Usmle Flashcards
Diseases with Psammoma Bodies
P-SA-MM-oMaPapillary carcinoma of thyroidSerous papillary cystAdenocarcinoma of ovaryMalignant MesotheliomaMeningioma
Cancers caused by mutation on Rb gene
RetinoblastomaOsteosarcomaBreastLungColon
B Cell surface proteins
IgCD 19, 20, 21, 40MHC II, B7
Macrophages surface proteins
CD 14, 40MHC II, B7Fc and C3b receptors
NK cells surface proteins
CD 16CD56 (unique to NK)
Cells with CD15
GranulocytesReed-Sternberg cells (useful for diagnosis of Hodgkin lymphoma)
Selegine mechanism of action
Selectively inhibits MAO-B
Amantadine mechanism of action
Increases dopamine releaseDecreases dopamine reuptake
Bromocriptine mechanism of action
Direct dopamine agonist(use can delay need for l-dopa)
Pramipexole, ropinirole mechanism of action
Direct dopamine agonist(use can delay need for l-dopa)
Tolcapone mechanism of action
Inhibits central and peripheral COMT
Low potency, typical antipsychotics side effects
Anticholinergic (most)antihistaminicantinoradrenergic
High potency, typical antipsychotics side effects
Less anticholinergicEPS / tardive dyskinesia (mouth movements)Neuroleptic Malignant Syndrome
Atypical antipsychotics side effects
little EPSlittle AnticholinergicWeight Gain
Histological alterations in Hepatitis B
Finely granular homogenous eosinophilic intracellular inclusions(HBs accumulation)
Histological alterations in hepatic steatosis
Large and small vesicles of fat
Histological alterations in alcoholic hepatitis
Mallory bodies (intracytoplasmatic eosinophilic inclusions of damaged keratin filaments)NecrosisNeutrophilic infiltrate
Difference between Tourette and Chronic Tick Syndromes
Tourette: multiple motor AND 1 or more vocal ticks >1 yearChronic Tick: motors OR vocals > 1 year
Urge incontinence etiology
Detrusor overactivity
Urge incontinence symptoms
Sudden, overwhelming or frequent need to urinate
Urge incontinence treatment
Anti-cholinergic drugs:OxybutyninImipramine
Overflow incontinence etiology
Impaired detrusor contractility, bladder outlet obstruction
Overflow incontinence symptoms
Constant loss of urine & incomplete emptying
Overflow incontinence treatment
Treat obstruction (finasteride if BPH)Betanechol if detrusor pathology
Function of NF-kB
Production of cytokines
Sulfa Drugs
"Sulfa Pills Frequently Cause Terrible Acute Symptoms"SulfazalazineProbenecidFurosemideCelexoxibeThiazides/TMP-SMXAcetazolamideSulfonylureas
Cytochrome P450 inducers
"Coronas, Guinness and PBRS induce chronic alcoholism."(also remember C, P and B, like alcohol depress CNS)CarbamazepineGriseofulvinPhenytoinBarbituratesRifampinSt John's WartChronic alcoholism
Cytochrome P450 inhibitors
CRACK AMIGOSCimetidineRitonavirAcute AlcoholCiprofloxacinKetoconazoleAmiodaroneMacrolidesIsoniazidGrapefruit juiceOmeprazolSulfonamides
Mushroom toxin and its mechanism of action
AmatoxinInactivates RNA polymerase II
Test for fetal lung maturity
Lecithin/Sphingomyelin > 1.9Lecithin is aka phosphatidylcholine
Wiskott-Aldrich Syndrome triad
WATERThrombocytopeniaEczemaRecurrent infections
Presentation of Chédiak-Higashi syndrome
Recurrent pyogenic infectionsPartial albinismPeripheral neuropathyProgressive neurodegenerationInfiltrative lymphohistiocytosis
Physiopathogeny of Chédiak-Higashi syndrome
Genetic defect in lysosomal trafficking leading to microtubule dysfunction in phagosome-lysosome fusion
Small cell carcinoma of the lung secretion
(possibly) ACTH and/or Vasopressin
Squamous cell carcinoma of the lung secretion
(possibly) PTHrP (PTH-like hormone)
Symptoms of primary hyperparathyroidism
"bones, stones, groans and psychic overtones."Bone painRenal stonesAbdominal pain (e.g. peptic ulcer disease)Psychiatric disorders
Bone alterations in hyperparathyroidism
Subperiosteal erosions in phalanges of the hand"Salt and pepper" pattern in skullCystic bone lesions in long bones
Bone alterations in Paget disease
Disorganized lamellar bone structure in a mosaic pattern(Paget: french artist that does mosaics)
Bone alterations in Vitamin D defficiency
Osteoid matrix accumulation around trabeculae
Bone alterations in Osteoporosis
Trabecular thinning with fewer interconnections
Bone alterations in Osteopetrosis
Persistence of the primary spongiosa in the medullary cavity with no mature trabeculae
Differences between NMS and Serotonin Syndrome
NMS SSHyporeflexia Hyperreflexia (saltitante)Normal pupils Dilated pupils (= ecstasy)
Meiosis phases for the oocyte during female life
Formation in embryogenesisArrest in prophase ICompletion of Meiosis I during ovulationArrest in Metaphase II until fecundation
Causative agents of culture-negative endocarditis
HACEKHaemophilusActinobacillusCardiobacteriumEikenellaKingella
Structure injured on decelerations/pivots on an extended knee
Anterior cruciate ligament
Structures injured on lateral force applied to an extended knee
"Unhappy triad"Anterior cruciate ligamentMedial (tibial) collateral ligamentLateral meniscus / Medial meniscus
Diseases associated with Non-Bacterial Thrombotic Endocarditis
LESAntiphospholipid syndromeDICAdvanced malignancy
Drugs that can cause gynecomastia
"Some Drugs Create Awesome Knockers"SpironolactoneDigoxinCimetidineAlcoholKetoconazole
Histological appearance of an intraductal papilloma
Papillary cells with fibrovascular core
Red rashes of childhood
Hand-foot-mouth disease (Coxsackie A)Roseola/Exanthem subitum (HHV-6)Measles/rubeolaErythema infectiosum/5th disease (Parvovirus B19)Rubella/german measlesScarlet fever (Streptococcus pyogenes)Chickenpox (VZV)
Structures damaged in a fracture of the surgical neck of the humerus
Posterior circumflex arteryAxillar nerve
Structures damaged in a midshaft fracture of the humerus
Deep brachial arteryRadial nerve
Structures damaged in a supracondylar fracture of the humerus
Brachial artery
Parameters to monitor with amiodarone use
Pulmonary, liver and thyroid function
Parameters to monitor with lithium use
Thyroid and renal function
Diseases that can course with hilar adenopathy
TuberculosisEndemic mycosisSarcoidosisSilicosisBerylliosisLymphomaBronchogenic carcinoma
Mechanism of action of Fibrates
Upregulates lipoprotein lipase â increases uptake and oxidation of fatty acidsActivates PPAR-α â â HDL synthesisInhibits cholesterol 7α-hydroxylase (rate limiting step in bile acid synthesis) â cholesterol stones
Medications that can cause hyperkalemia
Nonselective beta blockers (Ã-2 mediated intracellular K+ uptake)ACE inhibitorsAngiotensin II receptor blockersK+ sparing diureticsDigoxin (Na+/K+ pump)NSAIDs (impair renin and aldosterone synthesis)
Mechanism of action of Organophosphates
Irreversible inhibition of acetylcholinesterase
Antidote for organophosphate poisoning
Pralidoxime (binds to drug thus unblocking AChterase)Atropine
Mechanism of action of pralidoxime
Reverses organophosphate AChsterase phosphorylation
Hallmark of Acute Respiratory Distress Syndrome
Hyaline membranes in alveolar ducts
Foregut structures and artery
Mouth to second part of duodenumCeliac trunk (exception of mouth, pharynx and superior esophagus)
Midgut structures and artery
Third part of duodenum to proximal 2/3 of transverse colonSuperior mesenteric artery
Hindgut structures and artery
Distal third of transverse colon to rectumInferior mesenteric artery (below pectinate line: inferior rectal a.)
Difference between 21-hydroxylase vs aromatase deficiency
No salt wasting on aromataseNo mother virilization on 21α-hydroxylase
Antibody associated with Antiphospholipid Antibody Syndrome
Anti-cardiolipin
Antibody associated with Primary Biliary Cirrosis
Anti-mitochondria
Antibody associated with Autoimune hepatitis
Anti-smooth muscle
Antibody associated with Pemphigus Vulgaris
Anti-desmoglein (1 and 3)
Features of patella fracture
PainSwellingInability to extend the knee
Always prescribe together with Isoniazid
Pyridoxin
Features of McCune Albright Syndrome
Café-au-lait spotsEndocrine abnormalities (precocious puberty, hyperthyroidism)Fibrous dysplasia
Histopathologic findings in Alzheimer's Dementia
Senile (β-amyloid) plaquesNeurofibrillary tangles of tau proteinAmyloid angyopathy
Histopathologic findings in Vascular Dementia
Large areas of encephalomalacia
Histopathologic findings in Frontotemporal Dementia
Pick bodies: round/oval intracytoplasmic inclusions seen on silver stain
Neural crest derived structures
MOTEL PPAASSMelanocytesOdontoblastsTracheal cartilageEnterochromaffin cellsLaryngeal cartilageParafollicular cells of the thyroid - Pia and ArachnoidAorticopulmonary septum - Adrenal medulla and all gangliaSchwann cells - Spiral membrane
Conditions that cause wide splitting of the heart sounds
(those that delay pulmonic valve closure)Pulmonic stenosisRight bundle branch block
Conditions that cause fixed splitting of heart sounds
Atrial septal defect(increase in RV volume is so great that inspiration makes no difference)
Conditions that cause paradoxal splitting of heart sounds
(those that delay aortic valve closure)Aortic stenosisLeft bundle branch block
Meglitinides (repaglinide) mechanism of action
(similar to sulfonylureas)Bind to Katp channelsincrease [Ca]release insulin
Glitazones mechanism of action
Bind to PPAR-gamaIncrease transcription of genesDecrease insulin resistance
GLP-1 (exenatide, liraglutide) analogs mechanism of action
Increase insulin secretionDecrease glucagon releaseDecrease gastric emptying
DPP-4 inhibitors (linagliptin, saxagliptin, sitagliptin) mechanism of action
Inhibit DPP-4, enzyme that breaks incretins (GLP-1, GIP)Increase insulin secretionDecrease glucagon releaseDecrease gastric emptying
Examples of alpha-glucosidade inhibitors
AcarboseMiglitol
SGLT-2 inhibitors (-gliflozin) mechanism of action
gli - glucose ; flo - flow, urineInhibit glucose reabsorption in PCT
Thiazolidenediones side effects
Fluid retention-Weight gain-Heart failure
GLP-1 agonists side effects
Pancreatitis
DPP-4 inhibitors side effects
Nasopharyngitis
Pathophysiology of Paget bone disease
Increased RANK activation (increased RANK-L and/or decreased OPG) resulting in:Osteolytic phaseMixed phaseOsteosclerotic phase
Features of acute poststreptococcal glomerulonephritis
LM - glomeruli enlarged and hypercellularIF - starry sky appearance due to IgG, IgM and C3 deposition along GBM and mesangiumEM - subepithelial immune complex humps~2 weeks after group A strep infectionType III hypersensitivity - ATB doesn't preventâ anti-DNase Bâ complement levels
Features of rapidly progressive (crescentic) glomerulonephritis
LM and IF - crescent moon shapeCrescents of fibrin and plasma proteins (C3b) + parietal cells, monocytesAssociated with:Goodpasture Syndrome (type II hypersensitivity - AB to GBM and alveolar BM)Granulomatosis with polyangiitis (Wegener)Microscopic polyangiitis
Types of RPGN
Anti-Glomerular Basement Membrane RPGNImmune-complex RPGNPauci-immune RPGN
Features of Anti-GBM RPGN
Linear deposits of IgG and C3Associated with Goodpasture Syndrome
Features of Immune-complex RPGN
Lumpy-bumpy deposits of IgG/IgA and complementAssociated with PSGN, LES, IgA nephropathy
Features of Pauci-immune RPGN
No immune complex depositionAssociated with Granulomatosis with polyangiitis, microscopic polyangiitis and idiopathic RPGN
Features of diffuse proliferative glomerulonephritis
LM - wire looping of capillariesEM - sub endothelial and sometimes intramembranous IgG-based ICs often with C3 depositionIF - granularAssociated with LES and Membranoprolipherative glomerulonephritis
Features of IgA nephropathy (Berger)
LM - mesangial proliferationEM - mesangial IC depositsIF - IgA-based IC deposits in mesangiumAssociated with Henoch-Schonlein purpura
Features of Alport Syndrome
Mutation in type IV collagen â thinning and splitting of BMEye problemsGlomerulonephritisSensorineural deafness
Features of membranoprolipherative glomerulonephritis
Type I - subendothelial IC deposition â tram-track appearanceType II - intramembranous IC depositsAssociated with hepatitis B or C (type I) and C3 nephritic factor (type II)
Features of focal segmental glomerulosclerosis
LM - segmental sclerosis and hyalinosisIF - focal deposits of IgM, C3, C1EM - effacement of foot process (~to minimal change)Most common nephrotic sd in Blacks and Hispanics
Features of minimal change disease
LM - normalIF - normalEM - efficient of foot processesMost common nephrotic sd in childrenAssociated with recent infection, immunization...
Features of membranous nephropathy
LM - diffuse capillary and GBM thickeningIF - granular (IC deposition)EM - spike and dome appearanceMost common nephrotic sd in whitesCan be triggered by drugs or infectionsIgG4 AB against PLA2R in podocytes
Features of Amyloidosis
Apple-green birefringence on Congo red stainAL/1º - Ig Light chainsAA/2º - Amyloid A, chronic inflammatory conditionsDialysis-related - β2-microglobulin, may present with carpal tunnel syndromeHeritable - mutated transthyretin depositionAge-related/senile systemic - wild transthyretin depositionAge-related/senile organ-specific - Alzheimer's, Islet amyloid polypeptide in DM2
Features of diabetic glomerulonephropathy
LM - mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesions - bolotas gordas)Non enzymatic glycosylation of GBM â â permeability, thickeningNon enzymatic glycosylation of efferent arteriole â âGFR â mesangial expansion
Class IA anti arrhythmics alterations on the depolarization curve
ââ slope of depolarizationâ depolarization time
Class IB anti arrhythmics alterations on the depolarization curve
â slope of depolarizationâ depolarization time
Class IC anti arrhythmics alterations on the depolarization curve
âââ slope of depolarizationno alteration on depolarization time
Number Needed to Harm formula
NNH = 1 / Attributable RiskAR = Risk(treatment) - Risk(control)
Cause of pseudohypoparathyroidism
Peripheral resistance to PTH
Hypomagnesemia induces this parathyroid abnormality
Hypoparathyroidism
Paroxysmal Nocturnal Hemoglobinuria pathophysiology
PIGA gene mutationâ synthesis of GPI anchor proteinâ binding of cell surface proteins CD55 and CD59â protection against complement-mediated lysis
Paroxysmal Nocturnal Hemoglobinuria features
Hemolytic anemiaHematuriaThrombosisPancytopenia (stem cell injury)
Mechanism of action of Buspirone
nonbenzodiazepine anxiolyticpartial agonist of 5HT1a receptor
Antibody associated with Rheumatoid Arthritis
Anti-cyclic citrullinated peptide antibodies
Diseases associated with HLA-B27
PAIRPsoriasic arthritisAnkylosing spondylitisIBD associated arthritisReactive (Reiter) Arthritis
Glioblastoma multiforme features
Highly malignant astrocytomaCerebral hemispheresCan cross corpus callosumGFAP +Pseudopalisading pleomorphic tumor cells
Meningioma features
Typically benignOften occur in superficial parts of the brainArises from arachnoid cellsPsammoma bodies
Hemangioblastoma features
Most often cerebellarAssociated with von Hippel-Lindau sd when found with retinal angiomasCan produce erythropoietinThin-walled capillaries with minimal parenchyma between
Schwannoma features
Classically at cerebellopontine angleS-100+Association with NF 2
Oligodendroglioma features
Rare, slowMost often in frontal lobesFried egg cells (round nuclei with clear cytoplasm)
Pilocytic (low grade) astrocytoma features
ChildrenBenignMost often in posterior fossa (e.g. cerebellum)GFAP +Rosenthal fibers - eosinophilic fibers coming out of tumor
Medulloblastoma features
ChildrenHighly malignantCerebellarCan compress 4th ventricle â hydrocephalusDrop metastases to spinal cordSolid, small blue cells
Ependymoma features
ChildrenMalignantMost common in 4th ventricleCan cause hydrocephalusPerivascular rosettes
Craniopharyngioma features
ChildrenBenignMost common supratentorial in childrenConfused with pituitary adenoma
Temporal (giant cell) arteritis features
Large-vesselElderly femalesAffects branches of carotid arteryUnilateral headacheJaw claudicationOphthalmic artery occlusionAssociated with polymyalgia rheumaticaFocal granulomatous inflammationâ ESRHigh dose corticosteroids prior to temporal artery biopsy to prevent blindness
Takayasu arteritis features
Large-vesselYoung asian femalesWeak upper extremity pulsesFever, night sweats, arthritis, myalgias...Granulomatous thickening and narrowing of aortic arch and proximal great vesselsâ ESR
Polyarteritis nodosa features
Medium-vesselYoung adultsAssociated with hepatitis BMany systemic symptomsRenal and visceral vesselsNOT Pulmonary arteriesImmune complex mediatedTransmural inflammation of the arterial wall with fibrinoid necrosisRenal microaneurysms
Kawasaki disease features
Medium-vessel< 4 yo Asian childrenCoronary artery aneurysms â fatal"CRASH and burn your Kawasaki."Conjunctival injectionRashAdenopathyStrawberry tongueHand-foot changesFever
Buerger disease features
Medium-vesselHeavy smokersMales < 40 yoIntermittent claudication â gangreneSegmental thrombosingRaynaud phenomenon
Granulomatosis with polyangiitis (Wegener) features
Small-vesselTriad:Focal necrotizing vasculitisNecrotizing granulomas in the lung and upper airwayNecrotizing glomerulonephritisPR3-ANCA/c-ANCA +
Microscopic polyangiitis features
Small-vesselNecrotizing vasculitis in lung, kidneys, skinno nasopharyngeal involvementNo granulomasMPO-ANCA/p-ANCA +
Eosinophilic granulomatosis with poliangiitis (Churg-Strauss) features
Small-vesselAsthmaSinusitisSkin (purpura)Peripheral neuropathyCan involve heart, GI, kidneysGranulomatous, necrotizing vasculitis with eosinophiliaMPO-ANCA/p-ANCA +
Henoch-Schonlein purpura features
Small-vesselOften follows URITriad:Palpable purpuraArthralgiasAbdominal pain
Burkitt lymphoma features
Mature B cellsAdolescentst(8;14) - c-myc (transcription activator) + Ig heavy chainStarry sky appearanceAssociated with EBVJaw lesion in endemic form in AfricaPelvis or abdomen lesion in sporadic form
Follicular lymphoma features
Mature B cellsAdultst(14;18) - Ig heavy chain + BCL-2 (â apoptosis)IndolentWaxing and waning lymphadenopathy
Mantle cell lymphoma features
Mature B cellsOlder malest(11;14) - cyclin D1 + Ig heavy chainCD5+
Adult T-cell lymphoma features
Mature T cellAdultsCaused by HTLV (~ IV drug)Cutaneous lesionsLytic bone lesions â hypercalcemia
Mycosis fungoides / Sézary syndrome features
Mature T cellAdultsCutaneous CD4+ T-cell lymphoma â T-cell leukemia (Sézary sd)
Acute Lymphoblastic Leukemia/Lymphoma features
< 15 yearsAssociated with Down SdBlood and marrow âââ lymphoblastsTdT+ (pre-T/B) or CD10+ (pre-B)Spread to CNS and testest(12;21) â best prognosis
Small Lymphocytic Lymphoma / Chronic Lymphocytic Leukemia features
> 60 yearsMost common adult leukemiaCD20+, CD5+ (B-cell neoplasm)Autoimmune hemolytic anemiaSLL = CLL except CLL has â blood lymphocytosis and marrow involvement
Hairy cell leukemia features
AdultsMature B cell tumors in the elderlyCauses marrow fibrosis â dry tapStains STRAP
Acute myelogenous leukemia features
±65 years oldperoxidase + cytoplasmic inclusions in M3 AMLâ â â myeloblasts in bloodAssociated with Down Sdt(15;17) â M3 AML
Chronic myelogenous leukemia features
45-85 yoPhiladelphia chromosomet(9;22) - BCR + ABLâ neutrophils, metamyelocytes, basophilsMay transform into AML or ALLâ LAP (leukocyte alkaline phosphatase) vs leukemoid reactionTreat with imatinib
Langerhans cell histiocytosis features
Childlytic bone lesions and skin rash or recurrent otitis mediaS-100+
Chromosomal translocations causing leukemia
L1mphom4t(8;14) â Burkeight t(9;22) â Philadelphiat(11;14) â Man11e cellt(14;18) â Follicular lymphomat(15;17) â M3 type of AMLt(12;21) â ALL
Retroperitoneal Organs
SAD PUCKERSuprarenal glandsAorta & inferior vena cavaDuodenum (except 1st and 4th parts)Pancreas (except tail)UterusColon (except transverse)KidneysEsophagusRectum
Spinal cord morphology variations
Rostrally: more ovoidmore white/gray matterNear the arms & legs: â ventral hornFrom T1-L2: lateral horns (sympathetic)
Kozak sequence
Required for Eukaryotic translation initiationGCCGCC(g/a)CCAUGgAUG - start codon / methionine
Shine-Dalgarno sequence
Required for E. coli translation initiationAGGAGGU..........AUGAUG - start codon / f-methionine
Use of Para-aminohippuric acid (PAH)
Calculate Renal Plasma Flow (RPF)RPF = PAH clearance = [PAH] urine/[PAH]plasma * urine flow rate
How to calculate GFR
Inuline/creatinine clearanceGFR = Cl(Cr) = [Cr]urine*urine flow rate/[Cr]plasma
Nerves involved in corneal reflex
V1 - afferent limbVII - efferent limb
Lung areas affected by aspiration in supine position
Posterior segment of right upper lobeorSuperior segment of right lower lobe
Lung areas affected by aspiration in upright position
Basal segment of right lower lobe
Cystinuria features
Hereditary defect of renal PCT and intestinal aa transporterCOLA loss - Cysteine, Ornithine, Lysine, ArgininePrecipitation of hexagonal cystine stones
Degradation of hematoma
Hemeâ (heme oxygenase)Biliverdinâ (biliverdin reductase)Bilirubin (unconjugated)â (glucuronyl transferase)Conjugated Bilirubinâ UrobilinogenâStercobilin
Alterations in the maintenance stage of Acute Tubular Necrosis
â Urine outputâ Cr/BUNHyperkalemiaPathognomonic muddy brown casts
Alterations in the recovery stage of Acute Tubular Necrosis
â Urine outputâ K, Ca, Mg and PO4
Severe toxicities of aggressive manitol therapy
Pulmonary edema:â plasma osmolarity â â exit of K and water from cells â â plasma volumeVolume depletion and hypernatremia:Eventually manitol and the correspondent volume is filtered by the kidneys
Thiazide diuretics indications
Treat edema secondary to:Kidney diseaseCHFLiver disease
Thiazide diuretics side effects
Common:HypokalemiaHypomagnesemiaLess common:Volume depletionHypotensionHypercalcemiaHyponatremia
Loop diuretics indications
Treat CHF edema
Loop diuretics side effects
HypokalemiaHypomagnesemiaHypocalcemia
Function of nitric oxide
Neurotransmitter involved in memoryDoes not need a receptor, diffuses freely
Milrinone mechanism of action
Inhibits PDE-3 â âcAMPâ cAMP in heart: â[Ca]cytosol â inotropicâ cAMP in blood vessels: âCa reuptake by sarcoplasmic reticulum â vasodilation
Drug used for anti-psychotic induced Akathisia
Beta-blockers
Drug used for Restless Leg Syndrome
Dopamine agonists
Erythrocyte alteration seen in Thalassemia
Target cells
Wrist bones
So Long To Pinky, Here Comes The ThumbScaphoidLunateTriquetrumPisiformHamateCaptateTrapezoidTrapezium
Erb palsy features
C5-C6 lesion:Deltoid, supraspinatus â no abductionInfraspinatus â no lateral rotationBiceps brachii â no forearm flexion or supination
Kulmpke palsy features
(holding a tree branch palsy)C8-T1 lesion:Ulnar â Intrinsic hand muscles â total claw hand âSensory deficit on medial side of forearm/hand
Microscopic changes seen 4-12 hours after Acute MI
Wavy fibers with narrow elongated myocytes
Microscopic changes seen 12-24 hours after Acute MI
Myocyte hypereosinophilia with pyknotic nuclei
Microscopic changes seen 1-3 days after Acute MI
Coagulation necrosisProminent neutrophilic infiltrate
Microscopic changes seen 3-7 days after Acute MI
Disintegration of dead neutrophils and myofibersMacrophage infiltration in border
Microscopic changes seen 7-10 days after Acute MI
Robust phagocytosis by macrophagesBeginning of formation of granulation tissue
Microscopic changes seen 10-14 days after Acute MI
Well developed granulation tissue with neovascularization
Microscopic changes seen 2 weeks-2 months after Acute MI
Progressive collagen deposition and scar formation
Treatment for essential tremor
Beta-blockers
Hormones inhibited by testosterone
LH and GnRH
Radial head subluxation features
Similar presentation to Erb palsy ("waiter's tip")Children 1-4 yoTraction to the radius on a pronated forearmâ Annular ligament disconnects from radial headâ Slides between radius and humerusâ Becomes entrapped
Hemochromatosis features
male: 40 yo / female: ±60 yoSkin pigmentationLiver cirrhosisImpaired glucose homeostasisCardiac dysfunctionAtypical arthritisHypogonadism
Treatment of vestibular system nausea (motion sickness)
H1 blocker - diphenhydramine, meclizineM1 blocker - scopolamine(Tonhão HM passou no vestibular)
Treatment of hyperemesis gravidarum
Promethazine(pra mãezinha)
First line medication for nausea/vomiting in pregnancy
Pyridoxine (B6)
Treatment of emetogenic substances nausea
D2 blocker - metoclopramide5-HT3 blocker - ondansetronNeurokinin 1 blocker - Aprepitant
Treatment of gastrointestinal nausea
5-HT3 blocker - ondansetron
Treatment of postoperative nausea
Ondansetron
Most vulnerable to hypoxia areas of the brain
Pyramidal cells of hippocampus and neocortexPurkinje cells of the cerebellumWatershed areas
Mechanism of action and use of etanercept
Decoy receptor for TNF-alphaUsed in Rheumatoid Arthritis
Joint usually affected by HLA-B27 arthritis
Sacroiliac joints
Diseases associated with Cheyne-Stokes breathing
CHeyne-Strokes:CHFNeurologic disease(Cheyne-Stokes is the rhythmic crescendo-then-decrescendo)
Diseases associated with Kussmaul breathing
Kussmaul - KetoacidosisAny severe metabolic acidosis(Kussmaul is the pattern with high highs and low lows)
Where to perform thoracocentesis
Midclavicular line: 6th-8th ribsMidaxillary line: 8th-10th ribsParavertebral line: 10th-12th ribs
Importance of CD18
Synthesis of integrins and thus leukocyte adhesion
Region of the brain that contains noradrenergic neurons
Locus cereleus
Region of the brain that contains cholinergic neurons
Nucleus basalis of Meynert
Venous pressure curve
a: Atrial contractionc: tricuspid valve bulging during RV Contractionx: atrial relaXationv: steady Venous blood intakey: passYve emptYing of atrium w/ tricuspid opening
Murmur in ASD
MAY be associated with a mid systolic pulmonary ejection murmur due to volume overload
Why fresh frozen plasm does not work in heparin overdose
Contains Antithrombin III
Calcium oxalate nephrolithiasis microscopic appearance
Octahedron (square w/ X in the middle)
Calcium phosphate nephrolithiasis microscopic appearance
Elongated, wedge shaped; forms rosettes
Magnesium ammonium nephrolithiasis microscopic appearance
Rectangular prism ("coffin lids")
Uric acid nephrolithiasis microscopic appearance
Yellow or red-brown, diamond or rhombus
Cystine nephrolithiasis microscopic appearance
Flat, yellow, hexagonal
How L-DOPA crosses the blood-brain-barrier
Transporter
mRNA post transcriptional modifications
5' methylguanosine cap3' poly-A tailRemoval of introns
Mechanism of action of second generation anti-psychotics
D2 blocker (less than 1st)5HT2 blocker
Major function of ventromedial hypothalamic nuclei
Mediates satiety; destruction leads to hyperphagia(damage ventromedial makes you grow ventral and medial)
Major function of ventrolateral hypothalamic nuclei
Mediates hunger; destruction leads to anorexia(damage to ventrolateral makes your ventre looks like your side)
Major function of anterior hypothalamic nuclei
Mediates heat dissipation(AC - anterior/cooling)
Major function of posterior hypothalamic nuclei
Mediates heat conservation(posterior opposite of anterior)
Major function of arcuate hypothalamic nuclei
Secretion of dopamine (â PRL), GnRH & GHRH(release the arch)
Major function of paraventricular hypothalamic nuclei
ADH, ACTH, oxytocin & TRH(para-ventre: oxytocin/pregnancy; ADH/edema; ACTH/Cushing; TRH/hypothyroidism)
Major function of supraoptic hypothalamic nuclei
ADH & oxytocin
Major function of suprachiasmatic hypothalamic nuclei
Circadian rhythm & pineal gland function
GABAb type of receptor
G-protein associated(muscle relaxant Baclofen is an agonist)
Associated event with increased serum tryptase
Mast cell degranulation
Causes of metabolic alkalosis
Vomiting / nasogastric suctioningThiazide / loop diureticsHyperaldosteronism
Pathophysiology of vomiting metabolic alkalosis
Loss of H+ & Cl- â â HCO3- / â Cl- in urineSaline responsive
Pathophysiology of diuretics metabolic alkalosis
[Loss of NaCl in loop/distal tubule â â activity of aldosterone â â Na+ reabsorption in collecting ducts by Na/H+ or Na/K+ exchanger]â Cl- in urineSaline responsive
Pathophysiology of hyperaldosteronism metabolic alkalosis
[â Na+ reabsorption in collecting ducts by Na/H+ or Na/K+ exchanger]â H+ in serumâ K+ in serumâ Cl- in urineSaline unresponsive (volume overloaded already)
Rituximab mechanism of action
Antibody against CD20Used in B cell lymphomas
Trastuzumab mechanism of action
Antibody against Her2/neu receptorUsed in some breast cancers
Infliximab mechanism of action
IgG monoclonal antibody against TNF-alphaUsed in rheumatoid arthritis, Crohn and ankylosing spondylitis(TNFliximab)
Imatinib mechanism of action
-nib = kinase inhibitorInhibits BCR/ABL tyrosine kinase protein in CML
Utility of NADPH
Reduce glutathione in cells with high oxidative stressUsed in synthesis of cholesterol, fatty acids and steroidsUsed in phagocytes (NADPH oxidase)
Types of renal tubular acidosis
Distal/type 1 - â H+ excretion "1 proton, type 1"Proximal/type 2 - loss of HCO3-Hyperkalemic/type 4 - â aldosterone â hyperkalemia â â NH3 synthesis in PCT â â NH4+ excretion
Sarcomere bands and lines
"An Interesting Zoo Must Have Mammals"Actin filaments in the I band attach to the Z lineMyosin filaments in the H band attach to the M line
Main artery supply to the femoral head
Medial circumflex artery
Causes of a left shift on the hemoglobin dissociation curve
â H+â 2,3-diphosphoglycerateâ Temperature(less need of O2; more affinity)
Causes of a right shift on the hemoglobin dissociation curve
â H+â 2,3-diphosphoglycerateâ Temperatureâ altitude(think of exercising)
Pathogenesis os Small Intestinal Bacterial Overgrowth
Roux-en-Y gastric bypassâ Large stomach pouch + duodenum are excluded from main food routeâ Bacterial proliferation thereâIncreased synthesis of vitamin K & folate
Spontaneous lobar hemorrhage features
Most common cause: cerebral amyloid angiopathyRecurrent hemorrhagesOften parietal/occipital lobes
Embryological formation of the kidneys
Mesonephric duct (ureter to collecting ducts)+Metanephric blastema (distal convoluted tubules "up")
PTH effect on kidneys
â Ca reabsorptionâ PO4 reabsorptionâ Vitamin D3 synthesis
Dabigatran mechanism of action
Direct Thrombin inhibitor
Common causes of renal papilla necrosis
SAD PeeSickle cell anemiaAnalgesics (NSAID)Diabetes MellitusPyelonephritis
Difference between DNA Polymerase I and III
DNA Polymerase I has 3' â 5' (proofreading) AND 5' â 3' exonuclease activity (primers)DNA Polymerase III only has 3' â 5' exonuclease activity
Cyanide poisoning antidotes
Amyl nitriteSodium thiosulfate
Amyl nitrite mechanism of action
Oxidizes hemoglobin to methemoglobin (Fe2+âFe3+)âMethemoglobin has low O2 affinity but high CN affinity
Relative position of parasympathetic to motor fibers in CN III
Superficial: parasympatheticDeeper/central: motor
High-dose dexamethasone test results
Supression of ACTH & cortisol â Pituitary adenomaNo supression â Extra-adrenal ACTH production(other cells don't have ACTH receptors so can't respond)
Distribution of ciliated cells on respiratory tree
Trachea to proximal portions of respiratory bronchioles
Distribution of goblet cells on respiratory tree
Trachea to larger bronchioles
Distribution of club cells on respiratory tree
Terminal bronchioles
Pathophysiology of Bernard-Soulier Syndrome
Deficiency of GpIb (binds platelet to vWF)
How to differentiate Bernard-Soulier Syndrome from vWF Disease
Addition of plasma aggregates on vWF DiseaseBoth have abnormal ristocetin assay (induces expression of GpIb)
Muscles present in the middle ear and their innervation
Stapedius muscle - CN VIITensor timpani muscle - CN V3
Pathophysiology of DM Polyol pathway injury
Cells that don't require insulin for glucose transport (lens, peripheral nerves, blood vessels and kidneys)âIncreased intracelular glucose concentrationâGlucose is converted to sorbitol, then to fructose in cellsâIncreased osmolarity â increased intracelular waterâ Cell burts
Stages of sarcoidosis
I â bilateral hilar adenopathyII â bilateral hilar adenopathy + pulmonary infiltratesIII â no adenopathy; lung infiltrates onlyIV â pulmonary fibrosis
Sarcoidosis features
Common in young blackPulmonary symptomsSkin lesionsAnterior/posterior uveitisHypercalcemia/hypercalciuria (â macrophage 1,25-dihydroxyvitamin D production)Elevated ACE levelsSterile noncaseating granulomas
Tumor marker for hepatocellular carcinoma
Alpha-fetoprotein
Tumor marker for ovarian tumors
CA 125 for epithelial (serous/mucinous)β-hCG for dysgerminomaαFP for yolk sac (endodermal sinus)Estrogen for granulosa cellTestosterone for Sertoli-Leydig
Tumor marker for carcinoid tumors
5-hydroxyindoleacetic acid (serotonin metabolite)
Tumor marker for germ cell tumors
Alpha-fetoproteinÃ-hcg
Tumor marker for gastrointestinal tumors
Carcinoembryonic antigen (CEA)
Tumor marker for neuroendocrine tumors
5-hydroxyindoleacetic acid (serotonin metabolite)
Pathogenesis of Hemochromatosis
Mutation in HFE gene (protein that helps absorbed iron-transferrin uptake in cells)â Enterocytes and hepatocytes understand there's iron deficitâIncrease enterocyte iron transport and decreased hepcidin
Conditions associated with Dohle bodies
Lymphoid reactionBurn victimsMyelodysplasia
Description of Dohle bodies
Small basophilic (blue) cilindric inclusions in neutrophils(Ribosomes)
Steps in collagen synthesis
1. Synthesis2. Hydroxylation (vit C dependent)3. Glycosylation (Osteogenesis imperfecta)4. Exocytosis5. Cleavage of N/C residues6. Cross linking by lysyl oxydase (Menkes/Ehlers-Danlos)
Description of Auer rods
Azurophilic rods in cytoplasm of blastsPathognomonic of AML
Characteristics of leukocytes in lymphomas
Small with cleaved nuclei
Causes of decrease of aortomesenteric angle
Loss of mesenteric fat (â weight, burns, any catabolism)Correction of scoliosisHyperlordosis
Structure that herniates through the falx cerebri
Cingulate gyrus (part of limbic system)
Artery that might be compressed on a subfalcine herniation
Anterior Cerebral Artery
Structures compressed in a uncal herniation
CN IIIPCA â contralateral homonymous hemianopsia w/ macular sparingContralateral cerebral penduncle â ipsilateral hemiparesisBrainstem hemorrhages â death
Calculation of Absolute Risk Reduction
ARR = Control Rate - Treatment Rate
Calculation of Relative Risk Reduction
RRR = ARR / Control Rate
Calculation of Relative Risk
RR = Treatment Rate/Control Rate
Calculation of Number Needed to Treat
NNT = 1 / ARR
Bloom syndrome features
Helicase gene mutation (BLM gene)MicrocephalyPhotosensitive rashImmunodeficiency
Fanconi anemia etiology
Incapacity to repair double-stranded DNA breaks
Evolution of melanocytic nevi
Junctional (epidermis)Compound (epi + dermis)Intradermal (dermis)
First generation sulfonylurea drugs
ChlorpropamideTolbutamide
Second generation sulfonylurea drugs
Glipizide (short acting, â risk of hypoglycemia)GlimepirideGlyburide(all DM medications that start w/ Gli)
TNF-α, cathecolamines, glucocorticoids and glucagon mechanism of insulin resistance
Activation of serine kinasesâPhosphorylation of serine residues in insulin receptorâDecreased tyrosine kinase activity of receptor
Drugs used in treatment of opioid addiction
Methadone (full mu-opiod agonist)ORBuprenorphine (partial agonist) + naloxone (antagonist)
Findings on Dandy-Walker malformation
"Dandy-Walker can't walk."Agenesis of cerebellar vermisCystic enlargement of 4th ventricle â hydrocephalus
Findings on Chiari II malformations
Herniation of cerebellar tonsils and vermis through foramen magnumâ Aqueductal stenosisâ HydrocephalusAssociated with lumbosacral meningomyelocele
Rb phosphorylation pathway
Cyclin D+CDK4 & Cyclin E+CDK2 phosphorylate Rb+E2FâE2F is transcription factor for proteins necessary to start S phase
T cell maturation process
Double negative T cell migrates to thymusIn cortex: Double positive (CD4+ and CD8+)Affinity test for MHC (positive selection - only those that bind, +, are selected)Then in the medulla: Single positive (CD4+ or CD8+)Test increased affinity for self (negative selection - only that that do not bind, -, are selected)
Relationship between Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome
Part of same spectrum:FeverAcute Renal FailureNeurologic impairmentThrombocytopeniaMicroangiopatic hemolytic anemiaTTP has more neurologic symptoms, affects more adultsHUC has more renal symptoms, affects more children
Difference between DIC and TTP-HUC
In DIC there is activation of coagulation cascadeIn TTP-HUC only platelets are involved
Etiopathology of TTP
Impaired ADAMTS13, a vWF cleaving proteaseLarge, uncleaved vWF are prothrombotic
Neuroendocrine Immunohistochemical markers
ChromograninEnolaseSynaptophysin
Neutrophil chemotactic substances
C5aLTB4 / 5-HPETEIL-8N-formyl residues
Azathioprine mechanism of action
Azathioprine â 6MPâ XO / â HGPRTInactive / 6-thioguanine (chemotherapic)
5-Fluoruracil mechanism of action
Pyrimidine analog that complexes folic acidInhibits Thymidylate synthase
Antitumor antibiotics drugs
-bicin / -mycin (like macrolide antibiotics)BleomycinDactinomycinDoxorubicinDaunorubicin
Antitumor antibiotics mechanism of action
Intercalates in DNA and/or generate free radicals
Alkylating agents drugs
BusulfanCyclophosphamideNitrosoureas
Alkylating agents mechanism of action
Cross-link DNA
Microtubule inhibitors drugs
PaclitaxelVincristine, vinblastine
Cisplatin, carboplatin mechanism of action
Cross-link DNA
Etoposide, teniposide mechanism of action
Inhibits topoisomerase II
Irinotecan, topotecan mechanism of action
Inhibits topoisomerase I
Hydroxyurea mechanism of action
Inhibits ribonucleotide reductase
Chemotherapics that act on S phase
Antimetabolites, topoisomerase inhibitors, hydroxyurea
Chemotherapics that act on G2 phase
Antitumor antibiotics, cisplatin, carboplatin
Chemotherapics that act on M phase
Microtubule inhibitors
Molecular pathogenesis of colon cancer
(order of gene loss: AK-53)Loss of APC gene (â intracellular adhesion and â proliferation)â Methylation abnormalities, COX2 overexpressionâKRAS activation (Unregulated signal transduction)âAdenomaâLoss of p53 / DCC (deleted in colon cancer)âCarcinoma
MEN 1 neoplasias
Parathyroid tumorsPituitary adenomasPancreatic endocrine tumors (Zollinger-Ellison sd, insulinomas, VIPomas)Associated with MEN1 mutations
MEN 2A neoplasias
Parathyroid tumorsPheochromocytomaMedullary thyroid carcinoma (secretes calcitonin)Mutation in RET gene (receptor tyrosine kinase)
MEN 2B neoplasias
PheochromocytomaMedullary thyroid carcinomaMucosal neuromas / glanglioneuromatosisMutation in RET geneAssociated with marfanoid habitus
Aortic arch derivatives
1st - maxillary artery (1st is maximal)2nd - Stapedial artery and hyoid artery (Second - Stapedial)3rd - Common Carotid artery and proximal internal Carotid artery (C is 3rd letter)4th - on left: aortic arch; right: proximal right subclavian6th - Proximal pulmonary arteries and ductus arteriosus
Branchial cleft derivatives
1st cleft develops into external auditory meatus2nd to 4th form temporary cervical sinuses
Branchial arch derivatives
1st - M structures / Mastication / CN V2 and V32nd - S structures / CN VII (Smile)3rd - Pharyngeal stuff / CN IX4th-6th - swallow and speak stuff / CN X
Branchial pouch derivatives
1st - Middle ear2nd - Palatine tonsils3rd - Inferior parathyroids / Thymus4th - Superior parathyroids
Arsenic antidote
Dimercaprol, DMSA
Acetoaminophen antidote
N-acetylcisteine (replenishes glutathione)
Amphetamines antidote
NH4Cl (acidify urine)
Antimuscarinic, anticholinergic agents antidote
Physostigmine, control hyperthermia
β-blockers / verapamil antidote
Glucagon
Carbon monoxide antidote
100% O2
Copper, arsenic, gold antidote
Penicillamine (pennies made of gold)
Cyanide antidote
Nitrite + thiosulfate
Digoxin antidote
Anti-dig Fab fragments
Heparin antidote
Protamine sulfate (H+ = proton)
Iron antidote
Deferoxamine, deferasirox
Lead antidote
EDTA, dimercaprol, succimer, penicillamine
Mercury, arsenic, gold antidote
Dimercaprol, succimer
Methanol, ethylene glycol antidote
Fomepizole
Methemoglobin antidote
Methylene blue, vitamin C
Opioids antidote
Naloxone, naltrexone
Salicylates antidote
NaHCO3 (alkalanize urine)
TCAs antidote
NaHCO3Alkalizine plasmaTCAs block Na+ channel in heart; NaHCO3 keeps TCAs in non-ionized form & â[Na] to compete for channel
TPA, streptokinase, urokinase antidote
Aminocaproic acid
Mitochondrial membrane proteins involved in apoptosis
Bcl-2 and Bcl-x (anti-apoptotic)Bak, Bax and Bim (pro-apoptotic)
Receptors involved in extrinsic pathway apoptosis
TNF 1 receptorFas
Etiopathogeny of Diastolic Heart Failure
â Left ventricular compliance
Etiopathogeny of Systolic Heart Failure
â Left ventricular contractility
Insulin release mechanism
Glucoseâ glucokinaseGlucose-6-Pâ glycolysis + Krebs cycleATP â âATP/ADPâK+ channels close â depolarizes cellâCa2+ channels open â â[Ca] promotes insulin vesicles to fuse
MODY etipathogeny
â glucokinase activity(heterozygous mutation)
Difference between common vs superficial peroneal nerve injury
Only in common peroneal nerve injury there is decreased foot dorsiflexion
Gene mutation associated with Melanoma
BRAF (a protein kinase that is an intermediate in NRAS activation)
Tumors with bone metastasis propensity
"Lead kettle": PB KTLProstateBreastKidneysThyroidLungs
Histologic features in ischemic brain disease/stroke in 12-48 hours of onset
Red neurons (loss of Nissl substance)
Histologic features in ischemic brain disease/stroke in 24-72 hours of onset
Necrosis + neutrophils
Histologic features in ischemic brain disease/stroke in 3-5 days of onset
Macrophages (microglia)
Histologic features in ischemic brain disease/stroke in 1-2 weeks of onset
Liquefative necrosisReacitve gliosisVascular proliferation
Activities associated with Asbestosis
Roofing, plumbing, shipbuilding
CXR findings in Asbestosis
"Ivory white", calcified supradiaphragmatic and pleural plaquesOnly pneumoconiose to affect the lower lobes(telhas de amianto no diafragma)
Neoplasias associated with Asbestosis
Bronchogenic carcinoma > mesothelioma
Activities associated with Berylliosis
Aerospace and manufacturing industries(affects upper lobes â rockets go up)
Histology of Berylliosis
Granulomatous
Activities associated with Silicosis
Foundries, sandblasting, mines
Pathophysiology of Silicosis
Disruption of phagolysosomesâIncreased release of fibrogenic factorsâFibrosis and increased risk of TB and bronchogenic carcinoma
Mechanism of action of Clopidogrel
Blocks platelet ADP receptors
Mechanism of action of Abcximab
Blocks Gp IIb/IIIa receptor(ABciximab â IIIA/IIB receptor)
Tuberous sclerosis features
Autosomal dominantâ incidence of benign tumors:Cortical tubers (malformed tissue)Brain hamartomasFacial angiofibromasCardiac rhabdomyomasRenal angiomyolipomaetc...
Cyclosporine mechanism of action
Inhibits NFAT (transcription factor)âDecreased IL-2 synthesis
Thyroid cancers in order of frequency
Papillary > Follicular > Medullary > Anaplastic
Function of P bodies in cells
Store and degrade mRNAs
Receptors blocked by TCAs
"Chola HαS Sodium" Central and peripheric CHOlinergicH1 receptorsPeripheral α-1 adrenergicSerotonin and norepinephrine reuptakeCardiac fast sodium channels
Muscles of the rotator cuff
SItSSupraspinatusInfraspinatusteres minorSubscapularis
Most affected tendon in rotator cuff syndrome
Supraspinatus (supra is the most)Test with "empty beer can" maneuver
Cells that derivate from monocytes
MacrophagesKupffer cellsMicrogliaOsteoclastsMesangial cellsLanghans cells (foreign-body-giant cells)
Main side effects of erythropoietin
Thromboembolic eventsHypertension(think that they thicken the blood)
Primary biliary cirrhosis features
Autoimmune reaction with lymphocytic infiltrate and granulomasAnti-mitochondrial antibody +Associated with other autoimmune disorders
Primary sclerosing cholangitis
Unknown cause of concentric "onion skin" bile duct fibrosisAssociated with IBDMPO-ANCA/p-ANCA +
Path of CSF
Choroid plexus of lateral ventricles (also 4th ventricle)â (interventricular foramen of Moro)3rd ventricleâCerebral aqueductâ4th ventricleâ (foramina of Luschka and Magendie)Subarachnoid Space â arachnoid granulations
Mechanism by which body adapts to chronic acidosis
â in renal acid excretion:glutamine â glutamate + (NH4+) + (HCO3-)NH4+ is excreted in PCT while HCO3- is reabsorbed
What vitamin absorption is decreased by egg whites
Biotin (B7) due to binding to avidin in egg whites(think that eggs have life inside them; lifeâbio)
Enzymes that require Biotin (B7)
Pyruvate carboxylase (gluconeogenesis)Acetyl-CoA carboxylase (fatty acid synthesis)Propionyl-CoA carboxylase (fatty acid oxidation)
Function of hepcidin
â ferroportin degradationâ iron absorptionâ iron exportation as transferrin
Lung tumors centrally located
Small cell carcinomaSquamous cell carninoma(both are associated with smoking; think that the smoke burns your bronchi)
Values of the confidence interval that invalidate the study
If CI is about difference of two variables, CIâ 0If CI is about odds ratio or relative risk, CIâ 1
Effects of desmopressin
â vWF and factor VIII release from endothelial cellsâ aquaporin placement in collecting tubules (V2 receptors)(does not act on V1 receptors)
Osteolytic bone metastasis causes
Multiple MyelomaNon-small cell carcinomaNon-Hodgkin lymphomaMelanomaRenal cell carcinoma
Osteoblastic bone metastasis causes
Hodgkin lymphomaSmall cell carcinomaProstate cancer
Phisiopathology of Pulmonary Embolism
Embolus â V/Q mismatch â âpO2 â â Resp Freq â âpCO2 / respiratory alkalosysHCO3- levels remain normal in acute phaseIn chronic respiratory alkalosys kidneys waste HCO3-
Phisiopathology of Eisenmenger syndrome
VSD â left to right shunt â pulmonary hypertension â right to left shunt â cyanosis
Familial hyperchylomicronemia features
Autosomal recessiveLipoprotein lipase or apolipoprotein CII deficiency (CII-Cofactor)â Chylomicrons, TG, cholesterolPancreatitis, hepatosplenomegaly and eruptive xanthomas
Familial hypercholesterolemia features
Autosomal dominantLDL receptor deficiencyâââLDLPremature atherosclerosis, tendon xanthomas, corneal arcus
Familial dysbetalipoproteinemia features
Autosomal recessiveApoE deficiency (e to Exit circulation)â chylomicron & VLDL remnantsPremature atherosclerosis, palmar xanthomas
Familial hypertriglyceridemia features
Autosomal dominantâ VLDL, TGHepatic overproduction of VLDLAcute pancreatitis
Arteriosclerosis associated with Malignant Hypertension
Hyperplastic arteriolosclerosisOnion-like concentric thickening of arteriolar walls
Causes of restrictive cardiomyopathy
Sarcoidosis, amyloidosis, hemochromatosis and radiation therapy(basically the -osis)
Pancreatic β-cells receptors
M3 (Gq)Glucagon (Gq/Gs)GIP (Gs)β-2 adrenergic (Gs)α-2 adrenergic (Gi)Somatostatin-2 (Gi)
Formula for half-life
t(1/2) = 0.7 * Vd / CL
Diseases that can course with cold agglutinins
Mycoplasma pneumoniaeEBVHematologic malignancies
Diseases that can course with warm agglutinins
SLECLLCertain drugs (α-methyldopa)
Loading dose formula
LD = Css x Vd
Maintenance dose formula
MD = Css x Clearance
Movement performed by the supraspinatus muscle
Abducts arm initially
Movement performed by the infraspinatus muscle
Lateral rotation
Movement performed by the teres minor muscle
Lateral rotation and adduction
Movement performed by the subscapularis muscle
Medial rotation and adduction
Mechanism of action of Mesna
Detoxifies cyclophosphamide and ifosfamide metabolites preventing hemorrhagic cystitis
Diseases that cause macrophage â1-α-hydroxylase function
(leads to âvitamin D)Granulomatous diseases: sarcoidosis, tuberculosisHodgkin lymphomasNon-hodgkin lymphomas (some)
Uses of leucovorin (folinic acid)
â MTX toxicityâ 5-FU action
Mechanism of action of cilostazol
Inhibits platelet phosphodiesterase â âcAMP â âplatelet aggregation & âgranule releaseAlso, direct arterial vasodilator
Use of argatroban
Treatment of heparin-induced thrombocytopenia
Interatrial septum formation
Septum primum (SP)âSP + Ostium primumâSP + Ostium secundum (OS)âSP + OS + Septum secundum (SC)âSP + OS + SC + Foramen ovale
Mechanism of action of most inhaled anesthetics
Potentiate GABA action
Side effects of most inhaled anesthetics
â CO â hypotensionRespiratory depressants (except NO)â Brain blood flow (â IC pressure)â Liver blood flowâ Kidney blood flow and function
Main difference between adult and infant Aorta Coarctation
infant: pre-ductal (fatal if not corrected)adult: post-ductal
Etiopathogeny of normal-pressure hydrocephalus
â CSF resorption by the arachnoid granulationsCan be caused by subarachnoid hemorrhage, brain trauma or be idiopathic
Adverse effects of succinylcholine
Malignant hyperthermia (esp. w/ halothane)Severe hyperkalemiaBrady/tachychardia
Mechanism of severe hyperkalemia w/ succinylcholine
Succinilcholine is not degraded by AChteraseSuccinilcholine keeps activating nAChRnAChR binding opens Na+ channel and depolarizes cellNa+ channel is not selective and K+ also flows out
Mechanism of hyperestrinism in liver cirrhosis
â adrenal androstenedione â estradiolestradiol â âTBGlobulin â â free testosteroneresults: â free testo / â estradiol
Orotic aciduria causes
Defect in Uridine monophosphate synthaseorDefect in Ornithine transcarbamylase (â ammonia too)
Stages of behavioral change
Precontemplation (does not recognize problem)Contemplation (recognize problem but is not ready to change)Preparation (is ready to change and taking steps towards)Action (is changing)Maintenance
Genes associated with Pheochromocytoma
VHL (von Hippel Lindau)RET (MEN 2)NF1 (Neurofibromatosis)
Common medications causing Acute Intersticial Nephritis
PenicillinsNSAIDsSulfonamidesRifampinDiuretics
Vessels in order of atherosclerotic damage
Abdominal aorta > coronaries > popliteal > internal carotids > circle of Willis
Rinne test
(Rinne ~ ringing)AC > BC bilaterally â normal / sensory neural lossBC > AC â conductive loss in affected side
Weber test
(Weber ~ wibrates)sensory neural loss â best heard in healthy sideconductive loss â best heard in unhealthy side(conduction loss dampens environment sound and increases test)
Syndrome associated with Neuroblastoma
Opsoclonus-myoclonus syndromes(dancing eyes-dancing feet syndrome)
Risk factors for pancreatic cancer
AgeSmokingChronic pancreatitisDiabetes MellitusGenetic (MEN sds, hereditary colon cancer sds)
Pathophisiology of H. pylori duodenal ulcers
H. pylori antral damage (from pathogen + immune response)âDecreased production of somatostainâIncreased gastrin â Increased acid
Pathophisiology of H. pylori gastric ulcers
Destruction of local mucous layer + immune inflamation leaves mucosa susceptible to acid damageAcidity is normal or even low
Most common clinical manifestations of vitamin E deficiency
Neuromuscular disease and hemolytic anemia(vitamin E is antioxidant; neurons and erythrocytes suffer more from oxidative stress)
Chronic high intake of vitamin C side effect
Calcium oxalate kidney stones
Mechanism of action of Ethosuximide
Blocks Ca channels in thalamic neurons
Drugs that cause IgE-independent mast cell degranulation
OpioidsVancomycinRadiocontrast agents
Causes of S3
(volume overload leading to turbulence when entering the ventricle)Restrictive cardiomyopathyHeart failureHigh-output statesCan be normal in individuals < 40 yo
Causes of S4
(rush of blood against a stiff LV wall)Ventricular hypertrophyMyocardial infarctionCan be normal in healthy older individuals
Difference between Pancoast tumors vs mediastinal tumors
Pancoast tumors can cause Horner's sd, shoulder pain & superior vena cava sdMediastinal tumors can cause only superior vena cava sd
Benzodiazepines preferred in liver disease
(don't undergo oxidation in liver and don't have active metabolites)LorazepamOxazepamTemazepam(LOT)
Systolic murmur that increases with inspiration
Tricuspid regurgitation(inspiration â â RV preload)
Systolic murmur that decreases with inspiration
Mitral regurgitationVentricular Septal Defect(inspiration â â lung vessels capacity â transient â LV preload)
Dexrazoxane use
Prevents anthracyclin-induced (doxorubicin) cardiotoxicity(DeXrazoXane bloX DoXorubicin)
Types of neoplastic colonic polyps
SerratedAdenomatous (villous > tubulovillous > tubular)
Types of non-neoplastic colonic polyps
HyperplasticSubmucosalMucosalInflamatory
Diagnostic criteria for schizoaffective disorder
Concurrent mood episode & active-phase symptoms of schizophrenia + >2 week lifetime history of delusions/hallucinations w/o mood disorder
Conditions associated with target cells
"HALT - said the hunter to his target"HbC disease, Asplenia, Liver disease, Thalassemias
Difference between Allelic, Genetic and Phenotypic heterogeneity
Allelic heterogeneity: â mutation in same loci leading to similar phenotypeGenetic heterogeneity: mutations in â genes leading to similar phenotype
Difference between Phenotypic heterogeneity and Pleiotropy
Phenotypic heterogeneity: mutations in same gene leading to â phenotypePleiotropy: mutation in a gene leading to a multi-system seemingly independent defects
Uses of octeotride
(somatostatin analog)Acute variceal bleedsAcromegalyVIPomaCarcinoid tumors
Muscles innervated by the recurrent laryngeal nerve
All and only the -arytenoid
Group C nerve fibers
(unmyelinated)Autonomic postganglionicAfferent slow-onset pain (dull/burning/visceral pain)Afferent slow-onset heat
Celecoxib effect on thrombogenesis
â thrombogenesisInhibits only COX-2 (no action on platelets' COX-1), thus increase imbalance between TAX-2/PGI2
Substances associated with high anion-gap metabolic acidosis
MUDPILESMethanolUreaDiabetic ketoacidosisPropylene glycol/ParaldehydeIsoniazid/IronLactic acidosisEthylene glycol (antifreeze)Salicylates
Appropriate compensation for metabolic acidosis
PaCO2 = [HCO3-]*1,5 + 8 ±2
Appropriate compensation for metabolic alkalosis
0,7 mmHg â in PaCO2 / 1 mEq/L â in HCO3-
Appropriate compensation for respiratory acidosis
1 mEq/L â in HCO3- / 10 mmHg â in PaCO2
Appropriate compensation for respiratory alkalosis
2 mEq/L â in HCO3- / 10 mmHg â in PaCO2
Acid-base disturbance caused by salicylates overdose
Respiratory alkalosis (directly stimulate respiratory center)Then metabolic acidosis
Aromatase inhibitors
Anastrazole, letrozole, exemestane
Tricyclic antidepressive inhibitory activities
Serotonin/noradrenalin reuptakeH1Cardiac Na+ channelsMuscarinic AChα-1 adrenergic
Hydrophobic aminoacids
("Pra Gripe? Mate de BCAA")Pro GlyPhe MAT BCAAProlineGlycinePhenylalanineMethionineAlanineTryptophanvalineleucineisoleucine
Von Hippel-Lindau Syndrome features
Mutation in VHL tumor suppressor in chromosome 3Hemangioblastomas in cerebellumCysts in kidneys and pancreasPheochromocytomaRenal (clear) cell carcinoma
Difference between acute distress disorder and PTSD
PTSD > 1 month
Effect of adenosine and dypiradamole in Acute Myocardial Infarction
Coronary arteriole vasodilatorsDivert blood from ischemic to non ischemic areas
Only apocrine gland
Mammary gland
FEV1/FVC patterns
normal = 80Obstructive < 70Restrictive >= 80
FEV1/FVC patterns
normal = 80Obstructive < 70Restrictive >= 80