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S3 heart sounds due to?
- Dilated ventricles = ventricle volume overload
- Mitral or tricuspid regurgitation
Sickle cell mutation in what gene
B-globin chain (Valine to Glutamic acid)
- 1. External iliac from the AA
- 2. Femoral a.
- 5. Popliteal a.
- 6. Posterior tibial
- 7. Anterior tibial
- 8. Dorsalis pedis (branch off 7)
- 9. Lateral plantar
- 10. Medial plantar
After an MI, a patient is given metoprolol along with an anti-platelet drug. MoA?
- Decreases TXA2 synthesis
Drainage from the right ovary (veins)
Pamphinform plexus --> ovarian vein --> IVC
Features of CML
- 9:22 translocation
- Increased production of neutrophils, basophils, eosinophils
Fracture proximal to the femoral condyles. What artery is damaged?
- Politeal artery.
- (Anterior tibial is distal and deep femoral artery does not supply the popliteal region)
Reed-Sternberg cells - what type?
B lymphocytes that have undergone somatic hypermutation (CD20 marker is not specific for these - only for lymphocyte predominant ones)
Epithelium of Barretts
- NON-CILIATED columnar epithelium with goblet cells
- (n.b. ciliated columnar epithelium found in respiratory tract)
Patient with polycythemia vera develops ascites and a tender liver. Liver function tests are normal. Dx?
Test used to demonstrate lesions in the biliary tree
Carotid occlusion - what does the BR reflex think?
False decrease in BP; therefore, increases HR and BP
Which vessels have highest ratio of wall cross-sectional area to lumen cross-sectional area?
- Arterioles (thick vessels)
- Greatest decrease in BP occurs in the arterioles
Plummer-Vinson syndrome develops what esophageal cancer
- (occurs most commonly on proximal 1/3 of the esophagus)
Blood flow pattern that occurs during coarctation of the aorta
- Distal to the subclavian is blocked
- Intercostal arteries arise off the descending aorta, except the 1st one that branches off the subclavian (anterograde flow to cause notching off the ribs)
- Blood flow to the aorta is retrograde by the intercostal a.
Transduction when a phage can integrate into the bacterial chromosome and then transfer bacterial DNA from one cell to another
Specialized transduction (lyogenic - temperate phages)
Th1 cells attack what pathogens
Th2 cells attack what pathogens
CD8 T cells attack what pathogens
- Th1: cell-mediated immunity, intracellular pathogens
- Th2: humoral immunity, makes Ab against bugs
- CD8: viruses and self proteins
Cafe-au-lait spots present with what other skin tumor in the syndrome
Neurofibromas (peripheral nerve tumors)
- 2nd amyloidosis (autoimmune dz, chronic infection)
- (deposits in the kidney, spleen, liver)
- Long-term emodialysis
- Primary amyloidosis
- (light chain deposition: heart, kidney)
Squamous cell carcinoma in situ on the shaft of the penis
- Bowen disease
- Appears like SCC grossly, but does not invade the BM
Drugs given with leukemias
- Allopurinol, Febuxostat
- (prevents the formation of uric acid crystals due to increased purine breakdown)
Sx of a tumor that blocks the 4th ventricle in the posterior fossa
- Blockage of CSF drainage
- Nuchal rigidity
- B/L papilledema
- mental status changes
Adverse effect of electro-convulsive therapy (ECT)
- Anterograde and retrograde memory loss
- Patients return to full cognitive function in 6 months
Action of propriothiouracil
- 1. Peroxidase: inhibits the organification of iodide
- 2. 5'deiodinase: peripheral conversion of T4 to T3
Elderly patient presents with opthalmoplegia, pseudobulbar palsy (vertical gaze defect which becomes horizontal gaze, etc), bradykinesia
Dx and pathology?
Progressive supranuclear palsy
Widespread gliosis and neuronal loss in subcortical tissues (spares cerebral and cerbellar cortices)
Diffused cortical atrophy with relative sparing of the motor and sensory areas.
Ulcerated lesion on the lower lip
SCC (precursor = actinic cheilosis (same as actinic keratosis))
Growth factors that promote angiogenesis in neoplastic and granulation tissue
VEGF (endothelial) and FGF
Lipid-lowering agent that causes hyperTG
- (binds bile and hepatic cholestrol secretion increases to make more bile, increasing LDL uptake (decreases LDL levels)
Hyaline arteriolosclerosis causes
- 1. DM
- 2. benign hypertension
Factors that can decrease kidney stone formation
- Citrate (binds to free Ca+2 and decreases its excretion)
- High fluid intake
Function of ApoB
Function of ApoE
- ApoB: present on LDL; mediates LDL receptor uptake
- ApoE: on chylomicrons and VLDL; chylomicrons and VLDL receptor uptake
What does foscarnet inhibit?
Does it require intracellular activation?
- DNA polymerase (for herpes) and reverse transcriptase (for HIV)
- No intracellular activation (like Cidofovir)
Interferon expression for killing viruses
Make antiviral proteins to impair the synthesis of viral mRNA, not cellular mRNA
Ureters pass lateral and medial to what structures
- Lateral to the internal iliac
- Medial to the gonadal vessels
Patient presents with perioral ulcers "cold sores" - primary or reactivation of HSV?
- Can produce interstital pneumonitis, hepatitis etc.
If a patient is infected with C.diptheria, what to give to reverse the sx immediately
Passive immunity (pre-formed antibodies)
Active immunity (via toxoid) will prevent the infection
Lipid-lowering agent that gives hyperglycemia and hyperuricemia (gout)
Action of mifepristone
- Progesterone antagonist
- (progesterone needed to mediate implantation for pregnancy, antagonist causes expulsion of fetal contents)
Treatment of Conn syndrome (adrenal adenoma)
Xeroderma pigmentosum - damage to what enzyme
- (remove mismatched nucleotides - prevents repair of thymidine dimers)
Endothelial injury causes intimal hyperplasia and fibrosis by what cells
SM cells (migrates from media to the intima)
With heart failure, there's an increase in hydrostatic pressure and filtration which will cause edema. What can prevent edema?
Increased lymphatic drainage
Neoplastic cells that don't resemble the normal tissue
- (seen with multiple mitoses and giant cells)
Migratory thrombophlebitis is a sign of?
BPH causes what changes in the bladder and kidney
- Bladder hypertrophies to increase contractile force, causing urinary retention
- Kidney: hydronephrosis due to urinary retention, renal parenchyma becomes atrophic and scarred due to reflux of urine
Drug used to treat systolic hypertension but causes peripheral edema and flushing as side effects
Ca+2 channel blockers
Subjects assigned to 2+ treatments one after the other, but a washout period is present in between to diminish the effects of the other. Type of study?
Consequence of hepatitis C infection
- Chronic stable hepatitis
- (can progress to cirrhosis (end-stage liver disease), doesn't really cause HCC)
Location of femoral hernias
- Below the inguinal ligament
- Lateral to the pubic tubercle
- Medial to the femoral vein (and artery)
Aortic regurg, mediastinal widening, syphilis (+)
Vaso vasorum obliteration = inflammation, ischemia, and weakening of thoracic adventitia = thoracic aneurysms
Loss of epidermal melanocytes and complete absence of melanin pigment. Dx
Normal # of melanocytes that don't produce melanin
- defective tyrosinase
Ovarian arteries (brach of the aorta) are carried in what ligament
Uterine arteries are carried in what ligament
Tranverse cervical (cardinal)
Structures that are surrounded by the broad ligament
uterine tube, ovarian ligament, round ligament, part of suspensory ligament of the ovary
Benefits of fatty acid oxidation inhibitors for heart problems
- FA oxidation = main source of E production
- results in greater ATP production, but uses more oxygen than glycolysis and glucose oxidation
Heart problems: less oxygen delivery, mismatch between demand and supply
- Inhibitors: shift E production to glucose oxidation, promoting oxygen efficiency
- decreases amount of oxygen needed to support cardiac function
p-ANCA (perinuclear - anti-neutrophil cytoplasmic Ab) are Ab against what?
- neutrophil myeloperoxidase
- e.g. Churg-Strauss syndrome
NE's affect on the heart and viscera
B1-receptor stimulation: increases contractility and conduction via cAMP (reflex bradycardia of NE)
a-1 receptor stimulation: peripheral vasoconstriction to increase BP via IP3 and DAG in vascular smooth muscle cells
Component of xanthelesmas
- Location on eyelids
- dermal accumulation of macrophages containing cholestrol and TG
- associated with hyperlipidemia/dyslipidemia; LDL receptor abnormality
- ribbon like pattern branching at 90 angles
Muscle cramps after exericise and decreased sexual performance in a patient who has had a MI. Dx
- Intermittient claudication
- result of artherosclerosis: obstruction of blood flow due to lipid-filled intimal plaques
Occlusive dz of external iliac and femoral arteries - can affect blood flow to the internal pudendal branches of the internal iliac a. (no erection)
Hyperplastic arteriosclerosis (concentric thickening of arterolar walls)
- malignant HT (DBP > 120 mmHg)
- kidneys, retina, and intestinal arterioles are most affected
- muscles not affected (no intermittent claudication)
- branching at 45 degree angles
- * look for V-shape*
Kaposi's sarcoma arise from what cells
- mesenchymal cells
- dermal plaques first appear on legs then spread proximally, then to face and gentials, then to GI tract
how do OC reduce the risk of non-heriditary ovarian cancers
- reduces the number of ovulatory cycles
- less need for repair at the ovarian surface
drugs with anti-cholinergic side affects
- H1 antagonists (e.g. diphenhydramine)
Rb in what state in active and has what function
- inhibits G1-S phase transition
(hyper-P means inactive, allows cells to go through mitosis)
myxomatous changes in the arterial walls predisposes to what condition
- cystic medial degeneration (fragmentation of elastic tissue)
- development of aortic dissections and aortic aneurysms
- seen with Marfan's
Dx test for cystic duct obstruction (gallbladder stones)
Radionuclide biliary scan
Condition associated with abnormal bleeding and painful menses, but normal sized uterus. If enlarged uterus?
characterisitics of a glomus tumor
- benign, very render red-blue lesion under the nail bed
- comes from modified SM cells
- controls thermoregulatory fx of dermal glomus bodies:
- a) shunts blood away from skin in cold temps
- b) increases blood flow to skin in hot temps for heat dissipation
Lymphoma that has a clinical course marked by remissions and recurrences. Abx therapy improves sx and decreases size of lymph node and then can increase again
- Follicular small cell lymphoma
- painless lymphadenopathy
- B cells
- bcl-2 overexpression
Acyclovir can work well against HSV and VZV, but weak against EBV and CMV. why?
- Drug phosphorylation rate
- acyclovir is activated by thymidine kinase
CMV has increased affinity to ganciclovir than other herpes viruses. Why?
viral DNA polymerase structural difference
Post-breast cancer, a patient develops chronic lymphedema involving her arm. She presents with multiple firm nodules n her arm. Cause?
- Lymphagiosarcoma/angiosarcoma = infiltration of the dermis with slit-like vascular spaces
- lymphatic malignancy
- Tx: amputation
Progression of strawberry hemangiomas seen in children
- aggregates of thin-walled capillaries
- grow in proportion to the growth of child and then regress by age 7
Intermittent claudication, cold sensitivity, ulcerations and gangrene of toes and fingers. Hypersensitivity to injected tobacco extract.
- Dx: Thrombangitis obliterans (buerger's disease)
- pathology: segmental vasculitis extending into contiguous veins and nerves, encases them in fibrous tissue