8/13 Cleanup Flashcards
(460 cards)
1
Q
What are the components of an ovarian teratoma?
A
3 germ cell layers: ectoderm, endoderm, and mesoderm Benign most of the time
2
Q
What is struma ovarii?
A
Thyroid tissue that is in a germ cell tumor
3
Q
What is a dysgerminoma?
A
- Clear cytoplasm and central nuclei
- The female equivalent of a seminoma.
- Malignant and radiosensitive.
- Good prognosis; responds to radiotherapy
- LDH is elevated in the serum
4
Q
What is an endodermal sinus tumor?
A
- Malignant tumor that mimics yolk sac; most common germ cell tumor in children
- AFP is marker
- Schiller duval bodies (look like glomeruli) are seen on histology
5
Q
What is a choriocarcinoma?
A
- Malignant tumor of cytotrophoblasts and syncytiotrophoblasts
- Similar to placental tissue with no villi
- Small and hemorrhagic
- B-hcg positive which leads to thecal cysts of the ovary
6
Q
What are the names of the germ cell tumors?
A
Teratoma
Dysgerminoma
Yolk sac
Choriocarcinoma
7
Q
What are the names of the sex cord stroma tumors?
A
- Fibroma
- Granulosa cell
- Leydig sertoli
8
Q
What is an ovarian fibroma? What is a major thing to look out for in a pt with ovarian fibromas?
A
- Benign tumor of fibroblasts
- Look out for Meigs syndrome: Ascites, pleural effusion
9
Q
What are seen in leydig sertoli cell tumors?
A
- High androgen production
- Virilization (hair lip) and pseudohermaphroditism
10
Q
What are the characteristics of a seminoma vs a nonseminoma?
A
- Seminomas - very responsive to radiotherapy and metastasize late (good prognosis)
- Nonseminomas - variable response to treatment and often metastasize early (bad)
11
Q
What is a seminoma composed of?
A
- Large cells with clear cytoplasm and central nuclei that forms a homogeneous mass
- No hemorrhage or necrosis
- Marker: B hcg
- Good prognosis
12
Q
What are the characteristics of a male embryonal carcinoma?
A
- Malignant tumor comprised of immature primitive cells that produce glands
- Aggressive tumor with early hematogenous spread
- CHemotherapy may result in differentiation into another type of germ cell tumor
13
Q
What is a yolk sac tumor?
A
- Malignant tumor that resembles a yolk sac
- Shiller duval bodies
- AFP positive
14
Q
What is a teratoma in a male? How is it different than one in a woman?
A
- Tumor composed of mature fetal tissue derived from two or three embryonic layers
- MALIGNANT IN MALES COMPARED TO NON MALIGNANT IN FEMALES
- AFP and b-hCG positive
15
Q
What is a choriocarcinoma in males?
A
- Syncytriotrophoblases and cytotrophoblasts
- Spreads early via blood
- b-hCG is characteristically elevated; may lead to hyperthyroidism or gynecomastia
16
Q
Compare acute and chronic prostatitis?
A
- Acute: Chlamydia and neisseria are common causes in young adults, E coli and pseudomonas are common in older adults.
- Prostate is tender and boggy on digital rectal exam
- Chronic: Dysuria with pelvic or low back pain
- Serum shows WBCs but are negative on culture
17
Q
What are the characteristics of a thyroid adenoma?
A
- Common
- Benign
- Cold (non-functional)
- If funcitonal, causes hyperthyroidism
18
Q
What are the characteristics of a papillary carcionma of the thyroid?
A
- Most common malignant thyroid cancer
- Radiation exposure
- Spreads lymphatically
- Excellent prognosis - slow growth
- Psammoma bodies “orphan annie nuclei”
19
Q
What are the characteristics of a follicular carcinoma of the thyroid?
A
- Hematogenous spread to bone and lungs
- Can present hurthle cells too
- Micro: Delimited by fibrous capsule surrounding tighly packed follicles, trabeculae, or solid sheets of tumor cells that are often cuboidal with dark or pale staining nuclei with inconspicuous nucleoli
20
Q
What are the characteristics of an anaplastic carcinoma?
A
- The worst
- Firm, bulky mass
- Early MTS to trachea and esophagus leading to dyspnea, dysphagia
- Bad prognosis, very aggressive
- Undifferentiated, anaplastic pleomorphic cells
21
Q
What are the functions of the leukotrienes?
A
- B4 - neutrophil attraction and activation
- C4, D4, E4 - Vasoconstriction, bronchospasm, increased vascular permeability
22
Q
What are the functions of COX products?
A
- I2,D2, E2 - vasodilation and increased vascular permeability
- E2 - also fever and pain
23
Q
What are the effects of bradykinin?
A
Vasodilation
Vascular permeability
Pain
24
Q
Define margination, rolling, and adhesion
A
- Margination - vasodilation leads to margination of cells from the center of the flow to the periphery
- Rolling - P and E selectin slow cells down to allow diapedesis to occur. These selectins are upgraded during inflammatory responses
- Adhesion - Firm adhesion leads to diapedesis
25
What are the contents of weibel palade bodies?
* P-selectin
* vWF
26
What are the two types of beta thalassemia?
* Minor - mildest form and is usually asymptomatic
* Major - more severe form and presents with severe anemia a few months after birth
27
What causes the crewcut appearance seen in beta thalassemia major?
* Unpaired alpha chains precpitate and damage the RBC membrane, resulting in ineffective erythropoiesis and extracascular hemolysis
* Because of this, there is expansion of hematopoiesis into the skull and facial bones leading to the classic crewcut appearance.
28
What type of anemia is thalassemia?
Microcytic, hypochromic RBCs
29
What is hemoglobin C? What is the mutation that causes it?
* AR mutation glutamic acid to lysine in the beta chain of hemoglobin
* Extravascular hemolysis
* HbC crystals seen in RBC smear
30
What is the body's respnose to decreased LV contractility?
1. Decreased cardiac output
2. Increased renin angiotensin aldosterone activation
3. Increased renal Na+ and H2O reabsorption
4. Increased venous pressure
5. Increased preload, increasd cardiac output
6. Increased sympathetic activity leading to increased LV contractility
31
Define kussmaul sign?
* Increased JVP on inspiration instead of normal decreased
* Inspiration leads to negative intrathoracic pressure not transmitted to heart leading to impaired filling of the right ventricle
* Blood backs up into the vena cava leading to JVD
32
What conditions feature Kussmaul sign?
Constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors
33
What are the extraintestinal manifestations of Crohn?
Kidney stones (calcium oxalate), gallstones, possible ASCA antibodies
34
In terms of correcting sodium levels too fast, what happens if you increase sodium too fast vs decreasing sodium too fast
* Low to high: Pons will die
* High to low: Brain will blow (cerebral edema and herniation)
35
What pathway is responsible for the positive symptoms of psychosis?
Mesolimbic pathway (VTA to NA) has excess dopamine
36
What pathway is responsible for negative symptoms of psychosis?
Mesocortical pathway (VTA to cortex) has less dopaminergic action
37
What is the root cause of parkinsons?
Decreased dopamine in the nigrostriatal pathway (Substantia nigra to the striatum)
38
Congenital manifestations of rubella
"I (eye) heart ruby (rubella) earrings
* Cataracts (eye)
* Ear (deafness)
* Congenital heart disease (PDA)
* Blueberry muffin rash
39
What are the congenital symptoms of syphilis?
Often results in stillbirth, hydrops fetalis; if child survives, presents with facial abnormalities (saddle nose, notched teeth, short maxilla), saber shins, CN8 deafness
40
What occurs in appropriate absolute polycythemia
* Increased RBC mass
* Decreased O2 saturation
* Incresed EPO levels
* Lung disease, congenital heart disease, high altitude
41
What occurs in inappropriate absolute polycythemia
* Increased RBC mass
* Increased EPO mass
* Malignancy, hydronephrosis
* Caused by ectopic EPO secretion
42
What are the characteristics of polycythemia vera?
* Increased plasma volume
* Increased RBC mass
* Decreased EPO levels
* EPO decreased in PCV due to negative feedback suppressing renal EPO production
43
Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter applies to what?
Atropine poisoning (muscarinic antagonist)
44
What are the symptoms of cholinesterase inhibitor poisoning?
DUMBBeLSS mnemonic
45
What are the zones in liver tissue?
* Zone 1: periportal - affected by viral hepatitis, hit hardest by toxins
* Zone 2: intermediate - Hit by yellow fever
* Zone 3: Pericentral vein - hit by ischemia, P450, metabolic toxins, site of alcoholic hepatitis
46
How is glucose, galactose, and fructose absorbed in the small intestine?
* Fructose: GLUT5
* Galactose and glucose: SGLT1
* All: GLUT2
47
What are the characteristics of a pleomorphic adenoma?
Most common salivary tumor composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively
48
What are mucoepidermoid carcinoma?
Most common malignant tumor, has mucinous and squamous components
49
What is a warthin tumor?
Benign cystic tumor with germinal centers typically found in smokers
50
What vitamins are malabsorbed in pancreatic insufficiency?
ADEK and B12
51
What is deficient in orotic aciduria?
* Orotic acid in urine
* Defect in UMP synthase
52
What is the presentation of orotic aciduria?
* Developmental delay and megaloblastic anemia refractory to folate and B12
* No hyperammonemia
* Increased orotic acid
53
What are the major causes of osteonecrosis?
* Corticosteroids
* Alcoholism
* SIckle cell disease
* Trauma
* the Bends
* Legg-Calve Perthes disease
* Gaucher disease
* Slipped capital femoral epiphysis
54
What is the trabecular outflow tract? What receptors are used to increase outflow through this tract?
* Drianage through the trabecular meshwork of the eye exiting through the canal of schlemm and into the episcleral vasculature
* M3 agonist increases outflow through this tract
55
What is the uveoscleral outflow tract? What receptors are utilized to increase outflow through this tract?
* Drainage into the uvea and sclera
* Increase with prostaglandin agonists
56
Where is aqueous humor produced? What receptors are present on this area?
* Ciliary body produces aqueous humor
* Beta blockers: decrease
* Alpha1 agonists decrease
* Carbonic anhydrase inhibitors decrease
57
What is the pathway involved in mediation of pupil dilation?
1. Hypothalamus to ciliospinal center of Budge (C8-T2)
2. Exit at T1 to superior cervical ganglion
3. Plexus along internal carotid, through cavernous sinus, enters orbit as long ciliary nerve to pupillary dilator muscles
58
What are the features of lupus nephritis?
**RASH OR PAIN**
1. **Rash**
2. **Arthritis**
3. **Serositis**
4. **Hematologic disorders (Leukopenia, thrombocytopenia, etc)**
5. **Oral/nasopharyngeal ulcers**
6. **Renal disease**
7. **Photosensitivity**
8. **ANA**
9. **Immunologic disorder**
10. **Neurologic disorders**
59
What causes retinal vein occlusion?
compression of nearby arterial atherosclerosis causes hemorrhage and venous emngorgement
60
What causes central retinal artery occlusion?
Acute painless monocular vision loss caused by some kind of embolic source
61
Why is horner syndrome associated with lesion above T1?
T1 is where the nerve arises that travels along the carotid to sympathetically innervate the eye
62
What is WAGR complex?
Wilms tumor, Aniridia (absensce of iris), Genitourinary malformations, mental Retardation
63
What is Denys Drash
Wilms tumor, early onset nephrotic syndrome, male pseudohermaphroditism
64
Beckwith Weidemann
Wilms tumor, macroglossia, organomegaly, hemihyperplasia
65
What is the mnemonic for that the testes cells do generally during development?
* Leydig cells lead to Male differentiation
* Sertoli Cells Shut Down Female differentiation
66
What is the pathological appearance of primary sclerosing cholangitis?
Onion skinning of bile duct in sections leading to beading of intra and extrahepatic bile ducts on ERCP
67
What is the pathologic appearance of primary biliary cholangitis?
Autoimmune destruction leading to lymphocytic infiltrate and granulomas which destroy intralobular bile ducts
68
In AK53 mutation sequence of colorectal cancer, what does each mutation do?
* A: loss of APC gene leads to decreased adhesion and increased proliferation
* K: Loss of KRAS gene leads to unregular intracelluar signaling
* 53: Loss of P53 leads to loss of tumor suppression
69
Crohn disease is mediated by TH 1 or 2? What about UC?
Crohns is Th1 and UC is Th2
(Crohn's is one word while UC is two words)
70
What is the importance of the submucosal layer of the gut wall?
Meissner's plexus is here, responsible ofr secretion of fluid
71
Which layer of the gut wall is responsible for motility?
Muscularis externa
72
TRH, along with causing TSH release, also causes the release of what other hormone?
Prolactin
73
What is the difference between Mobitz type 1 and type 2?
Type II has dropped beats but no lengthening of the PR interval
74
Conduction rates
Purkinge then atria then ventricles then AV node PAVA
75
76
B1 stimulation of the heart causes what cellular change?
* B1 receptor stimulation leads to Ca2+ channel phosphorylation leading to increased Ca2+ entry
* increased active Ca2+ ATPase leading to increased Ca2+ storage in the sarcoplasmic reticulum
77
Men1
* Pituitary tumors
* Pancreatic endocrine tumors
* Parathyroid adenomas
78
Men2a
* Thyroid (medullary)
* Pheochromocytoma
* Parathyroids
79
Men2b
Medullary thyroid
Pheochromocytoma
Mucosal neuromas
80
Difference between direct and indirect inguinal hernias?
* Indirect goes through indirect and goes INto the scrotum
* Lateral to inferior epigastric vessels
* Direct goes through parietal peritoneum medial to inferior epigastric vesels but lateral to rectus abdominis
* Goes through external inguinal ring only
81
What is diamond blackfan anemia?
Rapid onset anemia within first year of life due to intrinsic defect in erythroid progenitor
82
What are the symptoms of diamond-blackfan anemia
Short stature, craniofacial abnormalities, and upper extremity malformations
83
What are the muscles responsible for arm abduction of different levels?
* Supraspinatous: 15 degrees
* Deltoid: 15-100 degrees
* Trapezius: Over 90 degrees
* Serratus anterior: over 100 degrees
84
What are the differences between the meyer loop and the dorsal optic radiation?
* Meyer loop - lower retina, goes around lateral ventricle
* Dorsal optic radiation - superior retina, goes through internal capsule
85
What is precontemplation
Not yet acknowledging the problem
86
What is contemplation
Acknowledging the problem but not wanting to make a change
87
What is preparation/determination?
Getting ready to change behaviors
88
What is action?
Changing behaviors
89
What causes acute interstitial nephritis?
* Diuretics (pee)
* Pain free (NSAIDS)
* Penicillins and cephalosporins
* Proton Pump inhibitors
* RifamPin
90
Mesonephric ducts are (female/male) while paramesonephric ducts are (male/female)
Meso: Male Parameso: Female
91
What are the characteristics of cryptogenic organizing mnemonia?
Inflammation of the bronchioles and surrounding structure. Can be secondary to chronic inflammatory diseases or medication side effects
92
Baroreceptors are increase their firing due to (increased/decreased) pressure
Increased
93
What is the order of events in the cushing reflex?
1. Increased intracranial pressure constricts arterioles
2. Cerebral ischemia occurs
3. Increased pCO2 and decreased pH occur as result of ischemia
4. Increased central reflex sympathetic stimulation leads to increased perfusion pressure (hypertension\_
5. Increased stretch
6. Peripheral reflex baroreceptor induced bradycardia
94
What occurs when you massage the carotid?
1. Increased pressure on carotid sinus
2. Increased afferent baroreceptor firing triggers decreased AV node conduction speed and subsequent decreased HR
95
What triggers the chemoreceptors in the periphery?
* Carotid and aortic bodies are stimulated by decreased PO2, Increased PCO2, and decreased pH
96
What triggers chemoreceptors in the central areas?
* Changes in pH and PCO2 of brain interstitial fluid, which in turn are influenced by arterial CO2
* Do not directly respond to pO2
97
What is coronary steal syndrome?
Coronary stenosis causes maximally dilated vessels at baseline. Administration of vasodilators dilates normal vessels and shunts blood toward well-perfused areas, thereby diverting flow away from vessels that are stenosed and leading to ischemia in myocardium perfused by these vessels
98
What hormones are released from basophils?
B-Flat
* Basophils
* FSH
* LH
* ACTH
* TSH
99
Hemidesmosome connects what?
Keratin in basal cells to underlying basement membrane
100
What do desmosomes connect?
Intermediate filaments interact
101
Adherens junctions connect what?
Tight junction, forms belt connecting actin cytoskeletons of adjacent cells with CADherins
102
What are the jobs of the medial and lateral pterygoid muscles?
Medial is for munching and lateral is for lowering
103
What are the adverse effects of neonatal respiratory supplemental oxygen
RIB
* Retinopathy
* Intraventricular hemorrhage
* Bronchopulmonary dysplasia
104
What is CKMB used for?
Short term evaluation of myocardial infarction, but only lasts a short time
105
What is troponin used for
Long term confirmation of myocardial infarction
106
What is the function of endocannabinoids?
Act at cannabinoid receptors in hypothalamus and nucleus accumbens, two key areas for homeostatic and hedonic control of food intake, where it increases appetitie
107
Which receptors for ADH modulate osmolarity vs blood pressure?
* V2: Osmolarity
* V1: Blood pressure
108
When is GHRH levels increased?
* Exercise
* Sleep
* Puberty
* Hypoglycemia
109
What are some causes of hepatic adenoma?
Oral contraceptive or anabolic steroid use
110
Concerning features of hepatic adenoma
Rupture or regression
111
What is a greenstick fracture?
Incomplete fracture extending partway through the width of the bone
112
What is a torus fracture?
Buckle fracture of the cortex due to compression injury. Can be very subtle
113
What is the reason that seronegative spondyloarthropathy is called seronegative
No anti IgG rheumatoid factor
114
Destruction of the lateral hypothalamus leads to what
Lack of feelings of hunger meaning that the patient will rapidly lose weight
115
What is the mechanism of contraction alkalosis?
LOop diuretics and thiazides lead to increased AT2 which increases Na+/H+ exchange in the PCT leading to increased HCO3- reabsorption
116
What changes in the transition between bronchi and bronchioles?
Cartilage and goblet cells end when you transition from bronchi to bronhioles
117
What changes in the transition from terminal to respiratory bronchioles?
Terminal bronchioles have ciliated cuboidal cells compared to squamous cells in respiratory bronchioles
118
What is the function of TNF-alpha
Activates endothelium, causes WBC recruitment, vascular leak
119
120
Hepatitis B extrahepatic manifestations?
* Hematologic: Aplastic anemia
* Renal: Membranous GN
* Vascular: Polyarteritis nodosa
121
Hepatitis C extrahepatic manifestations
* Hematologic: Essential mixed cryoglobulinemia, increased B cell NHL, ITP, autoimmune hemolytic anemia
* Membranoproliferative GN
* Leukocytoclastic vasculitis
* Sporadic porphyrria cutanea tarda, lichen planus
* Increased diabetes risk
122
What are effects of insulin?
* Glucose tranasport into muscle and adipose
* Glycogen synthesis
* Triglyceride storage
* Sodium Retention
* Protein synthesis
* Cellular K+ uptake
* Decreased glucagon release
* Decreased lipolysis
123
What is the body's response to SIADH
1. Water retention leads to decreased aldosterone and increased ANP and BNP
2. Because ANP and BNP are increased, extracelluar fluid volume is normalized, leading to euvolemia hyponatremia
124
What are the differences between cis and trans deletions in alpha thalassemia?
* Cis - deletion (both deletions on the same chromosome) common in asian populations
* Trans - deletion (on different chromosomes) common in african populations
125
Describe what happens in a leukoerythroblastic reaction
* Left shift - more immature cells are seen because of the need for more cells
* Band cells and metamyelocytes more common in response to infection or inflammation
126
What is the major cause of relative polycythemia?
Dehydration and burns
127
What are the jobs of each rotator cuff muscle?
* Supraspinatus - laterally abducts arm
* Infraspinatus - laterally rotates arm
* Teres minor - adducts and laterally rotates arm
* Subscapularies - medially rotates arm
128
What are the common injuries of each rotator cuff muscle?
* Supraspinatus - most common
* Infraspinatus - pitching injury
* Teres minor - not typically injured
* Subscapularis - not typically injured
129
In the spinothalamic tract, what do the lateral and anterior parts do??
* Anterior: Crude touch, pressure
* Lateral: Pain, temperature
130
Difference between simple and complex seizures?
* Simple partial - consciousness intact, motor sensory, autonomic, psychic
* Complex partial - impaired consciousness
COMPLEX MEANS IMPAIRED CONSCIOUSNESS
131
What is an absence seizure?
3 Hz spike and wave discharge leading to no postictal confusion and a blank stare
132
What is the difference between myoclonic and tonic clonic seizure?
* Myoclonic - muscle (myo) repetitive jerks (clonic)
* Tonic clonic - Alternation between stiffening (tone) and movement (clonus)
133
What is the definition of an atonic seizure?
Drop seizure in which the patient falls to the floor and appears to have fainted
134
Low K+ leads to
U waves, flattened T waves on ECG, arrythmias, muscle cramps, spasm, weakness
135
High K+ leads to
Wide QRS and peaked T waves on ECG, arrhythmias, muscle weakness
136
Low calcium leads to
Tetany, seizures, QT prolongation, twitching, spasm
137
High Mg2+ leads to
Decreased deep tendon reflexes, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia
138
Low Mg2+ leads to
Tetany, torsades de pointes, hypokalemia, hypokalcemia
139
What are the symptoms of preecclampsia?
New onset hypertension with either proteinuria and end organ dysfunciton after week 20 of gestation caused by abnormal placental arteries and endothelial dyscunction, vasoconstriction and ischemia
140
What lobe do objects go into when the patient is laying down?
Posterior right upper
141
What are the functions of PDGF?
* Secreted by activated platelets and macrophages
* Induces vascular remodeling and smooth muscle cell migration
* Stimulates fibroblast growth for collagen synthesis
142
What are the cancers that spread hematogenously?
Four Carcinomas Route Hematogenously
* F: Follicular thyroid
* C: Choriocarcinoma
* R: Renal cell carcinoma
* H: Hepatocellular carcinoma
143
How does the foramen ovale form?
1. Septum primum grows superiorly and inferiorly
2. Septum segundum grows superiorly after
3. Superior part of the septum segundum grows and fuses with septum primum
4. Inferior part of septum primum closes hole of foramen secundum
144
What are the characteristics of primary closed angle glaucoma?
Enlargement or forward movement of lens against central iris leading to obstruction of normal aqueous flow through the pupil. Fluid builds up behind the iris, pushing the peripheral iris against cornea and impeding flow through trabecular meshwork
145
What are the characteristics of secondary closed angle glaucoma?
Hypoxia from retinal disease inducing vasoproliferation in the iris that closes the angle
146
What is the pathology that occurs with posterior urethral valves?
Membrane remnant in the posterior urethra in males leading to urethral obstruction. Can be diagnosed prenatally by hydronephrosis and dilated bladder on ultrasound
147
What are the major causes of low birth weight?
Caused by prematurity or intrauterine growth restriction
148
What are some conditions that are associated with low birth weight?
* Increased risk of sudden infant death syndrome and mortality
* Impaired thermoregulation and immune function
* Hypoglycemia
* Polycythemia
* Empaired emotional development
149
What does the HAVOCS mnemonic for menopause?
HAVOCS
* H: Hot flashes
* A + V: Atrophy of vagina
* O: Osteoporosis
* C: Coronary artery disease
* S: Sleep disturbances
150
Which breast tumors/pathology are found in the lactiferous sinus or major duct of the breast?
* Intraductal papilloma
* Abscess/mastitis
* Pagets disease
151
What are the pathologies that occur in the terminal duct lobular unit?
* Fibrocystic change
* DCIS
* LCIS
* Ductal carcinoma
* Lobular carcinoma
152
What breast pathologies are found in the stroma of the breast?
FIbroadenoma and phyllodes tumor
153
Derivatives of glycine
Porphyrin and heme
154
Derivatives of phenylalanine?
Tyrosine which can be converted to DOPA which can be converted to Dopamine then NE then Epinephrine
155
Glutamate derivatives
GABA and glutathione
156
Arginine derivatives
Creatine, urea, nitric oxide
157
Tryptophan derivatives
Niacin and serotonin
158
What is the pathogenesis of cystic fibrosis?
Misfolded protein leads to retention of Cl- channels in the RER causing decreased Cl- and H2) secretion leading to increased intracellular Cl- and compensatory Na+ reabsorption via epithelial Na+ and abnormally thick mucus secreted into the lungs and GI tract
159
How does cystic fibrosis effect membrane potential?
Makes membrane potential more negative
160
Whaat is the function of ouabain?
Inhibition of the ATPase by binding to the K+ site
161
162
Major genetic connections are present between osteosarcoma and what other tumor?
Retinoblastoma or pagets disease
163
Albinism leads to what potential pathology?
* Squamous cell carcinoma
* Basal cell carcinoma
* Melanoma
164
Large cell lung carcinoma that stains positive for what identifying factors?
* TTF-1 - adeno
* P40 (squamous)
* Chromogranin (Neuroendocrine)
165
What is the criteria for acute rheumatic fever?
1. Migratory polyarthritis
2. Pancarditis
3. Subcutaneous nodules
4. Erythema marginatum
5. Sydenham chorea - involuntary muscle movements
166
What is erythema marginatum?
annular, nonprutiritc rash with erythematous borders, commonly involving trunk and limbs
167
What causes rheumatic fever?
Cross reactivity with bacterial M protein
168
What situations will ESR be elevated?
* Anemias
* Infections
* Inflammation
* Cancer
* Renal disease
* Pregnancy
169
What conditions lead to decreased ESR
* Sickle cell anemia
* Polycythemia
* HF
* Microcytosis
* Hypogibrinogenemia
170
What occurs in the proliferative stage of wound healing?
Deposition of granulation tissue and type III collagen, angiogenesis, epithelial cell proliferation, dissolution of clots, and wound contraction
171
What occurs in the remodeling stage of wound healing
Fibroblasts deposit type I collagen and replace type III collagen leading to increased tensile strength of tissue
172
Most (carcinomas/sarcomas) spread hematogenously
Sarcomas
173
What parameters are changed by rapid squatting?
* Increased venous return
* Increased preload
* Increased afterload
174
Why does renal failure result in inhibited GnRH?
Prolactin is eliminated renally and therefore is increased which inhibits GnRH release
175
What are the characteristics of a neuroblastoma
* Most common tumor of adenal medulla in children
* CAN CROSS THE MIDLINE
* Usually in children
176
What is the histological appearance of a neuroblastoma
Homer-Wright rosettes
177
How do neuroblastomas stain?
Bombesin and NSE +
178
Motilin
* Source:
* Action:
* Regulation:
* Source: small intestine cells
* Action: MMC production
* Regulation: Increased in fasting state
179
VIP
* Source:
* Action:
* Regulation:
* Source: Parasympathetic ganglia in sphincters, gallbladder, small intestine
* Action: Increased intestinal water and electrolyte secretion, increased relaxation of intestinal smooth muscle and sphincters
* Regulation: Increased by distation and vagal stimulation, decreased by adrenergic input
180
What are the actions of CCK
* Increased pancreatic secretion
* Gallbladder contraction
* Decreased gastric emptying
* Increased sphincter of Oddi relaxation
181
Glucose dependent insulinotropic peptide action
* Exocrine: decrease gastric H+ secretion
* Endocrine: Increased insulin release
182
Define pseudofolliculitis barbae?
"Razor bumps" Foreign body inflammatory facial skin disorder characterized by firm hyperpigmented papules and pustules that are painful and pruritic located on cheeks jawline and neck
183
What are the main reasons for acanthosis nigricans
insulin resistance from diabetes, obesity, cushing syndrome, or some kind of visceral malignancy like a gastric adenocarcinoma
184
What autonomic responses are responsible for the male sexual response?
POINT SQUEEZE SHOOT
* Parasympathetic - erection
* Sympathetic (hypogastric nerve) - emmission
* Somatic (pudendal) - ejaculation
185
How does _anemia_ change Hb concentration, %O2 sat, DIssolved O2 and total O2 content?
* Hb concentration: Decreased
* %O2 sat: Normal
* DIssolved O2: Normal
* total O2 content: Decreased
186
How does polycythemia change Hb concentration, %O2 sat, DIssolved O2 and total O2 content?
* Hb concentration: Increased
* %O2 sat: Normal
* DIssolved O2: Normal
* total O2 content: increased
187
How does CO poisoning change Hb concentration, %O2 sat, DIssolved O2 and total O2 content
* Hb concentration: Normal
* %O2 sat: Decreased
* DIssolved O2: Normal
* total O2 content: Decreased
188
How does bicarb get out of the red blood cell?
Exchanged with Cl-
189
190
What two reactions is B12 involved in?
* Homocystine to methionine
* Methylmalonyl-CoA to succinyl CoA
191
How does a B12 deficiency differ from a B9 defieicny?
* Homocysteine and methylmalonyl CoA are elevated in B12 deficiency
* JUST homocysteine is elevated in B9 deficiency
* No neurologic deficits in B9 deficiency
192
Apo CII does what?
Cofactor for LPL
193
Apo A1 does what
Activates LCAT
194
ApoB48 does what
Mediates chylomicron secretion into lymphatics
195
ApoE does what?
Mediates remnant uptake
196
ApoB100 does what
Binds the LDL receptor
197
Describe the receptor composition of T cells as they migrate
* T cell precursor in bone marrow: No CD4 or CD8
* Thymic cortex: CD4 and CD8
* Thymic Medulla: Either CD4 or CD8 but not both
198
What is the coactivator molecule on T cells and what does it bind to?
CD28 on T cells binds B7(CD80/86)
199
What triggers anergy in T cells
Exposure to antigen without costimulatory signals
200
What organisms are vaccinated by live vaccines?
Mrr VZ Mapsy
* BCG
* Influenca
* Measles
* Mumps
* Polio
* Rotavirus
* Rubella
* Varicella
* Yellow fever
201
What organisms are vaccinated with inactivated vaccines?
RIP Always
* Rabies
* Influenza
* Polio
* Hep A
202
What organisms are treated with passive immunity
To Be Healed Very Rapidly
* Tetanus toxin
* Botulinum
* HBV
* Varicella
* Rabies
* (sometimes diptheria)
203
Describe Romano-Ward syndrome vs Jervell Lang Neilsen syndrome
* Romano Ward - autosomal dominant, pure cardiac phenotype
* Jervell Lange Nielsen - autosomal recessive, sensorineural deafness
204
What local metabolites lead to vasodilation in times of increased oxygen need
CO2, H+, Adenosine, Lactate, K+
CHALK
205
What are the main treatments for air emboli?
Nitrogen bubbles precipitate in ascending divers can be treated with hyperbaric O2
206
What are the two sensory neuron fiber types that free nerve endings utilize?
* C - Slow, unmyelinated fibers
* A delta - fast, myelinated
207
What are the neuron fiber types utiliized by meissner corpuscles
Large, myelinated fibers; adapt quickly
208
What are the sensory neuron fiber types utilized by pacinian corpuscles
Large myelinated fibers that adapt quickly
209
What are the sensory neuron fiber types utilized by merkel discs
Large myelinated fibers that adapt slowly
210
What are the sensory neuron fiber types that are utilized by ruffini corpuscles?
Dendritic endings with capsule; adapt slowly
211
Characteristics of each stage of sleep from awake to REM
At night BATS Drink Blood
* Awake: Beta
* Awake (eyes closed): Alpha
* N1: Theta
* N2: Sleep spindles and K ocmplexes
* N3: Delta
* REM: Beta
212
What is desmopressin?
ADH analog
213
What tract decussates in the medulla?
Dorsal column
214
Friedreich ataxia mutation
GAA on chromosome 9 in gene that codes for frataxin
215
What is presbyopia?
Aging-related impairment of accomodation (focusing on near objects) primarily due to decreased lens elasticity, changes in lens curvature, decreased ciliary muscle strength. Patients resultantly need reading glasses
216
What is the mechanism and adverse effects of memantine?
* NMDA receptor antagonist; helps prevent excitotixicity
* AE: Dizziness, confusion, hallucinations
217
What are the drugs that can be uzed for AChE inhibition in alzheimers
Donepezil, galantamine, rivastigmine, tacrine
218
what is the 60-40-20 rule
* 60% of the body is water
* 40% of that water is ICF
* 20% of that water is ECF
219
220
Chronic irritation of the urinary bladder leads to what kind of carcinoma?
Squamous cell carcinoma of the bladder from dysplasia and squamous cell carcinoma
221
Incidence order of gynecologic tumor epidemiology?
Endometrial then ovarian then cervical
222
Prognosis order of gynecological tumors
Ovarian endodermal then cervical
223
What is the pathogenesis of achalasia?
Increased LES tone due to loss of NO secretion
224
Punched out esophageal ulcers are indicative of
HSV-1 infection
225
Pyruvate kinase deficiency leads to
Decreased ATP and rigid blood cells leading to extravascular hemolysis
226
What are the markers of pyruvate kinase deficiency
Increased 2,3 BPG and decreased hemoglobin affinity for O2
227
What is the appearance of stevens johnson syndrome?
* Fever
* Bullae formation
* Necrosis
* Sloughing of skin at dermal epidermal junction
* 2 mucous membranes are involved
* targetoid skin leasoins or
* erythema multiforme
228
What is the chemical composition of a person with narcolepsy
Hypocretin production in lateral hypothalamus
229
Describe the physiologic adaptations in pregnancy
* Increased cardiac output
* Increased HR to perfuse placenta
* Anemia
* Hypercoagulability
* Hyperventiliation
230
What causes increased hCG in pregnancy?
Increased in multiple gestations, hydatidifor moles, choriocarcinomas, and Down Syndrome
231
When is hCG decreased in pregnancy?
Ectopic and failing pregnancy, edward syndrome, patau syndrome
232
What are the treatments for CN- poisoning?
CN poisoning
* Nitrites oxidize hemoglobin to methemoglobin which binds CN- and relieves cytochrome c oxidase
* Thiosulfate binds CN- - thiocyanate is then excreted
233
Excess nitrogen in the body is converted to what?
Carbamoyl phosphate which is converted to citrulline
234
What is the problem that occurs with abetalipoproteinemia?
Absence of chylomicrons, VLDL, and LDL caused by a deficiency in ApoB48, ApoB100
235
What are the tests for neurosyphilis
VRDL, FTA-ABS, and PCR
236
Gag gene
(p24 and p17) Capsid and matrix proteins respectively
237
What are the phase 2 reactions?
Conjugation (Methylation, glucuronidation, acetylation, sulfation). Yields polar, inactive metabolites
238
Define xanthogranulomatous pyelonephritis
rare; grossly orange nodules htat can mimic tumor nodules; characterized by widespread kidney damage due to granulomatous tissue containing foamy macrophages
239
240
What is the cellular pathway utilized by the T cell receptor
* Calcineurin activation leads to dephosphorylation of NFAT
* NFAT leads to transcription of NF-kB which leads to synthesis of inflammatory cytokines
241
What is increased in the cell when the IL2 receptor is activated
mTOR, which triggers the transcription of proliferation genes
242
What is the result of subthalamic nucleus damage
Contralateral hemiballismus
243
What is kluver bucy syndrome?
Disinhibited behavior (hyperphagia, hypersexuality, hyperorality) usually caused by HSV1 encephalitis
244
What is perinaud syndrome
Paralysis of conjugate vertical gaze as a result of stroke, hydrocephalus or pinealoma
245
Conductive hearing loss will show up how on a rinne test?
Bone is more loud than air
246
What is the difference between a somatic symptom disorder and a conversion disorder?
* Somatic symptom: Unconscious production of physical symtoms causing significant distress and impairment
* Conversion disorder: Loss of sensory or motor function, often following an acute stressor
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248
How does age change sleep patterns?
* Decreased rem and slow wave sleep
* Increased onset sleep latency
* Increased early awakenings
249
What is the cause of osteitis fibrosa cystica
Osteoclast overactivity leading to cystic spaces with deposited hemosiderin from hemorrhages
250
What is the main cause of the basophilic stipling in lead poisoning?
ALA dehydratase and ferrochelatase are inhibited by lead poisioning, meaning that heme synthesis is inhibited, but rRNA degradation is as well. THis leads to aggregates or rRNA which stain basophilic around the nucleus
251
Which type of hodgkin lymphoma has the best prognosis?
Lymphocyte rich
252
What is the appearance of mixed cellularity hodgkin lymphoma
Eosinophilia, seen in immunocompromised patients
253
What is the pair mnemonic of seronegative spondyloarthritis
PAIR
* Psoriatic arthritis
* Ankylosing spondylitis
* Inflammatory bowel disease
* Reactive arthritis
254
What is the list of things that occur in sarcoidosis?
* Increased ACE
* Restrictive lung disease
* Vitamin D
* Bells Palsy
* Uveitis
* Hypercalcemia
* Erythema nodosum
* Lupus perino
255
What is lupus perino
Manifestation of sarcoidosis in which the nose and face has red erosive lesions that appear like frostbite
256
What nerve endings sense dynamic, fine light touch, and position sense
Meissner corpuscles
257
What receptors sense vibration and pressure?
Pacinian corpuscles
258
What receptors sense pressure, deep static touch, and position sense
Merkel
259
What receptors sense pressure, slippage of objects along skin surface, joint angle change
Ruffini
260
What foramen drain to the lateral 4th ventricle and which drain to the medial 4th ventricle?
Lateral = luschka
Medial = magendie
261
What is the treatment of ischemic stroke?
If within 3-4.5 hours, use tPA to but clot and regain perfusion of desired area
262
Describe what happens during a transient ischemic attack
Brief, reversible episode of focal neurologic dysfunciton that SHOWS UP NEGATIVE NO MRI and resolves in 15 minutes due to local ischemia
263
MCA aneurysm leads to
Rupture leads to ischemia in MCA distribution and ontralateral upper extremity and facial hemiparesis, sensory deficits
264
List the things that cause bell palsy
Lovely Zoey Has an STD
* Lyme disease
* Zoster
* Herpes simplex
* Sarcoidosis
* Tumors
* Diabetes mellitus
265
Infndibulopelvic ligament
* Carries ovarian vessels
* Connects ovaries to lateral wall
* Ligated during oophorectomy
266
Carcinal ligament
* Cervix to pelvic wall
* Uterine vessels
* When ligated can injure ureters
267
Ovarian ligament
* Medial pole of ovary to lateral uterus
* connects ovary to lateral uterus
268
Describe the major findings of acromegaly
Large tongue with deep furrows, deep voice, large hands and feet, coarsening of facial features with aging, frontal bossing, diaphoresis, impaired glucose tolerance
269
Acromegaly increases the risk of what two things?
Colorectal polyps and cancer
270
What receptors are responsible for Tight binding
ICAM and VCAM on vasculature/stroma bind CD11/18 integrins and VLA-4 on leukocytes respectively
271
Diapedesis is mediated by what recpetors
PECAM1 on vasculature and leukocyte
272
What is opsoclonus myoclonus ataxia syndrome
Dancing eyes and dancing feet due to a neuroblastoma in children and a small cell lung cancer in adults
273
What are the major causes of paraneoplastic encephalomyelitis
Antibodies against Hu antigens in neurons that originate from small cell lung cancer
274
What are the causes of paraneoplastic cerebellar degeneration? Make sure to include the specific antibodies
* Small cell lung cancer (anti Hu)
* Gynecologic and breast (anti-Yo)
* Hodgkin lymphoma (anti-Tr)
275
What is the difference between somatostatin and somatomedin
* Somatostatin - keeps your growth static
* Somatomedin - mediates growth
276
What is the result of decreased Steroid Hormone Binding Globulin?
Increased amounts of free hormones leading to greater effects
277
What is the function of somatostatin?
* Decreased gastric acid and pepsinogen
* Decrease pancreatic and small intestine fluid secretion
* Decrease gallbladder contraction
* Decrease insulin and glucagon
278
What are the results of a VIPoma?
Pancreatic tumor that secretes VIP
* WDHA syndrome
* WD: Watery Diarrhea
* H: Hypokalemia
* A: Achlorohydria
279
What are the usual causes (Other than H pylori) of Gastric ulcers and duodenal ulcers?
Gastric ulcers are usually caused by NSAIDs while duodenal ulcers are usually caused by Zollinger Ellison syndrome
280
Contents of primary granules of neutrophils
* Primary
* Peroxidase (MPO or myeloperoxidase)
* Permeability-increasing protein
* Proteases (Serine proteases)
* Elastase (Neutrophil elastase)
* Defensins
281
Contents of Azurophilic granules of neutrophils
Proteases, acid phosphatase, myeloperoxidase, beta-glucuronidase
282
What is the presentation of follicular lymphoma
* Indolent course; bcl2 inhibits apoptosis meaning that cells live forever
* Presents with waxing and waning lymphadenopathy that is not painful
283
What is the lcinical presentation of burkitt lymphoma?
Starry sky appearance with sheets of lymphocytes with interspersed tangible body macrohages that cause cleared out areas. Associated with EBV
284
What is heparin bridging?
Heparin frequently used when starting warfarin because heparins activation of antithrombin enables anticoagulation during the initial, transient hypercoagulable state caued by warfarin
285
What does IPEX stand for?
* Immune dysregulation - autoimmunity
* Polyendocinopathy
* Enteropathy
* X linked
286
What is the pathogenesis of IPEX?
Autoimmunity caused by genetic feficiency of FOXP3 in regulatory T cells
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288
289
What is the cause and result of erbs pallsy?
* Injury: Tear of the upper trunk C5-C6 roots
* Result: Loss of abduction, lateral rotation, flexion and supination
290
What is the injury and result of klumpkes palsy?
* Lower trunk injury C80T1
* Total claw hand: lumbricals normally flex MCP joints and extend DIP and PIP joints
291
What is the result of hracic outlet synddrome?
* Same as klumpkes palsy
* Atrophy of the intrinsic hand muscles, ischemia, pain, and edema due to vascular compression
292
Trendelenburg sign is caused by injury to what nerve
Superior gluteal nerve
293
What is the mechanism and AE of leflunomide
* Mech: Reversibly inhibit dihydroorotate dehydrogenase, preventing pyrimidine synthesis. Suppressing T cell function
* AE: Diarrhea, hypertension, hepatotoxicity, teratogenicity
294
What is febuxostat?
Inhibitor of xanthine oxidase
295
Bisphosphonate
* Pyrophosphate analog; bind hydroxyapatite in bone and inhibits osteoclast activity
* Can cause esohagitis, osteonecrosis of jaw, atypical stress fractures
296
What is allopurinol?
Inhibit xanthine oxidase used in lymphoma to derease conversion of hypoxanthine to urate
297
What is etanercept?
Fusion protein produced by recombinant DNA that intercepts TNF
298
What are the anti-TNF monoclonal antibodies?
Infliximab, adalimumab, certolizumab, golizumumab
299
What is the function of human placental lactogen
* Stimulate insulin production
* Increased insulin resistance due to shunting of carbohydrate metbaolism toward supplying glucose/amino acids to the fetus
* Increased lipolysis (due to insulin resistance)
300
What are the markers for mesothelioma?
* Psammoma bodies
* Cytokeratin and calretinin
301
What is the effect of endotoxins
Directly stimulate macrophages by binding to endotoxin receptor TLR4(CD14) TH CELLS ARE NOT INVOLVED IN THIS PROCESS
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303
What are the nuclei of the cerebellum from lateral to medial
Dentate, eboligorm, GLobose, Fastigial
304
Fibroadenoma
Small well defined and mobile mass increased in size and tenderness with increased estrogen
305
What is the difference between red and white pulp?
* Red pulp is where red blood cells are processed
* White pulp is where white blood cell ferminal centers are
306
What is Hfr x F- conjugation?
F+ plasmid can become incorporated into bacterial chromosomal DNA, termed high-frequency recombination cell. Transfer of leading part of plasmid and a few flanking chromosomal genes. High frequency recombination may integrate some of those bacterial genes. The recipient cell remains F- but now may have new bacterial genes
307
Azathioprine or 6 mercaptopurine use
* Purine analogs that inhibit pruine synthesis
* Must be activated by HGPRT
* Used for organ rejection, IBD, SLE and to wean patents off steroids in chronic disease
308
Adverse effects of azathioprine and mercaptopurine
* Myelosuppression, GI, liver damage
* Increased toxicity with allopurinol and febuxostat
309
What is the use and mech of cladribine
* Purine analog - multiple mechanisms
* Used for hairy cell leukemia
310
Adverse effects of cladribine
Myelosuppression, nephrotoxicity, neurotoxicity
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5FU mechanism and use
* Mech: COmplexes with thymidylate synthase and folic acid, inhibiting it
* Use: Colon cancer, pancreatic cancer, basal cell carcinoma (topically)
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5FU adverse effects
Myelosuppression, palmar plantar erythrodysesthesia
313
Methotrexate mech and use in cancers
* Folic acid that inhibits dihydrofolate reductase decreasing DNA synthesis
* Cancers: Leukemias, lymphomas, choriocarcinomas, sarcomas
314
Non cancer uses of Methotrexate
Extopic pregnancy, medical abortion, rheumatoid arthritis, psoriasis, IBD, vasculitis
315
What are cytarabine used for?
Pyrimidine analog used for leukemias and lymphomas
316
Sirolimus inhibits what and causes what toxicity
* mTOR inhibitor by binding FKBP to prevent response to IL2
* Pancytopenia, insulin resistance, hyperlipidemia
317
Tacrolimus mech and toxicity
* Prevents IL2 transcription by binding FKBP
* Increased risk of diabetes and neurotoxicity
318
Cyclisporine mechanism
* Calcineurin inhibitor prevents IL2 transcription
* Nephrotoxicity, hypertension, hyperlipidemia, neurotoxicity, gingival hyperplasia, hirsutism
319
Azathioprine mechanism
* Inhibit lymphocyte proliferation by blocking nucleotide synthesis
* Pancytopenia
320
MMF mechanism and toxicity
* IMP dehydrogenase preventing purine synthesis in B and T cells
* Pancytopenia, hypertension, hyperglycemia
321
What is a temporary effect of corticosteroids
Temporary leukocytosis
322
Drugs for kidney transplant rejection prophylaxis
Sirolimis and basiliximab
323
What are phase 1 reactions
Reduction, oxidation and hydrolysis
324
Chloroquine uses. What do you use if there is resistance?
Blocks plasmodium heme polymerase, but if there is resistance go to mefloquine or atovaquone/proguanil
325
What is primaquine used for?
Hypnozoite form of plasmodium vivax and ovale
326
What is the mechanism of sulfonimides
Mimic action of glucose by closing K+ channels in pancreatic β cells, which leads to depolarization and increased Ca2+ influx, releasing insulin.
327
Metformin Mechanism
meets glucose and advises it to stay out of the blood. It asks the liver to keep glucose in the house (Inhibits hepatic glucose production) and asks the glucose in the bloodstream to go into adipose and skeletal muscle (Stimulates peripheral uptake of glucose). Metformin never met a glucose molecule and did not tell him to not stay in blood :P
328
Biguanides
Inhibits hepatic glucogenesis and increases peripheral uptake of glucose.
329
Gliptans
Drugs ending with -gliptins (Sitagliptin, etc) are dipeptidyl peptidase 4 (DPP-4) inhibitors. They act to inhibit degradation of the endogenous incretins GLP-1 and GIP.
330
Amylin
Amylin rhymes with insulin to remember that amylin mimetics like pramlintide increase secretion of insulin and delay gastric emptying.
331
Thiazolinidione toxicity
THiazoLidinedione: Toxic to Heart and Liver
332
Pioglitazone mnemonic
Pioglitazone - PI
Peroxisome proliferator-activated receptors (PPARs)
Improves insulin sensitivity
333
Adverse effects of acetazolamide
Proximal renal tubular acidosis, paresthesias, NH3 toxicity, sulfa allergy, hypokalemia
334
Loop diuretics adverse effects
OHH DAANG
* Ototoxicity, hypOkalemia, hypOmagnesmia, dehydration, allergy, metabolic Alkalosis, Nephritis, Gout
335
Thiazide diuretics adverse effects
* HyperGLUC
* G: hypoGlycemia
* L: hyperLipidemia
* U: hyperUricemia
* C: hyperCalcemia
Also metabolic alkalosis, hyponatremia
336
Angiotensin converting enzyme inhibitor adverse effects
* Cough
* Angioedema
* Teratogen
* Increased Creatinine
* Hyperkalemia
* Hypotensino
337
Adverse effects of aliskiren?
Hyperkalemia, decreased GFR, hypotension, angioedema
338
What are the 5 bacterial products produced by phages
ShigA-like toxin (this is aka Verotoxin)
Botulinum toxin
Cholera toxin
Diphtheria toxin
Erythrogenic toxin (Strep pyogenes)
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340
Irinotecan and topotecan mechanism and adverse effects
* Mech: Inhibit topoisomerase I and prevent DNA unwinding
* AE: Myelosuppression and diarrhea
341
What is the function of the ulnar nerve
* Ulnar claw on digit extension
* Radial deviation of wrist upon flexion
* Loss of wrist flexion, flexion of medial fingers, abduction and adduction of fingers, actions of medial 2 lumbrical muscles
342
What is a cystic hygroma associated with
Turner syndrome
343
What is the gene involved in Sturge weber?
GNAQ gene
344
What drug has the highest and lowest lipid and blood solubility
Nitrous oxide has the lowest blood and lipid solubility and **H**alothane has the **h**ighest
345
Mature ego defenses
Sublimation, altruism, suppression, humor
346
Findings of tay sachs
* Neurodegeneration
* Developmental delay
* Red spot on macula
* Onion skin on lysosome
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Fabry findings
* Episodic peripheral neuropathy
* Angiokeratomas
* Hypohidrosis
* Renal failure
* Cardiovascular disease
348
Metachromatic leukodystrophy findings
Central and peripheral demyelination with ataxia, dementia
349
Krabbe disease findings
* Peripheral neuropathy
* Oligodendrocytes
* Developmental delay
* Optic atrophy
* Globoid cells
350
Gaucher disease findings
* Hepatosplenomegaly
* Pancytopenia
* Osteoporosis
* Avascular necrosis of femur
* lipid laiden macrophages
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Neiman pick disease
* Neurodegeneration
* Hepatosplenomegaly
* Foam cells
* Cherry red macula
352
Catalase positive organisms
Nocardia, pseudomonas, listeria, aspergillus, candida, e coli, staphylococci, serratia, B cepacia, H pylori
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354
Glut 5 transporters are found where?
Spermatocytes and GI tract
355
Which andrenal enzyme deficiency features an increase in 17 hydorxyprogesterone?
21 hydroxylase
356
What is a giveaway that you are dealing with a adrenal enzyme deficiency?
Bilateral enlargement of the adrenal glands and hyperpigmentation from large amounts of ACTH secretion
357
What are the congenital markers of hypothyroidism?
Pot bellied, protruding umbilicus, protuberent tongue, poor brain development, pale, puffy faced
358
What are the features of ulcerative colitis?
ULCCCERS
* Ulcers
* Large intestine
* Continuous
* Colorectal carcinoma
* Crypt abscesses
* Extends proximally
* Red diarrhea
* Sclerosing cholangitis
359
Markers for ALL?
TdT+, CD10+
360
What is a renal oncocytoma?
Tumor arising from collecting ducts, featuring large eosinophilic cells with abundant mitochondria and presenting with painless hematuria, flank pain, and abdominal mass
361
Mnemonic for lung development
1. Embryonic (3-8 weeks, i.e. embryonic period)
2. Pseudoglandular (5-16 weeks)
3. Canalicular (16-26 weeks)
4. Terminal saccular (26-36 weeks)
5. Alveolar (36 weeks to 40 weeks and continues to childhood)
362
Where are the bifurcations
* Common carotid: C4
* Trachea: T4
* AA: L4
363
What is a common weird thing that is seen with bronchogenic cysts
Filled with fluid, seen on xray
364
What is the problem of lesion of the reticular activating system?
Reduced levels of arousal and wakefulness
365
Define cyclothymic disorder
Milder form of bipolar disorder lasting at least 2 years
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367
What are the features of 5 alpha reductase deficiency?
Inability to convert testosterone to DHT leading to male internal genitalia, ambiguous external genitalia until puberty where testosterone levels increase
368
What happens in a person who has no sertoli cells?
Lack of mullerian in hibitory factor leading to the development of both male and female internal genitalia and male external genitalia
369
How is estrogen made in the theca and granulosa cells?
* Cholesterol is used by the theca cells and is converted to androstenedione by desmolase
* Androstenedione is passed over to the granulosa cells and converted to estrone by aromatase
370
What is it called when the V/Q ratio = 0
Shunt, meaning that there is no air coming in and this section of lung is just a connection between the right and left ventricle with no gas exchange
371
What is the presentation of bronchiectasis?
* Clubbing, purulent sputum, recurrent infections, hemoptysis
* Chronic necrotizing infection of pronchi leading to permanently dialated airways
372
What are some common reasons for serial platelet thrombi on heart valves?
Adenocarcinomas, especially pancreatic
373
Ulnar claw is caused by what?
* Occurs when extending fingers at rest
* Distal ulnar nerve injury
374
What types of lesions produce clawing of the hand?
Distal ulnar or median nerves
375
Clawing of the thumb, pointer and middle finger is caused by what
* Injury to the distal median nerve
* Occurs when trying to extend fingers
376
Patient is making the ok gesture when trying to close his hand
Proximal ulnar nerve injury leading to this gesture when trying to make a fist
377
Popes blessing is caused by what?
Injury to the proximal median nerve and seen when making a fist
378
Atrophy of the thenar and hypothenar eminence is indicative of what two things?
* Thenar: Median
* Hypothenar: Ulnar
379
What arae some things that can injure the long thoracic nerve?
Axillary node dissection after mastectomy, stab wounds
380
What are the deadlines for twinning in embryogenesis
* First 72 hours (up to morula stage): Dichorionic Diamnionic (No risk of Twin-Twin transfusion syndrome)
* Between 4 and 8 Days (Blastocyst stage): Monochorionic Diamnionic
* Between 9 and 12 Days (Splitting of embryonic disk) ---\> Monochorionic Monoamnionic
381
What is the difference between the left and right gonads in terms of venous drainage?
Left takes the longer route and goes into the left renal vein first
382
What are the cytokines of T reg cells
Anti inflammatory IL10, TGF-beta
383
Symptoms of arsenic poisoning
Vomiting, rice water stools, garlic breath, QT prolongation
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385
What is the difference between decerebrate and decorticate posturing?
Decorticate has more Cs and moves the hands more toward the cord while decerebrate has more es and moves the hands toward the extension position
386
What are the short acting benzos?
ATOM: Alprazolam, triazolam, oxazoepam, midazolam
387
What is the effect that benzos have on sleep?
Decreased REM
388
What is a perfusion limited gas
One that reaches equilibration early, like CO2 and N20
389
390
Glucagon causes what change in PFK2
1. Low glucose
2. Glucagon increases cAMP
3. Phosphorylation of FBPase2
4. Decreased F26BP
5. Inhibition of glycolysis, stimulates gluconeogenesis
391
Insulin causes what change in PFK2
1. High blood glucose
2. Insulin leads to dephosphorylation of FBPase2 and activation of PFK2
3. Increased F26BP
4. Stimulates glycolysis and inhibits gluconeogenesis
392
What is the difference between duchenne and becker muscular dystrophy?
Duchenne has a much earlier onset whereas becker has an onset in adolescence
393
What is the worst subtype of breast cancers? Who commonly gets this?
Triple negative, mostly african americans
394
What is the distinction between dystrophic and metastatic calcification
* Dystrophic: Deposition of calcium that occurs in dead or dying tissue that occurs with normal serum levels of calcium and normal calcium metabolism
* Metastatic calcification: Deposition of calcium in normal tissues as a result of derangement in calcium metabolism and increased levels of calcium
395
Wolff Chaikoff vs Jod Basedow
* Wolff-Chaikoff: Hypothyroidism because of ingestion of large amount of iodine
* Jod-Basedow effect: Iodine induced hyperthyroidism in patient with multinodular goiter and graves
396
What drug can cause parkinsonian symptoms?
MPTP which is metabolized to MPP
397
What is vilazodone?
INhibits 5HT uptake; 5HT1A receptor partial agonist. Used for MDD, and generalize anxiety. Can cause nausia vomiting and diarrhea, increased weight, and anticholinergic effects
398
What is vortioxetine
5HT reuptake inhibitor that agonizes 5HT1A and 5HT3 receptor antagonist. Used for MDD. Can cause nausea, sexual dysfunction ,sleep disturbances, antichoinergic effects
399
How do sarcomas stain?
+ for desmin
400
What is the appearance of brenner's tumor on histology?
Coffee bean nuclei and looks like bladder cells
401
What is used primarily to study gene exrpression?
Northern blot
402
What are the jobs of the D and T arms of tRNA?
* D = detection of tRNA by aminoacyl-tRNA synthetase
* T = tethers tRNA molecule to ribosome
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404
What is the direction of blood flow compared to bile flow
Bile flows opposite of blood toward zone 1 and blood flows toward zone 3 into the central hepatic vein
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What are the symptoms of colonic ischemia?
* Reduction in intestinal blood flow causing ischemia
* Abdominal pain followed by hematochezia
* Occurs in splenic flexure or distal colon
* Thumbprint sign on imaging due to mucosal edema
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What are some treatments for acne?
Retinoids, benzoyl peroxide, antibiotics
408
What are some major causes of cataracts?
* Age
* Smoking
* Alcohol
* Sunlight
* Corticosteroids
* Diabetes
* Trauma
* Infection
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What are the congenital reasons for cataracts?
* Galactosemia
* Galactokinase deficiency
* Trisomies (13,18,21)
* ToRCHeS infections
* Marfan
* Allport
* Myotonic dystrophy
* Neurofibromatosis 2
410
What are the adverse effects of copper intrauterine devices?
Heavier or longer menses, dysmenorrhea, risk of pelvic inflammatory disorder
411
What is refsum disease?
Scaly skin, ataxia, shortening of the 4th tow, epiphyseal dysplasia
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Homocysteinuria can be caused by what defects?
* Deficiency of cystathionine synthase
* Defective cystathionine synthase
* Methionine synthase deficiency
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What are the symptoms of homocystinuria?
* Increased homocystine
* Osteoporosis
* Marfanoid habitus
* Ocular damage
* Cardiovascular thrombosis and atherosclerosis
* kYphosis
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What toxin functions like TSST1 but comes from strep pyogenes?
Exotoxin A
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Jarisch Herxheimer reaction
Flu like syndrome after antibiotics are started due to killed bacteria releasing toxins
417
What is the beers criteria?
* Avoid certain medications due to decreased efficacy or increased risk of adverse effects
* Anticholinergics, antihistaminergics, antidepressants, benzos, opioids
* alpha blockers
* PPIs
* NSAIDS
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What is hospice care indicated for?
Those whose life expectance is less than six months, giving priority tocomfort and relieving pain over side effects (for example: Opioids are given despite the odds of respiratory depression)
419
Define cor pulmonale
Isolated right HF due to pulmonary causes
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What is the mech and use of paclitaxel?
* Stabilize microtubules so the mitotic spindle cant break down
* Ovarian and breast carcinomas
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Mechanism and use of vincristine and vinblastine
* Bind beta tubulin and inhibit polymerization
* Solid tumors, leukemias, hodgkin (vinblastine), non-hodgkin (vincristine)
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What other hormone shares a subunit with LH, FSH, and TSH? What is the consequence of this?
hCG, meaning that it can cause hyperthyroidism
423
What is SBLA syndrome?
Sarcoma, breast, leukemia, adrenal gland malignancy associated with TP53 mutation
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CD14 receptor is what
Receptor for PAMPs like LPS, usually found on macrophages
425
Marker for hematpooietic stem cells
CD34
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What are the consequences of splenectomy?
* Howell-Jolly bodies
* Target cells
* Thrombocytosis (loss of sequestration of platelets)
* Lymphocytes (loss of sequestration)
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What is the treatment for the different forms of homocystinuria?
* Cystathionine synthase deficiency: decrease methionine, increase cysteine, increase B6 and B12, increase folate
* Cystathionine synthase defect: Increase B6 and increased cysteine
* Methionine synthase deficiency: Increase methionine
428
What is glutamate converted to for assistance in the cahill and cori cycle?
Combined with pyruvate to form alpha ketoglutarate and alanine
429
What are the processes of collagen synthesis that occurs within the cell?
Synthesis, hydroxylation, glycosylation
430
What are the processes of collagen synthesis that occurs outside the cell?
Proteolytic processing, gross linking
431
What are the early adrenergic symptoms of hypoglycemia?
Sweating, tremors, palpitations, hunger, nervousness due to NE and Epi release
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What are the late symptoms of hypoglycemia?
confusion, visual disturbances, stupod, seizures, and neurological deficits
433
What is the main difference between endometrial hyperplasia and carcinoma?
* Hyperplasia: excess estrogen syimulation leads to increased gland proliferation and can lead to carcinoma
* Carcionma: Vaginal bleeding cauased as a gynecological malignancy at 55
434
fdsds ddsf
435
What is the chromosomal makeup of most complete moles?
46XX
436
Zebra sign is a sign of what?
Horizontal lines of dense bone progressing away from the growth plate in children in osteogenesis perfecta
437
What is a howell jolly body?
BLUE Remnant of chromatin that is usually consumed by the spleen but is not consumed in splenectomy or sickle cell patients
438
What lesion produces total claw hand
Both ulnar and median nerve are damaged
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440
What is the mechanism of ranolazine? Adverse effects
* Inhibits late phase of sodium current thereby reducing diastolic wall tension and oxygen consumptoin
* Causes constipation, dizziness, headache, nausea, and QT prolongation
441
What is the mechanism of milrinone?
PDE3 inhibitor leading to increased cAMP accumulation, ca2+ accumulation and increased inotropy and chronotropy as well as smooth muscle dilation
442
Ivabradine mech and AE
* Mech: selective inhibition of funny sodium channels prolonging depolarization
* Luminous phenomena/visual brightness, hypertension, bradycardia
443
What are the adverse effects of digoxin?
* Cholinergic - nausea, vomiting, diarrhea, blurry yellow vision, arrythmias, AV block
* Hyperkalemia
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What is the function of Th1 and Th2 cells respectively
* Th1: Activates macrophages and cytotoxxic T cells
* Th2: Recruits eosinophils for parasite defense and promotes IgE production by B cells
446
What diuretics lead to acidemia and how?
* Carbonic anhydrase inhibitors: decreased bicarbonate resorption
* K sparing: prevents K+ secretion and H+ secretion
* Hyperkalemia leads to K+ entering all cells in exchange for H+
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What diuretics cause alkalemia and how?
* Loop diuretics and thiazides
* Volume contraction causes increased ATII leading to increased Na+/H+ exchange in the PCT
* K+ loss leads to K+ exiting all cells in exchange for H+
* Low K+ state causes H+ to be exchanged for Na+ in cortical collecting tubule
448
What diuretics lead to decreased calcium?
Loop diuretics LOSE CALCIUM
449
Name the reportable diseases
Hep, Hep, Hep, Hooray, the SSSMMART Chick is Gone
* ○ Hep A
○ Hep B
○ Hep C
○ HIV (actually varies by state, although AIDS is always
reportable)
○ Salmonella
○ Shigella
○ Syphilis
○ Measles
○ Mumps
○ AIDS
○ Rubella
○ TB
○ Chickenpox
○ Gonorrhea
450
What exactly is a psammoma body
Laminated, concentric spherules with dystrophic calcification seen in papillary carcinoma (thyroid), serous papillary cystadenocarcinoma of the ovary, meningioma, malignant mesothelioma
451
What forms of malaria have dormant forms in the liver
Hypnozoite
452
What is the effect of rapid squatting on heart murmurs
* Decreased intensity of hypertrophic cardiomyopathy murmur
* Increased intensity of AS, MR, VSD murmurs
* MVP has a later onset of click
453
What is the effect of valsalva and standing up on murmurs
* Decreased intensity of most murmurs
* Increased intensity of hypertrophic cardiomyopathy murmur
* MVP: earlier click
454
What is the result of inspiration murmurs?
Increased intensity of all right sided murmurs
455
What is takotsubo cardiomyopathy
Broken heart syndrome caused by ventricular apical ballooning due to increased sympathetic stimulation
456
What is the insulin dependent glucose transporter? Where is it found?
GLUT4 in the adipose and muscle
457
Markers of CLL?
CD20+, CD23+, CD5+
458
What changes are seen in psoriasis
Increased spinosum and decreased franulosum, as well as auspitz sign
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