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What should you do in the case of a patient that speaks a different language and you would like to enter them into a study with written consent required?
You need a consent form in the language native to the patient and an interpretor to discuss any questions or concerns the patient has.
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What is a confounding error?
Occurs when a variable other than the one being studied is influencing the results.
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What is splitting?
An immature defense mechanism in which there is a belief that people are either all good or all bad.
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What can be used to determine if someone is the carrier of cystic fibrosis?
- PCR to amplify the region of interest
- sequencing to see if the cystic fibrosis mutation is present
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What do Hashimoto's thyroiditis and pernicious anemia have in common?
They are associated with the DR5 human leukocyte antigen subtype, which are autoimmune diseases.
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What is vancomycin effective against?
What is a form of resistance against Vancomycin?
- Vancomycin is effective against gram positive cocci.
- Resistance is built via conversion of D-ala D-ala to D-ala D-lac which means no binding of vancomycin.
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What is the treatment for a continous murmur heard in the left upper sternum?
This is patent ductus arteriosus. This can be closed via the use of indomethacin, an NSAID that inhibits PGE1 production.
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What is the pathogenesis of renal agenesis in the fetus?
Oligohydramnios because fetus cant excrete urine into the amniotic sac -> compression of the fetus -> pulmonary hypoplasia, limb deformities, abnormal facies, and wrinkly skin.
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What is the general rule for branchial arches and branchial pouches?
- Arches give rise to mesoderm-derived tissue
- Pouches give rise to endoderm derived tissue.
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What are the characteristics of Coccidioides immitus?
- Endospores containing spherules when cultured at 37C and branched hyphae when the organism is cultured at 25C.
- Seen in southwest U.S
- seen in immunocompromised or the elderly
- Causes penumonia that can progress to disseminated granulomatous disease.
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What is the urease, catalase, and oxidase properties of H. pylori?
- urease (+)
- catalase (+)
- oxidase (+)
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What causes a well-demarcated skin lesion with a black base following a tick or deerfly bite or contact with the body fluid or fur of an infected rabbit?
The skin lesion is ulceroglandular tularemia and it is caused by francisella tularenis.
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What is a syngeneic graft?
An allogenic(homograft) from a patient's identical twin sibling.
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What separates juvenile rheumatoid arthritis from adult rheumatoid arthritis?
- Before age 16
- increased likelihood of systemic onset(high fevers, lymphadenopathy, and hepatomegaly)
- increased likelihood of joint involvement
- increased likelihood of antinuclear antibody seropositivity
- Less likely to have rheumatoid nodules and rheumatoid factor.
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What is the cause of recurrent viral infections if the number of T cells are normal?
It is a defect in the activation of T cells. Viral infections need CD8 T cells to be activated to help fight the infection. Therefore there is a defect in IL-2 which activates the T-cells. They are present but not doing their job.
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What are the complications that are caused by the organism that produce large, round intranuclear inclusion with perinuclear halo seen in cells. Appear as "owl's eyes"and are seen in AIDS patients with a CD4 coutn <100/mm3
- These are the Cowdry type A bodies of CMV.
- COMPLICATIONS:
- retinitis
- pneumonitis
- inflammation along the gastrointestinal tract
- polyradiculopathy
- transverse myelitis
- focal encephalitis
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How does neurofibromatosis type 1 occur?
NF1 protein functions as a tumor suppressor by acting as a GTPase for the G protein Ras. A mutation in this gene means no GTPase -> Ras is bound to GTP -> uncontrolled growth.
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What is the equation for drug clearance?
(rate of drug elimination)/ ([plasma drug])
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What drug is metabolized by and induces the CYP450 enzyme and turns all bodily fluid orange and treats tuberculosis?
Rifampin
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What changes should be made to loading dose and maintenance of a drug given to a patient with chronic renal failure?
- The loading dose remains the same
- The maintenance dose should be lowered in order to avoid drug toxicity.
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What viruses are responsible for myocarditis with dilated cardiomyopathy?
- Coxsackievirus
- influenza virus
- adenovirus
- echovirus
- cytomegalovirus
- HIV
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What is the main target of atherosclerosis?
- Areas of high turbulence:
- abdominal aorta and iliac arteries
- femoral and popliteal arteries
- tibial and peroneal arteries
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What is pseudohypoparathyroidism?
- An autosomal dominant disease with variable penetrance.
- Kidney is unresponsive to PTH -> elevated PTH, low Ca2+ and high phosphate
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What 2 diseases have a high association with Hashimoto's thyroiditis?
Celiac disease and type 1 diabetes mellitus.
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What helminth is found in the fresh water of South America, pentrates the host skin and invades the portal or pelvic venous vasculature.
SYMPTOMS include:
fever, diarrhea, weight loss
Later on- portal hypertension, hepatosplenomegaly, and cirrhosis.
Schistosoma mansoni
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What other complication do you need to worry about in a patient who has rheumatoid arthritis?
The use of non-steroidal anti-inflammatory drugs because this could lead to acute gastritis.
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What are the similarities and differences between raloxifene and tamoxifen?
- SIMILARITIES:
- selective estrogen receptor modulator
- estrogen antagonist in the breast
- partial agonist in the bone
- DIFFERENCES:
- Tamoxifen: increased endometrial cancer because of agonists effects at the endometrium.
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What has an elevated mean corpuscular hemoglobin concentration with the treatment being splenectomy?
How would test it?
- Hereditary spherocytosis
- The osmotic fragility test ([salt] at which RBC will hemolyze)
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Elevated homocysteine and methmalonic acid demonstrate a deficiency in what vitamin?
Cobalamin (B12)
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What is Reiters syndrome
- conjunctivitis, urethritis, arthritis
- can't see, can't pee, can't climb a tree
- 80% positive for HLA-B27
- Thought to be an autoimmune reaction after a GI or GU infection.
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What is the general treatment for an acute gout attack?
- Begin with NSAIDs
- then colchicine (inhibits microtubule polymerization by binding to tubulin)
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What is innervated by the ulnar nerve?
- adductor pollicis
- hypothenar muscles
- lumbricles (3 and 4)
- dorsal interossei
- palmar interossei
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What is innervated by the median nerve?
- Abductor pollicis
- flexor pollicis
- lumbricles (1 and 2)
- opponens pollicis
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What is supplied by the 7th cranial nerve?
- afferent taste fibers from anterior 2/3 of the I/L tongue
- general touch and pain sensory fibers from a small area around the I/L ear
- motor fibers to the muscles of facial expression
- stapedius muscle
- parasympathetic fibers to I/L lacrimal gland
- eye closure
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Damage to the lower division of the geniculocalcarine tract resutls in what problem?
- This is damage to Meyer's loop which contain input from the inferior retinal quadrants
- -> contralateral upper quadrantanopia
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What differentiates the two disease associated with melanin-containing neuron with pink staining inclusons in the substantia nigra?
- Parkinsons and Lewy body dementia.
- Dementia separates the two diseases.
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What is a unique side effect of clozapine?
This is an atypical antipsychotic with a side effect of agranulocytosis (sore throat and fevers)
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What antidepressant drug is known to increase the risk of seizure in anorexic patients?
Bupropion
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What is the most likely cause of proteinuria, generalized edema and hypertension in a 50 year old man.
Membranous glomerulonephritis (a nephrotic syndrome)
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What is the predominant cell type in WBC casts of acute pyelonephritis?
PMNs
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What drug acts on the early distal tubule and limit loss of calcium?
Thiazide diuretics
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What are risks factors for endometrial carcinoma?
- Prolonged estrogen use
- obesity
- diabetes
- hypertension
- nulliparity
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What are the expected levels of PSA, calcium, and alkaline phosphatase in prostate cancer that has metastasized to vertebrae?
- High PSA
- Low calcium and high ALK-P because bone is being produced.
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Male impotence with leak of blood from the dorsal vein to the saphenous vein. What is going on?
Venous outflow due to insufficient relaxation of the smooth muscle resulting from excessive adrenergic tone or damaged parasympathetic innveration.
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What causes a left shift of the adult oxygen-hemoglobin dissociation?
- increased pH
- decreased temperature
- decreased 2,3 DPG levels
- decreased arterial carbon dioxide levels
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Sarcoidosis involves:
- noncaseating granulomas and hilar lymphadenopathy.
- ACE levels are elevated due to its overproduction by immune cells comprising the granulomas.
- Hypercalcemia via excess vitamin D production by macrophages
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What branchial structure is involved in Digeorge Syndrome?
- Aberrant development of 3rd and 4th branchial pouches lead to:
- Cleft palate
- Abnormal facies
- Thymic aplasia
- Cardiac defects
- Hypocalcemia
- 22 = chromosome
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What enzymes need Vitamin B1
- Vitamin B1 = thiamine ->thiamine pyrophosphate
- cofactor for:
- 1. pyruvate dehydrogenase (glycolysis)
- 2. a-ketoglutarate dehydrogenase (TCA cycle)
- 3. Transketolase (HMP shunt)
- 4. Branched-chain AA dehydrogenase
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What is seen with a deficiency in vitamin E?
- increased fragility of erythrocytes (hemolytic anemia)
- muscle weakness
- posterior column and spinocerebellar tract demyelination
Its main function is to protect erythrocytes and membranes from free-radical damage.
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What is the function of the rate-determining enzyme of glycolysis?
Phosphofructokinase-1 -> uses ATP to add high energy phosphate group onto substrate.
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What is NADPH used for?
- Anabolic process
- Respiratory burst
- P-450
- Glutathione reductase
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What happens to fructose bisphosphatase-2 and phosphofructokinase-2 in the fed state?
Fed state -> increase insulin -> decrease cAMP -> decrease protein kinase A -> decrease FBPase-2 and increase PFK-2 -> increase fructose-2,6-bisphosphate (from Fructose-6-phosphate) -> PFK-1 induction -> (fructose-6-phosphate to F1,6BP)
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What are the cofactors need in pyruvate dehydrogenase?
What else uses these 5 cofactors?
- Pyrophosphate (thiamine, B1)
- FAD (riboflavin, B2)
- NAD (niacin, B3)
- CoA (pantothenate, B5)
- Lipoic acid
a-ketoglutarate dehydrogenase (of TCA cycle) uses the same cofactors.
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What are the products that can be made from pyruvate?
- 1. Alanine (carries amino groups to liver from muscle)
- 2. oxaloacetate (replenish TCA or go to gluconeogenesis)
- 3. Acetyl-CoA (transition from glycolysis to TCA)
- 4. Lactate (anaerobic glycolysis; RBC)
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What are the antimuscarinic drugs?
- Atropine
- ipratropium
- Tropicamide
- Benztropine
- Scopolamine
- Pilocarpine
- Oxybutynin
- Darifenacin
- Tolterodine
- trospium
- Homotropine
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What organisms would a patient with Chronic granulomatous disease have to avoid getting sick with and why?
CGD is a deficiency in NADPH oxidase (O2 to O2 . -> H2O2)
- Catalase positive organisms breakdown their own H2O2 leaving the WBC without a reactive oxygen intermediate to fight with.
- 1. Staph aureus
- 2. Listeria
- 3. Corynebacterium diphtheriae
- 4. Nocardia
- 5. Enterobactericea
- 6. Mycobacterium tuberculosis
- 7. Aspergillus
- 8. Cryptococcus
- 9. Pseudomonas aeruginosa
- or SPACE
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