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Misc from UW 3


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____% of observations are within 2 standard deviations from the mean.
____% of observations are within 3 standard deviations of the mean.
delayed detachment of the umbilical cord
leukocyte adhesion deficiency other sx: poor wound healing recurrent skin infections WITHOUT formation of pus gingivitis/periodontitis genetic defect: absence of CD18 antigen that is necessary for formation of integrins
substrate of myeloperoxidase
prokaryotic 16S rRNA
-sequence found in 30S subunit -complementary to Shine-Dalgarno sequence found in all prokaryotic mRNA -binding of these 2 seq's is necessary for initiation of prot translation
intermittent claudication
-muscle pain with exercise that remits with rest -almost always a result of atherosclerosis of larger arteries
medial band-like calcifications
Monckeberg's medial calcific sclerosis affects muscular arteries clinically asx
onion-like concentric thickening of arteriolar walls
hyperplastic arteriolosclerosis can result from malignant HTN
homogenous acellular thickening of arteriolar walls
hyaline arteriolosclerosis, usu due to diabetic microangiopathy
diarrhea weight loss bone pain, weakness improves when gluten-free
celiac disease - defective malabsorption leads to Vit D deficiency
dobutamine's primary effect
B1 agonist
enzyme that activates FAs to undergo B-oxidation
fatty acyl-CoA synthetase
catalyzes first committed step in fatty acid synthesis
acetyl-CoA carboxylase biotin-dependent present in both liver and adipose tissues
fatty acid oxidation occurs in the _________ while fatty acid synthesis occurs in the ______________
mitochondria cytosol
Which nitrate agent has the highest bioavailability if given orally?
isosorbide mononitrate
familial hypocalciuric hyperCa
defective Ca-sensing R on parathyroid cells does not allow PTH to be suppressed by an increase in Ca level. mild to moderate hyperCa and normal to high PTH
arteries spared by PAN
pulmonary PAN mostly affects kidneys, heart, liver, GI tract. bead-like aneurysm formation in mesenteric circulation. up to 1/3 pts have cutaneous manifestations - livedo reticularis, palpable purpura
marker of OB activity
serum level of bone-specific alkaline phosphatase
urinary deoxypyridinoline and hydroxyproline
measures of OC activity
characteristics of drugs with high intrinsic hepatic clearance
high lipophilicity, good CNS penetration high volume of distribution
3 significant causes of polyuria and polydipsia
DM DI primary polydipsia
bluish neoplasm under the nail bed
-glomous tumor (glomangioma) -subungual melanoma
-tumor of the modified smooth muscle cells of a glomus body glomus bodies - small, encapsulated neurovascular organs found in the dermis of the nail bed, the pads of the fingers and toes, and the ears. Role is to shunt blood away from the skin surface in cold temperatures and vice versa.
hepatitis that is most often anicteric
Hep A
3 major etiologies of hepatocellular carcinoma
-viral infxn with B or C -chronic alcoholism -food contaminants (aflatoxins)
pathologic features of Vit D deficiency
-increased unmineralized matrix and widening btwn osteoid seams -genu varus (bowing of wt-bearing bones) -rachitic rosary (bony prominence at costochondral jct) -Harrison's sulci (indentations in lower ribs) -craniotabes (softening of skull) -also hypoCa, hypophos, hypertonia, growth retardation
trabecular thinning with fewer interconnections
subperiosteal resorption with cystic degeneration
lamellar bone structure resembling a mosaic
Paget's disease seen in elderly only involves focal pts of skeleton starts with OC then OB
sponguosa filling medullary canal with no mature trabeculae
-recent viral illness -thyrotoxicosis sx -tenderness over thyroid gland -inc ESR -reduced radioactive iodine uptake
subacute granulomatous thyroiditis initial PMN infiltration, then lymphocytes, histiocytes, multinuc giant cells antithyroid peroxidase Ab is NOT elevated
diffuse mononuclear infiltration of thyroid, with formation of germinal centers
Hashimoto's thyroiditis aka chronic lymphocytic thyroiditis nl ESR hypothyroidism nontender gland with rubbery texture HIGH TITERS OF ANTITHYROID PEROXIDASE AB
death from cardiac tamponade is due to
cardiogenic shock
radial pulse disappears on inspiration
pulsus paradoxus (drop of over 10 mmHg)
pulsus alternans
LV dysfct beat to beat variation of pulse pressure in the presence of a regular cardiac rhythm
dicrotic pulse
2 peaks - one during systole, other during diastole severe systolic dysfct
hyperkinetic pulse
rapid ejection of a large SV against decreased AL fever, exercise in nl ppl PDA, AV fistula
headaches, visual sx, N/V, proteinuria, hematuria
malignant HTN
structures formed from dorsal pancreatic bud
tail, body, most of the head, accessory pancreatic duct
structures formed from the ventral pancreatic bud
uncinate process, a part of the pancreatic head, main pancreatic duct
strict vegetarian diet would cause _____ deficiency
ddx of acquired night blindness
1. toxic retinopathy due to phenothiazines or chloroquine 2. vit A deficiency 3. congenital rubella, syphilis, or other infxns 4. diabetic retinopathy
mediate delayed hypersensitivity reactions and granuloma formation
TH1 cells also produce IL-2 and IFN-g and activate MPs to produce TNF note: while TH1 is implicated in Crohn's, TH2 is implicated in UC
cystic medial degeneration
fragmentation of elastic tissue and separation of elastic and fibromuscular components of tunica media by small, cleft-like spaces associated with aortic dissections
most common cause of death in diabetes pts
statin SEs
myopathy, hepatotoxicity
DNA glycosylases
base excision repair
What happens after a growth factor binds to its tyrosine kinase R?
autophosphorylation interaction with SOS activation of Ras (by binding GTP) activation of Raf activation of MAPK gene txn
gastric erosion
mucosal defect that does not penetrate into muscularis mucosa usu occurs in the setting of acute erosive gastritis (NSAIDs surgery, head trauma - Cushing ulcers, burns - Curling ulcers, smoking, alcohol)
AV shunts/AV fistulas
-abnl connection btwn artery and vein that bypasses cap beds, which are the major source of resistance in the vascular system -allow blood under arterial P to directly enter venous system - INCREASE CARDIAC PRELOAD -pulsatile mass with a thrill on palpation; constant bruit
phase 4 (pacemaker potential)
-slow influx of Na -slow decrease in K efflux as K channels continue to close -when membrane potential reaches -50, T type Ca channels open and allow Ca to enter cell and contribute to depol -ADENOSINE AND ACH ACTIVATE K CHANNELS AND PROLONG K FLOW - thus reduce rate of spontaneous depol
major RFs for sqCC of esophagus
cigarettes and alcohol
pancreas is grossly edematous focal areas of fat necrosis, Ca deposition and interstitial edema on LM
acute interstitial pancreatitis
chalky-white areas of fat necrosis of the pancreas interspersed with hemorrhage
necrotizing (hemorrhagic) pancreatitis
chronic antral-predominant gastritis
H. pylori infxn inc acid prodxn, inc risk of duodenal ulcer
SEs of protease inhibitors
-lipodystrophy -hyperglycemia -inhibition of P-450 indinavir in particular: nephrotoxicity, nephtolithiasis NOTE: use rifabutin, NOT rifampin, in pts on protease inhibitors
severe chest pain not relieved by rest or NG diaphoresis, dyspnea, nausea, etc. peaked T waves STE Q waves (hrs to days)
acute TRANSMURAL MI most commonly caused by acute plaque change (e.g. rupture) which produces a superimposed thrombus that completely occludes the involved coronary artery
Sx of stable angina do not become apparent until ____% of the cross-sectional area is occluded.
defects in heme synthesis that cause photosensitivity
URO decarboxylase COPRO oxidase PROTO oxidase ferrachelatase
CANNOT use ketone bodies
-hepatocytes - lack succinyl-CoA-acetoacetate-CoA transferase (thiophorase) -RBCs - lack mitochondria
cofactor for ALA synthase
Vit B6
most common cause of fatigue and new cardiac murmur in young adult
bacterial endocarditis can be complicated by immune cplx deposition resulting in acute diffuse proliferative GN
How do you get Campylobacter?
-domestic animals -contaminated food
Campylobacter gastroenteritis
inflammatory diarrhea (watery then bloody), abd cramps, tenesmus, WBC in stool
cirrhotic stigmata related to hyperestrinism
gynecomastia palmar erythema spider angiomas
most important factors for OC differentiation
M-CSF RANK-L OC are multinucleated (2-5) and arise from the monocytic lineage
primary biliary cirrhosis
-middle-aged women -pruritis is first sx -hepatosplenomegaly, ascites, xanthomatous lesions -increased alk phos, IgM, XOL -a/w Sjogrens, scleroderma, autoimmune thyroid, hypothyroid, Raynauds syndrome
comma-shaped, oxidase + G- rod that can survive in ALKALINE environments
V. cholerae (compare with C. jejuni) activates AC, same mech as E. coli heat-labile toxin
WBCs without RBCs in stool
WBCs and RBCs in stool
invasive organisms such as Shigella
RBCs in stool
painless hematuria 2-3d after URI
IgA nephropathy + abd pain and purpuric lesions = HSP
1st line drugs for isolated systolic HTN
-thiazide diuretics -dihydropyridine CCBs
insoluble yellow-brown perinuclear pigment
lipofuscin sign of nl wear and tear / aging composed of lipid, phospholipids
traction diverticula
due to inflammation and subsequent scarring e.g. midesophageal diverticula
granulomatous inflammation of the media
-temporal arteritis (branches of carotid artery) -Takayasu (aortic arch)
transmural inflamm of arterial wall with fibrinoid necrosis
mixed cellular infiltration of thyroid with occsasional multinuclear giant cells
subacute thyroiditis / granulomatous thyroiditis brief thyrotoxic phase, then transient hypothyroid
-deficiency of a-galactosidase A -accumulation of ceramide trihexoside
Fabry's disease hypohidrosis acroparesthesias angiokeratomas - punctate, dark red, non-blanching macules and papules btwn umbilicus and knees progress to renal failure
risk of acute leukemias
Down syndrome Patau syndrome Bloom syndrome ataxia-telangiectasia Fancomi anemia
acute calculous cholecystitis
first step is obstuction of GB neck or cystic duct 2nd to last step is ischemic damage to mucosa last step is bacterial invasion
bilious vomiting after first 24h of birth
intestinal obstruction below second part of duodenum common causes: intestinal and colonic stenosis or atresia Jejunal, ileal, and colonic atresia are NOT congenital malformations - due to vascular accidents in utero. "apple peel" appearance.
-palpable but non-tender gallbladder (Courvoisier sign) -wt loss -obstructive jaundice (pruritis, dark urine, pale stools)
adenocarcinoma at the head of the pancreas, compressing common bile duct.
RFs for pancreatic adenoCA
age smoking DM chronic pancreatitis (risk highest after 20 yrs) genetics - hereditary pancreatitis, MEN syndromes, HPNCC, FAP
transmitted by tick bites causes malaria like illness in asplenic pts
mono-like illness in immunocompetent CNS involvement in immunocompromised
Isospora belli
chronic, watery, profuse diarrhea in immunocomp, esp AIDS
Campylobacter fetus
opportunistic pathogen septicemia in newborns, pregnant women, elderly
slowest conduction velocity
AV node
fastest conduction velocity
purkinje fibers also, atrial muscle has higher conductivity than ventricular muscle
medical therapy for disseminated carcinoid
medication of choice in gestational DM
alcohol-induced hepatic steatosis
decrease in FA oxidation secondary to excess NADH production by alcohol metabolism enzymes
mainly B1 agonist; also works at B2 and A1 treatment of acute heart failure associated with dec myocardial contractility effects: -inc cardiac contractility -inc HR and myocardial O2 consumption -inc cardiac conduction velocity
tx for recurrent Ca-based kidney stones
most common cause of hypothyroidism in places where iodine is sufficient
anti-thyroid peroxidase Ab
Hashimoto's also see: intense mononuclear infiltrate with germinal ctrs metaplastic follicular cells - large, oxyphilic with granular cytoplasm (Hurthle cells)
HFE protein
on basolateral surface of epi cells in SI crypts complexes with B2 microglobulin and then binds transferrin R to facilitate endocytosis of transferrin/Fe cplx into cells
What is the specific defect in hemochromatosis?
mutant HFE that cannot detect circulating Fe levels leads to unregulated uptake of Fe Cx: cirrhosis, hepatocellular CA
basal ganglia atrophy
Wilson's disease
cause for increase in staph bacteremia and sepsis
intravascular devices most common pathogens: coag neg staph S. aureus Enterococcus E. coli Enterobacter Psuedomonas Klebsiella Candida

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