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Printed from www.StudyDroid.com USMLE world -- Cloned from: USMLE world heman55555 Front Back symetrical arthritis in the the PIP, wrists, and knee. will present very similarly to RA, but symptoms will resolve. A child will present with fever and a facial rash. "slapped face disease" should be differentiated from roseola infantum that has a rash, Hep 6 virus, and is a common cause of seizures
what are the signs and symptoms of fifth (parvovirus B19) disease in an adult?
What is mitochondral myopathy?
pt presents with red ragged muscle fibers and lactic acid it is an example of heteroplasmy, which is a when a conditions severity is dependent on the organelles having unique gene expression.
what condition present with facial swelling and dark urine?
Post-strep GN- usually following a skin infection
Chlorthalidone
They work by inhibiting reabsorption of sodium (Na+) and chloride (Cl) ions from the distal convoluted tubules in the kidneys by blocking the thiazidesensitive Na+-Cl symporter. also they will cause increased uric acid and increase plasma calcium levels.
Guillain-Barre syndrome
acute demylination of peripheral nerves using following a fibrile respiratory infections. Also can rarely occur following the influenza vaccine.
what is "chloride shift"
CO2 +h20-h2co3---H+ + Hco3---- when co2 enters the rbc from the peripheral tissue it froms HCo3- which when it leaves the RBC chloride- will enter inorder to replace the negative bicarbonate.
what kind of murmur does a PDA have?
continous murmur heard best at the left sternal border listen post. (S2) and sounds like machinery running.
PCo2= 1.5 (HCO3-) + 8 +/- 2

formula for respiratory conpensation in metabolic
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formula for respiratory conpensation in metabolic acidosis ?
Pco2 increase .7 for every 1 meq/l of HCO3- or dr k pco2- for every 10 mmhg change from normal 40 the PH will change .08
Def in HGPRT leads to LEsch Nyhan syndrome and self mutalation- treat with allopurinol.
Adenosine deaminase (ADA1) deficiency severe combined immunodeficiency disease (SCID) Accumulation of dATP inhibits ribonucleotide diphosphate reductase Reduction in generation of deoxyribonucleotides Impaired proliferation of lymphocytes Loss of immune system, no T-cells and Bcells scid.
Regulated step is the production of carbamoyl phosphate CPS II activity is regulated Activated by PRPP Inhibited by UTP The phosphorylation of CPS II makes it more sensitive to activation Occurs during S-phase Deficiency of the second enzyme of urea cycle leads to accumulation of carbamoyl phosphate in mitochondrion Leaks to cytoplasm pyrimidine production Reaction catalyzed by CPS II, is being bypassed, which leads in orotic aciduria
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Orotic acid (orotate) is converted to UMP in two steps T wo enzymatic activities are located on one polypeptide, UMP synthase Deficiency of UMP synthase Hereditary orotic aciduria Accumulation of orotic acid Block of pyrimidine synthesis leads to growth retardation Tre atme nt : Oral administration of uridine Uridine is converted to UMP bypassing metabolic block
Missense- code for a new amino acid that is similar in structure what is a missense mutation/nonsense/ and silent mutation? Nonsense- codes for a stop codon Silent- 3rd position codon ( wobble position) no change in aa. severity is nonsense>misssense>silent
Phase I- use healthy people to test toxicity, pharm kinetics, and safety phaseII- small trial with people with the diseaseoptimal dosing and efficacy what is involved of Phases I-IV of a clinical drug trial? Phase III- Large group and control trial against current best available medication Phase IV- postmarking surveillance- long term adverse effects.
what is a meta analysis?
pools of data from several studies to come to an overall conclusion. may be limited by bias
what drugs inhibit folate synthesis by inhibiting Dihydrofolate reductase?
methrotrexate,pyrimethamine, trimethaprime
cypto neoformas- often causes meningitis in immuno

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cypto neoformas- often causes meningitis in immuno compromised patient- diagnosed with a mucicarmine staining of the lung tissue and a b a l washing. it is a budding yeast with a very thick capsule.
HIstoplasmosis
Strep Pyrogens (GAS)-Beta hemolytic-bacitracin sensitive to distinguish between that and (GBS)
N.Gonnorehea- Gram negative dipplococci
AIDS- Pneumocytisis jiroveci
strep pneumonia- P disc (optochin sensitivie)- Gram positive dipplococci
cocci immites
trimethoprim-sulfamethoxazole (Bactrim DS) for 3 days is the drug of choice for uncomplicated cysitis Nitrofurantoin (Macrobid) 100mg for 5 days is another drug of choice for uncomplicated cysitis
TREATMENT IN UNCOMPLICATED AND COMPLICATED UTI''S?
FOR COMPLICAT ED T he drugs of choice are:
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ciprofloxacin (Cipro) 500mg for 10 days
levofloxacin (Levaquin) 750mg for 5 days
diabetes mellitus pregnancy immunosuppression (AIDS, steroids, SC) an indwelling urinary catheter history of polycystic kidney disease kidney stones neurogenic bladder recent urinary tract instrumentation all me n
WHAT IS A COMPLICATED UTI?
WHICH ANTIBOTICS TO US IN A PREGNANT WOMEN FOR UTI?
Nitrofurantoin (Macrobid) 100 mg orally every 12 hours for 7 to 10 days Cefpodoxime (Vantin) 100 mg twice daily for 7 days
GONNORHEA: Ceftriaxone 250mg IM Cefixime 400mg PO single dose Azithromycin 2gm PO single dose CHYLAM IDIA
treatment for GC ?
Doxycycline 100mg PD BID for 7 days Azithromycin 1gm PO single dose
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Caused by infection with Gardnerella vaginalis Risk factors: new sexual partner, IUD, and douching T ypically only symptom is malodorous vaginal discharge (often increased after coitus) Vaginal discharge is classically described as white-grey, homogenous, non adherent pH > 4.5 Fishy odor due to positive amines (Positive whiff test) Clue cells seen on wet mount T x of choice: Metronidazole 500mg PO BID for 7 days
pseudohyphea budding yeast. diamorphic.
Caused by infection with Candida (Albicans and Glabrata) more frequently in women taking antibiotics or using oral contraceptives T ypical symptoms are vulvovaginal itching and irritation, vaginal discharge Vaginal discharge is classically described as white, odorless, curd-like adhering to the vaginal wall pH is normal Negative whiff test Pseudohyphae or budding yeast cells seen on KOH/saline wet mount T x of choice: T opical antifungals or Diflucan 150mg PO x 1
Caused by infection with T richomonas vaginalis T ypical symptoms are vaginal discharge, vulvovaginal irritation, dyspareunia, dysuria Almost always asymptomatic in men Vaginal discharge is classically described as green-yellow, frothy, non adherent Motile trichomonads seen on saline wet mount pH > 4.5 Positive/Negative KOH whiff test
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T x of choice: Metronidazole 2g PO x 1 Male partners must be treated
what are some of the findings in Turner's Syndrome (45 XO)? also also an increased risk of the horseshoe kidney, lymphedema
when is the developing oocyte arrested?
at birth 46 (4N) prophase meiosis i and then at puberty FSH stimulate division and then is arrested at metaphase meosis II at day 14 until fetilaztion
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aspergillus- branching septate hyphea. oftenforms long cavities called fungus balls. it is a mold of a septate hyphae that branch it acute angles think a for acute angles in aspergillus not dimorphic
Warfarin- Prevents vitamin K from regenerating and thus prevents the formation of the coagulation cascade- factor II(prothrombin), Factor IX, and factor X How do Warfarin, Tpa, streptokinase, and low molecular wt heparin ( enoxaparin) work? Streptokinase- is a thrombolytic like T-Pa that convert plasminogen to plasmin which will dissolve clots through fibrin Haparin - binds to antithrombin III and increases its affintiy towards prothrombin to stop the clotting cascade.
why is it important to have a patient have a nitrite free time in a day while using nitrites for chest pain?
not taking a pill at night will prevent tolerance from developing.
Men I. , MENI, MENIIA,MENIIB?
MENI- the p\''s parathyroid, pancreas, pituitary MENIIA- Medullary carcinoma of thyroid, pheochromocytoma, parathryoid MENIIB- SAME BUT MUCOSAL NEUROMAS INSTEAD OF Pth
Test for encasulated bacteria and will cause the capsules to swell.. (swellung)
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what is a Quellung test?
Encapsulated bacteria are: "Some killer have shinny coats" Step Pneumonia, Klebsiella, H.Influenza, Salmonella, and Group B Strep.
Rickettsia and chlamydia and facultative are: Salmonella, neisseria, brucella, mycobacterium,listeria,francisella,leginella "some nasty bugs may live facltatively"
What bugs are intracelluar?
what are the antidotes for: TpA's warfarin Heparin Methemoglobin Copper,arseinic, gold Organophosphates Iron lead
}
tPA- Aminocaproic acid Warfarin-Vit K FFP Haparin- Protamine Methemoglobin-methlyene blue&Vit C Organophosphates- Atropine,pralidoxime Iron- Deferoxamine Lead-Caedta,panicillamine,dimercaprol,succimer
Brutons (x linked) agammaglbulinia
B cell defect in BTK that prevents pre-b cell maturation No B cells in peripheral evidence by flow cell ( b19 abscents) Becomes mostly apperent 2-3 yr old males Pyrogenic infections not oppurtunistic,mostly encapsulated bacteria Low igG and none of other antibodies
} Defect in Isotype switching caused by the abscense of the CD40L on the T CELL LEADS TO HIGH LEVELS OF IGM and low levels to zero levels of other antibodies Diagnosis with a proliferative assay and in the presence of anti CD 40 the T cells will proliferate vs AID they will not There is absence of germinal center in the lymph nodes and other secondary lymphoid organs Pyrogenic and oppurtunistic infections Neutropenia from No GM-csf because of unstimulated macrophages
Hyper IgM X linked
what cytokines produce isoswitching of IgE,IgA,IgG

IgE- IL-4 and IL-13 IgA- IL-5 and TGF-B

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igG-INF-Y
Function of the cytokines
IL-1-FEVER IL-2-STIM T CELLS IL--3 STIM B CELLS IL-4- STIM IGE IL-5- STIM IGA "HOT T BONE STEAK IL-8 - CLEAN UP ON AISLE 8 CALLING ALL NEUTROPHILS IL-12 INDUCE THE MAC'S by increasing th1 and Nk cells TNF-a- shock , wbc recruitment, adn vascular leak
th1- IL2 AND INF-Y - ANTI VIRAL AND TUMUR what cytokines do TH1 and Th2 cells release? TH2- IL4-5 AND IL10 FOR REG CELLS AND ISOTYPE SWITCHING
vasculitis size nomenclature?
petecia,purpora, eccymouses, bruise/hematoma
Histologic section of thyroid gland from a patient with Graves Disease. Graves Disease is an autoimmune disorder of the thyroid gland in which the patients produce antibodies directed against the TSH receptor. In Graves Disease, the TSH receptor antibodies act as agonists and result in constitutive activation of the TSH receptors on the follicular epithelial cells. Constitutive activation of the TSH receptors results in hyperthyroidism, as well as hyperplasia and hypertrophy of the follicular epithelial cells. In this histologic section, there is formation of numerous papillae which project into the lumen of follicles. This change is caused by the increased number of cells lining the follicles, and is referred to as papillary hyperplasia. Papillary hyperplasia occurs diffusely throughout the thyroid gland in Graves Disease. Also note the paucity of colloid within the follicles. In Graves Disease, the follicular epithelial cells are pinocytizing colloid and degrading thyroglobulin to release more T3 and T4, almost as fast as more colloid can be produced.
Histologic sections from a case of Hashimoto

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Thyroiditis. The low power image on the left reveals the presence of numerous lymphoid follicles with reactive germinal centers (yellow arrows point to several of these). The high power image on the right reveals numerous follicular epithelial cells exhibiting so-called Hurthle cell metaplasia (yellow arrow). Hurthle cells have abundant eosinophilic granular cytoplasm. Numerous mononuclear inflammatory cells are also noted (blue arrow). Hashimoto thyroiditis is an autoimmune disorder of the thyroid gland. These patients do not respond to anti-inflammatory drugs, and eventually develop hypothyroidism requiring thyroid hormone replacement therapy.
Aspergillus infection of the pituitary gland. Fungal and Mycobacterial infections can involve the pituitary gland resulting in hypopituitarism. Most of these infections are encountered in immunosuppressed individuals. The histologic section on the left is from the anterior pituitary. The area bounded by the yellow rectangle is extensively necrotic. Remnants of viable pituitary are seen above the yellow rectangle. The section on the right is from the necrotic area inside the yellow rectangle stained with a Gomorri Methenamine Silver (GMS) stain. The GMS stain reveals the presence of numerous fungal hyphae. Some of the hyphae exhibit acute angle branching (yellow arrow) typical of Aspergillus species.
what drugs are non selective alpha and beta antagonists?
Carvedilol, labetalol
what class of drugs are clonidine and a-methyldopa in?
alpha 2 agonists and are central acting to decrease the symphathic response. Good for hypertension in renal diseased pt because you don''t decrease renal blood flow.
Posterior lobe, peripherial zone, increase PSA, and decreased free Psa. what are the P's of prostate cancer signs? Also will be a hard nodule bph is found in the lateral and middle lobes
howell- jolly bodies(nuclear remnants) after splenectomy. which would make you suseptable to
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encapsulated bacteria [IMGPATH:]/sdcard/StudyDroid/card-5872398front.jpg Shin's- salmonela, strep pneumonia, h. infle=uenza, N. Menigitisidis also remember that The white pulp of spleen Pals (t cells) and follice b cells located in the central region and the red pulp is in the perpiheral.
what diseases does paramyxovirus cause?
paramyxovirus causes Parainfluenza-croup Rsv-treat with ribavirin Measles- rubeola Mumps Most Rna virus's are ss besides reovirus is ds
Erythe ma infe ctiosum (O r fifth dise ase ) Parvovirus B19 Most often occurs in epidemics with school age children Confluent net like red rash slapped face apperance Begins on checks and spreads to trunk Polyarthritis in common in adults like rube lla (ge rman me asle s)
Rose ola infantum:
Herpes 6 virals
Roseola (aka 6th disease) HHV-6; most common viral exanthem children < 2 years old Macules on soft palate before rash Occurs after 3 to 7 days of high fever Common cause of fe brile convulsions
signs of amphetamine abuse?
impaired judgement, papillar dilation, prolonged wakefulness attention dilusions halluniation and fever... cramps hunger and hyper solmonlence
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erb''s palsy (waiter tip) vs klumpkes palsy (claw hand)
erb''s- Medial rotated arm and pronated- defect in the upper trunk klumpkes- low trunk defect. "pick the erbs from the top of the trunk."
bethanechol- ach agonist to activate bowls and bladder hexamethonium- put a hex on the smoker(nicotine) to get them to quite carbachol- carban copy of ach for glaucoma and interocular pressure Physostigmine- achase agonist for glaucoma and atropine overdose
bethanechol, hexamethonium, carbachol, physostigmine
macrolides- clarithromycin- inhibit ps by blocking translocation. bind to the 23 AND 50 ''s "buy AT 30 , CCELL 50" drug class good for atypical pneumonas? (MYCOPLASMA,CHLAMYDIA, LEGIONELLA) A-AMINOGLYCOSIDES T-TETRACYCLINE C-CHLORAMPHENICOL, CLINDAMYCIN E-ERTHRO L-LINCOMYCIN L-LINEZOLID
microbes passed from mother to fetus T-toxoplasma gondii- cat feces and undercooked meat (triad - chorioretinitis, hydrocephalus, and intracranial calcifications) Rubella- PDA,Cataracts,deafness and blueberry muffin rash CMV- hearing loss seizures and petechial rash H- Hiv -chronic diarrhea,recurrent infections H-herpes -encephalitis S-syphilis- still born or facial abnormalities
WHAT IS ToRCHeS acronym ?
WHAT HLA IS HASIMOTO'S THROIDITIS ASSOCIATED WITH?
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-
Waterhouse-Friderichsen syndrome:
Waterhouse-Friderichsen syndrome Meningococcal septicemia DIC with widespread purpura Massive bilateral adrenal hemorrhage acute adrenocortical insufficiency Rapidly progressive hypotension shock Possible causes of adrenal hemorrhage: bacterial seeding of small vessels DIC endotoxin-induced vasculitis hypersensitivity vasculitis High mortality rate
finding in TETRALOGY OF FALLOTPULMONARY STENOSIS (determines prognosis) RVH OVERIDING AORTA VSD early cyanosis- pt learns to squat to improve symptoms. increase increase TPR thereby decrease rt to left shunt and get more blood to the lungs
Two forms infantile form: narrowing of aortic arch proximal to a PDA adult form: narrowing of aortic arch just opposite a closed ductus arteriosus Coarctation with a PDA systolic murmur & continuous murmur cyanosis in the lower half of the body may require surgery during the neonatal period Coarctation without a PDAdistal to subclavian artery may go unrecognized until well into adulthood hypertension in the upper extremities with lower BP in the lower extremities pallor, claudication, coldness in lower extremities LVH, notching of ribs on CXR, systolic murmur Surgery yields excellent results llor, cstolic murmur Surgery yields excellent results
assocated congenital heart conditions 22Q11 SUNDROMES DOWN SYNDROME (TRISOMY 21) RUBELLA TURNERS 45XO MARFANS DIABETIC MOM
22Q11- TRUNCUS ARTERIOSUS, FALLOT DOWN- ASD,VSD, SEPTAL RUBELLA- SEPTAL, PDA, PA STENOSIS MARFANS- AORTIC INSUFFICIENCY DIABETIC- TRANSPOTION OF GV
C- COUGH
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SIDE EFFECTS OF CAPTOPRIL?
A-ANGIOEDEMA P-PROTEINURIA T-TASTE CHANGES O-HYPOTENSION P-PREGNANCY CONGENITAL RENAL R-RASH I-INCREASE RENIN L-LOWER ANGIOTENSION HYPERKALEMIA
BE WISE FOOLS GOLD HEED SILLY HOPE Brutons aggamaglobulinemia wiskott-aldrich fabry G6PD def Ocular albinism Lesch-Nyhan Duchenne's Hunter's syndrome and Hemophillia a/b
X LINKED RECESSIVE DISORDERS?
what is fragile x syndrome?
X linked defected affecting the methylation of FMR1 GENE. second cause of MR after down's. macro-orchidism, long face, large jaw MV prolapse. trinucleotide repeat CGCn "fragile x = extra large testes, jaw, and ears. "
"try hunting for my fried eggs (x) what are the trinucleotide repeat expansion diseases? Huntinton disease (CAG) MYOTONIC DYS (CTG) FRAGILE X (CGG) FRIEDREICH ATAXIA (GAA)
simian crease, epicathal folds trisomy 21.. increase risk ALL and alzheimers meiotic non-disjunction blood tests- decrease AFP, ESTRIOL, increaseBHCG AND INHIBIN " think drink at 21, election 18, puberty 13" downs,edwards, pataus
Edwards -trisomy 18Second most common pattern of human malformation

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Genetics older maternal age; faulty chromosome distribution Findings - Growth deficiency - Mental retardation Low-set, ma1formed ears - Microcephaly, micrognathia - Prominent oociput - Clenched handindex over third; fifth over fourth - Short sternum Hernia-inguinal, umbilical - VSD, ASD, PDA Rocker-bottom feet, hammer toe
Patau's syndrome- cleft palate, holoprosencephaly, polydactlyly
22Q11 DELETION SYNDROME
"CATCH 22" CLEFT PALATE AB FACIES THYMIC APLASIA- T CELL DEF CARDIAC AB HYPOCALCIEMIA DIGEORGE- THYMIC PTH HYPOCALCEMIATETANY, CARDIAC DEFECT VELOCARDIOFACIAL SYNDROMESPALATE FACIAL AND CARDIAC
Neuroectoderm- Think Brain and CNS (oligodentrocyte, astrocytes, retina, and Spical cord Neural crest- PNS and non neural structures nearby ( Dorsal root ganglia, chromaffin cells of adrenal medulla, c cells of thyroid, schwann, odontoblost (think crest tooth paste) Surface ectoderm- Adenohypopysis (rathkes pouche s- which can lead to a craniopharyngioma with cholesterol cystals and calcifications), lens of eye, epidermis, salivery, and sweat glands
What derives from the surface ectoderm, neuroectoderm, and Neural crest?
what derives from the endoderm?
Gut tube epithelum and derivatives (lung and liver), pancrease, thymus, pth, thyroid follicular cells
Heart , CT, Bone, Lymph, blood, uretha, vagina , ear tube, kidneys, adrenal cortex, ovaries, testes VACTERLVerterbral defect AnaL atresia cardiac trachio-esophageal fistula
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What derives from the mesoderm?
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Renal Limb defects (bone and muscle)
terms Agensis Hypoplasia aplasia Deformation malformation
malformation- intrinsic disruption during embyonic period- (3-8) deformation- extrinsic disruption after 8 wks Hypoplasia- incomplete organ development with primordial tissue Aplasia- abscent organ despite primordial tissue present agenesis- absent organ with no primordial tissue present
antibody drugs?
Rituximab- CD-20 B cells in non hodg Abciximab- Glyco IIb/IIa anti-coag in cardiac ischemia or angina (unstable) adalimumab- TNF-A chron''''s, RA, psoriatic arthritis infliximab- same and Anklosing spondylitis digoxin fabDaclizumab- IL-2 prevent acute renal rejection muromonab- CD3- organ rejections prevention mormons have 3 wifed trastuzumab- HER-2 in breast cancer
Male genital development Genital tubercle, urogential sinus/folds, labioscortal swellens
GT- Glans/clitoris cavernosum/vestibular bulb Urogential sinus - bulbourtheral&prostate/greater vestibular (bartholin) Urogential folds - Ventral penis/labia minor Labioscrotal swellings - majora/scrot
what are my anti-helminthic drugs?
Pyrantel pamoate - Nictinic receptor contraction and paralysis, don't use on the tape or flukes ivermectin- intenssifies GABA and causes immobilization Diethylcarbamazine -? Praziquantel- increase calcium permeability
Anti-protozoan drugs?
primethamine - inhibits dihydrofolate reductasetoxoplasmosis w/ sulfadiazine suramin- inhibits energy metabolism-No CNS melarsoprol- Inhibits sufhydrol enzyme- w/ CNS involvement nifurtimox- froms toxic radicals sodium stibogluconate- inhibit PFK glycolysis choloroquine- blocks plasmodium heme polymerase leading to accumlation of toxic hemeglobin byproducts mefloquine- ?
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quinine- for cholorquine resistants use with primethamine/sufonamide
Medicare parts A-D
A- inpatient care B- OUT PATIENT C- COMBO D- STAND ALONE DRUG COVERAGE
What are some reportable diseases?
Hep,Hep,Hep, Hooray, the sssmmart chick is gone!" HEP-a-c, Hiv, salmonella,shigella,syphillis,MMR,Aids, tb, chicken pox, gonorrhea
What are the Zoonotic bacteria?
Baronella- cat scratch fever -angiomatosis in aids patient Borrelia burgdorferi- lyme disease Borrelia recurrentis- recurrent fever from head/body louse brucella- undulant fever (get it from the udder) dairy Unpasturize mile francisella tularensis- Tularemia- tick or rabbit Yersinia pestis- plague, flea pasteurella - cellulitis, osteomyeltis- animal bit or cat or dog
AZOLES- inhibit p-450 and thus ergosterol synthases Use Fluconazole for invasive cryptococcal in aidscross BBB flucytosine- inhibit dna synthesis by conversion to 5FU (candida,crypto) use in combo with AMPB Amphotericin B- binds ergosterol and causes it to leak-- use with serious systemic infections- doesn't cross BBB very toxic-fever/chills nephrotoxic, remember to hydrate What are my antifungal drugs? nystatin-same action as AMP B, use only with topical vaginal, and topical diaper rash, or swish and spit for oral candiasis" Terbinafine- inhibits precursor or ergosterol (squalene) - us with onychmycosis Griseofulvin- interfers with microtubule function, use for superficial infections of dermatophytes (like tinea corpus -ring worm) is a teratogene,carcinogene and increases warfarin metabolism
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Altitude and lung/ or congential heart disease will have what effect on: plasma volume, RBC mass, O2 saturation, and EPO
plasma volume- no change RBC MASS- increase o2 sat- decrease EPO- Increase
A 5-alpha reductase deficency in a man will result in what defects?
He will have internal structures of the "SEED" seminal vesicles, epidydimis, ejaculatory duct, ductus deferens" at bith though he will have undeterminate genitila, tell he reaches pubety and his high testosterone levels will develop the penis
What is male/female pseudohermaphrodite?
female (XX)- exposure to androgens during pregancy or adrenal hyperplasia, ovaries are present but ambigous ex genitial. Male (XY)- most common is adrogen insensitivity-testes with women looking external genitial.
What is Androgen Insensitivity?
Defect in the androgen receptor resulting in normal looking femal external genitia with rudimentary vagina, not uterus or sexual hair, will have testes in the labium majora and and increase in testosterone and estrogen..
What is Kallman syndrome?
Decrease in gonadotropin from the anterior pituitary ,anosmia, lack of secondary sex characteristics.
what is testicular feminization
it is complete androgen insensitivity is characterized by normal external female genetalia think harley absent wolffian and mallarian structures
what ligament contains the ovarian artery
the nerves arteried and lymphatic suppling the ovary are all delivered by the suspensory ligament. suspensOOry
what ligament must get ligated during a hysterectomy
the transverse cervical ligament also known as the cardinal ligament contains the uteral artery. U Must remember the cardinal rule.
what are CD 14 and CD 20 celluar markers for?
CD 14 - MACROPHAGES AND CD- 20 - B CELLS ANTI CD 20 DRUG RITUXIMAB WORKS AGAINST B CELL LYMPHOMAS
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What is the filtration fraction?
Is the fraction of renal plasma flow that is filteted across the glomularus capillaries into bowman space. should be 20. % FF=GFR/RPF 125/625 GFR=Kf( Pg-Pb) -(g-b)
[IMGPATH:]/sdcard/StudyDroid/USMLE world66-true.jpg
1-receptors: vasoconstriction, mydriasis,relaxation of gastrointestinal smooth muscle (except the sphincters), thick viscid salivary secretions, and hepatic glycogenolysis, decreases renin release, Ejaculation
2-receptors: inhibition of transmitter release (including NE and Ach release from autonomic nerves), platelet aggregation, Vasoconstriction, inhibition of insulin release , Ejaculation
1-receptors: Increased cardiac rate and force, Increases renin release
2-receptors: Bronchodilation, Vasodilation, relaxation of visceral smooth muscle, hepatic glycogenolysis and skeletal muscle tremor
3-receptors: Lipolysis what are of adrenergic receptor activationa1,a2,b1,b2? 1-receptors: vasoconstriction, mydriasis,relaxation of gastrointestinal smooth muscle (except the sphincters), thick viscid salivary secretions, and hepatic glycogenolysis, decreases renin release, Ejaculation
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2-receptors: inhibition of transmitter release (including NE and Ach release from autonomic nerves), platelet aggregation, Vasoconstriction, inhibition of insulin release , Ejaculation
1-receptors: Increased cardiac rate and force, Increases renin release
2-receptors: Bronchodilation, Vasodilation, relaxation of visceral smooth muscle, hepatic glycogenolysis and skeletal muscle tremor
3-receptors: Lipolysis
sympathic vs parasympathic response on the different body systems
neurotransmitter receptors?
alpha1- Gq-stimulation of PLC to IP3 and Dag Alpha2- Gi- inhib AC-decrease Camp, Ca and increase K Beta1- Gs stim AC-- increase Camp Beta 2- Gs-- increase Cam and Increase in K efflux so hyperpolarization and relaxation of smooth muscle.
M1,m2,m3 odd are excitory and act through Gq-Increase in IP3/Dag and increase in calcium and PKC signal transduction of muscarinic receptors ? M2,M4- inhibitory Gi---Inhibitionof AC and decrease in CAMP and hyperpolarization
Name 3 differences in type 1 diabetes vs type II?
Excess glucose in DM is converted to -----Glucose-www.studydroid.com/printerFriendlyViewPack.php?packId=114961 20/76
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Aldose convertase----Sorbitol. This reaction uses up NAPH, which is needed for the glutathione to reduce oxidative radicals. This result in radical damage in pt with DM.
what are some complications of diabetes?
Pancreas Type I - insulitis, in number & size of islets Type II amyloid deposition in islets
Vascular System accelerated atherosclerosis
myocardial infarction- number one cause of death in DM gangrene
hyaline arteriolosclerosis contribute to gangrene diabetic microangiopathy thickening of capillary basement membranes
capillary basement membranes are more permeable underlies the development of diabetic nephropathy & retinopathy
Waterhouse-Friderichsen syndrome Meningococcal septicemia DIC with widespread purpura Massive bilateral adrenal hemorrhage acute adrenocortical insufficiency [IMGPATH:]/sdcard/StudyDroid/card-6156161front.jpg
Rapidly progressive hypotension shock

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Possible causes of adrenal hemorrhage: bacterial seeding of small vessels DIC endotoxin-induced vasculitis hypersensitivity vasculitis High mortality rate
n -
Neoplasm composed of chromaffin cells that secretes catecholamines (0.1 - 0.3 % of all cases of hypertension) The 10% tumor: 10 % extra-adrenal
- 10 % bilateral in sporadic cases, but up to 50% are bilateral in familial cases what is the rule of ten''s with pheochromatoma? 10 % in children
- 10 % are malignant in adrenal cases, but up to 40% are malignant in extra-adrenal cases Up to 25% are familial Familial syndromes associated with pheochromocytoma, include: MEN-2A & MEN-2B Neurofibromatosis, type 1 Von Hippel-Lindau disease
elevated afp and achase occur in what condition?
NTD - failed fusion disorder
during pregnancy are in response to elevated estrogen

increased in levels of tBg lead to increase in the circulating in total t 4 and total t 3. however the level
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what happens to the total t 4 levels
of free thyroid hormone is normal. or slightly decreased requiring alterations in the thyroid replacement
what irregular heart rhythm can occur after a day of celebration with alcohol
and the ir regular irregular of a fib. with no p waves.
what kind of reaction is a transfusion blood reaction causinf DIC?
It is an antibody mediated type 2 hypersensitivity Reaction where in host antibody bind antigen of transfused donor red blood cells. this will activate the complement system. resulting in m a c complex is that will lyse RBC VASOdilation AND anaphylactic shock red blood.
what is ticlopidine?
citizen antiplatelet drugs just like plavix (clopidogrel). and is useful in preventing a ischemic strokes. it works by antagonizing ADP. BUT DOES have serious side effects Like fever and mouth sores And nutro pina
what are niacins side effects?
gout, hyperglycemia hepatitis it is a good drive for raising hdl as well as lowering ldl.
what class of drug is GEMFIBROZIL?
it is a fibrate that will activate LPL and lower triglycerides. myopathy, gall stones and hepatitis are its side effects
in thyroid hormone synthesis thyroid peroxidase has what function
it catalyzes iodine oxidation the formation of mono and diiodotyrosinen\''t and the coupling the forms t 3 and t 4.
[IMGPATH:]/sdcard/StudyDroid/card-6157562back.jpg
histological how can you diff pct from dct.
pct- has a brush border
Option A (Chronic renal failure) is correct. In chronic renal failure, the aldosterone-mediated Na+, K+-ATPase pump in the renal tubules is dysfunctional. This leads to increased urinary loss of Na+ and retention of K+ (hyperkalemia). The ECG shows a peaked T wave, indicating hyperkalemia. Any increase or decrease in K+ concentration produces conduction disturbances in muscle that may
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lead to weakness. Option B (Diarrhea) is incorrect. Diarrhea in adults is associated with an isotonic loss of fluid (normal serum sodium), loss of HCO3- (normal anion gap metabolic acidosis), and loss of K+ (hypokalemia). On an ECG, hypokalemia is indicated by a prominent U wave following the T wave (not a peaked T wave). Option C (Primary aldosteronism) is incorrect. An increase in aldosterone enhances the Na+-K+ pump in the late distal and collecting tubules. This increases the exchange of Na+ for K+, causing loss of K+ in the urine (hypokalemia) and retention of Na+ (hypernatremia). Option D (Type 1 renal tubular acidosis) is incorrect. Type 1 (distal) renal tubular acidosis results from dysfunction of the aldosterone-mediated H+, K+-ATPase pump in the collecting tubule. This is associated with retention of H+ (normal anion gap metabolic acidosis) and loss of K+ in the urine, leading to hypokalemia. Option E (Vomiting) is incorrect. Vomiting causes metabolic alkalosis due to the loss of acid and retention of Hco3-. Alkalosis causes a shift of H+ out of the cells in exchange for K+, causing hypokalemia.
MRI of a pituitary adenoma after administration of contrast media. The yellow arrow is pointing to a large pituitary adenoma. MRI, especially after administration of contrast media, is the best imaging technique to confirm a diagnosis of pituitary adenoma. Note the sharp border between the adenoma and surrounding brain. Pituitary adenomas being benign tumors most commonly exhibit expansile but not infiltrative growth.
However, in as many as 30% of cases, pituitary adenomas are not grossly encapsulated and infiltrate neighboring tissues, such as the cavernous and sphenoid sinuses, dura, and on occasion, the brain itself. Such lesions are termed invasive adenomas . Not unexpectedly, macroadenomas tend to be invasive more frequently than smaller tumors.
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Some features associated with aggressive behavior by pituitary adenomas, include: increased mitotic activity, > 3% of the tumor cells staining positive for the proliferation marker Ki-67, overexpression of cyclin D1, p53 mutations, and epigenetic silencing of RB1. It is recommended that adenomas with these features be classified as atypical adenomas , since these tumors have a higher propensity for aggressive behavior, including invasion and recurrence. HRAS mutations are observed in the rarely occurring pituitary carcinomas.
how do NSAIDS cause acute renal failure?
Inhibiting prostaglandins which keep the afferent arterioles vasodilated to maintain GFR and RBF.
TYpes of Necrosis: Coagulative, liquefactive, caseous, fatty, fibroid, gangrenous?
coag- heart, liver, and kidney liquefactive- brain, abcess, plueral effussion caseous- tb, systemic fungi fatty- pancrease fibroid- blood vessels Gangrenous- dry ( ischemic coagulative), wet ( bacteria common in limbs or GI)
Both pathways result in the cytosolic caspases activatation and cellular breakdown Intrinsic- Increase in pro-apoptosis BAX and decrease in BCL-2 ( anti apop) and mitochondrial release of cytochrome c (ie menstruation,atrophy,radiation,and toxins) Extrinisic- Fas ligand (killer t cellser ) and granzyme, and perforinZ)
What pathway is similar in the extrinsic and intrinsic ?
M''s Munch- Masseter ,temporalis, medial pterygoid what muscles close and open your mouth? Lateral pterygoid- opens All intervated by V3
Signs of Cranial nerves lessions of XII,V,X, and XI
XII- Tongue deviated towards to the side of the lession (lick your wounds) V-jaw deviates towards lession X- Uvula deviation away from lesion XI- SCM (can't turn head away form lession ) and Trapezius - drooping shoulder on side of the lession.
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what is Kartagerner's syndrome?
Immotile cilia due to a dynenin arm defect. Results in male and female infertility (sperm immotile), bronchiectasis, and recurrent sinusitis and is ASSOCIATED WITH SITUS INVERSUS
I cell disease is a lysomal storage disease resulting from the absents of Mannose 6 phosphate addition defect this causes lysosomal enzymes to be released into the cell. Pt will present with; What are the signs and symptoms of I cell disease? Course facial features clouded corneas restricted joint movements high plasma levels of lysosomal enzymes
Glycans serve a variety of structural and functional roles in membrane and secreted proteins.[1] The majority of proteins synthesized in the rough ER undergo glycosylation (N-liked). It is an enzymedirected site-specific process, as opposed to the nonenzymatic chemical reaction of glycation. It might help prevent degradation of the protein and encourage proper protein folding. Glycosylation is also present in the cytoplasm and nucleus as the O-GlcNAc modification. Five classes of glycans are produced: N-linked glycans attached to a nitrogen of asparagine or arginine side-chains O-linked glycans attached to the hydroxy oxygen of serine, threonine, tyrosine, hydroxylysine, or hydroxyproline side-chains, or to oxygens on lipids such as ceramide (golgi) phospho-glycans linked through the phosphate of a phospho-serine; C-linked glycans, a rare form of glycosylation where a sugar is added to a carbon on a tryptophan side-chain glypiation, which is the addition of a GPI anchor that links proteins to lipids through glycan linkages.
What is the role of glycolation in the cell?
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It is the site of sythesis of secretory (exported) proteins and of N-liked oligosaccharides addition. what is the function of the rough ER? Free ribosomes attached to the ER are the site of cytosolic and oranelle protein synthases. Goblet cells of the Small bowel and Plasma cells are rich in RER.
It is the site of Steriod synthesis and drug detoxificaiton-
What is the function of the Smooth ER?
Liver hepatocytes adrenal cortex both rich in SER
it is the packaging and distrubition center. (lipids,proteins to the plasma membrane, lysosome, and secretory vesicles) what is the function of the Golgi? Also modifies N-oligio on asp adds O-oligo to serine threoninie adds mannose-6 phosphate
permanent- remain in G0, regenerated with stem cells (ie muscles (cardiac and skeltal), RBCS what are the features of the three cell types? permanent, stabile, and labile cells Stable- Enter G1- from G0 when stimulated (hepatocytes, lymphocytes) Labile- Never go to G0, divide rapidly when stimulated (skin, hair, bone marrow, gut epithilum.
Pronephros- degnerates meSonephros-S-SEX0RGANS function for 1st trimester and then will contribute to male
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gential tract
MeTanephros [IMGPATH:]/sdcard/StudyDroid//sdcard/StudyDroid/card6436139-front.jpg uteric bud- caudal end of metanephros and forms ureter, pelvises, calyces, collecting duct Metanephric mesenchyme- formation of Glomerulus,bowmans capsule and DCT
Uteropelvic junction is the the most common site of obstruction and leads to hydroneprosis in a fetus.
Tell me about a horseshoe kidney?
Occurs when the inferior poles of the both kidneys fuse. As they ascend they will get traped under the inferior mesenteric artery-- will still have normal kidney function.
All are S phase specific chemotherapy durgs MTX- folate analog that inhibits Dihydrofolate reductases- Will cause Myelosupression but CAN BE RESCUED WITH LEUCOVORIN 5-Fu- Pyramidine analog that complexes with folic acid to block thymidylate syntase--causes myelosuppression but can't be rescued with leucovorin also overdose use thymidine 6-MP- purine analoge blocks devo synthsesis metabolized by xathine oxidase so allopurinol combination is toxic 6-TC- same but can give with allpurinol Ara-c pyrimidine antagonist- inhibit dna polmerase used with AML,ALL--megoblastic anemia and leukopenia
what do : Methotrexate 5-fluorouracil 6-mercaptopurine 6-thioguanine cytarabine (ara-C) All have in commone?
Dump>>>>>>(Thymidylate Synthase )>>>>>dTUMp what is the relationship between thymidylate syntase and DHF reductase? >>>>>CH2-THF>>>>DHF>>>>(DHF reductase )>>>>>ch2-THFThymidylate syntases uses the methlated folate that was methylaed by DHF reductase to form dTMP from dUMP.
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What is the main difference between tamoxifen and raloxifene?
Both are estrogen receptor antagonist in the breast and agonist in the bone. but raloxifene has no increase risk for breast or endometrial cancer so it can be used safely for osteoporsis therapy. where as tamoxifen is a patial agonist of results in hot flashes and increase risk of endometrial cancer.
All are chemo drugs that inhibit microtubules what do ; Vincristine vinblastin paclitaxel and other taxols have in common Vincristine/vinblastin- binds tubulin in m phase and block polymerization so spindles can't form--used in Hodgkins,wilms,chriocarcimoma-- vinBLASTin BLASTS bone marrow and vincristine- neurotoxicty TAXOLs- Mphase- prevent anaphase by preventing break down. (ovaian and breasts)myelosuppresion and hypersenstivity
What are my antitumor antibotics?
Dactinomycin(actinomycin D)- Kids like to act out---wilms tumurs,ewings, rhabdomyosarcoma doxorubicin (adriamycin)Bleomycin- free radicals--testicular and hodkins-- pulmonary fibrosis etoposides (Vp-16) small cell of the lung- inhibits topoisomerase II
Busulfan- alkylates DNA--CML- and ablates BM for BMT also causes PULMONARY FIBROSIS Nitroureas (tines-carmustine,lomustine,semustine,streptozocin)-brain tumors and cns toxicity cyclophosphamide,-hemmoragic cystitis ifosfamide-
what are my alkylating chemo drugs
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Cisplatin,carboplatin what chemo drugs cause ototocity and nephrotoxcity like aminoglycosides? Cross link DNA used in testicular,bladder,ovary and lungs will cause nephro and ototoxicty .
Most common adrenal medulla tumor. it is derived form chromaffin cells Presents as episodic hypertension and Urinary VMA Occurs in both MEN IIa and IIB treat with Phenoxybenzamine an nonselective and irreversiable ablocker and surgery Tell me all you know about pheochromocytomas? Follows the rules of 10's 10% malignant bilateral extraadrenal calicified kids family
Venous Left ovary/testes-leftgonadal vein-left renal-ivc Right drains straight to Rt gondal--IVC Lymphatic drainage describe lymph and venous drainage of male/female gonads? Ovaries/testes-para-aoritc Distal 1/3 vagina/scrotum/vulva-superficial ingunials Proximal 2/3 vagina/uterus- external illiac and hypogastric nodes
Describe origin and attachment of : Suspensory ligaments cardinal ligaments round ligament broad ligament ligament of ovary
Suspensory ligament- Ovaries to pelvic wall-contains ovarian vessels Cardinal ligament- Cervix to was of pelvis-contains uterine vessels -"u (uterine vessels) need to remeber the cardinal runle" round- uterus to labia majora--nothing broad ligament- uterus, tubes, ovaries, to pelvic wall-- containes ovaries, tubes, round ligament, and uterus ligament of ovary- ovary to lateral uterus
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what structures are formed by by fusion of paramesonephric duct? and what results from failure of fusion.
in females, it forms the uterine tubes uterus and superior 1/3 of vagina. failure of fusion results in bicornuate uterus or uterus didelphys
which TB drug effects visual acuity and hepatotoxicity?
ethambutol - carb polymerization inhibition. inhinhibits mycolic synthase flouroquinolones- dna winding rifampin- dna dependent rna polymerase
A pt presents with malignant hypertension after having a big pizza and wine party what meds he on?
he is on a MAOI for depression. tyramine ( a sympathomimetic) is found in cheese and wine and is usually broken down by MAO, accumulation will result in elevated catecholamines and high bp
pharyngeal/aortic arches
what veins are used for a bypass? where would you Harvest the GSV
A: Internal thoracic and GSV and surgeons will get access to the GSV in the just below the pubic tubercle close to where it joins the femoral vein
How would taking Losartan for controling blood pressure effect the following blood levels: Renin ANG I ANG II Aldosterone Bradykinin
It is an angiotension receptor blocker and as a result you would see It would increase: Renin ANG I/II and it would Decrease Aldosterone And have no effect on Bradykinin
why would a doctor givet a high dose steroids to somebody with hyper thyroid
high dose steroids are often given to patients with graves disease to decrease the severity of inflammation and decreasing extraocular volume. this is done because conventional anti thyroid drugs do not improve opthalmopathy seen with graves.
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do alpha receptor blockers or beta receptor blockers stimulate insulin release
alpha receptors inhibit insulin secretion and beta receptors stimulate insulin secretion pre treatment with a alpha blocker with result in predominance of beta a fact. ie phenoxybenzamine is a non selective alpha blocker
N receptors are located at all presynaptic ganglia via ACH- they are ligand gated Na/K channels. where are nictinic receptors located and how does their MOA differ from muscarinic receptors? Muscarinic receptors are G protein receptors-located on post synaptic parasympathic terminals and on post synaptic sympathic intervated sweat glands
TYPE OF G PROTEIN RECEPTOR a1-Q a2-I b1-S b2-S m1-Q m2-I m3-Q What does qiss qiq till your siq of sqs stand for? d1-S d2-I h1-Q H2-S V1-Q V2-S GQ- PLC<<<PIP<<IP3/DAG--Ca/PKC Gs-AC>>increaseCAMP>>pka Gi-same but decrease camp and pka
which drugs are nephro an ototoxic?
aminoglycosides,vanco,loop, cispatin
where would an aspirated peanut be found if the patient was supine vs upright?
Upright- lower portion of right inferior lobe s upine- s uperior portion of the right inferior lobe.
T8- Vena cava T10- o (esophagus)

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T12- aortic hiatus what structures penatrate diaphragm at levels T8,T10, T12? " I (ivc) ate (8) ten (10) eggs (esophagus) at (aorta) age 12. also C3,4,5 keeps the diaphragm alive"
what are the volumes make up the TLC?
What spinal level damage correlates with bowel incontinence?
If a patient comes in with both right facial swelling and right upper exteremity swelling, which veinous drainage might be blocked?
a- right brachiocephalic
What are the branches of the the aorta?
A- The branches are the brachiocephalic (that branches into the right subclavian and rt common carotid), the left common carotid, and left subclavian
What are the branches of the subclavian and axillary artery?
A- Remember for Subclavian- "Vit C &D -Veterbral, internal thoracic,thyrocervical, costocervical, and dorsal scapular. For Axillary see the picture attached
What are the branches of external carotid artery?
A- Slaf o Pms From inferior to superior: Arising in carotid triangle[1]** Superior thyroid artery-(arise from anterior aspect) Ascending pharyngeal artery-(arise from
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medial(deep)aspect) Lingual artery-(arise from anterior aspect) Facial artery-(arise from anterior aspect) Occipital artery-(arise from posterior aspect) Posterior auricular artery-(arise from posterior aspect) Terminal branches Maxillary artery Superficial temporal artery
What structures would be in danager with stab wound at the Left 5th intercostal space/mid clavicular line?
A- APex of the heart, and Left lung, Right ventricle would be to the right of the 5th mid clavicular line.
A patient with first metacarpal inflamation and neg bifr cyrstals recieves treatment with a drug that gives him bad diarrhea and vomitting? whats the drug and it's MOA
The drug is colchine and it inhibits microtuble formation and impairs migration/phagocytosis of neutrophils.
Both used to treat gouty arthritis, however not to be used in acute cases.
Tell me about probenicid and allopurinol?
allopurinol- inhibits Xanthine oxidase for overproducers of uric acid Probenicid- increases uric acid secretion - for uric acid underexcersion.
what drug class has the side effect of fat redistrubtion form the extremities to the abdomenal area?
HIV-proteases inh
What drug may actually prevent reoccurant kidney stones caused by hypercalciurea?
TZD direutics- But are contrindicated in hypercalcemia patients??

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IL-2 is released by Th1 cells (with Inf-y) it's main role is to stimulate Cd-8 cytoxic t cells to fight intracelluar pathogens (virus) Th1 cells also secrete Inf-y that stimulates macrophages to release (IL-1, TNF-A) -Th1 cells are inhibited by IL-10 which is secreted by TH2 cells. Th2- secrete IL-4,5, and IL10 and are inhibited by INF-Y
Which cells secrete IL-2 and what is it's function?
What type of leukemia often appears in older individuals (>60) and has smuge cells on a peripheral smear.
Small cell lymphocytic lymphoma/ Chronic lymphocytic leukemia- often assymptomatic w/ smudge cellsSLL Differs from CLL in that CLL has increase peripheral lymphocytes.
What type of leukemia presents with auer rods?
AML- Auer rods, responds to all trans retinoic acid inducing differentiation of myeloblasts.
Female reproductive histoloy Ovary fallopain tube Uterus Endo/Ect cervix vagina
Ovary-Simple cubodial fallopain tube-sim Colu ciliated Uterus-simple columar-pseud Endo- Simple columnar Ect cervix-Stratified squamos vagina-stratified squamous-NK
What are the clinical findings in Homocystinuria and the 3 forms?
A-Lens subluxation,Mental retardation, osteoporosis, tall stature, and increase kyphosis. 3 forms Homocystein methyltransferese def Cystathione synthase def
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cystathionine synthase decrease affinity for b6
what is the MOA of sulfonamides ? SMx-TMP?
SMx (sulfamethoxazole)- mimics precrusor of Folate "Papa" and Tmp (Trimethoprim,pyrimethamine) with inhibit Dihydrofolate reductase. Side effects- SJS, and Kernicterus in infants
Bacteriostatic anitbiotics vs bactericidal?
Static- "just think protein synthesis inhibitors and TMP-smx" Erythro,clinda,SMx-TMP,tetra,chloramphenicol Cidal-Vanco,fluoro,penicillin,amino,cephal ,metronidazole
MNO Methicillin,nafcillin,diclOXACILLIN What are the penicillinase resistant penicillins because of a bulky R group? Often used for staph infections (no MRSA) Side effects-meth-interstitial nephritis
What are my wider spectrum penicllins (amp,amoxicillin) used for?
Have a wider coverage that includes Gram Negative (HELPS h.flu,e coli,listeria,proteus,salmonella,enterococi) always combines with b lactmase inhibitors (Clavulanic acid, sulbactam,tazobactam)
What are some general principles of cephlosporins?
Gram positive coverage stays the same or slightly decrease going from1-4, but gram negative coverage increases-
1st generation- CeFAzolin, Cephalexin "invited fAmily to see you get your phd completing az 2nd- Cefoxitin (covers anerobes),cefaclor,cefuroxime,cefuroxime "think of the foxy tan lady" 3rd-all others besides cefepime (4th generation is "prime"one used for pseudo) Ceftriaxone X ONE FOR SEX W MEN-meningitis and Gonorrhea Ceftazidime-Pseudo "worth way more then a dime"
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What are my 1st through 4th generation cephalosporins?
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what pencillin class antibotic is a rare nich player for patients that can't tollerate aminoglycosides and are allergic to penicillin?
AZTREONAM- though it only is effective against Gram negative rods
what must be admistered with Imipenem to avoid inactivation in the renal tubules?
CiLastin- if you want it LASTIN then you must give CILASTIN
Does NOT have many problems Side effects of Vancomycin? NEPHRO,OTOTOXICITY,THROMBOPHLEBITIS RED MAN SYNDROME
What drug is a oral outpatient option for MRSA?
Linezolid- inhibits 50's ribosomes
Which drug of the tetracycline family can be used as a diurectic for SiADH?
Democlocycline
When to use Doxycycline?
Lyme, h pylori, m.pneumonia. It also accumulates intracelluarly and thus is great for chlamydia and rickettsia SE-teeth discoloration,inhib bone growth in kids, CI pregnancy.
binds 23SrRNA of 50's ribosomes MOA of Macrolides and main uses? Atypical Pneumonia streptococcal in allergic pt.
NOT AMINOGLYCOSIDES what are some good drugs for anerobes? above diaphragm-Clindamycin (but will cause C-diff) Below diaphragm-Metronidazole Also 2nd Cephlosporins - cefoxitin
what amino acids are in over abundance in maple syrup disease?
branched aa- isoleucine, leucine, and valine can be helped w the 5 co factors thyamine pyrophospate, FAD, NAD, LIPOATE, AND COENZYME A. some pt may respond to high dose thiamine supplement
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what glands are unique to the duodenum that secrete a alkaline substance?
[IMGPATH:]/sdcard/StudyDroid/USMLE world191-false.jpg
It forms free radicals in the cell. "GET GAP" on the METRo G- GIARIA E-ENTAMOEBA T-TRICHOMONAS GARDNERELLA A-ANEROBES P-HPYLORI TRIPLE THERAPY FOR H PYLORI METRO,BISMUTH,AMOXICILIN
What is metronidazoles use, MOA, and side effects.
What are the four R's of Rifampin?
Rna polymerase inh Revs up P450 Red/orange pee rapid resistance if used alone
Locations / Site of ischemic injury Leads that best detect changes in commonly described locations are classified as follows: ST elevation in Leads II,III, and AVF where is the infarct? Inferior : II, III and aVF Lateral: I, aVL, V5 and V6 Septal: V1 and V2 Anterior: V3 and V4 Anteroseptal:V1, V2, V3 and V4
A patient comes into the ER after having a sensitive injury while mountain biking, most likely a urethal injury. Would this be an anterior or posterior urethral tear?
Anterior- more common in saddle injury Posterior- abover pelvic diaphagm and is more common in pelvic automobile accidents.
What are the differences between primary and secondary hyperaldosterism?

Primary- might be a tumor in the adrenal cortex and will result in elevated Aldosterone levels (low K, High BP) but decresed RENIN levels
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Second- could result in a juxtamedullary tumor and you would have high RENIN and Aldosterone levels.
This is an osteoclast, Which are multinucleated giant cells formed through fusion of multiple cells. They can be indentified by M-CSF and RANKL which both stimulate osteoclast. in Pagets disease (hearing loss, Hat doesn't fit,mosaic bone patter, Osteolytic phase with a wimpy osteoblastic phase) you would see many osteoclasts on a slide. Fibroblast GF, IGF-1, TGf-a all are stimulates of osteoblasts.
Explain how reflex bradycardia works when giving a alpha agonists.
An alpha agoinst will result in Vasocontriction causing an increase in Blood pressure that will be percieved in the aortic arch and carotid receptors-this will give raise to an increase vagal response and bradycardia.
How are small particles of sizes 10-15um 2.5-10 um less the 2.5 Cleared from our respiratory system.
10-15um- caught with mucous in the upper respiratory tract. 2.5-10 um- cleared via mucocillary system less the 2.5- Phagocytosis of macrophages in the lower respirtory tract If the particles are engulfed by macrophages it can result in pneumoconiosis as macrophages will release fibrosis stimulating cytokines like PDGF and IGF.
How does Chron's disease precipatate Gall stones?
Chron's disease often affects the terminal segment of the lieum. Usually Bile Joins cholestrol and secreted into the duodenum. Bile is usually then reabsorped in the ileum, but in chrons that is significant decreased. This leads to a decrease in bile to cholestrol ratio and the cholestrol will precipitate forming gallstones.
In the SA and AV node there are 4 phases 4- Sodium funny channels are responsible for reaching the threshold (influenced by para and sympathic tone) 0- Is calcium influx depolarization 3- is repolarization K channel EFFlux
Describe phases 1-4 of a ventricular action potential?
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phase 0, specialized membrane proteins (voltagegated sodium channels) in the cell membrane selectively allow sodium ions to enter the cell. This causes the membrane potential to rise at a rate of about 300 V/s. As the membrane voltage rises (to about 40 mV) sodium channels close due to a process called inactivation. The sodium channel opening is followed by inactivation. Sodium inactivation comes with slowly inactivating Ca2+ channels at the same time as a few fast K+ channels open. There is a balance between the outward flow of K+ and the inward flow of Ca2+ causing a plateau of length in variables. The delayed opening of more Ca2+-activated K+ channels, which are activated by build-up of Ca2+ in the sarcoplasm, while the Ca2+ channels close, ends the plateau. This leads to repolarisation. The depolarization of the membrane allows calcium channels to open as well. As sodium channels close calcium provides current to maintain the potential around 10 mV. The plateau lasts on the order of 100 ms. At the time that calcium channels are getting activated, channels that mediate the transient outward potassium current open as well. This outward potassium current causes a small dip in membrane potential shortly after depolarization. This current is observed in human and dog action potentials, but not in guinea pig action potentials. Repolarization is accomplished by channels that open slowly and are mostly activated at the end of the action potential (slow delayed-rectifier channels), and channels that open quickly but are inactivated until the end of the action potential (rapid delayed rectifier channels). Fast delayed rectifier channels open quickly but are shut by inactivation at high membrane potentials. As the membrane voltage begins to drop the channels recover from inactivation and carry current.
what is a big side effect of doxorubicin and other chemo anthracyclines?
cardiomyopathy. can give dextrazoxane to help minimze free radical accumulation
*the left circumflex coronary artery- ateral wall of the left ventricle . *LAD- anterior wall of the left ventricle AND ANTERIOR SEPTUMAND APEX * right coronary artery Posterior wall of the left ventricle AND POSTERIOR WALL OF THE SEPTUM and inferior wall . In approximately 15 30% of patients with occlusion of the RCA, the infarct will extend across the ventricular septum and also involve the posterior wall of the right ventricle.
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St elevation in V1 and V2 means what?
Inferior wall(RCA):II, III and aVF Lateral (LCX) I, aVL Anterior Lateral(LCX)- V4- V6 Anterior wall (LAD): V1 to V4 Anteroseptal (LAD): V1 to V2
Aphasia- is a higher order inability to speek Aphasia vs Dysarthia? Dysarthia- is motor speech abilty
Broca's area defect results in Non fluent aphasia with intact comprehension (inferior frontal gyrus) Wernickes- Fluent aphasia with impaired comprehension- superior temporal gyrus Global- Non fluent aphasia with bad comprehesion-both areas Conduction- Poor repetition- Arcuate fasciculus Can't repeat No ifs and buts
Descibe the findings in the following disorders Gilbert's syndrome Crigler-Naijjar Dublin-Johnson syndrome Rotor's syndrome
Gilbert's syndrome- Mild decrease in UDP Glucuronyl transferase or derease uptake of Billi----Elevated Uncojugated bili increasing in fasting and stress Crigler-Naijjar- Total defect in UDP-GTmajor increase in unconjugated Billi- results in death in a few years Dublin-Johnson syndrome- Conjugated hyperbilli due to defect in liver excretiongrossly black liver Rotor's syndrome- same as DJ but no black liver
A- ASTERIXIS (Flapping tremors) B-Basal ganglia-like parkinsons C- low Ceruloplasmin, High copper in liver, corneal deposits, carcinoma,choreiform movements
what are the ABCD signs and symptoms of wilson disease?
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D- Dementia Hemolytic anemia
Primary vs secondary Tuberculosis?
Primary- Will have hilary lymph nodes and Ghon fucus in the lower lobes (together Ghon complex) Secondary tb- Fibrocaseous Cavitary lession usually in the upper lobes
Bullous lIgG
pempigoid
antibodies against the basement membrane-Hemidesmosomes vs desmosome in pemphigous valgaris lType II hypersensitivity reaction lVesicles are subepidermal l Disease usually subsides after months or years. PV and bullous pemphigoid: type II hypersensitivity reactions lMay requires systemic corticosteroid in resistant cases
Hemidesmosomes (HD) are very small stud- or rivet-like structures on the inner basal surface of keratinocytes in the epidermis of skin. They are similar in form to desmosomes when visualized by electron microscopy. While desmosomes link two cells together, hemidesmosomes attach one cell to the extracellular matrix. Rather than using cadherins, hemidesmosomes use integrin cell adhesion proteins. Hemidesmosomes are asymmetrical and are found in epithelial cells connecting the basal face to other cells.
antibodies against the basement membrane-Hemidesmosomes lType II hypersensitivity reaction lVesicles are subepidermal l Disease usually subsides after months or years. PV and bullous pemphigoid: type II hypersensitivity reactions lMay
lIgG
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requires systemic corticosteroid in resistant cases

lThis is Pemphigous Vugalris-IgG
antibodies against
desmosomes betw een keratinocytes lType II hypersensitivity lVesicles and bullae develop interepidermaly and in the oral mucosa lNikolsky sign(outer epidermis separates from basal layer w ith minimal pressur) and Tom bstone apperance lTreatmentCorticosteroids and other immunosuppressive agents (e.g., methotrexate, azathioprine)
Generally, the duct fully obliterates (narrows and disappears) during the 7th week of fertilization age (9th week of gestational age), but a failure of the duct to close is termed a vitelline fistula. This results in discharge of meconium from the umbilicus.[2] About two per cent of fetuses exhibit a type of vitelline fistula characterized by persistence of the proximal part of the vitelline duct as a diverticulum protruding from the small intestine, Meckel's diverticulum, which is situated about two feet above the ileocecal junction and may be attached by a fibrous cord to the abdominal wall at the umbilicus. Tell me about the Vitelline Duct.
A mnemonic used to recall details of a Meckel's diverticulum is as follows: "2 inches long, 2 feet from ileocecal valve, 2% of population, 2% symptomatic, 2 types of ectopic tissue: gastric and pancreatic.
How can you prevent reflex tachycardia and thus increase in increased myocardial oxygen tissue damand, when taking a nitrate/calcium blocker/ or alpha blocker?
Use a beta blocker that will decrease AV conductance and prevent reflux tachycardia.
What type of channel is defective in cystic fibrosis?
Atp linked Cl channel that pumps Cl- against the concentration gradient into the lumen and draws water with it. IN CF on gene 7 a Phenylalanine mutation in position 508
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Transmural Increase necrosis affects entire wall ST elevation Q waves Transmural vs subedocardial infarts? Subendocardial Ischemic necrosis less the half of the ventricle wall Subendocardium especially vulnerable to ischemia Due to few collaterals, higher pressure ST depression on ECG
What are some common causes of Dialated cardiomyopathy?
A- ALCOHOL ABUSE BERIBERI COXSACKIE B VIRUS MYOCARDITIS,COCAINE,CHAGAS DISEASE DOXORUBICIN TOXICITY CLINICAL FINDINGS- SYSTOLIC DYSFUNCTION, S3 HEART SOUND AND BALLON APPERENCE ON CHEST X RAY.
What happens in phase 0 of both ventricular and SA/AV node action potentials?
Phase 0 is dep0larization phase
wHAT STUCTURES ARE RETROPERITONEAL?
Duodenum (2-4th parts) descending colon Ascending colon kindey and ureters Pancrease (not tail) Aorta IVC Adrenal gland rectum
" qUIN IS A PRO DISCO DANCER" Qunidine (cinchonism of HA,tinnitus),procainamide, disopyramide Na blockers- increase ERP and Ap duration the most of class I
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Class IA
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"Id buy Lindy's mexican tacos" Class IB IB- Lidocaine, Mexiletine, tocanide-- Decrease ap duration (good post MI)-Na blocker
"chipotles food has excellent produce" C-class c Class IC Flecainide,Encainide, Propafenone for Vtach that go to Vfib No action on inc/dec action potential CI- MI
Sotalol, Ibutilide, Bretylium,dofetilide, amiodarone Increase AP duration, QT,ERP Class III antiarrhythmics? Sotalol- torsades,arrythimias Amiodarone- Check PFT,LFT,TFT "pulmonary fibrosis, hepatotoxic, thryoidism" blue skindeposits
Duodenum- Brunners gland and cypts of leiberkuhn
Illeum- preyers patches plicae circulares and cypts
colon has crypts but no vili
GI Blood supply and innveration: FOregut- T12-L1- sotomach liver gallbladder pancrease and spleen to proximal duodenum midgut- Distal duodenum to 2/3 of transverse colone hindgut-Distal 1/3 of transverse colon to upper rectum, splenic flexure is watershed area. Foregut- Celiac art,Vagus, T12-L1 Midgut-SMA,Vagus,L1 Hindgut-IMA,Pelvic, L3
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What is contained in your femoral trangle and femoral sheath.
Femoral triangle- Femoral nerve,artery, and vein Femoral Sheath- Femoral vein,artery, and canal (deep inguinal lymph nodes) BUT NOT FEMORAL NERVE " go lateral to medial to find your NAVEL" NERVE ARTERY VEIN LYMPH "pENIS NEAR THE VENOUS"
Tri screen includes estriol, HcG, and AFP and should be tested between 16 and 18 weeks of Gestation. The most common increase of AFP levels is due to error in age of gestation since AFP levels rise through out the pregnacy INcrease AFP-ALSO NEURAL TUBE, ABDOMINAL WALL DEFECTS,OMPHECEPHELE DEcrease AFP= downs Estriol-placental health HCG- increased in hydradiform mols and multiple births and choricocarcinoma
When should the Tri screen occur?
This patient is exhibiting Subungual splinter hemmorages. This can often be associated with Subacute bacterial endocarditis.
Beta blockers- Propanolol,esmolol,metoprolol,... Decrease slope 4- remember phase 0 is always depolarization phase, phase 4 is steady stage before depolarization decrease camp,Calcium and increase PR interval
Class II- antiarrhythmics
What is Flocculation of mixture of cardiolipids,lecitin, and cholestrol indicative of?
Aggregation or flocculation demostrates the prescence of cardiolipin anitibodies resulting from descruction by T. pallidum. Follow with RPR and VDRL and if positive confirm with FTA-ABS
VPL- recieves imput from spinothalamic tract (pain and temperature) and Medial Lemniscus
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VPL VPM LATERAL GENICULATE MEDIAL GENICULATE
(postion and proprioception). It transmits impulses to the primary somatosensory cortex (areas 1,2,3) VPM- Receives imput from the trigeminal and gustatory pathways and transmits to (1,2,3 of brodmans areas) LATERAL GENICULATE- Relay VISIONARY pathway-- recieves from the optic nerve and transmits via opic radiations to the visual cortex (calcarine sulcus) M EDIAL GENICULATE- "hearning voices in your M IND"Auditory- recieves from superior olivary nu and inferior colliculus of pons and projects to temporal lobe (41 and 42)
vagal nuclei- - nucleus solitarius -nucleus ambiguus
solitarius- visceral senory (taste baroteceptors gut distention)- vii,IX X AMBIGUUS- MOTOR to the pharynx larynx an upper asapa guess- cranial nerves 910 and 11 dorsal motor nucleus send autonomics parasympathetic fibers to the heart longs an upper gastrointestinal system
[IMGPATH:]/sdcard/StudyDroid/USMLE world182-true.jpg
name the translocation and receptor defect in AMl?
t15,17-auer rods- retinoic acid receptor- failure of immature myeloid precursors to diff into mature granulocytes
active ingredients is THC which stimulates cannabinoid receptors to produce effects of mood,memory, and propreciaption . Common physiologic effects of Marijuana? RAPID HEART RATE, CONJUCTIVAL INJECTION.(RED EYES THAT APPEAR TO HAVE BLOOD IN THEM)
Most likely microemboli from Subacute bacterial endocarditis Things to know about SBE "From Jane" Fever Roth spots (round white spots on retina) Osler's nodes Murmur Janeway lessions (lessions on plams and soles) Anemia
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A patient has a heart murmur and purpura lessions on the soles of his feet?
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nail bed hemmorages Emboli Valve replacement-Staph Epidermis Drug user-Tricuspid-Aures,pseudo Most common valve- Mitral Acute-staph aureus subacute- strep viridians
Ethanol-----Acetaldehyde----Acetate Alchol Acetylalde Dehydrogenase dehydrogenas (cytosol) (mitochondria) Uses NAD+ --NADH Fomepizole- Inhibits alcohol dehydrogenase and is the antidote for methanol and ethylene glycol posioning Disulfiram-(antabuse) inhibits Acetaldehyde dehydrogenase and will give bad hang over---helps you quit
Describe EtOH metabolism and what the drugs Fomeprizole and Disulfiram ?
Describe ethanol hypoglycemia?
Ethanol metabolism produces high amounts of NADH which will inhibit glyconeogensis and stimulate fatty acid synthesis (fatty liver)
Kwashiorkor- Protein malnutrion, skin lesions, edema, liver malfunction fatty liver due to low apoliprotein synthesis)-- small kid with big belly Difference between Kwashiorkor and Marasmus? Marasmus-energy malnutriton resulting in tissue and muscle wasting, loss of sub q fat,and variable edema muslce wasting=marasmus
DEcrease CO and BP (JGA cells decrease release of RENIN) Great post MI AV node conductance decrease for arrthymias (class II) Slow progression of CHF DEcrease secrtion of Glaucoma (TImolol)
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SIDE EFFECTS- Impotence, asthmas, bradycardia, av block ACtion,application, and side effects of beta blockers. USE a "BEAM" for astmatics, or COPD Betaxolol esmolol atenolol metoprolol They have selective B1 activiting NON selective alpha beta Carvedilol and lebetaolol.
Heart Embryology Truncus Arteriosus- ascending aorta and pulmonary trunk Bulbus cordis- Rt ventricle and smooth rt and left ventricle SMOOTH LIGHT BULBS Primitive Ventricle- other portion of ventricle Primitive atria-trabeculated left and rt atrium Left horn of SINUS venosus-Coronary sinus Right horn of SV- Smooth right atrium Right Common cardinal vein and right anterior cardinal vein- Superior Vena cava
Truncus Arteriosus Bulbus cordis Primitive Ventricle Primitive atria Left horn of SINUS venosus Right horn of SV Right Common cardinal vein and right anterior cardinal vein
THANKYOUTEN
Mean- average medium--10,20,30,40,50 "put numbers in order and then pick the middle one Mode----10,20,20,30,40, 50 " it is the most occuring number so 20 IN a normal bell curve they will all be equal to each other. Mean,Medium, and MOde? Positive skew_ mean>Median>Mode hump to the left and tail on right Negative skew- Mean<medium<mode tail to the left
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Influenced by outliners all but the mode.
Types of bias selection recall sampling late-look procedure confunding lead-time pygmalion hawthorn
selection-nonrandom seleciton recall- knowledge of prescense of disorders alters recal by subjects sampling-not random late-look- study using fatal disease (only those alive to tell) procedure- treatment not the same confunding-2 factors not seperated lead-time- early detection of a disease, increases treatment, and makes us believe that survial is up when it is just early detection pygmalion-Dr.s belief changes outcome hawthorn- subjects knowledge of being studied changes outcome avoid bias Blind studies,plecebo,crossover, random
excessive daytime sleepiness and hypnagogic/hypnopompic (Hallunictions rt before sleep or wake) What are signs of narcolepsy and cataplexy and the treatment? Cataplexy is loss of muscle tone when excited.. (genetics is big and treat with stimulants ampeta,ome,modafinil and GHB
Describe the carcadian rythum?
Suprachiastic nucleus (SCN) of hypothalmus, Controls ACTH,prolactin, melatonin NE release-SCN-NE release--pineal glanD---melatonin---SCN is regulated by light
RUBELLA VIRUSMEASLESMUMPSVZVHHV-6PAROVIRUS B19STRP PYROGENSCOXACKIE VIRUS TYPEA -
RUBELLA VIRUS- Begins on head and moves down post auricular lymphs MEASLES-rRubeola Paramyxovirus beginging at head and moving down (coryza,cough, conjuctivitis, kopliks spots (blue whit spots on mouth) MUMPSVZV- Chickenpox- trunk and sprends out HHV-6-roseala-6kids w roses and seizures rash after fever can cause seizures usually in infants PAROVIRUS B19- erythema infectiosumslapped face and reticular lacy pattern latter and arthritis in adults STRP PYROGENS- erythematous sand paper
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rash fever and sore throat COXACKIE VIRUS TYPEA - vesicular rash on soles and palms, ulcers in mouth.
Decrease KM = increase affinity Competitive inhibitors Cross on graph can be overcome with substrate bind active site don't change V max increase KM decrese potency NON competitive Don't change Km decrease efficacy opposite everything else Efficacy - deals with increase of maxium response potency- the more potent the lower the ED ED= the concentration when you reach 50 percent of maxium response
PharmokinecticsKM competetive vs non competetive inhibitos
Volume of distrubition Clearance half life Loading dose maintance dose RUBELLA VIRUSMEASLESMUMPSVZVHHV-6PAROVIRUS B19STRP PYROGENSCOXACKIE VIRUS TYPEA -
Volume of distrubition= vd=drug amount in body/plasma Clearance=rate elimination/plasma drug concentration half life Takes 4-5 half lifes to reach steady state Loading dose=cp x vd/F (bio) cp x cl/F cp=plasma concentration f-bioavalibilty Cl-clearence vd-volume of disbution can be altered by liver and kidney disease with protein bound drugs.
Describe the two types of Albinsim?
1) tyosinase def- can't synthesis melanin 2) defecective tyrosine transporter-decrease in tyrosine and thus melanin
When Can you use the following muscarinic antagonists?

ATROPINE,TROCPICAIMIDE- Produce mydriasis, and cyclopegia

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ATROPINE,TROCPICAIMIDESCOPOLAMINE IPRATROPIUM OXYBUTNIN METHSCOPOLAMINE,PIRENZEPIN,PROPANTHELINE-
SCOPOLAMINE-CNS motion sickness IPRATROPIUM-Asthma COPD " I pray I can breath soon" OXYBUTNIN- reduce urgency METHSCOPOLAMINE,PIRENZEPIN,PROPANTHELINEPUD BENZOTROPINE- parkinsons disease -"park my benz"
What drug Keeps the ductus arteriosus open in a patient with transpostion of the great vessels?
PGEE1- KEEPS IT OPEN INDOMETHACIN- ENDS it
Bloody Campylobacter-comma s shaped grow at 42 salmonella- lactose negative-flaggelar shigella- lactose negative- shiga toxin and very low ID50 Enterohemorragic ECOLI- 0157:h7 can cause HUS, makes shiga Enteroinvassive ECOLI-INvades colonic mucosa Yersenia enterocolitica- Day care and pseudoappendicitis C diff- pseudomembranous colitis(can cause watery too) Watery Enterotoxigenic ECOLi - travelers diarrhea St LT toxins v.cholerae- comma shapped and rice watery diarrhea C. Perfringesn- gas gangrene too Protozoa- giardia,crypto virus- rotavirus,adenovirus,norovirus
Causes of watery diarrhea vs bloody diarrhea?
The spermatic cord is ensheathed in three layers of tissue: external spermatic fascia, an extension of the innominate fascia that overlies the aponeurosis of the external oblique muscle cremasteric muscle and fascia, formed from a continuation of the internal oblique muscle and its fascia internal spermatic fascia, continuous with the transversalis fascia
what are the layers of the spermatic cord?
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Indirect vs Direct inguinal hernia? "Remember the MD's LIe Medial to Inferior epigastric vesels- DIrect Lateral to inferior gastric = Indirect
Indirect inguinal hernia: passes through the deep inguinal ring, inguinal canal, and superficial inguinal ring and descends into the scrotum. The hernia lies lateral to the inferior epigastricvessels. Indirect inguinal hernia is found more commonly on the right side in men and is more commonthan direct inguinal hernia. It is congenital (present at birth), associated with the persistence of the proces-sus vaginalis, and covered by the peritoneum and the coverings of the spermatic cord. Direct inguinal hernia: occurs directly through a weakened area of the abdominal wall muscles(posterior wall of the inguinal canal), lateral to the edge of the conjoint tendon, in the inguinal trianglebut does not descend into the scrotum. The hernia lies medial to the inferior epigastric vessels and pro-trudes forward to (rarely through) the superficial inguinal ring. It is acquired (develops after birth), asso-ciated with weakness in the posterior wall of the inguinal canal lateral to the falx inguinalis, and has asac that is formed by the peritoneum and occasionally the transversalis fascia.
What are the borders of Hesselbach's triangle?
Inferior epigastric, lateral border of the rectus abdominis...--Direct Hernias go through Hesselbachs triangle and are only covered with external spermatic fascia.
Low flow rate- gives more time for CL- to be reabsorbed so it is hypotonic High Flow rate- Less time so hypertonic Lets talk about spitLow flow Rate? High flow Rate Salivary secretion has sympathic innervation (T1-T3) superior cervical ganglion and parasympathic (facial/glossopharngeal nerve) Lastly "Serous =SIde (parotids)& Mucinous=Middle" (sublingual)
Function of the following GI hormones: GIP VIP

GIP- K cells of duodenum, Decrease H+ and increase Insulin (used with antidiabetic drugs VIP- source is Parasympathic ganglia, Intestinal secreation of water and electrolytes (VIPoma result in bad diarrhea ), causes
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NO Motilon
relaxation of spincters to facilatrate movement. NO- LES relaxation Motiln- Produces MMC (migratory complex) in small intenstine can be given to increase paristalis- increases in times of fasting.
Digeorge syndrome 22q11.2 deletion facial,cardiac, and immunological abnormalities. third/4th pharngeal pouch- thymic aplasia, and parathyroid malformation tetany and reccuren viral and bacterial infections due to t cell deficiency tetralogy of fallot and interuppted aortic arch
A causcasian newborn with facial dysmorphia and cleft palate is found to have a deletion in the long are of chromosome 22?
Physcial examine shows wide based gait, bad balance, and numerous superficial blanching nests of distended capillaires on sun exposed areas of the skin?
Ataxia Telangiectasia- mutated gene responsible for DNA break repait and are very sensitive to X rays.
Neisseria Meningitidis?
Is gram negative dipplococcus transmitted via respiratory droplets close living conditions(ie prisons, or dorms ) promote spread Virulence factors include polysacchride capsule, IgA protease and can be prevented with meningoccal vaccine vaccine stimulates anticapuslar antibodies
Name types of the following vaccines? HEAT KILLED BACTERIA RECOMBINANT BACTERIA OUTER SURFACE PROTEIN INACTIVATED TOXINS LIVE ATTENUATED ORGANISM
HEAT KILLED BACTERIA-bordetall pertussia,v.cholerae,yersinia pestis RECOMBINANT BACTERIA OUTER SURFACE PROTEIN-lyme disease(borrelia burgdoferi) INACTIVATED TOXINSc.diptheria,clostriduim tetani LIVE ATTENUATED ORGANISM-BCG vaccine,francisella tularensis,salmonella typhi
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What are some signs and symptoms of measles and complications.
Prodromal fever,cough,coryza (runny nose),conjunctivitis, maculopapular rash complication acute encephalitis ,pneumonia, and secondary infections Paramyxoviridea family
Let's review murmurs again MITRAL REGURGITATION MITRAL STENOSIS AORTIC STENOSIS PULMONIC REGURGITATION TRICUSPID REGURGITATION
MITRAL REGURGITATION- high pitched holosystolic murmur greater on expiration, best heard in lateral decubitus postion MITRAL STENOSIS-mid-dialostic murmur between S2 and S1 AORTIC STENOSIS-midsystolic ejection murmur (crescendo-decrescendo) PULMONIC REGURGITATION- early diastolic murmur (decrescendo config) may increase w inspirations ( high pitched and blowing sound heard and 2/3 left intercostal space TRICUSPID REGURGITATIONholosystolic murmur increases with inspiration
Pt gets stabed in the left neck just above the clavicle and left of the manubrium, what he hit?
Tension pneumothorax scenirio- which will result in lower hemidiapragms from increase air in pleural space and deviation of the lungs to the opposite side.
what two hormones are responsible for neurophysis synthesis?
ADH and OXytocin, which are produced in the supraoptic and paraventricular nuclei of the hypothalmus and carried via neurophysis to posterior pituitary to be released.
what is the cause of varicose veins?
incompitent venule valves often caused by DVT,pregnancy, and genetics.
review neuropower point in drop box >>
Craniopharyngioma?
found in children and young adults most commonly located in the suprasellar region. on macroscopic exam they are cystic filled with thick brownish fluid. derived from rathkes pouch envagination of ectoderm that forms anterior pituitary. posterior is from neuroectoderm.
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If a disease is in a certain population (1/4) and in another population (1/2) what is the chances that a child born from parents from both population will have the diseae?
(1/4 x 1/2) x (1/2 x 1/2) =
The sciatic nerve branches into the tibial nerve and the common fibular nerve COmmon Fibular branches into deep and superficial superficial inervates lateral muscles of the leg responsible for everting the foot and sensory to between the toes Deep gives sensation to the dorsum of the foot and goes anterior to intervate dorsal flexors. The tibial nerve-Plantar flexion and invertion and sensation of the plantar surface of the foot.
what are some reasons for hypocapnia hyperventilation and some for hypercapnia hypoventilation.
Hypocapnia hyperventilation- Pulmonary edema, pulmonary emboli, and pneumonia Hypercapnia hypoventilation- upper airway obstuction,decrease cheast wall expansion, CNs depression.
what are the signs of anterior glenohumeral dislocation?
usually occurs on a fall of an outstretced arm. Patients deltoid will appear flattened. Often results in an axillary nerve injury which innervates the deltoid and teres minor muscles and sensation to the lateral shoulder.
what are the three D's of pellegra or niacin deficiency ?
Diarrhea, Dementia, dermititis
Liver Highly lipophilic molecules can get out of the blood stream more easily,cross membranes, and enter hepatocytes to be excreted via bile and stool. also drugs will high volume distrubution Kidneys Need the drug to stay in the blood stream- low lipophillic and low volume of distrubution..
What charateristic make a drug metabolised mostly by the liver and not the kidneys ?
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What bacteria is gram postive rod with a a tumbuling motilty and often is spread through food contamination because it grows at low tempertures?
Listeria
2 Umbelical arteries and 1 umbelical vein- Arteries are most deoxygenated.
what cells don't need Insulin for glucose uptake?
BRICK L bRAIN RBC iNTESTINE CORNEA KIDNEY LIVER PS THESE ARE OFTEN LOCATIONS OF NON ENZYMATIC GLYCOLATION DAMAGE. GLUT 1-brain,rbc Glut4- adipose tissue, skeltal muscle Glut2- liver kideny small intestines b islet cells (bidirectional)
Common causes of Meningits newborn 6months-to 6 yr 6-60yr over 60
newborn-GBS,ecoli,listeria 6months-to 6 yr-strep pneumo,n.menigitis 6-60yr-N.menigitis,hsv,strep pneumo over 60-s. pneumo newborn 6months-to 6 yr 6-60yr over 60
Common causes of pneumonia Neonates to 18yrs adults (18-40_ 40-65 oldies
Neonates-GBS,ecoli to 18yrs- "Runts my cough sputum" RSV,Mycoplasma,chylamydia,strep pneumonia adults (18-40)-Myco,chlamydia,strp pneumo 40-65-strep,h influ,anerobes,viruse myco oldies-strep pneumo,influexa, gram negative rods Hospital-staph, immunocomprimised-staph,pneumocytis jiroveci aspiration-anerobes
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alcholoic-strep pnemo,klebsiella cf-pseudo post viral-staph atypical-myco,leginella,chlamydia
MCL/medial meniscus/and ACL--The unhappy triad? Test ACL with Anterior drawer test.
BRAIN- "lots of bad stuff kills glia" Lung,breast,skin (melanoma),kidnerys (renal cell carcinoma), GI Metastasis BRAINLIVERBONELiver-"Cancer sometimes penetrates benign livers" Colon,stomach,pancrease,breast,lung bone -"P.T barney loves kids" Pancrease,thyroid,breast,lung, kidneys Lung-lytic prostate-blastic breast bothe
" No man picks his nose nose w his Sphinger" "Tay-sax- Hexosaminidase" "Hunters see clearly (nocornea clouding) and aim for the x" all others besides fabry''''s is autosomal recessive Lysosomal storage diseases? Gaucher''''s ("looks like crouches)- Bone necrosis/HS-B-glucocerbrosidaseGlucocerebrosides Fibry''''s (F for feelings)-Progressive neuropathy-enzyme a-galactosidase-ceremide accumulates (feelings are fragile and break like ceramics) Neimann pick- Sphingomyelinasesphingomyelin Tay sachs-hexosamidase-GM2 ganglioside
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Gaucher''''s Fibry''''s Neimann pick Tay sachs Metacromatic leukodystrophy Hunters syndrome
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Hurley
Metacromatic leukodystrophyataxia/dementia-cerebroside sulfate Hunters syndrome-mild hurley w/o cornea clouding-iduronate sulfate- Haparan sulfate/darmatan sulfate Hurley-cornea clouding/airway obstructionHaparan sulfate/darmatan sulfate
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what is a good why to remember aortic arches?
1st of Maximal second=Stapedial C is 3rd letter in alphebet 4th arch (4 limbs=systemic) 6th -6 ducks crossin the line Ductus arteriosus 1-Maxilary artery 2-Stapedius artery/hyoid 3-common Carotid artery 4-(l)Aortic arch and (rt) rt subclavian 6-proximal part of pulmonary arteries (ductus)
Brachial apparatusClefts archespouches_
CAPs- Ecto,Endo, Mesoderm Clefts1st- external auditory meatus other five who cares.
"pro mens wrestling"- top down Pros smash heads/Men (mid weights)
Regional development of the brain Prosencephalon Mesencephalon Rhombencephalon
Pro-tele(cerebral and lateral ventricle) and Dien (thalmus and third ventricle) Mesencephalon-midbrain (adeuduct) Rhomboencphalon- meten (pons and cerebellum) and myelen (medulla) ---combined make 4th ventricle and pons joins midbrain to make cerebral aqueduct.
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what are the symptoms of vitamin b 12 deficiency
it is associated with anemia. the classic presentation is a northern european women of lemon colored skin. who has a smooth shiny tongue with the broad based gate. stomatitis cheilosis dermatitis corneal vascularization
what is the role of sertoli cells
spermatic genesis releases inhibin and secrete mullian inhibitory factor. inhibin only inhibits fsh
what is the drug of choice for petite mal seizures?
abscence seizures are best treated w valpraote or ethosuximide. grand mal- diazapam, tonic clonocphenobarbital, carb and complex partialcarbamazepine
1. Right anopia 2. bitemporal hemianopia 3.left homonymous hemianopia 4.left upper quad anopia (rt temporal lesion MCA) 5. left lower quad anopia (rt parietal lession,MCA) 6. Left hemianopia with macular sparing-- (PCA) 7. Central scotoma (macular degeneration)
Blastomycosis-
B for Broad Based buds- states of east of mississippi river and central america causes inflammatory lung disease and gramulomatous nodules.
which of the 4 chambers of the heart is responsible for dysphagia?
the left atrium - could be caused by mitral stenosis or left ventricle failure
Peripheral neuropathy of hands and feet angioketatomas- Fabry's disease- X lined recessive Lysosomal storage diseases: Peripheral neuropathy of hands and feet angioketatomasCorneal clouding aggressive behavior and MRDemyelination of peripheral nervesSphingomelinAccumulation of galactocerbrosides in brainwww.studydroid.com/printerFriendlyViewPack.php?packId=114961
Corneal clouding and MR- Hurleys/like hunters but will have coneal clouding and no aggressive behavior like hunters does, both accumulate heparan sulfate central and peripheal Demyelination of peripheral nerves with ataxia- Metachromatic leukodystrophy Sphingomelin- Pick nose with sphinger (nieman's pick)-progressive neurodegeneration like Tay sachs but tay sachs won't have heptosplenomegaly like niemans' but both have cherry red macula spots
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Accumulation of galactocerbrosides in brainKrabbes disease- opic atrophy and globoid cells.
Polyhydraminos- is associated with esophageal /duodenal atresia, since baby can't swallow fluid Oligo- renal agensis or posterior urethal valve- Can't pee associated with potters ( bilateral renal agenesis, oligohydraminos,limb deformities, pulmonary hypoplasia. Uteric bud malformation) High AFP-neural tube defects,twins, omphalocele Low AFP- trisomy 21 down's think " afp levels are down"
Poylhydramnios vs oligohydramnios! and high AFP vs low AFP
Malignant bone tumorsosteosarcoma Ewings sarcoma Chondrosarcoma
osteosarcoma-2 most common behind multiple myeloma;sunburst sign on xray(codman's triangle);peaks 10-20; usually in knee area metaphysis. Ewings sarcoma-11:22 translocation;anaplastic blue cell;boys 15;onion skin apperence;diaphysis- " think of patrick ewing tall (diaphysis) number 33 (11 +22) smelling of onion rings Chondrosarcoma- cartliaginous tumur; men 30-60;pelvis spine scapula
Benign bone tumursOsteomaosteoid osteomaosteoblastoma giant cell tumurosteochondroma enchondroma-
Osteoma- Gardners syndrome (familal polyposis w/osteoma);bone growth on bone osteoid osteoma- men less then 25; interlacing of trabeculaw woven bone by osteoblasts osteoblastoma- " " but in spine giant cell tumur-found in epiphyseal of long bones; 20-40; knee; "bubble soap tumur" osteochondroma-most common young men;better nsaids;in metahphysis enchondroma-
Superficial inguinal nodes will drain all superfical structures from ubellicus to the feet. infection in the anus will drain to which nodes? Internal illiac- Prostate Paraaortic-testes
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RightMidclavicular-bottom of the 7th rib Midaxillary- upper border the 10th paravertebral-bottom of the 12th rib Left Midclavicular-bottom of the 7th rib Midaxillary- bottom of the 10 rib paravertebral line-bottom of the 12th rib "paravetebral is the gutter" Therefore a thoracenteiss should be perform at the upper margin (intercostal vessels located at the bottom margin) of : Midclavicular-5-7 Midaxillary- 7-9 paravertebral line-9-11
What are the borders of the lung pleura?
what is a major side effect of Subacrchmoid hemmorage?
50 percent of patients will later experinces vasospasm , resulting in ischemia-- to avoid this it is important to do a doppler study as well as the intial ct or mri.
what are the 4 parts of the duodenum?
1- where the pylorus of stomach enters it is the only portion that is not retropenitineal. (L1) 2- L3- where the pancreatic duct and common bile duct enter the descending duodenum. just below the major duodenal papilla is the junction of foregut and midgut 3-crosses over the aorta and inferior vena cava and if perforated it would damage superior mesenteric artery and uncate process of pancrease.
squamos cell carcinoma-- stains brightly eosinophilic (acidophilic)- in the esophagus it is the second most common cause of cancer with barrets adenocarcinoma. and is caused by alcohol and smoking.
what organisms are catalase positive.
Pathogens that are catalase-positive, such as staph, Mycobacterium tuberculosis, Legionella pneumophila, and Campylobacter jejuni, make catalase in order to deactivate the peroxide radicals, thus allowing them to survive unharmed within the host.[
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most common adrenal medulla tumur in children;secrete HVA by product of dopamine in urine; less likely to have hypertension, Overexpression of N-MYC what is neuroblastoma? VMA- Norepinephrine in pheochromacytoma of adults 5 P's and 10 rule Presure,pain(HA), perspiration, Palpations, and pallor. 10's malignant, bilateral,extraadrenal, califiy,kids,family.
Cretinism?
severe hypothyrodism in child, endoemic occurs in places where goiters are common place, sporatic defect in t4 formation Findings: pot belly,pale, puffy face, with protruding tongue and umbelicus
SAFE Moms Take Really Good Care Sulfonamides- Kernicterus Aminoglycosides- Ototoxic Fluoroquinolones-Cartligage Erythomycin- Acute cholestatic hepatitis in mom Metronidazole-mutagenesis tetracycline-teeth and bone Ribavirin- teratogenic Griseofulvin-Teratogenic Chloramphenicol-gray baby syndrome
What antibiotics should be avoided in pregnacny?
Interferons therapy Inf alphaINf betaINfy-
inf alpha- Hep B and C,kapos sarcoma INf beta- MS INfy- NADPH oxidase deficiency All cause neutropenia Glycoprotein synthesized by virus infected cells block replication of both RNA and DNA virus.
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what drugs inhibit microtubule formation?
Mebendazole,Griseofulvin (fungal-tertagen), Vincristine (m phase, no bone marrow suppression,) Vinblastine, Paclitaxelm(breast), Colchine (anti gout and bad dirrhea)
PAoz=150- (Pco2/.8) Normaly should only be 5 mmgh (PA 100-95) How do you calculate the normal P A-a gradient? This helps determine if the cause of hypoxia is respiratory of orgin(A-a gradient greater then 30)or extrarespiratory
Phases of gastric secretion
Cephalic phase - This phase occurs before food enters the stomach and involves preparation of the body for eating and digestion. Sight and thought stimulate the cerebral cortex. Taste and smell stimulus is sent to the hypothalamus and medulla oblongata. After this it is routed through the vagus nerve and release of acetylcholine. Gastric secretion at this phase rises to 40% of maximum rate. Acidity in the stomach is not buffered by food at this point and thus acts to inhibit parietal (secretes acid) and G cell (secretes gastrin) activity via D cell secretion of somatostatin. Gastric phase - This phase takes 3 to 4 hours. It is stimulated by distension of the stomach, presence of food in stomach and decrease in pH. Distention activates long and myentric reflexes. This activates the release of acetylcholine which stimulates the release of more gastric juices. As protein enters the stomach, it binds to hydrogen ions, which raises the pH of the stomach. Inhibition of gastrin and gastric acid secretion is lifted. This triggers G cells to release gastrin, which in turn stimulates parietal cells to secrete gastric acid. Gastric acid is about 0.5% hydrochloric acid (HCl), which lowers the pH to the desired pH of 1-3. Acid release is also triggered by acetylcholine and histamine. Intestinal phase - This phase has 2 parts, the excitatory and the inhibitory. Partially digested
what are the three phases of gastric secretion?
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food fills the duodenum. This triggers intestinal gastrin to be released. Enterogastric reflex inhibits vagal nuclei, activating sympathetic fibers causing the pyloric sphincter to tighten to prevent more food from entering, and inhibits local reflexes.
explain the innervation of the tongue?
then anterior 2/3 somatosensory (pain touch, temperature) is through the lingual nerve (V3 which also is somtasensory to the face), taste however is through the lingual nerve (chordi tympani) , the posterior 1/3 is all through the glossopharngeal.. muscle is through xII and remember to lick your wounds... ( the tongue protrudes to the side of the the insult.)
what is lambert eaton syndrome/?
auto antibodies to pre synaptic calcium channel, decrease a c h release leading to muscle weakness. ass w paraneplastic syndrome in smwll cell. it is different from myasthenia gravis is in that symptoms improve with mscle use.
foregut- gives rise to the esophagus stomach liver gallbladder pancreas and upper duodenum-celiac trunk primitive gut tube derivatives? midgut- it gives rise to the small intestines ascending: the proximal 2 thirds of the transfers colon- superior messenteric hindgut-rest - inferior mesentwric
what is the washerboard area of the call on that is most susceptible to ischemia?
the spleenic flexure is where the blood supply of SMA and IMA overlap.
What is the role of secretin.
It is released from the duodenum. in response to stimulus from gastric secretions in the stomach it is a potent stimulator of bicarb. s cells
what nerve runs with e superior thyroid artery and is in danger ugh injury during a thyroid gland surgery?
the superior laryngeal nerve and intervates the cricothyroid (external branch) muscle all other larngeal muacles are intervated by the recurent laryngeal nerve.
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he fine means are facial pain headache and have black necrotic eschar in the nasal cavity is highly suggestive of mucorymycosis ( mucur,rhizopus,absidia) the diagnostic test of choice is a you mucosal biopsy
will also be ketoacidosis
what does duodenal enteropeptidase do?
Enteropeptidase (also called enterokinase ) is an enzyme involved in human digestion. It is produced by cells in the duodenum wall, and is secreted from duodenum's glands, the crypts of Lieberkhn, whenever ingested food enters the duodenum from the stomach. Enteropeptidase has the critical job of turning trypsinogen (a zymogen) to trypsin, indirectly activating a number of pancreatic digestive enzymes. typsin will then acticate chymotrypsin and carboxypeptidase and elastase.
Ok so the jistTwo regulations CAP (cyclic amp binding protein) and Repressor protein . When is not present then High CAMP levels allow for CAp to bind to the operator and significantly increase affinity of RNA polyermase to the promotor to transcribe LAc Z gene b galactadase. Also the repressor protein when lactose is low will bind to the operator and shut down RNA polymerase... Also remember that prokaryates often have one mRNA code for many genes as in this case the LAC gene codes for many enzymes, Eukaryatic cells are not like that.. ONe mRNA one proten....
anterior/posterior communicating artery/ anterior/posterior/ middle cerebral artery infarts?
Anterior communicating- most common site and results in visual field defects. Posterior communicating results in a CN III palsy- Eye movement impairment (all but LR,SO so eye will be down and out), pupillary dilation (efferent limb of light reflex), blurry vision (loss of accomadation), ptsosis (eye lid opeing) Posterior cerebral- Contralateral hemianopia with macular sparing Anterior cerebral- Contraleral leg and footparalysis and sensory loss. Middle cerebral- Contralateral face and arm paralysis and sensory loss, and left sided neglect.
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Squammous cell carcinoma- sunlight and arsenic exposure- precursor is actinic keratosis - Chronic draining sinus and keratin Pearls what is the defining features of : Squammous cell carcinoma Basal cell Melanoma Basal cell- most common . rolled edges with central ulcerations --pearly papules with telangiectasis Melanoma- dysplastic nevus is the precursor... S-100 tumur marker increase risk with depth ABCD-- assymetry, border irregular, color, depth
LEAD L-lead lines on gingivea and bone xrays E- Encephalopathy adn erythrocyte basophilic striping Abdominal colic and siderblastic anemia D- drops of foot and wrist Treatment Dimercaprol and EDTA--- succimer for kids
what are the signs,symptoms, and treatment of lead poisoning?
Simple difference between first and second degree heart block?
1st- prolonged PR interval-- greater then .12 mmsec ( 3 small squares each mini square in .04 mmsec) 2nd degree --must drop a p wave..
LMN-- will result in both upper and lower facial paraylsis and eye closer on effected side (ALexander graHam BELL with STd aIDS, hERPES, sARCODOSIS, TUMUR, DIABETES) uPPER MOTOR --DUAL INNERVATION OF THE UPPER FACE SO PARALYSIS OF ONLY LOWER FACE AND IS CONTRALTERAL TO THE LESSION.
facial lession UMN vs LMN (bells palsy)-- Many with ipsilateral paralysis of upper and lower face?
WHAT CONDITIONS WILL CAUSE HIGH RENIN AND WHICH WILL CAUSE LOW RENIN HYPERTENSION?
Low renin-- Conns syndrome of primary hyperaldosterism will result in negative feedback on renin High renin- renal stensis- or arthroscolric arteries JGA senses low blood pressure on the afferent
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arteriole and the macula densa on the dct will sense low na and cause the JG cells to secrete renin
Lypodystrophy- will increase fat deposits of buffalo hump and cetral obesity but decrease fat in face what are the most important side effects of protease inhibitors (saquinavir, ritonavir, indinavir, nelfinavir, amprenavir[1] hyperglycemia and inhibiton of p 450 NRTI - Nukes will also cause lipoatrophy without subq deposition just wasting.
Promoters vs enhancers
Enhancers are located anywhere on the gene up or down stream where as promoters are (hox tata box) located 25-75 base pairs upstream.
Hepatitis E?
High incidence of mortality in pregnant women due to fulminat hepatic failure--- non-enveloped ssRNA
Superior thyroid artery runs with the superior laryngeal muscle and is a brach of the external carotid artery.... unlike the inferior thyroid artery that runs with the Recurrent laryngeal nerve (innvates all phonation muscles beside cricothyroid (innervated by superior laryngeal (external)) other branches of the thyrocervical trunk are inferior thyroid artery suprascapular artery transversalis artery colli or transverse cervical artery And action and innervation of the cricothyroid muscles are. superior thyroid artery and inferior thyroid artery run with what nerves?
Action
The Cricothyroid muscle produces tension and elongation of the vocal folds by drawing up the arch of the cricoid cartilage and tilting back the upper border of the thyroid cartilage lamina; the distance between the vocal processes and the angle of the thyroid is thus increased, and the folds are consequently elongated, resulting in higher pitch phonation.
Innervation
This muscle is innervated by the external branch of the superior laryngeal nerve. runs with superior thyroid artery...
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A,C, V a- the atrium contracts in late diastole resulting in increase jugular pressure. c- contraction of the RV causes the tricuspid to enter the right atrium and increase jugular pressure v- filling of right atrium against closed valve
Describe the jugular venous pulse rythum?
S2 spliting patterns? Normal wide split fixed split paradoxical split
Normal- should increse with inspiration Wide split- pulmonic stenosis or right bundle block Fixed split- ASD no increase spliting on inspiration Paradoxical-- Aortic stenosis or left bundle block-- split on inspiration then expiration...
Loading Dose-- Desired plasma concentration x VD/F Maintance Dose- Cp x CL/F Loading Dose, maintance dose, and CL and VD? VD- total in body/plasma Cl- rate elimation/ plasma concentraion (urine concentration x rate/plasma) So in hepatic or renal failure you only worry about the maintance dose not the loading dose
Abetalipoproteinemia, or Bassen-Kornzweig syndrome ,[1] is a rare autosomal recessive[2] disorder that interferes with the normal absorption of fat and fat-soluble vitamins from food. It is caused by a deficiency of apolipoprotein B-48 and B-100, which are used in the synthesis and exportation of chylomicrons and VLDL respectively. The signs and symptoms of abetalipoproteinemia appear in the first few months of life(because pancreatic lipase is not active in this period). They can include failure to gain weight and grow at the expected rate (failure to thrive); diarrhea; abnormal star-shaped red blood cells (acanthocytosis); and fatty, foul-smelling stools (steatorrhea).
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why don't you give glucose w/o thiamine in an alcholic patient?
Etoh depletes your thiamine stores and thiamine is needed in the TCA for a-ketoglutorate dehydrogenase----a-keto to succinate
Neuraminidase inhibitors
Antiviral drugs such as oseltamivir (trade name Tamiflu) and zanamivir (trade name Relenza) are neuraminidase inhibitors that are designed to halt the spread of the virus in the body.[113] These drugs are often effective against both influenza A and B.[114]
Influenza drugs
M2 inhibitors (adamantanes)
The antiviral drugs amantadine and rimantadine block a viral ion channel (M2 protein) and prevent the virus from infecting cells
Cystic hygroma -cavernous lymphangioma of the neck associated with turners (XO) Labs oon turners: Low estrogens so high FSh and LH short, ovarian dysgensis, wide nips,bicupsid aortic valve, webbing of neck, corcation of aorta,,no barr body and common cause of primary amenorrhea
What should you know about renal papillary necrosis?
Analgesic nephropathy is a cause of renal papillary necrosis.[2] The damage is cumulative and most patients of renal papillary necrosis would have ingested at least 20 kg of analgesics in the past. The risk is higher for phenacetin and acetaminophen compared to aspirin and other NSAIDs. Combination analgesic products, such as Goody's, also have a high risk of causing papillary necrosis. It can be an outcome of chronic analgesic nephritis, with persistent use or abuse of phenacetin or its derivatives (such as Acetaminophen). This is less common since phenacetin is no longer available over the counter. But is more common when patient's taken combination analgesic products for an extended period of time. It is also caused by diabetes mellitus and vaso-occlusive sickle cell crisises, in which it is related to renal infection or vascular disease. It can also occur as a result of acute pyelonephritis[citation needed ] or sickle cell disease.[3]
1. Clinical and laboratory findings in all restrictive

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a. b. c. d.
e.
lung diseases Dry cough and exertional dyspnea Late inspiratory crackles in lower lung fields Potential for cor pulmonale Pulmonary function test findings and arterial blood gases (1) All volumes and capacities are equally decreased. (2) Decreased FEV1 sec (see Fig. 16-1B) Restrictive lung disease: volumes/capacities, normal to FEV1 sec/FVC ratio Example-3 L (normal 4 L) (3) Decreased FVC (see Fig. 161B) Often the same value as FEV1 sec (3 L) due to increased lung elasticity (4) Increased ratio of FEV1 sec/FVC Example-3/3 = 100% (normal is 80%) (5) Respiratory alkalosis (arterial PCO2 < 33 mm Hg) (6) Decreased PaO2 Chest radiograph findings Diffuse bilateral reticulonodular infiltrates
pirometry showing normal lung volumes and capacities and forced expiratory volume at 1 second (FEV1 sec) and forced vital capacity (FVC) findings in a normal person (A), a person with restrictive lung disease (B), and a person with obstructive lung disease (C). ERV, expiratory reserve volume; FRC, functional residual capacity; RV, residual volume; TLC, total lung capacity; TV, tidal volume; VC, vital capacity.
This is a a spider angioma consistant with a pt with cirrhosiss of the liver. This finding is a result of the liver unable to metabolise circulating estrogen, other clinical findings resulting from excess circulation of estrogen are : testicular atrophy, and palmar erythema.
what is a thayer martin media used to culture?
N Gonnorhea most commonly. It contains Vanco to inhibit gram positive growth and Nystatin and Polymoxin/TMP for gram negative inhibition (ECOLI adn Klebsiella)
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1. 2.
Centriacinar vs Paniacinar emphysema which one is associated with smoking?
3.
C=Cigs Centriacinar (centrilobular) emphysema (Fig. 16-23B) a. Epidemiology Most common type of emphysema in smokers b. Pathogenesis (1) Primarily involves the apical segments of the upper lobes Centriacinar emphysema: destruction of the distal terminal bronchioles and RBs; upper lobe (2) Distal terminal bronchioles and the RBs (Fig. 16-24) are the sites of elastic tissue destruction. (3) Air trapped behind the collapsed distal terminal bronchioles distends the RBs. The trapped air increases RV and TLC. Panacinar emphysema (see Fig. 16-22C) a. Epidemiology (1) Associated with AAT deficiency Genetic or acquired causes (cigarette smoke inactivates AAT)
what are the four types of glycogen storage disease? pg110
what is pioglitazone?
it decreases insulin resistance by increasing adiponectin through prar gamma nuclear receptors....its main se is weight gain edema beware with CHF
cromolyn and nedocromil in bronchial asthma?
they are mast cell stabalizers...second line behind glucocoricoids.
Henoch-Schonlein purpura?
usually affects small vessels in children most commonly: -skin -Joints -GI IgA systemic vasuclitis . Skin rashs on butt and legs (palpable purpura,arthralgis, intestinal hemmorages,
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ab pain, and melena.. Follows URI. Immune complex and association w IgA nephropathy.
Nacin does have vasodilation properties and so htn medication should be reduced. It can also cause insulin resistance so DM meds so be increased.. Flushing is also a common side effect due to PGE so asprin should be given with it at night. Special considerations when using Nacin in a diabetic? other important facts about Niacin is that: produced from TYptophan so in carcinoid tumurs with excess serotonin Nacin Def can result... leading to Pellegra (the three D"s Dementia, dermatitis, diarrhea)
What results in an Antericor cerebral Artery Defect?
of the opposite foot and leg UMN lesion nSensory deficits over toes, foot, and leg
nParalysis
n Paralysis
of opposite face and arm nSensory
deficits over opposite face and arm nAphasia if on
Middle cerebral artery defect?
the left side nVisual field defects nInattention and neglect of contralateral side of body or space and denial of illness if on right side
qHomonymous
Posterior Cereral artery defect?
Hemianopia (with macular sparing MCA provides collateral supply to occipital pole- macular vision) qPure Alexia (inability to read) with involvement of posterior corpus callosum and left visual cortex; color agnosia may also be present.
Learn anti fungals in 1 minute or less Amphotericin B Nystatin Azoles flucytosin caspofungin terbinfine griseofulvin
Amphotericin B-- Nephrotoxic (use h20),holes in plasma membrane,for systemic mycoses, liposomal amphtericin reduces toxicity Nystatin--swish swollow/topical like amp b MOA Azoles-inhibit ergosterol synthesis/Cypto in aids (BBB), inhibit p450 , gynco,liverdys, fever chills flucytosin-Dna conversion of 5-FU caspofungin- Cell wall "invasive Aspergilosis" terbinfin-squalene--onchomycisis griseofulvin-microtubule disruption (tineas) -teratogenic and carcinogenic , Increase p450
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why are patients given T4 for hypothyroidism versus T3 usually?
Because T4 is converted peripherally to T3. So exogenous administration of T4 will be automatically regulated.. T3 however is not converted to t4. so If you administer t3 then lab result will be .... decreased TSH,Decreased T3 and no change in T4 or inactivated rT3
A1--Ip3 increase in peripheral vessels resulting in vasoconstriction ( and reflex bradycardia) What receptors do NE typically activate.. b1-- Increase Camp on cardiac tissue, but this effect is opposed by the reflex tachycardia
Epidural- Will NOt cross sutures/biconcave shape/arterial bleed (middle menigeal a) Subdural- Will cross sutures/ will NOT cross midline (falx cerebri), venous bleed Sub A- "worse HA of life"- spinal tap w xanthochromatic yellow/ a parenchymal- htn/DM
Epidural/ subdural/subarachnoid
stop and start codeons?
AUG-START STOP-UAA,UAG,UGA
ureter passes under/medial to the gonadal vessles and vas deferens and over the illac vessels. over the water (ureter) and under the the bridge (uterine artery and vas deferense)
Increased maternal -fetoprotein (AFP) in serum or amniotic fluid 1. Anencephaly Anencephaly: absence of brain; maternal polyhydramnios a. Complete absence of brain (Fig. 25-6) b. Frog-like appearance c. Maternal polyhydramnios 2. Spina bifida occulta (Fig. 25-7A) Spina bifida occulta: dimple/tuft of hair overlying L5-S1 a. Defect in closure of the posterior vertebral arch
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Dimple or tuft of hair in the skin overlying L5-S1 3. Meningocele (Fig. 25-7B) Meningocele: cystic mass with meninges a. Spina bifida with cystic mass containing meninges b. Most common in lumbosacral region 4. Meningomyelocele (Fig. 25-7C) Meningomyelocele: cystic mass with meninges and spinal cord a. Spina bifida with cystic mass containing meninges and spinal cord b. Most common in lumbosacral region
b.
hypopotassium sodium hyperthaizides side effects? calcium uric acid cholestrol glucose
This is hemosiderin that has engulfed by macrophages in the tissue. This patient is probably receiving multiple infusions of blood, resulting in excess iron which will be degraded to hemosiderin and depositing in the tissue ( ie b-thalasemia)
Embryo derivatives: Surface ectoderm neuroectoderm neurocrest Endoderm

Surface ectoderm- Lens and craniopharyngioma rathkes pouch (also epidermis and sweat) neuroectoderm-CNS (oligodentrocytes and astrocytes,retina(spinal cord and brain) neurocrest-ANS (schwann cells and Neurofibromas 1 (teeth) and nonneural stuff nearby (chromaffin cells adrenal medulla) Endoderm- Guit (lungs liver, pancreases thymus)
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Mesoderm
Mesoderm- Muscle bone CT. think of VACTERL Vertebral defects,anal atresia, cardiac defects, tracheo-esphageal fistual, renal defects, limb defects.
nucleus ceruleus and raphe nucleus?
raphe- serotonin ceruleus- NE
what two cholestrol reducing drugs increase risk of gall stones and which increase risk of rhabdomyolysis?
Most fibrates can cause mild stomach upset and myopathy (muscle pain with CPK elevations). Since fibrates increase the cholesterol content of bile, they increase the risk for gallstones. also choles.. drugs In combination with statin drugs, fibrates cause an increased risk of rhabdomyolysis, idiosyncratic destruction of muscle tissue, leading to renal failure. A powerful statin drug, cerivastatin (Lipobay), was withdrawn because of this complication. The less lipophilic statins are less prone to cause this reaction, and are probably safer when combined with fibrates. They also may increase the risk of cancer.[citation needed ]
what is the trade of with increase/decrease half life with benzos?
increase half live--less dependence more drowsy increase fall risk... decrease half life-- more depence less drowsy and less chance of falls
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9/26/12

What is mitochondral myopathy?

what condition present with facial swelling and dark urine?

Post-strep GN- usually following a skin infection

what is "chloride shift"

what kind of murmur does a PDA have?

PCo2= 1.5 (HCO3-) + 8 +/- 2

formula for respiratory conpensation in metabolic

formula for respiratory conpensation in metabolic acidosis ?

what is a meta analysis?

what drugs inhibit folate synthesis by inhibiting Dihydrofolate reductase?

cypto neoformas- often causes meningitis in immuno

N.Gonnorehea- Gram negative dipplococci

AIDS- Pneumocytisis jiroveci

strep pneumonia- P disc (optochin sensitivie)- Gram positive dipplococci

TREATMENT IN UNCOMPLICATED AND COMPLICATED UTI''S?

FOR COMPLICAT ED T he drugs of choice are:

ciprofloxacin (Cipro) 500mg for 10 days

levofloxacin (Levaquin) 750mg for 5 days

WHAT IS A COMPLICATED UTI?

WHICH ANTIBOTICS TO US IN A PREGNANT WOMEN FOR UTI?

Doxycycline 100mg PD BID for 7 days Azithromycin 1gm PO single dose

pseudohyphea budding yeast. diamorphic.

T x of choice: Metronidazole 2g PO x 1 Male partners must be treated

when is the developing oocyte arrested?

not taking a pill at night will prevent tolerance from developing.

Men I. , MENI, MENIIA,MENIIB?

what is a Quellung test?

What bugs are intracelluar?

Brutons (x linked) agammaglbulinia

Hyper IgM X linked

what cytokines produce isoswitching of IgE,IgA,IgG

IgE- IL-4 and IL-13 IgA- IL-5 and TGF-B

Function of the cytokines

vasculitis size nomenclature?

petecia,purpora, eccymouses, bruise/hematoma

Histologic sections from a case of Hashimoto

what drugs are non selective alpha and beta antagonists?

what class of drugs are clonidine and a-methyldopa in?

what diseases does paramyxovirus cause?

Rose ola infantum:

signs of amphetamine abuse?

erb''s palsy (waiter tip) vs klumpkes palsy (claw hand)

bethanechol, hexamethonium, carbachol, physostigmine

WHAT IS ToRCHeS acronym ?

WHAT HLA IS HASIMOTO'S THROIDITIS ASSOCIATED WITH?

SIDE EFFECTS OF CAPTOPRIL?

X LINKED RECESSIVE DISORDERS?

what is fragile x syndrome?

Edwards -trisomy 18Second most common pattern of human malformation

Patau's syndrome- cleft palate, holoprosencephaly, polydactlyly

22Q11 DELETION SYNDROME

what derives from the endoderm?

What derives from the mesoderm?

Renal Limb defects (bone and muscle)

terms Agensis Hypoplasia aplasia Deformation malformation

Male genital development Genital tubercle, urogential sinus/folds, labioscortal swellens

what are my anti-helminthic drugs?

quinine- for cholorquine resistants use with primethamine/sufonamide

Medicare parts A-D

A- inpatient care B- OUT PATIENT C- COMBO D- STAND ALONE DRUG COVERAGE

What are some reportable diseases?

What are the Zoonotic bacteria?