question

Diabetic neuropathy symptoms

answer

Numbness and tingling of extremities Dysesthesia (abnormal sensation to a body part) Diarrhea Erectile dysfunction Urinary incontinence (loss of bladder control) Facial, mouth and eyelid drooping Vision changes Dizziness Muscle weakness Difficulty swallowing Speech impairment Fasciculation (muscle contractions) Anorgasmia *Burning or electric pain*

question

Glipizide

answer

Second generation sulfonylurea Close K+ channel in β-cell membrane, so cell depolarizes → + triggering of insulin release via ↑ Ca2+ influx. Stimulate release of endogenous insulin in type 2 DM. Require some islet function, so useless in type 1 DM Toxicity: Hypoglycemia

question

NF-κB

answer

Activation occurs when it's inhibitor, I-κB, is phosphorylated by specific protein kinase (IKK) & degraded -Leads to ↑ synthesis of prostaglandins and leukotrienes

question

IκB

answer

Releases NF-κB after undergoing phosphorylation

question

Insulin secretion

answer

1. Glucose binds Glut2 receptor on β-cells 2. Glucose oxidizes to ATP → closes K⁺ channels in cell membrane → depolarization of β-cells 3. Depolerizatino opens Ca²⁺ channels → ↑ intracellular [Ca²⁺] → [name of this card]

question

Glucokinase

answer

Liver and β cells of pancreas Low affinity (High Km), high capacity (High Vm) Induced by insulin It's a *glu*ton → has high Vmax b/c it can't be satisfied At low glucose concentration, hexokinase sequesters glucose in the tissues. Ah high glucose concentration, excess glucose is stored in the liver

question

Glucose-6-phosphatase

answer

In ER Glucose-6-P → Glucose Liver (Not present in muscle) Probably stimulated by glucacon Deficient in Von Gierke's disease -Severe fasting hypoglycemia -↑ glycogen in liver -↑ blood lactate -hepatomegaly

question

Glycogen phosphorylase

answer

Rate determining enzyme for glycogenolysis Skeletal component deficient in McArdle's disease -↑ glycogen in muscle, but can't break it down -Painful muscle cramps, myoglobinuria w/ strenuous exercise

question

Phosphoenolpyruvate carboxykinase

answer

Irreversible enzyme in Gluconeogenesis

question

Phosphorylase kinase

answer

An early component of Gluconeogenesis

question

Branchial apparatus

answer

CAP Covers outside from inside Clefts = ectoderm Arches = mesoderm Pouches = endoderm

question

1st Brachial arch

answer

Cartilage: Meckel's (Mandible, Malleus, Mandibular) Muscles: Muscles of mastication (Masseter, medial pterygoids, Mylohyoid) Neves: CN V2, V3 -Chew

question

Treacher Collins Syndrome

answer

1st arch neural crest fails to migrate -Mandibular hypoplasia -Facial abnormalities

question

2nd Brachial arch

answer

Cartilage: Reichert's (Stapes, Styloid, Stylohyoid) Muscles: Stapedius, Stylohyoid Nerves: CN VII -Smaile

question

3rd Brachial arch

answer

Cartilage: Greater horn of hyoid Muscles: Stylopharyngeus -Stylopharyngeus innervated by glossopharyngeal nerve Nerves: CN IX -Swallow stylishly

question

Congentio pharyngo-cutaneous fistula

answer

Persistence of cleft and pouch → fistula between tonsillar area, cleft in lateral neck

question

4th-6th Brachial arches

answer

Cartilage: Thyroid, cricoid, Muscles: 4 = pharynheal constrictors 6 = intrinsic muscles of larynx Nerves: 4 = CN X (superior laryngeal branch) -Simply swallow 6 = CN X (recurrent laryngeal branch) -Speak

question

Arches 3 & 4

answer

Posterior 1/3 of tongue

question

Brachial Arches (Pneumonic)

answer

When at the golden arches, 1. Chew 2. Smile 3. swallow stylishly or 4. simply swallow 6. speak There is no 5!

question

micrognathia

answer

Jaw is undersized

question

glossoptosis

answer

Downward displacement or retraction of the tongue

question

S. pyogenes (Group A)

answer

The bacteria behind post-streptococcal glomerulonephritis PHaryngitis can results in PHever & glomerulonePHritis

question

Stratification

answer

Strata are constructed based on values of prognostic variables and a randomization scheme is performed separately within each stratum Put another way: Achieved by performing a separate randomisation procedure within each of two or more subsets of participants

question

Trapezium bone

answer

Forms the radial border of the carpel tunnel Distal to the Scaphoid Some might say it is in close proximity to -Abductor pollicis longus -Extensor pollicis brevis That being side, is not the right answer for the question that you seek!

question

Scaphoid bone

answer

Most commonly fractured carpel bone Prone to avascular necrosis due to retrograde blood supply Receives its blood primarily from the distal end Failure of the fracture to heal ("non-union") can result in loss of blood supply to the proximal pole - Can result in avascular necrosis of the proximal segment.

question

SNoW DRoP

answer

Southern = DNA Northern = RNA Western = Protein

question

Southwestern blot

answer

Identifies DNA-binding proteins

question

Affinity column chromatography

answer

Method of separating biochemical mixtures -Based on a highly specific interaction such as that between antigen and antibody, enzyme and substrate, or receptor and ligand. Can be used to. 1. Purify and concentrate a substance from a mixture into a buffering solution 2. Reduce the amount of a substance in a mixture 3. Discern what biological compounds bind to a particular substance 4. Purify and concentrate an enzyme solution.

question

Density Gradient Centrifuge

answer

Used to separate certain organelles from whole cells for further analysis of specific parts of cells 1. A tissue sample is first homogenised to break the cell membranes and mix up the cell contents. 2. The homogenate is then subjected to repeated centrifugations, each time removing the pellet and increasing the centrifugal force. 3. Finally, purification may be done through equilibrium sedimentation, and the desired layer is extracted for further analysis.

question

Immunohistochemistry

answer

Process of detecting antigens (e.g., proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues

question

Incidence

answer

Looks at new incidents

question

Prevalence

answer

Looks at all current cases

question

Imatinib

answer

A small molecular inhibitor of bcr-abl tyrosine kinase Treatment of CML Trade name Gleevec

question

Hydroxyurea

answer

Inhibits ribonucleotide reductase → ↓ DNA Synthesis (S-phase specific) Used with: Melanoma, CML, Sickle cell disease (↑ HbF) Toxicity: Bone marrow suppression GI upset

question

Cytarabine

answer

Pyrimidine analog → inhibition of DNA polymerase Used with: Leukemia, lymphomas Toxicity: Leukopenia Thrombocytopenia Megaloblastic anemia

question

IL-5

answer

From Th₂ cell Promotes differentiation of B-cell Enhances class switching of IgA. Stimulates the growth of and differentiation of eosinophils

question

Interferons

answer

Proteins that place uninfected cells in an antiviral state Induce production of ribonuclease that inhibits viral protein synthesis by degrading viral mRNA (but not host mRNA) α & β: inhibit viral protein synthesis γ: ↑ MHC I & II expression and antigen presentation in all cells Activate NK cells to kill virus-infected cells

question

Leukemia

answer

Unregulated growth of leukocytes in *bone marrow* ↑ or ↓ in # of circulating leukocytes in blood Marrow failure → anemia (↓RBC), infections (↓WBC), hemorrhage (↓platelets) Infiltrates in liver, spleen, and lymph nodes possible

question

Lymphoma

answer

Discrete tumor masses arising from lymph nodes.

question

Chronic myelogenous leukemia (CML)

answer

30 - 60 year olds Myeloid stem cell proliferation - ↑ neutrophils, metamyelocytes, basophils t(9;22) Low leukocyte alkaline phosphatase (as opposed to leukemoid reaction)

question

Leukemoid reaction

answer

Acute inflammatory response to infection ↑ WBC count with ↑ neutrophils and neutrophil precursors such as band cells ↑ leukocyte alkaline phosphatase

question

Deoxyhemoglobin

answer

Better buffer for H⁺ than oxyhemoglobin -Advantageous that hemoglobin has been deoxygenated by the time it reaches the venous end of the capillaries

question

Carbaminohemoglobin

answer

CO₂ bound to hemoglobin -Account for very small amount of CO₂ in blood

question

Loading dose

answer

Cp x Vd (mass/volume) x (volume) Remember: If volume of distribution is given in L/kg -Need to multiply by body weight to find actual volume distribution

question

Maintenance dose

answer

Cp x CL/F Cp = target plasma concentration Remember: If volume of distribution is given in L/kg -Need to multiply by body weight to find actual volume distribution

question

Oxytocin

answer

Stimulates labour Uterine contraction Milk let down Controls uterine hemorrhage

question

H1 (Histamine)

answer

Found on smooth muscle, endothelium, and central nervous system tissue Causes: Bronchoconstriction Bronchial smooth muscle contraction Vasodilation Separation of endothelial cells (responsible for hives) Pain and itching due to insect stings; the primary receptors involved in allergic rhinitis symptoms and motion sickness; sleep and appetite suppression.

question

H2 (Histamine)

answer

Located on parietal cells and vascular smooth muscle cells Causes: Primarily involved in vasodilation Also stimulate gastric acid secretion

question

Salmonella enterica

answer

Most cases of salmonellosis are caused by food infected with w/ this bacteria, which often infects cattle and poultry A remarkable large number of fimbrial and non-fimbrial adhesins are present in Salmonella -Mediate biofilm formation and contact to host cells Secreted proteins are also involved in host cell invasion and intracellular proliferation -Two hallmarks of Salmonella pathogenesis Usually does not need ABs (Only if complicated in people at risk such as infants, small children, the elderly) -Will lead to prolonged fecal excretion of bacteria

question

Carnitine deficiency

answer

Inability to transport LCFA (Long chain fatty acids) into mitochondria Results in toxic accumulation in the cytoplasm Causes weakness, hypotonia, hypoketotic hypoglycemia

question

Phytanic acid

answer

Branched chain fatty acid that humans can obtain through the consumption of dairy products, ruminant animal fats, and certain fish Undergoes α-oxidation in the peroxisome, where it is converted into pristanic acid by the removal of one carbon

question

Peroxisome

answer

Membrane-enclosed organelle involved in catabolism of very long fatty acids (VLFA) & amino acids

question

Pipecolic acid

answer

Accumulates in Pipecolic acidemia - Very rare autosomal recessive metabolic disorder that is caused by a peroxisomal defect

question

Hypokinesis

answer

Diminished or abnormally slow movement

question

Right Coronary Artery

answer

Supplies blood to right ventricle & 25-30% of left ventricle In 85% of patients, gives off posterior descending artery Supplies SA nodal artery in 60% of patients Give off branch to right marginal artery If lungs are clear to auscultation, no LVF. Think RVF!

question

Hypoxemia

answer

Decrease in arterial Po₂

question

A-a gradient

answer

Used to compare causes of hypoxemia PAo₂ - Pao₂ Normal 10 -O₂ does not equilibrate between alveolar gas and arterial blood (diffusion defect, V/Q defect, right to left shunt)

question

Hypoxia

answer

Decreased O₂ delivery to tissues O₂ delivery = Cadiac output x O₂ content of blood Dependes on: Hemoglobin concentration O₂-binding capacity of hemoglobin % saturation of hemoglobin by O₂ (Depends on Po₂) Can be caused by: ↓ cardiac output ↓ O₂-binding capacity of hemoglobin ↓ arterial Po₂

question

↓ cardiac output

answer

↓ blood flow → hypoxia

question

Hypoxemia

answer

↓Pao₂ causes ↓ %saturation of hemoglobin → hypoxia

question

Anemia

answer

↓ Hb concentration causes ↓ O₂ content of blood → hypoxia

question

Carbon monoxide poisoning

answer

↓ O₂ content of blood → hypoxia

question

Cyanide poisoning

answer

↓ O₂ utilization by tissues → hypoxia

question

Mesoblastic nephroma

answer

Type of kidney tumor that is usually found before birth by ultrasound or within the first 3 months of life. It contains fibroblastic cells (connective tissue cells), and may spread to the other kidney or to nearby tissue

question

Nephroblastoma (Wilms tumor)

answer

Most common renal malignancy of early childhood (Age 2-4) Contains embryonic glomerular structure Presents with huge flank mass / hematuria Deletion of WT1 on chromosome 11 Can be hypervascular....

question

Tanner stages

answer

I. Childhood (9 and under) II. Pubic hair appears; breast bud forms III. Pubic hair darkens and becomes curly; penis size/length ↑; breast enlarges IV. Penis width ↑, darker scrotal skin, developed glans; raised areolae V. Adult; areolae are no longer raised (14 and over)

question

Anabolic steroids

answer

Leads to ↑ sex-hormone binding globulin ↓ free testosterone -Gynecomastia results

question

Ubiquitin

answer

Tags proteins for destruction by proteasome

question

pVHL

answer

An E3 ligase that ubiquitinates HIF1α and causes its degradation by the proteasome. In low oxygen conditions or in cases of VHL disease where the VHL gene is mutated -pVHL does not bind to HIF1α. -This allows the subunit to dimerise with HIF1β and activate the transcription of a number of genes (vascular endothelial growth factor, platelet-derived growth factor B, erythropoietin and genes involved in glucose upatake and metabolism)

question

Type I error

answer

Stating there is an effect when none exist

question

Type II error

answer

Stating there is not an effect when there is one

question

Fluoxetine

answer

SSRI Use: Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD

question

Lorazepam

answer

Facilitates GABAa action by ↑ frequency of Cl⁻ channel opening Use: Anxiety Spasticity Status epilepticus Detoxification

question

Olanzapine

answer

Atypical antipsychotic Use: Schizophrenia - both +ve and -ve Bipolar, OCD, anxiety disorder, depression, mania Fewer extrapyramidal side effects than traditional antipsychotics

question

Valproic acid

answer

A wide spectrum seizure medication -1st line for tonic-clonic Not for status epilepticus

question

Medial Longitudinal faciculus

answer

Pair of tracts that allow for cross talk between CN VI & CN VIII nuclei Coordinate both eyes to move in the same horizontal direction Highly myelinated (Communicate quickly so eye's move at the same time) Lesion: Lack of communication such that when CN VI nucleus activates ipsilateral rectus, contralateral CN III nucleus does not stimulate medial rectus to fire (impaired abduction) Abducting eye get's nystagmus (CN VI overfires to stimulate CN III) Convergence normal

question

Albinism

answer

Congenital deficiency in: Tyrosinase Defective tyrosine transporter (↓ tyrosine → ↓ melanin) Can result from lack of migration of neural crest cells Lack of melanin results in ↑ risk of skin cancer

question

Slipped-strand mispairing

answer

Denaturation and displacement of the DNA strands, resulting in mispairing of the complementary bases. Can result in either insertions or deletions. Insertions are thought to be self-accelerating: as repeats grow longer, the probability of subsequent mispairing events increases

question

Testosterone

answer

Pre-peripubertal: Causes growth spurt / accelerated bone maturation Pubertal: Completion of bone maturation / termination of growth

question

Hyperparathyroidism

answer

Stone, Bones, and Groans Hypercalcemia Hypercalciuria (Stones) Hypophosphatemia ↑PTH, ↑Alk Phos, ↑cAMP in urine

question

PTH

answer

Ca+ resorption from Kidney (Inhibits PO4 resorption) Stimulates Vit D. synth -Increased Ca+ absorbed from intestine Ca+ release from bone ↑ serum calcium

question

Histone deacetylase

answer

Removes acetyl groups from AA -Allows histones to wrap DNA more tightly Actions are opposite to that of histone acetyltransferase These would affect transcription of DNA!!!!

question

Internal urethral orifice

answer

Opening of the urinary bladder into the urethra

question

Ureteric orifice

answer

Placed at the postero-lateral angles of the trigonum vesicae, and are usually slit-like in form

question

Supraspinatus

answer

Abduction of the arm at the shoulder joint -Main agonist muscle for this movement during the first 10-15 degrees of its arc Can test: Shoulder at 90% Empty can (Wrists pronated)

question

Wound healing

answer

1. Inflammatory (immediate) -Platelets, neutrophils, macrophages 2. Proliferative (2-3 days after wound) -Fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages -Granulation tissue depostion, angiogenesis, wound contraction (mediated by myofibroblasts) 3. Remodeling (1 week after wound) -Fibroblasts -Type III collagen replaced by type I collagen

question

Myofibroblast

answer

Cell that is in between a fibroblast and a smooth muscle cell in differentiation Can contract by using smooth muscle type actin-myosin complex, rich in a form of actin called alpha-smooth muscle actin -These cells are then capable of speeding wound repair by contracting the edges of the wound

question

Scurvy

answer

Swollen gums Bruising Hemarthrosis Anemia Poor wound healing

question

Vitamin C

answer

Required fro the hydroxylation of specific purine and lysine residues -If deficient, will cause scurvy --Inadequate hydroxylation of collagen peptides

question

Irradiated packed RBCs

answer

Destroys DNA in WBCs -Prevents graft vs host disease occurring from transfusion Important if transfusion is from: 1. Close family relation 2. Someone who is immunocompromised (Di George Syndrome, Wiskott Aldrich, and SCID)

question

Packed RBCs with adenine-saline added

answer

Allows the blood to flow readily without the addition of saline

question

Washed packed RBCs

answer

RBCs washed in sterile saline to remove: WBCs Lytic mediators Non-self antigens Most useful in IgA deficient persons who have circulating anti-IgA Abs -Use ↓ febrile, urticarial and anaphylactic reactions

question

Whole blood

answer

Blood that is unmodified except for the presence of an anticoagulant Usually not used because the extra plasma can contribute to transfusion associated circulatory overload (TACO), a potentially dangerous complication

question

Transfusion associated GVH

answer

Results from transfusion of immunocompetent T cells capable of engrafting and initiating an immune response against recipient antigens The most susceptible patient groups are those who are severely immunocompromised Gamma irradiation abolishes the proliferative activity of the lymphocytes in the donor blood. Fresh frozen plasma and cryoprecipitate do not contain viable lymphocytes and thus do not need to be irradiated

question

1st Brachial Pouch

answer

Middle ear cavity Eustachian tube Mastoid air cells

question

2nd Brachial Pouch

answer

Epithelial lining of palatine tonsil

question

3rd Brachial Pouch

answer

Dorsal wings -Inferior parathyroids Ventral wings -Thymus 3 structures Thymus, right & left parathyroids

question

4th Brachial Pouch

answer

Dorsal wings -Superior parathyroid

question

Brachial pouch pneumonic

answer

Ear, tonsils, bottom to top 1(ear) 2(tonsils) 3 dorsal (bottom for inferior thyroid) 3 ventral (to = thymus) 4 (top = superior parathyroids)

question

DiGeorge syndrome

answer

Aberrant development of 3rd & 4th pouches: T-cell deficiency (thymic aplasia) Hypocalcemia (failure of parathyroid development)

question

Homonymous hemianopsia

answer

Visual field loss that respects the vertical midline, and usually affects both eyes Vascular and neoplastic (malignant or benign tumours) lesions from the optic tract, to visual cortex can cause -If lesion is in optic tract, will be pupillary reflex problem! The more posterior the cerebral lesion, the more symmetric (congruous) symptoms will be 1. Person who has a lesion of the right optic tract will no longer see objects on his left side 2. Person who has a stroke to the right occipital lobe will have the same visual field defect, usually more congruent between the two eyes, and there may be macular sparing

question

Hemispatial neglect

answer

Results most commonly from brain injury to the right cerebral hemisphere, causing visual neglect of the left-hand side of space A stroke affecting the right parietal lobe of the brain can lead to neglect for the left side of the visual field, causing a patient with neglect to behave as if the left side of sensory space is nonexistent (although they can still turn left) -Extreme case, a patient with neglect might fail to eat the food on the left half of their plate, even though they complain of being hungry -Someone with neglect is asked to draw a clock, their drawing might show only numbers 12 to 6, or all 12 numbers on one half of the clock face, the other side being distorted or left blank

question

Temporal lobe lesion

answer

Upper quadrantic anopia

question

Parietal lobe lesion

answer

Lower quadrantic anopia

question

Optic chiasm lesion

answer

Bitemporal anopia

question

Aplasia

answer

Lack of growth

question

Excess lymphoblasts

answer

Age < 15 Found in acute lymphoblastic leukemia (ALL) TdT+ (Marker of pre-t & pre-b cells) CALLA+ t(12;21) = good prognosis Increased incidence in people with Down Syndrome

question

Megaloblastosis (Megaloblastic anemia)

answer

Results from inhibition of DNA synthesis in red blood cell production -Most often due to hypovitaminosis, specifically a deficiency of vitamin B12 and/or folic acid Characterized by: Many large immature and dysfunctional red blood cells (megaloblasts) in the bone marrow Hypersegmented neutrophils (those exhibiting five or more nuclear lobes ("segments"), with up to four lobes being normal)

question

Parvovirus inclusions

answer

Fifth disease -Develop the illness after an incubation period of four to fourteen days. -Fever and malaise while the virus is most abundant in the bloodstream -Patients are usually no longer infectious once the characteristic rash of this disease has appeared Parvovirus B19 is a cause of chronic anemia in individuals who have AIDS Aplastic anemia -Patients have an arrest of erythropoiesis (production of red blood cells) during infection -Patients who have sickle cell anemia or hereditary spherocytosis are heavily dependent on erythropoeisis due to the reduced lifespan of the red cells Infection in pregnant women is associated with hydrops fetalis due to severe fetal anemia

question

Ringed sideroblasts

answer

Body has iron available but cannot incorporate it into hemoglobin, which red blood cells need to transport oxygen efficiently Abnormal nucleated erythroblasts (precursors to mature red blood cells) with granules of iron accumulated in perinuclear mitochondria -Seen in aspirates of bone marrow Most common cause of is excessive alcohol use Primary pathophysiology = failure to completely form heme molecules (whose biosynthesis takes place partly in the mitochondrion)

question

Rouleaux formation

answer

Stacks of red blood cells (RBCs) which form because of the unique discoid shape of the cells in vertebrates Conditions which cause: Infections Multiple myeloma Inflammatory and connective tissue disorders Cancers Occurs in diabetes mellitus (one of the causative factors for microvascular occlusion in diabetic retinopathy)

question

SLE Criteria

answer

4 out of 11 of the following 1. Malar rash 2. Discoid rash 3. Serositis: Pleurisy or Pericarditis 4. Oral ulcers 5. Arthritis 6. Photosensitivity 7. Blood disorder: Hemolytic anemia, leukopenia, lymphopenia, thombocytopenia, ~hypocomplementemia 8. Renal disorder 9. ANA +ve 10. Immunologic disorder 11. Neurologic disorder

question

Case Control

answer

Two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute

question

Case series

answer

Medical research descriptive study that: 1. Tracks patients with a known exposure given similar treatment 2. Examines their medical records for exposure and outcome Can be retrospective or prospective Usually involves a smaller number of patients than more powerful case-control studies or randomized controlled trials May be consecutive or non-consecutive -Depends on whether all cases presenting to the reporting authors over a period were included, or only a selection May be confounded by selection bias -Limits statements on the causality of correlations observed -Physicians who look at patients with a certain illness and a suspected linked exposure will have a selection bias in that they have drawn their patients from a narrow selection (Their hospital)

question

ARDS

answer

Inflammation of the lung parenchyma leads to impaired gas exchange with systemic release of inflammatory mediators, causing: Inflammation Hypoxemia Frequently multiple organ failure. Condition has a 90% death rate in untreated patients. With treatment, usually mechanical ventilation in an intensive care unit, the death rate is 50%. A less severe form is called acute lung injury (ALI) 3 main clinical causes 1. Sepsis (most important) 2. Severe multiple trauma 3. Aspiration of saliva / gastric contents Any cardiogenic cause of pulmonary edema should be excluded -Done by placing a pulmonary artery catheter for measuring the pulmonary artery wedge pressure 4 main criteria for ARDS: 1. Acute onset 2. Chest X-Ray: Bilateral diffuse infiltrates of the lungs 3. No cardiovascular lesion 4. No evidence of left atrial hypertension: PaO2/FiO2 ratio equal to or less than 200 mmHg.

question

Alveolar ventilation

answer

The volume of gas per unit time that reaches the alveoli

question

Left sided heart failure signs

answer

Tachypnea (increased rate of breathing) Increased work of breathing (non-specific signs of respiratory distress) Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields -Suggest the development of pulmonary edema (fluid in the alveoli) -Cyanosis which suggests severe hypoxemia, is a late sign of extremely severe pulmonary edema.

question

PaO2/FiO2 ratio

answer

The ratio of partial pressure arterial oxygen and fraction of inspired oxygen Comparison between the oxygen level in the blood and the oxygen concentration that is breathed Helps to determine the degree of any problems with how the lungs transfer oxygen to the blood If equal to or less than 200 mmHg is one criteria for diagnosing ARDS

question

Erythropoietin

answer

Its primary effect on red blood cell progenitors and precursors (which are found in the bone marrow in humans) is promoting their survival through protecting these cells from apoptosis

question

Bacillus subtilis

answer

Gram-positive, catalase-positive bacterium Rod-shaped Has the ability to form a tough, protective endospore, allowing the organism to tolerate extreme environmental conditions Only known to cause disease in severely immunocompromised patients

question

Bacteroides fagilis

answer

Gram-negative bacillus bacterium species Involved in 90% of anaerobic peritoneal infections Predominates in bacteremia associated with intraabdominal infections, peritonitis and abscesses following rupture of viscus, and subcutaneous abscesses or burns near the anus

question

Clostridium perfringens

answer

Gram-positive, rod-shaped, anaerobic, spore-forming bacterium Infections show evidence of tissue necrosis, bacteremia, emphysematous cholecystitis, and gas gangrene Toxin involved in gas gangrene is known as α-toxin -Inserts into the plasma membrane of cells, producing gaps in the membrane that disrupt normal cellular function

question

Staphylococcus aureus

answer

Facultative anaerobic Gram-positive coccal bacterium Appears as grape-like clusters when viewed through a microscope, and has large, round, golden-yellow colonies, often with hemolysis, when grown on blood agar plates Catalase-positive -Able to convert hydrogen peroxide (H2O2) to water and oxygen Virulence factors: Enzymes -Coagulase clots plasma and coats the bacterial cell which probably prevent phagocytosis -Hyaluronidase breakdown hyaluronic acid and help in spreading Toxins -Superantigens (TSST-1) induce toxic shock syndrome (TSS), usually from prolonged tampon use. Cause non-specific activation of T-cells resulting in polyclonal T cell activation and massive cytokine release (IFNγ) -Enterotoxin that is the causative of gastroenteritis that is self-limiting, characterized by vomiting and diarrhea one to six hours after ingestion of the toxin with recovery in eight to 24 hours. Symptoms include nausea, vomiting, diarrhea, and major abdominal pain. -Exfoliative toxins implicated in (SSSS), which occurs most commonly in infants and young children. Protease activity of the exfoliative toxins causes peeling of the skin observed with SSSS. Other -Protein A, an IgG-binding protein, binds to the Fc region of an antibody

question

Listeria monocytogenes

answer

Gram-positive bacterium Motile via flagella at 30°C and below Can move within eukaryotic cells by explosive polymerization of actin filaments (known as comet tails or actin rockets). Facultative anaerobic bacterium (Capable of surviving in the presence of oxygen) Can grow and reproduce inside the host's cells One of the most virulent food-borne pathogens, with 20 to 30 percent of clinical infections resulting in death Due to its frequent pathogenicity, causing meningitis in newborns (acquired transvaginally), pregnant mothers are often advised not to eat soft cheeses -It is the third-most-common cause of meningitis in newborns

question

Partial hydatidiform mole

answer

Occurs when an egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY

question

Complete hydatidiform mole

answer

Caused by a single (90%) or two (10%) sperm combining with an egg which has lost its DNA The genotype is typically 46,XX (diploid)

question

Placenta accreta

answer

Abnormally deep attachment of the placenta to the myometrium without penetrating it. Placenta grows completely through the endometrium Great risk of haemorrhage during placental removal -Commonly requires surgery to stem the bleeding and fully remove the placenta -In severe forms can often lead to a hysterectomy or be fatal

question

Wernicke's aphasia

answer

Fluent aphasia with impaired comprehension. Wernicke's area-superior temporal gyrus of temporal lobe. Wordy, but makes no sense

question

Broca's aphasia

answer

Nonfluent aphasia with intact comprehension.

question

Diaphoresis

answer

Excessive sweating

question

δ-ALA dehydratase

answer

Lead poisoning Accumulates: Protoporphyrin, δ-ALA Microcytic anemia, GI and kidney disease. Children-exposure to lead paint -+ mental deterioration Adults-environmental exposure (battery/ ammunition/radiator factory) -+ headache, memory loss, demyelination

question

δ-ALA synthase

answer

Sideroblastic anemia

question

Ferrochelatase

answer

Lead poisoning Accumulates: Protoporphyrin, δ-ALA Microcytic anemia, GI and kidney disease. Children-exposure to lead paint -+ mental deterioration Adults-environmental exposure (battery/ ammunition/radiator factory) -+ headache, memory loss, demyelination

question

Porphobilinogen deaminase

answer

Acute intermittent porphyria Accumulates: Porphobilinogen, δ-ALA, uroporphyrin 5 P's 1. Painful abdomen 2. Port wine-colored urine 3. Polyneuropathy 4. Psychological disturbances 5. Precipitated by drugs

question

Uroporphyrinogen decarboxylase

answer

Porphyria cutanea tarda Accumulates: Uroporphyrin (tea colored urine) Blistering cutaneous photosensitivity. Most common porphyria.

question

Holosystolic murmur

answer

Tricuspid insufficiency -Best heard over the fourth left sternal border, radiates to right sternal border -Intensity can be accentuated following inspiration --Due to increased regurgitant flow in right ventricular volume -most often secondary to pulmonary hypertension Mitral regurgitation -Best heard at the apex with diaphragm, radiates toward axilla -No intensification upon inspiration -Difference in pressure extends throughout systole and can even continue after the aortic valve has closed Ventricular septal defect -Best heard over the left third and fourth intercostal spaces and along the sternal border -S2 Normal (Distinguish from pulmonary stenosis, which has a wide splitting S2) -No intensification upon inspiration

question

Hyperammonia

answer

Can be acquired (e.g., liver disease) or hereditary (e.g., urea cycle enzyme deficiencies) excess NH4+ → depletes a-ketoglutarate → inhibition of TCA cycle Rx: limit protein in diet

question

RTA1 ("distal", Renal tubular acidosis)

answer

Defect in collecting tubule's ability to excrete H+ urine pH >5.5 hypokalemia ↑ risk for calcium phosphate kidney stones as a result of ↑ urine pH and bone resorption

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RTA2 ("proximal", Renal tubular acidosis)

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Defect in proximal tubule HC03- reabsorption Fanconi's syndrome urine pH < 5.5 hypokalemia ↑ risk for hypophosphatemic rickets

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RTA4 ("hyperkalemic", Renal tubular acidosis)

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Hypoaldosteronism or lack of collecting tubule response to aldosterone Resulting hyperkalemia impairs ammoniagenesis in the proximal tubule ↓ buffering capacity and ↓ urine pH

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Ammoniagenesis

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Occurs within proximal tubular cells Glutamine made in the liver, is received from peritubular capillaries and is metabolized into 1. Alpha-keto glutarate (Metabolized further into two HCO3- ions, which then leave the cell and enter systemic circulation by crossing the basolateral membrane) 2. NH4+ (Secreted into renal tubules)

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CN III Palsy

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eye is "down and out" with ptosis and pupil dilation

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Posterior Communicating Artery

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Common site ofsaccular (berry) aneurysm. CN III Palsy: Eye is "down and out" with ptosis and pupil dilation Lesions are typically aneurysms, not strokes

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Avoidant Personality Disorder

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Display a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social interaction Consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked

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Dysthymic disorder

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Mood disorder consisting of the same cognitive and physical problems as in depression, with less severe but longer-lasting symptoms, which may persist for at least 2 years A serious state of chronic depression, which persists for at least 2 years; it is less acute and severe than major depressive disorder Sufferers may experience symptoms for many years before it is diagnosed, if diagnosis occurs at all

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Major depressive disorder

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Characterized by episodes of all-encompassing low mood accompanied by low self-esteem and loss of interest or pleasure in normally enjoyable activities Presence of a severely depressed mood that persists for at least two weeks

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Narcissistic personality disorder

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Being excessively preoccupied with issues of personal adequacy, power, prestige and vanity

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Obsessive compulsive disorder

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Characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry

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Schizoid personality disorder

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Characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness and apathy May simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world

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Schizotypal personality disorder

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Characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs May feel extreme discomfort with maintaining close relationships with people, and therefore they often do not May display peculiar manners of talking and dressing and often have difficulty in forming relationships. May react oddly in conversations, not respond or talk to themselves Frequently misinterpret situations as being strange or having unusual meaning for them; paranormal and superstitious beliefs are not uncommon

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Peptic ulcers

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Chronic inflammation due to Helicobacter pylori that colonizes the antral mucosa NSAIDs Some studies have found correlations between smoking and ulcer formation Caffeine and coffee, also commonly thought to cause or exacerbate ulcers, have not been found to affect ulcers to any significant exten

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Substance Abuse Teratogens

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Alcohol: Leading cause of birth defects and mental retardation; fetal alcohol syndrome Cocaine: Abnormal fetal development and fetal addiction; placental abruption Smoking: Preterm labor, placental problems, IUGR, ADI-ID

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Prenatal cocaine effects

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Associated with premature birth, birth defects, attention deficit disorder

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Absence seizure

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Brief (usually less than 20 seconds), generalized epileptic seizures of sudden onset and termination Clinically, the impairment of consciousness (absence) Electroencephalography (EEG) shows generalized spike-and-slow wave discharges ~3Hz

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Complex partial seizure

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Often preceded by a seizure aura. -A simple partial seizure. Aura may manifest itself as a feeling of déjà vu, jamais vu, fear, euphoria or depersonalization. Seizure aura might also occur as a visual disturbance, such as tunnel vision or a change in the size of objects (macropsia or micropsia). Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing. There may also be loss of memory (amnesia) surrounding the seizure event. Person may still be able to perform routine tasks such as walking, although such movements are not purposeful or planned. Witnesses may not recognize that anything is wrong.

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Generalized tonic clonic

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Generalized seizure that affects the entire brain Divided into two phases, the tonic phase and the clonic phase. Preceded by aura Tonic = skeletal muscles tense Clonic = Rapid contraction and relaxation of muscles

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Simple partial seizures

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Consciousness is not impaired Often precursors to larger seizures, where the abnormal electrical activity spreads to a larger area of (or all of) the brain, usually resulting in a complex partial seizure or a tonic-clonic seizure -In this case they are often known as an aura

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Leukocidin

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Type of cytotoxin created by some types of bacteria Is a type of pore forming toxin Get their names by killing ("-cide") leukocytes Associated with increased virulence of certain strains (isolates) of Staphylococcus aureus Cause of necrotic lesions involving the skin or mucosa, including necrotic hemorrhagic pneumonia

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Staph α-toxin

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The major cytotoxic agent released by bacterium Staphylococcus aureus and the first identified member of the pore forming beta-barrel toxin family

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Muscarinic ACh receptor

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Receptors that form G protein-receptor complexes in the cell membranes of certain neurons and other cells Play several roles, including acting as the main end-receptor stimulated by acetylcholine released from postganglionic fibers in the parasympathetic nervous system

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Nicotinic ACh receptor

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Receptors that form ligand-gated ion channels in the plasma membranes of certain neurons and on the postsynaptic side of the neuromuscular junction As ionotropic receptors, these are directly linked to ion channels and do not use second messengers (as metabotropic receptors do).

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Dysostosis multiplex

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Hereditary disease (autosomal recessive) consisting of an error is mucopolysaccharide metabolism Characterized by severe abnormalities in development of skeletal cartilage and bone and mental retardation

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Lysosomal storage disease

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Caused by lysosomal dysfunction usually as a consequence of deficiency of a single enzyme required for the metabolism of lipids, glycoproteins (sugar containing proteins) or so-called mucopolysaccharides When a particular lysosomal enzyme exists in too small an amount or is missing altogether, substances accumulate in the cell. In other words, when the lysosome doesn't function normally, excess products destined for breakdown and recycling are stored in the cell.

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inclusion cell disease (I-cell disease)

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Inherited lysosomal storage disorder Failure of addition of mannose-6-phosphate to lysosome proteins -Enzymes are secreted outside the cell instead of being targeted to the lysosome Presentation: Coarse facial features Clouded corneas Restricted joint movement High plasma levels of lysosomal enzymes

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Inferior mesenteric lymph nodes

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Sigmoid colin → Colic Ends up in these lymph nodes

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Internal iliac lymph nodes

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Rectum (lower portion) of anal canal (Above pectenate line) Ends up in these lymph nodes

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Superficial inguinal lymph nodes

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Anal canal (below pectenate line) Scrotum Thighs Ends up in these lymph nodes

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Internal iliac lymph nodes

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Receive lymphatics from: All the pelvic viscera Deeper parts of the perineum -membranous and cavernous portions of the urethra Buttock and back of the thigh Cervix! Not: Ovary, testis, or superior half of the rectum Gonads drain to the paraaortic lymph nodes Superior half of the rectum drains to the pararectal lymph nodes

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