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X linked recessive woman: Patients carrier status is uncertain because of random X inactivation
Turner syndrome: mosaicism of mitotic nondisjunction
N. gonorrhea frequent episodes by antigenic variation of pili
Restrict her daily intake calories increase hepatic lipid oxidation
Timolol for glaucoma is a beta blocker causes adverse effects bronchoconstriction give
albuterol which is a beta agonist
Pain below knee, plays soccer, warmth, swelling and tenderness attached to abnormal
anterior tibial area: patellar ligament
They know about the treatment they are taking: open label clinical trial
Thermostable DNA pol, nucleotides, oligonucleotides specific for SNA, Repetitive cycles of
heating and cooling, detected by gel electrophoresis: PCR
Electrical alternans: bid pericardial effusion (and usually cardiac tamponade). Heart cannot fill
properly, preload decreases, hypotension, tachycardia, fluid backup elevated JVP
Some drugs require an acidic environment to be satisfactorily broken down or dissolved for GI
absorption. Omeprazole raises gastric pH and reduces GI absorption
Giving PTH raises calcium and vitamin with an overall decrease in phosphorus (due to
decreased urinary resorption)
Active hyperemia also called functional hyperemia is when the blood vessel is occluded like
getting ischemia, it gets buildup of necrotic debris necrosis and then when it is not occluded a
anymore it gets a fast backflow of fluid to remove the cell debris and shit increasing the blood
flow.
In a reactive passive/active hyperemia is when the body is active in one way or another such as
in exercise they use more oxygen for metabolic demands and create more metabolic waste
causing vasodilation increase blood flow. Both together would increase even more. Passive
congestion hyperemia is most always pathologic like DVT, Bud Chiari (passive congestion of
liver aka nutmeg liver) and right heart failure. So if you do exercise in an occluded vessel you
vasodilate it even more with all that buildup and then once occlusion is gone flow will be
increased even more.
Ectopic pregnancy in ampulla, ampulla ruptured into surrounding tissue fluid found in pouch
of douglas space between the uterus and the rectum ( ex. Pace where pelvic free fluid goes)
RR >1 increase risk; CI doesn’t cross 1 statistically significant but nit clinically significant
Sertoli Leydig cell increase testosterone acne, clitoral enlargement in woman, facial
growth; Granulosa tumor increase estrogen precocious puberty in adolescents and older
woman endometrial carcinoma and hyperplasia; teratoma dermoid cyst; thecoma carci
Most precipitating factor in this patients decision to file a malpractice suit? The patients
perception that the physician is uncaring.
Coagulation defects alone ONLY affect PT or PTT without any effect on BT. If there is BT
increased then it has to be something that causes a platelet defect even if PT or PTT are
increased. If PTT increased with no increase in bleed time then its hemophilia A; if there is a
combination of increase bleeding time and increase PTT (platelet and coagulation dysfunction)
coupled with aggregation problem then its vWD (its deficiency affects platelet function and
intrinsic pathway)
Sterilize anaerobic gram positive aka endospores clostridium difficile exposure to saturated
steam 121C for 15 minutes: AUTOCLAVE. They are resistant to boiling , alcohol and heating.
PTT intrinsic heparin
PT extrinsic warfarin
Diabetics foot wounds: gram positive rods, clostridium perfringens, crepitus, gs in tissues, alpha
toxin
Rabbit antithymocyte globulin develops signs type 3 immune complex deposition
Fibrinous exudate over peritoneum and serosal surfaces and a punctate opening is seen in wall
of a thickened loop of small intestine. Several lengths of a small and large intestins are also
thickened and adherent to one another with marked areas of narrowing: chrons disease
Annular pancreas: pancreas wrapped around second descending portion of duodenum. When
symptomatic (in adults, when there is superimposed pancreatitis), it can block flow of GI
contents through intestines. Jaundice, upper abdominal pain, dehydration, vomiting, nausea,
hyperbilirubinemia. Upper abdominal distention.
P value corresponds to likelihood of a type 1 error a false positive. A low p value means a lower
acceptable likelihood of obtaining the same results by chance and this signifnicant results can
be reported more confidently (a 1% false positive rate instead of a 5% rate)
The medial side drains to the superficial inguinal lymph nodes. Lateral side will stop st the
popliteal nodes prior to ascending the thigh.
Turner syndrome: lymphedema of nec: cystic hygroma, 45,. Mosaic nondisjunction mitosis.
TOTAL monosomy and trisomies are from nondisjunction during meiosis. Uniparental disomy is
Prader willi and angelman syndromes(CHR15). Anaphase lag.
Pancreatic cancers arise from ductal epithelium. Acinar epithelum responsible making exocrine
secretions. Islet cells can form neuroendocrine tumors(insulinomas).
Kidneys hold onto salt and fluid in the event of volume loss. Vasoconstriction occurs to maintain
blood pressure, and while this is related to RAAS, its not the best answer because the kidneysa
aren’t doing the constricting. The vasculature is so its retainint water.
One can do a thallium or PET scan to distuinguish lymphoma being metabolically active and
toxoplasma which is not. In AID patients.
Infliximab and adalimumab which block TNF alpha are both mouse antibodies and they can lose
efficacy by eventually forming an immune response to the foreign protein. Antibodies to the
drug.
Compression of abducens nerve, nothing to do with muscles in the cavernous sinus thrombosis
ITP immune mediated consumption of platelets so low platelet and petechiae. The bone
marrow bipsy results demonstrate that the body increase platelet production so not a platelet
production issue. Megakaryocitic hyperplasia. You don’t see in TTP megakaryocytic hyperplasia.
Wallnut size mass in right parametrium, intermittent vaginal bleeding, lower abdominal pain,
has not has menstrual period: ectopic pregnancy
Parents can be very overprotective in children with diabetes, SLE, etc. : Vulnerable child
syndrome=unreasonable parental anxiety
Image: tube in a tube; currant jelly stools, abdominal pain and vomiting, hyperactive bowel
sounds, sudden onset colicky pain, palpable mass: intessuception
Right lower quadrant lesion causes pain and hematochezia in a child: Meckels
Reyes syndrome: vomiting followed by liver damage(hepatic steatosis and hepatomegaly) and
encephalopathy beginning with irritability and aggressive behavior and potentially progressing
to coma.
Hookworm(helminthic) infection can cause intestinal irritation leading to chronic blood loss and
iron deficiency anemia. Boy who lives in missisipi playing in mud in his bare feet can get it. TX:
bendazoles.
Xanthogranulomatous pyelonephritis: rare form of chronic pyelonephritis, especially associated
with proteus infection. Tumor like growth, upper urinary tract infection and lipid laden foamy
macrophages. Yellow, 3.2 cm in diameter and centrally bur not marginally necrotic.
Lymphocytes and mononuclear cells with macrophages. Predominance of epithelioid cells with
clear and granular to foamy macrophages. Scattered lymphocytes and plasma cells intermixed.
Malacoplakia causes GU papules and ulcers, typically of the bladder.
Its antibodies to surface antigens that are protective. Hemagglutinin is a surface antigen that is
responsible for clumping RBCS in vitro. The mumps vaccine.
Polycythemia vera: pruritis to exposure of hot water, super high hematocrits. Low EPO is
because its trying to tone down the RBC production. JACK2 mutation. Treatment is bloodletting.
Rosary sign of small aneurysms strung like beads on a rosary. Inflamed artery(arteritis), Skin
heart kidneys GI polyarteritis nodosa. Andiogysplasia: painless GI bleeding(like in
diverticulosis). Kawasaki: children, 5 days of fever, strawberry tounge. Takayasu arteritis: big
arteries, like aorta, carotids and subclavians with dimished upper extremities pulses.
Thromboangitis obliterans (Burgers disease) smokers, peripheral arterial disease)legs much
more so than hands). Wegners: combination of renal and lung and sinus with granulomas and C
ANCA positive.
Over 6 understand what is death, being final. Infants have no understanding. Preeschool age
often think deaths in reversible.
Blurred double vision 8 hours after eating home preserved peppers= CANS. Dysphagia, dry
mouth, eyes dry, progressive weakness of arms and legs and urinary retention. Awake and
alert: botulism inhibition of acetylcholine release which is for nicotinic receptors in skeletal
muscle
Delirium can be by being in the hospital(ICU), medications and infections in the elderly. Its
acute.
Anaphylaxis treated with epinephrine. Stung dry skin, decrease capillary refill, nmultiple
erythematous inflamed mars on the back and pitting edema of ankles.
Symptomatic anemia. Microcytic nature implies iron deficiency. Elderly think colon cancer and
reprodrocutive female more commonly to uterin pathology.
Factor V laeiden most common heritable cause of hypercoagulability. Most common cause.
Episode of deep venous thrombosis, large filling defect in the right pulmonary artery.
Rickets: Pectus carinatum: pigeon chest (protruding sternum) and bead like enlargement of the
costochondral junction is describing a rachitic rosary. Vitamin D deficiency (dieatary or
functional). Osteoblasts lay down excess unmineralized osteoid as they are less able to
mineralize osteoid into mature bone.
Explain risks and symptoms and adverse effects but at the end thehe patients decide.:
autonomy.
Pregnant patients should avoid fish and seafood high in mercury. Such as shellfish, big salt
water fish (tuna, swordfish, shark, king mackerel, tilefish, etc).
Finasteride for male pattern baldness and prostate hypertrophy. It’s a 5 alpha reductase
inhibitor which prevents conversion of testosterone to DHT.
Temporary treatment for uncontrolled bleeding is vasopressin which causes for addition vWf
release. Factor 8 however is a more dramatic and effective treatment.
Diffuse low level ST elevation: pericarditis. Causes: viruses, uremia, 2-3 weeks after myocardial
infarction: dressler syndrome.
Profuse super water diarrhea means cholera: rice water stool. Regardless of the cause you treat
all causes of volume loss with volume replacement(normal saline 0.9%) and give rehydration for
cholera.
Torticollis is a type of focal dystonia, which is a type of extrapyramidal symptoms caused by
antipsychotics such as haloperidol. Uncontrollable facial gramiacing is a description of tardive
dyskinesia.
Yes, drug addicts should have narcotics also to relieve pain.
Long term use of OTC pain medications: papillary necrosis: ischemia from disruption of blood
flow from vasa recta causes necrosis and sloughing of renal papilla. Hematuria and sterile pruria
are common.
Altitude sickness can cause high altitude pulmonary edema(type of ARDS). Diffuse bilateral
fluffy infiltrates.
Chronic microcytic anemia in a patient with normal iron studies should make you think
thalassemia. Beta thalassemia minor is the most common and is mild. As there is decreased
beta chain production, there is a relative excess of alpha chains.
Chronic anovulation is a common cause of infertility. Long periods are often anovulatory where
lack of an LH surge leads to unchecked estrogen and prevent ovulation and the secretory and
menstrual phases that follow leading to chronic proliferative phase endometrium and ireregular
menses which can be long or short, often light. (as only endometrial tissue that outgrows its
blood supply sloughs off.
Stress incontinence common complaint in women after vaginal childbirth, risk increases with
number of deliveries, the size of baby and use of forceps. The pelvic floor muschles and
urogenital diaphragm are innervated by S3-S4.
Psychogenic polydipsia: hyponatremia due to excessive free water intake. In some cases a
water deprivation test is necessary to distinguish it from diabetes insipidus. If psychogenic, do
water restriction.
Foot drop after compression in lower leg: common fibular and peroneal nerve. Nerve
compression syndrome: one reason why casts shouldn’t be that tight.
Renal artery stenosis decreases blood flow to the supplied kidney that’s clamped causing
secreted renin from juxtaglomerular cells the normal kidney has normal renin secretion
however the additional circulating aldosterone will cause the normal kidney to retain sodium
and water too.
A lot of exercise, followed by renal failure, dark urine is due to myoglobinuria aka
rhabdomyolysis which can cause a false positive urine dipstick.
Cholesterol xanthomas, high cholesterol levels, early death by MI and family history: familial
hypercholesterolemia(LDL receptor defect)
Surgical portosystemic shunts are most often performed by anastomosing the splenic vein to
nearby left renal vein. The splenic and SMV join to form main portal vein. Which are portal
system veins. A TIPS procedure is preformed to create an intrahepatic shunt between the portal
and hepatic veins.
Middle age woman with progressive shortness of breath? Think of idiopathic pulmonary fibrosis
a restrictive lung disease decreasing lung compliance.
Endotracheal tubes irritate the sensitive respiratory mucosa, causing the more delicate
pseudostratified ciliated epithelium to be replaced by metaplastic stratified squamous
epithelium. When tissues are exposed to an atypical and noxious environment they become
metaplastic.
HTN, headache, visual changes during pregnancy: preeclampsia. Once you get seizures,
eclampsia. Tx: rapid delivery of fetus(with magnesium to prevent seizures)
Renal failiure means that NSAIDS, methothrexate and colchicine are undesirable. Etanercept is
a TNF antagonist and all around DMARD used for RA psoriasis. DMARDS SE is
immmunosupresion. Rare complication is leukemia and lymphoma.
Nurse, munchausens: factitious disorder; insulinoma from exogenous insulin is via c peptide. If c
peptide and insulin levels are high=insulinoma(pancreas). If c peptide is low, exogenous insulin
supplementation.
Athletes, sodium and potassium and urine super high, fatigue, abusing diuretics to lose weight:
forcing renal excretion. Hypokalemia. In aldosterone deficiency aka RTA type 4 causes
hyperkalemia, not hypokalemia.
Fever and acute left lower quadrant pain in an older person is always diverticulitis.
Diverticulosis on the other hand bleeds.
CT scans: black means air: main stem bronchi; white means vessel or shit
If coronary arteries are clean then aerobic excercose, weight loss, less red meat doesn’t count.
Reduce risk of cardio problems drink less alcohol
If you want to drain fluid you have to be low enough in the chest to get it, but now so low that
youll puncture though the diaphragm into abdomen
DVT swelling is acute painful red swelling and its by increase hydrostatic pressure vs
lymphedema by cancer that is by lymphatic obstruction
Neoplastic lesion with uniform epithelial and myoepithelial cells, cells from acini, tubules and
ducts supported by myxoid and chondroid stroma. Painless mas in aprotid gland. The most
common tumor of parotid gland. PLEOMORPHIC ADENOMA. Not aggressive but difficult to
resect do to the important surrounding real estate(favcial nerve branches) so local recurrence is
common.
Malaria infections caused by plasmodium vivax are prone to relapse due to this organisms
ability to infiltrate and then lie dormant in the liver.
Varicose veins: symptomatic varicosities. Incompetent valves allow reflux of blood into
dependent feet and legs. The pooling blood increases hydrostatic pressure causing edema.
High conjugated bilirubin means that the liver is working. Alcholic pale or clay colored not
brown stools means that this conjugated bile is not being excreted normally into small bowel.
So there is a block(obstruction). A congenital block is trypically dye to either choledochal cyst or
biliary atresia.
Kinesin is responsible for bringing synaptic vesicles produced in the nucleus down to the axon
terminus.
He cuts himself, threatens a person, there is motives. So instead of borderline its antisocial
personality disorder.
Jaw deviating slightly to the left on elevation. Area around legft mandibular condyle painful on
palpation. Mandibular depression because of pain. Tightness indicative of a muscle spasm along
the left mandibular ramus. Pain in left jaw, left sided earache and headache.
This is temporal mandibular joint syndrome/disorder. Called TMJ. Muscles of mastication
affected: masseter, temporalis, medial lateral pterygoids all innervated by amandibular branch
of V.
Ulcerative colitis: continuous mucosal involvement starting in the rectum and extending
proximally. Chrons is markes by transmural infvolvement with sip lesions that can extend from
mouth to anus. More likely to be complicated by fistula and abscess formation. UC is more
likely to be associated with extra GI symptoms such as anterior uveitis, as well as a greater risk
of colon cancer.
Paternalism: when a physician makes decisions for patients instead of providing them with
options and allowing them to then make an informed decision.
Between tendons of the flexor carpi radialis and flexor digitorum supericialis is the recurrent
branch of the median nerve. Opposition functions.
Radial side is lateral (thumb side); the ulnar side is medial (finger side) and the fingers(digit rum
are middle.
CK RISE 2-4HRS AFTER MI AND BACK TO NORMAL BY 72 HOURS. TROPONIN BEGIN TO RISE AT
2-4 HOURS BUT REMINAL ELEVATED TO 7-10 DAYS. MYOCARDIAL RUPTURE OCCURS 5-7 DAYS
AFTER MYOCARDIAL NECROSIS.
SCHIZOPHRENIA IS A RISK FOR SUICIDE. OTHERS RISKS: SOCIAL ISOLATION, OLD AGE,
SUBSTANCE ABUSE AND HOPELESNESS.
LEFT RENAL VEIN AND SPLENIC VEIN OR PORTAN VEIN AND IVC
BLEEDING PROLONGED IN A PERSON WHO TAKES LARGE QUANTITIES OF ASPIRIN BECAUSE
INHIBITION OF PLATELET AGGREGATION.
LOW BLOOD:GAS PARTITION COEFFICIENT ACT RAPIDLY AND TIME TO RECOVER IS SHORT.
MAC IS INVERSELY RELATED TO POTENCY AND DOES NOT INFLUENCE IN RECOVERY.
HONEY AND CORN SYRUP(SWEETENED), SOIL HOUSE DUST, INFANT BECOMES CONSTIPATED
AND FEEDS POORLY, WEAK CRY, HYPOTONIA AND LOSS OF HEAD CONTROL. DESCENDING
PARALYSIS PROGRESSES OVER HOURS TO DAYS. VENTILARATORY SUPPORT NECCESARY..
CLOSTRIDIUM BOTULINUM. INFANT BOTULISM.
INULIN IS NOT REABSORBED SO WHEN WATER REABSORBED INULIN INCREASES F/P, ITS
CONCENTRATION WILL INCREASE IN THE TUBULE.
INACTIVATION OF P450 WILL SHIFT THE DOSE RESPONSE CURVE TO THE LEFT AND WILL
INCREASE THE PLASMA HALF LIFE OF THE COMPETING DRUG.
ZINC DEFICIENCY: ALOPECIA, MAUCLOPAPULAR RASH AROUND MOUTH AND EYES, TASTE AND
SMELL ABNORMALITIES AND PROBLEMS WITH HEALING WOUNDS. HYPOGONADISM.
IDIOPATHIC SCOLIOSIS: FORWARD BENDING HAS PRIMNENT RIB HUMP(PARASPINOUS
PRIMNENCE) TO THE SIDE BY AN ABNORMAL LATERAL CURVATE OF THE SPINE. SCOLIOSIS:
LATERAL DISPLACEMENT OF SPINE, KYPHOSIS: FORWARD DISPLACEMENT OF SPINE.
PPI GIVEN TO INHIBIT ACID SECRETIO, STILL ULCERS PRESENT: PROBLEM IS ZOLLINGER ELLISON
SYNDROME, GASTRIN INCREASED.
APPROX 50% OF PATIENTS WITH CALCIUM OXALATE STONES HAVE INCREASED EXXCRETION OF
CALCIUM WITHOUT HYPERCALCEMIA. IDIOPATHIC HYPERCALCIURIA.
OPTIC CANAL: OPHTALMIC ARTERY AND OPTIC NERVE, CENTRAL VEIN OF RETINA. THE
OPHTALMIC VEIN AND NERVE PASS THROUGH SUPERIOR ORIBITAL FISSURE.
PROGNOSIS OF TETRALOGY OF FALLET DEPENDS ON PULMONIC STENOSIS WIHICH
DETERMINES THE DEGREES OF HYPOXEMIA AND RIGHT VENTRICULAR HYPERTROPHY. BOOTH
SHAPED HEART WITH DIMINISHED PULMONARY VASCULAR MARKINGS.
COLICKY ABDOMINAL PAIN WITH PERSISTENCE AND PAIN BETWEEN SPASMS, ADOMINAL
DISTENTION AND VOMITING. VIRD BEAK OR ACE OF SPADES IN SIGMOID COLON, WITH LUMEN
OF BOWEL TAPERING TOWARD THE VOLVULUS. VOLVULUS. MASSIVELY DILATED SIGMOID
COLON WITH A COLUMN.
PANCREATITIS WITH UPPER ABDOMINAL PAIN, GREY TURNERS SIFN(ECCHYMOSIS INDICATING
INTRA ABDOMINAL HEMORRHAGE, DIFFICULTY BREATHING DEEPLY DUE TO DIAPHRAGM
IRRITATION, HYPOCALCEMIA FROM FAT NECROSIS/SAPONIFICATION. SIDE EFFFECT OF
STAVUDINE.
WIDENING THE REFERENCE INTERVAL OF A TEST INCREASES SENSITIVITY BECAUSE THERE WILL
BE FEWER FALSE NEGATIVES IN THIS RANGE. INCREASING SENSITIVIT DECREASES SPECIFICITY
BY INCREASING NUMBER OF FALSE POSITIVES.