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bidamifi 's
version from
2017-04-04 22:01
Section
Question Answer
ARDS Normal pulmonary wedge pressure
Common peroneal VS Superficial peroneal Defect of dorsiflexion , evertion & sensory loss over dorsum VS Defect of evertion & sensory loss over dorsum ONLY
ALS VS Syringomeylia(Upper & Lower) No sensory Loss vs Sensory loss
Repurfusion injury leads to free radical formation and which can neutralized by Superoxide Dismutase
CGD Organisms due to defective NADPH oxidase of catalase + orgainsms ASSMN -> Aspergilliosis, Serratia cepacia, S.Aureus, Marcescens, Nocardia
Molar prgancy Enlarged chorionic villi and avascular edematous stroma
Pt with no smoking history has lungmass in the lowerlung Adenocarcinoma(Common) NOT Large cell carcinoma(Not common)
Aortic Stenosis Bood pressure values Systolic pressure low, Diastolic pressure Low
Diastolic Hear failure Left ventricular end-diastolic pressure & volume Increased & Normal , Ejection fraction Normal
Aortic Regurgitation Blood Pressure values Systolic pressure Normal(Unhealthy), Diastolic pressure Low
DNA Polymerase I has 5-3exonuclease activity VS DNA Polymerase III has 3-5exonuclease activity
B-thalassemia Alternative splicing
CF & DMD think of Frame shift
Sickle cell think of Missense
Stages Grief Deniel, Anger, Bargaining, Sadness, Acceptance
Pt presenting with transient visual changes"loss of vision for a minute" while bending forward or lifting objects, with persistent headaches , obese, Increased bp Idiopathic intracranial hypertension Impaired optic nerve axoplasmic flow causing papilledema -> Picture shows blurred disc margins and elevation of optic disc
Increase in RBC MASS Absolute Polycythemia
Atriovenous Fistula does what? Increase VOLUME ONLY Increase preload ONLY NOT CONTRACTION
Superior Gluteal nerve injury Positive Rohomberg test where pelvis tilts to the opposite side of lesion
PCOS High Tesosterone,Estrogen, LH / Low FSH
Normal RBC MASS OR Decrease in PLASMA VOLUME Relative erythrocytosis
Hypothyroidism labs TSHIncreased / Free T4Decreased / Total T3Normal
Mitral stenosis left atrium tracing is starting at high pressure
Mitral Regurgitation left atrium tracing is starting normal
LH & FSH fEEDBACK (Picture)
Chronic Granulomatous disease NAPD OXIDASE -> Catalase + -> S.Aureus, Burkholderia Cepacia Serratia Marcescens, Nocardia, Aspergillus
Pt with hx of hypertension and high bp has Unilateral MLF lesion due to Lacunar Stroke of pontine artery -> Lateral Pons -> CN VI
Normal Aging lung values TLC - Unchanged, FVC(Forced air out), Residual volume - Increase, Decrease chest wall compliance BUT Increase in lung compliance
Fat Jeffs Lung volume & capacity Restrictive Lung disease -> Respiratory Rate Increased , FEV1 Decreased , FVC Decreased, ERV Decreased, RV Normal, TLC Decreased~
Granuloma IL-12, TNF-a, Interferon-y
G+ Diploccous S.Penumonia
Shizoaffective vs Shizophrenia mania,delusions,hallucinations VS mania, delusions, hallucinations, Depression episodes
Nitroglycerine vs Nitrpursside Venodilator decrease preload vs Veno&Vasodilator Decrease preload & afterload
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Abduction, External rotation, Adduction & External rotation, Adduction & Internal rotation
Question Answer
S-I-T-S Abduction, External rotation, Adduction & External rotation, Adduction & Internal rotation
Aspirin allergy(wheezing & SOB) DOC Clopidogrel NOT Cilostazol
Immediate sensitivity vs Antibody mediated hypersensitivity Anaphylaxis VS Graft becomes cyanotic and mottled soon after blood vessels connected
g- COCCOBACILLI that causes meningitis in infants, grows in blood agar and needs X & V H. Influenza
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Bone
Question Answer Column 3
Pagets disease Serum calcium/phosphorus NORMAL / Excessive Osteoclasts / Activation of RANKL N.kb Lamellar bone structure resembling a mosaic pattern/ Prominent cement lines, Haphazard oriented lamellar bone
Vitamin D defiency Low urinary calcium Osteoid matrix accumulation around trabecula
Osteopetrosis Accumulation of woven bone& skeletal thickening Spongiosa filling medullary canals with no mature trabeculae
Hyper parathyroidism Low phosphate, High calcium, Calciuria Subperiosteal resorption with cystic degeneration
Osteoporosis Normal lab values Trabecular thinning with fewer interconnections
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Diagnosing Cushing
Question Answer
Check first ACTH Levels
Normal or Elevated ACTH levels DO WHAT? High Dose dexamethasone test
After Dexamethsone Test -> Suppresed ACTH & Cortisol Levels Pituitary Adenoma
After Dexamethasone Test -> Unchanged ACTH & Cortisol Levels Ectopic ACTH production
Low ACTH levels TO BEGIN WITH Adrenal Adenoma,Adrenal Malignancy, Exogenous Glucocorticosteroid intake
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Receptors
Question Answer
Aortic arch receptor transmits via vagus nerve to solitary nucleus of medulla responds only to ↑ BP
Carotid sinus transmits via glossopharyngeal nerve to solitary nucleus of medulla responds to ↓ and ↑ in BP
Hypotension and baroreceptor mechanism ↓ arterial pressure → ↓ stretch → ↓ afferent baroreceptor firing → ↑ efferent sympathetic firing and ↓ efferent parasympathetic stimulation → vasocontriction, ↑ HR, ↑ contractility, ↑ BP Important in the response to severe hemorrhage
Carotid massage mechanism ↑ pressure on carotid a → ↑ stretch → ↑ afferent baroreceptor firing →↓ HR
Peripheral chemoreceptors carotid and aortic bodies - stimulated by ↓ PO2 (<60mmHg), ↑ PCO2, and ↓ pH of blood
Central chemoreceptor stimulated by changes in pH and PCO2 of brain interstitial fluid, which are influenced by arterial CO2. Do not directly respond to PO2
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GI
Question Answer
Eosinophil Infiltration of lamina propria & mucosa Crohns
Granulomas in bowel wall and serosa Ulcerative colitis
Loss of vili & increased number of epithelial lymphocytes Celiac
Macrophages containing periodic acid-schiff positive bacilli in lamina propria Whipple(Arthralgia, cardiac, and neurologic)
Normal villi with epithelial cells vacuolated with fat Lactase Deficiency
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Thyroid
Question Answer
Hypothyroidism(Hashimoto thyroiditis) Well developed germinal centers
Subacute thyroidits After flu -> Get hyperthyroid -> Mixed infiltrate with occasional giant cells
Reidels thyroidits Hard painless rock like goiter replaced by fibrous tissue
Papillary Carcinoma Ground glass nuceli & orphan annie
Follicular Carcinoma Uniform follicles
Medullary Carcinoma Parafollicular C Cells, Calcitonin, Amyloid Stroma
Anaplastic carcinoma Giant cells or Megaloblastic cells
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Ring enhancing
Question Answer
Solitary with butterfly appearance Glioblastomas
Travel history to south or central America Neurocysticercosis
HIVORAL THRUSH , Cd 4 count less than 200, brain lesions with cervical and inguinal lymphadenopathy, seizures , NO need for cat exposure but instead contaminated food Toxoplasmosis
pt with cat has 2.5centimeter cyst in brain Taneia Solium
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Question Answer
Vitamin D & Renal failure lab Low calcium / High PTH
Hyperparathyroidism High Calcium / High PTH
Ca Tumors High Calcium / Low PTH
Getting sun light effect what step in vitamin D synthesis 7-dehydrocholestrol -> Cholecalciferol
Liver issues affects what step in vitamin D synthesis Cholecalciferol -> 25-hydroxycholecalciferol
Kidney issues affect what step in vitamin D synthesis 25-hydroxycholecalciferol -> 1,25-dihydroxycholecalciferol
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Question Answer
21hydroxylase deficiency Low Cortisol & Aldosterone, High ACTH & 17-hydroxyprogesterone Tx - SUPPRESS ACTH
Metyaprone test Inhibits production of Cortisol via 11b-hydroxylase -> CAUSE INCREASE in ACTH, 11-deoxycortisol & urinary 17-hydroxycorticosteroid
Female with ambiguous genitalia - clitoral enlargement & High bp 11B-Hydroxylase
Female with normal genitalia & High Bp 17A-Hydroxylase
Male with undervirilized -no puberty ,& Highbp 17A-Hydroxylase
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Question Answer
Enveloped, single stranded RNA virus Rubella
Gram positive coccus in chains Group B Streptococcus
Enveloped, double stranded DNA CMV, HSV, VZV
Obligate intracellular protoza Toxoplasma gondii
Rhinovirus Nonenveloped single strand RNA virus
Influenza Enveloped single stranded RNA virus
Adenovirus Nonenveloped Double stranded DNA virus
Parvovirus Enveloped single stranded DNA virus
Pregnant women with pain on both feetarthritis , has a baby with pleural effusion pulmonary hypoplasia, ascites Parovirus Nonenveloped single stranded DNA virus
Increased A-fetaprotein, liver mass in a HBV carrier pt Hepatocellular Carcinoma due to Viral DNA integration into the host genome
Most common hepatits Hepatitis B -> CIRCULAR DS Enveloped DNA
Progressive Multifocal leukoencephalopathy Infectious demyelinating disorder by JC VirusDD-DNA of polyomavirus in immunocompromised pts
Progressive mutlifocal leukoencephalopathy VS Subacute sclerosing panencephalitis JC Virusdna virus VS Measles(Rubeola)RNA VIRUS
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Question Answer
Brief Psychotic Disorder <1 month
Schizophreniform 1 - 6 months
Schizoaffective Disorder They have shizo + bipolar psychotic symptoms -> Hallucinations, dellusional, mania, depression, ATLEAST 2 weeks of stable mood
Autism VS Asperger Below normal intelligence VS Normal Intelligence
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Question Answer
Thiamine B1 Cofactor Dehydrogenases -> Pyruvate dehydrogenase, a-Ketoglutarate dehydrogenase, Isocitrate dehydrogenase, Transketolase
Biotin Cofactor Carboxylation -> Propionyl-CoA carboxylase, Acetyl-CoA carboxylase, Pyruvate carboxylase
Homocysteine defect of methylene tetrahydrofolate reductase (THF) FAD cofactor Impaired conversion of Homocysteine to Methionine Remethylation
Young boy presenting with severe chest pain during physical activity, troponin is elevated with st segment elevation Homocystinuria -> Deficiency of cystathionine synthase OR b6(Pyridoxine) deficiency as cofactor -> Cysteine becomes essential -> Elevated methionine is also seen
Niacin deficency due to cofactor b6 -> Pyridoxine deficiency
Pyruvate -> Oxaloacetate cofactor? B7 Biotin - raw egg associations
Propionic acidemia amino acid VOMIT -> Valine,Isoleucine, Threonine, Methionine, Cholestrol & odd chain fatty acids -> NEED B7(biotin) as cofactor
Transamination(Making of amino acid) requires what cofactor in the liver B6 Pyridoxine
Normal phenylalanine levels, neurological abnormalities, microcephaly, elevated prolactin(low dopamine) Cofactor enzyme- Dihydropteridine reductase OR Enzyme Deficiency DOPA -> Dopamine- Dopa decarboxylase OR Enzyme deficiency Phenylalanine -> Tyrosine- Phenylalanine hydroxylase
Succinate to Fumarate -> Succinate Dehydrogenase cofactor? B2 Riboflavin FAD
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Rate limiting
Question Answer
Glycolysis PFK 1
Gluconeogenesis Fructose 1-6 Bisphosphatase
TCA Icocitrate dehydrogenase
Glycogen Synthesis Glycogen synthase
Glycogenolysis Glycogen phosphorylase
HMP Shunt G6PD
De Novo Pyrmidine synthesis Carbamoyl Phosphate synthetase II
De Novo Purine synthesis Glutamine PRPP aminotransferase
Urea cycle Carbamoyl Phosphate synthetase I
Fatty acid synthesis Acetyl-Coa Carboxylation Biotin b7
Fatty acid oxidation Carnitine Aceyl transferase I
Ketogenesis HMG-Coa synthase
Cholestrol Synthesis HMG-Coa reductase
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Vitamins
Question Answer Column 3
B1 Thiamine Decarboxylation of a-keto acids(Carbohydrate metabolism) Beri Berineuropathy, heart failure / Wernicke Korsakoff syndrome
B2 Riboflavin Mitochondrial Hydrogen carrier Angular cheilosis, stomatitis, glossitis, Normocytic anemia
B3 Niacin Hydrogen receptor Dermatits, Dementia, Diarrhea, Neuropathy
B6 Pyridoxine Transamination of amino acids Cheilosis, stomatitis, glossitis
B7 Riboflavin Carboxylation In gluconeogenesis, fatty acid synthesis & oxidation
B9 Folate Hydroxymethyl/fomyl carrier Megaloblastic anemia, NTD
B12 Cobalamin Isomerase & methyltransferase cofactor( DNA & Methionine synthesis) Megaloblastic anemia, Neuropathy
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Kidney
Question Answer
Decrease Renal Plasma flow / Increase Filtration Fraction & GFR Constriction of efferent arteriole
Decreased GFR / No change on RPF / Decreased Filtration fraction Hyperproteinemia
Decreased GFR/ No change on RPF / Decreased FF Bladder neck obstruction
Decreased GFR/ Decreased RPF / No change FF Constriction of afferent arteriole
Decrease GFR / Increased RPF / Increased FF Dilation of efferent arteriole
Low RPF, LOW GFR, HIGH FF Hypovolemia(DEHYDRATION) -> afferent dilation & efferent constriction
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RIPE SX
Question Answer
Rifampin Red orange or orange body fluids, Hepatotoxic
Isonazid Neurotoxicity can be prevented by giving b6, OR Hepatocyte damage OR SLE
Pyrazinamide Hyperuricemia & Hepatoxicity
Ethambutol Optic Neuropathy / Red green color blindness
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Heart
Question Answer Column 3
Extensive valve calcification with impaired leaflet mobility Aortic Stenosis in a 75yr old Harsh ejection type systolic murmur at the base of heart radiating to neck with S4 due to HCM
Fusion of valve commissures due to repetitive inflammation Rheumatic valve disease in earlier age Mitral valve
Infectious vegetations attached to the valve cusps Aortic regurgitation due to infective endocarditis Decrescendo high pitched blowing diastolic murmur that begins after A2
Myxomatous valve degeneration with leaflet prolapse Mitral valve prolapse Non ejection click & mid to late systolic murmur
Hypertrophic of basal interventricular septum with subaortic obstruction HCM Harsh crescendo-decresendo murmur heard best at the apex
Holosystolic Murmur best heard at the apex of the heart that radiates to the axilla Mitral regurgitation Best indicator of this condition - Presence of audible S3
Presense of midsystolic click Mitral valve prolapse Sudden tensing of chordae tendineae
S2 to opening snap time interval Mitral stenosis Indicator of the severity of mitral valve stenosis
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Drug
Question Answer
Fluoroquinolone DNA Gyrase with altered A subunit, Impaired influx/Increased Eflux
Aminoglycoside Mutated Porin, Mutated Ribosonal subunits protein, Aminoglycoside modyfying agents
Methicillin resistant Staph Aureus Penicillin binding protein with reduced antibiotic affinity - Transpeptidases
Vancomycin Peptidoglycan cell wall with amino acid modification / Impaired Influx/Increased efflux
Extended spectrum Beta lactamase Plasmid ocngugation with drug resistance gene
Macrolides Ribosome with methylated 16s RNA
Rifamycins Mutated RNA polymerase
Tetracyclines Inactivated enzyme, impaired influx or increased eflux
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Parkinson
Question Answer
COMT inhibitors / Carbidopa Decreasing peripheral levodopa degradation
Bromocriptine, Pramipexole, ropinirole Directly stimulating dopamine receptors
Amantidine Enhancing the effect of endogenous dopamine
Anti-cholinergics(benztropine,trihexyphenidyl) reduce tremor Inhibiting central muscarnic receptors
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