UWORLDS Flashcards

Question

anti-U1 RNP (speckled ANA) antibodies are associated with....

Answer 1

MIXED CONNECTIVE TISSUE DISEASE

Answer 2

LS endo has vegetations composed of sterile platelet thrombi with immune complexes (SMALL) vegetations on both surfaces of valve)-mitral and aortic Bacterial endocarditis has LARGE vegetations on valve cusps that contain inflammatory cells and bacteria (staph or strep) both contain fibrin

Answer 3

**HIGH ANION GAP** METABOLIC ACIDOSIS **FOMEPIZOLE: INHIBITS ALCOHOL DH** **(cant go from ethanol to acetaldehyde)** **can also use for METHANOL INTOX**

Answer 4

Nf kappa beta normally upregulates synthesis of inflammatory proteins Corticosteroids

Answer 5

**Xanthogranulomatous Pyelonephritis**

Answer 6

Risk of **1.** **bronchogenic carcinoma** **\>\> 2.** risk of mesothelioma. **3. risk of pleural effusions.**

Answer 7

pseudomonas can form a **biofilm**

Answer 8

Kwashiorkor results from a protein-deficient (carbs\>protein) BUT total caloric intake is NORMAL (unlike marasmus) kid with big belly **(ASCITES!) + dec CMI (inc risk for parasites) +Apathy, listlessness, poor appetite --\> POOR PROGNOSIS!!** MEAL: **Malnutrition** Edema **(pittng)** **Anemia:** RBC hypoplasia; iron/ folic acid/vitamin B12 deficiencies **Liver (fatty)**--(due to dec apolipoprotein synthesis..NEED APO B100 FOR vldl to leave liver)--\> **massive hepatomegaly** dont confuse with **Marasmus!** which is **Total calorie malnutrition** resulting in emaciation (tissue and muscle wasting, **loss of subcutaneous fat);** +/– edema.

Answer 9

DI GEORGE (low Ca2+) SCID (normal Ca2+)

Answer 10

1. Vasculitis (eg: PAN) 2. Malignant HTN

Answer 11

**PRADER WILLI syndrome!** IMPRINTING!!!! At some loci, only one allele is active; the other is **inactive (imprinted/inactivated by methylation).** With one allele inactivated, deletion of the active allele disease. 25% of cases due to **maternal uniparental disomy** (two maternally imprinted genes are received; **no paternal gene received).**

Answer 12

**ethylene glycol!!!!** **glycolic acid** is **toxic** to tubule cells AND **oxalic acid** precipates to **Ca2+ OXALATE stones**!!!!!!!!! watch out for antifreeze ingestion in **(homeless) ALCOHOLIC PTS** bc they ingest it in place of alcohol!

Answer 13

BIOTIN!!!! b7!!!!!!! avidin binds b7 and prevents its reabsorption needed for carboxylase reactions which need ABCs ATP Biotin (b7) Co2

Answer 14

**Turners syndrome (XO and XX in one person)** **McCune Albright Syndrome** [due to mutation affecting **G-protein signaling.** Presents with **unilateral café-au-lait spots**, **polyostotic brous dysplasia**,**precocious puberty**,**multiple endocrine abnormalities**. -----Lethal if mutation occurs **before** fertilization *(affecting all cells*), but **survivable in patients with mosaicism.**

Answer 15

**T cells (Th)** protect **against SUPERFICIAL Candida** infections (oral, cutaneous, vulvovaginitis, **MUCOCUTANOUS**) so someone with **HIV** who has a **LOW T CELLS COUNT is affected with SUPERFICIAL CANDIDIASSIS** VERSUS **NEUTROPHILS PREVENT HEMATOGENOUS SPREAD OF CANDIDA** (dissemmmmminated infections: **CANDIDEMIA/endocarditis)** affected **NEUTROPENIC PTS or otherwise immunocompromised (CHEMOTHERAPY or INHERITED IMPAIRMENTS OF PHAGOCYTOSIS)** **aspergillus and psuedomonas bad for neutropenics too**

Answer 16

**INC B**lood pressure: * Upregulates α1-receptors on arterioles sensitivity to norepinephrine and epinephrine * ***At high concentrations****,* can bind to mineralocorticoid (aldosterone) receptors **INC I**nsulin resistance (diabetogenic) **INC G**luconeogenesis, lipolysis, and proteolysis **DEC F**ibroblast activity (causes striae) InFLammatory and **I**mmune responses: * Inhibits production of leukotrienes and prostaglandins * Inhibits WBC adhesion **neutrophilia!!!! INCREASED NEUTROPHILS BC NOT MARGINATING!** * Blocks histamine release from mast cells * Reduces eosinophils * **B**locks IL-2 production **DEC B**one formation ( DEC osteoblast activity) **Exogenous corticosteroids** can cause reactivation of TB and candidiasis (blocks IL-2 production).

Answer 17

1. P**rematurity** 2. **Maternal diabetes** (due to fetal insulin) 3. **C-section delivery** (release of fetal glucocorticoids).

Answer 18

**Reduviid bug** (“kissing bug”) feces, deposited in a **painless bite** (much like a kiss) **Benznidazole** or **nifurtimox;** **Cruzi**ng in my **Benz**, with a **fur** coat on

Answer 19

**NO!!!!!!!!** **hence why it can be synergistic with Cyclsporine which IS nephrotoxic**

Answer 20

**von Willebrand disease** **Platelet agglutination** caused by **ristocetin** can occur **only in the presence of von Willebrand factor multimers**, so if ristocetin is added to blood lacking the vwf, **the platelets will not clump.** The **antibiotic ristocet**in causes von Willebrand factor **to bind the platelet receptor glycoprotein Ib (GpIb),** so when ristocetin is added to normal blood, it causes agglutination. **Treatment: desmopressin**, *which releases vWF stored in endothelium.*

Answer 21

**Overdose produces hepatic necrosis;** ***_acetaminophen metabolite (NAPQI) depletes glutathione_*** ***---\>*** and forms **toxic tissue byproducts** in liver. **N-acetylcysteine** is **antidote**—*_regenerates glutathione._*

Answer 22

DIRECT vasodilation Minoxidil is a **Direct** arteriolar vasodilator. uses for: -Androgenetic alopecia severe refractory hypertension. note that the fact that norepi or epi but just saline were added to the solution IMPLIES the the effect of this drug MUST be a direct effect on vasc sm NOT one mediated IN THE PRESENCE of norep or epi which is why adding something like Phentolamine would NOT cause the same vasodilatory effect even though we think of an alpha antag as opposing vasocontstriction and hence vasodilating. but it does it in the presence of Norepi. (thats the catch)

Answer 23

HISTOPLASMOSIS

Answer 24

**(inc Transferrin; dec % sat Transferrin)** **Estrogen** (as is seen **in inc amt** in both **Pregnancy & OCP** use)---\> **upregulation of TRANSFERRIN SYNTHESIS in the liver** this, in turn, alters the ratio that makes up % Transferrin Saturation): **Fe2+: TIBC** same as: Fe2+/TIBC in such a way that bc the liver is making MORE TIBC and the amt of Fe2+ has not changed or is even DEC in pregnancy bc of INC demand, the numerator gets smaller so the **%saturation DECREASES**

Answer 25

**JVP** is supposed to **DECREASE** on **inspiration** **Kussamaul sign:** JVP increases on inspiration instead. seen in: Constrictive pericarditis Restrictive CM RA or RV tumors

Answer 26

**Celiac sprue** **(due to malabsortion)**

Answer 27

B. pertussis grame -ve cocobacillus stain = Bordet Gengou medium "WHOOPING COUGH" PERTUSSIS EXOTOXIN (ab toxin) **Overactivates adenylate cyclase (cAMP**) by **disabling Gi,** ***impairing phagocytosis to permit survival of microbe.***

Answer 28

its a subtype of adenocarcinoma IN SITU !!!!! called: Bronchioloalveolar subtype mucin +ve! Just like adenocarcinoma!

Answer 29

famously causes **recurring fever** (due to antigenic variation)!!!!!!! changes its **VARIANT SURFACE GLYCOPROTEINs** every time host mounts and immune response!!!! **Trypanosoma brucei = Tsetse fly= a PAINFUL bite** **Trypanosoma cruzi = Reduviid bug (“kissing bug”)** feces**,** deposited in **a PAINLESS bite** (much like a kiss)

Answer 30

Lymphocytes of **mesenchymal origin.**

Answer 31

**Vit b6!!! (PLP)** along with INH

Answer 32

Renal cell carcinoma metastatic melanoma

Answer 33

large cell lung ca Highly anaplastic undifferentiated tumor; poor prognosis. Less responsive to chemotherapy; removed surgically. **peripheral location**

Answer 34

**neuroblastoma** and **medulloblastoma.**

Answer 35

Tetany, torsades de pointes, hypokalemia

Answer 36

**anti-histidyl trna synthetase abs!**!!! **POLYMYOSITIS** **ENDOMYSIAL (vs PERImysial inflamm in Dermatomyositis)** INFLAMMATION WIHT **CD8+ T** CELLS **PROGRESSIVE/INSIDIOUS PROXIMAL MUSCLE WEAKNESS** *_"TROUBLE GOING UP STAIRS, GETTING OUT OF CHAIR"_* *_ANA ab_* *_ANTI-SRP ab_* *_ANTI-Mi-2 ab_* *_Increased CK and aldolase in serum_*

Answer 37

**GUILLAIN BARRE!** (aka: acute **inflammatory demyelinating** polyradiculopathy)

Answer 38

**CHRONIC CHOLECYSTITIS** **(Rokitansky-Aschotf sinus,** Chronic inflammation of the gallbladder Due to chemical irritation from longstanding cholelithiasis, with or without superimposed bouts of acute cholecystitis Characterized by herniation of gallbladder mucosa into the muscular wall **(Rokitansky-Aschotf sinus,** Fig. 11.3A) Presents with vague right upper quadrant pain, especially after eating Porcelain gallbladder is a late complication (Fig. 11.3B). 1. Shrunken, hard gallbladder due to chronic inflammation, fibrosis, and dystrophic calcification

Answer 39

**Bleeding, thrombocytopenia (HIT),** **osteoporosis** drug-drug interactions. (NOTE: **enoxaparin, dalteparin:** LMWH does **NOT** cause osteoporosis), **Heparin-induced thrombocytopenia (HIT)—**development of **IgG antibodies** against **heparin- bound platelet factor 4 (PF4)** *BC (this _complex_ acts as a* **hapten) THAT ACTIVATES our immune system to form those antibodies** **Antibody-heparin-PF4 complex (now all three things are together forming a complex which** THEN **activates platelets--\>** thrombosis and thrombocytopenia (due to depletion). **For rapid reversal (antidote),** use **protamine sulfate** (positively charged molecule that *binds negatively charged heparin).* * note: PF-4 is a chemokine that is released from alpha-granules of activated platelets during platelet aggregation, and promotes blood coagulation by moderating the effects of heparin-like molecules* * replace hep with* * direct thrombin inhibitors (argatroban,* * bivalirudin, dabigatran)*

Answer 40

**polio** **rabies** **herpes** **tetanus toxins** are (except herpes which is taken up via sensory fibers) take up via retrograde trasports via axons that **innervate skeletal muscle**

Answer 41

**70–80%** of tensile strength regained at 3 months; little additional tensile strength will be regained afterward.

Answer 42

**Oprelvekin (IL-11)**

Answer 43

these are due to **Poor breathing mechanics, not an interstitial lung issue so the DIFFUSING CAPACITY is UNAFFECTED and therefore--\>** **n*_ormal A-a gradient):_*** **the issue is *Extrapulmonary, _peripheral hypoventilation (normal Aa with Hypoventilation, we know this)_*** ** Poor muscular effort**—polio, myasthenia gravis, Guillain-Barré syndrome ** Poor muscular effort**—scoliosis, morbid obesity

Answer 44

**autoimmune hepatitis** middle aged woman with sxs of chronic hep

Answer 45

St. John’s wort Chronic alcohol use Rifampin (a) Phenytoin Phenobarbital Nevirapine (NNRTI) Carbamazepine Griseofulvin Ginseng &

Answer 46

**VIT A!!!!!!!!!**

Answer 47

**Resistanace=P/Area x Velocity** note: also the relationship btw Cross sectional area and Velocity of flow are INVERSE. inc A (cross sectional area)--\> DEC in Velocity of flow. (look at how flow velocity is different in capillaries vs, venules etc (KNOW THIS CONCEPT)-there are graphs showing this so if you increase cross sectional area you DECREASE resistance to flow as is seen in the TERMINAL bronchioles where resistance to flow is the LEAST of anywhere in the Respiratory tree and this is bc even though the diameters of the term are small there are many (inc cross sectional area) lined up in **PARALLEL** so this decreases the resistnace! (**highest resistnace** is seen in **MEDIUM** sized bronchii like: segmental and lobar bronchi)

Answer 48

neisseria or chlamydia **URETHRITIS!** sterile pyuria is wbcs in urine "without bacteria"---but this is bc neiss and chlam are not seen on a gram culture!

Answer 49

In the 3rd week the yolk sac forms the--\> allantois, which extends into urogenital sinus.---\> Allantois becomes the---\> urachus (**a duct between fetal bladder and umbilicus)** **yolk sac---\> allontois---\> urachus** ***ADENOCARCINOMA OF THE BLADDDDERRR!!!!!!!*** **1. a urachal remnant-eg: urachal cyst (**fluid-filled cavity lined with uroepithelium, between umbilicus and bladder) **-(tumor develops at the DOME of the bladder),**

Answer 50

Examples of drugs— **P**henytoin, **E**thanol, and **A**spirin (at high or toxic concentrations). Rate of elimination is constant regardless of Cp (ie, constant **AMOUNT** of drug eliminated per unit time).

Answer 51

Calcium phosphate: **INC pH** **hypocitraturia (with DEC ph)--\> calcium oxalate or phosphate** **radioopaque can see on xray**

Answer 52

**Bupivacaine** note: Esters just have **1 "i"** in their name, ulike the amides. but **both end in: -caine**

Answer 53

**Acute mesenteric ischemia** (adults) **intussusception** (children)

Answer 54

**ATHERO-EMBOLIC DISEASE** (THINK ABOUT THE NAME) -during that invasive procedure like aortic catheritizatoin, **CHOLESTEROL** containing debris can **DISLODGE** and travel to smaller vessels where they block the area and cause ischemia to that tissue which presents a few days to weeks post surgery as: MOST COMMONLY: **acute kidney injury!!!!** (oliguria and azotemia)----THE PATIENT **WOULD NOT HAVE A FRANK INFARCTION WITH HEMATURIA AND FLANK PAIN** AND THE WHOLE SHABANG BC CHOLESTEROL EMBOLI ARE WITTLE. ON HISTO (if in the kidney) you could see **needle shaped cholesterol clefts** that partially or completely obstruct the arcuate or intralobular renal arteries other organs that can be involved are: GI, CNS (like retina vessels)

Answer 55

High K+ conductance (efflux) and some Na+ conductance

Answer 56

**Glanzmann thrombasthenia** **DEC** GpIIb/IIIa--\> defect in platelet-to-platelet aggregation. **Labs**: blood smear shows no platelet clumping + INC BT

Answer 57

Guillain-Barré syndrome.

Answer 58

**endocarditis!!!!!** from candida! in **(IV drug users)**

Answer 59

1. pathogenesis: Recessive mutations in HFE gene (C282Y chromosome 6) **abnormal iron sensing and INCREASED intestinal absorption** **2. LABS:** (INC ferritin, INC iron, DEC TIBC--\>INC transferrin saturation)---**SAME as** *SIDEROBLASTIC ANEMIA* 3. TX: repeated phlebotomy, chelation with **deferasirox, deferoxamine, oral deferiprone.**

Answer 60

**Allelic heterogeneity** * **b or a-Thalassemia** * **G6PD deficiency (there are over 400 *diff* mutations on the *same* disease-causing locus in G6PD that are knows to cause this deficiency)**

Answer 61

**first dose HYPOtension (AE)** can occur if someone is volume depleted and also takes an ACE-I since they block vasoconstriction

Answer 62

the ***_pathologic hallmark of Parkinson's disease_*** remains **synuclein-filled Lewy bodies in the nigrostriatal system.** eg: 67-year-old man with 1 year progressive difficulty writing and walking. Pt is stooped and talks slowly. PE shows **bland facial expression**, fine **resting tremor in both hands, no tremor when moves**, walks with difficulty **starting and stopping, cogwheel rigidity.** Brain tissue histology shown as well as gross cross sections of midbrain both normal and diseased.

Answer 63

MOA is that **NITROPURSSIDE DIIIIRREEECCCTTTLLLLYYYYYYYYY** releases **NO** and causes and **increase in cGMP** leading to **VASO and VENO dilation** and is the: **DOC for HYPERTENSIVE 911's** bc of its **SHORT t1/2** **main AE= CN toxicity (cn is a metabolite)** **antidote: SODIUM THIOSULFATE** helps make thiocyanate which **can be eliminated:)**

Answer 64

**INC SNS activity:** via **stim of β1 receptors** in heart = CO, HR, SV, contractility **INC basal metabolic rate** via **INC** synthesis of: **Na+/K+-ATPase!!!!!!!!!!!!!!!--\>** activity INC O2 consumption, RR, body temperature!!!!!!!!

Answer 65

INC **IgA!!!!** **IgE!!!!!** W**A**T**E**R

Answer 66

INC cholesterol and/or bilirubin DEC bile salts, gallbladder stasis all cause stones

Answer 67

HIV/AIDS!!!!!!!!!!!!!!!!!!! **Considered an AIDS-defining illness.** Variable presentation: confusion, memory loss, seizures. Mass lesion(s) on MRI, needs to be distinguished from toxoplasmosis via CSF analysis or other lab tests.

Answer 68

Malignant proliferation of glands, usually involving bladder Arises from 1. **a urachal remnant-eg: urachal cyst-**(tumor develops at the ***_DOME_*** of the bladder), 2. **cystitis glandularis** **(causes columnar metaplasia!)** 3. bladder **exstrophy** (congenital failure to form the caudal portion of the anterior abdominal and bladder walls)...bc bladder exposed to outside world and can cause is to get cancer and change epi

Answer 69

**Symptoms can vary depending on location of implants.** **ITS CYCLICAL and IT HURTS!!!** **leiomyomacause===\> abnormal uterine bleeding, or result in miscarriage. Severe bleeding may lead to iron de ciency anemia.** **extra manifestations of endometriosis!** * Large intestine: **Pain during defecation,** abdominal bloating, or ***_rectal bleeding during menses!!!!!!!!!!!!!_*** * Bladder: Dysuria, hematuria, suprapubic pain (particularly during urination), or a combination * Ovaries: Formation of an endometrioma (a 2- to 10-cm cystic mass localized to an ovary), which occasionally ruptures or leaks, causing acute abdominal pain and peritoneal signs * Adnexal structures: Formation of adnexal adhesions, resulting in a pelvic mass • Extrapelvic structures: Vague abdominal pain (sometimes)

Answer 70

**DIVERTICULOSIS (left sided!)** **ANGIODYSPLASIA** (**right sided!** **-**-cecum, terminal ileum, ascending colon **BOTH COMMON IN *_PPL GREATER THAN 60_*** **_also ischemia colitis (colonic ischemia) which unlike acute (due to embolism in SMA) and chronic mesenteric ischemia (due to atherosclerosis of celiac, sma, or ima), is NOT due to obstruction._** **_\*while the mesenteric ischemias present with lots of pain_** **_Colonic ischemia is due to HYPOPERFUSION eg: Hypotension; presents with crampy pain_**

Answer 71

**MACROLIDES!!!!!!** **NON billious** (unike duodenal atresia) **"palpable olive mass"** in the epigastric region **2-6 WEEKS post birth** (inlike duodenal atresia seen 1-2 DAYS) side note on AE of macrolides: **MACRO:** Gastrointestinal **M**otility issues\*\*\*\*\*\*\*\*\*\*\*\*\*\* **A**rrhythmia caused by prolonged QT interval acute **C**holestatic hepatitis, **R**ash, e**O**sinophilia

Answer 72

**folate** vit b9 **INC** homocysteine **normal** methylmalonic acid levels. read the description to understand also refer to FA for a simpler version of the pathway

Answer 73

## Footnote **\*Rheumatic fever** **\***Immune mediated (type II hypersensitivity); not a direct effect of bacteria. Antibodies to M protein cross-react with self antigens **(molecular mimicry).** \*Interstitial myocardial granulomas aka: **ASCHOFF BODIES** \*Murmur bc an Early lesion is **mitral valve regurgitation** **boy had signs and sxs of MYOCARDITIS**

Answer 74

**Visceral leishmaniasis** (kala-azar)—**spiking fever**s, hepatosplenomegaly, pancytopenia **Cutaneous leishmaniasis**—skin ulcers **Sandfly trasmits it!!!** **its a protozoal infection**

Answer 75

high K+ conductance (some) Na+ conductance

Answer 76

**IL-6** *It has been demonstrated to be involved in the proliferation of plasmablastic cells in bone marrow and in the differentiation of these cells into mature plasma cells.* **AL (primary) 1º AMYLOIDOSIS!!!!** **Due to deposition of proteins from Ig Light chains.** Can occur as a **plasma cell disorder or associated with multiple myeloma**. Often affects multiple organ systems, including renal (nephrotic syndrome), cardiac (restrictive cardiomyopathy, arrhythmia), hematologic (easy bruising, splenomegaly), GI (hepatomegaly), and neurologic (neuropathy).

Answer 77

**Coarctation of the aorta** Aortic narrowing near insertion of ductus arteriosus (“juxtaductal”). Associated with **bicuspid aortic valve, other heart defects, and Turner syndrome**. Hypertension in upper extremities and weak, delayed pulse in lower extremities **(brachial-femoral delay).** W**ith age, intercostal arteries enlarge due to collateral circulation; arteries erode ribs notched appearance on CXR.** Complications include HF, risk of **cerebral hemorrhage (berry aneurysms), aortic rupture**, and possible endocarditis.

Answer 78

**Toxin A**, ***_enterotoxin_***, binds to the brush border of the gut. **Toxin B**, ***_cytotoxin,_*** causes cytoskeletal disruption via **actin depolymerization--\>** diarrhea--\> **pseudomembranous colitis!!!!!** **due to antibiotics**

Answer 79

Vitamin B5!!!! (pantothenic acid!) eg: FA oxidation (FaCoA SYNTHASE and CPT (an acyl transferase) need it!!! FA--\> fatty acyl co A

Answer 80

with a **viral** or **atypical pneumonia (eg: *NEONATAL PNM CAUSED BY CHLAMIDYA -----here you also eosinophilia)***

Answer 81

ARENSIC VINYL CHLORIDE

Answer 82

Antiphospholipid Antibody Syndrome (Anti-Cardiolipin Antibodies; Lupus Anticoagulant)

Answer 83

inc physiological dead space ventilation leading to v/q mismatch bc **poorly ventilated areas are perfused!** **see attached photo for the three reasons you get** ***OXYGEN INDUCED HYPERCAPNEA IN COPD!!!!*** note: **ROS prod would present differently** *like pleuritic chest pain, cough, dyspnea*, **WITHIN 24 HOURS OF BREATHING PURE 02**

Answer 84

Most common **ectopic thyroid tissue** site is the tongue **(lingual thyroid) *@ base of tongue*!** note: Removal may result in hypothyroidism if it is the only thyroid tissue present. **Thyroglossal duct cyst:** presents as an ***anterior midline neck mass*** that **moves with swallowing** or protrusion of the tongue note: (vs persistent cervical sinus leading to branchial cleft cyst in lateral neck).

Answer 85

methylation, acetylation Phosphorylation, hydroxylation, ubiquitination. glycosylation,

Answer 86

**DIRECT THROMBIN INHIBITORS!** **if you're bleeding too much** Since theres no specifoc reversal agent. Can attempt to use activated prothrombin complex concentrates (PCC) and/or fibrinolytics (eg, tranexamic acid**).**

Answer 87

**PBG *Deaminase*** def--\> **Acute intermittent porphyria** note: this is the **2nd enzyme** used in the **CYtoplasm** during heme syn (the first is ALAD) **Uropor *Decarboxylase*** def---\> **Porphyria cutanea tarda** **note:** this is the **4th enzyme** used in the **CYtoplasm** during heme synth

Answer 88

NOOOO!!! JUST THE PARTS **BTW** THE RESP EPITHELUM AND CARTILAGE

Answer 89

Absolute neutrophil count of **\<500mm** **FUNGI and VIRUSES & bacteria (pseudomonas)** **eg: Aspergillus Fumigatus--\> Invasive Pulmonary Aspergilosis (pneumonia)**

Answer 90

NOOOOO needs chocalate agar! in 5% CO2 atmosphere RESPIRATORY DROPLETS

Answer 91

AGEEEEE!!!!!!!!!! **Riedel thyroiditis *_is young female!!!!_*** *_AND_* **anaplastic carcinoma is ELDER!!!!!!!!!!!** **dont you frickin fall for this trick on the test day.**

Answer 92

**GREATER (\>1month)** for **ptsd** **3d-1** month and no longer! for **brief psychotic disorder**

Answer 93

**horseshoe kidney!** due to the halted ascent, renal vascular anomalies are common: usually multiple renal arteries arise from the distal aorta or iliac arteries; this is important when these patients undergo any procedure, particularly a renal angiogram not multiple ureters,

Answer 94

FREAKIN **AML!!!!!!!!!!** **AZUROPHILIC RODSSSSSSSSSSS** PLUS IMMATURE CELLS HTEY ARE **MPO +VE** INCREASED NUMER OF **MYELOBLASTS**

Answer 95

parietal cells light pink with blue nucleaus in the middle looks like a fried egg This slide shows several parietal cells. Parietal cells have a characteristic “fried-egg” appearance, with a basophilic, peripherally located nucleus and a rather eosinophilic cytoplasm. **These cells secrete HCl and intrinsic factor.** Under the electron microscope, the parietal cell appears pyramidal, with a central nucleus and many mitochondria. Why may mitochondria be so numerous in parietal cells?

Answer 96

Thyroid tissue is derived from **endoderm.** Parafollicular cells (aka, C cells) of the thyroid are derived from **neural crest.** **derived from the 4th pouch** **eg: medullary Ca of the thryroid is a**

Answer 97

Jervell and Lange-Nielsen syndrome

Answer 98

**c-Jun** is a protein that in humans is encoded by the JUN gene. **c-Jun** in combination with **c-Fos,** forms the **AP-1** early response transcription factor. NOTE! **C-JUN and C-FOS** are ***_nuclear proto-oncogenes and are induced in patients with hypertrophic cardiomyopathy,_*** **Overexpression of c-jun i**n cells results in **decreased level of p53 and p21**, and exhibits ***_accelerated cell proliferation (hence the hypertrophic CM)._***

Answer 99

**Menetrier!!!!!**

Answer 100

NOOOO!!!!!!! but asbestos is!

Answer 101

schistosoma!!!!!!!! tx: DOC prazi

Answer 102

ANTIHYPERTENSIVE MEDS 1. **Diuretics** (HYDROCHLOROTHIZIDE) 2. **ACE inhibitors** (Captopril, enalapril, lisinopril, ramipril ) 3. **Antiotensin II receptor blockers** (Valsartan. Losartan, candesartan,)

Answer 103

**NO!** therefore, **PCR** has largely replaced it.

Answer 104

Proximal muscle weakness (cant go up stairs, get up from chair) that improves with use **Autonomic symptoms _are huge_ and not seen in MG** like: **DRY MOUTH** **IMPOTENCE** also see **HYPO or AREFLEXIA!!!!!!**

Answer 105

- Double-stranded RNA (weird) segmented /no envelope-NAKED /icosahedral bc +VE sense! REO the weirdo causes ROTAvirus (also causes Colorado tick fever) all negative sense are HELICAL

Answer 106

eXO toxins are actively secreted ENDO toxins are not Listeria monocytogenes listerolysin O and it helps the organism evade phagocytosis

Answer 107

Pre eclampsia May proceed to **eclampsia** (*pre-eclamp + maternal seizures*) and/or **HELLP** syndrome. **Caused by abnormal placental spiral arteries** **endothelial dysfunction, vasoconstriction &** **ischemia.** **Treatment: antihypertensives, IV magnesium sulfate (to prevent seizure); de nitive is delivery of fetus.**

Answer 108

LACUNAR INFARCT they are result of small vessel occlusion due to lipohyalinosis and microatheroma in pentrating vessels of DEEP brain structures

Answer 109

positive immunohistochemical staining for **desmin and myogenin.** **rhabdomysosarcoma**

Answer 110

**AMIODARONE!** i was describing characteristic features of inflamation and **FIBROSIS in the pulmonary intersitium!** will present with **PROGRESSIVE DYSPNEA & DRY COUGH!** AMIODARONE CAUSES **INTERSTITIAL PNEUMONITIS (pulmonary fibrosis!)!!!!!!!!**

Answer 111

**Vit K deficiency** Vit K is Synthesized by intestinal flora. (neonates have **sterile intestines** and are **unable to synthesize vitamin K**). \*\*\*Can also occur after **prolonged use of broad-spectrum antibiotic** Newborns, as mentioned above, fit into this category, **as their colons are frequently not adequately colonized in the first five to seven days of life** since Vit K is not in breast milk; neonates are given **vitamin K injection at birth to prevent hemorrhagic disease of the newborn.**

Answer 112

Yersinia enterocolitica Gram ⊝ rod. Usually transmitted from pet feces (eg, puppies), contaminated milk, or pork.

Answer 113

**Critical blockage** of intestinal blood flow (often **embolic occlusion of SMA**) *_small bowel necrosis_*--\> abdominal pain **out of proportion** to physical findings. ^^^[May see red “currant jelly” stools.] **“Intestinal angina”**: **atherosclerosis of celiac artery, SMA, or IMA--**\> *_intestinal hypoperfusion postprandial--\> epigastric pain--\> food aversion and weight loss._*

Answer 114

decreased Tyrosinase activity and decreased/absent MELANIN prod = **ALBINISM** autoimmune destruction of MELANOCYTES= **VITILIGO**

Answer 115

**verap, dili! Non-dihydropyridine:** cardiac depression, AV block, hyperprolactinemia, constipation. **the -dipines! Dihydropyridine:** *peripheral edema,* ushing, *dizziness, gingival hyperplasia.* *MOA below*

Answer 116

decreased degradation of estrogen by the liver. degrad/metabolism of estrogen to its metabolites bf being urinated out occurs in large part by the CYP450 enzymes in the lIVER

Answer 117

1. the proximal jejunum ends in a BLIND POUCH 2. followed by an are of absent bowel 3. KEY: terminal ileum distal to atresia spirals (like an APPLE CORE OR XMAS TREE) **around a**n ileocecel **bloodvessel** (aroudn a " thin vascular stalk)

Answer 118

**Hepatoduodenal** Portal triad: proper hepatic artery, portal vein, common bile duct

Answer 119

**freakin ITP!!!!!** **autoimmune platelet destruction** by autoimmune platelet antibodies (IgG autoantibodies against plt **membrane glycoprotein GPIIb/IIIa)** in kids (eg: after viral infection or immunization) its self limited, in adults (most common in woman of child bearing age (or with SLE): can cause short lived thrombocytopenia in offspring since IgG can cross the placenta) its an insidious chronic course \*can see INC megakaryocytes on BM biopsy.

Answer 120

**Calcium pyrophosphate deposition disease** Deposition of calcium pyrophosphate crystals within the joint space. Occurs in patients \> 50 years old; both sexes affected equally. Usually idiopathic, sometimes associated with hemochromatosis, hyperparathyroidism, joint trauma. Pain and swelling with acute in ammation (pseudogout) and/or chronic degeneration (pseudo- osteoarthritis). Knee most commonly affected joint. Chondrocalcinosis (cartilage calci cation) on x-ray. Crystals are rhomboid and weakly ⊕ birefringent under polarized light (blue when parallel to light)

Answer 121

***Limited* scleroderma (**_C_**REST syndrome) shows** Anti**_C_**entromere abs! **C for C!!!**

Answer 122

**CTLA-4 (CD152)** on ACTIVATED T cells binds **CD80/86 (B7**) on its target (APC, tumor cells) MOA: competes with CD28 on t cells for binding to B7 on APCs how we are used to seeing (which is normally stimulatory) and CTLA4 has a higher affinity for B7 so it wins---\> no t cells--\> no tumor apoptosis--\> cancer. AND **PD-1** on ACTIVATED T cells binds **PD-1L** on its target (APC, tumor cells) NOTE:used to treat **ADVANCED MELANOMA**

Answer 123

intermittent relieved with defecation is IBS for IBS diarrhea you can give - **LOPERAMIDE**: Accentuates of μ-opioid myenteric plexus receptor--\> dec Ach release and then DECREASE GI motility. note: Cholestyramine (now spelt colestyramine) has been given for many years for diarrhoea in patients with ileal resection (bc they cant absorb bile acids) so you give a bile acid binding resin in this case

Answer 124

**IL-4** 1. promotes T helper cel differentiatoin into the **Th2 subset** 2. Stimulates B cell growth adn **isotype switch to IgE** **IL-5** 1. promotes growth and differentiation of **b cells and eosinophils** 2. Stimulates **isotype switching to IgA**

Answer 125

SPONTANEOUS PNEUMOTHORAX FROM APICAL BLEBS

Answer 126

**RNA dep DNA pol** \*NOTE RETRO has a RNA dep DNA pol (reverse transcriptase) Naked nucleic acids of **⊝ strand ssRNA** and **dsRNA** viruses are **not infectious. need RNA dep RNA Pol (note these are all NEGATIVE)** **BUT** most **dsDNA** (except poxviruses and HBV) and **⊕ strand ssRNA** ( which is same as ≈ mRNA) viruses **are infectious.**

Answer 127

**febrile non hemo** is due to host abs against donor **HLA** ags and **wbcs (just fever, chills, flushing and HA)** vs **hemolytic type** is due to **abo group i**ncompatibility or **host abs against foreign ags on donor RBCS (more severe)...HEMOGLOBINURIA (this is due to COMPLEMENT MEDIATED CELL LYSIS)**

Answer 128

freakin **hemosiderin laden macrophages** MOST FREAKIN COMMONLY **CAUSED BY LEFT HEART FAILURE** LEADING TO INC HYDROSTATIC P IN THE CAPS==\> PULMONARY EDEMA. THE RISE IN PRESSURE OF THE BLOOD INTO THE LUNGS INC CAPILLARY PERMEABILITY AND **DISRUPTS THE CAPILLARY ENDOTHEIAL AND ALVEOLAR EPITHELIAL BLOOD GAS BARRIER!!!!** BLOOD LEAKS INTO ALVEOLI (EXTRAVASTION) AND THERE YOU HAVE IT **ALVEOLAR HEMMORAGE!!!!** **RBC ARE PHAGOCYTOSED BY MACS AND IRON FROM THE HB IS CONVERTED TO HEMOSIDERIN!!!**!

Answer 129

Most commonly **viridans streptococci** and **Staphylococcus aureus**. If dental infection or extraction precedes abscess, **oral anaerobes** commonly involved. **Multiple abscesses** are usually from **bacteremia; Single lesions** from **contiguous sites**: ----**otitis media and mastoiditis---\>** t**emporal lobe and cerebellum;** **------sinusitis or dental infection----\> frontal lobe.** **Toxoplasma** reactivation in **AIDS.**

Answer 130

name that pneumoconiosis! **“Ivory white,” calci ed, supradiaphragmatic and *_pleural plaques._* pathognomonic of--\> Asbestosis** **aerospace and manufacturing industries.** **Noncaseating granulomas** on histology in the lung, hilar lymph nodes, and systemic organs and therefore *occasionally responsive to steroids. --\>* **Berrylliosis** **Sandblasting.** mines“**Eggshell” calcification** of hilar lymph nodes + Macrophages respond to this particle and release bronchogenic factors, leading to **fibrosis.**.. may disrupt phagolysosomes and impair macrophages, **increasing susceptibility to TB!!!!!!!!!!!!!!!!!!!! --\> Silicosis** **asymptomatic** (not a pneumoconiosis) **condition found in many urban dwellers exposed to sooty air.** **--\> Anthracosis** **Carbon dust;** Massive exposure leads to diffuse fibrosis ('black lung'); --\> **Coal workers’ pneumoconiosis**

Answer 131

(cervical lymphadenitis in children).

Answer 132

**Hairy cell leukemia** **CLADRIBINE** (antimetabolite) **PURINE analogue** inhibits DNA pol and causes DNA strand breaks note: the other purine analogue (inhibits DE NOVO purine synthesis is 6MP)

Answer 133

Branchial arches— derived from **mesoderm (**muscles, arteries) **neural crest** (bones, cartilage).

Answer 134

Ventral wall defects (tummy side) Developmental defects due to **failure of: *_CAUDAL_* fold closure**—**bladder exstrophy** Exstrophy of the bladder is associated with 1. **Epispadias** 2. **Adenocarcinoma of the bladder** note: Developmental defects due to **failure of:** ** ***Rostral* fold** closure—**sternal defects** ***Lateral* fold** closure—**omphalocele & gastroschisis**

Answer 135

Up to 25% of cases associated with germline mutations (eg, **NF-1,** **VH**L, **RET** [MEN 2A, 2B]).

Answer 136

**dont fall for it!** ISONIAZID **DOES NOT WORK** AGAINST MAC!!!!!! **JUST AZITHRO OR CLARTHRO (MACROLIDES)**

Answer 137

For **acute cough,** the most common cause is • Viral URI For **chronic cough,** the most common causes are * Asthma (most common) * Gastroesophageal reflux disorder (GERD) * Postnasal drip

Answer 138

1. down syndrome 2. hypothroidism (cretinism) 3. Beckwith Wiedman syndrome

Answer 139

Cofactor for 1. **ferroxidase** (binds iron to transferrin), 2. **lysyl oxidase** (cross-linking of collagen and elastic tissue), 3. **tyrosinase** (melanin synthesis)

Answer 140

PECAM-1 (CD31) **on both**

Answer 141

GAD last \>6 mos and is NOT brought on by a specifc event, person, place or thing adjustment disorder is \<6 months (\>6 months is the INCITING STRESSOR is chronic) so here we have an actual stessor causing impairment (divorce, illness, etc)

Answer 142

GRANULATION AND FIBROUS TISSUE THATS WHY IS A PSEUDO AND NOT REAL CYST

Answer 143

**Calcium pyrophosphate deposition disease** **[PSEUDOGOUT]** X RAY: **chondrocalcinosis** (cartilage calcificaitons) **\*knee** is most affected

Answer 144

STRICTURE (ESOPHAGEAL)--\> SQUAMOUS CELL CA

Answer 145

amphotericin B

Answer 146

1. **Pituitary adenoma resection.** If not cured, treat with 2. **Octreotide** (somatostatin analog) 3. **Pegvisomant** (growth hormone receptor *antagonist*).

Answer 147

due to underdevelopment of Posteror fossa **chiari 1:** more mild (relatively benign) presents at **adolescence,** due to **cerebellar tonsils that extend beyond foramen magnum** into the vertral canal: present like **Paroxsymal occipital HA** (due to meningeal irritation) and **cerebella dys** (ataxia and dizziness) due to compression of cerebella tonsils ---associated with **SYRINGOMYELIA!** **chiari 2**: **more severe**, presents in **neonate** (**tonsils, vermis and medulla even through FM)** -**NON COMM hydrocep** always happens bc of aqueductal stenosis **(compression of medulla**--\> **dysphagia, apnea, and stridor + lumar Associated with: Myelomeningoclee!** --\> lower limb paralysis

Answer 148

1. Oxygen toxicity: **retinopathy of prematurity** *(abnormal vascularization)* & **bronchopulmonary** **dysplasia (from Therapeutic supplemental O2 to a baby who has ARDS when its done too quickly!)** 2. Drug/chemical toxicity: **carbon tetrachloride--\>** *causes FATTY change in liver by decreasing protein synthesis (inlcuding apoliopproteins--\>causes fat to be able to come into liver but cant get out)* & **acetaminophen overdose (hepatotoxicity)** 3. Metal storage diseases: **hemochromatosis (iron)** and **Wilson disease (copper)**

Answer 149

Cimetidine Ritonavir Amiodarone ciprofloxacin Ketoconazole Isoniazid (I**N**H) Macrolides (except azithromycin) Acute Alcohol Abuse Grapefruit juice Quinidine SulfonamideS SSRI's Be careful with **-cyclosporin** (narrow therapeutic index, extenseively met in liver and intestine by CYP3A4)

Answer 150

**HEP A!!!!!!!!!** **NOTE!** the eosinophiic apop bodies are **COUNCILMAN BODOIES!!!!!!!!!** **first is a prodrome: fever**, **ANOREXIA,** N/V**,** malaise THEN CHOLESTATIC signs: jaundice, **DARK COLORED URINE**, LIGHT STOOL, pruitis no carrier state and self limited KNOW THAT HISTO

Answer 151

well since macrolides work by BINDING TO THE 23S SUBUNIT OF THE 50 S ribosome and blocking translocation if you METHYLATE that 23S rRNA binding site the DRUG CANT BIND AND VOILA!

Answer 152

1. kwashikor 2. marasmus seconday a**. Secondary PEM** is **common in the elderly** (living alone or in hospitals or nursing homes), chronic alcoholics, the homeless population, and bedridden patients.

Answer 153

**Homan sign**—WHEN DORSIFLEXTIONof foot calf CAUSES PAIN! **DVT!!!!!!!! (inc d-dimer)**

Answer 154

Primary hyperparathyroidism

Answer 155

**Congenital long QT syndrome** **Jervell and Lange-Nielsen syndrome**— autosomal recessive, sensorineural deafness. (AR) **Romano-Ward syndrome**—autosomal dominant, pure cardiac phenotype (no deafness).

Answer 156

LV ED**P** increases at the SAME LV ED**V** **moves up and to the left**

Answer 157

ADCDK follows a clear inheritance pattern. mcdk is congenital and SPONTANEOUS NOT INHERITED adckd have cysts but their renal system is developed just fine mcdk had an issue of the ureteric bud not taking to the metanenpheric mesenchyme so the kidney (ureter, tubules, etc) DO NOT develop propersly AND THIS CAUSES BUILD UP OF URINE AND SUBSEQUENT cysts that dont communicate and fibrosis with lots of cartilage

Answer 158

loperamide diphenoxylate they bind mu opiod receptors in the GI and SLOW MOTILITY give atropine (causes dry mouth, blurry vision, nausea) so pts wont want to take the opiods in high doses or else they'll get these ae's

Answer 159

kallikrein LTB4 IL-8 C5a Platelet-activating factor

Answer 160

lichun planus!!

Answer 161

Fetal Hb (2α and 2γ subunits) Adult is 2a, 2b

Answer 162

Vasoconstriction is thought to be due in part to 1. **enhanced activity** of **thromboxane and endothelin-1 (both vasoconstrictors)** and 2. **reduced activity** of **prostacyclin and nitric oxide (both vasodilators).** * **BosENtan:** Competitively **antagonizes ENdothelin-1 receptors--\> DEC.** pulmonary vascular resistance. * **Sildenafil:** I**nhibits cGMP PDE-5** and **prolongs vasodilatory effect of nitric oxide.** * **Epoprostenol, iloprost: PGI2 (prostacyclin) with direct vasodilatory** effects on pulmonary and systemic arterial vascular beds. **Inhibits platelet aggregation.** The increased pulmonary vascular pressure that results from vascular obstruction further injures the endothelium. Injury activates coagulation at the intimal surface, which may worsen the hypertension.

Answer 163

**Mitral** Mitral\>Aortic\>\>\>\>tricuspid (high-pressure valves affected most).

Answer 164

**Asbestosis**

Answer 165

staph aureus! prevents opson and phago binds the fc part of IgG

Answer 166

Inguinal lig (superior) Adductor longus (medially) Sartorius muscle (laterally) EXTERNAL ILIAC VEIN

Answer 167

* Myasthenia gravis is **intermittent** and **worsened by exertion.** * Botulism may **cause fixed dilated pupils (in 50%)** and **prominent cranial nerve dysfunction** with *_normal sensation._* * Poliomyelitis usually **occurs in epidemics.** * Tick paralysis causes **ascending paralysis** but *_spares sensation._* * West Nile virus causes headache, fever, and **asymmetric** flaccid paralysis but *_spares sensation._* * Metabolic neuropathies occur with a **chronic metabolic disorder.**

Answer 168

**Malonyl CoA** inhibits **CPT-I,** thus preventing the entry of long-chain acyl groups into the mitochondrial matrix. Therefore, when **fatty acid synthesis is occurring in the cytosol** (as indicated by the presence of malonyl CoA), the newly made palmitate cannot be transferred into the mitochondria and degraded. so that FA synthesis and degrad are not happening at the same time?

Answer 169

**its an: mTOR inhibitor;** **binds FKBP.** Blocks T-cell activation and B-cell differentiation **by preventing response to IL-2.** **calcineurin: Calcineurin inhibitor; binds *_cyclophilin. --_*Blocks T-cell activation by preventing IL-2 *transcription.*** **tacrolimus: Calcineurin inhibitor; binds *_FK506 binding protein (FKBP)._*** **Blocks T-cell activation by preventing IL-2 *transcription.*** ***both tacrolimus and calcineurin are NEPHROtox but SIROLIMUS is NOT NEPHROTOXIC! its causes pancytopenia, insulin resistance & hyperlipidemia;*** ***\*\*\*\*\*\*******Kidney “sir-vives.”* Synergistic with** **cyclosporine.**

Answer 170

REA**SS**ORTMENT requires a VIRUS WITH A **S**EGMENTED GENOME S for S eg: **influenza**

Answer 171

DOWN SYNDROME

Answer 172

serotoninc syndrome!!!

Answer 173

Hypernatremia, hypervolemia, and a hypokalemic alkalosis may occur, causing episodic weakness, paresthesias, transient paralysis, and tetany. Diastolic hypertension and hypokalemic nephropathy with polyuria and polydipsia are common note: Low levels of both **PRA (Plasma renin activity (**) and **aldosterone** suggest **nonaldosterone mineralocorticoid excess** (eg, due to licorice ingestion, Cushing's syndrome, or Liddle syndrome).

Answer 174

**Neuroblastoma** * Most common tumor of the adrenal medulla in children, **usually \< 4 years old.** * Originates from **neural crest cells.** Occurs anywhere along the sympathetic chain Can also present with **opsoclonus-myoclonus syndrome (“dancing eyes-dancing feet”).** **NOTE: you can say the "adult" version of this is tumor is Pheochromocytoma which is MORE likely to present with HTN than this neuroblastoma**

Answer 175

stable at 100 deg for 1 hour

Answer 176

1. Granular **eosinophilic “ground glass”** appearance; [cytotoxic T cells mediate damage] = **HEP B** 2. **Lymphoid aggregates** with focal areas of **macrovesicular steatosis = HEP C** 3. Hepatocyte swelling, **monocyte** infiltration, **Councilman bodies = HEP A**

Answer 177

c. IL-12 (induces t helper cells differentialtion into the Th1 subtype) d. IFN gamma (produced by **mature Th1 cells** which then activate macs, improving their abiity to kill ingested mycobacteria. f. TNF-a (produced by **activated macs** to recruit additonal monocytes and macs to the area) macrophage mediated immunity to Mycobacterium Tb is led by Th1 helper cells (you go down this pathway **when IFN-gamma \> IL-4)**

Answer 178

-Most common childhood **supratentorial tumor.** - Derived from **remnants of Rathke pouch.** * *-Calcification** is common on imaging -May be confused with pituitary adenoma (both can cause **bitemporal hemianopia)**

Answer 179

increased wall stress on **right-**-\> HEMATOCHEZIA=associated with **ANGIODYSPLASIA (Most often found in cecum, terminal ileum, ascending colon)** increased wall stress on **left**--\> PAINLESS HEMATOCHEZIA=**DIVERTICULOSIS** [Many false diverticula of the colon, commonly sigmoid. Caused by intraluminal pressure and focal weakness in colonic wall. Associated with low- FIber diets.

Answer 180

b-endorphins (delta receptor) ACTH MSH

Answer 181

an inactivating mutation in **BMPR2 gene** (normally inhibits vascular smooth muscle proliferation); poor prognosis. note: Other causes include drugs (eg, amphetamines, cocaine), connective tissue disease, HIV infection, portal hypertension, congenital heart disease, schistosomiasis.

Answer 182

OSMOTIC DIARRHEA bc lactose attracts water into the small bowel A **DECREASED STOOL pH** bc **BACTERIA** in the gut **FERMENT** THE LACTOSE INTO LACTIC ACID! NOTE: **Lactose hydrogen breath test: ⊕** for lactose malabsorption **if postlactose breath hydrogen value rises \> 20 ppm** compared with baseline.

Answer 183

Coarctation of the aorta

Answer 184

**Dry beriberi**—polyneuritis, **symmetrical** muscle wasting. **Wet beriberi—**high-output cardiac failure (dilated cardiomyopathy), edema.

Answer 185

(associated with I**V drug abuse)** Adults present with **cutaneous lesions;** especially affects populations in J**apan, West Africa, and the Caribbean.** **Lytic bone lesions, hypercalcemia**.

Answer 186

**answer is AMPHOTERICIN** general funal treatment: Treatment: Fluuconazole or itraconazole for **local infection;** ***_amphotericin B for systemic infection._*** ***_H-B-C-P_*** **are the SYSTEMIC MYCOSIS** **side note:** Systemic mycoses can form granulomas (like TB) but cannot be transmitted person-to-person (unlike TB).

Answer 187

1. Paramesonephric (MULLERIAN) duct 2. urogenital sinus

Answer 188

**tesamorelin!**

Answer 189

**neurocysticercosis** treat with **albendazole**

Answer 190

a **CONGENITAL CMV i**nfection! (transmitted to mom via **sexual contact or TRANSPLANT)** Hearing loss, seizures, petechial rash, “blueberry muffin” rash, **periventricular calci cations** *not periventricular plaques assoc with MS*

Answer 191

**MITRAL VALVE PROLAPSE WITH REGURGITATION** (deposits on valves can become colonized by microorganism (eg: strep viridans) during episodes or bacteremia (eg: following a dental extraction). NOTE: IE--\> embolic stoke (middle cerebral artery)--- (common complication) **RHEUMATIC HEART DISEASE (under developed nations)**

Answer 192

B. Extensive **solar elastosis** Histo feature seen in **Actinic keratosis!** Premalignant lesions caused by sun exposure. Small, rough, erythematous or brownish papules or plaques . Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia.

Answer 193

Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

Answer 194

"Right shift—When curve shifts to the right, DECREASED affinity of Hb for O2 (**facilitates unloading** of O2 to tissue). ACE BATs right handed" **A**cid **C**O2 **E**xercise 2,3-**B**PG **A**ltitude **T**emperature

Answer 195

**FIBRIN!!!!!**

Answer 196

**Vitamin E DEFICIENCY** DONT BE FOOLED. THIS IS SIMILAR TO VIA B12 DEFICIENCY BUT IS DIFFERENT BC HERE WE ARE LACKING: megaloblastic anemia hypersegmented neutrophils INC serum methylmalonic acid levels.

Answer 197

Sulfa drugs, **\*\*Hydralazine,** **\*\*Isoniazid,** **\*\*Procainamide (class 1A antiarrythmic)** (note: Procainamide is metabolize by hepatic ACETYLATION: therefore, SLOW acetylators are at higher risk of DILE **Phenytoin,** **Etanercept** **SHIPP-E**

Answer 198

**HYPOnatremia** bc they be drinking so much water (UNLIKE central or nephro DI where they have HYPERnatremia!!!) INITIAL low urine OSMOlarity (but then quickly responds to water depriv and urine inc in osmolarity). also, urine will not change in osm after ADH is given bc max endogenous ADH has already been used The most common presenting symptom is tonic-clonic seizure, found in 80% of patients.[21] Psychogenic polydipsia should be considered a life-threatening condition, since it has been known to cause severe hyponatraemia, leading to cardiac arrest, coma and cerebral oedema. Euvolemic hyponatremia: In euvolemic (dilutional) hyponatremia, total body Na and thus ECF volume are normal or near-normal; however, TBW is increased. Primary polydipsia can cause hyponatremia only when water intake overwhelms the kidneys' ability to excrete water. Because normal kidneys can excrete up to 25 L urine/day, hyponatremia due solely to polydipsia results only from the ingestion of large amounts of water or from defects in renal capacity to excrete free water. Patients affected include those with psychosis or more modest degrees of polydipsia plus renal insufficiency. Patients with acute psychogenic water drinking are able to concentrate their urine during water deprivation. However, because chronic water intake diminishes medullary tonicity in the kidney, patients with longstanding polydipsia are not able to concentrate their urine to maximal levels during water deprivation, a response similar to that of patients with partial CDI. However, unlike CDI, patients with psychogenic polydipsia show no response to exogenous ADH after water deprivation. This response resembles NDI, except that basal ADH levels are low compared with the elevated levels present in NDI. After prolonged restriction of fluid intake to ≤ 2 L/day, normal concentrating ability returns within several weeks.

Answer 199

SIADH!!!! Characterized by: * Excessive free water retention * Euvolemic hyponatremia with continued urinary Na+ excretion which is protective to keep BP and vLs in check via the following mechanisms: \*\*\*Body responds to water retention with aldosterone and ANP and BNP---\> INC urinary Na+ **secretion--\>** normalization of extracellular uid volume---\> euvolemic hyponatremia.

Answer 200

**IDIOPATHIC PULMONARY FIBROSIS (IPF)** aka: Cryptogenic fibrosing alveolitis a type of restrictive lung disease affecting the interstitium

Answer 201

jews african americas

Answer 202

**MESODERM!** * *V**ertebral defects * *A**nal atresia * *C**ardiac defects **T**racheo-Esophageal stula **R**enal defects **L**imb defects (bone and muscle)

Answer 203

**FIDAXOMICIN!!!!!!!!!!!!** its i**nhibits the sigma subunit of RNA POL**!!!!! its a macrocylic antibiotic **SAFE!!!!**

Answer 204

1. in pts at high risk for iron overload, VIT C can cause IRON OVERLOAD (bc its job is to convert fe 3+ to fe 2+ (which can then be absorped in intestine) 2. can cause ca2+ oxalate stones bc (vit C--\> metabolized into Oxalate!

Answer 205

Nonhemolytic, normocytic anemia **Fanconi anemia** **ataxia telangiectasia is the other one!**

Answer 206

ICAM-1 (CD54)- on **endothelium** CD11/18 integrins (LFA-1, Mac-1) on **WBC** (defective in **leukocyte adhesion deficiency type 1** (CD18 integrin subunit)

Answer 207

Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) **SMUDGE CELLS!!!!!!**

Answer 208

**DUE TO PRIMARY HYPERPARATHYROIDISM** **Osteitis brosa cystica**—cystic bone spaces lled with brown brous tissue (“brown tumor” consisting of osteoclasts and deposited hemosiderin from hemorrhages; causes bone pain).

Answer 209

**Guillain-Barré syndrome**. [an Acute in ammatory demyelinating polyradiculopathy) Associated with infections (eg, **Campylobacter jejuni,** viral)---\> autoimmune attack of peripheral myelin Findings: CSF protein with **normal cell count** (**albuminocytologic dissociation**). Complication of the labs findings: protein may cause **papilledema.**

Answer 210

**Ondansetron!!!** * Control vomiting ***postoperatively and in patients undergoing cancer chemotherapy.*** * **AE: Long QT interval WHICH predisposes to torsades de pointes.** **Metoclopramide!!!** * **Diabetic and postsurgery gastroparesis,** * **Antiemetic** * **AEL Parkinsonian effects, tardive dyskinesia. Restlessness, drowsiness, fatigue, depression, diarrhea.** * **Drug interaction with digoxin and diabetic agents.** * **Contraindicated in patients with small bowel obstruction or Parkinson disease (due to D2-receptor blockade).**

Answer 211

* **Hypo**thyroid myopathy (proximal muscle weakness, **INCREASED CK)** * \*this is bc **DEC** THYROID HORMONE I**NC THE PERMEABILITY OF SKELETAL MUSCLE MEMBRANES** SO CK LEAKS INTO BLOOD AND IS MEASURED AS INC IN SERUM. VS. * **Thyrotoxic (hyperthyroidism)** myopathy (proximal muscle weakness, normal CK) * you get the myopathy bc of INC PROTEIN CATABOLISM (but no inc in CK bc the membranes of the skeletal muscle are ok).

Answer 212

**AngelMan syndrome** **Paternal** Imprinting gene from **dad** is normally silent and **Maternal** gene is deleted/mutated.

Answer 213

Dilated cardiomyopathy **A**lcohol abuse, **w**et Beriberi, **C**oxsackie B viral myocarditis, **c**hronic **C**ocaine use, **C**hagas disease, **D**oxorubicin toxicity, **p**eripartum cardiomyopathy. **s**arcoidosis, **h**emochromatosis, **\*Systolic dysfunction ensues. \*Eccentric hypertrophy**

Answer 214

NOT OSTEOPOROSIS, labs are NORMAL in osteoporosis **OSTEOMALACIA!!!!!!!!!**

Answer 215

Chronic myelogenous leukemia!!!!!!! NOTE: **Very low LAP** as a result of low activity in malignant neutrophils (vs benign neutrophilia [leukemoid reaction], in which LAP is INC ). Responds to **bcr-abl tyrosine kinase inhibitors** (eg, **imatinib**).

Answer 216

bc Cadherins which bind to cadherins on neighboring epithelial cells are CALCIUM dependent.

Answer 217

clomipramine

Answer 218

seen in malnourished areas dri: muscle and neuro + NO EDEMA wet: tachy and high output cardiac failure (dilated CM) + WITH EDEMA

Answer 219

SMOKING!!!! #1 **Pee SAC:** Phenacetin, Smoking, Aniline dyes Cyclophosphamide.

Answer 220

Germ tubes: **short outgrowth, non-septate germinating TRUE hyphae**. They are ½ the width and 3 – 4 times the length of the cell from which they arise. When cells of **Candida** are incubated in serum at **37C** for **2-4 hours** Candida albicans produce short, slender, tube like structures called **germ tubes** Note: A germ tube test is a diagnostic test in which a sample of fungal spores are suspended in animal serum and examined by microscopy for the detection of any germ tubes.[2] It is particularly indicated for colonies of white or cream color on fungal culture, where a positive germ tube test is strongly indicative of Candida albicans.[2]

Answer 221

GLYCINE!! dont you dare say proline

Answer 222

primary cns lymphoma leucemia ATM gene is mutated and leads to INACTIVATION OF tp53--\> which leads to failure to repeair DNA double stranded breaks---\>CELL CYCLE ARREST INCREASED AFP! DECREASED IgA, G & E! you see lyphopenia and cerebellar atrophy!

Answer 223

**LICHTENBURG FIGURES** LIGHTNING INJURY (can have 2nd degree burns too) (ESPECIALLY IF THE PT IS FOUND ON WET GROUND OR UNDER A TREE AND UNCONSCIOUS )

Answer 224

**blastema!!!!!!!!!!** = (immature kidney mesenchyme), primitive glomeruli and tubules, and stromal cells

Answer 225

SSRIs venlafaxine (SNRI) **clomipramine (**TCA)\*\*\*\*\*\*\* know this association!

Answer 226

Mycophenolate mofetil moa: Reversibly inhibits **IMP dehydrogenase,** preventing purine synthesis of B and T cells.

Answer 227

NOOOOOO!!!!!!! LGN is involved in your VISION pathway with CN II NOT CNIII in the PNS pathway for pupillary constriciton if you messed up the LGN you woudlnt be able to too on one side of the eye on both eyes, like Left LGN injury--\>vision in BOTH EYES on one side being affected/lost)

Answer 228

cholera and ETEC (one of its enterotoxins is the Heath Labile (LT) that also inc camp---\> diahrrhea

Answer 229

CONTRALAT LOSS OF PAIN AND TEMP 2 LEVELS BELOW AND EVERYTHING UNDER! **EG: INJURY AT T8** **LOST OF PAIN AND TEMP** ONE OR TWO SEGMENTS **BELOW!!!**! LIKE AT **T9/T10!!**

Answer 230

Vitamin E (tocopherol/tocotrienol)

Answer 231

**Pulmonary hypertension** **[if the pulmonary HTN is due to Primary processes affecting the lung] its called "PAH (Pulmonary arterial hypertension )**

Answer 232

**Cell death due to peroxidation of membrane lipids.**

Answer 233

Major risk factors include • **Neutropenia!!!!!!!!!!!!!!!!** • Long-term high-dose corticosteroid therapy • Organ transplantation (especially bone marrow transplantation) • Hereditary disorders of neutrophil function (eg, chronic granulomatous disease) • AIDS Aspergillus sp tends to infect open spaces, such as pulmonary cavities caused by previous lung disorders (eg, bronchiectasis, tumor, TB), the sinuses, or ear canals (otomycosis). UNIQUE: Produces **conidia in radiating chains** at end of conidiophore E .

Answer 234

dextrans (insoluble extracell polysaccarhide), which bind to brin-platelet aggregates on damaged heart valves and tooth enamel. **STREP VIRIDANS** {(*Streptococcus mutans* and *S mitis*) and subacute bacterial endocarditis at damaged heart valves (*S sanguinis*) ) Gram ⊕, α-hemolytic cocci. Resistant to optochin, [differentiating them from S pneumoniae, which is α-hemolytic but is optochin sensitive]

Answer 235

Fanconi Syndrome due to deposition of Cu in the PCT

Answer 236

**ASPIRIN = INC BLEEEEEDING TIME!!!** **ACETMINOPHEN = INC PT!!!!!!!**

Answer 237

EMBRYONIC PERIOD weeks 3-8 **Neural tube formed by neuroectoderm** and closes by week 4. **Organogenesis.**

Answer 238

* **Pseudohypoparathyroidism type 1A** **(Albright hereditary osteodystrophy)** * Defect must be inherited from **mother due to imprinting. ** * **Pseudo*pseudo*hypoparathyroidism—**physical exam features of **Albright hereditary osteodystrophy but _*without end-organ PTH resistance*._** * **Occurs when defective Gs protein α-subunit is inherited from *_father_*.**

Answer 239

**abduction and adduction of fingers (interossei),** **Ulnar (C8-T1) !!!!**

Answer 240

Torsades de pointes

Answer 241

out of all the type of poycythemia, its is the only one that has **DECREASED** **EPO due to negative feedback suppressing renal EPO production**

Answer 242

retinitis pigmentosa seen spicules arond macula

Answer 243

diagphragmatic and mediastinal parts

Answer 244

**VIPoma!** its also called WDHA ("whaddha" like "water" stands for Watery Diarrhea HypoKalemia and Achlorhydria bc it causes secretory diarrhea (3L/day) not osmotic like lactose bc that would repsond to diet mod and not inflamm diarr bc that has pus or blood its SECRETORY (do to inc relase of na, cl and water into bowel)

Answer 245

involves nvolve **nonimmunologic** platelet destruction Coombs'-**negative** hemolytic anemia!!!!!!!! Inhibition or deficiency of **ADAMTS 13** (**vWF metalloprotease)---\>** degradation of vWF multimers. **Pathogenesis: INC** large vWF multimers--\> platelet adhesion--\> **platelet aggregation and thrombosis.** **Labs:** 1. **Schistocytes** 2. **LDH** **Symptoms**: ***_pentad_*** of: 1. neurologic 2. renal symptoms 3. fever 4. thrombocytopenia, 5. microangiopathic hemolytic anemia. **Treatment:** plasmapheresis, steroids.

Answer 246

**Gonococcal arthritis** **—STI that presents as either** **1. purulent arthritis (eg, knee)** **2. triad of polyarthralgias, tenosynovitis (eg, hand), dermatitis (eg, pustules).**

Answer 247

**co dominance** when both alleles contribute to the phenotype of the heterozygote

Answer 248

SUlfonamides

Answer 249

the **superficial epigastric artery** and the **inferior epigastric artery** (more medial)

Answer 250

**Wiskott-Aldrich syndrome** Mutation in **WAS gene**; T cells **unable to reorganize actin cytoskeleton**. X-linked recessive. **WATER**: **W**iskott-**A**ldrich: **T**hrombocytopenia, **E**czema, **R**ecurrent infections. **risk of autoimmune disease and malignancy.**

Answer 251

**Hypo**thyroidism---\> **Hyper**cholesterolemia (due to **DEC** LDL receptor expression) **Hyper**thyroidism--\> **Hypo**cholesterolemia (due to **INC** LDL receptor expression)

Answer 252

liposarcomas have a SCALLOPED BORDER to the nuclear membrane (they are pleiomorphic)

Answer 253

**Yellow fever virus** A **flavivirus** (also an arbovirus) transmitted by **Aedes mosquitoe**s A . Virus has a monkey or human reservoir. Symptoms: **high fever, black vomitus, and jaundice.** May see ***_Councilman bodies_*** (eosinophilic apoptotic globules) on liver biopsy. affects **ZONE 2** of liver **HAS Live attenuated vaccines**

Answer 254

TYPE II MPGN (CALLED DENSE DEPOSIT DISEAE) NOTE: T**YPE 1** WITH **PAS +VE STAIN AND H&E** shows ***_TRAM TRACK ON LM_*** appearance due to mesangial ingrowth **splitting the GBM** (dont confuse with the **"spike and dome** appearance seen in MN where you realy thick GMB thickening so thick due to NEW GBM proliferation)

Answer 255

MCV!!!! bc in alcoholism [EVEN WITHOUT A FOLATE DEF] YOU CAN STILL SEE macrocytosis!!!! **MCV\>100!!!!!!**

Answer 256

**3rd!** C is the 3rd letter in the alphabet!

Answer 257

CYTOSOL!!!! not the nucleus! and this deNOVO synthesis requires CO2 so if a probe following CO2 was used you would see it in the CYTOSOL

Answer 258

the cause is **VASCULAR INJURY!!!!!** **MIDGUT structures are listed so SUPERIOR MESENTERIC VESSELS ARE DISRUPTED--\> segmental resorption/atresia/bowl discontinuity-** **not** failure to recanalize (that would be DUODENAL ATRESIA)==\> double bubble sign on xray and it presents in 1-2 days of life

Answer 259

Inc capillary hydrostatic Pressure by impairing normal arteriolar dilation--\> non inflammatory edema (excess accum of transudative fluid in teh interstitial tissues)

Answer 260

RETINOPATHY AND skin pigmentation pruiris

Answer 261

**increased lipid solubility** = **MORE POTENT**= **small MAC** (potency is **INVERSLY** related to MAC) why? bc MAC is the **MINIMAL ALVEOLAR CONCETRATION** (of INHALED anesthetic) required to precent 50% of subjects from moving in response to noxious stimuli (eg: skin incision) the **more lipid soluble (and blood soluble)-**-\> slow inc in PP (arterial tension)/LARGE amount needed to SATURATE blood--\> slower equilibrium with brain---\> S**LOWER ONSET OF ACTION & RECOVERY/ELIMINATION**

Answer 262

Wilsons is a genetic defect impairs copper transport. The **impaired transport decreases copper secretion into the bile**--\> copper overload and resultant **accumulation in the liver.** Then copper diffuses out of the liver into the blood, then into other tissues; which begins at birth. The impaired transport also interferes with incorporation of copper into the copper protein ceruloplasmin, thus decreasing serum levels of ceruloplasmin **BC CERULOPLASMIN IS STABALIZED BY COPPER SO WITH OUT COPPPER ITS HALF LIFE IS DECREASED SO THE LEVEL OF IT ARE DECREASED IN THE SERUM** Hepatic fibrosis develops, ultimately causing cirrhosis. It is **most destructive to the brain (eg, dysarthria, dystonia, tremor, parkinsonism)**,but also damages the **kidneys and reproductive organs** and causes **hemolytic anemia.** Some copper is deposited in Descemet's membrane of the cornea, causing **Kayser-Fleischer rings.**

Answer 263

**Vibrio cholerae** Sensitive to stomach acid (acid labile); requires **large** inoculum (high ID50) unless host has gastric DECREASED acidity (then itll be ok bc it likes all the alkaline things)

Answer 264

Na+ KIDNEY

Answer 265

**vitamin C**.

Answer 266

HIGH chol HIGH BR LOW BILA ACIDS AND LOW PC = GALL STONE FORMATION BC AS BILE GETS SECRETED INTO THE GALL BLADDER THE JOB ON THE BILE SALTS AND PC TO MAKES IT SOLUBLE FOR EXCRETION WHEN THERE IS MORE BILE DUE TO INC CHOLES, THE LOAD FOR THESE BILE ACIDS AND PC IS TOO MUCH AND BILE FORMS ROCKS

Answer 267

Lateral to medial: **Nerve-Artery-Vein**- Lymphatics. REMEMBER: **You go from lateral to medial to find your NAVeL.** **BELOW the inguinal ligament**

Answer 268

bc its from a **MALFORMATION OF THE WOLFFIAN (MESONEPHRIC DUCTS!)**

Answer 269

when pt has DVT or pulmonary embolism who what contraindications to anticoagulation

Answer 270

BAD PROGNOSIS (death within months-a year) Adult T-cell lymphoma Caused by **HTLV** (associated with IV drug abuse)

Answer 271

**Repression**=IMMATURE **Involuntarily** withholding an idea or feeling from conscious awareness. -blacking out the 10 years in your life you were raped vs **Supression**=MATURE **Intentionally** withholding an idea or feeling from conscious awareness; *temporary.* * -*choosing to not worry about clinical rotations until its a more appropriate time to think about it bc other things are more important - putting Bobby and boys in general on the way back burner bc school is more important

Answer 272

**Narcolepsy** **hypocretin orexin maintains wakefullness**

Answer 273

**methotrexate!** **its doesnt just cause BM suppression!** its PREFERENTIALL INHIBITS RAPIDLY GROWING CELLS LIKE INFLAMMATORY AND NEOPLASTIC CELLS (WHICH LEAD TO CHARACTERISTIC BM SUPPRESSION--WHICH leucovorin reverses) **BUT ALSO....** **CELLS WITH RAPID TURN OVER LIKE** **GI (ORAL/GI ULCERS), LIVER (HEPATOX: CIRRHOSIS AND FIBROSIS)**

Answer 274

Primary sclerosing cholangitis

Answer 275

RCC spreads hematogenously (exceptino to carcinome spreads via LN rule) t**o LUNG #1** bone also adrenals and liver

Answer 276

these are all things that are controlled by stuff made by the pituitary so SHEEHAN! Sheehan syndrome—**ischemic infarct of pituitary following postpartum bleeding;** * pregnancy-induced pituitary growth susceptibility to hypoperfusion (bc not enough blood supply to keep up with the growth:( meu * Usually presents with failure to, lactate, absent menstruation, cold intolerance

Answer 277

**Nodular** Toxic multinodular goiter Thyroid adenoma Thyroid cancer Thyroid cyst **Smooth/difuse GOITER seen in...** Graves disease Hashimoto thyroiditis Iodine deficiency TSH-secreting pituitary adenoma

Answer 278

**Induced methemoglobinemia** ## Footnote you use: **nitrites,** **followed by thiosulfate--\> which oxidizes Fe2+ to Fe3+= and there you have it: Methemoglobinemia**) ratioale; Oxidized form of Hb **(ferric, Fe3+)** that does **not** bind O2 as readily, but h**as affnity for cyanide. So it can scavenget it bascially by preferentially binding it over O2.** note: **CN** is a mitochondrial toxin that specifically inhibits **complex IV** in the ETC.

Answer 279

increase serum: CA2+ uric acid=Hyperuricemia (gout) glucose cholesterol TAGs Lower Na+, K+ and Mg2+ metabolic alkalosis note-Thiazide use is implicated in lithium toxicity in bipolar patients.

Answer 280

**Acute attack** tends to occur after a large meal or **alcohol consumption** (alcohol metabolites **compete for same excretion sites in kidney as uric acid--**\> **DECREASED uric acid** secretion and **subsequent buildup in blood).**

Answer 281

Cellular swelling (secondary to changes in ion concentration and the influx of water)

Answer 282

LOOK HERE TOO FOR MORE EXPLANATION

Answer 283

**GLYCINE** (bc **collagen is 1/3 Glycine)** remember the **alpha chains** are: **GLY-X-Y** **X-Y (are Proline or Lysine)** **STEP 2** or the **HYDROXYLATION STEP needs VIT C** (this is a **post-transciptional step** where **Proline and Lysine are hydroxylated** **in the RER**!!!!)

Answer 284

**Charcot-Marie-Tooth disease** Also known as hereditary motor and sensory neuropathy (HMSN). Group of progressive hereditary nerve disorders related to the defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath. Typically **autosomal dominant** inheritance pattern * associated with **foot deformities (pes cavus),claw hands, steppage gait, skinny legs, loss of sensation in feet,** l**ower extremity weakness and sensory deficits.**

Answer 285

**Small cell (oat cell) carcinoma**

Answer 286

Vaginal tumors **Sarcoma botryoides (embryonal rhabdomyosarcoma variant)** **spindle-shaped cells; desmin ⊕.**

Answer 287

**meiosis 1 !!!!!!!** the RFLP will how **3 bands!** one from dad t**wo from mom**---\> this indicates that the baby inherited BOTH of her homologous chromosomes so separation of them did not occur in meiosis one like normal note if the baby had 2 band: 1 from dad of NORMAL thickness and one from mom but it is THICKER then this indicates non disjunction in MEIOSIS 2!!! baby inherits both sister chromatids, which will produce equal size restriction fragments but TWICE THE NORMAL AMOUT FOR ARE FATTER BANDS LOOK IN NOTEBOOK!

Answer 288

**Primary biliary cirrhosis** **histo same as GVHD histo**

Answer 289

**HEPATITIS B VIRUS** I Initially like **serum sickness** **"PLAN PR FFHV"** **P**roteinuria **L**AD **Arthralgia** **N**eutropenia (not -philia) **Pruitic Rash** **Fever** **F**ibrinoid **N**ecrosis **H**yptocomplementenemia **V**asculitis (vasculitis) **HISTO**: Granular eosinophilic “**ground glass”** appearance **cytotoxic T cells mediate damage** **Mode of transmission:** Parenteral (**Blood)**, sexual (**Baby- making**), perinatal (**Birthing**) **YES**, may progress to carcinoma

Answer 290

**hypoxemic vasoconstriction**

Answer 291

**Patent foramen ovale (btw RA & LA)** **ASDs** (atrial L--\>R shunts can faciliate paradox emb due to periods of **transient shunt reversal (!!!!!)** **to a R--\>L** during eg: **coughing or straining**)--\> RA--\> LA--\> LV-\> aorta--\> paradoxical embolism (can go to MCA and bam, stroke) VSDs (also: Large pulmonary arteriovenous malformations)

Answer 292

**Pilocytic (low-grade) astrocytoma** **Most often found in posterior fossa (eg, cerebellum). May be supratentorial.** **GFAP ⊕. Benign** **good prognosis.**

Answer 293

Ornithine transcarbamylase deficiency, Fabry disease, Wiskott-Aldrich syndrome, Ocular albinism, G6PD deficiency, Hunter syndrome, Bruton agammaglobulinemia, Hemophilia A and B Lesch-Nyhan syndrome, Duchenne (and Becker) muscular dystrophy. Note-Female carriers can be variably affected depending on the percentage inactivation of the X chromosome carrying the mutant vs normal gene.

Answer 294

**INVASIVE Aspergillosis** Treatment is with **voriconazole, amphotericin B (or its lipid formulations), caspofungin, itraconazole, or flucytosine.** Fungus balls may require surgical resection. Recurrence is common.

Answer 295

**#1 Pancreatic adenocarcinoma** [also **Lung and colon** adenocarcinoma]

Answer 296

**Pulmonary hypertension !!!!!!**

Answer 297

**Ankylosing spondylitis** **U**veitis, **Symmetric** involvement of **spine and sacroiliac joints----\> ankylosis** *_(joint fusion)_*, **A**ortic regurgitation.

Answer 298

Lipoic acid!

Answer 299

NO!!!!!!!!! so you are not resonsive **gradual** loss of consciousness is **NOT seizure or a cardiac even**t but instead is **metabolic like Hypoglycemia** **a sudden loss of consciousness is**

Answer 300

**NEEDS CYSTEINE!!!!**

Answer 301

Coxsackie A, 2° syphilis, Rocky Mountain spotted fever

Answer 302

staph enterotoxin is not killed

Answer 303

**Sporotrichosis!!!** Sporothrix schenckii **rose gardener’s” disease** Treatment: **itraconazole** or **potassium iodide.**

Answer 304

1. IMMATURE rbc (erythrocyte precursors)/ERYTHROBLASTS 2. hepatocytes note: after dividing a bunch. IMMATURE rbcs LOST not only their nucleus but their MITONCHONDRIA as well so they CANNOT MAKE HEME ANYMORE (need mitochondria for FIRST AND LAST 3 STEPS OF HEME SYNTHESIS!) SO MATURE RBCS live to 120 days all the while unable to make heme

Answer 305

**Subacute granulomatous thyroiditis (de Quervain)** **severe neck pain!!!!!!!!!!!!!!!!!** you missed this before bc you thought HYPERTHYROID bc of sxs. BUT this can be HYPERthryroid AT FIRST and then is HYPO. BUT THE PAINNNNN!!!!!!!!!!! main point. dont overlook shit like that.

Answer 306

E-selectin P-selectin ON WBC Sialyl-LewisX ON ENDOTHELIUM

Answer 307

**internal jugular vein** **subclavian vein** femoral vein {NOT preferred bc has higher risk of infection)

Answer 308

whats they KEY diff? one has deafness, Jervel and Lange, the other doesnt, Romano Ward -one is AD, the other is AR.

Answer 309

**CHIARI MALFORMATION 2**! presents in childhood bc more severe. not 1. (1 is milder and more common); presents at adolescence or later

Answer 310

Group of neoplasms originating from **Kulchitsky and enterochromafin-like cells**. Occur in various organs eg, **thyroid:** medullary carcinoma; **lungs**: small cell carcinoma; **pancreas**: islet cell tumor; **adrenals:** pheochromocytoma). Cells contain **amine precursor** uptake decarboxylase **(APUD**) and secrete different hormones (eg, 5-HIAA, neuron-specific enolase **[NSE]**, **chromogranin A**).

Answer 311

Doxyclycline Ceftriaxone

Answer 312

well seeing as ghrelin is made my the stomach, gastric bypass **DECreases ghrelin** and in prader they are fat so **ghrelin inc**

Answer 313

**Immune thrombocytopenia** ## Footnote **Anti-GpIIb/IIIa antibodies-**-\> splenic macrophage consumption of platelet-antibody complex. -Commonly due to *viral illness.* ***Labs:** **megakaryocytes INC** on bone marrow biopsy.* ***Treatment:** steroids, IVIG, splenectomy (for refractory ITP).*

Answer 314

Desmopressin releases vWf stored in the endothelium & increases circulating factor VIII \*vWf enhances clotting in 2 way: 1. augments platelet binding (which helps form the initial plt plug). 2. stabalizes factor VIII (vwf is non covalently attached to VIII)

Answer 315

Bulbus cordis

Answer 316

**DECREASED** affinity of HbF for **2,3-BPG**----\> **INCREASED** affinity of Hb for O2!

Answer 317

**Lymphogranuloma venereum C trachomatis (L1–L3)** Infection of lymphatics; **painless** genital ulcers, **painful** l**ymphadenopathy (ie, buboes)** **and YERSINA PESITS (one sided inguinal bubo after hiking) + HA and fever ---\> leads to plague**

Answer 318

**ALWAAYYYSSS opposite!!!!!** ferritin is stored iron and tibc indirectly measures transferrin which is what transports Fe3+ state iron in the blood; so if there is iron stores, transferrin wouldnt need to be going arond in the blood looking for more iron to transport (bc either its locked away or bc there just isnt enough iron to transport even.

Answer 319

alcohol is NOT a direct RF!!!!!!!!!!!!!!!! but smoking iSSSsSSSSSSSSsssss DUCTSSSSS!!!!!!!!!!!

Answer 320

AV septal defect (**endocardial cushion defect**), VSD, ASD

Answer 321

**Reaction formation:** when you have an obsession with something thats probably unacceptable **so you _(unconsciously choose to)_ do the extreme opposite** ***-sex addict becomes priest*** **vs** **Sublimation:** Consciously, replacing an *unacceptable* wish with a course of action that is similar to the wish but **does not conflict with one’s value system** **-angry teen dances off her stress and excels**

Answer 322

Proximal part of pulmonary arteries and (on left only) **ductus arteriosus.**

Answer 323

**Focal to massive hepatic necrosis (LIVER!)** Pts has **"inhaled anesthetic hepatoxicity"** **PT** is prolonged bc failure of liver to be able to synthesize factor VII (which has the shortest half life of all the coag factors)

Answer 324

its usually UNCHANGED!!!! or even a little decreased bc of the stenotic valve, but the pressures before it are high so if a gives you an altered LVEDV there is likely aortic valve involvement! (AR)

Answer 325

Squatting helps: INCREASES Peripheral SVR (afterload), DEC right-to-left shunt, improves cyanosis.

Answer 326

“Wet, wobbly, and wacky.” ## Footnote **Normal pressure hydrocephalus**

Answer 327

Associated with obstetric catastrophes (eg, **abruptio placentae**), **septic shock.**

Answer 328

1. **PDA** due to Persistently low O2 tension 2. **Necrotizing enterocolitis:** Seen in premature, formula-fed infants with immature immune system. Necrosis of intestinal mucosa (primarily colonic) with possible perforation, which can lead to p*neumatosis intestinalis, free air in abdomen, portal venous gas.* **RFs:** prematurity, maternal diabetes (due to fetal inc insulin), C-section delivery ( dec release of fetal glucocorticoids).

Answer 329

TRICK! PT will NOT CHANGE!!! but BT increases. dont fall for this. in a pt with plt sequestration due to hypersplenism and subsequent thrombocytopenia who has cirrhosis and also due to less thrombopoeitin being made in liver....you are only affected Plts NOT coag cascade directly so labs for PT and PTT wil be normal. this is how you would diff it from a factor 7 def due to cirrhosis where the PT would be increased. (note: in this case, they will tell you, that after giving Vit K, the PT had NO change, thats bc the liver is so sick it cant make enought factors 2,7,9,10 to even attempt to correct coag

Answer 330

due to ascending (DCML) AND descending (Corticospinal) look at attahced

Answer 331

viral protein \_**E6**\_\_\_\_ degrades p53, the tumor suppressor protein regulating the cell cycle) viral protein\_\_**E7**\_\_inhibits the retinoblastoma gene product Rb

Answer 332

Chronic pyelonephritis

Answer 333

Nitrites (eg, from dietary intake or polluted/high altitude H2O) and benzocaine cause poisoning by oxidizing Fe2+ to Fe3+.

Answer 334

risk of **cor pulmonale** **cancer** **Caplan syndrome** (**rheumatoid arthritis** and **pneumoconioses** with **intrapulmonary nodules**).

Answer 335

hydronephrosisi due to uteric obstruction during surgery

Answer 336

**partial/focal ones** **[can be simple PARTIAL or complex PARTIAL!!!!]** Affect **single area** of the brain (like **one not both hemispheres!**). Most commonly originate in **medial temporal lobe**. Often **preceded by seizure aura**; can secondarily generalize. Types: ** Simple** partial (**consciousness intact**)— motor, sensory, autonomic, psychic..PATIENT **CAN STILL HEAR YOU** AND **IS RESPONSIVE** BUT **A SINGLE PART OF THEIR BODY** LIKE THEIR ARM OR FACE (ARM AND FACE IF TEMORAL ETC)...BUT **NOT THEIR WHOLE BODIES!!!!!!!** **Complex** partial (impaired consciousness) PATIENT **CANNOT** HEAR YOU AND IS **NOT** RESPONSIVE BUT A **SINGLE PART OF THEIR BODY** LIKE THEIR ARM OR FACE (ARM AND FACE IF TEMORAL ETC)...BUT **NOT THEIR WHOLE BODIES!!!!!!!** **generalized affect your whole body like both hemispheres**

Answer 337

TYPE 2 COLLAGEN= cartilage (including HYALINE), vitreous body and nucleous pulposus safranin O stains CARTILAGE!!! photo is of articular cartilage = HYALINE GLASS LIKE COLLAGEN

Answer 338

**chromaffin cells are here!** (arise from neural crest). cortex from **MESOderm!!!!**

Answer 339

NERP. dont fall for it. they are used as a hypnotic so HELP insomniacs they are even used as a muscle RELAXANT so no to the muscle rigidity

Answer 340

dilated but also restrictive (mostly dilated)

Answer 341

cysticercosis or neurocysticercosis is from EATING POOP FROM HUMAN FECES CONTAMINATED WITH EGGS (FROM A CARRIER WHO HAD INTESTINAL TAPEWORM)----NOOOTTTTT FROM UNDERCOOKED PORK! intestinal tapeworm is from EATING LARVAE CYTS IN UNDERCOOKED PORK!

Answer 342

Primary sclerosing cholangitis

Answer 343

**CCS** **CARBAMAZEPINE** **CYCLOPHOSPHAMIDE** **SSRIs** MAGNOCELLULAR NEURONS

Answer 344

atrial septal defects such as: 1. Patent foramen ovale 2. ASD (atrial septal defect)

Answer 345

**OSLER NODE** ARE **IMMUNOLOGICAL** (IMMUNE COMPLEX DEPOSITIONS); **JANE WAY** ARE JUST **VASCULAR** DUE TO SEPTIC EMBOLI FROM THE VEGETATIONS AT HEART VALVE **OSLERS HURT**!!!! **JANEWAY IS NICE AND THEY DONT HURT!** **JANEWAY** ARE **AT PALMS AND SOLES** **OSLERS** ARE AT THE P**AD OF FINGERS ON FEET AND HANDS**

Answer 346

Reverse transcriptase is a **very inaccurate DNA polymerase;** it makes lots of mistakes. **High mutation rate** causes HIV to constantly change, a serious problem for making a vaccine.

Answer 347

**Brugada syndrome** It is caused by a defect in **the sodium channel** of the cardiac cell membrane. **Syncope and cardiac arrest: Most common clinical manifestations; in many cases, cardiac arrest occurs during sleep or rest** **Nightmares or thrashing at night** **Asymptomatic, but routine ECG shows ST-segment elevation in leads V1-V3** **Associated atrial fibrillation (20%) [1]** **Fever: Often reported to trigger or exacerbate clinical manifestations**

Answer 348

believe it or not **BULIMIA NERVOSA** why? bc to meet the criteria you need to binge eat at least once per week for at least 3 months and have SOME TYPE OF COMPENSATORY BEHAVIOR (EG: LAXATIVE, PURGE (VOMIT), EXERCISE A TON, FAST) **YOU DONT HAVE TO VOMITTTTTTT** - note: in binge eating disorder there is NO compensation - and in body dysmorphinc you can be meeting criteria for an eating disorder like this and simply be given a BDD diag. duh.

Answer 349

the cells characteristically seen in **HAIRY CELL LEUKEMIA** mature b cell tumor also can be described as filamentous hair like projections" **either way, PROJECTIONS FROM THE CYTOPLASM!!!!!!!!!!!!!!!!**

Answer 350

**_laryngeal papillomatosis_** * **Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis or glottal papillomatosis or associated with condyloma acuminata, is a rare medical condition** * **caused by a human papillomavirus (HPV) infection of the throat.** * **Laryngeal papillomatosis is caused by HPV types 6 and 11, in which benign tumors form on the larynx or other areas of the respiratory tract. These tumors can recur frequently, may require repetitive surgery, and may interfere with breathing.** * **Laryngeal papillomatosis causes assorted tumors or papillomas to develop over a period of time.** * **Without treatment it is potentially fatal as uncontrolled growths could obstruct the airway.**

Answer 351

1. HYDROCELE (smal hole so just fluid leaks) 2. INDIRECT INGUINAL HERNIA (larger hole so abd contents can leak it) [BOTH have SAME PATHOGENISIS, just different extremes of "obliteration"]

Answer 352

b lactasmases are hydrolytic enzymes that accumulate in the **PERIPLASMIC SPACE =** space btw cytplasmic membrane and **outer membrane** in gram NEGATIVE bacteria

Answer 353

**they LACK MHC-1** expression! so smart. **normally** MHC-1 is Expressed **on all nucleated cells** and hence, not expressed on RBCs

Answer 354

**- Spillage of contrast which *_normal_***

Answer 355

**hCG is INC** in multiple gestations hydatidiform moles choriocarcinomas **Down syndrome** **note:** Large cell lung carcinoma *secretes bhcg!* **hCG is DEC** in ectopic/failing pregnancy, Edward syndrome, and Patau syndrome.

Answer 356

**freakin MANIA (like you would see in bipolar 1)** pts comes in wanting to spend recklessly, grandiosoty, racing thoughs, dec need for sleep. pressure speech....MANIC sxs! remember DIG FAST mnemonic

Answer 357

a person who gets **hemibalismus (wild LARGE AMPLITUDE, flinging movements on one side)** is often due to a LACUNAR STROKE which itself is due to 1. LONG STANDING (BENIGN) HTN 2. DIABETES MELLITUS! \*BC BOTH LEAD TO **HYALINE ARTERIOSCLEROSIS**---\> small LACUNAR **infarct** **so LACUNAR infarct secondary to hyalnie arteriosclerosis (which dev due to long standing benign HTN and DM)**

Answer 358

**Abetalipoproteinemia** (Bassen-Kornzweig syndrome): This **autosomal recessive** condition is caused by mutations in the gene for microsomal triglyceride (TG) transfer protein, a protein **critical to chylomicron (B48) and very-low-density lipoprotein (VLDL) formation (B100).** Diagnosis is made by the **absence of apoprotein B (apo B) in plasma!!! so the two above apolipoproteins are missing!**

Answer 359

**High lactose--\>** unbinding of the repressor protein from repressor/operator site (also tells **allolactose** to bind the repressor so it doesnt try to pull any sneaky moves)--\>**transcription.** **Low glucose--\>** adenylate cyclase (adenylyl cyclase) activity generation of cAMP from ATP--\> activation of catabolite activator protein (CAP)-\> **transcription.**

Answer 360

**adenosine** inc K out of cells, hyperpolarizes the cell and dec amt of Ca2+ inside adenosine itself is blocked by theophylline and caffeine (both are adenosine receptor antag)

Answer 361

**GAP JUNCTIONS (CONNEXINS)**

Answer 362

**NYSTATIN!!!!!** swish n swallow

Answer 363

adrenal cortex from mesoderm chromaffin cells of adrenal medulla derived from neural crest

Answer 364

clonorchis sinesis tx: prazi its a trematode fluke

Answer 365

**Nitrites** (eg, from dietary intake or polluted/high altitude H2O) **Benzocaine** (a local anaesthetic in the "esters" group) **by cause poisoning by oxidizing Fe2+ to Fe3+.** **note: nitrited used to INDUCE Methemoglobinemia in cases of CN poisoning**

Answer 366

**Menetrier Disease!** theres **IDIOPATHIC gastric HYPERplasia of the MUCOSA**

Answer 367

**Time constant** is **HOW LONG it takes** to reach a new membrane potentional, the shorter amont of time, the faster the axonal conduction [**MYELIN DECREASED THE TIME CONSTANT** (this is favorable) **Length constant** is **HOW FAR along an axon** an electrical impulse can propogate [**MYELIN INCREASED THE LENGTH CONSTANT** (this is favorable) opposite is the case if there is demyelination!

Answer 368

Anti-Scl-70 aka: **(anti-DNA topoisomerase I)** **Scleroderma (diffuse)**

Answer 369

**ATP** is needed for the **MYOSIN** head (crossbridge) to **DETACH from ACTIN!!!** if you **dont have ATP** you get r**igor mortis (just stiff)..**. **BC THE CROSSBRIDGE PERSISTS!!!** **KNOW THAT PIC!**

Answer 370

**Invasion** is **the key** to pathogenicity; organisms that produce little toxin can cause disease due to invasion **shigella** * **gram ⊝ rods, non-lactose fermenters, oxidase ⊝** * **can invade the GI tract via M cells of Peyer patches.**

Answer 371

Protozoa: BABESIA causes BABESIOSIS NORTHEAST USA same as LYME DISEASE AND ANAPLASMOSIS (both use ixodes)

Answer 372

**Montelukast, zafrlukast**—block **leukotriene receptors** (CysLT1).

Answer 373

Cold agglutinins are Abs directed against **Antigens** in the cell membrane of **MYCOPLASMA PNEMONIAE (the bug!) that just so happen to be the same as the Antigens present on the surface of human RBCs** **seen in military recruits and prisons**

Answer 374

**Denys-Drash disease** **one of the many associations with WT1 mutation**

Answer 375

**DELIRIUM: diffuse *_SLOWING OF EEG_*** \*reversible **DEMENTIA: *_NORRRMAL!_*** \*usually not reversible

Answer 376

Adult T-cell lymphoma Caused by HTLV (associated with IV drug abuse)

Answer 377

**Cardiac tamponade** **Equilibration** of **diastolic pressures in all 4 chambers.** **Pulsus paradoxus** DEC in amplitude of **systolic BP by \> 10 mm Hg** during inspiration. Seen in cardiac tamponade, a**sthma, obstructive sleep apnea, pericarditis, croup.**

Answer 378

aka: nutcracker phenomenon, **renal vein entrapment syndrome,** or **mesoaortic compression of the left renal vein.** **It results most commonly from the compression of the left renal vein between the abdominal aorta (AA) and superior mesenteric artery (SMA),** **associated with hematuria (which can lead to anemia)[3] and abdominal pain (classically left flank or pelvic pain).[4]**

Answer 379

**Fixation:** is being an adult who acts like a kid (having the maturity level of a child as a grown ass adult); adult who still plays video games every day at the age of 48. vs **regression:** *involuntarily* reverting back to a younger (could be due to an illness, stress, new sibling); eg: a kid who WAS potty trained all the sudden beginning to wet his bed.

Answer 380

GERMLINE MOSAICISM!!!!

Answer 381

**LOW Mg2+** Hypocalcemia with tetany (acquired hypoparathyroidism due to impaired PTH secretion and resistance in target tissue) **Tachycardia** **EXCESS mg2+** Neuromuscular depression (depressed deep tendon reflexes, muscle weakness) **Bradycardia**

Answer 382

bc abolishing the eff art vasocontriction effect leads to a **DEC Filtration fraction with dec GFR.** \*usually normalizes in a few weeks this is **only an issue in** ppl who have DEC GFR states to begin with like **bilat RAS** **decomp HF** **chronic kidney disease** **volume depletion** but actually ACE-I are renoprotective for diabetic pts bc they reduce the hyperfiltration injury

Answer 383

Risk factors: multiple sexual partners (#1), smoking, starting sexual intercourse at young age, HIV infection.

Answer 384

Staph Group A strep (Pyogene) Clostridium difficile

Answer 385

Integrein (hepara sulfate) what receptor does CMV use? **Integrein (hepara sulfate)** how about Rabies **Nicotininc AchR** how about Rhino virus **(i cam)**

Answer 386

TISSUE FACTOR (aka: THROMBOPLASTIN)

Answer 387

**GGT!!!** bc ALP is found mostly in BONE and LIVER so GGT can tell you if the issue is of BONE OR LIVER origin BC GGT is NOT found in the BONE!!!

Answer 388

**1. Retinopathy of prematurity,** **2. Intraventricular hemorrhage** **3. Bronchopulmonary dysplasia** **(RIB)**

Answer 389

**MUSCARINIC ANTAG!** **Oxybutynin (first and foremost),** solifenacin, tolterodine (careful not to use Muscus antag in someone with angle closure glaucoma **they reduce bladder spasms and urge urinary** **incontinence (overactive bladder).** **Overactive bladder (detrusor instability)--\>leak with urge to void immediately. T** **reatment: Kegel exercises, bladder training (timed voiding, distraction or relaxation techniques), antimuscarinics (eg, oxybutynin).**

Answer 390

**HEMOGLOBINURIA** (PEE ALLS THE SUDDEN IS DARK)---bc of hemolysis! note that the **hemolytic type** is much **more severe.** can lead to DIC; its also strats within MINUTES! fast! **intravasc hemolysi**s if ABO blood group incompatibiliut and **extravasc hemolysis** if host ab rxn against foreign ag on donor rbcs

Answer 391

**Progressive multifocal leukoencephalopathy (PML)** reactivation of latent JC virus infection).---POLYOMA virus

Answer 392

a. H and I b. A! c. thin (actin) are LIGHT, thick (myosin) are DARKER d. the M line! e. Z line (darkest line on EM!) f. thin for H, thick for I and A has both think and thick (H band is included inside the A band).

Answer 393

Mycobac Avium Complex look at that low ass CD count it grows in the special temp CLEARRR chest xray it targets the RES system! give AZITHROMYCIN for prophylaxis NOT isoniazid, it wont work!

Answer 394

**ZE!!!!!** just bc it says diarrhea dont get tricked. key is they can happen beyond the duodenum and meds wont help. will do test to see if they are associated with MEN1 (often times are!), so check prolactin and Ca2+) and also so the secretin test

Answer 395

False-positive results on VDRL with: **Vi**ral infection (eg, **EBV, hepatitis)** * *D**rugs * *R**heumatic fever **L**upus and **l**eprosy

Answer 396

Substance P

Answer 397

5-HT3 antagonist; DEC vagal stimulation. Powerful **central-acting antiemetic.** **Ondansetron !!!!! is the "best choice"** ---can also be used for chemo-induced nausea **-metoclopromide (prokinetic)** is more for **Diabetic and postsurgery gastroparesis (5HT4 agonist) and D2 antagonist** and is an *antiemetic* **HIGH doses---** IT INC resting tone, contractility, LES tone, motility. Does not influence colon transport time. ***watch out for EPS sxs*-** **first gen H1 blockers** (diphenhydramine, Meclizine, -Cyclizine) is for **MOTION SICKNESS** (so vesibular nausea)--these cross BBB. also scolpalamine would be wrong for the same reason **dronabinol;** NO! its for ppl on **chemo** with nausea! Pharmaceutical form is **dronabinol** (tetrahydrocannabinol isomer): used as **antiemetic (chemotherapy**) and **appetite stimulant (in AIDS).**

Answer 398

HLA-DR4+ RFs: smoking, silica exposure. * **_⊕ rheumatoid factor_** (**anti-IgG antibody**; more specifically its the M that tarts the G); **IgM antibody that targets *IgG Fc* region); in 80%),** \*note Fc is the region on the antibody that binds Macs and Complement * **anti-cyclic citrullinated peptide antibody-** anti-CCP *(more specific)!* *RF is not diagnostic bc is seen in a bunch of other things too.*

Answer 399

Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol (dose depedent=*anemia* & dose independent *APLASTIC anemia*)-Limited use owing to toxicities but often still used in developing countries because of low cost. Propylthiouracil **C**an’t **M**ake **N**ew **B**lood **C**ells **P**roperly also Radiation, alkylating agents, and antimetabolites

Answer 400

**Teriparatide**

Answer 401

YOU are looking at **ASCARIASIS.** So common. Treat with Mebendazole (WHICH WORKS BY BLOCKING GLUCOSE UPTAKE). gives you Loeffler syndrome Early phase (The early phase coincides with larval tissue-migration. Typically, 4-16 days after egg ingestion.) The main symptoms include the following: **-fever** **-cough** **-wheeze** then later Intestinal infection with possible **obstruction at ileocecal valve** This is FECAL ORAL SPREAD. **pork products**

Answer 402

**HOCM!!!!!** **lv outflow tract obstruction at systole**

Answer 403

ENDODERM---\> thyroid follicular cells NEURAL CREST---\> parafollicular (C) cells of thyroid

Answer 404

**_MOSAICISM_** **"Mosaic Turner Syndrome"** Mosaicism is *also seen in:* Most commonly: **MC CUNE ALBRIGHT SYNDROME** also: in 1% of **Down syndrome** cases

Answer 405

HYPERSENSITIVITY PNEUMONITIS (very much occupational) (FARMERS LUNG) TYPE 3 AND 4 HS RXN - dont need to be a smoker - dont need to have a history of asthma or allergies pt may have **• Recurring atypical pneumonias** The most typical HRCT finding is the presence of profuse, **poorly defined centrilobular micronodules.** The disorder seems to represent a **type IV hypersensitivity reaction**, in which **repeated exposure to antigen** in genetically susceptible people leads to **acute neutrophilic and mononuclear alveolitis,** followed by **interstitial lymphocytic infiltration and granulomatous reaction.** **Fibrosis with bronchiolar obliteration occurs with continued** exposure. **Acute disease** occurs in **previously sensitized people** with acute **high-level antigen exposure** and manifests as **fever, chills, cough, bilateral vice-like chest tightness** (as can occur in asthma), and dyspnea **4 to 8 h after exposure.** Anorexia, nausea, and vomiting may also b e present. Physical examination shows tachypnea, diffuse fine-to-medium inspiratory crackles, and, ***_in almost all cases, absence of wheezing._*** Chronic disease occurs in people with chronic low-level antigen exposure (such as owners of birds) and manifests as onset over months to years of exertional dyspnea, productive cough, fatigue, and weight loss. There are few physical findings; clubbing uncommonly occurs and fever is absent. In advanced cases, pulmonary fibrosis causes symptoms and signs of right heart failure, respiratory failure, or both

Answer 406

**ANGIOSARCOMA (OF LIVER)** DUE TO **CARCINOGENS** **1. VINYL CHLORIDE** **2. ARSENIC** **3. THOROTRAST!** **PE CAM IS EXPRESSED ON VASC ENDOTHELIUM** (BUT ALSO ON THE WBC) DURING **"TRANSMIGRATION OR DIAPEDIS OF WBC THROUGH THE ENDOTHELIUM!!!**

Answer 407

TRH prolactin **INCREASES secretion!** for (eg, in 1° or 2° **hypo**thyroidism) where TRK is increased! also: **Dopamine antagonists** (eg, most **antipsychotics**) and **estrogens** (eg, OCPs, pregnancy) **stimulate prolactin secretion.**

Answer 408

Paradoxical embolsim (**venous** thromboemboli that enter **systemic** arterial circulation), eg: seen in **Patent foramen ovale**—caused by failure of septum **primum** and septum **secundum** to fuse after birth; most are left untreated. if untreated can have this complication.

Answer 409

baby has BETA CELL HYPERPLASIA!!!! MAKES A TON OF INSULIN WHEN ITS BORN, MOM HIGH GLUCOSE NO LONGER BEING TRANSPLACENTALLY TRANSFERRED SO BABY IS PROFOUNDLY HYPOGLYCEMIS AND FAT (MACROSOMIA) NOTE: INSULIN DOESNT CROSS PLACENTA! SO DONT PICK AN ANSWER THAT HAS TO DO WITH INSULIN FROM THE MOM IN THE BABY IN UTERO

Answer 410

Brugada syndrome

Answer 411

**Romiplostim** **eltrombopag**

Answer 412

GRAFT VS HOST DISEASE ## Footnote both are characterized by: **lymphocytic infiltrate + granulomas destruction of intralobular (intrahepatic) bile ducts.**

Answer 413

**Neuroblastoma (children),** **small cell lung cancer (adults)**

Answer 414

a freakin **armadillo**!

Answer 415

**HOMOCYSTINURIA** (MOST COMMON: **CYSTATHIONINE SYNTHASE DEFICIENCY** ---needs **vit B6** (PLP=pyridoxal phosphate is the active form of Vit B6) ALSO: **METHIONINE SYNTHASE DEFICIENCY-**--needs **vit B12**

Answer 416

Pale (anemic) infarcts occur in **solid organs** with a **single (end-arterial) blood supply**, such as **heart, kidney, and spleen.**

Answer 417

1. **Insulin preps** (rapid, short, intermediate and long acting) 2. _Glitazones_ Pio**glitazone** (improves HDL), Rosi**glitazone** **MOA:** Binds to **PPAR-γ nuclear transcription regulator.** 3. _GLP-1 analogs_ * *-Exenatide** - Liraglu**tide** (sc injection) answer to **PS**: *DIDANOSINE (NRTI)* answer to **PSS**: *DPP-4 enzyme* 4. _DPP-4 inhibitors_ Lina**gliptin**, saxa**gliptin**, sita**gliptin** **MOA**: inhibit *DPP-4 enzyme! (the one we just talked about up there!)* 5. α-glucosidase inhibitors Acarbose, miglitol **MOA:** ***delay carb hydrolysis and glucose absorption** by a*cting at the intestinal brush border & **Inhibitig** ***alpha-glucosidases**--\> decreased abs of disaccharides* 6. _Sodium-glucose co-transporter 2_ **_(SGLT-2) inhibitors_** Cana**gliflozin**, dapa**gliflozin,** empa**gliflozin** **MOA:** decrease reabsorption of glucose in PCT--\> promote an osmotic diuresis: **DECREASE:** vL, BP, Phosphate and **INCREASE:** K+, Mg2+, Cr 7. _Sulfonylureas_ **First generation:** chlorprop**amide**, tolbut**amide** **Second generation**: **glip**iz**ide**, **glime**pir**ide**, **gly**bur**ide** **AND** they are called **"Insulin Secretagogues"** _Meglitinides_ Nate**glinide**, repa**glinide** **PS:** both are Contraindicated in renal failure, both INCrease weight and both can cause hypoglycemia 8. _Biguanides_ **Metformin** **MOA: reduces gene expression of gluconeogenic enzymes;** +activates AMPK and decreases insulin resistance and decreases GNG

Answer 418

DILE = **ANTI HISTONE ABS** IN 95% OF CASES of DILE SLE = **ANTI dsDNA abs** in SLE but RARELY in DILE

Answer 419

**Mixed connective tissue disease**

Answer 420

NORMAL CALCEMIC!!!!! **HYPER**CALCI**URIA** **unless pt has sxs of something that inc ca+ in blood** **like Hyperpara, sarcoidosis, hyperacidemia, malignancy they will have NORMAL ca2+ levels in blood!!!!**

Answer 421

Hypertrophic pyloric stenosis

Answer 422

MACROLIDES AZITH CLARITH ERYTH

Answer 423

day 12!!!!

Answer 424

**Caused by parainfuenza viruses (paramyxovirus).** Results in a “seal-like” barking cough and inspiratory stridor. Narrowing of upper trachea and subglottis leads to characteristic **steeple sign** on x-ray . Complication: Severe croup can result in **pulsus paradoxus** (2° to upper airway obstruction)

Answer 425

**Lean body mass** most important factor affecting BMR * *Key factors a ecting BMR** * *(1) Body mass**—the greater the amount of lean body tissue, the higher the BMR **• Lean body tissue** is more metabolically active than fat, so the way to increase BMR to the maximal rate is to make endurance and strength-building activities a daily habit. (**2) Gender—**men’s lean body mass greater than women’s * *(3) Hypothyroidism**—BMR is lower (hypometabolic) * *(4) Hyperthyroidism**—BMR is higher (hypermetabolic)

Answer 426

CAVERNOUS HEMANGIOMA!! BENIGN COMMON AGE 30-50

Answer 427

Wernicke-Korsako syndrome

Answer 428

OSTEOID OSTEOMA (benign bone tumor that arises from **osteoblasts**) HAS A **CENTRAL NIDUS** (Radiographs in osteoid osteoma typically show a round lucency, containing a **dense sclerotic** central nidus (the characteristic lesion in this kind of tumor), surrounded by sclerotic bone. The nidus is seldom larger than 1.5 cm

Answer 429

phenytoin, sulfa drugs, β-lactams,

Answer 430

SPLEEN supplied by celiac trunck---\>splenic artery (foregut structure)

Answer 431

Babesiosis !!!!!! Blood smear: ring form **“Maltese cross”**

Answer 432

native america = RF for CHOLESTEROL TPN = RF for pigment

Answer 433

**Pinealoma** ## Footnote pineal gland sits right above the **SUPERIOR COLLICULI** which is why **PARINAUD syndrome** (which is: paralysis of conjugate vertical gaze due to lesion in superior colliculi (eg, stroke, hydrocephalus, pinealoma).

Answer 434

COCCIDIOIDOMYCOSIS IS A **SPHERULE at 37 degrees in tissue**

Answer 435

tetrology of fallot squatting helps to INCREASE SVR (inc afterload) and helps dec the right--\> left shunt

Answer 436

**SPPARTAS**: **S**epsis, **P**ancreatitis, **P**neumonia, **A**spiration, u**R**emia, **T**rauma, **A**mniotic **F**luid embolism, **S**hock- -\> Endothelial damage increased alveolar capillary permeability--\> protein-rich leakage into alveoli--\> **diffuse alveolar damage (DAD)** and **_noncardiogenic_ pulmonary edema**

Answer 437

premature rupture of membranes

Answer 438

**Lambert-Eaton syndrome** **Arises as a paraneoplastic syndrome,** most commonly due to **small cell carcinoma of the lung (vs MG:** Associated with **thymic hyperplasia or thymoma; thymectomy improves** **symptoms.** **Lambert eaton:** Leads to **impaired acetylcholine release** **1. Firing of *presynaptic calcium channels* is required for acetylcholine release.** **Clinical features** **Proximal muscle weakness that _improves with use;_ *eyes are usually spared (vs MG shows: Ptosis, diplopia)*** **\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*Anticholinesterase agents do not improve symptoms (unlike MG)** **Resolves with resection of the cancer**

Answer 439

**CMV esophagitis!** **Basolphiiic INTRANUCLEAR inclusions** CMV--\> shallow **linear** ulcers if--\> Candida: white pseudomembrane if HSV-1--\> punched-out ulcers

Answer 440

**Bile acid resins** - choestyramine - colestipol - colesevelam since they stop intestinal absorption of bile acids, the liver takes up cholesterol from blood to make more bile acids but in turn also increases hepatic prod of TAGS:(

Answer 441

New epithelial cells are generated in the ***_base of the crypt_*** and migrate and differentiate during their journey along the villus until they are shed at the extrusion zone at the villus tip. mitosis at base of the crypt furthest from the lumen and then the daughter cells migrate up the the tips (villI)

Answer 442

simple cuboidal simple columnar NK stratified squamous epi

Answer 443

**Dialysis-related Amyloidosis**

Answer 444

screen for depression hypothyroidism (TSH) b12 these can present like dementia (PSEUDODEMENTIA)

Answer 445

venous thrombosis!!!! dont be fooled. if you know the pathogenesis you know that the issue is an ACQUIRED mutation in a HEMATOPOEITIC STEM CELL THAT MAKES CELLS FROM ALLLLLLL LINEAGES (RBC, PLTS, WBC (GRANULOCLYTES), THAT LACK THE GPI ANCHORING MOLECULE (BC PIG-A GENE SOMATIC MUTATION) SO DAF (CD55) AND CD59 (MIRL) CANT STOP COMPLEMENT FROM LYSING THESE CELLS BC THEY USUALLY PROTECT THESE CELLS FROM LYSIS PLTS ARE INCLUDED IN THIS BUNCH SO ALL THE LYSED PLTS RELEASE THEIR CYTOPLASMIC GRANULES AND ACTIVATE COAG CASCADE! **VEIN THROMBOSIS!!!!!!**

Answer 446

these conditions can produce INC EP--\> **"innapropriate/pathologic"** ## Footnote **Reactive** **SECONDARY Polycythemia**

Answer 447

**HYPERTROPHY** INC IN in **size of cells.** **HYPERPLASIA**: INC in number of cells. May be a risk factor for future malignancy (eg, endometrial hyperplasia) but not considered premalignant.

Answer 448

**WISKOTT ALDRICH SYND (XR)!!!!** WA**T**ER!!!! **W**iskott-**A**ldrich: **T**hrombocytopenia, bczema, **R**ecurrent infections. \*risk of autoimmune disease and malignancy. **HYPER IGE is: FATED:** coarse Facies, cold (nonin amed) staphylococcal Abscesses, retained primary **T**eeth, IgE, Dermatologic problems (eczema).

Answer 449

IT **INTERFERES WITH _*CLAUDIN AND OCCLUDIN* PROTEINS_** WHICH MAKE OF ***_tight junctions_*** WHICH ARE IN CHARGE OF **ACTING AS A PARACELLULAR BARRIER TO WATER AND SOLUTES** **\*LOOK AT CELL JUNCTIONS SHEET IN IPAD FOR DETAILS**

Answer 450

**Hyper-IgM syndrome** Most commonly due to defective **CD40L on Th cells** **no: IgG,** IgA, IgE. no opsonization! no class switch

Answer 451

Pseudobulbar palsy

Answer 452

ISONIAZID--\> VIt B6 deficiency--\> SIDEROBLASTIC ANEMIA VIt B6 is needed as co factor for 1st of Protoporphyrin synthesis for enzyme ALA synthase--\> no Protoporphyrin--\> iron accumulates, no heme made----\> No Hb made--\> microcytic anemia

Answer 453

NOOOOO!!!!!! you use it for Swish and swallow” for **oral candidiasis (thrush**); topical for **diaper rash (CUTANEOUS CANDIDA!)** or **vaginal candidiasis.** **not skin fungi like dermatophytes (you use**

Answer 454

**platelts and fibrin!!!!!!!!!!!!!** tells you it fomed **BEFORE DEATH (its a pre-mortem)** thrombus.

Answer 455

Prostaglandins produced by the intrauterine tissues of both mother and fetus (myometrium, decidua, placenta, chorion, and amnion) are involved with all of the physiologies of parturition (membrane rupture, cervical dilatation, myometrial contractility, placental separation, and uterine involution). For parturition to occur, however, the intrauterine tissues need to first be activated to prepare for the work of labor, then stimulated to initiate labor. Prostaglandins normally are considered to be stimulators of the physiologies of labor. This review presents evidence that one prostaglandin, PGF2alpha, and its receptor, FP, are also activators, especially of the decidua. Stimulated by cytokines, the decidual synthesis of PGF2alpha and the expression of FP lead to increased matrix metalloproteinase activity, further enhancement of cytokine activity, increased decidual oxytocin and oxytocin receptor expression, decreased progesterone responsiveness, and possibly, enhanced expression of vascular endothelial growth factor. These collective actions prepare the decidua for its role in parturition.

Answer 456

**Polycythemia vera (main one)** **can be seen in: Essential thrombocythemia too**

Answer 457

PULMONARY EFFUSION but a **HEMORRHAGIC (BLOOOOD!!!!)** **exudative** (not transudative) **UNILATERAL** usually **large** **PULMONARY EFFUSION** (on x ray, the two sides of the diaphragm will NOT BE EVEN bc of the fluid) and on CT there will be GRAY amonst the BLACK which is AIR (should be all AIR!) **Bonus: PSAMMOMA BODY!**

Answer 458

**AUTOANTIBODIES to *PRE*-synaptic _Ca2+ CHANNEL_-**--\> **decreased Ach release!**

Answer 459

K is the only freakin ion found OUTSIDE in the extracellular space bc ATPase doesnt work so it leaks out NA+, Ca2+, H2O, Hco3-, Cl- all come INTO THE CELL CYTOPLASM

Answer 460

because divalent cations inhibit drugs’ absorption in the gut.

Answer 461

normal PCWP!!!!!!!!!!!!!!!!!!!!!!!!

Answer 462

this is **Sarcoidosis** and the ratio is **CD4:CD8 \>2:1!!!!** **so more CD4+T cells!!!!!!!!!!!!!**

Answer 463

**Pneumatosis intestinalis** (also called intestinal pneumatosis) is gas cysts in the bowel wall. As a radiological sign, **In newborns, pneumatosis intestinalis is considered diagnostic for _necrotizing enterocolitis!!!!!!!!!!!!!!!!!!!!!_** This is in contrast to gas in the intestinal lumen (which is relieved by flatulence). **In newborns, pneumatosis intestinalis is considered diagnostic for necrotizing enterocolitis,** and the air is produced by bacteria in the bowel wall.

Answer 464

**generalized Diffuse. *_loss of consciousness (unresponsive)..both hemis all ove brain._* _unlike_** _partial/focal ones that only affect ONE part/area of your brain_ **Types:** ** Absence (petit mal)**—**3 Hz, *no postictal*** ***confusion*, blank stare** **Myoclonic**—quick, repetitive jerks **Tonic-clonic (grand mal)—**alternating stiffening and movement (jerky) **Tonic**—stiffening **Atonic**—“drop” seizures (falls to floor); commonly mistaken for fainting; floppy

Answer 465

hepatoxic **Zileuton**

Answer 466

JUST THE (superficial) **DERMIS**!!!!!! igE mediated degranulation of mast cells and basophils--\> INCREASED PERMEABILITY OF MICROVASCULATURE AND **EDEMA OF THE SUPERFICIAL DERMIS!!!!!!!** NOTE!!! if the subcut or deeper dermis **is affected this is ANGIOEDEMA**

Answer 467

Nitrites (eg, from dietary intake or polluted/high altitude H2O) and benzocaine cause poisoning by oxidizing Fe2+ to Fe3+.

Answer 468

Subacute granulomatous thyroiditis (de Quervain)

Answer 469

Clostridium BOTULIN motile obligate anaroebe

Answer 470

NURSEMAIDS ELBOW EFFED UP THE RADIAL HEAD VIA SUBLUXATION AND THEN THE ANNULAR LIGAMENT TEARS OFF AND UP TO GET STUCK IN BETWEEN WHERE THE PIC SHOWS \*not common after age 5 bc the ligament gets tougher and more stable

Answer 471

Can ***_enhance_*** anticoagulant effects of warfarin.

Answer 472

Heritable PAH (Pulmonary arterial hypertension )

Answer 473

on immature LYMPHOCYTES so PRE-t and PRE-b cells NOT mature lymphocytes and NOT on myeloid cells so its positive in **ALL (b-all & t-all)**

Answer 474

diagnosis: **Polymyositis, dermatomyositis** **Anti-Jo-1 = aka: Antihistidyl-tRNA synthase** **two complications=** **1. myocarditis** **2. interstitial lung disesae**

Answer 475

1. hydrocele 2. Hypospadias 3. Epispadias 4. Bifid scrotum

Answer 476

anti M's SCOLPAL**AMINE** HYOSCY**AMINE** DICYCLO**MINE** **NOT PILOCARPINE! (thats a M agonist!)** **and its nice bc these M blockers listed above dont interfere with the NMJ where pyridostig is working bc there they have NIcotinic not muscarinic receptors! yay**

Answer 477

**Phosphodiesterase III inhibitor-**-\> **inc cAMP** in platelets, resulting in **inhibition of platelet aggregation** *(PDE in endothelium usuall breaks down cAMP which is needed for vasodilation)* **and** is a **direct arterial vasodilator** **Used for: Intermittent claudication, coronary vasodilation, prevention of stroke or TIAs (combined with aspirin), angina prophylaxis.**

Answer 478

hereditary spherocytosis **SPLENECTOMY!!!** Spherocytes, no central pallor. (note: splenectomy is NOT indicate thal major and Fetal HbF is protective til 6months so no anemia til then and **target cells** are seen with **anisopoikilocytosis**

Answer 479

**Pseudo–Pelger-Huet anomaly**—neutrophils with bilobed nuclei. Typically seen after chemotherapy. **associated with: Myelodysplastic syndromes**

Answer 480

NATURAL KILLER CELLS and they target VIRALLY infected cells and tumor cells!

Answer 481

Sinus venosus Sinus venarum Coronary sinus

Answer 482

**Displacement**: angry recently divorced dad *takes ange*r out on innocent kids vs **Projection**: Husband who is cheating or wants to cheat blames his wife of cheating

Answer 483

**ERV is DECREASED greatly** ## Footnote if we say that **Expiratory reserve volume** is the Air that _can still be breathed out after normal expiration_ _and_ **RV + ERV= FRC** **then a dec in ERV--\> a decrease in FRC bc** **Functional residual capacity** is the Volume of gas in lungs after normal expiration; includes RV, *cannot be measured on spirometry*

Answer 484

CD14!!!!!!! aka: TLR-4! LPS of gram -ve bacteria! (thymus independent) Endotoxins/LPS DIRECTLY stimulate macrophages by binding to their exotoxin receptor. NO T helper cell involved \*\*\*UNLIKE SUPERANTIGEN MOA\*\*\*

Answer 485

Hepatotoxicity **(halothane)** nephrotoxicity **(methoxy urane)** proconvulsant (**enflurane),** expansion of trapped gas in a body cavity **(N2O)**.

Answer 486

**Serotonin syndrome was described** **antidote= cyproheptadine (5-HT2 receptor antagonist).** Neuroleptic malignant syndrome (NMS)— **RIGIDITY!!!!!, myoglobinuria,** autonomic instability, hyperpyrexia. antidote= **dantrolene**, D2 agonists (eg, **bromocriptine)**.

Answer 487

**Nelson syndrome**

Answer 488

**urgency** is **NO ORGAN DAMAGE** sxs with a **BP \>180-120** **Emergency** severe **HTN (eg: 225/115)** **with END ORGAN DAMAGE** (eg: pappiledema, pulmonary edema, aortic dissection, AKI (elevated Cr--Fenoldopam real food for this), encephalopathy (no focal sxs but confusion), Acute coronary syndrome

Answer 489

(VIRULENT) **MYCOBACTERIUM TB** not found in avirulent strains Cord factor presence increases the production of the cytokines interleukin-12 (IL-12), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor (TNFα), which are all pro-inflammatory cytokines important for granuloma formation. IL-12 is particularly important in the defense against M. tuberculosis; without it, M. tuberculosis spreads unhampered.[30][31] IL-12 triggers production of more cytokines through T cells and natural killer (NK) cells, while also leading to mature Th1 cells, and thus leading to immunity.[32] Then, with IL-12 available, Th1 cells and NK cells produce interferon gamma (IFN-γ) molecules and subsequently release them.[33] The IFN-γ molecules in turn activate macrophages.[34] When macrophages are activated by cord factor, they can arrange into granulomas around M. tuberculosiscells.[13][35] Activated macrophages and neutrophils also cause an increase in vascular endothelial growth factor (VEGF), which is important for angiogenesis, a step in granuloma formation

Answer 490

**Malignant hyperthermia**—rare, life-threatening condition in which inhaled anesthetics or succinylcholine induce fever and severe muscle contractions. Treatment: **dantrolene,** a **ryanodine receptor antagonist.**

Answer 491

**Furosemide** **bumetanide** **torsemide** **Ototoxicity,** **Hypokalemia,** **Dehydration,** **Allergy (sulfa)/metabolic Alkalosis,** **Nephritis (*interstitial)*,** **Gout.**

Answer 492

ATP7B gene; chromosome 13 = **Wilson disease (hepatolenticular degeneration)** C282Y chromosome 6 = **Hemochromatosis**

Answer 493

**Vitamin B1 (thiamine) used in the cofactor _Thiamine pyrophosphate (TPP)._**

Answer 494

The substances vinblastine and vincristine extracted from the plant are used in the treatment of leukemia [16] and Hodgkin's lymphoma. so a person on chemo who has BM suppressio should not take it!

Answer 495

MYOGLOBIN!!! these have SUPER high affinity for O2 (UNLIKE FETAL Hb) and therefore, cannot unload O2. this is very bad

Answer 496

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Answer 497

**Pulmonary arterial hypertension** [idiopathic or heritable-inactivating mutation in BMPR2 gene] **Left heart disease** [systolic/diastolic dysfunction and valvular disease (eg, mitral lung).] **Lung diseases or hypoxia** [Destruction of lung parenchyma (eg, COPD), hypoxemic vasoconstriction (eg, obstructive sleep apnea, living in high altitude).] **Chronic thromboembolic** [Recurrent microthrombi--\> cross-sectional area of pulmonary vascular bed] **Multifactorial** [Causes include hematologic, systemic, and metabolic disorders.]

Answer 498

Fibromyalgia!!!

Answer 499

they possess a HYDROPHOBIC N TERMINAL PEPTIDE SEQUENCE THAT IDENTIFIES THEM AS SUCH---if these sequences are removed, protein will accumulate in the CYTOSOL

Answer 500

A **PGE1 analog**. INC production and secretion of gastric mucous barrier, DEC acid production. Prevention of NSAID-induced peptic ulcers (NSAIDs block PGE1 production); maintenance of a PDA. Also used off-label for induction of labor (ripens cervix).

Answer 501

**MESOTHELIOMA!!!!!** **fun fact: smoking is NOT A RISK FACTOR FOR IT!!!!!** **but asbestos is!!!!!!!!!!!!!!!!!!!!!**

Answer 502

Macrovesicular fatty change-**_Hepatic steatosis_** Swollen and necrotic hepatocytes with neutrophilic in ltration. **Mallory bodies** (intracytoplasmic eosinophilic inclusions of damaged keratin laments).-**_Alcoholic hepatitis_** Micronodular, irregularly shrunken liver with “hobnail” appearance. Sclerosis around central vein (zone III).-**_Alcoholic cirrhosis_** Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis-**Budd Chiari** Panlobular ***_microvesicular_*** steatosis (no necrosis or inflammation!); on EM, the number of mitonchondria are reduced too-**Reye Syndrome** Fatty in ltration of hepatocytes A cellular “ballooning” and eventual necrosis-**Non-alcoholic fatty liver disease**

Answer 503

Familial **hypocalciuric hypercalcemia** * **Defective Ca2+-sensing receptor** (CaSR) in multiple tissues (eg, **parathyroids, kidneys**). * Higher than normal Ca2+ levels *required* to suppress PTH. * Excessive renal Ca2+ reuptake mild hypercalcemia and **hypo**calci*uria* with *normal to PTH levels.* * do not confuse with pseudohypoparathyroidism* * which is called pseudo bc PTH is actually High (this is a type of seconary hyperparathyroidism)...but the body is acting as thougth there is low pth which is why it has this name.* * importanttly (the type 1) thats called albright hereditary osteodystrophy (is only gotten from MATERNAL imprinting)...this gene mutation in the mom affects the kidney so her kids will have end organ PTH resistnace and present the HYpocal, (due to the Hyperphos) and inc PTH (since body thinks it has low PTH) + phenotypic features* * BUT the dad will only pass on the Phenotypic exam exams features like shorted 4th/5th digits, intell disabilyt, short stature BUT his kids kidneys are ok so lab values are fine*

Answer 504

**VEmuRAFenib** Small molecule inhibitor of **BRAF oncogene ⊕ melanoma.** **VE**mu**RA**F-enib is for **V**600E- mutated B**RAF** inhibition.

Answer 505

**Foveolar cells or surface mucous cells** are mucus-producing cells which cover the inside of the stomach, protecting it from the corrosive nature of gastric acid.These cells line the gastric mucosa (mucous neck cells are found in the necks of the gastric pits). The mucus-secreting cells of the stomach can be distinguished histologically from the intestinal goblet cells, another type of mucus-secreting cell.

Answer 506

**Extrahepatic** biliary obstruction (gallstones, biliary strictures, pancreatic carcinoma). )--\> INC pressure in **intrahepatic ducts injury/ fibrosis and bile stasis** May be complicated by **ascending cholangitis.**

Answer 507

**HYPO** Mg2+ **HYPO** K+ reflects increased DIstal tubule permeability ***_Distal renal tubular acidosis (type 1)_*** Defect in ability of **α intercalated cells to secrete H+** **--- inc PH of urine (unique feature) + hypokalemia**

Answer 508

**Methylene Tetrahydrofolate Reductase (MTHFR)** **-uses FAD as a cofactor** **-homocystein----remethylated----\> *Methionine*** *note: [remethylation occurs with the donation of a methyl group from MTHFR via Methionine Synthase) with vit b12 (cobalmin as the cofactor)*

Answer 509

**Toll-like receptors (TLRs)**: are pattern recognition receptors **ON APCs** (mac, dendridic cells, etc) that recognize pathogen-associated molecular patterns **(PAMPs)** on **Ag/invader/offending agent**! Examples of PAMPs include 1. **LPS** in (gram ⊝ bacteria) 2. **Flagellin** in (bacteria) 3. **N****ucleic Acids** in (viruses).

Answer 510

**AORTIC DISSECTION!!!!!!!!!!** due to long standing UNCONTROLLED HTN seen in MARFANS too bicuspid aoritc valve (inherited)

Answer 511

**Parkinsons** **Lewy bodies** (composed of **α-synuclein**—intracellular **eosinophilic inclusions** **Alzheimer disease** Neuro brillary tangles/ intracellular**, hyperphosphorylated tau protein** = i*nsoluble cytoskeletal elements*; number of tangles correlates with degree of dementia. (look like tears)

Answer 512

**gigantism** [vs. acromegaly in adults] **most common COD= HF!!!**

Answer 513

**Marijuana (cannabinoid)** _***\*Dronabinol\****_ Pharmaceutical form is dronabinol (tetrahydrocannabinol isomer)=**therapeutic THC** **used as antiemetic (chemotherapy)** **appetite stimulant** (in ***AIDS)** & **chemo & anorexia***

Answer 514

Hartnup disease presents like: * Diarrhea, * Dementia (also hallucinations) * Dermatitis (C3/C4 dermatome circumferential “broad collar” rash [Casal necklace], hyperpigmentation of sun- exposed limbs

Answer 515

this is **NE extravasation** (causes a1 receptor mediated vasoconstriction & tissue necrosis) **TREAT: PHENTOLAMINE** an a1 blocker B2 + like Isoproterenol can vasodilate also BUT there are alot more a1 receptors SUBCUTANEOUSLY. vs. B2 are more in striated muscle, renal, and mesenteric vasc beds so they dec PVR and inc CO

Answer 516

first off: **Livedo reticularis** is a common skin finding consisting of a **mottled** reticulated vascular pattern that appears as a **lace-like purplish discoloration** of the skin. The discoloration is caused by swelling of the venules owing to obstruction of capillaries by small blood **clots.** this is suspect of **ATHERO-EMBOLIC DISEASE** (THINK ABOUT THE NAME) -during that invasive procedure like aortic catheritizatoin, **CHOLESTEROL containing debris can DISLODGE** and **travel to smaller vessels where they block the area and cause ischemia to that tissue** which presents a few days to weeks post surgery as: ***_MOST COMMONLY:_*** acute kidney injury!!!! (oliguria and azotemia)----THE PATIENT **WOULD NOT** HAVE A FRANK INFARCTION WITH HEMATURIA AND FLANK PAIN AND THE WHOLE SHABANG BC CHOLESTEROL **EMBOLI ARE WITTLE.** ON HISTO (if in the kidney) you could see **needle shaped cholesterol clefts** that **partially or completely obstruct the arcuate or intralobular renal arteries** other organs that can be involved are: GI, CNS (like retina vessels)

Answer 517

**CHRONIC INTERSTITIAL NEPHRITIS!** "analgesic nephropathy" nsaid damage tubules directily after a while through uncoupling oxid phos and by decreased PG synth causing constriction of medullary vasa recta and subs pap necrosis i got tricked on this bc i didnt see eosinophila and thought of "acute interstitial nephritis" also note that if you look at BUN: C its less than 15 telling you an INTRArenal issue (like a TUBULAR issue) bc cant absorb proper amt of urea (ration is supposed to be 15)

Answer 518

2. **Essential fatty acids** b. Functions of **linolenic acid (ω-3)** and **linoleic acid (ω-6)** **(1) Important in the synthesis of eicosanoids (** **• Eicosanoids are important in muscle contraction/relaxation, blood vessel constriction/relaxation, blood clot formation, blood lipid regulation, and immune response to injury and infection, including fever, in ammation, and pain.**

Answer 519

Guaifenesin

Answer 520

decreased estrogen **INCREASE in FSH**!!!! is DIAGNOSTIC!!!!!!!

Answer 521

**Locus heterogeneity** ## Footnote **1.** **Albinism.** **2.** **Osteogenesis Imperfecta** (eg: 2 genes on chr, 17 and 1 gene on chr. 7---\> both lead to OI type 2 that are indistinguishinable from one another despite coming from idff loci. same phenotype, diff loci. **3. Ehlers Danlos** **4. Tuberous Sclerosis** **5. Retinitis Pigmentosa**

Answer 522

CT PULMONARY ANGIOGRAPHY LOOKING FOR FILLING DEFECTS

Answer 523

just the pns bc in the CNS the buildup and persistnace of myelin debris (mac cant cross BBB so quicly or easily), secretion of inhibitory neuronal factors and dev of dense glial scar both by astrocytes DONT allow regeneration!

Answer 524

GABA (inhibitory) is **INCREASED** (too much!) Glutamate (excitatory) is **DECREASED** (not enough!) know that ***_GI bleeding (alchoholic comes in with GI bleed; eg: vomiting bright red blood)_*** is a huge one that **INCREASED the LOAD OF NITROGENOUS** substances (in the form of Hb that is then convereted to ammonia) and absorbed by the gut and thats bad!!!! know the other RFs too!

Answer 525

HIGH! IGF-1 is made by liver and promotes growth Glucose is SUPPOSED to SUPPRESS GH (somatotropin) so if you give Glucose and GH doesnt decreaes then ACROMEGALY

Answer 526

**Pegloticase:** metabolism of uric acid to **allantoin** (a more water-soluble product). **Probenecid**: **Inhibits reabsorption of uric acid in proximal convoluted tubule** (also inhibits secretion of penicillin). AE: *Can precipitate uric acid calculi.*

Answer 527

**Frontotemporal dementia** ## Footnote **SEEN IN HISTO:** severe atrophy, neuronal loss, gliosis (severely atrophic, sometimes paper-thin gyri in the temporal and frontal lobes) and presence of abnormal neurons (Pick cells) containing inclusions (Pick bodies= Inclusions of hyperphosphorylated tau (round Pick bodies ) FTD **affects personality, behavior, and usually language function (syntax and fluency) while memory is in tact and impaired in** *Alzheimer's disease rather*

Answer 528

**iron def anemia**

Answer 529

**ALL!!!!!!!!!!!!!! B-ALL specifically!!!** bc CD10+ve!!!! Peripheral blood and bone marrow have SUPER INCREASED lymphoblasts **TdT+** (marker of pre-T and pre-B cells), **CD10+** (marker of pre-B cells).

Answer 530

**1. Calcium phosphate** **2. ammonium mg phosphate-**--**STRUVITE-**--(from urease +ve bugs) **3. Ca2+ oxalate too** bc a DEC ph lead to less citrate in pee and WE NEED CITRATE to buffer Ca2+ in pee. so this needs an **Inc PH as well.** note **PHOSPHATE is involved and ca2+ as well**

Answer 531

**AORTIC REGURG**

Answer 532

• Component of **glutathione peroxidase**, which produces reduced glutathione, an antioxidant that converts hydrogen peroxide to water

Answer 533

**RECTUS abdominus** is the main muscle used in **VALSALVA** can give **ADENOSINE (dec the rate of diastolic depol and decreased HR)**

Answer 534

Actinic keratoses usually **pink or red, poorly marginated, and scaly** on palpation, although some are **light gray or pigmented, giving them a brown appearance.** They **should be differentiated** from seborrheic keratoses which increase in number and size with aging. Seborrheic keratoses tend to appear **waxy and stuck-on** but can often take on an appearance similar to actinic keratoses. Unlike actinic keratoses, ***_seborrheic keratoses also occur on non-sun-exposed areas of the body and are not premalignant. =very different from_*** **Actinic keratoses !!!!!!!!!!**

Answer 535

**B-THALASSEMIA** (also can be due to a mutation in the promoter region) **FRAMESHIFT MUTATIONS!**

Answer 536

**Polymyalgia rheumatica**

Answer 537

Rett syndrome

Answer 538

**Methemoglobinemia**

Answer 539

freaking gram -ves! especially **PSEUDOMONAS!!!!!** it gives you **ecthyma gangrenosum!!!!** (which looks like DIC kinda but lab values dont match!) you will be give leukocute count of like 800 \*real low\* and then told its 60% neutrophils so neutrophils are 480 total and thats less than 500 and thats real low burn pts, NEUTROPENICS, indwelling catheterrs. hospitalized are very susceptible

Answer 540

**Paracoccidioidomycosis** **Cryptococcus** **Coccidioidomycosis**

Answer 541

**GLUCOKINASE!!!!!!!!** pts has **MODY** (maturity onset diab of the young)-**inherited** \*\*\*\*this is **easily controlled with dietary mids!** basically glucokinase is **ONLY in liver and PANCREAS** and has low aff low glucose. so when glucose is high, glucose (**via GLUT 2)** transporter it (glucokinase) catalyzes the first step in GLYCOLYSIS--\> kreb--\> ATP--\> causes K channel to close so no more K comes into cell (causes depol) --\> Ca2+ comes into cell---\> **exoctyosis of INSULIN.** **so if not glucokinase, this does not occur in the panc beta cells--\> hyperglycemia** note: in the liver, **glucokinase** works to help activae glycogen synthesis (so it has diff roles in panc and liver).

Answer 542

**(PGF2a )** **Latanoprost** **Bimatoprost,** **AE: Darkens color of iris (browning), eyelash growth**

Answer 543

INC risk of 1. **colorectal polyps** 2. **GI cancer**

Answer 544

Enzymatic digestion of carbohydrates (CHOs) a. **Digestion begins in the mouth.** (1) **Amylase** from the salivary glands breaks down **polysaccharides** (e.g., starch) into **disaccharides** (lactose, maltose, sucrose). (2) In **Sjögren syndrome**, the salivary glands are destroyed and **amylase is not available to digest polysaccharides.**

Answer 545

Smooth muscle Calmodulin

Answer 546

**Toxo**= **MULTIPLE** *ring-enhancing l*esions on MRI **EBV= CNS lymphoma**—*ring enhancing****,* may be SOLITARY** *_vs Toxoplasma)_* JC reactivation= **(PML)= NON ENHANCING areas of *demyelination* on MRI** on imaging?

Answer 547

Ataxia-telangiectasia Defects in ATM gene failure to repair DNA double strand breaks cell cycle arrest. Triad: 1. cerebellar defects-PURKINJE cells layer--\> (Ataxia), 2. spider Angiomas in the EYE (telangiectasia), 3. IgA defciency (DEcrease in Ig, A, G E)

Answer 548

on pap smear, a cluster of basophilic thin filaments that reemble COTTON CANDY can be an incidental finding in pts with\_**\_IUDs**\_\_\_ **actinomyces like organisms**

Answer 549

A & E are non env and hence are NOT destroyed in the gut

Answer 550

you are testing for lung maturity and presence of SURFACTANT causes the ring of foam \*additionally you can do - surfactant to albumin ratio - slide agglutination for phosphatidylglycerol - and the common lecithin: spingomyelin ratio

Answer 551

**Epinephrine!!!!!!!!!**

Answer 552

DNA pol I !!!!!!!!!! dna pol III only has 3'---\>5' exonuclease activity and cannot remove RNA primers so it needs DNA pol I in its life.

Answer 553

CORNEA!!!!!!!!!!!

Answer 554

Arises via two distinct pathways **Flat-**develops as a **high-grade flat tumo**r and then **invades;** associated with **early p53 mutations (damn aggresive)** **Papillary-**develops as a **low-grade** papillary tumor that progresses to a **high- grade** papillary tumor and **then invades**; *NOT associated with early p53 mutations*

Answer 555

* **BosENtan:** Competitively **antagonizes ENdothelin-1** receptors--\> DEC. pulmonary vascular resistance. * **Sildenafil:** **Inhibits cGMP PDE-5** and **prolongs vasodilatory effect of nitric oxide.** * **Epoprostenol, iloprost: PGI2 (prostacyclin)** with **direct vasodilatory** effects on pulmonary and systemic arterial vascular beds. **Inhibits platelet aggregation.** **they work bc pulm vasoconstriction thought to be due in part to** **1.** enhanced activity of **thromboxane and endothelin-1 (both vasoconstrictors)** **and** **2.** reduced activity **of prostacyclin and nitric oxide (both vasodilators).**

Answer 556

since pts with COPD have a dec sensitivity to or a blunted response to pCO2 (unlike normal individuals whose central chemoreceptors response to even small increases in pCO2), the pts with COPD respond to O2 so its their PERIPHERAL chemo receptors that drive their respiratory changes. not PCo2 like healthy people. the q had asked what was the cause of the pts respiratory rate DECreasing after receiving supplemental o2

Answer 557

**Creutzfeldt-Jakob disease** ## Footnote Spongiform cortex. Prions (PrPc PrPsc sheet [β-pleated sheet **resistant to proteases**]).

Answer 558

Blocks peptidyltransferase at 50S ribosomal subunit. Bacteriostatic. (BLOCKS FORAMTION OF A **PEPTIDE BOND)** -used in developing nations bc too high risk of aplastic anemia, etc (but its also cheap so good for dev. nations) **USED TO TREAT: Meningitis (Haemophilus in uenzae, Neisseria meningitidis, Streptococcus pneumoniae) and Rocky Mountain spotted fever (Rickettsia rickettsii).** **Ae: Anemia (dose dependent), aplastic anemia (dose independent), gray baby syndrome (in premature infants because they lack liver UDP-glucuronyl transferase).**

Answer 559

NOOO!!! THEY GENERALLY AFFECT CELL WALL SYNTHESIS DAPTO creates a transmembrane channel and inserts its lipid tail into the membrane and causes depol vanco actually effs up the wall with blocking d ala d ala bacitracin is only topical and prevents phosphorylaiton adn mucopolypeptide transfer into cell wall thus disrpition CELL WALL synth NOTTTT crosslinking (beta lactams do that)

Answer 560

**LOW!!!** **low c3 and c4** **THEY HAVE ORAL OR NASAL ULCERS** antibodies agains self antigens lead to immune complexes forming and depositing in tissues and causing coplement activation

Answer 561

osteoblastic aka: SCLEROTIC: due to osteoBLAST stim= more indolent course seen in prostate cancer (african american men at highest risk) osteolytic: LUCENT: due to osteoCLAST stim= more aggressive

Answer 562

Just a mild deficiency leads to **GLOSSITIS** Severe deficiency leads to **PELLAGRA** which can be caused by 1. **Hartnup disease** 2. **Malignant carcinoid syndrome** ( tryptophan metabolism to make serotonin depletes tryptophan so then you cant make Niacin 3. **Isoniazid** (vitamin B6). * Symptoms of pellagra: **Diarrhea, Dementia** (also hallucinations), **Dermatitis** (C3/C4 dermatome circumferential “broad collar” rash [Casal necklace], hyperpigmentation of sun- exposed limbs

Answer 563

**PENICILLAMINE!!!!!!!!!!** dont choose De**fe**roxamine! look at that **FE** in the middle of the name and think of **Fe2+ IRON which is what its an antidote for!!!!**

Answer 564

NOT CREATININE!!!!!! (even if you were thinking it bc of the myopathy, if you check creatinine you are looking at RENAL fx and statins are NOT associated with renal AE!!) BUT it IS associated with **HEPATOXICITY SO YOU NEED TO CHECK LIVER TRANSAMINASES!!!!!!**

Answer 565

what effect do **HIGH dose salicylates** and **Probencid** share in common as it relates to URIC ACID--\> Uric acid **stop** tubular **reabsorption** and **increase EXCRETION** what effect do **LOW dose salicylates** and **DIURETICS** (loop diuretics) share in common as it relates to URIC ACID?--\> **block urinary excretion of Uric acid = bad** **^^^this is why Aspirin is CI in GOUT**

Answer 566

needs to last at least **2 whole years!** its a milder form of biopolar that fluctuates btw mild depression and hypomanic symptoms

Answer 567

Activated by colonic bacteria. **Sulfasalazine** A combination of **sulfapyridine** (antibacterial) and **5-aminosalicylic acid** (anti-in ammatory). !!!!

Answer 568

**s4!!!!!!!!!!!!!!!!!!!**! in **late diastole** (“**atrial kick”**). Best heard at apex with patient in left lateral decubitus position. **High atrial pressure**. **Associated with ventricular noncompliance (eg, hypertrophy)**. \*\*\*Left atrium must push against stiff LV wall. Consider abnormal, regardless of patient age. **heard in: Hypertrophic cardiomyopathy, Concentric Ventricular HTN (eg: from Aortic Stenosis), HTN, Mitral stenosis, Restrictive CM**

Answer 569

**Ethacrynic acid**

Answer 570

Early lesion is mitral valve **regurgitation;** late lesion is mitral **stenosis.**

Answer 571

## Footnote **Purified nucleic acids of most dsDNA (except poxviruses and HBV) and** **⊕ strand ssRNA (which basically ≈ mRNA) viruses *_are infectious._*** **Naked nucleic acids of** **⊝ strand ssRNA and dsRNA viruses are *_not infectious_*.** **They require polymerases contained in the complete virion. eg: RNA dep RNA pol** **\*NOTE RETRO has a RNA dep DNA pol (reverse transcriptase)**

Answer 572

**BIPOLAR staining; safetly pin, zoonotic, grame -VE coccobaciili. fac intracellular, F1 capsular antigen!!!!** Three mammals fall prey to Yersinia pestis: **wild ro- dents**, domestic city **rodents**, and **human**s. The bacteria reside in the **wild rodent p**opulation between epidemics and are carried from rodent to rodent by the flea. When wild rodents come into contact with domestic city rats (during droughts when wild rodents forage for food), **fleas** can then carry the bacteria to domestic rats. As the domestic rat population dies, the fleas become hungry and search out humans. **During interepidemic periods (we are in one now),** bubonic plague **may be contracted during camping, hunting or hiking.** The human victim either t**ouches a dead infected rodent or is bitten by an infected flea.** The bacteria **invade the skin and are gobbled up by macrophages.** They continue to **reproduce intracellu- larly and within a week move to the nearest lymph nodes**, usually the **ONE SIDED INGUINAL NODES** ***_boubon is the Greek word for "groin")_***. The nodes swell like eggs and become **hot, red, and painful**. **Fever and headache** set in. The bacilli **invade the bloodstream, liver, lungs, and other** **organs**. Hemorrhages under the skin cause a **blackish discoloration**, leading people to call bubonic plague the "**Black Death."**

Answer 573

NIMODIPINE fill in

Answer 574

**Autosomal dominant hyper-IgE syndrome (Job syndrome)** **FATED:** coarse **F**acies, cold (noninflamed) staphylococcal **A**bscesses**!!!!!!\*\*\*\*\*\*** retained primary **T**eeth, INC Ig**E (blood eosinophilia)** **D**ermatologic problems *(eczema).* ***INC** IgE; **DEC** IFN-γ.* *pathogen: reason for high IGN is that theres **LOW Th1** (**pms do not respond to chemostaxis!!)** --\> **LOW IFN**--\> **NOT INHIBITION ON TH2-**-\> il4 wins--\> lots of class switching to i**gE.***

Answer 575

**Beckwith-Wiedemann!**

Answer 576

Total calorie malnutrition (no carbs no protein) resulting in emaciation (tissue and **muscle wasting,** loss of subcutaneous fat); +/– edema. **-anemia** **-dec cell med imm** **\*\*no edema, no ascites, no big belly!** **-NOT** Apathy, listlessness, poor appetite---\> GREAT PROGNOSIS! (2) **Loss of subcutaneous fat** • Due to a **decrease in leptin** stores in the adipose, which stimulates the hypothalamic-pituitary axis to **release cortisol, a lipolytic agent**

Answer 577

**LEGIONELLLLLLAAAA** **LEGIONAIRRES DISEASE** (ATYPICAL PMN + HIGH FEVER+ GI + NEURO SXS) STAIN WITH: **BCYE + IRON AND CYSTEINE** (USE **SILVER STAIN**!) **GRAM STAINS POORLY!**

Answer 578

Hypophosphatemic rickets Fragile X syndrome Alport syndrome Rett Syndrome

Answer 579

Gram ⊕ cocci. Enterococci (E faecalis and E faecium) are normal colonic ora that are penicillin G resistant and cause UTI, biliary tract infections, and subacute endocarditis (following GI/GU procedures). Catalase ⊝, PYR ⊕, variable hemolysis. VRE (vancomycin-resistant enterococci) are an important cause of nosocomial infection.

Answer 580

foreign body aspiration.

Answer 581

**RUBELLA** (TOGA) presents with P**OST AURICULAR TENDER LAD!!!!!!** *BUT NOTTTTT RUBEOLOA* **[BOTH** START AT FACE WITH MACPAP RASH AND SPREAD TO TRUCK + EXTREMETIES!]\ TOGA---\> **CONGENITAL RUBELLA** (BLUBERRY MUFFIN BABY DUE TO DERMAL EXTRAMEDULLARY HEMATOPOIESIS) **PARAMYXO** HAS **F PROTEIN** THAT FORMS MULTINUCLEATED GIANT CELLS AND CAUSES PARAINFLUENZA (CROUP), MUMPS, RSV (causes resp tract infection in infacs (bronchiolitis, pmn)-----GIVE **PALVIZUMAB** *(MONOCOLONAL AB AGAINST F PROTEIN*) TO PREVENT PMN CAUSES BY RSV INFECTION IN PREMATURE BABIES

Answer 582

2. Digestion of **protein** a. Digestion begins in the s**tomach** (pepsin and acid) (1) Hydrochloric acid (HCl) cleaves pepsinogen into pepsin. (a) HCl is synthesized by parietal cells. (b) **If acid** is absent (e.g., **chronic atrophic gastritis**), protein cannot be digested.

Answer 583

Drug-induced long QT **(ABCDE)**: Anti**A**rrhythmics (class **IA, III**) Anti**B**iotics (eg, **macrolides**) Anti“**C**”ychotics (eg, **haloperidol**) Anti**D**epressants (eg, **TCAs**) Anti**E**metics (eg, **ondansetron**) **Ranolazine** (used to treat Angina refractory to other meds)

Answer 584

**B! IMPAIRED CLOTTING FACTOR CARBOXYLATION!**! BABY HAS IMMATURE GUT MOMS VIT K DOESNT CROSS PLACENTA AND IS BARELY IN BREAST MILK CLOTTING FACTORS CANT BE ACTIVATED (DUE TO LOW VIT K!) THEREFORE IMPAIRED CLOTTING! you're supposed to give babies vit K injection after birth to help this but this mom was stubborn! also it wouldnt be the germinal matric one bc these babies are **PREMIE and bleeding is INTRAVENTRICULAR!!!**

Answer 585

**Androgen insensitivity Syndrome (X,Y)-**normal appearing female (but **no uterus or tubes** and a **rudimentary vagina)...the Y in the male allows MIF to be secreted so no UUF development (upper vag (lower from UG sinus), uterus, fallopian tubes)** **Mullerian Agenesis (Mayer-Rokitansky Kuster-Hauser Syndrome**)-have fully developed Secondary sexual characteristics bc ovaries are functional (but **VAGINAL AGENESIS: which is absent of an organ due to absent primordial tissue**) BUT **Turners** have Ovarian insufficiency (degenerated) so no Estrogen--\> **have uterus** but since **no (functional) ovaries**-\> no estrogen--\> **no secondary sex characteristics (breast dev or menstruation)**

Answer 586

**PILOCARPINE!** **DIRECT M3 +** Contracts ciliary muscle of eye (open-angle glaucoma), pupillary sphincter (closed-angle glaucoma) resistant to AChE. “You cry, drool, and sweat on your ‘pilow.’ ” Use pilocarpine in emergencies—**very effective at opening meshwork into canal of Schlemm**

Answer 587

**ADENOMYSOSIS** ENDOMETRIAL TISSUE CREEPING INTO MYOMETRIUM PAIN WITH MENSES (DYSMENORRHEA) HEAVY MENSTRUAL BLEEDING (MENORRHAGIA)

Answer 588

VAGINAL cancer from the **lower 2/3 of** vagina goes to: **inguinal nodes** cancer from the **upper 1/3 goes** to regional **iliac nodes**

Answer 589

(Neutrophils release lysosomal enzymes that digest the tissue)--\> **1.enzymatic degradation first** **2.** **then proteins denature?** **=====LIQUEFACTIVE!** (Ischemia or infarction)--\> 1. **proteins denature** 2. **then enzymatic degradation** **=====COAGULATIVE!** **[know this difference]**

Answer 590

it **maintaines renal blood flow** as it lowers BP by causing arterioloar DILATION of CORONARY, PERIHPHERAL, **RENAL** AND SPLANCHNIC arterioles.

Answer 591

GET BIGGER RAPIDLY AND THENNNNN REGRESS SPONTANEOUSLY BY PUBERTY (most cases by 7 y/0) (DO NOT PICK THE ANSWER THAT SIMPLY STATES THEY PROGRESSIVELY REGRESS)

Answer 592

Modeling behavior **after another person who is more powerfu**l (though not necessarily admired). **the child who got raped BECOMES THE RAPIST**

Answer 593

at apex: MR at left sternal border (**\*\*\*\*TR\*\*\*\*** and VSD=harsh) TR increases in intensity upon inspiration

Answer 594

**CEREBRAL AMYLOID ANGIOPATHY!!!**

Answer 595

**meckels diverticulum** (usually pts are NOT IN PAIN; if yes its in the RLQ); presents in FIRST TWO YEARS OF LIFE! **intussiception: intermittent severe abdominal pain** often with **red “currant jelly” bloody stools**. associatied with recent viral infection, such as adenovirus **volvulos:** billious vomiting + abd pain +bloody diarhhea **henoch schnolem purpura (**crampy abd pain + palpable purpura + bloody diarrhea) **intermittent severe abdominal pain** often with **red “currant jelly” bloody stools**. associatied with recent viral infection, such as adenovirus

Answer 596

**FRECKLES!!!!!!** (EPHELIS) Due to increased number of ***_melanosomes_*** (melanocytes are **no**t increased) vs: **VITILIGO (**Localized loss of skin pigmentation; Due to **autoimmune destruction of *_melanocytes_***

Answer 597

1-4--\> **SKIN WARTS** [VERRUCA VULGARIS] 6,11--\> **GENITAL WARTS** [CONDYLOMATA ACUMINATA] 16,18--\> **CERVICAL, VAGINAL, VULVAR, ADN ANAL NEOPLASIA** (msm)

Answer 598

**Enterobius vermicularis**, Intestinal infection causing anal pruritus (diagnosed by seeing egg A via the tape test) **Ascaris lumbricoides** (giant roundworm) Intestinal infection with possible obstruction at ileocecal valve-eggs visible in feces under microscope **bendazoles (all nematode round worms you treat with this!)**

Answer 599

**C) Inflamed maternal decidua release of prostaglandin (she probs had an infection).** * **see beautiful (up to date) explanation below** Preterm premature rupture of membranes Genital tract infection is the single most common identifiable risk factor for PPROM. Three lines of epidemiologic evidence strongly support this association: (1) women with PPROM are significantly more likely than women with intact membranes to have pathogenic microorganisms in the amniotic fluid, (2) women with PPROM have a significantly higher rate of histologic chorioamnionitis than those who deliver preterm without PPROM, and (3) the frequency of PPROM is significantly higher in women with certain lower genital tract infections (particularly bacterial vaginosis) than in uninfected women. The association between bacterial colonization of the lower genital tract and PPROM is not surprising. Many of the microorganisms that colonize the lower genital tract have the capacity to produce phospholipases, which can stimulate the production of ***_prostaglandins_*** and thereby lead to the onset of uterine contractions. In addition, the host's immune response to bacterial invasion of the endocervix and/or fetal membranes leads to the production of multiple inflammatory mediators that can cause localized weakening of the fetal membranes and result in PPROM [3].

Answer 600

this is Salmonella typhi!!!! **Causes typhoid fever** (rose spots on abdomen, constipation, abdominal pain, fever); Both **Salmonella and Shigella are gram ⊝ rods,** **non-lactose fermenters, oxidase ⊝,** and **can invade the GI tract via M cells of Peyer patches.** Salmonella Typh **make H2S** just like salmonella but note! (shigella dont make it! and shigella does not do human to human spread, just spreads across cells! and shigellla is not motile bc it aint got flagella like the other two anddd bc its resistant to gastric acid you need a real SMALL inoculum to get sick from it. whomp.

Answer 601

**Osler-Weber-Rendu syndrome** **[Hereditary hemorrhagic telangiectasia]** **AD** **c**- Pulmonary AV shunting

Answer 602

Sarcoidosis

Answer 603

*Lysosomal storage disease* **Krabbe disease** Autosomal recessive lysosomal storage disease due to de ciency of galactocerebrosidase. **Buildup of** galactocerebroside and psychosine destroys myelin sheath

Answer 604

**AA (secondary)** **(not the AL from Ig Light chains)** Seen with **chronic in ammatory conditions** such as rheumatoid arthritis, IBD, spondyloarthropathy, **familial Mediterranean fever,** protracted infection. Fibrils composed of serum Amyloid A SAA---\> AA

Answer 605

1. **ADH antagonist** (member of tetracycline family). **SIADH TX.-------***Demeclocycline* 2. **Synthetic analog of aldosterone with little glucocorticoid effects.** Mineralocorticoid replacement in **1° adrenal insufficiency---***Fludrocortisone* 3. Block action of ADH at V2-receptor. **SIADH Tx-------***ADH antagonists (conivaptan, tolvaptan)* 4. **Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ PTH. TX: 1° or 2° hyperparathyroidism-----***Cinacalcet*

Answer 606

**Crigler-Najjar syndrome, type I** (MORE SEVERE) **Treatment:** plasmapheresis and phototherapy (non UV...simply makes BR soluble for excretion, doesnt conjugate it!) **Crigler-Najjar syndrome, type II (**less severe) **Treatment:** responds to **phenobarbital**, which INC liver enzyme synthesis.

Answer 607

diseases with **hyperCHOLESTEROL!!!** **XANTHELESMAS!!!!!** eg: dyslipidemias 1 or 2a also **chronic CHOLESTATIC DISEASES LIIIKKKEE** **PRIMARY BILIARY CIRRHOSIS!!!!!!!!** ps: you would see hyperlipidemia in HYPOthyroidims not hyper

Answer 608

CLUE CELLS IN BACTERIAL VAGINOSIS (pH\>4.5) +ve whiff test (amine odor with KOF)

Answer 609

Between approximately days **9- 13, the estradiol level dramatically rises.** At a certain point, it no longer has an inhibitory effect on LH and FSH, but paradoxically a stimulatory effect. The oocyte exits from the follicle, the new corpus luteum is stimulated by LH to secrete considerable progesterone, and the luteal phase continues. However, the progesterone level would be much below that of estradiol UNTIL after the LH surge. **Answer= C**

Answer 610

**Malrotation** **Anomaly of midgut rotation** during fetal development--\> improper positioning of bowel, formation of fibrous bands (Ladd bands). Can lead to volvulus, duodenal obstruction

Answer 611

VSD harsh holoSYStolic thrill loudest at tricuspid area actually VSD in Tet of Fallot

Answer 612

NOOO! but they are dec in Botulism and Lambert eaton

Answer 613

**Atypical** antipsychotics **Schizophrenia**—treats **BOTH** both positive **and** negative symptoms. **Risperidone**—**hyperprolactinemia--\>** (**amenorrhea, galactorrhea, gynecomastia)**. **D2 antagonists;**

Answer 614

**Mycosis fungoides/ Sézary syndrome**

Answer 615

HbF!!!! in order to be super selfish and extract as much O2 as possible from mom, it has GAMMA instead of beta chains and, unlike beta chains these gamma chains DO NOT bind 2,bpg (which is -ve charge) bc instead of Histinidine (+ve) is has SERINE!

Answer 616

RIGHT! (it si medial to the duodenum adn anterior to the right side of the verterbral body) the simlar but slightly smaller round structure to the left of the IVS is the abdominal aorta (which bifurcates at L4)

Answer 617

Hemangioblastoma Most often **cerebellar** . Associated with **von Hippel-Lindau syndrome** when found with **retinal angiomas**. Can produce **erythropoietin--\> 2° polycythemia.** HISTO: Closely arranged, thin-walled capillaries with minimal intervening parenchyma

Answer 618

**freakin JUST FINE AND NORMAL!!!!!!!!!!!!!!**

Answer 619

**CIRCADIAN RHYTHMA!** info comes in from (photosensitive ganglion cells) in the retina, **SCN** relays info to **hypothal nuclei and pineal gland** to modulate body temp, and prod of hormones like **cortisol** and **melatonin (induces sleep)** **eastward travel harder to get over jetlag**

Answer 620

just **Wegeners** (granulomatosis with Polyangitis)

Answer 621

CD!!!!!!!!

Answer 622

1. Toxoplasma gondii Classic triad in BABY: chorioretinitis, hydrocephalus, and intracranial calci cations, +/− “blueberry muf n” rash in mom: ASYMPTOMATIC 2.Rubella (Toga) Classic triad in BABY: abnormalities of eye (cataract) and ear (deafness) and congenital heart disease (PDA); ± “blueberry muf n” rash. in MOM: Rash, lymphadenopathy, polyarthritis, polyarthralgia 3. CMV Hearing loss, seizures, petechial rash, “blueberry muf n” rash, periventricular calci cations

Answer 623

**Scabies** Common in children, crowded populations (jails, nursing homes); transmission through fomites. Treatment: **permethrin cream**, washing/drying all clothing/bedding, **treat close contacts.** | (Sarcoptes scabiei)

Answer 624

**SIADH** classic association too much adh normal bp anp and bnp to the rescue

Answer 625

1. pringle maneuver is occulsion of the **PORTAL TRIAD** in the **HEPATODUODENAL LIG** **1. Portal Vein** **2. Hepatic Artery** **3. Common bile duct** 2. it would have to be a VEIN bc its NON PULSATILE FIRST OFFFFF. and the most commonly causes of RUQ bleed if you ruled out anything involving contents of portral triad = **IVC !!!!!!!!** or _HEPATIC VEIN_

Answer 626

Aromatic amines (eg, **benzidine, 2-naphthylamine**)---found in CIGARETTE SMOKE---\> **Transitional cell carcinoma** **A**rsenic---\> **L**ung cancer * *A**ngiosarcoma (LIVER) * *S**quamous cell carcinoma (SKIN) for arsenic think: **ALAS**

Answer 627

**Leflunomide** **(look at the little pathway)**

Answer 628

rosental corskrew fibers eosinophii are pilocytic astrocytoma and a small blue cell PNET homer wright rosette are Medulloblastoma!!!!!!!!!!!!!

Answer 629

below part 2! 1. intestinal atresia (duodenal if below second part) or jej/ileum 2. midgut volvulus (911 situation) 3. intestinal stenosis proximal is more billious if more distal = moreso see abdominal distention (eg: colonic atresia or hirshsprungs)

Answer 630

**Tuberous Sclerosis Complex** Autosomal dominant Mutation in TSCl (hamartin) and TSC2 (tuberin) genes, which are tumor suppressor proteins Multiple hamartomas Cortical tubers Renal angiomyolipomas Cardiac rhabdomyomas Pulmonary hamartomas

Answer 631

All can cause **hypokalemia.**

Answer 632

LIVER NOT SPLEE, OR HEART OR BRAIN OR KIDNEY THE LIVER (WITH ONE NOTABLE EXCEPTION MENTIONED BELOW)

Answer 633

hypertrophic scar: amount of collagen synthesis in a hypertrophic is INCREASED keloid scar: amount of collagen synthesis is SUPER SUPER INCREASES the organization of this collagen hypertrophic scar=parallel keloid scar=disorganzied (more common in dark skinned people)

Answer 634

WEGENERS! glomerulonephritis--\> oliguria performation of nasopharyn--\> saddle nose (also seen in congenital syphilis) Granulomatosis with Polyangitis PR3/c-ANCA +ve

Answer 635

Charcot triad of cholangitis: Jaundice Fever RUQ pain

Answer 636

**ISOLATED MITRAL STENOSIS-**-\> inc LA diastolic P--\> inc PCWP, Pulmonary HTN, Dec Pulm Vascular Compliance, RV dilatation--\> functional Tricuspid regurg! \*\*LEAVES **LV DIASTOLIC PRESSURE** ALONE (or even decreased when stenosis is severe)! if **Aortic valve** is involved--\> **LV DIASTOLIC PRESSURE IS INCREASED**

Answer 637

**SIDEROBLASTIC ANEMIA** note: although x linked, 1/3 of women have it due to skewed x inactivation **PRUSSIAN BLUE!** THIS IS A MICROCYTIC ANEMIA

Answer 638

**ZINC DEFICIENCY** **in the last step of wound healing called "Remodeling" (1 week–6+ months after wound)** **Fibroblasts Type III collagen replaced by type I collagen...this is mediated by COLLAGENASE WHICH USES ZINC AS A CO FACTOR!** note: zinc can also help to treat **Wilson's disease**

Answer 639

**PFO = HIGHLY ASSOCIATED WITH PARADOX EMBOLISM** (incomplete fusion of the ATRIAL septum primum and secundum) \*\*\*note these are usually closed but if a patient does something to INC pressure in RA LIKE RELEASING a valslava (which itself normally dec preload and afterload), it can caused flow of blood from the RA--\>\> LA and then cause a paradoxical embolism leading to a cryptogenic stroke! ASD

Answer 640

Brush border intestinal enzymes **(disaccharidases)** (1) Lactase hydrolyzes lactose to give galactose and glucose, maltase hydrolyzes maltose to produce two glucoses, and sucrase hydrolyzes sucrose to form fructose and glucose. (2) **Disaccharidase**s produce **glucose, galactose, and fructose.** (a) In certain types of diarrhea (e.g., **Rotavirus)**, the **brush border is temporarily** * *destroyed** and **disaccharidases cannot hydrolyze disaccharides.** (b) People with lactase deficiency cannot hydrolyze lactose in dairy products.

Answer 641

veins are NON PULSATILE arteries are PULSATILE

Answer 642

**b-galactocidase** **also makes permease and transacetylase enzymes**

Answer 643

BASAL CELL CA NOTE: picture

Answer 644

**GLUCAGONOMA!!**

Answer 645

**Behcet's syndrome** is a multisystem, r**elapsing**, **chronic vasculitic** (due to **immune complex**) disorder with prominent mucosal inflammation. Common manifestations include **recurrent oral ulcers**, ocular inflammation, **genital ulcers, and skin lesions**. The **most serious manifestations are blindness,** neurologic or GI manifestations, **venous thromboses,** and **arterial aneurysms.** Diagnosis is clinical, using international criteria

Answer 646

**BLOOM SYNDROME**

Answer 647

**Von Hippel-Lindau Disease** Von Hippel-Lindau disease (VHL) is a rare hereditary neurocutaneous disorder characterized by tumors in multiple organs.

Answer 648

**Renal oncocytoma**

UWORLDS Flashcards

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