Correct and Incorrect Flashcards
1
Q
Symptoms
Acute intermittent porphyria
A
Abdominal pain and neurologic symptoms due to a buildup of d-Ala and porphobolinogen
2
Q
Inheritance
Acute intermittent porphyria
A
Autsomal dominant. Caused by porphobilinogen deaminase deficiency
3
Q
Treatment for acute intermittent porphyria
A
IV heme products which will downregulate aminoallevulinate synthase
4
Q
Triggers for acute intermittent porphyria
A
Low calorie diet, alcohol use, smoking, phenobarbital, phenytoin
5
Q
The ureteric bud (metanephric diverticulum) is responsible for making which parts of the kidney?
Embryology
A
All of the collecting parts of the kidney
Ureter, collecting ducts, renal pelvis, major and minor calyxs
6
Q
The metanephric mesenchyme receives signals from the ureteric bud to grow what part of the kidney?
A
Starting with the distal tubule, it makes the remaining of the working part of the kidney to the glomerulus.
7
Q
What is the pathophysiology behind an allergic reaction to a blood transfusion? (Happens within minutes)
A
Self antibodies reacting to IgA on the blood products
8
Q
What is the pathophysiology behind acute hemolytic reaction to a blood transfusion? (Happens within minutes)
A
Self antibodies against ABO of the blood product
9
Q
What is the pathophysiology behind acute lung injury after a blood transfusion? (Happens within hours)
A
The donor blood products have antibodies against the patient
10
Q
What is the pathophysiology behind a delayed hemolytic reaction after a blood transfusion? (Happens within days)
A
Self antibodies react against blood product minor antigens (Not ABO)
11
Q
Marfan Syndrome
1. Inheritance, chromosome
2. Substance impacted
3. Symptoms/manifestations
A
- Autosomal dominant, chromosome 15
- Fibrillin-1 (forms sheath around elastin fibers in blood vessels)
- Myxomatous degeneration in the media of the blood vessels –> aortic dissection. Marfan habitus (long body, long fingers)
12
Q
Ehlers-Danlos Syndrome
1. Substance impacted
2. Symptoms/manifestations
A
Connective tissue disorder that effects processing of collagen.
Several types: Lysine-hydroxylysine, Type III collagen, Type V collagen. Each type has different manifestations.
13
Q
Abnormalities - definitions
Association
Disruption
Syndrome
Sequence
A
Association - symptoms are seen together but without a common cause
Disruption - physical factor that disrups normal growth
Syndrome - symptoms are seen together with a common cause
Sequence- symptoms seen together as a result of an initial abnormality
14
Q
Role of
Type I pneumocytes
Type II pneumocytes
A
Type I - forms the wall of the alveoli and do gas exchange
Type II - forms surfactant
15
Q
Preterm baby with respiratory distress due to lack of surfactant formation would show what on chest x-ray?
A
Ground glass opacities and atelectasis which is the collapse of the alveoli
16
Q
Inheritance of hereditary pulmonary hypertension
A
Autosomal dominant inactivating mutation of BMPR2 which leads to excessive endothelial injury and smooth muscle proliferation in the pulmonary artery
17
Q
Heart sounds meaning
S1
S2
S3
S4
A
S1 - mitral and tricuspid valves closing
S2 - pulmonic and aortic valves closing
S3 - sudden stop of blood flow into the left ventricle due to elevated blood volume in the left atrium (mitral regurgitation
S4 - after the atrial kick, reflects blood colliding with a stiff ventricle wall
18
Q
Leukocyte esterase in a urine sample is indicative of what?
A
An infection. Leukocyte esterase is released by lysed neutrophils/macrophages
18
Q
Zika virus is double stranded or single stranded?
DNA or RNA
A
Single stranded RNA Flavivirus
19
Q
CMV, HSV, VZV are all double stranded or single stranded?
DNA or RNA?
A
Double stranded DNA
20
Q
Which part of the brain is effected in Parkinson’s Disease?
A
Substantia Nigra
21
Q
“Wilson eats his Lentils”
What part of the brain is effects in Wilson’s Disease?
A
Lentiform nucleus
22
Q
“I’m hunting cod”
What part of the brain is effected in Huntington’s Disease?
A
Caudate Nucleus
23
Q
Gram positive bacilli with filamentous branching that is associated with mandibular abscess
A
Actinomyces israelii
24
E. Coli virulence factor that facilitates meningitis in neonates
K1 Capsule
25
E. Coli Virulence factor that causes bloody diarrhea
MOA?
Shiga Toxin
Inactivates 60S subunit halting protein synthesis and causing cell death --> bloody diarrhea
26
**Pneumocystic jirovecii** and **histoplasma capsulatum** are opportunistic infections in HIV patients with a CD4 count below what?
Less than 200 cells/mm
27
**Cryptococcus neoformans** and **Toxoplasma gondii** are opportunistic infections in HIV patients with a CD4 count below what?
Less than 100cells/mm
28
Mycobacterium avium complex and CMV is an opportunistic infection in HIV patients with a CD4 count below what?
Less than 50
29
What fungus is found using India staining?
Cryptococcus neoformans - opportunistic meningitis infection in HIV patients that causes meningitis.
Histology: spherical yeast forms with thick capsules.
Route: Inhalation from bird droppings
30
# Certain Bugs Really Try my Patience
Giemsa staining is used to see what infections?
H. Pylori
Chlamydia
Borrelia (Lyme)
Rickettsia
Trypanosomes
Plasmodium (malaria)
31
Toxoplasma gondii causes what symptoms in HIV patients?
Ring-enhancing focal lesion in the brain
32
What medication is use to prophylactically treat HIV patients for pneumocytis jirovecii, cryptococcus neoformans, and toxplasma gondii?
Pyrimethamine and sulfadiazine
33
What is the function of Protein A with Staph Aureus?
Binds to Fc portion of antibody which prevents opsonization
34
Influenza is:
Envoloped or non-enveloped?
Single stranded or double stranded?
RNA or DNA?
Envoloped, single stranded, negative-sense RNA orthomyxovirus
35
How is influenza transmitted?
What are the precautions to be taken?
Droplets.
Precautions - mask and gown, hand hygeine
36
Are adenovirus, rhinovirus, enterovirus, and poliovirus susceptible to hand sanitizer?
Why?
No. They are not enveloped
37
# SHIN
Which bacteria can cause meningitis after colonization of the nasopharynx?
Strep pneumoniae
Neisseria meningitidis
Haemophilus influenzae
38
Crytococcus neoformans is transmitted to humans from what exposure?
Bird droppins, inhalation
39
Apixaban is what class of medication?
Factor 10a direct inhibitor
This directly decreases the conversion of factor 2 (prothrombin) to thrombin
40
Renal disease has what effect on homeostasis?
It has major effect on platelet function. This will have negative effects on adhesion and aggregation. PT/PTT will be normal.
41
Pathophysiology of DIC
There is an excess of activation of the **intrinsic** cascade leading to an **increase of thrombin**.
The body counterreacts by increasing **fibrinolysis** (which leads to increased plasmin)
Because of the excessive activation, PT/PTT are prolonged and platelets are consumed.
42
Which medications are P450 inducers which impacts the activity of Warfarin
Phenytoin, pehnobarbital, St. John Wort carbamazepine, and rifampin.
This will increase the metabolization of Warfarin --> low INR
43
Which medications are P450 inhibitors which will impact the efficacy of Warfarin
Cimetidine, amiodarone, Metronidazole, grapefruit juice.
This will decrease the metabolization of Warfarin --> high INR
44
Beta oxidation, citric acid cycle, gluconeogenesis all happen in the mitrochondria or cytoplasm?
MItochondria
45
Glycolysis, fatty acid synthesis and the pentose phosphate pathway occur in the mitochondria or cytoplasm?
Cytoplasm
46
Transketolase uses what vitamin as a cofactor?
Thiamine (B1)
47
The amino acid most abundant in collagen
Glycine
48
Transamination reactions (moving a nitrogen) requires what cofactor?
B6 (Pyridoxine)
49
Alanine transfers nitrogen to what to form glutamate?
a-ketoglutarate
50
Hydroxylation of proline and lysine during collagen synthesis needs what cofactor?
Vitamin C. Deficiency leads to scurvy
51
GLUT-4 is the insulin-sensitive transporter that transports glucose inside of cells. GLUT-4 is found in which cells?
Skeletal muscle and adipocytes
52
GLUT-2 glucose transporter facilitates export of glucose from which organs?
Liver, small intestine, and kidneys
53
In a starved state, cortisol binds to intracellular receptors to do what?
Increase transcription of gluconeogenic enzymes as well as lipolysis and proteolysis to maintain blood sugar
54
Catecholamines and glucagon bind to what kind of receptor?
They bind extracellularly to G-protein receptors that activated adenyl cyclase and increased cyclic AMP
55
Growth hormone increases or decreases gluconeogenesis?
Increase
56
Medium chain acyl-CoA dehydrogenase deficiency is mostly asymptomatic until what trigger?
Fasting. It leads to an inability to oxidize fatty acids to maintain glucose and ketone body production --> hypoketotic hypoglycemia
57
Primary risk factor for thiamine deficiency
Malnutrituion (alcohol use, anorexia, gastric bypass)
58
Impaired pyruvate dehydrogenase activity due to B1 deficiency leads to an increase in what?
Lactate .. Since it can't make acetyl coA for the TCA cycle using pyruvate dehydrogenase
59
Symptoms of herediary orotic aciduria
Developmental delay, megaloblastic anemia, and elevated urinary orotic acid levels
60
Hereditary orotic aciduria is due to a defect in what enzyme?
Uridine UMP synthase which is used in de novo pyrimidine synthesis
61
Pyruvate carboxylase, acetyl-coA carboxylase, propionyl-coA carboxylase all need what cofactor?
B7 (biotin)
62
Pathway of Gq receptor
1. Phospholipase C activation
2. PLC hydrolyzes PIP2 into DAG and IP3
3. IP3 medates Ca release from SR and DAG sactivates protein kinase C
63
What are the 2 ketogenic amino acids that should be incorporated into the diet of a person with pyruvate dehydrogenase deficiency?
Lysine and Leucine. They completely bypass pyruvate and instead generates acetyl-CoA.
64
Which 2 labs are elevated in ornithine transcarbamylase deficiency?
Elevated urinary orotic acid and hyperammonemia
65
Hurler syndrome symptoms
intellectual disability, corneal clouding, coarse facial features
Early death by cardiac complications due to accumulation of heparan sulfate and dermatan in vessels
66
Hurler syndrome is caused by a deficiency of what enzyme?
alpha-L-iduronidase which hydrolyzes dermatan and heparan sulfate
67
Arginase deficiency is implicated in which cycle?
Urea cycle. It produces urea and ornithing from arginine. There is no hyperammonemia in this disorder
68
Steps of RAS pathway
1. Growth factor binds to tyrosine kinase receptor
2. GTP binding = activation
3. Ras phosphorylates MAPK
4. MAPK enterns nucleus --> gene transcription
69
Young child with a heart attack.. what is on the differential
Homocyteinuria. Homocysteine is prothrombotic and is usually due to a deficiency in cystathionine synthase
70
Conversion from homocysteine to methionine requires which cofactor?
Vitamin B12
71
Conversion of homocysteine to cystathionine and cystein requires which cofactor?
Vitamin B6 (pyridoxine)
72
Phospholipase C function vs Protein Kinase C function
Phospholipase C cleaves PIP to IP3 and DAG
Protein Kinase C phosphorylates downstream targets after calcium and DAG activate it
73
What is the allantois?
The connection between the bladder and umbilicus in utero. Failed obliteration can lead to a patent urachus
74
Gastroschisis is an incomplete closure of the abdominal wall resulting in herniation through the umbilicus or to the side of it?
GastRoschisis - Right side
Not covered by membrane, better prognosis
75
Patent vitelline (omphalomesenteric) duct results in what kind of drainage from the umbilicus?
Stool. It connects the midgut to the umbilicus
76
Describe the population characteristics:
Expansive
Stable
Constrictive
Expansive - very high birth rates, short life expectancies (small amount of old people)
Stationary - somewhat equal percentage of people in each age, long life expectancy. LOoks like normal
Constrictive - Significantly lower birth rates and long life expentancies
77
Diabetic neuropathy pathophysiology
Glycosylation of proteins results in hyalinazation of endoneurial arterioles --> ischemic nerve damage
Glucose --> sorbitol which promotes oxidative stress in the nerve
78
Accessory nipple pathophysiology
Incomplete involution of the mammary ridge. They can become larger during butery due to rising estrogen and progesterone
79
The sciatic nerve is derived from what nerve roots?
L4-S3
80
S1 radiculopathy/compression can lead to the absence of what reflex?
Achilles
81
Horner Syndrome symptoms
Unilateral ptosis and miosis (constriction) due to impaired sympathetic activity
82
Anterior cerebral artery strokes will result in motor and sensory deficits in what areas?
Contralateral lower extremities
83
Middle cerebral artery strokes will result in motor and sensory deficits in what areas?
Contralateral upper extremities
84
Posterior cerebral arteries supply which lobes of the brain?
Occipital lobes
Infarct of these arteries can produce blindness with confabulation and anosognosia (unaware)
85
Renal injury in rhabdomyolysis pathophysiology
Myoglobin is released from the damaged muscle. The filtration and degredation of the myoglobin causes acute tubular necrosis by cytotoxicity and renal constriction.
86
Anastrozole method of action
Aromatase inhibitor. Used in estrogen positive breast cancer, reduces the aromatization of androgens in the periphery
87
Cushing Syndrome is a paraneoplastic syndrome to what cancer?
ACTH secreting small cell lung cancer
88
Lab results of aspirin overdose
Metabolic alkalosis - increased ventilation
Anion gap metabolic acidosis - ketoacids and lactate in the blood
Normal pH
89
Low pH with elevated PaCo2
Respiratory acidosis
Due to respiratory depression seen in opioid overdose
Bicarb increases for metabolic compensation
90
High pH with high bicarb
Metabolic acidosis
Due to vomiting (gets rid of all the acid)
CO2 increases for respiratory compensation
91
Bicarb and CO2 decrease or increase for compensation
Increase
92
High pH with low PaCO2
Respiratory alkalosis
93
Rasburicase method of action
Used to help with tumor lysis syndrome
Converts uric acid into allantoin which is more soluble than uric acid
94
What are the percents for normal gaussian distribution
68 - 95 - 99.7
There is also 50% on either side of the mean
95
Ureteral obstruction results in what changes in GFR and filtration fraction
Decrease of both
96
Common bacterial causes of intraabdominal infections
B. fragilis
97
Symptoms of mercury intoxication
Sweating, insomnia, tremor, hypertension, rash
This is due to catecholamine excess because mercury inactivates the enzyme used for catecholamine breakdown
98
Seleneium toxicity symptoms
GI upset, hair loss
99
Bacteria most common to cause osteomyelitis in healthy children
Staph aureus
100
Is testosterone or DHT needed to differentiate into male external genitalia?
DHT
101
Is testosterone or DHT needed to form internal male genitalia?
Testosterone. Secreted by the Leydic cells
102
How to calculate the number needed to harm
1/(absolute risk increase)
103
Symptoms of reflux nephropathy
Recurrent pyelonephritis (dilated calyces with cortical atrophy) - renal scarring.
104
Posterior urethral valves occur in boys or girls
Malformation of wolffian duct = males
Due to a blockage out of the bladder
105
Cat scratch disease is caused by what organism
Bartonella henselae
This organism can also cause bacillary angiomatosis in immunocompromised patients
106
Symptoms of cat scratch disease
Tender regional lymphadenopathy, especially axillary
107
Glossopharyngeal nerve (IX) functions
Elevates larynx during swallowing (stylopharyngeus muscle)
Inner ear, gag reflex, carotid body, and carotid sinus
Posterior third of tongue taste
108
The anterior tongue taste sensation is supplied by which cranial nerve
Facial nerve (7)
109
Protrustion of the tongue is supplied by which cranial nerve
Hypoglossal (12)
110
Falsification vs malingering
Factitious = wanting to be a patient. Yes to invasive procedures
Malingering = wanting a reward. NO invasive procedures
111
Sjogren syndrome
Autoimmune disorder of the exocrine glands (salivary, lacrimal)
Histology shows periductal lymphocytic infiltrates with germinal centers
112
Shigella toxin symptoms
fever, abdominal pain, bloody diarrhea
113
Enterotoxigenic E. Coli causes bloody or watery diarrhea
Watery (travelers)
114
How do bisphosphonates (risedronate) help improve osteoporosis?
Inhibits osteoclast-mediated bone resorption by inducing osteoclast apoptosis
115
Taking ARBs during pegnancy leads to what complications
Abnormal fetal renal development. This will lead to oligohydraminos (low fluid)
116
Do stem cells or permanent cells have long telomeres?
Stem cells because they diffrentiate alot
117
Cocaine overdose symptoms
Sympathomimetic
Hyperthermia, tachycardia, cardiac arrhymias, hypertension, sweating
118
Serotonin syndrome symptoms
Hyperthermia, tachycardia, sweating, hypertension, hyperreflexia
119
Tricyclic overdose symptoms
Sympathomimetic/anticholinergic
Dilated pupils, hyperthermia, tachycardia, decreased bowel sounds, urinary retention. QRS widening, hypotension (a1 blockage = vasodilation)
120
Alveolar macrophages with golden-brown cytoplasmic granules that turn dark blue with Prussian blue staining
The macrophages phagocytosed red blood cells. The Prussian blue stain shows iron from the RBCs. This is indicitave of heart failure
121
Opioid intoxication causes constricted or dilated pupils
Constricted
122
Opioid intoxication causes hyperthermia or hypothermia
Hypothermia
123
Treatment for scabies
Topical permethrin
124
Floppy baby with diminished gag reflex after eating honey
Due to infant botulism (clostridium botulinum) which then inhibits presynaptic acetylcholine release
Constipation, weakness, weak cry, flaccid paralysis
Must test the stool for toxin
125
Noise induced hearing loss is due to damage to what part of the ear?
Trauma to sterociliated hair cells of the Organ of corti
126
Which part of the ear registers low frequency sound
Cochlear cupula
127
Best way to handle somatic symptoms disorder
Schedule regular outpatient office visits for stress reduction
128
hCG and inhibin are decreased or increased in down syndrome
Down syndrom is HI up
Both hCG and inhibin are high
129
Most common cause of prostatitis in older men
E. coli
130
Male gonadal arteries aries from which artery?
The abdominal aorta
131
Does the internal or external inguinal artery become the femoral artery?
External
132
Doxazosin, prazosin, and terazosin block what receptor?
a1- adrenergic
133
Doxazosin, prazosin, and terazosin are a1 adrenergic receptor blockers. This aids in what conditions?
BPH and HTN
It causes smooth muscle relaxation of the bladder and smooth muscle in the walls of arterioles
134
Testes descend into the scrotum through what physiologial opening?
Opening in the external oblique aponeurosis (superficial inguinal ring)
135
The testes enter the inguinal canal through the deep inguinal ring or superficial?
Deep inguinal
Then after it goes through the superficial ring to get to the scrotum
136
Ovarian tumor with oily substance that has thyroid tissue
Mature teratoma which is germ cell
137
3 types of ovarian tumors
Epithelial
Germ cell - egg
Sex stroma - theca/granulosa
138
Clue cells are found in what vaginal condition?
Bacterial vaginosis
Gray, fishy discharge
Epithelial cell covered with bacteria
139
Having an erection is under control of sympathetic or parasympathetic control?
Parasympathetic
140
Which ligament carries ovarian vessels?
Suspensory ligament (infundibulopelvic ligament)
141
Proteus mirabilis can cause UTI in men. This would result in acidic or basic urine?
Basic >8 pH
142
UTI with enterococcus faecalis would result in positive or negative nitrites?
Negative
143
Testicular cancer is most likely to spread via lymphatics to which lypmph group?
Para aortic
144
Letrozole, anastrozole are what kind of medications?
Aromatase inhibitors
This will decrease decrease estrogen = less negative feedback on GnRH
145
Clomiphene MOA
Bind to estrogen receptors on hypothalamus leading to decreased feedback on GnRH
146
Pain with sex, abdominal pain with menstruation, regular periods, not getting pregnant
Endometriosis
147
