Clinical manifestations of sarcoidosis
What is seen in synovial asparate in gout?
Gout: - Birefringence with needle shaped crystals
Pseudogout: + birefringence with Rhomboid shapped crystals
Decreased AFP on amniocentesis
Psammoma bodies are observed in these patholigic conditions
Papillary adenocarcinoma of thyroid
Serous cystAdenocarcinoma of ovary
Parotid gland enlargement in a thin female?
Parotid gland enlargement is evidence of purging
Which DNA polymerase has 5'-->3' exonuclease activity?
DNA Polymerase I
Which prokaryotic polymerase has 3'-->5' exonuclease activity?
DNA polymerase III to proofread
Dark urine upon exposure to light
Acute intermittant porphyria
Uroporphyrinogen I Synthase defect
Major lamotrigine use and side effect?
Partial refractory seizures
Major adverse effect associated with Ethosuxamide
Location of GLUT-1,2,3,4,5
GLUTE-1: RBC and Brain
GLUTE-2: Liver, B islet cells, Kidney
GLUTE-4: Skeletal muscle and Adipose
GLUTE-5: Frutose trnasporter in the GI
What structures are derived from the first aortic arch?
The maxillary artery
Structure derived from the second aortic arch?
(Stapedial is Second)
Third aortic arch
Common carotid and proximal internal carotid
(C is the 3rd letter of the alphabet)
Fourth aortic arch
Left: Aortic Arch
Right: proximal part of right subclavian
6th aortic arch
Proximal part of the pulmonary arteries
Which embryonic layer are the folling dervied from:
Arches: mesoderm (ARMESoderm)
or CAP from outside to inside
Cartilage, muscles and nerves derived from the first branchial arch?
Meckel's cartilage, Mandible, Malleus, Mandibular ligament
Muscles: Muscles of Mastication, Masseter, lateral and Medial pterygoid, myelohyoid, anterior belly of digastric and tensor tymapni and tensor veli palitini
Nerves: V2 and V3
2nd branchial arch cartilage, muscles, and nerves
Cartilage: Stapes, Styloid preocess, Stylohyoid ligament
Muscles: Facial expression, Stapedius and Stylohyoid
Nerves: CN VII (Seven=Smile)
3rd branchial arch cartilage, muscles and nerves
Catilage: greater horn of hyoid
Muscles: stylopharyngeus innervated by glossopharyngeal nerve (CNVIII)
Arches 4-6 cartilage, muscles, and nerves
Cartilage: thyroid, cricoid, and other laryngeal cartilage
Muscles: 4th: Pharyngeal constrictors, cricothyroid, levator veli palatini
Muscles: 6th: all intrinsic laryngeal except cricothyroid
Nerves: 4th: Superior laryngeal branch of CNX
Nerves: 6th: Recurrent laryngeal branch of CNX
Structures derived from the 3rd and 4th branchial pouches
3rd: inferior parathyroids and thymus
4th: superior parathyroids
Developes into the ascending aorta and pulmonary trunk
forms the smooth part of the left and right ventricles
The primitive ventricle and primitive atria form
The trabeculated parts of the ventricles and trabeculated parts of the atria respectively
coronary sinus is formed by the
left horn of the sinus venosus
Right horn of the sinus venosus forms the
smooth part of the right atrium
SVC is formed by
the right common cardinal vein and the right anterior cardinal vein
What does HCV lack that makes it so prone to mutations?
3'-->5' exonuclease activity
How is the fick principle used to calculate Cardiac Output?
CO= O2 consumption/(arterialO2-VenousO2)
These drugs are hypnotics that cause sedation and are also anxiolytics. What is their MOA?
Increase Cl channel frequenzzzzzz
What is the most common indolent non-hodgkin lymphoma in adults?
protein that regulates the G1-->S phase transition
How does it work?
Supresses transcription when in the hypophophrylated (active) state and is bound to EF2
When CyclinD and E and CDK4 and 6 (respectively) phophorylate Rb it becomes inactive and releases EF2 allowing transcription to take place
receptor that contains C and Adelta fibers and transmits pain and temperature
Free nerve endings
Sense pressure and deep static touch, are located in hair follicles...
What kind of fibers do they carry?
Carry large myelinated fibers and adapt slowly
Fine, light touch receptors that are located on hairless skin and adapt quickly...
What kind of fibers
Large myelinated fibers
Location, function, and fiber type associated with paccinian corpuscles
Large myelinated fibers
Deep skin, ligaments and joints
Sense vibration and pressure
Most common salivary glad tumor
Pleomorphic adenoma--> painless mobile mass composed of cartilage and epithelium and recurs frequently
Benign cyctic tumor with germinal centers found in the parotid gland
(papillary cystadenoma lymphomatosum)
msot common malignant salivary gland tumor
What is it composed of?
How does it present?
-->mucinous and squamous components
-->presents as a painful mass and commonly involves the facial nerve
acute, fatty, foul smelling diarrhea
(pear shapped nuclei with tumbling motility)
Tx for giaridia
RBC inside of trophozoites with multiple nuclei
DOC for entomoeba histolytica
--Trophozoites with Metronidazole and tinidazole
--Cysts with iodoquinol and paromycin
Bugs treated with metronidazole?
GET GAP on the Metro
Pylori (H. pylori)
Triad of conginital toxoplasmosis?
Tx of toxoplasmosis
Sulfadiazine and pyrimethamine
Bug that causes african sleeping sickness
trypanosoma bruci (tsetse fly)
Macrophages containing amastigotes
Leishmania donovani (sand fly)
Cutaneous ulcers that are slow to head after a bug bit?
48 hr fever cycle
P. vivax and ovale
Malaria assocatied with irregular fever
72hr fever cycle
Vivax and oval can remain dormant so must be treated with what drug
Bananna shapped gametocyte
Tx for malaria
Start with Chloroquine
If resistant add Mefloquine
if Vivax/Ovale (48hr cycle) add primaquine
Tx for babesiosis
Quinine and azithromycin
Neomatodes that are trasmitted orally (either Fecal-oral or ingestion)
Enterbius (pinworm-scotch tape)
Asacaris (giant roundworm--Loeffler eosinophilic pneumonitis)
Trichinella (bears--> in the muscle)
Stongyloids transmission and Tx
Penetrate skin of feet-->venous-->lungs blahblahblah
Ivermectin or albendazole
Three worms from feet penetrations
Cestode that causes neurocystercerosis
Cysts from dog feces
echinococcus granulosus (ethanol injected to kill cysts before removal)
Helminths with portal hypertension and splenomegaly
Top 3 most common cancers in men in US
Most common cancer in women in US
Men most mortalities from cancer
(switch one and two most common)
Most mortalities from cancer in women in US
(Switch first and second most common)
What CDK and cycldin is involved in Rb protein phosporylation
Cyclin D activated CDK4-->Rb phosphorylation
Phosphorlated Rb detaches from EF2 and allows G1-S phase to continue
Tumors associated with tuberous sclerosis?
Skin manifestation to TS?
-Cardiac rhabdomyoma, renal angiomyolipoma, astrocytoma
Ash Leaf spots
Most common three drug regimin for testicular cancer?
Eradicate Ball Cancer
Bleomycin (can be replaced with Ifosfomide)
Cancer drug that stabilizes microtubules
Paclitaxel and taxols
TAXES stabilize society
Side effects of glucocorticoid use
Necrosis of the femoral head
Galucoma and cataracts (hyperglycemia)
Patient with a recent subarachnoid hemorrhage (4-12d) develops similar symptomes (muscle weakness) as the original event. What is the most likely cause?
Seen in >50% of SAH and will manifest with similar physical finidings and a negative non-contrast CT
MOA of colchicine
Inhibits microtubule formation thereby affecting leukocyte migration and chemotaxis
Morphine acts by...
Inihbiting mu receptors and causing increase potassium efflux from the post-synaptic neuron.
Paitient with a significant family Hx of early cancers of the brain, adrenal cortex, breast, leukemia and sarcomas. What is the mutation and what is the name of the disorder?
Mutation in p53
Mutation in pecam-1 would affect this step of leukocyte migration...
A young child with difficulty walking, oral telangiextasias and recurrent infections
ATM gene mutation
Hemosiderin laden macrophages in the lungs are indicative of this pathology
Left ventricular dysfunction
Heart failure cells
This is supplemented in orotic acidurea
Pulmonary edema has what effect on lung compliance?
Where does osteomyelitis most common occur?
Metaphysis of long bones
What does hyperPTH look like on xray?
Subperiosteal thinning with cystic degeneration
Loss of albumin without loss of the bulkier proteins like IgG and IgM
Why is albumin the predominant protein lost in minimal change disease?
Becuase mostly the negatively charged molecules are lost from the GBM in MCD and albumin is small enough to fit through pores.
Without charge exclusion from heparan sulfate and other proteoglycans, albumin leaks
X-linked disorder consisting of excema, recurrent infections and thrombocytopenia
Replicates in cold environment and exhibits tumbling motility. Almost exclusively seen in IC adults.
A 85 year old patient with focal motor deficits and hypertension.
CT of the head reveals a small cystic lesion in the brain. What is the cause of this lesion?
What cholesterol lowering drugs cause hypertriglyceridemia? How?
Bile acid binding resins (cholecytyramine)
-->raise TGs by binding bile acids and forcing the liver to mobilize LDL and increase uptake to resynthesize bile acids
What lipid lowering drug increases the toxicity of statins?
Increased the myopathic toxicity
Lobular strokes occuring in the cerebral hemisphere and not as severe as other strokes
Cerebral amyloid angiopathy
Nitrogen in urea are derved from what two compounds?
NH3 and Aspartate
antipsychotic that causes retinal deposits
Findings in pulmonary silicosis
Eggshell calcification of hilar lymph nodes
Birefringent silica crystals
What is the most potent echosinoid chemotactic agent?
Which of these are implicated in asthma related bronchospasm?
Asthma: LTC4, D4 and E4
Which of the anti-tuberculoid drugs have highest acticity at low pH (in the lysosmes)
Is KRAS an anti- or proto-oncogene?
What AAs should be restricted in a pt with MSUD
I Love Vermont maple syrup
Enzyme defect in acute intermittant porphyria?
KNOW WHERE IN THE CYCLE THIS FITS
Uroporphyrinogen I Synthase
Hemophilia inheritance pattern?
Myasthenia gravis pts will benefit from what surical procedure? Why?
Most MG pts have hyperplastic thymic tissue producing the AChR auto antibodies (causing a type II hypersensitivity) and a small percentage of them also have thymoma
Digeorge syndrome--> conginital aplasia of which structures
3rd (thymus and inferior parathyroids) and 4th (superior parathyroids) pharyngeal POUCHES
Levels of serum pH, K, and Na in DKA
pH is low
K is high (relitively because total stores are low due to loss in urine)
Na is low (due to osmotic pressure of glucose and loss in urine)
Anti-cancer agent that is extremely ototoxic
Slowly progressive cough and dyspnea in a patient being Tx'ed for a ventricular arrythmia
Process by which fatty acids are anchored to the plasma membrane
mutations in the same gene presenting with varying degrees of disease
Point mutation in FGFR3
Two enzymes that require thiamine (B1) as a cofactor.
Alpha-ketoacid decarboxylase (MSUD)
Type and size of RBC seen in thalassemias
In females the gubernaculum persists as the
round ligament of the uterus
PAF (platelet activating factor) causes what response through what receptor?
Platelet activation and thrombus formation
Gq receptor mediated (IP3 and Ca)
First step of FA oxidation is catalyzed by what enzyme?
Deficiency causes severe fasting hypoglycemia with decreased ketones
Which of the tumor supporssor and proto-oncogenes is a transmembrane (rather than intranuclear) receptor?
In a lineweaver-burke plot, increased enzyme will have what effect on the graph
The y-intercept will decrease (Increased 1/vmax)
x-intercept (1/Km) will stay the same becuase the affinity of the receptor for the substrate has not changed
Pt with apthous (oral) ulcers and perianal disease. What part of the GI tract is most likley affected?
--> Most commonly area affected by crohns disease
Which fibers are the only ones in the body that are unmyelinated
Postganglionic autonomic fibers
First order olefactory fibers
C fibers carrying slow pain and dull sense
Entero viruses (coxsackie, polio, echo, entero, and hepatitis) are all part of what family of viruses?
During antigen processing, what chain is processed by macrophages
Different mutations in different genes causing similar phenotypes is called:
Different mutations in the same gene causing similar phenotypes is called:
Different mutations in the same gene causing different phenotypes is called:
Aminoglycosides, amphoterocin B, radiocontrast dyes and heavy metals are all toxic to the...
GnRH analogue which decreases LH and FSH when dosed continuously
Mimics endogenous GnRH when dosed in pusatile manner
Only type of renal stone that does not show up on plain x-ray
Uric acid stones
How does N-acetylcysteine tx the pulmonary sx of cystic fibrosis
N-acetylcysteine breaks the disulfide bonds of the mucus glycoproteins which leads to loosening of the mucus
Polyarteritis nodosa is associated with what other disease
TZDs should be monitored closely with what tests?
LFTs due to heptaotoxicity
Should be given to reduce cisplatin toxicity
What toxicity is associated with cisplatin?
2 year old child with non-rhytmic eye movements, myoclonus and an abdominal mass
Fist coagulation factor to decrease in chronic liver disease?
C-myc serves what function?
In which neoplastic process is it dysfunctional?
Burkitt Lymphoma t(8;14)
Medical Tx of pulmonary HTN
Bosetan--> endothelian antogonist--> vasoconstriction and inhibition of endothelial cell proliferations
Swish and swallow for oral cadidiasis
Not absorbed from the GI tract
Similar in action to amphertericin B
chonic lung transplant rejection
Obliteration of the small airways
Patient treated for bradycardia now has eye pain
Atropine--> caused acute closed angle glaucoma
bradycardia and STEMI in II III and aVF, what artery
Right coronary artery
Supplies SA node (brady) and inferior heart (II, III, aVF)
Migratory thrombophelbitis should make you think....
Acidophillic bodies on H&E stain indicating apoptosis
Most common benign liver tumor
endoneural inflammatory infiltrate present after upper respiratory tract infection
Preferred location of biopsy in hirshprung Dz
Rectal suction biopsy
Reactive arthritis marker
Besides a phepchromocytoma, what else would be on the differential of a person with maligant HTN and palpitations
Withdrawl from clonidine and B-blockers
Purpose of bromodeoxuridine in tumor grading
--> increased uptake into the tumor indicates many cells in the S-phase-->High grade and rapidly dividing
Patient diagnosed with dibetes mellitus who has epidermal necrolysis of the lower extremity and abdominal pain
Mitral valve deposits and MI in the setting of no coronary artery involvement
caused by SLE and hypercoagulability
Cofactor needed to convert glutamyl residues into y-carboxyglutamate
Increaed serum transaminases with dificulty speeking and ataxia
Slip lamp exam for keiser fleischer rings
What malignancy is likely to arise with retinoblastoma
Anti-Hu, Anti-Yu, and Anti-Pu Ab
Paraneoplastic degeneration of the cerebellum
Disturbed color preception, nausea, vomiting and anorexia are caused by what medication
Comedocarcinoma is also known as a
Ductal carcinoma in situ
Type of degeneration seen in hepatitis
Foscarnet chelates this electrolyte
Calcium-->Tx of cmv retinitis can lead to neprotoxicity and seizures