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1

calcineurin inhibitors

cyclosporin and tacrolimus

2

germline mutations in RET proto-onco gene affect cells of what origin

neural crest cells!

men2a: medullary thyroid carcinoma (parafollicular C cells of thyroid), pheo, and parathyroid gland

men2b: medullary thyroid carcinoma, pheo, and mucosal neuromas

3

thyroid parafollicular cells arise from..

4th and 5th pharyngeal pouches

4

name development of pharyngeal pouches (5)

1. ears (middle ear, mastoid air cells, eustachian tube = endoderm lined)
2. tonsils
3. inferior parathyroid, thymus
4. superior parathyroid, medullary thyroid parafollicular cell
5. medullary thyroid parafollicular cells

5

development of thyroid

thyroid follicular cells = outpouching of pharyngeal epithelium, migrate to lower neck & fuse with parafollicular C cells from 4/5th pharyngeal pouch.

6

pathophysiology of mutation in VHL

VHL gene regulates transcription of HIF-1 (hypoxia inducible factor).

unregulated HIF --> increased VEGF & EPO

= hemangiomas

also associated w/ pheos & RCC

7

projection

misattributing one's own unconscious, undesired thoughts, feelings, impulses onto another person, who does NOT actually have them

occurs when a person ins unable to express difficult thoughts themselves.

transplant thoughts to another --> relieves difficult feelings without causing internal confluct of self-expression.

angry w/ parents, think parents mad at you.

lack insign and acknowledgement of their own motivations & feelings

8

identification

modeling one's behavior after someone perceived to be more powerful / prestigious.

may be admirable or non admirable.

child of abusive father becomes child abuser

9

acting out

avoiding unacceptable feelings by behaving badly

expressing unwanted thoughts/impulses through action instead of reflection and mature discourse

10

most severe trisomy

trisomy 13 -- patau
usu die in first week
only 5% survive 6 months

11

describe trisomy 13-patau

associated w/ early defect in prechordal mesoderm

midface, eye, forebrain most affected.

1. head/neck: severe cleft lip/palate, microopthalmia or anopthalmis, coloboma, cylops, malformed/absent nose, deafness, scalp defects

2. CNS: severe MR, microcephaly, holoprosencephaly, absent olfactory nerve or bulb, NT defects

3. extremities: polydactyly, rocker-bottom feet

4. renal: polycystic kidney disease

5. GI: abdominal wall defects: omphalocele or umbilica hernia, pyloric stenosis

12

47 XXY

klinefelter; tall male w/ gynecomastia, small testes, and infertility

13

47 XXX

clinically silent, maybe slightly decreased IQ

14

47 XYY

tall stature, acne, delays in motor and language

15

k-ras mutations common in..

pancreatic malignancy

16

when is opening snap of mitral stenosis head

really really close to closure of S2

due to tensing of MV leaflet after cusps completed their opening excursion

17

relationship between time of A2-opening snap in mitral stenosis and severity

inverse. shorter interval, more severe.

bc higher steady state left atrial pressure.

18

control symptoms of a neonate in opiod withdrawal (leaky baby)

tincture of opium or paregoric

19

what maintains blood brain barrier

tight junctions [claudins & occludins]

between endothelial cells in capillary beds of CNS.

materials can only move transcellularly or carrier mediated.

20

why use naficillin usu

penicillinase-resistant penicillin.

use often against s. aureus.

skin infections and soft tissue infection -- folliculitis, abscesses.

21

rx for lung abscesses

usu clindamycin

'above the belt' anaerobes'

22

petechia, purpura, ecchymoses? blanch?

petechia 1cm

do not blanch, bc RBC are not in vasculature. RBC leaked in skin/subcutaneous tissue

PPE

23

which blanch. telangietcasia or petechiae/purpura/ecchymoses?

teleangiectasia, bc in a vessel

24

intranasal glucocortoids localization

unlikely to cause systemic immunosuppression -- very localized

25

causes of candida vaginitis

OFTEN:
1. ANTIBIOTIC use! suppress normal flora, facilitates candida overgrowth.

2. contraception, high estrogen
3. systemic corticosteroids
4. uncontrolled diabetes
5. immunosuppression

26

normal pH of vagina? gardnerella infection? trichomonas? candida vulvovaginitis?

normal: 3.8-4.2

gardnerella: pH > 4.2 (more basic)

trichomonas: pH >4.5 (more basic)

candida: pH normal, acidic

27

major bacterial flora of vagina

gram + lactobacilli

also: corynebacterium, fungi (candida), group B strep, e. coli

usu pH ~4

28

decrease thickening of vaginal epithelium and decreased glycogen associated with..

postmenopausal & lactating women

29

elevation of vaginal secretion pH suggests (pH > 4.5)

gardnerella or trichomonas

30

how are many carcinogens activated in humans

via microsomal monooxygenase (cytochrome p450 monooxygenease)

often convert procarcinogen -> carcinogen

like benzopyrene-induced lung cancer