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Cloze Budd-Chiari syndrome is caused by the obstruction of the

{{c1::hepatic}} veins.
Cloze A key risk factor for Budd-Chiari syndrome which presents with
jaundice ascites and hepatomegaly is {{c1::polycythemia vera}}.
Cloze Budd-Chiari syndrome often presents with elevated liver enzymes
jaundice and abdominal pain localized to the {{c1::right upper}} quadrant.
Cloze Hereditary hemochromatosis is characterized by excessive absorption
and deposition of {{c1::iron}} in various organs.
Cloze The diagnosis of hereditary hemochromatosis includes elevated serum
{{c1::ferritin}} and transferrin saturation levels.
Cloze Hereditary hemochromatosis is an {{c1::autosomal recessive}} disorder.
Cloze Polycythemia vera is characterized by an increased {{c1::red blood
cell}} mass.
Cloze Diagnosis of polycythemia vera is confirmed by elevated
hemoglobin/hematocrit and low {{c1::erythropoietin}} levels.
Cloze A common mutation found in polycythemia vera is the {{c1::JAK2}}
mutation.
Cloze Chediak-Higashi Syndrome is an autosomal recessive disorder caused by
mutations in the {{c1::LYST}} gene.
Cloze A characteristic feature of Chediak-Higashi Syndrome is the presence of
{{c1::giant granules}} in neutrophils and other leukocytes.
Cloze Physical findings in Chediak-Higashi Syndrome include partial
{{c1::albinism}} and recurrent {{c1::infections}} due to impaired neutrophil
function.
Cloze Exogenous T3 supplementation {{c1::suppresses::action}} TSH levels
by increasing negative feedback which in turn decreases T4 secretion from the
thyroid gland. Furthermore reverse T3 (rT3) {{c1::decreases::effect on rT3}}
because less T4 is available for conversion.
Cloze TSH from the anterior pituitary stimulates the thyroid to produce
thyroxine (T4) and a small amount of triiodothyronine (T3). T4 is converted in
peripheral tissues to {{c1::T3 (active form)}} and {{c1::reverse T3 (inactive
form)}}.
Cloze Iron bound to heme is normally in the reduced ferrous ({{c1::Fe2+::state
of iron in heme normally}}) state. Nitrites cause poisoning by inducing the
conversion of this heme iron to the oxidized ferric ({{c1::Fe3+::oxidized state}})
state leading to the formation of ({{c1::methemoglobin}}.
Cloze Methemoglobinemia causes {{c1::dusky::type of discoloration}}
discoloration of the skin (similar to cyanosis) and because methemoglobin is
unable to carry oxygen a state of functional anemia is induced.
Cloze Anaphylaxis is a systemic type I hypersensitivity reaction characterized
by increased vascular permeability and multisystem edema leading to massive
shifting of intravascular fluid to the extravascular compartment. Symptoms often
begin within {{c1::seconds to minutes::timeline}} after intravascular exposure to
an inciting factor (e.g. insect stings intravenous medications) but can take up to 2
hours to develop with orally ingested antigens.
Cloze Anaphylaxis results from widespread {{c1::mast cell and basophil
degranulation::cells involved}} and resultant {{c1::histamine and
tryptase::substances released}} release. The latter is an enzyme that is relatively
specific to mast cells and elevated serum levels of it are often used to support a
clinical diagnosis of anaphylaxis after the patient has been stabilized.
Cloze The high-affinity IgE receptor (FcεRI) is found on the surface of mast
cells and basophils and normally binds the Fc portion of circulating IgE antibodies.
Cross-linking of multiple membrane-bound IgE antibodies by a multivalent antigen
results in {{c1::aggregation of the FcεRI receptors::mechanism triggered by
multivalent antigen}}.
Cloze {{c1::Aggregation::process}} of the FcεRI receptors on mast cells and
basophils causes degranulation and the release of preformed mediators (e.g.
histamine tryptase) that initiate an allergic response.
Cloze A 57-year-old man with a history of type 2 diabetes obesity
hyperlipidemia hypertension and gout presents with nausea vomiting and severe
crampy pain in the right flank. Abdominal ultrasound reveals right-sided
hydronephrosis and proximal ureteral dilation. Urinalysis would most likely reveal
the presence of {{c1::red blood cells (RBCs)::substance}} in the urine.
Cloze In ureterolithiasis the disruption of the ureteral epithelium typically
results in hematuria with {{c1::normal::RBC morphology in ureterolithiasis}}
morphology of RBCs differentiating it from glomerular causes of hematuria where
{{c1::RBC casts::RBC morphology in glomerular causes}} are found in the urine.
Cloze A 15-year-old boy presents with right arm numbness fluctuating tingling
and numbness involving the right shoulder arm and hand. The symptoms worsen
with overhead activities and throwing a baseball. This condition is most likely due
to compression of the brachial plexus within the {{c1::scalene triangle::location}}
bordered by the anterior and middle scalene muscles and the first rib.
Cloze In thoracic outlet syndrome (TOS) compression of the brachial plexus
occurs as it passes through the scalene triangle which is formed by the
{{c1::anterior and middle scalene::muscles}} muscles and the first rib. Patients
often present with upper extremity numbness tingling and weakness.
Cloze A 43-year-old immigrant from Southern Asia with a history of cough and
recent hemoptysis reports 15-lb weight loss over the past four months. Sputum
cultures grow acid-fast bacilli that are susceptible to most antimycobacterial drugs
in vitro. Isoniazid monotherapy in this patient would most likely result in
{{c1::selective survival of bacterial cells secondary to gene mutation::outcome}}.
Cloze Isoniazid resistance in Mycobacterium tuberculosis specifically occurs
due to two selective gene mutations. The first is a decrease in bacterial expression
of the {{c1::catalase-peroxidase::enzyme}} enzyme required for isoniazid
activation and the second is through modification of the {{c1::protein
target::binding site}} binding site.
Cloze Celiac disease is a chronic malabsorptive disorder caused by a
hypersensitivity to {{c1::gluten::protein}} a protein found in wheat barley and rye.
This triggers an immune-mediated reaction causing {{c1::villous atrophy::immune
reaction effect}} {{c1::crypt hyperplasia::effect}} and intraepithelial lymphocyte
infiltration.
Cloze Screening for celiac disease is done with serology testing for elevated
IgA {{c1::anti-endomysial::antibody}} and anti-tissue
{{c1::transglutaminase::antibody}} antibodies. Diagnosis is confirmed by
{{c1::endoscopic biopsy::diagnostic method}} and treatment involves a
{{c1::gluten-free::diet}} diet.
Cloze Acetylcholinesterase inhibitors improve skeletal muscle weakness (Ach
nicotinic) but can cause {{c1::muscarinic overstimulation::effect}} of the smooth
muscles and excessive glandular secretions (e.g. diarrhea diaphoresis abdominal
cramping emesis). Selective {{c1::muscarinic antagonists::medications}} (e.g.
glycopyrrolate hyoscyamine propantheline) can be used to reduce these adverse
effects without affecting the action of cholinesterase inhibitors on skeletal muscle.
Cloze Drug-induced lupus erythematosus (DILE) should be considered in
patients presenting with signs and symptoms of systemic lupus erythematosus
(SLE). Both {{c1::hydralazine::drug 1}} and {{c1::procainamide::drug 2}} are
categorized as high-risk drugs for the development of DILE. Other implicated
drugs include isoniazid minocycline and quinidine.
Cloze ST-segment elevation in the inferior leads is diagnostic of an inferior
myocardial infarction (MI). Inferior MIs are often due to blockage of the
{{c1::right coronary artery::artery}} the artery usually responsible for sinoatrial
(SA) and atrioventricular (AV) node perfusion. Thus inferior MIs are often
associated with bradycardia.
Cloze Atropine blocks vagal influence on the SA and AV nodes and is effective
in increasing heart rate in patients with bradycardia. However in the eye atropine
causes {{c1::mydriasis::effect on eye}} resulting in narrowing of the anterior
chamber angle and diminished outflow of aqueous humor. This can precipitate
{{c1::angle-closure glaucoma::condition}} in patients with shallow anterior
chambers or higher than normal intraocular pressures.
Cloze A hypertensive emergency is defined by a systolic blood pressure ≥180
mm Hg or diastolic pressure ≥120 mm Hg along with evidence of {{c1::end-organ
damage::condition}}.
Cloze Labetalol is a nonselective vasodilatory beta blocker that blocks beta-1
beta-2 and alpha-1 adrenergic receptors. The alpha-1 receptor blockade outweighs
beta-2 receptor blockade in vascular smooth muscle to cause {{c1::peripheral
vasodilation::effect}} leading to decreased {{c1::systemic vascular
resistance::outcome}} and heart rate.
Cloze A major polysaccharide component of the fungal cell wall is {{c1::13-
beta-D-glucan::polysaccharide}}. Caspofungin and the other echinocandin
antifungals (e.g. micafungin) block {{c1::glucan::synthesis}} synthesis.
Cloze Caspofungin is most active against {{c1::Candida::fungus 1}} species
and {{c1::Aspergillus::fungus 2}}. It is not active against {{c1::Cryptococcus
neoformans::fungus 3}} and has limited activity against Mucor and Rhizopus
species.
Cloze Coronary sinus dilation seen on echocardiography is usually an
indication of elevated {{c1::right-sided heart pressure::pressure}} as occurs with
{{c1::pulmonary hypertension::condition}}.
Cloze HIV enters the central nervous system via infected monocytes and
establishes a productive infection in {{c1::microglial cells::CNS macrophages}}
(resident macrophages of the central nervous system) and blood-derived
perivascular macrophages. Activation of these cells leads to the formation of
{{c1::microglial nodules::structure 1}} and {{c1::multinucleated giant
cells::structure 2}}.