last min facts Flashcards
(129 cards)
1
Q
calculate ejection fraction
A
Ef=(EDV-ESV)/EDV
Ef= SV/EDV
Normal >55%
2
Q
Immunohistochemistry test and 5 examples
A
using an antibody to detect a intermediate filament protein
Vimentin –> sarcomas
Desmin –> rhabdomyosarcoma
Cytokeratin –> epithelial tumors (squamous cell carcinoma)
GFAP –> astrocytoma, glioblastoma
Neurofilaments –> neuroblastoma
3
Q
IL-5 (3 things) and who secretes it?
A
- promotes growth and differentiation of B cells.
- Enhances class switching to IgA
- Stimulates growth and differentiation of eosinophils
(secreted by Th2 cells)
4
Q
where do ubiquitin tagged proteins get degraded?
A
proteasome
5
Q
what type of cancer comes from calcitonin “C cells”
A
Medullary Carcinoma –> sheets of granular cells embedded in hyaline stroma
6
Q
neural plate is present, but neural tube not yet complete…what day am I?
A
Roughly day 12
7
Q
what day does neural tube close
A
day 28
8
Q
MS lesions with vision think what?
A
MLF…always
9
Q
E. Coli infection, pt in sepsis, what is virulence factor?
A
LPS endotoxin (lipopolysaccharide)
10
Q
melanoma in-situ
A
lentigo maligna…consists of malignant cells but does NOT show malignant growth
11
Q
seborrheic keratosis
A
waxy brown wart
noncancerous
originated is outer layer of keratinocytes
“stuck on”
12
Q
Leser-Trélat sign
A
sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (eg, GI, lymphoid)
13
Q
left shoulder referred pain in context of internal bleeding
A
Kehr Sign: it is irritation of the diaphragm signaled by the phrenic nerve because the supraclavicular nerves have the same cervical nerve origin as the phrenic nerve –> this is commonly seen in a splenic rupture, ruptured ectopic pregnancy, or any other internal bleeding
14
Q
ipsilateral CN III palsy mydriasis (“blown pupil”); may also see ptosis, “down and out” eye….caused by what?
A
Posterior communicating artery aneurysm rupture
15
Q
down and out gaze
A
think occulomotor nerve…then need to decide if being compressed by PCA aneurysm, uncal herniation…
16
Q
what does fick equation tell us?
A
CO=O2 consumption / (Art O2- Ven O2)
O2 consumption is proportional to body size/Hb
Art O2 is finger probe O2
Ven O2 is from Swan Ganz in pulm artery
SWAN GANZ GIVES US CO, and SVR
17
Q
PCWP is equal to
A
LA pressure
18
Q
all 3 types of shock share what characteristics?
A
low BP
high HR
19
Q
Causes and hallmark of Cardiogenic shock
A
Causes: Acute MI, CHF, valvular dysfunction, arrhythmia
Hallmark: low CO caused by weak heart muscle..so all intracardiac pressure measurments are high (RA, RV, PCWP)
SVR is also high because body is clamping down trying to maintain BP
20
Q
Hypovolemic shock, causes and hallmark
A
Causes: hemorrhage, dehydration, burns
Hallmark: low CO with ALL the internal heart measurments low (RA, RV, PCWP)
SVR is high to try to maintain BP
21
Q
septic shock hallmark
A
hallmark –> LOW SVR
pressures are variable depending on early or late
22
Q
take a bunch of acetaminophen, what do you do to liver?
A
deplete glutathione, replace with N-Acetylcysteine
23
Q
organophosphate poisoning…FIRST STEP…then second step
A
GIVE ATROPINE FIRST!! (think that the organophosphate irreversibly inhibits the ACh-E, so have a shit ton of ACh. Need to give Atropine, a muscarinic antagonist to block these effects.
Then you can give Pralidoxime that regenerates ACh-E
24
Q
acute intermitent porphyria enzyme
A
porphobilinogen deaminase
Remember 5 P’s
painful abd
port wine urine
polyneuropathy
psych
precipitated by drugs
25
what is the role of IkB in NF-kB signal transduction pathway
release NF-kB after undergoing phosphorylation
IkB INACTIVATES NF-kB
It is acted on by glucocorticoids
26
incidence calculation
new cases/# people at risk (during a specific time period)
27
platelet 804,000
leukocyte 146,000
anemia
this pt has CML
tx. imatinib
28
hydroxyurea mechanism and uses
mechanism: inhibits ribonucleotide reductase (disrupts purine and pyrimadine synthesis)
uses: sickle cell anemia (increase HbF), CML, Melanoma, polycythemia vera
29
foot drop
damage to deep peroneal nerve
30
what does dorsiflexion of the foot?
**This is the deep peroneal nerve**
- tibialis anterior
- extensor hallicus longus
- extensor digitorum longus
- peroneus tertius
31
treacher collins syndrome
neural crest dysfunction --\> mandibular hypoplasia, facial abnormalities
This is a problem with the **FIRST** pharyngeal arch
32
micrognathia
glossoptosis
small lower jaw
downward displacement of the tongue
BOTH of these findings are seen in Pierre Robinson sequence...derivative of the 1st arch
33
phosphocreatine in the context of early exercise
phosphocreatine = creatine phosphate
can anaerobically donate a phosphate group to ADP to form ATP during the first 2-7 seconds following an intense muscular or neuronal effort
\*\*This makes it so ATP does not fall appreciably in these first few seconds because remember that not much ATP is stored in a cell\*\*
34
4yo boy with a karytotype of 47,XY+21 develops pancytopenia, lethargy, numerous bruises, pallor, and fever. Subsequent examination of bone marrow will show?
excess lymphoblasts
\*need to remember that a kid with Down Syndrome has a higher risk of having ALL, which has MUCH increased Lymphoblasts
35
bladder anatomy
specifically, what is at the top of the trigone
These are the **ureteric orifices**
36
loss of peripheral vision in BOTH eyes to the LEFT. Metastatic tumor where?
Tumor in occipital lobe
37
SLE systemic sx
RASH OR PAIN
* *RASH OR PAIN:**
* *R**ash (malar A or discoid)
* *A**rthritis (nonerosive)
* *S**erositis
* *H**ematologic disorders (eg, **thrombocytopenia**) **O**ral/nasopharyngeal ulcers
* *R**enal disease
* *P**hotosensitivity
* *A**ntinuclear antibodies
* *I**mmunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
* *N**eurologic disorders (eg, seizures, psychosis)
38
ruptured AAA, what see on physical exam
decreased femoral pulses
severe abd pain
tachycardia, low BP
pulsatile periumbilical mass
39
ampicillin/amox mechanism of resistance
penicillinase in bacteria (a type of **B-lactamase**)
NOT ALTERATION IN PCN BINDING PROTEIN...that is mechanism for cephalosporins
40
RANK and RANK-L
Osteoclast precursors express a cell-surface receptor known as RANK(RANK stands for Receptor Activator of Nuclear factor-Kappa B). Osteoblasts express RANKL (RANK Ligand) on the extracellular surface of their plasma membrane.
41
18mo boy with severe combined immunodeficiency syndrome requires a blood transfusion for severe anemia. Which blood product is most appropriate
irradiated RBC
\*this kid has no immune system and nothing to fight any infection with. give him some clean shit
42
Hereditary hemorrhagic telangiectasia
=Osler-Weber-Rendu syndrome.
AD
Inherited disorder of blood vessels. Findings: branching skin lesions (telangiectasias), recurrent epistaxis, skin discolorations, arteriovenous malformations (AVMs), GI bleeding, hematuria
Displays incomplete penetrance
43
pouches vs arches
**pouches --\> endoderm**. ears, tonsils, bottom, to, top
**arches --\> Mesoderm + neural crest.** MOST of the stuff (cartilage, muscle, nerve)
remember CAP (ecto, meso + nc, endo)
44
ursodial
nontoxic bile acid
increases bile acid secretion, decrease cholesterol secretion and reabsorption
used for gallstone prevention in someone who does not want surgery
45
most dangerous type of Ehlers Danlos
Vascular type (deficient Collagen III- reticulin, blood vessels)
Berry Aneurysms
Hollow organ rupture
LIFE THREATENING...80% have vascular event by age 40
46
Menke's vs Wilsons
Think of them as opposite
Menke's: ATP7A gene, impaired copper absorption leads to decrease activity lysyl oxidase (requires copper as a cofactor so unable to cross-link collagen) --\> brittle, kinky hair
Wilson's: ATP7B gene, TOO MUCH COPPER
47
holoprosencephaly
trisomy 13
fetal alcohol syndrome
--\> failure of midline cleavage of embryonic forebrain
48
drug that inhibits axonal transport along microtbules
colchicene
49
wallerian degeneration
anterograde degeneration
disappearance of axons and myelin sheats and secondary prolif of Schwann Cells
50
ependymal cells
produce CSF...they line the choroid plexus
51
neuromelanin
blackish intracytoplasmic pigment found in substantia nigra and locus ceruleus
(disappears w/ Parkinson)
52
neurofibrillary tangles
intracytoplasmic degenerated neurofilaments seen in Alzheimers
53
Cowdry Type A inclusion bodies
intranuclear inclusions that are found in neurons and glia in HSV encephalitis
54
most common site of cerebral aneurysm
anterior communicating artery
55
posterior communicating artery aneurysm
third nerve palsy (down and out)
56
blood supply of broca and wernicke
middle cerebral
57
posterior cerebral artery occlusion
contralateral hemianopia with macular sparing
\*provides major blood supply to midbrain\*
58
lacteration of bridging veins
**subdural hematoma**
- not cross midline
- crescent shaped
- ALWAYS cause brain damage
59
lacteration of middle meningial artery
epidural hemorrage
"lucid interval"
-branch of the maxillary artery, enters cranium through foramen spinosum
60
noncommunicating hydrocephalus caused by
blockage of cerebral aqueduct
(often congenital)
61
normal-pressure hydrocephalus
CSF not absorbed by arachoid villi
wet, wobbly, wacky
62
pseudotumor cerebri
benign intracranial hypertension
increased resistance to CSFoutflow at arachnoid villi
OBESE women
papilledema w/o mass, elevated CSF, deteriorating vision
63
bloody csf
subarachnoid hemorrhage
64
etoposide
topoisomerase II
65
deviation of infundibular septum
Tet of fallot
66
HCTZ effect on calcium in serum
increase
(remember it blocks the Na/Cl and it subsequently increases Ca reaborption
67
neuro sx incompatable with any known neurologic disease.
conversion disorder
(often acute and assoicated with stress event)
68
excessive anxiety and preocupation with \>1 unexplained sx
somatic symptom disorder
69
enhancers
can be upstream, downstream, or within introns or wherever the fuck they want to be
70
primary cause lacunar infarcts
lipohyalinosis
71
parkinson surgery target where
deep brain stimulation of subthalamic nuclei
high frequency stim inhibits firing of these nuclei
72
wide fixed splitting of S2 (not vary with resp)
ASD
Eventually results in pulm artery hypertrophy, when gets super strong, this increases resistance and end up getting reversal...eisenmenger syndrome
73
raltegravir
integrase inhibitor
disrupts the ability of the DS HIV DNA to integrate into the host cell's chromosomes
In the absence of integration, the viral genome CANNOT be transcribed by host cell machinery
74
precursor for NO
arginine + O2 --\> NO
via endothelial nitric oxide synthase
75
ribavirin mechanism
interfere with duplication of viral genetic material
inhibits inosine monophosphate dehydrogenase
use in Hep C and RSV
(nucleoside antimetabolite drug)
76
PE pt
what is pH, CO2, O2, Bicarb
hypoperfusion causes V/Q mismatch will cause hypoxemia which causes hyperventilation
pH increase
CO2 decrease
O2 decrease
Bicarb normal (acute phase, loss in 48 hrs)
77
CREST syndrome manifestation in lungs
desposition of collagen results in intimal thickening of pulm arterioles --\> pulm HTN --\> cor pulmonale
78
egg whites
biotin (B7)
Important in
1. pyruvate **carboxylate**
2. Acetyl-CoA **carboxylase**
3. Propionyl CoA **carboxylase**
(ate whe WHOLE **BOX** of EGGS)
79
abortion, few days later sick...what called and what bug?
septic abortion (retained products of conception)
S. Aureus (can be E. Coli and GBS)
tx: broad spectrum abx, surgical evacuation (careful not take all layers and end up with Ashermann syndrome)
80
what gives bruise its green color?
heme oxygenase making biliverdin
81
S cells
S cells --\> secretin --\> increase pancreatic bicarb secretion (from brunner glands), decrease gastric H secretion
82
HIV replication cycle starting at polyprotein (env)
polyprotein --\> glycosolated to become gp160 --\> protealytically cleaved to gp120 and gp41
gp120 mediates viral attachment by binding to the CD4 receptor (what miriviroc binds)
gp41 is transmembrane and anchors gp120
83
gray hepatization in pneumonia
day 4-6
RBC disintegrate
alveolar exudate contains neutrophils and fibrin
**GRAY-BROWN firm lobe**
(congestion --\> red --\> **grey** --\> resolution)
84
enterobius vermicularis
pinworm
butt
scotch tape
tx: bendazoles
85
electrolyte abnormality from massive transfusion
hypocalcemia
86
why does H. pylori cause an ulcer
chronic antral gastritis --\> decrease in # somatostatin producing cells (delta cells) --\> these cells normally inhibit gastrin release --\> now have no brake on that, so get increased H+ secretion by parietal cells --\> duodenal ulceration (not adequately neutralized by bicarb)
87
most common cause of spontaneous lobar hemorrhages in the brain
amyloid angiopathy
hemorrhage tends to be recurrent and involves occipital (homonomous hemianopia) and parietal lobes
88
doxorubicin side effect
dilated cardiomyopathy
89
day 12 post MI
granulation tissue with neovascularization
90
what is the point of IgA protease
bacterial adherance to mucosa
91
infant infected with Hep B, what show up on lab resort
This means mom was a HBeAg + carrier (thus high infectivity)
Infants have **HIGH viral loads and HIGH HBeAg levels\*\*\***
92
name 2 effects of milrinone
+ inotropy (cardiac muscle)
vasodilation (smooth muscle) (decrease afterload on heart)
--\> workse by PDE3 inhibition, used in CHF
93
pt with gastrectomy needs to take HIGH
Vit B12 (water soluble)
-not getting any intrinsic factor that is normally secreted in stomach from parietal cells and necessary for B12 absorption in terminal ilium
\*pts with gastrectomy need to be on lifelong B12 supplementation
94
urge incontinence
detrusor overactivity
| (sudden urge to empty bladder)
95
MS lesion involving micturition
lead to detrusor hyperreflexia and urge incontinence
96
pt in DKA uses what process to create glucose
triglyceride metabolism (lipase) --\> glycerol + fatty acids --\> glycerol 3 phosphate (**glycerol kinase**) --\> DHAP
--\> glucose (gluconeogenesis)
--\> energy (glycolysis)
97
medullary carcinoma thyroid
parafollicular calcitonin secreting cells (neuroendocrine tumor seen in MEN2A/B)
see nests or sheets of polygonal or spindle shaped cells with extracellular amyloid depositon --\> CONGO RED (derived from calcitonin)
98
what part of bone does osteomyolitis affect
metaphysis
99
DI that is given desmopressin and responds....central DI...now what renal clearance value will decrease?
urea
vasopressin activates urea transporters in the medullary collecting duct increasing urea reabsorption and decreasing urea clearance
100
drug that controls uterine hemorrhage post birth
oxytocin
101
skin cancers
upper lip
lower lip
upper --\> basal cell carcinoma
lower --\> Squamous cell carcinoma
REMEMBER **BS!**
102
actinic keratosis
precursor lesion of SQUAMOUS CELL CARCINOMA
\*\*think keratin=squamous cells\*\*
103
variants of melanoma
**1. superficial spreading** --\> most common. dominant early radial growth (side to side). good prognosis
**2. Lentigo maligna melanoma** --\> radial growth. good prognosis
**3. Nodular** --\> early vertical growth. POOR prognosis
**4. Acral lentiginous** --\> palms and soles, dark skinned individuals. NOT related to UV exposure
104
levels of skin affected by Staph scalded skin syndrome and toxic epidermal necrolytis
**SSSS** --\> stratum **granulosum** (exofoliative A and B toxins) destroys the keratinocyte attachments. (+ Nikolski skin)
**TEN** --\> destroys dermal/epidermal **junction**
105
Lichen planus (think P)
pruritic, planar, polygonal, purple papules often with reticular white lines on thier surface.
DERMAL-EPIDERMAL junction with "saw tooth" appearance
**Associated with Hep C virus**
106
modafinil use
narcolepsy
107
where is the lowest osmolality in the tubule of the kidney
distal convoluted tubule
108
probability of being free from a disease is the test result is negative
negative predictive value
109
posterior urethral valves
only occur in males
results in bilateral hydronephrosis
due to malformation of wolffian duct
110
simple cuboidal lining where in female repro tract
ovary
| (fallopian, uterus is simple columnar)
111
beri beri seen what vitamin def
**B**er**1** Ber1 **(B1)**
dry --\> polyneuritis + muscle wasting
wet --\> high output cardiac failure, edema
112
hartnup disease
cannot reabsorb tryptophan from PCT --\> pellagra-like sx
(remember tryptophan --\> niacin (via B6)
113
calculate coefficient of determination
squaring the correlation coefficient
so lets say correlation of coefficient is (0.-8)
take this number .8x.8-.64=64% is explained by whatever factor you are analyzing
114
lack of time frame in study
cross-sectional study
\*\*snapshot of time
Can determine **PREVALENCE**
115
Glycogen stuck in:
liver only
lysosomes
muscles + liver
muscles only
liver only --\> **Von Gierke** (glucose 6 phosphatase)
lysosomes --\> **Pompe** (alpha-1,4-glucosidase)
muscles + liver --\> **Cori** (debranching, alpha-1,6)
muscles only --\> **McArdle** (myophosphorylase)
116
cytotoxic T cells
Helper T cells
Regulatory T cells
**cytotoxic --\> CD8.** Kill virus infected cells, neoplastic cells, donor graft cells by inducing apoptosis (perforin, granzyme B)
**Helper --\> CD4** These are the Th1 (Cell mediated immunity, INF-y) and Th2 cells (Humoral Immunity, IL4, IL5, IL10, IL13 activate B cells to produce Ab)
**Regulatory T cells --\>** Suppress CD4 and CD8 T cells. Express CD3, CD4, CD25, FOXP3. These secrete IL-10 and TGF-Beta
117
cytokine cause cachexia
TNF-alpha (mediates septic shock, activates endothelium, cause WBC recruitment, vascular leak)
118
IL-3
supports growth and differentiation of bone marrow stem cells
-Functions like GM-CSF
119
_Organ Transplant Rejection_
hyperacute
acute
chronic
hyperacute --\> preformed AB (Type II)
acute --\> CD8 T cells, see lymphocytes (Type IV)
chronic --\> CD4 cells, see fibrosis (Type II and IV)
120
_serum calcium levels in:_
dystrophic calcification
metastatic calcification
**dystrophic calcification --\> Ca in ABNORMAL** tissues (seen in TB, liquifactive necrosis, fat necrosis, infarcts, thrombi, schistosomiasis, mockingberg arteriolosclerosis, congenitam CMV, psammona bodies. Pts usually **NORMOCALCEMIC**
**metastatic calcification --\> Ca in NORMAL** tissue secondary to hypercalcemia (primary hyperparathyroidism, sarcoidosis, hypervitaminosis D) Pts usually are **NOT NORMOCALCEMIC**
121
neonatal lupus
Mom Ab --\> fetus
Caused by any autoimmune dz, but most commonly by **SJORGEN**
Need anti-SSA/SSB (can be found in SLE, but more common in sjorgen)
Rash
Conenital complete HEART BLOCK
122
lymphocytic sialadentis
specific for Sjorgen Syndrome
also remember that 40-65% of pts with PBC also have Sjorgens
123
pilocarpine uses
stimulator of sweat, tears, and saliva
- Open-angle and closed-angle glaucoma,
- Sjögren syndrome
\*Remember it is a muscarinic **agoinst**
124
PCP mechanism
NMDA **ANTAGONIST**
125
why is essential fructosuria benign
because hexokinase can rescue it and convert
fructose --\> fructose 6 phosphate, which is back in glycolysis
126
hyperventilate head injury pt, why?
low co2 causes vasoconstriction. This results in a reduction in cerebral blood volume leading to decreased ICP
Remember that CO2 is a potent VASODILATOR of cerebral vasculature
(increased cerebral vascular resistance)
127
treatment of adrenal crisis
dexamethasone and aggressive fluids
128
treat neonatal opiate withdrawl
methadone (long t1/2)
morphine
sx are tachypnea, irritability, diarrhea
129
increased acetylcholinesterase in amniocentesis
neural tube defect
