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How do we calculate negative predictive value?
- = TN/ (TN+ FN)
- = 180/ (180 + 140)
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What forms the Allantois?
Yolk sac forms the allantois, which extends into the urogenital sinus.
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What does the allantois become?
Urachus, a duct between the fetal bladder and yolk sac.
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What is the urachus? What forms it?
- Uracus is a duct between the fetal bladder and yolk sac.
- It is formed by the Allantois.
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What is a patent urachus? What does it present with?
- Connects the umbilicus and the bladder.
- Presents with urine discharge from the umbilicus.
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Urine discharge from the umbilicus is characteristic of?
Patent urachus
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What is a Vesicourachal diverticulum? What does it present as?
- Failure to close the part of urachus adjacent to the bladder
- → Outpouching of bladder
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Outpouching of the apex of the bladder is due to?
Vesicourachal diverticulum
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What is a urachal sinus? What does it present as?
- Failure to close the distal part of the urachus (adjacent to the umbilicus).
- It presents with periumbilical tenderness and a purulent discharge from the umbilicus due to the persistent and recurent infections.
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What is a urachal cyst? What can it lead to?
- Failue of central portion of urachus to obliterate. Leads to formation of a urachal cyst, a fluid-filled cavity lined with uroepithelium, between umbilicus and bladder.
- Can lead to infection, adenocarcinoma
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What is Omphalocele?
Incomplete closure of anterior abdominal wall causes persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum.
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What is the pathology seen below?
Omphalocele
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What is Gastrochisis?
- Due to inadequate enlargement of the peritoneal cavity.
- Extrusion of abdominal contents through abdominal folds, not covered by peritoneum.
-
What is the pathology seen below?
- Gastrochisis
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Where does Acetazolamide work? How does it work?
- c- Proximal convoluted tubule
- It inhibits Carbonic anhydrase which effectively blocks reabsorption of NaHCO3- → urinary alkalinization
-
Glaucoma drug which causes a highly alkaline urine?
- Acetazolamide
- Carbonic anhydrase inhibitor- blocks reabsorption of NaHCO3-
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Describe the presentation and findings of a transient ischemic attack.
- Sudden onset of transient numbness and tingling of left arm which lasts less than 15 mins
- Normal MRI - e.g echo
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Patient experiences sudden onset of transient numbness and tingling of the left arm. MRI shows no abnormalities. What is the pathology?
Transient ischemic attack
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Increased gastrointestinal blood loss is the most common side effect of?
Aspirin
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Describe the mutation of sickle cell anemia.
Valine replaces glutamate at position 6 of the beta chain
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What promotes sickling of RBCs?
- Low oxygen / oxygen unloading
- High altitude
- Increased acidity
- Low blood volume (dehydration)
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Which complement deficiencies are associated with increased susceptibility to Neisseria?
C5-C9
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Which complement deficiencies are associated with lupus-like syndrome?
C1, C3, C4
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What are some of the long term symptoms of hydrocephalus?
- Lower extremity spasticity.
- Spasticity results from loss of inhibition of motor neurons, causing excessive muscle contraction.
- →Hyperreflexia & hypertonicity.
- Results from upper motor neuron damage caused by stretching of the periventricular pyramidal tracts.
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Lower extremity hyporeflexia would result from?
- Damage to the lower motor neurons of the lower extremities
- Can occur in Poliomyelitis or Werding-Hoffman disease
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What is the composition of the 3' end of the tRNA molecule?
CCA
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What does the D arm of the tRNA contain?
Dihydrouracil residues necessary for tRNA recognition byt the correct aminoacyl-tRNA synthetase.
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Dihydrouracil residues are contained in this part of the tRNA.
D arm
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What does the anticodon arm contain?
Contains sequences which are complementary to the mRNA codon and is read in the 3'-5' direction.
-
This part of the tRNA contains sequences which are complementaty to the mRNA codon.
Anicodon arm
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What does the T arm contain?
Contains the TψC sequence (thiamine, pseudouracil, cytosine) sequence necessary for binding of tRNA to ribosomes.
-
This part of the tRNA contains the thiamine, pseudouracil, cytosine sequence.
T arm
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Label the diagram below.
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Polyadenylation occurs at which end ?
3' end
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The 7-methylguanosine cap is added at which end?
5' end
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The cell type below is diagnostic of?
- Cytomegalovirus
- Owl eye inclusions
-
The image below indicated infection with?
- Cytomegalovirus
- Owl eye inclusion
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Explain the pathology seen below.
- Left Avascular necrosis/ Osteonecrosis
- Note how the femoral neck is markedly shortened compared to the right side.
- Are common in elderly patients with osteoporosis who have sustained a fall.
- The medial femoral circumflex artery is vulnerable to damage from femoral neck fractures.
-
Injury to this vessel can cause avascular necrosis of the femoral head.
Medial circumflex femoral artery
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What is the function of the ductus arteiosus?
- Deoxygenated blood from the SVC passes through the RA → RV → pulmonary artery →
- patent ductus arteriosus → descending aorta
- DEOXYGENATED BLOOD BYPASSES THE LUNGS
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The ductus arteriosus is an embryonic derivative of?
The 6th aortic arch
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The ductus arteriosus closes shortly after birth secondary to?
- Decreased prostaglandin E2 (PGE2) levels
- Increased oxygen concentration
-
Describe the murmur of a patent ductus arterisosus.
Continuous machinery-like murmur
-
What are the effects of Indomethacin on the patent ducuts arteriosus?
- Closes the PDA
- Inibitor of PGE2 synthesis
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What does the bulbus cordis form?
The smooth part (outflow tract) of the left and right ventricles
-
The embryonic structure forms the smooth part (outflow tract) of the left and right ventricles.
Bulbus cordis
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What does the primitive atrium form?
Rough/ trabeculated part of the left and right atrium
-
This embryonic structure forms the rough/ trabeculated part of the left and right atrium.
Primitive atrium
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What does the right horn of the sinus venosus form?
Smooth part of right atrium (sinus venarum)
-
This embryonic structure forms the sinus venarum.
Right horn of sinus venosus - Smooth part of right atrium
-
This embryonic structure forms the smooth part of the right atrium
- Right horn of sinus venosus -
- Sinus venarum
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How does leuprolide work?
GnRH analog with agonist properties when used in a pulsatile fashion and antagonist properties when used in continuous fashion.
-
What is the mechanism of Finasteride?
A 5α-reductase inhibitor (↓conversion of testosterone to DHT)
-
What is the mechanism and use of Cladribine?
- Purine analog which is resistant to degradation by adenosine deaminase, inhibits DNA polymerse, DNA strand breaks
- DOC for hairy cell leukemia
-
This drug is resistant to degradation by adenosine deaminase.
Cladribine- purine analog
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What is the DOC for hairt cell leukemia?
-
What is the most common cause of nephrotic syndrome in adults?
Membranous glomerulopathy
-
Spike and dome appearance on methenamine silver stain is characteristic of this glomerular nephropathy?
Membranous glomerulopathy
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Incomplete gallbladder emptying/ gallbladder hypomotility resutls in?
Bile precipitation and formation of BILIARY SLUDGE
-
Black pigment stones result from?
Intravascular hemolysis
-
Brown pigment stones result from?
Biliary tract infection
-
Loss of infectivity after ether exposure is a characteristic feature of?
- Enveloped viruses
- Ether and other organic solvents dissolve the lipid bilayer that makes up the outer viral envelope.
-
How is the Hepatitis A virus transmitted?
- Fecal-oral
- Often via ingestion of oysters, shellfish
- * At restaurants, overcrowded areas
-
What is the use of Inulin clearance?
Inulin clearance can be used to calculare GFR because it is freely filtered and is neither reabdorbed nor secreted.
-
What can be used to estimate GFR?
- Inulin clearance
- Creatinine clearance
-
Paraaminohippuric acid is used to calculate?
Renal plasma flow
-
Where is Coccidioides immitis endemic to?
- Southern & central California
- Arizona
- New Mexico
- Western Texas
- Northern mexico
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Rupture of apical blebs or cysts is the most common cause of?
Primary spontaneous pneumothorax- tall thin, males
-
What causes a primary spontaneous pneumothorax? Who does it frequently occur in?
- Rupture of apical blebs or cysts
- Occurs most frequently in tall, thin, young males
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Tall, thin male presents with sudden-onset unilateral chest pain with hyperresonance and absent breath sounds on physical examinaton? What is the most likely diagnosis?
Primary spontaneous pneumothorax- due to rupture of apical blebs or cysts
-
Describe the presentation of a pneumothorax.
- Unilateral chest pain
- Unilateral chest expansion
- Hyperresonance
- Absent breath sounds
- ↓tactile fremitus
-
Describe the metabolism of Nitroprusside.
Nitroprusside is initally metabolized to cyanide, with subsequent conversion to thiocyanate by liver rhodanase.
-
How can we treat cyanide toxicity?
Nitrates followed by sodium thiosulfate (donates SULFUR to liver rhodanase to enhance conversion of cyanide to thiocyanate.
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