Everything Flashcards Preview

FirstAID > Everything > Flashcards

Flashcards in Everything Deck (1178):
1

GGT (gamma-glutamyl transpeptidase)

serum marker for liver disease; elevated with heavy alcohol consumption

2

sensitivity =

#NAME?

2

Defective sonic hedgehog gene?

-gene is involved in patterning along anterior-posterior axis-defect assoc with holoprosencephaly (forebrain fails to develop into 2 hemispheres; have 1 central eye...)

2

ErythrocytosisAnisocytosisPoikilocytosisReticulocyte

#NAME?

2

site of B cell localization and proliferation in lymph nodes?

Follicle - in outer cortex

2

Which kidney is usually taken during liver donor transplantation and why?

Left Kidney; because it has a longer renal vein

2

List the 4 most important pharmacokinetics equations: (Vd, Cl, LD, MD)

1) Vd = (amount of drug given)/([drug] in plasma)2) Cl = (Vd X 0.7)/t1/23) LD = Css X Vd4) MD = Css X Cl

2

Retroperitoneal structures:

"SAD PUCKER"-Suprarenal (adrenal) gland-Aorta and IVC-Duodenum (2nd, 3rd, and 4th parts)-Pancreas (except tail)-Ureters-Colon (descending and ascending)-Kidneys-Esophagus (lower 2/3)-Rectum (upper 2/3)

2

decreased ceruloplasmin?

Wilson's disease

2

Wheezing (asthma symptoms) + diarrhea + facial flushing + mass lesion in appendix area: Diagnosis? Treatment?

Carcinoid syndrome--> ultimate treatment = surgery--> symptomatic treatment = Octreotide (long-acting somatostatin analog)

3

specificity =

#NAME?

3

Defect in FGF gene?

-involved in lengthening of limbs-defect --> Achondroplasia

3

Spectrin

supplies the biconcavity/flexibility of RBCs

3

Which part of lymph node houses T cells?

Paracortex - area of cortex between follicles and medulla-becomes enlarged during extreme immune responses-not well developed in DiGeorge syndrome pts (b/c no T cells...)

3

Where is the macula densa located?

Distal convoluted tubule

3

competitive vs noncompetitive inhibitors:1) Resemble substrate?2) Overcome by increased [S]?3) Bind active site?4) Effect on Vmax?5) Effect on Km?6) Pharmacodynamics: effect on potency? efficacy?

Competitive inhibitors:1) Yes2) Yes3) Yes4) Vmax does not change5) Km increases6) decreased potency (increased Km, decreased potency); no effect on efficacyNoncompetitive inhibitors:1) No2) No3) No4) Vmax decreases5) Km does not change6) decreased efficacy (decreased Vmax, decreased efficacy); no effect on potentcy

3

GI ligament that is a derivative of the fetal umbilical vein? what structure does it contain? what does it connect?

Falciform ligament-contains the ligamentum teres-derivative of the fetal umbilical vein-connects liver to anterior abdominal wall

3

elevated amylase?

-acute pancreatitis-also elevated in MUMPS!

3

Most common adrenal medulla tumor in adults? kids?

adults--> pheochromocytoma (causes HTN)kids--> neuroblastoma (does not cause HTN)

4

Positive Predictive Value = PPV =

= TP/(TP + FP)*PPV = proportion of test results that are true positive*if increased prevalence, then increased PPV

4

Hox genes: -what do they code for? if defective?

-code for DNA-binding transcription factors; involved in segmental organization of embryo in a cranio-caudal direction-Hox mutations--> appendages in wrong locations (ie extra fused digit between 3rd and 4th fingers)

4

1/3 of platelets are stored in?

Spleen (lifespan = 8-10 days)

4

lymph node drainage from upper limb, lateral breast?

Axillary lymph nodes

4

Where are JG cells located?

Afferent arteriole

4

Zero-order elimination

rate of elimination of drug is constant, regardless of the plasma concentration; Cp decreases linearly with time.Examples = PEA: Phenytoin, Ethanol, Aspirin

4

GI ligament that contains the portal triad (hepatic artery, portal vein, common bile duct)?

Hepatoduodenal ligament

4

elevated lipase?

acute pancreatitis

4

Aldosterone is secreted from?

zona glomerulosa of adrenal cortex--> "salt"--> stimulated by Renin-angiotensin

5

Negative Predictive Value = NPV =

#NAME?

5

When is embryo most susceptible to teratogens?

between 3-8 weeks, embryonically (so, 5-10 weeks of pregnancy) = "embryonic period" (b/c this is when organogenesis occurs)***note: before week 3: all-or-none (miscarriage or nothing)***after week 8: growth and function are affected

5

Causes of polycythemia/erythrocytosis?

-Any time have increased EPO (hypoxia, renal cell carcinoma, HCC, pheochromocytoma, hemangioblastoma)-Down's babies at birth-Polycythemia vera --> have increased RBCs, but normal EPO

5

lymph node drainage from stomach

celiac nodes

5

ureterovesicular junction

narrowest part of the ureter; common site for stones to get stuck

5

First-order elimination

Rate of elimination is proportional to drug concentration (a constant fraction of the drug is eliminated per unit time); the plasma concentration decreases exponentially with time.

5

Which GI ligament may be compressed to control bleeding by placing fingers in the omental foramen?

Hepatoduodenal ligamentf

5

elevated Alkaline Phosphatase?

*non-specific:-obstructive liver disease (hepatocellular carcinoma)-bone disease-bile duct disease*if elevated ALP, can then check GGT. If elevated GGT, then know it's d/t liver disease

5

Cortisol (and some sex hormones) secreted from?

zona fasciculata of adrenal cortex--> "sugar"--> stimulated by ACTH, hypothalamic CRH

6

Point prevalence =

#NAME?

6

What week, embryologically, does the heart begin to beat?

week 4

6

Barr bodies

=inactivated X in neutrophils-->seen in all women + KF men

6

lymph node drainage from duodenum and jejunum

superior mesenteric node

6

nephrocalcinosis

calcification of the medullary periods; assoc w/hyperparathyroidism

6

Phase I vs Phase 2 metabolism:Which phase do geriatric patients lose first?

Phase I: -reduction, oxydation, hydrolysis-usually yields slightly polar, water-soluble metabolites (often still active)-cytochrome P-450Phase II:-GAS: Glucuronidation, Acetylation, Sulfation-usually yields very polar, inactive metabolites (renally excreted)*Geriatric patients lose phase 1 first

6

Frequency of waves/peristalsis in stomach? duodenum? ileum?

stomach--> 3 waves/minduodenum--> 12 waves/minileum--> 8-9 waves/min

6

What is Reye's syndrome? What are the signs/symptoms?

=Childhood Hepatoencephalopathy:-->mitochondrial abnormalities-->fatty liver (microvesicular fatty change)-->hypoglycemia-->vomiting-->hepatomegaly-->comaMechanism: aspirin metabolites decrease Beta-oxidation by reversible inhibition of mitochondrial enzy

6

Androgens (sex hormones) are secreted from?

zona reticularis of adrenal cortex--> "sex"--> stimulated by ACTH, hypothalamic CRH

7

Prevalence =

#NAME?

7

When is it "embryo"? "fetus"?

-"embryo"--> weeks 3-8-"fetus"--> at week 8, on

7

When do you see hypersegmented polymorphic neutrophils?

#NAME?

7

lymph node drainage from sigmoid colon

colic --> inferior mesenteric node

7

passage of ureters in relation to the uterine artery and ductus deferens?

ureters pass under uterine artery and under ductus deferens (retroperitoneal) -->"water passes under the bridge"-water=ureters-bridge=uterine arteries and ductus deferens

7

Efficacy vs Potency

Efficacy: -proportional to Vmax (increase Vmax, increase efficacy)-maximal effect a drug can produce-high efficacy drugs: analgesics, antibiotics, antihistamines, decongestantsPotency:-inversely proportional to Km (increase Km, decrease potency)-amount of drug needed for a given effect-increased potency, increased affinity for receptor-highly potent drugs: chemo drugs, anti-hypertensive drugs, antilipid drugs

7

Meissner's plexus:-where's it located?-other name?-what's its function?

-located in Submucosa -"submucosal plexus"-controls secretory activity; secretes mucus (so is near the lumen...)

7

One disease when children should be treated with aspirin?

Kawasaki's (to prevent coronary artery thrombosis)

7

Catecholamines are secreted from?

chromaffin cells of adrenal medulla (neural crest derivative!)-->stimulated by preganglionic sympathetic fibers

8

Incidence =

#NAME?

8

When does hCG secretion begin?

within 1 week after fertilization

8

Neutrophil chemotactic factors?

-Leukotriene B4-IL-8-C5a

8

lymph node drainage from rectum?

internal iliac node

8

60-40-20 rule (of total body weight):

60% = total body water40% = ICF20% = ECF

8

Pharmacodynamics: Effects of adding competitive antagonists, noncompetitive antagonists, and partial agonists to an agonist on pharmacodynamic curves:

1) Competitive antagonist + agonist --> shift curve to the right = decreased potency (increased Km); no change on efficacy2) Noncompetitive antagonist plus agonist: shift curve down = decreased efficacy (decreased Vmax); no effect on potency3) Partial agonist: acts at the same site as a full agonist, but with reduced maximal effect. Get decreased efficacy (decreased Vmax); potency is variable, can be either increased or decreased.

8

Auerbach's plexus:-where's it located?-other name?-what's its function?

-located in Musculara externa (really, between muscularis externa inner circular and outer longitudinal layers) -"Myenteric plexus"-controls muscle contractions; coordinates motility along entire gut wall

8

Best indicators of Liver function and progrnosis?

Prothrombin time and Serum albumin*hypoalbuminemia + elevated PT = POOR prognosis.

8

Adrenal gland drainage: Left adrenal? Right adrenal?

Left adrenal --> L adrenal vein --> L renal vein --> IVCRight adrenal --> R adrenal vein --> IVC(same as left and right gonadal veins!)

9

Odds Ratio = OR =

=(a/b)/(c/d) = ad/bc*use OR for case-control studies

9

What week does the neural tube close?

Neural tube formed by neuroectoderm and closes by week 4 (this is why MUST already be taking folic acid prior to pregnancy, b/c spinal development occurs within the first 4 weeks!)

9

CD14 = cell marker for?

Macrophages

9

lymph node drainage from anal canal?

superficial inguinal node

9

How to measure plasma volume?

radiolabeled albumin

9

Therapeutic Index: What is it? What's the equation? Is it safer to have a higher or lower TI?*Examples of drugs with low TI?

TI = measurement of drug safetyTI = LD50/ED50 = median lethal dose/median effective dose("TILE")Safer drugs have higher TI valuesExamples of drugs with low TI (must monitor these patients!):-Phenobarbital-Lithium-Digoxin-Coumadin/Warfarin

9

Roles of the mucosa of the GI tract?

mucosa = innermost layer of gut wall*has 3 parts, each with a role:-epithelium--> absorption-lamina propria--> support-muscularis mucosa--> motility

9

3 stages of alcoholic liver injury:-Reversible?

1) Hepatic steatosis--> Macrovesicular steatosis/fatty change associated with moderate alcohol intake-->REVERSIBLE with alcohol cessation2) Alcoholic hepatitis:-->from sustained, long-term alcohol intake-->swollen and necrotic hepatocytes; neutrophil infiltration-->Mallory bodies (intracytoplasmic eosinophilic inclusions)3) Alcoholic cirrhosis:-->shrunken liver with "hobnail" appearance-->sclerosis around central vein-->looks like chronic liver disease: hypoalbuminemia, jaundice...-->IRREVERSIBLE

9

neurohypophysis (post pit) is derived from? adenohypophysis (ant pit)?

-neurohypophysis = neuroectoderm derivative-adenohypophysis = surface ectoderm derivative (from Rathke's pouch)!

10

Relative Risk = RR=

= [a/(a+b)]/[c/(c+d)]*use RR for cohort studies

10

Adenohypophysis arises from which embryologic derivative/germ layer?

Adenohypophysis = Ant pituitary; arises from Rathke's pouch, from Surface Ectoderm

10

Causes of Eosinophilia?

*DNA-CAAPA:-Drugs-Neoplastic-Asthma (and Churg-Strauss)-Collagen Vascular diseases-Allergic processes-Addison's (adrenal insufficiency)-Parasites (invasive)-Acute Interstitial Nephritis

10

lymph node drainage from testes

superficial and deep plexuses --> para-aortic nodes = retroperitoneal nodes

10

how to measure extracellular volume?

Inulin

10

Nicotinic vs Muscarinic ACh receptors

Nicotininc ACh receptors = Na+/K+ channelsMuscarinic ACh receptors = G-protein-coupled receptors, act through 2nd messengers; 5 subtypes = M1, M2, M3, M4, M5

10

cell type in esophagus?

stratified squamous epithelium

10

Hepatic steatosis:

-macrovesicular fatty change of liver; see hepatocytes filled with lipid droplets-Reversible effect of moderate alcohol intake; can reverse by stopping to drink alcohol***can also get fatty liver from certain HIV drugs; metabolic syndrome; etc...

10

Rathke's pouch gives rise to?

Adenohypophysis (ant pit)!--> Rathke's pouch = oral ectoderm

11

Attributable Risk =

= [a/(a+b)] - [c/(c+d)]*AR is the proportion of disease occurences attributable to exposure to a risk factor

11

Neurohypophysis arises from which embryologic germ layer/derivative?

Neuroectoderm

11

Phagocytes:-in brain-in tissue-in liver-in joints

#NAME?

11

lymph node drainage from thigh (superficial)

superficial inguinal nodes

11

Glomerular Filtration barrier is composed of: -Fenestrated Capillary Endothelium-Fused basement membrane -Epithelial layer*What is each one's role?*Composition?*What is lost in nephrotic syndrome? What's the result?*What is lost in Minimal Change disease?

*Fenestrated Capillary Endothelium:-Size barrier*Fused basement membrane:-negative Charge barrier-has heparin sulfate-lose charge barrier in neprhotic syndrome; get: albuminuria, hypoproteinemia, generalized edema, hyperlipidemia*Epithelial layer:-consists of podocyte foot processes-lose podocytes in MCD

11

Gq:-what receptors stimulate it?-what are its effects?

-Stimulated by alpha 1, M1, M3, H1, V1-stimulates phospholipase C, which stimulates lipid conversion to PIP2, which stimulates increased diacylglycerol and increased inositol triphosphate. --> increased DAG leads to increased protein kinase C--> increased

11

cell type in stomach?

gastric glands

11

Mallory bodies

intracytoplasmic eosinophilic inclusions within hepatocytes; see in alcoholic hepatitis

11

hormones secreted from posterior pituitary?

#NAME?

12

Absolute Risk Reduction

the reduction in risk associated with a treatment as compared to a placebo

12

Neural Crest derivatives:

-ANS-dorsal root ganglia-cranial nerves-celiac ganglion-melanocytes-chromaffin cells of adrenal medulla-parafollicular (C) cells of thyroid-Schwann cells-pia and arachnoid-bones of skull-odontoblasts (teeth-->crest toothpaste!)-aorticopulmonary septum (sp

12

Mast cells vs Basophils?

Both are similar, mediate allergic rxn-Basophils in Blood-Mast cells in tissue-mast cells are involved in type 1 hypersensitivity rxns

12

lymph node drainage from lateral side of dorsum of foot

popliteal nodes

12

What substances can be used to measure GFR?

-Inulin or Creatinine Clearance.*Inulin is freely filtered, but is neither reabsorbed nor secreted.*BUT: Creatinine clearance slightly overestimates GFR, b/c creatinine is moderately secreted by renal tubules

12

Gs:-what receptors stimulate it?-what are its effects?

-stimulated by: B1, B2, D1, H2, V2-stimulates adenylyl cyclases --> increases cAMP --> increases protein kinase A --> increased intracellular Calcium *lots of bacterial toxins use this mechanism!

12

where in GIT are Brunner's glands?

Duodenum-->submucosal glands that produce alkaline-rich/bicarb secretion

12

7 diseases associated with increased risk of hepatocellular carcinoma:

-Hepatitis B-Hepatitis C-Hemochromatosis-Carcinogens (specifically Alfatoxin from Aspergillus)-Alcoholic cirrhosis-alpha-1-antitrypsin deficiency-Wilson's disease

12

hormones from anterior pituitary?-which are acidophils?-basophils?

"FLAT PiG"-FSH-LH-ACTH-TSH-Prolactin-GH*Acidophils: GH, Prolactin*Basophils = "B-FLAT" = FSH, LH, ACTH, TSH

13

Number needed to treat = NNT =

= 1/absolute risk reduction = 1/[a/(a+b)]

13

Which germ layer does the spleen arise from?

Mesoderm

13

Langerhans cells

#NAME?

13

lymph node drainage of prostate

internal iliac nodes

13

What substance can be used to meausre the ERPF (Effective Renal Plasma Flow)?

-PAH clearance; b/c all PAH entering kidney is secreted

13

Gi:-what receptors stimulate it?-what are its effects?

-stimulated by: alpha 2, M2, D2-inhibits adenylyl cyclase (so decreased cAMP and decreased protein kinase A)...

13

Where in GIT are Crypts of Lieberkuhn?

Duodenum, Jejunum, Ileum, and Colon

13

cancer associatd with elevated alpha-fetoprotein?

Hepatocellular carcinoma

13

alpha- vs beta-subunit of pituitary hormones:

-alpha = common to TSH, LH, FSH, hCG-beta = determines hormone specificity; different in all of them!

14

Number needed to harm = NNH =

#NAME?

14

Nucleus pulposus is derived from?

Notochord; Notochord induces ectoderm to differentiate into neuroectoderm and form the neural plate; neural plate gives rise to neural tube and neural crest cells; notochord becomes the nucleus pulposus of the intervertebral disk in adults

14

Main inducers of primary antibody response?

Dendritic cells = professional APCs

14

right lymphatic duct vs thoracic duct drains?

right lymphatic ducts drains: right arm and right half of headthoracic duct drains: everything else

14

ERPF vs true RPF?

ERPF underestimates true RPF by about 10%

14

alpha 1 receptor:-which G-protein class?-Major functions?

*Gq*Functions:-increase vascular smooth muscle contraction (increase BP)-mydriasis-increase intestinal and bladder sphincter muscle contraction

14

Where in GIT are villi and microvilli?

Small intestine; not Colon (makes sense, b/c villi are there to increase absorptive surface)

14

Common benign liver tumor in 30-50 year olds?

-Cavernous Hemangioma-->DON'T biopsy it! b/c may lead to hemorrhage

14

Hormones produced by alpha, beta, and delta cells of Islets of Langerhans in pancreas?

alpha cells --> glucagon (peripheral)beta cells --> insulin (central)delta cells --> somatostatin (interspersed)*note: somatostatin is also produced by delta cells in gastric mucosa and throughout gut*insulin inhibits glucagon release by alpha cells!

15

Precision, Accuracy, Reliability, Validity, Random error, Systemic error

Precision = ReliabilityAccuracy = ValidityRandom error - reduces precision in a testSystemic error - reduces accuracy in a test

15

Agenesis vs Hypoplasia vs Aplasia

Agenesis: No primordial tissue, so no organHypoplasia: Primordial tissue present, but incomplete organ developmentAplasia: Primordial tissue present, but no organ

15

clock-face chromatin

Plasma cells (B cells differentiate into plasma cells; plasma cells produce lots of antibody specific to a particular antigen)

15

Where are B cells found in the spleen?

Follicles within white pulp of spleen

15

RBF =?

RBF = RPF/(1-Hct)

15

alpha 2 receptor:-G-protein class?-major functions?

*Gi*Major functions:-decrease sympathetic outflow (decrease NE secretion)-decrease insulin release-decrease BP (vasodilation)-increase glucagon secretion from alpha cells in pancreas

15

Where in GIT are goblet cells?

Ileum--> has most goblet cells in the small intestine; but, also found in other parts of small intestine: as go along the small intestine, # of goblet cells increases

15

Nutmeg liver

Backup of blood into liver; d/t right heart failure and Budd-Chiari syndrome-->if it persists, may result in cardiac cirrhosis

15

Does insulin cross the placenta?

nope!

16

Standard error of the mean = SEM =

=σ/sqrt of nused in Normal/Guassian/Bell-Shaped curves (where mean = mode = median)where: σ = standard deviationsqrt of n = square root of sample size*note: SEM decreases as n (sample size) increases

16

Malformation vs Deformation

Malformation: Intrinsic disruption (like a teratogen); occurs during embryonic period (3-8 weeks)Deformation: extrinsic disruption; occurs after embryonic period (after week 8)

16

plasma cell neoplasm?

Multiple Myeloma --> make a whole bunch of one particular type of B cell, all making one type of antibody (so see monoclonal antibody spike)

16

Where are T cells found in spleen?

PALS = periarterial lymphatic sheath within white pulp of spleen

16

Normal Filtration Fraction =?

20%

16

Beta 1 receptor:-G-protein class?-Major functions?

*Gs*Functions:-increase HR-increase contractility-increase renin release-increase lipolysis

16

Where in GIT are Peyer's patches?

only in Ileum

16

Condition that looks similar to Right Heart Failure (Hepatomegaly, etc) BUT, absence of jugular venous distension:

Budd-Chiari syndrome

16

Effects on insulin release of:-GH-somatostatin-Beta-agonists-alpha-agonists

GH-->increase insulinSomatostatin-->decreases insulinBeta-agonists-->stimulate insulinAlpha-agonists-->inhibit insulin

17

In a normal/gaussian/bell-curve (where mean=median=mode), what percent of the population is 1 σ (standard deviation) to either side of mean? 2σ to either side of mean? 3σ on either side of mean?What percent of the population correlates wtih a σ = 1.645 on either side of the mean?

1σ on either side of mean = 68% of popl2σ = 95%3σ = 100% (99.7%)1.645σ = 90% of popl

17

teratogenic effect of aminoglycosides?

CN VIII toxicity (hearing problems)

17

CD3

on ALL T-cells -->Th also have CD4-->Cytotoxic also have CD8

17

immunlogic results of/response to splenic dysfunction?

splenic dysfunction: decreased IgM-->decreased complement activation --> decreased C3b opsonization --> increased susceptibility to encapsulated organisms (SSHiNK: Salmonella, S. pneum, H. influenza, N. meningitidis, K. pneumonia)

17

Effect of prostaglandings on kidney:Effect of NSAIDs on kidney?

Prostaglandins dilate afferent arteriole --> so, get:-increased RPF-increased GFR-constant FF*NSAIDs-->inhibit PGs --> get constriction of Afferent Arteriole:-decreased RPF-decreased GFR-constant FF

17

Beta 2 receptor:-G-protein class?-Major functions?

*Gs*Functions:-vasodilation-bronchodilation-increase HR (compensatory to increase BP)-increase contractility-increase lipolysis-increase insulin release-decrease uterine tone

17

Where does celiac trunk come off the abdominal aorta?

T12

17

Budd-Chiari syndrome:

-Occlusion of IVC or hepatic veins --> leads to congestive liver disease (hepatomegaly, ascites, abdominal pain, eventually liver failure)-->may have varices and visible abdominal/back veins-->Looks kind of similar to Right heart failure, BUT absence of J

17

Cell types that don't need insulin for glucose uptake?

"BRICK L"-Brain-RBCs-Intestine-Cornea-Kidney-Liver

18

relationship of mean, median,mode in a positively-skewed statistical distribution?

positive skew: asymmetry with tail on the right mean > median > mode

18

teratogenic effect of DES (diethylstilbestrol), a synthetic estrogen

Vaginal clear cell adenocarcinoma (in female fetuses, when older)

18

anti-AB antibodies (Ig type?)

-IgM --> don't cross placenta

18

Howell-Jolly bodies, Target cells, and thrombocytosis

Post-splenectomy

18

Effect of Angiotensin II on kidneys?

Acts on Efferent Arteriole; constricts EA:-decreased RPF-increased GFR-increased FF

18

M1 receptor:-G protein?-Functions?

*Gq*Functions:-CNS, enteric nervous system

18

Where does the SMA come off the abdominal aorta?

L1

18

Liver cirrhosis + Panacinar Emphysema?

alpha-1-antitrypsin deficiency -->this is a CODOMINANT trait

18

GLUT-1

-RBCs-Brain*tissues with GLUT-1 receptors take up glucose regardless of insulin levels

19

relationship of mean, median,mode in a negatively skewed statistical distribution

negative skew - asymmetry with tail on leftmean < median < mode

19

Ebstein's anomaly (enlarged Right atrium; small Right ventricle) - assoc with which teratogen?

Lithium

19

anti-Rh antibodies (Ig type?)

=IgG --> can cross placenta and cause hemolytic disease of newborn (erythroblastosis fetalis) if fetus is Rh+

19

Thymus is derived from what branchial pouch?

3rd branchial pouch

19

Effect of ACE-inhibitors on kidneys?

ACE-inhibitors--> inhibit Ang II --> dilate Efferent Arteriole:-increased RPF-decreased GFR-decreased FF*so, may have increased Creatinine levels in blood (b/c decreased GFR, and Creatinine clearance is a measure of GRF, so decreased Creatinine clearance --> more Creatinine in blood)

19

M2 receptor:-G-protein?-Functions?

*Gi*Functions:-decreased HR and contractility of atria

19

Where do the renal arteries come off the abdominal aorta?

L1

19

PAS-positive globules in liver?

alpha-1-antitrypsin deficiency

19

GLUT-2

#NAME?

20

Null hypothesis = H0 =

hypothesis of no difference; there's no association between disease and the risk factor in the population

20

Neural tube defects --> caused by which teratogens?

-Folate antagonists-Carbamazepine-Valproate (Valproate and Carbamazepine decrease folate absorption; so, if pts are taking these drugs during pregnancy, then must take extra folate)

20

Blood type A (example)

#NAME?

20

Where in thymus does positive selection occur? Negative selection?

positive --> corexnegative --> medulla/corticomedullary jxn

20

What is Creatinine in urine a measurement of?

Glomerular Filtration Rate

20

M3 receptor: -G-protein?-Functions?

*Gq*Functions:-increase exocrine gland secretions (ie sweat, gastric acid)-increase gut peristalsis-increase bladder contraction-bronchoconstriction-increase miosis-accommodation (ciliary muscle contraction)

20

Where does the inferior mesenteric artery come off the abdominal aorta?

L3

20

Cause of physiologic jaundice in neonates? Treatment?

Immature UDP-glucuronyl transferase at birth (physiologic): can't convert unconjugated bilirubin to conjugated in liver --> get unconjugated/indirect hyperbilirubinemia --> Jaundice*Treat with phototherapy: converts unconjugated bilirubin to a water-soluble form, so it can be renally excreted! COOL!

20

GLUT-4

*Requires insulin to be activated!-Adipose tissue-Skeletal muscle

21

Alternative hypothesis = H1

hypothesis that there is some difference; there is some association between the disease and the risk factor in the population

21

infant with flat nasal bridge, "railroad track" ears, thin upper limb, small palpebral fissures, epicanthal folds, upturned nose, smooth philtrum (space from nose to upper lip)... may be caused by which teratogen?

Alcohol (Fetal Alcohol Syndrome)

21

erythroplastosis fetalis-cause?-symptoms?-hypersensitivity type?-how to prevent?

-type 2 hypersensitivity rxn-cause: Rh- mother exposed to Rh+ fetal blood during delivery; makes anti-Rh IgG --> can cross placenta in subsequent pregancies, causing hemolytic disease of newborn in next fetus who is Rh+-Symptoms in infant: hepatosplenomeg

21

beta-2-microglobulin is found on which class of MHC molecule?

MHC I: has a heavy chain and a beta-2-microglobulin chain

21

Where in kidney is glucose normally reabsorbed?

Proximal tubule by Na+/glucose cotransport

21

D1 receptor:-G-protein?-Functions?

*Gs*Functions:-relaxes renal vascular smooth muscle

21

What level is the bifurcation of the abdominal aorta?

L4

21

What is jaundice? What are the 3 causes/types of pathologic jaundice (not counting physiologic neonatal jaundice)?

Jaundice = yellowing of skin and/or sclerae d/t elevated bilirubin*Causes:-Hepatocellular injury-Obstruction to bile flow-Hemolysis

21

Anabolic effects of insulin (X6)

1) increases glucose transport into adipose and skeletal muscle2) increases glycogen synthesis and storage3) increases TG synthesis and storage4) increases Na retention in kidneys5) increases protein synthesis in muscles6) increases cellular uptake of K and AAs

22

type 1/alpha error = false positive error

stating there is an effect or difference when none exists; accepting H1 (rejecting H0) when H0 is really true*ie convicting an innocent man

22

Which fetal structure secretes hCG?

Syncytiotrophoblast (outer layer of chorionic villi)

22

Deficiency of Factor VIII?

Hemophilia A("Aight")

22

Which HLA genes code for MHC I? MHC 2?

MHC I: HLA-A, HLA-B, HLA-CMHC II: HLA-DR, HLA-DP, HLA-DQ

22

At what plasma glucose levels does glucosuria begin (threshold)?At what glucose levels is Tm (all transporters fully saturated)?

-see glucosuria at plasma glucose levels of 160-200-all transporters are fully saturated (Tm) at plasma glucose levels = 350 mg/dL

22

D2 receptor:-G protein?-Functions?

*Gi*Functions:-modulates transmitter release, especially in brain

22

Muscle types composing the Esophagus:

*upper 3rd--> striated muscle (voluntary)*middle 3rd--> striated + smooth muscle*lower 3rd--> smooth muscle (involuntary)

22

Jaundice, elevated bilirubin in response to fasting, stress, exercise?

--> Gilbert's syndrome--> have mildly decreased UDP-glucuronyl transferase (so decreased conversion of indirect to direct bilirubin) or decreased bilirubin intake-->mild disease; quite common, but most pts don't even know they have it-->when flares: have

22

Glucagon:-secreted by?-secreted in response to?-inhibited by?-effects?

-secreted by alpha cells of islets of pancreas-secreted in response to hypoglycemia-inhibited by: insulin, hyperglycemia, somatostatin-effects:-->glycogenolysis, gluconeogenesis-->lipolysis and ketone production-->increases glucose production/release so i

23

p value

p = probablity of making a type 1 (alpha) error ps not actually there)

23

Decidua basalis

maternal component of the placenta; derived from the endometrium; if absent, get placenta accreta (placenta attaches to myometrium instead of to endometrium; so, no separation of placenta after birth; get massive bleeding after delivery)

23

Deficiency of Factor IX?

Hemophilia B ("Benine")

23

which cell types express MHC I? MHC II?

MHC I --> expressed on almost all nucleated cells (not expressed on RBCs)MHC II: expressed only on APCs

23

Hartnups disease:

deficiency of neutral amino acid (tryptophan) transporter in proximal tubule; so, can't reabsorb tryptophan-results in pellagra (niacin/B3 deficiency; b/c B3 is derived from Tryptophan)

23

H1 receptor:-G protein?-Functions?

*Gq*Functions:-increase nasal and bronchial mucus production-bronchiole contraction-pruritus-pain

23

Artery that supplies the Foregut? Innervation of the foregut?

#NAME?

23

pathologic jaundice early in life + kernicterus (bilirubin deposition in brain) + elevated unconjugated bilirubin

Crigler-Najjar Syndrome Type 1-->absent UDP-glucuronyl transferase (so can't convert indirect to direct bilirubin) --> get elevated indirect/unconjugated bilirubin

23

Bromocriptin

dopamine agonist-->inhibits prolactin secretion; so, can be used to treat prolactinomas

24

Type 2/Beta error = False negative error

stating there is not an effect or difference when one exists; not rejecting H0 when it actually is false (so choosing H0 when H1 is true) *ie setting a guilty man free

24

How many umbilical artery/ies? Vein/s?

2 umbilical arteries1 umbilical vein*both are derived from the allantois

24

Vitamin K deficiency?

decreased synthesis of "diSCo 1972"-proteins C and S-Factors X, IX, VII, II (10, 9, 7, 2)*Vitamin K normally catalyzes carboxylation of glutamic acid residues on proteins involved with blood clotting

24

HLA-A3

Hemochromatosis

24

Where in nephron is glucose, AAs, and most of bicarbonate, Na, Cl, and water reabsorbed?

Early proximal tubule

24

H2 receptor:-G protein?-Functions?

*Gs*Functions:-increase gastric acid secretion

24

Artery and Nerve that supply the Midgut?

#NAME?

24

Treatment for Crigler-Najjar syndrome type 1?

-phototherapy (makes Unconjugated bilirubin water-soluble, so can excrete in urine)-Plasmapheresis (get rid of excess unconjugated bilirubin)-->Crigler Najjar type 1 is fatal within a few years

24

Drug types that stimulate prolactin secretion?

#NAME?

25

Beta

probability of making a type 2 (beta) error

25

Urachal duct: what is it? what's it formed from? what if duct fails to obliterate?

During 3rd week: yolk sac forms allantois, which extends into urogenital sinus; allantois becomes urachus, which is a duct between bladder and yolk sac (so, connects fetal bladder to maternal system)*If urachus does not obliterate after birth:-patent urachus --> urine discharge from umbilicus-vesicourachal diverticulum --> outpouching of bladder; asymptomatic

25

Vitamin K antagonist?

Warfarin-->acts by inhibiting Epoxide Reductase (vitamin K-->activated vitamin K)

25

HLA-B27

PAIR: -Psoriasis-Ankylosing spondylitis-Inflammatory bowel disease-Reiter's syndrome

25

Where in kidney is there "isotonic absorption"?

Early proximal tubule

25

V1 receptor:-G protein?-Functions?

*Gq*Functions:-increase vascular SM contraction

25

Artery and Nerve that supply the hindgut?

#NAME?

25

Crigler-Najjar type 2: -what is it?-treatment?

milder form of Crigler-Najjar type 1; have decreased amount of UDP-glucuronyl transferase (not absent, as in type 1)-->can treat with phenobarbital (increases synthesis of liver enzymes, including UDP glucuronyl transferase)

25

Why is a side effect of anti-psychotic drugs galactorrhea?

-anti-psychotics are dopamine antagonists-dopamine inhibits prolactin; if decrease dopamine, then increase prolactin-prolactin stimulate milk production!

26

Power =

= 1 - Betaprobability of rejecting H0 when it is in fact false or likelihood of finding a difference when one in fact existsif increase sample size, then increase power (power in #s!)

26

urine discharge from umbilicus in neonate: what's the cause/abnormality?

#NAME?

26

Antithrombin inhibits?

Antithrombin inhibits:-thrombin-factors VIIa, IXa, Xa, XIa, XIIa

26

HLA-B8

Graves disease

26

Which part of nephron generates and secretes ammonia?

Early proximal tubule

26

V2 receptor:-G protein?-Functions?

*Gs*Functions:-increase H20 permeability and reabsorption in the collecting tubules of the kidney("V2 is found in the 2 kidneys")

26

Watershed area of the GIT?

=> splenic flexure-supplied by the terminal branches of the IMA and SMA, so most sensitive to hypoxia

26

Phenobarbital

Treatment for Crigler-Najjar type 2 (and can be used for symptomatic Gilbert's)-->increases synthesis of liver enzymes --> so, increases synthesis of UDP-glucuronyl transferase

26

Prolactin functions:

-stimulates milk production in breast-inhibits GnRH --> so decreases LH and FSH --> so inhibits ovulation in females, spermatogenesis in males

27

Meta analysis

pools data/results from several similar studies to reach an overall conclusion; increases power

27

Vitelline duct: What is it? Abnormalities associated with it?

-Vitelline duct = omphalomesenteric duct --> connects yolk sac to midgut lumen--> obliterated at 7th week*Abnormalities:-Vitelline fistula = failure of duct to close; get meconium discharge from umbilicus-Meckel's diverticulum = partial closure of duct, m

27

Drug that activates antithrombin?

Heparin

27

HLA-DR2

-Multiple sclerosis-Hay fever-SLE-Goodpasture's

27

Which part of the nephron is the most hypertonic/concentrated urine?

Thin descending limb of loop of Henle-->impermeable to sodium; passively reabsorbs water b/c sodium can't get in, so the medulla is hypertonic --> water leaves nephron into medulla, making urine more concentrated.

27

What class of drugs are these:Bethanochol, Carbachol, Pilocarpine, Methacholine?

Cholinomimetic agents: Direct agonists

27

What structures make up the foregut? midgut? hindgut?

*foregut: stomach to proximal duodenum; also: liver, gallbladder, pancreas, spleen*midgut: Distal duodenum to proximal 2/3 of transverse colon*hindgut: distal 1/3 or transverse colon to upper part of rectum; inludes splenic flexure (watershed area)

27

Conjugated Hyperbilirubinemia + Black liver on gross examination-->otherwise benign

=Dubin-Johnson syndrome-->defective liver excretion of bilirubin; so get elevated conjugated bilirubin in blood

27

Somatotropin = Growth Hormone:-stimulated by?-inhibited by?-when is their increased secretion?

#NAME?

28

Confidence Interval = CI =

Range from [mean - Z(SEM)] to [mean + Z(SEM)]*example, for a 95% CI: = mean +/- 1.96 X SEM = mean +/- 1.96 X (σ/sqrt n)*if 95% CI for a mean difference between 2 variable includes 0, then there's no significan different and H0 is not rejected*if 95% CI for odds ratio or relative risk includes 1, H0 is not rejected

28

meconium discharge from umbilicus: what abnormality caused this?

Vitelline fistula (failure of the vitalline/omphalomesenteric duct to close)

28

Coagulase

Produced by S. aureus-->can convert fibrinogen-->fibrin

28

HLA-DR3

Diabetes type I

28

Which part of nephron is impermeable to water?

Thick ascending limb of loop of Henle

28

What class of drugs are these:Neostigmine, Pyridostigmine, Edrophonium, Physostigmine, Echothiophate, Donepezil

Cholinomimetic agents: Indirect agonists = anti-cholinesterases

28

Portal triad:

#NAME?

28

Rotor's syndrome:

mild disorder, similar to Dubin-Johnson syndrome (but less severe); have defective liver excretion of bilirubin, so mildly elevated conjugated bilirubin in blood; unlike Dubin-Johnson syndrome, does not cause black liver

28

17-alpha-hydroxylase deficiency:-what's increased/decreased?-symptoms

-increased MCs (aldosterone)-decreased GCs (cortisol) and androgens-symptoms:-->Hypertension-->Hypokalemia --->XY: decreased DHT --> pseudohermaphroditism (looks female, but no internal reproductive structures b/c of mullerian inhibiting factor)-->XX: loo

29

CI 90%, Z = ?CI 95%, Z = ?CI 99%, Z = ?

CI 90%, Z = 1.645CI 95%, Z = 1.96CI 99%, Z = 2.58*95% CI, corresponds to p=0.05

29

Meckel's diverticulum cause?

Due to partial closure of the Vitelline duct (instead of full closure)

29

tPA, Streptokinase, Urokinase:

All facilitate: plasminogen--> plasmin(so, stimulate breakdown of clots!)

29

HLA-DR4

#NAME?

29

Which part of nephron is the "diluting segment", where urine has the lowest osmolality?

Early distal convoluted tubule

29

What class of drugs are these:Atropine, homatropine, tropicamide, benztropine, scopolamine, ipratropium, oxybutynin, glycopyrrolate, methscopolamine, pirenzepine, propantheline

muscarinic antagonists = cholinergic antagonists

29

Branches of celiac trunk?

*celiac trunk comes off abdominal aorta at T12*branches:-common hepatic artery-splenic artery-left gastric artery--> these branches make up the main blood supply of the stomach!

29

Disease d/t problem with bilirubin uptake into liver?

-Gilbert's-->elevated unconjugated bilirubinemia

29

phenotypic female who lacks internal reproductive structures; has HTN and hypokalemia

17-alpha-hydroxylase deficiency-->XY pseudohermaphrodite, but decreased DHT; no internal organs b/c of MIF

30

t-test vs ANOVA vs chi^2

t-test --> checks difference between means of 2 groupsANOVA --> checks difference between means of 3 or more groupschi-square test --> checks the difference between 2 or more percentages or proportions of categorical outcomes (not of mean values)

30

Truncus Arteriosus: What does it give rise to?Pathologies associated with abnormal formation?

Gives rise to ascending aorta and pulmonary trunk:-Have neural crest migration --> truncal and bulbar ridges that spiral and fuse to form the aorticopulmonary septum --> ascending aorta and pulmonary trunkPathologies:-Transposition of great vessels (failure to spiral)-TOF (skewed AP septum development)-Persistent TA (from partial AP septum development)

30

vWF receptor on platelets? Fibrinogen receptor on platelets?

-vWF --> GpIb-Fibrinogen --> GpIIb/IIIa***vWF and Fibrinogen are both inside platelets

30

HLA-DR5

-Pernicious anemia --> B12 deficiency-Hashimoto's thyroiditis

30

Where are Na, K, and Cl actively reabsorbed and Mg and Ca indirectly reabsorbed?

Thick ascending limb of loop of Henle (this is the part that is also impermeable to H20; so, have reabsorption of electrons + water cannot leave (nor enter) --> so this portion of the loop makes the urine less concentrated as it ascends; eventually, it has the lowest osmolality at the early distal convoluted tubule)

30

List the direct agonists/cholinomimetic agents (X4):

#NAME?

30

Which arteries supply the lesser curvature of the stomach? greater curvature?

*lesser curvature --> L and R gastric arteries (L gastric comes off the Celiac trunk; the two gastrics anastamose)*Greater curvature: L and R gastro-omental arteries (also anastomose with each other)

30

Diseases d/t problem with bilirubin conjugation

-Gilbert's-Crigler-Najjar types 1 and 2-physiologic neonatal jaundice-->elevated unconjugated bilirubinemia

30

phenotypic female with normal internal sex organs, but lacks secondary sex characteristics; has HTN and hypokalemia

-XX with 17-alpha-hydroxylase deficiency

31

correlation coefficient = r:

r is always between -1 and 1; the closer the absolute value of r is to 1, the stronger the correlation between the 2 variables*usually report r^2 = coefficient of determination

31

Bulbus cordis gives rise to:

Right Ventricle and smooth parts (outflow tract) of LV and RV

31

ESR in pregnancy?

increased

31

HLA-DR7

steroid-responsive nephrotic syndrome

31

Where in nephron does PTH act?

Early proximal tubule: PTH inhibits Na/P cotransport --> get increased phosphate excretionEarly distal convulted tubule: increased Ca/Na exchange --> get increased Ca reabsorption

31

List the indirect agonists/cholinomimetic agents = anticholinesterases (X6)

#NAME?

31

3 Portosystemic shunts (alleviate portal hypertension)

1) Esophageal varices --> anastomosis at the esophagus2) Caput medusae --> anastomosis at the umbilicus3) Internal hemorrhoids --> anastomosis at the rectum

31

Diseases d/t problem with bilirubin excretion from liver?

-Dubin-Johnson-Rotor's-->elevated direct/conjugated bilirubinemia

31

21-hydroxylase deficiency:-what's increased/decreased?-symptoms?

-increased androgens-decreased MCs (aldosterone) and GCs (cortisol)-symptoms:-->masculinization (female pseudohermaphrodite)-->hypOtension-->hyperkalemia-->increased renin activity***this is the most common form of congenital adrenal hyperplasia

32

Medicare vs Medicaid:

Medicare: pts > 65 years old ( e for elderly), <65 with certain disabilities, and pts with ESRDMedicaid: federal and state healt assistance for people with very low income (d for destitute)

32

Left horn of sinus venosus gives rise to:

coronary sinus

32

Decreased ESR:

#NAME?

32

only lymphocyte member of innate immune system?

natural killer cells

32

Where in nephron does Angiotensin II act?

Early proximal tubule --> AT II stimulates Na/H exchange --> increased Na and water reabsorption

32

List the muscarinic antagonists;

#NAME?

32

type of hemorrhoids and cancers seen above and below the pectinate line:

*above pectinate line:-internal hemorrhoids (not painful)-adenocarcinoma*below pectinate line:-external hemorrhoids (painful)-squamous cell carcinoma (main risk factor for squamous cell carcinoma here = HPV 16,18,31)

32

Penicillamine

Treatment for Wilson's disease

32

11-beta-hydroxylase deficiency: -what's increased/decreased?-symptoms?

-increased: Androgens and 11-Deoxycorticosterone (not aldosterone though)-decreased: GCs (cortisol) and Aldosterone-symptoms:-->Hypertension (d/t 11-deoxycorticosterone)-->Masculinization

33

core ethical principles: autonomy, beneficence, nonmaleficence, justice

autonomy - must respect patients as individuals and honor their preferences in medical carebeneficence - physicians must act in patients' best interest; may conflict with autonomy. if pt can make an informed decision, then pt ultimatley has right to decidenonmaleficence - "do no harm"; but, if benefits of an intervention outweigh risks, pt may make informed decision to proceed (ie with surgeries, meds...)justice - treat persons fairly

33

Right horn of sinus venosus gives rise to:

smooth part of right atrium

33

Spur cell (Acanthocyte)

Liver disease, Abetalipoproteinemia -->irregularly spiked RBCs

33

What CD-?'s are expressed on NK cells?

#NAME?

33

ADH vs Aldosterone:

ADH primarily regulates osmolarity; but, also responds to low blood volume, when necessary (b/c low volume takes precedence over osmolarity)Aldosterone primarily regulates blood volume

33

Cholinesterase inhibitor poisoning symptoms (ie excess parasympathetic activity): Antidote to anti-AchE poisoning?

#NAME?

33

Pathway of bile: from production to secretion into duodenum:

Bile made in liver --> R and L hepatic ducts --> Common hepatic duct --> some into common bile duct, some into cystic duct --> from cystic duct, stored in gallbladder, then released back into cystic duct when needed, into common bile duct --> common bile duct meets pancreatic duct at Ampulla of Vater --> bile released via Sphincter of Oddi into Ampulla of Vater in duodenum!

33

Kayser-Fleischer ring

yellow-green-golden brown corneal ring seen in Wilson's disease

33

Finasteride

-inhibits 5-alpha-reductase-->so: decreased DHT-->used to treat male baldness! and BPH

34

Exceptions to informed consent:

1) Pt lacks decision-making capacity or is legally incompetent (ie minors)2) Implied consent in an emergency3) Therapeutic privilege - withholding information when disclosure would severely harm pt or undermind informed decision-making capacity4) Waiver - pt waives right of informed consent

34

Right common cardinal vein and right anterior cardinal vein give rise to:

SVC

34

basophilic stippling

TAIL:-Thalassemias-Anemia of chronic disease-Iron deficiency-LEAD poisoning!-->have denatured RNA within RBCs

34

Which cytokines activate natural killer cells?

IL-12IFN-alphaIFN-beta

34

Juxtaglomerular Apparatus:

-JG cells in AA-Macula densa = Na sensor --> in distal convoluted tuule*JGA defends GFR via the RAAS system: JG cells secrete renin in response to low renal BP, low Na delivery to distal tubule, and increased sympathetic tone (beta-1 receptors)

34

What's parathion?

Parathion = insecticide = organophosphate; causes cholinesterase-inhibitor poisoning (DUMBBELSS)

34

Lodging of a gallstone where may lead to obstruction of both bile and pancreatic ducts?

if gallstone is lodged in Ampulla of Vater

34

decreased levels of ceruloplasmin?

seen in Wilson's disease-->ceruloplasmin=major copper-carrying protein in blood

34

Functions of Cortisol (X5):

"BBIIG"1) Blood pressure maintenance (stimulates alpha-1 receptors on arterioles)2) decreased Bone formation (side effect = osteoporosis)3) anti-Inflammatory/Immunosuppressive4) increases Insulin resistance (diabetogenic)5) increases Gluconeogenesis, lipolysis, proteolysis

35

Minors: Exceptions for when parental consent is NOT required:

#NAME?

35

Where does fetal erythropoiesis occur at different stages?

"Young Liver Synthesizes Blood"*Yolk sac --> 3-8 weeks*Liver --> 6-30 weeks*Spleen --> 9-28 weeks*Bone marrow --> 28 weeks onward

35

type of anemia caused by folate or B12 deficiency?

Macrocytic, Megaloblastic anemia

35

which cytokine induces Th2 formation? which cytokines are secreted by Th2 and what are their actions?

*IL-12 induces Th2*Th2 makes:-IL-4 --> stimulates B-cells-IL-5 --> stimulates B-cells-IL-10 --> inhibits Th-1 cells and macrophages

35

Which cells secrete renin?

JG cells (in Afferent Arteriole)

35

When do you give atropine + pralidoxime?

Give as an antidote to organophosphate poisoning/ Cholinesterase-inhibitor poisoning

35

What sort of tumor may obstruct the common bile duct?

Tumors of head of pancreas --> can compress ampulla, like a gallstone, thus obstructing common bile duct

35

Signs/symptoms of Wilson's disease: "CCCCCopper is Hella BADDD"

-decreased Ceruloplasmin-Corneal deposits = Kayser-Fleischer rings-Cirrhosis-Copper accumulation (in liver, brain, cornea, kidneys, joints, etc)-hepatocellular Carcinoma (increased risk)-Hemolytic anemia-Basal ganglia degeneration (specifically, degenerat

35

source of PTH?

#NAME?

36

Advance directives:-Oral-Living will-Durable power of attorney

*oral advance directive - use incapacitated pt's prior oral statements as a guide; more valide if pt was informed, directive was specific, pt made a choice; decision was repeated over time to multiple people*living will = written advance directive - written by pt ahead of time, in case he/she become incapacitated and cannot communicate*durable power of attorney - pt designates a surrogate to make medical decisions in case he/she loses decision-making capacity; surrogate retains power unless revoked by a patient; more flexible than a living will

36

Which fetal shunt is patent in about 20-30% of normal adults?

Patent Forament Ovale (kept closed b/c LA pressure > RA pressure)

36

iron deficiency anemia + esophageal web + atrophic glossitis?

Plummer-Vinson syndrome

36

which cytokine induces Th1 formation? which cytokines are secreted by Th1 and what are their actions? Which cytokine inhibits Th1?

*IL-4 induces Th1*Th1 secretes:-IL-2 --> stimulates T-cells-IFN-gamma --> stimulates macrophages*IL-10 (secreted by Th2 cells) inhibit Th1 cells

36

How may NSAIDs cause acute renal failure?

NSAIDs inhibit the renal production of prostaglandins, which normally keep the afferent arterioles vasodilated and maintain GFR-NSAIDS-->constrict AA-->decrease both RPF and GFR

36

Atropine:-class of drug?-clinical uses?-effects on eyes, airway, stomach, gi, bladder?-toxicity?

atropine = muscarinic antagonist*used to treat bradycardia and for ophthalmic applications*effects: blocks DUMBBELSS!-Eye--> increases mydriasis, cycloplegia-Airway-->decreases secretions-stomach --> decreases acid secretions-GI --> decreases motility-bladder --> decreases urgency in cystitis*Toxicity: Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter, Bloated as a toad:-increased body temp, decreased sweating-rapid pulse-dry mouth; dry/flushed skin-cycloplegia (blurry, near vision)-constipation (and urinary retention in men with prostatic hyperplasia)-disorientation-acute angle-closure glaucoma in elderly-hyperthermia in infants

36

Lateral to Medial organization of the Femoral Region:

Lateral: "NAVeL" :Medial-Nerve-Artery-Vein-Lymphatics

36

What part of brain is degenerated in Wilson's disease?

Basal ganglia, specifically Putamen, degeneration-->get Parkinsonian symptoms

36

PTH functions/effects (X4):

1) increases bone resorption-->increases Ca and P2) increases kidney reabsorption of Ca (in distal convoluted tubule)3) decreases kidney reabsorption of phosphate4) increases vitamin D (calcitriol) production by stimulating kidney 1-alpha-hydroxylase***stimulates osteoclasts (and thus bone resorption) by increasing production of M-CSF and RANK-L in osteoblasts, which stimulates osteoclasts***low serum Phosphorous stimulates vitamin D conversion to active form --> vitamin D stimulates phosphate release from bone and increases phosphate reabsorption (though PTH causes decreased phosphate reabsorption)

37

Can a pt's family require a doctor to withhold information from the pt?

No.

37

Ductus Venosus

shunts blood from umbilical vein to IVC (bypasses hepatic circulation)

37

"crew cut" on skull x-ray?

Bone Marrow expansion --> see in beta-thal major-thalassemias-Sickle cell disease

37

What are the antigen presenting cells?

#NAME?

37

4 endocrine functions of the kidneys:

1) Erythropoietin production2) 1,25-(OH)2-vitamin D production --> in proximal tubule; convert vit D to active form*Note: vitamin D--> increases Ca and P absorption in intestines*note: PTH acs directly on the kidney to reabsorb P, but not reabsorb P*note: PTH also stimulates formation of active Vitamin D, which increases absorption of both Ca and P in intestines! 3) Renin --> beta-1 effect4) Prostaglandins --> vasodilates AA to increase GFR

37

What sympathomimetic should be used to treat:-anaphylactic shock?-cardiogenic shock?-septic shock?

#NAME?

37

Femoral triangle: -formed by?-contains?

*formed by:-inguinal ligament-sartorius muscle-adductor longus muscle*contains:-femoral nerve, artery, vein (lateral-->medial)

37

micronodular Cirrhosis + Diabetes + skin pigmentation?

Hemochromatosis = "Bronze" diabetes

37

what stimulates PTH secretion?

#NAME?

38

Priority of surrogates, if a patient becomes incompetent, but did not prepare an advance directive:

spouse > adult children > parents > siblings > other relatives

38

Foramen Ovale

shunts blood entering RA from IVC into LA so that it can be pumped out through the aorta to the head and body

38

chipmunk facies

beta-thal major

38

What are the 2 signals needed for Helper T-cell activation?

signal 1: foreign antigen, after being phagocytosed by APC, is presented on MHC II of APC and is recognized by TCR on the Th cellsignal 2 = "co-stimulatory signal": interaction between B7 (on APC) and CD28 (on Th cell)

38

Hormones that act on the kidney:

1) ANP2) PTH3) AT II4) Aldosterone5) ADH

38

Epinephrine:-type of drug-what receptors does it act on?-clinical applications

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1, beta 2-use for anaphylaxis, open angle glaucoma, asthma, hypotension (anaphylactic shock)

38

What does the femoral sheath contain?

#NAME?

38

Deferoxamine

Treatment for hereditary Hemochromatosis-->also do repeated phlebotomy

38

vitamin D3 vs D2?

D3--> from sunD2--> from plants*both are converted to 25-OH vitamin D in liver and to 1,25-(OH)2 vitamin D (active form) in kidney

39

Exceptions to confidentiality:

-potential harm to others is serious-likelihood of harm to self is great-no alternative means exist to warn or to protect those at risk-physicians can take steps to prevent harm:1) reportable disease - physicians my have to warn public officials and ident

39

Ductus Arteriosus

connects pulmonary artery to aortic arch; blood from LV can bypass pulmonary circulation

39

Ringed sideroblasts

sideroblastic anemia = defect in heme synthesis (x-linked defect in ALA synthase gene) -treat with B6 (Pyridoxine)

39

2 signals needed for cytotoxic T-cell activation?

signal 1: viral or self proteins are presented on MHC I and recognized by TCR on cytotoxic T-cellsignal 2: IL-2 from Th1 cell activates cytotoxic T-cell to kill the virus-infected cell

39

ANP = Atrial Natriuretic Peptide

#NAME?

39

norepinephrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1-use for hypotension (septic shock)

39

Sliding vs Paraesophageal Hiatal Hernias:

*Both are types of diaphragmatic hernias, which occur at the gastro-esophageal jxn; stomach herniates upward through the esophageal hiatus of the diaphragm.-sliding hiatal hernia: GE jxn is displaced; have an "hourglass stomach"-paraesophageal hernia: GE jxn is normal; cardia of stomach moves into the thorax

39

Causes of hemochromatosis?

-herditary (autosomal recessive)-secondary to repeated blood transfusions (ie in Beta-thalassemia major)

39

Conversion of vitamin D to active form:-enzyme?-what stimulates enzyme?-where does it happen?

1-alpha-hydroxylase-PTH stimulates enzyme-in kidney

40

What are considered "reportable diseases" (which may be exceptions to confidentiality)

1) STDs: AIDS, gonorrhea, syphilis (sometimes chlamydia, depends on state)2) Hepatitis3) Child immunization infections: MMR and chickenpox4) Food poisoning: shigella, salmonella 5) TB

40

Fossa Ovalis

Foramen Ovale, after it closes (upon baby's first breaths)

40

Lead poisoning symptoms: LEEAADDS

-Lead lines on gingivae (Burton's lines) and on epiphyses of long bones on x-ray-Encephalopathy-Erythrocyte basophilic stippling-Abdominal colic-Anemia (sideroblastic anemia)-Drops (wrist and foot drop)-Dimercaprol and EDTA = treatment-Succimer = treatmen

40

2 signals needed for B-cell activation and class-switching?

First, helper T-cells are activated LOOK UP IN IMMUNO BOOK!

40

PTH:

-secreted in response to low plasma Ca, high plasma P, or low plasma vitamin D-causes: increased Ca reabsorption in DCT, decreased P reabsorption in PCT, and increased vit D productionAlso causes: increased Ca and P absorption from gut (b/c of effects of

40

isoproterenol:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts equally on beta 1 and beta 2 receptors-used for AV block

40

"hourglass stomach"

sliding hiatal hernia

40

lab findings in Hemochromatosis: ferritin, iron, TIBC, transferring?

-elevated ferritin (stores iron within cells)-elevated iron-decreased TIBC (indirect measure of transferrin, which transports iron in blood)-elevated transferritin saturation (serum Fe/TIBC)

40

functions of vitamin D (X2):

#NAME?

41

What do you do if a 17 year old girl is pregnant and requests an abortion?

many states require parental notification or consent for minors for an abortion; UNLESS SHE IS AT MEDICAL RISK, do not advise a patient to have an abortion regardless of her age or the condition of the fetus

41

What happens when infant takes a breath at birth?

Breath--> decreased resistance in pulmonary vaculature --> pressure in LA > pressure in RA; foramen ovale closes --> increased O2 leads to decreased PG's --> closure of ductus arteriosus

41

Dimercaprol

treatment for lead poisoning (also EDTA)

41

Th1 cells:-regulate:-secrete which cytokines?-activate what?-inhibited by?

-regulate cell-mediated response-secrete Th1 cytokines: IL-2, IFN-gamma-activate macrophages and CD8+ T-cells-inhibited by IL-10 (from Th2 cell)

41

AT II = Angiotensin II

-Causes EA constriction --> decreased RPF, increased GFR and increased FF; also get compensatory Na reabsorption in proximal and distal nephron (b/c goal is to increase BP!)

41

dopamine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on all receptors, but its effects vary by dose:*low dose --> acts on D1*medium dose --> acts on B1 > B2*high dose --> acts on alpha 1 and alpha 2-used for shock (increases renal perfusion), heart failure

41

What kind of inguinal hernia occurs in infants?

INdirect inguinal hernia in INfants-->goes through the INternal/deep inguinal ring, external/superficial inguinal ring, and into the scrotum (Basically, follows the path of the testes)-->occurs in infants d/t failure of processus vaginalis to close--> Covered by all 3 layers of spermatic fascia

41

Which HLA is associated with hemochromatosis?

HLA-A3

41

why is their increases vitamin D and hypercalcemia in sarcoidosis?

-b/c granulomas --> macrophages generate vitamin D (active form)

42

what to do if a patient is suicidal?

assess the seriousness of the threat; if serious, suggest that the patient voluntarily remain in the hospital; a patient can be hospitalized involuntarily if he/she refuses.

42

How does deoxygenated blood in fetus go back to mother's circulation?

After circulating, blood goes through internal iliac arteries to Umbilical arteries ---> mother!

42

Succimer

=treatment for kids with lead poisoning ("SUCks to be a kid with lead poisoning")

42

Th2 cells:-regulate?-secrete which cytokines?-another action they do?-inhibited by?

-regulate humoral response-secrete Th2 cytokines: IL-4, IL-5, IL-6, IL-10-help B-cells make antibody (IgE> IgG)-inhibited by IFN-gamma (from Th1 cell)

42

Aldosterone:

#NAME?

42

dobutamine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on Beta 1 mostly (also, slightly on alpha 1, alpha 2, beta 2)-used for heart failure, cardiac stress testing, cardiogenic shock

42

What type of inguinal hernia passes through the inguinal/Hesselbach's triangle?

Direct inguinal hernia--> only covered by external spermatic fascia (unlike indirect, which is covered by all 3 layers)-->usually in older men

42

Complications/Results of Hemochromatosis:

#NAME?

42

Source of Calcitonin?

Parafollicular (C) cells of thyroid (neural crest derivative!)

43

Apgar score

= assessment of newborn health via a 10-point scale; evaluated at 1 minute and 5 minutes post-birth*based on:-Appearance-Pulse-Grimace-Activity-Respiration*> or = to 7 - good*4-6 - assist and stimulate*<4 at later time points, then risk that child will

43

Amniotic fluid findings in neural tube defects

increased alpha-fetoprotein and increased Acetylcholinesterase (AChE)

43

Hypersegmented neutrophils + glossitis +increased homocysteine and:-normal methylmalonic acid?-increased methylmalonic acid?

-if normal methylmalonic acid: Folate deficiency -if increased methylmalonic acid: B12 deficiency***both cause megaloblastic macrocytic anemia (so have impaired DNA synthesis and ineffective erythropoiesis = pancytopenia)

43

How do natural killer cells induce apoptosis?

use perforin and granzymes to induce apoptosis

43

ADH/Vasopressin

-secreted in response to elevated plasma osmolarity and decreased blood volume-causes increased # of water channels and increased water reabsorption

43

phenylephrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on alpha 1 mostly (and a little on alpha 2)-used for pupillary dilation, vasoconstriction, nasal decongestion; good for stopping epistaxis

43

Hernia that's most common in women?

Femoral hernia

43

Cause of primary biliary cirrhosis?

-->Autoimmune reaction: get lymphocytic infiltrate and granulomas-->mostly seen in middle-aged women-->anti-mitochondrial antibodies

43

Medullary thyroid carcinoma:

abnormal growth of C-cells (doesn't really affect Calcium metabolism though; despite that Calcitonin is released from C cells)

44

Definition of low birth weight?

<2500 g*associated with increased physical and emotional problems*caused by prematurity or intrauterine growth retardation*complications: infections, RDS, necrotizing enterocolitis (if feed neonate with formula too soon), intraventricular hemorrhage, and persistent fetal circulation (PDA, PFO...)

44

Anencephaly: Findings in amniotic fluid?

-malformation of anterior end of neural tube --> no brain-increased alpha-fetoprotein in amniotic fluid + polyhydramnios (b/c no swallowing center in brain)

44

Megaloblastic anemia that's not correctable by vitamin B12 or Folate?

--> Orotic Aciduria

44

How do cytotoxic T-cells induce apoptosis?

release cytotoxic granules containing preformed proteins: -perforin (delievers granules into target cell)-granzyme (activates apoptosis inside target cell)-granulysin (antimicrobial, induces apoptosis)

44

6 situations that shift K+ out of cells --> causing HYPERkalemia:

#NAME?

44

Metaproterenol, Albuterol, Salmeterol, Terbutaline:-types of drugs?-what receptors do they act on?-Applications

-direct sympathomimetics-B2-agonists (also act very slightly on B1)-Metaproterenol and Albuterol --> used for acute asthma-Salmeterol --> for long-term treatment of asthma-Terbutaline --> to reduce premature uterine contractions

44

Hernia that's a leading cause of bowel incarceration/obstruction?

Femoral Hernia

44

Elevated anti-mitochondrial antibodies?

Primary biliary cirrhosis

44

hormones that use cAMP signaling pathways:

"FLAT CHAMP + GCG" (all the ant pit hormones, except prolactin and GH)-FSH-LH-ACTH-TSH-CRH-hCG-ADH (V2 receptor)-MSH (melanocyte stimulating hormone)-PTH-GHRH-Calcitonin-Glucagon

45

Berkson's bias

a type of selection bias; studies on hospitalized patients

45

Holoprosencephaly: What is it? What conditions are associated with?

no separation of hemispheres, so may get one central eye (cyclopia), etc...-Associated with: Patau's syndrome (trisomy 13), severe fetal alcohol syndrome, cleft lip/palate, abnormal sonic hedgehog gene

45

Pancytopenia =

#NAME?

45

Natural Killer vs Cytotoxic T-cells

Both induce apoptosis of virally-infected or tumor cells*NK cells --> Recognize ABSENCE of MHC-1 on target cell surface*Cytotoxic T-cells --> have CD8, which BINDS to MHC-1 on virus-infected cells

45

4 situations that shift K+ into cells --> causing HYPOkalemia:

#NAME?

45

Ritodrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on B2 receptors ONLY!-used to reduce premature uterine contractions

45

Hesselbach's triangle:-borders?-what type of hernia goes through it?

*Borders:-inguinal ligament-inferior epigastric artery-lateral border of rectus abdominis*Direct inguinal hernias (older men) go through Hesselbach's triangle

45

Causes and pathophysiology of Secondary Biliary Cirrhosis?

-->Extrahepatic biliary obstruction (like a gallstone, biliary stricture, carcinoma of head of pancreas, chronic pancreatitis) --> so, get increased pressure in intrahepatic ducts --> injury and fibrosis --> bile stasis

45

hormones that use cGMP signaling pathway:

*Vasodilators:-ANP-NO

46

selection bias

nonrandom assignment to study group (ie berkson's bias; loss to follow-up)

46

Chiari II

cerebellar tonsillar herniation through foramen magnus with aqueductal stenosis and hydrocephaly; often presents with syringomyelia

46

Fanconi's anemia

DNA repair defect --> get aplastic anemia(NOT the same as Fanconi's syndrome = proximal tubule reabsorption defect in kidneys!)

46

What part of the antibody is recognizes antigens?

the antigen binding fragment on the Fab part of the antibody; the VL and VH (variable light and variable heavy) chains recognize antigens.

46

Too rapid correction of Hyponatremia?

get Central Pontine Myelinosis (irreversible; acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness)

46

List 3 indirect sympathomimetics:-What are their actions?-What are their clinical applications?

1) Amphetamines:-indirect general sympathetic agonist; release stored catecholamines-used for narcolepsy, obesity, ADD2) Ephedrine:-indirect general sympathetic agonist-release stored catecholamines-used for nasal decongestion, urinary incontinence, hypotension3) cocaine:-indirect general sympathetic agonist; uptake inhibitor-causes vasoconstriction and local anesthesia

46

G cells (antrum of stomach) secrete?

Gastrin ("pro-gastric")

46

"onion skin" bile duct fibrosis?

Primary Sclerosing Cholangitis (a biliary tract disease)

46

hormones that use IP3 signaling pathway:

"GOAT + HAG" (post pit hormones!)-GnRH-Oxytocin-ADH (V1 receptor)-TRH-Histamine (H1)-Angiotensin II-Gastrin

47

recall bias

knowledge of presence of disorder alters recall by subjects

47

Dandy Walker

Large posterior fossa, absent cerebellar vermis with cystic enlargement of 4th ventricle; may lead to hydrocephalus and spina bifida

47

Why anemia in kidney disease?

decreased EPO --> decreased hematopoiesis

47

Which part of the antibody fixes complement?

Complement binding is at CH2 of the Fc part of the antibody (of IgG and IgM only)

47

U waves on ECG, flattened T waves, arrhythmias and paralysis?

low serum K+

47

clonidine and alpha-meythldopa:-type of drugs?-act on what type of receptor?-applications?

#NAME?

47

I cells (duodenum, jejunum) secrete?

CCK ("pro-duodenum", "anti-gastric"--> CCK stimulates pancreatic secretions)

47

Presentation and Labs in Biliary Tract Diseases (Primary and Secondary Biliary Cirrhosis, Primary Sclerosing Cholangitis):

Presentation:-Pruritis-Jaundice-Dark urine (b/c elevated urobilinogen in urine)-Pale stools (b/c bile not making it into stools)-HepatosplenomegalyLabs:-Conjugated/Direct Hyperbilirubinemia-elevated cholesterol-elevated ALP

47

hormones that use cytosolic steroid receptors:

"VET CAP" (adrenal hormones + vitamin D!)-Vitamin D-Estrogen-Testosterone-Cortisol-Aldosterone-Progesterone

48

sampling bias

subjects are not representative relative to general population; so, results are not generalizable

48

Syringomyelia

-enlargement of central canal of spinal cord; usually at C8-T1*loss of pain and temperature sensation in upper extremities with preservation of touch sensation *associated with Chiari II malformation

48

Aplastic anemia

#NAME?

48

Which part of antibody do macrophages bind to?

Fc fragment, below the complement binding area

48

Peaked T waves, wide QRS, arrhythmias:

high serum K+

48

-azole =

anti-fungal (ie ketoconazole)

48

S cells (duodenum) secrete?

Secretin ("pro-HCO3", "nature's antacid")

48

Pruritus in a middle-aged woman + elevated conjugated bilirubinemia?

-->Consider primary biliary cirrhosis-->may also consider primary sclerosing cholangitis

48

hormones that use nuclear steroid receptors:

-Thyroid hormones --> T3, T4

49

late-look bias

information gathered at an inappropriate time; a type of recall bias-ie using a suvery to study a fatal disease (b/c only pts still alive can answer the survey...)

49

Aortic Arch Derivatives:

*1st aortic arch --> Maxillary artery (branch of external carotid)*2nd aortic arch --> Stapedial artery and Hyoid artery*3rd aortic arch --> common carotid artery and proximal part of the internal carotid artery*4th aortic arch --> on left: aortic arch; on right: proximal part of right subclavian artery*6th aortic arch --> proximal part of pulmonary arteries and (on left only) ductus arteriosus

49

Hemolytic anemia in a newborn?

Pyruvate kinase deficiency --> decreased ATP --> rigid RBCs

49

Which part of the antibody determines the isotype (ie IgG, IgM, IgD, IgE, IgA)? idiotype (ie unique antigen-binding pocket)?

Isotype --> determined by the FcIdiotype --> determined by Fab

49

effects of low serum Ca?

#NAME?

49

-cillin =

penicillin (ie methicillin)

49

D cells (pancreatic islets, GI mucosa) secrete?

Somatostatin (inhibits everything!)

49

Complication of Secondary Biliary Cirrhosis?

Ascending cholangitis = infection of biliary tree (makes sense, b/c have an obstruction of bile flow; bile stasis; etc...)

49

hormones that use intrinsic tyrosine kinase (MAP kinase pathway) signaling pathway:

*growth factors:-insulin-IGF-1-FGF (fibroblast growth factor)-PDGF (platelet-derived growth factor)

50

procedure bias

subjects in different groups are not treated the same - ie pay more attention to treatment group, stimulating greater compliance

50

Derivative of 1st branchial cleft

1st cleft --> external auditory meatus

50

HbC defect

Glutamic acid-to-lysine mutation *pts with HbSC (1 of each mutant gene) have milder disease than HbSS pts (full sickle cell)

50

opsonization vs neutralization vs complement activation:

opsonization - antibody promotes phagocytosisneutralization - antibody prevents bacteral adherencecomplement activation - antibody activates complement, enhancing opsoninzation and lysis

50

effects of high serum Ca?

"stones, bones, groans, moans"-delirium-renal stone-abdominal pain

50

-cycline =

antibiotic, protein synthesis inhibitor (ie tetracycline)

50

Which hormone is increased in Zollinger-Ellison syndrome?

Gastrin

50

What condition is Primary Sclerosing Cholangitis associated with?

Ulcerative Cholitis-primary sclerosing cholangitis can also lead to secondary biliary cirrhosis

50

hormones that use receptor-associated tyrosine kinase (JAK/STAT pathway) signaling pathway:

-Prolactin-GH-cytokines (IL-2, IL-6, IL-8...)

51

confoundibg bias

occurs with 2 closely associated factors; the effect of 1 factor distorts or confuses the effect of the other

51

Branchial Cleft Cysts vs. Thyroglossal Duct Cysts

Branchial Cleft cysts --> within lateral neck; doesn't move with swallowing; d/t persistent cervical sinus Thyroglossal duct cyst --> in midline of neck; moves with swallowing

51

older pt, unexplaned anemia:

must rule out colon cancer

51

Main antibody in secondary/delayed response to an antigen, and most abundant antibody in blood?

IgG (t1/2 of IgG = 21 days; one reason it's most abundant!)

51

effects of low serum Phosphate?

bone loss and osteomalacia

51

-navir =

protease inhibitor (HIV trtmt) (ie saquinavir)

51

Which GI hormone is stimulated by Phenylalanine and Tryptophan?

Gastrin

51

Biliary tract disease with Hypergammaglobulinemia (IgM)?

-->Primary sclerosing cholangitis

51

Which is the active form of hormones: bound or unbound?

-unbound --> free hormone = active hormone

52

lead-time bias

early detection confused with increased survival; seen with imporved screening (the natural history of the disease is not changed; but, early detection makes it seem as though survival has increased)

52

1st branchial arch derivatives:

Ms and Ts!Cartilage: Meckel's; Mandible, Malleus, Mandibular ligamentMuscles of Mastication: Temporalis, Masseter, lateral and Medial pterygoids, Mylohyoid, Tensor Tympani, Tensor veli palatini, ant Two-Thirds of TongueNerves: CN V2 and V3 (Mandibular and Maxillary of Trigeminal)

52

reversible etiologies of sideroblastic anemia?

#NAME?

52

Which antibodies can fix complement?

IgM and IgG

52

effectsof high serum Phosphate?

renal stones, metastatic calcifications

52

-triptan =

5-HT1B/1D-agonists (for migraines) (ie sumatriptan)

52

What AAs may stimulate gastrin release?

Phenylalanine and Tryptophan

52

5 main risk factors for gallstones/cholelithiasis:

5 F's:-Female-Forty-Fat-Fertile (multiparity)-Feathers (Native Americans)

52

SHBG (sex hormone-binding globulin):-what happens if increased in men?-if decreased in women?-during pregnancy?

-if increased in men--> decreased free testosterone --> gynecomastia-if decreased in women--> increased free testosterone--> hirsutism*have increased SHBG levels during pregnancy

53

Pygmalion effect

when a researcher's belief in the efficacy of a treatment changes the outcome of that treatment

53

2nd branchial arch derivatives:

S's!Cartilage: Stapes, Styloid process, Stylohyoid ligament, etcMuscles: Stapedius, Styloyoid, etcNerve: CN VII (Seven! for Smiles!)

53

what vitamin should be supplemented in vegans/vegetarians?

B12 (may get deficiency --> megaloblastic anemia)

53

Which antibody can cross the placenta?

IgG

53

Compensatory response to respiratory acidosis or alkalosis?

--> kidneys!*if respi acidosis --> kidneys increase renal HCO3 reabsorption*if respi alkalosis --> kidneys decrease renal HCO3 reabsorption--> these compensatory mechanisms take time, are delayed! (unlike compensation of metabolic acidosis/alkalosis, whic

53

-ane=

inhalational general anesthetic (ie halothane)

53

What does CCK cause?

Stimulates pancreatic secretion, gallbladder contraction, and gastric emptying

53

Charcot's triad of cholangitis (infection of biliary tree/common bile duct):

1) Jaundice2) Fever3) RUQ pain

53

Source of T3 vs T4?

T4 is from follicles of thyroidT3 is formed from T4 conversion in blood

54

Hawthorne effect

when a group being studied changes its behavior owing to the knowledge being studied

54

3rd branchial arch derivatives:

Pharyngeal! Cartilage: greater horn of hyoidMuscle: stylo-pharyngeusNerve: glossopharyngeal (CN IX)

54

Hepcidin

released by liver, binds ferroportin on intestinal mucosal cells and macrophages-increased in cases of inflammation: increased hepcidin-->decrease release of iron from macrophages*this is what happens in anemia of chronic disease: decreased iron, decreased TIBC, increased ferritin

54

Which antibody is found in secretions (tears, saliva, mucus) and breast milk ("colustrum")?

IgA

54

Causes of metabolic acidosis with a high anion gap?

MUDPILES!-Methanol (formic acid)-Uremia-DKA-Paraldehyde or Phenformin-Iron tablets or INH (Isoniazid)-Lactic acidosis, hypoxia-Ethylene glycol (oxalic acid)-Salicylates (ie aspirin)

54

-caine=

#NAME?

54

What does Secretin do?

Stimulates pancreatic HCO3- secretion, decreased gastric acid secretion, increased bile secretion--> it's "nature's antacid" --> neutralizes gastric acid in duodenum to allow pancreatic enzymes to function

54

Murphy's sign

-->positive in cholecystitis; good way to dx pain in the RUQ-->positive: when deeply palpate, pt has inspiratory arrest b/c such deep pain

54

4 main functions of T3:

*4 B's:1) Brain maturation (CNS maturation)2) Bone growth (synergistic with GH)3) Beta-adrenergic effects (Beta-1 receptors in heart--> increased CO, HR, SV, contractility)4) increased BMR (via Na/K-ATPase activity --> so increased O2 consumption, RR, body temp)*Also: increased glycogenolysis, gluconeogenesis, lipolysis

55

How to reduce bias:

1) Blind studies 2) Placebos3) Crossover studies (ie each subject is at some point on placebo and some point on drug; so each subject acts as own control to limit confounding bias)4) Randomizaton to limit selection bias and confounding bias

55

4th-6th branchial arch derivatives:

Neck and Voice box!*4th arch --> muscles include cricothyroid muscle; nerve: superior laryngeal branch of CN X*6th arch --> all intrinsic muscles of larynx EXCEPT cricothyroid; nerve: recurrent laryngeal branch (CN X)

55

decreased iron + decreased TIBC + increased ferritin

anemia of chronic disease (inflammation--> increased hepcidin --> decreased release of iron from macrophages

55

Which antibody is a monomer in circulation, but a dimer when secreted?

IgA

55

Causes of normal anion gap metabolic acidosis?

#NAME?

55

-operidol=

butyrophenone (neuroleptic) (ie haloperidol)

55

Somatostatin:-where is it secreted from?-what does it do?

-secreted from D cells in pancreas (islets) and GI mucosa-inhibits:-->decreased gastric acid and pepsinogen secretion-->decreased pancreatic and intestinal secretions-->decreased gallbladder contraction (so, if lots of somatostatin, may get biliary stones

55

Pain on deep palpation, causing inspiratory arrest

Positive Murphy's sign--> positive in cholecystitis; way to dx RUQ pain

55

TBG:-what is it?-how is it affected in hepatic failure? pregnancy? OCP use?

thyroxine-binding globulin --> binds most T3/T4 in blood-->only free hormone is active-reduced in hepatic failure-increased in pregnancy and OCP use (increased estrogen-->increased TBG)

56

At what age does the moro reflex disappear?

between birth and 3 mos

56

1st branchial pouch derivatives:

middle ear cavity, eustachian tube, mastoid air cells

56

Cause of hereditary spherocytosis?

-extravascular intrinsic hemolytic normocytic anemia-caused by defect in proteins interacting with RBC membrane skeleton and plasma membrane (ankyrin, band 3, protein 4.2, spectrin)-premature removal of RBCs by spleen --> splenomegaly, aplastic crisis; ev

56

Which antibody is produced in primary/immediate response to an antigen?

IgM

56

Causes of Respiratory alkalosis:

-Hyperventilation (early high-altitude exposure)-Initially after aspirin ingestion (then becomes anion-gap metabolic acidosis)

56

-azine =

phenothiazine (neuroleptic, antiemetic) (ie chlorpromazine)

56

What is used more rapidly: oral glucose load or equivalent given by IV?

oral glucose is used more rapidly, d/t GIP = Gastric Inhibitory Peptide = Glucose-dependent insulinotropic peptide

56

3 causes of gallstones:

-elevated cholesterol and/or bilirubin-decreased bile salts-gallbladder stasis-->all of these can cause stones

56

TSI

thyroid-stimulating-immunoglobulin-->acts like TSH to stimulate follicular cells in Grave's disease

57

when does a child begin to have stranger anxiety?separation anxiety?

stranger anxiety: 7-9 mosseparation anxiety: 12-15 mos

57

2nd branchial pouch derivatives

Palatine tonsil

57

Labs for PNH (paroxysmal nocturnal hemoglobinuria)?

increased urine hemosiderin

57

Which antibody can exist as a pentamer (as well as a monomer)?

IgM

57

Causes of metabolic alkalosis with compensation (Hypoventilation):

-Diuretics-Vomiting-Antacids-Hyperaldosteronsim (increases H+ secretion)***These are all cases where get rid of acid!

57

-barbital =

barbiturate (ie phenobarbital)

57

VIP = Vasoactive Intestinal Peptide:-secreted from?-actions?

*source: Parasympathetic ganglia in sphincters, gallbladder, small intestine*actions:-increases intestinal water and electrolytes secretion-increases relaxation of intestinal smooth muscle and sphincters

57

Most common cause of cholecystitis (inflammation of gallbladder)?

Gallstones-->have positive Murphy's sign!

57

anti-thyroid peroxidase antibodies

Hashimoto's

58

when does a child begin to climb stairs?

12-24 months

58

3rd branchial pouch derivatives:

dorsal wings --> inferior parathyroidsventral wings --> thymus

58

complication of PNH?

thrombosis

58

Which antibody mediates immediate/type I hypersensitivity reactions through release of histamine?

IgE

58

Causes of Respiratory Acidosis:

*any time can't get rid of CO2!-airway obstruction-acute lung disease-chronic lung disease-opiods, narcotics, sedatives-weakened respiratory muscles

58

-zolam =

benzodiazepine (ie alprazolam)

58

VIPoma:-origin-symptoms?

non-alpha, non-beta pancreatic islet cell tumor-may be associated with MEN I -secretes VIP-symptoms:-->tons of watery diarrhea (b/c VIP stimulates intestinal water and electrolyte secretion) --> so, as a result also have: dehydration, hypokalemia, etc...

58

Ascending cholangitis =

inflammation of bile duct; usually d/t obstruction of duct by gallstones

58

Wolff-Chaikoff effect:

transient decrease in T3/T4 due to ingestion of iodide, which inhibits thyroid peroxidase, and therefore organification --> hypothyroidism symptoms

59

block stacking milestones in child development?

-stacks 3 blocks at 1 year-stacks 6 blocks at 2 years

59

4th branchial pouch derivatives:

superior parathyroids

59

Treatment for sickle cell anemia?

-Hydroxyurea --> increases HbF-Bone marrow transplant = ultimately

59

Which antibody mediates immunity to worms by activating eosinophils?

IgE

59

How to calculate anion gap:

Anion gap = Na - (Cl + HCO3) = Na - Cl - HCO3

59

-azepam =

benzodiazepine (ie diazepam)

59

Endocrine tumor that leads to lots of watery diarrhea?

VIPoma (pancreatic tumor, secretes tons of VIP)

59

What is acute pancreatitis?

#NAME?

59

Cushing's syndrome

increased cortisol; causes vary

60

when can a child begin feeding self with a fork and spoon?

24-26 months

60

Most common ectopic thyroid tissue site?

Tongue

60

Coomb's positive anemia?

autoimmune hemolytic anemia (ie warm agglutinin or cold agglutinin anemias)

60

which antibody is in lowest concentration in serum?

IgE

60

3 types of RTA (Renal Tubular Acidosis)

*Type 1 = "distal": defect in CT's ability to excrete H+ (so increased urinary pH)-associated with hypokalemia and risk for calcium kidney stones*Type 2 = "proximal": defect in PT HCO3 reabsorption-associated with hypokalemia and hypophosphatemic rickets*Type 3 = "hyperkalemic": Hypoaldosteronism or lack of Ct response to aldosterone-associated with hyperkalemia and can't excrete ammonium in PT-decreased urinary pH d/t decreased buffering capacity

60

-etine =

SSRI (ie fluoxetine)

60

Action = binds vitamin B12 to allow uptake of B12 in terminal ileum?

Intrinsic Factor

60

Causes of Acute Pancreatitis:

"GET SMASHED"-->Gallstones and Ethanol = Most common causese-Gallstones-Ethanol-Trauma-Steroids-Mumps-Autoimmune disease-Scorpion sting-Hypercalcemia/Hypertriglyceridemia-ERCP (Endoscopic Retrograde Cholangiopancreatography = endoscopic technique to dx/treat problems of pancreatic or biliary ducts; but, main risk of it = acute pancreatitis) -Drugs (ie sultas, HIV drugs...)

60

#1 cause of Cushing's syndrome?

Exogenous/Iatrogenic steroids--> increased cortisol--> decreased ACTH and decreased CRH

61

when may a child kick a ball?

24-36 months

61

Foramen cecum

normal remnant of thyroglossal duct

61

microangiopathic anemia

-see schistocytes-RBCs damaged when passing through obstructed or narrowed vessel lumina-see in: DIC, TTP-HUS, SLE, malignant HTN; prosthetic valves, aortic stenosis...

61

Which blood types of mothers may lead to erythroblastosis fetalis and hemolytic disease of newborn?

Type O mothers; because in type O mothers, antibodies are mostly IgG, so can cross placenta and cause fetal hemolysis.But, maternal blood types A and B: anti-A and anti-B antibodies are IgM, so can't cross placenta...

61

RBC casts

Glomerulonephritis-Also: ischemia, malignant HTN

61

-ipramine =

TCA (ie imipramine)

61

Which substances are secreted by Parietal Cells of stomach?

#NAME?

61

#1 cause of chronic pancreatitis?-other main cause?

#1 = alcoholismother main cause = smoking

61

Endogenous causes of Cushing's syndrome: (and ACTH levels)

1) Cushing's disease --> pituitary adenoma --> increased ACTH secretion2) Ectopic ACTH: nonpituitary tissue making ACTH (have very high ACTH; ie from Small cell lung cancer, bronchial carcinoids)3) Adrenal: adenoma, carcinoma, nodular adrenal hyperplasia --> decreased ACTH (very low/undetectable)

62

toilet training age?

24-36 months (pee at three!)

62

Failure of fusion of the maxillary and medial nasal processes

Cleft lip

62

rate limiter of heme synthesis?

ALA synthase (delta-aminolevulinic acid synthase)

62

3 complement pathways:

1) Classic: IgG or IgM mediated; form antigen-antibody complexes2) Alternative: stimulated by spontaneous and microbe surface molecules3) Lectin: mannose

62

WBC casts

#NAME?

62

-triptyline =

TCA (ie amitriptyline)

62

Gastrinoma

gastrin-secreting tumor; get constant high levels of acid secretions and ulcers

62

labs in acute pancreatitis:

-elevated amylase and lipase (lipase = more specific)

62

Dexamethasone test

test to determine cause of Cushing's syndrome

63

tricycle riding age?

3 years (3-cycle at 3!)

63

Failure of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine processes

Cleft palate

63

effect of heme on ALA synthase activity

low heme--> increased ALA synthaselots of heme-->decreased ALA synthase

63

Which 2 complement factors are involved in anaphylaxis?

C3a and C5a

63

"muddy brown"/Granular casts

Acute tubular necrosis

63

-olol =

beta-antagonist (ie propranolol)

63

Secreted by chief cells of stomach

Pepsin

63

steatorrhea, fat-soluble vitamin deficiency, diabetes

pancreatic insufficiency; may be a result of chronic pancreatitis (which is usually d/t alcoholism or smoking)

63

Which cause of Cushing's syndrome is affected by Dexamethasone?

ACTH-Pituitary tumor --> get decreased cortisol levels when give a high dose of dexamethasone

64

gender identity development age?

24-36 months

64

Which artery supplies the foregut? midgut? hindgut?

Celiac Artery --> foregutSMA --> midgutIMA --> hindgut

64

Rate limiter of heme synthesis

ALA synthase (requires B6!)

64

Which 2 complement factors are involved in opsonization of bacteria?

C3b and IgG

64

Waxy casts

advanced/chronic renal disease

64

-terol =

beta2-agonist (ie albuterol)

64

Action of pepsin?

protein digestion

64

CA-19-9

specific tumor marker for Pancreatic adenocarcinoma

64

Causes of primary hyperaldosteronism?-results?-treatment?

Caused by adrenal hyperplasia or aldosterone-secreting adrenal adenoma (Conn's syndrome)*Effects:-hypertension-hypokalemia-LOW plasma renin-metabolic alkalosis *Trtmnt:-surgery to remove tumor-K-sparing diuretic --> aldosterone antagonist

65

buttons and zippers, brushes teeth, hops on 1 foot, makes stick figure drawings?

4 years old

65

Foregut =

pharynx to duodenum; supplied by celiac artery

65

tea-colored urine + blistering cutaneous photosensitivity?

-Porphyria cutanea tarda (most common porphyria)-d/t deficiency of Uroporphyrinogen Decarboxylase (needed for heme synthesis); get accumulation of Uroporphyrin (hence the tea-colored urine)

65

What complement complex stimulates cytolysis by MAC?

C5b-9

65

Hyaline casts

nonspecific

65

-zosin =

alpha 1-antagonist (ie prazosin)

65

what activates pepsinogen-->pepsin?

Acid (H+)

65

CEA

less specific tumor marker for pancreatic adenocarcinoma

65

Causes of secondary hyperaldosteronism?-results?

--> have an overactive RAAS system, because the kidney "thinks" that there's a low intravascular volume*Causes:-renal artery stenosis-chronic renal failure-CHF-Cirrhosis-Nephrotic syndrome--> cirrhosis and nephrotic syndrome are low protein states --> so,

66

imaginary friends age?

4 years old

66

Midgut =

duodeum to transverse colon (splenic flexure/watershed area); supplied by SMA

66

painful abdomen + red-wine colored urine + polyneuropathy + psych disturbances; precipitated by drugs:

Acute Intermittent Porphyria -d/t deficiency of Porphobilinogen Deaminase (aka uroporphyrinogen-I-synthase)-accumulate Porphobilinogen, ALA, and uroporphyrin (in urine)

66

Hereditary angioedema: have increased bradykinin (so increased vasodilation and vascular permeability), episodes of painless, non-pitting, well-circumscribed edema

C1 esterase inhibitor deficiency (C1 esterase inhibitor prevents complement activation on self cells; but, in this case, it is deficient)

66

What does the presence of casts in urine indicate?

-->casts indicate that hematuria/pyuria is of renal origin*so, with bladder cancer, kidney stones --> have hematuria, but no casts*with acute cystitis --> have pyuria (WBCs), but no casts

66

-oxin =

cardiac glycoside (inotropic agent) (ie digoxin)

66

Which cells secrete HCO3-?

-mucosal cells (in stomach, duodenum, salivary glands, pancreas)-Brunner's glands (in submucosa of duodenum)

66

painless jaundice in male >50 years old?

consider Pancreatic adenocarcinoma

66

primary vs secondary vs tertiary adrenal insufficiency:

-primary --> level of adrenal gland-secondary --> level of pituitary (ie no ACTH)-tertiary --> d/t abrupt withdrawal of GCs (still have aldosterone, so no hyperkalemia)***primary--> have hyperpigmentation and hyperkalemia***secondary --> no hyperpigmentat

67

copies line or circle drawings - development age?

3 years old

67

Hindgut =

distal transverse colon (splenic flexure/watershed area) to rectum; supplied by IMA

67

Treatment for Acute Intermittent Porphyria?

-Glucose and Heme --> inhibit ALA synthase

67

recurrent pyogenic sinus and respiratory tract infections (esp S. pneum and H. infl), and increased susceptibility to type III hypersensitivity rxns (esp glomerulonephritis)

C3 complement deficiency

67

Nephritis vs Nephrotic syndromes:

*Nephritic--> Inflammatory; hematuria and RBC casts in urine-->have azotemia (increased BUN and increased Creatinine), oliguria, HTN (d/t salt retention), and mild proteinuria ( Proteinuria (>3.5g/day), frothy urine, hyperlipidemia, fatty casts, edema-->associatd with thromboemolism and increased risk of infection (b/c loss of immunglobulins) ***lose charge barrier (fused basement membrane) of glomerular filtration barrier in nephrotic syndrome

67

-pril =

ACE-inhibitor (ie captopril)

67

How do NSAIDs lead to acidic damage in stomach?

-Prostaglandins generate mucus that covers that covers the gastric epithelium-->NSAIDs-->decrease PGs--> decrease mucus --> decrease HCO3- --> increased susceptibility to acidic damage in stomach

67

#1 risk factor for Pancreatic Adenocarcinoma?-other risk factors?

#1 = Smoking (but, not alcoholism)*other risk factors:-chronic pancreatitis (which is usually caused by alcoholism or smoking... kind of contradicts the not alcoholism thing...)-Jewish and African American males- >50 years old-Diabetes-Genetics

67

Acute primary adrenal insufficiency:

Caused by Waterhouse-Friderichsen syndrome --> adrenal hemorrhage associated with N. meningitidis septicemia, DIC, petechial rash, endotoxic shock

68

Changes in the elderly: (sex, sleep, suicide, vision, hearing, immune, bladder, renal, pulmonary, GI, muscle mass, fat)

1) Sex: (note: sex interest does not change)-Men--> slower erection/ejaculation, longer refractory period -Women --> vaginal shortening,thinning, dryness2) Sleep: -decreased REM, slow-wave sleep (stages 3 and 4)-increased latency and awakenings (takes longer to reach REM sleep)3) increased suicide rate (males 65-74 yo have highest suicide rate in US)4) decreased vision, hearing, immune response, bladder control5) decreased renal, pulmonary, GI function6) decreased muscle mass, increased fat*Note: 5 and 6 affect drug dosage and metabolism; for this reason, start SLOW and LOW when giving drugs to elderly!

68

Gastroschisis

extrusion of abdominal contents through abdominal folds; not covered by peritoneum (increased AFP in amniotic fluid)

68

Defect in factors I, II, V, VII, X -->?

increased PT (extrinsic pathway defect)

68

Recurrent Neisseria bacteremia (N. gonococcal and N. meningococcal)

C5-C9 complement deficiency

68

Lumpy bumby appearance of glomeruli on LM?

Acute PSGN

68

-afil =

erectile dysfunction (ie sildenafil)

68

Which glands secrete saliva? What stimulates saliva secretion (PSNS, SNS?)? When is saliva hypotonic/isotonic?

-secreted from parotid, submandibular, sublingual glands-stimulated by Sympathetic AND Parasympathetic activity-Normally is hypotonic, but is more isotonic with higher flow rates, b/c less time for absorption***Sympathetic stimulation--> thicker secretion

68

Courvoiseier's sign:

-obstructive jaundice with palpable gallbladder-->pruritus, dark urine, pale stools (all signs of obstructive jaundice...) -->see with pancreatic adenocarcinoma

68

increased urinary VMA

VMA= breakdown product of norepinephrine*increased in pheochromocytoma-->also have increased plasma catecholamines

69

Normal bereavement vs Pathologic grief

Normal bereavement: shock, denial, guilt, somatic symptoms; can last up to 2 months; may experience illusionsPathologic grief: excessively intense grief, grief that lasts >2 months; or grief that is delayed, inhibited or denied. May have depressive symptoms, delusions, hallucinations.

69

Omphalocele

persistence of herniation of abdominal contents into umbilical cord; covered by peritoneum (Increased AFP in amniotic fluid)

69

Defect in all factors EXCEPT VII and XIII?

increased PTT

69

DAF (decay accelerating factor) deficiency may cause?

DAF is a complement inhibitor, meant to prevent complement activate on self-cells. If deficient, may lead to Paroxysmal Nocturnal Hemoglobinuria and to complement-mediated lysis of RBCs

69

child with peripheral and periorbital edema, dark urine, elevated anti-ASO, elevated anti-DNAse B, decreased C3 and total complement levels

Acute PSGN

69

-tropin =

pituitary hormone (ie somatotropin)

69

How does Gastrin stimulate acid secretion in stomach?

G cells in antrum of stomach are stimulated by vagus nerve (via GRP transmitter)--> release Gastrin into circulation --> Gastrin stimulates ECL (EnteroChromaffin-Like) cells to release Histamine --> Histamine induces Parietal cells to secrete HCl

69

Trousseau's syndrome:

-migratory thrombophlebitis--> redness and tenderness on palpation of extremities-->see with pancreatic adenocarcinoma

69

Symptoms of pheochromocytoma:

*6 P's:-Pressure --> elevated BP-Pain --> headache-Perspiration-Palpitatons --> tachycardia-Pallor-Panic attacks***symptoms occur in "spells" - relapse and remit

70

Physiologic effects of stress:

stress induces production of: -free fatty acids-17-OH corticosteroids (increased corticosteroids --> immunosuppression)-lipids-cholesterol-catecholamines-also, affects: water absorption (have decreased water absorption), muscular tonicity, gastrocolic reflex, and mucosal circulation

70

infant with cyanosis, choking/vomiting with feeding, air bubble in stomach on CXR, polyhydramnios (in utero), can't pass NG tube into stomach, pneumonitis

Tracheoesophageal fistula (polyhydramnios, b/c fetus can't swallow amniotic fluid, b/c blind esophagus, etc...)

70

Defects in platelet plug formation?

increased BT (bleeding time)

70

pro-inflammatory cytokines?anti-inflammatory cytokines?

IL-1 and IL-6 --> pro-inflammatoryIL-10 and TGF-Beta --> anti-inflammatory

70

supepithelial humps on EM

Acute PSGN

70

-tidine =

H2-antagonist (ie cimetidine)

70

Affects of atropine on GI secretions?

Atropine = anti-cholinergic--> blocks vagal stimulation of parietal cells (use ACh as transmitter)--> BUT, no effect on G cell stimulation by vagal cells, because G cells use a different transmitter, GRP (not ACh) --> so, Gastrin can still stimulate parietal cells to secrete Intrinsic Facor and (via enterochromaffin-like cells and histamine) to secrete HCl

70

Presentation of pancreatic adenocarcinoma:

-abdominal pain that radiates to back-weight loss-redness and tenderness on palpation of extremities (migratory thromboephlebitis = Trousseau's sign)-Obstructive jaundice and palpable gallbladder --> pruritus, dark urine, pale stools (=Courvoiseier's sign

70

Treatment for Pheochromocytoma?

#NAME?

71

How to calculate BMI?What BMI range = overweight?

BMI = weight in kg/(height in meters)^2Overweight: 25.0-29.9 Obese: >30morbidly obese: >40

71

infant about 2 weeks old with: palpable "olive" mass in epigastric region and non-bilious projectile vomiting

Congenital pyloric stenosis (most common condition requiring surgery during first month of life)

71

Bernard-Soulier disease:-defect-labs (BT =bleeding time; PC=platelet count)

defect in Gp1b--> so vWF can't bind platelets for platelet plug formation*increased BT*decreased PC

71

functions IL-1 through IL-5

"Hot T-Bone stEAk"IL-1: Hot --> pyrogen, fever, acute inflammationIL-2: T --> stimulates growth of helper and cytotoxic T-cells (note: lots of immunosuppressants block IL-2)IL-3: B--> stimulates Bone marrow stem cells (functions like GM-CSF = granulocyte macrophage colony stimulating factor)IL-4:E -->stimulates class-switching to IgE and IgG. Also: induces differentiation into Th2 cells, and promotes growth of B cellsIL-5: A --> stimulates class-switching to IgA and stimulates eosinophil production (it's the mucus-producing IL!); also: promotes differentiation of B cells.

71

Wegener's vs Goodpasture

both cause Crescentic/RPGN-->Goodpastures only affects lung and kidneys (hematuria + hemoptysis)-->Wegener's: c-ANCA; and can also affect upper airways, so may present with sinusitis, nasal perforation, as well as hematuria, hemoptysis

71

-dronate =

bisphosphonate (for osteoporosis) (ie alendronate)

71

How do prostaglandins protect the stomach?

-decrease acid secretion (Gi-->decreased cAMP-->decreased proton pumping)-increase mucus and HCO3- production

71

Asterixis:

See in:-liver cell failure-Wilson's disease

71

elevated urinary HVA (homovanillic acid)

Neuroblastoma (=most common adrenal medulla tumor in kids)-->HVA=breakdown product of domapine

72

Drugs, Diseases, and Psychological issues that may lead to sexual dysfunction:

Drugs: antihypertensives, esp Beta-blockers; neuroleptics; SSRIs; ethanolDieases: depression, diabetes, atherosclerosis (because decreased blood flow to area), hyperprolactinemia, low testosteronePsychological: Performance anxiety

72

What germ layer does the pancreas arise from?

Endodermal

72

Glanzmann's thrombasthenia:-defect?-BT/PC?

-defect in GpIIb/IIIa --> platelets can't link to eachother, so no platelet aggregation for platelet plug formation-increased BT-no effect on PC

72

Which cytokines are secreted by macrophages?

IL-1, IL-6, IL-8, IL-12, TNF-gamma

72

subendothelial and maybe intramembranous IgG-based immune complexes, often with C3 deposition seen on EM

Diffuse Proliferative GN

72

-sartan =

Ang II-receptor-antagonist (ie losartan, valsartan)

72

3 factors that stimulate G-cells to make Gastrin?

#NAME?

72

Drugs that end in "-dine"

H2 blockers: Cimetadine, Ranitidine, Famotidine, Nizatidine--> take H2 blockers before you "dine"

72

T3 uptake in hypothyroidism? hyperthyroidism?

#NAME?

73

only serotonin-releasing neurons in CNS?

Raphe nucleus

73

Ventral pancreatic bud becomes? Dorsal pancreatic bud becomes?

*Ventral pancreatic bud --> pancreatic head, uncinate process, and main pancreatic duct*Dorsal pancreatic bud --> becomes everything else

73

ITP = Idiopathic Thrombocytopenic Purpura:-defect?-labs?

-defect:have anti-GpIIb/IIIa antibodies--> antibodies bind platelets --> complex gets consumed by splenic macrophages-increased BT-decreased PC-also have increased megakaryocytes (trying to make more platelets!)

73

Which cytokines are secreted by all T-cells? by Th1 only? by Th2 only?

*all T-cells secrete IL-3*Th1 secrete: IL-2, IFN-gamma*Th2 secrete: IL-4, IL-5, IL-10

73

wire looping of capillaries on LM

Diffues Proliferative GN-->see in SLE or MPGN (Membranoproliferative GN)

73

-chol =

cholinergic/muscarinic agonist (ie bethanechol, carbachol)

73

What may cause hypertrophy of Brunner's glands?

Peptic ulcer disease (b/c lots of acid to deal with)-->Brunner's glands are located in duodenal submucosa; function = secrete alkaline mucus to neutralize acid contents entering duodenum from stomach

73

Ranitidine

H2 blocker

73

antimicrosomal, anti-thyroglobulin antibodies

Hashimoto's

74

Which stage of sleep do we spend most of the time in?

Stage 2

74

Annular pancreas

Ventral pancreatic bud abnormally encircles 2nd part of duodenum; forms ring of pancreatic tissue that may cause duodenal narrowing

74

TTP = Thrombotic Thrombocytopenic Purpura-defect?-labs?

deficiency of vWF metallprotease --> decreased degradation of vWF multimers: so: increased vWF multimers--> increased platelet aggregation and thrombosis--> decreased platelet survival-increased BT-decreased PC-schistocytes-increased LDH

74

Which cytokine is the major chemotactic factor for neutrophils?

IL-8 ("clean up on aisle 8!" --> neutrophils come clear infections!)

74

most common cause of death in SLE?

-Diffuse Proliferative GN (associated with anti-dsDNA marker)--> can present as nephrotic and nephritic syndrome concurrently

74

-curium or -curonium =

paralytic drugs (non-depolarizing NM-blocking drugs; reversed with neostigmine) (ie atracurium, vecuronium)

74

Trypsinogen:-secreted by?-converted to trypsin by?-action?

-secreted by pancreas-enterokinase/enteropeptidase converts trypsinogen-->trypsin-converts other proenzymes/zymogens and more trypsinogen to active form-trypsin (and other zymogens)--> involved in protein digestion

74

Cimetidine

H2 blocker-->inhibits cytochrome P450!-->also: -gynecomastia, impotence, decreased libido in males (anti-androgen effects)-can cross BBB (headaches, dizziness, confusion)-can cross placenta

74

Hurthle cells

enlarged epithelial cells with excessive eosinophilic granular cytoplasm; found in Hashimoto's

75

EEG waveform patterns during each sleep stage:

"at night, BATS Drink Blood"*awake (eyes open) --> Beta waves (highest frequency, lowest amplitude)*awake (eyes closed) --> Alpha waves *stage 1 --> Theta waves*stage 2 --> Sleep spindles and K complexes*stage 3 --> Delta waves (lowest frequency, highest amplitude)*REM --> Beta waves

75

Potter's syndrome:

bilateral renal agenesis --> oligohydramnios --> limb deformities, facial deformities, pulmonary hyperplasia *caused by malformation of ureteric bud

75

Affect of aspirin on BT/PC?

increased BTno effect on PC(like Glanzmann's)

75

Interferons alpha, beta, and gamma functions:

-all activate NK cells and kills virus-infected cells-alpha and beta --> inhibit viral protein synthesis-gamma --> stimulate MHC I and II expression and antigen presentation in all cells

75

Nephritis + IgA immune complexes in mesangium + URI or acute gastroenteritis

Berger's disease = IgA nephropathy-->related to Henoch-Schonlein disease (vasculitis, also have IgA immune complexes)

75

-stigmine =

anti-cholinesterase (ie neostigmine, physostigmine, pyridostigmine)

75

alpha-amylase

secreted by pancreas-digests starch***also have amylase in saliva, which digests starch in saliva

75

Famotidine

H2 blocker

75

What cancer is increased risk in Hashimoto's?

non-Hodgkin's lymphoma

76

During which sleep stage does one have sleep spindles and K complexes on EEG?

Stage 2 sleep

76

Horseshoe kidney

Fusion of inferior poles of both kidneys; get trapped under INFERIOR MESENTERIC ARTERY and thus remain low in the abdomen*kidneys function normally*assoc. with Turner's syndrome

76

All platelet disorders effects on BT/PC?

-all increase BT-all decrease PC, except Glanzmann's

76

All T-cells express:

-TCR (binds antigen-MHC complex)-CD3-CD28 (binds B7 on APC)*Th cells --> CD4 also*cytotoxic T-cells --> CD8

76

Nephritis with mutation in type IV collagen --> split Basement membrane, X-linked

Alport syndrome = "can't see, can't pee, can't hear"-->have nerve disorders, ocular disorders, deafness

76

-mustine =

nitrosureas (cross BBB, used to treat brain cancers)

76

Lipase

secreted by pancreas-digests fat

76

Nizatidine

H2 blocker

76

pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberant tongue:

Cretinism --> d/t severe fetal hypothyroism-endemic in areas lacking dietary iodine-sporadic d/t defect in T4 formation or developmental failure in thyroid formation

77

What is the key to initiating sleep?

Serotonergic predominance of the raphe nucleus

77

Mesonephric duct develops into:

Mesonephric duct = Wolffian duct (development is stimulated by androgen secretion from Leydig cells)*Develops into male internal structures (except prostate!): "SEED"-Seminal vesicles-Epididymis-Ejaculatory duct-Ductus deferens

77

most common inherited bleeding disorder?

von Willebrand's disease

77

CD19, CD20, CD21 --> all present on what cell type?

B-cells

77

most common glomerular disease in HIV pts?

Focal Segmental Glomerulosclerosis

77

-statins =

HMG-coA reductase inhibitors (ie atorvastatin)

77

salivary amylase vs pancreatic amylase:

*both digest starch-salivary: hydrolyzes alpha-1,4-linkages to form disaccharides-pancreatic: hydrolyzes starch to oligosaccharides and disaccharides

77

Drugs that can cause gynecomastia? (random, not necessarily GI)

"Some Drugs Create Awesome Knockers"-Spirinolactone-Digitalis-Cimetidine-Alcohol-Ketoconazole

77

Very tender thyroid, following a flulike illness; self-limited hypothyroidism

Subacute thyroiditis = de Quervain's-->have increased ESR, jaw pain, tender thyroid... may look hyperthyroid early in course

78

What drug can be used to treat enuresis (bed-wetting) and why?

Imipramine, because it decreases stage 3 sleep (when bed-wetting occurs)

78

Paramesonephric duct develops into:

Paramesonephric duct = Mullerian duct; develops into female internal structures: -Fallopian tube-Uterus-upper 1/3rd of vagina (Lower 2/3rds of vagina develop from urogenital sinus)

78

PC, BT, PT, PTT findings in von Willebrand's disease?

#NAME?

78

CD14, CD16, and CD40 are present on what cell type?

Macrophages

78

Most common cause of adult nephrotic syndrome?

Membranous GN

78

-glitazones =

increase target cell response to insulin (ie rosiglitazone, pioglitazone)

78

D-Xylose absorption test

Test to distinguish GI mucosal damage from other causes of malabsorption-->D-xylose is normally easily absorbed by intestines; if problem with intestinal absorption, get low levels of D-xylose in urine and blood

78

Mechanism of H2 blockers?

-reversibly block Histamine (released from ECL cells, after stimulation by Gastrin) from binding to the H2 receptor on gastric parietal cells-->get decreased cAMP, meaning no stimulation of the ATP-ase --> decreased H+ secretion from parietal cells into g

78

rock-hard, painless goiter

Riedel's thyroiditis --> type of hypothyroidism-thyroid replaced by fibrous tissue-histology: fibrosis, macrophages, eosinophils infiltrate in thyroid

79

During what sleep stage does teeth grinding (bruxism) occur?

Stage 2 (deeper sleep, when have sleep spindles and K complexes on EEG)

79

Cause of bicornuate uterus?

Incomplete fusion of paramesonephric ducts

79

-treatment for von-Willebrand's disease?

DDAVP = Desmopressin (releases vWF stored in endothelium)

79

CD16, CD56 are present on what cell type?

NK cells (CD16 is also on macrophages; but CD56 is a unique marker for NK cells)

79

Spike and dome appearance on EM with subepithelial deposits

Membranous GN

79

-bendazoles=

anti-parasitic (esp anti-helminthic)

79

SGTL1 = Sodium-Glucose-Co-Transporter:

Na-dependent transporter; absorbs Glucose and Galactose in enterocytes

79

What are more potent drugs: H2 blockers or PPIs?

PPIs are more potent than H2 blockers; so, use H2 blockers for less severe cases; PPIs for more severe*note: H2 blockers are reversible; PPIs are irreversible

79

pretibial myxedema

Grave's disease

80

During what sleep stages may one experience sleepwalking, night terrors, or bed-wetting?

Stage 3 sleep (deepest, non-REM sleep; slow-wave sleep; have delta waves on EEG)

80

Female equivalent of glans penis?

glans clitoris

80

PC, BT, PT, PTT findings in DIC?-other lab findings?

-decreased PC-increased BT-increased PT-increased PTT-also: schistocytes, increased D-dimers (fibrin split products), decreased fibrinogen, decreased factors V and VIII)

80

How do superantigens work?

Superantigens (like from S. aureus, and Group A Strep) --> cross-link the TCR on T-helper cells to the MHC class II on APCs: So, get uncoordinated release of IFN-gamma from Th1 cells; IFN-gamma stimulates macrophages, so get release of IL-1, IL_6, and TNF-alpha from macrophages

80

Foot process effacement on EM

Minimal Change Disease

80

-dipine =

Ca-channel blockers (specifically dihyropyridine CCB's) (ie nifedipine, amlodipine)

80

GLUT-5

absorbs Fructose (by facilitated diffusion) into enterocytes

80

drugs ending in "-prazole"

PPIs (proton pump inhibitors)-Omeprazole-Lansoprazole-Pantroprazole-Esomeprazole

80

Thyroid storm:-what is it?-treatment?

-stress-induced catecholamine surge leading to death by arrhythmia--> complication of Grave's and other hyperthyroid syndromes-->treat with Beta-blockers (Propranolol)

81

During what sleep stage does one experience: dreaming, loss of motor tone, memory processing, erections, increased brain oxygen use?

REM sleep; Beta waves on EEG

81

female equivalent of corpus cavernosum and spongiosum?

vestibular bulbs

81

Causes of DIC?

"STOP Making New Thrombi"-Sepsis-Trauma-Obstetric complications-acute Pancreatitis-Malignancy-Nephrotic syndrome-Transfusion

81

How do endotoxins/lipopolysaccharides work?

ie in gram (-) bacteria --> stimulate macrophages directly (Th cells not involved, unlike with superantigens) by binding to CD14 receptor --> release of acute phase cytokines (IL-1, IL-6, TNF-alpha)

81

Treatment for Minimal Change Disease?

Corticosteroids

81

-prost =

prostaglandin analogues (treat glaucoma) (ie unoprostone)

81

GLUT-2

Transports all monosaccharides (Glucose, Galactose, Lactose) from intestines into blood

81

Omeprazole

PPI

81

Focal patches of hyperfunctioning follicular thyroid cells; cells work independently of TSH d/t a mutation in TSH receptor-->elevated T3 and T4 = hyperthyroid

Toxic multonodular goiter

82

Alcohol, Benzos, and Barbiturates do what to sleep stages?

Reduced REM and delta (stage 3) sleep

82

female equivalent of bulbourethral glands?

greater vestibular glands (of Bartholin)

82

Factor V Leiden

most common cause of inherited hypercoagulability-production of mutant factor V, that can't be degraded by protein C

82

After exposure to which diseases/microbes should a person be given preformed/passive antibodies?

"To Be Healed Rapidly"-Tetanus toxin-Botulinum toxin-Hepatitis B-Rabies virus(also: should give RSV abs to premature babies born during winter months)

82

Selectively lose albumin, but not globulins:

Minimal Change Disease

82

-mab =

monoclonal antibody (ie infliximab, daclizumab)

82

Where in GIT is Iron absorbed?

Duodenum

82

Lansoprazole

PPI

82

Jod-Basedow phenomenon

Classic example: pt receives radio-contrast dye with iodine and becomes hyperthyroid from it-->thyrotoxicosis if a pt with iodine defiency goiter is made iodine replete

83

What drug may be useful to treat night terrors and sleepwalking and why?

Benzos; because decrease stage 3 sleep, during which sleepwalking and night-terrors occur

83

female equivalent of prostate gland?

Urethral and paraurethral glands (of Skene)

83

Cryoprecipitate

contains fibrinogen, factor, VIII, factor XIII-used to treat coagulation factor deficiencies (if deficient in fibrinogen or factor VIII)

83

What kind of immune response is induced by live attenuated vaccines? inactivated or killed vaccines?

-live attenuated --> cellular response-inactivated or killed -->humoral imunnity (weaker response; usually need booster shots)

83

What conditions are associated with nephrotic syndrome caused by Amyloidosis (have amyloid deposits in mesangium)?

Associated w/chronic conditions:-multiple myeloma-TB-Rheumatoid arthritis

83

alpha 1 blockage leads to?alpha 2 blockage leads to?

alpha1-blockage --> vasodilationalpha2-blockage --> vasoconstriction

83

Where in GIT is folate absorbed?

Jejunum

83

1st line treatment for Zollinger-Ellison syndrome?

Proton Pump Inhibitors

83

Papillary thyroid carcinoma

-most common and excellent prognosis-Orphan Annie nuclei = "ground glass" nuclei -psammoma bodies (whorled, look like a rose!)-increased risk with childhood radiation

84

What is the principal neurotransmitter in REM sleep?

Acetylcholine

84

female equivalent of of ventral shaft of penis (penile urethra)?

labia minora

84

CD30+ and CD15+ cells of B-cell origin?

Reed-Sternberg cells

84

4 types of hypersensitivity reactions (briefly)

"ACID" (types 1-3 = antibody-mediated) Type 1 - Anaphylactic and AtopicType 2 - CytotoxicType 3 - Immune complexType 4 - Delayed (cell-mediatedd)

84

Tram-track appearance on LM with GBM splitting

Type I Membranoproliferative GN

84

phenoxybenzamine:-type of drug?-application?-toxicity?

-nonselective alpha-blocker (irreversible/non-competitive)-used for pheochromocytoma (use phenoxybenzamine before removing tumor)-toxicity: orthostatic hypotension, reflex tachycardia

84

Where in GIT is Vitamin B12 absorbed?

Terminal ileum, along with bile acids; requires intrinsic factor (from parietal cells)!

84

Mechanism of PPIs?

Irreversibly inhibit Proton Pump (H/K-ATPase) in parietal cells (so, can't excrete H+ into gastric lumen from parietal cells)

84

thyroid cancer with psammoma bodies and orphan annie nuclei?

Papillary thyroid carcinoma

85

How does NE affect REM sleep?

NE reduces REM sleep

85

female equivalent of scrotum?

labia majora

85

Most common Hodgkin's lymphoma? Prognosis?

-Nodular Sclerosing-Excelent prognosis (b/c Lymphocytes>>>R-S cells)-see collagen banding in lymph node-mostly young adults

85

What type of hypersensitivity reaction is this: anaphlaxic ("wheal and flare"), atopic; free-antigen cross-links IgE on pre-sensitized mast cells and basophils --> release of histamine, etc. How quickly does this reaction develop?

Type I --> happens very rapidly after antigen exposure to pre-formed antibody

85

Glomerulonephritis associated with HBV, HCV

Type I Membranoproliferative GN

85

Phentolamine:-type of drug-application?

-nonselective alpha-blocker (reversible/competitive)-give to patients on MAO-inhibitors who eat tyramine-containing foods

85

Peyer's patches:-where?-function?

-located in ileum-Peyer's patches = lymphoid tissue in lamina propria and submucosa of small intestine-function:-->contain M-cells that take up antigen-->B-cells stimulated in germinal centers of Peyer's patches differentiate into IgA-secreting plasma cel

85

Bismuth

-treatment of ulcers and traveler's diarrhea-mechanism: binds to ulcer base, providing physical protection; thus allowing HCO3- secretion to reestablish pH gradient in mucus layer

85

thryoid cancer associated with childhood irradiaton?

Papillary thryoid carcinoma

86

How often does REM sleep occur?

Every 90 minutes; increased duration as go through the night

86

Female and Male remnants of Gubernaculum?

Female: ovarian ligament + round ligament of uterusMale: fibrous tissue that anchors testes within scrotum

86

t(8;14) c-myc gene

Burkitt's lymphoma (non-Hodgkin lymphoma; neoplasm of mature B cells)

86

Hypersensitivity type: IgM, IgG bind fixed antigen on an "enemy" self cell --> lysis by complement or phagocytosis = cytotoxic

type II

86

"dense deposits" on EM

Type II Membranoproliferative GN

86

prazosin, terazosin, doxazosin:-types of drugs?-applications?-toxicity?

-alpha-1-selective-blockers-used for hypertension, urinary retention in BPH-toxicities: orthostatic hypotension with first dose; dizziness, headache (should give pts first dose before bed, while lying down)

86

Lymphoid tissue of the GIT?

Peyer's patches-located in ileum-B-cells in germinal centers of Peyer's patches differentiate into IgA-secreting plasma cells --> IgA lives in lamina propria and protects gut from pathogens!

86

Sucralfate

Same mechanism as bismuth; treatment of ulcers and traveler's diarrhea-->bind to ulcers, providing physical protection; allows HCO3- secretion to reestablish pH gradient in mucus layer-Requires an acidic environment to polymerize; WONT WORK IF TAKING ANTACIDS CONCURRENTLY!

86

Medullary thryoid carcinoma:

-from parafollicular "C" cells of thryoid-produces calcitonin-assoc with MEN 2A and 2B-sheets of cells in ayloid stroma

87

Pulse, BP, eye activity, and penile/clitoral tumescence (swollen-ness) during REM sleep:

-increased and variable pulse and BP-extraocular movements during REM sleep d/t PPRF activity (REM = Rapid eye movements; mediated by PPRF)-Penile/Clitoral tumescence"REM sleep is like sex: increased pulse, penile/clitoral tumescence, decreases with age)

87

Female and Male remnants of Processus vaginalis?

Female: ObliteratedMale: forms the tunica vaginalis

87

Most common adult non-Hodgkin lymphoma?

Diffuse large B-cell lymphoma -->20% of cases are in kids though

87

Hypersensitivity type: Immune complex (antigen-antibody) activates complement--> neutrophils --> release lysosomal enzymes

type III

87

Pathology behind Diabetic Glomerulonephropathy:

Non-enzymatic glycosylation of GBM --> increased permeability and thickeningAlso: nonenzymatic glycosylation of efferent arterioles --> increased GFR --> mesangial expansion ***see GBM thickening on LM! and mesangial expansion..

87

mirtazapine:-type of drug-application-toxicity

#NAME?

87

specialized M-cells that take up antigen in GIT?

-in Peyer's patches --> the lymphoid tissue of GIT!

87

Misoprostol:-mechanism-clinical uses-side effect-contraindications

*Prostaglandin analog*Mechanism: binds receptor on parietal cell --> stimulates Gi --> decreased cAMP --> decreased stimulation of Proton Pump --> decreased acid production/secretion into gastric lumen *Clinical uses:-Prevent NSAID-induced peptic ulcers (b/c NSAIDs decrease prostaglandins)-Treatment of PDA-Induce labor*Side effect:-Diarrhea*Conraindication:-Pregnant women/women of child-bearing age (b/c induces labor)

87

Renal stones + Bone loss + GI upset/ulcers + psychiatric disorders

Primary hyperparathyroidism--> elevated PTH d/t adenoma, usually-Hypercalcemia-Hypophosphatemia-elevated PTH-elevated ALP-elevated cAMP in urine-may be asymptomatic or have weakness and constipation*initiating problem in primary hyper-PTH = elevated PTH

88

Why is REM sleep also called "paradoxical sleep" or "desynchronized sleep"?

Because it has the same EEG pattern as wakefulness (Beta waves)

88

t(11;14); affects cyclin D regulatory gene

Mantle Cell Lymphoma-affects older males; poor prognosis

88

What type of hypersensitivity reaction is serum sickness?

type III: serum sickness-->antibodies to foreign proteins form over about 5 days --> form immune complexes --> deposit in membranes --> fix complement --> tissue damage

88

Kimmelstein-Wilson lesion:

#NAME?

88

List the B1-selective antagonists (A BEAM):

Acebutolol (partial agonist)BetaxololEsmolol (short-acting)AtenololMetoprolol

88

IgA in GIT comes from?

Peyer's patches: have B-cells in germinal centers of Peyer's patches (lymphoid tissue) that differentiate into IgA-secreting plasma cells-->IgA protects the gut from pathogens!

88

Octreotide:-mechanism-clinical uses

Somatostatin analog*Somatostatin/Octreotide --> Gi --> blocks/decrease cAMP --> blocks Proton Pump --> decreased acid secretion into gastric lumen *Uses:-secretory diarrhea-acute variceal bleeds-acromegaly (inhibits GH)-VIPoma (pancreatic islet cell tumor that secretes lots of Vasoactive Intestinal Polypeptide, causing lots of diarrhea)-Carcinoid tumors

88

bone pain and bone spaces filled with brown fibrous tissue

osteitis fibrosa cystica

89

What mediates the rapid eye movements of REM sleep?

PPRF (paramedian pontine reticular formation/conjugate gaze center)

89

t(14;18) bcl-2 overexpression

-Follicular Lymphoma-affects adults-indolent course, but difficult to cure-bcl-2 inhibits apoptosis (normally; it's a proto-oncogene)

89

fever, urticaria, arthralgias, proteinuria, lymphadenopathy 5-10 days after antigen exposure?

serum sickness (type III hypersensitivity)

89

Most common type of kidney stones?

Calcium (Calcium oxalate, Calcium phosphate, or both)

89

List the nonselective Beta-antagonists (Please Try Not being Picky)

PropranololTimololNadololPindolol

89

Only way body can excrete cholesterol?

Bile

89

Treatment of VIPoma?

Octreotide

89

Cause of and Findings in Secondary Hyperparathyroidism:

-usually d/t chronic renal disease. Why?-->renal disease --> can't convert vitamin D to active form --> decreased Ca absorption in gut --> increased PTH --> increased bone resorption --> increased phosphate and increased ALP from bone resorption --> but,

90

How do sleep patterns change in depressed patients?

-decreased slow-wave sleep (stage 3)-decreased REM latency (so, get to REM quicker!)-increased REM early in sleep cycle-increased total REM sleep-repeated nighttime awakenings-early-morning awakenings

90

Lymphoma caused by HTLV-1?

Adult T-cell lymphoma-->adults present with cutaneous lesions-->aggressive

90

Arthrus reaction

Type III hypersensitivity reaction-test by immunofluorescent staining-intradermal injection of antigen induces antibodies-->form antigen-antibody complexes in the skin --> edema, necrosis, activation of complement*ex = swelling and inflammation following tetanus vaccine.

90

Calcium kidney stones: -ph they precipitate at?-x-ray appearance?-what conditions may cause them?

-most common type of kidney stones; may be calcium oxalate or calcium phosphate or both-precipitate at neutral or decreased pH-radiopaque on x-ray-conditions that cause hypercalcemia (like cancer, elevated PTH) can lead to hypercalciuria and stones-may ge

90

List the partial beta-agonists (PAPA):

PindololAcebutolol

90

How is copper excreted from the body?

Bile; can't excrete it in Wilson's disease though...

90

Treatment of Carcinoid Syndrome?

Octreotide

90

tap facial nerve --> get contraction of facial muscles

Chovstek's sign --> sign of hypocalcemia-get with hypoparathyroidism

91

Hypnagogic vs Hypnopompic hallucinations?

Hypnagogoic = just before sleepHypnopompic = just before awakening*pts wtih narcolepsy may have these hallucinations

91

Mycosis fungoides/Sezary syndrome

-mature T-cell lymphoma; adults present with cutaneous lesions-indolent

91

Type IV hypersensitivity? How long does it take?

-Delayed/T-cell-mediated --> sensitized T-cells encounter antigen--> release lymphokines --> macrophage activation...-takes about 48 hours*4 T's:-T-lymphocytes-Transplant rejections-TB skin tests-Touching (contact dermatitis)

91

Vitamin C abuse may lead to what type of kidney stones?

Calcium oxalate crystals

91

Nonselective alpha and beta -antagonists:

CarvelidolLabetalol

91

3 functions of Bile:

1) Digest and absorb lipids and fat-soluble vitamins2) Excrete cholesterol3) Anti-microbial activity (by disrupting membranes)

91

Diphenoxylate

opiate-anti-diarrheal drug;-->binds to Mu opiate receptors in GI tract and slows motility

91

BP cuff causes carpal spasm

Trousseau's sign --> sign of hypocalcemia; see with hypoparathyroidism

92

Naroclepsy:-what is it?-main presentation?-treatment?

#NAME?

92

Bence-Jones protein

Multiple Myeloma-Ig light chains in urine (don't see on urinalysis though)

92

Direct and Indirect Coombs' test --> tests for what kind of hypersensitivity rxn?

Type II = antibody-mediated

92

Ethylene glycol (anti-freeze) may lead to what kind of kidney stones?

Calcium-oxalate kidney stones

92

Clinical applications of beta-blockers:

-hypertension (decrease CO, decrease renin secrtion - by beta-receptor blockade on JGA cells)-angina pectoris (decrease HR and contractility, so have decreased O2 consumption of myocardium)-MI (metoprolol and carvedilol --> decrease mortality from MIs)-SV

92

Pale/Clay-colored stools?

#NAME?

92

Side effects of Antacids?

-all can cause hypokalemia (b/c block H/K-ATPase)-Can chelate and decrease effectiveness of other drugs

92

Hypocalcemia (pee out calcium) + shortened 4th/5th digits + short stature

Pseudohypoparathyroidism = Albright's hereditary osteodystrophy-->autosomal dominant-->kidney is unresponsive to PTH at renal tubule; so have high PTH, but pee out calcium (clinically looks like PTH is low)

93

Cataplexy

#NAME?

93

Rouleaux formation

Multiple Myeloma

93

List 8 disorders/situations with type IV hypersensitivity:

-diabetes - type I-multiple sclerosis-contact dermatitis-PPD-Hashimoto's thyroiditis-Graft-vs-Host disease-Granulomatous inflammation-Guillain-Barre syndrome

93

Staghorn calculi

Get these with ammonium-magnesium-phosphate kidney stones (caused by infection with urease-positive bugs...)

93

Toxicity of Beta-blockers

-impotence!-exacerbates asthma-CV adverse effects (bradycardia, AV block, CHF)-CNS adverse effects (sedation, sleep alterations)-use caustiously with diabetics! (b/c B-blockers block sympathetically-mediated symptoms of hypoglycemia; so, patient won't be

93

Cholestyramine

-Bile Acid Resin --> a lipid-lowering agent-->interferes with ability to reabsorb Urobilinogen--> so, more is excreted in stool or kidney; the liver then must use cholesterol to make more...

93

Side effects of Aluminum Hydroxide (antacid) overuse?

#VALUE!

93

Cabergoline

Dopamine agonist-can be used to treat pituitary adenomas (Bromocriptine is also a dopamine agonist; can be used to treat pit adenoma)

94

What controls the circadian rhythm?

SCN (suprachiasmatic nucleus) of the hypothalamus drives the circadian rhythm; controls ACTH, prolactin, melatonin, nocturnal NE release*Retina stimulates SCN --> NE release --> Pineal gland --> Melatonin*So, SCN is regulated by the environment (light); so retina stimulates SCN

94

most common primary tumor arising within bone in elderly?

Multiple Myeloma

94

List 7 disorders/situations with type III hypersensitivity

-Serum sickness-Arthus reaction-Post-Strep GN-SLE-Rheumatoid arthritis-Polyarteritis nodosum-Hypersensitivity pneumonitis (ie Farmer's lung)

94

Ammonium-Magnesium-Phosphate kidney stones:-ph precipitate at?-X-ray appearance?-Caused by?

#NAME?

94

Bethanechol applications

Bethanecol = direct cholinomimetic-used for postoperative and neurogenic ileus and urinary retention (activates Bowel and Bladder)

94

Colestipol

Bile-acid resin (like Cholestyramine; lipid-lowering agent)

94

Side effects of Magnesium Hydroxide (antacid) overuse:

"Must Go to the bathroom" = diarrhea-hypokalemia and decrease efficacy of other drugs (all antacids)-others

94

Octreotide

=Somatostatin-->used to treat acromegaly (following pit adenoma resection) b/c inhibits GH-->also can treat carcinoid, gastrinoma, glucagonoma

95

Kubler-Ross Grief Stages

(may not occur in this order)1) Denial2) Anger3) Bargaining4) Grieving5) Acceptance

95

CRAB symptoms of Multiple Myeloma:

#NAME?

95

List examples of type II hypersensitivity disorders/reactions

-Anemias (hemolytic anemia, pernicious anemia)-erythroblastosis fetalis (Rh incompatibility)-acute hemolytic transfusion rxns-idiopathic thrombocytopenic purpura-rheumatic fever-Goodpasture's syndrome-Bullous pemphigoid, Pemphigus vulgaris-Grave's disease

95

Uric acid kidney stones:-precipitates at what pH?-x-ray appearance?-associated with?

-low pH-radio-lucent-assoc with hyperuricemia (ie gout); also diseases with high cell turnover, like leukemia

95

Carbachol applications

carbachol = direct cholinomimetic-used for glaucoma, pupillary contraction, relief of intraocular pressure

95

Colesevelam

-Bile-acid resin (like cholestyramine; lipid-lowering agent)

95

Side effects of Calcium carbonate (antacid = TUMS!)

-Hypercalcemia-may cause rebound increase in acid!-hypokalemia and decrease efficacy of other drugs (all antacids)

95

How to dx acromegaly?

elevated serum IGF-1-also failure to suppress serum GH following oral glucose tolerance test

96

Down syndrome pts: increased risk of which cancers?

#NAME?

96

What type of hypersensitivty reaction is Goodpastures? PSGN?

Goodpastures--> type 2PSGN--> type 3

96

Cystine kidney stones:-precipitate at what pH?-x-ray appearance?-causes?-treatment?

#NAME?

96

Pilocarpine applications

-pilocarpine = direct cholinomimetic-used to stimulate sweat, tears, saliva ("cry, spit, sweat on your pillow")

96

Urobilin

breakdown product of bilirubin, excreted in urine; gives urine it's color

96

Magnesium hydroxide

-osmotic laxative-also an antacid (with side effect of diarrhea!)

96

Central vs Nephrogenic DI

Central --> lack ADHNephrogenic -->lack renal response to ADH

97

stains TRAP positive (tartrate-resistant acid phosphatase)

Hairy cell leukemia-mature B-cell tumor in elderly; cells have filamentous, hairlike projections

97

what type of hypersensitivity rxn is Grave's disease? Hashimoto's?

Graves-->type 2Hashimoto's --> type 4

97

What causes hydronephrosis?

Results for complete or partial obstruction of urinary tract

97

Which cholinomimetics are resistant to AChE?

Bethanechol, Pilocarpine

97

Stercobilin

breakdown product of bilirubin, excreted in feces; gives color of stool (without it, have pale/clay-colored stool)

97

Magnesium citrate

osmotic laxative

97

Demeclocycline

ADH antagonist --> can lead to nephrogenic DI-Lithium can also cause nephrogenic DI!

98

Age group affected by ALL?

<15 years old-most responsive to therapy-may spread to CNS and testes-t(12;21) = better prognosis

98

ANA (anti-nuclear antibodies)

-SLE-nonspecific (Sjogren's, scleroderma, polymyositis, dermatomyositis, rheumatoid arthritis,juvenile arthritis, MCTD)

98

polygonal clear cells on histology

Renal cell carcinoma-->cells are filled with lipids and carbohydrates

98

Methacholine applications?

methacholine = direct cholinomimetic-used as a challenge test to diagnose asthma

98

Urobilinogen

-breakdown product of conjugated/direct bilirubin, after gut bacteria alter it in the gut; has 3 possible fates:1) excreted in feces as Stercobilin (about 80% of it)2) excreted in urine as Urobilin (very little of it --> about 2%)3) reabsorbed by liver vi

98

Polyethylene glycol

Osmotic laxative

98

Desmopressin

=synthetic ADH--> can distinguish b/w central and nephrogenic DI

99

Hallmark of Acute Leukemias?

-lots of blast cells (>20% blasts)-rapid onset and progression

99

anti-dsDNA, anti-Smith

SLE (anti-dsDNA=specific for renal disease)

99

2 main sites of metastasis of renal cell carcinoma?

lung and bone

99

Neostigmine applications?

neostigmine - anticholinesterase (indirect cholinomimetic)-used for postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NM jxn blockade-increases endogenous ACh; does not penetrate the CNS

99

Biggest risk factor for a malignant salivary gland tumor?

Smoking

99

Infliximab clinical uses?

-monoclonal anti-TNF antibody*Uses:-Crohn's disease-Rheaumatoid arthritis

99

Treatment for nephrogenic DI:

-Hydrochlorothiazide --> concentrates urine-Indomethacin --> decreased RBF-Amiloride --> for lithium-induced nephrogenic DI (it's a K-sparing diuretic)

100

Auer rods

AML = t(15;17)-responds to vitamin A

100

anti-IgG antibodies

=Rheumatoid facor = IgM antibodies that attack IgG --> Rheumatoid arthritis

100

Most common renal malignancy of childhood?

Wilm's tumor = Nephroblastoma-->2-4 yo

100

Pyridostigmine applications?

pyridostigmine = anticholinesterase (indirect cholinomimetic)-used for myasthenia gravis (gets RID of MG)-does not penterate CNS-increases endogenous ACh

100

most common location of benign salivary gland tumor?

Parotid gland

100

Sulfasalazine:-mechanism?-clinical uses?

=combo of Sulfapyridine (antibacterial) + 5-ASA (aminosalicylic acid = anti-inflammatory)-->activated by colonic bacteria (so, only effective in distal ileum and colon)*clinical uses:-Ulcerative Colitis (always)-Crohn's (but, only acts in distal ileum and

100

Demeclocycline

treatment for SIADH

101

Which leukemia can be treated with Vitamin A?

AML -t(15;17)-auer rods

101

antimitochondrial antibodies

primary biliary cirrhosis

101

huge, palpable flank mass and/or hematuria in child 2-4 yo?

Wilm's tumor = Nephroblastoma

101

Edrophonium applications

endrophonium = anticholinesterase (indirect cholinomimetic)-used to diagnose myasthenia gravis-increases endogenous Ach

101

Pleomorphic salivary gland adenoma:

#NAME?

101

Odansetron:-mechanism-clinical uses-side effects

=anti-serotonin and anti-emetic*Clinical uses:-pts undergoing chemo, to combat nausea/vominiting-pregnant women with morning sickness*side effects:-headache (think opposite of triptans, which are serotonin-agonists; relieve headaches)-constipation (think

101

Causes of SIADH:

1) Ectopic ADH (ie small cell lung cancer)2) CNS disorders/head trauma3) Pulmonary disease4) Drugs --> ie cyclophosphamide ***SIADH = Syndrome of Inappropriate ADH secretion

102

t(9,22), bcr-abl

Philadelphia chromosome-CML-30-60 yrs old-more mature cells (<5% blasts); insidious onset-resonds to imatinib = bcr-abl tyrosine kinase inhibitor

102

anti-desmoglein antibodies

pemphigus vulgaris

102

WAGR complex:

-Wilm's tumor-Aniridia (no iris)-Genitourinary malformation-mental-motor Retardation*d/t deletion on chromosome 11*often obese too

102

Physostigmine applications

physostigmine = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma and atropine overdose ("phyxes" atropine OD)-crosses the BBB!-increases endogenous Ach

102

Warthin's tumor

-benign salivary gland tumor; trapped in a lymph node, surrounded by lymph tissue

102

Metoclopramide:-mechanism-uses-toxicity/side-effects-contraindications

=D2-receptor antagonist (Dopamine-blocker) *uses:-diabetic and post-surgery gastroparesis (delayed gastric emptying)*Toxicities/Side effects:-may lower seizure threshold -parkinsonian symptoms (b/c block dopamine)-diarrhea, etc...*Contraindications:-Parki

102

Empty sella syndrome

unexplained atrophy of pituitary --> get hypopituitarism-->common in obese women

103

Imatinib

treatment for CML-inhibits bcr-abl tyrosine kinase

103

anti-microsomal, anti-thyroglobulin antibodies

Hashimoto's thyroidits

103

Squamous cell cancer of the bladder associated with?

Schistosomiasis

103

Echothiophate applications

echothiphate = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma-increases endogenous Ach

103

Mucooepidermoid carcinoma

#NAME?

103

4 Drugs that may lower seizure threshold? (random, not specific to GI)

1) Metoclopramide (treats gastroparesis)2) Buproprion (anti-depressant w/out sexual side effects; increased seizures, especially pts with bulemia or anorexia)3) Tramadol (used to treat chronic pain; weak opiod-agonist; inhibits serotonin and NE reuptake, but not used to treat depression)4) Enflurane (inhaled anesthetic)

103

Fatigue + failure to lactate post-partum?

-->Sheehan's syndrome = postpartum hypopituitarism-->Cause: increased size of ant pituitary during pregnancy, without increased blood supply; so, have increased risk of pituitary infarction. If have lots of bleeding/hemorrhage during delivery or post-part

104

Teardrop cell

Myelofibrosis-->fibrosis of bone marrow (-->bone marrow is crying because it's fibrosed :(

104

anti-Jo-1 antibodies

polymyositis, dermatomyositis

104

Painless hematuria, no casts:

Bladder cancer --> Transitional cell carcinoma

104

Donepezil applications

donepezil = anticholinesterase (indirect cholinomimetic)-used to treat Alzheimer's disease-increases endogenous Ach!

104

loss of Myenteric/Auerbach's plexus?

Achalasia -->can't relax Lower Esophageal Sphincter-->get esophageal aperistalsis-->progressive dysphagia of solids and liquids (vs obstruction, which is dysphagia to solids only)-->increased risk of esophageal carcinoma

104

Causes of small and large vessel disease in chronic diabetes:

-NON-enzymatic glycosylation --> glucose gets tacked on to thins

105

JAK2 mutations: positive/negative?Philadelphia chromosome?-polycythemia vera-essential thromboyctopenia-myelofibrosis-CML

*JAK2:-positive in polycythemia vera, essential thrombocytosis, myelofibrosis-negative in CML*Philadelphia:-only positive in CML

105

anti-SS-A antibodies

=anti-Ro antibodies --> Sjogrens

105

most common tumor of urinary tract system?

Transitional cell cancer (can occur in renal calyces, pelvis, ureters, bladder...)

105

pKa = acid dissociation constant = ?

pKa = pH at which amount of the non-protonated form = the amount of the protonated form

105

Bird's beak on barium swallow

Achalasia (esophageal aperistalsis; can't relax LES d/t loss of Myenteric/Auerbach's plexus)

105

Kimmelstein-Wilson nodules

-->diabetes

106

thombolytics mechanism? (streptokinase, urokinase, tPA, APSAC)

aid conversion of plasminogen-->plasmin, which cleaves thrombin and fibrin clots

106

anti-SS-B antibodies

=anti-La --> Sjogrens

106

Problems associated with Transitional Cell Carcinoma?

Pee SAC:-Phenacetin (analgesic; acetaminophen=phenacetin derivative)-Smoking-Aniline dyes-Cyclophosphamide (alkylating agent, used to treat cancers/immunosuppressant)

106

if pH < pKa...

acidic environment; have more of the protonated form (so, basic drugs get trapped)

106

2 conditions that may lead to secondary achalasia?

-Chaga's disease (mega-esophagus)-CREST scleroderma (Esophageal dysmotility)

106

What causes cataracts in chronic diabetes?

#NAME?

107

Affect of aspirin on BT, PT, PTT

increased BT-no effect on PT, PTT

107

anti-U1-RNP (ribonucleoprotein)

mixed connective tissue disease

107

Histology of Acute vs Chronic Pyelonephritis?

-Acute --> neutrophil infiltration ito renal interstitium-Chronic --> lymphocytic invasion with fibrosis

107

if pH > pKa...

basic environment; have more of the nonprotonated form (acidic drugs get trapped)

107

increased risk of what cancer with Achalasia?

--> esophageal carcinoma

107

What causes retinopathy and glaucoma in chronic diabetes?

#NAME?

108

Ticlopidine toxicity?

-Neutropenia (should monitor CBC during first few months of trtmt)(Ticlopidine = ADP-receptor blocker, so inhibits platelt aggregation; like Clopidogrel)

108

anti-smooth muscle antibodies

autoimmune hepatitis

108

Thyroidization of kidney (eosinophilic casts in tubules)

Chronic pyelonephritis

108

Treat acidic drug OD (ie slicylates) with?

NaHCO3 (traps the acidic drug in the basic urine)

108

progressive dysphagia of solids AND liquids, vs just solids vs progressive dysphagia first of solids THEN of liquids?

*solids + liquids--> Achalasia *only solids--> obstruction*solids, then liquids--> esophageal cancer

108

HLA's associated with DM I?

#NAME?

109

Drug side effect = tinnitus?

Aspirin!

109

anti-glutamate decarboxylase antibodies

type 1 diabetes

109

fever + rash + hematuria + flank tenderness 1-2 weeks after taking certain drugs

Drug-induced / Acute Interstitial Nephritis

109

Treat basic drug OD (ie amphetamines) with?

NH4Cl (ammonium chloride; traps basic drug in the acidic urine)

109

Painless bleeding in lower 1/3rd of esophagus?

Esophageal varices-->associated with portal HTN

109

Histology of DM I vs DM II?

DM I --> Islet leukocytic infiltrate (leukocytes!)DM II --> Islet amyloid deposit (amyloid!)

110

Raloxifene vs Tamoxifen: Which is better for osteoporosis prevention?

-both are SERMs-->antagonists in breast (treat breast cancer)-->agonists in bone (bone-building)-Tamoxifen may increase risk of endometrial carcinoma, b/c it's a partial endometrial agonist-Raloxifene is an endometrial antagonist, so no increased risk of

110

anti-TSH receptor antibodies

Grave's

110

What causes Acute Interstitial Nephritis?

*DRUGS!:-NSAIDs-diuretics-penicillins-sulfonamides-rifampin*get interstitial renal inflammation, pyuria, azotemia, 1-2 weeks after taking meds*also: fever, rash, hematuria, flank pain

110

What class of drugs can cause excess parasympathetic activity (ie DUMBBELSS symptoms)?

Cholinomimetic agents

110

Dysphagia + Glossitis (swollen, smooth tongue) + Iron-deficiency anemia

Plummer-Vinson syndrome-->Dysphagia is d/t esophageal webs = thin membrane-like protrusion into esophagus-->associated with increased risk of Squamous Cell Carcinoma of Esophagus

110

Kussmaul respirations

rapid/deep breathing; DKA (try to exhale CO2 to fix acidosis)

111

anti-Ach receptor antibodies

Myasthenia gravis

111

Most common cause of acute renal failure in hospital?

Acute tubular necrosis-->can be reversible, but fatal if left untreated

111

What drug regenerates AchE after organophosphate poisoning?

Pralidoxime (regenerates active AchE) (also, give atropine to treat symptoms!)

111

Boerhaave syndrome:

-TRANSMURAL esophageal rupture d/t violent vomiting--> vs Mallory-Weiss which is just lacerations at the G-E jxn

111

labs in DKA

-hyperglycemia-elevated H+ = decreased pH-decreased HCO3 (anion gap met acidosis)-ketonemia-Hyperkalemia (though depleted intracellar K+; decreased insulin shifts K+ outside cells) -Hyponatremia-Leukoctyosis

112

p-ANCA antibodies

Vasculitides: -microscopic polyangitis-churg-strauss syndrome

112

3 stages of Acute Tubelar Necrosis:

1) Inciting event(ie renal ischemia from shock, sepsis, or crush injury like myoglobinuria)2) Maintenance phase --> oliguric; 1-3 weeks; risk of hyperkalemia; have muddy brown casts3) Recovery --> polyuric, risk of hypokalemia; get decreased levels of BUN and serum creatinine

112

What are the symptoms of inhibiting parasympathetic activity?

(ie atropine side effects)Hot as a hareDry as a boneRed as a beetBlind as a batMad as a hatterBloated as a toad

112

Esophageal pathology associated with lye ingestion and acid reflux?

Esophageal strictures

112

Treatment of DKA?

#NAME?

113

Boys with recurrent bacterial infections after 6 months, B-cell deficient, and deficient in all classes of Ig's. What's the condition and what gene is defective?

Bruton's agammaglobulinemia; defect in BTK, a tyrosine kinase gene. can form pro-B cells, but not beyond that. X-linked recessive, so increased in males

113

Definition of Acute Renal Failure = Acute Kidney Injury:

-->abrupt decline in renal function with elevated Creatinine and elevated BUN (so, Azotemia) over several days

113

In what populations is atropine contraindicated?

-Glaucoma (because don't want to dilate eyes)-BPH or any urinary retention-GI obstruction (ie ileus)-Dementia or Elderly (because can cause delirium)-Infant with fever (because can cause hyperthermia)-

113

Barrett's esophagus: what sort of metaplasia occurs? increased risk of what kind of cancer?

Glandular metaplasia: squamous epithelium of distal esophagus is replaced with columnar/intestinal epithelium-d/t chronic GERD-assoc w/increased risk of Adenocarcinoma of esophagus-also associated with esophagitis and esophageal ulcers

113

most common tumor of appendix?

-Carcinoid tumor!

114

Defect in BTK gene

BTK = a tyrosine kinase gene --> defect = Bruton's agammaglobulinemia

114

Pre-Renal Azotemia: Acute Renal Failure

--> not enough blood to kidney: so decreased RBF (ie hypotension) --> decreased GFR-Na, H20, and urea are retained by the kidney (not excreted in urine) to conserve volume-So: get elevated BUN/Creatinine ratio

114

List 4 classes of drugs with anti-cholinergic side effects:

1) First generation H1-Blockers (diphenhydramine, doxylamine, chlorpheniramine)2) Traditional neuroleptics3) TCAs4) Amantadine

114

What type of esophageal cancer is most common worlwide? in US?

#NAME?

114

recurrent diarrhea + cutaneous flushing + asthmatic wheezing + right-sided valvular disease + elevated 5-HIAA in urine?

Carcinoid syndrome (5-HIAA = serotonin metabolite)

115

Defect that causes hyper-IgM syndrome?

defective CD40L on helper T-cells--> can't class switch

115

Intrinsic Renal: Acute Renal Failure

usually d/t acute tubular necrosis or ischemia/toxins-->have necrosis or something that obstructs the tubule, so get fluid backflow across the necrotic tubule --> decreases GFR-Also: BUN reabsorption impaired --> decreased BUN/Creatinine ratio

115

List 4 treatment options for Myasthenia Gravis:

1) Anti-cholinesterases (indirect cholinergic agonists)2) Corticosteroids (because MG = autoimmune disease)3) Thymectomy (often curative)4) Plasmapheresis

115

*What part of esophagus is affected in each of these cancers?-What risk factors cause Squamous Cell Carcinoma?-What risk factors associated with Adenocarcinoma?

*Squamous Cell: upper 2/3-smoking-alcohol-achalasia-esophageal webs (ie Plummer-Vinson syndrome)*Adenocarcinoma: lower 1/3-Barret's esophagus-Esophagitis-Diverticula (like Zenker's)

115

Treatment for serotonin syndrome?

Octreotide = somatostatin analogue

116

anaphylaxis on exposure to blood products with IgA; and: sinus and lung infections, milk allergies, and diarrhea...

Selective Ig deficiency, usually to IgA -caused by a defect in isotype switching to a specific class

116

Postrenal: Acute Renal Failure

-->d/t outflow obstruction (ie stones, BPH, neoplasia, congenital anomalies)-->only have bilateral obstruction with postrenal...

116

What are the 5 classes of drugs used to treat glaucoma?

1) alpha-agonists2) beta-blockers3) Diuretics (Carbanic anhydrase inhibtors and mannitol)4) cholinomimetics5) prostaglandins

116

Whipple's disease:

-Tropheryma whippelii infection (gram +)-PAS + foamy macrophages in intestinal lamina propria-mostly older men-CAN:-->cardiac symptoms-->Arthralgias-->Neurologic symptoms***Also, classic malabsorption symptoms: diarrhea, steatorrhea, weight loss, weakness

116

When may carcinoid syndrome be subclinical?

if limited to GI tract - only --> because serotonin undergoes first-pass metabolism in liver

117

normal # of B cells, but decreased plasma cells, decreased Immunoglobulin...

Defect in B-cell maturation --> CVID = common variable immunodeficiency

117

2 most common causes of chronic renal failure?

#NAME?

117

P-450 Inducers

Barb Steals Phen-phen and Refuses Greasy Carbs Chronically:BarbituratesSt. John's wortPhenytoinRifampinGriseofulvinCarbamazepineChronic alcohol use

117

Which part of intestine is affected in Celiac sprue?

#NAME?

117

Rule of 1/3rds in Carcinoid syndrome:

-1/3 metastasize-1/3 present with 2nd malignancy-1/3 multiple

118

22q11 deletion

90% of pts with DiGeorge syndrome (thymic aplasia) --> failure to develop 3rd and 4th pharyngeal pouches (so, no thymus)

118

Renal Osteodystrophy:

*get this with chronic renal failure*failure of vitamin D hydroxylation --> Calcium wasting and Phosphate retention --> secondary hyperparathyroidism*causes subperiosteal thinning of bones

118

P-450 inhibitors

Q-MAGIC RACKS:QuinidineMacrolidesAmiodaroneGrapefruit juiceIsoniazidCimetidineRitonavirAcute alcohol abuseCiprofloxacinKetoconazoleSulfonamides

118

What part of intestine is affected in lactase deficiency?

only tips of intestinal villi (b/c that's where lactase is located)-->so, get normal look villi

118

Carcinoid tumors are derived from what kind of cells?

#NAME?

119

absent thymic shadow

#NAME?

119

Autosomal dominant mutation in PKD1 or PKD2 gene?

ADPKD

119

acetaminophen antidote? (toxic dose = 4 g/day = 8 extra-strength tablets)

N-acetylcysteine (replenishes glutathione)

119

fat accumulation in enterocytes + malabsorption in childhood + neurologic manifestations?

Abeta-lipoproteinemia-->have decreased synthesis of apo-B --> can't generate chylomicrons --> decreased secretion of cholesterol and VLDL into bloodstream --> so, fat accumulates in enterocytes***this is a malabsorption syndrome-treat with vitamin E supplementation (helps body produce some apoproteins)

119

Zollinger-Ellison syndrome

tumor in pancreas or duodenum that secretes gastrin --> so, get hypersecretion of acid in stomach and rugal thickening-get recurrent ulcers!-may be assoc with MEN I (pancreatic endocrine tumors...)

120

tetany, recurrent viral infections, congenital heart and great vessel/aortic arch defects, cleft palate, mandible deformities...

DiGeorge syndrome = thymic aplasia: no thymus or parathyroids, so: deficient T-cells, PTH, Calcium-absent thymic shadow on CXR

120

What conditions are associated with ADPKD?

#NAME?

120

salicylates (ie aspirin) antidote?

NaHCO3 (alkalinizes urine)Dialysis

120

Causes of pancreatic insufficiency? What must be supplemented?

Causes:-cystic fibrosis-obstructing cancer-chronic pancreatitis*get malabsorption of fat and fat-soluble vitamins (A, D, E, K)*get increased fat in stool*treat by pancreatic enzyme replacement, limit fat intake, and supplement A, D, E, K.

120

Which thyroid cancer is associated with amiloid deposition?

medullary thyroid carcinoma (MEN 2A and 2B)

121

Disseminated mycobacterial infections, decreased levels of IFN-gamma

IL-12 receptor deficiency --> so decreased Th1 response --> decreased IFN-gamma secretion

121

bilaterally enlarged kidneys + oligohydramnios + small/absent bladder in-utero (by US)?

-->ARPKD

121

amphetamines antidote

NH4Cl (acidifies urine)

121

List the Malabsorption syndromes:

"These Will Cause Devastating Absorption Problems"-Tropical sprue-Whipple's disease-Celiac sprue-Disaccharidase deficiency (like lactose intolerance)-Abetalipoproteinemia-Pancreatic insufficiency

121

Clinical uses for Insulin:

-Type 1 DM-Type 2 DM, once necessary-life-threatening hyperkalemia (b/c insulin shifts potassium INTO cells, so can cause HYPOkalemia) -stress-induced hyperglycemia

122

Job's syndrome

=Hyper-IgE syndrome-Th cells don't produce IFN-gamma --> neutrophils can't respond to chemotactic stimuli-increased levels of IgE-presentation = FATED:--coarse Facies--non-inflamed staph Abscesses--retained primary Teeth--increased IgE--Dermatological pro

122

Thin, nonenhancing, cortical, fluid filled cysts in kidney?

Benign simple cysts; incidental finding in elderly***don't confuse these with medullary cystic disease --> medullary cysts, fibrosis, progressive renal insufficiency, can't concentrate urine, small kidney --> poor prognosis!

122

anti-acetylcholinesterase and organophosphates antidote?

Atropine + Pralidoxime

122

Blunting of villi + Crypt hyperplasia in small intestines?

Celiac sprue

122

Sulfonylureas mechanism of action:

Sulfonylureas:*1st gen:-Tolbutamide-Chlorpropamide*2nd gen:-Glyburide-Glimepiride-Glipizide*Mechanism:-Close K+ channels in Beta-cells of pancreas (which is what glucose usually does: glucose-->increased ATP-->closes K+ channels-->depolarizes cell allowing for Calcium influx into cell-->release of insulin into blood) -->SO: stimulates release of endogenous insulin (so, must have some functional Beta cells left to work; so, can only be used in DMII, not in DMI)

123

Abscesses + still have primary teeth + eczema + high levels of IgE

think Job's syndrome = Hyper-IgE syndrome

123

Osmotic diuretic

Mannitol -->increased tubular fluid osmolarity, so helps excrete free H2O)

123

antimuscarinic, anticholinergic agents (ie atropine) antidote?

physostigmine salicylate

123

Curling's ulcer

Burning of the esophagus --> can lead to sloughing of gasric mucosa and Acute Erosive Gastritis

123

Glyburide

2nd generation sulfonylurea-->stimulates release of endogenous insulin

124

Recurrent infections, Chronic diarrhea, FTT; have NK cells, but no B or T cells

SCIDVariable causes:-defective IL-2 receptor (most common, X-linked)-Adenosine Deaminase deficiency-failture to synthesize MHC II antigens

124

Diuretic with Pulmonary edema side effect?

Mannitol

124

beta-blockers antidote?

(same as verapamil antidote!) = glucagon, calcium, atropine (all increase HR)

124

Cushing's ulcer

Brain injury that can lead to Acute Erosive Gastritis:brain injury--> increased vagal stimulation --> increased ACh --> increased H+ production --> Gastritis

124

Clinical use of Glyburide?

-->Diabetes Type II-stimulates endogenous release of insulin from Beta cells, so must still have some functional islet cells; therefore, it's useless in type I

125

Most common cause of SCID?

-defective IL-2 receptor (X-linked)

125

Diuretic used to treat altitude sickness?

Acetazolamide-->Carbonic anhydrase inhibitor --> helps get rid of HCO3-->can also be used for glaucoma-->may cause hyperchloremic metabolic acidosis....

125

Iron antidote

deferoxamine

125

Main causes of Acute Erosive Gastritis:

*Acute Erosive Gastritis = disrupton of mucosal barrier --> inflammation*Main causes:-Alcoholics-Pts taking daily NSAIDs (ie Rheumatoid Arthritis pts)-Curling's ulcer = burning esophagus-Cushing's ulcer = brain injury resulting in increased vagal stimulation-Stress

125

Side effects of Glyburide?

Hypoglycemia

126

Cerebellar deficits + spider angiomas + IgA deficiency (so increased risk of sinopulmonary infections)

=Triad of symptoms in Ataxia-telangiectasia:-cerebellar deficits =ataxia-spider angiomas = telangiectasia-IgA deficiency -->d/t defects in ATM (Ataxia Telangiectasia Mutated) gene, which codes for DNA repair mechansims --> so, also hypersensitive to x-ray

126

Diuretics used to treat Glaucoma?

-Acetazolamide --> for long-term treatment-Mannitol --> for emergencies

126

lead antidote

CaEDTA (in adults)Dimercaprolsuccimer (in kids)penicillamine

126

Autoimmune disorder with:-autoantibodies to parietal cells-pernicious anemia (b/c no parietal cells, so no IF, so no B12)-Achlorydia (b/c no acid from parietal cells)

Chronic/Non-erosive gastritis of the Fundus/Body = Type A

126

Side effects of 1st generation sulfonylureas?

1st gen sulfonylureas = Tolbutamide, Chlorpropramide-->Disulfiram-like effects (so, not used much)*Remember: Disulfiram = Antabuse --> get hangover-like effects

127

In which immune deficiency are patients hypersensitive to X-ray radiation (b/c it causes chromosomal breaks)?

Ataxia-Telangiectasia --> mutation in ATM gene, which codes for DNA repair enzymes

127

Diuretic of choice to treat edematous states (ie CHF, cirrhosis, nephrotic syndrome, pulmonary edema...)?

Furosemide (loop diuretic)

127

mercury, arsenic, gold antidote

-dimercaprol (BAL) (dimes = money = gold; merc = mercury!)-succimer

127

Cause of chronic/non-erosive gastritis to the fundus/body of the stomach

Autoimmune disorder with: -autoantibodies to parietal cells-pernicious anemia-achlorydia

127

Side effects of 2nd generation sulfonylureas?

2nd gen sulfonylureas = Glyburide, Glimepiride, Glipizide (all the "G---ides"!) Hypoglycemia

128

Thrombocytopenic purpura, recurrent pyogenic Infections, Eczema; Low IgM

Triad of symptoms in Wiskott-Aldrich syndome --> "TIE" = Thrombocytopenic purpura, Infections, Eczema-X-linked recessive-get progressive deletion of B and T cells-decreased IgM; increased IgE and IgA

128

Side effects of Furosemide?

"OH DANG"-Ototoxicity-Hypokalemia-Dehydration-Allergy (sulfa)-Nephritis (Acute Interstitial Nephritis)-Gout

128

copper, arsenic, gold antidote

penicillamine (copper pennies!)

128

Cause of chronic/non-erosive gastritis affecting the antrum of the stomach?

H. pylori-this is the most common type of chronic gastritis-increased risk of MALT lymphoma

128

1st line drug for DM II?

Metformin

129

Defect in LFA-1 integrin/CD18 protein; poor wound healing -- no pus formation, delayed separation of umbilicus

Leukocyte adhesion deficiency (type 1)-->defect in LFA-1 integrin (CD18) protein on phagocytes

129

NSAIDs inhibit the effect of which type of diuretic? Why?

NSAIDs inhibit Furosemide-->Furosemide/Loop diuretics stimulate Prostaglandin release; so, if give NSAIDs + loop diuretics together --> get decreased diuretic response

129

cyanide antidote

(may get cyanide poisoning from nitroprusside, used for malignant HTN; also, from house fires -- see CN toxicity along with CO poisoning)-nitrite-hydroxocobalamin-thiosulfate

129

What part of the stomach does H. pylori affect?

Antrum

129

Metformin mechanism?

unknown exactly; but: -decreases gluconeogenesis in liver (so, decreased glucose!)-increased glycolysis (use that glucose up!)-increase peripheral glucose uptake by whatever insulin that is (so, increased insulin sensitivity)***so, overall: decreases glucose in blood!***can use in pts without any islet cell function

130

recurrent infections with staph and strep, partial albinism, peripheral neuropathy/neuro defects; defect in LYST gene

Chediak-HIgashi syndrome:-autosomal recessive-defect in LYST: lysosomal trafficking regulator gene-microtubule dysfunction in phagosome-lysosome fusion-see abnormal giant lysosomal inclusions on LM of peripheral smear

130

Drugs that are both Ototoxic and Nephrotoxic?

-Aminoglycosides-Loop diuretics (Furosemide)-Cisplatin and Carboplatin (anti-cancer drugs)-Vancomycin

130

Carbon monoxide antidote

100% O2Hyperbaric O2

130

Disease in which rugae of stomach look like brain gyrae?

Menetrier's disease-->gastric hypertrophy-protein loss-parietal cell atrophy-increased mucous cells-precancerous-->rugae are so hypertrophied that look like brain gyri!

130

Mechanism of Exogenous Insulin?

Binds insulin receptor (Tyrosine Kinase activity)

131

absent respiratory burst in neutrophils, increased susceptibility to catalase positive organisms (ie S. aureus, E. coli, Aspergillus, Serratia, Nocardia...); negative nitroblue tetrazolium dye reduction test

Chronic granulomatous disease

131

Ethacrynic acid

Loop diuretic, works the same way as Furosemide. But, not a sulfonamide (unlike furosemide)-->give to pts with sulfa allergy

131

opioids antidote