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acute onset of lung dysfunction. pulmonary edema, normal LA pressure and PaO2/FiO2 of < 200.
-damage to endothelial cells lining the pulmonary capillaries resulting in leakage of fluid into the alveoli, sometimes referred to as the exudative stage.
-The process evolves to include a proliferative stage and sometimes a final fibrotic stage



-assoc with Pagets disease
-arrising in the femur, tibia, humerous and other bones
-destruction of the normal trabecular bone pattern, mixed radiodense and radiolucent areas, periosteal new bone formation, lifting of the cortex and codmans triangle.
-adjacent soft tissue usually demonstrates ossification in a sunburst pattern.


Globus hystericus (glubus sensation or lump in throart)

-emotions trigger
-fear, tension, anger, mental anguish
-assoc. GERD, upper esophageal sphincter abnormalities, achalasia, psychiatric disorders and stress
-the neck examination and barium swallow will show nothing



-characterized by the presence of endometiral glands and stroma outside the uterus
-significant pelvic pain, dysmenorhhrea, infertility and deep dyspaeunia are frequent


oseltamivir (tamiflu)

-sialic acid analogue that inhibits the neuraminidases of the influezna A and influenza B viruses. Which attacht to cells and respiratory tract mucins though hemagglutinin binding of glycoconjugate receptors.
-prevents release


DNA laddering

-lab phenomenon used to identify apoptotic cells and distinguid them from necrotic cells.
-during karyorrhexis, endonucleases degrade DNA into fragments that are mutioles of 180 base pairs, these fragments are equally spaced on gel electrophoresis giving the appearance of a ladder


slower benzodiasepine metabolism in the elderly increases the likelihood of adverse effects

confusion, anterograde amnesia, and psychomotor retardation are commonly reported in this patient population


Anticholinergic syndrome
hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter

-fever, dry skin, mucous membranes, flushing, mydriasis, cycloplegia and altered mental status.

thus confusion, blurred vision, dry mucous membranes and intense thirst are associated with anticholinergic toxicity


germline mosaicism

-the presence of two or more genetically different gamete cell lines
-should be considered when a genetic mutation is identified in the offspring but not the parents


Name an interleukin which is produced exclusively by antigen-stimulated T-lymphocytes

-stimulates growth and differentiation of T, B and NK cells and macrophages.



-calcium dependant transmembrane proteins that participate in desmosome formation via homolougous interaction with cadherins on adjoining cells

-bind within the cytoplasm to intermediate filaments (keratin) or microfilaments (actin) via intermediate proteins (catenin, plakoglobin and demoplakin) and bind extracellularly to cadherin molecules on adjacent cells, forming adherin junctions and desmosomes.


Molluscum contagiosum
-caused by Poxvirus (MC virus_

-contagious in children from skin to skin contacts and formites
-in adults --> sexually transmitted
-HIV or other immunocompromised individuals they experience a longer course

-multiple firm, flesh colored, dome shaped papules on the skin and mucous membranes. The papules are often pruitic and have umbilicated centers containing white, curdlike material


Endometritis is an infection of the uterus, most cases follow dlivery

-signs: fever, leukocytosis, uterine tenderness and foul smelling discharge
-it is most commonly cause by mixed flora with Bacteriodes the most commonly isolate organism


reflection interview technique

-this assures the patient that the physician has been listening to his concerns and allos the patient to clarify any points that have been misunderstood
-repeats what the paitents has just siad


long term intranasal cocaine abusers

-chronic nasal discharge
-atrophic nasal mucosa
-thinning of the nasal septum are likely to be long term intranasal cocaine abusers
-nasal septum perforation
-oropharyngeal ulcers and osteolytic sinusitis



-causes an acute reduction of the total GFR to 50%
-The long term results --> compensatory hyperfiltration and hypertrophy of the nephrons in the remaining kidney. ~ 80%


site of sidenfinil

-the cavernous venous sinuses of the corpora cavernosa


false positive ratio

= 1- specificity


HSV encephalitis

-most common viral encephalitis
-both immunocompetent and immunosupressed patients can be affected
-the temporal lobe is the main region of the brain affected, so in addition to fever, headahce and malaise, patients may experience seizures, personality changes and psychosis


Acute intermittent porphyria

-caused by a deficiency of HMB synthase
-characterized by intermittent episodes of abdominal pain with neurological manifestations after exposure to an offending medication
-urine will classically darken upon standing and contain porphobilinogen and aminolevulinic acid
-skin photosensitivity is characteristically absent


Exudates vs transudates
CHF is transudate

Exudates will demonstrate pleural fluid protein/serum protein < 0.5
-pleural fluid LDH/serum LDH > 0.6 or a pleural fluid LDH more than 2/3 the upper limit of normal serum LDH.

Transudates will lack these features, CHF cause a pleural fluid that is transudative

excudative pleural effusions result from infection, malignancy