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STEP 1 MIXED > Deck 7 > Flashcards

Deck 7 Flashcards

1
Q

Patient with headaches, HTN, and ruptured cerebral aneurysm. WHat is cardiac defect?

A

CoA –> Causes hypertension and puts them at risk for ruptured aneurysms
CoA also associated with berry aneurysm formation

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2
Q

What part of ToF determines cyanosis?

A

RVOT (degree of pulm stenosis determines how much blood is shunted from R-L through VSD)

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3
Q

What happens to CFTR proteins in CF?

A

Misfolding and failure of glycosylation, followed by proteasome degredation

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4
Q

What does western blot test for?

A

Specific proteins. They are first separated via gel electrophoresis and then bound to antibodies to be detected

Example: HIV proteins

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5
Q

What does Northern and Southern blot test?

A

Northern - specific RNA sequences

Southern- specific DNA sequences in an unknown sample

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6
Q

What cells are responsible for Toxic Shock Syndrome?

A

Macrophages and T cells
T cells interact with MHC II –>
IL 2 from T cells
IL 1 & TNF-alpha from macrophages

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7
Q

What are phases of digestion in stomach and their relation to gastrin?

A

Cephalic (vagal, and cholinergic mechanisms. Gastric phase –> gastric acid production
Intestinal phase —> protein digestion in duodenum, down-regulates gastrin***
Release YY peptide which inhibit ECL cells from releasing histamine

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8
Q

Which substances inhibit gastric acid secretion?

A

Prostaglandin, somatostatin, YY peptide

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9
Q

What type of disease causes RPGN? What do you see on light microscopy and on immunoflorescence?

A

Anti-GBM disease (such as goodpastures)
Antibodies against basement membrane, type IV collagen

LM- crescents
Immunoflorescence- smooth linear deposits

Clinically- nephritic syndrome, crescentic GN

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10
Q

What does granular appearance on immunofluoresence mean?

A

Membranous nephropathy or PSGN, IgG and C3 deposits

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11
Q

What are baroreceptors in aortic arch vs internal carotids innervated by?

A

Aortic arch - vagus

Carotids - glossopharyngeal

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12
Q

Where is the AV node located anatomically?

A

Interatrial septum (tricuspid valve) near opening of coronary sinus

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13
Q

Which organ clears digoxin?

A

Kidney. Decreased renal function associated with digi toxicity

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14
Q

What cranial nerve pass through jugular foramen?

A

CN IX, X, XI

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15
Q

Symptoms if jugular foramen compressed?

A

Loss of gag reflex ipsilateral side,
Loss of accessory muscle use on affected side,
Loss of taste from posterior tongue
Dysphagia
Hoarseness
Uveal deviation toward away from lesion (CNX)

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16
Q

What are labs in hypothyroidism?

A

TSH increased, T4 decreased, T3 normal

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17
Q

Which antibodies are found in polymyositis?

A

Muscle enzyme CK
ANA
Anti-Jo (anti-hystidyl-tRNA synthase)

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18
Q

How does polymyositis present?

A

Middle age, insideous onset of weakness in extremities. Biopsy showing patchy muscle fiber necrosis

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19
Q

Risk associated with polymyositis and dermatomyositis?

A

Increased risk of adenocarcinoma

dermatomyositis has this risk as well

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20
Q

How to decrease MR murmur?

A

Decrease afterload

via decreasing systemic vascular resistance

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21
Q

How do you calculate how often a drug needs to be given?

A

Via the half-life (t 1/2) Time it takes to get to 50% of drug availability

t 1/2 = (0.7 x Vd) / CL
Vd = volume distribution
CL = clearance rate

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22
Q

How many half lives to elimate 50% of drug? 75%?

A

1 and 2 half lives

So calculate thehalf life and then determine how many hours needed based on number of half lives

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23
Q

Which drugs for BPH decrease prostate size?

A

5-alpha reductase inhibitors (finasteride, dutasteride) inhibit conversion to DHT

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24
Q

SE of EPO?

A

Thromboemolic events, HTN

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25
Q

What happens to aorta in tertiary syphilis?

A

Vasa vasorum gets destroyed
Weakening of adventitia
Aneurysmal dilation of thoracic aorta and aortic root dilation
May see murmur and mediastinal widening

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26
Q

Blue neoplasm under nail- what is it?

A

Either melanoma or glomangioma (regulates temperature via shunting blood to and from extremities)

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27
Q

What meds do you use for MRSA if patient has vanc allergy?

A

Dapt or linezolid

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28
Q

MOA daptomycin?

A

Creates transmembrane channels that cause leakage in cell. Causes depolarization of cell and inhibits DNA and RNA synthesis in bacteria

Inactivated by surfactant –> can’t use to tx pneumonia

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29
Q

SE daptomycin?

A

Increased CPK levels, myopathy

30
Q

What type of injuries result in radial nerve damage?

A

Injury to midshaft of humerus or axilla

31
Q

What is greatest RF for cervical cancer in HIV?

A

Immunosuppression

HIV increases expression of E6 and E7 viral oncogenes

32
Q

What is cause of HUS?

A

Microangiopathic hemolytic anemia (microthrombi in small vessels)

33
Q

What are symptoms of HUS?

A

Hemolytic anemia, thrombocytopenia, AKI

34
Q

How does oxygen-induced hypercapnia occur in COPD patients?

A

Main mechanism is V/Q mismatch

O2 dilates pulmonary arteries, so when the arteries dilate in poorly ventilated areas, they become hypoxic

35
Q

What is function of kinesin?

A

ATP powered protein that assists microtubules in moving vesicles anterograde toward synaptic nerve terminal

36
Q

What is overexpressed in GBM? What type of cells proliferate?

A

Epidermal growth factor receptor- tyrosine-kinase signal transduction system promoting cellularsurvival and proliferation of glial cells (pleuripotent neural stem cells)

37
Q

Which brachial pouch is absent in Digeorge syndrome?

A 
Pouch III (Inferior parthyroid gland, thymus)
And IV (superior PTH, ultimobrachial body)
38
Q

What does the 1-4 branchial pouch become?

A

1st - auditory canal
2nd - palatine tonsil
3rd - inferior PTH, thymus
4th - Superior PTH, ultimobrachial body

39
Q

What is pathogenesis of Turner syndrome? WHich gene is affected?

A

Pathogenic SHOX gene
Meiotic non-disjunction in meosis II
45X or 46XX with mosaicism

40
Q

What are clinical features of Thrombotic Thrombocytopenic Purpura (TTP?)

A

Hemolytic anemia with schistocytes
Thrombocyotpenia, increased bleeding time, normal PT/PTT
Microangiopathies

41
Q

What is pathogenesis behind TTP? WHat is Tx?

A

Decreased ADAMTS13 level –> uncleaved vWF –> more platelet trapping & activation

Tx = plasma exchange
glucocorticoids, retuximab

42
Q

What is equation for minute ventilation and alveolar ventilation?

A

Minute ventilation = tidal volume(L)/ breaths per min
Alveolar ventilation = (tidal volume - dead space)/ breaths per min

Where dead space = ventilated but poorly perfused areas

43
Q

Equation for physiologic dead space?

A

Physiologic dead space = tidal volume x (PaCO2- expired CO2/PaCO2)

44
Q

What is cutoff level for triglycerides causing acute pancreatitis?

A

> 1000mg/dL

45
Q

Where is the vomiting center located? What drugs are used as first line from GI irritation to treat nausea/vomiting?

A

Medullary vomiting center
5_HT3 receptor antagonists- ondasteron

GI causes include traveller’s diarrhea, infections, chemotherapy, distension

46
Q

Which anti-nausea medications are used for vestibular nausea? Migraines?

A

Anticholinergics and antihistamines

Migraines - anti-dopaminergics

47
Q

What is H2PO4- urine level in DKA patient?

A

Raised. It acts as a buffer for H+, allows kidney to excrete more H+ via H2PO4- and NH4+ without raising urinary pH

48
Q

What antipsychotics are highest risk for causing metabolic syndrome?

A

Olanzapine
Clozapine

Get fasting glucose and lipid levels

49
Q

What determines risk for UTI in hospital?

A

Duration of catheter insertion

Remove when no longer indicated

50
Q

Which nerve is affected in MS when one eye fails to react to light?

A

CN II (optic nerve, sensory info toward EDW nucleus)

51
Q

What do kegel exercises do?

A

Strengthen levator ani and help control urethral hypermobility

52
Q

Which hormones are released from hypothalamus?

A

TRH, VIP, dopamine

53
Q

How do antipsychotics cause galactorrhea and amenorrhea? Which path is blocked?

A

Inhibit dopamine, which normally inhibits prolactin. Hyperprolactinemia —> inhibition of GnRH

Blocks tubuloinfundibular (mesolimbic) path

54
Q

Where is Edinger-Westfall nucleus located?

A

Midbrain

Light from CN II –> pretectal nucleus —> EDW –> ciliary body —> pupillary sphincter

55
Q

What is D-xylose? What can it test for?

A

Monosaccaride like glucose/galactose. It tests for direct absoprtion through brush border (coeliac). WIll be normal in pancreatic insufficiency but abnormal in coeliac

56
Q

What type of arthritis can occur with reactive arthritis?

A

Ank spond, HLA B27 +, seronegative, sarcroilitis**

57
Q

What are functions of angiotensin II?

A

Stim aldosterone ( more Na+ reabsorption), vasoconstriction, vasoconstriction of efferent arteriole to maintain GFR

ACE/ARBs will inhibit above effects- BP control

58
Q

How do Betablockers lower BP?

A

Inhibit renin production, block B1 receptors in JG cells

59
Q

How do aminoglycosides work?

A

Bind 30s subunit of ribosome - causes genetic code misreading*
Gentamycin. Often used to treat endocarditis from enterococci

60
Q

Boy with bone tumor mets to lungs. Cells are small round, with clear cytoplasm. What is it?

A

Ewing sarcoma

61
Q

What type of cells result in Ewing sarcoma?

A

Mesenchymal stem cells

Patches of necrosis and hemorrhage, fibrous septae

62
Q

Why prescribe primaquine?

A

They have action against latent hypnozoites from P vivax and ovale. Inhibit relapse.

63
Q

How does topical capsiasin treat post-herpetic neuralgia?

A

Deletes substance P and defunctionalization of pain fibers

64
Q

What surface proteins are absent in PNH?

A

CD 55 and CD59 (Anti-MAC complex)
Aplastic anemia, pancytopenia
PIGA gene mutation

65
Q

What chemokines cause COX2 secretion?

A

IL-1 and TNF-alpha

66
Q

What is venous pressure in RA, RV, and pulmonary arteries?

A

RA - 1-6mmHg
RV - 25mmHg sys 5mmHG dias
Pulmonary artery - 25mmHg sys, 6-12mmHg dia (sudden rise in diastolic because of pulmonary capillary backpressure and pressing against LA)

67
Q

What type of tumor is associated with cytokeratins?

A

Epithelial

68
Q

WHat is Trastazumab?

A

Monoclonal antibody against HER2r

69
Q

What does HER2 code for?

A

Oncogene encoding for transmembrane glycoprotein with intrinsic tyrosine kinase activity. Accelerates cell proliferation

70
Q

What ischemic changes do you see after ischemic stroke at 1 day, 2 days, 1 week, and 2 weeks?

A

1 day- red neurons (eosinophilic cytopasm, loss of Niisl substance)
2 days - Neutrophils
3-7 days: macorphages and microglea
2 weeks; reactive gliosis and neovascularization, liquefactive necrosis
>2 weeks glial scar

STEP 1 MIXED (13 decks)

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