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Pharm Formulas > 8/13 Cleanup > Flashcards

8/13 Cleanup Flashcards

1
Q

What are the components of an ovarian teratoma?

A

3 germ cell layers: ectoderm, endoderm, and mesoderm Benign most of the time

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2
Q

What is struma ovarii?

A

Thyroid tissue that is in a germ cell tumor

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3
Q

What is a dysgerminoma?

A
  • Clear cytoplasm and central nuclei
  • The female equivalent of a seminoma.
  • Malignant and radiosensitive.
  • Good prognosis; responds to radiotherapy
  • LDH is elevated in the serum
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4
Q

What is an endodermal sinus tumor?

A
  • Malignant tumor that mimics yolk sac; most common germ cell tumor in children
  • AFP is marker
  • Schiller duval bodies (look like glomeruli) are seen on histology
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5
Q

What is a choriocarcinoma?

A
  • Malignant tumor of cytotrophoblasts and syncytiotrophoblasts
  • Similar to placental tissue with no villi
  • Small and hemorrhagic
  • B-hcg positive which leads to thecal cysts of the ovary
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6
Q

What are the names of the germ cell tumors?

A

Teratoma

Dysgerminoma

Yolk sac

Choriocarcinoma

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7
Q

What are the names of the sex cord stroma tumors?

A
  • Fibroma
  • Granulosa cell
  • Leydig sertoli
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8
Q

What is an ovarian fibroma? What is a major thing to look out for in a pt with ovarian fibromas?

A
  • Benign tumor of fibroblasts
    • Look out for Meigs syndrome: Ascites, pleural effusion
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9
Q

What are seen in leydig sertoli cell tumors?

A
  • High androgen production
  • Virilization (hair lip) and pseudohermaphroditism
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10
Q

What are the characteristics of a seminoma vs a nonseminoma?

A
  • Seminomas - very responsive to radiotherapy and metastasize late (good prognosis)
    • Nonseminomas - variable response to treatment and often metastasize early (bad)
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11
Q

What is a seminoma composed of?

A
  • Large cells with clear cytoplasm and central nuclei that forms a homogeneous mass
  • No hemorrhage or necrosis
  • Marker: B hcg
  • Good prognosis
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12
Q

What are the characteristics of a male embryonal carcinoma?

A
  • Malignant tumor comprised of immature primitive cells that produce glands
  • Aggressive tumor with early hematogenous spread
  • CHemotherapy may result in differentiation into another type of germ cell tumor
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13
Q

What is a yolk sac tumor?

A
  • Malignant tumor that resembles a yolk sac
  • Shiller duval bodies
  • AFP positive
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14
Q

What is a teratoma in a male? How is it different than one in a woman?

A
  • Tumor composed of mature fetal tissue derived from two or three embryonic layers
  • MALIGNANT IN MALES COMPARED TO NON MALIGNANT IN FEMALES
  • AFP and b-hCG positive
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15
Q

What is a choriocarcinoma in males?

A
  • Syncytriotrophoblases and cytotrophoblasts
  • Spreads early via blood
  • b-hCG is characteristically elevated; may lead to hyperthyroidism or gynecomastia
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16
Q

Compare acute and chronic prostatitis?

A
  • Acute: Chlamydia and neisseria are common causes in young adults, E coli and pseudomonas are common in older adults.
    • Prostate is tender and boggy on digital rectal exam
  • Chronic: Dysuria with pelvic or low back pain
    • Serum shows WBCs but are negative on culture
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17
Q

What are the characteristics of a thyroid adenoma?

A
  • Common
  • Benign
  • Cold (non-functional)
  • If funcitonal, causes hyperthyroidism
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18
Q

What are the characteristics of a papillary carcionma of the thyroid?

A
  • Most common malignant thyroid cancer
  • Radiation exposure
  • Spreads lymphatically
  • Excellent prognosis - slow growth
  • Psammoma bodies “orphan annie nuclei”
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19
Q

What are the characteristics of a follicular carcinoma of the thyroid?

A
  • Hematogenous spread to bone and lungs
  • Can present hurthle cells too
  • Micro: Delimited by fibrous capsule surrounding tighly packed follicles, trabeculae, or solid sheets of tumor cells that are often cuboidal with dark or pale staining nuclei with inconspicuous nucleoli
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20
Q

What are the characteristics of an anaplastic carcinoma?

A
  • The worst
  • Firm, bulky mass
  • Early MTS to trachea and esophagus leading to dyspnea, dysphagia
  • Bad prognosis, very aggressive
  • Undifferentiated, anaplastic pleomorphic cells
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21
Q

What are the functions of the leukotrienes?

A
  • B4 - neutrophil attraction and activation
  • C4, D4, E4 - Vasoconstriction, bronchospasm, increased vascular permeability
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22
Q

What are the functions of COX products?

A
  • I2,D2, E2 - vasodilation and increased vascular permeability
  • E2 - also fever and pain
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23
Q

What are the effects of bradykinin?

A

Vasodilation

Vascular permeability

Pain

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24
Q

Define margination, rolling, and adhesion

A
  • Margination - vasodilation leads to margination of cells from the center of the flow to the periphery
  • Rolling - P and E selectin slow cells down to allow diapedesis to occur. These selectins are upgraded during inflammatory responses
  • Adhesion - Firm adhesion leads to diapedesis
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25
Q

What are the contents of weibel palade bodies?

A
  • P-selectin
  • vWF
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26
Q

What are the two types of beta thalassemia?

A
  • Minor - mildest form and is usually asymptomatic
  • Major - more severe form and presents with severe anemia a few months after birth
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27
Q

What causes the crewcut appearance seen in beta thalassemia major?

A
  • Unpaired alpha chains precpitate and damage the RBC membrane, resulting in ineffective erythropoiesis and extracascular hemolysis
  • Because of this, there is expansion of hematopoiesis into the skull and facial bones leading to the classic crewcut appearance.
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28
Q

What type of anemia is thalassemia?

A

Microcytic, hypochromic RBCs

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29
Q

What is hemoglobin C? What is the mutation that causes it?

A
  • AR mutation glutamic acid to lysine in the beta chain of hemoglobin
  • Extravascular hemolysis
  • HbC crystals seen in RBC smear
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30
Q

What is the body’s respnose to decreased LV contractility?

A
  1. Decreased cardiac output
  2. Increased renin angiotensin aldosterone activation
  3. Increased renal Na+ and H2O reabsorption
  4. Increased venous pressure
  5. Increased preload, increasd cardiac output
  6. Increased sympathetic activity leading to increased LV contractility
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31
Q

Define kussmaul sign?

A
  • Increased JVP on inspiration instead of normal decreased
  • Inspiration leads to negative intrathoracic pressure not transmitted to heart leading to impaired filling of the right ventricle
  • Blood backs up into the vena cava leading to JVD
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32
Q

What conditions feature Kussmaul sign?

A

Constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors

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33
Q

What are the extraintestinal manifestations of Crohn?

A

Kidney stones (calcium oxalate), gallstones, possible ASCA antibodies

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34
Q

In terms of correcting sodium levels too fast, what happens if you increase sodium too fast vs decreasing sodium too fast

A
  • Low to high: Pons will die
  • High to low: Brain will blow (cerebral edema and herniation)
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35
Q

What pathway is responsible for the positive symptoms of psychosis?

A

Mesolimbic pathway (VTA to NA) has excess dopamine

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36
Q

What pathway is responsible for negative symptoms of psychosis?

A

Mesocortical pathway (VTA to cortex) has less dopaminergic action

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37
Q

What is the root cause of parkinsons?

A

Decreased dopamine in the nigrostriatal pathway (Substantia nigra to the striatum)

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38
Q

Congenital manifestations of rubella

A

“I (eye) heart ruby (rubella) earrings

  • Cataracts (eye)
  • Ear (deafness)
  • Congenital heart disease (PDA)
  • Blueberry muffin rash
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39
Q

What are the congenital symptoms of syphilis?

A

Often results in stillbirth, hydrops fetalis; if child survives, presents with facial abnormalities (saddle nose, notched teeth, short maxilla), saber shins, CN8 deafness

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40
Q

What occurs in appropriate absolute polycythemia

A
  • Increased RBC mass
  • Decreased O2 saturation
  • Incresed EPO levels
  • Lung disease, congenital heart disease, high altitude
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41
Q

What occurs in inappropriate absolute polycythemia

A
  • Increased RBC mass
  • Increased EPO mass
  • Malignancy, hydronephrosis
  • Caused by ectopic EPO secretion
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42
Q

What are the characteristics of polycythemia vera?

A
  • Increased plasma volume
  • Increased RBC mass
  • Decreased EPO levels
  • EPO decreased in PCV due to negative feedback suppressing renal EPO production
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43
Q

Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter applies to what?

A

Atropine poisoning (muscarinic antagonist)

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44
Q

What are the symptoms of cholinesterase inhibitor poisoning?

A

DUMBBeLSS mnemonic

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45
Q

What are the zones in liver tissue?

A
  • Zone 1: periportal - affected by viral hepatitis, hit hardest by toxins
  • Zone 2: intermediate - Hit by yellow fever
  • Zone 3: Pericentral vein - hit by ischemia, P450, metabolic toxins, site of alcoholic hepatitis
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46
Q

How is glucose, galactose, and fructose absorbed in the small intestine?

A
  • Fructose: GLUT5
  • Galactose and glucose: SGLT1
  • All: GLUT2
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47
Q

What are the characteristics of a pleomorphic adenoma?

A

Most common salivary tumor composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively

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48
Q

What are mucoepidermoid carcinoma?

A

Most common malignant tumor, has mucinous and squamous components

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49
Q

What is a warthin tumor?

A

Benign cystic tumor with germinal centers typically found in smokers

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50
Q

What vitamins are malabsorbed in pancreatic insufficiency?

A

ADEK and B12

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51
Q

What is deficient in orotic aciduria?

A
  • Orotic acid in urine
  • Defect in UMP synthase
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52
Q

What is the presentation of orotic aciduria?

A
  • Developmental delay and megaloblastic anemia refractory to folate and B12
  • No hyperammonemia
  • Increased orotic acid
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53
Q

What are the major causes of osteonecrosis?

A
  • Corticosteroids
  • Alcoholism
  • SIckle cell disease
  • Trauma
  • the Bends
  • Legg-Calve Perthes disease
  • Gaucher disease
  • Slipped capital femoral epiphysis
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54
Q

What is the trabecular outflow tract? What receptors are used to increase outflow through this tract?

A
  • Drianage through the trabecular meshwork of the eye exiting through the canal of schlemm and into the episcleral vasculature
  • M3 agonist increases outflow through this tract
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55
Q

What is the uveoscleral outflow tract? What receptors are utilized to increase outflow through this tract?

A
  • Drainage into the uvea and sclera
  • Increase with prostaglandin agonists
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56
Q

Where is aqueous humor produced? What receptors are present on this area?

A
  • Ciliary body produces aqueous humor
  • Beta blockers: decrease
  • Alpha1 agonists decrease
  • Carbonic anhydrase inhibitors decrease
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57
Q

What is the pathway involved in mediation of pupil dilation?

A
  1. Hypothalamus to ciliospinal center of Budge (C8-T2)
  2. Exit at T1 to superior cervical ganglion
  3. Plexus along internal carotid, through cavernous sinus, enters orbit as long ciliary nerve to pupillary dilator muscles
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58
Q

What are the features of lupus nephritis?

A

RASH OR PAIN

  1. Rash
  2. Arthritis
  3. Serositis
  4. Hematologic disorders (Leukopenia, thrombocytopenia, etc)
  5. Oral/nasopharyngeal ulcers
  6. Renal disease
  7. Photosensitivity
  8. ANA
  9. Immunologic disorder
  10. Neurologic disorders
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59
Q

What causes retinal vein occlusion?

A

compression of nearby arterial atherosclerosis causes hemorrhage and venous emngorgement

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60
Q

What causes central retinal artery occlusion?

A

Acute painless monocular vision loss caused by some kind of embolic source

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61
Q

Why is horner syndrome associated with lesion above T1?

A

T1 is where the nerve arises that travels along the carotid to sympathetically innervate the eye

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62
Q

What is WAGR complex?

A

Wilms tumor, Aniridia (absensce of iris), Genitourinary malformations, mental Retardation

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63
Q

What is Denys Drash

A

Wilms tumor, early onset nephrotic syndrome, male pseudohermaphroditism

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64
Q

Beckwith Weidemann

A

Wilms tumor, macroglossia, organomegaly, hemihyperplasia

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65
Q

What is the mnemonic for that the testes cells do generally during development?

A
  • Leydig cells lead to Male differentiation
  • Sertoli Cells Shut Down Female differentiation
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66
Q

What is the pathological appearance of primary sclerosing cholangitis?

A

Onion skinning of bile duct in sections leading to beading of intra and extrahepatic bile ducts on ERCP

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67
Q

What is the pathologic appearance of primary biliary cholangitis?

A

Autoimmune destruction leading to lymphocytic infiltrate and granulomas which destroy intralobular bile ducts

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68
Q

In AK53 mutation sequence of colorectal cancer, what does each mutation do?

A
  • A: loss of APC gene leads to decreased adhesion and increased proliferation
  • K: Loss of KRAS gene leads to unregular intracelluar signaling
  • 53: Loss of P53 leads to loss of tumor suppression
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69
Q

Crohn disease is mediated by TH 1 or 2? What about UC?

A

Crohns is Th1 and UC is Th2

(Crohn’s is one word while UC is two words)

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70
Q

What is the importance of the submucosal layer of the gut wall?

A

Meissner’s plexus is here, responsible ofr secretion of fluid

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71
Q

Which layer of the gut wall is responsible for motility?

A

Muscularis externa

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72
Q

TRH, along with causing TSH release, also causes the release of what other hormone?

A

Prolactin

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73
Q

What is the difference between Mobitz type 1 and type 2?

A

Type II has dropped beats but no lengthening of the PR interval

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74
Q

Conduction rates

A

Purkinge then atria then ventricles then AV node PAVA

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75
Q
A
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76
Q

B1 stimulation of the heart causes what cellular change?

A
  • B1 receptor stimulation leads to Ca2+ channel phosphorylation leading to increased Ca2+ entry
  • increased active Ca2+ ATPase leading to increased Ca2+ storage in the sarcoplasmic reticulum
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77
Q

Men1

A
  • Pituitary tumors
  • Pancreatic endocrine tumors
  • Parathyroid adenomas
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78
Q

Men2a

A
  • Thyroid (medullary)
  • Pheochromocytoma
  • Parathyroids
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79
Q

Men2b

A

Medullary thyroid

Pheochromocytoma

Mucosal neuromas

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80
Q

Difference between direct and indirect inguinal hernias?

A
  • Indirect goes through indirect and goes INto the scrotum
    • Lateral to inferior epigastric vessels
  • Direct goes through parietal peritoneum medial to inferior epigastric vesels but lateral to rectus abdominis
    • Goes through external inguinal ring only
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81
Q

What is diamond blackfan anemia?

A

Rapid onset anemia within first year of life due to intrinsic defect in erythroid progenitor

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82
Q

What are the symptoms of diamond-blackfan anemia

A

Short stature, craniofacial abnormalities, and upper extremity malformations

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83
Q

What are the muscles responsible for arm abduction of different levels?

A
  • Supraspinatous: 15 degrees
  • Deltoid: 15-100 degrees
  • Trapezius: Over 90 degrees
  • Serratus anterior: over 100 degrees
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84
Q

What are the differences between the meyer loop and the dorsal optic radiation?

A
  • Meyer loop - lower retina, goes around lateral ventricle
  • Dorsal optic radiation - superior retina, goes through internal capsule
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85
Q

What is precontemplation

A

Not yet acknowledging the problem

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86
Q

What is contemplation

A

Acknowledging the problem but not wanting to make a change

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87
Q

What is preparation/determination?

A

Getting ready to change behaviors

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88
Q

What is action?

A

Changing behaviors

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89
Q

What causes acute interstitial nephritis?

A
  • Diuretics (pee)
  • Pain free (NSAIDS)
  • Penicillins and cephalosporins
  • Proton Pump inhibitors
  • RifamPin
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90
Q

Mesonephric ducts are (female/male) while paramesonephric ducts are (male/female)

A

Meso: Male Parameso: Female

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91
Q

What are the characteristics of cryptogenic organizing mnemonia?

A

Inflammation of the bronchioles and surrounding structure. Can be secondary to chronic inflammatory diseases or medication side effects

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92
Q

Baroreceptors are increase their firing due to (increased/decreased) pressure

A

Increased

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93
Q

What is the order of events in the cushing reflex?

A
  1. Increased intracranial pressure constricts arterioles
  2. Cerebral ischemia occurs
  3. Increased pCO2 and decreased pH occur as result of ischemia
  4. Increased central reflex sympathetic stimulation leads to increased perfusion pressure (hypertension_
  5. Increased stretch
  6. Peripheral reflex baroreceptor induced bradycardia
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94
Q

What occurs when you massage the carotid?

A
  1. Increased pressure on carotid sinus
  2. Increased afferent baroreceptor firing triggers decreased AV node conduction speed and subsequent decreased HR
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95
Q

What triggers the chemoreceptors in the periphery?

A
  • Carotid and aortic bodies are stimulated by decreased PO2, Increased PCO2, and decreased pH
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96
Q

What triggers chemoreceptors in the central areas?

A
  • Changes in pH and PCO2 of brain interstitial fluid, which in turn are influenced by arterial CO2
  • Do not directly respond to pO2
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97
Q

What is coronary steal syndrome?

A

Coronary stenosis causes maximally dilated vessels at baseline. Administration of vasodilators dilates normal vessels and shunts blood toward well-perfused areas, thereby diverting flow away from vessels that are stenosed and leading to ischemia in myocardium perfused by these vessels

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98
Q

What hormones are released from basophils?

A

B-Flat

  • Basophils
  • FSH
  • LH
  • ACTH
  • TSH
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99
Q

Hemidesmosome connects what?

A

Keratin in basal cells to underlying basement membrane

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100
Q

What do desmosomes connect?

A

Intermediate filaments interact

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101
Q

Adherens junctions connect what?

A

Tight junction, forms belt connecting actin cytoskeletons of adjacent cells with CADherins

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102
Q

What are the jobs of the medial and lateral pterygoid muscles?

A

Medial is for munching and lateral is for lowering

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103
Q

What are the adverse effects of neonatal respiratory supplemental oxygen

A

RIB

  • Retinopathy
  • Intraventricular hemorrhage
  • Bronchopulmonary dysplasia
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104
Q

What is CKMB used for?

A

Short term evaluation of myocardial infarction, but only lasts a short time

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105
Q

What is troponin used for

A

Long term confirmation of myocardial infarction

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106
Q

What is the function of endocannabinoids?

A

Act at cannabinoid receptors in hypothalamus and nucleus accumbens, two key areas for homeostatic and hedonic control of food intake, where it increases appetitie

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107
Q

Which receptors for ADH modulate osmolarity vs blood pressure?

A
  • V2: Osmolarity
  • V1: Blood pressure
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108
Q

When is GHRH levels increased?

A
  • Exercise
  • Sleep
  • Puberty
  • Hypoglycemia
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109
Q

What are some causes of hepatic adenoma?

A

Oral contraceptive or anabolic steroid use

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110
Q

Concerning features of hepatic adenoma

A

Rupture or regression

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111
Q

What is a greenstick fracture?

A

Incomplete fracture extending partway through the width of the bone

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112
Q

What is a torus fracture?

A

Buckle fracture of the cortex due to compression injury. Can be very subtle

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113
Q

What is the reason that seronegative spondyloarthropathy is called seronegative

A

No anti IgG rheumatoid factor

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114
Q

Destruction of the lateral hypothalamus leads to what

A

Lack of feelings of hunger meaning that the patient will rapidly lose weight

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115
Q

What is the mechanism of contraction alkalosis?

A

LOop diuretics and thiazides lead to increased AT2 which increases Na+/H+ exchange in the PCT leading to increased HCO3- reabsorption

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116
Q

What changes in the transition between bronchi and bronchioles?

A

Cartilage and goblet cells end when you transition from bronchi to bronhioles

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117
Q

What changes in the transition from terminal to respiratory bronchioles?

A

Terminal bronchioles have ciliated cuboidal cells compared to squamous cells in respiratory bronchioles

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118
Q

What is the function of TNF-alpha

A

Activates endothelium, causes WBC recruitment, vascular leak

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119
Q
A
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120
Q

Hepatitis B extrahepatic manifestations?

A
  • Hematologic: Aplastic anemia
  • Renal: Membranous GN
  • Vascular: Polyarteritis nodosa
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121
Q

Hepatitis C extrahepatic manifestations

A
  • Hematologic: Essential mixed cryoglobulinemia, increased B cell NHL, ITP, autoimmune hemolytic anemia
  • Membranoproliferative GN
  • Leukocytoclastic vasculitis
  • Sporadic porphyrria cutanea tarda, lichen planus
  • Increased diabetes risk
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122
Q

What are effects of insulin?

A
  • Glucose tranasport into muscle and adipose
  • Glycogen synthesis
  • Triglyceride storage
  • Sodium Retention
  • Protein synthesis
  • Cellular K+ uptake
  • Decreased glucagon release
  • Decreased lipolysis
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123
Q

What is the body’s response to SIADH

A
  1. Water retention leads to decreased aldosterone and increased ANP and BNP
  2. Because ANP and BNP are increased, extracelluar fluid volume is normalized, leading to euvolemia hyponatremia
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124
Q

What are the differences between cis and trans deletions in alpha thalassemia?

A
  • Cis - deletion (both deletions on the same chromosome) common in asian populations
  • Trans - deletion (on different chromosomes) common in african populations
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125
Q

Describe what happens in a leukoerythroblastic reaction

A
  • Left shift - more immature cells are seen because of the need for more cells
  • Band cells and metamyelocytes more common in response to infection or inflammation
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126
Q

What is the major cause of relative polycythemia?

A

Dehydration and burns

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127
Q

What are the jobs of each rotator cuff muscle?

A
  • Supraspinatus - laterally abducts arm
  • Infraspinatus - laterally rotates arm
  • Teres minor - adducts and laterally rotates arm
  • Subscapularies - medially rotates arm
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128
Q

What are the common injuries of each rotator cuff muscle?

A
  • Supraspinatus - most common
  • Infraspinatus - pitching injury
  • Teres minor - not typically injured
  • Subscapularis - not typically injured
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129
Q

In the spinothalamic tract, what do the lateral and anterior parts do??

A
  • Anterior: Crude touch, pressure
  • Lateral: Pain, temperature
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130
Q

Difference between simple and complex seizures?

A
  • Simple partial - consciousness intact, motor sensory, autonomic, psychic
  • Complex partial - impaired consciousness

COMPLEX MEANS IMPAIRED CONSCIOUSNESS

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131
Q

What is an absence seizure?

A

3 Hz spike and wave discharge leading to no postictal confusion and a blank stare

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132
Q

What is the difference between myoclonic and tonic clonic seizure?

A
  • Myoclonic - muscle (myo) repetitive jerks (clonic)
  • Tonic clonic - Alternation between stiffening (tone) and movement (clonus)
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133
Q

What is the definition of an atonic seizure?

A

Drop seizure in which the patient falls to the floor and appears to have fainted

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134
Q

Low K+ leads to

A

U waves, flattened T waves on ECG, arrythmias, muscle cramps, spasm, weakness

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135
Q

High K+ leads to

A

Wide QRS and peaked T waves on ECG, arrhythmias, muscle weakness

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136
Q

Low calcium leads to

A

Tetany, seizures, QT prolongation, twitching, spasm

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137
Q

High Mg2+ leads to

A

Decreased deep tendon reflexes, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

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138
Q

Low Mg2+ leads to

A

Tetany, torsades de pointes, hypokalemia, hypokalcemia

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139
Q

What are the symptoms of preecclampsia?

A

New onset hypertension with either proteinuria and end organ dysfunciton after week 20 of gestation caused by abnormal placental arteries and endothelial dyscunction, vasoconstriction and ischemia

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140
Q

What lobe do objects go into when the patient is laying down?

A

Posterior right upper

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141
Q

What are the functions of PDGF?

A
  • Secreted by activated platelets and macrophages
  • Induces vascular remodeling and smooth muscle cell migration
  • Stimulates fibroblast growth for collagen synthesis
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142
Q

What are the cancers that spread hematogenously?

A

Four Carcinomas Route Hematogenously

  • F: Follicular thyroid
  • C: Choriocarcinoma
  • R: Renal cell carcinoma
  • H: Hepatocellular carcinoma
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143
Q

How does the foramen ovale form?

A
  1. Septum primum grows superiorly and inferiorly
  2. Septum segundum grows superiorly after
  3. Superior part of the septum segundum grows and fuses with septum primum
  4. Inferior part of septum primum closes hole of foramen secundum
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144
Q

What are the characteristics of primary closed angle glaucoma?

A

Enlargement or forward movement of lens against central iris leading to obstruction of normal aqueous flow through the pupil. Fluid builds up behind the iris, pushing the peripheral iris against cornea and impeding flow through trabecular meshwork

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145
Q

What are the characteristics of secondary closed angle glaucoma?

A

Hypoxia from retinal disease inducing vasoproliferation in the iris that closes the angle

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146
Q

What is the pathology that occurs with posterior urethral valves?

A

Membrane remnant in the posterior urethra in males leading to urethral obstruction. Can be diagnosed prenatally by hydronephrosis and dilated bladder on ultrasound

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147
Q

What are the major causes of low birth weight?

A

Caused by prematurity or intrauterine growth restriction

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148
Q

What are some conditions that are associated with low birth weight?

A
  • Increased risk of sudden infant death syndrome and mortality
  • Impaired thermoregulation and immune function
  • Hypoglycemia
  • Polycythemia
  • Empaired emotional development
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149
Q

What does the HAVOCS mnemonic for menopause?

A

HAVOCS

  • H: Hot flashes
  • A + V: Atrophy of vagina
  • O: Osteoporosis
  • C: Coronary artery disease
  • S: Sleep disturbances
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150
Q

Which breast tumors/pathology are found in the lactiferous sinus or major duct of the breast?

A
  • Intraductal papilloma
  • Abscess/mastitis
  • Pagets disease
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151
Q

What are the pathologies that occur in the terminal duct lobular unit?

A
  • Fibrocystic change
  • DCIS
  • LCIS
  • Ductal carcinoma
  • Lobular carcinoma
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152
Q

What breast pathologies are found in the stroma of the breast?

A

FIbroadenoma and phyllodes tumor

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153
Q

Derivatives of glycine

A

Porphyrin and heme

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154
Q

Derivatives of phenylalanine?

A

Tyrosine which can be converted to DOPA which can be converted to Dopamine then NE then Epinephrine

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155
Q

Glutamate derivatives

A

GABA and glutathione

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156
Q

Arginine derivatives

A

Creatine, urea, nitric oxide

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157
Q

Tryptophan derivatives

A

Niacin and serotonin

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158
Q

What is the pathogenesis of cystic fibrosis?

A

Misfolded protein leads to retention of Cl- channels in the RER causing decreased Cl- and H2) secretion leading to increased intracellular Cl- and compensatory Na+ reabsorption via epithelial Na+ and abnormally thick mucus secreted into the lungs and GI tract

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159
Q

How does cystic fibrosis effect membrane potential?

A

Makes membrane potential more negative

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160
Q

Whaat is the function of ouabain?

A

Inhibition of the ATPase by binding to the K+ site

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161
Q
A
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162
Q

Major genetic connections are present between osteosarcoma and what other tumor?

A

Retinoblastoma or pagets disease

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163
Q

Albinism leads to what potential pathology?

A
  • Squamous cell carcinoma
  • Basal cell carcinoma
  • Melanoma
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164
Q

Large cell lung carcinoma that stains positive for what identifying factors?

A
  • TTF-1 - adeno
  • P40 (squamous)
  • Chromogranin (Neuroendocrine)
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165
Q

What is the criteria for acute rheumatic fever?

A
  1. Migratory polyarthritis
  2. Pancarditis
  3. Subcutaneous nodules
  4. Erythema marginatum
  5. Sydenham chorea - involuntary muscle movements
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166
Q

What is erythema marginatum?

A

annular, nonprutiritc rash with erythematous borders, commonly involving trunk and limbs

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167
Q

What causes rheumatic fever?

A

Cross reactivity with bacterial M protein

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168
Q

What situations will ESR be elevated?

A
  • Anemias
  • Infections
  • Inflammation
  • Cancer
  • Renal disease
  • Pregnancy
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169
Q

What conditions lead to decreased ESR

A
  • Sickle cell anemia
  • Polycythemia
  • HF
  • Microcytosis
  • Hypogibrinogenemia
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170
Q

What occurs in the proliferative stage of wound healing?

A

Deposition of granulation tissue and type III collagen, angiogenesis, epithelial cell proliferation, dissolution of clots, and wound contraction

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171
Q

What occurs in the remodeling stage of wound healing

A

Fibroblasts deposit type I collagen and replace type III collagen leading to increased tensile strength of tissue

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172
Q

Most (carcinomas/sarcomas) spread hematogenously

A

Sarcomas

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173
Q

What parameters are changed by rapid squatting?

A
  • Increased venous return
  • Increased preload
  • Increased afterload
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174
Q

Why does renal failure result in inhibited GnRH?

A

Prolactin is eliminated renally and therefore is increased which inhibits GnRH release

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175
Q

What are the characteristics of a neuroblastoma

A
  • Most common tumor of adenal medulla in children
  • CAN CROSS THE MIDLINE
  • Usually in children
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176
Q

What is the histological appearance of a neuroblastoma

A

Homer-Wright rosettes

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177
Q

How do neuroblastomas stain?

A

Bombesin and NSE +

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178
Q

Motilin

  • Source:
  • Action:
  • Regulation:
A
  • Source: small intestine cells
  • Action: MMC production
  • Regulation: Increased in fasting state
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179
Q

VIP

  • Source:
  • Action:
  • Regulation:
A
  • Source: Parasympathetic ganglia in sphincters, gallbladder, small intestine
  • Action: Increased intestinal water and electrolyte secretion, increased relaxation of intestinal smooth muscle and sphincters
  • Regulation: Increased by distation and vagal stimulation, decreased by adrenergic input
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180
Q

What are the actions of CCK

A
  • Increased pancreatic secretion
  • Gallbladder contraction
  • Decreased gastric emptying
  • Increased sphincter of Oddi relaxation
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181
Q

Glucose dependent insulinotropic peptide action

A
  • Exocrine: decrease gastric H+ secretion
  • Endocrine: Increased insulin release
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182
Q

Define pseudofolliculitis barbae?

A

“Razor bumps” Foreign body inflammatory facial skin disorder characterized by firm hyperpigmented papules and pustules that are painful and pruritic located on cheeks jawline and neck

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183
Q

What are the main reasons for acanthosis nigricans

A

insulin resistance from diabetes, obesity, cushing syndrome, or some kind of visceral malignancy like a gastric adenocarcinoma

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184
Q

What autonomic responses are responsible for the male sexual response?

A

POINT SQUEEZE SHOOT

  • Parasympathetic - erection
  • Sympathetic (hypogastric nerve) - emmission
  • Somatic (pudendal) - ejaculation
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185
Q

How does anemia change Hb concentration, %O2 sat, DIssolved O2 and total O2 content?

A
  • Hb concentration: Decreased
  • %O2 sat: Normal
  • DIssolved O2: Normal
  • total O2 content: Decreased
186
Q

How does polycythemia change Hb concentration, %O2 sat, DIssolved O2 and total O2 content?

A
  • Hb concentration: Increased
  • %O2 sat: Normal
  • DIssolved O2: Normal
  • total O2 content: increased
187
Q

How does CO poisoning change Hb concentration, %O2 sat, DIssolved O2 and total O2 content

A
  • Hb concentration: Normal
  • %O2 sat: Decreased
  • DIssolved O2: Normal
  • total O2 content: Decreased
188
Q

How does bicarb get out of the red blood cell?

A

Exchanged with Cl-

190
Q

What two reactions is B12 involved in?

A
  • Homocystine to methionine
  • Methylmalonyl-CoA to succinyl CoA
191
Q

How does a B12 deficiency differ from a B9 defieicny?

A
  • Homocysteine and methylmalonyl CoA are elevated in B12 deficiency
  • JUST homocysteine is elevated in B9 deficiency
  • No neurologic deficits in B9 deficiency
192
Q

Apo CII does what?

A

Cofactor for LPL

193
Q

Apo A1 does what

A

Activates LCAT

194
Q

ApoB48 does what

A

Mediates chylomicron secretion into lymphatics

195
Q

ApoE does what?

A

Mediates remnant uptake

196
Q

ApoB100 does what

A

Binds the LDL receptor

197
Q

Describe the receptor composition of T cells as they migrate

A
  • T cell precursor in bone marrow: No CD4 or CD8
  • Thymic cortex: CD4 and CD8
  • Thymic Medulla: Either CD4 or CD8 but not both
198
Q

What is the coactivator molecule on T cells and what does it bind to?

A

CD28 on T cells binds B7(CD80/86)

199
Q

What triggers anergy in T cells

A

Exposure to antigen without costimulatory signals

200
Q

What organisms are vaccinated by live vaccines?

A

Mrr VZ Mapsy

  • BCG
  • Influenca
  • Measles
  • Mumps
  • Polio
  • Rotavirus
  • Rubella
  • Varicella
  • Yellow fever
201
Q

What organisms are vaccinated with inactivated vaccines?

A

RIP Always

  • Rabies
  • Influenza
  • Polio
  • Hep A
202
Q

What organisms are treated with passive immunity

A

To Be Healed Very Rapidly

  • Tetanus toxin
  • Botulinum
  • HBV
  • Varicella
  • Rabies
  • (sometimes diptheria)
203
Q

Describe Romano-Ward syndrome vs Jervell Lang Neilsen syndrome

A
  • Romano Ward - autosomal dominant, pure cardiac phenotype
  • Jervell Lange Nielsen - autosomal recessive, sensorineural deafness
204
Q

What local metabolites lead to vasodilation in times of increased oxygen need

A

CO2, H+, Adenosine, Lactate, K+

CHALK

205
Q

What are the main treatments for air emboli?

A

Nitrogen bubbles precipitate in ascending divers can be treated with hyperbaric O2

206
Q

What are the two sensory neuron fiber types that free nerve endings utilize?

A
  • C - Slow, unmyelinated fibers
  • A delta - fast, myelinated
207
Q

What are the neuron fiber types utiliized by meissner corpuscles

A

Large, myelinated fibers; adapt quickly

208
Q

What are the sensory neuron fiber types utilized by pacinian corpuscles

A

Large myelinated fibers that adapt quickly

209
Q

What are the sensory neuron fiber types utilized by merkel discs

A

Large myelinated fibers that adapt slowly

210
Q

What are the sensory neuron fiber types that are utilized by ruffini corpuscles?

A

Dendritic endings with capsule; adapt slowly

211
Q

Characteristics of each stage of sleep from awake to REM

A

At night BATS Drink Blood

  • Awake: Beta
  • Awake (eyes closed): Alpha
  • N1: Theta
  • N2: Sleep spindles and K ocmplexes
  • N3: Delta
  • REM: Beta
212
Q

What is desmopressin?

A

ADH analog

213
Q

What tract decussates in the medulla?

A

Dorsal column

214
Q

Friedreich ataxia mutation

A

GAA on chromosome 9 in gene that codes for frataxin

215
Q

What is presbyopia?

A

Aging-related impairment of accomodation (focusing on near objects) primarily due to decreased lens elasticity, changes in lens curvature, decreased ciliary muscle strength. Patients resultantly need reading glasses

216
Q

What is the mechanism and adverse effects of memantine?

A
  • NMDA receptor antagonist; helps prevent excitotixicity
  • AE: Dizziness, confusion, hallucinations
217
Q

What are the drugs that can be uzed for AChE inhibition in alzheimers

A

Donepezil, galantamine, rivastigmine, tacrine

218
Q

what is the 60-40-20 rule

A
  • 60% of the body is water
  • 40% of that water is ICF
  • 20% of that water is ECF
220
Q

Chronic irritation of the urinary bladder leads to what kind of carcinoma?

A

Squamous cell carcinoma of the bladder from dysplasia and squamous cell carcinoma

221
Q

Incidence order of gynecologic tumor epidemiology?

A

Endometrial then ovarian then cervical

222
Q

Prognosis order of gynecological tumors

A

Ovarian endodermal then cervical

223
Q

What is the pathogenesis of achalasia?

A

Increased LES tone due to loss of NO secretion

224
Q

Punched out esophageal ulcers are indicative of

A

HSV-1 infection

225
Q

Pyruvate kinase deficiency leads to

A

Decreased ATP and rigid blood cells leading to extravascular hemolysis

226
Q

What are the markers of pyruvate kinase deficiency

A

Increased 2,3 BPG and decreased hemoglobin affinity for O2

227
Q

What is the appearance of stevens johnson syndrome?

A
  • Fever
  • Bullae formation
  • Necrosis
  • Sloughing of skin at dermal epidermal junction
  • 2 mucous membranes are involved
  • targetoid skin leasoins or
  • erythema multiforme
228
Q

What is the chemical composition of a person with narcolepsy

A

Hypocretin production in lateral hypothalamus

229
Q

Describe the physiologic adaptations in pregnancy

A
  • Increased cardiac output
  • Increased HR to perfuse placenta
  • Anemia
  • Hypercoagulability
  • Hyperventiliation
230
Q

What causes increased hCG in pregnancy?

A

Increased in multiple gestations, hydatidifor moles, choriocarcinomas, and Down Syndrome

231
Q

When is hCG decreased in pregnancy?

A

Ectopic and failing pregnancy, edward syndrome, patau syndrome

232
Q

What are the treatments for CN- poisoning?

A

CN poisoning

  • Nitrites oxidize hemoglobin to methemoglobin which binds CN- and relieves cytochrome c oxidase
  • Thiosulfate binds CN- - thiocyanate is then excreted
233
Q

Excess nitrogen in the body is converted to what?

A

Carbamoyl phosphate which is converted to citrulline

234
Q

What is the problem that occurs with abetalipoproteinemia?

A

Absence of chylomicrons, VLDL, and LDL caused by a deficiency in ApoB48, ApoB100

235
Q

What are the tests for neurosyphilis

A

VRDL, FTA-ABS, and PCR

236
Q

Gag gene

A

(p24 and p17) Capsid and matrix proteins respectively

237
Q

What are the phase 2 reactions?

A

Conjugation (Methylation, glucuronidation, acetylation, sulfation). Yields polar, inactive metabolites

238
Q

Define xanthogranulomatous pyelonephritis

A

rare; grossly orange nodules htat can mimic tumor nodules; characterized by widespread kidney damage due to granulomatous tissue containing foamy macrophages

240
Q

What is the cellular pathway utilized by the T cell receptor

A
  • Calcineurin activation leads to dephosphorylation of NFAT
  • NFAT leads to transcription of NF-kB which leads to synthesis of inflammatory cytokines
241
Q

What is increased in the cell when the IL2 receptor is activated

A

mTOR, which triggers the transcription of proliferation genes

242
Q

What is the result of subthalamic nucleus damage

A

Contralateral hemiballismus

243
Q

What is kluver bucy syndrome?

A

Disinhibited behavior (hyperphagia, hypersexuality, hyperorality) usually caused by HSV1 encephalitis

244
Q

What is perinaud syndrome

A

Paralysis of conjugate vertical gaze as a result of stroke, hydrocephalus or pinealoma

245
Q

Conductive hearing loss will show up how on a rinne test?

A

Bone is more loud than air

246
Q

What is the difference between a somatic symptom disorder and a conversion disorder?

A
  • Somatic symptom: Unconscious production of physical symtoms causing significant distress and impairment
  • Conversion disorder: Loss of sensory or motor function, often following an acute stressor
248
Q

How does age change sleep patterns?

A
  • Decreased rem and slow wave sleep
  • Increased onset sleep latency
  • Increased early awakenings
249
Q

What is the cause of osteitis fibrosa cystica

A

Osteoclast overactivity leading to cystic spaces with deposited hemosiderin from hemorrhages

250
Q

What is the main cause of the basophilic stipling in lead poisoning?

A

ALA dehydratase and ferrochelatase are inhibited by lead poisioning, meaning that heme synthesis is inhibited, but rRNA degradation is as well. THis leads to aggregates or rRNA which stain basophilic around the nucleus

251
Q

Which type of hodgkin lymphoma has the best prognosis?

A

Lymphocyte rich

252
Q

What is the appearance of mixed cellularity hodgkin lymphoma

A

Eosinophilia, seen in immunocompromised patients

253
Q

What is the pair mnemonic of seronegative spondyloarthritis

A

PAIR

  • Psoriatic arthritis
  • Ankylosing spondylitis
  • Inflammatory bowel disease
  • Reactive arthritis
254
Q

What is the list of things that occur in sarcoidosis?

A
  • Increased ACE
  • Restrictive lung disease
  • Vitamin D
  • Bells Palsy
  • Uveitis
  • Hypercalcemia
  • Erythema nodosum
  • Lupus perino
255
Q

What is lupus perino

A

Manifestation of sarcoidosis in which the nose and face has red erosive lesions that appear like frostbite

256
Q

What nerve endings sense dynamic, fine light touch, and position sense

A

Meissner corpuscles

257
Q

What receptors sense vibration and pressure?

A

Pacinian corpuscles

258
Q

What receptors sense pressure, deep static touch, and position sense

259
Q

What receptors sense pressure, slippage of objects along skin surface, joint angle change

260
Q

What foramen drain to the lateral 4th ventricle and which drain to the medial 4th ventricle?

A

Lateral = luschka

Medial = magendie

261
Q

What is the treatment of ischemic stroke?

A

If within 3-4.5 hours, use tPA to but clot and regain perfusion of desired area

262
Q

Describe what happens during a transient ischemic attack

A

Brief, reversible episode of focal neurologic dysfunciton that SHOWS UP NEGATIVE NO MRI and resolves in 15 minutes due to local ischemia

263
Q

MCA aneurysm leads to

A

Rupture leads to ischemia in MCA distribution and ontralateral upper extremity and facial hemiparesis, sensory deficits

264
Q

List the things that cause bell palsy

A

Lovely Zoey Has an STD

  • Lyme disease
  • Zoster
  • Herpes simplex
  • Sarcoidosis
  • Tumors
  • Diabetes mellitus
265
Q

Infndibulopelvic ligament

A
  • Carries ovarian vessels
  • Connects ovaries to lateral wall
  • Ligated during oophorectomy
266
Q

Carcinal ligament

A
  • Cervix to pelvic wall
  • Uterine vessels
  • When ligated can injure ureters
267
Q

Ovarian ligament

A
  • Medial pole of ovary to lateral uterus
  • connects ovary to lateral uterus
268
Q

Describe the major findings of acromegaly

A

Large tongue with deep furrows, deep voice, large hands and feet, coarsening of facial features with aging, frontal bossing, diaphoresis, impaired glucose tolerance

269
Q

Acromegaly increases the risk of what two things?

A

Colorectal polyps and cancer

270
Q

What receptors are responsible for Tight binding

A

ICAM and VCAM on vasculature/stroma bind CD11/18 integrins and VLA-4 on leukocytes respectively

271
Q

Diapedesis is mediated by what recpetors

A

PECAM1 on vasculature and leukocyte

272
Q

What is opsoclonus myoclonus ataxia syndrome

A

Dancing eyes and dancing feet due to a neuroblastoma in children and a small cell lung cancer in adults

273
Q

What are the major causes of paraneoplastic encephalomyelitis

A

Antibodies against Hu antigens in neurons that originate from small cell lung cancer

274
Q

What are the causes of paraneoplastic cerebellar degeneration? Make sure to include the specific antibodies

A
  • Small cell lung cancer (anti Hu)
  • Gynecologic and breast (anti-Yo)
  • Hodgkin lymphoma (anti-Tr)
275
Q

What is the difference between somatostatin and somatomedin

A
  • Somatostatin - keeps your growth static
  • Somatomedin - mediates growth
276
Q

What is the result of decreased Steroid Hormone Binding Globulin?

A

Increased amounts of free hormones leading to greater effects

277
Q

What is the function of somatostatin?

A
  • Decreased gastric acid and pepsinogen
  • Decrease pancreatic and small intestine fluid secretion
  • Decrease gallbladder contraction
  • Decrease insulin and glucagon
278
Q

What are the results of a VIPoma?

A

Pancreatic tumor that secretes VIP

  • WDHA syndrome
  • WD: Watery Diarrhea
  • H: Hypokalemia
  • A: Achlorohydria
279
Q

What are the usual causes (Other than H pylori) of Gastric ulcers and duodenal ulcers?

A

Gastric ulcers are usually caused by NSAIDs while duodenal ulcers are usually caused by Zollinger Ellison syndrome

280
Q

Contents of primary granules of neutrophils

A
  • Primary
  • Peroxidase (MPO or myeloperoxidase)
  • Permeability-increasing protein
  • Proteases (Serine proteases)
  • Elastase (Neutrophil elastase)
  • Defensins
281
Q

Contents of Azurophilic granules of neutrophils

A

Proteases, acid phosphatase, myeloperoxidase, beta-glucuronidase

282
Q

What is the presentation of follicular lymphoma

A
  • Indolent course; bcl2 inhibits apoptosis meaning that cells live forever
  • Presents with waxing and waning lymphadenopathy that is not painful
283
Q

What is the lcinical presentation of burkitt lymphoma?

A

Starry sky appearance with sheets of lymphocytes with interspersed tangible body macrohages that cause cleared out areas. Associated with EBV

284
Q

What is heparin bridging?

A

Heparin frequently used when starting warfarin because heparins activation of antithrombin enables anticoagulation during the initial, transient hypercoagulable state caued by warfarin

285
Q

What does IPEX stand for?

A
  • Immune dysregulation - autoimmunity
  • Polyendocinopathy
  • Enteropathy
  • X linked
286
Q

What is the pathogenesis of IPEX?

A

Autoimmunity caused by genetic feficiency of FOXP3 in regulatory T cells

289
Q

What is the cause and result of erbs pallsy?

A
  • Injury: Tear of the upper trunk C5-C6 roots
  • Result: Loss of abduction, lateral rotation, flexion and supination
290
Q

What is the injury and result of klumpkes palsy?

A
  • Lower trunk injury C80T1
  • Total claw hand: lumbricals normally flex MCP joints and extend DIP and PIP joints
291
Q

What is the result of hracic outlet synddrome?

A
  • Same as klumpkes palsy
  • Atrophy of the intrinsic hand muscles, ischemia, pain, and edema due to vascular compression
292
Q

Trendelenburg sign is caused by injury to what nerve

A

Superior gluteal nerve

293
Q

What is the mechanism and AE of leflunomide

A
  • Mech: Reversibly inhibit dihydroorotate dehydrogenase, preventing pyrimidine synthesis. Suppressing T cell function
  • AE: Diarrhea, hypertension, hepatotoxicity, teratogenicity
294
Q

What is febuxostat?

A

Inhibitor of xanthine oxidase

295
Q

Bisphosphonate

A
  • Pyrophosphate analog; bind hydroxyapatite in bone and inhibits osteoclast activity
  • Can cause esohagitis, osteonecrosis of jaw, atypical stress fractures
296
Q

What is allopurinol?

A

Inhibit xanthine oxidase used in lymphoma to derease conversion of hypoxanthine to urate

297
Q

What is etanercept?

A

Fusion protein produced by recombinant DNA that intercepts TNF

298
Q

What are the anti-TNF monoclonal antibodies?

A

Infliximab, adalimumab, certolizumab, golizumumab

299
Q

What is the function of human placental lactogen

A
  • Stimulate insulin production
  • Increased insulin resistance due to shunting of carbohydrate metbaolism toward supplying glucose/amino acids to the fetus
  • Increased lipolysis (due to insulin resistance)
300
Q

What are the markers for mesothelioma?

A
  • Psammoma bodies
  • Cytokeratin and calretinin
301
Q

What is the effect of endotoxins

A

Directly stimulate macrophages by binding to endotoxin receptor TLR4(CD14) TH CELLS ARE NOT INVOLVED IN THIS PROCESS

303
Q

What are the nuclei of the cerebellum from lateral to medial

A

Dentate, eboligorm, GLobose, Fastigial

304
Q

Fibroadenoma

A

Small well defined and mobile mass increased in size and tenderness with increased estrogen

305
Q

What is the difference between red and white pulp?

A
  • Red pulp is where red blood cells are processed
  • White pulp is where white blood cell ferminal centers are
306
Q

What is Hfr x F- conjugation?

A

F+ plasmid can become incorporated into bacterial chromosomal DNA, termed high-frequency recombination cell. Transfer of leading part of plasmid and a few flanking chromosomal genes. High frequency recombination may integrate some of those bacterial genes. The recipient cell remains F- but now may have new bacterial genes

307
Q

Azathioprine or 6 mercaptopurine use

A
  • Purine analogs that inhibit pruine synthesis
  • Must be activated by HGPRT
  • Used for organ rejection, IBD, SLE and to wean patents off steroids in chronic disease
308
Q

Adverse effects of azathioprine and mercaptopurine

A
  • Myelosuppression, GI, liver damage
  • Increased toxicity with allopurinol and febuxostat
309
Q

What is the use and mech of cladribine

A
  • Purine analog - multiple mechanisms
  • Used for hairy cell leukemia
310
Q

Adverse effects of cladribine

A

Myelosuppression, nephrotoxicity, neurotoxicity

311
Q

5FU mechanism and use

A
  • Mech: COmplexes with thymidylate synthase and folic acid, inhibiting it
  • Use: Colon cancer, pancreatic cancer, basal cell carcinoma (topically)
312
Q

5FU adverse effects

A

Myelosuppression, palmar plantar erythrodysesthesia

313
Q

Methotrexate mech and use in cancers

A
  • Folic acid that inhibits dihydrofolate reductase decreasing DNA synthesis
  • Cancers: Leukemias, lymphomas, choriocarcinomas, sarcomas
314
Q

Non cancer uses of Methotrexate

A

Extopic pregnancy, medical abortion, rheumatoid arthritis, psoriasis, IBD, vasculitis

315
Q

What are cytarabine used for?

A

Pyrimidine analog used for leukemias and lymphomas

316
Q

Sirolimus inhibits what and causes what toxicity

A
  • mTOR inhibitor by binding FKBP to prevent response to IL2
  • Pancytopenia, insulin resistance, hyperlipidemia
317
Q

Tacrolimus mech and toxicity

A
  • Prevents IL2 transcription by binding FKBP
  • Increased risk of diabetes and neurotoxicity
318
Q

Cyclisporine mechanism

A
  • Calcineurin inhibitor prevents IL2 transcription
  • Nephrotoxicity, hypertension, hyperlipidemia, neurotoxicity, gingival hyperplasia, hirsutism
319
Q

Azathioprine mechanism

A
  • Inhibit lymphocyte proliferation by blocking nucleotide synthesis
  • Pancytopenia
320
Q

MMF mechanism and toxicity

A
  • IMP dehydrogenase preventing purine synthesis in B and T cells
  • Pancytopenia, hypertension, hyperglycemia
321
Q

What is a temporary effect of corticosteroids

A

Temporary leukocytosis

322
Q

Drugs for kidney transplant rejection prophylaxis

A

Sirolimis and basiliximab

323
Q

What are phase 1 reactions

A

Reduction, oxidation and hydrolysis

324
Q

Chloroquine uses. What do you use if there is resistance?

A

Blocks plasmodium heme polymerase, but if there is resistance go to mefloquine or atovaquone/proguanil

325
Q

What is primaquine used for?

A

Hypnozoite form of plasmodium vivax and ovale

326
Q

What is the mechanism of sulfonimides

A

Mimic action of glucose by closing K+ channels in pancreatic β cells, which leads to depolarization and increased Ca2+ influx, releasing insulin.

327
Q

Metformin Mechanism

A

meets glucose and advises it to stay out of the blood. It asks the liver to keep glucose in the house (Inhibits hepatic glucose production) and asks the glucose in the bloodstream to go into adipose and skeletal muscle (Stimulates peripheral uptake of glucose). Metformin never met a glucose molecule and did not tell him to not stay in blood :P

328
Q

Biguanides

A

Inhibits hepatic glucogenesis and increases peripheral uptake of glucose.

329
Q

Gliptans

A

Drugs ending with -gliptins (Sitagliptin, etc) are dipeptidyl peptidase 4 (DPP-4) inhibitors. They act to inhibit degradation of the endogenous incretins GLP-1 and GIP.

330
Q

Amylin

A

Amylin rhymes with insulin to remember that amylin mimetics like pramlintide increase secretion of insulin and delay gastric emptying.

331
Q

Thiazolinidione toxicity

A

THiazoLidinedione: Toxic to Heart and Liver

332
Q

Pioglitazone mnemonic

A

Pioglitazone - PI
Peroxisome proliferator-activated receptors (PPARs)
Improves insulin sensitivity

333
Q

Adverse effects of acetazolamide

A

Proximal renal tubular acidosis, paresthesias, NH3 toxicity, sulfa allergy, hypokalemia

334
Q

Loop diuretics adverse effects

A

OHH DAANG

  • Ototoxicity, hypOkalemia, hypOmagnesmia, dehydration, allergy, metabolic Alkalosis, Nephritis, Gout
335
Q

Thiazide diuretics adverse effects

A
  • HyperGLUC
  • G: hypoGlycemia
  • L: hyperLipidemia
  • U: hyperUricemia
  • C: hyperCalcemia

Also metabolic alkalosis, hyponatremia

336
Q

Angiotensin converting enzyme inhibitor adverse effects

A
  • Cough
  • Angioedema
  • Teratogen
  • Increased Creatinine
  • Hyperkalemia
  • Hypotensino
337
Q

Adverse effects of aliskiren?

A

Hyperkalemia, decreased GFR, hypotension, angioedema

338
Q

What are the 5 bacterial products produced by phages

A

ShigA-like toxin (this is aka Verotoxin)
Botulinum toxin
Cholera toxin
Diphtheria toxin
Erythrogenic toxin (Strep pyogenes)

340
Q

Irinotecan and topotecan mechanism and adverse effects

A
  • Mech: Inhibit topoisomerase I and prevent DNA unwinding
  • AE: Myelosuppression and diarrhea
341
Q

What is the function of the ulnar nerve

A
  • Ulnar claw on digit extension
  • Radial deviation of wrist upon flexion
  • Loss of wrist flexion, flexion of medial fingers, abduction and adduction of fingers, actions of medial 2 lumbrical muscles
342
Q

What is a cystic hygroma associated with

A

Turner syndrome

343
Q

What is the gene involved in Sturge weber?

344
Q

What drug has the highest and lowest lipid and blood solubility

A

Nitrous oxide has the lowest blood and lipid solubility and Halothane has the highest

345
Q

Mature ego defenses

A

Sublimation, altruism, suppression, humor

346
Q

Findings of tay sachs

A
  • Neurodegeneration
  • Developmental delay
  • Red spot on macula
  • Onion skin on lysosome
347
Q

Fabry findings

A
  • Episodic peripheral neuropathy
  • Angiokeratomas
  • Hypohidrosis
  • Renal failure
  • Cardiovascular disease
348
Q

Metachromatic leukodystrophy findings

A

Central and peripheral demyelination with ataxia, dementia

349
Q

Krabbe disease findings

A
  • Peripheral neuropathy
  • Oligodendrocytes
  • Developmental delay
  • Optic atrophy
  • Globoid cells
350
Q

Gaucher disease findings

A
  • Hepatosplenomegaly
  • Pancytopenia
  • Osteoporosis
  • Avascular necrosis of femur
  • lipid laiden macrophages
351
Q

Neiman pick disease

A
  • Neurodegeneration
  • Hepatosplenomegaly
  • Foam cells
  • Cherry red macula
352
Q

Catalase positive organisms

A

Nocardia, pseudomonas, listeria, aspergillus, candida, e coli, staphylococci, serratia, B cepacia, H pylori

354
Q

Glut 5 transporters are found where?

A

Spermatocytes and GI tract

355
Q

Which andrenal enzyme deficiency features an increase in 17 hydorxyprogesterone?

A

21 hydroxylase

356
Q

What is a giveaway that you are dealing with a adrenal enzyme deficiency?

A

Bilateral enlargement of the adrenal glands and hyperpigmentation from large amounts of ACTH secretion

357
Q

What are the congenital markers of hypothyroidism?

A

Pot bellied, protruding umbilicus, protuberent tongue, poor brain development, pale, puffy faced

358
Q

What are the features of ulcerative colitis?

A

ULCCCERS

  • Ulcers
  • Large intestine
  • Continuous
  • Colorectal carcinoma
  • Crypt abscesses
  • Extends proximally
  • Red diarrhea
  • Sclerosing cholangitis
359
Q

Markers for ALL?

A

TdT+, CD10+

360
Q

What is a renal oncocytoma?

A

Tumor arising from collecting ducts, featuring large eosinophilic cells with abundant mitochondria and presenting with painless hematuria, flank pain, and abdominal mass

361
Q

Mnemonic for lung development

A
  1. Embryonic (3-8 weeks, i.e. embryonic period)
  2. Pseudoglandular (5-16 weeks)
  3. Canalicular (16-26 weeks)
  4. Terminal saccular (26-36 weeks)
  5. Alveolar (36 weeks to 40 weeks and continues to childhood)
362
Q

Where are the bifurcations

A
  • Common carotid: C4
  • Trachea: T4
  • AA: L4
363
Q

What is a common weird thing that is seen with bronchogenic cysts

A

Filled with fluid, seen on xray

364
Q

What is the problem of lesion of the reticular activating system?

A

Reduced levels of arousal and wakefulness

365
Q

Define cyclothymic disorder

A

Milder form of bipolar disorder lasting at least 2 years

367
Q

What are the features of 5 alpha reductase deficiency?

A

Inability to convert testosterone to DHT leading to male internal genitalia, ambiguous external genitalia until puberty where testosterone levels increase

368
Q

What happens in a person who has no sertoli cells?

A

Lack of mullerian in hibitory factor leading to the development of both male and female internal genitalia and male external genitalia

369
Q

How is estrogen made in the theca and granulosa cells?

A
  • Cholesterol is used by the theca cells and is converted to androstenedione by desmolase
  • Androstenedione is passed over to the granulosa cells and converted to estrone by aromatase
370
Q

What is it called when the V/Q ratio = 0

A

Shunt, meaning that there is no air coming in and this section of lung is just a connection between the right and left ventricle with no gas exchange

371
Q

What is the presentation of bronchiectasis?

A
  • Clubbing, purulent sputum, recurrent infections, hemoptysis
  • Chronic necrotizing infection of pronchi leading to permanently dialated airways
372
Q

What are some common reasons for serial platelet thrombi on heart valves?

A

Adenocarcinomas, especially pancreatic

373
Q

Ulnar claw is caused by what?

A
  • Occurs when extending fingers at rest
  • Distal ulnar nerve injury
374
Q

What types of lesions produce clawing of the hand?

A

Distal ulnar or median nerves

375
Q

Clawing of the thumb, pointer and middle finger is caused by what

A
  • Injury to the distal median nerve
  • Occurs when trying to extend fingers
376
Q

Patient is making the ok gesture when trying to close his hand

A

Proximal ulnar nerve injury leading to this gesture when trying to make a fist

377
Q

Popes blessing is caused by what?

A

Injury to the proximal median nerve and seen when making a fist

378
Q

Atrophy of the thenar and hypothenar eminence is indicative of what two things?

A
  • Thenar: Median
  • Hypothenar: Ulnar
379
Q

What arae some things that can injure the long thoracic nerve?

A

Axillary node dissection after mastectomy, stab wounds

380
Q

What are the deadlines for twinning in embryogenesis

A
  • First 72 hours (up to morula stage): Dichorionic Diamnionic (No risk of Twin-Twin transfusion syndrome)
  • Between 4 and 8 Days (Blastocyst stage): Monochorionic Diamnionic
  • Between 9 and 12 Days (Splitting of embryonic disk) —> Monochorionic Monoamnionic
381
Q

What is the difference between the left and right gonads in terms of venous drainage?

A

Left takes the longer route and goes into the left renal vein first

382
Q

What are the cytokines of T reg cells

A

Anti inflammatory IL10, TGF-beta

383
Q

Symptoms of arsenic poisoning

A

Vomiting, rice water stools, garlic breath, QT prolongation

385
Q

What is the difference between decerebrate and decorticate posturing?

A

Decorticate has more Cs and moves the hands more toward the cord while decerebrate has more es and moves the hands toward the extension position

386
Q

What are the short acting benzos?

A

ATOM: Alprazolam, triazolam, oxazoepam, midazolam

387
Q

What is the effect that benzos have on sleep?

A

Decreased REM

388
Q

What is a perfusion limited gas

A

One that reaches equilibration early, like CO2 and N20

390
Q

Glucagon causes what change in PFK2

A
  1. Low glucose
  2. Glucagon increases cAMP
  3. Phosphorylation of FBPase2
  4. Decreased F26BP
  5. Inhibition of glycolysis, stimulates gluconeogenesis
391
Q

Insulin causes what change in PFK2

A
  1. High blood glucose
  2. Insulin leads to dephosphorylation of FBPase2 and activation of PFK2
  3. Increased F26BP
  4. Stimulates glycolysis and inhibits gluconeogenesis
392
Q

What is the difference between duchenne and becker muscular dystrophy?

A

Duchenne has a much earlier onset whereas becker has an onset in adolescence

393
Q

What is the worst subtype of breast cancers? Who commonly gets this?

A

Triple negative, mostly african americans

394
Q

What is the distinction between dystrophic and metastatic calcification

A
  • Dystrophic: Deposition of calcium that occurs in dead or dying tissue that occurs with normal serum levels of calcium and normal calcium metabolism
  • Metastatic calcification: Deposition of calcium in normal tissues as a result of derangement in calcium metabolism and increased levels of calcium
395
Q

Wolff Chaikoff vs Jod Basedow

A
  • Wolff-Chaikoff: Hypothyroidism because of ingestion of large amount of iodine
  • Jod-Basedow effect: Iodine induced hyperthyroidism in patient with multinodular goiter and graves
396
Q

What drug can cause parkinsonian symptoms?

A

MPTP which is metabolized to MPP

397
Q

What is vilazodone?

A

INhibits 5HT uptake; 5HT1A receptor partial agonist. Used for MDD, and generalize anxiety. Can cause nausia vomiting and diarrhea, increased weight, and anticholinergic effects

398
Q

What is vortioxetine

A

5HT reuptake inhibitor that agonizes 5HT1A and 5HT3 receptor antagonist. Used for MDD. Can cause nausea, sexual dysfunction ,sleep disturbances, antichoinergic effects

399
Q

How do sarcomas stain?

A

+ for desmin

400
Q

What is the appearance of brenner’s tumor on histology?

A

Coffee bean nuclei and looks like bladder cells

401
Q

What is used primarily to study gene exrpression?

A

Northern blot

402
Q

What are the jobs of the D and T arms of tRNA?

A
  • D = detection of tRNA by aminoacyl-tRNA synthetase
  • T = tethers tRNA molecule to ribosome
404
Q

What is the direction of blood flow compared to bile flow

A

Bile flows opposite of blood toward zone 1 and blood flows toward zone 3 into the central hepatic vein

406
Q

What are the symptoms of colonic ischemia?

A
  • Reduction in intestinal blood flow causing ischemia
  • Abdominal pain followed by hematochezia
  • Occurs in splenic flexure or distal colon
  • Thumbprint sign on imaging due to mucosal edema
407
Q

What are some treatments for acne?

A

Retinoids, benzoyl peroxide, antibiotics

408
Q

What are some major causes of cataracts?

A
  • Age
  • Smoking
  • Alcohol
  • Sunlight
  • Corticosteroids
  • Diabetes
  • Trauma
  • Infection
409
Q

What are the congenital reasons for cataracts?

A
  • Galactosemia
  • Galactokinase deficiency
  • Trisomies (13,18,21)
  • ToRCHeS infections
  • Marfan
  • Allport
  • Myotonic dystrophy
  • Neurofibromatosis 2
410
Q

What are the adverse effects of copper intrauterine devices?

A

Heavier or longer menses, dysmenorrhea, risk of pelvic inflammatory disorder

411
Q

What is refsum disease?

A

Scaly skin, ataxia, shortening of the 4th tow, epiphyseal dysplasia

413
Q

Homocysteinuria can be caused by what defects?

A
  • Deficiency of cystathionine synthase
  • Defective cystathionine synthase
  • Methionine synthase deficiency
414
Q

What are the symptoms of homocystinuria?

A
  • Increased homocystine
  • Osteoporosis
  • Marfanoid habitus
  • Ocular damage
  • Cardiovascular thrombosis and atherosclerosis
  • kYphosis
415
Q

What toxin functions like TSST1 but comes from strep pyogenes?

A

Exotoxin A

416
Q

Jarisch Herxheimer reaction

A

Flu like syndrome after antibiotics are started due to killed bacteria releasing toxins

417
Q

What is the beers criteria?

A
  • Avoid certain medications due to decreased efficacy or increased risk of adverse effects
    • Anticholinergics, antihistaminergics, antidepressants, benzos, opioids
    • alpha blockers
    • PPIs
    • NSAIDS
418
Q

What is hospice care indicated for?

A

Those whose life expectance is less than six months, giving priority tocomfort and relieving pain over side effects (for example: Opioids are given despite the odds of respiratory depression)

419
Q

Define cor pulmonale

A

Isolated right HF due to pulmonary causes

420
Q

What is the mech and use of paclitaxel?

A
  • Stabilize microtubules so the mitotic spindle cant break down
  • Ovarian and breast carcinomas
421
Q

Mechanism and use of vincristine and vinblastine

A
  • Bind beta tubulin and inhibit polymerization
  • Solid tumors, leukemias, hodgkin (vinblastine), non-hodgkin (vincristine)
422
Q

What other hormone shares a subunit with LH, FSH, and TSH? What is the consequence of this?

A

hCG, meaning that it can cause hyperthyroidism

423
Q

What is SBLA syndrome?

A

Sarcoma, breast, leukemia, adrenal gland malignancy associated with TP53 mutation

424
Q

CD14 receptor is what

A

Receptor for PAMPs like LPS, usually found on macrophages

425
Q

Marker for hematpooietic stem cells

426
Q

What are the consequences of splenectomy?

A
  • Howell-Jolly bodies
  • Target cells
  • Thrombocytosis (loss of sequestration of platelets)
  • Lymphocytes (loss of sequestration)
427
Q

What is the treatment for the different forms of homocystinuria?

A
  • Cystathionine synthase deficiency: decrease methionine, increase cysteine, increase B6 and B12, increase folate
  • Cystathionine synthase defect: Increase B6 and increased cysteine
  • Methionine synthase deficiency: Increase methionine
428
Q

What is glutamate converted to for assistance in the cahill and cori cycle?

A

Combined with pyruvate to form alpha ketoglutarate and alanine

429
Q

What are the processes of collagen synthesis that occurs within the cell?

A

Synthesis, hydroxylation, glycosylation

430
Q

What are the processes of collagen synthesis that occurs outside the cell?

A

Proteolytic processing, gross linking

431
Q

What are the early adrenergic symptoms of hypoglycemia?

A

Sweating, tremors, palpitations, hunger, nervousness due to NE and Epi release

432
Q

What are the late symptoms of hypoglycemia?

A

confusion, visual disturbances, stupod, seizures, and neurological deficits

433
Q

What is the main difference between endometrial hyperplasia and carcinoma?

A
  • Hyperplasia: excess estrogen syimulation leads to increased gland proliferation and can lead to carcinoma
  • Carcionma: Vaginal bleeding cauased as a gynecological malignancy at 55
434
Q

fdsds ddsf

435
Q

What is the chromosomal makeup of most complete moles?

436
Q

Zebra sign is a sign of what?

A

Horizontal lines of dense bone progressing away from the growth plate in children in osteogenesis perfecta

437
Q

What is a howell jolly body?

A

BLUE Remnant of chromatin that is usually consumed by the spleen but is not consumed in splenectomy or sickle cell patients

438
Q

What lesion produces total claw hand

A

Both ulnar and median nerve are damaged

440
Q

What is the mechanism of ranolazine? Adverse effects

A
  • Inhibits late phase of sodium current thereby reducing diastolic wall tension and oxygen consumptoin
  • Causes constipation, dizziness, headache, nausea, and QT prolongation
441
Q

What is the mechanism of milrinone?

A

PDE3 inhibitor leading to increased cAMP accumulation, ca2+ accumulation and increased inotropy and chronotropy as well as smooth muscle dilation

442
Q

Ivabradine mech and AE

A
  • Mech: selective inhibition of funny sodium channels prolonging depolarization
    • Luminous phenomena/visual brightness, hypertension, bradycardia
443
Q

What are the adverse effects of digoxin?

A
  • Cholinergic - nausea, vomiting, diarrhea, blurry yellow vision, arrythmias, AV block
  • Hyperkalemia
445
Q

What is the function of Th1 and Th2 cells respectively

A
  • Th1: Activates macrophages and cytotoxxic T cells
  • Th2: Recruits eosinophils for parasite defense and promotes IgE production by B cells
446
Q

What diuretics lead to acidemia and how?

A
  • Carbonic anhydrase inhibitors: decreased bicarbonate resorption
  • K sparing: prevents K+ secretion and H+ secretion
    • Hyperkalemia leads to K+ entering all cells in exchange for H+
447
Q

What diuretics cause alkalemia and how?

A
  • Loop diuretics and thiazides
    • Volume contraction causes increased ATII leading to increased Na+/H+ exchange in the PCT
    • K+ loss leads to K+ exiting all cells in exchange for H+
    • Low K+ state causes H+ to be exchanged for Na+ in cortical collecting tubule
448
Q

What diuretics lead to decreased calcium?

A

Loop diuretics LOSE CALCIUM

449
Q

Name the reportable diseases

A

Hep, Hep, Hep, Hooray, the SSSMMART Chick is Gone

  • ○ Hep A
    ○ Hep B
    ○ Hep C
    ○ HIV (actually varies by state, although AIDS is always
    reportable)
    ○ Salmonella
    ○ Shigella
    ○ Syphilis
    ○ Measles
    ○ Mumps
    ○ AIDS
    ○ Rubella
    ○ TB
    ○ Chickenpox
    ○ Gonorrhea
450
Q

What exactly is a psammoma body

A

Laminated, concentric spherules with dystrophic calcification seen in papillary carcinoma (thyroid), serous papillary cystadenocarcinoma of the ovary, meningioma, malignant mesothelioma

451
Q

What forms of malaria have dormant forms in the liver

A

Hypnozoite

452
Q

What is the effect of rapid squatting on heart murmurs

A
  • Decreased intensity of hypertrophic cardiomyopathy murmur
  • Increased intensity of AS, MR, VSD murmurs
  • MVP has a later onset of click
453
Q

What is the effect of valsalva and standing up on murmurs

A
  • Decreased intensity of most murmurs
  • Increased intensity of hypertrophic cardiomyopathy murmur
  • MVP: earlier click
454
Q

What is the result of inspiration murmurs?

A

Increased intensity of all right sided murmurs

455
Q

What is takotsubo cardiomyopathy

A

Broken heart syndrome caused by ventricular apical ballooning due to increased sympathetic stimulation

456
Q

What is the insulin dependent glucose transporter? Where is it found?

A

GLUT4 in the adipose and muscle

457
Q

Markers of CLL?

A

CD20+, CD23+, CD5+

458
Q

What changes are seen in psoriasis

A

Increased spinosum and decreased franulosum, as well as auspitz sign

Pharm Formulas (10 decks)

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