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bidamifi 's2017-04-04 22:01
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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, NocardiaMolar 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 CilostazolImmediate 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 Carotid sinus transmits via glossopharyngeal nerve to solitary nucleus of medulla Hypotension and baroreceptor mechanism ↓ arterial pressure → ↓ stretch → ↓ afferent baroreceptor firing → ↑ efferent sympathetic firing and ↓ efferent parasympathetic stimulation → vasocontriction, ↑ HR, ↑ contractility, ↑ BP 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.
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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 ACTHMetyaprone 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 carboxylaseHomocysteine 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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