Deck Step1 All Subjects Two

FIRST

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1. Gap Junctions seen where?

gaps connect..

• Connexon proteins permit Electrical impluse transfers
• Enable coordinated cilia movement
• Cardiac myocytes connected to each other for electrically

2. Tight Junctions? where?

tight occludes and forms barriers

• claudins and occludins (prevents solute movement between cells)
• damaged by infarction
• Blood-Brain Barrier
• Blood-Testis barrier

3. Adherins — they are belts!

• Anti Growth signal!
• connect actin cytoskeleton between adjacent cells
• CADherins (Calcium dependent ADhesion proteins)
• Loss of E-Cadherin promotes Invasion
• Gastric Ca - diffuse type (E-CAD mutation)
• Breast Ca
  • Lobar Carcinoma in Situ
  • Invasive Lobar Ca.

4. AKI/Prerenal azotemia? Loss of Blood flow

• Main problem: ischemia, reduced RBF
• KIDNEY RESPONDS BY INCREASING CAPACITY to conserve FLOW
• Decreased RBF –> Decreased GFR –> (response) Increase Reabsorption of Na, Water, UREA –> Less Na excreted –> < 1% FENa, Low Urine-Na <20; Inc Water Reabsorption –> Increase UrineOsmolality >500
• Creatinine continues to be excreted while UREA is reabsorbed: >20 serum BUN/Cr ratio

5. AKI/Intrinsic-Acute Tubular Necrosis: loosing absorptive CAPACITY!

• Now we loose absorptive capacity
• Loss of Na –> FENa > 2%, Urine Na > 40; Loss of Water –> UrineOsmolality < 350; UREA not absorbed –> Serum BUN/Cr < 15

6. AKI: reduces GFR!

7. AKI: In Mainteinance phase, there is increased risk of?

• HYPOKALEMIA
• Electrolyte imbalance
• renal wasting

8. Intracellular Ca regulation -Sarcolemma Muscle contraction

• Action potential reaches NMJ inside Sarcolemma –> 3Na/Ca Exchanger (Na influx, Ca efflux in the T-Tubule space –> Ca reenters Cytoplasm via L-Type Ca Channel –+> Ca activates RyR2 channel on the Sarcoplasmic reticulum –> Sarcoplasmic Reticulum effluxes its Ca into Cytoplasm through the RyR2 channel –> binds to Troponin C –> Muscle contraction;
• After contraction, Myosin is detached upon binding of new ATP –> Ca-attached-to-troponin C is realeased –> Ca sequestered back into Sarcoplasmic Reticulum through the SERCA2 channel

9. GFR Autoregulation

• Dec BP –> Dec RPF (Reduced Hyderostatic PRessure) –> Dec GFR –> Dec NaCl @ macula densa:
  • Dec GFR –+> RAAS –> Eferent Arteriole Constriction –> Improved GFR
  • Dec GFR –+> Afferent Arteriole Dilation –> Improved GFR
    • Improved GFR –> Inc FF

10. Early pregnany loss, Inc risk of complications, prematurity:

• Bicornuate uterus: Incomplete fusion of Mullerian ducts

11. Double uterus, vagina, cervix:

• Complete failure of fusion
• Pregnancy POSSIBLE

12. Viral infection that flares and remits in cyclical fashion:

• HSV

13. CFTR is a problem of pre or post translational processing?

• POST translational
• due to misfolded proteins which are sent to preoteasome-ubiquitin system for degradation

14. Carpal Tunnel Sydnrome:

• MEDIAN NERVE
• Thenar eminence atrophies but spares sensation (cutaneous branch enters hand external to carpal tunnel)
• 90 degree flexion at wrist causes tingling Phalen
• Percussion of wrist: tingling Tinlen\

15. CTS causing Conditions

• RA, Preg, Hypothyroidism (GAGs), DM (connnective tissue thickening), Hemodialysis (b2Microglobulin, amyloidosis)

16. Cardiac reaction to decreased o2 delivery:

• Release Adenosin and NO –> Coronary vascular smooth muscle vasodilation –> maintaine adequate perfusion.
• Increased Pressure? –> reduce Adenosin and NO –> increase vascular resistance –> maintaine adequate perfiusn pressure
• Adenosine

17. Chest Pain RELIEVED by leaning Forward?

• Pericarditis: acute pleuritic chest pain
• retroperitoneal things

18. a factor, enters nucleous and makes acutephase reactants, cytokines, cell adhesion molecules, leukocyte growth factors

• Nuclear Factor Kappa B

19. Why precocious puberty short stature while Gigantism peeps are tall?

• Precocious puberty –> Inc sex hormones –> promote both growth and Epiphyseal plate closure –> Initial growth spurt but later no growth
• Gigantism: GH hormone does not cause Epiphyseal plate closure –> grow taller via growth plate –> epiphyseal == cartilage!

20. Erythema Multiforme:

• Target inflammatory skin lesion
• Multiforme: Mycoplasma & HSV
• deposition of antigens in keratinocytes –> Inc cytotoxoci Tcell response
• 
• 
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21. Skin lesion + 1 week history of focal neurologic deficit (seizure)

• Malignant melanoma metastasized to the brain
• also goes to GI, liver, lungs

22. Purulent cellulitis virulance factor?

• Panton Valentine Leukocidin from Staph Aureus

23. Non purulent cellulitis?

• Beta Hemolytic Streptococcia GROUP ABCD

24. Annular ring and scaling plaque five cm in diametr with central clearning?

• Tinea corporis
• 

25. Axillary lymph ndoe dissection is a risk factor for?

• chronic lyphedema. Duhh!

26: LMN symptoms with signs of infection (headache, mailaise, fever):

• Poliovirus, anterior horn
• feco-oral –> oropharynx –> blood –> CNS –> Anterior horn!

26: Spinal Lesions

• Caudia equina syndrome:
  • Loss of knee and ankle reflex + bladder/anal control + saddle anesthesia
  • along with radicular pain ofcourse!

27: Port wine stain + kid + glaucoma + seizures?

• Sturge-Weber syndrome
• Somatic mosaicism - GNAQ
• Capillary vascular malform –> Port wine stain
• Leptomeningeal angioma –> seizures
• Episcleral hemagioma –> Inc ICT –> glaucoma (early oneset)

28: Natalizumab associated with JC Virus activaction leading to

• Progressive Multifocal Leukoencephalopathy