physiology, I hardly know her
Intrapleural pressure [positive/negative/atmospheric]
normal lungs: _____
PTX: _____
tension PTX: _____
Intrapleural pressure
normal lungs: negative
PTX: atm
tension PTX: positive
What medication can cause weakness, muscle pain, with dark-colored urine as an adverse effect?
atorvastatin
(any statin - rhabdomyolysis)
This lab is the most specific biomarker for a myocardial infection (be specific!)
What is troponin I?
an "alternative" homeopathic remedy that should NOT be taken with ACE inhibitors due to drug interactions
(garlic should NOT be taken w/anti-coags like ASA, plavix vs. noni should NOT be taken w/ACEi)
This heart sound is heard in late diastole and is associated with ventricular noncompliance.
What is S4?
Aging is associated with all of the following changes in the immune system EXCEPT:
A. decreased regulatory T-cell count
B. decreased antibody affinity for antigens
C. increased susceptibility to neoplasms
D. deterioration of the adaptive immune system only
E. increased memory cell count
D: BOTH innate + adaptive immunity declines with aging
NTG works by increasing smooth muscle relaxation in what type of vessels
veins!
venodilator>>vasodilator, decreases preload
the below Nottingham grading indicates a [high/low/moderate] grade tumor?
-lots of tubules
-small, uniform cells
-5 mitoses/10 hpf
low grade (I) tumor
Live attenuated vax: influenza nasal spray (LAIV)
RIV/influenza vax, pneumococcal vax, Tdap, HepB, and zoster/RZV vax are all inactivated (dead)
Occlusion of this coronary artery can give ST-elevations or Q waves in leads V1 and V2
LAD (left anterior descending a.)
Identify these hallmarks of cancer based on their associated terms:
1. ______: HeLa cells, BRCA1/2, breakage-fusion-bridge
2. ______: aerobic glycolysis, TGF-beta up-regulation of GLUT1
3. ______: autocrine signaling, constituitive activation of MAP kinase, mutation of Ras GTPase
1. Genomic instability + mutation: HeLa cells, BRCA1/2, breakage-fusion-bridge
2. Reprogramming energy metabolism: aerobic glycolysis, TGF-beta up-regulation of GLUT1
3. Sustained proliferative signaling: autocrine signaling, constitutive activation of MAP kinase, mutation of Ras GTPase
the 4 R's of rifampin
1. RNA polymerase inhibitor
2. Ramps up cytochrome P-450
3. Red/orange body fluids
4. Rapid resistance if used alone
3 tests that can confirm a diagnosis of Type II diabetes mellitus
HbA1c (>/= 6.5%)
fasting plasma glucose (>/= 126 mg/dL)
oral glucose tolerance test (>/= 200 mg/dL)
What are the 5 stages of grief?
DABDA
Denial
Anger
Bargaining
Depression
Acceptance
What is Winter's formula and what is it used for?
Winter’s Formula: pCO2 =1.5 × [HCO3-] + 8 ± 2
Used to evaluated respiratory compensation in the setting of metabolic acidosis.
Measured pCO2 = calculated pCO2: adequate respiratory compensation
Measured pCO2 > calculated pCO2: concurrent respiratory acidosis
Measured pCO2 < calculated pCO2: concurrent respiratory alkalosis
Explain each step of atherosclerosis pathogenesis:
1. Fatty streak formation
2. Plaque progression
3. Plaque disruption
1. Fatty streak formation: endothelial cell dysfcn --> LDL oxidation and macrophage accumulation --> foam cell formation --> fatty streak
2. Plaque progression: smooth muscle cells migrate from tunica media to intima --> SMCs deposit ECM --> calcification --> fibrous cap formation
3. Plaque disruption: stress --> plaque rupture --> thrombus formation
tamoxifen (Soltamox) acts as an estrogen modulator in the _____ of the cell; it is an agonist in _____ tissue and an antagonist in _____ tissue.
tamoxifen (Soltamox) acts as an estrogen modulator in the nucleus of the cell; it is an agonist in bone + endometrial tissue and an antagonist in breast tissue.
Breast cancer testing:
quick sample collection method for evaluating cytology = _____
more invasive sample collection method for evaluating histology = _____
2D X-Ray imaging for healthy patients >40 y/o = _____
quick method to rule out solid vs fluid masses, useful in young pts with dense breast tissue = _____
3D reconstruction using multiple X-Ray images with increased detection at the cost of increased radiation exposure = _____
imaging via the Warburg effect and is primarily used for evaluating lymph node involvement + metastases = _____
quick sample collection method for evaluating cytology = FNA
more invasive sample collection method for evaluating histology = CNB
2D X-Ray imaging for healthy patients >40 y/o = screening mammogram
quick method to rule out solid vs fluid masses, useful in young pts with dense breast tissue = ultrasound
3D reconstruction using multiple X-Ray images with increased detection at the cost of increased radiation exposure = tomosynthesis (DBT)
imaging via the Warburg effect and is primarily used for evaluating lymph node involvement + metastases = PET/CT
Give 2 examples of ADLs and 2 of IADLs.
ADLs: grooming, feeding, bathing, dressing, using the toilet
IADLs: taking meds, grocery shopping, cooking, driving, paying bills, housekeeping
Breast cancer type + non-surgical treatment:
the best prognosis = ____ + ____
the worst prognosis = ____ + ____
Breast cancer type + treatment:
the best prognosis = ER+/PR+/HER2- (luminal A) + hormone therapy (tamoxifen/aromatase inhibitors)
the worst prognosis = triple negative + chemotherapy
After a big carby meal, up-regulation of ____ receptors aids glycogenesis, which primarily occurs in ____ + ____ tissue.
After a big carby meal, up-regulation of GLUT4 receptors aids glycogenesis occurring primarily in liver + muscle tissue.
(GLUT4 receptors: insulin-dependent, located in liver, striated muscle, and adipose tissue)
In renal failure pts, how can metformin (Glucophage) cause lactic acidosis as an adverse effect?
renal failure → metformin can't be metabolized → increases blood [Metformin] → decreases hepatic gluconeogenesis → increases blood [lactic acid] → lactic acidosis
Explain the basis of the diagnostic test for Leprosy.
What colors indicate +/- results?
skin biopsy: presence of acid-fast bacilli
(+): red
(-): blue/green
acid-fast a.k.a. Ziehl-Neelsen stain uses carbol fuchsin to stain for mycolic acid in the bacterial cell wall (vs. gram-staining for peptidoglycan)
Phases of Clinical Trials:
Which phase evaluates drug efficacy using a large sample population for FDA approval?
Phase III
Phase 0: no therapeutic or diagnostic intent
Phase I: adverse effects studied in small sample population
Phase II: evaluates safety + optimal dose range in a moderate sample population
Phase III: final confirmatory step for FDA approval, RCT in a large sample population
Phase IV: post-marketing surveillance
Explain the pathogenesis for the following bugs:
Influenza A: 2 virulence factors
Hepatitis A: immune mediated liver damage
Angiostrongylus cantonensis: life-cycle from primary host to humans
COVID: 2 virulence factors
Streptococcus pyogenes: 2 virulence factors
Influenza A: hemagglutinin (attachment/endocytosis), neuraminidase (viral budding)
Hepatitis A: hepatocytes present HAV antigens via MHC I molecules triggering liver destruction via cytotoxic (CD8+) T-cells
Angiostrongylus cantonensis: L1 larvae infect rats respiratory tract (primary host), L3 larvae ingested by humans migrates to brain where it grows then dies
COVID: S (spike) protein aids in host cell attachment/fusion to ACE2 receptors during viral entry, M (membrane) protein is the most abundant viral protein required for virus assembly/replication
Streptococcus pyogenes: hyaluronic acid capsule "disguises" bacteria from immune cells, M protein binds C3b + fibrinogen preventing opsonization - both resist phagocytosis by host