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Materials needed to perform PCR
- 1. DNA template (region of DNA to be amplified)
- 2. 2 primers (complementary to the regions flanking the amplified DNA)
- 3. DNA polymerase
- 4. Deoxynucleotide triphosphates (Adenosine TP)
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Thoracocentesis locations
Mid-axillary damage to liver and lung - locations?
- Mid-clavicular: b/w 5th and 7th rib
- Mid-axillary: b/w 7th and 9th rib
- Paravertebral: b/w 9th and 11th rib
Midaxillary: Inserting above 9th rib can cause damage to lung, insertion below 9th rib = damage to liver
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Somatic sensory sensation to the anterior 2/3 of the tongue?
Taste sensation to the anterior 2/3?
- Lingual nerve, branch of V3
- Chordae tympani, branc of VII
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Aspergillus growing in old TB cavities
Colonizing aspergillosis
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Aspergillus occuring in IC patients or neutropenic patients and has lung involvement as well as other organs
Invasive aspergillosis
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Bicornate uterus: failure to fuse paramesonephric ducts
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- Clue cells: Gardenella vaginosis
- Squamous epithelium with bacilli
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- Koilocyte: HPV 6 and 11
- Squamous cells with dense cytoplasm and perninuclear clearing
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Structure of mycolic acids
Long, branched chain lipids in the outer portion of the peptidoglycan cell wall
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HIV patient presents with weight loss, fever, and weakness, and enlarged spleen and liver. Blood cultures show acid-fast bacteria. Prophylaxis?
- Azithromycin
- (MAC with CD4 count <50)
Isoniazid if patient presented with M.TB
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Why does the LA have a lower pO2 than the pulmonary capillaries?
- LA receives oxygenated blood from the pulmonary veins
- LA receives deoxygenated blood from the bronchial veins
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Changes in genomic composition occur when host cells are co-infected with 2 segmented viruses that exchange whole genome segments
Causes alterations in the surface Ag of viral progency
- Reassortment
- Influenza virus - antigenic shift
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Exchange of genes between two dsDNA chromosomes by crossing over. Genomic change seen in the progency
Recombination
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Host co-infected and progeny contains genome from one virus and nucleocapsid proteins (invading host cell) from another. No genetic exchange
Phenotypic mixing
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Bronchial asthma patient with eosinophilia and proximal bronchiectasis
Allergic bronchopulmonary aspergillosis
nb. Pseudomonas seen in CF patients and neutropenia
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Bacteria that don't contain cell walls
- Mycoplasma
- Ureaplasma
- contain cholestrol in their cell membranes
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Electrolyte level differences of Ca+2 between calcium stones and primary hyper-PTH
- Stones: hypercalciuruia, normocalcemia
- Primary hyper-PTH: hypercalciuruia, hypercalcemia
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Trisomy 13
- Patau
- cleft lip and palate
- microcephaly
- holoprosencephaly
- polydactaly
- PDA, septal defects
- polycystic kidney dz
- abdominal wall defects: omphalocele, pyloric stenosis
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Trisomy 18
- Edward's
- Small mouth
- malformed ears and low-set
- micrognathia
- clenched hands
- GI: Meckel's diverticulum, malrotation
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Broad collagen bands with abundant lymphocytes and Reed-sternberg cells
Nodular sclerosing Hodgkin's disease
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Patient has aortic dissection but pain now involves both flanks and has hematuria. Cause?
aortic aneurysm has progressed to involve the renal arteries causing b/l renal infarct.
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Mechanism of thrombocytopenia occuring in ITP
- Autoimmune: splenic destruction of platelets
- Follows an URT infection or exanthem
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Multiple myeloma finds what molecule in the urine and its composition
Bence Jones proteins: Kappa light chains (VkCk)
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Acute hemorrhagic pancreatitis
- Pancreatic enzymes released into bloodstream after excessive alcohol consumption
- Cause severe local damage to pancreas and causes shock (intravascular fluid loss + pancreatic necrosis and hemorrhage)
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Three translocations of Burkitt's lymphoma
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TTP presentation: sx, microscopy, labs
- CNS sx, fever
- Micro: schistocytes (helmet cells)
- Labs: decrease PLT count, increased LDH
Ab against ADAMTS13 (metalloprotease) which prevents cleaving of vWF multimers
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Clot where no lines of Zahn are seen (dark red colour alternating with pale colour), homogenous colour, and not adhered to the vessel wall
Post-mortem clot
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What two hormones are increased in production to cause stress ulcer?
- Gastrin
- Pepsin
- Or altered gastric wall defenses
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CCK functions
- Gallbladder contractions
- Release of pancreatic enzymes (amylase, lipase)
- Causes vagal stimulation
- a) Inhibits gastric emptying
- b) Inhibits gastric acid secretion
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Kidney values in dehydration
- Decreased blood pressure causes a decrease in RPF
- RAAS stimulated and Ang-II constrict efferent arteriole to attempt to increase GFR, however, cannot fully compensate
- GFR is decreased
- Filtration fraction = increased as RPF is decreased more than GFR
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Chi-squared test
Use with nominal (categorical) variables
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Biliary atresia
- Obstruction of extrahepatic ducts
- Proliferation of intrahepatic ducts, parenchymal cholestasis.
- Dark urine and light-coloured stools
- Increased levels of bilirubin, ALP and GGT
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- Zenker's diverticulum:
- cricopharyneal motor dysfunction
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Function of phosphodiesterase inhibitors in the heart and vessels
- Heart: Increases cAMP which increases Ca+2 = increases contractility
- Vascular SM: Increased cAMP = vasodilation
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Cord factor
- Composed of two mycoside molecules
- Presence of cord factor correlates with virulence of M.TB
- Inactivates neutrophils
- damages mitochondria
- induces TNF-a
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Virus that can grow on true vocal cords
- HPV = warty growths
- Hoarseness and stridor (upper airway obstruction)
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Measures of lung volume, alveolar pressure, and pleural pressure at FRC
- Lung volume: 0
- Alveolar pressure: 0
- Pleural pressure: -5
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Mechanism of contraction in skeletal, cardiac, and smooth muscle?
- Skeletal: depolarization opens L-type Ca+2 channels within T-tubules and then causes Ca+2 release from the RyR-1 on SR. Ca+2 then binds Troponin C and allows actin and myosin to bind.
- Cardiac: Depolarization opens L-type Ca+2 channels on the plasma membrane, and Ca+2 comes in. Binds to RyR-2 on SR and releases Ca+2 and causes Ca+2 induced Ca+2 release. Then, like skeletal.
- Smooth: Depolarization via L-type Ca+2 channels and like cardiac. Then, Ca+2 binds to calmodulin (no troponin) and activates MLCK, causes phosp. of myosin.
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Most common cause of lung abscesses
Aspiration pneumonia from oropharyngeal (anaerobic) components
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Hib vaccine for H.influenza is directed against what virulence factor?
- Capule
- Strains without a capsule will not be targetted by the vaccine, and can still cause infection
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After total ischemia, when does the heart stop contracting?
When does irreversible injury occur?
- 60seconds: ATP decreases, anaerobic glycosis also begins, as lactate levels start to rise
- >30 minutes
n.b. <30 minutes = myocardial stunning (reversible loss of contractile function)
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Relative risk formula
[(a/a+b)]/[(c/c+d)]
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Ankylosis spondylitis organ involvement
- Uveitis
- Ascending aortitis leading to dilation of aortic valve = AR
- Pain, tenderness and swelling at sites of insertion of tendon into bones
- Pain at costovertebral and costosternal junctions: can limit chest wall expansion = hypoventilation
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Heteroplasmy
- Ragged muscle fibres on muscle biopsy
- Lactic acidosis
- Mitochondrial inheritance (only the mom's side of the family)
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Which ions contribute to the resting membrane potential?
K+ efflux (major) and some Na+ influx maintains at -70mV
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HYPOestrogenic states causes an increase or decrease in RANK-receptors
Increase in expression causing an increase in bone resorption = decreased bone mass
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Tetanus vaccine produces antibodies against?
Against the tetanospasmin (bacteria product); hence, does not activate the complement
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How are SLE-causing drugs metabolized?
- Liver N-acetylation
- Phase II clinical trial
- Patients who are slow acetylators = greatest risk of developing SLE from drugs (SHIPP)
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Phase I clinial trial
- Hydrolysis, oxidation, reduction
- Elderly lose this first
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Collagen synthesis steps that occur outside the RER of fibroblasts
- 1. Peptidase cleaves N and C terminal residues of procollagen that are water-soluble to make collagen.
- 2. Collagen cross-links by lysyl oxidase
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Caudal regression syndrome
- Sacral agenesis and flaccid lower extremity paralysis
- Urinary incontinence
- Uncontrolled maternal diabetes
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Osteomyelitis affects what part of bone
Different kinds?
- Bone metaphysis due to rich vascular supply and capillary fenestrae
- 1. Hematogenous seeding in normal bone: S. aureus and Strep pyogenes; occurs in children
- 2. Ischemic or infarcted bone: Salmonella for sickle cell
- 3. Infected diabetic wound: Psuedomonas
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Bugs causing reactive athritis
- HLA-B27
- Joint aspirates are sterile (no bacteria found)
- BCCSSY
- Bacillus
- Chlamydia
- Camplyobacter
- Shigella
- Salmonella
- Yersinia
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Skin disease associated with Pseudomonas
- Ecthema gangrenosum (looks like black eschar without edematous ring)
- Toxins produced:
- Exotoxin A (inhibits protein synthesis)
- pyocyanin (ROOS)
- Elastase (inhibits elastin)
- Phospholipase C (degrades cellular membranes)
- Seen in immunocompromised (neutropenic) pts.
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Osteoid matrix accumulation (un-mineralized osteoid) around trabeculae
Rickets
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Trabecular thinning with fewer connections
Osteoporosis (disrupts normal bone structure)
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Subperiosteal resorption with cystic degeneration
Paget's dz (increased osteoclast function)
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Spongiosa filling medullary canal with no mature trabeculae
- Osteopetrosis
- (primary spongiosa replaced by bone marrow in normal)
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Markers that reflects activity of osteoblasts
- ALP (denatured by heat: to distinguish from liver)
- Osteoblasts form bone matrix, and release ALP
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Markers for osteoclast activity
- TRAP (acid phosphatase)
- Urine hydroxyproline excretion
- Urine deoxypyridinoline excretion = (cross-links collagen fibres and released when osteoclasts absorb bone)
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Adverse affects of MTX
- Stomatitis (painful mouth ulcers and nausea)
- Hepatotoxicity (hepatitis, fibrosis, and cirrhosis)
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Malassezia furfur
- Hypoigmented or hyperpigmented skin patches
- Classified by tinea versicolor
- Become more visible after sun-tanning
- Predominant in hot and humid climates
- Localized to the stratum corneum
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