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STEP 1 MIXED > Deck 6 > Flashcards

Deck 6 Flashcards

1
Q

Where are androgens and progesterones synthesized in female?

A

Theca interna cells

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2
Q

Where is estradiol syntehsized?

A

Granulosa cells (contain aromatase)

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3
Q

What neuronal structure is used to transport HSV to and from epithelial cells

A

Toward epithelium = kinesin

Retrograde axonal = dynein

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4
Q

WHere does PCL attach?

A

From posterior tibia to medial condyle femer

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5
Q

Where does ACL attach?

A

From anterior tibia to lateral condyle of femur

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6
Q

Equation for number needed to harm?

A

NNH = 1/ absolute risk increase

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7
Q

Equation for absolute risk increase?

A

(# dead/ total receiving Tx A) - (# dead/ total receiving Tx B)

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8
Q

What is the Kozak censensus sequence? What happens if there is a mutation in it?

A

gccgccRccAUGG (r = A or G)
Initiation of translation
If mutation occurs, initiation of translation stops, like in B thalessemia

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9
Q

What is MHC I made of?

A

MHC I class Heavy chain + B-2 microglobulin

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10
Q

Why can’t you use NSAIDs with loops?

A

Loops increase prostaglandins and increase GFR, NSAIDs will inhibit prostaglandins and block effects of loops

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11
Q

What are the main electrolytes influencing the electrochemical gradient in a cell?

A

K+ and Na+ (K+ most)

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12
Q

What does azathioprine get converted to?

A

6MP – will cause purine synthesis inhibition

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13
Q

What are hypocretin-1 levels in narcolepsy? What is wrong with sleep cycle?

A

Low hypocretin-1 in CSF

Less than 15 mins REM latency

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14
Q

WHat does IL-5 stimulate? Which cells secrete IL-5?

A

Secreted by Th2 for Eosinophilic activation. Also activates IL-4 which stim IgE

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15
Q

What is Lynnch syndrome? What gene mutation causes it?

A

Hereditary nonpolyposis colorectal cancer (adenocarcinoma) (HNPCC)
MSH1 gene - DNA mismatch repair

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16
Q

Who gets Lynnch syndrome/

A

Young people <50

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17
Q

What does HAART therapy do to body habitus?

A

Lipoatrophy (NRTI) loss of fat in face and extremities
Central fat deposition
Metabolic syndrome - insulin resistance, hypertriglycerides, reduced HDL levels

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18
Q

What is neuroblastoma? Symptoms?

A

opsoclonus-myoclonus, raised catecholamines, abdo mass (renal medulla), periorbital ecchymosis, may have spinal cord compression

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19
Q

How do NSAIDS cause gastric erosion?

A

COX 1 inhibition –> Decreased prostaglandin synthesis causes gastric hyperacidity and impaired defense

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20
Q

What causes flat contour of R cardiac silouhette?

A

Compresion of RA by R middle lobe

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21
Q

MOA macrolides in diabetic gastropareisis

A

Increases gastric motility (erythromycin). Agonist on motilin receptors** in muscularis externa
Use when metclopramide doesn’t work

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22
Q

Equation for NNT?

A

NNT= 1/ARR

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23
Q

How do you calculate ARR?

A

Control event rate - treatment event rate (same as absolute risk increase?)

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24
Q

What structures are at risk if you do a horizontal transection of the rectus abdominus muscles?

A

Inferior epigastric arteries

Must ligate them during C section to prevent bleeding

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25
Q

SE of digoxin?

A

color blindness, n/v, arrhythmias, anorexia

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26
Q

How does biliary atresia present?

A

Obstruction of extrahepatic bile ducts, increased direct bili, dark urine, pale stools

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27
Q

Woman with watery diarrhea, hypokalemia, achlorydia. WHat is it?

A

VIPoma. VIP stimulating pancreatic bicarbonate and chloride secretion

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28
Q

Tx VIPoma?

A

Somatostatin (octreotide) inhibits VIP and many other gastric secretions

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29
Q

Focal neurological deficit after SAH. What caused it?

A

Cerebral vasospasm

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30
Q

What conditions within gallbladder cause stone formation?

A

High cholesterol, low bile salts and PPDC

Bile salts and PPDC increase cholesterol solubility

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31
Q

What are RF and symptoms of lead poisoning?

A

Behavior changes, constipation, abdo pain, decreased vit D, encephalopathy, anemia, interstitial nephritis

RF include living in homes built before 1978

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32
Q

How to diagnose lead poisoning?

A

Blood lead level. Interrupts heme synthesis

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33
Q

How does glucagon work in hypoglycemia Tx?

A

Increases hepatic glycogenolysis (glycogen breakdown) and gluconeogenesis
Stimulates insulin secretion from pancreas
Little/no effect on other organs/tissues

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34
Q

Where does portal HTN due to cirrhosis affect other organs?

A

Connected to portosystemic collateral veins (L gastric, esophagus, rectum, abdomen. Caput medusae, anorectal varices, esophageal varices

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35
Q

What layer of vessel is affected in Marfan Syndrome?

A

Tunica media shows myxomatous changes (weakening) due to decreased extracellular glycoprotein fibrillin-1.

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36
Q

What type of collagen is used in scar tissue after MI?

A

Type I collagen

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37
Q

Where else is Type I collagen found?

A

Dermis, bone tendons, ligaments, dentin, cornea BV, scar tissue

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38
Q

Where is type II collagen found?

A

Cartilage, vitreous umor, nucleus pulposus

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39
Q

Where is type III collagen found?

A

Skin, lungs, intestines, BV, bone marrow, lymphatics, granulation tissue

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40
Q

Where is type IV collagen found?

A

Basement membranes

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41
Q

What type of collagen is defective in Alport syndrome?

A

Type IV collagen (BM)

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42
Q

What collagen type is defective in Ehlers Danlos type 3 and 4?

A

Type III collagen (skin)

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43
Q

What type of collagen is defective in osteogenesis imperfecta?

A

Type I collagen–> bone

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44
Q

What are symptoms of Mullerian duct agenesis? Karyotype?

A

46 XX
Variable uterine growth —>primary amenorrhea
Short/absent upper vagina
Normal ovaries –> 2ndary sexual characteristics present

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45
Q

How does androgen insensitivity syndrome present? Karyotype?

A

46 XY
Phenotypically female
Cryptorchid testes, no uterus or ovaries
Due to complete androgen receptor insensitivity

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46
Q

What is Kallman syndrome? Presentation?

A

Decreased GnRH secretion from hypothalamus

  • Primary amenorrhea
  • Lack secondary sexual characteristics
  • Olfactory sensory defect
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47
Q

What is Klinefelter syndrome? Presentation?

A 
47, XXY
Males with tall stature
Poor secondary sexual characteristics
Atrophic testes
Infertility
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48
Q

New test for disease A that is 95% specific. If 8 people with disease A are tested, what is the probability that ALL tests will come back negative?

A

0.95^8 = 35%

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49
Q

Which antiviral causes nephrotoxicity?

A

Acyclovir - use aggressive IV hydration

50
Q

WHat is the effect of estrogen on thyroid hormone levels?

A

Increases TBG levels, which bind T4 and cause more stimulation of TRH from anterior pituitary –> greater overall T4 levels

51
Q

What antigen is needed for formation of integrins?

A

CD18

Absence causes leukocyte adhesion deficiency

52
Q

What are symptoms of leukocyte adhesion deficiency?

A

Recurrent skin and mucosal infections with *No pus** (no neutrophils at site)
Poor wound healing
Delayed umbilical cord separation (>21 days)
Marked peripheral leukocytosis and neutrophilia

53
Q

What disease causes progressive neurological degeneration of the putamen

A

Wilson’s disease

54
Q

Where is the caudate nucleus?

A

C shape in the lateral ventricles

55
Q

What heart murmur is seen with pulmonary artery HTN?

A

Tricuspid regurg from enlarged R ventricle

56
Q

What agents are used to treat primary pulmonary artery HTN?

A

Endothelin receptor antagonists. They inhibit vasoconstriction and SM proliferation in pulmonary arteries. (Bosentan, ambrisentan)

57
Q

What substances cause vasodilation?

A

Substance P, Ach, serotonin, bradykinin, sheer force

58
Q

What is pathway for activating vasodilation?

A

Substance (Ach etc) –> synthesis of endothelial nitric oxide synthase –> NO —> Vasodilation

59
Q

What is nitric oxide synthesized from?

A

Argenine, O2, NADPH

60
Q

What type of reaction is occurring when transplant patient has decreased UO, fever, and renal failure within first few weeks?

A

Acute graft rejection

61
Q

What is acute graft rejection usually caused by?

A

Host T-cell sensitization against graft MHC antigens, lymphocytic infiltrate(cellular)

Or humoral reaction (C4 deposition, nec vasculitis, neutrophilic infiltrate)

62
Q

What are symptoms of temporal arteritis (giant cell arteritis)

A

jaw claudication
headaches
visual disturbance (ischemic optic neuropathy)
May be associated with polymyalgia rheumatica

63
Q

What does oculomotor CN III palsy look like?

A

No reaction to light or accomodation
Ptosis
“down and out” appearance of eye due to unopposed action of Lateral rectus and Superior oblique (CN VI and CN IV)

64
Q

Where is aneurysm if it causes CN III palsy?

A

Posterior communicating artery

65
Q

What are clinical symptoms of splenic laceration?

A

Shoulder pain and hiccups (C3-C5) phrenic nerve irritation

66
Q

Where do you do femoral catherization?

A

Medial to femoral artery and below inguinal ligament

67
Q

What do pheochromocytoma cells contain?

A

Synaptophysin, chromogranin, neuron-specific enolase, catecholamines

68
Q

What type of CAH does infant have if they have ambiguous genatalia, hypokalemia, and HTN?

A

11-B-OH deficiency
11-Deoxycorticosterone is weak mineralcorticoid so they’ll have hypokalemia and HTN
**HTN distinguishes it from 21-OH deficiency

69
Q

What happens to venous return and CO after MI?

A

Decreased CO, normal venous return

70
Q

What is function of RNA polymerase i?

A

Transcribes 45S pre-rRNA gene that codes for ribosomal subunits
Found only in nucleus

71
Q

What is p53? Which stage of cell cycle does it act?

A

Tumor suppressor gene

G1, prevents it from moving on to mitosis

72
Q

What is a cholesteatoma made of? Effect?

A

Squamous cell debris, appears like a pearly white mass behind tympanic membrane
Causes conductive hearing loss, may cause vertigo or affect facial nerve if large enough

73
Q

What high potency antipsychotics cause tardive diskenesia?

A

Haloperidol

Fluphenazine

74
Q

What do blotchy red muscle fibers of Gomori stain indicate?

A

Midochondreal myopathies
“red ragged fiber”
Can only be passed down maternally

75
Q

Which receptors do atenolol work on?

A

Selective B1 adrenergic receptors found in cardiac tissue and JG cells
Decreased Gs pathway, decreases cAMP

76
Q

When do you use chi square test?

A

2x2 table

2 categorial variables compared

77
Q

when is t-test used?

A

to compare the means in 2 groups

78
Q

when does vasospastic angina occur?

A

at night

79
Q

What medication precipitates vasospastic angina

A

Dihydroergotamine (for headaches), provokes vasoconstriction. Triptans, smoking, and cocaine can also provoke variant angina

80
Q

MOA enfurvitide?

A

Binds gp41 and inhibits it from making conformational changes that allow viral fusion and entry

81
Q

Ash leaf-spots, brain hamartomas, and renal angiolipomas. What is it?

A

Tuberous sclerosis, autosomal dominant disease

82
Q

What is cystinuria?

A

Condition where amino acid transporter is defective, resulting in impaired renal and intestinal absorption/reabsorption

**recurrent Cysteine kidney stones form - flat yellow hexagonal crystals

83
Q

What is premature ejaculation?

A

Ejaculation in less than 1 min of penetration for at least 6 months

84
Q

Clubbing and cyanosis in lower extremities but not upper, increased fatigability on exertion, recurrent respiratory infections. Which heart abnormality is it?

A

PDA

85
Q

MOA fatty liver/ hepatic steatosis?

A

Triglyceride accumuliation, decreased free fatty acid oxidation due to excess NADH production via alcohol dehydrogenase and aldehyde dehydrogenase

86
Q

Wha are sofosbuvir and ledipasvir for?

A

TTx of HCV

87
Q

How do sofosbuvir and ledipasvir work?

A

RNA dependent RNA polymerase inhibitors, protease inhibitors, NS5A inihbitors

Inhibits viral repllication and assembly

88
Q

What fails to fuse in patent foramen ovale?

A

Septum premum and septum secundum

89
Q

What does patent foramen ovale put you at risk for?

A

Paradoxical brain embolism

90
Q

What is heteroplasmy?

A

Different mitochondreal genomes within a single cell Some cells will have normal mitochondrea and others won’t

Inheritence pattern will still go through mother but only some of the offspring will be effected

91
Q

Why do parkinson’s disease drugs sometimes cause good mobility and other times cause bradykinesia/rigidity?

A

“on-off” patterns, drug is upredictable in response, there is a small therapeutic window and as the nigrostriatum degenerates this window gets smaller

92
Q

Tx for juvenile myoclonic epilepsy?

A

Valproic acid (broad spectrum)

93
Q

Diastolic decrescendo murmur best year L sternal border?

A

AR - valvular type best heart at L 3rd intercostal space

Marfan’s AR due to root dilation best heard at R upper sternal border

94
Q

What does osteoporosis from hyperparathyroidism look like?

A

Subperiosteal respotion with cortical thinning

95
Q

Equation for RR?

A

RR = (a/(a+b))/(c/(c+d))

96
Q

What are symptoms of CMV colitis and who gets it?

A

Diarrhea, abdominal pain, fever, fatigue.

Renal transplant pts on immunosuppressive therapy

97
Q

What is Tx for CMV colitis? What do you see on colonoscopy? On histology?

A

Gancyclovir
Colonic ulcerations
Intracytoplasmic basophilic inclusions

98
Q

SE of gancyclovir?

A

Neutropenia
Anemia
Thrombocytopenia

99
Q

DMS criteria for MDD?

A

> 5 symptoms for >2 weeks, one must be depressed mood or anhedonia

100
Q

Main risk tamoxifen

A

Endometrial hyperplasia, and cancer

Also hot flashes and VTE

101
Q

What is age cutoff for understanding death

A

under 7 won’t understand

102
Q

What are hindgut derivatives?

A

Distal 1/3 of transverse colon, descending colon, sigmoid colon, and rectum

103
Q

What supplies the hindgut derivatives?

A

Inferior mesenteric artery

104
Q

How does silicosis increase risk of TB?

A

Impairs macrophage function

105
Q

What does tetrodotoxin from pufferfish do?

A

Bind voltage-gated sodium channels in nerve and cardiac tissue

106
Q

Papilledema, headache, vomiting from obstructive hydrocephalus. Limited upward gaze. What is it?

A

Pineal gland mass causing Parinaud syndrome

107
Q

What is pineal gland mass usually caused by?

A

Germinomas. They may present in young boys in gonads or mediastinu. Can cause hypothalamic/pituitary dysfunction

108
Q

Man dies from lung condition- what is condition if spindle cells positive for cytokeratin and calretininmean?

A

Mesothelioma

Asbestos exposure

109
Q

What is hyperacute renal rejection caused by?

A

Antibody-mediated reaction- preformed IgG against donor antigens (ABO and anti-HLA)

Type II hypersensitivity

Will see rapid necrosis and oligria

110
Q

What is graves ophthalmopathy caused by? What is treatment?

A

T-cell acivation and inflammatory infiltration, stimulation of orbital fibroblasts

Glucocorticoids

111
Q

MOA phenytoin?

A

blocks Na+ channels, inhibits depolarization

112
Q

Tx status epilepticus?

A

IV lorazepam and phenytoin concurrently

113
Q

What is Tx for hypertrigliceridiemia causing acute pancreatitis?

A

Fibrates (fenofibrate, gemfibrozil)

114
Q

Time length to diangose dysthymia?

A

> 2 years + presence of 2 depressive symptoms

115
Q

What changes will kidney undergo if they have hydronephrosis?

A

pressure induced parenchymal atrophy, scarring

116
Q

What does portal hypertension for alcoholic liver disease do to spleen?

A

Splenomegaly, **expansion of red pulp from venous congestion

117
Q

How does septic shock cause lactic acidosis?

A

Tissue hypoxia impairs oxidattive phosphrylation. Pyruvate gets shunted to lactate after glycolysis (due to NADH buildup).

118
Q

History o dementia/stroke will put someone at risk for aspiration pneumonia. Where will aspirate go?

A

Superior regions of lower lobes. Superior and posterior regions. Superior of lower lobes, posterior of upper lobes

119
Q

Which vessel does RCC usually obstruct?

A

IVC AFTERinvading the renal vein

120
Q

Why do RCC patients have erythrocytosis?

A

Excessive EPO production by RCC. May have hypercalcemia from overpoduction of PTHrP

STEP 1 MIXED (13 decks)

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