persistent nasal blockage and episodes of bronchoconstriction, also takes aspirin what is this?
High yield: Aspirin sensitivity syndrome- pseduo allergic reaction txt: leukotriene receptor antagonists**
Pt presents with refractory mania despite therapy with mood stabilizer what should be done next?
1. Check urine toxicology screen 2. Check urine lithium levels
Pt undergoes surgery w/ general anesthesia. Post op has elevated AST, ALT, confusion, nausea, fever. liver bx will show:
massive hepatic necrosis due to halothane. Ab against liver proteins. Massive centriloular hepatic necrosis.
Pt w/ anemia, inc LDH, and indirect bilirubin: Postivie osmotic frag test Complications:
hemolytic anemia D/t hereditary spherocytosis. Pigmented gallstones.
Pt w/ hx of prolonged bleeding after tooth extract (maternal uncle with hemarthrosis). Abnmality?
Hemarthrosis due to coagulopathy: Hemophilia A MC inherited coagulopathy. X linked inheritance. causes PTT elongation.
Pt w/ recurrent h influenza infxns receives Oneg RBC packked. develops hypotension, tachy, itching, skin rash, bronchospasm and dies 30 min.
selective immunoglobulin def (no IgA, so develop response to IgA in blood )
pt with cirrhosis and increasing creatinine that does not respond to IV fluid bolus what should you suspect?
Hepatorenal synrome txt: liver transplant
837.
pt with comidon rash:
athlete. use of anabolic steroids (methyltestosterone) Adrogen stim follicular epidermal hyperprolif and excessive sebum pdtn.
838.
pt with contralateral lower leg weakness with sensory deficiet?
anterior cerebral artery stroke
pt with increased FEV1/FVC ratio but normal DLCO, what is the dx?
Chest wall weakness
Pt with leukemia with dry tap and TRAP stain positive. what is the dx? and how do you txt?
Hairy Cell Leukemia txt: Cladribine
Pt with pulm edema and LV failure will show
cadiomegaly, pleural effusion, kerley B lines, inc vascular shadowing.
Pt with type 2 DM presents with elevated LFT's what could be causing these?
Non-alcoholic fatty liver disease 2/2 insulin resistance
Pts at risk for sacular aneurism (spontaneous intracranial hemorrhea) mcc
adult type coarctation of Ao (HTN assoc), marfan?, congenital berry aneurysm. MCC: AV malformation, rup cerebral aneurysm, abuse of sympathomimetic drugs (cocaine)
Pts that lack IL-12 have inc infectivity with what organism? Tx?
mycobacteria. Tx: INF gamma
pts with asthma, wrist drop, eosinophilia and Ab against neutrophil myeloperoxidase:
churg strauss
826.
827.
828.
829.
830.
831.
832.
833.
834.
835.
836.
839.
840.
841.
842.
843.
844. 845.
846.
pulmonary infarction
caused by pulmonary artery embolism Sx: dyspnea, cough, chest pain light microscope: hemorrhagic (red) infarct
pulmonary stretch receptors
myelinated and unmyelinated C fibers in lungs and airways=>reg duration of inspiration and expiration
Pure red cell aplasia associated with
thymoma, lymphocytic leukemias, parvovirus B19 ifxn.
849.
Px of peau d'orange
pitting edema in subcut breast tissue, w/ skin thickening around exagg hair follicles. Neoplastic cells plug dermal lymphatic channels.
850.
Px of platelet sequestration
splenomegaly and platelets low but above 30,000. abnl bleeeding not found
Px of: VHL Von recklinghausens NF 2 Sturge Weber TS OWR
VHL: capillary hemangioblastomas (retina, cerebellum); congenital cysts/neoplasms (kidney, liver, pancreas). inc risk RCC (bilat) NF1: peripheral NS tumor. neurofibromas, optic nerve gliomas, lisch nodules, cafe au lait NF2: bilat CNVIII schwannomas, and multiple meningiomas SW: cutaneous facial angiomas, leptomeningeal angiomas, retard, seizure, hemiplegia, skull radiopacities, skull tram track TS: kidney, liver, pancreatic cysts, CNS (cortical subependymal hamartomas), cutaneous angiofibromas, visceral cysts, renal angiomyolipomas, cardiac rhabdomyomas. OWR: telagiectasias, epistaxis, Gi bleed, hematuria.
pyelonephritis
common organisms: E. coli, S. saprophyticus, P. mirabilis, Klebsiella, Enterococci
847.
848.
851.
852.
Sx: flank pain, costovertebral angle tenderness, fever, chills, hematuria with casts labs: UA and micro show +leukocyte esterase, +nitrites, +bacteria, +WBC, +RBC occasionally, and maybe WBC casts idicating renal-based pyuria; CBC show elevated WBC 853.
Pyridoxine def:
cheilosis, glossitis, dermatitis, peripheral neuropathy
854.
pyruvate decarboxylase
enzyme that catalyzes initial step in gluconeogenesis converts pyruvate to oxaloacetate requires biotin as a cofactor *fxns within the mitochondria
855.
pyruvate dehydrogenase
converts pyruvate to acetyl-Coa for entry into the citric acid cycle coenzymes required: thiamine lipoic acid CoA, FAD, NAD+
856.
QRS complex duration and changes with excercise
.08-.120: slightly reduced durign exercise in respone to inc cardiac conduction veolocity.
857.
radiation and cell death
2 major mech initiating cell death: 1. DNA double strand breakage 2. formation of free radicals=>cause cellular and DNA damage effect is more pronounced in cells that are rapidly dividing bc they have less an ability to repair DNA damage induced by radiation *breakage of both strands gen required to cause cell death bc single strand breaks readily repaired by polymerases acute side effects: damage to epithelial surfaces (e.g., bowel mucosa and skin) characteristic cell death curve of exposure to radiation shows nearly flat line on initial exposure followed by steep increase in amount of cell death as dose of radiation increases *steep portion of radiation induced cell death due to sharp increase in dsDNA strand fractures and formation of free O2 radicals
858.
ras
proto-oncogenet hat codes for membrane-bound G-protein acts as 2° mediator for several hormones and cytokines that act on cell membrane receptors activation activates MAP kinase pathway and ultimately affects transcription
RCC arises from what part of kidney
proximal renal tubule. Pts 60-70 Macro: golden yellow micr: cuiboidal, or polygonal w/ clear cytoplasm.
recommendations for pts with kidney stones
drink lots of water Pyridoxine for hyperoxaluria Low protein diet (dec acid load and dec Ca release -->prevent hypercalciuria and calcium, uric acid stones) Low sodium diet (calcium stones)
relation b/w confidence interval and 'p' value:
if CI does not include 1, 95% CI, then p<.05.
862.
replication of HBV
dsDNA->template +RNA->dsDNA progeny
863.
restrictive cardiomyopathy
associated with: hemochromatosis amyloidosis sarcoidosis radiation therapy
restrictive cardiomyopathy etiology
heart failure due to LV diastolic dysfxn result of ↓ in diastolic LV compliance
859.
860.
861.
864.
diastolic dysfxn=>predominant mech of heart failure in restrictive CMP *may be idiopathic or due to amyloidosis, sarcoidosis, metastatic cancer, or products of inborn metabolic errors result of valine replacing glutamate in HbS
hydrophobic interaction among Hb molecules.
result of valine replacing glutamate in HbS (beta subunit)**
hydrophobic interaction among Hb molecules.
867.
Results acute liver failure:
dec PT, eosinophilia, inc aminotransferase levels
868.
retention cysts
formed if the duct of a gland is obstructed=>traps secretions
869.
retinoic acid receptor
play role in proper differentiation of myeloid precursors
865.
866.
interacts with retinoic acid to effect transcxn of genes required for maturation
870.
retroperitoneal hematomas
commonly assoc with abdominal pelvic trauma develop in up to 1/2 of pts with blunt abdominal trauma frequently caused by direct abdominal blows from malpositioned seat belts or by steering wheels during automobile collisions *pancreatic injury can cause mild Sx or be aSx **abdominal CT scan should be performed in stable pts with blunt abdominal trauma to exclude possible retroperitoneal hematoma ***nonexpanding hematomas in this location Tx conservatively
871.
retroperitoneum
space located behind peritoneal cavity and includes: 1: major vessels: abdominal aorta, IVC and their branches 2. solid organs: pancreas (except tail), kidneys, adrenal glands 3. hollow organs: parts 2 & 3 and a portion of part 4 of duodenum, the ascending and descending colon (secondarily retroperitoneal), rectum, ureters, and bladder 4. vertebral columns and pelvic muscles
Reverse warfarin effect reverse heparin effect
Vit K and fresh frozen plasma (faster) Protamine sulfate (binds heparin causing chemical inactivation)
873.
RF for aortic dissection
HTN and marfans.
874.
RF pathology
interstitial myocardial granulomas/Aschoff bodies typically found in acute RF
872.
Aschoff bodies contain plump macrophages with abundant cytoplasm and central, round to ovoid nuclei with central, slender ribbons of chromatin are Anitschow cells 875.
876.
right coronary artery
gives rise to posterior descending artery=>supplies inferior wall of left ventricle =>forms most of the diaphragmatic surface of the heart
right ventricular overload (cor pulmonale)
presentation: fatigue, dyspnea on exertion, peripheral edema PE: accentuation and splitting of pulmonary component of S2, distended neck veins and hepatomegaly with hepatojugular reflux commonly a consequence of pulmonary HTN or left heart LHF
Risk factors for adenocarcinoma of esophagus?
Barrett's Esophagus, GERD, high fat and calorie diet.
Risk factors for squamous cell ca of esophagus?
Smoking, alcohol, vitamin def, and pickled foods.
879.
Risperidone sfx
antidopaminergic-->hyperprolactinemia->breast tenderness, amenorrhea
880.
Ristocetin factor?
aggregates GP Ib-IX receptor on platelets and makes them available for vWF binding.
881.
Role of p450 monooxygenasae
detox but also activate pro-carcinogens
882.
role of Rb
stop progression of cell cycle from g1 to s (dna pol act and DHF red)
883.
Rx for atropine toxicity
physostigmine. (CNS and peripheral effects)
884.
Rx for hairy cell leukemia? properties
Cladribine. Adenosine analog and not degraded by adenosine deaminase.
Rx for lung abscesses (bacteroides, prevotella, fusobacterium, peptostrepto)
Clindamycin
886.
Rx for narcolepsy :
psychostim (modafinil)
887.
Rx for oral white plaque in infant?
oral candidiasis -- Nystatin (swish and swallow) , not absorbed by GI tract.
888.
Rx for person exposed to heavy isotope
potassium iodide : prevent thyroid abs of radioactive iodine isotopes via competitive inhibition
877.
878.
885.
Rx that reverses toxicity of methotrexate in non-cancerous cells in GI mucosa , BM.
Folinic acid
Rx that treats peripheral neuropathy from DM2 but can cause urinary retention?
TCA (amitriptyline)
Rx to breast cancer and prevent osteoporosis
(SERM) Tamoxifen/Raloxifene. binds Estrogen R and antagonizes. SFX: endometrial cancer, thromboembolic disease
Rx to counteract muscarinic overstimulation due to Cholinesterase inhibitors in MG?
Scopolamine (antimuscarinic)
893.
Rx to treat hirsutism
Spironolactone (antiandreogen prop) Flutamide (inhib Testosterone R) Finasteride (5-alpha red inhib)
894.
Rx with neg chronotropic effects
B blockers, non DH CCB, cardiac glycosides, amiodarone and sotalol, cholinergic agonists (pilocarpine, rivastigmine).
895.
S-100
homodimeric calcium-binding proteins *similar in structure to calmodulin
889.
890.
891.
892.
imp in intracellular fxns like protein phosphorylation and cell growth and differentiation marker for cells of neural crest derivation such as melanocytes, Schwann cells, and Langerhans 896.
S/S of Constrictive Pericarditis?
Elevated JVP, hepatomegaly, ascites. 2/2 Radiation, viral infection, or cardiac surgery.
897.
s/s unique to legionella pneumonia?
1. GI symptoms 2. Hyponatremia 3. Elevated LFT txt: quinolone or macrolide
898.
sarcoidosis
inflamm dz of unknown etiology that leads to development of non-caseating granulomas in many organs and tissues granulomas consists of aggregates of epithelioid cells (activated MØ) and multinucleated giant cells consistent with chronic granulomatous inflamm typical pt: young black woman with non-specific complaints of fever, malaise, and weight loss lung-involvement present in majority of pts and manifests clinically with cough, dyspnea, and chest pain skin-varied in presentation ranging from macules to plaques to erythema nodosum *CXR-essential for Dx stage I-reveals bilateral hilar lymphadenopathy stage II-bilateral hilar lymphadenopathy along with pulmonary infiltrates commonly in upper lobes stage III-lung infiltrates only stage IV-lung fibrosis
899.
Schilling test
helps differentiate dietary deficiency from pernicious anemia and malabsorption as causes of vit B12 deficiency and megaloblastic anemia in dietary deficiency oral radiolabeled vit B12 is absorbed in the gut and excreted by the kidneys in normal amounts normal urinary excretion suggests normal absorption; diminished urinary excretion is a sign of impaired intestinal absorption *normal excretion only after dose given with intrinsic factor is diagnostic of pernicious anemia; of excretion still low then suggestive of malabsorption syndrome
900.
Schilling test
determines cause of abnormal vit B12 absorption used to Dx pernicous anemia=>improved absorption of vit B12 after admin of intrinsic factor is typical
901.
schistocytes/helmet cells
fragmented erythrocytes=>RBCs deformed during mechanical destrxn of erythrocytes in vasculature artificial (mechanical valves) are more traumatic for RBCs than porcine prosthesis=>frequently cause hemolysis also appear if destrxn from narrowing of vascular spaces or disseminated thrombosis
902.
schizo patient on risperidone has breast tenderness, amenorrhea
med is antidopaminergic-->hyperprolactinemia->breast tenderness, amenorrhea
cx of amenorrhea 903.
scleroderma and pulmonary hypertension
pulmonary HTN develops in pts with scleroderma as result of damage to pulmonary arterioles due to increased deposition of collagen manifests with accentuated pulmonary component of 2nd heart sound and signs of rightsided heart failure
Secondary infections following influenza infxn? In elderly?
S. pneumo, S. aureus, H influenza
905.
selective beta blockers
met, aten, esmol, ace (preferred for COPD, asthma pts) Met a 10 w/ a SMALL ASS (being selective)
906.
Selective immunogloblulin def Px
recurrent sinopulm and GI tract infxn due to absence of secretory IgA. recurrent otitis media, sinusitis, bonchitis, pneumonias (encap bacteria). Gi infxns --
Septic arthritis in sxually active and non sexually active
N gonorrhea in sexually active S aureus in non sexually active
seratonin syndrome Antidote
hyperthermia, autonomic instability, muscle rigidity, myoclonus, diaphoresis. (MOAI and SSRI). Antidote: cyproheptadine
serotonin and coronary autoregulation
prod by neuroendocrine cells, platelets, and serotonergic neurons in CNS
904.
907.
908.
909.
little known about vasoactive effects=>has both vasoconstrictor and vasodilator effects 910.
SFx of almost all nitrates
HA and flushing: vasodilation in meninges and skin
911.
sfx of clopidegrel
mouth uclers, fevers (sounds like aspirin but its not if it presents with neutropenia)
912.
sfx of ethambutol
eye....
913.
SFX of TCA
..
914.
shaken baby syndrome
bilat retinal hemorrhages, subdural hematoma.
915.
Sheehan syndrome
high estrogen levels of pregnancy stim growth of pituitary=>enlarge and bc more vascular *sig hypotension (most common cause is postpartum hemorrhage) while still large=>ischemic necrosis=>panhpopituitarism commonly see prolactin deficiency (unable to lactate), hypothyroidism, and hypocortisolism
916.
shiga and shigalike toxin mech
inhibit ribosomal protein synthesis shiga toxin from Shigella shiga-like toxin from EHEC
917.
shiga toxin
causes cell destrxn by inhibiting cellular protein synthesis classic bacterial AB exotoxin with a single A subunit bound to five B subunits A subunit inactivates 60S ribosome of host=>halt protein synthesis=>cell death
918.
shiga toxin and shiga-like toxin
cause inactivation of 60s ribosomal subunit shiga toxin from Shigella shiga-like toxin from enterohemorrhagic E. coli (EHEC)
919.
Shigella
gram- rod bacteria; non-motile, non-lactose fermenting that prod acid causes hemorrhagic diarrhea most common causing shigellosis in industrialized countries is Shigella sonnei; most common in developing nations is flexneri transmitted by fecal-oral route=>never a component of normal bacterial gut flora primarily a pediatric dz but shows predilection for homosexual males and adults in skilled nursing facilities invades GI mucosa, specifically via M cels located in Peyer's patches=>lyses containment vacuole and enters cytosolic compartment=>induce apoptosis of host cell and spread laterally to adjacent cells via protrusions created thru host-cell actin polymerization=>triggers robust host inflamm response largely med by neutrophils (host response the primary cause of diarrhea) releases shiga toxin=>cell destrxn by inhibiting cellular protein synthesis *prod of toxins considered less imp in pathogenesis than cellular invasion bc nontoxigenic strains have been found to cause sig dz
920.
sickle cell trait heterozygotes
have Hb composed of 35-40% Hb S have relative protection from malaria, sickle cell crises, aplastic crises, and sequestration crises by presence of >50% normal Hb A usually aSx but may develop hematuria and a limited ability to concentrate urine; high incidence of UTI and splenic infarction at high altitude have also been reported have normal peripheral smears and indices, reticulate counts, and MCHC values *RBCs will sickle when sodium metabisulfite is added
921.
922.
Side effect of carbamezepine?
Aplastic Anemia
Side effect of Isoniazid?
1.) Peripheral Neuropathy 2.) Hepatitis
923.
Side effects seen with Carbidopa/levidopa?
hallucination, agitation. after several years will see dyskinesea
924.
Signif of Hb A2, Gower, bart
a2d2: 2-5% of Hb in nml adults Gower: zeta2 epsilon2. earliest Hb foudn in fetus (Yolk sac) Bart: 4 gamma. high o2 aff, no release--> hydrops fetalis.
Signs of vertical transmission of HIV from mother to fetus? Prevention?
1st year of life: oral thrush, interstitial pneumonia, severe lymphopenia. Prevention: Zidovudine, AZT (retroviral RT inhibitor) @ 14 wks, and infant 6 weeks postpartum.
silent mutations
when mutations do not alter the AA sequence=>do not alter protein structure
similarity b/w non-small cancer lung carcinoma and CML
NSCLC: inversion of short arm of C2 creating fusion gene b/w EML4 and ALK--> active TK CML: BCR-ABL 9;22 active TK
928.
Sister mary joseph
paraumbilical met of gastric ca
929.
situations that cx sickle cell aggregation
anoxia: low pH, high 2,3 DPG (binds 2 beta chains and stabilizes taut which releases o2). also tissues with high metabolic demand (Brain, muscle, placenta).
930.
SLE
present: combo of malar rash and pleural effusion
925.
926.
927.
assoc with circulating immune complex nephritis; most are ANA+; more specific to SLE is Ab to dsDNA and Smith 931.
Small cell CA markers ***
neuron specific enolase, chromogranin and synaptophysin
932.
Somatomedin C:
IGF-1.
933.
Spath infection has defense protein on PDG wall :
Protein A binds Fc on IgG and prevents complement activation. and impaired C3b.
934.
species that cause enteric bacteremia
E. coli (sepsis) Salmonella typhi (sepsis, typhoid fever) Pseudomonas aeruginosa (sepsis, endocarditits, osteomyelitis) Klebsiella (sepsis) Proteus (sepsis)
935.
spider angiomas
bright red central papule surrounded by several outwardly radiating vessels occur due to dilatation of central arteriole and its superficial capillary network are estrogen-dependent
936.
937.
Spindle shaped cell tumor w/ small-vessel prolif in AIDs paitnet found in Gi tract
kaposi
spironolactone
androgen receptor antagonist used to Tx acne and hirsutism in pts with PCOS
938.
spironolactone
mech: aldosterone antagonist with mild diuretic effects clinical use: K-sparing diuretic endocrine effects: hyperkalemia, gynecomastia, decreased libido, and ED
939.
spironolactone
K+-sparing diuretic anti-andronergic properties: blocks androgen receptors at hair follicles, decreases testosterone prod side effects: gynecomastia and testicular atrophy in men
940.
941.
942.
spoon nails and dysphagia Dx and mech
Fe def anemia. Plummer-vinson esophageal webs. Patternson kelly syndrome.
Sporadic colon cancer mutation steps: Adenoma to carcinoma sequence
APC, K-RAS, p53
ß-blockers and heart failure
↓ cardiac work by slowing the ventricular rate and decreasing afterload (decreasing peripheral resistance) *shown to slow progression of heart failure and reduce all-cause mortality in pts with CHF
943.
ß-hCG production
detectable in maternal serum only after the blastocyst successfully implants=>gen on day 6 after ovulation
944.
ß1-adrenergic receptor
classic G-protein coupled receptor located in cell membrane adenylyl cyclase cleaves ATP to form cAMP=>activates PKA
945.
stages of ATN
initiation stage: ischemic injury precipitated by hemorrhage, acute MI, sepsis, surgery, etc. maintenance stage: anion gap metabolic acidosis, decreased urine output, fluid overload, increasing Cr/BUN, hyperkalemia (>6.0 mEq/L will cause probs); hyperphosphatemia; muddy brown casts, low urinary osmolarity (<350) recovery phase: gradual increase in urine output leading to high-vol duresis; dehydration; electrolyte abnormalities may include decreased concentrations of K, Mg, PO4, and Ca due to slowly recovering tubular fxn *hypokalemia one of the most serious complications can be caused by aminoglycosides
946.
staging
refers to how much the tumor spreads into adjacent tissues and distant organs most tumors are staged by the TNM system: size or primary tumor involvement of regional lymph nodes presence of distant metastases
947.
Staphylococcus aureus and bacterial endocarditis
causes acute bacterial endocarditis with rapid onset of Sx: shaking chills (rigors) high fever dyspnea on exertion malaise *in IVDU causes RH endocarditis with septic embolization to lungs=>pulmonary abscesses *in non-IVDU causes rapid decompensation, heart failure, sepsis, septic embolization to brain and other end organs
948.
statin
competitively inhibit HMG CoA reductase, the enzyme that converts HMG CoA to mevalonate (rate-limiting step in hepatic cholesterol synthesis); increases LDL receptors effects: lowers cholesterol and directly stabilizes atheromatous plaques commonly prescribed to pts who have suffered an MI bc sig decrease both incidence of 2nd MI and mortality side effects: hepatotoxicity and myopathy common; myositis=>increases creatinine kinase when high doses used; myalgias more common Sx and not assoc with rise of creatinine kinase *risk increased when combined with fibrates and/or niacin
949.
statins
decrease cholesterol by inhibiting enzyme HMG-CoA reductase (imp for hepatic cholesterol synthesis) increase LDL receptor activity on hepatocytes produce modest reduction in serum TG *pts with marked hypertriglyceridemia Tx with high-dose statins have sig TG reduction (up to 20%)
950.
steps in base excision repair
Glycosylase (cleaves altered base) Endonuclease (5' cleaved ) Lyase (3' cleaved) DNA pol and ligase fill gap.
951.
steps of tumor cell invasion
1. Down regulate E-cadherin (detachment) 2. Adhere to basement membrane via laminin , etc 3. invasion via metalloproteinases, cathepsin D protease
952.
stop codons
UGA UAG UAA *mutations producing abnormally placed stop codons are called nonsense mutations=>premature termination of protein synthesis and formation of truncated protein molecule
953.
strawberry (infantile) hemangiomas
appear during first weeks of life initially grow rapidly then frequently regress spontaneously by 5-8 years of age bright red when near epidermis and more violaceous when deeper
954.
Streptococcus bovis and bacterial endocarditis
part of normal flora of colon *bacteremia or endocarditis by S. bovis associated with colonic cancer
955.
Streptococcus viridians and subacute bacterial endocarditis
most common etiologic agent in SBE following dental work *most frequently in pts with preexisting valvular abnormality like rheumatic heart dz or congenital heart malformations
956.
957.
958.
strongloydes in GI and stool
GI: both forms Stool: larva only
Structural alteration of enzymes inovlved in RNA synthesis
DNA-dependent RNA polymerase -- mech of rifampin resistance.
Subperiosteal reabs w/ cystic degen Unmin osteoid persistant primary, unmin spongiosa in medullary canals.
hyperparathyroidism Vit D def osteopet
959.
960.
Succhynil choline phase I and II and how to reverse it?
phase I: depol and paralyze train on four equal. Phase II: depol and dec train en four reverse with neostigmine in phase II. Augments in phase I.
succinate dehydrogenase
enzyme of TCA cycle that fxns to convert succinate to fumarate inner mitochondrial membrane protein fxns as part of electron transport chain
961.
sucralfate
binds base of mucosal ulcers=>provide physical protection against acid
962.
sulfasalazine
5-aminosalicylate=>inhibit prostaglandin and leukotriene synthesis during inflamm clinical use: Crohn's dz, ulcerative colitis
Superantigens that interact with MHC to give widespread release of CK
enterotoxins, exfoliative toxins, TSST-1
Superior laryngeal nerve branches and innervation Recurrent laryngeal n inner
SLN: ext -->cricothyroid m; int-->sensory above vocal cords RLN: all laryngeal m except cricothyroid. Sensory inn below vocal cords
Superior orbital fissure Rotundum (face is round) ovale spinosum (assoc w/ epidural hematoma) internal acoustic meatus Jugular foramen hypoglossal foramen magnum
III,IV,V1,VI V2 (maxillary-mid face) V3 (mandibular-open mouth like an oval) middle meningeal A/V VII,VIII IX,X,XI (jug V.) XII XI, brain stem, vertebral A.
supine hypotension in pregnant woman:
compression of inferior vena cava-->dec venous return and cardiac output
suppression of xol 7alphahydroxylase activity
Fibrates cause this. -->reduce conversion of xol to bile acids-->excess xol secretion in bile.
968.
systemic lupus erythematosus
present: young woman complaining of rash on malar prominences ("butterfly rash"), phosensitivity, malaise, anorexia, and arthralgias
969.
Systemic mastocytosis
Mast cell proliferation in BM and other organs. -->inc pdtn of gastric acid in parietal cells. N/V/cramps, gastric ulcers.
970.
systolic heart failure
characterized by ↓ in ventricular contractile performance = ↓ EF
963.
964.
965.
966. 967.
requires ↑ in LVEDP to create abnormally high LVEDV and achieve near-normal stroke vol *↑ seen in both LVEDP and LVEDV 971.
T3, rT3, T4
T4 converted to T3 or rT3 (inactive). T3 cannot be converted into anything else.
972.
Tachyphylaxis and examples
Vasoctxn by a-adrenergic agonists (Phenylephrine, xylometazoline, oxymetazoline) use >3 days causes dec NE synth. Nitroglycerine also dec release of NO (need drug free interval of 8-10h)
973.
tamoxifen
acts as antagonist or partial agonist of estrogen receptor=>depending on tissue type breast tissue: antagonizes estrogen receptor=>used as adjuvant therapy for estrogen receptor+ breast cancer bone: partial agonist endometrium: partial agonist CV tissue: partial agonist *assoc with side effects such as DVT, thromboembolism, and endometrial cancer
974.
975.
TB drug that actts intracel , extra?
intra: pyrazinamide (acidic environment activation) extra: isoniazid, rifampin
TCA sfx
Tri C's: convulsion, coma, cardiotox (arrhythmia). Tx: NaHCO3 for CV tox Inhib fx: Central &periph M Ach R -->tachy, delirium, dilated pup, flushing, dec diaph, hyperther, intestinal ileus, urin reten periph a-1 adre R->periph vasodil (orthos hypoTN) Cardiac fast Na ch-->conduc defect, arrhyth, hypoTN H1 R->sedation presyn NT (NE, 5-HT) reuptake->seiz, trem
976.
TCR DNA rearrangement
results in XS 10^15 diff possible Ag binding sites similar to immunoglobulin gene rearrangement in that it involves joining of V, D, J and C regions of the TCR gene and the processes of the junctional flexibility, N and P-region nuceotide addition, alternative joining of genes, and multiple peptides combining to form the intact receptor mature TCR is formed from joning of an a and a b protein segment=>these proteins are membrane-bound in close assoc with either CD4 or CD8 as well as the costimulatory CD28 and CD45
977.
temporal (giant cell) arteritis
characterized by granulomatous inflamm of media most common form of vasculitis in adults *typically develops in pts above age 50 causes headache, facial pain, jaw claudication, and visual loss
978.
terbanifine
inhibits fungal enzyme squalene-2,3-epoxidase=>decreased synthesis of ergosterol clinical use: dermatoophytoses side effects: accumulates in skin and nails
979.
980.
tests for treponema pallidum
RPR or VDRL (screening) then confirmatory test (FTA-ABS uses Ab)
Tetralogy of Fallot
caused by abnormal migration of neural crest cells thru the primitive truncus arteriosus and bulbus cordis Tetralogy of Fallot, transposition of the great vessels, and truncus arteriosus are three major cyanotic heart dzs also caused by this abnormal migration
981.
Theophylline intox
seizures, tachycardia
982.
983.
Thiamine deficiency associated with ___ in infants and __ IN ADULTS:
beriberi in both as well as Wernicke-Korsakoff in alcoholics. Infants (2-3mo): fulminant cardiac syndrome w/ cardiomegaly, tachycardia, cyanosis, dyspnea, vomiting. Adult beriberi: dry or wet. Dry- sym periph neuropathy w/ sensory and motor impairments (distal). Wet: cardiat (cardiomegaly, cardiomyopathy, CHF, peripheral edema, tachycardia).
thiazide diuretics
used to Tx edema 2° to heart failure, renal dz, and liver dz common side effects: hypokalemia, hypomagnesemia less common side effects: hypotension, vol depletion, hypercalcemia, hyponatremia
984.
thigh claudication
suggestive of occlusive dz of ipsilateral external iliac or common femoral arteries and/or both superficial femoral and profunda femoris arteries aortoiliac atherosclerosis can diminish blood flow to internal pudendal branches of the internal iliac artery=>difficult to sustain erection
985. 986.
987.
988.
thrombin time (TT)
prolonged by heparin and drugs that directly inhibit thrombin formation
thromboangiitis obliterans (Beurger disease) risk factors
smoking-assoc vasculitis of medium and small-sized arteries *principally tibial and radial arteries
Thyroid binding globulin: role and regulated by
Inc TBG --> inc circulating total T4, adn total T3. But free thyroid hormone is nml. Inc lvls in pregnancy, oral contraceptives, Hormone rep. tx.
ticlopidine and clopidogrel
inhibit ADP mediated platelet aggregation useful following PCI and for Tx of unstable angina and non-Q wave MI
time on insulin action
starts at .5h, peak at 2-4. last 5-8h
time to reach stead state concentration in drug elim by 1st order kinetics
4-5 half lives.
toxic megacolon and dx
plain film: presents with fever, bloody diarrhea, abdomina distenion. It is distended and tender abdomen.
toxin responsible in miningicoccemia
Meningococcal lipooligosacchardie
993.
Toxins of C diff
A: attaches to cell membrane B: actin depolymerization -->loss of cellular cytoskeleton integrity
994.
toxins of c diff
enterotoxin A: watery diarrhea cytotoxin B: colonic epithelial cell necrosis & fibrin deposition
995.
toxoplasma infection
causes mononucleosis-like illness in immunocompetent hosts and CNS involvement in immunocompromised pts
996.
Transcobolamin II def
B12 carrier-->hyperseg PMN but no illness
997.
Transformation
take up naked DNA form environment (aka competence) SHiN
998.
transketolase
enzyme of PPP
989. 990.
991.
992.
uses thiamine (vit B1) as a cofactor 999.
transmembrane ion channels
selectively allow certain ions to pass into or out of the cell=>facilitate formation of voltage gradient across cell membrane participate in formation of urine, nerve and myocyte depol, muscle contraction, sweat formation, and exocrine secretion formation
1000.
Transmission of vibrio parahemolytics
contaminated shellfish
Transmural inflammation w/ fibrinoid necrosis. Fever, malaise, weight loss, abdominal pain, melena.Muscle aches. Dx?
PAN associated with hep B infection.
1002.
Treatment for acute dystonia?
Anti-histamines and Dopamine Agonists (benztropine or trihexyphenidol)
1003.
Treatment for Akathesia?
Feeling of restlessness Beta Blockers
1004.
Treatment for Cat Scratch Disease?
Usually self-resolves. But Azithromycin can speed recovery.
1005.
Treatment for Immune thrombocytopenia?
Self-resolves--->observe. If platelet count falls below 30,000 treat with Corticosteroids.
1006.
triamterene
mech: blocks Na channels in DCT and CD=>increased Na and fluid excretion
1001.
clinical use: K-sparing diuretic triple test
preformed at weeks 16-18 of gestation
Triple Test Elevated AFP: Dec AF:
High: multiple gestation, neural tube defects (spina bifida, anencephaly), abdominal wall defect. Low: DS (dx w/ karyotyping).
1009.
tRNA contains :
pseudouridine, thymidine etc. and CCA end
1010.
true diverticula of esophagus
result of scarring and traction of the esophagus
1007. 1008.
usually seen in mid-portion of esophagus and result from mediastinal lymphadenitis (tuberculosis, fungal infxns) 1011.
Trypanosoma Cruzi
transmitted by reduviid bug causes Chagas's dz prod neurotoxin that destroys myenteric plexus and causes intramural, parasympathetic denervation of smooth muscle esophagus: incapacitates lower esophageal sphincter=>food gets "stuck" in esophagus *proximal to this esophagus is markedly dilated sigmoid colon: megacolon ureter: megaureter
1012.
Tryptase: marker for
mast cell activation
1013.
tuberculosis
presents with malaise, weight loss, low-grade fever and cough CXR: patchy or nodular infiltrates, cavities, or calcified nodules PPD test and sputum culture are used for Dx histo: caseating granulomas
1014.
tumor marker for liver angiosarcoma?
cd31 (endothelial cell marker)
1015.
Turner's syndrome
diminished femoral pulses compared to brachial pulses, Sx of inadequte perfusion of lower extremities during ambulation, and enlarged intercostal arteries in child/young adult =>typical of adult-type congenital coarctation of aorta assoc with coarctation of the aorta in girls
Two major causes of hematuira after upper respiratory tract infection?
1. IgA neprhorpahty- normal complement levels 2. Post-strep GN- complement levels low
1017.
Tx Fe poisoning
Deferoxamine : chelating agent used to tx Fe poisoning (transfusion)
1018.
Tx for acute mania
Lithium, valproate, carbamazepine
1019.
tx for aresenic poisoning
dimercaprol: chelating agent . displaces arsenic ions form sulfhydryl groups on enzymes (cellular metab). Toxicity of dimercaprol: nephro and HTN
1020.
tx for bradycardia post IM
Atropine. dec vagal influence on SA, AV node SFX: intraocular pressure -->acute-closed angle glaucoma.
1021.
tx for bradycardia post MI
Atropine. dec vagal influence on SA, AV node SFX: intraocular pressure -->acute-closed angle glaucoma.
1022.
tx for chronic hep C:
interferon a and ribavirin Ribavirin MOA :(multifocal) Inhib RNA pol & IMP DH (depleting GTP); Defective 5' cap formation on viral mRNA txn; Modulating better immune respnse
1023.
Tx for CMV in HIV
ganciclovir. greater aff against CMV DNA polymerase
1024.
Tx for CNS toxo?
Pyrimethamine, and sulfadiazine
1025.
Tx for crypto
Amp B, flucytosine
1026.
Tx for fainted diabetic?
IM glucagon (IM glucose not practical)
1027.
Tx for gestational GDM
diet, excercise. Insulin when those fail.
1028.
Tx for graves opthalmopathy
HD glucocorticoids
1029.
tx for h pylori
2 ABx w/ adj agent (metronidazole, tetracycline, amox, clarithro) w/ (PPI, Bismuth) 14 d.
Tx for hemorrhagic cystitis during therapy by cyclophosphamide or ifosfamide (caused by toxic metabolite acrolein)
Agressive hydration, bladder irrigation, administration of mesa (sulfahydryl compoudn that binds to acrolein in urine)
1031.
tx for inc VLDL (hypertriglyceridemia)
Fibrates and nicotinic acid tx
1032.
Tx for lyme's
doxycycline or penicillin-type Abx (ceftriaxone)
1033.
Tx for organophosphate tox
Atropine (reverses muscarinic effects) but not effects of nicotic R. Pralidoxime-- reverses both by restoring cholinesterase.
Tx for pts w/ dec libido, anorgasmia and inc latency to ejac taking SSRI (alternative)
bupropion
1035.
tx for trigeminal neuralgia
carbamazipine
1036.
tx lead and mercury poisoning
CaNa2EDTA: complexes w/ mono, di, tryvalent ions
1037.
Tx of acetaminophen and mx
Nacetyl cysteine --: provides sulfhydryl groups.
1038.
Tx of cyanide poisoning
Sodium thiosulfate
1039.
tx of cyanide poisoning
amyl nitrate: forms methemoglobin that bidns to CN- -->cyanomethemoblogbin
1040.
tx of drug induced parkinsonism
benztropine and amantidine Benztropine and trihexyphenidyl avoided in eldery (BPH, glaucoma)
1041.
Tx of DVT in pregnancy?
heparin. Warfarin (main tx is CI)
1016.
1030.
1034.
1042.
Tx of N. meningiditis. Prof?
Penicillin. Prof: rifampin or ceftriaxone (only ones that can eliminate from nasal).
1043.
Tx of N. meningiditis. Prof?*
Penicillin. Prof: rifampin or ceftriaxone (only ones that can eliminate from nasal).
1044.
Tx that block radioactive iodine tx?****
Anion inhibitors (perchlorate, pertechnetate) block Iodide abs by thyroid gland via competitive inhibition. Thionamides (methimazole and propylthiouracil) dec formation of thyroid hormones by inhib thyroid peroxidase. Iodide salt inhib synth as well as release of thyroid hormones. PTU also dec peripheral conversion of T4 to T3
Tx to prevent GBS in child? Consequences of not treating?
intrapartum antibiotic prophylaxis. GBS -->sepsis, pneumonia, meningitis.
1046.
Txt for Constrictive Pericarditis?
Diuretics or Pericardiectomy
1047.
Txt for disc herniation?
1. Mobilization-make sure pt moves around 2. NSAIDS
1048.
Txt for Essential Tremor?
First line is Propranolol. Can also try Primodine or Topirimate.
1049.
Txt for Pneumonia in a CF patient?
Most likely Pseudomonas. txt with Cephalosporin/Penicillin + aminoglycoside.
1050.
txt for tinea corporis?
tebinafine (topical) griseofulvin ( systemic) Pts with extensive disease should be investigated for conditions that may cause immunosuppresion
1051.
Txt for toxic megacolon?
1. IV steroids 2. NG decompression 3. fluids
1052.
Txt of choice for fibromuscular dysplasia?
agioplasty with stent
Txt of choice for hyperthyroidism induced atrial fibrillation?
Beta Blockers
1054.
type of renal injury associated with NSAIDS
papillary necrosis and chronic intersttial nephritis
1055.
tyrosine kinase receptors
gen mediate effects of hormones that promote anabolism and cell growth
1045.
1053.
ex) insulin, insulin-like growth factor 1, epidermal growth factor, platelet-derived growth factor 1056.
ulcer in descending duodenum
zollinger ellison
1057.
urea filtration
filtered at glomerulus passively reabsorbed in PCT and inner medullary collecting ducts passively secreted by TDL *everywhere else urea is impermeable
1058.
urethritis
common organisms: N. gonorrhoeae, C. trachomatis Sx: pain or burning sensation during urination, urgency or frequent urination labs: UA shows +WBC
1059.
Use and MOA of FA oxidation inhibitors
inhibit FA ox and shfit energy pdtn to glucose oxidation--> promoting oxgen efficiency. Dec amt of oxygen needed to support cardiac fxn, and dec potentially toxic FA metabolic pdtn.
Use of chloroquine? other drug added, why?
eradicates plasmodia from blood stream but not latent hepatic infections (P vivax, P ovale) Primaquine to prevent relapse.
1061.
Use of rifampin:
prophylaxis of those exposed to N meningitidis. Multidrug tx for typical and atypical mycobacgerial pulm infxn, leprosy, staph endocarditis.
1062.
uterus epithelium
simple (pseudostratified) columnar
1060.
charac: contains tubular glands; divided into fxnal and basal layers; undergoes cyclic changes assoc tumors: endometrial CA 1063.
UTIs
most commonly caused by E. coli=>80% or more of cases; rest of cases in sexually active women are caused by Staphylococcus saprophyticus *most often due to invasion by enteric coliform bacteria that inhabit periurethral vaginal introitus and ascends to bladder via urethra Tx: 3-day course of fluoroquinolone or TMP-SMX **Sx of fever, chills and flank pain should alert physician to possibility of pyelonephritis
1064.
1065. 1066.
UV blocked by PABA esters
UVB--cx UV radiation (sunburn), histologic skin damage and UVRinduced immun supp, skin photoaging, photo carcigenosis.. No block from UVA.
UV damage
pyrimidine dimers -endonuclease (repair by nicking strand @ thymine dimer)
UV-specific endonucleases
specifically detect abnormalities in DNA structure caused by formation of DNA photoproducts then excise defective region causes nicks at damaged sites to be later excised by 5' to 5' exonuclease activity of DNA polymerase=>also synthesizes new DNA in place of damaged DNA *lack of this enzyme results in condition known as Xeroderma Pigmentosum
1067.
1068.
1069.
1070.
Vaccination for C diptheriae
Dipth toxoid --> induces IgG against toxin B. Prevents AB toxin damage of neuro and cardiac organs.
vaccine for n meningitidis
Capsular polysaccharides (four major serotypes)
Vaccine that's conjugated with Dipth toxoid?
Hib
vaccines and immunology
gen principle dictates that local secretory Ab synthesis is best promoted when specific mucosal surfaces are directly stim by Ag when both live and killed vaccines applied to mucosal surface the live attenuated viral vaccines are more effective of two in gen prolonged mucosal IgA secretion
1071.
vagina epithelium
nonstratified squamous non-keratinized charac: contains glycogen assoc tumors: squamous cell CA
1072.
1073.
varenicline
Partial agonist of nicotinic AchR. Competes with nicotine to prevent binding. Limited release of dopain (less reward). assist in tobacco cessation - reduce cravings and attenuate reward effect of nicotine.
ventricular septal defect murmur
holosystolic murmur
1074.
verapamil
non-dihydropyridine Ca2+ channel blocker=>slow conduction thru AV node *most effect on heart out Ca2+ channel class and potent neg inotrope clinical use: rate control in AFib anti-anginal medication antihypertensive most frequent adverse rxns: constipation gingival hyperplasia bradycardia 1st/2nd/3rd degree AV nodal block
1075.
verapamil specificity
skeletal muscle is resistant to effect of Ca2+ channel blockers bc it doesn't require an influx of extracellular Ca2+ for excitation-contraction coupling cardiac and smooth muscle depend on extracellular Ca2+ entering cell via voltagegated L-type Ca2+ channels for excitation-contraction coupling=>target of verapamil and other Ca2+ channel blockers
1076.
Vibrio cholerae
produces cholera toxin=>AB toxin A-activate adenylate cyclase thru G-protein=>increased transport of Na+ and Cl- out of gut mucosal cell and decreased sodium and chloride reabsorption=>free water loss into gut lumen=>water diarrhea
1077. 1078.
Viral cells and binding R
CD4 and HIV gp120; CD21 and EBVgp350; erytrocyte antigen and parvovirus B19
viral myocarditis and cardiomyopathy type
dilated CMP systolic dysfxn the main mech of heart failure
1079.
Virchow's nod
stomach met to left supraclavicular sentinel node
1080.
Viridans needs to attach to
fibrin-platelet aggregates.. Then it creates extracel polysacc (dextrans) w/ sucrose as a subtrate
1081.
Viridans streptococci
viridians streptococci produce dextrans from glucose that aids in colonizing host surfaces such as dental enamel and heart valves
S. mutans and S. sanguis cause subacute bacterial endocarditis most classically in patients with preexisting cardiac valvular defects after dental manipulation=>why antibiotic prophylaxis used prior to dental work in patients with valvular abnormalities 1082.
1083.
1084.
1085.
1086.
virilization
hirsutism clitoromegaly increased muscle mass acne increased libido voice deepening
Virion and cellular receptor: CMV, EBV, HIV, Rabies, Rhinovirus
cellular integrins, CR2, CD4&CXCR4/CCR5, nAch, ICAM1 (CD54)
Virus part that forms spheres and tubules 22nm in diameter:
Envelope component of Hep B virus (HBsAg). Correlates poorly with viral replication.
Vit B2 def: (riboflavin) cheilosis, stomatitis, glossitis, dermatitis, corneal vacularization, arioboflavinosis
...
vit b12:
pernicious anemia, smooth tongue, atrophic glossitis, shuffle broad based gait.
1087.
Vit c def
hemorrhage, bleeding into jiont space, gingivl swell, imapired wound healing, weak immune response
1088.
Vit C mx
hydroxylation of prline adn lysine residues in pro-collagen deficiency: perifollicular hemorrahage, bruise, gum. Children-bony deform, subperiosteal hemorr
1089.
Vit K and CF
dec fatty vit abs. Vit E -->protect FA from oxdiation (so dec levels-->ox injury of axons and erythrocytes). Dorsal column..
vitamin A deficiency
characterized by: night blindness xerophthalmia=no tear prod vulnerability to infxn=>esp measles
vitamin B1 (thiamine) deficiency
associated with infantile and adult beriberi as well Wernicke-Korsakoff syndrome in alcoholics
vitamin B2 (riboflavin) deficiency
characterized by: cheilosis stomatitis glossitis dermatitis corneal vascularization ariboflavinosis
vitamin B6 (pyridoxine) deficiency
characterized by: cheilosis glossitis dermatitis peripheral neuropathy
vitamin B12 (cobalamin) deficiency
frequently associated with pernicious anemia
vitamin C (ascorbic acid) deficiency
characterized by scurvy: hemorrhages bleeding into joint spaces gingival swelling impaired wound healing weakened immune response to local infxns
vitamin C and iron
enhance absorption of inorganic iron in GI tract
W/u for diarrhea, and fatty stool
stool sample *sudan III stool stain to id fat in stool. CC: pancreatic exocrine insuff, intestinal mucosal defects, bacterial prolif
wall of mycoplasma org?
no PDG
warfarin
inhibits vit K depending-carboxylation of glutamic acid residues of clotting factors II, VII, IX, and X; also of anticoagulant proteins C and S
1090.
1091.
1092.
1093.
1094.
1095.
1096.
1097.
1098.
1099.
classic presentation: older, mentally slow woman of northern European descent who is "lemon colored" (anemic and icteric), has a smooth shiny tongue indicative of atrophic glossitis and demonstrates shuffling broad-based gate
inhibition of protein C can predispose pts to warfarin-induced skin necrosis=>typically occurs during first week *activity of protein C reduced to 50% within one day along with factor VII while other procoagulant vit K dependent factors decline as slower rate (II, IX, X)=>risk increases in pts already deficient in protein C and S=>paradoxical thrombosis 1100.
warfarin hematoma RF
inc age, DM, HTN, alcoholism
1101.
Warfirin induced lesion?
Protein C or S def.
1102.
Wegener's granulomatosis
present: URT (sinusitis, nasal ulceration), LRT (hemoptysis), and kidneys (RPGN)=>can develop ARF IF: pauci-immune assoc with c-ANCA
1103.
Wegener's granulomatosis
systemic vasculitis of small and med-sized arteries presents with involvement of URT (sinusitis, nasal obstrxn, epistaxis, otitis), lungs (hemoptysis), and kidneys (rapidly progressing glomerulonephritis) *presence of cANCA is typical
1104.
1105. 1106.
1107.
1108.
1109.
1110.
1111.
1112.
1113.
1114.
What are Howell-jolly bodies and what is their significance?
they are the nuclear remnants of RBC's which are normally removed by the spleen. if present it means the spleen isn't working
What are Marjolin Ulcers?
Squamous Cell ca arising from burn wounds
What are pts with hyperthyroidism at risk for if left untreated?
1. bone loss - increased osteoclastic activity 2. arrhythimias- like a. fib
What are some causes of restrictive cardiomyopahty? And which can be reversed with txt?
1. Hemochromoatosis 2. Amyloidosid 3. Sarcoidosis 4. Scleroderma **Hemoochromatosis only one that can reversed with txt- phelbotomy
What are some of the causes of bloody diarrhea with fever?
1. Shigella 2. Campylobacter 3. Salmonella
what are some of the feared complications of Mononucleosis?
1. Autoimmune hemolytic anemia 2. Splenic rupture
what are some of the presenting symptoms of HIV in infants?
1. thrush 2. lymphadenopathy 3. hepatosplenomegaly **serologic testing is not useful for HIV testing in nenoates use PCR, viral culture or P24 antigen testing.
what are some of the s/s of Vitamin B2 riboflavin def?
1. red and swollen oropharyngeal mucous membranes. 2. cheilitis 3. stomatitis 4. glossitis 5. seborrheic dermatitis 6. photophobia
what are the absolute indications for starting dialysis?
1. Fluid overload not responsive to medical txt 2. Hyperkalemia not responsive to medical managment 3. Uremic pericarditis 4. Refractory metabolic alkalosis
What are the absorption conditions that cause decreased B12?
1. Pancreatic insufficiency 2. Short gut syndrome 3. Bacterial overgrowth
what are the causes for exudative effusions?
1. Infection 2. Malignancy 3. PE 4. connective tissue disease 5. iatrogenic causes.
1115.
what are the causes of euvolemic hyponatremia?
1. SIADH 2. Psychogenic polydipisa 3. Hypothyroidism
1116.
what are the causes of hypervolemic hyponatremia?
1. CHF 2. Cirrhosis 3. Chronic Kidney Diseae
1117.
what are the causes of hypovolemic hyponatremia?
GI losses: diarrhea, vomiting Renal losses: diuretics, **decreased volume leads to increase in renin, angtiotensin, and ADH
1118.
What are the causes of Pulsus Paradoxus?
1. Cardiac Tamponade 2. Tension Pneumothorax 3. Severe asthma
1119.
What are the characteristics of a pt with TCA overdose?
Hypotension CNS depression hyperthermia and anti-cholingerics effects
1120.
What are the common causes of exertional syncope?
1. Ventricular tachycardia 2. Hypertrophic cardiomyopathy 3. Aortic Stenosis
1121.
What are the complications associated with measles?
early: vitamin A deficiency, pneumonia, and bronchiectasis
What are the contraindications for radioablation therapy for Grave's Disease?
1. Pregnancy 2. Severe Ophthalmopathy
1123.
What are the contraindications of Triptans?
1. familial hemiplegic migraine 2. uncontrolled hypertension 3. pregnancy 4. CAD 5. Prinzemetals angina 6. ischemic stroke 7. basilar stroke
1124.
What are the contraindications to breastfeeding?
1. Active drug abuse 2. TB 3. HIV
1125.
What are the diagnostic features of CLL?
extreme leukocytosis with predominant leukocytes smudge cells
1126.
what are the dietary recommendations for pts with renal calculi?
1. Decrease protein and oxalate 2. decrease sodium intake 3. increase fluid intake 4. increase calcium intake
what are the different areas that a tumor in the superior sulcus in the lung affect?
1. Horner's- compress sympathetic trunk 2. Pancoasts 3. Compress recurrent laryngeal nerve- Hoarenss 4. Sup. vena cava
What are the exrahepatic sequalie of pt with Chronic Hepatitis C?
1. Cryoglobinuria 2. Porphyria cutanea tarda 3. Glomerulonephritis
what are the indications for chest tube placement with regards to pleural fluid findings?
pH < 7.2 or Glucose < 60 suggest epmyema
1122.
1127.
1128.
1129.
1130.
what are the indications for ECT?
1. severe depression 2. depression in pregnancy 3. catatonic schizophrenia 4. refractory mania 5. neuroleptic malignant syndrome
1131.
What are the indications for O2 therapy in COPD?
1. PaO2 < 55 2. SO2< 88% 3. Evidence of cor pulmonale 4. Hematocrit > 55%
1132.
What are the indications for txt of chronic hepatitis C?
1. Elevated ALT levels 2. Presence of HCV RNA 3. moderate grade based on histiologic findings **Txt with double combination of Interferon alpha and ribavarin. If pt has normal ALT levels then no txt is required. If pt has mild disease txt with monotherapy with just interferon alpha.
What are the lab findings in a pt with gallstone trapped in common bile duct?
1. Jaundice 2. Very high Alk. Phophatase
1134.
What are the lab findings in primary hyperparathyroidism?
Increased Calcium Normal or increased PTH
1135.
What are the major extra-renal manifestations of APKD?
1. heptic cysts 2. heart valve disease 3. colonic diverticuli 4. abdominal wall and inguinal hernia
What are the most common organisms responsible to otitis media and what is txt?
1. Strep. Pneumo. 2. Non typeable H. influenza 3. Moraxella Catarrhalis txt: 10 day course of Amoxicillin
1137.
What are the rate controlling drugs for A. Fib?
Rate control + anti-coag. preferred. Diltizaem Metoprolol Verpamil Digoxin
1138.
What are the risk factors for uterine atony?
1. Overdistention of uterus ( fetal macrosomia, multiparity) 2. Uterine fatigure 2/2 prolonged labor
1139.
What are the s/s of Beta blocker toxicity and what is the txt?
Wheezing, bradycardia, hypotension First give Atropine and IV fluids then give Glucagon
1140.
What are the s/s of theophylline toxicity?
1. CNS toxicity 2. GI disturbance 3. Cardiac distrubance Ciproflxoain and Erythromycin decreases its clearance
1141.
What are the sequlae associated with Aortic Dissection?
1. Cardiac tamponade 2. Aortic regurg. 3. Stroke 4. Renal failure
1142.
What are the side effects of Amiodarone?
1. hepatotoxicty 2. thyrotoxic 3. pulmonary toxic 4. Corneal deposits 5. skin changes
1133.
1136.
What are the three most common organisms that cause pneumonia in patients with CF?
1. Heamophillus 2. Pseudomonas 3. Staph.
1144.
what are two risks associated with Tamoxifen use?
1. Endometrial cancer 2. Venous Thrombosis
1145.
What can cause inc K excretion?
High extracell K levels Inc aldosterone Alkalosis Inc fluid vol (vol exp, high Na intake, diuretic)
1146.
what causes a syncope with clonic jerks?
arrhythima-clonic jerks 2/2 brain hypoxia
What causes decreased breath sounds immediately after intubation?
Endotracheal intubation into main stem bronchus
1148.
What causes exopthalmos in Graves disease?
Lymphocytic infiltration of EOM
1149.
What causes Foot Drop?
Peripheral neuorpathy 2/2 damage to Common Peroneal nerve or levels L4-S2.
1150.
what causes smooth round cysts in liver with daughter cells in it?
Sheep breeder 2/2 Echinococcosis
what causes thrombocytopenia 2/2 antibody production against platelets?
ITP
what causes thrombocytopenia 2/2 platelet activation and consumption?
1. DIC 2. TTP 3. HUS
1153.
what causes thrombocytopenia is Wiskott-Aldrich syndrome?
x-linked disorder decreased platelet production
1154.
what cells does Shigella invade first?
M cells of peyer patches (ileum) through endocytosis
What conditions are pts with Nephrotic syndrome at increased risk for?
1. Hypercoaguable 2. Increased atherosclerosis increased risk for stroke or MI
what disease can the use of Primidone for essential tremor precipitate?
Acute intermittent porphyria: check urine porphobiliinogen levels- abd. pain, neuro, and psych. abnormalities
What disorders are associated with FSGS?
1. Obesity 2. HIV 3. Heroin use More common in African Americans
what do you suspect when newborn presents with failure to thrive, bilaterla cataracts, jaundice, convusionls and hypoglycemia?
Galactosemia-deficiency in galactose 1 phopshate uridyl transferase deficiency.
1159.
What does a positive straight leg test suggest?
Herniated disk
1160.
What does elevated transaminase levels indicate?
Ongoing hepatocyte damage as enzymes leak from cells.
1161.
What does it mean if someone says Anion Gap Metabolic Acidosis?
MUDPILES
1162.
What does Leukocyte esterase signify?
Significant Pyuira
1163.
What does nitries in urine signify?
Presence of enterobacteriacae
What does one see on histo. of a pt with Reyes syndrome and what is the txt?
Fatty valculoization of the liver without inflammation txt: glucose with FFP and mannitol to decrease cerebral edema
What does pain to palpation of the back suggest?
1. infection 2. lytic lesion
1143.
1147.
1151.
1152.
1155.
1156.
1157.
1158.
1164.
1165.
1166.
What does the Femoral nerve innervate?
Motor: Knee extension and hip flexion Sensory: anterior thigh and medial leg via saphenous nerve
1167.
What does the presence of bilirubin in the urine suggest?
Conjugated bilirubinemia
what drugs are assoicated with medication induced body fat distribution characterized by redistr of fat form extremeities to abd viscera and subcut adip tissue of thorax, post neck adn supraclav region
HIV-1 protease inhib and GC
1169.
what drugs should be avoided in prinzmetal's angina?
Beta blockers and Aspirin they can cause vasoconstriciton
1170.
What electrolytes are typically low in chronic alcoholics?
1. Hypokalemia 2. Hypomagnesium 3. Hypophosphatemia
1171.
what fractures injure deep brachial a, brachial a
midshaft fracture, supracondylar fracture
1172.
What happens when a patient takes exogenous steroids for a disease?
They suppress the secretion of CRH from the hypothalamus. Results in decreased ACTH and cortisol levels
1173.
What is a complication of a retropharyngeal abscess?
spread into medistinum
1174.
What is a complication of bronchiectasis?
Hemoptysis
1175.
What is a side effect of Fluphenazine?
High potency anti-psychotic **Can cause hypothermia
1176.
What is a side effect of Metoclopramide?
It has dopamine antagonist effects can cause Extra pyramidal symptoms txt with Benztropine or diphenhydramine
1177.
What is another name for Klebsiella Pneumonia?
Friedlander's pneumonia gram negative rod encapsulated affects the upper lob currant jelly sputum
1178.
What is another name for Paget's disease?
Osteitis Deformans
1179.
what is associated with breath holding spells?
Iron def. anemia
1180.
What is best non invasive measure to use for acute exacerbation of COPD?
Non invasive positive pressure ventilation
1181.
what is best way to maintain an airway in an apneic pt?
Orotracheal intubation
1168.
**nasotracheal intubation is only for pts that are spontaneously breathing 1182.
What is Cauda equina Syndrome?
Saddle anesthesia, bowel and bladder dysfunction, and low back pain.
1183.
What is central cord syndrome?
presents as weakness more pronounced in upper extremities than lower extremities. maybe accompanied by loss of pain and temp. sensation
1184.
What is CHADS2 and what are the criteria?
Congestive Heart failure Hypertension Age > or = 75 Diabetes Prior stroke ( 2 points) pt with > 2 points start Warfarin or Dabigatran ( direct thromin inhibitor)
1185.
What is classic triad of Kartegener's syndrome?
1. recurrent sinusitis 2. bronchiectassis 3. dextrocardia 2/2 Primary Ciliary Dyskinesia
What is concerning about recurrent pneumonia in the same spot?
For possible cancer- Bronchiogenic cancer
1187.
What is electrical alternans?
Is when the amplitude of the QRS complex varies from beat to beat. Pathonogomic for pericardial effusion
1188.
What is Enthesitis?
Inflammation and pain occur at site of insertion of tendons and ligaments. Associated with Anklysoing Spondylitits
1189.
what is esodeviation of the eye?
medial deviation of eye
1190.
What is found in the CSF of MS pts?
1. normal protein, pressure and cell count 2. increased T lymphocytes 3. increased IgG
1191.
What is Hyposthensuria?
body's inability to concentrate urine. commonly seen in pts with sickle cell
1192.
What is Legg-Calves-Perthe Disease?
Idiopathic avascular necrosis 1. Unilateral subacute hip pain in male child 2. Progressive antalgic gait 3. Thigh muscle atrophy 4. Decreased hip range of motion
1193.
What is malignant otitis externa?
ear infection in diabetics unreponsive to topical antibiotics, ear pain and ear drainage, granulation tissue progression can lead to osteomyelitis of the skull base and destruction of facial nerve 2/2 pseudomonas txt with ciprofloxacin
What is mebranoproliferative glomerulopenphritis?
basement membrane thickening with double layer train tack appearance. IgG deposits seen on basement membrane. nephrotic range portineuria and hematuria positive for C3 persistent activation of alternative complement activation pathway
1195.
What is Morton's Neuroma?
pain in runners between 3rd and 4th foot, reproduce with palpation. txt with bilateral shoe inserts
1196.
What is most common type of kidney stone?
Calcium oxalate pts with small bowel disease, surgical resection, or chronic diarrhea
1197.
What is most common type of pituitary tumor?
Lactotroph adenoma- produces prolactin
1198.
What is mucormycosis?
Fungal infection in the nasal passages of diabetics.
What is one of the most deadliest consequences of aortic dissection?
Cardiac Tamponade 1. hypotension 2. tachycardia 3. jugular venous distention
What is optic neuritis?
Central scotoma, afferent pupillary defect, changes in color perception, and decreased visual acuity.
1186.
1194.
1199.
1200.
What is pin worm infection caused by and what meds. are used to txt it?
1. Enterobius Vermicularis txt with albendazole or mebendazole. alternative txt is Pyrantel Pamoate
1202.
What is pulsus paradoxus?
A drop of greater than 12 mmHg in Systolic blood pressure during inspiration.
1203.
What is reaction formation?
An neurotic defense mechanism in which a person does exactly of what he/she feels to cover socially unacceptable thoughts.
What is seen in stool after vibrio cholera infxn?
Mucus and some epithelial cells. No leukocytes or red blood cells since the toxins only modify electrolyte handling by enterocytes.
1205.
What is suppression?
A mature defense mechanism in which a person voluntary suppresses unpleasant thoughts.
1206.
What is sympathetic opthalmia?
Damage of one eye after a penetrating injury to the other eye it is 2/2 immunologic mechanism of uncovering of hidden antigens.
1207.
What is test reliability?
repeat results that are close together
1208.
what is test validity?
results are similar to the gold standard results
What is the best imaging study used to look for necrotizing fascitits?
CT scan
What is the best measurement to assess fetal growth?
Abdominal circumference
what is the best prophylactic txt for cat bites?
worry about pastrurella multicoida txt with Amox/Clavulanate
what is the best test to assess for coronary reocclusion after an MI?
CK-MB because it returns to normal levels more quickly
What is the best txt for pt with intrauterine fetal demise?
immediate induction of labor **low normal fibrinogen levels indicates impending DIC
what is the best way to assess liver function in ACUTE hepatitis?
1. Liver function tests 2. Viral serology
what is the best way to assess liver function in CHRONIC hepatitis?
Liver biopsy
what is the cause of bleeding in Mallory-Weiss tears?
Ruptured Submoucsal Arteries
what is the cause of hypotension after epidural placement?
Blood redistribution to the lower extremities and venous pooling.
What is the cause of irregular menstrual cycles in women starting menses?
Hypothalamic-Pituitary-gondal axis immaturity
What is the cause of low back pain in pt in 3rd trimester?
Increased Lumbar lordosis
What is the classic triad of hydatidform mole?
1. enlarged uterus 2. hyperemesis 3. markedly elevated hcg > 100,000
What is the CSF presentation of a pt with Guillien Barre?
Increased protein everything else normal
What is the difference between Subacute and Acute endocarditis?
Acute: pts with previously normal valves Subacute: pts with previously defected valves
What is the drug of choice for chlamydia in pregnancy?
Erythromyocin
What is the earliest renal abnormality seen in Diabetic nephropathy?
Glomerular Hyperfiltration. Thickening of the glomerular basement membrane.
1201.
1204.
1209.
1210.
1211.
1212.
1213.
1214.
1215.
1216.
1217.
1218.
1219.
1220.
1221.
1222.
1223.
1224.
1225.
what is the empiric IV therapy for pyelonephritis?
IV ampicillin + gentamicin
1226.
what is the empiric oral therapy for pyelonpehritis?
Ciprofloxacin
1227.
What is the first drug of choice for pt with OA?
Acetaminophen
1228.
what is the first line anti-hypertensive treatment in pregnant patients?
labetaolol or methyldopa
1229.
What is the first step in the management of DKA?
1. Normal Saline IV fluids + Regular Insulin
1230.
What is the first step in the work up of a pt with delirium?
serum electrolytes and urinalysis
1231.
What is the first step in txt of a Sickle Cell pt with stroke?
Exchange Transfusion
1232.
What is the gold standard for dx Duchenne muscular dystrophy?
Genetic studies x-linked recessive
1233.
What is the Kehr Sign?
Left shoulder pain 2/2 splenic hemorrhage irritating the phrenic nerve
1234.
what is the light's criteria for exudative effusions?
Has to have at least one of the following: pleural protein/serum protein > 0.5 pleural LDH / serum LDH > 0.6 pleural fluid LDH greater than 2/3 of the upper limit of normal for serum LDH
1235.
What is the major source of estrogen in menopausal women?
Peripheral conversion of androgens by aromatose enzyme to estrogen by fat tissue
1236.
What is the most cancer associated with Dermatomyositis?
Ovarian cancer
What is the most common adverse effect of inhaled steroid therapy for asthma?
Thrush
1238.
what is the most common cause of acute bacterial sinusitis?
strep. pneumonia
1239.
what is the most common cause of ambylopia?
Strabismus txt is occlusion of normal eye
1240.
What is the most common cause of cerebral palsy?
Cerebral Anoxia
1241.
What is the most common cause of chronic inspiratory noise in infants?
Laryngomalacia-flaccidity of the larynx. self resolves by 18 months of age. tell parents to keep child upright after feeding.
What is the most common cause of congenital hypothyroidism in the US?
Thyroid dysgenesis
What is the most common cause of ductopenia?
Loss of intrahepatic bile ducts Primary biliary cirrhosis
What is the most common cause of hypernatremia and what is the txt and what complication should one try to avoid?
2/2 hypovolemia txt: mild cases: 5% dextrose in .45% saline severe cases: 0.9% Saline Complications: Cerebral Edema
1245.
What is the most common cause of pneumonia in nursing homes?
strep. pneumoniae
1246.
What is the most common cause of preventable fetal growth restriction?
Smoking
1247.
what is the most common cause of prinzmetal's angina?
Smoking
1248.
What is the most common cause of Thryoid NODULES?
Benign Colloid Nodules
1249.
What is the most common cause of viral arthritis?
parvovirus
1250.
What is the most common deficiency in Celiac's?
Iron deficiency
1237.
1242.
1243.
1244.
what is the most common middle ear pathology in HIV pts?
Serous Otitis Media: presence of middle ear effusion without signs of an active infection. Dull tympanic membrane
what is the most common mutation in Cystic Fibrosis?
Deletion of three base pair coding for phenylalanine. (DF508). CFTR gene is located on chromosome 7
What is the most common presentation of sickle cell trait?
Pain less hematuria
What is the most common pulmonary complication in pts with systemic sclerosis?
Interstitial fibrosis
What is the most common type of neuropahty in diabetics?
Symmetric distal polyneuropathy
What is the most common type of tumor in a child?
Astrocytoma
What is the most rapidly acting med. to txt symptoms of pulmonary edema?
Nitroglycerin
What is the nephrotoxic side effect of Acyclovir?
When giving in high doses IV: It causes crystalluria and causes renal tubular obstruction. pt presents with oliguria, and elevated BUN and creatitine. **must hydrate patient before
what is the next step in the management of pt with hyperthyroidism?
24 hour thyroid radioiodine uptake and scan
What is the pathogenesis of Giardia?
Trophozites adhere to the mucousal surface by adhesive disks and produce malabsorption
What is the pathology of Stevens-Johnson Syndrome?
Immune complex mediated hypersensitivity
What is the preferred study for the diagnosis of Melanoma?
Excisional biopsy with narrow margins. * If depth of melanoma is less than 1mm than can be excised with 1 cm margin **If depth is > 1mm then should have sentinal node biopsy
What is the radiologic finding one sees with necrotizing enterolcolitis?
pneumatosis intestinalis (intramural air)
What is the respiratory quotient for pt mostly metabolizing carbohydrates?
RQ = 1
What is the respiratory quotient for pt mostly metabolizing fatty acids?
RQ = 0.7
What is the respiratory quotient for pt mostly metabolizing protein?
RQ = 0.8
What is the risk of getting bipolar if one parent has it? what bout if both parents have it?
one parent: 5-10% both parents: 60%
What is the significance of the HER2 oncogene?
Presence can be determined by immunohistochemicial staining or FISH. Positivity means one call Traustuzamaub and anthracyclin chemotherapy
1269.
What is the txt for a Hydrocele?
Reassurance-self resolves by 12 months If not resolved by 12 months-surgically remove since it has an increased risk of inguinal hernia
1270.
What is the txt for Acute Cholangitis?
1. Supportive care and Broad spectrum antibiotics 2. If pt still doesn't improve proceed to ERCP
1271.
What is the txt for acute exacerbations of MS?
High dose IV steroids
1272.
What is the txt for acute hypercalcemia?
1. First give IV fluids since they are usually dehydrated 2. Then give loops to lose calcium
What is the txt for Acute symptomatic hyponatremia?
3% normal saline
1251.
1252.
1253.
1254.
1255.
1256.
1257.
1258.
1259.
1260.
1261.
1262.
1263.
1264.
1265.
1266.
1267.
1268.
1273.
what is the txt for an empyema with thick rim that fails to improve with a chest tube?
Proceed to Surgery.
What is the txt for bradycardia in a pt that is hemodynamically stable vs a pt who is not hemodynamically stable?
Stable: IV Atropine Unstable: IV Epinephrine
what is the txt for CML and what is the MOA?
9;22 translocation with BCR/ABL fusion gene. Tyrosine Kinase Inhibitors which function by inhibiting the abnormal BCR/ABL gene.
what is the txt for Hep. A infection for close contacts of those infected?
Immune globulin
1278.
What is the txt for lichen sclerosis?
low dose corticosteroids
1279.
What is the txt for Myasthenia crisis?
1. Endotracheal intubation 2. Hold anticholinesterases for several days
What is the txt for necrotizing fascitis and what organisms are commonly involved?
Group A Strep and Staph. Aureus and anaerobes. txt: (Ampicillin + Sulbactam + Clindamycin)
1281.
What is the txt for Neuroleptic malignant syndrome?
1. Dantrole 2. Bromocriptine 3. Amantadine
1282.
What is the txt for normal pressure hydrocephalus?
serial large volume lumbar punctures, if successful proceed to place ventriculoperitoneal shung
1283.
What is the txt for overflow incontinence 2/2 epidural?
Self-cathe.
1284.
what is the txt for premature ventricular contractions?
Unless they are symptomatic you do not treat them. if you txt start with Beta blockers if that doesn't work then proceed to Amiodarone
what is the txt for solitary brain metastasis? what about multiple brain mets?
solitary: surgical resection followed by whole brain radiation multiple: palliative whole brain radiation
1286.
What is the txt for Tourette's?
Typical antipsychotics-Haloperidol or Pimozide
1287.
what is the txt for Vaginismus?
1. Relaxation 2. Kegel exercise 3. Gradual dilation
What is the txt of choice for bacterial endocarditis 2/2 strep. viridians that is susceptible to penicillin?
Either IV Pen. G or IV Ceftriaxone
1289.
What is the txt of choice for MCL tears?
bracing and early ambulation
1290.
what is the txt of choice in fibromyalgia?
1. TCA 2. Cyclobenazprine- muscle relaxant increase stage 4 sleep
1291.
What is the txt regimen for gastroparesis?
1. Metoclopramide 2. Bethanecol 3. Erythromycin
What is the typical murmur associated with Aortic regur and how do you txt it?
Diastolic decrescendo murmur heard best at 3rd left intercostal txt: Decrease afterload with -- ACE-I or Ca channel blockers
1293.
What is Transient Synovitis?
hip pain in children have history of recent viral infection and present with limp txt with NSAIDS and restrict weight bearing
1294.
what is used to raise HDL ?
goal of > 40. use Nioctonic acid
1274.
1275.
1276.
1277.
1280.
1285.
1288.
1292.
What is Volkman's Ischemic Contracture?
Final sequlae of compartment syndrome where necrosised muslce has been replaced with fibrous tissue
What kind of bacteria causes foul smelling cough in pneumonia and how do you txt it?
Anaerobic bacteria txt with Clindamycin
1297.
What kind of cancer does DES exposure in utero cause?
adenocarcinoma of vagina
1298.
What kinds of infections do children with SCID present with?
defect in T and B cell prone to viral, fungal and bacterial infections
What medications should be held prior to performing exercise stress test?
1. anti-ischemic drugs 2. digoxin 3. beta blockers
What nerve controls the stapedius muscle? Clinical consequence of damage?
CN VII. sensitivity to sounds
What organisms are children with chronic granulomatous disease prone to?
prone to abscesses 2/2 catalse producing organisms like aspergillus and staphylococcus
1302.
What organisms are involved with Epiglottis?
1. Heamophillius Influenza 2. Strep. Pyogenes
1303.
What organisms are pts with deficient B lympthocytes prone to?
impaired ability to destory encapsulated orgnaiss H. influ, s. pneumo, lack of IgA predisposes to Giardia
1304.
What part of the Ao ruptpures in MVA
isthmus of aorta.
1305.
What part of the pituitary is affected in Sheehan's syndrome?
Anterior Pituitary pts don't lactate because of decreased prolactin secretion
What presents as a mobile cavitary mass in the lung with intermittent hemoptysis?
Aspergiolloma
1307.
what Receptors inc and dec insulin respectively.
Alpha r block. beta r inc.
1308.
what region of the heart forms the diaphragmatic surface?
inferior wall of left ventricle. supplied by post descending (RCA)
1309.
What should be done if a child refuses to be potty trained?
stop training attempts for several months and try again when child is ready
What should be given to pts who are allergic to pencillin if they have syphillis?
Either single dose of Azithromycin or 14 days of Doxycylicne or Tetracycline
What should be suspected if a down syndrome pts presents with upper motor neuron symptoms?
Atlanto-axial instability
what should be the next step in a pt with pyelonephritis who fails to improve with oral antibiotics after 48-72 hours?
Do renal ultrasound
what should one consider when pt with BPH presents with increased creatinine and what test should be done?
Suggest Hydronephrosis - dx with Ultrasound of abdomen
what should you do if someone get a needle stick but already got the Hep. B vaccine?
nothing
what should you do if someone get a needle stick but doesn't know Hep. B immunity status?
Get Hep B immune globulin and Hep. B vaccination series
what should you do in the work up of a pt with BPH after you have dx with rectal exam?
1. Urinalysis 2. Serum creatitine
What should you give a pt with gall stones who doesn't want surgery?
Ursodeoxycholic Acid
1295.
1296.
1299.
1300.
1301.
1306.
1310.
1311.
1312.
1313.
1314.
1315.
1316.
1317.
What should you give to pt who presents with mania but has impaired renal function?
Lithium is contraindicated in impaired renal function. Give: 1. Valproic Acid or 2. Carbamezipine
What should you suspect if pt is only having asthma like symptoms only at night?
GERD
What should you suspect if pt presents with 1. Fever 2. chest pain 3. leukocytosis 4. widened mediastinum on CXR? how do you txt it?
Dx: Acute Mediastinitis (usually follows cardiac surgery) Txt: drainage, surgery, and prolonged antibiotics
What should you suspect if you see clubbing and sudden onset joint pain in a chronic smoker?
Hypertrophic osteoarthropathy-can be sign of lung cancer
what should you suspect if you see needle shaped crystals on urinaalyasis?
Uric Acid Stone needs to evaluated by CT scan or IV pyelography
What should you suspect in a child with new onset hearing loss or chronic ear drainage despite antibiotic txt?
Cholesteatoma
what should you suspect in a young child with persistent leg pain only at night and physical exam is negative?
growing pains,- reassure parents
What should you suspect in an Asian pt with insenstate hypopigmented patch of skin?
Leprosy dx with skin biopsy -acid fast bacilli
What should you suspect in an HIV pt with altered mental status, EBV DNA in the CSF, and weakly ring enhancing periventricular mass?
CNS Lymphoma *EBV DNA is pathonomic*
What should you suspect in child that presents with a vomiting and abdominal pain in which he screams and then is fine in between episodes?
Instussception
What should you suspect in pt with bloody diarrhea but without fever?
Enterohemorrhagic E. Coli
what should you suspect in pt with chest pain mostly at night and has transient ST eelvation on EKG?
Prinzmetal's angina txt with Calcium channel blocker or nitrates
what should you suspect in pt with EKG that shows no discrenable P waves and and tachycardia and irregulary irregular rate?
Atrial Fibrillation **if hemodynamically unstable do immediate DC cardioversion
What should you suspect in young healthy pt suddenly presenting with signs of CHF?
Myocarditis 2/2 recent viral infection like coxsackie
what should you suspect when you see child that is talkative at home but refuses to speak in select settings?
selective mutism
1333.
What structure keeps the BBB impermeable to ions?
tight junctions b/w endothelial cells of cap beds of CNS
1334.
what test can be used to confirm the dx of CLL?
Flow cytometry
1335.
What test can be used to screen for PKU?
Guthrie test
1336.
What test can one perform to confirm vasovagal syncope?
tilt table testing
1337.
What test should be done if quadruple screen is abnormal?
proceed to amniocentesis (18-20 weeks)
1338.
What test should be done if you suspect a pt with Amariousis Fugax?
Get Carotid Duplex ( most are 2/2 emboli)
What test should can done early in the first trimester for pts with h/o genetic diseases?
CVS
1318.
1319. 1320.
1321.
1322.
1323.
1324.
1325.
1326.
1327.
1328. 1329.
1330.
1331.
1332.
1339.
What three things can one see on EKG of pt with WPW?
1. Delta waves (slur right before QRS) 2. shortened PR interval 3. Wide QRS
what tool does one use to determine involvement of Paget's disease?
Bone scan
What two diseases present with increased calcium and normal/increased PTH?
1. primary hyperparathyroidism 2. familial hypocalciuric hypercalcemia
What two heart conditions are strongly associated with Marfan's?
1. Mitral valve prolapse 2. Aortic dissection
what two markers are elevated in neural tube defects?
1. AFP 2. acetylcholinesterase
What type of knee injury produces popping sound and and severe pain at time of injury?
Medical meniscus injury
What type of murmur is heard in a pt with hypertrophic cardiomyopathy?
crescendo-decrescendo systolic murmur heard best at left sternal border does not radiate to carotids
What urinary abnormality will one find in patient's with Dubin-Johnson syndrome?
Abrormally elevated copropophryrion I levels
1348.
What virus causes Measles?
paramyxovirus
1349.
What vitamin metabolizes levodopa:
vit B6.
1350.
What will one see with TTP?
1. Thrombocytopenia 2. Anemia 3. Fever 4. Mental status changes 5. Renal failure Peripheral blood smear will reveal schistocytes
1351.
when anovulation is common
common during first five to seven years after menarche and the last ten years before menopause
1340.
1341.
1342.
1343.
1344.
1345.
1346.
1347.
manifests with marked menstrual cycle variability When are steroids indicated in conjunction with TMPSMX for PCP in HIV pts?
1. PaO2 < 70% 2. A-a gradient > 35mmHg
When do you start colo-rectal cancer screening for pt with UC?
Start 8 years after diagnosis and continue every year after that
When do you txt Paget's disease?
when pt is symptomatic txt with bisphosphonates
When do you use prednisone in combination with TMPSMX for HIV pts with PCP?
When PaO2 is < 70
When does one administer calcium gluconate for hyperkalemia?
1. potassium level > 6.5 2. Cardiac toxicity as evidenced by EKG changes 3. Muscular paralysis
1357.
When does one operate on an umbilical hernia in a child?
1. hernia persist to age 3 2. exceeds 2cm in diameter 3. causes symptoms
1358.
When does one see calcium phosphate stones?
common in renal tubular acidosis and hyperparathyroidism
When is a c-section indicated in the case of placental abruption?
1. If there are obstetrical indications (breech position, prior csection) 2. Mother or fetus are unstable
1352.
1353.
1354.
1355.
1356.
1359.
When is neuroimaging required when a pt presents with a migraine?
1. Decline in school performances 2. Early morning headaches 3. Behavior changes 4. Decline in growth 5. Abnormal growth parameters 6. Seizures
when is screening for gestational diabetes performed? and which test is used?
performed between 24-28 weeks. Use the 50g one hour GTT If BS> 140 then do 3 hour 100gram GTT
1362.
When should one start oral Isotretinoin on a pt?
1. when they have SCARS 2. With Nodulocystic acne 3. Moderate acne unresponsive to all other forms of txt
1363.
When should Rh status be checked?
Should be checked at first prenatal visit and at week 28. If at risk for Rh isoimmunization they should be given anti- Rh immunoglobulin at 28 weeks and again at delivery
1364.
When you see the "3 Sign" on a CXR what should you suspect?
Aortic Coarcation
1365.
where are lipids (TG, XOL, PL) digested and abs
digested in duodenum and abs in jejunum
1366.
where are PDA heard best
left sternal border, loudest at S2
Where do Actinomycosis Israelli normally present with infection and what is the txt?
Cervicofacial, thoracic, or abdominal region. gram positive branching bacteria txt: high dose Penicillin for 6-12 weeks
Where is the most common place for ischemic colitis to occur?
1. splenic flexure 2. recto-sigmoid junction watershed areas
1369.
Where is the most common site for ulnar nerve entrapment?
Elbow where it lies at the medial epicondylar groove
1370.
Which 3 bacteria cause subacute endocarditis?
1. strep. viridians 2. staph. epidermitis 3. enterococcus
1371.
Which AA can be catabolized to form propionyl CoA?
Isoleucine, valine, threonine, methionine (branched AA), xol, oddchain FA. Porpionyl coA then is converted to Methylmalonyl CoA.
which bacteria are pts with hemochromatosis or cirrhosis at increased risk for?
Listeria Monocytogenes
Which blood product contains all the coagulation factors and should be given to pts with coagulopathy?
Fresh frozen plasma
1374.
Which cancer are pts with PCOS at increased risk for?
endometrial cancer
1375.
which cancer has a high associated with HNPCC?
Endometrial Cancer
Which cranial nerve palsy is associated with Pseudotumor Cerebri?
CN VI
Which heart defect presents with a pansystolic murmur with loudest at left lower sternal border plus diastolic murmurs at apex?
Ventricular septal defect
Which infection should you suspect if you see Bone Marrow Transplant pt with pneumonia and abdominal pain like symptoms?
CMV
Which lab do you check when an asymptomatic person presents with Thrombocytoopenia?
HIV antibodies
Which labs are elevated in Sarcoidosis and what is the txt?
Elevated calcium and ACE txt with steroids
1360.
1361.
1367.
1368.
1372.
1373.
1376.
1377.
1378.
1379.
1380.
Which medication is most commonly associated with hearing loss?
Loop diuretics
Which medication should be used for breast cancer that is positive for HER2? and what should be performed prior to beginning txt?
Trastuzumab cardiotoxic so perform ECHO
Which meds. should be given to schizophrenic pts who have poor compliance with oral meds?
Depot Antipsychotics: 1. Haloperidol 2. Fluephenazine 3. Risperidone 4. Paliperidone
Which nephropathy is associated with minimal change disease?
Hodgkin's lymphoma
1385.
Which nerves are injured in Erb-Duchenne Palsy?
5th and 6th cervical nerves Absent Moro reflex
1386.
Which nerves are injured in Klumpke's Paralysis?
7th and 8th cervical nerves 1st thoracic nerve present with ipsilateral horners
Which neuromuscular blocker should not be used in pts with hyperkalemia?
Succinycholine do not use in pts with: 1. crush or burn injuries 2. guillien barre 3. tumor lysis syndrome
Which neuromuscular blocking agent can you use in pt with renal and liver insufficiency?
Atracurium
Which neuromuscular blocking agent can you use in pt with renal insufficiency?
Rocuruonium
which ogranasims are pts with iron overload at increased risk for?
1. Yersinia entercolitica 2. Vibrio Vulnificisu
which patients are at risk for developing ALL?
DS, ataxia-telangiectasia, NF type 1
Which pulmonary renal syndrome requires emergent plasmpharesis?
Goodpasture's
Which rash usually follows infection with herpes simplex?
erythema multiforme
Which statistical observation is most significantly effected by outliers?
Mean
Which substance is elevated in pts with deficiency in B12 and Folate?
Homocysteine
1396.
Which substance is elevated only in B12 def. and not Folate?
Methylmalonic Acid
1397.
Which virus is nasopharyngeal cancer associated with?
High incidence with Epstein Barr Virus
1398.
WHy does haptoglobin decrease in sickel cell disease.
binds free hemoglobin and rapidly cleared by liver.
why does pt with lung mass and signs of SIADH (low Na) have nml extracell vol?
transient inc in ECvol-->dec aldosterone, inc BNP-->loss of further Na (causes neurologic sx). Normalization of fluid but severily hyponatremic.
Why is acyclovir and co better for HSV and VZV than EBV/CMV
phosphyrylation that activates the drug (rate limiting step)
WHy is is necessary to wait 14 days when switching from MAO to SSRI drugs
avoid seratonin syndrome. allow time for enzyme resynthesis. (MAO)
1381.
1382.
1383.
1384.
1387.
1388.
1389.
1390.
1391. 1392.
1393. 1394.
1395.
1399.
1400.
1401.
1402.
Wilson's disease
rare autosomal recessive dz most often identified in younger indiv aged 5 to 40 years mutation in gene ATP7B on c'some 13 assoc with Wilson dz and hinders copper metabolism by reducing formation and secretion of ceruplasmin and decreasing secretion of copper into biliary system copper a pro-oxidant and causes damage to hepatic tissue thru gen of free radicals=>leaks form injured hepatocytes into blood=>deposits into tissues including cornea and basal ganglia
1403.
Winter's formula
range that det superimposed respiratory acidosis and respiratory failure in metabolic acidosis PaCO2=1.5x(HCO3-)+8±2 *when steady state PaCO2 persists above this range
1404.
Wiskott-aldrich syndrome
TIE: thrombocytopenia (@ birth), infxn, eczema. (6-12mo) dec to nml IgG, IgM. Inc IgE, IgA.
1405.
withdrawal symptoms
occurs when patient forms physiologic dependence on drug/medication then discontinued common in patients using alcohol, opiates, BNZ, stimulants, and some antidepressants
1406.
Wolff-Parkinson-White syndrome and ventricular remodeling
electrophysiological abnormality of AV cardiac conduction=>accessory pathways directly connect atria and ventricles to bypass AV nodes *net result: pre-excitation and arrythmias
1407.
1408.
1409.
1410.
Work up for pt on antithyroid med and fever, throat pain
WBC and differential
young pt presents with ear drainage and difficulty hearing, what is the dx?
Acute otitis media
young pt presents with lump on neck. neg sx of hypo, hyperthyorid except "hot". meds for epilepsy.
phenytoin
Zenker diverticulum
consists only of mucosa=>false diverticulum can cause food retention with regurgitation occurring days later food aspiration may lead to pneumonia can be palpated as a lateral neck mass
1411.
zidovudine
NRTI can bind and inhibit some mammalian cellular and mitochondrial DNA polymerases=>particularly ß- and gamma-polymerases major adverse effect: bone marrow suppression (e.g., anemia, granulocytopenia)
1412.
Zollinger-Ellison syndrome
gastrin hypersecretion by pancreatic tumor=>peptic ulcer dz and diarrhea Dx with serum gastrin measurement
