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failure of NC migration to the GI would inhibit development of what structure?
- Hirschprung's disease
- rectum (NC cells migrate caudally)
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which enzyme inhibited by ASA is only detected when inflammatory cells are present?
COX-2
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prokaryotic 16sRNA on 30S RNA is complementary to what sequence?
shine-dalgarno sequence on prokaryotic mRNA initiating translation
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Bias most commonly associated with retrospective, case-control studies
recall bias
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which drugs treat exopthalmos?
glucocorticoids = decreases inflammation and extraocular volume
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H. pylori association with decreased # of somatostatin-producing antral cells. duodenal or gastric ulceration?
- duodenal ulceration
- decreased somatostatin, therefore no inhibition of gastrin
(stomach doesn't need increased acid to have ulcers)
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Kid presents with mental retardation, seizures, and pallor of substantia nigra, locus cereleus, and vagal nucleus.
enzyme def?
phenylalanine hydroxylase
tyrosinase doesnt give mental retardation (albinism)
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adverse effects of methotrexate
- hepatotoxicity
- painful mouth ulcers (stomatitis)
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markers for osteoblastic and osteoclastic activity
- osteoblasts: bone-specific alkaline phosphatase
- osteoclasts: TRAP, urinary hydroxyproline, urinary deoxypyridinoline (most specific)
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seizure drugs associated with adverse effects of:
a) generalized lymphadenopathy
b) severe hepatotoxicity
c) Steven-Johnson syndrome
- a) Phenytoin
- b) Valproate
- c) Lamotrigine
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liver biopsy shows hepatocytes with fine, cytoplasmic protein granules
- ground-glass appearance
- Hep B
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Acute GVHD can develop 1 week after a transplant and present with liver, GI, and skin symptoms. Cause?
graft T cells against host MHC antigens
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acute (vasculitis of graft vessels) and chronic (fibrosis) rejection - cause?
host T cells against graft MHC antigens
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long - term treatment for peptic ulcers
antibiotics
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Structures that lie on the inferior portion of the rib
- intercostal vein, artery, and nerve
- thoracocentesis should be performed above the rib
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how does desmopressin treat hemophilia A/von willebrand disease?
- stimulates release of factor VIII and VWF from the endothelial cells
- (factor VIII: made in the hepatocytes and stored in the endothelium)
- has no affect on hemophilia B
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which drugs inhibit platelet aggregation and cause vasodilation?
phosphodiesterase inhibitors which increases cGMP
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Diarrhea containing a lot of mucoid material and colonoscopy shows a mass in the sigmoid colon. Dx?
Villous adenoma --> colonic cancer
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Cause of pancytopenia in SLE patients
type II H.S. - Ab against RBCs (peripheral destruction)
n.b. BM hypoplasia occurs due to meds, parvovirus, and Fanconi's anemia
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HIV-nef gene product
- enhances viral replication
- downregulation of CD4 and MHC-I
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bacterial endocarditis is caused by what most common valve defect?
- mitral valve prolapse (can lead to regurg)
- pre-disposes to infected vegetations on the valve
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infant presents with anemia, hepatosplenomegaly, jaundice and then dies a few days after.
- erythroblastosis fetalis
- maternal Ab (IgG) against fetal RBC
- Type II HS
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age presentations of hemachromatosis
- silent until around age 40
- men: GI bleeding, typical sx of the dx
- women: after menopause, menstrual periods protects against Fe accumulation
* blood donations/phlebotomy can also slow the progression of the dx *
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what part of the kidney is the regulating site for potassium?
collecting duct
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Ehrlos-danlos patients have a defect in what step of collagen synthesis
- 1. procollagen peptidases that cleave the N and C terminal groups to form insoluble collagen
- 2. lysyl oxidase to cross-link collagen
collagen triple helix accumulates and becomes weak
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Skin disease that presents with pruritic vessels and plaques on the extensors surfaces of extremities
dermatitis herpetiformis
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Rash that presents in infants with red, weeping crusted lesions with intense pruritis
- atopic dermatitis
- associated with asthma and allergic rhinitis
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which vitamin increases the peripheral metabolism of levodopa?
- B6
- not enough drug to treat the parkinson's
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patient is infected with Listeria - what mechanism is defective in their body?
cell-mediated immunity (macrophages are not produced)
* deficient neutrophil oxidative burst patients are more prone to infections by catalase + organisms
* humoral immunity is defective in Bruton's (increased infection risk for Staph and Strep)
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patient is treated for HT but presents with peripheral edema and flushing. Drug given?
Ca+2 channel blocker (dihydropyridine antagonists)
Thiazides are also given first-line but would not present with the above adverse effects
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Fanconi's anemia
- DNA repair defect
- produces aplastic anemia
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Cryoprecipitate contents
fibrinogen, factors VIII and XIII
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how do opiods cause biliary colic?
- cause contraction of the smooth muscle cells in the sphincter of Oddi = constriction and spasm
- increases bile duct pressures = biliary colic (pain associated with irritation of the viscera)
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Milirone
- phosphodiesterase inhibitor
- increases cardiac contractility, and decreases preload and afterload
- short-term use
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Colchicine affects what cell structure
microtubules in cytoskeleton (not nucleus)
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- medulloblastoma
- solid, malignant tumor
- cerebellar vermis
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- Pilocytic astrocytoma
- location: cerebellum
- solid and cystic components seen
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muscles (abductors) for the hip
gluteal minimus and medius
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hip flexors muscles
- iliopsoas: psoas major and minor, iliacus
- rectus femoris
- tensor fascia lata
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hip extensors
- gluteal maximus
- semitendinosus
- semimembranosus
- biceps femoris: long head
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any trauma or surgery in the axillary region damages what nerve?
long thoracic nerve
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organ system involvement with ankylosis spondylitis
- 1. musculoskeletal: inflammation at site of tendon insertion into bone.
- 2. respiratory: inflammation of costovertebral angles: pain can cause hypoventilation
- 3. cardiac: ascending aortitis = dilation of aortic ring and aortic insufficiency
- 4. eye: uveitis
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how does digoxin decrease HR?
- by increasing PNS tone
- (not by increasing contractility)
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spinal syndrome caused by flaccid paralysis of the bladder and rectum, and impotence caused by disc herniations, tumors, and spinal fractures
- conus medullaris syndrome
- lesion at L2
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Caused by any trauma to the lower vertebral column
Low back pain radiating to one or both legs, loss of sensation in the perianal area, no contraction of the anal sphincter
- Cauda equina syndrome
- S2-S4 (damaged pudendal nerve that innervates the perineum)
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Treatment for drug-induced Parkinsonism
- benztropine
- n.b. levodopa is c/i as it can precipitate psychosis
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which drug inhibits thrombin more? heparin or enoxaparin?
Heparin: acts on anti-thrombin and inhibits thrombin and factor Xa equally.
Enoxaparin inhibits factor Xa more
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what type of polycythemia has a normal RBC mass
- relative erythrocytosis
- due to dehydration, or excessive diuresis
- plasma volume = normal
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adult-type coarctation of the aorta is associated with what complications
- aortic regurg (due to dilation proximal to the obtruction)
- hypertensive problems: LVF, ruptured dissecting aortic aneurysm, intracranial hemorrhage
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drugs that cause a decreased in BP and HR
- negative ionotropic agents
- (Ca+2 channel blockers, [non-dihydropyridine], B-blockers)
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first symptom of alcohol withdrawal
delirium tremens (48-72 hrs after the last drink)
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lymph drainage of the bladder
- superior: external iliac nodes
- inferior: internal iliac nodes
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lymph drainage of the rectum and anal canal
- rectum: above the pectinate line
- internal iliac
- anal canal: below the pectinate line
- superficial inguinal
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how does ASA cause reye's syndrome?
inhibits B-oxidation of reversible inhibition of a mitochondrial enzyme
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Budd-Chiari syndrome can result from what two causes? How to differentiate from cirrhosis?
- HCC and nutmeg liver
- centrilobular congestion and necrosis
absence of JVD
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treatment for Crigler Najjer type II
phenobarbital increases liver enzyme synthesis (UDP-glucuronyl transferase)
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Pro-carcinogens enter the body and are converted to carcinogens by what enzyme?
- cytochrome P450
- microsomal monooxygenase
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what molecule is the adaptive immunity against Giardia?
- secretory IgA (duodenal)
- Giardia adheres to the mucosal barrier
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what molecule regulates total iron content?
hepcidin released from the liver parenchymal cells
intestinal absorption is crucial because blood and gut epithelial loss are the only pathways for iron excretion
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why do you wait 2 weeks between the use of a SSRI and MAO-inhibitor?
- Prevent serotonin syndrome
- Need to regenerate MAO so it can work to inactivate neurotransmitters
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halothane causes what liver damage?
centrilobular hepatic necrosis
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diabetic peripheral neuropathy
- 1. non-enzymatic glycosylation of proteins leads to thickening of the arteries = endoneural arterioles
- 2. increased sorbitol accumulation in Schwann cells - increases cell osmolarity and water influx
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if change in free energy is positive, does the reaction favor reactants or products formation?
- reactants
- (free E of products is higher)
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BPH can cause what complications?
- increased pressure in the urinary tract and reflux nephropathy
- hydronephrosis and renal interstital atrophy and scarring can result
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Schilling test: causes of normal urinary excretion of B12 vs. decreased urinary excretion of B12
- normal: dietary B12 deficiency
- decreased: B12 absorption problem (then give a 2nd dose of B12 with IF to distinguish between pernicious anemia and malabsorption)
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signet cell gastric adenocarcinoma - histology?
- infiltrative growth of the gastric wall
- diffused adenocarcinoma (vs. intestinal = glands)
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Patients with subarachnoid hemorrhage can survive to develop what problem?
- vasospasm due to ruptured berry aneurysm
- can cause cerebral ischemia and cause focal neurological problems (e.g. stroke sx)
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