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Osgood-Schlatter disease muscle

Quadricpes femoris

Reye syndrome liver biopsy show

Microvesicular steatosis

PE problem

V/Q mismatch

Autoimmune hepatitis liver biopsy

Portal and periporal lymphoplasmacytic cell infiltration, Anti-smooth muscle high

Anatomical feature last to disappear in lung

Cilia

Regeneration of alveolar ep lining a month later. what cells?

Type II pneumocytes

C7 nerve damage - increase, decrease or normal

Max inspiratory pressure and max epiratory p

Normal inspiratory (accessary inspiratory muscle and diaphram fine)

Decreased expiratory ( expiration muscles )

Acetaminophen overdose underlying mechanisms

Drug metabolite-induced mitochondrial dysfunction

Small particles in terminal bronchiole. what is responsible for clearing?

Ciliated cells

Coal dust worker, small, nodular opaciites in upper lobes, particle in respiratory bronchioles and alveolar duct? What responsible?

Phagocytosis - alveolar macrophages

Does Celiac disease have genetic component

Yes - DR2 and DR8

Chronic bronchitis most common cause

Tobacco smoking

Herpes simplex virus reactivation process? Mediated by?

Mediated by anterograde axonal transport

By kinesin

cause of Spina bifida occulta?

Failure of vertebral arch fusion

Anastrozole mechanism of action

Aromatase inhibitor - reduce synthesis of estrogen from androgen

Insulin increases glycolysis by?

Activating phosphofructokinase-2

Increase fructose 2,6-bisphosphate --> activate phosphofructokinase 1 -> convert fructose-6-phosphate to fructose-1,6-bisphosphate

Dobutamine causes increase in what

Increase HR, cardiac contractility --> increased myocardial oxygen consumption

Nutritional deficiency in vegan diet

Low vitamin B12, Vitamin D, calcium

Possible - iron, zinc * [low yield]

Neonate with rhinorrhea and maculopapular rash invovling palms/soles, limited prenatal care. Diagnosis?

Congenital syphilis

Pain on defecation, sharp severe subside in minutes. Tear in location?

Anal fissure - posterior midline distal to dentate line

Skin prick test 3 hours later wheal. Cause?

Ep damage from major basic protein

Gilbert syndrome levels

[ heaptocyte bilirubin storage, hepatocyte bilirubin excretion, bilirubin conjugation]

↓bilirubin conjugation

- hepatocyte bilirubin excretion

- hepatocyte bilirubin storage

Which receptors decrease insulin levels

A2 adrenergic

Somatostatin 2 (Gi)

14 yo boy chronic diarrhea, failure to gain weight, recurrent respiratory infeciton, previous sputum + Psuedomonas, younger bro died from resp infection. Diagnosis?

Cystic Fibrosis

Recurrent epigastric pain, vomiting chornic alch consumption, bilious vomiting, palpable epigastric mass. Vital and physical signs unremarkable. Diagnosis?

Pancreatic pseudocyst from chronic pancreatitis (leakage of pancreatic exocrine secretion from damaged duct)

Alcoholic, fever, tachy, jaundice, hepatomegaly, nausea, weight loss

Steatohepatitis

Increased glycerol 3-P formation

Mallory Body (shows balloon degenration)

What artery supplies upper esophageal sphincter

Inferior thyroid artery from thyrocervical trunk (cervical portion of esophagus and thoracic inlet)

Why does H. influenza grow better with Staph aureus on 5% blood sheep agar

H influenza requires both X factor (hematin) and V factor (NAD+) to support growth, staph aureus secrete V factor (NAD+)

Firm, violaceous nodules on patient's right upper arm after 10 years of breast cancer treatment and extensive axillary lymph dissection. Diagnosis?

Angiosarcoma [extensive lymph node dissection causing chronic lymphedema] A rare vascular tumor that can arise in areas of chronic lymphedema, often associated with prior radiation or surgical interventions.

How does angiosarcoma develop in patients with chronic lymphedema?

Combination of increased lymphatic proliferation (increase likelihood of malignant cells) and decreased number of lymph node (decrease ability to remove malignant cells)

Angiosarcoma develops in patients with chronic lymphedema due to prolonged exposure to inflammatory mediators and tissue hypoxia, which promote neoplastic transformation of lymphatic endothelial cells.

Adult with Single, soft, rubbery, asymptomic, cutaneous nodule durign second and third decade of life. Diagnosis?

neurofibroma

A new inhaled anesthetic has a large arteriovenous (A-V) concentration gradient shortly after inhalation begins. What does this indicate about:

• peripheral solubility

• onset of action

• arrival to brain

• indicates high peripheral tissue solubility (likely lipid solubility)

• a slow onset of action

• The large A-V gradient means the anesthetic is being avidly taken up by peripheral tissues

  • delaying its arrival to the brain

  • thus slowing the onset of anesthesia.

what causes postpartum thyroiditis

autoimmune destruction of thyroid follicles, lymphocytic infiltration of thyroid tissue, leading to transient primary hyperthyroidism followed by hypothyroidism.

loss of testosterones effects

• lean body weight

• subcutaneous fat

• bone density

• prostate glandular volume

• decreased lean body weight

• increased subcutaneous fat

• decreased bone density

  • decrease prostate glandular volume

tissues supplied by what artery would be most liekly affected by compression of splenic artery

short gastric

(remember left gastroepiploic has anastomes)

why would you add acetazolamide to treatment regimen when you give patient other loop diruetics ?

metabolic alkalosis

headache, difficulty with vision. acute hemorrahge in left temporal lobe, compression of anteiror medial temporal lobe against tenorium cerebelli. diagnosis? what nerve affected?

uncal herniation

Oculomotor

Of the following, which will appear earliest in alcohol withdrawl?

• nystagmus

• tremulousness

• seizures

• visual hallucinations

tremulousness

what most likely cause these findings?

central diabetes insipidus [decrease vsopressin secretion → excessive free water excretion —> hyperosmotic volume contraction

emergency SOB, palpitation, pulmonary edema, afib with rapid ventricular response. Histology= thick myocardial fibers with large hyperchromatic nuclei and mild intersitiial fibrosis. autopsy shown. Diagnosis?

hypertensive heart disease (uniform thickened)

How to differentiate between hypertensive heart disease vs. hypertorphic caridomyopahty?

hypertrophic - uniform thickening of LV walls with reduction in LV cavity size

hypertorphic cardiomyopahty - localized thickening of LV walls predominantly affecting interventricular septum

osteoporosis bone structure changes

trabecular thinning with fewer interconnections

best initial treatment for gout

NSAID (COX inhibitor)

how can high-dose IL 2 therapy used for advanced renal cell carcinoma and metastatic melanoma lead to long-lasting remission?

enhanced activity of natural killer cells

why do patients on warfarin who take antibiotics (eg - metronidazole, marolides, fluroquiolones for gram - organisms) develop supratherapeutic INR

alter gut flora → disruption of vitamin K producing intestinal flora [remember supratherapeutic means higher INR]

if you take cytochrom P450 inducer (ex- phenytoin, carbamazepine, rifampin) with warfarin, what will happen to INR?

subtherapeutic INR (decreased INR)

what is the most direct cause of fibrous cap formation of atheorma (atheroscloersis)?

medial smooth muscle cells (synthesize extracellular matrix protein → form fibrous cap)

what organ is least susceptible to infarction after occlusion from left atria?

liver (dual/collateral blood supply, hepatic artery and portal vein)

stepped on old nail, pain near site, imaging shows gas in tissues, extensive tissue necorsis. gram positive rod. organism? mechanism of action?

clostridium perfingens → splits host phospholipid

pentad for acquired thormbotic thrombocytopenia purpura (TPP)

1) severe thrombocytopenia

2) microangiopathic hemolytic anemia

3) neurologic manifestations

4) renal insufficiency

5) fever

pathophysiology of TTP

↓ ADAMTS13 → uncleaved vWF multimers → platlet trapping and activation

Mucosal Lymphocyte Trafficking - "Common Mucosal System"

Lymphocytes activated in one mucosa (e.g., lung) can travel to other mucosae (e.g., vagina) and provide IgA protection.

Acyclovir - Activation Enzyme

Viral Thymidine Kinase (TK)

Acyclovir - Drug Class

Guanosine Analog, Viral DNA Polymerase Inhibitor

Hydatidiform Mole - Fetal Tissue: Complete vs. Partial

Complete: Absent; Partial: Present (but abnormal)

baby with cardiac defect (tetralogy of fallot), abnormal facies (clef palate, wide eyes), thymic aplasia, cleft palate and hypocalcemia. diagnosis and mechanism?

DiGeorge - 22q11.2 microdeletion

Mannitol

Drug Class and MOA?

osmotic diuretic

MOA: draws water from tissue (brain) into blood stream, recedue cerebral edema/ICP

Mannitol Side effect respiratory

pulmonary edema (rapid increase in intravascular volume)

Atrial fibrillation - effect on preload in Aortic stenosis

sudden decrease in left ventricular preload (loss of atrial kick)

Carotid Sinus Massage - Effect on Baroreceptor Firing Rate

INCREASED firing rate (stimulates baroreceptors, they sense increased pressure)

how does carotid sinus massage decrease heart rate?

via vagal nerve stimulation, prolonged AV node refractory period

Monoclonal Antibody (mAb) Therapy - Primary Immune Mechanism

Antibody-Dependent Cellular Cytotoxicity (ADCC)

Antibody-Dependent Cellular Cytotoxicity (ADCC) primary effector cell Type

Natural Killer Cells

Monoclonal Antibody DRUG" (e.g., Trastuzumab) - Type of Immunoglobulin

IgG (therapeutic, specific target, Antibody Dependnet Cellular Cytotoxicity) - NOT IgM

Fever + Fatigue + Early Diastolic Murmur (AR) + subungal Splinter Hemorrhages + Leukocytosis + Elevated ESR + gram positive cocci

strep viridians —> subacute bacterial endocarditis

which bacteria Synthesizes DEXTRANS from sucrose

strep viridians

Jarisch-Herxheimer Reaction - Primary Mechanism

Drug-induced bacterial cell wall disintegration releases bacterial components (lipoproteins, cytokines) -> Systemic inflammatory response.

Jarisch-Herxheimer Reaction vs. Penicillin Allergy (type 1) timing

Hours (2-12 hours) after treatment initiation vs. minutes to 1 hour

Thoracodorsal Nerve - Primary Function

Motor to Latissimus Dorsi Muscle (shoulder adduction, extension, internal rotation)

Post-mastectomy, medial upper arm burning pain and sensory loss near axilla, normal shoulder ROM. what nerve injury

INTERCOSTOBRACHIAL NERVE INJURY (sensory only)

Diabetic Cataracts - Primary Metabolic Pathway

Glucose -> aldose reductase —> Sorbitol (Polyol Pathway)

Galactosemia Cataracts - Primary Metabolic Pathway

galactose -> aldose reductase —> Galactitol (Polyol Pathway)

Hyperthyroidism - Bone Loss Mechanism

Increased Osteoclast Stimulation -> Increased Bone Resorption - NOT primarily decreased mineralization

Proximal Fibula Fracture - Nerve at Risk (Most Common)

Common Peroneal Nerve (Common Fibular Nerve)

Superficial Peroneal Nerve - Sensory Territory

Dorsum of the Foot (major area), Distal Anterior/Lateral Lower Leg

Deep Peroneal Nerve - Sensory Territory

Webspace between 1st and 2nd Toes (small area)

Common Peroneal Nerve Injury - Motor Deficit (Classic)

Foot Drop (Dorsiflexion weakness), impaired Eversion

Abrupt-onset, Severe, "Tearing" or "Ripping" Chest Pain, Radiating to Back. Diagnosis?

Aortic Dissection

Aortic Dissection - Key Physical Exam Finding

Blood Pressure Differential between Arms (or pulses)

post-neck surgery (tongue cancer, lymph nodes), increasing shortness of breath, large LEFT PLEURAL EFFUSION. what structure injured?

thoracic duct

Sarcoidosis - Cytokine Profile (Key Set)

Th1 cytokines:

IL-2 - T cell growth factor, prolif

IFN-γ - macrophage activation and granuloma

TNF-alpha

(less primary than IL-2, IFN-γ for defining Th1 response in sarcoidosis immunology questions)

Th1 Response - Primary Immune Function

Cell-mediated immunity, Intracellular pathogen defense, Granuloma formation

Th2 Response - Primary Immune Function

Humoral immunity (antibody production, especially IgE), Extracellular parasite defense, Allergic reactions

pregnant woman with fever, vomit, dirreha (febril gastronetiertiis) and gram positive rods in blood stream. what bacteria"?

LIsteria monocytogenes

Listeria monocytogenes pathogenesis

• listerionolysin O: pore in phagosome memrbane

• actin-based transcellular spread (hijack actin cellular motility)

most important opsonin

IgG and complement C3b * coating proteins

Normal Hemoglobin (HbA)

• Structure

• _____ Binding

• _______ Dissociation Curve

Tetramer (α2β2), Cooperative Binding, Sigmoidal Oxygen Dissociation Curve

Monomeric Beta Subunits - Cooperativity?

No Cooperativity (tetramer disrupted)

Cooperativity and Curve Shape

Cooperativity -> Sigmoidal Curve; No Cooperativity -> Hyperbolic Curve

Monomeric Beta Subunits - Oxygen Affinity

Higher Oxygen Affinity (especially at low PO2) compared to HbA

Oxygen Dissociation Curve - Left Shift Indicates...

Increased Oxygen Affinity

HIV Entry Coreceptors - Primary Types

CCR5 and CXCR4

CCR5 Coreceptor - Cell Tropism Association (General)

Macrophages and T-cells

CXCR4 Coreceptor - Cell Tropism Association (General)

Primarily T-cells

gp120 V3 Loop - Role in Tropism

Determines Coreceptor Preference (CCR5 vs. CXCR4)

Maraviroc - Antiretroviral Class and Target

Entry Inhibitor, CCR5 Antagonist

V3 Loop Mutation Causing CCR5 Resistance - Drug Ineffective?

Maraviroc (CCR5 Antagonist) - Ineffective if virus is no longer CCR5-dependent for entry (especially into macrophages)

Painful, Heavy Menses (Dysmenorrhea & Menorrhagia), Regular Cycles, Endometrial Tissue in Myometrium. Diagnosis?

Adenomyosis

Irregular Bleeding, Pelvic Pain, Plasma Cells in Endometrium. Diagnosis?

Chronic Endometritis

Painful Menses (Dysmenorrhea), Pelvic Pain, Endometrial Tissue Outside Uterus. Diagnosis?

Endometriosis