kaposi sarcoma is another form of presentation in HIV Positive individual it present purple papule on skin and mucosa and metastazise to lymph nodee continuous secretion of progesterone by corpus luteum esential for develop of fetus, during first trimester, placental prod of hcg sustain the corpus luteum and ensures continued progesterone secretion, by the second
trimester, progesterone production by placenta increase to level sufficient to sustain fetal growth and developmt
ectopoic
40 yearold female present with amenorrhea and hirsutism, which hormone in excess in this woman with polycystic ovarian syn
androgens\
in PCOD estrogen is usually elevated from non ovarian sources, progesterone levels are usually unchanged, FSH LOW, ANDROGEN Elevated and cause these sx
SINGLE FIRM non tender freely movable breast mass in woman of this age likely fibroadenoma and is confirmed by bx.
an ovarian mass raises possibility of tumor and vaginal hemorrhage in post menopausal woman suggests estrgen producing tumor, one of first estrogen producg tumor is granulosa cell tumour
chlamydia are obligate intracellular parasites because they cannot synthesize ATP, they are classified as bacteria because they divide by binary fission to form polypeptides,produceRNA ,DNA and DNa gyrase, finally they synthesize 2 unique morphologic forms, ie extracellular infective and metabolically inert elementary body, and intracellular metabolically active reticulate body
woman who is in 20 is sleeping with bf, later woman develop painful =swelling in her elbow, what characteristic?
can live within neutrophils
the pattern of rash erythema infectiousum is self limited mild systemic disease caused by human parvo virus, usual therapy supportive measure such as antipruritic relieve itching,
humidified air contain 149.3 mm hg
partial press of oxygen in alveolar air under normal circumstaces at sea level 104 mm hgsevere dyspnea in patient with chronic bronchitis
bronchial mucus gland hypertrophhy common feat of chronic bronchitis transthoracic needle asp is most common cause of pneumothorax
patient has contracted HIV from shared needle and has suffered
pneumocystitis carinni infecx, diffuse bilateral alveolar shadowing sparing lower zones, is typical on xray,
pulm embolism is emergency with suden collpse or breathlessnes silicosis associated with increased susceptibility to tb/ asbestosis
demonstrate diffuse interstitial fibrosis of lower lobe and dense hyalinized fibrocalcific plaque of parietal pleura,coal workers pneumoconiosi is related to exposure to coal dust,
ARDS is sequela of Pancreaatic cancer,lead to death, signs and sympt
include,resistant hypoxiam diffuse alveolar infiltrate on CXR, DYSPNEA, treat involve Oxygn, diuretics, and posiitive end exp pressure,this wil prevent airway collapse ina falling lung and expand alveoli for better diffusion, DM is sequela of long standing chronic pancreatitis, esophageal varices are ass with cirrhosis, MI and Pancreatic Ca are not ass with acute pancreatitis
healthy 21 year old stdt preparing for 5 km race, he has been training for 3m onths, increasing his distance each week,what is likely effect on his body from training regimen
venous Pco2 increases
IL5 is resp for activating eosinophils
TNF alpha is involved in type 1 hs reaction seen in asthma
IL2 SECRETED by T helper cells,which help secrete cytotoxic and helper T cells.
TNF ALPHA os secreted by macrophage resp for attracting and activating neutrophils
interferon gamma is secreted by helper T cells and resp for stimulation of macrophages
histologic find is that of a pleural plaque, most common manifestation of asbestos exposure, these well circumscrbed plaque composed of dense collagen,asbestos usually affect lower lung lobes, upper lung lobes are affected in silicosis and coal worker;s pneumoconiosis,
oat cells are characteristic of small cell carcinoma,
HEMOSIDERIN laden macrophages are common in diffuse pulmonary hemorrhage syndromes
19 year old man dies of progresive renal failure, on autopsy lungs heavy with areas of red brown consolidationthere is also acute focal lesion necrosis on alveolar walls ie associated with intraalveolar hemorrages the alveoli contain hemosiderin laden macrophages, this disease is characterized by
antibodiesfor which type of collagen
patient died of good pasture syndrome characcterized by rapidly progressive glomerulonephritis and necrotizing hemorrhagic interstiial pneumonitis'type 1 in bone, type 2 in cartilage, type 3 is made of reticulin and found in skin bv, and granulation tissue, type 10 in epiphysel plate
pseudomonas aerug is one of most common orgas to cause hospital acquired pneumonia, it cause lobar infiltrte to be present on CXRand produce blue greem pigment when cultured, atypical mycobacterium ass withpneumonia in HIV positiv patient when levelof CD4 CELLS Are decreased, h INFLUENZA cause pneumonia, but since advent of Hib vaccine, incidence has decreased, influenza vaccine can cause pneumonia but owing to viral properties does not produce lobar infiltrate, with influenza, b.l streaky infiltrates seen on CXR, m CATARRALIS CAUSE OF OTITIS MEDIA
HOMOZGOTE for PIZ protein has severealpha 1 antitrypsin deff,which is resp for inhibiting proteases,such as neutrophil elastase which is capable of digesting lung tissue, THus with deff of alpha 1 at,neutrophil elastase and other protease will not be inhibited
individual with Pizz protein increased risk of develping emphysema smokers have greater risk, so smoking cesation advised, eotaxin, major basic protein and PGD2 both involved in immune resp seen in asthma
the sup segment of right lower lobe is most likely segment ivolved in asp pneumonia
oxacillin classfied as peniciilinase resistant penicliin that s relatively acid stable and theefore useful in oral administration, major adverse reactions include penicliin hypersensity and interstitial nephritis.with exception of
methicillin which is 35% bound to serum proteins all penicillinase resistant peniclin highly bound to plsma protein,oxacilin has very narow spectrum and used primarily as antistaphylococal agent
flconazole inhibit ergosterol synthesis. it inhibit CYT p45o which is key
enzyme system for cyt p450 dependent sterol 14 alpha demethylase,this lead to accumulation of 14 alpha sterol resulting in impairment of cytoplasmic memb
fluconazole penetrate into CSF WHERE it is active against cryptococus
neoformans,when given oraly, blood level are almost high as whenit is given parenterally, amphotericin administered intravenously and does not appear highly effectve in fungal infex
wegener granulomatosis characterissed by necrotising granulomatous vasculitis of vessel of resp tract,kidney and other organ, it present with chronic sinusitis,hemoptysis otitis media cough,dyspnea
comon find , Canca, CXR WITH large nodular granule,hematuria, and red cell casts.changes in lips and oral mucosa may be seen in Kawasaki disease which is acute necrotizing vasculitis of small and medium sized vessels,it is disease of infants and child.
nail hemorage seen in bacterial endocarditis\pericardial pain in pericarditis
brown rod shaped bodies wth clubbed ends that stain for prussian blue are ferruginous bodies, these are characteristic of asbestosis
pulmonary edema is due to incraeased hydrostatic presure in glandular stage 5-17 weeks ,resp not possible,
at second cannalicular stage week 13 to 25 , resp bronchiole and terminal sacs form
fetuses born prior to week 20 rarely survive,
at 3rd or terminal sac stage week 24 to birth, type 1 and type 2 alveolar cells are presnt and resp is possible,
premature infant born between 24 and 28 weeks of gestation survival with intensive care
last stage alveolat stage birth to year 8 , in this stage, bronchile, terminal sac, alveolar ducts and alveoli proliferate
week 35 is when type 2 alveolar cells start to secrrete surfactant
resp PfT value ratio less than 1 is obstructive lung disease for eg asthma, FEV1 Decreaes which leaves more air in lungs, thus increasing FVC. iN RESTRICTIVE lung disease, Ratio unchanged or increased slightly in severe cases,patient cannot inspire air into lungs,becuse of restriction so FVC decreses which cause increase in ratio, THE FEV1 is never equal to FVC
blastomycosis in mississpi riverr
histoplamosis demonstrate yest form in macrophages and is found in ohio/msisipi river valleys
cryptococus is encapsulted yeast that cause meningtitis,associated with pigeons
coccidodomycosis in s western us COCCODOIDES
spherules with endospore
paracoccidoides in rurral latin americarom
paracocidoides dimorphic yeast with bud in pattern resembling captain;s wheel
lung abscess can result from aspiration of oropharyngeal or nasopharyngel contents, where bacterial orgs as part of normal flora can be picked up and transported into lungs,the straughter bronchus to right lung is more likely to conduct aspirated material
with septicemia,multiple abscess likely to be present
pneumocystitis carinii pneumonia associationg wth AIDS, pCP HAS an exudate composed of pneumocystitis cysts and trophozoites with little accompanying inflamation
silicosis associated with increased susceptibility to tb / asbestosis
demonstrate diffuse interstitial fibrosis of lower lobe and dense hyalinized fibrocalcific plaque of parietal pleura,coal workers pneumoconiosi is related to exposure to coal dust,
ARDS is sequela of Pancreaatic cancer,lead to death, signs and sympt include,resistant hypoxia/ diffuse alveolar infiltrate on CXR, DYSPNEA, treat
involve Oxygn, diuretics, and posiitive end exp pressure,this wil prevent airway collapse ina falling lung and expand alveoli for better diffusion, DM is sequela of long standing chronic pancreatitis, esophageal varices are ass with cirrhosis, MI and Pancreatic Ca are not ass with acute pancreatitis
healthy 21 year old stdt preparing for 5 km race, he has been training for 3m onths, increasing his distance each week,what is likely effect on his body from training regimen
venous Pco2 increases
IL5 is resp for activating eosinophils
TNF alpha is involved in type 1 hs reaction seen in asthma
IL2 SECRETED by T helper cells,which help secrete cytotoxic and helper T cells.
TNF ALPHA 's secreted by macrophage resp for attracting and activating neutrophils
interferon gamma is secreted by helper T cells and resp for stimulation of macrophages
histologic find is that of a pleural plaque, most common manifestation of asbestos exposure, these well circumscrbed plaque composed of dense collagen,asbestos usually affect lower lung lobes, upper lung lobes are affected in silicosis and coal worker;s pneumoconiosis,
oat cells are characteristic of small cell carcinoma,
HEMOSIDERIN laden macrophages are common in diffuse pulmonary hemorrhage syndromes
19 year old man dies of progresive renal failure, on autopsy lungs heavy with areas of red brown consolidationthere is also acute focal lesion necrosis on alveolar walls ie associated with intraalveolar hemorrages the alveoli contain hemosiderin laden macrophages, this disease is characterized by
antibodiesfor which type of collagen
patient died of good pasture syndrome characcterized by rapidly progressive glomerulonephritis and necrotizing hemorrhagic interstiial pneumonitis'type 1 in bone, type 2 in cartilage, type 3 is made of reticulin and found in skin bv, and granulation tissue, type 10 in epiphysel plate
pseudomonas aerug is one of most common orgas to cause hospital acquired pneumonia, it cause lobar infiltrte to be present on CXRand produce blue greem pigment when cultured, atypical mycobacterium ass withpneumonia in
HIV positiv patient when levelof CD4 CELLS Are decreased, h INFLUENZA cause pneumonia, but since advent of Hib vaccine, incidence has decreased, influenza vaccine can cause pneumonia but owing to viral properties does not produce lobar infiltrate, with influenza, b.l streaky infiltrates seen on CXR, m CATARRALIS CAUSE OF OTITIS MEDIA
HOMOZGOTE for PIZ protein has severealpha 1 antitrypsin deff,which is resp for inhibiting proteases,such as neutrophil elastase which is capable of digesting lung tissue, THus with deff of alpha 1 at,neutrophil elastase and other protease will not be inhibited
individual with Pizz protein increased risk of develping emphysema smokers have greater risk, so smoking cesation advised, eotaxin, major basic protein and PGD2 both involved in immune resp seen in asthma
the sup segment of right lower lobe is most likely segment ivolved in asp pneumonia
55 year old present to 2 day hx in clinic of progresive cough/fever, he is sexualy active has numerous partners in past,cultur of sputum does nt reveal any organism,what is appropriate treatment for this patient?
tetracycline chlamydial infecx
patint present to ambulatory clinic with 5 month clinic hx of
diarhea,polyarthralgia and mild pleuritic chest pain, a biopxy of small
intestine reveal intestinal mucosa with macrophages laden with PAS POSITIVE GRANULE,what appropriate rx of this patient?
tropheryma whipelli causative of whipple's disease, it is gram positive
bacillus,appropriate rx is antibiotics, PAS positve macrophages are diagnostic for this disesae,this is not cancer, so it is not necesary to test for CEA,
prednisone would be used to treat crohn's diseae, Mesalamine derivative would be used fr UC, fINALLY if left untreated, this patient will not improve clostridium difficle produce exotoxin, this kil. enteric cells and cause pseudomembranous colitis, antibiotic use often culprit, particularly
clindamycin and ampicillin, erythromycin,clindamycin,azithromycin would not treat this and may exacerbate it, ors not sufficient for pseudomembranous colitis
potential side effect of antimalarial t herapy is aplastic anemia, which occur with some anti inflammatory medication folate deff anemia usualy grow in 1 of 3 ways, dietary imbalance, pregnancy, and int malabsorption, Iron deff anemia induced by pregnancy growth.dietary lack and chronc blood loss, pernicious anemia caused by type a gastritis, which lead to maked decrease in Intrinsic factor
penicillin G doc for syphilis, doxycycline and tetra cycline alternative rx. tetracycline doxycycline not used in pregnant women, doxycycline oral tetracycline antibiotic used to treat urethritis and prostatitis, ketoconazole is antifungal agent used to treat hormone refractory prostate cancer
34 year old co excruciating pain in left toe, PE reveal red toe sensitive to touch,what approp treat ofthis patient/
aspirate fluid from joint and send it for cultures
27 year old HIV pos patient with granuloma lesion in right ling field and intracranial lesion on CT scan ,On pwe, he has decreased breath sounds at both lung bases and scattered rales, Crdiac exam reveal no evidence of rubs,murmurs or gallop
what is app treat amphotericin B
INTRAVENOUS ACYCLOVIR RECOMMENDED FOR RASH IN IMMUNOCOMPROMISED PEOPLE
inh toxicity cause seizure
rocky mountain spoted fever, doxycycline rx,
efavirenz is non nucleoside reverse transcriptase inhibitor that act to prevent transcription of Viral RNA TO dna, OF OTHER CHOICES, zidovudine is
nucleoside analog used in pregnancy, to prevent transmission of HIV TO fetus.
zidovudine cause megalobalsticanemia
15 year old boy present to PCP with whar appears to be mild to moderate acne spread diffusely over face, his past medical hx notable for recurrent bouts of otitis media, his past medical hx note right inguinal hernia.hydrocele repairk PE of heart lung abd unremarkable he begun therapy with
tetracycline, which follm potential side effect of drug concrening?
tetracycline is bacteriostatic agent that bind to bacterialn 30 s subunit and prevent attachment of Aminoacyl T rna
fanconi's syndrome is acquired disorder due to prox tubule defect that result in decreased blood ph, bicarbonate,phosphate ,glucose amino acids because of leakage of kidney, of other toxicities, tetracycline cause tooth discloration, but this seen below 7 years of age,anothr side effect seen in this age group is inhibiton of bone growth
cephalosporin c.i in patients alergic to penicillin
65 year old with 20 year hx of smoking present to PCP co chronic cough, sampling of epitheliial cells in patients trachea and bronchi would reveal ehat pathological change
metaplasia specifically stratified squamous epithelial cells replacing normal columnarciliated epithelial cells
metaplasia is replacement
dysplacia is some times premalgnant tissue change charaterized by pleomorphism changes in spatial orientation of cell and increased mitotic activity
child aspirated a button from shirtforeign object obstruct right middle lobe bronchus due to its vertical orientation with trachea, air wil be allowedinto obstructed lobe, but will not be exhaled as easilyy, leading to
hyperinflation,ventilation of hyperinflated lobe will be inadequate m with resulting hypoxia leading to vasoconstriction of pulmonary vasculature, serving affected area,increased resistance in pulmonary artery system will lead to increased flow in left pulmonary artery system, a collapsed lung should decrease flow in right pulmonary artery, but hx does not sugest an etiology of collapsedlung
tellurite agar, for corynebacterium diphtheriae
ankle sprain very common most involve lateral ligament complex particularly anterior talofibular ligament up to 85% og the time sprain inversion injury pain will be elicited with this motion, pain usually in morning and subside after few mins of ambulation
where porto caval shunt, correct ans is splenic vein left renal vein,splenic vein drains into portal system and left renal vein drains directly into inferior vena cava, both left and right renal veins drain into caval system,the right
testicular vein drains into caval system, the superor mesenteric vein drains into portal system
striation,smooth muscle cell activate myosin light chain kinase,contractio of smooth muscle slower and last longer than skeletal muscle because its rate of atp hydrolysis is slowe,
organ most likely damaged by stab wound to left midaxillary line in refion of 9th and 11 th rib is spleen, spleen is characterized by red pulp removed from circulation and also white pulp which consist of lymphoid cells, PALS is
collection of T lymphocytes surrounding splenic arterioles, enterochromaffin cells located in adrenal gland and produce epinephrine and norepinephrine, Hsals corpuscles are located in thymus, their function not entirely clear, islet of langerhan collection of endocrine cells in pancreas
neurologic sensation of C5 LEVEL IS associated with motor,reflex,and sensory level,this will result in shoulder abductionloss of biceps reflex and loss of sensation over lateral arm,lateral forearm supplied by C6 DERMATOME, medial arm supplied by t1 Dermatome, medial forearm supplied by C8 DERMATOME
stroke in lateral medulla knwn as wallenburg synd, damage vestibular
nucleus,causing vertigo,nystagmus and nausea,the spinotalamic tract cause c.l loss of pain and temp on body
sympathtic tract causing i.l horner syndrome,
9th and 10th cranialnerve causing hoarsnes and dysphagia, spinocerebellar tract cause i.l limb ataxia,
NUCLEUS TRACT OF 5TH cranial nerve cause pain.numbnes of I.L FACE nucleus solitarius and trractus solitarius causing loss of taste sensation syndrome most often caused by occlusion of vertebral artery , or less often posterior inf cerebellar artery or lateral medullary a
cerebellum demonstrate somatotropic organization, midline of cerebellum is converned vermis more with axial tone and coordination with lower parts of body represented more anteriorly in vermis,
DEGENERATION in area ocur more classically with chronic alcoholism lesion in hemispheres tend more to cause ipsilaeral limb ataxia, floculonodular lobe concerned with vestibular connections
cell
they are genrally hydrophilic or too large to cross membrane unaided, oxygen and co2 are both soluble in lipid and read to pass the membrane of cell ,this is beneficial in that only rate limiting step for O2 to cross plasma memb is partial press gradient, Glucose is water soluble, and require transp prtein, and variety of ligand to cross hydrophobic cell memb, sodium ion are polar and unable to diffuse across membrane, they require channels voltage or ligand gated or a transporter
potassium ion are polar and unable ddiffuse across plasma memb,they require channels,voltage or ligand gated or transport proteins
17 year old girl camping in Ohio 2 weeks, approx a week latr,she present toPCP c.O RED macule in her right leg, similar lesion in low back. what is treat?
doxycycline
oxacilin classified as penicillinase resistant penicillin that is relatively acid stable and therefore useful for oral administration, major adverse react
penicillin hyprsensitivity and interstitial nephritis, with exceptionof methicillin whch is 35% bound to serum proteins,all penicillinase resistant penicillin are highly bound to plasma proteins, oxacillin has very narrow spectrum and used primarily as an antistaphylococcal agent
fluconazole penetrate into csf where it active against cryptococcus
neoformans,when it is given orally,blood levels are almst high as when is given parentally ,amphotericin administered iv and does not appear to be highly effective in fungal meningitis, even when administered intrathecally oxacillin and MRSA RAPIDLY increasing in incidence MRSA AND MSSA coexist in hereogenous populations,treatment of pnnatient harboring this
heterologous population may provide selective environment for MRSA famciclovir is guanosine that is phosphorylated to acycloGMP by viral thymidine kinase then to acyloGTP by cellular enzymes,it then act as chain terminator and viral dna polymerase inhibitor, specificity due to need for viral tk and higher affinity of viral DNA polymerase than humans DNA pol for
acycloGTP. in short, inhibiton of viral DNA synthesis
acyclovir is guanosine analogue that terminate viral DNA replication,it is activated in cells by virus encoded thymidine kinase which phosphorylate drug,only virus that produce thymidine kinase such as HSV 1 OR 2 OR VZV are suspectible to acyclovir
trimetoprim blocks nucleic acid synthesis by inhibiting DHF , an enzyme necesary in synthesis of Deoxythymidine nucleotide and involving
interconversion of DIHYDROFOLATE to tetrahydrrofolate,MECH of resistance to TMP is acquisition of plasmid that code for formation of TMP resistant dihydrofolate reductase
macrolide inhibit protein synthesis by blocking translocation step, penicillin resp for inhibiting proper cell wall synthesis by blocking transpeptidase cross linking of cell wall,
choramphenicol inhbit 50 s peptidyl transferase disrupting translation,
aminoglycoside are resp for inhibiting formation of initiation complex needed to start protein synthesis
cephalosporin and penicilline have similar structures, penicillin have penicillic acid and cephalosporin, cephalosporinic acid moiety, because patient and moiety.both groups inhibit transpeptidase enzyme ,necessary for cross linking of peptidoglycan layer necesary for cell wall stabilization,it appears that mechanism not totally identical for every drug for every bactrial process
30 year old college football player suffer a sevvere knee injury dislocating joint,even after team physician resect knee, pulses distal to injury
still absent what vessel posterior to knee joint often damages with knee dislocations?
popliteal artery
large portion of circulation of lower extremity begin with superficial femoral artery which forms popliteal artery passing behind the knee joint, the vessel then branches into anterior tibial , posterior tibial and peroneal arteries, with knee injuries,popliteal artery often damaged owing to its location just
posterior to the joint, because of extensive supply of popliteal artery, it is always important to palpate for pulse in artery not just in knee injuries but in all patients in order to determine vascular supply to distal leg
a common condition found in older woman is presence of varicose veins, which are abnormally dilated tortuous veins, they typically arise due to increased intraluminal pressure from standing erect for long periods of time,varicose vein found on surface of lower leg just medial to tibial bone
drained by which vein? great saphenous vein
grat and small saphenous vein begin respectively as medial and lateral extensions of dorsal venous arch of foot,tributaries of great saphenous vein gather on anterior aspect of foot and profress upward anterior to medial malleolus, the tributaries of great saphenous vein serve to drain all superficial tissues of lower limb except those on side of foot , and posterolateral aspect of leg, the small saphenous vein extends upwaeds into leg, by passing behind the lateral malleolus and extending upward, usually uniting with popliteal vein,the accessory saphenous veins are lovated on proximal and medial aspect of thigh, the anterior tibial and peroneal veins are deep veins that do not drain superficial tissues
the developing fetus depend on mother for oxygenation of its blood, the exchange occurs in umbilical cord and blood is transported back into fetal circulation once infant delivered and takes its first breath which structure immediately closes to block right to left shunt
foramen ovale
anterior cruciate ligament is most often stretched torn, or both by sudden twisting motion, posterior cruciate ligament most injured by direct
contact,impact as in automobile accident, or football tackle, injury to cruciate ligament may not cause pain,tather patienthear popping sound, immediately followed by swelling and leg may buckle when he.she tried to stand on it, abnormal passive abduction indicate torn medial collateral ligament
gynecoid pelvis is most favorable pelvis for vaginal delivery,this pelvis type is seen in 50 percent of woman and is characterized by oval inlet straight side walls , non prominent ischial spines,anthropoid pelvis common in african american woman marked by an ovall inlet with divergent pelvic side
walls,platypelloid pelvis rare and characterixed by wide transverse diameter of inlet
44 year old man present to ED c.o Visual changes,when eye exam performed, it is noted right eye has normal motor function but left one continues to look in inferior and lateral direction,damage to which cranial nerve responsible for appearance of left eye/
cranial nerve 3
37 year old gun shot person wound to abdomen, after initial exam,patient taken to ER, celiac trunk is branch of splenic artery
celiac trunk originates from abdominal aorta at level of T12-L1 intervertebral disc,it then give rise to splenic artery which is major blood supply to spleen splenic artery also gives rise to gastrowpiploic artery which supplies left greater curvature of stomach, the abdominal aorta gives rise to celiac artery which then give rise to splenicartery,
superior mesenteric artery comes off abdominal aorta and supplies duodenum,jejenum,ileum, and proximal 2/3rd of transverse colon,
right gastric artery supplies right leser curvature of stomach and does not give rise to any other arteries
lateral epicondylar tendinitis, or tennis elbow is painful condition involving soft tissue over lateral aspect of elbow, pain originate at or near site of attachment of common extensors to lateral epicondyle and may radiate into forearm and dorsum of wrist, as in this patient, this conditionthought to be caused by small tears of external aponeurosis resulting from repeated resisted contraction of extensor muscle,passive flexion of fingers and wrist and having patient extend wrist against resistance can elicit pain, biceps tendinitis caused by friction on tendon of long head of biceps as it passes through bicipital groove, a patient will experience anterior shoulder pain that radiates down biceps into forearm, carpal tunne syndrom result from
compression of of median nerve of carpal tunnel it manifest, numbness and pain in thumb as well as second and 3rd fingers and radial half of 4th, it is sometimes accompanied by thenar atrophy, medial epicondylar tendinitis or golfers elbow is similar disorder of common flexor mucle group at its origin, the medial epicondyle of humerus, pain can be elicited by resisting wrist flexion and pronation with elbow extended.
1 year old infant present with cardiomegaly and CHF she has increased ICP and cranial bruit
A VEIN OF galen aneurysm , revealed by MRI shown to compress aqueduct of Sylvius,post part of 3d ventricle, and splenium of corpus callosum, normally cerebral vein of galen join which dural venous sinus?
inf sagittal sinus
centroacinar cells are components of exocrine pancreas that contain zymgen granule which are released under action of cholecystokinin from duodenum, the zymogen granule contain inactive proenxymes, that normally become activated within duodenum, .premature activation of pancreatic enzyme such as trypsin lead to autodigestion of centroacinar cells of pancreatic acini which secrete these enzymes, this result in acute hemorrhagic pancreatitis, which can be caused by excessive alcohl ingestion,
middle meningeal a arised from first or mandibular part of maxillary a ,it runs through foramen spinosum to reach middle cranial fossa, from there,art divides into anterior and post branch supplying meninges7
abnormal development of either septum primum or septu secundum in ostim secundum atrial septal defect in area of fossa ovalis, common type of
Congenital heart defect manifested by patent foramen ovale betwen right and leftatria
intranuclear opthalmoplegoa.MLF , conjugate movt of eyes depend on
integrity of MLF, which link I.L lateral gaze center in pons with CL occulomotor nucleus in midbrain, Lesion of MLF disconect the brain nuclei resulting
intranuclear opthalmoplegia and bilateral condition can be seen in patients with MS
uterine artery crosees anterior and superior to ureter near lateral fornix of vagina, ureter is thus in danger of being clamped or severed by mistake during hysterectomy
18 Y EAR OLD patient thrown from house and suffered extensive damage to back and pelvic regon,after 2 weeks of recovey i t is noted patient was unable to initiate micturition, spastic neurogenic urrinary bladder,bladder
periodically empties itself , what lesion control of bladder in this patient located?
spinal cord above level of S2,THE MICTURITION reflex work s follows, when bladder become distended, sensory impulse travel back from blader to synapse onto preganglionic parasymapthetic neuron located at level of S2-4, THIS Neuron excite post ganglionic parasympathetic neuron which innervate and cause contraction of detrusor muscle of urinary bladder thus emptying bladder, this primitive reflex loop caomes under supraspinal influence in e arly childhood when child learns control of micturition reflex,when supraspinal influence removed,a s happens with spinal lesions above level of s2,
PRIMITIVE reflex loop remain and neurogenic spastic bladder empties whenever it becomes ful
the internal laryngeal nerve supplies laryngeal mucosa above level of vocal fold as well as mucosa of piriform recess and epiglottic valleculae
patient c.o heightened sensitivity to loud noises due to paralysis of stapedius muscle,patient also display neurologic signs manifested by injury to which foll?
7th cranial nerve supply stapedius muscle whch dampen sound by reducing movement of stapes in oval window, a patient with injury to facial nerve also display paralysis of facial musculature,loss of taste sensation and los of lacrimation on afected side, facial nerve provide motor innervation to musle of facial expressxion,taste sensation on anterior 2/3rds of tongue,Via chorda tympani and parasympathetic innervation to pterygopalatine ganglion via greater petrosal nerve
jaw jerk reflex is monosynaptic reflex to masseter muscle, proprioceptive fibers from mucle travel by way of trigeminal nerve back to their cell bodies in mesencephalic trigmeninal nucleus
stasis ulcer,failure of valve, varicose vein are tortuous dilated vein caused by increased hydrostatic pressure resulting in venous valve incompetency and failure, legs common location for varicose veins and pregnancy or obesity will increase risk for thiscondition, the varicosities may bleed leading to stasis ulcers in overlying skin and stasis dermatitis,varicose veins may be
congenital or acquired
femoral canal medial compartment of femoral sheath contain only slight amount of loose connective tissue and one or two lymphatic vessels and nodes
which nerve involved in gag reflex?
motor innervation of pharyngeal constrictor muscles derived from ambigus nucleus in medulla oblongata, these motor fibers reach constrictor muscles via vagusnerve
arch of aorta is formed from left 4thaortic arch,part of 4th aortic arch become proximal portion of rght subclavian artery whereas rest of 4th arch
disappears, however if it persists,right aortic arch is formed passing posterior to trchea and esophagus, with formation of normally occuring left aortic arch,which runs anterior to trachea and esophagus, a double aortic arch is created, this defect clamp trachea and esophafus resulting in respiratory sx individual sustained severe knife wound damaging spinal nerve adjoining its entry to spinal cord,if one could examine peripheral nerve and its cell body,
which following events would he .she likely to observe>\ displacement of nucleus toward periphery of cell
damage to nerve fiber proximal to its cell body will cause among other changes retrograde degeneration of cell body, a no of changes occur in neuron during process of reterograde degeneration the cel body intiially shows some swelling and becomes distended, at beGINING OF
DEGENERATIVE PROCESS, there is accumulation of mitochondria in axoplasm at Ranvier's nodes
15 year old boy present TO ed with paroxysm of dyspnea,cough,wheezing, his parents indicate he had these attacks,past winter and have worsened and become more frequent during spring allergy season,which foll cell types correctly matched to a funcx it may perform in patient;s disease?
teenage patient suffering asthmatic attack probably allergen induced, mast cells key player , mast cells in bronchiles are stimulated to release histamine that induce contraction of smooth bronchiolar muscle and edema in wall, if bronchoconstriction is chronic, long term result is thickening of bronchiolar musculature
several days after yur teenage male patient fell on his outstretched hand,he reprt increasing pain movement of wrist, your exam reveal particular
tenderness in area of anatomic snuffbox,which carpal bone likly injured scaphoid
macrophages have irregular morphology, and diameter of between 25 and 50 nm, their nucleus eccentriclly situated may be round.kidney shaped, and may contain 1 or more nucleoli, cytoplasm contain several large azurophilic granule,due to pinocytic acivity, periphery of cells often contain
vacuoles,tendency of macrophages to adhere to glass surface may give them thinned appearance,with cell otganelles concentrated in centre of cell and leaving surface of cell with ruffled appearance
INFLUENZA VIRUS common org with resp tract infecx, it has single stranded,negative polarity 8 segmented
20 year man involved in motor vehicle accident which result mltiple blunt trauma and laceration to his lower extremties. the left femora; artery
lacerated, and hw incur extensiv e blod loss and remain hypotensive for hour. which least metabolically active?\
sk muscleable to funcx with anaerobic glycolysis
mural thrombi can form over damaged area of ventricular wall foll myocardial infarction,portions can break off and embolize to places such as cerebral circultion
histamine lead to vasodilation and fluid exudatiion, that is why people with allergies take antihistamines
alzheimer disease lead to senile dementia
5 year old boy brought to ED in resp distress with temp of 103 degree,he has difficulty swalowing and on PE,inspiratory stridor , his x ray swelling of
epiglottis, culture used for this organism/
hemophilus influenxa , causative agent for epiglottitis, Neiseria gonorhea uses thayer martin agarmycobacterium TB uses LJ AGAR
Charcoal yeast used to culture Legionaella pneumophila
corticosteroid are now recomended as first line therapy in treatment of asthma they act by inactivating transcription factor NF kB WHCIH induces production of proinflamatory molecule TNF alpha THUS Inhibiting chronic reax of Asthmatic attack, Ipratropium block acetylcholine signalling, theophyllone inhibitis Phosphodiesterase, Cromolyn prevents mast cell Mediator release and albuterol activatES beta 2 receptors
LTD4 and other leukotrienes are thought to be responsible for
bronchOconstriction, increased bronchial activity,increased secretion of mucus and edema,zafirleukast interupt leukotriene activity ,aspirin is NSAID responsible for DECREASING prduction of PG, which serve to limit inflamatory response, ASA shift pathway to leukotriene side, thus favoring
bronchoconstriction,these agents do not inhibit lipooxygenase pathway or phosphodiesterase.Sildenafil is inhibitor of type 5 phosphodiesterase
33 year old G2P2 woman develop headache and nausea at 26 week gestation .she is found to have bP OF 168.1-08, A Urinalysis show 4+proteinuria,later in 3rd trimester 36 week gestation she suffer seizure emergent delivery done, baby;s apgar score 7 and 9 in 1 and 5 mins which foll cond likely affect baby? pregnancy induced HTN,toxemia of pregnancy produce intrauterine growth retardation probably from chronic placental insufficiency
big fatty liver seen in conjunction with chronic alcoholism
48 year old man has chronic fatigue, a Pe yield no abnormal finds CBC show Hgb 10.7 gdl Hct 33% MCV 104 FL platelet count 239 000/microliter and WBC 7720/MICROLITER, HIS Serum vit B12 512 PG.ML and folate 4.7 NG.ML his serum haptoglobin 151 MG/DL , direct and indiret coombs test negative,whih underlying cond explain this find
chronic alcoholism
penicillamine is effective agent in acute severe RA in those patient who can tolerate it, penicillamine is not first line treatment but gaining acceptance as alternative to gold, chloroquine , and cytostatic agents, s.e . 1/3rd patient taking this drug, most side effect,maculopapular dermatitis, gastrointestinal upset.loss of taste sensation,thrombocytopenia and leukopenia, salcicylate are drug of choice mild frm of inflamatory disease,these include acute rheumatic fever, RA, Oa, And mild systemic lupus erythemstous,chloroquine used in infex of plasmodium malaria
ibuprofen,indomethacin and Naproxen are NSAIDS
baby with low birth rate <2500 xignificant increased risk death
patau synd can cause cleft lip cleft palate. nasal defecct and single central eye cyclop. trisomy 13
non disunction of first meiotic divison resp for trisomy 21. in about 93 percent patient with down syndrome, non dysjunnction during mitosis ,of a somatic cell early during embryogenesois result in mosaicism in abut 2% cases down synd
baby with low birth rate <2500 xignificant increased risk death
patau synd can cause cleft lip cleft palate. nasal defecct and single central eye cyclop. trisomy 13
non disunction of first meiotic divison resp for trisomy 21. in about 93 percent patient with down syndrome, non dysjunnction during mitosis ,of a somatic cell early during embryogenesois result in mosaicism in abut 2% cases down synd
9 year boy evaluated for deafness. PE reveal child with short stature,coarse facial feature and large tongue,clear cornea,lab show incrreased urinary level of heparan sulfate and dermatan sulphate. metachromatic granule( Reilly bodies)
found in leukocytes from bone marrow biopsy. these leukocytes are found deficient in iduronosulfate sulfatase
dx hunter disease
middle aged man who has been working hard all day longcarying load of brick to build a wall uses NSAIS drug such as ibuprofen in order to try dimnish which foll process in arm
pain
20 year man involved in motor vehicle accident which result mltiple blunt trauma and laceration to his lower extremties. the left femora; artery
lacerated, and hw incur extensiv e blod loss and remain hypotensive for hour. which least metabolically active?\
sk muscleable to funcx with anaerobic glycolysis
mural thrombi can form over damaged area of ventricular wall foll myocardial infarction,portions can break off and embolize to places such as cerebral circultion
hostamine lead to vasodilation and fluid exudatiion, that is why people with allergies take antihistamines
alzheimer disease lead to senile dementia
9 year boy evaluated for deafness. PE reveal child with short stature,coarse facial feature and large tongue,clear cornea,lab show incrreased urinary level of heparan sulfate and dermatan sulphate. metachromatic granule( Reilly bodies)
found in leukocytes from bone marrow biopsy. these leukocytes are found deficient in iduronosulfate sulfatase
dx hunter disease
middle aged man who has been working hard all day longcarying load of brick to build a wall uses NSAIS drug such as ibuprofen in order to try dimnish which foll process in arm
pain
20 year man involved in motor vehicle accident which result mltiple blunt trauma and laceration to his lower extremties. the left femora; artery
lacerated, and hw incur extensiv e blod loss and remain hypotensive for hour. which least metabolically active?\
sk muscleable to funcx with anaerobic glycolysis
mural thrombi can form over damaged area of ventricular wall foll myocardial infarction,portions can break off and embolize to places such as cerebral circultion
hostamine lead to vasodilation and fluid exudatiion, that is why people with allergies take antihistamines
alzheimer disease lead to senile dementia
54 year old male develop thrombus in anterior left descending coronary artery,area of myocardium suplied byt his vessel irreversibly injured, the thrombus destroye by infusion of streptokinase which plasminogen activator and injured area is reperfused, the ptient howver develop an arrythmia and dies, an electron microscopic picture taken of irreversibly njured myocardium reveal presence of dark irregular amorphic densities within mitochondria , referred to as
flocculent densities'
23 YEAR old female inreased trouble swallowing, PE reveal HTN and sclerodactyly, skin bx revealdermal fibrosis and absence of adnexal
structure,while lab exam find autoantibody against DNa topoisomerase _ANTI SCL 70.Wht best dx of individual
progressive systemic sclerosis
2 year old child demonstrate failure to thrive, hepatomegaly present ,along with ecchymosis of skin on PE. child exhibit convulsion and Blood glucose
found to be only 31 mg.dl,liver bx show cell filled with clear vacule that stain positive for glycogen,which foll explain find?
von gierke
there is deff ogf glucose 6 phosphatase so glycogen is not metabolized readily to glucose,because of abnormalitypatient have severe hypoglycemia leading to convulsion,intracytoplasmic accumulation of glycogen occur mainly in liver and kidney
38 year old man incur traumatic blow to his left upper arm,he continue to have pain and tenderness every 3 months have passed, plain film
radiography reveal 4 cm circumscribed mass in soft tissue adjacent to humerus, mss contain area of brightness on X ray, overnext year, process gradualy resolve, which describe process?
metaplsia
brightness on X ray sgest calcification from osseous metaplasia that
developed in healing process,this condt myositis ossificans, because there is bone formation in injured musCLe
45 year old female caucasian present to office with numbmess of right palm ,after taking detailed hx and physical exam,you suspect median nerve lesion at wrist, before reaching wrist median nerve courses between
flexor digitorium superficialis and flexor digitorium profundus
54 undergo thyroidectomy for several thyroid nodules, that were suspicious for malignancy on FNAB, while ligating suprior thyroidectomy, surgeon accidentaly severenearby nerve, which foll muscle denervated as result of this injury/
cricothyroid
superior thyroid brach of comon carotid artery and inf thyroid artery branch of thyroocrvical trunk, provide blood supply to thyroid and parathyroid gland, the sup thyroid artery,superior thyroid vein and ext branch ofsuperior
laryngeal nerve course together in neurovascular triad that originate suprior to thyroid gland and lateral to thyroid cartilage,
sup laryngeal nerve divided ext and int branch
ext branch cricothyroid , int branch sensory innervation above vocl cords 56 year old male evaluation of fatigue vague abd discomfort and bloddy stool
colonoscopy reveal mass in descending colon, surgical removal of mass require proper ligation of inf mesenteric artery tumor is from descending colon
recrent laryngeal nerve all laryngeal m ,except cricothyroid, sensory innevation below vocal cords
rejection of organ transplants involve humoral and cell mediated
immunologic reaction, hyperacute rejection due to preformed antibodies directed against antigens of graft , occur within mins after transplantation, histologically neutrophils are found within glomerulus, and peritubular capilaries,thse changes illustrate antigen antibody reaction at vascular endothelium similar to Arthus reacx
35 year old healthy person with no major underlying disease processex who eat lot of pizza and get very little exercise will most likely devlp
hypertrophy of steatocyts
49 year old woman has marked pain in her lower extremities, on ambulation more thsn 3oo m, her body masss index 32. she is smoker , on PE extremities cool and pale, without swelling/erythm. no dorsalis pedis or post tibial pulse palpable.which foll abnormalities of vsculture, is most likely to account thse findings?
atherosclerosis
she had claudication from severe peipheral arterial atherosclerosis,most likely from iliac arteries downshe has risk factor for atherosclerosis
58 year old african american man c.o pain in his eyes cannot go outside without sunglasses,he also have lowerback pain which wake him up in middle of night, whenever he sit long period pain gets worse,however on walking a bit pain subside significantly,which test for this patient might have a positive result?
HLAB27
ANKYLOSING SPONDYLITIS
means it can affect entire body,it cause fever,loss of appetite and fatigue and it can damage other orgsbeside joints, such as lung,heart and eyes, low back most involved, the eye mostly affected in ankylosing spondylitis, eye
inflamtion occur from time to time in 1/4th people with ankylosing spondlitis iritis result in red painful eye ,that can lead to photophobia or increased pain
when looking at bright light,inflamation ankylosing spondylitis,usually start at sacroiliac joint ,where lower spine joined to pelvis,pain inflammtion
associated with ank spondylitis,worse during period of rest or inactivity ,people at this condt wake up at middle of night with back pain,typically sx lessen with movt and exercise,
45 year old man has hx of recurrent gastric ulcer preent tohis PCP reporting that he has been vomiting up bright red blood and unable to swet. his doctor decide to do UGIseries as well as CT scan, result of CT show solid tumor in apex of left lung,which of foll most likely consequence of tumor.?
horner;s syndrome pancoast tumor
36 year old man with type 4 ehler danlos syndrome present to PCP for followup exam,he has no complaint,PE of heart, lung and abdomen is noncontributory,which foll likely complication of disease/
rupture of small intstine after eating meal
43 year old present to PCP foll triad micronodular pigment cirrhosis diabetes and changes in skin color and pigmentation,he also co difficulty catching breath when climbing stairs and has noticed increased swelling in his ankle at end of day, what likely dx?
hemochromatosis,the clssical triad hemochromatosis, iron deposited in various organ and causes triad symptoms, alcoholic hepatits, can have definite associated liver changes, budd chiari syndrome occlusion of inf vena cava or hepatic veins, it is associated with polycythemia vera and
hepatocellular ca and pregnancy,congestive heart failure definitly present but is secondary to hemochromatosis not a primary diagnosis\
61 year old male co headacheand pain in her jaw, when she try to eat, she also have visual impairment,pe reveal tenderness and nodules on left side of face near eye. biopsy of nodule seen,cardiac pulmonary annd abd exam wnl, good bowel sound in all quadrant, there is no evidenceof guarding or rebound tendernes esr 29 mm.hr, what appropriate treatment for this patient?
high dose corticosteroids
58 year old african american man c.o pain in his eyes cannot go outside without sunglasses,he also have lowerback pain which wake him up in middle of night, whenever he sit long period pain gets worse,however on walking a bit pain subside significantly,which test for this patient might have a positive result?
HLAB27
ANKYLOSING SPONDYLITIS
means it can affect entire body,it cause fever,loss of appetite and fatigue and it can damage other orgsbeside joints, such as lung,heart and eyes, low back most involved, the eye mostly affected in ankylosing spondylitis, eye
inflamtion occur from time to time in 1/4th people with ankylosing spondlitis iritis result in red painful eye ,that can lead to photophobia or increased pain when looking at bright light,inflamation ankylosing spondylitis,usually start at sacroiliac joint ,where lower spine joined to pelvis,pain inflammtion
associated with ank spondylitis,worse during period of rest or inactivity ,people at this condt wake up at middle of night with back pain,typically sx lessen with movt and exercise,
45 year old man has hx of recurrent gastric ulcer preent tohis PCP reporting that he has been vomiting up bright red blood and unable to swet. his doctor decide to do UGIseries as well as CT scan, result of CT show solid tumor in apex of left lung,which of foll most likely consequence of tumor.?
horner;s syndrome pancoast tumor
36 year old man with type 4 ehler danlos syndrome present to PCP for followup exam,he has no complaint,PE of heart, lung and abdomen is noncontributory,which foll likely complication of disease/
rupture of small intstine after eating meal
43 year ikd present to PCP foll triad micronodular pigment cirrhosis diabetes and changes in skin color and pigmentation,he also co difficulty catching breath when climbing stairs and has noticed increased swelling in his ankle at end of day, what likely dx?
hemochromatosis,the clssical triad hemochromatosis, iron deposited in various organ and causes triad symptoms, alcoholic hepatits, can have definite associated liver changes, budd chiari syndrome occlusion of inf vena cava or hepatic veins, it is associated with polycythemia vera and
hepatocellular ca and pregnancy,congestive heart failure definitly present but is secondary to hemochromatosis not a primary diagnosis\
61 year old male co headacheand pain in her jaw, when she try to eat, she also have visual impairment,pe reveal tenderness and nodules on left side of face near eye. biopsy of nodule seen,cardiac pulmonary annd abd exam wnl, good bowel sound in all quadrant, there is no evidenceof guarding or rebound
tendernes esr 29 mm.hr, what appropriate treatment for this patient? high dose corticosteroids
EM of zebra body in lysosomes in nieman pick diseas, zebra body look like lamellar boies in type 2 pneumocytes
enamel injury in young woman, bulimia, metabolic alkalosis from vomiting, boerhave syndrome
anorexia nervosa,secondaryamenorrhea, distorted bodyimage,osteoprosis, ventricular arythmia, most common cause of death
kwashirkor,decreased proteinintake bur normal total calorie intake,fatty liverfrom decreased apolipoproteins,pitting edema,flaky paint dermatitis marasmus, decreased total calorie intake,loss of muscle mass
vit a deff, squamous metaplasia in eyes, bronchus, nyctalopia vit a TOXICITY ,increased intracranial press, hypercalcemia
primaryhypothyroidisn, betacarotenemia, from decreased conversion of beta carotene into retinoic acid in intestine,thyroxine is cofactor,patient is
yellowbut for eyes
ricket vs osteomalacia,craniotabes and rachitic rosary in rickets, not osteomalacia, both have an increase in unmineralized osteoid
vit E DEFF.cerebellar dysfuncx, hemolytic anemia, toxicity ,interfere with Vit k dependent factor leading to hemorrhagic diathesis
vitC DEFF Teeth bleed when brshed,glossitis,perifollicular hemorrhage, tea and toast diet,
thimin deff\alcohol abuse most common, important biochemical reactions pyruvate dehydrogenase, transketolase,ketogluarate dehydrogenase, wenicke,confuson,ataxia, and nystagmus, korsakoff , antegrade and retrograde memory deficit, ring hemorhage in mamilary bodes and
periventriclar area, high output failure, congestive cardomyopathy, periphral neuropathy
niacin deff, importantbicochemical reacx, NAD/NADH, NADP/NADPH , pellgra, trytophan can be used to synthesize niacin, tryptophan decreased in Hartnup disease, carcinoid syndrome, converted into serotonin, corn diet,
diarrhea,dementia
Riboflavin deff, impt biochemical reac, FMN And FAD reac synthesis of
pyridoxine deff,INH most common cause,impt reacx, transaminase,heme synthesis,sidroblastic anemia with ringed sideroblasts, neurotransmiter synthesis ,absnt in goat;s milk
pantothenic acid, impt in fatty acid synthase complex,coenxyme reacx biotin deff, avidin in raw egg, binds vitamin,alopecia
gluconeogenesis well fed state increased fasting stat none starved state none glycogenolysis wel fed decreased some in liver and some in
muscle,fastingstat increased supplu of glucose derived from liver not muscle starved state, non glycogen used up
gluconeogenesis well fed none fasting , increased primary source after glycogenolysis,decreased just enough to supply rbc
triacylglycerol synthesis in liver/adipose well fed increased fasting none, starved none
lipolysis none, fasting increaed ,starved state increased
fate of glycerol well fed synthesise more Triacylglycerol in liver, fasting, substrate for gluconeogenesis starved substrate for gluconeogenesis
beta oxdation of fatty acids well fed non, fasting increased starved markedly increased primary fuel for muscle
cherry 15 year old girl periodically awaken middle of night screaming rapid breathing and tachycardia, she become oriented after several seconda and soon calm down and return to sleep morning she remember the dream andoften talks abot it at breakfast, what dignosis ,if any chrsty receive? nightmare disorder
hyperlippoproteinemia ,type 1 and 5 are having chylomicron associatd with them,type 2 increase in LDL and type 3 remnant
disease,dysbetalipoproteinemia, and increase in VLDL in type 4 and 5 PCR mechanism USES dna polymerase to break DNa into fragments physiologic effect of hemorrhage, drop in diastolic BP activeaiton of RAA system from decreased renal blood flow and catecholamine stimulation, catecholamine release from high presre barorecepor increased cardiac contractionincrease in peripheral resistance,stimulation of JG
apparatus,increased reabsorption of sodium from kidneys release of ANP and release of ADH
pneumocystitis, CMV,crytococcus, MAI,tb and herpes candida, cryptosporidium
cocain decreased uptake of DOPA AND NOR,
sign and sx of abuse serum protein electrphoresis diference between polyclonal and monoclonal gammopathy ch
absence of Y chromosome, germinal ridge move in direction of ovarian differentiation,presence of Y chromosome,testes differentiation
UVB light produce thymidine dimer,which if not replaced with Normal DNA by DNA REPAIR enzyme will result in cancer
ESR increase witha ge, probably abnormal and indicate a disease process rather than being age related finding
key element in wound healing,granulation tissue and fibronectin cause of death in 15-25 age Black male ishomicide
xeroderma pigmentosum
AR disease with absent DNA REPAIR enzyme and increased incidence of UVB related skin cancers
Cytochrome oxidase inhibited bby CO and cyanide
Chronic granulomatous disease of child hood SXR ABSENT NADPH oxidase absent respiratry burst, cannot kill catalase positive S aureus but can kill catalase negative streptococci
mosaicism non disjunction of somatic cells
mc vit deficency in alcoholic folate, most common meta deff in alcoholics, magnesium
vitamin asociatd with pyruvate dehydrogenase , thiamine always determine genetic sex of child with ambiguous genitalia
respiratory burst NADPH oxidase conversion of molecular oxygen into superoxide free radicals neutrophils and monocytes only
in caison disease, what is decreased when a diver comes up too quickly. PN2 inblood since it form bubbles in vessels and move into tisue
if 1 kidney damage other one undergo hypertrophy
vit E TOXICITY decrease vit leevel vit K dependent factor, and increased incidence of hemorhagic stroke,potentiates action of warfarin
biotin reaction carboxylase reaction in conversion of pyruvate to oxaloacetate pyridoxine transmination reacx involving transaminases AST and ALT
FUNX OF ANP
opposite of ang 2 inhibtion of ADH release, inhibit AT 2 effect on stimulating thirst,inhibits aldosterone secretion,inhibits renal reabsorption of Na, loss of sodium in urine and inhibit renin release
vasodilation of peripheral resistance vessels disorder asso with smokin and alcohol
chance of male with cystic fibrosis have child LESS than 5 percentsince vas deferns never flly develop or are atretic,female with CF pregnant but difficult owing to thick cervical mucus
ambiguous genitalia in 17 hydroxylase deficiency, nom male melepseudohermaphrodite
salt loser with volume depletion, yes in 21 hydroxylase, no in 11 hydroylase and 17 hydroxykase
salt retentiion with HTN no in2 1 hydroyzlase yes in 11 hydroxylase and 17 hydroxylase deff
plasma ACTH INCREASED IN 21,11, AND 17 hydroxylase hypocortisolism seen in 21,11 and 17
urine 17 ketosteroids, increased in 21 and increased in 11 decreased in 17 hydroxylase
urine 17 hydroxycorticoids decreased in 21 , and decreased in 17 and increased in 11
location of biochemical processes in cell
cytosol, glycolysis/pentose phosphate shunt/ FA synthesis \glycogen synthesis mitochondrial matrix , beta oxidation of FA/TCA cycle
Both cytosol and mi , gluconeogenesis urea cycle
heme synthesis
neurotransmiter from an essential amino acid ,serotonin coming from tryptophan
brain energy during starvation, ketone bodies/uses glucose during fed and fasting state
gluconeogrnic enzyme
'pyruvate carboxylase, phosphoenolpyrruvate carboxykinase, fructose 1,6 bisphosphatase,rate limiting, glucose 6 phosphatase
(deficient in von gierke glycogenosis_) RBC Ribosome
lost fter RBC leave bone marrow,persistence in peripheral blood produce Basophilic stippling, coarse basophilic stippling sign of lead poisoning, Ribonuclease denatured by Lead
beta thalasemia mechanisms
most often splicing defect for mild forms, severe beta thalasemia is due to a stop codon preventing betachain transcription
man with 2900 caloriediet with 30 percent of it representing fat, how many grams is fat
fat has 9 cal/g, 2900*0.30 IS 870 870/9=97 GMS
vmaxa and Km glucokinase high Km and low affinity for glucose and high vmax, in hexokinaselow km and low vmax
i cell disease inabilty to phosphorylate mannose residue of potential
lysosomal enzyme located in golgi apparatus hence they cannot be taken up by lyzosyme to degrade complex substrates
no of glucose necessary to build palmitic acid at 16 carbon compound 4 glucose each glucose run produce 2 acetyl coa ,latter containing 2 carbons
each
insulin lack in DKA ,DECREASED GLYCOLYSIS, glycogenesis ,fatty acid synthesis, storage of fat in adipose
24 year old femlae evaluated for progressive sob, she has no past medical hx and do not take any medication,
pulmonary HTN
most comon cause of coronary sinus dilatation evident on echocardiography is elevated right sided heart presusee and secondary to pulmonary artery HTN
esophageal manometric study perfrmed in 43 ear old male demonstrate periodic non peristaltic contraction of large amplitude and long
duration,clinical manifestationof patient condition mostly mimic' angina pectoris
group of investigator pattern of blood flow in various tissue, one of pattern they obtain
subendocardial myocardium
23 year old caucasian female come to phsicain office becos of migratory athralgia and skin rash thatexacerbaterd by sun exposure,urinalysis shows moderate proteinuria and RBC cast,serum autoantibodies with high
specificity for patients condition react wth ds DNA
an elderly female present to Er with sudden onset of severe low back pain, PE REVEAL severe kyphosis, xray back reveal compression fractur, of vertebral body in lumbar area along with marked thinning of bones, Serum calcium, phosphorus and alkaline phosphatase and parathyroid hormone levels are in normal limits,this woman;s bone changes likely due to
osteoporosis
osteopenia is reduction in amount of bone, is seen in
osteoporosis,osteomalacia and osteitis fibrosa, osteopoross predispose to fracture of weight bearing bone, such as femur and vertebral body
18 year old female vist gynecologist patient report she reeived vitamin A TREATMENT of acne, UNKNOWINGLY during 1st 2 months of undetected
pregnancy,which organ system develop fetus likely affected? skeletal and CNS
vitamin A is a member of retinoic acid family, retinoic acid directs in development of CNS axial skeleton vertebral column and probable
appendicular skeleton as well/ retinoic acid turn on various combination of homeobox genes depending on tissue type and location
51 year old woman presnt with pain in left leg that worsen on weight bearing , An x ray show demineralisation and decalcified biopsy show reduction in bone quality, quantity,undergone menopause age 49 without estrogen replacement, she report long standing diarrhea, also shw low vitamin D,CAL CIUM AND PHOSPHORUS AND elvated alk phosphatase, a second bone biopsy, which was not decalcified shows uncalcified osteoid on all bone surfaces, ON BASIS of data most likely diagnosis\
osteomalacia
58 year woman with lung cancer receiving adjucant therapy present with back pain that intensifies on movement and pain over L1 vertebral body when she cough and that radiate down her right lower extremity to her leg and foot, After patient passes , you suspect gross pathology of her vertebra, most likely etiology of disorder/
spinal cord compression
localized back pain and tenderness most initial complaints
6 year old patient present in clinic with megaloblastic anemia and failure to thrive, Blood chemistries reveal orotic aciduria, Enzyme measurement of white blood cells reveal deficiencyof pyrimidine biosynthesis enzyme orotate phosphoribosyltransferase and abnormally high activity of enzyme aspartate transcarbamoylase, Which following treatments will reverse all symptoms if carried out chronically?
25 year old pregnant female exhausted all times of day, Hrconjunctivae are pale lab test show she has normocytic normochromic anemia with low serum iron and increased TIBC, HEMOCULT test negative, which likely cause of anemia?
red cell Hb concentration is dramatically decreased and it contains only beta globin chains with virtual deficiency of alpha globin chains. which following mechanism potential explanation?
45 year man 1 week post MI now being treated with Iv heparin,Stool guaiac on admission was negative, but is now 4+ and he has episode of
hematemesis, The heparin is discontinued, and drug is counteract thr bleeding, what drug was given?
68 year old with hypercholesterolemia,which agent cause decreased VLDL and LDL. which cause cutaneous vasodilation that subsides with increased doses?
PGI2
in a presurgical patient great saphenous vein was cannulated with vicnity of ankle , during procedure, patient experienced severe pain that radiated along medial border of foot, Which following nerves was accidentally included in a ligature during this procedure?
saphenous nerve accompanies great saphenous vein along medial aspect of leg and foot as far as great toe
superficial fibular nerve innervate central portion of dorsum of foot, the medial and latral plantar branches of tibial nerve supple sole of foot 9 month baby girl brought tohospital emergency room because she has episodes of vomitting, headaches and problems in acquisition of motor skills, cranial nerve dysfunction and problem in breathing CT done, combination of syndrome relate to which disorder?
hydrocephals cause vomitting,hedaache acquisition of motor skill and
problem breathing. HYDROCEPHALUS often result fromcongenital acqueductal stenosis, whre there is impaired circulation of CSF DUE TO narrowing of
cerebral acqueduct
patient has muscular weakness, His parents and sister do not have weakness but his mother's brother has weakness yu suspect Duchenne Muscle
dystrophy, This is an example of X liked recessive disorder.
34 year old male hit by car and present to ER with compound fracture, THE DOCTORS are very concerned that this patient will develop osteomyelitis, which following organism account for majority cases of acute hematogenous and contiguous focus osteomyelitis?
staphylococcus aureus
a teenage girl enters Er suffering painful muscle spasms throughout exam, she sustan facial sneer, stiff arched back and clamped palms, Her father is anxious about fact she also experienced difficulty eating , probably due to stiff jaw, The father affrm daughter is usually quite active and boast, a week ago, she continued a soccer game, even after falling on a nail in field, what mechanism of action of toxin that is produced by organism that has infected this girl?
clostridium tetani
blocks release of inhibitory neurotransmitters GABA and glycine from Renshaw cell interneurons of spinal cord
the mechanism of action of synaptobrevin is blocking vesicle formation and release of inhibitory neurotransmitters GABA and glycine
a woman in India c.o fever, muscle pain and weakness of her trunk, abdomen and legs, This morning, she notes difficulty in swalowing, and neck pain, which prompts her to come to the hospital.. Physical exam reveal
fasiculations, and flacid paralysis, of lower limb and trunk, breathing troubled.CSF analysis reveal lymphocytosis ,pmn, and normal glucose and protein levels. The physician confirm the diagnosis by checking the womans vaccination history and prepares respiratory support in case her
breathingdifficulties worseN what is mechanism/.diagnosis?
poliovirus spreads toCNS by viremia, or retrograde transport in peripheral nerves, Then binds to receptors of anterior horn motor neurons and replcated lysing motor neurons innervating distal muscles, LOWER MOTOR NEURON DISEASE and proximaal muscles which lead to respiratry insufficiency and possibly death
44 year old woman goes to doctor complaining of weakness in her limbs and fatigability of her muscles, which lessens aftershe restsSometimes she does not have any muscle weakness, for months at a time, then she does, all this happening to her past few years, Her biggest complaint is that she
experience droopiness of her eyelidds.what is procedure to provide definite diagnosis?
anti acetylcholine receptor radioimmunoassay
women peaks in their 20 and 30 often affected/measurement in antibody acetyl choline receptor provide definitve diagnosis in 90% cases of
generalized disease which this patient manifest, and 50 percent inocular disease alone
after recovering viral resp infection, 20 year old female present with
weakness in her distal extremities that rapidly ascends to involve proximal muscles.PE OF PERIPHERAL nerve reveal inflammation and demyelination , radiculoneuropathy, what is best diagnosis?
guallian barre syndrome
this disease is characterized by weakness begining in distal limbs, but rapidly advancing to affect more proximal muscle function ascending paralysis and histlogically by inflammation and demyelination of peripheral nerves and spinal nerve roots.deep tendon reflex disappear early in process, although sensory involvement can often be detected, it is less troublesome than weakness, A resp infection always preced GBS
\55 YEAR old male discvered he had pain inneck and right arm and weakness in extending his fingers, of his right hand with loss of sensation in right thumb and middle fingers, A neurological exam frther revealed weakness of right biceps reflex, but other neurological signs could not be detected, most likely diagnosis
cervical disc prolapse, disorder involve pain in neck and arm which increases in movement of head. it also cause loss of some sensation in thumb and other fingers, as well as weakness in both finger extension and biceps reflex, Syringomyelia would produce bilateral segment loss of pain and temperature 44 year male bilateral pain in lwer back and legs with prolonged standing while working in car factory, whenever he sits down and takes a break he get some relief, but pain recur when he resume his job, no other inciting event can be identified, the mostlikely cause of problem
lumbar spine stenosis
it occur at times withexertion thus causng confusion with PVD, nerve
impingement by OA and BY degenerative disk diseaseteds to give radicular patern to discomfort
49 yar old male executive develop paralysis in rght side face which produce expressionless and drooping appearance, He is unable to close right eye and also c.o difficulty chewing and drinking, examinatio show loss of blink reflex in right eye to stimulation of either right.lef conjunctiva'lacrimation appear normal in right side but salivation is diminished and taste is absent on anterior right side of tongue, there is no complaint of Hyperacusis, audition and balance normal lesionlocated in
in facial canal just distal to genu of facial nerve
