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1
Q

effect of main exposure on outcome is modified by presence of other variable

A

effect modification- not a bias

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2
Q

effect modification vs confounding

A

effect modification is like only smokers have increased DVT but entire population does
confounding is like shoe size increasing sig. with intelligence- sig. gone with confounding factor of age

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3
Q

segmented viruses

A

BOAR: Bunyavirus, Orthoyxovirus, Arenavirus, Reovirus (rotavirus)

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4
Q

infected freshwater + painless hematuria (risk SCC) and pulm HTN
or + fibrosis and portal HTN

A

Schistosoma- snail

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5
Q

conditions that promote sickling in sickle cell/ what is sickling

A

low oxygen, increased acidity, low blood volume, high 2,3- bPG/ hydrophobic aggregation

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6
Q

Where and why traumatic aortic rupture

A

isthmus and because tethered by ligamentum arteriosum

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7
Q

two microtubular motor proteins and their fx

A

dynein- negative end to nulceus

kinesin- positive end points to periphery

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8
Q

virus of lung transplant pt on immunosuppresent

A

CMV

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9
Q

histo of CMV

A

owl eyes, enlarged cells with intranuclear inclusions

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10
Q

All herpes virus

A

enveloped, DS, linear, icosehedral

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11
Q

eicosanoid that promotes neutrophil migration

A

Leukotriene B4

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12
Q

link of hypothyroid and high cholesterol

A

decreased LDL receptor expression

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13
Q

contralateral weakness with rigidity, hyperreflexia, and positive babinski stroke

A

internal capsule

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14
Q

bladder of MS

A

hypertonic

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15
Q

Addison’s disease electrolyte findings

A

hypoaldosterone- leads to hyponatremia leads to increased H+ and K+ absorption, and Cl- absorption

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16
Q

riboflavin containing coenzyme and associated enzyme

A

FAD and succinate dehydrogenase

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17
Q

significance of succinate dehydrogenase

A

in TCA cycle (succinate to fumirate) and ETC as complex II

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18
Q

what is in the medulla of adrenal gland and what derived from

A

chromaffin cells from neural crest

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19
Q

fx of chromaffin cells

A

stim by acetylcholine and secrete catecholamines

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20
Q

cause of annular pancreas

A

fail of ventral bud to migrate and fuse with dorsal bud

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21
Q

mutation of sickle cell

A

sub of valine for glutamic acid on 6th position of b globin

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22
Q

DNA damage of radiation for cancer

A

double strand breakage and free radical accumulation

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23
Q

pathogenesis of histoplasmosis

A

replicates in intracellular of macrophages, spread from lungs to lymph nodes

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24
Q

where does complement bind on immunoglobin

A

Fc portion of heavy chain near hinge

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25
Q

apex of heart which structure and where reach

A

LV and 5th intercostal space MCL. Lung is superficial

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26
Q

most common CF mutation and problem associated

A

3 base pair deletion at AA position 508 for CFTR gene. impaired post translational processing of CFTR, misfoldf (ATP gated)-> shunting of CFTR to proteosome. high Na and Cl in sweat

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27
Q

contributors of resp drive for COPD vs normal

A

COPD: PaO2, normal: PaCO2

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28
Q

major stim of resp in healthy indvs and where

A

PaCO2 in arterial stim central receptors in medulla

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29
Q

hypoketotic hypoglycemia after significant fast

A

medium chain acyl Coa dehydrogenase deficiency

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30
Q

newborn with flat facies, limb deformities, pulm hypoplasia

A

Potter’s sequence

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31
Q

which AA makes nitric oxide- which does what

A

arginine and NO- vasodilation-decrease preload and increase coronary blood flow

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32
Q

immunostain of poststrepotococal GN

A

IgG, IgM, and C3

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33
Q

critical cytokines for granuloma formation- TB

A

IL-12- help CD4 become Th1, IFN-gamma- activate macrophages, and TNF-alpha

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34
Q

characteristics of malignant cells

A

large amount of rRNA and prominent nucleoli

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35
Q

fx of eukaryotic RNA polymerase 1, 2, 3

A
  1. rRNA
  2. mRNA, snRNA, micro RNA
  3. tRNA, rRNA for 60S
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36
Q

define Jarish-Herxheimer rx

A

acute inflammmatory rx after tx for spriochete infection like syphilis. b/c of rapid lysis of spirochetes

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37
Q

1st step in pathogenesis of TB (b4 CD4 activation of Interferon gamma)

A

intracellular replication in alveolar space and alveolar marcophages

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38
Q

MOA of etanercept

A

decoy to TNF alpha therefore do TB test b4 start Tx

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39
Q

timeline of psychotic disorders

A

brief: >=1 day and <1 month
schizphreniform: >=1month and <6 months
schizophrenia: = or more than 6 mo

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40
Q

epicanthal folds, upslanting palpebral fissures, protruding tongue, excess skin at nape of neck, hypotonia, cardiac defects

A

Down Syndrome

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41
Q

uncommon way to get Down Syndrome

A

Robertsonian translocation

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42
Q

stop codons

A

UAA, UGA, UAG

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43
Q

normal dev to 6-18 mo, loss of motor and language skills, hand movements, decel of head growth

A

Rett syndrome

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44
Q

CHF lung histo finding

A

pigmented, hemosideran laden macrophages

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45
Q

diabetic pt with early satiety, regurg undigested food, n/v

A

diabetic gastroparesis

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46
Q

pathophys of diabetic gastroparesis

A

destruction of enteric neurons due to chronic hyperglycemia

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47
Q

clue cells definition

A

epithelial cells covered with anaerobic gram variable rod

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48
Q

3 holosystolic murmurs

A

mitral regurg, VSD, tricuspid regurg

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49
Q

holosystolic murmur that increases intensity with inspiration

A

tricuspid regurg

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50
Q

enzyme deficient: vomit, lethargy, jaundice, E.coli sepsis

A

galactose 1-phophate uridyltransferase

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51
Q

vessel affected if get ulcer in lesser curvature

A

left gastric

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52
Q

transferance vs countertransferance

A

trans: pt’s rxn to provider (elderly pt lloves dr. b/c resemble daughter
counter: provider rx to pt (res prescribe haloperidol to pt that insults her and reminds her of mean father)

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53
Q

Hot T-bone stEAK

A

IL-1: fever
IL-2: stim T cells
IL-3: stim bone marrow
IL-4: stim IgE production
IL-5: stim IgA production as well as eonsinophil activation and survival
IL-6: stim aKute phase protein production

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54
Q

SA and AV node location

A

SA: right atrial wall near SVC
AV: endocardial surface of RA near septal leaflet of tricuspid valve and coronary sinus

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55
Q

left vs right spermatic/gonadal vein

A

right: into IVC
left: into left renal

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56
Q

left vs right renal vein; artery

A

right: into IVC and short
left: cross aorta under superior mesenteric artery, pressure higher

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57
Q

branches of sciatic nerve and fx

A

sciatic: knee flex
common peroneal: dorsiflexion, sensation dorsal foot and posterolateral calf
and tibial: plantar flex and inversion, ankle reflex

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58
Q

late ASD findings

A

left ot riight shunt becomes right to left shunt because of lots of pulm HTN and sclerosis

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59
Q

virulence factor of TB and fx

A

cord factor-prevent macrophage mediated destruction, leads to formation of caseating granulomas-of macrophages that are differentiated into epithelioid histocytes and multinucleated giant cells

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60
Q

cephalosporins and penicillins bind…

A

transpeptidase

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61
Q

cephalosporin mechanism of resistance

A

structural change in penicillin binding proteins

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62
Q

sensory innervation of tongue

A

anterior 2/3 (ant to foramen cecum) chorda tympani VII (taste) and trigeminal nerve V3 (sensation)
posterior 1/3: glossopharygeal
very posterior +larynx+esophagous: vagus

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63
Q

MOA of desmopressin to tx von Willbrand bleed

A

release vWF from endothelial storage

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64
Q

MOA of varenicline

A

partial agonist of nicotinic acetylcholine receptors. reduce withdrawal sx and decrease pleasure of tobacco

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65
Q

glycolysis in eyrthrocyte vs other cells

A

erythro: produce 2,3-BPG (which decrease Hgb affinity for O2) instead of ATP

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66
Q

pathophys and EKG of sick sinus syndrome

A

degen of SA node, bradycardia with dropped P waves

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67
Q

absence of cerebellar vermis, cystic dilation of 4th ventricle, posterior fossa enlargement, non communicating hydrocephalus

A

dandy walker malformation

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68
Q

dorsal vs ventral pancreatic bud structures

A

dorsal: most of head, body, tail
ventral: uncinate process, inf/post of head, major pancreatic duct

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69
Q

long term effect of renal artery stenosis on JG cells

A

hyperplasia (of modified smooth muscle cells)

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70
Q

inflammatory mediators released in anaphylaxis

A

histamine (first released) and tryptase

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71
Q

what changes in IGE receptor and antibody cause degranulation in anaphylaxis

A

IgE ABs are crosslinked and cause aggregation of high affinity IgE receptors. activate non receptor tyrosine kinases-causes mast cell and basophil degeneration

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72
Q

gum welling or bleeding, lose teeth, poor wound healing, hyperkeratotic follicles, bruising; who affected

A

scury- vit C deficiency; alcoholic

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73
Q

fx of vit C

A

hydroxylation of proline and lysine in pro collagen

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74
Q

high prolactin in PKU

A

BH4 (tetrahydrobiopterin) variant of PKU- Dihydrobiopterin reductase deficiency

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75
Q

test for stool fat

A

sudan III stain

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76
Q

ulnar nerve injury at elbow motor prob

A

impaired wrist flexion and adduction (think ulnar deviation)

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77
Q

levetiracetam MOA

A

disrupt vesicle fusion

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78
Q

first line for social anxiety disorder

A

SSRI

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79
Q

action of Hgb in lungs vs peripheral

A

releasing CO2 and H+

unload O2, take up CO2 (converts to CO3 and H+)

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80
Q

MOA of dobutamine and what used for

A

beta-1 agonist, increases HR and contractility and vasodilate, chemical stress test, immitate exercise

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81
Q

pathophys of stress test and stable angina

A

mismatch between O2 supply and demand, more than 70%

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82
Q

receptor stimulation of NE

A

alpha 1 and 2, B1 with no B2

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83
Q

B1 receptor fx

A

increase contractlity and HR

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84
Q

pathophys of tetanus

A

bacteria replicate, make toxin, retrograde thru LMN to spinal cord where blocks inhibitory interneurons, sporadic muscle contractions

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85
Q

sx of tetanus and dx

A

jaw stiffness, contracted facial muscles, spastic neck movments, resp failure; clinical

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86
Q

tx unconcious hypoglycemia in field vs in hospital

A

field: IM glucagon
hospital: IV dextrose

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87
Q

why can H flu cause upper resp and otitis

A

b/c those infections are non typal, without capsule

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88
Q

what cell bio wise leads to insulin resistance

A

phosphorylation of insulin receptor and insulin receptor substrate by serine kinase

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89
Q

phosphorylation that leads to insulin resistance is mediated by…

A

TNF alpha, catecholamines, glucocorticoids, and glucagon

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90
Q

histo of pheochromocytoma

A

stains for synaptophysin, chromogranin, neuron specific enolase. EM shows membrane bound secretory granules

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91
Q

pacemaker action potential steps

A
  1. Na in in funny current
  2. Ca in in steep slope
  3. K+ out
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92
Q

what is HER2 and how to treat HER2+, s/e

A

tyrosine kinase receptor-accelerates cell proliferation

trastuzumab-cardiotox-decreased contraacility without destruction

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93
Q

findings of conductive hearing loss

A

Rinne: bone >air
Weber: localize to affected ear

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94
Q

examples of types of collagen

A
  1. bone, tendons, ligaments, scar tissue, blood vessels
  2. cartilage, nucleos pulpus
  3. skin, lungs, intestines, blood vessels, bone marrow
  4. BM
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95
Q

side effect of topical corticosteroids

A

dermis atrophy

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96
Q

primary virulence factor of strep pneumo

A

capsule evades phagocytosis and opsonization

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97
Q

histo brain tumor of dilated blood vessels with thin adventia, lack of structural support causes bleeding- also presents with seizures

A

cavernous hemangiomas

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98
Q

BRCA fx

A

DNA repair, tumor suppressor

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99
Q

Fetal circulation after umbilical vein

A

liver bypasses through ductus venosus, enters IVC, to heart

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100
Q

cells of bronchioles

A

simple cuboidal, some ciliated

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101
Q

tx urea cycle disorders

A

restrict protein

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102
Q

IV fluids effects on heart mechanics

A

increase left end diastolic volume/preload, stretches myocardium, increase in stroke volume

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103
Q

what does an S4 mean

A

diastolic dysfx- sound created atrial contraction against stiff ventricle—> aortic stenosis, hypertensive heart disease, hypertrophic cardiomyopathy

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104
Q

lecithin to sphingomyelin ratio significance

A

must be greater or equal to 2 to indicate adequant surfactant production

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105
Q

histo of C dif

A

pseduomembranes with neutrophil predominant infiltrate, fibrin, bacteria, and necrotic epithelium

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106
Q

complication of C dif

A

toxic megacolon

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107
Q

complete vs incomplete mole on presentation and karyotype

A

complete: no fetal structures (grapes), only parental DNA- 46XX
partial- fetal parts, 69XXX or 69XXY, fert by 2 sperm

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108
Q

tx for cyanide poisening and why

A

amyl nitrate- creates Fe3+ Hgb which binds cyanide- keeping it from inhibiting cytochrome c oxidase in mitochondria, creates methemoglobin + sodium thiosulfate-detox cyanide-binds

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109
Q

differentiate between 17, 21, and 11 deficiencies

A

17: only one to decrease sex hormones
21: only one with reduced BP
11: high sex hormones, high BP

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110
Q

nerve that provides sensation to suprapubic and gluteal regions, and motor fx to anterolateral abd wall muscles
-can be damaged by appendectomy

A

iliohypogastric

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111
Q

lipohyalinosis and microatheroma formation

A

lacunar infarct

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112
Q

MOA of amphoteracin B and complication

A

binds ergosterol in fungal membranes , renal toxicity- hypokalemia, hypomag

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113
Q

dental carries, aspiration, lower lobe consolidation

A

actinomycosis

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114
Q

histo of actinomycosis

A

filamentous branching patterns with sulfur granules that stain purple/blue

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115
Q

most common bacteria of dog and cat bite

A

Pasteurella multocida

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116
Q

permanent pacemaker placement + signs of RHF

A

tricuspid regurg

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117
Q

nursemaid’s elbow/radial head subluxxation injury mech and to what structure

A

pulling arm up of child and annular ligament, hold elbow fixed and pronated

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118
Q

differentiating MENs

A

MEN 1: primary hyperpara, pituitary tumors, pancreatic tumors
MEN 2A: Medullary thyroid ca (calcitonin), pheochromocytoma, primary hyperpara
MEN 2B: Medullary thyroid ca (calcitonin), pheocchromocytoma, Marfanoid, mucosal neuromas

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119
Q

pathophys of acute hemolytic transfusion rxn-fever, hypotension, back pain, hemoglobinuria

A

type 2 hypersensitivity- complement mediated lysis

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120
Q

red neuron features

A

eosinophilic cytoplasm, pyknotic nuclei, loss of Nissl substance

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121
Q

calculate maintanance dose

A

clearance x steady state plasma [ ]

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122
Q

calc loading dose

A

(vol dis x steady state plasma [ ] )/ bioavailablity

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123
Q

virus of maculopapular rash that starts on face and spreads, plus tedner llymphadenopathy behind ears

A

rubella- togavirus

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124
Q

debilitating arthalgias, blue black cartilage and sclerae, black urine

A

alkaptonuria- homogentisate oxidase deficiency

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125
Q

define premature ejaculation

A

within 1 minute occur for at least 6 months

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126
Q

esophageal adenocarcinoma occur where and why

A

distal esophagous due to Barrets

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127
Q

lung mass, cerebellar sx, cerebellar mass with Purkinje cell degeneration + mediators

A

subacute cerebellar degeneration + autoimmune of Anti Yo, Anti-P/Q, anti-Hu

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128
Q

neural crest derivatives

A

SOME SALT.
Schwanna cells, odontoblasts, melanocytes, enterochromaffin cells, spinal membranes, adrenal medulla, laryngeal cartilage, tracheal cartilage

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129
Q

nerve of trendelenburg sign, injured if IM too laterally

A

superior gluteal

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130
Q

pathogensis of rheumatic fever

A

anti GAS ABs cross react and attach cardiac and NS antigens

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131
Q

vein implicated in esophageal varices in cirrhosis

A

left gastric

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132
Q

pathophys and sx of Hyper IgM

A 
defective CD40L in T cells- class switching defect;
opportunistic infections, GI and sinopulm infections
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133
Q

define false diverticulum

A

outpouching without muscularis layer

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134
Q

tx panic disorder

A

ssri

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135
Q

dependency on calcium for the three types of muscle

A

cardiac and smooth: depend on L type channels on surface for extracellular influx

skeletal: calcium release based on mechanical interaction between extracellular L and intracellular RyRr
therefore: verapamil no work

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136
Q

injury to radial nerve to produce motor sx of thumb and fingers

A

supinator canal

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137
Q

where nose bleed come from

A

Kisselbach plexus on anterior septum

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138
Q

how does renal excrete acid in acidosis?

A

through renal ammoniagenesis- metabolize glutamine to glutamate, generate ammonia for urine and bicarb for blood

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139
Q

MOA and use of diphenoxylate and loperamide

A

dip: opiod anti diarrheal, binds mu opiod receptors and slows motility
lop: opiod agonist, slow peristalsis, no cross blood brain barrier

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140
Q

electrolyte abnormality of bulemia

A

hypokalemia

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141
Q

clostridium perfringens causes

A

gas gangrene and delayed watery diarrhea after food poinsening

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142
Q

why down syndrome higher risk for Altzheimers

A

3 copies of amyloid precurser protein b/c on chrom 21

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143
Q

what is endothelin I?

A

stimulated by RAAS, cause vasoconstriction

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144
Q

hypovolemia leads to what ANS?

A

increased sympathetic activity

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145
Q

tx and goal of treating acute intermittent porphiria

A

glc and heme- attempt to inhibit aminolevonulate synthase, which creates ALA

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146
Q

s/e of erthyropoesis stimulating agents

A

HTN and thrombolic events

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147
Q

sore throat, fever, psuedomembrane in back of throat, cervical adenopathy, immigrant

A

Diptheria

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148
Q

diptheria toxin fx

A

adds ribose (ribosylation) to EF-2, promotes cell death

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149
Q

outbreak in close quarters: fever, cough, conjestion, conjunctivitis, pharyngitis

A

adenovirus

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150
Q

MOA of dantrolene

A

RYR receptor blocker, inhibits Ca release from sarcoplasmic reticulum

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151
Q

diarrhea, dermatitis, dementia

A

niacin (B3) deficiency/pellagra

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152
Q

Niacin

  1. cofactor
  2. and for which enzymes
  3. how get
A

NAD and NADP; isocitrate dehydrogenase, alpha-ketoglutarate dehydrogenase, malate dehydrogenase
3. by diet or from tryptophan

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153
Q

what happens in chronic lung transplant rejection

A

scarring of small airways, leads to bronchiolitis obliterans

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154
Q

which cells secrete Intrinsic factor and where histo located

A

parietal and upper glandular layer of body and fundus

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155
Q

fx of sertoli and Leydig cells

A

sertoli secrete MIF

leydig secrete T, differentiate wolf into male internal, while DHT responsible for male external

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156
Q

pathophys of S3

A

heard during rapid passive filling of ventricles, heard with increased left ventricular end systolic vol-volume overload, systolic CHF

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157
Q

enzyme that converts adenosine to inosine

A

ADA- if deficient, toxic to lymphocytes, one of the etiologies of SCID

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158
Q

phases of leukocyte adhesion and mediators

A
  1. Margination
  2. Rolling-L- seletin on Leuk and E and P selectin on on vasc
  3. activation
  4. crawling/tight adhesion: CD 11/18 on leuk, ICAM-1 on vasc
  5. transmigration: PECAM-1
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159
Q

Rathkes pouch from

A

ectoderm

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160
Q

follicular lymphoma translocation and overexpression

A

14;18 and Bcl-2

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161
Q

matching ppl in study controls for…

A

confounding

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162
Q

how to glc transported into cell

A

faciliated diffusion with carrier protein GLUT. Down [ ] gradient

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163
Q

how does heart use oxygen

A

myocardial O2 extraction exceeds any other tissue, therefore coronary sinus most deoxygenated in body

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164
Q

patient does not want to know result of test

A

right to refuse medical info

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165
Q

how do coal and dust get removed from airway

A

alveolar macrophages

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166
Q

how to tell if hypoglycemia from exogenous insulin or from glyperide or endogenous

A

exogenous will have normal C peptide, endogenous will have elevated C peptide

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167
Q

Class III antiarrythmics

A

AIDS: Amiodarone, Ibutilide, Dofetilide, sotalol

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168
Q

PCWP actually a measure of

A

left atrial and left ventricular end diastolic pressure

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169
Q

which cells cannot use ketones

A

erythrocytes b/c lack mitochondria

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170
Q

type of vaccine for N. meningitius

A

capsule

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171
Q

3 phases of Paget’s disease

A
  1. osteolytic/ osteoclast predominant
  2. mixed/ osteoclastic-osteoblastic
  3. osteosclerotic/ osteoblast predominant
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172
Q

medulloblastoma vs astrocytoma on imaging

A

astrocytoma cystic and solid features in parenchyma vs medulloblatoma solid and enlarged 4th ventricle

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173
Q

fx of clavulanic acid, sulbactam, and tazobactam

A

beta lactamase inhibitors which decreases amoxicillin cleavage by beta lactamase of bacteria

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174
Q

clinical manifestations of bartonella henselae

A

cat scratch, bacillary angiomatosis, culture negative endocarditis

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175
Q

low C1 esterase

A

hereditary angioadema

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176
Q

Beck’s triad (hypotension, JVD, muffled heart sounds) + pulsus paradoxus

A

cardiac tamponade

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177
Q

high fever, cough, confusion, diarrhea, interstitial infiltrates

A

Legionella

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178
Q

lab finding of legionella

A

hyponatremia

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179
Q

cells of liver that mediate fibrosis

A

stellate cells- in quiet phase- store vit A, in actiavted phase- transform into myofibroblast to secrete collagen

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180
Q

cell marker for macrophages and monocytes

A

CD14

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181
Q

makeup of granuloma in TB

A

central region of necrotic debri surrounded bylarge epitheliod macrophages

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182
Q

where Vit C in cell and what do

A

RER because cofactor in hydroxylating proline and lysine in collagen synth

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183
Q

MOA of ezetimibe

A

prevents cholesterol abdorption at small intestine brush border

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184
Q

s/e of methmiazole and PTU

A

agranulocytosis

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185
Q

fx and innervation of lat

A

innervate by thoracodorsal nerve, action of internal rotation, adduction, extension

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186
Q

both apoptosis pathways end with

A

caspases

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187
Q

significance of suspensory lig of ovary

A

contains ovarian artery, vein, and nerve

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188
Q

location of Histoplasmosis and biopsy results

A

Ohio and Mississipi River Valleys, macrophages with small yeasts inside

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189
Q

intrabdominal infections pathogen

A

polymicrobial with predominant B. frag and E. coli

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190
Q

painless initial genital sores caused by

A

Syphilis and lymphogranuloma venereum (chlamydia trach)

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191
Q

what restrict in maple syrup urine disease

A

branched chain amino acids- leucine, isoleucine, valine

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192
Q

cross sectional vs ecological

A

cs: looks at exposure and outcomes in indiv simultaneously; selected based on criteria for the study
e: looks at populations

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193
Q

sx of glomus tumor and what cell derived from

A

painful red blue under nail, from modified smooth muscle cells of the thermoregulatory glomus body

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194
Q

MOA and use of cilostazol

A

phosphodiesterase inhibitor, increase cAMP in plts- inhibit aggregation, vasodilate; PAD to reduce sx

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195
Q

why give dexamethasone in meningitis

A

reduce cytokines released in response to bacteria

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196
Q

exam and histo of Asbesosis

A

pleural plaques and lower lobe fibrosis; interstitial fibrosis and ferruginous bodies

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197
Q

why ventilation perfusion mismatch if give COPD pt too much oxygen

A

pum vasoconstriction at baseline, high O2 reverses constriction away from well ventilated alveoli, increase dead space (well ventilated areas less perfused) less CO2 exchange

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198
Q

activation of the extrinsic pathway

A
  1. FasL or TNF alpha bind to receptor

2. cytotoxic T cell release of granzyme

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199
Q

power of study

A

1-B

B is type II error which is concluding no difference between groups when there is one

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200
Q

how are osteocytes organized in Haverian system

A

central canal surrounded bymultiple lamallae of bony matrix, each with lacunae filled with osteocytes and bone fluid. canicula connect the lacuna via gap junctions

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201
Q

3 stages of perfusion of anethesia drugs

A
  1. central compartment -plasma
  2. high perfused compartment- brain, liver, kidney, lung
  3. poorly perfused compartment- muscle, bone, fat
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202
Q

MOA of cyclosporine and tacrolimus and s/e

A

inhibit calciurin activation which inhibits IL-2, which usually promotes growth and differentiation of T cells; nephrotoxicity

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203
Q

histo of brain in HIV dementia

A

microglial nodules (groups of macrophages/microglia surrounding necrosis) and multinucleated giant cells

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204
Q

bookends of intron in order to be able to splice out

A

GU at 5’ site and AG at 3’ splice site

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205
Q

murmur of pulmonary stenosis

A

mid systolic cres dec hear at P site, wide split S2

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206
Q

nitrates and PVR

A

modest decrease even tho arteriole

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207
Q

penile discharge + rash+ conjunctivitis + right knee pain + ___ = ____

A

+ sacroillitis = reactive arthritis

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208
Q

hypersegmented neutrophil, large RBC, weird purplish RBC

A

vit B12 deficiency

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209
Q

transmission, sx,and histo of Ehrlichia chaffeensis

A

tick from white tailed deer in SE and SW US, nonspecific sx + labs-lymphopenia, thrombocytopenia, eevated transaminases; mulberry shaped intracellular inclusions in monocytes

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210
Q

how is copper eliminated from body

A

old ceruloplasmin (circulating Cu) and unabsorbed Cu are secreted into bile and excreted into stool

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211
Q

fusion of HIV to cell requires

A

attachment of coreceptor CCR5 on macrophages or CXCR4 on T cells

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212
Q

adrenal mass plus hypertension, hypokalemia, renin down, normal sodium, metabolic alkalosis

A

Conn’s syndrome- aldostersone secreting tumor, aldosterone escape limits edema and hypernatremia

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213
Q

cytochrome P450 inducers

A

barbituates, phenytoin, carbamazepine; rifampin, griseofulvin; cyclophosphamide; St. John’s Wart; Modafinil, alcohol

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214
Q

what happens to the C peptide after cleavage

A

stored in granules until exocytosed

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215
Q

why hydroceole

A

patent processus vaginalis

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216
Q

carotid sinus reflex limbs

A

IX affarent then X efferent

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217
Q

proteins that make up cell junctions

A

cadherins: adherens and desmosomes
integrins: hemidesmosomes
connexins: gap junctions
claudins: tight junction

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218
Q

what is dev field defect and what is example

A

multiple malformations secondary to embryonic in adjoining group of cells; holoprosencephaly

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219
Q

bloody diarrhea in HIV patient not on retroviral, violet/red or hemmorrhagic lesions on endoscopy

A

Kaposi sarcoma

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220
Q

what can survive up to 248 F

A

spores of Bacillus and Clostridium

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221
Q

flex hip

A

rectus femoris, tensor fascia latte, iliopsoas: psoas major and minor +ilacus

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222
Q

action of infraspinatus, teres minor, and subscap

A

infra: ext rotate
teres minor: ext rotate and adduct
subscap: adduct and internal rotate

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223
Q

where does ADH act in nephron

A

medulary collecting duct

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224
Q

where does parvo replicate and what disease susceptible

A

bone marrow, toxic to erythoid precurser cells, sickle cell

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225
Q

5- hydroxyindoleacetic acid

A

end product of serotonin met

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226
Q

plaque like fibrosis tissue on R endocardium, tricuspid regurg and R HF

A

carcinoid syndrome

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227
Q

enzyme with which cort increases conversion of norep to ep

A

phenylethanolamine-N-methyltransferase

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228
Q

autoAB of polymyositis

A

ANA and anti-histidyl-tRNA synthetase (anti-Jo1)

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229
Q

pulmonary edema leads to

A

decreased compliance

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230
Q

undev part of lymph node in DiGeorge and why

A

paracortex b/c that’s where the T cells are

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231
Q

pressure changes of aorta and LV in aortic regurg

A

aorta: increased systolic, decreased diastolic
LV: increased systolic and diastolic

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232
Q

meds to avoid in HOCM and why

A
  • vasodilators: di Ca blockers, nitro, ACEi
  • Diuretics
  • b/c want to avoid outflow obstruction. anything that reduces preload is bad idea
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233
Q

structures of midgut

A

distal duo to proximal 2/3 of transverse colon

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234
Q

RF for pancreatic ca

A
  1. smoking
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235
Q

Ehlers Danlos enzyme deficient and fx

A

procollagen peptidase deficiency; impaired cleavage of terminal propeptides in extracelllular space

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236
Q

3 types of RPGN

A
  1. linear IF: Goodpasture
  2. granular IF: lupus IgA, Henoch-sch (type III hypersen)
  3. negative IF: pauci immune: microscopic polyangitis, Wegener
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237
Q

area implicated in Hirshsprung

A

always rectum

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238
Q

difference in graphs between facilitated diffusion and simple diffusion

A

faciliated: go up quick but flatten out because tranport saturated with facilitator protein
simple: same slope throughout

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239
Q

fx of type I vs type II pneumocytes

A

I: 95% of alveolar coverage
II: make surfactant and regenerate alveolar lining after injury

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240
Q

primary vs secondary TB lung findings

A

prim: Ghon focus of lower lobe and ipsilateral hilar node
sec: apical cavitary lesion

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241
Q

tRNA arms and bases

A

top: CCA-OH
T loop: bind to ribosomes, ribothymine, pseudouridine and cytidine
D loop:faciliate rec by tRNA synthetase: has dihydrouridine

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242
Q

describe case-control

A

look for exposure in people with disease and those without

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243
Q

atresia in utero due to

A

vascular occlusion

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244
Q

physiology of complete AV block

A

SA contract atria, AV contract ven, not in synch

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245
Q

what vessel a danger in horizontal c/s and why

A

inf epigastric b/c no posterior sheath supporting

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246
Q

middle meningeal artery branch from what? and where located

A

maxillary artery and the pterion (where frontal, parietal, temporal, and sphenoid bones meet)

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247
Q

renal bx findings of TTP

A

plt rich thrombi in glomeruli and arterioles

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248
Q

major characteristic of Rotavirus and histo

A

infectious diarrhea in children-UNVACCINATED-dehydration

histo: villus blunting in epithilium of duodenum and proximal jejunum

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249
Q

MOA of flutamide and use

A

anti-androgen, competitive inhibitor of testosterone receptors, used with GnRH agonists to tx prostate Ca

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250
Q

2 MOA of opiates

A
  1. reduce influx of Ca presynapse

2. effflux K+ of cells post synapse

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251
Q

mechanism of washout after MAOi into SSRI

A

allow time for monoamine oxidase to build up

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252
Q

first line for CMV colitis and reitinitis and s/e. other tx and why special

A

ganciclovir, pancytopenia

foscarnet and does not require intracellular activation

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253
Q

how is INH metabolized and why matter

A

by acetylation- slow acetylers have increased levels

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254
Q

PE findings for pneumonia vs pleural effusion

A

pneu: incraesed breath, increased tactile frem, dull to percus
pleur: decreased breath, decreased tactile, dull to percus

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255
Q

gene responsible for increase in polyp size

A

KRAS

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256
Q

sx and pathophys of xerdoerma pigmentosum

A

increased sensitivity to UV light and high incidence of cutaneous malignancy

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257
Q

area involved in chron disease and issue with that area

A

terminal illeum-bile acids reabsorbed here, can have fat malabsorption and def. in fat soluble vitamins

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258
Q

tx propionyl def

A

restrict valine, isoleucine, methionine, threonine, and odd chain FA (VOMIT)

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259
Q

why give allopurinal with 6 MP

A

can increase [ ] by inhibiting xanthine oxidase (which usually degrades 6 MP)

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260
Q

heat stroke can lead to

A

DIC

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261
Q

rise in CK levels after thrombus extraction

A

reperfusion injury mediated by free radicals, mito damage, inflammation, activate complement: lead to cell membrane permeability

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262
Q

MOA of killed vs live vaccines

A

killed: prevent virus from enter cell
live: destruction of cells by CD8 lymphocytes

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263
Q

Hct up in CHF patient in hospital

A

relative erythrocytosis from diuresis, only hypoxic if <92% or <65 mmHg

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264
Q

effect of ARBs on renin, ang I and II

A

all go up because fall in BP but can’t do anything

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265
Q

what is SMA syndrome

A

transverse portion of durodenum entrapped between SMA and aorta causing partial obstruction

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266
Q

fx of gyri on either side of central sulcus

A

precentral gyrus = primary motor

postcentral gyrus = primary somatosensory

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267
Q

intracellular, round oval protazoa with rod shaped kinetoplasts, + beach +skin finding

A

Leishmania

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268
Q

nontyhoidal vs typhoidal salmonella pathophys

A

non: invasion of erythrocytes and inflammatory response in Peyer’s patches
typh: capsular antigen-> replication in macrophages

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269
Q

path of N. meningitis

A

pharynx-blood-choroid plexus-meninges

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270
Q

reentrant circuit of A flutter

A

large reentrant through cavotricuspid isthmus of R atrium

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271
Q

progressive weak diaphragmatic inhlation but intact phrenic nerve activity

A

Myasthenia gravis

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272
Q

pathophys of giant cell arteritis

A

granulomatous inflammation of media

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273
Q

where is rRNA transcribed

A

nuceolus

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274
Q

enzyme that catazlyes the mobilization of TG into free FA and glycerol

A

Hormone sensitive lipase

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275
Q

examples of drugs dosed by weight and why adjust for obese

A

aminoglycosides, heparin, analgesiacs: hydrophilic, not distribute into adipose

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276
Q

normal pressure of RV; LA

A

25/5; <12

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277
Q

cause of meningitis in immunocompromised adult and characteristic

A

listeria- tumbling motility

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278
Q

susceptibility to infarct organ ranking

A

brain> heart> kidney> spleen> liver (liver low because dual blood supply)

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279
Q

EKG of WPW 3 things

A
  1. delta wave- upstroke of QRS
  2. short PR
  3. wide QRS
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280
Q

pathophys of WPW

A

accessory pathway that bypasses AV node

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281
Q

HIV esophagitis 3 ddx and appearance

A
  1. candida: gray/white psuedomembrane
  2. HSV-1: punched out lesions
  3. CMV: linear ulcerations
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282
Q

most common protazoal inf, common in hiker, + histo

A

Giardia; idiodine stained stool, pear shaped, flagellated, smooth walls with 2+nuclei

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283
Q

vWF binds to…

A

collagen

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284
Q

virulence factor of Enterotoxic E coli

A

plasmid encoded, heat labile and heat stable enterotoxins

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285
Q

orotic aciduria vs OTC deficiency

A

Both: high orotic acid in blood and urine
oa: megaloblastic anemia
OTC: increased amonnia

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286
Q

what almost always necessary to dev acute pyelo

A

vesicoureteral reflux

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287
Q

2 areas of intestine prone to ishemic damage

A

splenic flexure and rectosigmoid junction

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288
Q

s/e of cyclophosphamide and how to prevent

A

hemmorrhagic cystitis and administer mesna

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289
Q

cocaine moa

A

inhibit reuptake of Nor, dopamine and serotonin

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290
Q

s/e of non di CCB (verapamil, diltiazem)

A

constipation, bradycardia, AV block, worse of HF

291
Q

what arteries does splenic give rise to

A

left gastroepiploeic, pancreatic, short gastric

292
Q

histo of alpha 1 anti trypsin

A

red/pink globules on periodic acid Shiff stain

293
Q

history of angiography procedure, what can happen

A

showering of cholesterol-rich microemboli: kidneys, CNS, GI, skin

294
Q

histo of celiac

A

crypt hyperplasia and villous atrophy

295
Q

which ABs cross placenta

296
Q

2 tx for hepatic encephalopathy and MOA

A
  • lactulose: increase conversion ammonia to ammonium

- rifaximin: decrease intraluminal ammonia production

297
Q

CO effect on Hgb

A

same PaO2, increase carboxyHgb, no methhemoglobin

298
Q

what are formed as result of UV light exposure

A

pyrimidine dimers, excised by endonuceases

299
Q

what is plasma renin activity and what raises it

A

measure of angiotensin I generated over time; low sodium intake, antiHTN: ACE, diuretics, ARB

300
Q

Class 1 antiarrythmic Na channel blocking

301
Q

after hysterectomy, have flank pain and fever

A

ureter severed

302
Q

bug of necrotizing fascitis

303
Q

flow rate equation

A

flow rate = flow velocity x cross sectional area

304
Q

steps of base excision repair

A

Glycosylase-Endonuclease-Lyase-Polymerase-Ligase

305
Q

assoc with Pseudomonas bacteremia

A

ecthyma grangrenosum

306
Q

lymphatic drainage distal and proximal to dentate line

A

prox: inferior mesenteric and internal iliac
dist: inguinal

307
Q

hypo areas and fx/deletion: lateral, ventromedal, ant, post, suprachiasmatic, supraoptic and paraventricular

A

lat: “shrink laterally” hunger
ventromedial: “grow medial and lateral” satiety
ant: “A/C” cooling, parasympathetic
post: heating, sympathetic
suprachia: circadian rthymn
supraoptic/paravent: synth ADH and oxytocin

308
Q

what happen if you inhibit proteasome

A

apoptosis due to accumulation of toxins

309
Q

pathophys of tetrolagy of falot

A

nterosuperior displacement of infundibular septum

310
Q

pathophys of opening snap of mitral stenosis

A

sudden open of mitral valve leaflets after pressure in LV falls below left atrial pressure

311
Q

nodules that spread along lymphatics, caused by thorn prick

A

Sporothrix schenkii

312
Q

clinical course of ascaris lumbricoides

A

transmitted via contaminated food or water, eggs hatch in small intestine, migrate across lung to alveoli, larvae coughed up and swallowed, mature into adult worms that shed eggs into stool

313
Q

timeline for GAD

314
Q

genetic problem of DiGeorge

A

chromosome 22.q11.2 microdeletion

315
Q

fever, flu like sx, anemia, indirect hyperbili

316
Q

difference between plasmodium falciparum and vivax

A

fal: Africa
viv: non Africa, dormant liver phase

317
Q

normal saline %

318
Q

who at risk for vibrio vulnificus and how transmitted

A

hemochromatosis and through raw seafood or marine contamination

319
Q

caudate on coronal section of brain

A

bean near lateral ventricle

320
Q

s/e of bisphosphates

A

esophagitis, osteonecrosis of jaw, atypical femoral fx

321
Q

what is directly left and a little further left of internal capsule on coronal section, what is right

A

globus palidus then putamen; right is amygdala

322
Q

pathophys of superantigen

A

interact with APC and T cells, cause widespread T cell activation

323
Q

pathophys of abscess formation

A

neutrophil recruitment and activation leads to release of lysosomal granules which kill bacteria but also cause liquefying necrosis

324
Q

most common site of compartment syndrome and what is in there

A

anterior compartment

deep peroneal nerve and anterior tibial artery and vein

325
Q

cause of neuromuscalar issues in hepatic encephalopathy

A

ammonia crosses blood brain barrier and causes glutamine to accumulate in astrocytes which decreases amount to be converted to glutamate in neurons

326
Q

which cholesterol med increases TG levels

A

bile acid binding resins (cholestyramine, colestipol, colesevelm)

327
Q

timeline of adjustment disorder

A

within 3 months of stressor

328
Q

what secretes enzymes and proteases in COPD

A

neutrophils, CD8 T cells, and macrophages

329
Q

most common complication of aneurysmal SAH, and what cause

A

vasospasm and delalyed cerebral ischemia

330
Q

histo of renal cell carcinoma and common met place

A

clear cyto b/c of lipids and glycogen

lung: cannonball lesions

331
Q

moa of cromylyn and nedocromil

A

inhibit mast cell degranulation

332
Q

s/e of fibrate b/c of MOA

A

formation of cholesterol gallstones, inhibit cholesterol 7 alpha hydroxylase, activate PPAR-alpha- leads to decreased VLDL production; and myopathy if combine with statin

333
Q

integrase inhibitor MOA

A

inihibit HIV genome integration, inhibit viral mRNA formation.

334
Q

imaging of acute acalculus cholecystitis

A

acute inflammation of GB in absence of gallstones

335
Q

where is testicular ca, what can secrete

A

in tunica albuginea, hCG

336
Q

who is at greatest risk of developing drug induced SLE

A

slow acetylers

337
Q

s/e of statin other than muscle

338
Q

hypopigmentation of skin, hair, eyes and ___ = ___

A

catecholamine brain centers; PKU

339
Q

median and mean of positve and negative skew

A

pos: mean > median
neg: median > mean

340
Q

what happens with deacetylation of histones

A

prevent transcription

341
Q

fx of thyroid peroxidase

A
  1. catalyzes oxidation of iodide to iodine
  2. iodination of thyroglobin tyrosine residues
  3. iodotyrosine coupling rxn form T3 and T4
342
Q

where from single vs multiple brain absesses

A

single from direct invasion

multiple from hematogenous spread

343
Q

airway resistance throughout resp tract

A

inversely related to total cross sectional area of all airways at that level; high in trachea, higher in medium bronchioles, progressively decreases from there

344
Q

crutches, wrist drop, loss of tricep reflex

A

injury to radial nerve

345
Q

Shigella pathogenesis

A

can hijack actin filaments to propel self and enter M cells that overly Peyer’s patches

346
Q

best way to prevent hospital acquired infections

A

hand hygeine

347
Q

tx cholinesterase inhibitor s/e

A

muscarinic antagonists like glycopyrrolate, hyosycamine, propantheline

348
Q

dopamine phases of action as dose increase

A
  1. D1 stim: increase in renal blood flow
  2. B1 stim: increase HR and contract
  3. alpha 1 stim: generalized vasoconstriction
349
Q

MOA of ampho B/nystatin vs echinocandins (caspofungin) vs azole

A

ampho: binds ergosterol in mem and causes cell lysis
echino: inhibit cell wall synth through B-glucan
azole: inhibits ergosterol synth

350
Q

toxic effect of mannitol

A

pulm edema

351
Q

s/e of niacin and how to pre treat

A

flushing,aspirin

352
Q

linear vs grandular IF on picture

A

linear look like special mushroom, grandular is blotchy

353
Q

histo of crytococcus + CSF of

A

yeast with thick polysacchride capsule, CSF is budding yeast

354
Q

aortic arch derivatives and CN

A
  1. V, maxillary
  2. VII, stapedial
  3. IX, common carotid
  4. superior laryngeal X, true aortic arch
  5. recurrent laryngeal X, pulm arteries, ductus arteriosus
355
Q

recurrent kidney stones in young patient and histo

A

cystinuria and hexagons

356
Q

what do acetylcholinesterase inhibitors do and what is a non med example

A

inhibit breakdown of acetylcholine into choline and acetate. organophosphate

357
Q

role of BNP and ANP

A

diuresis (increase GFR) and peripheral vasodilation, inihibit RAAS

358
Q

MOA of neprolysin inhibitors (sacubitril)

A

prevent degradation of BNP and ANP- antagonize RAAS

359
Q

what can be used to synth glucose in gluconeo in DKA

A

glycerol from fatty acids, used by glycerol kinase

360
Q

tumor lysis syndrome definition and electrolytes

A

large number of tumor cells destroyed, ions released and uric acid; hyperkalemia, hyperphosphatemia, hyerucicemia, hypocalcemia (PUCK)

361
Q

how prevent tumor lysis syndrome

A

hydration and hypouricemic agents: allopurinal or rasburicase

362
Q

uti after procedure

A

enterococcus

363
Q

define somatic vs germline mosaic

A

somatic: produce clinical manifestations
germ: no clinical manifestations only in cells that give rise to gamete

364
Q

why infertile given shot of hCG

A

simulate LH surge

365
Q

stool histo of vibrio or e. coli diarrhea

A

toxin mediated so some mucous and noerythrocytes or leukocytes

366
Q

HOCM vs VSD

A

handgrip: HOCM decrease intensity, VSD increase

367
Q

why combine aluminum hydroxide and magnesium

A

aluminum hydroxide cause constipation and magnesium cause diarrhea

368
Q

after calcium released from sarcoplasmic reticulum, where bind

A

troponin C

369
Q

why continue 4 weeks after trip for malaria prophylaxis

A

to ensure elimination of hepatic schizonts

370
Q

MOA of DPP-4 inhibitors

A

inhibit DDP-4 enzyme that deactivates GLP-1 therby increase glc-dependent insulin release

371
Q

dimorphic yeast with bx of large, round with single bud

A

blastomyces

372
Q

MOA of isoproteranol

A

B1 and B2 receptor agonist, increase contractility and decrease peripheral resistance

373
Q

rheumatic fever vs infective endocarditis valve

A

RHeum: diffuse fibrosis thickening
IE: large friable vegetations and destruction instead of fibrosis

374
Q

2 mutations of osteosarcoma

A

in mesenchymal stem cell: RB1 or TP53

375
Q

virus of croup

A

parainfluenza

376
Q

adult vs child spleen of sickle cell

A 
adult = fibrosis and atrophy
child= conjestion and infarction
377
Q

why sickle cell have macrocytossis

A

increased folic acid requirement from turnover

378
Q

most common cause of viral gastroenteritis

379
Q

what are P bodies

A

mRNA translation regulation and degradation

380
Q

mutation of familial hypocalciuric hypercalcemia

A

autosomal dom- defective Gs coupled Ca+ sensing receptor

381
Q

what would increase CO, decrease resistance, and increase venous return

A

AV fistula

382
Q

tx mycoplasma pneumonia

A

macrolides, tetracyclines

383
Q

ethanol inhibits what to cause hypoglycemia

A

gluconeogenesis

384
Q

MOA of phenytoin

A

blocks Na+ sodium channels

385
Q

what are neurophysins

A

carrier proteins for oxytocin and vasopressin

386
Q

pt hasnt seen doctor in a while, cough until vomit

387
Q

increased sensitivity to sound caused by

A

paralysis of stapedius muscle- innervated by branch of facial nerve

388
Q

bone lesions in hyperparathyroid

A

subperiosteal resorption

389
Q

mass of hypothalamus and pituitary that causes increase in a hormone and why

A

prolactinoma- dopamine negatively regulates in hypothalamus vs other hormones are positively regulated

390
Q

property of drugs eliminated by liver

A

lipophillic

391
Q

zero vs first order kinetics

A

zero: constant amount is metabolized
first: constant proportion met

392
Q

increased LDL receptor recycling in what drug

393
Q

issue with looking down stairs or reading

A

trochlear nerve

394
Q

define left shift on curve and etiologies

A

50% sat at lesser [ ]

decrease H+, 2,3-BPG, temperature

395
Q

splenomegaly, esophageal varices, normal liver

A

portal vein thrombosis

396
Q

low TSH and T4

A

central hypothyroid (secondary)

397
Q

most common cause of infectious encephalitis in US and how to prevent

A

arbovirus, and eliminating vector (mosquito)

398
Q

most common site of urethral obstruction

399
Q

pathophys of I cell disease, what is low

A

defective phophotransferase enzyme that catalyzes phosphorylation of mannose residues on lysosomal bound proteins, Mannose 6 phosphate

400
Q

why LA and RA lower O2 than alveolar capillaries

A

mix of ox blood from pulm veins with deox blood from bronchial circulation and thebesian veins

401
Q

where should thoracentesis be done based on location

A

below 6th rib anterior, below 8th axilla, below 10th vertebral, but below 9th risk abd injury

402
Q

lymphatic draining of lower extremities

A 
lateral = popliteal and inguinal
medial = just inguinal
403
Q

metabolic pathways of mito vs cyto

A

mito: B ox, TCA, gluconeo
cyto: glycolysis, Pentose phos, FA synth

404
Q

sciatic nerve symtoms also known as… and why

A

piriformis syndrome and because pass thru greater sciatic foramen

405
Q

pathophys of hyperacute transplant rejection

A

preformed ABs in recipient: anti ABO or anti- HLA

406
Q

LV PV loop read

A

MAAM
COCO
start at left bottom corner and go cw

407
Q

makeup of cholesteatomas

A

squamous cell debri

408
Q

feedback of inhibin B

A

low levels –> high FSH

409
Q

why high dose of oral isosorbide dinitrate

A

1st pass metabolism in liver

410
Q

nonspeecific sx, lymphadenopathy, hepatosplenomegaly, not TB, AIDS patient

411
Q

bone marrow bx of mycobacterium

A

foamy epithelial cells and multinucleated langerhan cells

412
Q

MOA of acyclovir and what used for, complication

A

guanosine derivative that is phosphorylated by viral TK, incoperated into viral DNA, DNA synth terminated; not as efffective with EBV and CMV b/c dont’ have the same TK as HSV and VZV; crystalline nephropathy

413
Q

mutation of TTP

414
Q

mutation of congenital prolong QT

A

mutation in K+ channel, delayed rectiifier current of AP.

415
Q

pure red cell aplasia (no erythrocytes) associated with

A

thymoma, lymphocytic leukopenias, and parvo B19

416
Q

histo of syphilis

A

endarteritis of small vessels and plasma cell-rich infiltrate

417
Q

histo of aquamous cell carcinoma

A

ovoid epithelial cells with eosinophillic cytoplasm, keratin nests/pearls within/btwn cells, intercellular bridging

418
Q

RF for squamous cell carcinoma of esophagous

A

alc, smoking, oven hot foods, pre existing esophageaal injury

419
Q

saline responsive vs non responsive met alk

A

SR: vomit, NG suction, thiazide/loop diur
NR: hyperaldosterone, cushing

420
Q

transporter assocaited with antigen processesing (TAP) proteins fx

A

allow loading of cytoplasmic/viral proteins onto MHC class I molecules

421
Q

low Vd

422
Q

what causes low Vd

A

high weight, charged, high plasma protein binding, hydrophillic –> trapped in plasma compartment

423
Q

presentation of methylmalonyl- CoA mutase deficiency

A

MMA in urine, hyperammoninemia, ketotic hypoglycemia, metabolic acidosis

424
Q

fluid level in old lung cavity

A

aspergilloma-colonization

425
Q

same rate per employee either insurance company pay hospital or payor directly pay

A

capitation

426
Q

AP film what are the border of the heart

A

Bot to top R: IVC, Right atrium, SVC

Bot to top L: LV, LA, PA, Aortic knob

427
Q

prolonged exposure to loud noises hearing loss pathophys

A

stereocilliated hair cells of organ of Corti

428
Q

nerves of radial plexus superior to inferior

A

MARMU (MC, Ax, Rad, Med, Ul)

429
Q

deficiency of McCardle’s and what the enzyme does

A

Glycogen phosphorylase-breakdown glycogen to limit to 4 sugar on side of branch and extra G1P

430
Q

presentation of neonatal tetanus

A

clench all muscles, arch back, lock jaw

431
Q

MOA of enoxaparin/LMW heparin

A

bind and activates Antithrombin III, which binds to Xa and stops from converting prothrombin to thrombin

432
Q

constrict efferent arteriole what happen to GFR

A

first increase then decrease

433
Q

MOA of anastrazole, letrozole, and exemestane

A

aromatase inhibitors

434
Q

pathophys of valve degneration of aortic stenosis

A

calcific dengeneration after cell necrosis

435
Q

embryologic thryoglossal cyst derivative

A

endoderm of foramen caecum

436
Q

what are the atypical cells of EBV

A

reactive CD8 T cells

437
Q

order of ventricle drainage

A

lat ven- Monro- 3rd- sylvius/cerebral aquaduct- 4- Lushka or Magendie- SA space

438
Q

course facial features, clouded corneas, restricted joints, high lysosomal

439
Q

Bengay/ capsaisan cream MOA

A

depletes substance P

440
Q

microtubule inhibitors

A

paclitaxel, vincristine, vinblastine,eribulin

441
Q

defect of hereditary spherocytosis

A

proteins interacting with RBC mem skeleton and plasma membrane–> ankyrin, spectrin, protein 4.2

442
Q

lipoprotein lipase def schematic

A

def causes increases in TG- deposit in skin, probs with pancreas and liver- diabetes

443
Q

splanchnic nerves are…

A

sympathetic except for pelvic splanchnic

444
Q

2 phases of succinylcholine

A
  1. block potentiated by cholinesterase inhibs

2. reversed with cholinesterase inhibs

445
Q

pathopys of TSS

A
  1. replicate locally and release superantigen into blood
  2. bind to MHC-II and activate T cells
  3. Dramatic release of cytokines
446
Q

T cell vs B cell ALL

A

B cell most common, T cell present with mediatinal mass-dysphagia

447
Q

Cori vs von Gierkes enzyme and sx

A

both: hypoglycemia, ketosis
Cori: debranching enzyme, no lactic acidosis, hypotnoia
vG: Glc-6-phosphatase, lactic acidosis, hepatic steatosis

448
Q

contents of reactive T cells

A

granules with perforin and granzymes

449
Q

vesicles on lips and hard palate, lymphadenopathy, fever

A

gingivostomatitis- HSV in young child

450
Q

presentation of arsenic poisening and where come from

A

n/v, hypotension, garlic breath

-from insecticides and contaminated water

451
Q

1st line for arsenic poisening

A

dimercaprol

452
Q

daptomycin MOA and what used for and s/e

A

MOA: depol bacterial cell mem and inhibit DNA, RNA, protein synth
use: MRSA, not pneumonia
s/e: increased CPK, myopathy

453
Q

lower> upper extremity cyanosis and clubbing without BP discrepancies

454
Q

MOA of finasteride

A

5 alpha reductase inhibitor- tx BPH

455
Q

structures from the metanephic blastema

A

glomeruli, Bowman’s space, proximal tubules, loop of Henle, distal convoluted tubule

456
Q

rhabditiform larvae in stool

A

strongyloides

457
Q

mutations and its pathophys for hemochromatosis

A

HFE gene; excessive intestinal absorption of iron

458
Q

sleep walking and night terrors sleep stage and wave

A

non REM3- delta

459
Q

where does median nerve travel in forearm

A

humeral and ulnar heads of the pronator teres and betweeen flexor digitorum superficialis and flexor digitorum profundus

460
Q

testis vs scrotum lymph drainage

A

testis: para-aortic (b/c orignially in abdomen)
scro: superficial inguinal

461
Q

gingival hyperplasia as s/e

462
Q

coinfection cell by 2 viral strains, have capsid proteins from one strain and genome from other; next generation is unmixed phenotype

A

phenotypic mixing

463
Q

paradoxical emboli because of what

A

PFO, ASD, VSD, large pulm AV malform

464
Q

angiogenesis is driven by…

A

VEGF and FGF-2

465
Q

MOA of iprotropium

A

anticholinergic-bronchodilator, block parasympathetic stim of tracheobronchial mucosal galnds

466
Q

renal fail + hypoglycemia in DM patient

A

reduced insulin clearance

467
Q

MOA of sevelamer

A

binds intestinal phosphate, reduce absorption

468
Q

where are H pylori colonized and how lead to ulcer

A

antrum of stomach, less somatostatin from D cells, more gastrin-more acid production, ulcer

469
Q

histo of Beurger’s

A

inflammatory intraluminal thrombi with vessel wall sparing, extension into nearby veins and nerves

470
Q

mediation of calcium efflux prior to relaxation

A

Na+/Ca+ exchange pump

471
Q

anesthetic injury of halothane to liver

A

shrunken, elevated LFTs, long PT

472
Q

brain location of locus cerulus

A

paired brainstem nucleus in posterior rostral pons near lateral floor of 4th ventricle

473
Q

med s/e: arrythmia, vision change, hyperkalemia, n/v

474
Q

MOA of carbamazepine and s/e

A

reduce ability of Na channels to recover from inactivation; bone marrow suppression and SIADH

475
Q

tx spasticity of MS and other

A

Baclofen-GABA agonist

476
Q

corneal reflex limbs

A

Af: V1
Ef: VII

477
Q

slow vs fast insulin names

A

slow: d, d, glarg
fast: GAL (glu)

478
Q

histo of meningioma

A

whorled pattern of cellular growths that form nests, may calcify into psammoma bodies

479
Q

apple green with Congo red=

A

amyloid, which is also found in Altzheimers

480
Q

calc number needed to harm (number treated before 1 adverse event occurs)

A

1/ absolute risk increase

481
Q

MOA of entacapone

A

prevent peripheral L-DOPA degradation by inhibiting COMT

482
Q

asthma, eosinophila, rhinosinusitis, involve peripheral nerves

A

churg strauss (eosinophillic granulomatosis with polyangitis)

483
Q

cholinergic tox mneumonic

A

DUMBELS: diarrhea, urination, miosis, bronchospasm, emesis, lacrimation, salivation

484
Q

muscle targeted with Kegels

A

levator ani

485
Q

where are anal fissures located

A

posterior midline

486
Q

cause of transposition of great vessels

A

fail of spiral of fetal aorticopulmonary septum

487
Q

define pulsus paradoxus

A

fall in BP >10 mm during inspiration

488
Q

what measure b4 metformin and why

A

Cr b/c bad kidneys predispose to lactic acidosis

489
Q

derivatives of POMC

A

ACTH, MSH, and beta-endorphins (opiod peptide)

490
Q

ureter course through abdomen

A

posterior to uterine artery and anterior to internal iliacs

491
Q

MOA of benzos

A

allosterically modify binding of GABA, result in increase freq of Cl ion channel opening, influx of Cl cause hyperpol and inhibit AP

492
Q

lack of tissue necrosis in PE?

A

collaterol circulation

493
Q

MOA of milrinone

A

PDE-3 inhibitor, in cardiac myocytes: increase contractility; in vascular smooth muscle- vasodilation

494
Q

atrition bias is a type of ___ bias and defined as

A
  • selection

- unequal loss of follow up

495
Q

net filtration pressure equation

A

nfp= (hydrostatic cap- hydrostatic interstitium)- (oncotic cap-oncotic interstit)

496
Q

MOA of decrease AV node conduction by increasing parasympathetic vagal tone. positive ionotrope

497
Q

aortic stenosis compensatory occurance and why bad

A

atrial contraction contributes to ventricular filling. AF means less preload

498
Q

area postrema significance and location and tx

A

vomiting reflex-less dev blood brain barrier; dorsal medulla/caudal 4th ventricle; serotonin receptor antagonists-odansteron

499
Q

adrenergic regulation of insulin

A

release stim by beta 2, inhibit by alpha 2

500
Q

intraventricular hemmorrhage location and presentation

A

germinal matrix into lateral ventricles; premee-bulge fontanelle, hypotonic, seizure

501
Q

mediators for osteoclast differentiation

A

start from hematopoetic progenitor cells; M-CSF and RANK-L important factors for differentiation

502
Q

histo of mesothelioma

A

cuboidal, flattened, spindle cells-stain positive for cytokeratins and calretinin

503
Q

why restricted have increased flow rates if correct for lung volume

A

increased elastic recoil results in increased outward pulling of the airways (radial traction)

504
Q

kidney injury of rhabdo and why

A

heme pigment mediated tubular injury- ATN

505
Q

MOA of thiazolidinedoines

A

decrease insulin resistance by activating PPAR-gamma, increases GLUT-4-increases glc uptake; increases adiponectin-which increase differentiation of preadipocytes into insulin-responsive adipocytes

506
Q

unilateral RAS- what happens to the other kidney

A

high BP cause arteriolar wall thickening

507
Q

what does carotid massage do

A

increase parasym vagal tone- slow conduction thru AV node

508
Q

resistance to chemo agents

A

MDR1 gene- code for ATP dependent efflux pump protein-reduce influx of drugs into cyto

509
Q

MOA of Ramelteon

A

melatonin agonist

510
Q

unilateral pulm opacification and trachea deviated towards that side

A

obstructive lesion in main stem bronchus leads to collapse of that lung

511
Q

histo of graves

A

scalloped colloids

512
Q

upper extremity LMN, lower extremity UMN, kyphoscoliosis, loss pain and temp in upper extremity

A

syringomyelia

513
Q

carotid waves and fx

A

a: R Atrial contract
c: RV Contract
x desc: R atrial relaX
v wave: venous f(v)ill RA
y descent: RA emptY into RV

514
Q

rat poisen is..

A

super warfarin

515
Q

tx pulm HTN and MOA

A

bosentan; endothelin receptor antagonists

516
Q

MOA of sulfonurea (glyberide)

A

inhibit ATP K+ channel on beta cell mem, induce depol and L-type Ca channel open–> insulin release

517
Q

lesion of cerebellar- vermis vs hemisphere

A

vermis= truncal ataxia

lat hemisphere=limb dysmetria

518
Q

5 P’s of lichen planus

A

purple/pink, pruritic, polygonal, papule, plaques

519
Q

histo of lichen planus

A

thickened stratum granulosum and sawtooth rete ridges

520
Q

ANCA stand for

A

antineutrophil cytoplasmic AB

521
Q

JAK2 receptor type, and mutated in what

A

non-receptor tyrosine kinase;PV, essential thrombo, primary myelofibrosis

522
Q

Retroperitonel structures

A

SAD PUCKER
Suprarenal glands/adrenal glands, Aorta/IVC, Duodenum 2nd-4th, Pancreas-not tail, Ureters, Colon-desc and asc, kidneys, esophagous, rectum-part

523
Q

pathophys of alzheimer’s

A

decreased levels of acetylcholine in nucleus basalis of meynert and the hippocampus, deficiency in acetyltransferase

524
Q

origin of type A vs type B aortic dissection

A

A: near sinotubular junction
B: near subclavian artery

525
Q

midshaft hummerous fx injure

A

brachial artery and nerve

526
Q

acid base of PE

A

resp alkalosis

527
Q

gigantism cause

A

increased IGF-1 from liver

528
Q

MOA of metyrapone stimulation test

A

block cortisol synth thru inhibit 11-B hydroxylase

529
Q

PMS I Cry

A

Poststrep, membranous proliferative, SLE, IgA, cryglobinemia

530
Q

things secreted in sarcoid

A

Th1 mediated- secrete IL-2 and IFN-gamma

531
Q

calculate odds ratio

A

(a/b)/(c/d)

532
Q

P450 inhibitors

A

cimetidine, cipro, erythro, azole antifungals, protease inhibs (ritonavir), INH, grapefruit juice, diltiazem, verapamil

533
Q

translocation of CML vs AML

A

9;22- Philly, BCR-ABL;; 15;17

534
Q

urinalysis of AIN

A

WBC and white blood cell casts

535
Q

pathoophys of NSAID cause prerenal azotemia

A

COX normally dilates afferent arteriole, inhibit COX- slow GFR

536
Q

nerve facilitate erection

A

cavernous nerve- can be injured if clip prostatic plexus

537
Q

anesthetics that are hepatotoxic

A

halogenated- end in “rane” or “thane”

538
Q

MOA of ethosuxamide

A

blocks T type Ca+ channels in thalamus

539
Q

pathophys of struvite stones

A

recurrent upper UTI with urease pos orgs-Klebsiella, Proteus; hydrolysis of urea to produce ammonia, increase urine pH, precip of magnesium ammonium phosphate salt

540
Q

bone marrow bx of primary myelofibrosis

A

fibrotic marrow with clusters of megakaryocytes

541
Q

endoscopic findings of eosinophilic esophagitis

A

stacked ringlike indentations, linear furrowing, scattered whitish papules

542
Q

cytokines of systemic inflammation

A

IL-1, IL-6, TNF-alpha

543
Q

what papillary muscle at risk of rupture and why

A

posteromedial b/c single blood supply from posterior descending artery

544
Q

what give after iodine nuclear accident

A

potassium iodide- competitively inihibits uptake of radioactive iodine

545
Q

histo of Guillan Barre

A

demyelination of peripheral nerves- ascending, endoneural inflammatory infilltrate

546
Q

injury to musculocuteanous nerve

A

loss biceps reflex, loss forearm flexion, loss sensation lateral forearm

547
Q

pathophys of complete 3rd degree AV block

A

degenerative changes of AV node

548
Q

pathophys of diabetic neuropathy

A

post sx: small fibers

neg sx: large fibers

549
Q

right shift hgb curve

A

ACE BAT: acid, CO2, exercise, 2,3-BPG, Altitude, temperature; facilitate unloading O2 into tissues

550
Q

what is increased in diastolic CHF (preserved EF)

A

systemic vascular resistance

551
Q

what is reverse T3

A

inactive form generated from T4

552
Q

RF for uric acid stones

A

increased uric acid excretion, increased urine concentration, low urine pH

553
Q

target rash mediated by CD8+, after HSV, myoplasma,cancers or autoimmune

A

erythema multiforme

554
Q

vasopressin action in nephron

A

V2 receptor mediated increase in water and urea permeability in collecting duct-increase water and urea reabsorption

555
Q

3 drugs for open angle glaucoma and MOA

A
  1. timolol 2. acetyazolamide; decrease aqueous humor production by ciliary epithelium
  2. prostaglandin (-prosts): increse outflow of aqueous humor
556
Q

ring sideroblasts vs basophillic stippling

A

ring in marrow, stippling in peripheral blood

557
Q

low PCWP and RA pressure

A

cardiogenic shock from RHF

558
Q

necrolytic migratory erythema seen in

A

glucogonoma

559
Q

cell injured what happens to ions

A

increase intracellular Na and CA, decreased K

560
Q

alpha error what is it and how change it

A

false positive- nothing

561
Q

niacin (nicotinic) MOA

A

inhibits cholesterol breakdown to VLDL

562
Q

pathophys postprtum thyroiditis

A

lymphocytic inflitrate causing transient hyperthyroid, hypothyroid, or hyper followed by hypo

563
Q

compliance equation

A

tital vol/ (end inspiratory-end expiratory)

564
Q

sporatic retinoblastoma

A

unilateral, two spontaneous mutations

565
Q

MOA of spironolactone

A

decrease luminal permeability to Na+ in collecting duct, inhibit Na/K ATPase

566
Q

aminoglycoside mech of resistance

A

abx-modifying enzymes, add chemical group to abx- unable to bind ribosome

567
Q

bone marrow bx of aplastic anemia

A

hypocellular marrow filled with fat cells and marrow stroma

568
Q

chalk white areas of fat necrosis in mesentary

A

necrotizing pancreatitis

569
Q

branchial arch derivatives mneumonic

A

ear, tonsils, bottom to top

570
Q

thymus embryological derivative

A

3rd branchial pouch

571
Q

pathophys of bullous impetigo

A

bacterial toxin induced desmoglein cleavage

572
Q

tx PCOS and MOA

A

estrogen receptor modulator, prevents negative feedback in hypothalmus, increases FSH and LH secretion

573
Q

how MI cause mitral regurg

A

ischemia to papillary muscle

574
Q

acid base findings of altitude

A

resp alk with hypoxemia

575
Q

preventative migraine tx

A

beta blockers, TCA, valproate, topiramate

576
Q

histo of gliobastoma multiforme

A

pseudopallisating tumor cells around area of necrosis and new vessel formation

577
Q

Whipples disease mnemonic

A

Foamy whipped cream in a CAN: Foamy macrophages, Cardiac sx, Arthalgias, Neruo, plus steattorrhea

578
Q

junctional vs compound vs intradermal nevus

A

J: dermoepidermal jx
C: dermal and epidermal involvement
I: older, only dermal, dome shaped

579
Q

what cells produce EPO

A

peritubular interstitial cellls

580
Q

eat toxic mushroom Amantia phalloides

A

hepatotoxicity, inhibit RNA poly II

581
Q

how does NO cause smooth muscle contraction

A

increase intracellular cGMP, lead to myosin chain dephosphorylation

582
Q

saddle anethesia and cauda equina which nerve roots

583
Q

regular insulin start peak dead

A

start 30 mins, peak 2-4 hours, lasts 5-8

584
Q

voluntary portion of pooping

A

puborectalis muscle relaxes and external sphincter relaxes

585
Q

what is in urine of multiple myeloma

A

light chains

586
Q

mechanism of lithium nephrogenic DI

A

antagonize ADH action on principal cells at collecting duct

587
Q

clinical features of hypoaldosteronism

A

HTN, muscle weakness, paresthesias

588
Q

ATN affects what part of kidney and why

A

medulla b/c low blood supply, straight portion of proximal tubule and thick loop of henle

589
Q

esophagous on CT

A

between vertebral body and trachea

590
Q

myelination __ length constant and ___ time constant

A

increases; decreases

591
Q

action of gluteus medius

A

hip abduction

592
Q

causes of methehemoglobinemia

A

nitrates, local anesthetics, sulfa drugs

593
Q

equation of half life

A

(0.7 x Vd)/ CL

594
Q

pathophys of huntington’s disease

A

accumulation of huntingtin protein in neural cells, especially GABA neurons in caudate

595
Q

why hypercalcemia in sarcoid vs multiple myeloma

A

1-alpha hydroxylase expression in activated macrophages, causes PTH independent production 1,25 dihydroxy vitamin D
-lytic bone lesions

596
Q

hox gene code for and fx

A

transcription factor and segmental organization of embryo over cranial caudal axis

597
Q

when during cell cycle does vincristine work and s/e

A

S and peripheral neuropathy

598
Q

mneumonic for acute pancreatitis

A

I GET SMASHED: Idiopathic, Gallstone, Ethanol, Trauma, Steroids, Mumps, Autimmune disease, Scorpion, Hypercalcemia/Hypertriglyceridemia, ERCP, Drugs (sulfa, 6-MP, NRTI, protease)

599
Q

tumor suppression path

A
  1. p53 induce p21 which inhibits CDKs
  2. hypophosphorylation of Rb
  3. inhibit G1S progression
600
Q

what happens to systemic vascular resistance in exercise

601
Q

MOA of pembrolizumab

A

programmed-death receptor 1 (PD-1) inhibitor;; normally PD-1 is a checkpoint inhibitor that downregulates cytotoxic T cell response

602
Q

tx varicella zoster in AIDS

A

foscarnet or cidofovir

603
Q

pioglitazone is ___. MOA

A

thiazolidinedione; binds PPAR-gamma: transciprtion factor that affects glc nd insulin metabolism

604
Q

genetics of Fragile X

A

trinucleotide repeat CGG, hypermethyltion and decreased expression

605
Q

urethral injury

A

bulbar/ spongy in catheter, membranous in fx

606
Q

infraorbital fx

A

maxillary branch of V damaged and damage to inferior rectus

607
Q

DM patient with red-brown calfs

A

venous stasis-depostion of hemosideran

608
Q

cause of stress incontinence vs urge incontinence vs overflow

A

stress: urethral spinchter tone relax, urge, MS: detruser hyperactivity, overflow: impaired detruser contracility, bladder outflow obstruction

609
Q

wht causes outflow obstruction in HOCUM

A

systolic motion of the anterior leaflet of the mitral valve towards the hypertrophied interventricuar septum

610
Q

pathophys of angina in aortic stenosis without occlusion

A

increased myocardial oxygen demand from increase in LV mass and wall stress

611
Q

pathophys of photaging

A

exposure to UVA, decreased collagen fibril production and increased degradation of collagen and elastin in dermis

612
Q

diffuse axonal injury (type of TBI) pathophys

A

disruption of white matter tracts: axonal swelling at gray-white junction with accumulation of transport proteins

613
Q

why can glucagon tx BB overdose

A

activates G protein coupled receptors, cause activation of adenylyl cyclase and raise intracellular cAMP. Ca+ release and SA node fire

614
Q

candida defense variations

A

local: T cells, systemic: neutrophils

615
Q

nodular infiltrates, non caseating granulomas, enlarged lymph nodes- not sarcoid

A

berryllioisis- aerospace

616
Q

ependymoma location and origination

A

originate from ependymal cells that line the ventricular sys and central canal of spinal cord; can block flow through interventricular foramen- obstructive hydrocephalous

617
Q

how join SMA and IMA

A

marginal artery

618
Q

what concentrations increase across proximal tubule and which decrease

A

increase: PAH, inulin, urea
decrease: bicarb, glc, AA

619
Q

failure of ristocetin assay

A

von willebrand and bernard soulier

620
Q

more rapid clearance of biologic

A

antidrug antibodies

621
Q

xray findings of osteosarcoma

A

periosteal new bone formation with lifting of the periosteum- Codman’s triangle

622
Q

where does sildenifil act, s/e

A

corpus cavernosa-two “eyes”

blue vision, sudden monocular vision loss due to ischemic optic neuropathy

623
Q

injure long thoracic nerve

A

paralysis of serratus anterior: also injured during chest tube placement

624
Q

enzyme deficient in AIP vs porphira cut tarda

A

AIP: porphobilinogen deaminase
PCT: Uroporphyrinogen decarboxylase

625
Q

s/e of cisplatins/platins

A

ototoxicity and nephrotoxicity

626
Q

fx of androgen binding protein and where from

A

from Sertoli cells; secretedinto semineferous tubule lumen, bind T and DHT less able to diffuse out

627
Q

high PTH, low Ca, short 4th/5th digits, short stature, defective Gs protein from MOTHER

A

pseudohypoparathyroidism- Alright hereditary osteodystrophy

628
Q

different mutations in same loci produce same phenotype

A

allelic hetergeneity- B thalassemia

629
Q

mutation of achondroplasia

630
Q

short stature, blue sclera, scoliosis, hearing loss, increased skin laxicity, easy bruising; gene,

A

osteogenesis imperfecta, COL1A1 and 2. glycosylation step of collagen synth

631
Q

what is Ras

A

oncogene so susceptable to gain of fx mutation: signals from cell mem to nucleus: promote mitosis

632
Q

Li Fraumeni mutation

633
Q

muslces innervated by R and L recurrent laryngeal

A

5 arytenoids

634
Q

efferent nerves myelinated except for

A

postganglionic autonomic neurons

635
Q

pathophys of achalasia

A

degeneration of inhibitory ganglion cells in myenteric (Aurebach) plexus

636
Q

acanthosis nigracans assoc with

A

gastric adenocarcinoma

637
Q

what in sarcomere changes with contraction and relaxation

A

I band: lengthen during relaxation, shorten during contraction

638
Q

define imprinting

A

inactivated by methylation, one parental chromosome is inactivated

639
Q

myositis with delayed reflex relaxation

A

hypothyroid induced

640
Q

myositis normal CK

A

glucocorticoid and PMR

641
Q

elastin cross linked by…

A

lysine, allows for rubber band like effects

642
Q

calculate CI

A

CI = mean +/- [z score] x SE

643
Q

high CD4/CD8 ratio

644
Q

substance P increase in chemotherapy 1-5 days after, cause vomiting, how treat

A

-aprepitant, neurokinin-1 receptor antagonists because NK-1 is activated by substance P

645
Q

how do eosinophils fight parasites

A

AB dependent cell mediated toxicity

646
Q

MOA of emicizumab

A

mimics factor VIII by binding both IXa and X

647
Q

renal clear cell carcinoma arise from and gross pathology

A

proximal tubules and golden yellow tissue with necrosis and hemorrhage

648
Q

DM neuropathy vs compression CN III monoinjury

A

DM: nerve ischemia to middle: only have down and out and ptosis
comp: above plus pupil dysfx

649
Q

abesence of melanocytes

650
Q

anemia, thombocytopenia, high WBC, stain CD20

651
Q

acute complication of left ventricular MI in lungs and histo

A

pulm edema and engorged alveolar capillaries, aceullar pink material

652
Q

mneumonic for familial dyslipids

A

1 LP, 2 LD, b add V, 3 is E, 4 adds more

653
Q

Peutz- Jeghers syndrome triad

A

autosomal dom, 1. hamartomas in GI 2. hyperpigmented macules mouth lips, hands, 3. increased risk breast and GI cancer

654
Q

pemphigous vul vs bullous pem clinical presentaiton

A

PV: oral mucosa, nikolsky pos, extend blister on pressure
BP: spare oral, tense blisters, nikolsky neg

655
Q

ataxia, truncal instability, postural tremor of fingers

A

alcholic cerebellar degeneration

656
Q

wide split S2: Aortic then pulm valve close

A

pulm HTN, pulm stenosis, RBBB

657
Q

mutation of Lynch syndrome

A

mismatch repair genes, lead to microsatellite instability: MSH2, MLH1, MSH6, PMS2

658
Q

substantia nigra located in

659
Q

what types of drugs cross the placenta

A

lipophillic, water soluble cannot

660
Q

EKG of hyper vs hypokalemia

A

hyper: peak T wave, progress to v tach
hypo: QT prolong, ST depression, progress to torsades

661
Q

pathophys of Grave’s opthalamos

A

stimulated by orbital fibroblasts by thyrotropin receptor ABs and cytokines released from T cells; fibroblasts proliferate and secrete glycosaminoglycans, excess adipose too

662
Q

most important RF for thyroid cancer

A

radiation exposure

663
Q

Kluver- Bucy syndrome

A

disinhibited behavior- bilateral amygdala

664
Q

midshaft fx of humerus

665
Q

only DNA virus replicate in cyto

666
Q

fall in renal perfusion pressure (renal art stenosis, systemic hypotension) lead to

A

cause efferent arteriole constriction, help improve GFR at expense of RPF

667
Q

counter effect of orthostatic hypotension- what receptor

668
Q

mneumonic for membranous nephropathy, histo

A

“tumors, hepatitis, and rheumatoid arthitis”, diffuse GBM thickening

669
Q

venous drainage above vs below dentate line

A

above: superior renal vein- inferior mesenteric vein- splenic vein-portal
below: inferior rectal- internal pudendal- internal iliac-common iliac- IVC

670
Q

MOA of probenacid

A

block organic anion transporters on renal tubular cells; inhibit secretion of Abx (penicillin)

671
Q

high estrogen in cirrosis clinical findings

A

spider angiomas, pallmar erythema, gynecomastia, testicular atrophy, less body hair

672
Q

after insulin binds to insulin receptor- what 2 paths happen?

A
  1. RAS/MAP kinase path- cell growth and DNA synth

2. PI3K path-glycogen, lipid, prot synth and GLUT4 translocated to membrane

673
Q

deep vs superficial peroneal nerve

A

deep: foot eversion and toe extension; sensory between big and second toe
super: foot eversion; sensory lat calf and dosri foot

674
Q

ACTH, LH, and renin in 17 hyrdxylase def

A

ACTH and LH increased, renin decreased

675
Q

common phrase of HIV meds

A

NNRTI: EfaVIRenz
PI: ritoNAVIR
InteGRAse inhibitor: ralteGRAVIR
FUsion inhibitor: EnFUvirtide

676
Q

leucine zippers are in…

A

eukaryotic transcription factors

677
Q

what is required for de novo pyrimidine synth

A

CO2, glutamine, 2 ATP

678
Q

moa of retinoid in acne

A

reduce hyperkeritinization, deccrease sebum production

679
Q

moa of di CCB

A

selective for arteriolar smooth muscle, decrease afterload

680
Q

stroke with dysarthria, contralateral face and body hemiparalysis

A

medial pons

681
Q

PV loop cardio explain

A

left line ESV, right line EDV, increase size right is increase preload, increase size up is increase afterload

682
Q

nitroprusside vs nitro moa

A

nitropruss: decrease preload only
nitro: decrease preload and afterload

683
Q

wrist bone mneumonic

A

s start at low thumb, that start at thumb again

684
Q

how drug get into blood brain barrier

A

inhibit p-glycoprotein which usually efflux pump put

685
Q

telangiectesias of skin and mucous mems that can rupture and cause bleeding

A

Osler-Weber-Rendu

686
Q

what nerve is involved: TMJ pain, muffled hearing/ ear pain

687
Q

only insulin dependent glucose transporter and location

A

GLUT-4, adipose and striated muscle

688
Q

sympathetic system 2nd neuron is usually ___, but what are the 2 exceptions

A

Usually: postsynaptic release NE

  1. chromaffin cells of adrenal medulla-stim by acetylcholine
  2. sweat glands are cholinergic
689
Q

IgE independent degranulation

A

opiods, radiocontrast, vanc

690
Q

dilated cardiomyopathy in 35 year old after illness

A

viral myocarditis

691
Q

clavicle displaced superior vs inferior

A

inf: deltoid
sup: sternocleido and trapezius

692
Q

two ways of absess formation in liver

A
  1. S aureus: hematogenous seed of liver

2. Eneric bacteria ( e coli, klebsiella, enterococci): ascend biliary tree

693
Q

urine: where see RBC free vs RBC casts

A

RBC free: kidney stones

RBC casts: nephritis

694
Q

how is eosinophil toxic to helminth

A

secrete major basic protein

695
Q

cause of comunicating hydrocephalus

A

comm: dysfx of subarachnoid villi- where CSF absorbed

696
Q

what cause insulin to increase way more in oral glucose

A

incretins: GLP-1 and GIP

697
Q

beta 2 adrengeric stim

A

vasodilation, bronchodilation, uterus relax

698
Q

alpha 1 adrenergic stim

A

increase SBP, mydraisis, contraction internal urethral sphincter

699
Q

increased renin and aldosterone

A

secondary hyperaldosteronism: renal artery stenosis, diuretic use, malignant htn, renin secreting tumor

700
Q

acetazolamide act at the

A

proximal tubule- urinary bicarb wasting

701
Q

itraperitoneal fluid after trauma

A

bladder dome rupture

702
Q

tx homocystenuria

A

pyroxidine

703
Q

jaw jerk reflex limbs

704
Q

HUS from..

A

Shigella or E. coli

705
Q

net excretion rate of substance

A

NER= (inulin cl x plasma [] of substance) - tubular reabsorption

706
Q

mutation of xeroderma piigmentosum

A

UV specific endonuclease

707
Q

esophageal cancers location and type

A

top 2/3- SCC

low 1/3- adenocarcinoma

708
Q

alpha 1 vs smoking emphysema location

A

alpha 1: panacinar

smoking: centriacinar

709
Q

TB reactivated vs primary

A

secondary: top
primary: bottom

710
Q

ovarian torsion ligament

A

infundibulopelvic ligament

711
Q

low elastase, elevated HgA1c, positive Sudan stain

A

chronic pancreatitis

712
Q

leuprolide MOA

A

GnRH analog

713
Q

—navir hiv moa and s/e

A

protease inhibitor and lipidystrophia, hyperglycemia, inihibit P450

714
Q

after 12-18 hours of fasting, start

A

gluconeogenesis

715
Q

tx orodic aciduria

716
Q

moa of zolpidem

A

GABA agonist

717
Q

triad of Plummer-Vinson

A
  1. dysphagia 2. Iron deficiency 3. esophageal webs +glossitis
718
Q

pigmented stones pathophys

A

biliary tract infection leads to release of B-glucuronidases- increase unconjugated bili

719
Q

G6PD prevents creation of ___ which is used in….

A

NADPH- FA synth, reduce glutathione

720
Q

steady state reached in __ half lives

721
Q

action and sensory of obturator nerve

A

adduct thigh, medial patch just superior to knee

722
Q

bioavail equation

A

AUC oral/ AUC IV

723
Q

chloride in arterial vs venous

724
Q

transport of ammonia by alanine

A

alanine carry NH3, give to alpha ketoglutarate by ALT with B6 as cofactor

UWORLD (10 decks)

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