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STEP1 Uworld > Deck 1 > Flashcards

Deck 1 Flashcards

0
Q

Do a card for AD and AR diseases etc

A
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1
Q

Absolute contraindications for OCPs

A
  1. Hx of thromboembolic event or stroke
  2. Hx of E2 dependent tumor
  3. women over age 35 who SMOKE
  4. High Triglycerides
  5. Active or decompensated liver dz
  6. Pregnancy
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2
Q

Effect modification?

A

When the effect of the main exposure is modified by the presence of another variable

  • NOT a bias
  • how is it different than confounding?
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3
Q

reaction formation vs altruism vs sublimation

A

RF - excessive, opposite reaction from feelings

Altruism - helping others to alleviate guilt and low self esteem

Sublimation - channeling unacceptable impulses into productive activity

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4
Q

Blood gas at high altitudes?

A
  • PaO2 decreases to 60 or less
    * stimulates carotid and aortic chemoreceptors—> incr ventilation
  • leads to hyperventilation and RESP ALKALOSIS (low PaCO2)
  • incr blood pH
  • Low Bicarb as renal compensation
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5
Q

Femoral hernia anatomy

A
  • below inguinal ligament
  • thru femoral ring
  • lateral to pubic tubercle
  • medial to femoral artery and vein

*present with pelvic pain, thigh mass. if incarceration: N/V abd pain, etc

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6
Q

Clue cell vs Koilocyte

A
  • Clue: BV, squamous cell covered with bacilli
  • Koilocyte: HPV infection, immature squamous cell with dense, staining cytoplasm and peri-nuclear clearing. looks like HALO
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7
Q

What enzyme is INCREASED in Lesch-Nyann?

A
  • PRPP

- to compensate by increasing de novo purine synthesis

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8
Q

histoplasma infxn: sx and cell appearance

A
  • in immunocompromised: HSM, ulcerated tongue lesions, pulm infiltrates causing SOB, hilar adenopathy, cavitary upper lobe lesions, fever, wt loss etc
  • Cell: small ovoid bodies within macrophage
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9
Q

Underlying pathophys in Beta-thalassemia? Smear?

A
  • Defective transcription, processing, and translation of beta-globin mRNA
  • microcytic anemia, target cells, incr Hgb F and A2
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10
Q

drugs causing myopathy:

A
  • Statins
  • fibrates
  • niacin
  • hydroxychloroquine
  • glucocorticoids
  • colchicine
  • IFN-alpha
  • Penicillamine
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11
Q

Vincristine side effect and mechanism?

A
  • Mech: microtubule inhibition, M-phase specific agent

- Neurotoxicity

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12
Q

Bone findings in primary hyperparathyroidism?

A
  • Subperiosteal thinning

- cystic degeneration

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13
Q

kid with grey pharyngeal exudates, unvaccinated? What agar does it grow in?

A
  • C. Diptheriae

- Tellurite agar….can also be detected on microscopy after methylene blue staining

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14
Q

Non-bacterial thrombotic endocarditis (NBTE)

A

hypercoagulable state

  • cardiac valve vegetations
  • similar to trousseau’s syndrome (migratory thrombophlebitis)
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15
Q

Prinzmetal’s angina

A
  • episodic, transient anginal CP
  • occurs at night and at rest
  • temporary ST-segment elevations
  • vasospasm

-Test: ergonovine…diagnostic:
constricts vascular SM via alpha stim and serotonergics as well. causes CP and ST segment elevation

Tx: CCBs

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16
Q

What are charcot-bouchard psudoaneurysms?

A
  • Aneurysms caused by hypertension in the brain
  • usually in small arterioles that penetrate the basal ganglia
  • cause intracerebral hemorrhage, vs SAH in saccular aneurysms
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17
Q

Drug of choice for GDM?

A

-Insulin

avoid oral hypoglycemics bc they can cross placenta and cause hypoglycemia, hyperinsulinemia

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18
Q

What tx for severe allergic asthma has been shown to decr exacerbation recurrence? Mechanism?

A
  • Omalizumab
  • anti-IgE antibody subQ injection
  • for use in pts with severe asthma, on oral steroids
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19
Q

How to workup metabolic alkalosis:

A
  • Volume status
  • Urine Cl
  • Vomiting and diuretics = saline and Cl responsive
  • Mineralocoticoid excess = saline and Cl UNresponsive
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20
Q

In hemophilia, addition of ______to blood will lead to clotting: why?

A
  • Thrombin
  • No 8 or 9 = no 10a
  • No 10a = no conversion of prothrombin to thrombin —> decr thrombin
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21
Q

What is intrapleural pressure at FRC?

A

negative 5 mmHg

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22
Q

Pathophys in HbS disease?

A
  • Valine in place of glutamate in 6th AA position of Beta subunit
  • promotes hydrophobic interaction between Hgb molecules
  • polymerization of Hgb —> RBC distortion (sickling)
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23
Q

What happens to volume-pressure curve in AV shunts?

A
  • Vol incr due to incr preload

- Pressure decreases due to decr afterload

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24
Q

defective enzyme in galactosemia?

A
  • Galactose-1-phosphate uridyl transferase

- cant go from G-1-P to UDP-galactose

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25
Q

What is the tx for Bblocker overdose? Mechanism?

A
  • Glucagon

- incr cAMP in cardiac myocytes –> incr Ca –> incr contractility and HR

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26
Q

Blood levels of ______ correlate with morbid/mortality of neisseria meningitidis infxn?

A

LOS

-Lipooligosaccharide on the outer membrane (endotoxin)

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27
Q

What nerve levels make sciatic nerve? Which level for ankle-jerk reflex?

A
  • L4-S3
  • S1 (purely posterior thigh and leg pain, plabtar flexion weakness, loss of ankle jerk)
  • L5 = post and lateral thigh and leg pain, shooting to inner foot
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28
Q

How is isoniazid, dapsone, hydralazine, procainamide metabolized?

A
  • Acetylation via N-acetyl transferase (NAC)

- Bimodal (some fast metabolizers, some slow)

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29
Q

What muscles allow you to sit up without hands?

A
  • External obliques
  • rectus abdominus
  • hip flexors: iliopsoas (psoas maj and min, iliacus)
  • rectus femoris, sartorius, IT band also help
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30
Q

What is thiopental used for and how does it work?

A
  • induction of anesthesia
  • rapid acting barbituate…accumulates in the brain within 1 minute —> LOC
  • subsequently is rapidly redistributed to muscle and adipose tissue –> declining plasma levels —> regain conciousness
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31
Q

Manifestations of friedrich’s ataxia

A
  • cerebellar ataxia
  • loss of position and vibration
  • Kyphoscoliosis
  • Hypertrophic cardiomyopathy
  • high plantar arch
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32
Q

Levels of Androgen, LH, FSH in PCOS?

A
  • high
  • high
  • normal

*incr LH/FSH ratio > 3

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33
Q

What type of collagen is found in scarring of myocardium?

A

Type 1: bone, skin, tendon

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34
Q

Inheritance of androgenic alopecia (male pattern baldness)?

A
  • polygenic inheritance

- variable penetrance

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35
Q

Middle meningial artery is a branch off of the _______

A

Maxillary

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36
Q

Which enzymes are deficient in narcolepsy?

A
  • hypocretin 1 and 2 (Orexin A and B)

* Measure in the CSF….undetectable levels

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37
Q

What chromosome is affected in hemochromatosis? inheritance? effect?

A
  • chromosome 6
  • ?
  • increased iron absorption in gut
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38
Q 
immunofluorescence = linear deposits in GBM
LM = crescents
A
  • anti-GBM dz, aka GOODPASTURES
  • igG and C3 deposits vs alphaa 3 chain of type 4 collagen
  • nephritic syndrome + hemoptysis
  • middle aged?
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39
Q

What markers are clue for NTD?

A
  • AFP (elev in amniotic and mom’s serum as well)

- Acetylcholinesterase

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40
Q

Describe the PI3K/Akt/mTOR pathway…

A

Growth factor pathway:

  1. GF binds to its rec-tyrosine kinase
  2. autophosphorylation
  3. These activate PI3K
  4. PI3K P-lates PIP2 –> PIP3 (plasma membrane)
  5. Activation of Akt, or protein kinase B (serine/threonine kinase)
  6. Akt activates mTOR –> translocation to nucleus
  7. Induces genes involved in cell survival, anti-apoptosis, angiogenesis
  • mTOR inhibited by PTEN (removes P from PIP3)
  • many cancers have overactivation of this system or inactivation of PTEN
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41
Q

Little girl with ambiguous genitalia (clitoral enlargement, labial fusion), high BP, Hypokalemia?

A

11-Beta-hydroxylase deficiency

  • 2nd most common form of congenital adrenal hypoplasia
  • 21-hydroxylase presents with HoTN and hyperkalemia
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42
Q

What value depicts the potency of an inhaled anesthetic?

A

MAC

  • minimal alveolar concentration
  • conc of anesthetic in the alveoli that renders 50% of pts unresponsive to painful stimuli
  • Potency is inversely proportional to MAC (lower MAC = higher potency)
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43
Q

Concentration of what substances increase as fluid runs along renal tubules?

A
  • PAH
  • Creatinine
  • Inulin
  • Urea

*bicarb, glucose, and AAs decrease (bc they get reabsorbed)

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44
Q

Serotonergic neurons are only found in the _______ nuclei, and project all over the CNS

A

Raphe

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45
Q

What is the main site of digestion of lipids? Main site of absorption?

A
  • Digestion = duodenum

- absorption = Jejunem

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46
Q

How does diphtheria immunization work?

A

Induces production of IgG vs exotoxin B circulating protein
-exotoxin B binds and allows exotoxin A to enter cells and inhibit ribosome function

*clinical sequelae: oropharynx (grey) –> cardiotox and neurotox

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47
Q

Alkaptonuria

A

-Black urine
-black pigment in ears, nose, cheeks
Mech:
-Deficiency of homogentisic oxidase –> incr homogentisate –> has black pigment in urine etc

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48
Q

Chi square test

A

used to test association between 2 categorical variables

  • ex: # of patients with ____ in group A vs group B
  • for actual values/means…use t or Z test
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49
Q

Psuedomonas is a __________ fermenter , oxidase _______, motile/non-motile?, Gram_____ rod

A
  • Non-lactose fermenter
  • oxidase positive
  • motile
  • Gram negative rod
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50
Q

Pantothenic acide, or vit B5 is biologically active as ______. An example of its use is _____

A
  • Coenzyme A

- Binds with Oxaloacetate to form citrate in first step of TCA cycle!

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51
Q

What is use for succinylcholine and how does it make a train of four response curve look?

A

-Depolarizing NMJ blocker
-used for rapid sequence induction and intubation
-train of 4 is used to assess degree of muscle relaxation
phase 1: shows sustained and equal reduction in all 4 phases
phase 2: fading pattern, reduction in each subsequent phase (down-step) In phase 2, cholinesterase inhibitors can rapidly reverse NMJ blockade (neostigmine)

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52
Q

How do fatty acid oxidation inhibitors work? and what are they used for?

A
  • inhibit oxidation and shift energy production to glucose oxidation, thus promoting oxygen efficiency (less O2 use per one ATP synthesized)
  • decreases amount of O2 required for cardiac myocytes
  • decreases toxic FA metabolites
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53
Q

Describe the Ras-MAP kinase pathway

A
  1. GF binding –> autophosphorylation
  2. Ras activation by P-lation of GDP to GTP attached to Ras
  3. Ras activates Raf kinase
  4. Activation of MAP kinase
  5. MAP kinase enters nucleus to influence transcription
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54
Q

What type of virus is CMV? What do infected cells look like on histo?

A
  • Enveloped, ds DNA

- Enlarged, centrally located epithelial cells with intranuclear and cytoplasmic inclusions

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55
Q

Ether and other organic solvents can impair infectivity of what type of viruses?

A

Enveloped

-Dissolves lipid bilayer that makes up envelope

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56
Q

Occlusion of the Anterior cerebral artery causes ______

A

LE weakness, sensory loss, etc

-Bc it supplies medial aspect of cortex, near midline. Like a mohawk

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57
Q

What drug do you use for HTN in a patient with bradycardia and prolonged PR interval?

A
  • Nifedipine
  • Selective peripheral action –> periph vasodilation –> reflex tachy….so good for bradycardia
  • Wont affect AV node unlike verapamil, diltiazem, and metoprolol
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58
Q

What structures arise from the Müllerian ducts? Features of mullerian agenesis?

A
  • tubes, uterus, cervix, upper vagina

- Amenorrhea, normal secondary sex char., weird vagina and/or uterus

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59
Q

About 2/3 of filtered K+ is reabsorbed in the _______. An additional 24-30% is reabsorbed in the ________

A
  • proximal tubule
  • Thick ascending limb of loop of henle

**EVEN IN HYPERKALEMIC STATES. The change in hyperK occurs distally, at the principal and alpha-intercaleted cells of the distal tubules and collecting ducts. They can secrete/reabsorb accordingly

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60
Q

What 2 enzymes are required for gluconeogenesis? and what is the reaction?

A
  • Pyruvate carboxylase
  • PEPCK

reaction: Pyruvate –> PEP (phosphoenoylpyruvate)
* requires GTP

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61
Q

What is the relationship between blood flow and vessel radius?

A

Flow is directly proportional to vessel radius^4th power

-Ex: radius decrease by 1/2 = decr flow by 16x

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62
Q

Mech of hartnup disease? result? clinical feature? Lab findings?treatment?

A
  • Defective intestinal and renal absorption of tryptophan
  • Niacin deficiency (tryptophan is precursor for niacin)
  • Usually Asx, but can have pellagra-like presentation along with neuro stuff like ataxia
  • Aminoaciduria (except for proline, hydroxyproline, and arginine**….unlike fanconi)
  • Tx = Nicotinic acid or nicotinamide and high protein diet
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63
Q

What makes snRNPs? and where?

A
  • RNA polymerase II

- nucleus

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64
Q

In CAH, most common enzyme deficiency is ________. This creates incr levels of _______, due to inability to convert _______.

A
  • 21-Hydroxylase
  • 17-hydroxyprogesterone
  • Prgesterone –> 11-deoxycorticosterone
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65
Q

Damage to the neck of the fibula can damage the ______ nerve, leading to problems with _______

A
  • Common peroneal nerve
  • weakness of dorsiflexion
  • weakness of eversion
  • loss of sensation over dorsum of the foot

*inversion and plantar flexion intact bc tibial nerve is intact

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66
Q

What anti-epileptic causes generalized lymphadenopathy? Mechanism? Uses?

A
  • Phenytoin
  • reduces Na+ channels’ ability to recover from inactivation –> incr refractory period
  • seizure ppx following trauma or before neurosurgery

*limited use bc of: hirsutism, acne, skin rash, gingival hypertrophy)

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67
Q

What drug acts as a partial agonist/weak antagonist of mu opioid receptors?

A
  • Pentazocine

- Little abuse potential, but bc of this can precipitate withdrawal in pts with existing opiate dependence etc

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68
Q

What anxiolytic has reduced abuse potential, minimal hypotonia, minimal sedation, and minimal euphoric effects?

A
  • Buspirone

- Non-sedating, serotonin agonist. Good for ppl with hx of abuse

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69
Q

What conditions cause polyhydramnios?

A
  • Decr fetal swallowing: GI obstruction, Anencephaly

- Incr urine production: High CO from anemia,twin-twin transfusion syndrome

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70
Q

How do you calculate odds ratio (OR)?

A

construct 4x4 table

-OR = AD/CB

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71
Q

What is drug of choice for Paroxysmal SVT? Side fx? Other use?

A
  • Adenosine
  • flushing, chest burning, HoTN, high grade AV block
  • Chemical stress test!
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72
Q

Which AAs have 3 titratable H+’s

A
  • Histidine, arginine, Lysine (HAL)

- Also aspartic acid, glutamic acid, cysteine, tyrosine

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73
Q

What antiviral can cause bone marrow suppression? What about an HIV drug?

A
  • Gancyclovir

- Zidovudine

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74
Q

What are clinical and lab abnormalities in patient with primary hyperaldosteronemia?

A
  • HTN
  • Low K+
  • metabolic alkalosis
  • low renin
  • normal sodium (aldosterone e
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75
Q

What type of vaccine promotes prolonged synthesis of mucosal IgA?

A

-Live attenuated

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76
Q

what are 3 ways in which Down syndrome can occur?

A
  1. meiotic non-disjunction
  2. robertsonian translocation
  3. mosaicism
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77
Q

Name 2 drugs that can cause drug-induced luppus or exacerbate lupus? How are they metabolized?

A
  • Hydralazine and procainamine
  • Acetylation in the liver

*create histone antibodies

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78
Q

Which drugs affect PT? PTT? Both?

A
  • extrinsic
  • intrinsic
  • Direct 10a inhibitors (apixaban, rivaroxaban) (does not affect Thrombin time)
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79
Q

What protein from bacteria facilitates mucosal penetration? Which prevents complement-mediated cell lysis?

A
  • IgA protease (Neisseria men and gon)

- Staph protein A (binds to Fc region of IgG

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80
Q

What is responsible for Ca efflux from cardiac myocytes just before relaxation? what about initiation of contraction cycle?

A
  • Ca/Na exchanger

- Voltage-dependent Ca channels (ryanodine receptors amplify via SR)

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81
Q

What is genome recombination?

A
  • Between 2 defective viruses co-infecting same host

- gene exchange that occurs through crossing over of 2 ds DNA molecules

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82
Q

Chronic granulomatous disease pathophys and features:

A
  • Genetic defect in NADPH oxidase (impaired intracellular killing)
  • recurrent bacterial and fungal infections
  • Diffuse granuloma/abcess formation
  • Catalase + bugs responsible: Staph A, Burkholderia, serratia, Nocardia, Aspergillus
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83
Q

Which bacteria produces Alpha toxin? how does it work?

A
  • C. perferingens
  • toxin aka Lecithinase
  • It decrades lecithin, destroying cell membranes (necrosis, hemolysis)
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84
Q

What is drug of choice for tx of drug-induced parkinsonism?

A
  • Benztropine or amantadine

- Dont use Levodopa or carbidopa bc they can precipitate psychosis

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85
Q

What is the cell type lining bronchi epithelium?

A
  • pseudostratified columnar, ciliated

- Eventually changes to simple cuboidal ciliated distally

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86
Q

What receptors are found on pancreatic Beta cells, and what are results of stimulation?

A
  • Alpha 2 : inhibits insulin secretion
  • Beta 2: stimulates insulin secretion

*Epinephrine works on both, but alpha effect predominates

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87
Q

Which family of enveloped viruses obtain their envelope by budding through the host’s NUCLEAR membrane, rather than plasma membrane?

A

-Herpes viruses (including CMV)

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88
Q

What is a normal A-a gradient?

A

10-15
-Alveolar - arterial O2

  • hypoxemia with normal A-a gradient = hypoventilation or inspiration of low PO2 (altitude)
  • hypoxemia with incr gradient = diffusion impairment or V/G mismatch
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89
Q

What is the net production of the HMP shunt? (from 1 glucose)

A
  • 5 carbon sugar (ribose-5-P)
  • 2 molecules of NADPH
  • CO2
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90
Q

Patient with bleeding has prolonged BT, prolobged PTT, NORMAL platelet aggregation in response to ADP, and DECR platelet aggregaton in response to RISTOCETIN. DIagnosis?

A

Von-willebrands

-Hereditary GP 2b/3a has opposite effects (normal Ristocetin, impaired ADP)

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91
Q

Diagnosis in a patient with PKU who has decr dopamine levels (Incr prolactin) with possible neuro Sx, despite adequate dietary changes and normal phenylalanine level?

A

Dihydrobiopterin deficiency
- enzyme for Tyrosine –> DOPA —–> (eventually dopamine, NE, Epi)

*AKA atypical PKU

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92
Q

What is Isoniazid’s mechanism of action? How does TB develop resistance to it?

A
  • Inhibition of mycolic acid synthesis by TB
  • Since Isoniazid must be processed by mycobacterial catalase-peroxidase, resistance is accomplished by non-expression of the catalase-peroxidase enzyme
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93
Q

How does blood arrive to the fetal circulation?

A
  • Through the umbilical vein –> Ductus venosus

- *remnants: ligamentum teres –> ligamentum venosum

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94
Q

What is the most notable side effect of ethambutol?

A

-Optic neuritis: color blindness, scotoma, decr visual acuity

other TB drugs (RIP) all affect Hepatic function potentially

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95
Q

What glands secrete sweat into hair follicles in the areola, axilla, and genital regions….and can cause odor 2/2 bacterial breakdown?

A

-Apocrine

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96
Q

What cell type moves to areas of brain infarct at 3-5 days, and contain high amounts of lipids from phagocytosis of myelin, etc?

A
  • Microglia

* Expect to see this at about a week after infarct on microscopy

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97
Q

Difference in skin test between Tuberculous and lepromatous leprosy?

A
  • tuberculoid: TH1 response –> IL-2, IFN-g, IL-12 in tissues —> limits disease
  • Lepromatous: Acid fast bacilli within macrophages in tissues, TH2 cytokine profile: IL-4, IL-5, IL-10, more widespread throughout the body…..SKIN TEST IS USUALLY NON-REACTIVE
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98
Q

DiGeorge results from maldevelopment of what embryonic structures?

A

-The 3rd and 4th pharyngeal (branchial) POUCH

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99
Q

What are some features of Anaplastic cells?

A
  • poorly differentiated –> very different from original tissue
  • high grade
  • disruption of tissue architecture, disorganized, infiltrative
  • Variation in size and shape
  • Large nuclei, deep staining
  • Mitotic figures abundant
  • Giant, multinucleated cells
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100
Q

What statistical test is used to compare the means of more than 2 groups?

A

-Analysis of variance (ANOVA)

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101
Q

What agent causing gastroenteritis is very sensitive to acid, and therefore is much more infectious with decreased stomach acid?

A

-Vibrio cholera

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102
Q

What organism affects immunocompromised individuals, most commonly causing meningitis, but potentially also pulm infxn……detected in lungs by mucicarmine staining…..shows budding yeast with thick capsules?

A

-Cryptococcus neoformans

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103
Q

What is Calcipotriene used to treat? And by what mechanism?

A
  • Psoriasis (topical)
  • Vitamin D analog, bind to Vit D receptor, activating nuclear transcription factors which inhibit keratinocyte proliferation and stimulate their differentiation
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104
Q

What DNA enzyme has 5’ to 3’ exonuclease activity? What does this function accomplish?

A
  • DNA polymerase I

- Removal of RNA primer ….also repairs damaged DNA

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105
Q

Describe what happens when blood flow is chronically decreased to a kidney:

A
  • Macula densa senses Decr GFR
  • Signals to nearby JG cells (modified smooth muscle cells)
  • JG cells secrete more renin
  • JG cells hypertrophy and hyperplasia if long term decr perfusion
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106
Q

What cytogenetic abnormality is associated with AML? CML?

A
  • AML: t(15;17)

- CML: t(9;22) (bcr-abl…philadelphia)

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107
Q

How does Heparin work?

A

-Indirect thrombin inhibitor…..increases effect of anti-thrombin-III when bound to it

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108
Q

What is the most bio-available oral Nitrate?

A
  • Isosorbide mononitrate

* nitorglycerin too if given sub-lingually….no orally (swallowed)

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109
Q

Where is tetrodotoxin found, and how does it work?

A
  • Puffer fish

- Binds to voltage-gated sodium channels, preventing influx and depolarization

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110
Q

What 2 things can reverse warfarin effects? which acts rapidly vs slowly?

A
  • FFP and vit K

- FFP fast….vit K slow

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111
Q

WHat makes HCV genetically unstable?

A

-It lacks 3’ –> 5’ exonuclease activity in its RNA polymerase. makes it prone to frequent mutation

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112
Q

What structures drain into the superficial inguinal nodes?

A

-all CUTANEOUS lymph from the umbilicus to the feet, including external genitalia and anus

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113
Q

How can you differentiate between pancytopenia caused by aplastic anemia vs myeloproliferative stuff like leukemia?

A

-Aplastic anemia = no hepatosplenomegaly

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114
Q

How does atrial myxoma present? what does it look lke on histo?

A
  • constitutional sx, mid-diastolic rumble, positional CV sx, embolic sx
  • Scattered cells within a mucopolysaccharide stroma, abnormal blood vessels, hemorrhaging
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115
Q

What is Lipofuscin?

A

product of lipid oxidation, accumulates in aging cells (especially in malnourished or cachectic patients)

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116
Q

Most common defect associated with imperforate anus?

A

-Genitourinary tract malformations

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117
Q

WHat vitamin is required to form Aspartate from Oxaloacetate + glutamate?

A

-B6 (transamination!)

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118
Q

What defect is seen in pts with familial dysbetalipoproteinemia?

A
  • They lack ApoE3 and ApoE4
  • Their Liver cant remove chylomicrons or VLDL remnants from circulation
  • Result = xanthomas and premature coronary and periph vascular disease
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119
Q

What antibiotic can induce serotonin syndrome? what is that antibiotic normally used for?

A
  • Linezolid (it is a weak MAO inhibitor)
  • serious gram+ infxns, particulary VRE and MRSA

*other drugs that can do the same: tramadol, odansetron

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120
Q

How does Vibrio cholerae cause diarrhea and what is seen on stool microscopy?

A
  • Cholera toxin (similar to heat labile toxin of ETC)
  • increases levels of cAMP in mucosal cells –> efflux of Cl and Na –> watery diarrhea

*DOES NOT penetrate cells –> no leukocytes or erythrocytes on microscopy, only mucous and epithelial cells

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121
Q

What substances increase gastric acid production? which of these also induces parietal cell proliferation?

*In what disease is incr acid secretion AND incr parietal cell proliferation seen?

A
  • Gastrin, Histamine, Acetylcholine
  • Gastrin

*Zollinger-Ellison syndrome

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122
Q

Direct inguinal hernias commonly occur in older men. They appear _____ the inguinal ligament, ________ to the inferior epigastric vessels, portrude through the _________, and are covered by _________.
They are caused by ________

A
  • Superior to inguinal ligament
  • Medial to inferior epigastrics
  • Portrude through only the external inguinal ring
  • Covered by external spermatic fascia
  • Weakness of the transversalis fascia
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123
Q

Describe effects of dopamine at different doses on vasculature:

A
  • Low dose: stimulates D1 receptors in renal vessels –> incr GFR + rbf
  • Higher doses: stimulates Beta-1 –> incr cardiac contractility
  • Higher still: stimulates alpha-1 is systemic vasc –> incr SVR –> incr afterload —> decr CO
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124
Q

What structures enter the orbit via the superior orbital fissure?

A
  • CN3
  • V1 (ophthalmic nerve….does afferent corneal reflex)
  • CN4
  • CN6
  • ophthalmic vein
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125
Q

In IP3 second messenger system….________ activates IP3 and DAG, then DAG activates ________ and IP3 causes _______

A
  • Phospholipase C activates IP3 and DAG
  • DAG activates Protein kinase C
  • IP3 releases Calcium from sarcoplasmic reticulum
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126
Q

H. Influenzae needs _____ and ______ to grow on agar? What other organism provides one of these things?

A
  • X factor (exogenous hematin)
  • V factor (NAD+)
  • Staph aureus provides NAD+, which it produces
  • in a culture medium w blood and staph….H influenza gets X factor from lysed RBCs, and V factor from staph A
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127
Q

What is the clinical presentation of an adrenal crisis?

A
  • No steroids

- HoTN, tachycardia, hypoglycemia, vomiting, abd pain, wt loss, hyperpigmentation

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128
Q

WHat are calcium, phosphorus, and PTH serum levels like in primary osteoporosis?

A

All NORMAL!!

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129
Q

WHat is the mechanism of action for anastrazole?

A
  • Aromatase inhibitor
  • decreased androgen aromatization to estrogen –> postmenopausal E2 levels
  • as good or better than tamoxifen
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130
Q

During continuous infusion of a drug metabolized by 1ST ORDER KINETICS, how many half-lives does it take to reach steady state?

A
  • 4 to 5
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131
Q

In statistics, what is power?

A

1-Beta

-probability of rejecting the null hypothesis when it is truly false

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132
Q

What adrenergic receptors are located on the Uterus? which ones in pupillary cilliary muscles?

*What drugs are used for tocolysis

A
  • Beta 2 in uterus: stimulation –> tocolysis (inhibits contractions)
  • Alpha 1 in eyes: contraction –> mydriasis

*Tocolytics: terbutaline and ritodrine (Beta 2 agonists)

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133
Q

in respiratory pathway….what is the cell type from nose –>sinuses–>nasopharynx–>most of larynx–>tracheobronchial tree?

A

-Pseudostratified, columnar, mucus-secreting epithelium

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134
Q

What are ways to screen vs diagnose syphllis?

A
  • Screening = non-treponemal tests (VDRL, RPR)

- Diagnosis: Treponemal tests (FTA-Abs, MHA-TP) OR Visualiation of spirochetes under darkfield microscopy

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135
Q

What structures in the neck derive from the 3rd pharyngeal pouch?

A
  • Thymus

- inferior parathyroid glands

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136
Q

Where do repressor proteins bind to lac gene?

A

Operator locus

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137
Q

What are the lab features of CML?

A
  • WBC > 50K
  • few blasts <10%
  • Neutrophil Alk Phos = Low
  • All types of granulocytic cells seen (myelocytes + neutrophils predom)
  • Bcr-abl t(9;22) Philly
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138
Q

What is the difference between a complete and a partial molar pregnancy?

A

Complete:

  • Sperm fertilizes empty egg, then duplicates –> 46XX
  • More severe sx, VERY HIGH Beta HCG
  • High malignancy risk

Partial:

  • more than one sperm fertilize one egg
  • 69 XXX or 69XXY
  • Some fetal parts
  • Lower malignancy risk
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139
Q

Murmur that increases with inspiration = ________

A

R-sided!

-tricuspid regurg

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140
Q

At low doses, aspirin inhibits ________, at higher doses, it inhibits ______

A
  • COX1 alone
  • COX1 and COX2

COX1=platelets, etc
COX2=inflammation

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141
Q

Is rabies virus live or killed?

A

Killed

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142
Q

Describe Arginase deficiency

A
  • Problem wth urea cycle
  • Cant turn arginine into Ornithine and urea
  • Get high arginine levels, spastic paresis, choreoathetoid movements
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143
Q

WHat is the best way to prevent neonatal tetanus infection? (other than obvious sterile procedures)

A
  • Vaccinate mom!

- Allows transfer of IgG’s across placenta to the fetus

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144
Q

What are some side effects caused by thiazide diuretics?

A

HYPERs:

  • Hyperuricemia
  • Hypercalcemia
  • Hyperglycemia
  • Hyperlipidemia

HYPOs:

  • Hypokalemia
  • HoTN
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145
Q

What is the workup for Cushing’s syndrome?

A
  • Measure ACTH
    -Measure cortisol
    -Dexamethason suppression test
    suppression test:
    -suppressed = Pituitary (cushings disease)
    -Not suppressed = exogenous source (small-cell carcinoma)
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146
Q

What does fibroadenoma look like histologically?

A
  • cellular, often myxoid stroma encircling and sometimes compressing epithelium-lined glandular and cystic spaces
  • Q 1109
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147
Q

What might low AFP be? Low estriol?

A
  • Downs

- placental insufficiency

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148
Q

Disease associated with acidemia and increased propionic acid? pathophys?

A
  • Propionyl coA carboxylase deficiency
  • Propionyl coA made from AAs Valine, threonine, methionine, cholesterol, and odd chain FAs
  • this enzyme converts propionyl coA to methylmalonyls coA….which then can convery to succinyl coA for TCA cycle

-clinical: poor feeding, vomiting, hypotonia, lethargy, AG acidosis, dehydration

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149
Q

Patient with joint stiffness, dark pigment in sclera and helix of ears…..enzyme deficiency?

A
  • Alkoptonuria
  • Homogentisic acid oxidase
  • Cant break down homogentisic acid–> accum –> pigment, dark urine, arthralgias from deposits etc
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150
Q

What is the TATA box?

A
  • A promotor region on eukaryotic DNA
  • binds TFs to facilitate transcription and binding of RNA polymerase II
  • 25 base pairs upstream from initiation site
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151
Q

What class of drug is acarbose? how does it work?

A
  • Alpha-glucosidase inhibitor (another is miglitol)
  • Decreases activity of disaccharidases at the brush border –> delays/impairs monosaccharide absorption

*Side fx: bloating, flatulence, abd pain, rash…dont use with malab, IBD, etc

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152
Q

What is the cause of focal neuro deficits in a pt who had a SAH 4-12 days ago? What drug prevents this from occuring?

A
  • Vasospasm

- Nimodipine

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153
Q

What AA is an immediate source of nitrogen for urea production in the urea cycle?

A

Aspartate

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154
Q

How can you differentiate between diffusion limited vs perfusion limited exchange in the alveoli?

A

-Diffusion limited = O2 will always be more affected

155
Q

What type of drug is Leuprolide? what is it used for?

A
  • GnRH analog (long-acting)
  • Causes brief intial increase in LH and FSH –> incr testosterone……but ultimately causes suppression of axis and low testosterone
  • Used to treat androgen-dependent cancers

*DHT is made from testosterone in tissues by 5-alpha-reductase

156
Q

Excellent DNA replication summary on question 1471!

A
157
Q

Baby with vom, lethargy, hypertonicity/rigidity, and sweet smelling urine has __________ deficiency causing what disease?

What is the pathophys?

A
  • Branched-chain alpha-keto-acid dehydrogenase deficiency
  • causes maple syrup urine disease
  • cant break down BCAA…..Leucine, Isoleucine, Valine —> buildup = neurotoxicity and urine smells sweet
158
Q

What is Laplace’s law regarding spheres? model for alveoli….

A

P = 2T/r

  • Pressure required to keep a sphere open (P) is directly proportional to surface tension (T) and inversely proportional to radius (r)
  • surfactant counteracts collapse by decreasing surface tension!
159
Q

What do enterotoxin A and cytotoxin B of C. diff do?

A
  • Enterotoxin A = causes watery diarrhea
  • Cytotoxin B = colonic epithelial cell necrosis and fibrin deposition (psudomembranous colitis)

*Dx c.diff with stool toxin gene PCR

160
Q

Neonates with positive HBV have _____ levels of HBV replication, have _____ levels of transaminases, and are at _______ risk for chronic infection

A
  • High levels of replication
  • Mildly elevated transaminases (immature immune response)
  • High risk for chronic disease
161
Q

How do you calculate risk?

A

Number of ppl with disease / number of people at risk

162
Q

How do cromolyn and nedocromyl work? what are they used to treat?

A
  • Mast cell stabilizers –> prevent degranulation
  • Treat bronchial asthma and allergic rhinitis

*not as effective as ICS

163
Q

Where is panacinar emphysema usually localized? What about centriacinar?

A

Panacinar = lower lobes…a-1-at deficiency

centriacinar = upper lobes ….chronic smoking

164
Q

What drug is used to treat male pattern baldness?

A

5-alpha-reductase inhibitors such as Finasteride

-decreases DHT

165
Q

What are the characteristics of schwannomas on histology?

A
  • biphasic pattern of cellularity
  • S-100 positive (neural crest origin)
  • Elongated cells with regular, oval nuclei
166
Q

What is the underlying mechanism of amenorrhea in annorexia nervosa?

A
  • loss of pulsatile secretion of GnRH from hypothalamus

- leads to low E2

167
Q

What causes the genetic form of dilated cardiomyopathy? what about HOCM?

A
  • Mutations affecting cytoskeletal proteins or enzymes of oxidative phosphorylation
  • Mutations affecting cardiac sarcomere proteins, usually Beta-myosin heavy chain
168
Q

What products play important role in alzhemier’s and accumulate in neurons?

A

-Neurofibrillary tangles and A-B-amyloid plaques

169
Q

In the ovaries, where are androgens and progesterone synthesized and what influences this process?

What about conversion to estradiol?

A
  • androgens and progesterone are synthesized in the Theca interna cells, under the influence of LH
  • Aromatase converts androgens to estradiol in the Granulosa cells, stimulated by FSH
170
Q

After X-linked SCID, what is the next most common cause?

A
  • Adenosine deaminase deficiency
  • Normally deaminates adenosine and inosine –> no function = adenosine accumulation –> toxic to lymphocytes –> destruction of both B and T cells
171
Q

What bacteria causing bloody diarrhea is a non-motile, non-lactose fermenting, who’s effects are mostly caused by mucosal invasion?

A
  • Shigella

* does not produce H2S!

172
Q

What is the Fas receptor and Ligand and their function?

A
  • They act to initiate the extrinsic pathway of apoptosis.
  • Mutation in Fas receptor or ligand can prevent apoptosis in auto-reactive lymphocytes –> incr risk of autoimmune diseases
173
Q

What type of drug is raloxifene?

A
  • SERM
  • in breast….antagonist (prevents breast cancer)
  • Bone…..agonist (protects bone)
174
Q

What is NF-kB, and in what disease is it mutated?

A
  • TF responsible for cytokine production

- Crohn’s disease

175
Q

What is telomerase? WHat exactly does it do? what cells can you find it in?

A
  • Reverse transcriptase enzyme
  • Adds TTAGGG repeats to the 3’ end of chromosomes. this protects DNA and allows for continued replication
  • FOund in stem cells and cancer cells
176
Q

What proliferative disorders tend to have a mutation in the cytoplasmic tyrosine kinase, JAK2…leading to constitutively active STAT transcription factors?

A

Myeloproliferative disorders

  • polycythemia vera
  • essential thrombocytosis
  • primary myelofibrosis
177
Q

Whats the difference between cortisol vs. glucagon and catecholamine activation of gluconeogenesis?

A
  • Cortisol –> receptor in the cytosol…translocates to nucleus
  • Glucagon and catecholamines –> receptors on cell surface…G-prot
178
Q

How do you acutely tx diphtheria?

A
  1. Diphtheria antitoxin
    - inactivates circulating toxin, but not toxin already in cardiac or neural cells. administer ASAP
    - Known as “passive immunization” bc transfer of pre-existing, neutralizing antibodies
  2. Penicillin or erythromycin
    - kills bacterua–> stops release of toxin, prevents transmission
  3. DPT vaccine
    - lasting immunity vs future infection
179
Q

What is the clinical picture and histologic appearance of granulomatous thyroiditis?

A

Clinical

  • recent infection
  • features of thyrotoxicosis
  • tenderness over thyroid gland
  • incr ESR
  • Markedly reduced Iodine uptake**

Histology:

  • Mixed, cellular infiltration
  • occasional multi-nucleated giant cells
180
Q

What might you prescribe a patient with initial incr anxiety and insomnia following start of SSRI therapy?

A

Short acting benzo before bed:

  • Alprazolam
  • Triazolam

*since short acting, reduces certain side effects like daytime sleepiness or impaired judgement

181
Q

What structures arise from fusion of the paramesonephric ducts in females?

A
  • uterine tubes
  • uterus
  • cervix
  • superior 1/3 of vagina

*failure to fuse = bicorneate uterus or uterus didelphys

182
Q

what is PrP, how can a change in this cause disease? and what disease?

A
  • Prion protein
  • If it alpha-helix normal structure converts to Beta-pleated sheets….it becomes resistant to proteases
  • leads to accumulation, causing deposition in gray matter –> spongiform transformation
183
Q

Phenytoin toxicity and side fx

A
  • Gingival hyperplasia
  • coarse facial features
  • hirsutism
  • megaloblastic anemia
  • decreases blood level of many drugs (P450)
  • pregnancy –> fetal hydantoin syndrome

Tox:

  • ataxia
  • nystagmus
184
Q

What compound is an activator of pyruvate carboxylase and thus gluconeogenesis?

A

-Acetyl CoA

185
Q

Glomerular immunofuoresence showing granular deposits of IgG, IgM, and C3….in the mesangium and BM = _____?

A

-Post-strep GN

186
Q

What is phenotypic mixing?

A
  • 2 viruses co-infect a host cell
  • progeny have nucleocapsid proteins from one virus and genome from other virus
  • since genome is still the same though…..next generation has original characteristics from grandma/grandpa
187
Q

What amino acids are typically found within the transmembrane domains of transmembrane proteins?

A

Hydrophobic AA’s

  • Valine
  • Alanine
  • Isoleucine
  • methionine
  • Phenylalanine

*VAL and AL were scared of water……so they Used ICE to make crystal METH out of FENNEL

188
Q

In what 2 locations can the ulnar nerve typically be injured?

A
  • Medial epicondyle of the humerus

- Guyon’s canal near the hook of the Hamate and pisiform bone in the wrist

189
Q

What are neurophysins?

A
  • carrier prroteins for oxytocin and vasopressin
  • carry from site of synthesis to posterior pituitary
  • Mutation in neurophysins = Diabetes insipidus (vasopressin defic.)
190
Q

Why might someone with Parkinson’s disease want to avoid certain supplements?

A
  • Vit B6 increases peripheral metabolism of Levodopa–> decr effectiveness
  • if theyre taking levoddopa of course…
191
Q

What are some side effects of Cimetidine?

A

Cimetidine - H2 receptor antagonist for peptic ulcer disease:

  • Gynecomastia*
  • P450 system inhibition: incr levels of warfarin, phenytoin, propranolol, metoprolol, quinidine, theophylline
192
Q

What are some hormone receptors that use the G-protein/adenylate cyclase 2nd messenger system?

A
  • TSH
  • Glucagon
  • PTH
  • Beta-adrenergic receptors

*Reminder:
Adenylate cyclase activated –> cAMP –> PKA activation –> P-lation of serine/threonine residues on downstream products –> transcription

193
Q

What is the Kozak sequence? and what type of mutation can lead to disease? WHich disease?

A
  • sequence that helps initiate translation (mRNA binding to AUG start codon)
  • When Guanine is replaced by cytosine in this sequence….3 bases upstream, the result = THALASSEMIA INTERMEDIA
194
Q

What fungal infection shows spherules filled with lots of endospores on histo?

A

-Coccidioides

195
Q

Which bacteria’s toxin compromises cytoskeletal integrity of intestinal mucosal cells?

A

-C. diff

AB toxin:

  • A = watery diarrhea
  • B = epithelial cell necrosis and fibrin depositin –> cytoskeletal integrity damaged
196
Q

What is coronary steal and what drugs can cause it?

A
  • phenomenon in which dilation of coronary arteries increases BF to normal areas, decreasing or “stealing” BF from ischemic areas
  • Drugs: Adenosine, Dipyridamole
197
Q

For what patients is Isoniazid MONOTHERAPY acceptable?

A

-Pts with positive PPD and negative CXR (no clinical evidence of dz)

198
Q

In gigantism in kids….excess GH increases ______ secretion from the _______

A
  • IGF-1

- Liver

199
Q

Which HIV gene allows for resistance to Reverse transcriptase inhibitors?

Which gene allows for escape from host neutralizing antibodies?

A
  • Pol gene
  • Env gene
  • HIV cant RESIST dancing on that POLe
  • HIV in ENVious of other bugs that escaped the immune system
200
Q

What is Flutamide and what is it used for?

A
  • non-steroid anti-androgen
  • competes with testosterone and DHT for testosterone receptors

-Used in Tx of prostate cancer in combination with GnRH agonists

201
Q

Describe tuning fork finding in conductive vs sensorineural hearing loss:

A

Conductive:

  • Rinne test = Abnormal in affected ear (decr sound when put outside ear)
  • Weber = Localizes (louder) to affected ear

Sensorineural:

  • Rinne = Normal in both ears
  • Weber = Localizes (louder) to unaffected ear
202
Q

In pemphigus vulgaris, Antibodies to ______ create flaccid bullae…usually ruptured

A
  • Desmosomal proteins 3 and 1

* in other disease, bullous pemphigoid, bullae are more tense, and Antibodies are vs hemidesmosomes on BM

203
Q

What will you find in patients with primary TB exposure?

A

Ghon complex:

  • lower lobe lung lesion
  • ipsilateral hilar adenopathy (with calcification)
204
Q

Describe a case control study:

A
  • select patients with disease and without disease

- Determine exposure differences

205
Q

Myelination increases the _______ constant of an axon, and decreases the ________ constant.

A
  • Increases the length constant…..allows signal to travel further
  • Decreases the time constant….amount of time it takes for a signal to be transduced?
206
Q

What is seen in renal arterioles of patients with diabetes long term?

A
  • deposition of eosinophilic hyaline material (stains pink homogenously)
  • same occurs with chronic HTN
207
Q

What drug, used to treat acute angle closure glaucoma, affects the kidneys as well? What part of the kidney does it affect and how?

A
  • Acetazolamide: carbonic anhydrase inhibitor
  • works in the proximal tubule….inhibits CA, decreasing HCO3 reabsorption in proximal tubules
  • incr HCO3 and water excretion –> incr urine pH
  • Eyes also produce HCO3……so they are the target for glaucoma

*side fx: incr urine pH, somnolence, dehydration, paresthesias, metabolic acidosis (rarely), hypokalemia, hyponatremia

208
Q

Incomplete obliteration of the __________ in males causes either Hydrocele or indirect inguinal hernia

A
  • Processus vaginalis
  • normally, it descends with testes from peritoneum, and remnants become tunica vaginalis. If incompletely obliterated and only fluid gets through (the inguinal canal) —> hydrocele….if abd contents get throu –> indirect hernia
209
Q

How does nitrite affect O2 delivery?

A
  • Changes Iron in Hgb from ferrous Fe2 to ferric Fe3 –> cant bind oxygen well
  • Leftward shift of dissociation curve
  • PO2 stays NORMAL bc that is measure of O2 dissolved in plasma
210
Q

What is a side effect of high dose loop diuretics (furosemide, torsemide, bumetanide, ethacrynic acid)?

A

Ototoxicity

*more common sid efx: hypoK, hypoMag, hypoCalcemia

211
Q

What organism most commonly causes traveler’s diarrhea, and how does it do this?

A

-ETEC

2 toxins:
Heat labile:
-very similar to cholera toxin
-increases intracellular adenylate cyclase activation and cAMP
-Incr fluid and e-lytes secretion –> watery diarrhea

Heat Stable toxin:

  • icr cyclic GMP…guanylate cyclase
  • Same end result
212
Q

Describe the 3 types of lung transplant rejection: Hyperacute, Acute, chronic

A

Hyperacute:

  • within minutes
  • preformed antibodies against ABO or HLA
  • GRAFT BLOOD VESSEL SPASM —> Ischemia
  • often irreversible

Acute:

  • 1-2 weeks later
  • reaction to HLA on the graft
  • Cell-mediated, predom CD8+
  • Vascular damage
  • dyspnea, dry cough, low-grade fever

chronic:

  • months - years
  • inflammation of small bronchioles, fibrosis
  • dyspnea, non-productive cough, wheezing
213
Q

Where are VLCFA’s metabolized?

A
  • Peroxisomes

- absent or non-functional peroxisomes –> disease, CNS defects from improper myelination

214
Q

What does the posterior cerebral artery supply? Where does it branch off from?

A
  • Branches off from Basilar artery
  • Occipital lobe, CN 3 and 4, midbrain stuff, thalamus, medial temporal lobe, splenium of corpus collosum, fusiform gyrus

*Q: 2127

215
Q

Describe the nephron’s actions on para-aminohippuric acid:

A
  • freely filtered by glom. into bowman’s space
  • BUT….majority is SECRETED in PCT by carrier-mediated active transport
  • NOT REABSORBED in any portion
  • highest conc is therefore in Bowman’s space
216
Q

What are some clinical and pathologic features of Paget’s disease of the bone?

A

Clinical:

  • bone pain
  • bone mass (tender)
  • hearing loss** (involves the skull as well)

Path:

  • Excessive osteoclastic bone resorption
  • childhood infxn of osteoclasts by paramyxovirus maybe
  • Huge osteoclasts seen with sometimes 100+ nuclei
  • incr bone turnover –> chaotic bone formation
  • Stimulation for M-CSF and RANK-L
217
Q

What are the 3 layers of the adrenal glands and what do they each produce?

A

GFR - glomerulosa, fasciculata, reticularis (outter –> inner)

G - mineralocorticoids (aldosterone)
F - cortisol
R - Androgens

218
Q

what are the 5 steps (in order) of neutrophil migration to injury site?

A
  1. Margination - incr vascular leakage
  2. Rolling - loose binding and un-binding via selectins
  3. Activation - sampling of chemokines from inflammed tissue –> integrin activation
  4. Tight adhesion and crawling - Tight binding to integrins and ICAM-1
  5. Transmigration - PECAM-1 –> squeeze btwn endoth cells
219
Q

Gogli-tendon organs are innervated by ________ fibers, and are exquisitely sensitive to muscle _________. They monitor this and contact inhibitory neurons in the spinal cord, causing activation of ______ neurons in the same muscle –> muscle relaxation

A
  • group 1b sensory fibers
  • MUSCLE TENSION, not length
  • alpha motor neurons

*protect MSK system from damage

220
Q

What 3 conditions are caused by Bartonella henselae?

A
  • Cat-scratch dz
  • Bacillary angiomatosis (immunocompromised)
  • Culture-negative endocarditis
221
Q

How does B12 deficiency cause methionine deficiency?

A
  • need B12 for N-5-THF to donate its methyl and convert homocysteine to methionine
  • this also impairs formation of THF from N-5-THF –> “Folate trap”
222
Q

Staph. _______ causes UTI in young, sexually active women. it is Catalase _______, coagulase ________, and Novobiocin _______.

A
  • Saprophyticus
  • catalase positive
  • coagulase negative
  • Novobiocin resistant*
223
Q

Why does infection with Neisseria gonorrhea not result in lasting immunity?

A

-Bc they modify their outer membrane proteins by antigenic variation

224
Q

In what disease can you see bilateral renal angio-myo-lipomas? What about bilateral RCC?

A
  • Tuberous sclerosis

- Von-hippel-Lindau (eyes, liver, cerebellum, kidneys)

225
Q

What dz is associated with mutation in FMR-1 gene on the long arm of chromosome X?

A
  • Fragile X
  • CGG repeats –> dont stain….chromosome appears broken
  • X-linked
226
Q

What BP drugs can decr GFR and cause hyperkalemia?

A

ACE-i’s

227
Q

What are the 2 functions of type 2 pneumocytes?

A
  1. Regeneration of alveolar lining following injury
  2. Surfactant production

*they are also progenitor cells for type 1 pneumocytes

228
Q

What organism shows budding yeast on sputum culture and forms true hyphae aka “germ tubes” at 37 degrees C?

A

Candida

-common contaminant of sputum cultures, from oral cavity

229
Q

What are risk factors for cervical cancer? What about endometrial?

A

Cervical:

  • multiple sex partners
  • smoking
  • lower SE status
  • early coitarche

Endometrial:

  • nulliparity
  • obesity
  • early menarche
230
Q

What bug causes pneumonia with GI Sx and high fever and some neuro Sx? What scenario do ppl normally get it in? Most common lab abnormality?

A
  • Legionella
  • Contaminated water (hotels, cruise ships, etc)
  • Hyponatremia
231
Q

How do you calculate the number needed to harm?

A

NNH = 1 / attributable risk

attributable risk:

  1. calculate the adverse event rate in the Tx and placebo groups
  2. subtract: Tx group risk - placebo risk = attributable risk
232
Q

What enzyme deficiency causes hyperaldosteronism, and impairs synthesis of both cortisol and androgens?

A

-17-alpha hydroxylase

  • Males are phenotypically female
  • females have normal genitalia
233
Q

What is a potential Tx for hypertensive HF? how does it work?

A
  • Nitroprusside
  • short acting balanced venous and arterial vasodilator
  • Decreases both preload and afterload….balanced though…so C.O maintained at lower LVEDPs
234
Q

What 2 tests can check for chronic granulomatous dz? What is the inheritance?

A
  • Nitro-BLUE tatrazolium

- Dihydrorhodamine flow cytomety (fluorescent green = normal)

235
Q

What is the lymph drainage for the scrotum vs testes?

A
  • Scrotum = superficial inguinal nodes

- testes = Para-aortic nodes

236
Q

Where is Hepcidin released from? What are its effects? What increases/decreases its release?

A
  • Released from Hepatocytes
  • Hepcidin interacts with Ferroportin. Ferroportin releases Iron to blood stream from macrophages and enterocytes. Hepcidin binds it and it gets internalized + destroyed —> decr iron release into blood
  • High iron levels, inflammation INCREASE HEPCIDIN
  • Hypoxia and erythropoesis LOWER HEPCIDIN
237
Q

Why do NSAIDS decrease diuretic response to pts taking diuretics?

A
  • THey inhibit prostaglandins

* diuretics normally incr prostaglandin release –> incr renal BF and incr GFR –> enhancing diuretic effect

238
Q

What inflammatory enzyme is absent from most tissue, but induced upon inflammation?

A

-COX-2

239
Q

Name some K+ sparing diuretics

A
  • Amiloride
  • triamterene
  • Spironolactone

*Hyperkalemia, especially when used with ACEi’s

240
Q

Why do uric acid stones form in tumor lysis syndrome? WHERE do they form and why?

A
  • Incr cell lysis –> incr uric acid release
  • DISTAL TUBULES AND COLLECTING DUCTS
  • Uric acid is normally soluble at physiologic pH, but precipitates in ACIDIC pH of distal tubules and collecting ducts
241
Q

How does Entacapone and tolcapone work?

A
  • They are COMT blockers
  • they increase Levodopa availability in the brain

*Levodopa is immediate precursor of dopamine, can cross BBB unlike dopamine. CARBIDOPA works similarly to Entacapone, but instead blocks DOPA DECARBOXYLASE

242
Q

Name some viruses with a segmented genome:

-WHat makes them capable of dangerous rapid changes?

A
  • Orthomyxoviruses and Rotaviruses
  • Capable of genetic shifts through REASSORTMENT, in which entire segments of their genome are interchanged with an animal strain. This is bc of their SEGMENTED GENOME
243
Q

Which bugs do not gram stain well?

A

“These Rascals May Microscopically Lack Color”

  • Treponema
  • Ricketsia
  • Mycoplasma
  • Mycobacteria
  • Legionella
  • Chlamydia
244
Q

Which bugs are Obligate Aerobes?

A

“Nagging pests must breathe”

  • Nocardia
  • Pseudomonas
  • Mycobacterium TB
  • Bacillus
245
Q

Which bugs are obligate Anaerobes?

A

“Can’t breathe Air”

  • Clostridium
  • Bacterioides
  • Actinomyces
246
Q

Which bugs are intracellular?

A
  • Rickettsia and Chlamydia = OBLIGATE

“Some Nasty Bugs May Live F-acultative-LY”

  • Salmonella
  • Neisseria
  • Brucella
  • Mycobacterium
  • Listeria
  • Francicella
  • Legionella
  • Yersenia pestis
247
Q

Which bugs are encapsulated?

A

“SHiN E SKiS”

  • Strep pneumo
  • H. Influenzae
  • Neisseria Meningitides
  • E. Coli
  • Salmonella
  • Klebsiella
  • Strep (GBS)
248
Q

Which bugs are Catalase-positive?

A

cats need “PLACESS” to live

  • Pseudomonas
  • Listeria
  • Aspergillus
  • Candida
  • E. Coli
  • Staph A.
  • Serratia
249
Q

Which organisms produce IgA protease

A

“SHiN”

  • Strep pneumo
  • H influenzae
  • Neisseria

Helps colonize resp. mucosa

250
Q

WHich organisms express Protein A? M protein?

A

-Staph Aureus
binds to Fc region of Ig, prevents opsonizaton and phagocytosis

-Group A Strep
prevents phagocytosis

251
Q

Which 2 bugs’ toxins inhibit EF-2, halting protein synthesis?

A
  • Diphtheria toxin

- Exotoxin A of Pseudomonas

252
Q

Which 2 bug toxins inhibit prot synth by inactivating 60 S ribosome subunit?

A
  • Shiga toxin (shigella)
  • Shiga-like toxin (EHEC)

*both bugs can cause HUS

253
Q

4 exotoxins increase fluid secretion…..which do so by incr intracellular cAMP? which 1 does cGMP?

A

cAMP:

  • Cholera toxin
  • Heat Labile toxin (ETEC)
  • Edema factor (Bacillus anthracis)

cGMP:
-Heat Stable toxin (ETEC)

254
Q

Which 2 toxins inhibit NT release by cleaving SNARE protein?

A
  • Tetanospasmin (Clostridium tetani)

- Cotulinum toxin (clostridium botulinum

255
Q

WHich 2 toxins Lyse cell membranes?

A
  • Alpha toxin (clostridium perfringens)

- Streptolysin O (Strep Pyogenes…lyses RBCs)

256
Q

Which 2 exotoxins cause shock?

A
  • TSST (staph A)

- Exotoxin A (Strep pyogenes)

257
Q

in strenuously exercising muscle cells undergoing anaerobic glycolysis, inhibition of Lactate dehydrogenase to slow lactate production causes a depletion of _________, which inhibits glycolysis?

A

NAD+

*NADH is used to make lactate…..which regenerates NAD+ needed to go from 1,3-BPG —> Pyruvate

258
Q

What nerve provides sensation for the plantar surface of the foot?

A

Tibial nerve

259
Q

What are 3 ways of differentiating between IgA nephropathy and post-infectious GN?

A
  1. Timing:
    - IgA happens days after infection
    - PSGN happens weeks later
  2. Complement:
    - Normal in IgA
    - Low C3 is post-strep
  3. Mesangial deposits
    - Post-strep does not have mesangial IgA deposits
260
Q

What enzyme is deficient is Niemann0Pick disease?

A

Sphingomyelinase
-Accum of sphingomyelin –> neuro deterioration

  • Period of normal development then –> deteri., MR, HSM, hypotonia
  • Foamy histiocytes
  • cherry red macula
261
Q

The ductus arteriosus is derrived from what embryological structure?

A

The 6th aortic arch

262
Q

Patient with mono-like Sx, who’s blood fails to agglutinate sheep erythrocytes?

A

-CMV

Most common heterophile-Ab negative mononucleosis

263
Q

Why do pts with sarcoid get hypercalcemia?

A
  • Extra-renal formation of calcitriol by activated macrophages
  • this occurs along with SUPPRESSION of PTH
264
Q

How is imprinting accomplished?

A

-Methylation of DNA’s cytosine residues

265
Q

What is an example of a methylxanthine drug? how does it work?

A
  • Theophylline, aminophylline

- decr PDE –> incr cAMP –> bronchiodilation

266
Q

What drug used to tx severe RA can cause stomatitis and liver function abnormalities?

A

-Methotrexate

267
Q

What is an indirect method of measuring visceral fat content?

A

Waist to hip ration

*High ratio assoc. with insulin resistance, metabolic syndrome, and type 2 DM

268
Q

Alcohols disrupt cell membranes and kill bacteria, mycobacteria, fungi, and viruses, they do not, however, kill __________

A

Bacterial spores

269
Q

How does glucose influence the Lac-operon gene?

A

-Down-regulates adenylate cyclase –> low cAMP –> poor binding of CAP to its binding domain –> decr expression of lac genes

270
Q

What are features of digitalis toxicity?

A
  • fatigue
  • BLURRY VISION
  • CHANGES IN COLOR PERCEPTION
  • N/V/D , abd pain
  • headache
  • dizziness
  • confusion
  • HYPERKALEMIA
  • **BRADYCARDIA from AV nodal block –> eventually escape rythms and V-tach or V-fib
271
Q

On an Abdominal CT slice, the portal vein is seen _______ to the IVC

A

Anterior

272
Q

What is the tx for cryptococcal meningitis?

A
  • Amphotericin B immediately
  • Flucytosine
  • follow with long-term Fluconazole (maintenance)

*CSF findings can have low glucose (like SBP)….but lymphocytes predominate

273
Q

What PROTEINS can be identified with a DNA-PROBE?

A 
only ones which can bind to DNA, such as:
-transcription factors
-steroids
-Thyroid proteins
-vit D receptors
-retinoic acid receptors
-DNA transcription and replication proteins
etc
274
Q

_____ is a drug that increases fetal hemoglobin. It is reserved for patients with sickle cell who have __________

A
  • Hydroxyurea

- Frequent pain crises

275
Q

How do gardos channel blockers work in sickle cell tx?

A
  • hinder the efflux of K+ and water from the cell

- Prevents dehydration of RBCs and reduces polymerization of Hb S

276
Q

In what condition do you see delayed relaxation of DTRs and dry, coarse, thick skin?
*What lab is notable?

A
  • Primary Hypothyroidism

* Will not show low TSH in primary hypothyroid bc primary = TSH deficiency by definition!!!

277
Q

How is the liver able to use Glycerol for TG synthesis, gluconeogenesis , and glycolysis??
*No other tissue can!

A
  • It has Glycerol Kinase

* Glycerol —> G-3-P —->glycolysis or gluconeogenesis

278
Q

Naked viruses containing _______ stranded, ________ -sense RNA can be infectious.

A
  • Single-stranded
  • Positive sense

*example = rhinovirus

279
Q

When does amniotic fluid levels of Lecithin (phosphatidylcholine) sharply increase? What about phosphatidyl glycerol?

A
  • 30 weeks

- 36 weeks

280
Q

What happens histologically 5-10 days after MI in affected myocardium?

  • WHat about 10-14 days after?
  • 2 weeks to 2 months?
A

5-10 days:
-macrophage phagocytosis of dead cells

10-14 days:

  • Granulation tissue…grows into and replaces dead myocardium
  • Neovascularization

2 weeks - 2 months:
-Collagen deposition/scar formation

281
Q

What are the most common organisms causing intra-abdominal infections?

A
  • Bacterioides fragilis (unique surface polysaccharides –> abcess form)
  • E. COli
  • enterococci
  • streptococci
282
Q

MCD nephrotic syndrome is known as a _______ proteinuria

A
  • Selective

- only allows passage of low mol. weight proteins like Albumin and transferrin

283
Q

How do triptans work?

What drugs are usually used as migraine PPX?

A

-Serotonin agonists
Triptans inhibit the release of vasoactive peptides, promoting vasoconstriction and blocking pain pathways

-Beta-blockers, antidepressants, anticonvulsants

284
Q

What drug used to treat heart failure can cause endocrine effects such as: gynecomastia, decreased Libido, and impotence?

A

Spirinolactone

  • Because it is structurally similar to steroid
  • Eplerenone is newer and may have less of these effects
285
Q

What is the AA precursor for Serotonin?

A

Tryptophan

286
Q

Sickle cell patient has very high MCV (114) and retics are 5…..why is the MCV likely high?

A
  • Folate deficiency from incr erythrocytosis

- 5% retics not enough to incr MCV by that much

287
Q

A kid who had delayed detachment of the umbilical cord, recurrent skin infections WITHOUT PUS, poor wound healing, has what disease?

*what is the pathophys?

A
  • Leukocyte adhesion deficiency

- AR genetic absence of CD18 —> inability to synthesize integrins

288
Q

Why can folate supplementation alone for a pt with B12 deficiency lead to worsening demyelination and thus worse neuro Sx?

A

-Bc it depletes Un-methylated B12 available for Methylmalonyl-CoA processing

289
Q

The deep branch of the median nerve allows for what movements? Where is it most commonly injured?

A
  • Weakness of forearm and hand extensors
  • “Wrist drop”

-Injured near radial head, medical epicondyle of humerus, common is radial head sublaxation in kids

290
Q

What is the best test to determine whether a gene is being transcribed?

A

-Northern blot –> to check for mRNA

291
Q

In addition to sinopulmonary and GI infection, patients with selective IgA deficiency can have fatal consequences following _________.

A
  • blood transfusions

- Anaphylactic response due to immune response against transfused IgA…..their bodies recognize it as foreign

292
Q

ACL vs PCL superior attachments

A
  • ACL more lateral

- PCL more medial

293
Q

WHat type of transporter is the CFTR protein?

A

-ATP-gated

294
Q

Patients with a much less severe form of galactosemia, causing only cataracts, have a deficiency of _________.

THis leads to increased production of ________, catalyzed by _______.

A
  • Galactokinase deficiency
  • Increased Galactitol
  • Catalyzed by Aldose Reductase
295
Q

In HIV patients, which organism causing esophagitis causes hyperemia and linear ulceration?

A

-CMV

296
Q

What is Varenicline used for? how does it work?

A
  • Smoking cessation

- Partial agonist of nicotinic AcH receptors –> decreases cravings and decreases pleasurable effects of cigarettes

297
Q

Why does mycoplasma cause anemia? What mediates this?

A
  • Shares antigens with RBC’s
  • Body mounts response to these RBCs –> Lysis
  • Antibodies are responsible (cold agglutinins…IgM)
298
Q

Cortisol increases transcription of this enzyme, leading to increased synthesis of Epinephrine?

A

-Phenylethanolamine-N-Methyltransferase

NE –> Epinephrine

299
Q

What e-Lyte abnormalities are present with amphotericin B treatment?

A
  • Hypokalemia
  • Hypomagnesemia

*from affects of kidney –> can lead to EKG changes (frequent premature beats)

300
Q

What type of damage is caused in the kidneys by sickle cell dz or trait?

A
  • papillary necrosis
  • same for DM, analgesic nephropathy, or severe obstructive pyelo

-gross hematuria, colicky flank pain,tissue fragments in urine

301
Q

What type of insulin is used acutely to Tx DKA?

A
  • Regular insulin IV
  • begins to lower glucose and ketones within minutes

*Sub-Q administration (not preferred) –> active within about 30 minutes. Volume depleted though –> erratic subQ absorption

302
Q

WHat types of drugs are used to prevent motion sickness? examples?

A
  • 1st generation anti-histamines, since they also have anti-muscarinic effects
  • Meclizine, Dimenhydrinate, scopolamine
  • Main side fx = Dry mouth
303
Q

How does Niacin influence the effects of anti-HTN and Diabetes meds?

A
  • Can potentiate anti-HTN effects by increasing vasodilation
  • May need to decr HTN meds befoee starting Niacin
  • Can increase insulin resistance
  • May need to Incr Diabetes meds

**Can also increase serum uric acid

304
Q

What does a blood gas look like in someone with a PE?

A
  • Respiratory Alkalosis and hypoxemia
  • Hypoxemia causes compensatory hyperventilation
pH = incr
PaO2 = low
PsCO2 = low
HCO3 = normal, or low if renal comp has occured
305
Q

What is the difference between Zero order and first order kinetics?

A

Zero order
-constant AMOUNT of drug is metab per unit time, independent of concentration

First order
-constant FRACTION of drug is metabolized per unit time, based on serum concentration

306
Q

Treatment of Hydatid cyst from echinococcus? Why no drainage?

A
  • Mebendazole or Albendazole

- Cyst contents in abdomen if released can cause anaphylactic shock

307
Q

What is the major cause of AAA? What happens pathologically first?

A
  • Atherosclerosis
  • Intimal (fatty) streaks
  • eventually these streaks can weaken the underlying media of the aortic wall
308
Q

What causes the hypoglycemia of an infant of diabetic mom?

A

-hyperglycemia –> pancreatic islet cell hyperplasia –> hyperinsulinemia

309
Q

How do nitrates work for CP?

A
  • Venodilators

- decr in cardiac work by decreasing LV filling volume (preload)

310
Q

WHere is damage done in ppl who get hearing impairment from chronic exposure to loud noises?

A
  • Organ of Corti

- damage of stereociliated hair cells

311
Q

Patient with flank pain radiating to the groin after having pelvic surgery?

A

-Hydronephrosis from ligation of the ureter

312
Q

What should stop you from using ACE inhibitors in people with atherosclerotic disease?

A
  • Development of ARF

- Bilateral renal artery stenosis

313
Q

The enzymes _________ and __________ are inactivated by lead. This leads to impaired heme synthesis, and accumulation of _________ and ________

A
  • Alpha-Aminolevulinate dehydratase
  • Ferrocheletase
  • Alpha-ALA (aminolevulinic acid)
  • Protoporphyrin 9
314
Q

What are the findings seen in caudal regression syndrome? What is thought to be a factor causing it?

A
  • baby with flaccid paralysis,
  • absent DTA,
  • agenesis of the sacrum and/or lumbar spine,
  • dorsiflexed contractures of of the feet,
  • urinary incontinence

*Uncontrolled diabetes

315
Q

What drug is used for reversal of heparin?

A
  • Protamine sulfate

* Not great for LMW heparin

316
Q

Parasitic infection causing renal stuff, liver and spleen granulomas, sometimes intestinal stuff?

A
  • Schistosoma
  • Snails
  • can also cause SCC of bladder (S. haematobium)
317
Q

Where is the saphenous vein harvested from for CABG? Where does it normally drain into?

A
  • Just inferolateral to the pubic tubercle

- Drains into femoral vein

318
Q

which pituitary hormone is constitutively controlled/inhibited by the hypothalamus? By what chemical?

A
  • Prolactin
  • Dopamine

*Hypothalamic lesion –> decr inhibition of prolactin due to decr dopamine –> increased prolactin

319
Q

What sign can be seen on a cellular level that indicates irreversible cellular damage?

What about reversible signs?

A
  • Mitochondrial vacuolization
  • Myofibril relaxation, disaggregation of polysomes, disaggregation of nuclear granules, glycogen loss, TGA droplet accumulation
320
Q

What 3 variables affect total oxygen content of blood?

*What condition shows normal PaO2, normal SaO2, and low oxygen content?

A
  1. Hgb concentration
  2. O2 saturation of Hgb (SaO2)
  3. Partial pressure of O2 dissolved in blood (PaO2)

*Anemia, which decreased Hgb concentration

321
Q

_________ is an essential activator of CPS-1 in the urea cycle, and is formed by the enzyme ___________, from Acetyl CoA and glutamate

A
  • N-Acetylglutamate

- N-Acetylglutamate synthetase

322
Q

WHat 3 chemicals stimulate acid secretion in the stomach?

A
  • AcH
  • Histamine
  • Gastrin
323
Q

Erythrocytes use the enzyme ___________ to produce 2,3-BPG, which increases O2 delivery to tissues.

A
  • Bisphosphoglycerate Mutase

* from 1,3-Bisphosphoglycerate –> leaves glycolysis and uses energy

324
Q

What bacteria is PYR positive and causes tissue necrosis?

A

-Group A strep

325
Q

Obstruction of the ______ causes dilated lateral and 3rd ventricles, with normal-sized 4th ventricle

A

-Cerebral aqueduct (of sylvius)

326
Q

Describe the path of CSF flow:

A
  • formed by choroid plexus
  • Lateral ventricles to 3rd ventricle via foramen of monro (interventricular foramen)
  • 3rd ventricle to 4th ventricle via cerebral aqueduct
  • exits 4th ventricle into Subarachnoid space via foramen of Luschka (2) or the foramen of Magendie
327
Q

How do TNF-alpha, catecholamines, glucocorticoids, and glucagon increase insulin resistance?

A
  • through activation of Serine/Threonine kinases

- results in phosphorylation of IRS-1, interfering with it’s interaction with the insulin receptor

328
Q

What drug is used for gram-positive bacteremia, including MRSA, and can cause incr CPK and myopathy?

How does it work?

A
  • Daptomycin
  • It is a Lipopeptide….it disrupts the bacterial membrane through creation of transmembrane channels –> leakage of ions –> depolarization of membrane –> inhibition of DNA, RNA, protein synthesis –> death
329
Q

What gene is mutated in AML type 3 (acute promyelocytic leukemia) and what does that gene code for?

A
  • translocation (15;17)
  • gene for retinoic acid receptor alpha

*fusion gene PML/RAR-alpha results –> inhibits myelocyte differentiation –> promyelocytic leukemia

330
Q

What drug specifically inhibits Mycolic acid, thereby making mycobacteria lose their acid-fastness, and preventing synthesis of new cell walls (stop proliferation)?

A

-Isoniazid

331
Q

What is the clinical presentation of, and pathophys underlying Lambert-eaton syndrome?

A
  • Proximal muscle weakness associated with malignancy (especially lung)
  • improves throughout the day
  • improves with exercise
  • **No improvement with Tensilon test
  • Nerve stim. study shows incremental response!

Pathophys:
-Antibodies vs. pre-synaptic calcium channels

332
Q

Describe the filtration of PAH

A
  • freely filtered in the glom.
  • also secreted in PCT by carrier-mediated process
  • Carriers can become saturated at high blood concentrations
333
Q

How is acute organ TPX rejection treated?

A

-Calcineurin inhibitors and systemic steroids

334
Q

CNS tumors of Neuronal origin stain positively for ________, whereas neoplasms of glial origin (astrocytomas, ependymomas, oligodendrogliomas) stain for __________.

A
  • Synaptophysin (protein found in presynaptic vesicles of neurons)
  • GFAP
335
Q

WHat drugs reduce Grave’s ophthalmopathy?

A
  • High dose steroids

* Conventional anti-thyroid meds dont help the eye symptoms

336
Q

WHat is the Tx for orotic aciduria and how does it work?

A
  • Uridine supplementation

- Inhibits CPS-2 –> decr orotic acid

337
Q

What parameter influences Positive and negative predictive values?

A

-diseaase prevalence

338
Q

What are some risk factors for formation of biliary sludge?

A
  • Pregnancy
  • TPN
  • Rapid weight loss
  • Prolonged use of octreotide
  • High spinal cord injuries
339
Q

WHat are some long term consequences of using topical steroids?

A
  • Dermal atrophy with loss of dermal collagen (synthesis decr by roids)
  • drying
  • cracking
  • tightening
  • telangiectasias
  • Striae
340
Q

Where is factor 8 synthesized? Stored?

WHat drug releases vWF and factor 8?

A

-Liver , endothelial cells

-Desmopressin
Synthetic vasopressin analog that releases vWF and factor 8 from endothelial cells

341
Q

Other than allopurinol, what other drug can be used to decr uric acid levels in tumor lysis syndrome?

A
  • Rasburicase

* catalyzes conversion of uric acid to allantoin (more soluble)

342
Q

________ is an extended spectrum PCN + BetaLactamase inhibitor that covers most Gram negative enteric bacilli, including pseudomonas and bacterioides

A

-Piperacillin-Tazobactam

343
Q

In addition to having beneficial sympathetic down-regulation, Beta-blockers are also helpful for thyrotoxicosis bc they also ________

A

Decrease peripheral conversion of T4 to T3 (more active)

344
Q

Riboflavin is necessary for which enzyme of the TCA cycle?

A
  • Succinate dehydrogenase

* converts succinate to fumarate

345
Q

What is the only bacteria that requires cholesterol for growth on culture?

A

Mycoplasma

346
Q

What disease come from poor intestinal absorption and renal re-absorption of Lysine, Arginine, Ornithine, and cysteine?

What results clinically?

A
  • Cystinuria
  • normally absorbed in the jejunem, re-ab in the PCT
  • Kidney stones! (Hexagonal cysteine crystals)
  • Cysteine stones bc cysteine is not soluble at physiologic urine pH
347
Q

Antibodies vs _______ have a high SPECIFICITY for RA

A

-Citrullinated peptides (CCP)

348
Q

WHat nerve provides somatic sensation (temperature, etc) to the anterior 2/3 of the tongue ?

A

-Trigeminal nerve

V3, branch from the mandibular division called the lingual nerve

349
Q

What drugs inhibit topoisomerases? What is the result?

A
  • Etoposide and podophyllin……chemo drugs
  • inhibit sealing activity of topoisomerase 2 –> chromosomal breaks acumulate –> cell death

Topoisomerase 1 makes single-stranded nicks. 2 induces transient breaks in dsDNA and seals them

350
Q

What is the most common cause of fetal hydronephrosis?

A
  • Obstruction at the ureto-pelvic junction
  • From inadequate recanalization of ureters at this location
  • 2nd most coomon is VUR
351
Q

WHat is the characteristic histological finding in Hashimoto’s thyroiditis? (2)

A
  • Mononuclear parenchymal infiltration
  • Well developed germinal centers

*Q: 769

352
Q

What cells are seen “hugging other cells” in peripheral smear of patient with EBV mono?

A
  • CD8+ T cells

* They are activated in response to virally-infected B-cells to try to kill them

353
Q

What should you suspect in a patient with EPISODIC tachycardia, HTN, diaphoresis….that resolve without intervention?

A
  • Possible pheochromocytoma

* Also possible is autonomic dysfunction, cocaine abuse, Panic attacks

354
Q

What does papillary cancer look like on histology?

A
  • Large cells with nuclei containing FINELY DISPERSED CHROMATIN with GROUND GLASS APPEARANCE (orphan annie’s eye)
  • Psammoma bodies (laminated calcium deposits
  • Intranuclear inclusions
355
Q

What enzyme defect is responsible for classic homocystinuria?

A

-Cystathionine-beta synthase

356
Q

WHat NT/receptor is responsible for Opiate tolerance?

A
  • Glutamate/NMDA

* Ketamine, an NMDA antagonist, may decrease morphine tolerance

357
Q

Loop diuretics are more likely to _______ calcium, and thiazide diuretics ________ calcium

A
  • Loop = Decrease

- Thiazides = increase

358
Q

What the clinical findings associated with Churg-strauss disease?

A
  • Adult onset asthma
  • Eosinophilia
  • Hx of allergy
  • Mono or poly neuropathy***
  • Pulm infiltrates
  • Paranasal sinus abnormalities

Labs: p-ANCA …..aka antibodies vs Neutrophil Myeloperoxidase

359
Q

What are 2 congenital syndromes associated with prolonged QT intervals?

A
  • Lange-Nielsen syndrome
  • AR
  • Neurosensory deafness
  • Romano-Ward syndrome
  • AD
  • No deafness

BOTH CAUSE MUTATIONS IN K+ CHANNELS

360
Q

Name 4 organisms that require only a VERY small amount of organisms in order to cause gastroenteritis:

A
  • Shigella (10)
  • Campylobacter jejuni (500)
  • Entamoeba histolytica (1)
  • Giardia Lamblia (1)
361
Q

What hypothalamic nucleus is responsible for satiety signals? What happens if it is damages?

A
  • Ventromedial nucleus
  • Bilateral lesions –> hyperphagia and obesity, sometimes also rage and aggressive behavior

*most common cause is tumor invasion….ex = craniopharyngioma

362
Q

What do the lateral, suprachiasmatic, supraoptic, and anterior hypothalamic nuclei do?

A
  • Lateral = signals hunger…..damage –> annorexa, starvation
  • Suprachiasmatic = circadian (directly above optic chiasm
  • Supraoptic = producce ADH and Oxytocin
  • Anterior = Temperature control….initiates body cooling. damage = hyperthermia
363
Q

What enzyme causes fructose intolerance? What are Sx and Tx?

A
  • Aldolase B
  • Sx = hypoglycemia following fructose ingestion , vomiting, cirrhosis, jaundice
  • Tx = limit fructose in diet, including sucrose
364
Q

What is Class 1B anti-arrhythmics’ dissociation speed compared to 1A and 1C? What is it useful for?

A
  • Fastest dissociation —> least amount of use dependence
  • Useful for treating ischemia-induced ventricular arrhythmias.
  • *Exmples: Lidocaine, Tocainide, Mexilitene
    • “One can C…the Canes usually and up in Mexico”
365
Q

WHat enzyme allows individuals with fructosuria to metabolize fructose / use it for glycogen storage?

A

-Hexokinase

366
Q

What forms the MAC complex? And pts with inability to form the MAC complex are especially succeptible to which bug?

A
  • C5b and C9 complement factors

- Deficiency = Neisseria Mening. infections

367
Q

What is cheyne-stokes breathing and who is it normally seen in?

A
  • Apnea —> Gradually incr TV->gradually decreasing TV —> Apnea
  • This CYCLE (pattern) is seen in pts with adv. CHF, or CNS disease
368
Q

What drugs, when used along with statins, increase the risk of myopathy?

A

-Fibrates (gemfibrozil, fenofibrate)

369
Q

In what organelle does heme synthesis occur?

A

-Mitochondria

370
Q

How do you stop PSVT?

A
  1. Vagal maneuvers

2. IV Adenosine if maneuvers fail

371
Q

What drugs can facilitate lithium toxicity?

A
  • Thiazide diuretics
  • ACEi’s
  • NSAIDS
372
Q

What releases IL-2 and what does IL-2 do?

A
  • produced by helper T cells
  • stim. growth, differentiation, and survival of:
    • Antigen specific CD4+ T cells
    • CD8+ T cells
    • B cells
  • Activates NK cells and monocytes
373
Q

In Gibbs free energy, if delta G is negative, Keq will be _________ 1, and the concentration of products at equilibrium will exceed substrates.
If delta G is positive, Keq will be _______ 1, and formation of substrates will be favored

A
  • Greater than 1

- Less than 1

374
Q

What are the levels (Incr vs Decr) of CRH, ACTH, and Cortisol, in a patient on chronic steroids, during an adrenal crisis?

A
  • Decr
  • Decr
  • Decr
375
Q

Sertoli cells secrete _______, which prevents development of female internal genitalia.

Leydig cells secrete Testosterone, which leads to _________

A
  • MIF
  • development of male internal genitalia
  • DHT converted peripherally from Testosterone, develops EXTERNAL male characteristics
376
Q

What is the clinical presentation of Cori disease?

What is the pathophysiology?

What is seen on histology of Liver?

A
  • Hypoglycemia, FTT, HyperTriglyceridemia, Ketoacidosis, Hepatomegaly
  • De-branching enzyme deficiency –> Cant break glycogen down past limit dextrins –> accumulation and insufficient mobilization of glucose
  • Hepatic fibrosis, WITHOUT FAT accumulation, accumulation of small chain Dextrin-like material within cytosol of hepatocytes
377
Q

Which CCB is the MOST cardioeffective of the CCBs?

What are it’s side effects? (4)

A
  • Verapamil

- Constipation, gingival hyperplasia, bradycardia, heart block (all degrees)

378
Q

WHich anti-inflammatory drugs do not affect platelets? Whats an example of one?

A
  • Selective COX-2 inhibitors

- Celecoxib

379
Q

What is the first histologic sign seen in the brain following ischemic damage and when can it be seen?

A
  • Red neurons (eosinophilic cytoplasm) , loss of Nissl substance, pyknotic nuclei
  • 12-48 hours
380
Q

WHat is the mechanism (intracellularly) of Nitrates for vasodilation?

A
  • Transformed to NO at vascular SM membrane –> increased cGMP
  • —> decr intracellular calcium —> myosin dephosphorylation –> SM relaxation and resultant vasodilation
381
Q

What is the Amphoterin B most notorious for as far as side effects?

A
  • Renal toxicity

* Monitor K+ and Mag!!

382
Q

What molecule/substance prevents formation of Calcium-Oxalate stones in urine?

A
  • Citrate!

* K+Citrate is often prescribed for recurrent calcium stones when dietary changes are unsuccessful

383
Q

What pathology is seen in the blood vessels of someone with malignant hypertension?

A
  • Hyperplastic arteriosclerosis
  • Onion-like concentric thickening of arteriolar walls, especially in the renal vasculature
  • *Decreases GFR –> incr renin –> further incr BP –> Viscious cycle!!
384
Q

_____ cell lung carcinomas commonly secrete ACTH and/or Vasopressin, whereas ________ cell lung carcinomas secrete PTHrP

A
  • Small cell = ACTH —> Hypercortisolism

- Squamous cell = PTHrP —> hypercalcemia

385
Q

How does Carcinoid syndrome affect the heart?

What is seen on pathology?

What lab value is diagnostic?

A
  • R-sided problems: Endocardial fibrosis, pulmonic stenosis, possible restrictive cardiomyopathy
  • Dense fibrous deposits
  • Incr serum SEROTONIN and URINE 5-HYDROXYINDOLEACETIC ACID
386
Q

What causes retraction of overlying skin in breast cancer?

A

-Invasion of the suspensory (cooper’s) ligament

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