1st Brachial arch
1st Brachial Pouch Pouch
2nd Brachial arch
2nd Brachial Pouch
3rd Brachial arch
Cartilage: Meckel's (Mandible, Malleus, Mandibular) Muscles: Muscles of mastication (Masseter, medial pterygoids, Mylohyoid) Nerves: CN V2, V3 -Chew
Middle ear cavity Eustachian tube Mastoid air cells
Cartilage: Cartilag e: Reichert's Reichert's (Stapes, Styloid, Stylohyoid) Muscles:Stapedius, Stylohyoid Nerves:CN 7 -Smile
Epithelial lining of palatine tonsil
Cartilage: Greater horn of hyoid Muscles: Stylopharyngeus Nerves: CN 9 -Swallow stylishly
Dorsal wings -Inferior parathyroids
3rd Brachial Pouch
Ventral wings -Thymus 3 structu str uctures res Thymus, right & left parathyroids
4th Brachial Pouch
4th-6th Brachial arches arches
Absence seizure seizure
Dorsal wings -Superior parathyroid
Cartilage: Thyroid, cricoid, Muscles: 4 = pharyngeal constrictors 6 = intrinsic muscles of larynx Nerves: 4 = CN X (superior laryngeal branch) -Simply swallow 6 = CN X (recurrent laryngeal branch) -Speak
Brief (usually less than 20 seconds), generalized epileptic seizures of sudden onset and termination
Clinically, the impairment of consciousness (absence) Electroencephalography (EEG) shows generalized spike-and-slow wave discharges ~3Hz
acute ischemic injury = kidney findings?
Acute Acute Tubular Necrosis Necrosis - Muddy Muddy Brown Casts with epithelial cells
Dorsal wings -Inferior parathyroids
3rd Brachial Pouch
Ventral wings -Thymus 3 structu str uctures res Thymus, right & left parathyroids
4th Brachial Pouch
4th-6th Brachial arches arches
Absence seizure seizure
Dorsal wings -Superior parathyroid
Cartilage: Thyroid, cricoid, Muscles: 4 = pharyngeal constrictors 6 = intrinsic muscles of larynx Nerves: 4 = CN X (superior laryngeal branch) -Simply swallow 6 = CN X (recurrent laryngeal branch) -Speak
Brief (usually less than 20 seconds), generalized epileptic seizures of sudden onset and termination
Clinically, the impairment of consciousness (absence) Electroencephalography (EEG) shows generalized spike-and-slow wave discharges ~3Hz
acute ischemic injury = kidney findings?
Acute Acute Tubular Necrosis Necrosis - Muddy Muddy Brown Casts with epithelial cells
Affinity Affinity column chromatograph chromatography y
African African American, bilateral bilat eral hilar adenopathy, adenopathy, righ paratracheal paratracheal node enlargment, noncaseating granuloma =???
Albinism
Method of separating biochemical mixtures -Based on a highly specific i nteraction nteraction such as that between antigen and antibody, enzyme and substrate, or receptor receptor and ligand. Can be used to. 1. Purify and concentrate concentrate a substance from a mixture into a bufferi ng solution 2. Reduce the amount of a substance in a mi xture 3. Discern what biological compounds bind to a particular substance 4. Purify and concentrate an enzyme solution.
sarcoidosis (ethnicity is risk factor)
Congenital deficiency in: Tyrosinase Defective tyrosine transporter transporter (↓ tyrosine → ↓ melanin) Can result result from l ack of migration of neural neural crest cells Lack of melanin results in
Ammonia Ammonia source in ammonioagenesis
↑ risk
of skin cancer
Aspartate & GLUTAMINE GLUTAMINE donate NH4 ( amonia ) in renal ammoniaagenesis
Occurs within proximal tubular cells
Ammoniagenesis Ammoniagenesis
Glutamine made in the liver, is received from peritubular capill cap illaries aries and is metabolized metabolized into 1. Alpha-keto glutarate (Metabolized further into two HCO3- ions, which then leave the cell and enter systemic systemic circulation by c rossing rossing the basolateral membrane) membrane) 2. NH4+ (Secreted into renal tubules)
Anabolic steroids
Anemia
Leads to ↑ sex-hormone binding globulin ↓ free testosterone -Gynecomastia -Gynecomastia results results
↓ Hb
concentration concentration causes ↓ O₂ content of blood → hypoxia
aneurysm of PCA?
oculomotor nerve palsy (NOT Horner's)
Arches Arches 3 & 4
Posterior Posterior 1/3 of tongue
ATP concentration concentration doesn't fall much much dring norm n ormal al twitches because?
ATP is quickly regenerated regenerated from from creatine phosphate
Avoidant Personality Disorder
baby, respiratory distress, cyanosis, narrow thorax, ears with periauricular skin tags, micrognathia, glossoptosis, mandibular cleft, short palate = which artch?
Bacillus subtilis
Consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked
first arch (Treacher-Collins)
Gram-positive, catalase-positive bacterium Rod-shaped Has the ability to form a tough, protective endospore, allowing the organism to tolerate extreme environmental conditions Only known to cause disease in severely immunocompromised patients
Bacteroides fragilis
Gram-negative bacillus bacterium species Involved in 90% of anaerobic peritoneal infections Predominates in bacteremia associated with intraabdominal infections, peritonitis and abscesses following rupture of viscus, and subcutaneous abscesses or burns near the anus
blast proliferation, eosinophils?
CML (9:22) responds to imatinib
Brachial Arches (Pneumonic)
When at the golden arches, 1. Chew 2. Smile 3. swallow stylishly or 4. simply swallow 6. speak There is no 5! Ear, tonsils, bottom to top
Brachial pouch pneumonic
1(ear) 2(tonsils) 3 dorsal (bottom for inferior thyroid) 3 ventral (to = thymus) 4 (top = superior parathyroids)
Broca's aphasia
Nonfluent aphasia with intact comprehension.
brown-black, mottled, scaly, irregular borders, atypical melanocytes along basilar layer?
lentigo maligna (melanoma)
Carbaminohemoglobin
CO₂ bound to hemoglobin -Account for very small amount of CO₂ in blood
Carbon monoxide poisoning
Carnitine deficiency
↓ O₂ content
of blood → hypoxia
Inability to transport LCFA (Long chain fatty acids) into mitochondria Results in toxic accumulation in the cytoplasm Causes weakness, hypotonia, hypoketotic hypoglycemia
Case Control
Two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute
Medical research descriptive study that: 1. Tracks patients with a known exposure given similar treatment 2. Examines their medical records for exposure and outcome
Case series
Can be r etrospective or prospective Usuall y involves a sma ller number of patients than more powerful case-control studies or randomized controlled trials May be consecutive or non-consecutive -Depends on whether all cases presenting to the reporting a uthors over a period w ere included, or only a selection May be confounded by selection bias -Limits statements on the causality of correla tions observed -Physicians who look at patients with a certain illness and a suspected linked exposure will have a selection bias in that they have drawn their patients from a narrow selection (Their hospital)
cervical cancer drains to?
internal iliac nodes
Chloroquine, primaquine MOA
Chloroquie kills malaria/ Primaquine kills hypnozoites
Chronic HTN, heavy heart?
Hypertrophy of heart
Chronic myelogenous leukemia (CML)
Myeloid stem cell proliferation (30-60 year olds) - ↑ neutrophils, metamyelocytes, basophils, t(9;22) Low leukocyte alkaline phosphatase (as opposed to leukemoid reaction)
Gram-positive, rod-sha ped, anaerobic, spore-forming bacterium
Clostridium perfringens
Infections show evidence of tissue necrosis, bacteremia, emphysematous cholecystitis, and gas gangrene
Toxin involved in gas gangrene is known as α-toxin -Inserts into the plasma membrane of cells, producing gaps in the membrane that disrupt normal cellular function
CML treatment
Imatinib. BCR-ABL 9:22
Complete hydatidiform mole
Caused by a single (90%) or two (10%) sperm combining with an egg which has lost its DNA The genotype is typically 46,XX (diploid) Often preceded by a seizure a ura. -A simple partial seizure. Aura may manifest itself as a feeling of déjà vu, jama is vu, fear, euphoria o r depersonalizatio n.
Complex partial seizure
Seizure aura might also occur as a visual disturbance, such as tunnel vision or a change in the size of objects (macropsia or micropsia). Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing. There may also be loss of memory (amnesia) surr ounding the seizure event. Person may still be abl e to perform routine tasks such as wa lking, al though such movements are not purposeful or planned. Witnesses may not recognize that anything is wrong.
Congentio pharyngo-cutaneous fistula
Cyanide poisoning
Cytarabine
Persistence of cleft and pouch → fistula between tonsillar area, cleft in lateral neck
↓ O₂ utilization
by tissues → hypoxia
Pyrimidine analog → inhibition of DNA polymerase Leukemia, lymphomas Toxicity: Leukopenia, Thrombocytopenia, Megaloblastic anemia
defect in ihibitory NT = seizures, floppy baby
glycine receptor
defect in renal ammoniagenesis, which substrate is source of ammonia production?
glutamine (and aspartate donate NH4 in agenesis)
Density Gradient Centrifuge
Dental procedure, bug?
Deoxyhemoglobin
Used to separate certain organelles from whole cells for further analysis of specific parts of cells 1. A tissue sample is first homogenised to break the cell membranes and mix up the cell contents. 2. The homogenate is then subjected to repeated centrifugations, each time removing the pellet and increasing the centrifugal force. 3. Finally, purification may be done through equilibrium sedimentation, and the desired layer is extracted for further analysis.
Strep Mitis - alpha hemolytic
Better buffer for H ⁺ than oxyhemoglobin -Advantageous that hemoglobin has been deoxygenated by the time it reaches the venous end of the capillaries
DEXA decreased bone density
increased osteoclast, RANKL, decreased osteoblast activity
Diabetic neuropathy pain?
burning pain
Diabetic neuropathy symptoms
Numbness, tingling, ED, Urinary incontinence, Vision changes, Dizziness, Muscle weakness *Burning or electric pain*
Diaphoresis
DiGeorge syndrome
Excessive sweating
Aberrant development of 3rd & 4th pouches: T-cell deficiency (thymic aplasia) Hypocalcemia (failure of parathyroid development)
DKA, give insulin, increases activity of which enzyme?
glucokinase
drug overdose?
respiratory acidosis
Dysostosis multiplex
Hereditary disease (autosomal recessive) consisting of an error is mucopolysaccharide metabolism Characterized by severe abnormalities in development of skeletal cartilage and bone and mental retardation
Ejection Fraction equation
SV/EDV (EDV-ESV)/EDV
elevated very-long-chain FA, phytanic acid, pipecolic acid = absence of?
peroxisomes (causes hypotonia, poor feeding)
EPO doping = ?
Erythropoietin
EPO will increase RBC's erythroid precursors
Its primary effect on red blood cell progenitors and precursors (which are found in the bone marrow in humans) is promoting their survival through protecting these cells from apoptosis Age < 15 Found in acute lymphoblastic leukemia (ALL)
Excess lymphoblasts
TdT+ (Marker of pre-t & pre-b cells) CALLA+ t(12;21) = good prognosis Increased incidence in people with Down Syndrome
Lead poisoning
Ferrochelatase
Accumulates: Protoporphyrin, δ-AL A Microcytic anemia, GI and kidney disease. Children-exposure to lead pain t -+ mental deterioration Adults-environmental exposure (battery/ ammunition/radiator factory) -+ headache, memory loss, demyelination
Generalized seizure that affects the entire brain
Generalized tonic clonic
Divided into two phases, the tonic phase and the clonic phase. Preceded by aura Tonic = skeletal muscles tense Clonic = Rapid contraction and relaxation of muscles
germline mosaicism
Glipizide
glossoptosis
produces disease that is not carried by parent's somatic cells
Sulfonylurea (stimulates endogenous insulin release) Close K+ channel in β-cell membrane = insulin release via ↑ Ca2+ influx.
Downward displacement or retraction of the tongue
Liver and β cells of pancreas, induced by insulin
Glucokinase
Low glucose = hexokinase sequesters glucose in the tissues High glucose = excess glucose is stored in the liver
In ER of liver, Glucose-6-P → Glucose Glucose-6-phosphatase
Deficient in Von Gierke's disease (fasting hypoglycemia, increased glycogen in liver, increased blood lactate, hepatomegaly)
Rate determining enzyme for glycogenolysis
Glycogen phosphorylase
guy with ulcers, what to do to improve symptoms?
H1 (Histamine)
Skeletal component deficient in McArdle's disease -↑ glycogen in muscle, but can't break it down -Painful muscle cramps, myoglobinuria w/ strenuous exercise
stop smoking
Found on smooth muscle, endothelium, and central nervous system tissue Causes: Bronchoconstriction, Bronchial smooth muscle contraction, Vasodilation, Separation of endothelial cells (responsible for hives), Pain and itching due to insect stings; SE = sleep and appetite suppression.
HDL with age in woman?
heme biosynthesis pathway
HDL of a 25 year old vs. 55 year old, high in 25, low in 55 (estrogen)
glycine + succ (ALA synthase) 5-ALA (ALA dehydratase) porphobilinogen (PBG deaminase) Hydroxymethylbilane (uro synthase) Urophyrinogen III (Uro decarboxylase) Coproporphyrinogen III (Copro oxidase) protoporphyrinogen IX (proto oxidase) protophorphyrin (IX) ferrochelatase + Fe = HEME
Results most commonly from brain i njury to the ri ght cerebral hemisphere, causing visual neglect of the left-hand side of space
Hemispatial neglect
A stroke affecting the right parietal lobe of the brain can lead to neglect for the left side of the vi sual field, causing a patient with neglect to behave as if the left side of sensory space is nonexistent (although they can still turn left) -Extreme case, a patient with neglect might fail to eat the food on the left half of their plate, even though they complain of bei ng hungry -Someone with neglect is asked to draw a clock, their drawing might show only numbers 12 to 6, or all 12 numbers on one half of the clock face, the other side being d istorted or left blank
Removes acetyl groups from AA -Allows histones to wrap DNA more tightly
Histone deacetylase
Actions are opposite to that of histone acetyltransferase These would affect transcription of DNA!!!!
Visual fi eld loss that respects the vertical midli ne, and usually affects both eyes
Homonymous hemianopsia
Vascular a nd neoplastic (mali gnant or benign tumours) lesions from the optic tract, to visual cortex can cause -If lesion is in optic tract, will be pupillary reflex problem! The more posterior the cerebral lesion, the more symmetric (congruous) symptoms will be 1. Person who has a lesion of the right optic tract will no longer see objects on his left side 2. Person who has a stroke to the right occipital lobe wil l have the same visual field defect, usually more congruent between the two eyes, and there may be macula r spar ing
Homozygous for point mutation (GT>AT) causes skipping of exon 12, mech?
RNA Splice error
How to calculate A-a gradient
PAO2 - PaO2 (PAO2=150 PaCO2/0.8)
How to identify a variant protein?
immunohistochemistry
Hydronephrosis causes?
Increased tubular hydrostatic pressure from blockage
Hydroxyurea
Inhibits ribonucleotide reductase → ↓ DNA Synthesis (S-phase specific) Melanoma, CML, Sickle cell disease (↑ HbF) Toxicity: Bone marrow suppression, GI upset
Hyperammonia
Can be acquired (e.g., liver disease) or hereditary (e.g., urea cycle enzyme deficiencies) excess NH4+ → depletes a-ketoglutarate of TCA cycle
→ inhibition
Rx: limit protein in diet
Stone, Bones, and Groans
Hyperparathyroidism
Hypercalcemia Hypercalciuria (Stones) Hypophosphatemia ↑PTH, ↑ Alk
Phos, ↑cAMP in urine
Hypokinesis of Posterior Left Ventricle?
Hypovolemic/cardiogenic shock
Hypoxemia
Stenosis of the right coronary artery
low-output failure, increased TPR, low CO, cold, clammy (hypovolemic = low volume, no JVD; cardiogenic = poor pumping, backflow, increased JVD)
↓Pao₂ causes ↓ %saturation
of
hemoglobin → hypoxia
I Cell Disease MOA
IkB function?
mannose 6 phosphate addition allows enzymes to go to lysosome, but this is defective = abnormal targeting of these enzymes to lysosomes
releases NFkB after undergoing phosphorylation
Imatinib
A small molecular inhibitor of bcr-abl tyrosine kinase Treatment of CML (blasts, basophils)
Immunohistochemistry
Process of detecting antigens (e.g., proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues
Inherited lysosomal storage dis order
inclusion cell disease (I-cell disease)
Fail ure of addition of mann ose-6-phosphate to lysosome proteins -Enzymes are secreted outside the cell instead of being targeted to the lysosome Presentation: Coarse facia l features Clouded corneas Restricted joint movement High plasma levels of lysosomal enzymes
incomplete penetrance vs. variable expressivity
IP = not all with mutant genotype show mutant phenotype; VE = genotype SAME, phenotype varies
Insulin increases?
glucokinase activity
Insulin secretion
Internal iliac lymph nodes
1. Glucose binds Glut2 receptor on β-cells 2. Glucose oxidizes to ATP → closes K ⁺ channels in cell membrane → depolarization of β-cells 3. Depolerizatino opens Ca² ⁺ channels → ↑ intracellular [Ca² ⁺] → [name of this card] Receive lymphatics from: All the pelvic viscera Deeper parts of the perineum -membranous and cavernous portions of the urethra Buttock and back of the thig h Cervix! Not: Ovary, testis, or superior ha lf of the rectum Gonads drain to the paraaortic lymph nodes Superior half of the rectum drains to the pararectal lymph nodes
Internal urethral orifice
Irradiated packed RBCs
Opening of the urinary bladder into the urethra
Destroys DNA in WBCs -Prevents graft vs host disease occurring from transfusion Important if transfusion is from: 1. Close family relation 2. Someone who is immunocompromised (Di George Syndrome, Wiskott Aldrich, and SCID)
IκB
Releases NF-κB after undergoing phosphorylation
Left Axillary line holosytolic murmur
Left sided heart failure signs
Leukemia
Mitral Regurg - Left Axillary line holosystolic murmur
Tachypnea (increased rate of breathing) Increased work of breathing (non-specific signs of respiratory distress) Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields -Suggest the development of pulmonary edema (fluid in the alveoli) -Cyanosis which suggests severe hypoxemia, is a late sign of extremely severe pulmonary edema.
Unregulated growth of leukocytes in *bone marrow* ↑ or ↓ in # of circulating leukocytes in blood Marrow failure → anemia (↓RBC), infections (↓ WBC), hemorrhage (↓platelets) Infiltrates in liver, spleen, and lymph nodes possible
Type of cytotoxin created by some types of bacteria Is a type of pore forming toxin
Leukocidin
Get their na mes by killing ("-cide") leukocytes Associated with increased virulence of certain strains (isolates) of Staphylococcus aureus Cause of necrotic lesions involving the skin or mucosa, including necrotic hemorrhagic pneumonia
Lithium induced Nephrogenic DI, where?
Collecting tubule
Loading dose
Cp x Vd/Bioavailability
long-chain-fatty-acids?
LCFA - peroxisomes
Facilitates GABAa action by channel opening
Lorazepam
↑ frequency
of Cl ⁻
Use: Anxiety Spasticity Status epilepticus Detoxification
Loss of left vision in both eyes =?
occipital lobe lesion
Low blood solubility = slow or fast induction?
141) low blood solubility --> rapid induction, low potency
lump in upper neck, mass moves up with swallowing and tongue protusion, uptake of technetium 99m pertechnetate, what type of cells?
Lymphoma
Lysosomal storage disease
thyroid follicles
Discrete tumor masses arising from lymph nodes.
Caused by lysosomal dysfunction usually as a consequence of deficiency of a s ingle enzyme required for the metabolism of lipids, glycoproteins (sugar containing proteins) or so-called mucopolysaccharides When a particular lysosomal enz yme exists in too small a n amount or is missing altogether, substances accumulate in the cell. In other words, when the lysosome doesn't function normally, excess products destined for breakdown an d recycling a re stored in the cell.
Maintenance dose
Megaloblastosis (Megaloblastic anemia)
Cp x CL/F
Results from inhibition of DNA synthesis in red blood cell production -Most often due to hypovitaminosis , specifically a deficiency of vitamin B12 and/or folic acid Characterized by: Many la rge immature and dysfunctional red blood cells (megaloblasts) in the bone marrow Hypersegmented neutrophils (those exh ibiting five or more nuclear lobes ("segments"), wi th up to four lobes being normal)
Melanoma ABCDE
Mesoblastic nephroma
Asymmetry, Border irregularity, Color variation, Diameter >6 mm, Evolution over time
Type of kidney tumor that is usually found before birth by ultrasound or within the first 3 months of life. It contains fibroblastic cells (connective tissue cells), and may spread to the other kidney or to nearby tissue
metabolic alkalosis with volume contraction
loop diuretic
metastaic colon cancer spread MOA
Hematogenous spread of Liver Tumor from Colon via Portal Venous System
Michaelis constant (Km) =?
Km = 1/2 Vmax
micrognathia
Jaw is undersized
MOA IKB
lkb --> NF-KB post phosphorylation for IL-1/IL-6 fever induction
Cell that is in between a fibroblast and a smooth muscle cell in differentiation
Myofibroblast
Can contract by using smooth muscle type actinmyosin complex, rich in a form of actin called alphasmooth muscle actin -These cells are then capable of speeding wound repair by contracting the edges of the wound
Most common renal malignancy of early childhood (Age 2-4)
Nephroblastoma (Wilms tumor)
Contains embryonic glomerular st ructure. Presents with huge flank mass / hematuria. Deletion of WT1 on chromosome 11 Can be hypervascular
NF-κB
Activation occurs when it's inhibitor, I-κB, is phosphorylated by specific protein kinase (IKK) & degraded
normal heart weight (450), enlarged at 600g after poorly controlled HTN?
hypertrophy
Oculomotor palsy from aneurysm?
Posterior Communicating Artery Anuerysm
Atypical antipsychotic
Olanzapine
Use: Schizophrenia - both +ve and -ve Bipolar, OCD, anxiety disorder, depression, mania Fewer extrapyramidal side effects than traditional antipsychotics
Oligomenorrhea
increased estrogen in adipose tissue
Optic chiasm lesion
Bitemporal anopia
optic nerve, Chiasm, optic tract
parietal lesion = optic tract lesion
Organophosphate poisoning- first antidote
Atropine first/Pralidoxime second
Oxytocin
Stimulates labour Uterine contraction Milk let down Controls uterine hemorrhage
Packed RBCs with adenine-saline added
Allows the blood to flow readily without the addition of saline
pain associated with diabetic neuropathy?
burning pain
pain in shoulder, reproduced with resisted abduction at 90, giving thumbs down
supraspinatus
Pain upper abdomen, refered to shoulder
Diaphram ulceration phrenic nerve
Pain with thumbs down, shoulders up
Arm up Thumbs down sign... supraspinatus...
pancreatic cancer associated with?
depression
paraesophageal hernia
portion of gastric fundus herniates through the diaphragm
parathyroid adenoma, decreased?
calcium concentration in feces
Parietal lobe lesion
Lower quadrantic anopia
Partial hydatidiform mole
Partial vs complete mole
Occurs when an egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY
Partial 1 egg two sperm 69XXY vs paternal complete 46XX 2 sperm no egg
Chronic in flammation due to Helicobacter pylori that colonizes the antral mucosa
Peptic ulcers
NSAIDs Some studies have found correlations between smoking a nd ulcer formation Caffeine and coffee, als o commonly thought to cause or exacerbate ulcers, have not been found to affect ulcers to any sig nificant exten
Peroxisome
Membrane-enclosed organelle involved in catabolism of very long fatty acids (VLFA) & amino acids
Phosphoenolpyruvate carboxykinase
Irreversible enzyme in Gluconeogenesis
Phosphorylase kinase
A component of Gluconeogenesis
Phytanic acid
Branched chain fatty acid that humans can obtain through the consumption of dairy products, ruminant animal fats, and certain fish Undergoes α-oxidation in the peroxisome, where it is converted into pristanic acid by the removal of one carbon
pinpoint pupils, unconscious
heroin OD
Pipecolic acid
Accumulates in Pipecolic acidemia - Very rare autosomal recessive metabolic disorder that is caused by a peroxisomal defect
Abnormally deep attachment of the placenta to the myometrium without penetrating it.
Placenta accreta
Placenta grows completely through the endometrium Great risk of haemorrhage during placental removal -Commonly requires surgery to stem the bleeding and fully remove the placenta -In severe forms can often lead to a hysterectomy or be fatal Acute intermittent porphyria
Porphobilinogen deaminase
Accumulates: Porphobilinogen, δ-ALA, uroporphyrin 5 P's 1. Painful abdomen 2. Port win e-colored urine 3. Polyneuropathy 4. Psychological disturbances 5. Precipitated by drugs
Common site ofsaccular (berry) aneurysm.
Posterior Communicating Artery
CN III Palsy: Eye is "down and out" with ptosis and pupil dilation Lesions are typically aneurysms, not strokes
postpartum hemorrhage treated with?
oxytocin
Prenatal cocaine effects
Associated with premature birth, birth defects, attention deficit disorder
progestin challenge with withdrawal bleed?
low estrogen production = estrogen increased in adipose tissue
protease inhibitors (navirs)
PTH
protein processing (assmebling of virions = cleave of polypeptide products of HIV mRNA into functional parts)
Ca+ resorption from Kidney (Inhibits PO4 resorption) Stimulates Vit D. synth (1,25 OH) -Increased Ca+ absorbed from intestine Ca+ release from bone ↑ serum
Recurrent severe mycobacterial diseases
calcium
INF-gamma receptor defect
renal failure causes loss of?
1,25-dihydroxycholecalciferol (from decreased conversion via 1ahydroxylase in PCT)
Supplies blood to right ventricle & 25-30% of left ventricle
Right Coronary Artery
In 85% of pa tients, gives off posterior descending artery Supplies SA nodal artery in 60% of patients Give off branch to right marginal artery If lungs are clear to auscultation, no LVF. Think RVF!
RNA splice error
skipping of exons
Stacks of red blood cells (RBCs) wh ich form because of the unique discoid sh ape of the cells in vertebrates
Rouleaux formation
RTA1 ("distal", Renal tubular acidosis)
Conditions wh ich cause: Infections Multiple myeloma Inflammatory and co nnective tissue disorders Cancers Occurs in dia betes mellitus (one of the causa tive factors for microvascular occlusion in diabetic retinopathy)
Defect in collecting tubule's ability t o excrete H+ urine pH >5.5 hypokalemia ↑ risk
for calcium phosphate kidney stones as a result of ↑ urine pH and bone resorption
RTA2 ("proximal", Renal tubular acidosis)
Defect in proximal tubule HC03reabsorption Fanconi's syndrome urine pH < 5.5 hypokalemia ↑ risk
RTA4 ("hyperkalemic", Renal tubular acidosis)
for hypophosphatemic rickets
Hypoaldosteronism or lack of collecting tubule response to aldosterone Resulting hyperkalemia impairs ammoniagenesis in the proximal tubule ↓ buffering
S. pyogenes (Group A)
capacity and ↓ urine pH
The bacteria behind poststreptococcal glomerulonephritis PHaryngitis can results in PHever & glomerulonePHritis
Salmonella enterica
Most cases of salmonellosis are caused by food infected with w/ this bacteria, which often infects cattle and poultry Usually does not need ABs (Only if complicated in people at risk such as infants, small children, the elderly) -Will l ead to prolonged fecal excretion of bacteria
Salmonella post antibiotic?
prolonged fecal excretement post antibiotic
Scaphoid bone
Schizoid personality disorder
Most commonly fractured carpel bone, prone to avascular necrosis due to retrograde blood supply
Characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness and apathy May simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world
Screening for CD markers?
Immunohistochemistry
Septic shock
high-output failure, decreased TPR, dilated arterioles, high venous return, hot patient
side effect of H1 blocker
drowsiness
Consciousness is not impaired
Simple partial seizures
Slipped-strand mispairing
Often precursors to larger seizures, where the abnormal electrical activity spreads to a larger area of (or all of) the brain, usually resulting in a complex partial seizure or a tonic-clonic seizure -In this case they are often known as an aura
Denaturation and displacement of the DNA strands, resulting in mispairing of the complementary bases. Can result in either insertions or deletions. Insertions are thought to be self-accelerating: as repeats grow longer, the probability of subsequent mispairing events increases
SNoW DRoP
Southern = DNA Northern = RNA Western = Protein
Southwestern blot
Identifies DNA-binding proteins
Stain Drug effects
Upregulates LDL receptors
Staph α-toxin
Staphylococcus aureus
The major cytotoxic agent released by bacterium Staphylococcus aureus and the first identified member of the pore forming beta-barrel toxin family
-Superantigens (TSST-1) induce toxic shock syndrome (TSS), usually fr om prolonged tampon use. Cause non-specific activation of T-cells resulting in polyclonal T cell activation and mas sive cytokine release (IFNγ) -Enterotoxin that is the causative of gastroenteritis that is self-limiting, characterized by vomiting and diarrhea one to six hours after ingestion of the toxin with recovery in eight to 24 hours. Symptoms include nausea, vomiting, diarrhea, and major abdominal pain. -Exfoliative tox ins implicated in (SSSS), which occurs m ost com monly in infants a nd young children. Prot ease activity of t he exfoliative toxins causes peeling of the skin observed with SSSS. Other -Protein A, a n IgG-binding protein, binds to the Fc r egion of a n antibody
Statin MOA (upregulate what?)
stratified sample
LDL receptors
NOT random, created to ensure a more representative sample of the population at large (ADHD more likely in boys than girls, therefore assigned differently) Alcohol: Leading cause of birth defects and mental retardation; fetal alcohol syndrome
Substance Abuse Teratogens
Cocaine: Abnormal fetal development and fetal addiction; placental abruption Smoking: Preterm labor, placental problems, IUGR, ADI-ID
Superficial inguinal lymph nodes
Anal canal (below pectenate line) Scrotum Thighs Ends up in these lymph nodes
suprasellar mass, hormone excess?
Supraspinatus
prolactin
Abduction of the arm at the shoulder joint -Main agonist muscle for this movement during the first 10-15 degrees of its arc Can test: Shoulder at 90% Empty can (Wrists pronated)
Temporal lobe lesion
Upper quadrantic anopia
Results from transfusion of immunocompetent T cells capable of engrafting and initiating an immune response against recipient antigens
Transfusion associated GVH
The most susceptible patient groups are those who are severely immunocompromised Gamma i rradiation abolishes the proliferative activity of the lymphocytes in the donor blood. Fresh frozen plasma and cryoprecipitate do not contain viable lymphocytes and thus do not need to be i rradiated
Treacher Collins Syndrome
1st arch neural crest fails to migrate -Mandibular hypoplasia -Facial abnormalities
Trisomy 21 associated with increased risk of which cancers?
ALL and AML
Type I error
Stating there is an effect when none exist
Type I error =
saw a difference when none existed = p-value (false positive error)
Type II error
Stating there is not an effect when there is one
Ubiquitin
Tags proteins for destruction by proteosome
ubiquitin tagged proteins go where?
proteosome for degradation
Ureteric orifice
Placed at the postero-lateral angles of the trigonum vesicae, and are usually slit-like in form
Porphyria cutanea tarda
Uroporphyrinogen decarboxylase
Accumulates: Uroporphyrin (tea colored urine) Blistering cutaneous photosensitivity. Most common porphyria.
Valproic acid
A wide spectrum seizure medication -1st line for tonic-clonic Not for status epilepticus
Valproic Acid MOA
Vitamin C
Washed packed RBCs
inhibits HISTONE ACETYLASE Histones were in DNA - transcription error
Required fro the hydroxylation of specific purine and lysine residues -If deficient, will cause scurvy --Inadequate hydroxylation of collagen peptides
RBCs washed in sterile saline to remove: WBCs Lytic mediators Non-self antigens Most useful in IgA deficient persons who have circulating anti-IgA Abs -Use ↓ febrile, urticarial and anaphylactic reactions
Wernicke's aphasia
Fluent aphasia with impaired comprehension. Wernicke's area-superior temporal gyrus of temporal lobe. Wordy, but makes no sense Blood that is unmodified except for the presence of an anticoagulant
Whole blood
Usually not used because the extra plasma can contribute to transfusion associated circulatory overload (TACO), a potentially dangerous complication
Why deoxyHB can carry CO2 better than OxyHB?
DeoxyHB = better buffer
1. Inflammatory (immediate) -Platelets, neutrophils, macrophages
Wound healing
2. Proliferative (2-3 days after wound) -Fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages -Granulation tissue depostion, angiogenesis, wound contraction (mediated by myofibroblasts) 3. Remodeling (1 week after w ound) -Fibroblasts -Type III collagen replaced by type I collagen
Zanamavir MOA
Zanamivir MOA - inhibit virion release
zanamivir, oseltamivir MOA
inhibits virion release
Lead poisoning
δ-ALA dehydratase
Accumulates: Protoporphyrin, δ-AL A Microcytic anemia, GI and kidney disease. Children-exposure to lead pain t -+ mental deterioration Adults-environmental exposure (battery/ ammunition/radiator factory) -+ headache, memory loss, demyelination
