Wha are the essential amino acids
Which of the essential amino acids contain only hydrophobic carbons as their R group
Isoleucine, leucine, and valine
What do the Northern, Southern, and Western Blot test for?
Southern blot - DNA
Northern blot - RNA
Western blot - Protein
What is so special about methionine?
It is an Amino acid that can donate a methyl group.
What are allele-specific oligonucleotide probes?
DNA sequences complimentary to the allele of interest. This is used to detect the presence of disease causing mutation.
Example Sickle Cell anemia
What is ELISA
- Enzyme linked immunosorbent assay
- Used to determine whether a particular antibody is present in a patient's blood with precoated antigens on ELISA plate and labeled antibodies.
What is this procedure?
DNA is mixed with 2 specific primers, deoxynucleotides and heat stable polymerase.
Solution is heated to denature the DNA and then cooled to allow synthesis.
This is done twenty times.
This is polymerase chain reaction which is used to amplify DNA
What uses an electric field to separate segments of DNA based on their size and uses dyes(ethidium bromide) to stain and visualize the gel on which all this is done.
What are the characteristics of Meckels Diverticulum?
- Rules of 2:
- 2 inches long
- 2 feet from ileocecal valve
- before 2 yoa
- 2 types of epithelium- pancreatic or gastric(can lead to ulceration and bleeding but does not cause severe pain until inflammation occurs.
Technectium 99m is used to detect the ectopic gastric tissue.
What are the causes and complications of congenital diaphragmatic hernia?
It is caused by a failure of the pleuroperitoneal folds to fuse with the other components of the diaphragm.
This leads to bowel into the thorax -> compression on the lung buds -> pulmonary hypoplasia -> dyspnea, cyanosis and death if not surgically repaired.
What are the 3 conditions that lead to early cyanosis or blue baby?
- Transposition of the great vessels
- Tetralogy of Fallot
- Truncus arteriosus
The 3 T's
What maternal condition leads to a high risk of her baby having transposition of the great vessels?
This is an early cyanosis as a result of failure of the neural crest cells to form the spiral septum
The mother is a diabetic
What condition is this:
Arachnodactyly, hyperextensible joints, and aortic aneurysm.
Marfans syndrome (defect in fibrillin -> connective tissue)
What condition is this:
Cold intolerance, delayed reflexes, constipation
This is hypothyroidism
What condition is this:
Mild fever with a descending maculopapular rash and clear buccal mucosa.
Rubella -> PDA, VSD, cataracts, and deafness.
Togaviridae, Enveloped (+) ssRNA virus
A sexually active patient comes in complaining of a rash on his back and penis. What virus is responsible?
- These are pearly white or skin colored nodules with central umbilication.
- This is molluscum contagiosum which is passed by the poxvirus either by sexual contact or skin to skin.
Poxvirus is an enveloped linear ssDNA virus.
Virus that affects oral mucosa. Starts off as erythema, then grouped vesicles appear that evolve to pustules, which erode and ulcerate leading to a crust. These lesions resolve spontaneously within 2-4 weeks. What is the treatment?
- HSV type 1
- Enevloped linear dsDNA virus
DX: via Tzanck or immunofluorescence.
TX: acyclovir or valacyclovir
Virus that causes an exanthematous disease that begins as Koplik's spots on the oral mucosa and progresses to a maculopapular rash. Malaise and fever are common.
This is measles which is caused by Rubeola virus a paramyxovirdae = enveloped (-) ssRNA virus.
- Other symptoms seen with virus are the 3 C's:
- cough, coryza and conjunctivitis.
Patient presents with low-grade fevers, night sweats, a painful sore throat, headaches, and increasing fatigue. He is complaining of a lack of energy to do exercise. Physical exam reveals enlarged cervical lymph node and a spleen that is palpable 2 inches below the left costal margin.
What are 2 viruses that are responsible for this presentation?
- This is mononucleosis
- 1. EBV- enveloped linear dsDNA virus
2. HIV- enveloped (+) ssRNA
What is the difference between
plasmodium ovale and vivax?
All cause cyclic fevers
P. Falciparum- is the only one to cause cerebral malaria
P. malariae- 72 hour cyclic fever
P. ovale & vivax= 48 hour cyclic fever and can remain dormant in liver as hypnozoites.
Protozoan that is transmitted by deer ticks that cause fever and hemolytic anemia and parasitize RBCs. They form maltese cross in blood.
Complications include shock, hypoxia, jaundice, hepatic necrosis, acute renal tubular necrosis, acute respiratory distress syndrome, hemolysis and hemorrhages.
This is babesia microti
64 year old patient has chronic renal failure and increasingly poor vision in his right eye. What is the best treatment to delay the progression of his renal failure.
- This is kimmelstiel-wilson disease, which is a result of diabetic microangiopathy.
- The best treatment is an ACE inhibitor because the JG cells are detecting a decrease in blood flow due to the microangiopathy which would lead to an increase in renin and vasoconstriction which is causing the pathology seen.
A 5year-old boy presents with chronic recurrent pulmonary infection and bronchitis. History includes chronic floating foul smelling diarrhea. Sweat analysis reveals increased [cl-]
What is the mutation?
An autosomal recessive defect in the cystic fibrosis transmembrane conductance regulator gene on chromosome 7. -> defective chloride channel that gets ubiquinated.
What are the phases
Phase 0 = voltage gated Na Channels open
- Phase 1 = inactivation of voltage gated Na channels
- - voltage gated K+ channels begin to open
Phase 2 = Plateau- voltage gated Ca2+ channels open -> balance K+ and cause myocyte contraction.
Phase 3 = massive voltage gated K+ channel opening and closure of voltage gated Ca2+ channel
Phase 4 = resting potential via K+ permeability
What is the timeframe of CK-MB and troponin I measurements?
What is quicker than this?
- CK-MB and troponin I accumulate in blood 4-6 hours
- - peak at 24 hours
- - are gone by 3 days post MI
- ECG is quicker
- - ST-segment elevation = transmural infarct
- - Q waves = transmural infarct
- - ST-segment depression = subendocardial infarct
What are the effects of epinephrine and phentolamine combined?
- - increase HR and contractility via B1 receptors
- - increase SVR via vasoconstriction through a1-receptors
Phentolamine= a receptor atagonists
COMBINED: a receptor vasoconstriction is eliminated which leaves only the B1 increase in HR & contractility along with the B2 activated vasodilation. (previously EPI effect on A 1 was much stronger than B2)
What is isoproterenol?
- B and A adrenergic receptor agonist.
- More effect on the B receptor = decrease in pressure via B2mediated vasodilation.
What are thew effects of phenylephrine and phentolamine?
Phenylephrine = A-adrenergic agonist
Phentolamine = nonselective A-adrenergic blocker
COMBINED= no change in blood pressure
What are the effects of giving a patient prednisone?
- Cushsings syndrome:
- - inc gluconeogenesis, proteolysis(muscle wasting) while decreasing insulin sensitivity peripherally.
- - Sodium retention due to the mineralocorticoid effects of the corticosteroid which will lead to hypertension.
What are the functions and locations of
Merkel nerve endings
- Pacinian Corpuscles:(large onion)
- Deeper layers of skin, ligament, and joint capsules
- Transduce vibration, pressure and tension.
- Ruffini Corpuscles: (spindle shaped mechanoreceptors)
- - soles of the feet
- - transduce pressure
- Meissners corpuscles:
- Just beneath the dermis of hairless skin
- Convey light touch
- Merkel Nerve endings:
- In all skin
- Convey discriminatory touch.
What are the sulfonyureas drugs and which one has a side effect that is similar to metronidazole, quinacrine, griseofulvin, chloramohenicol, and some cephalosporins?
- The side effect is disulfiram-like reaction.
What is Budd Chiari syndrome?
What is the significance of polycythemia vera with it?
- Thrombosis of 2 or more hepatic veins
- Associated with hypercoagulable states:
- myeloproliferative disorders
- inherited coagulation disorders
- intra-abdominal cancers
- oral contrceptive use
- abdominal pain, hepatomegaly, and ascites
What are the signs of achalasia?
- difficulty swallowing
- abnormal contraction of esophageal muscles
- absence of peristalsis
- absence of relaxation of LES
- TX: nitrates or CCB
- dilation via balloon
- botulinum toxin
An acoholic patient presents with severe bright red hematemesis, muscle wasting, jaundice, and ascites. What is the most likely cause of the hematemesis?
A fibrotic liver -> inc resistance in blood flow from portal vein -> portal hypertension -> compensation via increase blood flow from left gastric vein into the azgos vein. These veins ruptured which caused the hematemesis. (esophageal varices)
In what situation would you use enoxaparin or levonox and why?
DVT, pulmonary embolism, and acute coronary syndromes.
- They are low molecular weight heparin
- MOA: activate prothrombin III which leads to the inhibition of Xa which inhibits the formation of thrombin leading to the inhibition of a fibrin clot formation.
Cerebellar lesion that is on MICRO:
- cellular with sheets of anaplastic cells
- each tumor cell is small with little cytoplasm and crescent shaped, deep staining nuclei(high mitotic activity) arranged in pseudorosettes.
- Found in children and are radiosensitive
Pleomorphic anaplastic cells with foci of necrosis in a palisading pattern.
Presents with severe headache and symptoms of increased intracranial pressure.
Regular rouns cells aligned smoothly with spherical nuclei surrounded by clear cytoplasm and finely granular chromatin associated with calcificatiosn.
May present with headaches, seizures, changes in cognition, localized weakness, sensory loss, or aphasia.
Fried egg appearance is described.
Stratified squamos epithelial cells with oval shaped nuclei with indistinct cytoplasm and psammoma bodies.
Present with severe headaches, visual changes and pituitary dysfunction.
Whorls of meningothelial cells with oval-shaepd nuclei with indistinct cytoplasm and psammoma bodies.
Arises from arachnoid granlations.
Present with seizures or neurological deficit that gets worse over time.
Expand locally and are slow growing.
What are the symtpoms associated with Acute intermittent porphyria?
- Lack of uroporphyrinogen I synthetase
- buildup of ALA and porphobilinogen
Abdominal pain, neuropathy, high sympathetic tone, and neuropsych(anxiety, depression, seizures and paranoia)
What is Erb Duchenne palsy?
- A tear of the C5-C6 roots in the brachial plexus.
- Results in paralysis of the abductors, lateral rotators and biceps.
What would you treat the patient that presents with:
severe headache and red conjunctiva
rash on palms and soles after a few hours
This is Rocky Mountain spotted fever caused by Rickettsia Ricketsii transmitted via Dermacentor ticks. This organism is an obligate intracellular organsim.
Start immediately on tetracycline or chloramphenicol.
Which ligament is most frequently injured?
The lateral ligaments are injured easiest with the anterior talofibular being the MC one injured.
Where do the trigeminal nerves exit from the skull?
- V1- superior orbital fissure
- V2- foramen rotundum
- V3- foramen ovale
What type of neuronal loss is seen in amyotrophic lateral sclerosis?
- Anterior horn and corticospinal tract of the spinal cord.
- Asymmetric affect of the U/E and L/E involving LMN and UMN defects.
What type of neuronal loss is seen in Charcot-Marie-Tooth disease?
Anterior horn cells and posterior columns of the spinal cord.
How can meningitis lead to hydrocephalus?
Meningeal scarring of the arachnoid villi will lead to decreased absorption of CSF leading to hydrocephalus consisting of dilatation of the lateral and third ventricles with reduction of the extra-axial spaces.
What are the characteristics of disorganized schizophrenia?
- Disorganized speech and behavior
- Childlike and are usually incapable of mustering complete delusions.
Poor long term prognosis.
What is the immature defense mechanism in which the belief that something is all good or all bad?
What group of drugs are good in the treatment of a patient that avoids all social situations in order to avert any rejection or judgement?
- This is social phobia
- SSRI's or SNRI's are the recommended first line treatment for these patients.
What is most oftenly seen in African american women
increases with pregnancy but decreases after menopause
BIOPSY: whorled pattern of smooth muscle of the uterus.
This is a leiyomyoma.
What effect would be seen with chlorpromazine that would be seen with destruction of the hypothalamus?
Increase prolactin secretion -> milk production and breast development
Chlorpromazine- antipsychotic that is a dopamine receptor antagonist.
What is the origin of a tumor that shows high AFP and presents in 0-3 yoa. Presents with lump in testicle accompanied by pain.
This is a yolk sac tumor and it arises from endodermal cells.
What would be seen on immunofluorescenceof the kidney of a disease that presents with hemoptysis and hematuria.
This is Goodpastures syndrome an autoimmune disease in which antibodies are formed against alveolar and glomerular basement membrane.
Immunofluorescence would show linear staining along the basement membrane.
What predisposes a paitent with nephrotic syndrome to a ischemic stroke?
- They go into a hypercoagulable state via:
- loss of Protein C
- loss of protein S
- loss of antithrombin III
- increased fibrinogen
Fever chills, flank pain, costovertebral tenderness and WBC casts. What is the most likely diagnosis?
This is pyelonephritis that originated from an ascending infection from the lower urinary tract.
How do you diagnose the most common type of atypical pneumoniae?
The most common type of atypical pneumoniae is mycoplasma tuberculosis and the diagnosis is made via cold agglutinin test (measures agglutination of Igs when they are cooled.
A 50 year old smoker patient presents with SOB, increased AP diameter of the chest, pursed lips, and dyspnea. No scleral icterus, jaundice, hepatomegaly or liver nodules. The patient is tachycardic and hyperresonant. What is the most likely diagnosis?
- This is the pink puffer of emphysema which is of centriacinar origin.
- The negative findings of liver abnormalities R/O the possibilty of an a1-antitrypsin deficiency which causes panacinar emphysema.
How does Zileuton help in the case of bronchoconstriction that is the result of aspirin allergy? Why would Cromolyn not work in this case?
- An aspirin allergy is the result of blocking the cyclooxygenase enzyme leading to the leukotriene pathway which causes bronchoconstriction.
- Zileuton inhibits 5-lipoxygenase therefore blocking the leukotriene pathway and no bronchoconstriction.
Cromolyn only inhibits the release of inflammatory mediators from the mast cells. This drug is used in the prophylaxis of an aspirin allergy.
A patient demonstrated belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, and delirium. What is a unique characteristic of this substance?
This is phenycyclidine (PCP)
Reoccurence of the symptoms happens on withdrawal because PCP is ionized and trapped in the acidic gastric lumen and eventually gets reabsorbed in the alkaline duodenum.
What substance on acute intoxication will display disinhibition, emotional lability, slurred speech, ataxia, coma, and blackouts.
And on withdrawal demonstrates tremor, tachycardia, hypertension, malaise, nausea, seizures, delirium tremens, tremulousness, agitation, and hallucinations.
What susbstance intoxication will lead to psychomotor agitation, impaired judgement, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, and fever.
And on withdrawal show post-use crash with depression, lethargy, headache, stomach cramps, hunger, and hypersomnolence?
Number of individuals with a disease in a given population at a given time.
What are some things that are associated with the Good Samaritan law?
- Care provider must use standard procedures
- No request of compensation
- Care provider should stay with victim until someone of equal or greater capability takes over
- Patient can still refuse help
At what age do you use the Wechsler Intelligence Scale for Children-revised vs the Wechsler Adult intelligence scale-Revised?
Wechsler Intelligence Scale for Children-revised is used for kids between the ages of 6 to 16 1/2.
The Wechsler Adult Intelligence scale-revised is used for those older than 16 1/2.
How do you find the probability of having a condition if a patient recieved a positive test.
- This is positive predictive value and it is calculated as:
- True positive/ (True positive and false positives)
A patient had a heart attack and is placed on lisinopril and simvastatin. He is complaining of inability to achieve erections. Upon questioning you find out that the patient does have morning erections. What is the cause of this man's problem?
- This is most likey a psychological issue since the man is able to get morning erections and also that an ACE inhibitor and statin are unlikely to cause an erectile dysfunction.
- This man is scared of getting another heart attack during sex most likely.
How does increased intracellular calcium kill the cell?
- Activates enzymes:
- ATPases- decrease ATP supply -> inhibition of oxidative phosphorylation.
- Phospholipases- decrease membrane stability
- Endonuclases- induce DNA damage
What is the Michaelis-Menten constant value?
- It is Km reflects affinity of a compound.
- High Km = low affinity for receptor
What are some of the findings in a patient who has Acute intermittent porphyria?
- This is a deficiency of uroporphyrinogen I synthetase.
- δ-Aminolevulinic acid and porphobilinogen in the urine.
- hyponatremia, recurrent episodes of abdominal pain, and neuropsych problems.
- - Barbiturates and starvation diets intitiate attacks.
No cutaneous photosensitivity.
A disease that is characterized by:
deficiency in enzyme uroporphyrinogen decarboxylase
cutaneous fragility of the hands and forearms after sun exposure
No neurological symptoms.
Porphyria cutanea tarda
What is spermiogenesis?
- It is the final maturation of the spermatid(23, 1n).
- acrosome, neck, and tail formation.
What are secondary spermatocytes?
23, 2 n cells that come from primary spermatocytes that have undergone meiosis I.
What is the derivative of the following structures?
median umbilical ligament
medial umbilical ligament
- median umbilical ligament- allantois & urachus
- Medial umbilical ligament- umbilical arteries
- ligamentum arteriosum- ductus arteriosus
- ligamentum teres- umbilical vein
- ligamentum venosum- ductus venosus
- nucleus pulposus- remnant of notochord
What structures are formed by the dorsal pancreatic duct?
- Pancreatic body
- pancreatic isthmus
- pancreatic tail
What is the treatment for a patient that presents with fever, fatigue, cough, headaches, and shaking chills.
PE: tick bite on right inflamed leg
HISTO: maltese cross configuration.
This is malaria-like symptoms of babesiosis which is transmitted by the Ixodes tick.
Treatment - Quinine and clindamycin (not well tolerated)
What is the treatment for the following?
Hepatomegaly, splenomegaly, malaise, anemia, and weigth loss.
Transmitted by the sandfly.
- This is leishmania donovani
- Treatment = Sodium stibogluconate
What is the treatment the bug that causes Chagas diease and is transmitted via the reduviid bug?
What is associated with Burkitt's lymphoma and nasopharyngeal carcinoma. This is also associated with a 8;14 translocation.
How does HPV cause cervical carcinoma?
- Integration into the DNA -> E6(inactivate P53 suppressor gene) and E7 (inactivate Rb suppressor gene)
WHat is the difference between Antigenic drift and antigenic shift in influenza virus?
Antigenic drift= mutation in hemagglutinin and neuraminidase = small changes in viral toxicity.
Antigenic Shift = 2 different strains (human and avian strain)infect the same cell and exchange RNA -> a new virus never before encountered -> epidemic.
What is Chediak-Higashi disease?
- An autosomal recessive disease in which there is a defect in the micotubular function -> decrease in phagocytosis.
- Patient presents with recurrent strep and staph infections, parital albinism, and peripheral neuropathy.
What are the symptoms associated with a megaloblastic anemia associated with hypersegmented neutrophils?
- This is Vitamin B12 deficiency that is caused by antibodies to intrinsic factor.
- L/E neuropathy
- Loss of proprioception
What is the pathway for the presentation of an antigen to a CD8 cell?
Degradation via proteasome -> enters RER via TAP proteins -> bind with MHC I molecule -> Golgi complex to the cell surface to present to the CD8 T cell.
What are the cancers associated with HNPCC?
- 70% -> coloretal cancer between 40-45 yoa
- urinary tract
- small intestinal
- biliary cancer
What are the odd associations of a disease that presents with in the 3rd-4th decade with abdominal discomfort, frequent urinary tract infections, hematuria, polyuria, and nocturia.
Imaging would should cystic kidneys.
- This is APKD which is a mutation of polycystin 1 gene of chromosome 16.
- The 2 odd associations are:
- berry aneurysm
- mitral valve prolapse
What are the symptoms associated with imprinting of the maternal chromosome 15?
- This is Angelman syndrome
- microcephaly, maxillary hypoplasia, deep-set eyes, and a large mouth with tongue protrusion.
- Jerky gait
- inappropriate laughter
- severe mental retardation
- speech impairment
- epilepsy in 80-90%
The effect of thiazide diuretics.
There is body contraction -> RAS system -> vasoconstriction and kidney also releases prostaglandins in order to counteract the vasoconstriction of both the efferent and afferent arterioles.
- Finasteride- 5a-reductase inhibitor
- Flutamide - androgen receptor antagonist
- Leuprolide- GnRH analog
What drug used to treat Clostridium perfringes is not effective against C. difficile.
Clindamycin- leads to superinfection
What is diltiazem?
A benzothiazepine class calcium channel blocker that reduces myocardial oxygen demand and also causes vasodilation of peripheral and coronary arteries.
How does the heart deal with increased oxygen demand from activities like exercise?
Increase oxygen consumption -> local hypoxia -> vasodilation of the coronary arterioles -> compensatory increase in coronary blood flow and oxygen delivery to meet the demands of the cardiac muscle.
What are the characteristics of Takayasu's arteritis?
- Affects medium and large arteries-> thickening of aortic arch and/or proximal great vessels.
- fever, arthritis, night sweats, myalgias, skin nodules, ocular disturbance, and weak pulses in the upper extremities.
- Most common in Asian females
- Associated with elevated erythrocyte sedimentation rate.
What diseases are associated with the following:
Anti-IgG ab- rheumatoid arthritis
ANA- SLE, diffuse systemic sclerosis, sjogren syndrome, inflammatory myopathy.
C-ANCA- Wegener's granulmatosis
P-ANCA- microscopic polyangiitis and Churg-Strauss syndrome
Arteries to the duodenum and head of the pancreas
A 36 year old woman presents to the physician with amnorrhea. She reports an increase in her ring and shoe size over the past year, increased sweating, and increased fatigue. Physical examination shows BP of 150/90mmHg and coarse facial features with mild macroglossia. What is this patients problem?
Excess growth hormone.
What is the difference between MEN 2a and MEN 2b
MEN 2a = medullary thyroid carcinoma, pheochromocytoma, and tumors of parathyroid
MEN 2b = medullary thyroid carcinoma, pheochromocytoma, and neuromas.
A patient that has ulcerative colitis presents with
progressive fatigue, pruritis, and icteric sclera. What is it?
- This is primary sclerosing cholangiitis, irreversible condition characterized by inflammation, obliterative fibrosis, and segmental constriction of intrahepatic and extrahepatic bile ducts.
- Endoscopic retrograde cholangiopancreatograpy shows alternating strictures and dilations of bile duct.
What are the virulence factors of pseudomembranous colitis?
Exotoxin A and B of C. difficile form adherent inflammatory exudates on the injured mucosa.
What are the risks associated with gallbladder adenocarcinoma?
- Chronic gallbladder inflammation(gallstones)
- fat, female, forty, and fertile.
What is the difference between a papillary carcinoma and a follicular carcinoma?
Both are cold nodules with excellent prognosis
- Papillary carcinoma HISTO:
- - orphan Annie eye nuclei
- - psammoma bodies
- Follicular carcinoma HISTO:
- uniforms cells surrounding colloid-filled follicles with Hurthle cells(abundant granular eosinophilic cytoplasm)
What is the difference between Hemophilia A and Hemophilia B?
- Hemophilia A:
- More common 80%
- Factor VIII deficiency
- Hemophilia B:
- Less common 20%
- Factor IX deficiency
What condition in sickle cell patients leaves them vulnerable to bacteria like streptococcus pneumonia?
Microvascular infarct leading to functional asplenia -> susceptible to encapsulated organisms.
What are the tissues affected in osteogenesis imperfecta
- This is a type I collagen defect ->
- skin, bone, tendons, eyes, ears, & teeth
What are the 11 findings of which 4 are used to diagnose SLE?
- BRAIN SOAP MD
- Blood dyscrasias
- Renal disorder
- Imunologic disorder
- Neurologic disorder
- Oral ulcers
- Antinuclear antibody
What are the characteristics of Beckers Muscular dystrophy?
- X-linked recessive
- later and milder onset of muscular dystrophy.
Where is the area postrema located and what is its action?
- Located in the medulla
- A chemoreceptor trigger zone that intiates vomiting.
What does the lateral striate arteries supply?
They are from the MCA and supply the internal capsule, caudate, putamen, and globus pallidus.
What are the symptoms of an alcoholic that has a lesion on the mammillary bodies?
- Wernicke-Korsakoff encephalopathy
- anterograde amnesia
- oculomotor dysfunction
- motor ataxia
What schizophrenic drugs are responsible for causing tardive dyskinesia (lateral deviations of jaw)?
Typical antipsychotics like haloperidol and fluphenazine and chlorpromazine
Extrapyramidal A/E as a result of blocking dopamine receptors.
What effect occurs when Sertraline and Tranylcypromine are combined.
- Serotonin syndrome
- Sertraline= SSRI
- Tranylcypromine= MAO inhibitor
Why do you not want to use a ACE inhibitor in a patient who has bilateral renal artery stenosis?
There is decreased perfusion due to the stenosis which causes the RAS system to be activated and the vasoconstriction of the efferent arteriole which leads to increase in GFR. ACE inhibitor will negate this effect.
What does a fractional excretion of >4% indicate
A defect in the a structure that has a central pair of microtubules and nine surrounding pairs of microtubules causes what?
- These are cilia
- If they are defective this leads to Kartagener's syndrome.
So see recurrent respiratory tract infections and infertility.
What hormone sequence is responsible for ovulation?
High estradiol for 48 hours -> LH surge -> ovulation
What two ligaments carry blood supply to the ovaries?
Suspensory ligament- ovarian arteries
transverse ligament - uterine arteries
What is associated with productive cough for 2 years or 4 months duration.
Also cyanosis, wheezing, and crackles
Lung biopsy reveals hypertrophy of mucus-secreting glands in the bronchioles?
This is chronic bronchitis usually associated with smoking or air pollution.
If a kid swallowed a ball while walking to the room where would you most likely find it?
In the right lower lobe.
Why should Nadolol, timolol, propanolol, and pindolol not be used in a person with lung disease?
They are non-selective B-blockers which means they block the B2 receptors causing bronchoconstriction.
What makes a minor emancipated?
Financially independent and marriage -> minor is truely independent.
What is the difference between a prospective cohort study and a case-control study?
Prospective cohort study- population is free of the illness and organized into groups based on risk factors and then followed to see if they develop disease of interest.
Case-control study- Population already has the disease, research is retrospective in that you try to find any common risk factor among the group that has the disease.
What are the tanner stages?
- Stage 3 is when girls experience peak height velocity.
What are the characteristics of B-thalassemia major?
- Severe hemolysis and ineffective erythropoiesis
- transfusion dependent -> iron overload
- discomfort in right upper quadrant
- darker skin pigmentation
- elevated glucose levels
- increased transferrin saturation
What is the role of adolase reductase in the formation of cataracts in a diabetic patient?
Adolase reductase causes the breakdown of glucose into sorbitol. In poorly controlled hyperglycemia this leads to an accumulation of sorbitol -> rise in intracellular osmolality -> water into the cells -> cellular swelling and osmotic damage.
What cells have sodium-coupled glucose transporters?
Nephrons and enterocytes
What is Hirschsprung's disease?
- Congenital megacolon -> absence of ganglion cells in the large bowel as a result of failure of neural crest cell migration during development.
- Functional obstruction and colonic dilation proximally.
- DONT DO DRE OR YOU WILL BE CRAPPED ON!!
What is Edward's syndrome?
- Trisomy 18 -> chidren born with
- clenched fists, rocker-bottom feet
- congenital heart disease
- mental retardation
- survival < 1 year
What are the characteristics of tetralogy of Fallot?
- Pulmonary stenosis *
- Right ventricular hypertrophy
- Overriding aorta
- Ventricular septal defect
Results from abnormal migration of neural crest cells -> aorticopulmonary septum being displaced anterosuperiorly
Squatting increased systemic pressure -> reducing the right to left shunt and improving oxygenation.
What is the clinical presentation of a patient with a gram (+) catalase(+) positive organism that produces toxic shock syndrome toxin?
- This is a Staph Aureus toxin
- Symptoms =
- diffuse macular rash that desquamates after a few days
What is Bordet-Gengou medium used to culture?
- Bordetella pertussis
- Organism that casues whooping cough
What is charchoal yeast extract with increased iron and cysteine used to culture?
What organism is responsible for diplopia and dysphagia followed by general muscle weakness and respiratory muscle failure.
A/W contaminated homemade canned goods and smoked fish.
What is the syndrome that involves failure of helper T cells to produce IFN-gamma -> failure of neutrophils to respond to chemotactic stimuli.
And presents with recurrent staphylococcal abscesses, eczema, and high levels of IgE.
What causes hyper-IgM syndrome?
Defect in the CD40 ligand on CD4 Tcells -> can not help B cells to undergo isotype switching (IgM -> IgG)
What is the cause for the failure of the thymus and parathyroid glands to develop in DiGeorge's syndrome ?
The third and fourth pharyngeal pouches fail to develop.
What has C-ANCA antibodies and are specific for proteinase-3
Wegener's granulomatosis (vasculitis involving necrotizing granuloma formation in the lungs and kidneys.
What is Phenylalanine hydroxylase and what happens when it is deficient?
- PAH is an enzyme that catalyzes the conversion of phenylalanine to tyrosine.
- Deficiency -> Phenylketonuria = problems with brain development, mental retardation and seizures.
What are the symptoms associated with EBV and a diet high in carcinogenic nitrosamines?
- This leads to nasoppharyngeal carcinoma common in Asia and Africa
- nasal congestion
- ear infections
EBV = DNA virus of herpesvirus.
What is unique about squamos cell carcinoma of the bladder?
It is the most common tumor in the world except in the U.S.
- It is caused by schistosoma chronic irritation
- Histo presents with keratin pearl formation
What cholesterol lowering drug acts mainly to decrease Triglyceride levels and how?
- Fibrates (gemfibrozil) ligand
- They increase expression of the PPAR-alpha protein via binding -> increased expression of lipoprotein lipase on endothelial cells -> increased clearance of tg-rich lipoproteins.
In congestive heart failure with pulmonary edema what would be a combo that is good but has exceptions?
- Digoxin and diuretics.
- But: thiazides, furosemide, and ethacrynic acid are known to cause hypokalemia, which adds on to digoxin toxicity.
Why is Warfarin good in the setting of chronic atrial fibrillation?
- Warfarin inhibits gamma-carboxylation of vitamin K-independent clotting factors and is used for chronic anticoagulation.
- It is taken orally and has a long half-life.
How does Factor V lead to a hypercoagulable state?
Factor V Leiden is a mutation in the Factor V gene leading to resistance to deactivation by protein C thus creating a hypercoagulable state.
How does protein C and protein S lead to a hypercoagulable state?
They are negative regulators so a deficiency in these enzymes will cause a hypercoagulable state.
Which is why you need thrombin with Warfarin administration b/c Warfarin decreases Protein C and S alot more rapidly than the other factors(2,7,9, 10)
What is a cause of mitral regurgitation 3-10 days after an MI?
Rupture of the left ventricular papillary muscles due to the presence of granulation tissue weakening the heart.
What are drgus that cause torsades des pointes?
- Quinidine (prolong QT interval)
- class III antiarrhythmics (except bretylium)
- Bepridil (CCB class IV antiarrhythmic)
What inhibits growth hormone synthesis?
- Obesity (reduced really)
- Pregnancy (reduced really)
- Somatomedins (IGF that stimulates production of somatostatin)
Describe the appearance and function of the parathyroid chief cells.
Small pale cells with round central nuclei
- secrete PTH to increase Calcium via:
- osteoclastic resorption
- kidney reabsorption of Ca2+ and phosphate trashing
- Vitamin D activation -> Ca2+ absorption from the intestine
How can small cell carcinoma of the lungs result in seizures?
By production of ADH excessively leading to masive water reabsorption disrupting the sodium balance leading to an electrolyte imbalance which led to the seizure.
What are the signs of hypokalemia?
nausea, vomiting, muscle weakness, cardiac arrhythmias
What drugs are responsible for centrilobar necrosis of the liver?
- carbon tetrachloride
What is exudative diarrhea?
Diarrhea characterized by mucosal destruction that leads to purulent and bloody stools. This will persist with fasting.
Desrcibe the progression of chronic gastritis?
- It can lead to adenocarcinoma:
- first invades gastric mucosa and submucosa
- then invades muscularis propia
- invades muscularis layer -> linitis plastica
- Metastasis to liver and pancreas
- signet cells
What are the symptoms associated with Auer rods?
- This is Acute myeloid leukemia
- pancytopenia(anemia, bleeder, and cant fight infections)
- easy fatigue
- gingival bleeding
What is the most common tumor to metastasize to the liver?
How does lead cause anemia?
inhibits ALA dehydratase and ferrochelatase -> prevention of porphobilinogen formation and incorporation of iron into protoporphyrin IX. This leads to ineffective heme synthesis and subsequent microctic anemia.
Inflammation of subcutaneous fat with widening tissue septa from edema, increased neutrophils, and fibrin exudation.
GROSS: red tender subcutaneous nodules
What is this?
- Erythema nodosum.
- Occurs with:
- IBS, sarcoidosis, OCP, sulfonamides, neoplasms, TB, B-hemolytic streptococci, coccidioidomycosis, histoplasmosis, and leprosy.
Characteristics of osteoarthritis
- wear and tear -> destruction of articular cartilage
- subchondral bone formation
- improves with rest (gets worse as day goes)
- Narrowing of the joint space, sclerosis, and presence of osteophytes.
What controls the motor inervation of the palatal arches and uvula?
CN X - vagus nerve
Small grey plaques of demyelination present in the white matter of the central nervous system.
MICRO: gliosis and demyelination with lipid-laden macrophages.
What is schizophreniform disorder?
Symptoms of schizophrenia between 1 month and 6 months
Delusion that a widowers wife is controlling his thoughts.
This is a sign of pathologic grieving.
What are the warning signs of depression that are seen in sleep disorder?
- increased time spent in REM
- decreased delta waves (Stages III and IV)
- decreased daytime energy and motivation to complete tasks
What is methylphenidate used for?
To treat narcolepsy
What effect would ketorolac have on the kidneys?
- It is an NSAID
- NSAIDs inhibit renal prostaglandin synthesis
- prostaglandin causes afferent arterioles to vasodilate
- therefore NSAIDs cause afferent arteriole vasconstriction leading to a decrease GFR and possible acute renal failure.
What toxicity is seen with gentamicin?
It is an aminoglycoside -> ototoxic and nephrotoxic
Describe the receptors that ADH effects
V1 is a Gq receptor of vascular smooth muscle and activation leads to vasoconstriction
V2 is a Gs receptor that directs insertion of aquaporin water channels into the luminal wall -> water reabsorption and possible hyponatremia.
What does a 21 alpha-hydroxylase deficiency present with?
- Total lack of aldosterone and cortisol -> hypotension and hypovolemia
- also increased androgen production leading to masculinization of tissue.
What is perfusion-limited exchange?
gas equilibriates early along the length of the pulmonary capillary so the only way to increase gas exchange is to increase blood flow.
What presents with no tracheal deviation, decrease breath sounds over the lower lobe, dullness to percussion, and decreased tactile fremitus?