Boards Flashcards

Question

Protein-conjugated vaccines

Answer 1

Prevnar (pneumococcal) H. flu type B Meningococcal

Answer 2

K PUNCHES ``` Klebsiella Proteus Ureaplasma Nocardia Cryptococcus (fungi) H. pylori Epidermidis Saprophyticus ```

Answer 3

``` Red = Serratia Green/Blue = Pseudomonas Yellow = either Actinomyces israelii or Staph aureus ```

Answer 4

SHiN Strep pneumo H. influenza (Type B) Neisseria They can all transform DNA and all have an IgA protease (to colonize respiratory epithelium)

Answer 5

SHiN Strep pneumo H. influenza (Type B) Neisseria They also have IgA protease

Answer 6

M protein Prevents phagocytosis

Answer 7

Protein A Binds Fc region of Ig to prevent opsonization & phagocytosis

Answer 8

Diphtheria toxin - inactivates elongation factor (EF-2)

Answer 9

Exotoxin A - inactivates elongation factor (EF-2)

Answer 10

Shiga toxin: | inactivates 60S ribosome by removing adenine from rRNA

Answer 11

*Includes O157:H7 Shiga-like toxin: inactivates 60S ribosome by removing adenine from rRNA

Answer 12

Two toxins: Heat-labile - ^ adenylate cyclase activity --> Cl- excretion Heat-stable - ^ guanylate cyclase activity --> decreased NaCl absorption "Labile in the Air, Stable on the Ground"

Answer 13

Edema factor - mimics adenylate cyclase activity

Answer 14

Cholera toxin: Permanently activates Gs subunit --> ^ adenylate cyclase activity --> ^ Cl- secretion in gut

Answer 15

Pertussis toxin: Disables Gi --> ^ adenylate cyclase activity --> impaired phagocytosis

Answer 16

Tetanospasmin - cleaves GABA and Glycine SNARE proteins

Answer 17

Botulinum toxin - Cleaves Ach SNARE proteins

Answer 18

Alpha toxin/Phospholipase C/Lecithinase: Phospholipase that degrades tissue and membranes. Causes gas gangrene and hemolysis.

Answer 19

Streptolysin O: Degrades cell membranes --> hemolysis

Answer 20

TLR-2 = gram+ peptidoglycan TLR-4 = gram- LPS

Answer 21

Toxic shock syndrome toxin 1 (TSST-1): Connect MHCII and TCR --> activate all T cells --> ^ IFNg & IL-2

Answer 22

Exotoxin A: Connect MHCII and TCR --> activate all T cells --> ^ IFNg & IL-2

Answer 23

ABCDE ``` shigA-like toxin (EHEC) Botulinum toxin Cholera toxin Diphtheria toxin Erythrogenic toxin (GAS) ```

Answer 24

Alpha (partial): Strep pneumo Viridans strep Beta (complete): GAS GBS Gamma (absent): Enterococcus (Group D) Strep bovis

Answer 25

Staph: Saprophyticus is resistant Epidermidis is sensitive

Answer 26

Optochin: Strep pneumo is afraid of-the-chin, viridans are not Bacitracin BRAS --> B Resistant, A sensitive

Answer 27

``` Clostridium Corynebacterium Listeria Bacillus Mycobacterium ```

Answer 28

Only Bacille Calmette-Guerin (BCG for Tuberculosis) & F. tularensis.

Answer 29

test with maconCKEE'S agar ``` Citrobacter Klebsiella E. coli Enterobacter Serratia ```

Answer 30

Oxidase+: Pseudomonas H. pylori Oxidase-: Salmonella Shigella Proteus

Answer 31

Eosin-Methylene blue agar Lactose fermenters grow as purple/black colonies. E. coli grows as a purple colony with a green shine.

Answer 32

``` Meningococci = Maltose & glucose Gonococci = just Glucose ```

Answer 33

Viruses (mono, hepatitis) Drugs Rheumatic fever Lupus & Leprosy

Answer 34

Syphilis (secondary & congenital) Rocky Mountain Spotted Fever Coxsackie A (hand, foot, & mouth dz) Kawasaki dz

Answer 35

Ingested - EAT Enterobius Ascaris Trichinella Cutaneous - SANd Strongyloides Ancylostoma Necator

Answer 36

Bendazoles "Roundworms are bendy"

Answer 37

Cestodes (tapeworms) & Trematodes (flukes) = Praziquantel ``` The exceptions are those that have a cyst form: Taenia solium (cysticercosis --> bendazoles) Echinococcus granulosus (liver cysts --> bendazoles) ```

Answer 38

``` Smallpox Yellow fever Chicken Pox Polio (Sabin) MMR Influenza (intranasal one) ```

Answer 39

"RIP, eh" Rabies Influenza (IM) Polio (Salk) HAV

Answer 40

HBV (HBsAg) & HPV (6, 11, 16, 18)

Answer 41

HHAPPPPy ``` Hepadena Herpes Adeno Pox Parvo Papilloma Polyoma ```

Answer 42

ssDNA = Parvovirus (Par 1) dsRNA = Reovirus

Answer 43

Adenovirus & Rotavirus

Answer 44

All are haploid except retroviruses (2 identical ssRNA copies)

Answer 45

All DNA replicate in nucleus (except poxvirus) All RNA replicate in cytoplasm (except influenza & retroviruses)

Answer 46

"Naked CPR & PAPP Calcivirus Picornavirus Reovirus Papillomavirus Adenovirus Parvovirus Polyomavirus All others are enveloped

Answer 47

"Always Bring Polymerase Or Fail Replication" ``` Arenavirus Bunyavirus Paramyxovirus Orthomyxovirus Filovirus Rhabdovirus ```

Answer 48

Segmented genomes = BOAR Bunyavirus Orthomyxovirus Arenavirus Reovirus

Answer 49

Toxin A - enterotoxin; PMN chemoattractant & secretory diarrhea Toxin B - cytotoxin; actin depolymerization & mucosal necrosis

Answer 50

``` gag = p24, p7 (capsid and matrix proteins, respectively) pol = Reverse transcriptase, integrase, protease env = gp120, gp41 (gp160 is cleaved into them) rev = protein that transports viral transcripts out of nucleus nef = proteins to downregulate CD4 and MHCI ```

Answer 51

Macrophage tropic = CCR5 & CD4 T-cell tropic = CXCR4 & CD4 Early disease is macrophage tropic & late disease is T-cell tropic.

Answer 52

``` HBsAg = hepatitis B infection HBeAg = active viral replication (high transmissibility) Anti-HBs = immunity to HBV Anti-HBc = window period Anti-HBe = low transmissibility ```

Answer 53

SECES ``` HBsAg HBeAg Anti-HBc Anti-HBe Anti-HBs ```

Answer 54

Homozygous delta32 mutation. These patients have mutant CCR5. Heterozygotes have a slower progression of HIV disease.

Answer 55

``` Candida infection (thrush) Bartonella henselae (bacillary angiomatosis) ```

Answer 56

Cryptosporidium

Answer 57

``` Progressive multifocal leukoencephalopathy (JC virus) Toxoplasma abscesses Cryptococcal meningitis CMV retinitis HIV dementia ```

Answer 58

``` Kaposi's Sarcoma (HHV-8) Hairy Leukoplakia (EBV) Non-Hodgkin's Lymphoma (Waldeyer's Ring) SCC (cervix or anus if MSM) CNS Lymphoma ```

Answer 59

Pneumocystis jirovecii CMV pneumonia Invasive aspergillosis Mycobacterium avium-intracellulare (TB-like illness)

Answer 60

``` Vibrio parahaemolyticus & vulnificus Bacillus cereus S. aureus Clostridium perfringens Clostridium botulinum E. coli O157:H7 Salmonella ```

Answer 61

``` Campylobacter Salmonella Shigella EHEC EIEC Yersinia enterocolitica Entamoeba histolytica ```

Answer 62

``` ETEC Vibrio cholerae C. difficile (can also cause dysentery) C. perfringens Cryptosporidium (AIDS) Rotavirus (children) Norovirus (adults) ```

Answer 63

GBS | E. coli

Answer 64

"Runts May Cough Chunky Sputum" ``` RSV Mycoplasma Chlamydia trachomatis Chlamydia pneumoniae Strep pneumo ```

Answer 65

Strep pneumo Mycoplasma Chlamydia pneumoniae

Answer 66

``` Strep pneumo H. influenza Mycoplasma Anaerobes Viruses ```

Answer 67

``` Step pneumo Influenza H. flu Anaerobes Gram negative rods ```

Answer 68

Staph | Enteric gram negative rods

Answer 69

Strep pneumo Klebsiella Staph

Answer 70

Pseudomonas Staph aureus Strep pneumo Burkholderia cepacia

Answer 71

Mycoplasma Legionella Chlamydia

Answer 72

GBS E. coli Listeria

Answer 73

Strep pneumo Neisseria meningitidis H. flu (Type B) Enteroviruses

Answer 74

Strep pneumo Neisseria meningitidis (#1 in teens) Enteroviruses HSV

Answer 75

Strep pneumo Gram negative rods Listeria

Answer 76

Cefriaxone + Vancomycin + Ampicillin if < 6m or > 60y (Listeria)

Answer 77

``` Diabetics - Pseudomonas IVDA - Pseudomonas Sickle Cell - Salmonella Prosthetic replacement - S. epidermidis Vertebral osteomyelitis - MTB Cat/Dog bite - Pasteurella multocida Everyone else - S. aureus ```

Answer 78

Nitrite = Gram negative bacteria UTI | Leukocyte esterase = Bacterial UTI

Answer 79

1) E. coli 2) Staph saprophyticus 3) Klebsiella Others: Proteus Serratia (nosocomial) Pseudomonas (nosocomial) Enterobacter (nosocomial)

Answer 80

Triad: Chorioretinitis Hydrocephalus Intracranial calcifications

Answer 81

``` Triad: PDA Cataracts Deafness +/- rash ```

Answer 82

Convulsions (seizures) Mute (deafness) Violaceous rash (petechiae)

Answer 83

Recurrent infections | Chronic diarrhea

Answer 84

Encephalitis | Herpes lesions

Answer 85

Stillbirth/hydrops fetalis Syphilis facies: notched teeth, saddle nose Saber shins CNVIII deafness

Answer 86

Rubella (descending) Measles (descending) VZV (begins on trunk) Roseola (HHV-6; follows several days high fever) Parvovirus (slapped cheek rash) Streptococcus pyogenes (sandpaper-like rash) Coxsackie A (vesicular on palms, soles, oral mucosa)

Answer 87

Haemophilus ducreyi "It's so painful that you do-cry"

Answer 88

Gardnerella vaginalis "I don't have a Clue why I smell Fish in the Vagina Garden" Clue cells Fishy smell Gardnerella vaginalis Treatment = Metronidazole

Answer 89

Chlamydia trachomatis

Answer 90

Mechanical ventilation = Pseudomonas Urinary catheterization = E. coli, Proteus Open wounds = S. aureus

Answer 91

Encapsulated organisms, especially SHiN

Answer 92

Bind to PBP's (transpeptidases) to block cross-linking of peptidoglycan.

Answer 93

Naf for staph Cannot use for MRSA.

Answer 94

Aminopenicillins = "HELPS kill Enterococci" ``` H. flu E. coli Listeria Proteus Salmonella/Shigella Enterococci ```

Answer 95

Gram- rods Group & viridans strep Anaerobes

Answer 96

Clavulonic acid Sulbactam Tazobactam

Answer 97

They are beta-lactams that inhibit cell wall synthesis

Answer 98

PEcK: gram+ cocci Proteus E. coli Klebsiella

Answer 99

HEN PEcKS: ``` gram+ cocci H. flu Enterobacter Neisseria spp. Proteus E. coli Klebsiella Serratia ```

Answer 100

Ceftriaxone: Meningitis empiric therapy Gonorrhea Ceftazidime/Cefoperazone: Pseudomonas

Answer 101

Everything except LAME: Listeria Atypicals MRSA Enterococci

Answer 102

Gram- rods only (including pseudomonas)

Answer 103

Cover pretty much anything. Limited to life-threatening infections due to side effects. "We have a positive ID on a negative MD" Imipenem, Doripenem = gram+ Meropenem, Doripenem = gram-

Answer 104

Inhibits peptidoglycan formation by binding up D-ala D-ala portion of cell wall precursors.

Answer 105

Gram+ only Saved for use in serious multidrug resistant organisms: MRSA Enterococci C. diff

Answer 106

"Buy AT 30, CCEL at 50" 30S inhibitors: Aminoglycosides Tetracyclines ``` 50S inhibitors: Chloramphenicol Clindamycin Erythromycin Linezolid ```

Answer 107

``` Gentamycin Neomycin Amikacin Tobramycin Streptomycin ```

Answer 108

Gram- rod infections

Answer 109

AminO2glycosides do NNOT kill anaerobes Nephrotoxic Neuromuscular blockade Ototoxic Teratogenic

Answer 110

MACRO: ``` Motility issues Arrhythmia (prolonged QT) Cholestatic hepatitis Rash eOsinophilia ```

Answer 111

``` Clindamycin = anaerobes above the diaphragm Metronidazole = anaerobes below the diaphragm ```

Answer 112

Bactrim = Trimethoprim-Sulfamethoxazole (TMP-SMX) Trimethoprim - inhibits Dihydrofolate reductase Sulfamethoxazole - inhibits Dihydropteroate synthase

Answer 113

Inhibitis DNA Topoisomerase II (gyrase) & Topoisomerase IV -oxacin

Answer 114

Gram- rods of urinary and GI tracts | Neisseria

Answer 115

"GET GAP on the metro" ``` Giardia Entamoeba histolytica Trichomonas Garderella vaginalis Anaerobes Pylori (H. pylori; requires triple therapy PPI+MAC) ```

Answer 116

Forms free radicals in the bacterial cell --> cell damage & death

Answer 117

It has a longer half life (4h) but does not cover Pseudomonas.

Answer 118

Discoloration of teeth in children under 8y (contraindicated in pregnancy & children) Photosensitivity

Answer 119

``` MTB = Isoniazid MAC = Azithromycin ```

Answer 120

RIPE Rifampin Isoniazid Pyrazinamide Ethambutol

Answer 121

Neurotoxic Hepatotoxic Drug-induced lupus INH = Injures Neurons & Hepatocytes

Answer 122

Hepatotoxic Many drug interactions (^CYP450 activity) Orange body fluids ``` 4 R's: RNA polymerase inhibitor Revs up CYP450 Red/orange body fluids Rapid resistance if used alone ```

Answer 123

Optic side effects: Retrobulbar neuritis Central scotoma Red/green color blindness

Answer 124

Erythromycin drops

Answer 125

Ampicillin

Answer 126

Cefazolin (to prevent S. aureus infection)

Answer 127

< 200 = TMP-SMX (PCP) < 100 = TMP-SMX (PCP & Toxoplasmosis) < 50 = Azithromycin (MAC)

Answer 128

``` MRSA = Vancomycin; Daptomycin; Linezolid; Tigecycline; Ceftaroline VRE = Linezolid + Streptogramins ```

Answer 129

haEMOPhilus Epiglottitis Meningitis Otitis media Pneumonia Incidence has gone way down due to vaccination against Type B. Other nontypeable strains only cause mucosal infections (otitis media, conjunctivitis, bronchitis).

Answer 130

gamma-Interferon | IL-2

Answer 131

IL-4 IL-5 IL-10 IL-13

Answer 132

IL-4 --> IgG & IgE | IL-4 + IL-13 --> IgE

Answer 133

Th2 cells Promotes class switching to IgA and proliferation of eosinophils.

Answer 134

Bile = both Enterococci & other Group D Strep (S. bovis) | 6.5% NaCl = Just enterococci

Answer 135

Oseltmivir = NA inhibitor (inhibits virion release from cells)

Answer 136

Bacteroides fragilis > E. coli > everything else (polymicrobial)

Answer 137

``` Pregnancy (the only antifungal) Serious systemic mycoses Cryptococcus Blasto/Histo/Coccidio Mucormycoses Invasive candida Fungal meningitis (intrathecal) ```

Answer 138

Fever/Chills ("Ampho-terrible") Hypotension Anemia Thrombophlebitis

Answer 139

Histo/Blasto/Coccidio Itraconazole/Fluconazole for local infection Amphotericin B for systemic infection

Answer 140

Amphotericin B | +/- Flucytosine

Answer 141

Fluconazole If invasive --> Echinocandin (Caspofungin, Micafungin)

Answer 142

Inhibits IMP dehydrogenase --> no guanine synthesis

Answer 143

RSV | Chronic Hepatitis C

Answer 144

HSV and VZV infections Does NOT work against CMV (Ganciclovir)

Answer 145

Valacyclovir & Valganciclovir

Answer 146

CMV retinitis when Ganciclovir has failed | Acyclovir-resistant HSV

Answer 147

CMV retinitis | Acyclovir-resistant HSV

Answer 148

2 NRTI's + either: 1 NNRTI 1 PI 1 Integrase inhibitor

Answer 149

Ritonavir **All PI's end in -navir

Answer 150

Zidovudine (ZDV/AZT) To reduce risk of fetal transmission.

Answer 151

Metabolic syndrome | GI intolerance

Answer 152

Didanosine > Stavudine > Zidovudine

Answer 153

Chronic Hepatitis B & C | Kaposi's Sarcoma

Answer 154

Multiple Sclerosis

Answer 155

NADPH oxidase deficiency

Answer 156

"SAFe Children Take Really Good Care" ``` Sulfonamides (Kernicterus) Aminoglycosides (Ototoxicity) Fluoroquinolones (Cartilage damage) Clarithromycin (Embryotoxic) Tetracyclines (Discolored teeth) Ribavirin (Teratogen) Griseofulvin (Teratogen) Chloramphenicol (Gray baby syndrome) ```

Answer 157

ARES protocol: Azithromycin Rifampin Ethambutol Streptomycin

Answer 158

M. leprae Long term tx Tuberculoid form = Dapsone & Rifampin Lepromatous form = Dapsone, Rifampin, Clofazimine

Answer 159

Gemifloxacin Levofloxacin Moxifloxacin

Answer 160

Ciprofloxacin | Levofloxacin

Answer 161

Strep pneumo pneumonia

Answer 162

Heat stable toxin --> Emetic form (1-5h after ingestion) | Heat labile toxin --> diarrheal form (15-20h after ingestion)

Answer 163

``` Cortex = Follicles of B cells Paracortex = T cells (location of high endothelial venules) Medulla = Medullary cords & sinuses contain macrophages ```

Answer 164

Superior mesenteric

Answer 165

Colic --> inferior mesenteric

Answer 166

Internal iliac

Answer 167

Superficial inguinal

Answer 168

Superficial & deep plexuses --> para-aortic

Answer 169

Superficial inguinal

Answer 170

Superficial inguinal

Answer 171

Right lymphatic duct = Right arm, Right chest, Right 1/2 of head Thoracic duct = everything else They both empty into their respective subclavian veins.

Answer 172

Encapsulated organisms ``` Strep pneumo H. flu i Neisseria meningitidis E. coli Salmonella Klebsiella i Strep agalactiae (GBS) ```

Answer 173

Howell-Jolly bodies (nuclear remnants) Target cells Thrombocytosis

Answer 174

From cortex (positive selection) to medulla (negative selection).

Answer 175

``` Mental retardation Flat facies Prominent epicanthal folds Oblique palpebral fissures Simian crease Gap between first 2 toes Duodenal atresia Ostium primum-type ASD (cushion defect) ```

Answer 176

ALL | Alzheimers (young onset)

Answer 177

1) Meiotic nondisjunction (95% of cases; advanced maternal age) 2) Robertsonian translocation (4% of cases) 3) Mosaicism (1% of cases)

Answer 178

``` Staph epidermidis Strep mutans & sanguinis Pseudomonas Viridans strep Nontypable H. flu ```

Answer 179

MTB & Leprosy = combination therapy | H. flu & N. meningitidis = monotherapy prophylaxis

Answer 180

``` Maltose = Glucose + Glucose Lactose = Glucose + Galactose Sucrose = Glucose + Fructose ```

Answer 181

``` Prematurity Fetal macrosomia Neural tube defects Hypoglycemia Hypocalcemia Polycythemia NRDS Transient HOCM ```

Answer 182

beta-endorphins ACTH MSH

Answer 183

``` NRDS PDA Bronchopulmonary dysplasia Intraventricular hemorrhage (germinal matrix) Necrotizing enterocolitis Retinopathy of prematurity ```

Answer 184

CNII Ophthalmic artery Central retinal vein

Answer 185

CNIII, CNIV, CNV1, CNVI Ophthalmic vein Sympathetic fibers

Answer 186

Standing Room Only ``` V1 = Superior orbital fissure V2 = Foramen rotundum V3 = Foramen ovale ```

Answer 187

Middle meningeal artery & vein

Answer 188

CNVII, CNVIII

Answer 189

CNIX, X, XI Jugular vein "Nine, ten, eleven, jugular foramen"

Answer 190

Down Syndrome | Beta-thalassemia

Answer 191

``` MHCI = HLA-A,B,C MHCII = HLA-DR,DP,DQ ```

Answer 192

MHCI --> TCR & CD8 (CTL activation) | MHCII --> TCR & CD4 (Th activation)

Answer 193

``` MHCI = all cells except RBC's MHCII = only on APC's ```

Answer 194

Hemochromatosis

Answer 195

PAIR Psoriasis Ankylosing spondylitis IBD Reiter's syndrome

Answer 196

"DQ2, Celiac sprue" | Also DQ8

Answer 197

Multiple sclerosis Hay fever SLE Goodpastures

Answer 198

T1DM | Graves' Disease

Answer 199

Rheumatoid arthritis | T1DM

Answer 200

Pernicious anemia | Hashimoto's thyroiditis

Answer 201

Activity increased by IL-2, IL-12, IFN-alpha, IFN-beta | Activated to kill by absence of MHCI on target cell surface or nonspecific activation signals on target cell surface.

Answer 202

Positive selection = TCR cell can bind self Negative selection = TCR does not bind self with high affinity These occur in the thymus.

Answer 203

CD4: TCR/CD4-MHCII CD28-B7 (dendritic cell) CD8: TCR/CD8-MHCI CD28-B7 (dendritic cell)

Answer 204

1) BCR-mediated endocytosis (B cell) MHCII-TCR (CD4 T cell) (B cell) CD40-CD40L (T cell) This causes activation of B cell & release of cytokines from T cell --> class switching, affinity maturation, Ab production

Answer 205

IL-4, IL-5, IL-10, IL-13

Answer 206

Perforin - holes in membrane Granzyme - serine protease --> apoptosis inside target cell Granulysin - induces apoptosis

Answer 207

Th1: Activates macrophages (inflammation) & intracellular immunity Th2: Recruits eosinophils (parasites) & promotes Ig production (extracellular immunity)

Answer 208

CD3 CD4 CD25

Answer 209

IL-10 | TGF-beta

Answer 210

1) Opsonization (promotes phagocytosis) 2) Neutralization (prevents binding) 3) Complement activation (MAC)

Answer 211

CH2 portion (Fc portion close to the neck) This only occurs with IgM & IgG

Answer 212

TdT = Terminal deoxynucleotidyl Transferase

Answer 213

Most produced = IgA Highest titer = IgG Lowest titer = IgE

Answer 214

Binds to and sensitizes mast cells & basophils Activates eosinophils against worms Type I hypersensitivity

Answer 215

Activation of B cells is T-cell independent, either by: 1) Crosslinking of BCR's due to repeating epitopes 2) TLR activation in an innate cell --> signaling This type of response occurs in response to non-peptide antigens, such as a polysaccharide capsule. It generates NO IMMUNOLOGIC MEMORY. This is why we have to conjugate Strep pneumo, H. flu, Neisseria vaccines to a peptide. Then there can be an immunologic memory and a thymus-dependent response.

Answer 216

Lysis GRAM- cells by punching holes in it

Answer 217

C3b - opsonization C3a, C5a - anaphylaxis C5a - PMN chemotaxis C5b-C9 - MAC

Answer 218

Decay Accelerating Factor (DAF) C1 Esterase Inhibitor They help to prevent activation on self

Answer 219

``` Classical = Ab bound to microbial surface Alternative = C3 spontaneously hydrolyzed to C3b Lectin = Mannose-Binding Lectin (MLB) binds mannose, glucose, etc. (polysaccharide) ```

Answer 220

Hereditary angioedema, especially periorbital. ACE inhibitors contraindicated

Answer 221

Recurrent pyogenic sinus & respiratory tract infections Also ^ susceptibility to Type III (immune complex) hypersensitivity because C3 is involved in clearing of immune complexes.

Answer 222

Recurrent Neisseria infections

Answer 223

Decay Accelerating Factor (GPI anchored enzyme; normally inhibits complement) Complement mediated hemolysis & PNH

Answer 224

Glutamate + Aspartate

Answer 225

Glutamate + Aspartate + Glycine

Answer 226

Trpytophan

Answer 227

``` Ach Bradykinin Serotonin Substance P Shear forces NO ```

Answer 228

Depolarization of the microbial cell membrane

Answer 229

Myopathy & increased CPK

Answer 230

In order: 1) Strep pneumo 2) Staph aureus 3) H. flu

Answer 231

Definitive diagnosis is with EM. Mesothelioma = long slender microvilli Adenocarcinoma = short, plump microvilli

Answer 232

It depends: Alpha receptor stimulation --> decreased insulin release Beta receptor stimulation --> increased insulin release As a whole, sympathetic stimulation generally decreases insulin release while parasympathetic stimulation increases it.

Answer 233

Both are usually X-linked Hemophilia A is spontaneous in 30% of cases

Answer 234

X-linked recessive

Answer 235

BLT w/ Ketchup & Mustard ``` Breast Lung Thyroid Kidney Multiple myeloma ```

Answer 236

Hot T-Bone stEAk ``` IL-1 = pyrogen IL-2 = stimulates T cells IL-3 = stimulates bone marrow IL-4 = class switch to IgE IL-5 = class switch to IgA ```

Answer 237

Fever & acute-phase reactants

Answer 238

The major chemoattractant for neutrophils "Clean up on aisle 8"

Answer 239

Inhibits inflammation and Th1 Secreted by Th2 cells & T-regs

Answer 240

Protein Kinase R (PKR) is produced. In the presence of dsRNA, it phosphorylates two proteins: 1) RNAse L --> degrades RNA 2) eIF2 --> inhibits translation

Answer 241

``` TCR CD3 CD28 If Th - CD4, CD40L If CTL - CD8 ```

Answer 242

BCR (Ig) CD19,20,21,40 MHCII B7

Answer 243

CD14,40 MHCII B7 Fc & C3b receptors (for enhanced phagocytosis)

Answer 244

CD16 (binds Fc of IgG) | CD56 (unique to NK)

Answer 245

CD14 & TLR-4 | macrophages

Answer 246

if you want "To Be Healed Rapidly" Tetanus toxin Botulinum toxin HBV Rabies virus

Answer 247

``` Live-attenuated = cellular response Killed = humoral response ``` Killed are safer but often requires boosters.

Answer 248

Induces differentiation of T cells into Th1 cells | Activates NK cells

Answer 249

Responsible for septic shock Activates endothelium Leukocyte recruitment Vascular permeability

Answer 250

IL-1,6,8,12, TNF-alpha

Answer 251

5-10 days post-exposure

Answer 252

Both are type III hypersensitivity Serum sickness is systemic - fever, urticaria, proteinuria, LAD Arthus reaction is localized - edema, necrosis

Answer 253

Allergic (Type I) Anaphylactic Febrile nonhemolytic transfusion reaction (FNHTR; Type II) Acute hemolytic transfusion reaction (HTR; Type II)

Answer 254

Drug-induced lupus

Answer 255

Rheumatoid arthritis

Answer 256

CREST syndrome

Answer 257

aka anti-Scl-70 | Scleroderma

Answer 258

Primary biliary cirrhosis

Answer 259

Celiac disease

Answer 260

Goodpasture's

Answer 261

Pemphigus vulgaris

Answer 262

Hashimoto's

Answer 263

Polymyositis/Dermatomyositis

Answer 264

aka Anti-SSA/Anti-SSB Sjogren's syndrome

Answer 265

Mixed connective tissue disease

Answer 266

Autoimmune hepatitis

Answer 267

AKA c-ANCA Granulomatosis with polyangiitis

Answer 268

AKA p-ANCA Microscopic polyangiitis Churg-Strauss syndrome

Answer 269

Staphylococcus Burkholderia cepacia Serratia Nocardia Candida Aspergillus

Answer 270

T-cell deficiency = fungal & viral infections | B-cell deficiency = encapsulated bacteria, enteroviral, and giardia infection

Answer 271

Rounded cell body Nucleus displaced to periphery Central chromatolysis (dispersion of Nissl substance) These changes are secondary to Wallerian degeneration. They represent increased protein synthesis in order to regenerate a severed axon.

Answer 272

"Tender Loving Care For Nancy" ``` Thiamine pyrophosphate Lipoate Coenzyme A FAD NAD ```

Answer 273

Pulsus paradoxis = pulses decrease with inspiration ``` Ddx: Cardiac tamponade Constrictive pericarditis Severe obstructive lung disease Restrictive cardiomyopathy ```

Answer 274

``` Histo = small, within macrophages (Histo hides) Blasto = Blasto Buds Broadly; same size as RBC Coccidio = Large spherule filled with endospores (Coccidio crowds) ```

Answer 275

hCG is an LH analog & can also bind to TSH receptor if in high enough concentrations. Thus, patients with choriocarcinoma/teratoma can exhibit hyperthyroidism and men can sometimes show gynecomastia.

Answer 276

Serume carcinoembryonic antigen (CEA)

Answer 277

Normal number of B cells, reduced plasma cells & Ig titers

Answer 278

CATCH-22 ``` 22q11 deletion syndromes: Cleft palate Abnormal facies Thymic aplasia Cardiac defects Hypocalcemia (parathyroid aplasia) 22q11 deletion ``` ``` DiGeorge = TCH VeloCARDIOFACIAL = the cardiac and facial (including cleft palate) defects ```

Answer 279

Malformation of: 3rd branchial pouch (inf. parathyroids & thymus) 4th branchial pouch (sup. parathyroids)

Answer 280

Disseminated MTB infections | No Th1 response; no IFN-gamma

Answer 281

Hyper-IgE Syndrome = FATED ``` Facies (course) Abscesses (noninflammatory; Staph) Teeth (keep baby teeth) IgE Dermatologic problems (eczema) ```

Answer 282

Hyper-IgE Syndrome Caused by a failure of Th1 cells to release IFN-gamma --> no neutrophil chemotaxis

Answer 283

Various forms of T cell dysfunction

Answer 284

Severe Combine Immunodeficiency: 1) IL-2 receptor mutation (X-linked) 2) Adenosine Deaminase deficiency (ADA)

Answer 285

Failure to thrive Recurrent infections (bact, viral, fungal, protozoa) Chronic diarrhea, thrush Absence of thymic shadow, germinal centers, and T cells Decreased T-cell Recombinant Excision Circles (TRECs)

Answer 286

Bubble baby then BMT

Answer 287

ATM gene mutation | Normally involved in NHEJ

Answer 288

IgA deficiency Cerebellar defects Spider angiomas

Answer 289

Defective CD40L on Th cells --> B cells cannot class switch

Answer 290

Sever pyogenic infections early in life | ^ IgM, very low titers of all other classes

Answer 291

WASP gene (X-linked) Makes T cells unable to reorganize actin cytoskeleton

Answer 292

Thrombocytopenia | ^IgE & IgA, decreased IgM

Answer 293

Wiskott-Aldrich's TIE Thrombocytopenic purpura Infections Eczema

Answer 294

CD18 (LFA-1 integrin on phagocytes)

Answer 295

Delayed umbilical cord separation (usually caused by PMN's) Neutrophilia Recurrent bacterial infections No pus formation

Answer 296

Lysosomal Trafficking Regulator gene (LYST): Causes microtubule dysfunction in phagosome-lysosome fusion

Answer 297

``` Recurrent staph & strep pyogenic infections Albinism Giant granules in neutrophils Peripheral neuropathy Defective primary hemostasis Neutropenia ```

Answer 298

Lack of NADPH oxidase --> no ROS --> no respiratory burst in neutrophils

Answer 299

Infection with catalase+ organisms (PLACESS) Dx by either: Dihydrorhodamine (DHR) flow cytometry Nitroblue tetrazolium dye reduction test (no blue color --> CGD)

Answer 300

Preformed anti-donor Ab's --> vessel occlusion --> ischemia/necrosis

Answer 301

Recipient CTL's reacting against donor MHC's --> vasculitis of graft vessels with dense lymphocytic infiltrate Reversible with immunosuppressants

Answer 302

Non-self MHCI is perceived as self MHCI with non-self antigen by recipient CTL's --> T-cell & Ab-mediated vascular damage --> fibrosis of graft vessels & tissue Irreversible

Answer 303

Bone marrow & liver transplant

Answer 304

It's a weak lipophilic base used to treat malaria, RA, and lupus Can cause retinal damage or hemolysis

Answer 305

Binds cyclophilins --> inhibits calcineurin --> reduced production of IL-2 and IL-2R --> impaired T cell differentiation and activation

Answer 306

``` Cyclosporine Tacrolimus Sirolimus Azathioprine Muromonab-CD3 Corticosteroids ```

Answer 307

``` Nephrotoxic Metabolic syndrome Tremor Gingival hyperplasia Hirsutism ```

Answer 308

Binds FK-binding protein --> inhibits calcineurin --> decreased IL-2 secretion --> T cell suppression

Answer 309

Nephrotoxic Metabolic syndrome Tremor

Answer 310

Inhibits mTOR --> T-cells unresponsive to IL-2

Answer 311

Hyperlipidemia Thrombocytopenia Leukopenia

Answer 312

It's the precursor to 6-mercaptopurine --> inhibits purine synthesis

Answer 313

Bone marrow suppression Toxic effects are increased by xanthine oxidase inhibitors (metabolized by XO normally)

Answer 314

mAb against CD3 --> blocks CD3 --> no T cell activation

Answer 315

Cytokine release syndrome (cytokine storm)

Answer 316

``` rG-CSF = Filgrastim rGM-CSF = Sargrastim ```

Answer 317

Severe asthma. It is an Ab against IgE.

Answer 318

Case control --> Odds ratio (Casino odds) | Cohort --> Relative risk

Answer 319

Small number of healthy volunteers Meant to assess safety, toxicity, pharmacokinetics

Answer 320

Small number of diseased patients Assesses efficacy, optimal dosing, and adverse effects

Answer 321

Large number of diseased patients randomly assigned (RCT) to treatment of interest or standard of care/placebo. Used to compare the new treatment to the standard of care

Answer 322

Postmarketing surveillance following FDA approval Detects rare or long-term effects

Answer 323

SNOUT --> Sensitive test rules out | SPIN --> Specific test rules in

Answer 324

Sn = True Positive/All disease | = 1- false negative

Answer 325

PPV = TP/(TP + FP)

Answer 326

NPV = TN/(FN + TN)

Answer 327

PPV --> Increases with higher prevalence (pretest probability) NPV --> Decreases with higher prevalence (pretest probability) Sensitivity and Specificity are fixed properties of a test.

Answer 328

Incidence = (# new cases over a time period)/(Population at risk) Prevalence = (# of existing cases)/(Population at risk) Thus Prevalence ~ (Incidence rate)*(duration of disease)

Answer 329

OR = AD/BC

Answer 330

RR = (A/A+B)/(C/C+D)

Answer 331

AR = (A/A+B) - (C/C+D)

Answer 332

ARR = risk following treatment - control risk Determines how much reduction in risk is due to a treatment.

Answer 333

NNT = 1 / Absolute Risk Reduction

Answer 334

NNH = 1 / Attributable risk

Answer 335

Accuracy is affected by systematic error Precision is affected by random error

Answer 336

Berkson's bias (a type of selection bias)

Answer 337

The group knows it is being watched and changes its behavior. It's a form of measurement bias. "Dr. Hawthorne is watching you"

Answer 338

Observer-expectancy bias

Answer 339

Procedure bias

Answer 340

Crossover studies | Goo matching of groups

Answer 341

Lead-time bias

Answer 342

Late-look bias

Answer 343

For a Gaussian distribution: 1 SD = 68% 2 SD = 95% 3 SD = 99.7%

Answer 344

SEM = SD/(square root of n)

Answer 345

Type I error: Seeing something there when it's not (alpha accepts alternate) alpha is the probability of making Type I error We set significance at 0.05 to account for alpha error Type II error: Missing a difference that does actually exist beta is the probability of Type II error (beta blind to difference)

Answer 346

The probability of correctly rejecting the null hypothesis when there is a difference. ***Increases with larger sample (there is power in numbers) Power = 1 - beta "Alpha accepts, Beta blinds, Power perceives"

Answer 347

95% CI --> Z = 1.96 | 99% CI --> Z = 2.58

Answer 348

It's a range from: | [mean - Z(SEM)] to [mean + Z(SEM)]

Answer 349

Ranges from -1 to +1 Closer that it is to either -1 or +1 --> stronger the linear correlation of 2 variables

Answer 350

Primary prevents Secondary screens Tertiary treats

Answer 351

Drugs, sex, and emergencies

Answer 352

Appearance, Pulse, Grimace, Activity, Respiration Assessed at 1 minute & 5 minutes. >7 = good >3 = assist and stimulate 3 or less = resuscitate

Answer 353

Less than 2500g

Answer 354

Walk/talk at 1 200 words and 2 word phrases at 2 Pee at 3 (toilet training)

Answer 355

EEG waveforms: "at night BATS Drink Blood" ``` Awake (eyes open) = Beta Awake (eyes closed) = Alpha Stage N1 = Theta Stage N2 = Sleep spindles & K complexes Stage N3 = Delta REM = Beta ``` Most of time spent in N2. Sleepwalking, night terrors, bedwetting is in N3.

Answer 356

REM occurs every 90 minutes ACh --> REM NE --> inhibits REM

Answer 357

SCN --> NE release --> Pineal gland --> Melatonin release SCN is regulated by the environment (light)

Answer 358

Cytosine and Adenine

Answer 359

Methylation occurs at lysines & arginines --> histone more + --> heterochromatin Acetylation occurs at lysines --> euchromatin --> histone less + --> euchromatin

Answer 360

``` G-C = 3 H-bonds A-T = 2 H-bonds ```

Answer 361

Inhibits Ribonucleotide Reductase: UDP cannot --> dUDP Ultimately deprives cell of Thymidine

Answer 362

Inhibits Thymidylate Synthase (FU, TS): No dUMP --> dTMP Ultimately deprives cell of Thymidine (purine)

Answer 363

Methotrexate Trimethoprim (bacterial DHFR) Decrease availability of THF. N5,N10 THF required for dUMP --> dTMP (via thymidylate synthase)

Answer 364

Inhibits PRPP Amidotransferase (first step in dedicated purine synthesis) It is activated by HGPRT. Azathioprine is its prodrug.

Answer 365

``` Megaloblastic anemia (not responsive to folate/B12) Orotic acid in the urine ```

Answer 366

Oral uridine supplementation

Answer 367

Adenosine --> Inosine This is part of the purine salvage pathway: Adenine --> AMP --> Adenosine --> Inosine --> Hypoxanthine --> IMP

Answer 368

1) Excess dATP feedback inhibits ribonucleotide reductase --> imbalance of nucleotide pool --> impaired DNA synthesis --> lymphocyte depletion 2) Toxic metabolites build up in lymphocytes

Answer 369

HGPRT deficiency. Normally it catalyzes: Hypoxanthine --> IMP Guanine --> GMP

Answer 370

Mental retardation Self-mutilation Agression Hyperuricemia/gout

Answer 371

GOLD FOB Holds His Watch ``` G6PD deficiency OTC deficiency Lesch-Nyhan Duchenne's (& Becker's) muscular dystrophy Fabry's disease Ocular albinism Bruton's agammaglobulinemia Hemophilia A & B Hunter's syndrome Wiskott-Aldrich syndrome ```

Answer 372

T cells are killed by buildup of dGTP (vs ADA deficiency which kills both B & T cells) Normal reactions: Guanosine --> Hypoxanthine Inosine --> Hypoxanthine

Answer 373

Silent --> same amino acid Missense --> different amino acid (conservative if similar AA) Nonsense --> early stop codon (UGA, UAA, UAG) Frameshift --> usually truncated & nonfunctional

Answer 374

Removes pyrimidine dimers & 6-4 photoproducts | bulky lesions that distort helix

Answer 375

Xeroderma pigmentosum

Answer 376

Glycosylases recognize damaged base --> create apurinic/apyrimidinic site --> endonuclease cuts 3' end --> lyase cuts 5' end --> DNAP-beta fills it in --> ligase seals it

Answer 377

``` Removes damaged bases: Deamination products (via nitrates or spontaneous) ```

Answer 378

HNPCC ``` MLH1 = MutL MSH2 = MutS ``` **They find a mismatch, then find the nearest nick and recruit an endonuclease to degrade from the nick all the way to the mismatch and it is all replaced

Answer 379

RNAP I --> rRNA RNAP II --> mRNA RNAP III --> tRNA rampant, massive, tiny

Answer 380

``` Start = AUG (met or f-met; inAUGural codon) Stop = UGA, UAA, UAG (U Go Away, U Are Away, U Are Gone) ```

Answer 381

They contain alpha-amanitin --> hepatotoxic via inhibition of RNAP II

Answer 382

An anticodon is reversed and complementary

Answer 383

``` Eukaryotes = 40S + 60S --> 80S Prokaryotes = 30S + 50S --> 70S ```

Answer 384

Neurons skeletal muscle cardiac muscle

Answer 385

Hepatocytes Lymphocytes Can be stimulated to enter G1 but normally reside in G0

Answer 386

``` Bone marrow Gut epithelium Skin Hair follicles Germ cells ```

Answer 387

Mannose-6-Phosphate

Answer 388

Cells cannot add Mann-6-P to proteins intended for lysosomes. Instead the proteins are secreted into the plasma.

Answer 389

Course facial features Clouded corneas Restricted joints High plasma levels of lysosomal enzymes

Answer 390

COPI = golgi --> ER (retrograde) COPII = ER --> goldi (anterograde Clathrin = trans-golgi --> lysosomes; PM --> endosomes (responsible for receptor-mediated endocytosis)

Answer 391

Catabolism of very long chain fatty acids (beta oxidation) | Catabolism of amino acids

Answer 392

Dynein arm defect --> cilia dysfunction

Answer 393

Infertility (females have some but reduced) Bronchiectasis Recurrent sinusitis Often associated with situs inversus

Answer 394

Connective tissue intermediate filaments

Answer 395

Neuroglial intermediate filaments

Answer 396

Each ATP: 3 Na+ out 2 K+ in

Answer 397

Type I = bONE, skin, tendon (90% of total) Type II = car-two-lage Type III = Reticulin (skin, blood vessels, uterus, fetal tissue) Type IV = Basement membrane (Type IV is the floor)

Answer 398

Autosomal dominant deficiency in Type I collagen

Answer 399

Multiple easy fractures Blue sclerae (choroidal veins seen through them) Early hearing loss Dental problems

Answer 400

Hyperextensible skin Hypermobile joints Easy bruising Associated with joint dislocation, berry aneurysms, aortic dissection Caused by faulty COLLAGEN synthesis (vs. fibrillin for Marfan's)

Answer 401

Split renal basement membrane --> hereditary nephritis Deafness Ocular disturbances Due to abnormal Type IV collagen

Answer 402

alpha-1-Antitrypsin (A1AT)

Answer 403

Direct = tests for an Antigen in a patient's blood Indirect = tests for an Antibody in the patients blood

Answer 404

Targeted recombination or deletion of genes. Can be controlled by outside stimuli and targeted to cell types, etc. Useful if a global knockout mouse would die in-utero, etc.

Answer 405

Phenotype varies among individuals with the same genotype (i.e. 2 NF1 pts have varying severity)

Answer 406

One gene contributes to multiple (often seemingly unrelated) effects

Answer 407

The two-hit hypothesis of tumor suppressor genes

Answer 408

When 2 alleles occur together more often in a population that would be expected by chance

Answer 409

Mutations at different loci can produce the same phenotype

Answer 410

Presence of both normal and mutated mitochondrial DNA --> variable expression of mitochondrial inherited disease

Answer 411

Offspring gets 2 copies of a chromosome from 1 parent ``` Heterodisomy = meiosis 1 error Isodisomy = meiosis 2 error ``` Consider if a patient has an aut. recessive disease but only 1 parent is a carrier

Answer 412

p^2 + 2pq + q^2 = 1 and p + q = 1 Also 2pq = carrier frequency

Answer 413

Prader-Willi: The deleted allele comes from the father or uniparental disomy of the maternal (imprinted) chromosome. Angelman's: The deleted allele comes from the mother or uniparental disomy of the paternal (imprinted) chromosome. They are the same genetic deletion (15q11-15) but are normally imprinted differently based on which parent they came from. This causes differing symptoms.

Answer 414

Mental retardation Hyperphagia/obesity Hypogonadism Hypotonia

Answer 415

Mental retardation Inappropriate laughter Seizures Ataxia

Answer 416

Sons of carrier mothers have a 50% chance of showing disease.

Answer 417

If mother carries the allele: 50% chance of all offspring getting it If father carries the allele: all daughters & no sons get it

Answer 418

Hypophosphatemic Rickets: | phosphate wasting at the proximal tubule --> rickets-like presentation that is resistant to Vit. D supplementation

Answer 419

Mitochondrial myopathies: Present with myopathy & CNS disease "Ragged red fibers" on muscle biopsy All children of affected mothers will be affected (heteroplasmy seen)

Answer 420

``` Hyperlipidemia Type IIa: Autosomal dominant inheritance Homozygotes LDL = 700+ CVD early in life (often MI before 20) Tendon xanthomas ``` Heterozygotes LDL ~300

Answer 421

(aka) Hereditary Hemorrhagic Telangiectasia: ``` Autosomal dominant inheritance Telangiectasia Recurrent epistaxis Skin discolorations AVM's ```

Answer 422

CAG repeats on chromosome 4 "Hunting 4 CAG's

Answer 423

``` Autosomal dominant fibrillin defect Affects skeleton, heart, eyes: Marfanoid habitus Hyperflexible joints Arachnodactyly Pectus excavatum Cystic medial necrosis of aorta --> aortic regurgitation & aortic dissection Mitral valve prolapse Subluxation of lens (ectopia lentis) ```

Answer 424

Chromosome 17 von Recklinghausen = 17 letters

Answer 425

Bilateral acoustic shwannomas juvenile cataracts On chromosome 22. Type 2, NF2 --> 22

Answer 426

Deletion of Phe508 All CF stems from mutation of CFTR gene on chromosome 7

Answer 427

Recurrent pneumonia (S. aureus, H. flu, & Pseudomonas) Pancreatic insuficiency (malabsorption & steatorrhea) Meconium ileus in newborns Bronchiectasis, chronic bronchitis Male infertility (absence of vas deferens) Cirrhosis (late) Nasal polyps Salty sweat

Answer 428

CFTR channel misfolded & degraded before getting to cell surface CFTR normally: - Secretes Cl- in lung, small intestine, & pancreas - Reabsorbs Cl- from sweat

Answer 429

X-linked frameshift mutation --> deletion of dystrophin gene | Accelerated muscle breakdown is seen

Answer 430

``` Weakness beginning with pelvic girdle muscles (Progresses superiorly) Use of Gowers' maneuver Calf pseudohypertrophy Onset before 5y ``` Dx: ^ CPK & muscle biopsy

Answer 431

X-tra large testes, ears, jaw Autism Mitral valve prolapse

Answer 432

^CGG repeats in FMR1 gene It is X-linked & can be found in females but rarer

Answer 433

Females --> premature ovarian failure | Males --> tremor-ataxia in 40's-50's

Answer 434

Inability to release volitional contraction (aka unable to release handshake) Progressive weakness

Answer 435

"Try Hunting for My Fried Eggs" ``` Trinucleotide disorders: Huntington's (CAG) Myotonic dystrophy (CTG) Friedrich's ataxia (GAA) Fragile X (CGG) ```

Answer 436

``` Trauma Sepsis Shock Aspiration Uremia DIC Hypersensitivity reactions Acute pancreatitis Amniotic fluid embolism ```

Answer 437

His-Purkinje > Atria > Ventricles > AV node

Answer 438

Acute promyelocytic leukemia (M3) t(15;17) "Hey (A)! 15 miles per Auer"

Answer 439

Dimerization --> Cross-phosphorylation --> Intracellular active sites exposed --> phosphorylation of tyrosine residues on target proteins

Answer 440

Retinoblastoma Osteosarcoma *Requires knockout of other copy (2 hit hypothesis/loss of heterozygosity)

Answer 441

Histamine | Leukotrienes C4, D4, E4

Answer 442

(aka) Pseudohypoparathyroidism: Autosomal dominant kidney unresponsiveness to PTH Symptoms: Hypocalcemia Short 4th/5th digits (knuckle, knuckle, dimple, dimple) Short stature

Answer 443

Different mutations at the same locus cause similar variant phenotypes

Answer 444

``` "Bronze diabetes" Hepatomegaly --> Cirrhosis Diabetes Skin hyperpigmentation Testicular atrophy CHF ^ risk of hepatocellular carcinoma ```

Answer 445

Activating mutation of FGFR-3 | chromosome 4

Answer 446

Hydrophobic N-terminal signal sequences are recognized by signal recognition particles, which halt translation and carry the ribosome over to the RER to continue translation.

Answer 447

MAGIC RACKS in GQ ``` Macrolides Amiodarone Grapefruit juice Isoniazid Cimetidine Ritonavir Acute alcohol Ciprofloxacin Ketoconazole Sulfonamides Gemfibrozil Quinidine ```

Answer 448

"Carbemazepine By Pill Really Speeds Cyp450 Metabolism Greatly" ``` Carbemazipine Barbiturates Phenytoin Rifampin St. John's Wort Chronic alcohol Modafinil Griseofulvin ```

Answer 449

Unmineralized osteoid matrix surrounding the normally mineralized trabeculae

Answer 450

Germline p53 mutation 2nd hit causes: Early onset breast cancer Soft tissue sarcomas

Answer 451

R. side loops around the R. subclavian | L. side loops around the aortic arch

Answer 452

All are myelinated except for postganglionic autonomic neurons

Answer 453

They are myelinated, with the exception of slow C fibers (heat & pain from free nerve endings).

Answer 454

Enteroviruses | poliovirus, coxsackie, echovirus, HepA

Answer 455

MHCI --> beta-2-microglobulin | MHCII --> invariant chain

Answer 456

Children, sexually active adults, & immunodeficiency patients. It is a poxvirus

Answer 457

Order goes alpha-fetoprotein, beta-hCG, estriol, inhibin-A Down: down-up-down-up Edwards: down-down-down-normal

Answer 458

Decreased hCG Decreased PAPP-A Nuchal translucency

Answer 459

``` Trisomy 18: Severe mental retardation Rocker-bottom feet Low set ears Micrognothia (small jaw) Prominent occiput Clenched hands Congenital heart disease ``` Death usually occurs in <1y

Answer 460

``` Trisomy 13: Severe mental retardation Cleft lip/palate Microcephaly Holoprosencephaly Polydactyly Congenital heart disease ``` Death occurs in <1y Rocker-bottom feet

Answer 461

13, 14, 15, 21, 22 They are acrocentric chromosomes (1 large q arm and a tiny p arm) --> q arm is duplicated & p arm is lost --> normal if balanced, deletions/duplications if unbalanced

Answer 462

Microdeletion on 5p (short arm) ``` Symptoms: Mental retardation Crying/meowing (Cri-du-chat = cry of the cat) Epicanthal folds VSD Microcephaly ```

Answer 463

Microdeletion on long arm of chromosome 7 ``` Symptoms: Elfin facies Intellectual disability Vit. D sensitivity --> Hypercalcemia Extreme friendliness with strangers Cardiovascular problems (elastin is deleted) ```

Answer 464

``` aka Reactive arthritis Triad of: Conjunctivitis Urethritis Seronegative arthritis "Can't see, can't pee, can't climb a tree" ``` Associated with GU infection by: Chlamydia, Campylobacter, Salmonella, Shigella, or Yersinia HLA-B27

Answer 465

Presents as pruritic lesions on the extensor surfaces | Celiac sprue --> IgA/IgG cross-react with reticulin in dermal papillary tips

Answer 466

Insulin resistance | GI or lung malignancy

Answer 467

At CpG islands. This causes genetic silencing of this region & is associated with imprinting, etc.

Answer 468

Maxillary sinuses Because their drainage is superior, so gravity doesn't favor it.

Answer 469

Virchow's node drains the thoracic duct. Abdominal (GI) malignancies typically can show lymphatic dissemination to Virchow's node.

Answer 470

Aspergillus

Answer 471

Antioxidant Constituent of visual pigments (retinal) Differentiates epithelial cells (ATRA for APL) Prevents SCC

Answer 472

Vitamin A deficiency --> Night blindness & dry skin

Answer 473

``` Teratogenic (cleft palate, cardiac abnormalities) Arthralgias Headache (cerebral edema) Alopecia Sore throat ```

Answer 474

``` Thiamine --> TPP Used for decarboxylation reactions: Pyruvate dehydrogenase alpha-ketoglutarate dehydrogenase Transketolase Branched-chain amino acid dehydrogenase ```

Answer 475

1) Wernicke-Korsakoff syndrome - eyes, lies, capsize 2) Dry Ber1Ber1 - polyneuritis, symmetrical muscle wasting 3) Wet Ber1Ber1 - dilated cardiomyopathy, edema

Answer 476

B1 FIRST, then glucose. Giving glucose in the setting of thiamine deficiency can worsen symptoms.

Answer 477

Niacin - part of NAD+ & NADP+ (B3 --> 3 ATP) Synthesized from tryptophan & requires B6

Answer 478

Niacin deficiency --> Pellegra Pellegra (3 D's): Diarrhea Dermatitis (Casal's necklace) Dementia Excess --> facial flushing

Answer 479

``` Niacin deficiency can result from: Hartnup disease Carcinoid syndrome (^ tryptophan metabolism) INH (can cause B6 deficiency) ```

Answer 480

Riboflavin --> FAD & FMN (B2 --> 2 ATP)

Answer 481

Riboflavin deficiency (2 C's): Cheilosis (inflamed lips, fissures at the corners) Corneal vascularizaiton

Answer 482

Pantothenate - a component of CoA & fatty acid synthase "Pentothenate" = B5

Answer 483

``` Pantothenate deficiency: Dermatitis Adrenal insufficiency Enteritis Alopecia ```

Answer 484

Pyridoxine - converted to pyridoxal phosphate Used in: Transamination (ALT/AST) Decarboxylation Glycogen phosphorylase Synthesis of cystathionine, heme, niacin, histamine, serotonin, epinephrine, NE, GABA

Answer 485

``` Pyridoxine deficiency caused by - INH & OCP use Symptoms: Convulsions Hyper-irritability Peripheral neuropathy Sideroblastic anemia ```

Answer 486

Biotin - cofactor for carboxylation enzymes: Pyruvate carboxylase Acetyl-CoA carboxylase Propionyl-CoA carboxylase

Answer 487

``` Biotin deficiency is rare (abx use or egg white over-ingestion) Symptoms: Dermatitis Enteritis Alopecia ```

Answer 488

Folic acid - converted to THF for methylation rxns in DNA/RNA synthesis Found in leafy green vegetables

Answer 489

Folic acid deficiency - seen in pregnancy & alcoholism Megaloblastic anemia Neural tube defects in pregnancy *Most common vitamin deficiency in the U.S.

Answer 490

``` Cobalamin used for: Homocysteine methyltransferase (Homocysteine --> Methionine; also regenerates THF for thymidylate synthase) ``` Methylmalonyl-CoA mutase (Methylmalonyl-CoA (from odd-chain FA's) --> Succinyl-CoA)

Answer 491

Cobalamin deficiency: Megaloblastic anemia Hypersegmented PMN's Subacute combined degeneration (abnormal myelin) Caused by: Malabsorption Diphyllabothrium latum Lack of IF (pernicious anemia, gastric bypass) Lack of terminal ileum (Crohn's) Alcoholics Use Schilling test (radiolabeled B12) to determine cause

Answer 492

SAM (ATP + methionine) is used for conversion of NE --> EPI Requires Folic acid & B12 to regenerate Methionine (& thus SAM)

Answer 493

Ascorbic acid: Antioxidant Aids in Fe2+ absorption Hydroxylation of proline & lysine in collagen synthesis Used in dopamine beta-hydroxylase (Dop --> NE)

Answer 494

``` Scurvy: Swollen gums Bruising Hemarthrosis Anemia Poor wound healing Weakened immune response ```

Answer 495

N/V Diarrhea Fatigue Iron toxicity

Answer 496

D2 - ergocalciferol; ingested form plants D3 - cholecalciferol; ingested in milk & synthesized in skin 25-OH-D3 - storage form 1,25-OH-D3 - Calcitriol; active form

Answer 497

Antioxidant for erythrocytes Deficiency --> hemolytic anemia & subacute combined degeration

Answer 498

K is for Koagulation Catalyzes gamma-carboxylation of glutamic acid residues on clotting proteins (II, VII, IX, X, C, S)

Answer 499

Hemorrhagic disease of the newborn (given shot @ birth) ^ PT & aPTT but normal bleeding time Can also be seen following prolonged use of broad-spectrum antibiotics (only acquired through intestinal flora synthesis)

Answer 500

Delayed wound healing Hypogonadism Anosmia/Dysgeusia

Answer 501

Fomepizole inhibits alcohol dehydrogenase - it is the antidote for methanol or ethylene glycol poisoning.

Answer 502

It increases the NADH/NAD+ ratio in the liver --> inhibition of gluconeogenesis & ^ fatty acid synthesis (fatty liver).

Answer 503

Kwashiorkor - lack of protein --> skin lesions, edema, fatty liver, anemia, protruberant abdomen, change in hair color Marasmus - lack of calories --> loss of subQ fat, loss of muscle, edema

Answer 504

Aerobic (muscle; glycerol-3-P shuttle) - 30 ATP Aerobic (heart/liver; malate-aspartate shuttle) - 32 ATP Anaerobic glycolysis - 2 ATP

Answer 505

Hexokinase - ubiquitous, high affinity, low Vmax, inhibited by Glu-6-P Glucokinase - liver & pancreatic beta cells, low affinity, high Vmax, inhibited by Fru-6-P So at low [glu], sequestration in the tissues, and at high [glu], sequestration in the liver.

Answer 506

Glu + 2ADP + 2NAD+ --> 2pyruvate + 2ATP + 2NADH + 2H+ + 2H20

Answer 507

Glucagon --> ^ cAMP --> ^ PKA --> phosphorylates to activate Fructose-2,6-Bisphosphatase --> less Fructose-2,6-BP --> inhibited PFK-1 --> inhibited glycolysis Insulin does the opposite, by decreasing cAMP --> eventual ^ in PFK-2 activity --> ^ Fru-2,6-BP --> ^ PFK-1 activity --> glycolysis

Answer 508

Arsenic inhibits lipoic acid --> inhibited functioning of pyruvate dehydrogenase Symptoms: Vomiting Rice water stools Garlic breath

Answer 509

Dimercaprol It competes with pyruvate dehydrogenase thiols and binds up arsenic, which can then be excreted in the urine.

Answer 510

Most mutations are X-linked --> neurologic defects from birth Treatment = ketogenic diet (fats, Lysine & Leucine)

Answer 511

Fructose-6-P --> Fructose-1,6-Bisphosphate (PFK-1) PFK-1 ^ by AMP & Fructose-2,6-Bisphosphate PFK-1 inhibited by ATP & Citrate

Answer 512

Glucose --> Glucose-6-Phosphate (Hexokinase/Glucokinase) Fructose-6-Phosphate --> Fructose-1,6-Bisphosphate (PFK-1)

Answer 513

1,3-Bisphosphoglycerate --> 3-Phosphoglycerate (2 ATP total) (Phosphoglycerate kinase) Phosphoenolpyruvate --> Pyruvate (2 ATP total) (Pyruvate kinase)

Answer 514

1) Pyruvate --> Alanine (ALT; Used to carry NH3 to the liver via the Alanine cycle) 2) Pyruvate + Co2 + ATP --> Oxaloacetate (Pyruvate carboxylase; Produces Oxaloacetate to replenish it in the TCA cycle or for gluconeogenesis) 3) Pyruvate --> Acetyl-CoA + NADH + CO2 (Pyruvate dehydrogenase; Transition from glycolysis to TCA cycle) 4) Pyruvate --> Lactate + NAD+ (LDH; The end of anaerobic glycolysis, regenerates NAD+; Lactate enters Cori cycle)

Answer 515

``` RBC's Leukocytes Kidney medulla Lens Cornea Testes ```

Answer 516

``` Per 1 Acetyl-CoA: 3 NADH 1 FADH2 2 CO2 1 GTP ``` So 10 ATP total per Acetyl-CoA (x2 per glucose)

Answer 517

Citrate Is Krebs' Starting Substrate For Making Oxaloacetate ``` Citrate Isocitrate alpha-Ketoglutarate Succinyl-CoA Succinate Fumarate Malate Oxaloacetate ```

Answer 518

Cortisol is permissive because it increases vascular & bronchial smooth muscle reactivity to catecholamines.

Answer 519

``` -navir = protease inhibitor Raltegravir = integrase inhibitor Enfuvertide = fusion inhibitor Nevirapine, Efavirenz, Delaverdine = NNRTI All others = NRTI ```

Answer 520

Sumatriptan: Presynaptic 5-HT(1B/1D) agonist It inhibits functioning of trigeminal nerve & release of vasoactive peptide --> reduces neurogenic inflammation & causes vasoconstriction

Answer 521

Half of airway resistance comes from the upper airways (nose, pharynx) In the lower airways, resistance increases between the 2-5th bronchial generations due to turbulent flowbut then decreases due to ^ in cross-sectional area & laminar flow.

Answer 522

Vagus nerve --> Superior laryngeal n. & recurrent laryngeal n. Superior laryngeal nerve: External branch --> motor to cricothyroid muscle Internal branch --> sensory above the vocal cords Recurrent laryngeal nerve --> motor to all other laryngeal muscles; sensory below the vocal cords

Answer 523

Complex I: NADH is oxidized, 1 H+ is pumped (into intermembranous space) Complex II: FADH2 is oxidized, no H+ is pumped Complex III: 1 H+ is pumped Complex IV: 1 H+ is pumped Complex V: ATP synthase --> each proton allowed back into mitochondrial matrix = 1 ATP

Answer 524

Inhibits ETC complex 1 (RotenONE) | Decreased proton gradient

Answer 525

Cyanide & CO inhibit Complex IV of the ETC | Decreased proton gradient

Answer 526

Inhibits complex III of the ETC | decreased proton gradient

Answer 527

Directly inhibits ATP synthase | ^ proton gradient

Answer 528

"Pathway Produces Fresh Glucose" Pyruvate carboxylase (mitochondria; Pyruvate --> Oxaloacetate) PEP Carboxykinase (cytosol; Oxaloacetate --> Phosphoenolpyruvate) Fructose-1,6-Bisphosphatase (cytosol) Glucose-6-Phosphatase (ER)

Answer 529

``` Lactate Glycerol Alanine Glutamine (account for 90% of gluconeogenesis) ```

Answer 530

Liver >> Kidney, Intestinal epithelium

Answer 531

The pentose phosphate pathway (HMP shunt) provides: Ribose-5-P for nucleotide synthesis (pentose) NADPH for reductive reactions (Phosphate) (used to reduce Glutathione, produces ROI for resp. burst)

Answer 532

Oxidative: Glu-6-P --> 2 NADPH + Ribulose-5-P (G6PD; Irreversible; Rate-limiting) Non-oxidative: Ribulose-5-P --> Ribose-5-P or Glycerol-3-P or Fructose-6-P (Phosphopentose isomerase transketolases; Reversible; Requires B1)

Answer 533

1) O2 --> Superoxide (O2-) (NADPH Oxidase; Requires NADPH; Def. in CGD) 2) O2- --> H2O2 (Superoxide dismutase) 3) H2O2 + Cl- --> HOCl- (Myeloperoxidase; Produces hypochlorite/bleach) H202 can be inactivated by bacterial catalase or endogenous glutathione peroxidase

Answer 534

``` Infection Fava beans Sulfa drugs Primaquine Dapsone ```

Answer 535

Heinz Bodies - Oxidized Hb | Bite cells - splenic macrophages take a bite out of RBC's to remove heinz bodies

Answer 536

Fructose --> Fructose-1-P (Fructokinase) Fructose-1-P --> DHAP + Glyceraldehyde (Aldolase B) Glyceraldehyde --> Glyceraldehyde-3-P (Triose kinase)

Answer 537

Aut. recessive defect in Fructokinase Fructose appears in blood & urine (Benign disease, as are both fructose disorders when compared to their galactose counterparts)

Answer 538

Aut. recessive deficiency of Aldolase B Fructose-1-P accumulates, taking away phosphate groups from glycogenolysis & gluconeogenesis Symptoms: Hypoglycemia, jaundice, cirrhosis, vomiting

Answer 539

Exclude from diet. Fructose --> exclude fructose & sucrose Galactose --> exclude galactose & lactose

Answer 540

Galactose --> Gal-1-P (Galactokinase) Gal-1-P --> Glucose-1-P (Gal-1-P Uridyltransferase/GALT; Requires UDP-Glu from 4-epimerase)

Answer 541

``` Galactokinase deficiency: Galactose in blood/urine Infantile cataracts (Galactose --> Galactitol shunt) ``` ``` Classic Galactosemia (GALT deficiency): Failure to thrive Jaundice E. coli sepsis Infantile cataracts Mental retardation Hepatomegaly ```

Answer 542

It's an alternative method for trapping glucose within a cell (vs. hexokinase/glucokinase). Steps: Glucose --> Sorbitol (Aldose reductase) Sorbitol --> Fructose (Sorbitol dehydrogenase; Not present in Schwann, retina, kidney)

Answer 543

Both enzymes: Liver, lens, ovaries, seminal vesicles Insufficient Aldose Reductase: Retina, Schwann cells, kidneys

Answer 544

Glucose --> Sorbitol | Galactose --> Galactitol

Answer 545

PVT. TIM HALL ``` Phe Val Thr Trp Ile Met His Arg Leu Lys ``` Always Argues, never Tyres **His & Arg are semi-essential (required during growth)

Answer 546

Cori cycle: Converts lactate & pyruvate to glucose for export to tissues Alanine cycle: Alanine carries amino groups to liver

Answer 547

ALT: Alanine + alpha-Ketoglutarate --> Pyruvate + Glutamate (Part of alanine cyle; Glutamate enters urea cycle; Pyruvate enters gluconeogenesis) AST: Glutamate + Oxaloacetate --> alpha-Ketoglutarate + Aspartate (alpha-Ketoglutarate can then be used in alanine or TCA cycle; Aspartate can enter urea cycle; Glutamate can also enter urea cycle directly through deamination)

Answer 548

Carbamoyl phosphate synthetase I CO2 + NH4+ (+2ATP) --> Carbamoyl phosphate It's the first step

Answer 549

"Ordinarily, Careless Crappers Are Also Frivolous About Urination" ``` Ornithine +Carbamoyl phosphate Citrulline +Aspartate Arginosuccinate -Fumarate Arginine Urea ```

Answer 550

Symptoms: Asterixis, slurred speech, somnolence, vomiting, cerebral edema, blurred vision Treament: Lactulose - acidifies GI lumen --> ^ excretion of NH4+ Limit dietary protein Benzoate/Phenylbutyrate --> bind AA's --> ^ excretion

Answer 551

``` Dopamine/NE/EPI = Phenylalanine (converted to Tyr first) Serotonin/Melatonin = Tryptophan Heme = Glycine Histamine = Histidine Creatine/Urea/NO = Arginine GABA/Glutathione = Glutamate ```

Answer 552

Phenylalanine --> Tyrosine (Phenylalanine hydroxylase; requires tetrahydrobiopterin) Tyrosine --> DOPA (dihydroxyphenylalanine) (Tyrosine hydroxylase; requires tetrahydrobiopterin) DOPA --> Dopamine (Dopa decarboxylase; requires B6) Dopamine --> NE (Dopamine beta-hydroxylase; requires Vit. C) NE --> EPI (Phenylethanolamine N-methyltransferase; requires SAM)

Answer 553

Phenylalanine hydroxylase (Phe --> Tyr) deficiency or tetrahydrobiopterin (cofactor; 2% of cases) deficiency. ``` Symptoms: Mental retardation Growth retardation Fair skin Eczema Musty/Mousy body odor Phenylacetate/Phenyllactate/Phenylpyruvate in urine ```

Answer 554

``` Avoid phenylalanine (artificial sweeteners) Increase Tyrosine intake ```

Answer 555

If uncontrolled during pregnancy, child will be affected (mental/growth retardation, cardiac abn) despite the child being a heterozygote.

Answer 556

Alkaptonuria = a congenital deficiency of homogentistic acid oxidase (Tyr --> Fumarate to degrade Tyr). Symptoms: Dark connective tissue (ears, nose, cheeks) & sclera Urine turns black when exposed to air Severe arthralgias

Answer 557

Ocular albinism = X-linked Generalized albinism = varies Defect is either in tyrosinase (Tyr --> melanin) or in Tyrosine transporters (decreased Tyr available). Can also result from a lack of neural crest cell migration.

Answer 558

Three forms: 1) Cystathione synthase deficiency Tx: Decreased Met in diet & ^ Cysteine, B12, Folate 2) Decreased affinity of cystathione synthase for B6 Tx: ^^ dietary B6 3) Homocysteine methyltransferase deficiency

Answer 559

``` ^^ Homocysteine in urine Cysteine is essential Mental retardation Osteoporosis Tall stature Kyphosis Lens subluxation Stroke/MI ```

Answer 560

Hereditary defect in renal reabsorption of COAL (Cysteine, Ornithine, Arginine, Lysine) --> Staghorn calculi Think of this if recurrent kidney stones seen in a young pt. Tx: Good hydration & urinary alkalinization

Answer 561

Congenital deficiency of alpha-ketoacid dehydrogenase --> no degradation of branched amino acids. "I Love Vermont maple syrup" (Ile, Leu, Val) Symptoms: CNS defects/Mental retardation Death Urine smells like burned sugar

Answer 562

1) Hexagonal crystals in urine | 2) Sodium Cyanide-Nitroprusside test (detects sulfhydryl groups; purple --> + result)

Answer 563

Hereditary disorder preventing neutral amino acid transport in the kidney & intestine --> Tryptophan not absorbed in gut & ^ excretion in urine --> Pellegra (Niacin deficiency).

Answer 564

Glucagon (live only) or EPI (liver & muscle --> ^ cAMP --> PKA --> activated Glycogen phosphorylase kinase --> Activated Glycogen phosporylase Insulin --> Receptor tyrosine kinase --> Protein phosphatase --> inactive Glycogen phosphorylase **Ca2+/Calmodulin can also activate Glycogen phosphorylase kinase to coordinate glycogenolysis in active muscle

Answer 565

alpha (1,6) = straight | alpha (1,4) = branch

Answer 566

"Viagra Pills Cause A Massive Hard-on" ``` Type I = von Gierke's II = Pompe's III = Cori's IV = Anderson's V = McArdle's VI = Her's ```

Answer 567

Glucose-6-Phosphatase deficiency ``` Symptoms: Severe fasting hypoglycemia ^^ Liver glycogen --> Hepatomegaly ^ Blood lactate Fat cheeks, thin extremities ```

Answer 568

Lysosomal alpha-1,4-glucosidase deficiency Symptoms: Cardiomegaly (Pompe's trashes the pump) Systemic findings Early death

Answer 569

Debranching enzyme (alpha-1,6-glucosidase) deficiency Symptoms: Milder form of Type I (gluconeogenesis intact) Hepatomegaly Fasting hypoglycemia

Answer 570

Skeletal muscle glycogen phosphorylase deficiency Symptoms: Painful muscle cramps & myoglobinuria with exercise Often presents in early 20's

Answer 571

Tay-Sachs Niemann Pick Gaucher's

Answer 572

Fabry's Hunter's All others are autosomal recessive

Answer 573

alpha-galactosidase A deficiency --> ceramide trihexoside accumulation Symptoms: Glove & stocking neuropathy Angiokeratomas Cardiovascular/renal disease

Answer 574

Glucocerebrosidase deficiency --> glucocerebrosidase accum. ``` Symptoms: HSM Aseptic necrosis of femur Bone crises Gaucher's cells (crumpled macrophages) Thrombocytopenia & anemia ```

Answer 575

Sphingomyelinase deficiency --> Spingomyelin accum. ``` Symptoms: HSM Progressive neurodegeneration/Developmental delay Cherry red spot on macula Foam cells ```

Answer 576

Hexosaminidase A deficiency (Tay-SaX) --> GM2 ganglioside accum. ``` Symptoms: Progressive degeneration/Developmental delay Cherry red spot on macula Lysosomes with onion skin appearance NO HSM (vs. Niemann-Pick) ```

Answer 577

Galactocerebrosidase deficiency ``` Symptoms: Peripheral neuropathy Developmental delay Optic atrophy Globoid cells ```

Answer 578

Arylsulfatase A deficiency --> Cerebroside sulfate accum. Symptoms: Central & peripheral demyelination Ataxia Dementia

Answer 579

alpha-L-iduronidase deficiency --> Heparin & Dermatin sulfat accum. ``` Symptoms: Developmental delay Gargoylism Airway obstruction Corneal clouding HSM Gibbus deformity ```

Answer 580

Iduronate sulfase deficiency --> Heparin & Dermatin sulfate accum. Symptoms: Mild Hurler's dz but aggressive behavior & no corneal clouding Hunters are aggressive men & must see clearly

Answer 581

Citrate --> Acetyl-CoA --> Malonyl-CoA --> Fatty acid

Answer 582

Inability to transport long chain FA's into the mitochondria for beta oxidation --> Weakness, hypoketotic hypoglycemia

Answer 583

Acetoacetate Acetone beta-Hydroxybutyrate They are formed from the oxidation of FA's --> Acetyl-CoA. When TCA intermediates are depleted (Oxaloacetate) --> Ketogenesis instead

Answer 584

Prolonged starvation Alcoholics (Oxaloacetate is depleted due to --> to malate) DKA (Oxaloacetate is depleted from gluconeogenesis)

Answer 585

ATP Creatinine (seconds) Anaerobic glycolysis (minutes-1h) Aerobic metabolism & FA oxidation (surpasses anaerobic glycolysis @ 1h)

Answer 586

Uncouples ETC --> electron transport continues but no ATP is produced --> Heat

Answer 587

``` E --> mediates remnant uptake A-I --> Activates LCAT C-II --> Lipoprotein lipase cofactor B-48 --> Mediates chylomicron secretion B-100 --> Binds LDL receptor ```

Answer 588

Chylomicron - Delivers dietary TG's to peripheral tissue & cholesterol to the liver. VLDL - Secreted by liver to deliver hepatic TG's to peripheral tissue IDL - Degradation product of VLDL; returns to liver LDL - Delivers hepatic cholesterol to peripheral tissues; taken up into target tissues via LDLR; formed via hepatic lipase modification of IDL HDL - Reverse cholesterol transport from periphery to liver; acts as repository for ApoC & ApoE; secreted by liver & intestine

Answer 589

Lipoprotein lipase deficiency or altered C-II --> ^ chylomicrons, TG, cholesterol ``` Symptoms/Risks: Pancreatitis HSM Xanthomas No ^ risk for atherosclerosis ```

Answer 590

Autosomal dominant. Absent or reduced LDLR --> ^^LDL, cholesterol Symptoms: Early atherosclerosis Achilles xanthomas Corneal arcus (blue ring @ outside of iris)

Answer 591

Autosomal dominant. Hepatic overproduction of VLDL. Causes pancreatitis

Answer 592

Aut recessive mutation in Microsomal TRG Transfer Protein (MTP) gene --> reduced B-48 & B-100 --> reduced chylomicron & VLDL synthesis

Answer 593

``` Seen in the first few months of life Failure to thrive Steatorrhea Acanthocytosis (spur cells; Vit. E) Ataxia Night blindness (Vit. A) ``` Intestinal biopsy - Lipid accumulation within enterocytes

Answer 594

TCCAA ``` Temperature (hyperpyrexia) Convulsions Coma Arrhythmia Apnea ```

Answer 595

Picnic foods, especially containing mayonnaise.

Answer 596

Their IgE-specific Fc receptors bind IgE on opsonized parasites & they degranulate (antibody-dependent cytotoxicity)

Answer 597

Lipophilic drugs

Answer 598

Anti-cyclic citrullinated peptide Ab's --> Rheumatoid arthritis

Answer 599

Colony-simulating factors Prolactin Growth hormone

Answer 600

Fructose This is because it enters the glycolytic pathway after the rate-limiting step of glycolysis (PFK-1)

Answer 601

``` Pen = Ticarcillin, Piperacillin Ceph = Ceftazidime, Cefepime Aminogly = Tobramycin, Gentamycin, Amikacin FQ = Ciprofloxacin, Levofloxacin ``` Also Aztreonam, Imipenem, Meropenem

Answer 602

Chocolate agar is required for H. influenzae culture. It provides: Factor V = hematin Factor X = NAD+

Answer 603

5-HIAA | 5-Hydroxyindoleaceticacid

Answer 604

Pyrazinamide - it works best at acidic environments like within a phagosome The others (RIES) work on extracellular bacteria best.

Answer 605

Genitourinary abnormalities

Answer 606

Candida infections

Answer 607

``` Pyknosis (shrinkage) Karyorrhexis (fragmentation) --> DNA laddering (180 bp intervals) Karyolysis (destruction of chromatin) Cell shrinkage Apoptotic body formation ```

Answer 608

Intrinsic: Withdrawal of growth factor Injury (radiation, hypoxia) Extrinsic: FasL binding to Fas receptor Granzyme B (enters via perforin; CTL's)

Answer 609

Liquefactive = brain, bacterial abscesses, pancreas Fat necrosis = peripancreatic fat, breast Fibrinoid necrosis = blood vessels (malignant HTN, vasculitis) Gangrenous necrosis = extremities & GI (Can be dry (mummy) or wet (bacterial infection)

Answer 610

Dystrophic calcification = normal serum [Ca2+] Metastatic calcification = ^^ [Ca2+]

Answer 611

``` Irreversible: Disruption of 3 membranes -Plasma membrane -Mitochondrial membrane (Cyt. C) - Lysosomal membrane ``` Reversible: Cell swelling (due to reduced ATP --> reduced pump action) Ribosomal detachment Fatty change

Answer 612

HIE affects: - Pyramidal cells of hippocampus - Purkinje cells of cerebellum

Answer 613

``` Calor/Rubor = Histamine, Prostaglandins, Bradykinin Tumor = Histamine, Tissue damage Dolor = Bradykinin & PGE2 ```

Answer 614

The post-capillary venules This is the site of vascular permeability

Answer 615

1) Margination (occurs due to vasodilation) 2) Rolling (P/E-selectin binds Sialyl-Lewis) 3) Adhesion (ICAM-1 binds LFA-1 = integrin) 4) Diapedesis (PECAM-1 binds itself) 5) Migration (CILK: C5a, IL-8, LTB4, Kallikrein)

Answer 616

von Willebrand Factor | P-selectin

Answer 617

1) Inflammatory (immediate) 2) Proliferative (2 days; granulation tissue, collagen (III), contraction by myofibroblasts) 3) Remodeling (1 week; Type III collagen --> Type I)

Answer 618

Ascorbic acid - required for collagen hydroxylation --> crosslinks Copper - crosslinking enzyme requires it Zinc - collagenase requires it

Answer 619

``` MTB Fungal infections Syphilis Leprosy Bartonella hensalae (cat scratch disease) Sarcoidosis Crohn's disease Wegener's Churg-Strauss Berylliosis/silicosis ```

Answer 620

Either inflammation or lymphatic obstruction

Answer 621

Transudate < 1.012 | Exudate > 1.020

Answer 622

Sickle cell Polycythemia CHF

Answer 623

Congo red stain Lights up with "apple green birefringence" under polarized light

Answer 624

AL (primary) amyloisosis: Plasma cell dyscrasia or Multiple myeloma --> Ig light chain deposition AA (secondary) amyloisosis: Chronic inflammatory dz (RA, IBD, chronic infx), cancer, Familial Mediterranean fever --> Amyloid A (acute phase reactant)

Answer 625

``` Nephrotic syndrome Restrictive cardiomyopathy Easy bruising Hepatomegaly Neuropathy ```

Answer 626

Beta-2-microglobulin deposits in joints --> carpal tunnel & joint issues

Answer 627

MUTATED Transthyretin deposition in heart & brain

Answer 628

Deposition of beta-amyloid (from amyloid precursor protein) in the brain *APP is located on chromosome 21 (why Down's causes early-onset Alzheimer's)

Answer 629

``` Carcinomas = lymphatics Exceptions: -Renal cell carcinoma -HCC -Follicular thyroid carcinoma -Choriocarcinoma ``` Sarcomas = hematogenous

Answer 630

Females - G6PD expression (alleles should be 1:1) | B-cell tumors = Ig light chain (normal k:L = 3:1)

Answer 631

Reversible = Hyperplasia, Metaplasia, Dysplasia Irreversible = Anaplasia, Neoplasia, Desmoplasia

Answer 632

Leukemias Papillary thyroid cancer Breast cancer

Answer 633

``` Mesenchyme = Vimentin Neuroglia = GFAP Muscle = Desmin Neurons = Neurofilaments Epithelium = Keratin ```

Answer 634

Neuroendocrine tumors

Answer 635

myc = a transcription factor c-myc --> Burkitt's lymphoma L-myc --> small cell Lung carcinoma N-myc --> Neuroblastoma

Answer 636

Rb: Inhibits E2F G1-->S tumor suppressor p53: Transcription factor for p21 G1-->S tumor suppressor

Answer 637

Colorectal & Pancreatic carcinoma *Very nonspecific

Answer 638

Hepatocellular carcinoma | Yolk sac tumors

Answer 639

Ovarian cancer

Answer 640

Melanoma Neural tumors Schwannoma

Answer 641

Mets to bone | Paget's dz of the bone

Answer 642

Neuroblastoma | Lung/gastric cancer

Answer 643

Tartrate-Resistant Acid Phosphatase | Hairy cell leukemia TRAP the hairy animal

Answer 644

``` Pancreatic adenocarcinoma (19-9 = 10 = the # of letters in "pancreatic") ```

Answer 645

Burkitt's lymphoma Hodgkin's lymphoma Nasopharyngeal carcinoma CNS lymphoma (immunocompromised pts)

Answer 646

Liver angiosarcoma

Answer 647

(smoked foods) --> gastric adenocarcinoma (intestinal type)

Answer 648

``` Mouth/Esophageal/larynx Lung Pancreas Kidney Bladder ```

Answer 649

SCC (skin; like the women who used it to lighten their skin) | Liver angiosarcoma

Answer 650

Aniline dyes --> Transitional cell carcinoma (bladder)

Answer 651

SCC of the mouth & esophagus HCC (via cirrhosis) Pancreatic (not a risk factor; but chronic pancreatitis is)

Answer 652

Clinically --> Cushing's syndrome Small cell lung carcinoma

Answer 653

SIADH Small cell lung carcinoma Intracranial neoplasms

Answer 654

Clinically --> Hypercalcemia Squamous cell lung cancer Renal cell cancer Breast cancer *The most common cause of clinically apparent hypercalcemia = cancer

Answer 655

Clinically --> Hypercalcemia Lymphoma

Answer 656

Clinically --> Polycythemia Renal cell carcinoma Hemangioblastoma HCC Pheochromocytoma

Answer 657

``` PSaMMoma: Papillary thyroid Serous cystadenocarcinoma Meningioma Mesothelioma ```

Answer 658

``` Incidence = Breast/Prostate, Lung, CRC Deaths = Lung, Breast/Prostate, CRC ``` Cancer is the 2nd leading cause of death in the U.S.

Answer 659

Lung > Breast > GU > Osteosarcoma > Melanoma > GI 50% of brain cancer is mets (usually at gray/white junction)

Answer 660

CRC >> stomach > pancreas

Answer 661

Prostate = Breast > lung > thyroid = testes

Answer 662

``` HAV = Picornavirus HBV = Hepadnavirus HCV = Flavivirus HDV = Deltavirus HEV = Hepevirus ```

Answer 663

Propionyl-CoA carboxylase deficiency Normally Valine or Isoleucine --> Propionyl-CoA (branched chain alpha-ketoacid dehydrogenase) then Propionyl-CoA --> Methylmalonyl-CoA (propionyl-CoA carboxylase) then Methylmalonyl-CoA --> Succinyl-CoA (methylmalonyl-CoA isomerase) --> TCA cycle.

Answer 664

Candida: grey/white pseudomembrane patches Yeast & pseudohyphae HSV-1: Punched out ulcers Molding, marginated, multinuclear w/ intranuclear inclusions CMV: Linear ulceration Both intranuclear & cytoplasmic inclusions

Answer 665

Intracellular iron

Answer 666

These are heart failure cells Caused by left CHF --> ^ hydrostatic pressure in pulmonary capillaries --> RBC/heme leakage --> ingestion by macs

Answer 667

Ethosuximide It blocks T-type Ca2+ channels in the thalamus

Answer 668

Phenytoin Carbamazepine Valproic acid

Answer 669

Diplopia, dysphagia, dysphonia within 12-46h of ingestion. Can be caused by: - Improperly canned food - Wound infection - Honey (infantile botulism)

Answer 670

``` Decreased apex-to-base dimensions Sigmoid shaped interventricular septum Myocyte atrophy with interstitial fibrosis Lipofuscin accumulation (byproducts of lipid metabolism) ```

Answer 671

CD55 & CD59

Answer 672

Vaginal/rectal culture at 35-37 weeks. If positive --> intrapartum ampicillin (or penicillin)

Answer 673

Acyclovir- requires activation by HSV/VZV viral thymidine kinase Gancyclovir - requires activation by CMV viral kinase Cidofovir - does not require any activation *All are viral DNA polymerase inhibitors

Answer 674

It's a 5-HT3 antagonist: 1) Blocks vagal nerve stimulation of the medulla oblongata 2) Blocks central chemoreceptor trigger zone

Answer 675

Km = the concentration needed for 50% enzyme saturation (inversely related to affinity) Vmax is directly related to enzyme concentration

Answer 676

X intercept = 1/(-Km) Y intercept = 1/Vmax Slope = Km/Vmax

Answer 677

Competitive inhibitors increase Km --> decrease potency Noncompetitive inhibitors decrease Vmax --> decrease efficacy

Answer 678

F = (AUCoral)/(AUCiv)*100

Answer 679

Vd = Amount of drug in the body/plasma drug concentration It is the theoretical volume of fluid needed to maintain a constant dose at a constant plasma concentration.

Answer 680

Low Vd: Large/charged molecules Plasma protein bound High Vd: Lipophilic molecules Tissue protein bound

Answer 681

HL = (0.7*Vd)/CL *A property specific to first-order kinetics (constant % of drug eliminated)

Answer 682

``` CL = (rate of elimination of the drug)/(plasma drug concentration) CL = Vd*Ke --------where Ke is the elimination constant ``` It's given in units of flow

Answer 683

Takes 4-5 half lives Steady state is a function of half-life, therefore dosing frequency, size, loading doses, etc. have no effect on the time it takes to reach steady state

Answer 684

LD = Target plasma concentration*(Vd/F) MD = Target plasma concentration*(CL/F) Renal or liver disease --> lower maintenance dose (only)

Answer 685

PEA (round like 0): Phenytoin Ethanol Aspirin

Answer 686

Ionized form cannot traverse membranes: Weak acids are trapped in alkaline urine (give IV HCO3) Weak bases are trapped in acidic urine (give IV NH4Cl)

Answer 687

Phase I: REDOX, CYP450 --> slightly polar metabolites (often still active) Phase II: GAGS: Glucuronidation, Acetylation, Glutathione, Sulfation Usually yields inactive, very polar metabolites for urine excretion

Answer 688

Phase I is affected first

Answer 689

TI = LD50/ED50 TW = min. effective dose - min. toxic dose

Answer 690

Sweat glands Adrenal medulla All others are preganglionic ACh & postganglionic NE or Dop.

Answer 691

HAV 1 M&M = H1, a1, V1, M1, M3 --> Gq MAD 2's = M2, a2, D2 --> Gi All others = Gs

Answer 692

Gq --> Phospholipase C (cleaves PIP2) --> DAG & IP3 DAG --> PKC IP3 --> Ca2+ influx --> smooth muscle contraction Gi -/-> Adenylyl cyclase Gs --> Adenylyl cyclase --> ^ cAMP --> PKA --> --> ^Ca2+ (in heart) or ^MLCK activity

Answer 693

Alpha1: Vascular smooth muscle contraction Mydriasis Intestinal & bladder sphincter contraction ``` Alpha2: Lowers central sympathetic outflow Lowers insulin release Lowers lipolysis Causes platelet aggregation ```

Answer 694

``` M1 = CNS, enteric nervous system M2 = decreases HR & contractility of atria M3 = exocrine glad secretions, gut peristalsis, bladder contraction, bronchoconstriction, miosis, accommodation ```

Answer 695

D1 = relaxes renal vascular smooth muscle | D2 modulates NT release in the brain

Answer 696

H1 = nasal & bronchial mucus production, bronchiolar constriction, pruritis, pain H2 = gastric acid secretion

Answer 697

``` V1 = vascular smooth muscle contraction V2 = water reabsorption in the kidney ```

Answer 698

Cholinomimetic used to activate bladder & bowels. | postop ileus, neurogenic ileus, urinary retention

Answer 699

Cholinomimetic used for glaucoma, pupillary contraction.

Answer 700

Cholinomimetic that stimulates sweat, tears, saliva. Used for open-angle and closed-angle glaucoma. "You cry, drool, and sweat on your pilo (pillow)"

Answer 701

It is a cholinomimetic used in the challenge test to diagnose asthma.

Answer 702

It is an anticholinesterase inhibitor used for: Postop/neurogenic ileus & urinary retention Myasthenia gravis Postop reversal of neuromuscular junction blockade *Neo (no) CNS penetration

Answer 703

It is a long acting anticholinesterase inhibitor used for myasthenia gravis treatment *It does not cross the BBB

Answer 704

It is a short-acting acetylcholinesterase inhibitor used to diagnose myasthenia gravis.

Answer 705

It is a acetylcholineesterase inhibitor used to treat anticholinergic overdose (crosses the BBB). "Physostigmine phyxes atropine overdose"

Answer 706

It is an acetylcholinesterase inhibitor used to treat Alzheimer's disease.

Answer 707

Due to compounds that irreversible bind AChE (organophosphates) ``` DUMBBELSS: Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of skeletal muscle & CNS Lacrimation Sweating Salivation ```

Answer 708

Muscarinic antagonist used for Parkinson's disease. "Park my Benz"

Answer 709

Anti-muscarinic used for motion sickness.

Answer 710

Ipratropium/Tiotropium are antimuscarinic drugs used in COPD & asthma.

Answer 711

It is an antimuscarinic drug used to reduce bladder spasms & alleviate urgency seen with mild cystitis

Answer 712

It is an antimuscarinic used preoperatively to reduce airway secretions

Answer 713

Atropine is used to treat bradycardia & in ophthalmology. Overdose: "Hot as a hare, dry as a bone, red as a beet, blind as a bad, mad as a hatter"

Answer 714

A1, A2, B1, B2 Used in anaphylaxis, open angle glaucoma, asthma, hypotension

Answer 715

A1, A2 > B1 Used for hypotension (but decreases renal perfusion)

Answer 716

B1: ^ HR and contractility ^ renin release ^ lipolysis ``` B2: Vasodilation Bronchodilation ^ HR & contractility ^ lipolysis ^ insulin release Tocolysis Ciliary muscle relaxation ^ aqueous humor production ```

Answer 717

NE --> alpha-adrenergic stimulation --> ^ BP --> reflex bradycardia Isopreterenol --> beta-adrenergic stimulation -->B2 causes decreased BP --> reflex tacycardia (plus B1 stimulation ^ HR)

Answer 718

B1, B2 It is used in Torsades & bradyarrhythmias Don't use if ischemia is suspected (lowers BP and ^ HR)

Answer 719

D1 > B1, B2, > A1, A2 Used for shock (helps renal perfusion), heart failure Low dose = ^ RPF Medium dose = ^ CO High dose = lowered CO

Answer 720

B1 >> B2, A1, A2 Used for heart failure, cardiac stress testing.

Answer 721

A1, A2 Used for hypotension, ocular procedures (mydriasis), rhinitis (decongestant)

Answer 722

B2 >> B1 Albuterol is used for acute asthma. Salmeterol is used for long-term asthma or COPD control. Terbutaline is used to reduce premature uterine contractions.

Answer 723

B2 Reduces premature contractions

Answer 724

Amphetamine - releases stored catecholamines Ephedrine - same as amphetamine Cocaine - catecholamine reuptake inhibitor (never give beta blockers to cocaine abuser, can cause unopposed alpha stimulation --> malignant HTN)

Answer 725

It is a centrally acting A2 agonist --> reduces central sympathetic outflow. It's useful in HTN comorbid with renal disease because it does not reduce kidney perfusion.

Answer 726

Phenoxybenzamine is an irreversible alpha-adrenergic antagonist.

Answer 727

It is a reversible nonselective alpha-adrenergic antagonist. It is used to treat patients who are on MAOi's and eat Tyramine.

Answer 728

Prazosin, Terazosin, Doxazosin, Tamsulosin They are A1-selective adrenergic antagonists. They are used to treat HTN & urinary retention from BPH. They can cause 1st dose orthostatic hypotension, dizziness, headache.

Answer 729

It is an alpha-2 blocker used to treat depression.

Answer 730

``` Angina MI SVT (AV node) HTN (acts on heart and juxtaglomerular app. cells) CHF Glaucoma ```

Answer 731

Impotence Asthma exacerbation Bradycardia or AV block CNS - seizures, sedation, sleep alteration Use with caution in diabetics (mask hypoglycemia) & asthmatics

Answer 732

``` BEAM: Betaxolol (partial agonist) Esmolol (short-acting)\ Atenolol Metoprolol ```

Answer 733

``` "Please Try Not Being Picky" Propranolol Timolol Nadolol Beta blockers yo Pindolol ```

Answer 734

Carvedilol | Labetalol

Answer 735

Partial Agonist: Pindolol Acebutolol

Answer 736

``` KLAM treatment K+ normalization Lidocaine Anti-dig Fab fragments Mg2+ ```

Answer 737

EDTA Dimercaprol Penicillamine

Answer 738

DeFeroxamine

Answer 739

Dimercaprol | Succimer

Answer 740

Penicillamine

Answer 741

Penicillamine Dimercaprol Succimer

Answer 742

Methylene blue

Answer 743

Flumazenil

Answer 744

Alkalinize urine (NaHCO3)

Answer 745

Protamine sulfate

Answer 746

Fresh frozen plasma | Vitamin K

Answer 747

Aminocaproic acid

Answer 748

Beta blocker

Answer 749

``` VANC: Vancomycin Adenosine Niacin Calcium channel blockers ```

Answer 750

``` "Hemolysis IS PAIN" INH Sulfa drugs Primaquine Aspirin Ibuprofen Nitrofurantoin ```

Answer 751

Erythromycin

Answer 752

"Some Drugs Create Awkward Knockers" ``` Spironolactone Digitalis Cimetidine Alcohol (chronic) Ketoconazole ```

Answer 753

Lithium Amiodarone Sulfa drugs

Answer 754

hard to BLAB when you have pulmonary fibrosis BLeomycin Amiodarone Busulfan

Answer 755

Phenytoin Verapamil Cyclosporine

Answer 756

Fish N CHIPS Give myopathies ``` Fibrates Niacin Colchicine Hydroxychloroquine Interferon-alpha Penicillamine Statins Glucocorticoids ```

Answer 757

SAT for a photo Sulfa drugs Amiodarone Tetracycline

Answer 758

HIPP Hydralazine INH Procainamide Phenytoin

Answer 759

BITE MI tongue ``` Bupropion Imipenem Tramadol Enflurane Metaclopramide INH ```

Answer 760

Aminoglycosides Vancomycin Loop diuretics Cisplatin

Answer 761

Popular FACTSSS ``` Probenecid Furosemide Acetazolamide Celecoxib Thiazides Sulfa antibiotics Sulfasalazine Sulfonylureas ```

Answer 762

- iptan = 5-HT1B/1D agonist - caine = local anesthetic - azine = neuroleptic, antiemetic - etine = SSRI - ipramine/-triptyline = TCA - tidine = H2 antagonist - nib = kinase inhibitor - cept = receptor molecule

Answer 763

Men: age/2 Women: (age+10)/2

Answer 764

Deposition of normal TTR (Transthyretin)

Answer 765

MEN2A & MEN2B

Answer 766

Can be acquired in 20's-30's

Answer 767

Rupture of intervertebral disk --> compresses 2+ spinal nerves ``` Symptoms: Low back pain that radiates to legs Asymmetrical saddle anesthesia Loss of anocutaneous reflex Loss of knee & ankle jerk reflex (Generally unilateral) paraplegia ```

Answer 768

Disk herniation, tumor, spinal fracture --> L2 lesion --> conus medullaris syndrome ``` Symptoms: Acute onset severe low back pain Urinary & fecal incontinence Impotence Saddle anesthesia (S3-S5) Generally spares legs (might see mild weakness) ```

Answer 769

``` Class III (Sotolol) & Class Ia (Quinidine) antiarrhythmics TCA's ```

Answer 770

Bronchi - Cartilage, goblet cells Terminal bronchioles - Pseudostratified ciliated columnar cells (mucociliary escalator) Smooth muscle of the airways

Answer 771

Bronchi & terminal bronchioles = Pseudostratified ciliated columnar epithelium Respiratory bronchioles = cuboidal cells Alveolar ducts & alveoli = simple squamous

Answer 772

P = 2(surface tension)/radius

Answer 773

Lecithin:Spingomyelin ratio > 2.0 | <1.5 increases risk for NRDS

Answer 774

Intracellular type 2 pneumocte inclusions. They contain phospholipids for production of surfactant.

Answer 775

They are nonciliated columnar cells found in the small airways. They can degrade inhaled toxins (via CYP450) & act as reserve cells. They can also secrete substances to protect the bronchiolar lining.

Answer 776

Upright --> bottom of RLL Supine --> top of RLL

Answer 777

Pulmonary artery is RALS to the bronchus: Right anterior Left superior

Answer 778

"I ate ten eggs at noon" IVC = T8 Esophagus/Vagus = T10 Aorta/Azygous vein/Thoracic duct = T12

Answer 779

Inspiration - External intercostals, SCM, scalenes Expiration - Rectus abdominus, obliques, internal intercostals

Answer 780

LITER: | tLc = IRV + TV + ERV + RV

Answer 781

``` TV = 500 mL FRC = 2200 mL RV = 1200 mL TLC = 6000 mL ```

Answer 782

``` T = taut = low affinity for O2 R = relaxed = 300x higher affinity for O2 ``` This is the basis for the positive cooperativity seen with Hb. Binding of O2 induces the relaxed form in the other Hb molecules.

Answer 783

``` Increase in C-BEAT: CO2, Cl- BPG Exercise Acid/Altitude Temperature ``` "Taut in tissues, Relaxed in respiratory"

Answer 784

It does not efficiently bind 2,3-BPG

Answer 785

Nitrites oxidize Fe2+-->Fe3+ (cannot bind oxygen) Use METhyline blue for METhemoglobinemia

Answer 786

O2 cannot be unloaded in tissues because CO (higher affinity than O2 for Hb) holds Hb in the relaxed form. Causes left shift in the Hb dissociation curve.

Answer 787

It is found within muscle cells & is monomeric (Hb is tetrameric).

Answer 788

Perfusion limited = O2 (health), N2O, CO2 | Diffusion limited = CO

Answer 789

V(gas) = (Area/Thickness)*Diff. constant*(P1-P2) Emphysema --> decreased area Fibrosis --> increased thickness

Answer 790

Inactivating mutation in BMPR2 (normally inhibits vascular smooth muscle proliferation) Seen in young women.

Answer 791

Pulmonary artery pressure > 25 mmHg ``` Causes of secondary PHTN: COPD Mitral stenosis Recurrent PE's Autoimmune disease Left-to-right shunt Sleep apnea Living at high altitude ```

Answer 792

PVR = (Pulm art. Pressure - Wedge pressure)/Cardiac output

Answer 793

15g/dL of Hb * (1.34 mlO2/gHb) = ~20 mLO2/dL Cyanosis is seen when > 5g/dL of Hb is deoxygenated

Answer 794

PAO2 = PIO2 - (PaCO2/R) ``` PIO2 = PO2 of inspired air = 150 mmHg R = respiratory quotient = CO2 produced/O2 consumed = 0.8 ```

Answer 795

Normal = 10-15 mmHg Increased in: Right-to-left shunt Diffusion limitation V/Q mismatch

Answer 796

Normal A-a gradient: High altitude Hypoventilation Increased A-a gradient: Right-to-left shunt Diffusion limitation V/Q mismatch

Answer 797

High V/Q (dead space) should improve with O2 V/Q of 0 (shunt) will not improve with O2

Answer 798

``` Zone 1 (apex) = A > a > v Zone 2 = a > A > v Zone 3 (base) = a > v > A ```

Answer 799

High V/Q in apex (dead space) V/Q = 1 in the middle of the lung Low V/Q in base (shunt) *Note that the base is actually better ventilated than the apex, but it is much much better perfused --> low V/Q

Answer 800

1) Bicarbonate (90%) 2) HbCO2 (5%) 3) Dissolved CO2 (5%)

Answer 801

CO2 --(carbonic anhydrase)--> H2CO3 H+ & HCo3- --> H+ binds Hb --> taut Hb --> O2 release. The opposite happens in the lung due to high amount of O2. CO2 is released.

Answer 802

Acute ^ in ventilation --> decreased O2 & CO2 Chronic: ^ EPO ^ 2,3-BPG ^ renal excretion of bicarb (compensates for resp. alk.) Chronic hypoxic vasoconstriction --> RVH

Answer 803

PaO2 & PaCO2 are unchanged | Venous O2 is decreased & venous CO2 is increased

Answer 804

1) Stasis 2) Hypercoagulability 3) Endothelial damage These predispose to coagulation.

Answer 805

``` Fat (long bone fractures; hypoxemia + petechial rash) Gas (the bends, the chokes) Thrombus (95%) Bacteria Amniotic fluid (can cause DIC) Tumor ```

Answer 806

Chronic productive cough lasting > 3 months total over the past 2 years

Answer 807

Obstructive = LOW FEV1, low FVC --> lower FEV1/FVC Restrictive = low FEV1, LOW FVC --> FEV1/FVC > 80%

Answer 808

Chronic bronchitis = blue bloaters They are constantly hypoxemic RHF --> edema Emphysema = pink puffers They must work hard to breath Puff their lips out when they exhale (PEEP)

Answer 809

Thickness of the mucus gland layer in relation to the whole bronchial wall. It is > 50% in chronic bronchitis.

Answer 810

Smoking --> centriacinar emphysema in upper lobes (more smoke) A1AT deficiency --> panacinar emphysema in lower lobes (more blood)

Answer 811

Chromosome 5

Answer 812

Curschmann's spirals (shed epithelium plugs) | Charcot-Leyden crystals (from eosinophils)

Answer 813

Early phase: Histamine, LTC4,D4,E4 Late phase: Inflammation; Major basic protein

Answer 814

``` Cystic fibrosis Kartagener's Bronchial obstruction Smoking (poor ciliary motility) Bronchopulmonary aspergillosis ```

Answer 815

``` Idiopathic pulmonary fibrosis Pneumoconioses Hypersensitivity pneumonitis Sarcoidosis Drug toxicity (bleomycin, busulfan) Recurrent PE Also poor breathing mechanics (obesity, MG) ```

Answer 816

Anthracosis & silicosis --> upper lobes | Asbestosis --> lower lobes

Answer 817

Anthracosis - fibrosis Silicosis - fibrosis, TB infection, bronchogenic carcinoma Asbestosis - fibrosis, bronchogenic carcinoma, mesothelioma

Answer 818

Production begins at 28 weeks & is sufficient at 34 weeks

Answer 819

Risk factors: Prematurity Maternal diabetes (insulin decreases production) C-section (glucocoricoids ^ production) Treatment: Intrapartum dexamethasone Surfactant at birth

Answer 820

Hypoxemia --> Necrotizing enterocolitis & PDA Supplemental O2 --> Bronchopulmonary dysplasia & Retinopathy of the newborn

Answer 821

``` Trauma Sepsis Shock DIC Aspiration Uremia Acute pancreatitis Amniotic fluid embolism Hypersensitivity ```

Answer 822

Plexiform lesions Arteriosclerosis Hypertrophy of the media Intimal fibrosis

Answer 823

1) ^ release of catecholamines during night | 2) Hypoxia --> ^ EPO --> ^ erythropoiesis

Answer 824

``` SPHERE of complications: SVC syndrome Pancoast tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal (hoarseness) Effusions ```

Answer 825

``` Metastases (breast, colon, prostate, bladder) Adenocarcinoma Squamous cell carcinoma Small cell carcinoma Large cell carcinoma Bronchial carcinoid tumor ```

Answer 826

Adrenals Brain Bone Liver

Answer 827

Peripheral = adenocarcinoma, Large cell carcinoma Central = Small cell carcinoma, Squamous cell carcinoma

Answer 828

Adenocarcinoma

Answer 829

k-ras mutation

Answer 830

It is a subtype of adenocarcinoma. CXR resembles interstitial pneumonia because it grows along the alveolar septa. Seen in nonsmokers & Eastern Asian women.

Answer 831

Hypercalcemia (PTHrP) --> Squamous ACTH; ADH --> Small cell Lambert-Eaton --> Small cell

Answer 832

Grossly they are a polyp within the bronchus. | Histologically they are nests of neuroendocrine cells chromogranin positive

Answer 833

``` Small cell (Kulchitsky cells) Carcinoid ```

Answer 834

Carcinoma in the apex of the lung: Horner's syndrome (cervical chain) +/- Arm weakness (brachial plexus)

Answer 835

Compression of the SVC seen sometimes with lung cancer. Impairs blood drainage from the head, neck, & arms: Facial plethora (redness) JVD Upper extremity edema Is a medical emergency because it can raise ICP.

Answer 836

PGI2 (prostacyclin) | NO

Answer 837

1) IV lorazepam + load with phenytoin 2) (if still seizing) Phenobarbital 3) (if still seizing) Intubate & give general anesthesia

Answer 838

The left renal vein drains the kidney, left testicle, and left adrenal. The Right testicular vein drains directly to the IVC. And the Right suprarenal vein also drains directly to the IVC.

Answer 839

Serum FSH (>30 U/L)

Answer 840

Nystatin swish & swallow

Answer 841

5 half lives = ~97% cleared

Answer 842

Lobar Bronchopneumonia Interstitial (atypical) pneumonia

Answer 843

Mycoplasma Chlamydia Viruses (CMV, influenza) Coxiella (Q fever)

Answer 844

``` S. aureus Anaerobes: -Bacteroides -Fusobacterium -Peptostreptococcus ```

Answer 845

``` Moldy hay (farmers) Bird droppings (pigeon breeder's lung) ```

Answer 846

Mixed Type III/IV hypersensitivity reaction --> granulomatous reaction --> can lead to interstitial fibrosis

Answer 847

``` Transudate = low protein content Exudate = high protein content Chylothorax = High TRG content ```

Answer 848

Thoracic duct injury from trauma or malignancy.

Answer 849

Rupture of apical blebs. Usually seen in tall, thin, young males.

Answer 850

Allergy, motion sickness, sleep aid. Some examples: Diphenhydramine Dimenhydrinate Chlorpheniramine

Answer 851

Allergy meds. Far less sedating than 1st gen due to less CNS penetration. ``` Some examples: Loratadine Fexofenadine Desloratadine Cetirizine ```

Answer 852

It is used to cause bronchodilation in asthmatics. It inhibits phosphodiesterase --> ^ cAMP in smooth muscle cells. It also blocks adenosine's action (bronchoconstriction) in the lung.

Answer 853

Tiotropium | long-acting version of Ipratropium

Answer 854

Beclomethasone | Futicasone

Answer 855

Montelukast & Zafirlukast are leukotriene receptor antagonists. They are used to treat asthma, especially aspirin-induced asthma.

Answer 856

It is a 5-lipoxygenase pathway inhibitor (blocks conversion of arachidonic acid to leukotrienes). It is used to treat asthma.

Answer 857

1) Mucolytic - loosens mucous plugs in CF patients | 2) Donates sulfhydryl groups to treat acetaminophen OD

Answer 858

It is an endothelin-1 receptor antagonist used to treat pulmonary hypertension.

Answer 859

It is a synthetic codeine analog used as an antitussive.

Answer 860

Phenylephrine & pseudoephedrine are alpha-agonists used as OTC nasal decongestants. They are stimulants & can cause anxiety or hypertension with toxicity.

Answer 861

PGI2 (prostacyclin) | NO

Answer 862

1) IV lorazepam + load with phenytoin 2) (if still seizing) Phenobarbital 3) (if still seizing) Intubate & give general anesthesia

Answer 863

The left renal vein drains the kidney, left testicle, and left adrenal. The Right testicular vein drains directly to the IVC. And the Right suprarenal vein also drains directly to the IVC.

Answer 864

Serum FSH (>30 U/L)

Answer 865

Nystatin swish & swallow

Answer 866

5 half lives = ~97% cleared

Answer 867

Lobar Bronchopneumonia Interstitial (atypical) pneumonia

Answer 868

Mycoplasma Chlamydia Viruses (CMV, influenza) Coxiella (Q fever)

Answer 869

``` S. aureus Anaerobes: -Bacteroides -Fusobacterium -Peptostreptococcus ```

Answer 870

``` Moldy hay (farmers) Bird droppings (pigeon breeder's lung) ```

Answer 871

Mixed Type III/IV hypersensitivity reaction --> granulomatous reaction --> can lead to interstitial fibrosis

Answer 872

``` Transudate = low protein content Exudate = high protein content Chylothorax = High TRG content ```

Answer 873

Thoracic duct injury from trauma or malignancy.

Answer 874

Rupture of apical blebs. Usually seen in tall, thin, young males.

Answer 875

Allergy, motion sickness, sleep aid. Some examples: Diphenhydramine Dimenhydrinate Chlorpheniramine

Answer 876

Allergy meds. Far less sedating than 1st gen due to less CNS penetration. ``` Some examples: Loratadine Fexofenadine Desloratadine Cetirizine ```

Answer 877

It is used to cause bronchodilation in asthmatics. It inhibits phosphodiesterase --> ^ cAMP in smooth muscle cells. It also blocks adenosine's action (bronchoconstriction) in the lung.

Answer 878

Tiotropium | long-acting version of Ipratropium

Answer 879

Beclomethasone | Futicasone

Answer 880

Montelukast & Zafirlukast are leukotriene receptor antagonists. They are used to treat asthma, especially aspirin-induced asthma.

Answer 881

It is a 5-lipoxygenase pathway inhibitor (blocks conversion of arachidonic acid to leukotrienes). It is used to treat asthma.

Answer 882

1) Mucolytic - loosens mucous plugs in CF patients | 2) Donates sulfhydryl groups to treat acetaminophen OD

Answer 883

It is an endothelin-1 receptor antagonist used to treat pulmonary hypertension.

Answer 884

It is a synthetic codeine analog used as an antitussive.

Answer 885

Phenylephrine & pseudoephedrine are alpha-agonists used as OTC nasal decongestants. They are stimulants & can cause anxiety or hypertension with toxicity.

Answer 886

Pronephros = week 4; degenerates Mesonephros = interim kidney during 1st trimester; forms Wolffian ducts in male Metanephros = Permanent; nephrogenesis runs from 5th week to 32-36 weeks.

Answer 887

1) Ureteric bud: forms collecting system (collecting ducts, calyces, pelvises, ureters 2) Metanephric mesenchyme: forms glomerulus through DCT. Induced by interaction with the ureteric bud.

Answer 888

The ureteropelvic junction. This is why it is the most common site of obstruction (hydronephrosis) in the fetus.

Answer 889

Oligohydramnios --> limb/facial deformities, pulmonary hypoplasia, death in-utero Caused by: Bilateral renal agenesis, ARPKD

Answer 890

Inferior poles are fused --> get caught on IMA & remain low in abdomen. It is associated with Turner syndrome.

Answer 891

Abnormal interaction between ureteric bud and metanephric mesenchyme --> nonfunctional kidney composed of cysts and connective tissue. Usually unilateral, NON-inherited.

Answer 892

"Water under the bridge" They pass under the uterine artery, ductus deferens, & gonadal artery/vein.

Answer 893

60-40-20 rule: 60% water 40% is intracellular 20% is extracellular 1/4 of that extracellular fluid is plasma, 3/4 is interstitial.

Answer 894

Fenestrated capillary endothelium Basement membrane with heparan sulfate (neg. charge) Epithelial barrier of podocyte foot processes

Answer 895

CL = UV/P ``` U = Urine concentration of the solute V = Urine flow rate P = Plasma concentration of the solute ``` If CL > GFR --> net tubular secretion of the solute If CL < GFR --> net tubular reabsorption of the solute

Answer 896

Inulin = freely filtered, not reabsorbed/secreted --> GFR (Creatinine clearance approximates it but slightly overestimates) PAH = filtered & secreted completeley --> effective RPF (ERPF) (Underestimates true RPF by ~10%) By calculating the clearance of these substances (CL = UV/P), you can get the GFR & RPF.

Answer 897

RBF = RPF/(1 - HCT)

Answer 898

FF = GFR/RPF Normal = 20%

Answer 899

"Having Sex Brings Many Kids Later" ``` Heart = 250 mL/min = 5% Skin = 500 mL/min = 10% Brain = 750 mL/min = 15% Muscle = 1000 mL/min = 20% Kidney = 1250 mL/min = 25% Liver = 1500 mL/min = 30% ```

Answer 900

NSAIDs constrict afferent arteriole (inhibit prostaglandins that normally dilate it) ACE inhibitors dilate efferent arteriole (AT-II preferentially constricts efferent arteriole)

Answer 901

Filtered load = GFR*P[x] Excreted load = V*U[x] Reabsorption rate = filtered - excreted Secretion rate = excreted - filtered

Answer 902

>160 mg/dL --> glucosuria begins | >350 mg/dL --> all transporters saturated

Answer 903

Proximal tubule: PTH inhibits Na+/phosphate cotransport --> phosphate excretion Distal tubule: PTH increases Ca2+/Na+ exchange --> Ca2+ reabsorption

Answer 904

Proximal tubule: Stimulates Na+/H+ exchange --> ^ Na+/H2O/HCO3- reabsorption Also causes efferent arteriole constriction --> ^ FF

Answer 905

``` In order of reabsorption rate: Glucose Amino acids HCO3- Phosphate Na+ (65-80%) K+ Cl- Urea ```

Answer 906

Macrophage phagolysosomes are disrupted.

Answer 907

The angle of the superior mesenteric artery and the aorta decreases, compressing & obstructing the transverse portion of the duodenum. This will cause symptoms of small bowel obstruction.

Answer 908

Any very catabolic state (weight loss, burns, long bedrest) leading to diminished mesenteric fat Low body weight Severe lordosis Surgical correction of scoliosis

Answer 909

Myasthenic crisis: Too low of AChE inhibitor dose Responds to edrophonium (short-acting AChE inhibitor) Cholinergic crisis: Too high of AChE inhibitor dose (muscle cells depolarized too often & can't recover) Does not respond to edrophonium

Answer 910

Cleavage of N & C terminal peptides Spontaneous assembly of fibrils Covalent crosslinking by lysyl oxidase

Answer 911

It catalyzes Glycerol (from beta oxidation) --> DHAP This allows glycerol to enter glycolysis or gluconeogenesis. It is specific to the liver.

Answer 912

Colicky abdominal pain (lead colic), constipation, headaches Lead line (blue pigment) at the gum-tooth line Wrist/foot drop due to peripheral neuropathy Microcytic hypochromic anemia with basophilic stippling

Answer 913

Ki-67 fraction Ki-67 is an antigen that is only present on actively dividing cells. The closer to 100%, the more cells are actively dividing.

Answer 914

It inhibits mast cell degranulation. | It is used for asthma prophylaxis.

Answer 915

Initiator caspases = 8 & 10 | Executioner caspases = 3 & 6

Answer 916

Na+/K+/2Cl- (via symporter) Mg2+/Ca2+ (paracellular, pushed electrically by K+ backleak into tubule)

Answer 917

Na+/Cl- (symporter) Ca2+ (antiporter with Na+ is at basolateral membrane & channels are at apical membrane)

Answer 918

Reabsorb Na+ in exchange for K+ & H+ (Aldosterone) Water is reabsorbed via aquaporins (ADH)

Answer 919

TBW - tritiated water ECF - inulin Plasma - radiolabeled albumin

Answer 920

Principal cells: Reabsorb Na+ (Ald --> ENaC synthesis) Reabsorb H2O (ADH --> aquaporin insertion) Secrete K+ Intercalated cells: Secrete H+ (aldosterone stimulated ATPase)

Answer 921

Decreased BP Decreased NaCl delivery to DCT (sensed by macula densa cells) B1 adrenergic receptor simulation Secreted by JG cells

Answer 922

AT-1 receptors --> systemic vasoconstriction Constricts efferent arteriole (^ FF) Aldosterone & ADH secretion Increases activity of PCT Na+/H+ antiporter Stimulates thirst in hypothalamus

Answer 923

EPO is made in the peritubular capillary cells of the renal cortex in response to hypoxia.

Answer 924

Proximal tubule cells

Answer 925

DO LAB: ``` Digitalis Osmolarity ^ Lysis Acidosis Beta blockers ``` Whereas INsulin shifts K+ INto cells

Answer 926

Decreased DTR's Lethargy Bradycardia & hypotension Hypocalcemia

Answer 927

Calculate the expected PCO2 & see if the true PCO2 is adequately compensating (+/- 2). Expected PCO2 = 1.5*(HCO3-) + 8 If the true PCO2 is within 2 either way --> simple If it is not within 2 --> mixed acid-base disorder

Answer 928

Loss of blood volume --> Renin, AT, Ald system ATII: ^Na+/H+ exchange in PCT ^HCO3- reabsorption (due to ^H+ available in the lumen) Ald: ^ H+ ATPase activity --> H+ secretion

Answer 929

Na - (Cl + HCO3) Normal = 8-12

Answer 930

MUDPILES: ``` Methanol Uremia DKA Propylene glycol INH or Iron tablets Lactic acidosis Ethylene glycol Salicylates (late) ```

Answer 931

HARDASS: ``` Hyperalimentation (overeating, too much TPN) Addison's Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion ```

Answer 932

Loop diuretics Vomiting Antacids Hyperaldosteronism

Answer 933

Type 1 = Collecting duct cannot excrete H+ (distal) Type 2 = PCT cannot reabsorb HCO3 (proximal) Type 3 = Hypoaldosteronism or collecting duct not responsive to it --> hyperkalemia --> impaired ammoniagenesis --> urine cannot buffer titratable acids

Answer 934

"Stones, bones, and low aldosterones" Type 1 --> Nephrolithiasis Type 2 --> Hypophosphatemic rickets Type 3 --> hyperkalemic metabolic acidosis

Answer 935

``` RBC casts WBC casts Fatty casts (oval fat bodies) = nephrotic syndrome Granular (muddy brown) casts = ATN Waxy casts = Chronic/advanced disease Hyaline casts = nonspecific ```

Answer 936

PALE: Proteinuria (> 3.5g/day) Albumin low Lipidemia/lipiduria Edema ATIII loss --> thromboembolism Ig loss --> infection

Answer 937

LM - focal (< half) & segmental sclerosis & hyalinosis EM - effacement of foot processes

Answer 938

LM - diffuse GMB thickening ("membranous") EM - "spike & dome" appearance with subepithelial deposits

Answer 939

LM - normal glomeruli EM - effacement of foot processes

Answer 940

Type I - subendothelial immune complex deposits with "tram track" appearance; granular IF pattern Type II - intramembranous immune complex "dense deposits"

Answer 941

LM - mesangial expansion, GBM thickening; Kimmelstiel-Wilson nodules`

Answer 942

LM - PMN's, lump-bumpy appearance EM - subepithelial humps of immune complexes IF - granular deposits along GBM

Answer 943

Crescents Composed of: Fibrin Plasma proteins Macrophages IF - can be linear (type 1), granular (type 2), or pauci-immune (type 3)

Answer 944

LM - "wire looping" of capillaries EM - subedothelial & sometimes intramembranous immune complexes IF - granular

Answer 945

LM - mesangial proliferation EM - mesangial immune complex deposits IF - IgA-based immune complex deposits in mesangium

Answer 946

``` Most common nephrotic syndrome in Hispanic & Blacks HIV --> wall collapse variant Heroin Sickle cell Interferon treatment ```

Answer 947

Most common nephrotic syndrome in children Selective loss of albumin (loss of GBM polyanions) Responds to corticosteroids Hodgkin's lymphoma

Answer 948

Type I - HBV, HCV Type II - C3 nephritic factor (Ig that stabilizes C3 convertase leading to overactivation of complement)

Answer 949

Anything with "membrano-" in the name: Membranous = subepithelial IC deposits MPGN Type I = subendothelial IC deposits MPGN Type II = intramembranous IC deposits

Answer 950

Found in white adults SLE's nephrotic presentation Drugs, infections, solid tumors (caused by in-situ IC deposition)

Answer 951

PHAROH: ``` Proteinuria (<3.5 g/day) Hematuria & RBC casts Azotemia RBC casts Oliguria Hypertension ```

Answer 952

Type I = Goodpasture's syndrome (Ig's against kidney & lung BM) Type II = Any of the other nephritic syndromes but worse Type III = pauci-immune (GPA, Churg-Strauss, MP)

Answer 953

It is the nephritic presentation of SLE or MPGN. It is the most common cause of death in SLE.

Answer 954

aka IgA nephropathy Associated with Henoch-Schonlein purpura It is the most common nephropathy. It presents in childhood with intermittent gross or microscopic hematuria (following URI or gastroenteritis).

Answer 955

An X-linked mutation in Type-IV collagen --> triad of: Nephritic syndrome Deafness Ocular problems

Answer 956

Calcium (oxalate/phosphate) Ammonium-magnesium-phosphate (struvite) Uric acid Cystine

Answer 957

``` Acidic = Cystine, Uric acid & Calcium oxalate Basic = Calcium phosphate & Struvite ``` Uric acid stones are radiolucent. All others are radiopaque.

Answer 958

aka ammonium-magnesium-phosphate stones Caused by urease positive UTI's (Proteus, Klebsiella, Staph)

Answer 959

Struvite & Cystine stones

Answer 960

``` Often silent for a long time. Symptoms: Triad - hematuria, flank pain, palpable mass Paraneoplastic syndromes (EPO, ACTH, PTHrp) Left-sided varicocele ```

Answer 961

VHL gene deletion (chrom. 3) --> Constitutive HIF (angiogenic TF) Presentation: Bilateral renal cell carcinoma Hemangioblastomas of retina/cerebellum/medulla

Answer 962

aka nephroblastoma Most common renal cancer in children: Deletion of WT2 tumor suppressor gene on chromosome 11 May be part of: Beckwith-Wiedemann syndrome WAGR complex (Wilms', Aniridia, GU malformation, Retardation)

Answer 963

cancer in your P SAC: Phenacetin Smoking Aniline dyes Cyclophosphamide

Answer 964

Must have squamous metaplasia first. - Schistosoma hematobium (Middle-Eastern male) - Chronic cystitis (older woman) - Longstanding nephrolithiasis

Answer 965

``` Diuretics Penicillins Sulfa drugs Rifampin NSAIDs ```

Answer 966

``` AKI Fever Rash Hematuria Pyuria (eosinophils) ```

Answer 967

``` Diabetes Severe acute pyelonephritis Chronic phenacetin/Aspirin/Acetaminophen use Sickle cell anemia & trait Severe interstitial nephritis ```

Answer 968

1) Inciting event (ischemic or nephrotoxic) 2) Maintenance phase - 1-3 weeks; oliguria; risk of hyperkalemia 3) Recovery phase - polyuria; BUN & Cr return to baseline; risk of hypokalemia

Answer 969

Prerenal: >20 Intrinsic renal: 15, chronic <15

Answer 970

``` Aminoglycosides Heavy metals Myoglobinuria Ethylene glycol Radiocontrast dye Urate (tumor lysis syndrome) ```

Answer 971

``` Uremia Na+/H2O retention --> HTN Hyperkalemic metabolic acidosis Anemia Renal osteodystrophy Dyslipidemia ```

Answer 972

``` Nausea & anorexia Pericarditis Asterixis Encephalopathy Platelet dysfunction ```

Answer 973

CKD --> hyperphosphatemia alongside reduced Vit. D activation --> Secondary hyperparathyroidism --> subperiosteal thinning of bones & metastatic calcification

Answer 974

Autosomal Dominant mutation in PKD1 or PKD2 ``` Associated with: CKD HTN (^ renin production) Berry aneurysms Mitral valve prolapse Benign hepatic cysts ```

Answer 975

``` Potter's syndrome Congenital hepatic fibrosis HTN Portal HTN Progressive renal insufficiency ```

Answer 976

OH DANG ``` Ototoxicity Hypokalemia/Hypocalcemia Dehydration Allergy (sulfa) Nephritis (interstitial) Gout ```

Answer 977

``` Acetazolamide = carbonic anhydrase inhibitor Loop diuretics (furosemide, ethacrynic acid) = Na+/K+/2Cl- inhib. Thiazides = DCT NaCl transporter inhibitor Spironolactone = Aldosterone antagonists Triamterine/Amiloride = block cortical collecting duct ENaC's ```

Answer 978

``` Hypokalemic metabolic alkalosis Sulfa reaction hyperGLUC: Glycemia Lipidemia Uricemia Calcemia ```

Answer 979

Spironolactone Eplerenone Triamterine Amiloride

Answer 980

Captopril's CATCHH Cough (bradykinin; not seen with ARB) Angioedema (bradykinin; not seen with ARB) Teratogen (fetal renal malformations) Creatinine ^ (decreased GFR due to efferent art. dilation) Hyperkalemia Hypotension

Answer 981

Collagen Fibronectin Laminin

Answer 982

Fructose is converted to Fructose-6-P by hexokinase. This can then participate in glycolysis or glycogenesis. This is a minor pathway in normal individuals but becomes important in the setting of fructokinase deficiency.

Answer 983

``` Midclavicular = 5th-7th rib Midaxillary = 7th-9th rib Paravertebral = 9th-11th rib ``` This is the location where there is pleura but no lung. It should always be performed above a rib so as not to damage the van driving under the rib.

Answer 984

Dense granules: ADP, Ca2+ alpha-granules: vWF, fibrinogen

Answer 985

``` Neutrophils Lymphocytes Monocytes Eosinophils Basophils ```

Answer 986

II, VII, IX, X, C, S

Answer 987

Inhibits epoxide reductase. | Normall reduces Vit. K so that it can act as a cofactor in factors II, VII, IX, X, C, S

Answer 988

``` Polycythemia Sickle cell CHF Microcytosis Hypofibrinogenemia ```

Answer 989

Hereditary spherocytosis | Autoimmune hemolysis

Answer 990

HALT HbC disease Asplenia Liver disease Thalassemia

Answer 991

Asplenia Functional asplenia Naphthalene ingestion (mothballs)

Answer 992

``` MCV < 80 Iron deficiency Anemia of chronic disease (late) Thalassemias Lead poisoning Sideroblastic anemias ```

Answer 993

Plummer-Vinson triad: Iron-deficiency anemia Esophageal webs Atrophic glossitis

Answer 994

4 gene deletion --> Hb Barts --> hydrops fetalis (death in-utero) 3 gene deletion --> HbH disease anemia 1-2 gene deletion --> asymptomatic

Answer 995

Deletion of the alpha-globin genes. cis-deletion in Asians trans-deletion in Africans cis-deletion is associated with higher rates of hydrops fetalis in offspring.

Answer 996

Thalassemia minor (heterozygote): Asymptomatic Dx confirmed by HbA2 > 3.5% Thalassemia major (homozygote): Severe anemia requiring transfusions (hemochromatosis) Marrow expansion --> HSM, crew cut x-ray, chipmunk facies ^HbF & HbA2 Parvovirus infection --> aplastic crisis

Answer 997

ALA dehydratase & Ferrochelatase are inhibited (heme synth) ``` Symptoms: LEEAADD: Lead lines on gingiva & metaphyses of long bones Encephalopathy Erythrocyte stippling Anemia (sideroblastic) Abdominal colic Drops (wrist & foot) Dimercaprol & EDTA first line ```

Answer 998

Defects in heme synthesis: Hereditary - X-linked defect in ALA Synthase Acquired - EtOH, lead poisoning, INH (B6 def.)

Answer 999

B12 deficiency: ^Methylmalonic acid Subacute combined degeneration

Answer 1000

Megaloblastic: B12 def. Folate def. Orotic aciduria Non-megaloblastic: Alcoholism Liver disease Reticulocytosis

Answer 1001

Intravascular: ^LDH, depleted haptoglobin, Hb in urine Extravascular: ^LDH, ^unconjugated bilirubin

Answer 1002

Chronic inflammation --> ^Hepcidin --> sequestration of iron in intestinal mucosa & macrophages --> normocytic anemia that progresses to microcytic. Decreased iron, decreased TIBC, increased ferritin

Answer 1003

Drugs (chloramphenicol, alkylating agents, antimetabolites) Viruses (Parvovirus, EBV, HIV, HCV) Fanconi's anemia

Answer 1004

Corrected reticulocytes = (Absolute reticulocytes)*(HCT/45) If corrected > 3% --> adequate response If < 3% --> issue with the bone marrow

Answer 1005

``` G6PD deficiency Paroxysmal nocturnal hemoglobinuria Cold agglutinins Microangiopathic anemia Macroangiopathic anemia Infections (malaria, Babesia) ```

Answer 1006

``` Hereditary spherocytosis G6PD deficiency Pyruvate kinase deficiency Sickle cell anemia Warm agglutinins ```

Answer 1007

Defect in RBC cytoskeletal anchoring proteins (ankyrin, spectrin) --> small pieces of membrane removed by splenic macs ``` Symptoms: Splenomegaly Aplastic crisis (Parvovirus) Small, round RBC's with no central pallor ^MCHC, ^ RDW Positive osmotic fragility test ```

Answer 1008

Heinz bodies | Bite cells

Answer 1009

(AR) Hemolytic anemia in a newborn. Decreased ATP causes rigid RBC's

Answer 1010

AR mutation of beta chain. Glutamic acid --> LyCine at residue 6. Symptoms: Mild extravascular hemolytic anemia HbC crystals on blood smear (rectangular)

Answer 1011

Impaired formation of GPI anchors or DAF deficiency. It is an ACQUIRED mutation in a HSC line. ``` Symptoms: Pancytopenia Numerous DVT's; hepatic/portal/cerebral vein thromboses Hemolytic anemia Flow cytometry - CD55/59 negative RBC's 10% develop AML ```

Answer 1012

Eculizumab - C5 complement inhibitor

Answer 1013

HbS point mutation in beta chain Glutamic acid --> Valine at position 6. Low O2, dehydration, or acidosis --> polymerization of deoxygenated HbS --> Sickling

Answer 1014

Resistance to malaria | Microinfarctions in kidney medulla --> eventual inability to concentrate urine

Answer 1015

``` Salmonella osteomyelitis Autosplenectomy --> Infection with SHiNE SKiS (death in kids) Painful crises: --Dactylitis --Acute chest syndrome (death in adults) --Avascular necrosis Aplastic crisis (Parvovirus) Renal papillary necrosis ```

Answer 1016

Hydroxyurea --> HbF | Bone marrow transplant

Answer 1017

``` Antibiotic use! Contraceptives Systemic corticosteroids Diabetes Immunosuppression ```

Answer 1018

``` GLUT-1 = insulin-independent; RBC's, brain GLUT-2 = bidirectional; Beta cells, liver, kidney small intestine GLUT-4 = insulin-dependent; Adipocytes, muscle cells ```

Answer 1019

``` Early-onset cancers: Breast Brain Adrenal cortex Sarcomas Leukemias ```

Answer 1020

Vagina = nonkeratinized stratified squamous Ectocervix = stratified squamous Endocervix = simple columnar Uterus = simple columnar; pseudostratified glands Fallopian tube = ciliated columnar Ovary = simple cuboidal

Answer 1021

It is due to ^^uric acid following rapid killing of tumor cells. Methods: Hydration Urine alkalinization Allopurinol

Answer 1022

Stomatitis Hepatotoxicity (hepatitis, fibrosis, cirrhosis) Myelosuppression

Answer 1023

Warm agglutinins (IgG): SLE CLL Drugs (methyldopa) Cold agglutinins (IgM): CLL Mycoplasma pneumoniae Mononucleosis

Answer 1024

Pregnancy or OCP use

Answer 1025

Glycine Succinyl-CoA Iron (Fe2+) **B6 is required for the first step

Answer 1026

First & last step in the mitochondria. The middle is in the cytosol.

Answer 1027

ALA (aminolevulonic acid) | Protoporphyrin

Answer 1028

5 P's: Painful abdomen Port-wine colored urine (after it stands a while) Polyneuropathy Psychological disturbances Precipitated by drugs (CYP450 inducers --> ^Heme production)

Answer 1029

Caused by Porphobilinogen deaminase deficiency Porphobilinogen, ALA, & uroporphyrin accumulate

Answer 1030

Heme & Glucose --> both inhibit ALA synthase

Answer 1031

Uroporphyrinogen decarboxylase deficiency Uroporphyrin builds up Symptoms: Blistering cutaneous photosensitivity later on in life (cutanea tarda) Tea colored urine *The most common porphyria

Answer 1032

Bernard-Soulier syndrome = GPIb defect (adhesion) Glanzmann's thrombasthenia = GP IIb/IIIa defect (aggregation) *BS = big suckers (PLT's turned over faster --> low PLT count & larger platelets)

Answer 1033

Autoimmune Ab's against GPIIb/IIIa --> splenic consumption of platelets Tx: Steroids, IVIg, splenectomy (refractory)

Answer 1034

TTP: ADAMTS13 deficiency (acquired via autoimmunity or congenital) --> circulating ^vWF multimers --> ^PLT aggregation & thrombosis HUS: Verotoxin damage of endothelium --> PLT aggregation & thrombosis

Answer 1035

``` Altered mental status Acute kidney injury Thrombocytopenia Microangiopathic hemolytic anemia Fever ```

Answer 1036

Autosomal dominant deficiency in vWF: ^bleeding time & ^PTT Abnormal ristocetin assay Tx: Desmopressin (DDAVP) --> ^vWF release from W-P bodies

Answer 1037

"STOP Making New Thrombi Stupid" ``` Sepsis (gram-) Trauma Obstetric complications (tissue thromboplastin in amniotic fluid) Pancreatitis (acute) Malignancy Nephrotic syndrome Transfusion Snakebites (rattlesnake) ```

Answer 1038

Bleeding - vWD Hypercoagulable - Factor V Leiden (especially whites)

Answer 1039

``` Factor V Leiden Prothrombin mutation (3' UTR mut. --> ^^production) Antithrombin deficiency (normalizes with heparin) Protein C or S deficiency (^coumadin-induced-necrosis) ```

Answer 1040

``` CML: Myeloid:Erythroid > 10:1 Alkaline phosphatase negative ^Basophils t[9;22] ```

Answer 1041

Localized group of LAD | "B" symptoms (fever, night sweats, weight loss)

Answer 1042

"Owl's eye" nuclei = mirror image bi-lobed or bi-nucleated with nucleolus. CD15+ & CD30+ Usually surrounded by reactive lymphocytes. Hodgkin's Lymphoma

Answer 1043

Lymphocyte rich --> better prognosis | Lymphocyte depleted --> worse prognosis

Answer 1044

Nodular lymphocyte predominant hodgkin's lymphoma (NLPHL) Different from nodular sclerosing type (most commen; women = men)

Answer 1045

Hodgkin's = young adulthood & then > 55y Non-hodgkin's = 20-40y

Answer 1046

Reid-Sternberg cells that appear to be in a lake because there is a space around them. Nodular sclerosing hodgkin's lymphoma

Answer 1047

They have decreased CD16 (FcR) on their surface.

Answer 1048

``` B-cell: Burkitt's Diffuse large B-cell Mantle cell Follicular ``` T-cell: Adult T-cell Mycosis fungoides/Sezary syndrome

Answer 1049

Burkitt's lymphoma c-myc activation

Answer 1050

Burkitt's lymphoma Sheets of basophilic B-cells with interspersed macrophages.

Answer 1051

t(11;14) - Cyclin D1 translocated to Ig heavy chain location CD5+

Answer 1052

Follicular lymphoma & DLCL Translocation of Ig heavy chain and bcl-2.

Answer 1053

Rash & lytic bone lesions Caused by HTLV-1 (seen in Japan, Africa, Caribbean)

Answer 1054

Marginal zone only seen in chronic inflammatory conditions: MALToma Hashimoto's Sjogren's

Answer 1055

Sezary syndrome (systemic mycosis fungoides) Mycosis fungoides --> Pautrier microabscesses in skin

Answer 1056

``` CRAB: hyperCalcemia Renal insufficiency Anemia Bone lytic lesions --> back pain ```

Answer 1057

Punched out lytic bone lesions on x-ray M-spike on electrophoresis (IgG > IgA) Bence-Jones protein in urine (Ig light chain) Rouleaux formation Many plasma cells with "clock face" chromatin Risks: Susceptibility to infection (most common COD) Primary amyloidosis (AL)

Answer 1058

M spike of IgM (macro) --> hyperviscosity symptoms only

Answer 1059

Monoclonal Gammopathy of Undetermined Significance (MGUS) 1% chance per year of --> MM

Answer 1060

Marrow failure: Anemia (RBC's) Infection (WBC's) Hemorrhage (PLT's)

Answer 1061

Acute Lymphoblastic Leukemia/Lymphoma All ALL are TdT+ ``` Pre-B = CD10/19/20+ Pre-T = CD1/2/5+ ```

Answer 1062

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Smudge cells on peripheral smear Asymptomatic or autoimmune hemolytic anemia

Answer 1063

TRAP (tartrate-resistant acid phosphatase) "TRAP the hairy animal" It remains TRAPPED in red pulp (spleen) & bone marrow --> no LAD

Answer 1064

Cladribine It is a purine analog that inhibits ADA.

Answer 1065

APL (M3 subtype of AML) often presents with DIC because Auer rods (present on peripheral smear; crystallized MPO) can induce DIC.

Answer 1066

M3 subtype of AML = APL Treat with ATRA

Answer 1067

Chronic Myelogenous Leukemia (CML) t(9;22) = bcr-abl fusion

Answer 1068

^Basophils, neutrophils, metamyelocytes Splenomegaly May transform into AML > ALL Responds to Imatinib

Answer 1069

Before 5y --> Acute megakaryoblastic leukemia After 5y --> ALL

Answer 1070

Proliferation of dendritic cells --> lytic bone lesions & skin rash Birbeck granules (tennis rackets) S-100+ & CD1a+

Answer 1071

^RBC's, ^WBC's, ^PLT's DVT's #1 cause of bud-chiari Itching after a hot shower (^mast cells)

Answer 1072

Dacrocyte = teardrop cell --> Myelofibrosis "The marrow is crying because it's fibrosed" It is its own chronic myeloproliferative disorder and can also be seen late in polycythemia vera.

Answer 1073

``` Renal cell carcinoma Wilms' tumor Renal cysts HCC Hydronephrosis ```

Answer 1074

Cofactor for Antithrombin --> inactivates Xa & IIa

Answer 1075

Heparin-induced thrombocytopenia IgG Ab's against Hepatin-Platelet factor 4 --> Ab-Heparin-PF4 complex activates platelets --> thrombosis & thrombocytopenia

Answer 1076

Lepirudin & Bivalirudin are thrombin inhibitors used as an alternative to heparin following HIT

Answer 1077

Aminocaproic acid

Answer 1078

Alteplase (tPA), reteplase (rPA), tenecteplase (TNK-tPA) They cause activation of plasminogen --> plasmin --> cleaves thrombin & fibrin clots & fibrinogen Contraindicated in active bleeding, Hx of intracranial bleeding, severe HTN.

Answer 1079

Irreversible COX-1 & COX-2 inhibitor. Endothelial cells can resynthesize COX-2 --> PGI2. Platelets cannot resynthesize COX-1 --> decreased TXA2. Toxicity: Gastric ulcers Chronic use - AKI, interstitial nephritis, UGI bleeds Reye's syndrome in post-viral children Overdose --> Resp. alkalosis --> eventual metabolic acidosis

Answer 1080

Clopidogrel, Ticlopidine, Pasugrel, Ticagrelor Irreversibly bind ADP receptors --> PLT's don't activate or display GPIIb/IIIa --> cannot aggregate Ticlopidine --> neutropenia (Presents w/ fever & stomatitis)

Answer 1081

Xa inhibitors have X in the name: Apixaban Rivaroxaban Idraparinux IIa inhibitors have a G in the name: Argatroban Dabigatran

Answer 1082

PDEIII inhibitors = Cilostazol, Dipyridamole PDE III inhibition --> ^cAMP --> PLT aggregation inhibited & vasodilation Used for intermittent claudication, angina prophylaxis

Answer 1083

GPIIb/IIIa inhibitors = Abciximab, Eptifbatide, Tirofiban Used for angioplasty & ACS

Answer 1084

Pyrimidine analog --> inhibitor of DNAP Can cause pancytopenia

Answer 1085

Dactinomycin intercalates into DNA Used for childhood tumors! (Wilms', Ewing's sarcoma, rhabdomyosarcoma) Can cause myelosuppression

Answer 1086

Doxorubin/Daunomycin intercalate into the DNA & inhibit TopoII Toxicities: Cardiotoxic (prevented with Dexrazoxane) Vesicant Myelosuppression

Answer 1087

Bleomycin induces free-radical formation --> dsDNA breaks Toxicities: Pulmonary fibrosis Skin hyperpigmentation

Answer 1088

Cyclophosphamide/Ifosphamide are alkylating agents --> Crosslink DNA at guanine N-7 position Toxicities: Hemorrhagic cystitis (Mesna prevents) Myelosuppression Sterility

Answer 1089

Carmustine, Lomustine, Semustine, Streptozocin They are alkylating agents that can cross the BBB --> used for brain tumors. They can cause CNS toxicities (ataxia, dizziness)

Answer 1090

Busulfan is an alkylating agent used for CML & ablation of bone marrow prior to BMT Toxicities: Pulmonary fibrosis Skin hyperpigmentation

Answer 1091

Vincristine & Vinblastine block polymerization of microtubules --> inhibit mitotic spindle formation. Toxicities: Vincristine - peripheral neuropathy Vinblastine - bone marrow suppression (blasts bone marrow)

Answer 1092

Cisplatin, Carboplatin, & Oxaliplatin --> crosslink DNA Cisplatin - Nephrotoxic & ototoxic Carboplatin - Myelosuppression Oxaliplatin - Paresthesias & cold sensitivity

Answer 1093

Hydroxyurea inhibits ribonucleotide reductase (UDP --> dUDP) Toxicities: Bone marrow suppression

Answer 1094

Imatinib is a bcr-able tyrosine kinase inhibitor Used in CML & GIST Toxicity: Fluid retention

Answer 1095

mAb against CD20 Used in Non-hodgkin's lymphoma, RA

Answer 1096

Small molecule inhibitor of B-raf kinase with V600E mutation Used to treat metastatic melanoma

Answer 1097

mAb against VEGF --> inhibits angiogenesis

Answer 1098

Strep pneumo > H. flu They are functionally asplenic --> encapsulated organisms Also don't forget that they get Salmonella osteomyelitis

Answer 1099

Type I --> Osteogenesis imperfecta Type II Type III --> Ehlers-Danlos Syndrome Type IV --> Alport Syndrome

Answer 1100

Protein & Carbs = 4 cal Fat = 9 cal Ethanol = 7 cal

Answer 1101

It is an atypical antipsychotic used when other antipsychotics have all failed (it's the big gun). Toxicities: Agranulocytosis! Significant weight gain Seizures

Answer 1102

Bilateral renal artery stenosis (these pts are dependent on ACE-mediated constriction of efferent arteriole to maintain GFR) --> ARF if administered Also Pregnancy (teratogen)

Answer 1103

"Cancel Lab, Get Some Beer" ``` Corneum Lucidum (only present on thick skin) Granulosum Spinosum Basale ```

Answer 1104

Armpits, genitals, and nipples Secrete milky viscous fluid. Stinks because of bacteria.

Answer 1105

Tight junctions = Claudins & Occludens Adherens junctions = Cadherins (link to actin) Desmosomes = Desmogleins (link to keratin) Gap junctions = Connexins form Connexons Hemidesmosomes (bind basement membrane) Integrins (bind laminin in BM)

Answer 1106

Pudendal n. block (childbirth) --> Ischial spine Lumbar puncture --> Iliac crest

Answer 1107

SITS: Supraspinatus --> initial abduction (most common RC injury) Infraspinatus --> laterally rotates arm (pitching injury) Teres minor --> adducts & laterally rotates Subscapularis --> adducts & medially rotates

Answer 1108

Axillary nerve --> deltoid atrophy & numbness over deltoid

Answer 1109

Radial nerve (deep branch) --> wrist drop & numb dorsal hand/snuffbox

Answer 1110

Radial nerve --> wrist drop & numb posterior hand/snuffbox

Answer 1111

Proximal Median nerve --> Pope's blessing & lateral hand numbness

Answer 1112

C5, C6, C7, C8, T1 "The 3 Musketeers Assasinated 5 Rats, 5 Mice, & 2 Unicorns" ``` Musculocutaneous - C5,6,7 Axillary - C5,6 Radial - C5,6,7,8,T1 Median - C5,6,7,8,T1 Ulnar - C8,T1 ```

Answer 1113

Distal median nerve --> median claw (can't extend 2 & 3)

Answer 1114

Fractured hook of the hamate --> distal ulnar claw (cannot extent 4th & 5th digits)

Answer 1115

Waiter's tip - caused by torn upper trunk of brachial plexus (C5,6) seen in infants following delivery

Answer 1116

Torn lower trunk of brachial plexus (C8, T1). This can occur by pulling a baby out by its arms, falling and catching oneself on a tree branch, or thoracic outlet syndrome.

Answer 1117

Compression of the brachial plexus & subclavian vessels between the anterior & middle scalene (superior thoracic outlet). ``` Symptoms: Atrophy of intrinsic hand muscles Pain/paresthesias Decreased pulses in the arm Edema ```

Answer 1118

Fractured scaphoid --> avascular necrosis Dislocated lunate --> acute carpal tunnel syndrome (median n.) Fractured hook of hamate --> ulnar n. injury

Answer 1119

Clawing occurs with more distal lesions, because the deficit is pronounced even at rest. More proximal lesions present with deficits only when the muscle is used.

Answer 1120

``` Atropine TCA's H1 blockers (diphenhydramine, etc.) Neuroleptics Antiparkinsonian drugs ```

Answer 1121

``` Renal failure Liver failure CHF Alcoholism Sepsis ``` Anything that could predispose to lactic acidosis

Answer 1122

Sudden loss of motor tone triggered by emotion. This is seen in narcolepsy.

Answer 1123

Hypocretin-1 & Hypocretin-2 (Orexin-A & Orexin-B) Produced in the lateral hypothalamus, they promote wakefulness.

Answer 1124

Low potency --> blockade of: Cholinergic receptors --> anticholinergic Histamine receptors --> sedation Noradrenergic receptors --> orthostatic hypotension High potency: Extrapyramidal symptoms

Answer 1125

Histamine --> sedation Alpha adrenergic --> orthostatic hypotension Cholinergic --> anticholinergic effects

Answer 1126

A pt on TZD's (Rosiglitazone, etc.) must have their LFT's monitored.

Answer 1127

Foscarnet binds the pyrophosphate binding site on viral RNA polymerase. Second line for CMV retinitis & HSV. Adverse effects: Nephrotoxicity Hypocalcemia Hypomagnesemia

Answer 1128

Short: Lispro, Aspart, Glulisine Intermediate: NPH > Regular insulin Long: Glargine Detemir

Answer 1129

Physiologic DS = anatomic DS + V/Q mismatch DS = TV*(PaCO2-PeCO2)/PaCO2

Answer 1130

Increased risk of autoimmune disease & lymphoma

Answer 1131

Immature infant immune system: Mild initial illness High chance of chronic infection

Answer 1132

Sulfadiazine & Pyrimethamine

Answer 1133

Toxoplasma | Primary CNS lymphoma

Answer 1134

Methyldopa

Answer 1135

Normal colon --> APC mutation --> Proliferation --> K-RAS mutation --> Adenoma --> p53 mutation --> Carcinoma Order is AK-53

Answer 1136

Fever > 101.0 (38.3) Neurological sequelae = 42 degrees Death = 43 degrees

Answer 1137

Hyperpyrexia is a temperature > 40 degrees Treatment is NSAIDs/Acetaminophen & physical cooling of the body.

Answer 1138

Multiple sexual partners Cigarette smoking Early coitarche Low socioeconomic status

Answer 1139

ACE inhibitors Beta blockers (unless decompensated) ARB's Spironolactone

Answer 1140

Pulmonary edema Paroxysmal nocturnal dyspnea Orthopnea Hemosiderin-laden macrophages

Answer 1141

Chronic passive congestion --> hepatosplenomegaly (nutmeg liver) Peripheral dependent pitting edema JVD

Answer 1142

Acute = S. aureus --> large vegetations on a normal valve Subacute = Viridans strep --> small vegetations on congenitally abnormal or diseased valves

Answer 1143

``` Malignancy Hypercoagulability Lupus (Marantic/Libman-Sacks) HACEK organisms: -Hemophilus -Actinobacillus -Cardiobacterium -Eikenella -Kingella ```

Answer 1144

bacteria FROM JANE ``` Fever Roth's spots (IC mediated) Osler's nodes (Painful; IC mediated) Murmur Janeway lesions (Painless; septic emboli) Anemia (of chronic disease) Nail bed hemorrhage Emboli ```

Answer 1145

Chordae rupture Glomerulonephritis Suppurative pericarditis Emboli

Answer 1146

JONES criteria Joints (migratory polyarthritis) s chorea Minor criteria: Fever, ^ESR

Answer 1147

Early death = myocarditis Rheumatic heart disease affects Mitral > Aortic >> Tricuspid Early lesion - mitral regurgitation Late lesion - mitral stenosis

Answer 1148

``` Aschoff bodies (granulomas) Anitschkow's cells (activated histiocytes) ``` Caused by a Type II hypersensitivity reaction from Ab's against M protein.

Answer 1149

Sharp pain (worse w/ inspiration, better w/ leaning forward) Friction rub ST elevation in all leads

Answer 1150

Fibrinous - Dressler's syndrome, uremia, radiation Serous - viral pericarditis, inflammatory diseases (SLE, RA, etc.) Suppurative - bacterial pericarditis (rare due to abx)

Answer 1151

``` Beck's triad: -Hypotension -JVD -Distant heart sounds Pulsus paradoxus Electrical alternans ``` Pulsus paradoxus - systolic BP decreases by at least 10 mmHg upon inspiration

Answer 1152

Pulsus paradoxus - systolic BP decreases by at least 10 mmHg upon inspiration ``` Caused by: Cardiac tamponade Pericarditis Asthma Obstructive sleep apnea Croup ```

Answer 1153

Myxoma - Adults; ball-valve obstruction in the LA (syncope) Rhabdomyoma - Kids; associated with tuberous sclerosis Metastasis - Often to pericardium (effusion). Melanoma, lymphoma

Answer 1154

^ in JVP upon inspiration rather than a decrease ``` Seen in: Constrictive pericarditis Restrictive cardiomyopathy RA or RV tumors Cardiac tamponade ```

Answer 1155

Asian females under 40

Answer 1156

"Pulseless disease" (weak UE pulses) Visual & neurologic symptoms ^ESR Basically the same disease as Giant Cell arteritis but occurs at the aortic arch & proximal great vessels.

Answer 1157

``` HBV seropositivity Fever, weight loss, Abdominal pain w/ melena Hypertension Renal damage Neurologic symptoms (wrist/foot drop) "String of pearls" on arteriogram Fatal if untreated ``` SPARES THE LUNGS

Answer 1158

Young adults Transmural inflammation with fibrinoid necrosis

Answer 1159

``` Fever Cervial LAD Conjunctivitis Strawberry tongue (mucocutaneous LN syndrome) Desquamating rash on palms & soles ``` Can lead to coronary MI or aneurysm/rupture

Answer 1160

IVIg & high-dose aspirin

Answer 1161

Anti-endothelial or anti-smooth muscle Ab's

Answer 1162

Hemoptysis RPGN Palpable purpura p-ANCA's NO granulomas, NO eosinophilia

Answer 1163

Wegener's ``` Granulomas Sinusitis/Nasopharyngeal ulceration Hemoptysis (CXR shows large nodular densities) RPGN c-ANCA's ```

Answer 1164

``` Asthma, sinusitis Palpable purpura Peripheral neuropathy Granulomas with eosinophilia RPGN p-ANCA ^IgE ```

Answer 1165

``` Most common systemic childhoos vasculitis Follows an URI Palpable purpura on buttocks/legs Arthralgia Abdominal pain w/ melena IgA nephropathy ```

Answer 1166

c-ANCA = PR3-ANCA p-ANCA = MPO-ANCA

Answer 1167

Benign capillary hemangioma of infancy. | Grows rapidly and regresses spontaneously by 5-8y

Answer 1168

Benign capillary hemangioma of the elderly | Does not regress

Answer 1169

Polypoid capillary hemangioma that can ulcerate & bleed. | Associated with trauma & pregnancy

Answer 1170

Cavernous lymphangioma of the neck | Associated with Turner syndrome

Answer 1171

Benign, painful red/blue tumor under the fingernail | Arises from glomus body

Answer 1172

Benign capillary lesion found in AIDS patients Caused by Bartonella henselae infection Looks like Kaposi's sarcoma

Answer 1173

Head, neck, & breast following radiation | Liver due to PVC, arsenic, & Thorotrast exposure

Answer 1174

Endothelial malignancy of skin, mouth, GI, & respiratory tract Caused by HHV-8 & HIV together Seen in old Eastern European males, HIV pts, & transplant pts

Answer 1175

Port wine stain on face (trigeminal distribution) Ipsilateral (to port wine stain) leptomeningeal angioma Seizures Early-onset glaucoma It is a vascular disorder that affects the small vessels.

Answer 1176

Autosomal dominant deletion of VHL gene on chromosome 3p Cerebellar hemangioblastomas Clear cell renal carcinoma Pheochromocytomas

Answer 1177

Prepatellar bursitis. Seen in patients who do a lot of kneeling.

Answer 1178

Usually 10^10 Anything that decreases gastric acid can cause susceptibility (PPI's, food ingestion, achlorhydria)

Answer 1179

Senile calcific aortic stenosis Presents in 70's or earlier if bicuspid aortic valve is present.

Answer 1180

``` Fasting Stress Hemolysis Physical exertion Febrile illness Fatigue ```

Answer 1181

Arise from the descending thoracic aorta. Most of the venous blood is returned via the pulmonary veins. This accounts for part of the A-a gradient.

Answer 1182

They are somewhat selective for D-glucose

Answer 1183

Sterno --> Sternum Cleido --> Clavicle (medial portion) Mastoid --> Mastoid process

Answer 1184

``` Amifostine scavenges free radicals. Chloride diuresis (IV NaCl) is also used to keep cisplatin in a nonreactive state while in the kidney. ```

Answer 1185

Dexrazoxane (iron chelating agent)

Answer 1186

Eating disorder Amenorrhea Osteoporosis

Answer 1187

Rat poison is like a long-acting warfarin. Thus, the treatment to prevent bleeding is fresh frozen plasma.

Answer 1188

Atropine can be used to block vagal outflow to the SA & AV nodes. This can cause acute closed-angle glaucoma in susceptible patients. It is absolutely contraindicated in a patient with preexisting glaucoma.

Answer 1189

Low dose corticosteroids ---> inhibition of ACTH --> suppression of HPA axis

Answer 1190

Cushing ulcers can be in the esophagus, stomach, or duodenum. They arise due to ^ICP. Curling ulcers are found in the proximal duodenum only. They arise due to severe trauma/burns --> decreased oxygenation

Answer 1191

Pregnancy Rapid weight loss Long-term TPN or octreotide High spinal cord injuries

Answer 1192

It is likely due to inhibition of ventricular remodeling & cardiac fibrosis (normally facilitated by aldosterone).

Answer 1193

It is a balanced arterial & venodilator. This causes decreased preload and afterload.

Answer 1194

CAAT (-75) & TATA (-25)

Answer 1195

Less risk of bleeding Less GI ulceration They have a higher risk of clotting though.

Answer 1196

Damage to the deep branch of the radial nerve --> wrist drop without sensory deficit

Answer 1197

It is an ATP-driven efflux pump that is often upregulated in tumor cells & can cause resistance to chemotherapy.

Answer 1198

Alter the 60S ribosomal subunit to prevent tRNA binding to the ribosome --> inhibit translation

Answer 1199

Mitral valve prolapse

Answer 1200

Petechiae < 5mm 5 mm < Purpura < 1 cm Ecchymoses >1cm

Answer 1201

1) Aldose reductase conversion of intracellular glucose to sorbitol --> osmotic damage to axons & schwann cells 2) Hyaline arteriolosclerosis of endoneural arterioles --> ischemic nerve damage

Answer 1202

``` Reider's syndrome is typically caused by: Chlamydia Campylobacter Salmonella Shigella Yersinia ```

Answer 1203

Atrial natriuretic peptide | Nitric oxide

Answer 1204

Glucagon TSH PTH

Answer 1205

Painful, disorganized, sustained esophageal contractions "Corkscrew esophagus" on barium swallow Intermittent dysphagia & chest pain

Answer 1206

Tryptase It is released (with histamine) from mast cells & is relatively specific to them.

Answer 1207

Intrapleural pressure at FRC = -5 cm H20

Answer 1208

P antigen on immature erythroid cells | Can also infect mature ones but has tropism for immature

Answer 1209

K-1 capsular antigen

Answer 1210

alpha-4-beta-2 nicotinic ACh receptor --> downstream dopamine release

Answer 1211

It is an alpha-4-beta-2 nicotinic receptor partial agonist used to reduce nicotine cravings & attenuating the reward pathway of nicotine

Answer 1212

``` Protease inhibitors (lipodystrophy) Corticosteroids (Cushing's) ```

Answer 1213

Posterior cerebral artery Superior cerebellar artery CNIII runs between these vessels & aneurysm in either one can cause compression of it.

Answer 1214

Compression tends to cause GVE symptoms --> pupillary reflexes Ischemia tends to cause GSE symptoms --> motor palsy

Answer 1215

Paraneoplastic syndromes from: Breast/ovary (anti-Yo) Lung (Anti-P/Q; Anti-Hu)

Answer 1216

Chronic rejection of a transplanted lung --> lymphocytic inflammation & necrosis of bronchiolar walls --> granulation tissue & exudate in the lumen of the bronchioli --> fibrous tissue obliteration of small airways

Answer 1217

Lung diseases - cancer, TB, CF, bronchiectasis, pulmonary HTN, any with hypoxia. This is the most common cause. Heart diseases - cyanotic (5 T's), bacterial endocarditis Other - IBD, hyperthyroidism, malabsorption

Answer 1218

Inoculate Candida albicans into serum at 37 degress for 3h --> true hyphae will sprout from the yeast (often look like little J's)

Answer 1219

Hyaline cartilage Fat, smooth muscle, clefts Lined by respiratory epithelium Generally present as a peripheral "coin lesion"

Answer 1220

``` Everything coming off of the celiac trunk: Esophagus Stomach Liver Gallbladder Pancreas Upper duodenum ```

Answer 1221

``` Everything supplied by the SMA: Lower duodenum Small intestine Ascending colon Proximal 2/3 of the transverse colon ```

Answer 1222

Everything supplied by the IMA: Distal 1/3 of the transverse colon Descending colon Sigmoid colon

Answer 1223

Intestinal obstruction --> bilious vomiting in first week of life Cecum in RUQ, fixed by Ladd's fibrous bands Midgut volvulus --> gangrene or perforation

Answer 1224

ARP = (RR-1)/RR

Answer 1225

Repeating episodes of breathing followed by an apneic period Seen in advanced heart disease & neurologic disease. It is caused by a delayed response to increases in PaCO2.

Answer 1226

Recurrent small hemorrhagic strokes in multiple brain locations, especially outside of the basal ganglia & in the hemispheres.

Answer 1227

They link the portal vein to the systemic venous circulation 1) Left gastric vein --> Esophageal vein (Esophageal varices) 2) Superior rectal vein --> Middle & inferior rectal veins (Hemorrhoids) 3) Paraumbilical veins --> Superficial & inferior epigastric veins (Caput medusae)

Answer 1228

Mucor Rhizopus Absidia

Answer 1229

Ureaplasma urealyticum requires special media rich in urea & cholesterol to grow. It can cause urethritis.

Answer 1230

Fenfluramine Phentermine (Fen-Phen) If ingested for >3 months, they can cause pulmonary hypertension. Classic presentation is dyspnea on exertion --> cor pulmonale (RVH) --> sudden cardiac death.

Answer 1231

Atypical depression

Answer 1232

vivax/ovale - 48h malariae - 72h falciparum - severe & disorganized

Answer 1233

Normally < 20,000 If the PMN count is much greater than this, indicates a septic arthritis.

Answer 1234

Tyramine should be avoided. It is a sympathomimetic usually degraded in the GI tract. If ingested, it can cause hypertensive crisis. This is the most commonly tested side effect on boards.

Answer 1235

Diazepam Flurazepam Chlordiazepoxide Clorazepate

Answer 1236

Alprazolam Triazolam Oxazepam

Answer 1237

Gastrinoma Jejunal ulcers are almost never caused by your everyday PUD. Also consider if the gastrinoma is part of MEN1

Answer 1238

Impetigo --> only Acute post-strep GN only Strep throat --> Acute post strep GN or Rhematic fever Rheumatic fever can only follow strep pharyngitis.

Answer 1239

Restrictive --> higher breathing rates of low tidal volume Obstructive --> lower breathing rates of high tidal volume This minimizes the work of breathing for them.

Answer 1240

Estrogen --> ^HMG-CoA reductase activity --> ^Cholesterol Progesterone --> Gallbladder hypomotility & reduced bile acids Also seen with OCP use.

Answer 1241

Lidocaine Mexiletine Tocainide They are selective for depolarized cells (ischemic myocardium). Amiodarone is the DOC for V-tach.

Answer 1242

Pralidoxime It can only be used early on. Atropine is an alternative, though it will only combat the muscarinic effects. The patient will still be at risk for muscle paralysis.

Answer 1243

Cricopharyngeal muscle dysfunction --> increased oropharyngeal pressure during swallowing --> herniation through the muscular wall

Answer 1244

A positive swinging flashlight test indicates pathology involving the retina, optic nerve, optic chiasm, or optic tract. If the pathology was after this, the pupillary light reflex would be intact.

Answer 1245

``` High dose niacin (to treat dyslipidemia) can cause: Flushing Gout Hyperglycemia Hepatitis ```

Answer 1246

Succinate thiokinase | Succinyl-CoA Synthetase

Answer 1247

Soil & bird (pigeon) droppings

Answer 1248

Asian & African descent | Can also be secondary to viral gastroenteritis or any disease that damages the intestinal epithelium

Answer 1249

Decreases the synthesis of hepatic TG's & VLDL. | Also increases HDL (drug of choice)

Answer 1250

Sudan III stain on a stool sample reveals presence of fat

Answer 1251

^bleeding time, normal PLT count, PT & aPTT It is a qualitative platelet defect due to under-excretion of platelet inhibitory factors. Resolves with dialysis.

Answer 1252

Within the tunica vaginalis of the testicle It is derived from the peritoneum and can remain in communication to the peritoneal cavity, leading to hydrocele.

Answer 1253

CO2 (tissues) --> H+ & HCO3- --> HCO3- diffuses out --> Cl- diffuses in to maintain charge The reverse happens in the lungs. Thus, RBC [Cl-] is high in venous blood and low in arterial blood.

Answer 1254

Use Pilocarpine (cholinomimetic --> opens meshwork) Do NOT use epinephrine (effective at vasoconstricting to reduce production of aqueous humor but causes mydriasis --> blocks off canal of Schlemm)

Answer 1255

Agonists at mu opioid receptors --> opens K+ channels & closes Ca2+ channels --> inhibition of synaptic transmission Inhibits release of ACh, NE, 5-HT, glutamate, substance P

Answer 1256

``` Addiction Respiratory depression Constipation Miosis Additive CNS depression with other drugs ``` OD treated with naloxone

Answer 1257

It is a mu opioid receptor partial agonist used for severe pain. It has less respiratory depression than other opioids. If given to a pt who is dependent on a normal opioid, can cause withdrawal.

Answer 1258

It is a weak opioid agonist that also inhibits NE & 5-HT reuptake. It is used for chronic pain. It has toxicities similar to opioids & can lower the seizure threshold.

Answer 1259

Carbamazepine Both simple & complex partial seizures.

Answer 1260

``` Agranulocytosis Aplastic anemia SIADH Ataxia CYP450 induction Teratogenesis ```

Answer 1261

``` Nystagmus Drug-induced Lupus Gingival hyperplasia Hirsutism Megaloblastic anemia LAD Ataxia CYP450 induction Teratogenic (fetal hydantoin syndrome) ```

Answer 1262

Tremor Weight gain Fatal hepatotoxicity (measure LFT's) Neural tube defects (don't give in pregnancy)

Answer 1263

^DURATION of Cl- channel (GABAa) opening --> hyperpolarizes membrane --> decreases neuronal firing

Answer 1264

Increase FREQENCY of GABAa channel opening --> influx of Cl- --> hyperpolarization of neurons

Answer 1265

``` CNS depression (seen in elderly; additive) Dependence (Triazolam, Oxazepam, Midazolam) ``` OD Tx: Flumazenil (antagonist)

Answer 1266

``` EtOH Benzodiazepines Barbiturates 1st generation antihistamines Neuroleptics ```

Answer 1267

Zolpidem, Zaleplon, & Eszopiclone They are selective GABA agonists at the BZ1 receptor subtype. Used for insomnia.

Answer 1268

^lipid solubulity Potency = 1/MAC

Answer 1269

Minimum alveolar concentration to anesthetize 50% of population Affected ONLY by: Age Body temperature

Answer 1270

Hepatotoxicity: A few days after exposure: Eosinophilia, ^ALT, ^PT

Answer 1271

Malignant hyperthermia | not seen in N2O actually

Answer 1272

``` Barbiturates Benzos Arylcyclohexamines (Ketamine) Opioids Propofol ```

Answer 1273

Thiopental It is highly lipid soluble (rapid onset) & redistributes rapidly (effects are short-lived)

Answer 1274

Sedation for mechanically ventilated patients Anesthesia induction Short procedures Potentiates GABAa

Answer 1275

Ester = Procaine, Cocaine, Tetracaine | Amide = Lidocaine, Mepivacaine, Bupivacaine Amide's have 2 I's in the name

Answer 1276

Epinephrine can be given to vasoconstrict --> ^local action & decrease systemic concentration

Answer 1277

Small myelinated > Small unmyelinated > Large myelinated > Large unmyelinated Loss of sensation: 1) Pain 2) Temperature 3) Touch 4) Pressure

Answer 1278

Blocks release of Ca2+ from the SR of skeletal muscle Used to treat: Malignant hyperthermia (inhaled anesthetics except N2O) Neuroleptic malignant syndrome

Answer 1279

``` BALSA: Bromocriptine Amantadine Levodopa Selegiline (and COMT inhibitors) Antimuscarinics ```

Answer 1280

It is a D2 agonist used for Parkinson's disease & Prolactinomas

Answer 1281

Anxiety, agitation, insomnia, confusion, hallucinations Arrhythmias Dyskinesia

Answer 1282

Selective MAO-B inhibitor --> inhibits metabolism of Dopamine

Answer 1283

Memantine (NMDA antagonist) Donepezil, Ganatamine, Rivastigmine (AChE inhibitors) alpha-Tocopherol (Vit. E; Antioxidant)

Answer 1284

Tetrabenazine, Reserpine (inhibit VMAT -> dop not packaged) Haloperidol (Dopamine antagonist)

Answer 1285

Coronary vasospasm (contraindicated in Prinzmetal's angina)

Answer 1286

1) They have anaphylactic reactions to IgA-containing blood products 2) Can have false-positive hCG testing (heterophile Ab)

Answer 1287

BTK (Bruton's Tyrosine Kinase) No B cell maturation seen --> less B cells & way less Ig's of all classes

Answer 1288

Epinephrine metabolites are seen within the lysosomes Grossly, liver is black

Answer 1289

Very high CD4:CD8 ratio

Answer 1290

16S rRNA is complementary to the Shine-Dalgarno sequence (10 bp upstream from AUG)

Answer 1291

Bind 30S and inhibit formation of initiation complex

Answer 1292

Bind 30S and prevent tRNA from entering acceptor site

Answer 1293

Binds 50S and inhibits peptidyl transferase

Answer 1294

Bind 50S and prevent release of tRNA from the E site

Answer 1295

Whooping cough 3 stages: 1) Catarrhal stage - flu-like; highly contagious 2) Paroxysmal stage - many coughs then large whooping inspiration 3) Recovery stage - coughing slowly subsides Whole process lasts ~3 months

Answer 1296

AB exotoxin ribosylates EF-2 --> inhibits protein synthesis leading to cell death

Answer 1297

Glyceraldehyde-3-P --> 1-3-BPG

Answer 1298

aka pityriasis versicolor Caused by Malassezia furfur Symptoms: Light patches on skin Otherwise asymptomatic

Answer 1299

Spaghetti & meatballs appearance Causes tinea versicolor

Answer 1300

Vitamins D & K D levels will be adequate if the infant gets enough sunlight. Dark skinned children are at higher risk. K is administered at birth

Answer 1301

Suffocation due to pseudomembranes Heart pathology - myocarditis, arrhythmia, CHF CNS pathology - neuropathy, paralysis, coma

Answer 1302

The B portion of the AB exotoxin ``` A = active (ribosylates EF-2) B = binding ```

Answer 1303

Chlamydia trachomatis > Ureaplasma urealyticum >> Mycoplasma & Trichomonas Azithromycin is the treatment

Answer 1304

Nifedipine It is a vascular-selective CCB that causes vasodilation and can cause compensatory tachycardia.

Answer 1305

Abnormal trypsin cannot be cleaved and thus inactivated by other trypsin. Patients suffer recurrent attacks of acute pancreatitis.

Answer 1306

Hypokalemia Hypomagnesemia Hypocalcemia

Answer 1307

Diffuse musculoskeletal pain Insomnia Emotional disturbances Often seen in women 20-50

Answer 1308

Mesolimbic-Mesocortical --> regulates behavior Nigrostriatal --> coordination of movement Tuberoinfundibular --> controls prolactin secretion

Answer 1309

Lymphangiosarcoma Often seen after radical mastectomy

Answer 1310

Increased preload and decreased afterload

Answer 1311

In addition to their effects at the thick ascending limb, loop diuretics stimulate prostaglandin release, causing vasodilation of the afferent arteriole. This can be blocked by concurrent use of NSAIDs

Answer 1312

Use-dependence = prolong the QRS more at high HR's ``` Class Ic (Na+ channel blockers) --> use-dependence Class III (K+ channel blockers --> reverse use-dependence ```

Answer 1313

Pentazocine & Butorphanol They can cause withdrawal if full agonist opioids have been used.

Answer 1314

B1 selective The nonselective ones blunt the adrenergic symptoms normally seen with hypoglycemia. They also inhibit hepatic gluconeogenesis and peripheral glycogenolysis & lipolysis.

Answer 1315

Pyrophosphate (a component of hydroxyapatite)

Answer 1316

aka aortocaval compression syndrome Caused by the gravid (>20 weeks) uterus compressing the IVC upon lying down. This reduces venous return, which lowers CO --> hypotension & possible syncope

Answer 1317

Measurement of urinary [Cl-] & volume status Vomiting --> low urinary Cl- (saline responsive) Loop diuretics --> high urinary Cl- (saline responsive) Conn syndrome --> high urinary Cl- (saline unresponsive)

Answer 1318

It must be coated by the external coat antigen of HBV in order to survive & infect.

Answer 1319

Sympatholytics (to counteract compensatory tachycardia) Diuretics (to counteract sympathetic renin release --> edema)

Answer 1320

Class Ia & Class III Amiodarone is the only drug of these classes that does not predispose to torsades.

Answer 1321

Internal branch of the superior laryngeal nerve Damage to it leave the patient with no sensation to the pharynx above the vocal cords --> no cough reflex

Answer 1322

Terbinafine is used for dermatophyte infections. It inhibits fungal squalene epoxidase --> impaired synthesis of ergosterol. Toxicities: Abnormal LFT's Visual disturbances Not seen if used topically

Answer 1323

Cladribine It is an adenosine analog that is resistant to Adenosine Deaminase (usually a problem with treating HCL).

Answer 1324

Bone marrow suppression Hepatotoxicity SIADH

Answer 1325

Octreotide It is a synthetic somatostatin analog

Answer 1326

Amphotericin B & flucytosine

Answer 1327

PTU & Methimazole both cause agranulocytosis | Typically presents with fever & a sore throat

Answer 1328

Right atrium Right ventricle Left AV groove, within a vein of the coronary sinus

Answer 1329

Anterior - 25th day Posterior - 27th day Failure in either of these leads to neural tube defects.

Answer 1330

Accumulation of edema in the epidermis --> intercellular bridges are stretched. If the bridges tear --> vesicle

Answer 1331

Meningitis Subarachnoid hemorrhage Intraventricular hemorrhage

Answer 1332

Hemoglobin - 26 mmHg Myoglobin - 1 mmHg Therefore myoglobin has much higher affinity for O2 than does hemoglobin. It also has no cooperativity, leading to a steep, non-sigmoidal dissociation curve. Monomeric Hb acts very similarly to Mb.

Answer 1333

Schwann cell tumors They are rubbery and exhibit "buttonholing"

Answer 1334

BNP and even ANP can be released from the ventricles in severe volume overload/hypertrophy.

Answer 1335

Dermal atrophy Can present as loss of collagen, drying, cracking, tightening of the skin, telangiectasias & ecchymoses.

Answer 1336

Primary (psychogenic) polydipsia Strong increase in urine osmolarity due to water deprivation, then a weak increase following vasopressin injection.

Answer 1337

D-Ala-D-Ala

Answer 1338

INH Dapsone Hydralazine Procainamide

Answer 1339

Anti-GPIIb/IIIa --> blocks platelet aggregation Used during angioplasty

Answer 1340

1) Dilates afferent & constricts renal arterioles. Inhibits sodium reabsorption (PCT & CCD). Inhibits renin release. 2) Inhibits aldosterone secretion. 3) Peripheral vasodilation

Answer 1341

Inhibits arabinosyltransferase --> impaired carbohydrate polymerization --> impaired cell wall synthesis

Answer 1342

Aspirin This is because the side effect is mediated by prostaglandins.

Answer 1343

Pituitary damage --> transient DI Hypothalamus damage --> permanent DI

Answer 1344

Ballooning degeneration Hepatocyte necrosis Portal inflammation "Ground glass" appearance (intracellular HBsAg proteins)

Answer 1345

Lymphoid aggregates in the portal tracts | Focal macrovesicular steatosis

Answer 1346

Astrocytes take up NH4+ and combine it with glutamate to make glutamine --> accumulation & astrocyte damage. Also the glutamate content in the brain is then decreased. Additionally, neurons can detoxify ammonia by combining it with alpha-Ketoglutarate --> glutamate. This depletes stores of alpha-Ketoglutarate --> impaired Krebs cycle within neurons.

Answer 1347

Neurons convert glutamine --> glutamate (Glutaminase) --> release it into synaptic cleft as a NT Astrocytes take up glutamate and --> glutamine (Glutamine synthase) and release it for use by neurons.

Answer 1348

Affected myocytes cease contracting within ~1 minute. Irreversible cell injury occurs at ~30 minutes. As ATP is depleted, it is degraded to ADP --> AMP --> adenosine. Adenosine can diffuse out of the cell and cause vasodilation. Following 30 minutes of ischemia, half of cellular adenine stores are gone and thus the cell cannot recover.

Answer 1349

Methotrexate - cancer Trimethoprim - bacteria Pyrimethamine - malaria & toxoplasmosis

Answer 1350

Hepatotoxicity (check LFT's before prescribing) | Rhabdomyolysis

Answer 1351

Osteoblasts - Alkaline phosphatase Osteoclasts - TRAP, Urinary hydroxyproline, urinary deoxypyridinoline

Answer 1352

``` Tzanck test = scrapinf of an ulcer base to look for Tzanck cells (multinucleate giant cells) seen in: HSV VZV CMV Pemphigus vulgaris ```

Answer 1353

1) Feedback inhibition on the pituitary --> no LH spike 2) Thickened cervical mucus 3) No growth of endometrium --> not suitable for implantation

Answer 1354

Nitroprusside

Answer 1355

Sodium thiosulfate It acts as a sulfur donor to enhance conversion of cyanide --> thiocyanate

Answer 1356

Adults ingest preformed toxin, whereas infants ingest spores (honey) that germinate in the gut. Also, infantile is usually less severe.

Answer 1357

Lying on their side, passive hyperextension of the hip causes pain. A positive psoas sign can be indicative of a psoas abscess or appendicitis (if on the right).

Answer 1358

It is a pyridoxine analog that inhibits mycolic acid synthesis in MTB.

Answer 1359

Monoclonal T cell proliferation --> cytokine release (especially TGF-beta) --> excessive deposition of collagen by fibroblasts

Answer 1360

Vitamin A They don't know why, the measles virus may induce a deficiency.

Answer 1361

Phencyclidine Vertical or horizontal nystagmus Violent behavior

Answer 1362

PCP is an NMDA antagonist --> ^excitatory NT's --> hallucinations

Answer 1363

Migratory skin necrolysis Erythematous groin rash Diabetes Anemia

Answer 1364

Cushing disease - ACTH must be coming from pituitary adenoma HyperPLASIA of both the zona fasciculata & reticularis

Answer 1365

Thalamic stroke in the VPL/VPM area --> pure sensory stroke causing total sensory loss of the contralateral side of the body. No motor deficits but impaired proprioception can cause falls.

Answer 1366

Homocysteine + Serine --> Cystathionine --> Cysteine Both of these steps require Vit. B6

Answer 1367

1) Homocysteine + 5-M-THF --> Methionine + THF (Methionine synthase/Homocysteine methyltransferase) (Requires Methylcobalamin) 2) Methionine + ATP --> S-adenosyl methionine (SAM) 3) SAM --> S-adenosyl homocysteine (Methyltransferase) 4) S-adenosyl homocysteine --> Homocysteine

Answer 1368

Caspofungin & Micafungin (echinocandins) inhibit polysaccharide (glucan) synthesis --> inhibit fungal cell wall synthesis

Answer 1369

It enters fungal cells, binds MT's & inhibits mitosis.

Answer 1370

Massive centrilobular hepatic necrosis Mortality ~80%

Answer 1371

Terminal ileum damage --> Bile acids not reabsorbed --> Steatorrhea --> loss of Ca2+ as soaps in stool --> Ca2+ not available to bind up oxalate in the gut --> ^Oxalate absorption --> kidney stones

Answer 1372

Microvesicular steatosis | No necrosis or inflammation

Answer 1373

It has properties of a beta blocker & a Class III antiarrhythmic (K+ channel blocker) --> ^PR & ^QT

Answer 1374

``` Populations that subsist on corn Alcoholics Carcinoid syndrome INH Hartnup disease ```

Answer 1375

Niacin is synthesized from Tryptophan

Answer 1376

Hypertrophied septum is too close to anterior mitral valve leaflet --> (paradoxical) systolic anterior motion of the anterior mitral valve leaflet --> leaflet moves closer to septum --> outflow obstruction

Answer 1377

``` Topical antihistamines (endogenous NE is downregulated) Nitroglycerine (less NO release) ``` Both of these drugs require time off in order to maintain their efficacy.

Answer 1378

G6P + NADP --> 6-Phosphogluconate + NADPH

Answer 1379

Sodium bicarbonate

Answer 1380

GI bleeding This is seen even with low dose aspirin, but especially with high dose.

Answer 1381

Inhibits alcohol dehydrogenase. It is used for ingestion of methanol, ethylene glycol, propylene glycol.

Answer 1382

Decreased peristalsis | Decreased LES tone

Answer 1383

Macroslides --> elongation | Tetris --> blocks tRNA binding

Answer 1384

Obstruction of the Bartholin gland with subsequent infection. Seen in women of reproductive age. Unilateral painful cystic lesion just below the & adjacent to the vaginal vestibule.

Answer 1385

HPV 6 & 11 infection

Answer 1386

Leukoplakia with parchment-like vulvar skin in postmenopausal women. Slightly increased risk for SCC.

Answer 1387

Chronic irritation & scratching --> leukoplakia w/ thick leathery skin No increased risk of SCC (only lichen sclerosis has ^risk)

Answer 1388

Lichen sclerosis Lichen simplex chronicus Squamous cell carcinoma

Answer 1389

Two possible etiologies: 1) VIN due to HPV infection 2) Longstanding lichen sclerosis

Answer 1390

Rh+ infant born to a (sensitized) Rh- mother ABO type is mild Rh type is severe but preventable

Answer 1391

RhoGAM They are IgG against the Rh antigen that bind up & eliminate any fetal RBC's that are passed to mom. This prevents mom from mounting an immune response against the Rh antigen (fetal RBC's)

Answer 1392

The posterior walls of the ventricles & posterior 1/3 of septum

Answer 1393

Low neutrophil counts at birth or shortly afterward. Severe recurrent infections seen later w/ no pus.

Answer 1394

The RV is anterior & right border | The LV is posterior & left lateral

Answer 1395

They are less susceptible to beta-lactamases

Answer 1396

To prevent Transfusion-Associated Graft vs. Host Disease (TA-GVHD) Blood that is given to immunodeficient patients should be irradiated prior to transfusion.

Answer 1397

Usually asymptomatic Diagnosis is incidental by microcytic anemia on CBC Confirmation is via >3.5% of HbA2 on electrophoresis

Answer 1398

Atropine - reverses central respiratory depression & other symptoms Pralidoxime - Reverses AChE poisoning Give both at once

Answer 1399

Sp = TN /(TN + FP) Sp = 1 - false positive

Answer 1400

Sn = TP/ (TP + FN) Sn = 1 - FN

Answer 1401

Excessive activity of metalloproteinases & myofibroblasts can cause a wound contracture, which can lead to deformity or limit the mobility of a joint.

Answer 1402

Serum AFP levels are monitored regularly

Answer 1403

Colonization of the umbilical stump A common occurrence in developing countries.

Answer 1404

Arthritis in adults Erythema infectiosum in children

Answer 1405

Binding of growth factor --> Autophosphorylation of tyrosine kinase --> Activation of phosphoinositide-3 kinase --> Phosphorylation of PIP2 --> Activation of Protein kinase B --> Acivation of mTOR --> Translocation to nucleus to activity genes This pathway is active in many cancers. Sirolimus is an mTOR inhibitor.

Answer 1406

Enlargement of the left atrium --> compression of the esophagus

Answer 1407

Double negative --> Double positive --> single positive

Answer 1408

Either decreased expression of catalase-peroxidase (required for INH activation) or modification of the mycolic acid synthesis enzyme.

Answer 1409

They prefer alkaline environments & are killed easily by acid.

Answer 1410

Blood levels of lipooligosaccharide (LOS)

Answer 1411

Binds ergosterol in the cell membrane and creates pores in the membrane --> leakage of ions from the cells --> cell lysis Same as Amphotericin B

Answer 1412

They transfer chemical groups onto the drug (acetyl, adenyl, phosphate) that impair its binding to ribosomes.

Answer 1413

Migratory superficial thrombophlebitis seen with pancreatic, colon, or lung adenocarcinoma. These tumors can produce a thromboplastin-like (Tissue factor-like) substance.

Answer 1414

Autosomal dominant

Answer 1415

Folic acid deficiency This is because they have increased turnover of cells

Answer 1416

Bile acids not absorbed in terminal ileum --> Decreased concentration of them in the bile --> Gallstones

Answer 1417

It is like a T-test for more than 2 populations. It compares the numerical means of multiple populations.

Answer 1418

Binds to Na+ channels on neurons & prevents them from opening. It is found in puffer fish.

Answer 1419

Chlamydia trachomatis (L1-L3 serotypes) 1) Initial painless ulcer on genitals 2) Swollen painful inguinal nodes --> rupture (buboes) Treat with doxycycline

Answer 1420

ACE Azithromycin Clarithromycin Erythromycin

Answer 1421

(Anterior) humerus dislocation --> axillary nerve injury It is the most commonly dislocated joint in the body.

Answer 1422

Binds gp41 on HIV cell membrane --> prevents gp41 from undergoing conformational change & causing membrane fusion

Answer 1423

``` Increased synthesis of: Adiponectin Fatty acid transport protein Insulin receptor substrate GLUT4 ```

Answer 1424

In the nucleus. The other steroid hormone receptors are found in the cytosol & translocate to the nucleus upon binding.

Answer 1425

Mucicarmine --> red stained polysaccharide capsule India ink stain --> Clearing around the cell (polysaccharide capsule)

Answer 1426

Large/Plasma protein bound/Highly charged --> ~4L (plasma) Small & hydrophilic --> ~15L (extracellular fluid & plasma) Small & hydrophobic --> ~41L (everywhere)

Answer 1427

Ecthyma gangrenosum Cutaneous necrotic lesions caused by hematologic dissemination & subsequent local release of exotoxins.

Answer 1428

Space (length) constant is increased (further transmission) | Time constant is decreased (faster transmission)

Answer 1429

Valproic acid

Answer 1430

Drugs that affect Na+ handling in the kidney (thiazides) Drugs that affect GFR (ACEi, NSAIDs) Volume contraction (CHF, GI bleed, Cirrhosis) Li+ is handled just like Na+ is handled in the kidney. Thus, anything that could cause Na+ retention can cause Lithium toxicity. Treatment is cessation & hemodialysis.

Answer 1431

Neural crest ectoderm

Answer 1432

ACE Azithromycin Clarithromycin Erythromycin

Answer 1433

(Anterior) humerus dislocation --> axillary nerve injury It is the most commonly dislocated joint in the body.

Answer 1434

Binds gp41 on HIV cell membrane --> prevents gp41 from undergoing conformational change & causing membrane fusion

Answer 1435

``` Increased synthesis of: Adiponectin Fatty acid transport protein Insulin receptor substrate GLUT4 ```

Answer 1436

Neural crest ectoderm

Answer 1437

Drugs that affect Na+ handling in the kidney (thiazides) Drugs that affect GFR (ACEi, NSAIDs) Volume contraction (CHF, GI bleed, Cirrhosis) Li+ is handled just like Na+ is handled in the kidney. Thus, anything that could cause Na+ retention can cause Lithium toxicity. Treatment is cessation & hemodialysis.

Answer 1438

Valproic acid

Answer 1439

Space (length) constant is increased (further transmission) | Time constant is decreased (faster transmission)

Answer 1440

Ecthyma gangrenosum Cutaneous necrotic lesions caused by hematologic dissemination & subsequent local release of exotoxins.

Answer 1441

Large/Plasma protein bound/Highly charged --> ~4L (plasma) Small & hydrophilic --> ~15L (extracellular fluid & plasma) Small & hydrophobic --> ~41L (everywhere)

Answer 1442

Mucicarmine --> red stained polysaccharide capsule India ink stain --> Clearing around the cell (polysaccharide capsule)

Answer 1443

In the nucleus. The other steroid hormone receptors are found in the cytosol & translocate to the nucleus upon binding.

Answer 1444

It is congenital fibrosis of the SCM that causes tilting of the head & contralateral head turn, presenting at 2-4 weeks of age. It is caused by birth trauma or malposition of the head in utero. It can be treated with conservative therapy & stretching exercises.

Answer 1445

Oligoclonal bands of Ab's are found | None are against the M component of measles virus

Answer 1446

Attrition bias (a type of selection bias)

Answer 1447

The aortic isthmus Just distal to the branch point of the left subclavian, where the ascending & descending aorta meet.

Answer 1448

An increased volume of endolymph --> damage to vestibular & cochlear organs Triad of: Tinnitus Vertigo Hearing loss (sensorineural)

Answer 1449

Recurrent paroxysmal SVT Baseline ECG: Shortened PR Delta wave before QRS Widened QRS

Answer 1450

Eccrine (merocrine) - sweat glands Apocrine - genitals, axilla, areola; secrete onto hair follicles Sebaceous glands - holocrine secretion of sebum onto hair follicles

Answer 1451

Bartonella henselae Self-limited low fever, LAD Can cause bacillary angiomatosis in immunocompromised patients

Answer 1452

The same thing as precision. The ability to produce consistent results (whether or not they are accurate)

Answer 1453

They lie in the cytoplasm & play a role in mRNA translation regulation & degradation.

Answer 1454

Tranylcypromine Phenelzine Selegiline

Answer 1455

Papillary necrosis | Chronic interstitial nephritis

Answer 1456

HOCM - Autosomal dominant mutations in myosin heavy chain Dilated CM - Autosomal dominant mutations in cytoskeleton (dystrophin) or mitochondrial enzymes

Answer 1457

1) Diphtheria antitoxin (passive immunity) 2) Penicillin or erythromycin 3) DPT vaccine Important to give antitoxin early since it cannot affect toxin that has reached the CNS or heart. Most common cause of death is cardiomyopathy (5-10% mortality).

Answer 1458

Response to vasopressin administration: >50% increase in urine osmolarity --> complete central DI partial central DI Partial central DI = some ADH is produced but not enough for normal kidney function.

Answer 1459

1 and 3 --> long QT | 2 and 4 --> long PR

Answer 1460

"Double Quarter Pounder w/ Mayo Lettuce Tomato, and Fries Please" Ia: Disopyramide, Quinidine, Procainamide Ib: Mexiletine, Lidocaine, Tocainide Ic: Flecainide, Propafenone

Answer 1461

CML = t(9;22) --> BCR-ABL fusion protein Essential thrombocytosis, Polycythemia vera, Primary myelofibrosis = JAK2 mutation --> constitutive tyrosine kinase activity

Answer 1462

Primidone --> Phenobarbital & Phenylethylmalonamide Primidone can cause lethargy

Answer 1463

Drug-induced lupus

Answer 1464

Hepatitis B Vaccination is important

Answer 1465

Myeloperoxidase Seen in myelogenous leukemias

Answer 1466

Herpes zoster ophthalmicus (if in V1 ganglion) --> visual probs Post-herpetic neuralgia: Persistent pain for months after resolution Increases with ^age

Answer 1467

Coronary heart disease

Answer 1468

Malignant hyperthermia is caused by inhaled anesthetics & succinylcholine. Ryanodine receptors release large amounts of Ca2+ into the cytoplasm, exhausting ATP stores in an attempt to pump it back in to the SR. The treatment is Dantrolene - inhibits Ryanodine receptors to act as a muscle relaxant.

Answer 1469

Aldosterone escape: 1) Pressure natriuresis 2) Increased delivery of sodium to distal nephron overrides aldosterone's action there 3) ANP

Answer 1470

Atherosclerosis - older person with other atherosclerotic dz Fibromuscular dysplasia - young woman of childbearing age Both can cause HTN due to renal artery stenosis. Fibromuscular dysplasia shows a "beads on a string" appearance on angiography.

Answer 1471

"These Will Cause Lasting Absorption Problems" ``` Tropical sprue Whipple's disease Celiac sprue Lactose intolerance Abetalipoproteinemia Pancreatic insufficiency ``` Also infectious causes (giardia, etc.)

Answer 1472

"Foamy Whipped cream in a CAN" Foamy (PAS+) macrophages in SI lamina propria Cardiac symptoms, Arthralgias, Neurologic symptoms Most commonly occurs in older men.

Answer 1473

Blunting of villi & crypt hypertrophy in the distal duodenum & proximal jejunum

Answer 1474

1) Vitamin deficiencies 2) Small bowel carcinoma 3) Enteropathy-Associated T-cell Lymphoma (EATL)

Answer 1475

Type A - autoimmune (Type IV) against parietal cells Type B - H. pylori infection

Answer 1476

Gastric hypertrophy (look like brain gyri) Protein-losing gastropathy Parietal cell atrophy ^Mucous cells

Answer 1477

Gastric adenocarcinoma MALT lymphoma Esophageal SCC (protective against esophageal adenocarcinoma)

Answer 1478

``` H. pylori infection (intestinal type only) Smoked foods (nitrosamines) Achlorhydria Chronic gastritis Type A blood ```

Answer 1479

IgA deficiency If present, must test for IgG against gliadin, endomysium, tTG

Answer 1480

Posterior wall ulcer --> gastroduodenal artery bleed This can cause acute pancreatitis!

Answer 1481

Ulcerative colitis Microscopic polyangiitis Churg-Strauss disease

Answer 1482

``` Transmural inflammation Cobblestone mucosa Creeping fat Linear ulceration Stricture (string sign on barium x-ray) ```

Answer 1483

Mucosal & submucosal inflammation only Pseudopolyps Loss of haustra --> lead pipe appearance on x-ray

Answer 1484

Crohn's: Noncaseating granulomas Lymphoid aggregates UC: Crypt abscesses

Answer 1485

``` PSC Toxic megacolon CRC Pyoderma gangrenosum Ankylosing spondulitis Uveitis ```

Answer 1486

``` CRC Migratory polyarthritis Erythema nodosum Ankylosing spondylitis Uveitis Kidney stones (malabsorption --> Ca2+ excreted in feces) ```

Answer 1487

Smoking ^ risk of Crohns | Smoking protects against UC

Answer 1488

The same as for RA ``` Steroids Azathioprine MTX Infliximab Adalimumab ```

Answer 1489

Sulfasalazine (ASA prep) 6-MP Infliximab Colectomy

Answer 1490

Usually asymptomatic Hematochezia Diverticulitis Fistulas

Answer 1491

Diverticulitis --> colovesical fistula

Answer 1492

Persistence of the Vitelline duct, leading to: Melena RLQ pain Intussusception, volvulus, obstruction Dx: Pertechnate study for ectopic gastric tissue

Answer 1493

Children: Viral infection (adenovirus & rotavirus) --> LAD --> leading edge Adults: Tumor is leading edge

Answer 1494

Intussusception: Ileocecal valve Volvulus: Children = cecum, Adults = sigmoid colon

Answer 1495

Type 1 (distal) --> hypokalemia, urine pH > 5.5 Type 2 (proximal) --> hypokalemia, urine pH < 5.5 Type 4 (aldosterone) --> hyperkalemic

Answer 1496

Bronchiolitis obliterans The small airways are inflamed & then fibrosed, rather than the vascular beds as in other organ transplants.

Answer 1497

Gastric = local inflammation Duodenal = impaired somatostatin release --> ^gastrin --> ^acid

Answer 1498

Smooth muscle cells respond to endothelial injury signals (PDGF). These reactive smooth muscle cells are responsible for intimal hyperplasia & fibrosis.

Answer 1499

PDGF (from platelets, endothelial cells, & macrophages) | TGF-beta (from platelets)

Answer 1500

Hypothyroidism Diabetes Rhematoid arthritis Dialysis-associated amyloidosis (beta-2 microglobulin)

Answer 1501

Mediastinal mass It can compress local structures leading to SVC syndrome, dysphagia, or respiratory symptoms. Also the standard symptoms of lymphoma will be present.

Answer 1502

To shuttle fatty acids into the mitochondria for beta oxidation.

Answer 1503

Polyribosyl-ribitol-phosphate (PRP) Antibodies against this protein are associated with immunity against HiB. The vaccine is composed of PRP conjugated to diphtheria or tetanus toxoid.

Answer 1504

Spadmodic torticollis (cervical dystonia) Blepharospasm (eyes held closed) Writer's cramp

Answer 1505

"Double Quarter Pounder w/ Lettuce, Tomato, Mayo & More Fries Please" Ia: Disopyramide Quinidine Procainide Ib: Lidocaine Tocainide Mexiletine Ic: MORicizine Flecainide Propafenone

Answer 1506

Burns Myopathies Crush injuries Denervating injuries Succinylcholine constantly stimulates the AChR (a nonselective cation channel), allowing both Na+ influx and K+ efflux. When open for a long time, this can cause a lot of K+ efflux from muscle cells --> hyperkalemia

Answer 1507

D2 blockade in the nigrostriatal pathway

Answer 1508

Atherosclerosis of the external iliac or femoral arteries.

Answer 1509

Radial head subluxation (Nursemaid's elbow) Caused by a sudden pull on an extended arm that is pronated. The annular ligament slips over the radial head & into the radiohumeral joint. The child will hold his arm in a pronated & extended position close to the body & not want to move it. Reduction occurs by full supination & flexion of the elbow.

Answer 1510

Theophylline = a PDE inhibitor & stimulant used for asthma Overdose: Seizures Tachyarrhythmia

Answer 1511

MRP2 It is an organic anion transporter & is energy-dependent. Uptake of unconjugated bilirubin at the basolateral membrane is passive.

Answer 1512

Ulnar collateral ligament reconstruction This is an injury commonly seen in pitchers due to intense valgus stress on the elbow.

Answer 1513

1) Early respiratory alkalosis | 2) Late metabolic acidosis superimposed on the early alkalosis, resulting in a mixed acid-base disturbance.

Answer 1514

Does not ferment sorbitol | Does not produce glucuronidase

Answer 1515

Subperiosteal thinning

Answer 1516

Hereditary hemorrhagic telangiectasia Autosomal dominant disease Telangiectasias on all mucous membranes Recurrent mucosal bleeding (epistaxis, GI, hematuria)

Answer 1517

Hepatogastric & Hepatoduodenal ligaments

Answer 1518

Inhibin B --> pituitary (only) Tesosterone --> pituitary & hypothalamus

Answer 1519

Strep pyogenes is PYR+ It was used before bacitracin to determine if it was GAS or GBS

Answer 1520

Desmopressin --> vWF release --> ^Factor VIII levels

Answer 1521

PCT tubular cells

Answer 1522

Benzos - increase frequency of GABA opening Barbs - increase duration of GABA opening

Answer 1523

Congestion (24h) Red hepatization (days 2-3) Gray hepatization (days 4-6) Resolution

Answer 1524

Refractory hypotension & cardiac arrhythmia due to inhibition of Na+ channels in the heart. Use NaHCO3 to resuscitate.

Answer 1525

Obstruction of the brachiocephalic vein on one side. Can be caused by thrombosis or by external compression (tumor, etc.)

Answer 1526

It is a virulence factor found on mycobacteria ``` Causes: Neutrophil inhibition Mitochondrial destruction TNF release Also causes linear growth pattern of mycobacteria ```

Answer 1527

``` Hirsutism Coarse facial features Acneiform skin rash Gingival hypertrophy LAD (pseudolymphoma) ```

Answer 1528

TNF-alpha Glucagon Fatty acids Glucocorticoids

Answer 1529

Proximal tubule & thick ascending limb

Answer 1530

``` Bone marrow suppression Peripheral neuropathy Lactic acidosis (Zidovudine, Didanosine, Stavudine) Rash Anemia (Zidovudine) ```

Answer 1531

Ergonovine It stimulates both alpha-adrenergic & 5-HT receptors --> spasm

Answer 1532

Competitive anion inhibitors: Perchlorate Pertechnetate Also iodide can

Answer 1533

The oval window The round window is the one that just relieves pressure.

Answer 1534

The apex of the cochlea

Answer 1535

Fatty acid, cholesterol, steroid synthesis Drug metabolism Antioxidant in RBC's

Answer 1536

CNV --> paralysis of muscles of mastication & loss of corneal rflx CNVII --> facial paralysis & hyperacusis CNVIII ---> tinnitus, vertigo

Answer 1537

``` PSEUDO: Pneumonia (CF) Sepsis (ecthyma gangrenosum) External otitis (diabetics, severe) UTI Drug users Osteomyelitis in diabetics ```

Answer 1538

Central retinal artery occlusion (CRAO)

Answer 1539

At FRC At high lung volumes, alveolar vessels are stretched longitudinally & narrowed. At low lung volumes, extra-alveolar vessels are not pulled open.

Answer 1540

Larvae in the stool is diagnostic Must be treated because it can autoinfect the same host over and over, leading to superinfection.

Answer 1541

Alpha-ketoglutarate dehydrogenase

Answer 1542

``` Potentiates vasodilators (decrease meds) Increases insulin resistance (^meds) ```

Answer 1543

Renal toxicity Patients often require daily supplementation of potassium and magnesium.

Answer 1544

Splenomegaly

Answer 1545

Aneurysm or calcification of the internal carotid. It can compress the lateral side of the optic chiasm.

Answer 1546

Tramadol Ondansetron Linezolid

Answer 1547

Imperforate hymen | Müllerian duct abnormalities (back of vagina, uterus, fallopian)

Answer 1548

``` Serotonin (from tryptophan) NO (from Arg) Tyrosine (from Phe) Dopamine NE/EPI ```

Answer 1549

Anti-Phospholipase A2 (PLA2)

Answer 1550

^cAMP --> ^transcription (elevated in the absence of glucose) ^lactose --> ^transcription

Answer 1551

Shigella (10) Campylobacter (500) Entaoeba histolytic (1) Giardia (1)

Answer 1552

Exclusively in the cytoplasm

Answer 1553

Carbamoyl phosphate synthetase I | OTC

Answer 1554

Pulmonary edema Dehydration Contraindicated in CHF & anuria

Answer 1555

NMS - rigidity 5-HT - myoclonus Otherwise they are pretty similar (hyperthermia, autonomic dysfunction, altered mental status)

Answer 1556

Asthmatics that take steroids

Answer 1557

Macrosomia | Hypoglycemia (beta cell hyperplasia)

Answer 1558

1) Disorganized 2) Disinhibited 3) Apathetic

Answer 1559

Fever Pharyngitis Sandpaper-like rash Strawberry tongue

Answer 1560

Broken hip = fractured femoral head The medial femoral circumflex artery provides the majority of blood to the femoral head & neck. Injury can cause avascular necrosis of the femoral head.

Answer 1561

Intranuclear inclusions in keratinocytes | Multinucleate giant cells

Answer 1562

Cardiomegaly Pleural effusions Kerley C lines Vascular shadowing

Answer 1563

Gly-X-Y X & Y can be lysine or proline but glycine must be present every 3rd amino acid. Thus, it is the most prevalent.

Answer 1564

Carbamazepine

Answer 1565

1) Deficiency in Methylmalonyl-CoA mutase | 2) B12 deficiency

Answer 1566

Normal patient = 70's | Bicuspid aorta = 60's

Answer 1567

Bilateral retinal hemorrhages | Subdural hematoma

Answer 1568

"OPAS" ``` Oxytocin = Paraventricular ADH = Supraoptic ```

Answer 1569

Proteins that modify ADH & OXY as they are being transported to the posterior pituitary within vesicles. They are released along with the hormones into the hypophysial vein --> systemic circulation.

Answer 1570

IL-12 receptor deficiency IFN-gamma receptor deficiency Patients require lifelong treatment with antimycobacterial agents.

Answer 1571

Methemoglobin cannot bind O2 The remaining ferrous iron in the Hb molecule has a higher affinity for O2, causing a left shift.

Answer 1572

Mucinous adenocarcinoma of the pancreas Adenocarcinoma of the lung These cancers produce mucin & are associated with a hypercoagulable state. This is the same pathogenesis as Trousseau's sign.

Answer 1573

"AIDS" Amiodarone Ibutilide Dofetilide Sotalol

Answer 1574

Class Ia & Class III

Answer 1575

^CPK levels | Myopathy

Answer 1576

Listeria Staph aureus GAS GBS

Answer 1577

Patent foramen ovale seen in 20-30% of normal adults Normally held closed by LA >> RA pressures

Answer 1578

Fatigue (anemia) Constipation (hypercalcemia) Bone pain Renal failure

Answer 1579

Fibrin They produce dextrans from sucrose. These aid their adherence to fibrin at sites of endothelial damage.

Answer 1580

Skin, liver, & intestine

Answer 1581

IV Fluids Allopurinol Rasburicase - recombinant urate oxidase (converts urate to allantoin, which is 10x more soluble)

Answer 1582

Inter-chain crosslinking of lysine residues This is performed by extracellular lysyl hydroxylase

Answer 1583

It is a CCR5 receptor inhibitor Prevents viral attachment of HIV

Answer 1584

As a non-amphetamine daytime stimulant in narcolepsy It is a CYP450 inducer

Answer 1585

Tetrahedral | envelope

Answer 1586

Coffin lid

Answer 1587

1) Desmopressin | 2) Imipramine

Answer 1588

CD15, CD30

Answer 1589

8urkitt's = t(8;14) Mantle ce11 = t(11;14) Follicular = Fourteen eighteen = t(14;18)

Answer 1590

>20% blasts = acute

Answer 1591

t(12;21) --> Good prognosis; seen in children t(9;22) --> Philadelphia+ ALL; Poor prognosis; seen in adults

Answer 1592

APL (M3 form of AML) Auer rods can cause DIC. Thus, it can also occur following treatment.

Answer 1593

APL Give ATRA

Answer 1594

Acute monocytic leukemia

Answer 1595

When CML accelerates and transforms into AML or ALL.

Answer 1596

Uremic patients (dialysis, etc.) show normal PT, PTT, & platelet counts but an increased bleeding time. There are dialyzable platelet inhibitory factors responsible for this, thus it will improve following dialysis.

Answer 1597

Anteriorly the 4th rib = horizontal fissure (Right side only) The 6th rib = oblique fissure

Answer 1598

Between the internal oblique & transversus abdominus muscles. All of the deep abdominal wall arteries & nerves lie here.

Answer 1599

Inferior thyroid artery RLN can be damaged during thyroidectomy

Answer 1600

Amiloride Triamterene Spironolactone Eplerenone

Answer 1601

Fibrates > Niacin

Answer 1602

Statins > Ezetimibe

Answer 1603

It is an opiate anti-diarrheal It is combine with atropine to prevent abuse (unpleasant anti-cholinergic effects)

Answer 1604

Permethrin or Pyrethrin

Answer 1605

The RCA supplies BOTH the SA node & AV node. The LAD supplies the bundle of his (supplies anterior 2/3 of the interventricular septum)