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DIT Flashcards

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USMLE® Step 1 flashcards
1
Q

beta 2 Receptor actions

A

vasodilation (mild), bronchodilation, elevation of lipolysis and insulin, decrease in uterine tone

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2
Q

adrenergic receptor types in skeletal muscle

A

alpha 1 and beta 2

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3
Q

Zosin drugs–>what are they? what are they used for?

A

alpha 1 blockers; use for HTN and BPH (relax bladder neck muscles; especially Tamsulosin alpha 1A/D–>better for pts with BPH without HTN)

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4
Q

pheochromocytoma treatment

A

alpha blocker first: phentolamine/phenoxybenzamine

beta blocker

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5
Q

HTN and bradycardia patient–>how to treat

A

use acebutaolol or pindolol–>very weak beta 1/beta 2 agonists that are so weak they act as antagonists–>leads to less pronounced heart blocking effect

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6
Q

Alpha 1 and beta 2 blockers?

A

carvedilol/ labetalol

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7
Q

arotic dissection treatment

A

beta blocker–>lower blood pressure and rate of BP increase during systole

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8
Q

what not to give pt with cocaine overdose?

A

beta blocker. Cocaine inhibits NE uptake… therefore blocking beta will result in alpha stimulation–>increase in HTN.

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9
Q

beta blocker SE

A

bronchoconstriction; hypoglycemia, arrythmia, rebound HTN

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10
Q

Timolol, nadolol

A

glaucoma

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11
Q

partial beta agonists acting as antagonists?

A

Pindolol, acebutaolol

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12
Q

Clonidine mech? use?

A

alpha 2 R blocker; used as sedative and malignant HTN

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13
Q

beta blocker contraindications/use caution

A

asthmatics; DM; CHF/heart block patients/brady cardia

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14
Q

Lithium Side effects (in adults)

A
  • sedation/dizziness
  • tremors (POSTURAL TREMOR!!!)
  • sick sinus syndrome/heart block/bradycardia
  • hypothyroidism/goiter
  • polyuria (by blocking aquaporin)
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15
Q

Mania dx criteria

A 
Distractability
Irresponsibility
Grandiosity
Flight of ideas
Activity (goal directed)/agitation
Sleep decrease
Talkativity

More than 1 month

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16
Q

Major Depression Dx criteria

A

more than 2 weeks must have loss of interest or depressive mood. plus 4 of the others.

Sleep changes
Interest loss
Guilt
Energy loss
Concentration loss
Appetite loss
Psychomotor sx
Suicidal ideations
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17
Q

Risk factors of Suicide

A 
Sex (male)
Age (teenagers; elderly)
Depression
Previous attempts
Ethanol
Rational thought loss
Sickness
Organized plan
No Spouse/no support
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18
Q

Acute pancreatitis causes

A 
Gall stones
Ethanol
Trauma
Scorpion sting
Mumps
Autoimmune
Steroids
Hyperlipidemia/hypercalcemia
ERCP
Drugs
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19
Q

Hypercalcemia sx

A

Stones, groans, psychiatric overtones

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20
Q

Hypocalcemia signs

A

trousseau’s sign; chvostek’s sign

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21
Q

Audio hallucination most associated with?
Visual Hallucinations most associated with?
Tactile formication?
olfactory hallucinations?

A
  • auditory: schizophrenia
  • visual: medical illness (dementia/drugs/migraine)
  • tactile: alcohol withdrawal; cocaine user
  • olfactory: epilepsy/brain tumor
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22
Q

gram positive cocci in pairs

A

strep pneumo

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23
Q

What is Ferritin?

A

Ferritin is an acute phase reactant protein that stores iron (hides it away if there’s an infection)

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24
Q

Calcium D synthesis/activation organs?

A

cholecalciferol (synthesized in skin/ingested in milk) or ergocalciferol from plants–>liver converts to 25 hydroxyD–>kidney converts to 1,25 hydroxyD

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25
Q

Conditions associated with elevated calcium/vitamin D

A

Sarcoidosis/ Hodgkins’ lymphoma– activation of macrophages and T cells and alpha 1 hydroxylase

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26
Q

synthesis of what depends on having a normal GI flora?

A

vitamin K

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27
Q

What are vit K dependent clotting factors?

A

C, S, prothrombin, II, VII, IX, X

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28
Q

Infant with hemorrhage? Why, how to prevent

A

no vitamin K due to sterile flora, give IM vit K at birth

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29
Q

Vitamin K deficiency causing medications?

A

Warfarin
antibiotics
phenytoin (and other anticonvulsants)

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30
Q

eskimo polar bear hunter who consumes liver and develops visual changes, vomiting, vertigo

A

Vitamin A

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31
Q

Vitamin A deficiency

A 
Bitot spots on sclera
corneal degeneration (keratomalacia)
dry eyes (xerophthalmia)
night blindness
dry scaly skin
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32
Q

Vitamin A acute toxicity

A

Vomiting, Visual changes, Vertigo

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33
Q

Vitamin A chronic toxicity

A

increased intracranial pressure, papillary edema, hepatomegaly
joint pain, hair loss

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34
Q

fetal vitamin A teratogenic defects

A

clefting, dandywalker, cardiac abnl

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35
Q

What does vitamin E do primarily?

A

antioxidant protecting RBC

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36
Q

Vitamin E deficiency?

A

peripheral neuropathy, ataxia, muscle weakness, HEMOLYTIC ANEMIA!

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37
Q

acanthocytosis is associated with what two things

A

dysbetalipidemia (apoE deficiency and accumulation of VLDL remnants) and vitamin E deficiency

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38
Q

Major functions of vitamin C?

A
  1. collagen hydroxylation of pro and lys
  2. antioxidant of vitamin E thus protects RBCs
  3. Iron absorption
  4. Dopamine to NE (dopamine hydroxylase)
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39
Q

methemoglobinemia; cause? treatment?

A

cause: nitrates/sulfates; treatment: methylene blue and vitamin C

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40
Q

Guy back from camping trip… cyanotic doesnt respond to 100% o2; what does he have? How to treat?

A

has cyanide poisoning from wells; treat with nitrates and sulfates

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41
Q

corkscrew hair

A

vitamin C deficinecy

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42
Q

perifollicular hemorrhage; ring sideroblast

A

vitamin C deficiency induced iron deficiency

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43
Q

cofactors for pyruvate DH and alpha-ketoglutarate DH

A 
Thiamin
Lipoate
CoA
FAD
NAD
(Tender loving care for nobody)
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44
Q

Patient presents semi conscious. What do you give with GLucose?

A

Thiamine! or IV glucose will eat up all the thiamine and no ATP can be produced–>korsakoff/wernicke

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45
Q

Vitamin B2 deficiency sx

A

chelitis; corneal vascularization

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46
Q

casal necklace

A

Pellagra; niacin deficiency

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47
Q

Niacin SYnthesis

A

Tryptophan;
B2 (riboflavin)
B6 (pyridoxine)

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48
Q

Isoniazid decreases what vitamin?

A

B6 and thus B3

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49
Q

Niacin Deficiency causes

A

Hartnup disease (malabsorption of tryptophan)
malignant carcinoid syndrome
Isoniazid (INH): inhibits B6 and B2 thus B3 synthesis

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50
Q

prevention of niacin induced flushing with what

A

Asprin prophylaxis

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51
Q

What is B5? deficiency?

A

pentothenate AKA CoA

dermatitis, enteritis, alopecia, ADRENAL INSUFFICIENCY

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52
Q

What is B6? what is it involved in?

A

It’s pyrodoxine
porphyrin synthesis thus in RBC and hepatocytes (CYP)
transaminases (AST/ALT)
neurotransmitters

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53
Q

B6 deficiency sx?

A

neuropathy
convulsion (decrease in neurotransmitters)
chelitis/dermatitis/glossitis

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54
Q

Pt with TB what do you treat them with? what do you have to add?

A 
Isoniazid, rifampin, ethambutol, and pyrazinamide
PLUS B6 (pyridoxine)
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55
Q

Toxoplasma treatment

A

Pyramethemine and Sulfadiazine

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56
Q

B7 What is it?? what kind of reactions does it do? what specific reactions are these?

A

biotin, carboxylation reactions
pyruvate to oxaloacetate
acetyl coA to malonyl coA
prioprionyl CoA to methylmalonyl CoA

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57
Q

Pernicious Anemia –>antibodies are against what?

how to Dx?

A

gastric parietal cells and intrinsic factor

Dx: Immunofluorescense OR Schilling Test

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58
Q

Schilling Test

A

Radiolabeled B12 oral and measure in urine. If low–>poorly absorbed

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59
Q

First dose hypotension

A

alpha 1 blocker

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60
Q

3 ways of increasing power of a study

A

increasing power means increasing the ability to reject H0 when there infact is a difference.

  • increase sample size
  • increase “expected effect size” by anticipating people droping out
  • increase precision of measurement
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61
Q

hormones that increase gastric acid secretion

A

histamine, gastrin

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62
Q

hormones that inhibit gastric acid secretion

A

GIP, Somatostatin, Secretin, prostaglandin

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63
Q

Why does ACE I induce cough?

A

ACE I inhibit ACE thus inhibiting bradykinin breakdown…causing bronchoconstriction

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64
Q

1 standard deviation percent of population?

A

68

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65
Q

2 standard deviation inludes what percent of population?

A

95

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66
Q

3 standard deviation percent of population?

A

99.7

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67
Q

How does sample size affect confidence interval?

A

decrease

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68
Q

Z score is used to calculate what?

A

Z is multiplied by Standard Error and +/- to the mean to calculate the Confidence interval

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69
Q

CI=90%; Z score?

A

1.645

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70
Q

CI=99%; Z score?

A

2.58

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71
Q

CI=95%; Z score?

A

1.96

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72
Q

T test

A

continuous variable–>compares means of two groups

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73
Q

ANOVA

A

continuous variable–>compare means of 2+ groups

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74
Q

Chi squared test

A

categorical data

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75
Q 
correlation coefficient (r)
What does 1 mean?
What does 0 mean?
What does -1 mean?
A

1=perfect positive correlation
0=no correlation
-1=perfect negative correlation

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76
Q

first born male vomiting at 2-6 weeks; non bilious

A

congenital pyloric stenosis

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77
Q

dressler syndrome

A

pericarditis 2-4 weeks post MI

fever, pain, elevated ESR

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78
Q

xray finding during aortic dissection?

A

widening of mediastinum

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79
Q

which lipid lowering drugs bind c diff toxin?

A

cholestyramine

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80
Q

4 basic core ethical principles!!!

A

nonmaleficence
Beneficience
Autonomy
Justice

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81
Q 
Antibiotics with:
Tendonitis?
Gray Baby Syndrome?
Cartillage damage?
Nephrotoxicity?
Ototoxicity when use with loop diuretics
c diff?
A 
Tendonitis-Floroquinolones
Gray baby-Chloramphenocol
Cartilage-floroquinolones
Nephrotoxicity-Cephalosporins
Ototoxicity-aminoglycosides
C diff?clindamycine/ampicillin
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82
Q

three causes of megaloblastic anemia?

A 
Folate B9 deficiency
B12 deficiency
orotic aciduria (due to UMP synthase deficiency)
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83
Q

Adenosine deaminase deficiency?

A

SCID

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84
Q

SCID features?

A
  • severe recurrent infections–>candidiasis/ pneumocystis pneumonia
  • diarrhea
  • failure to thrive
  • no thymic shadow on CXR
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85
Q

Post operative fever causes

A

Wind water wound walking wonder drugs

  • Pneumonia-days after
  • UTI-foley
  • wound
  • walking-DVT
  • drugs
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86
Q

Floroquinolones mechanism?

A

inhibits topoisomerase

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87
Q

Mismatch repair?
base excision?
nucleotide exision?
non homologous end joining?

A

Mismatch repair–>recognizes base changes–>rids of the wrong ones and fill in the right ones

Nucleotide excision repair–>recognizes bulky defect. removes a chunk of DNA (thus need endonuclease, polymerase, and ligase)

Base excision–>base itself is damaged (modified)
glycosylase removes base, endonuclease activity, polymerase, and ligase

nonhomologous end joining–> double stranded break

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88
Q

What binds operator?

A

either repressor or inducer

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89
Q

which eukaryote RNA pol make which kind of RNA?

A

RNA pol I rRNA (Rampant)
RNA pol II mRNA (Massive)
RNA pol III tRNA (Tiny)

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90
Q

How does Tetracycline work?

A

inhibits tRNA binding to A site on 30S subunit; preventing elongation

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91
Q

How does Chloramphenicol work?

A

binds 50S subunit and inhibits aminopeptidyl transferase; therefore stopping elongation

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92
Q

How does Aminoglycoside work?

A

binds 30S subunit before anything else binds thus stopping initiation

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93
Q

How does macrolide work?

A

binding to 50S subunit preventing translocation from A to P thus stopping elongation

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94
Q

How does Linezolid work?

A

binds 50 S subunit preventing initiation

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95
Q

Williams syndrome. Mutation? Features/sx

A

Deletion of long arm on chr 7. Elvin facies, hypercalcemia /increased sensitivity to vit d! intellectual disability, well spoken and extremely friendly to strangers

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96
Q

Glycolysis rate limiting step

A

Phosphofructokinase 1

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97
Q

Gluconeogenesis rate limiting step

A

Fructose 1.6 bisphosphate

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98
Q

TCA cycle rate limiting st

A

Isocitrate dehydrogenase

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99
Q

Glycogenesis rate limiting step

A

Glycogen synthase

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100
Q

Glycogenolysis rate limiting step

A

Glycogen phosphorylase

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101
Q

Hmp shunt rate limiting step?

A

Glucose 6 phosphate dehydrogenase

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102
Q

De novo purine synthesis rate liming step

A

Prpp amidotransferase

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103
Q

De novo pyramiding synthesis rate limiting step

A

Carbamoyl phosphate synthase II (cyto)

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104
Q

Urea cycle rate limiting step

A

Carbamyol phosphate synthase I (mito)

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105
Q

Fatty acid oxidation rate limiting step

A

Carnitine acyl transferase I

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106
Q

Ketogenesis rate limiting step

A

HMG coa synthase

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107
Q

Cholesterol synthesis rate limiting step

A

HMG coa Reductase

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108
Q

three dz with marfanoid body habitus

A

marfan, MENIIB, homocysteine uria

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109
Q

prader-willi mutation?

A

paternal allele deletion (maternal allele is imprinted)

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110
Q

child with obesity, short, intellectual disability, tantrums/skin picking, hypogonadotropic hypogonadism, osteoporosis

almond eyes and down turned mouth

A

Prader-Willi

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111
Q

young child with ataxia, inappropriate laughing. dx?

A

Angelman syndrome (maternal deletion; paternal imprinted)

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112
Q

INdirect and direct ELISA

A

Direct=putting in antibody to look for antigen

Indirect =putting in antigen to look for antibody

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113
Q

what will increase PFK1 activity? what will decrease it?

A

it will increase with increased AMP and fructo2,6 bisphosphate

It will decrease with ATP and citrate

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114
Q

what are the 4 enzymes of gluconeogenesis?

A

pyruvate carboxylase, PEP carboxykinase, fructose 1,6 bisphosphatase, glucose 6 phosphatase

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115
Q

what organs can do gluconeogenesis?

A

liver, kidney, intestinal epithelium

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116
Q

What are three processes involving both cytosol and mitochondria?

A

Heme synthesis
Urea cycle
Gluconeogenesis

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117
Q

what are the 4 fates of pyruvate?

A

CoA, Oxaloacetate, lactate, alanine

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118
Q

vomiting, rice water diarrhea, and garlic breath? dx

A

arsenic poisoning; inhibition of Lipoic acid thus pyruvate dehydrogenase is ineffective

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119
Q

pyruvate dehydrogenase deficiency congenital presentation?

A

neurologic defets, lactic acidosis, and high alanine

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120
Q

What is the Cori Cycle and what enzyme is important?

A

Cori cycle converts lactate to glucose in liver and glucose to lactate in RBC and muscle cells.

Lactate dehydrogenase converts between pyruvate and lactate

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121
Q

what are the drug/things that inhibit electron transport chain complexes?

A

complex 1: Rotenone, Amytal, MPP
Complex 3: antimycin
Complex 4:: Cyanide, Azide, CO, and hydrogen sulfate
Complex 5: oligomycin

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122
Q

what is the point of the Alanine cycle?

A

carry nitrogen from muscle to liver in order to have it go through the urea cycle. The nitrogen is carried by both alanine and Glutamine

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123
Q

ALT catalyzes what reactino?

A

alpha ketoglutarate + alanine–>glutamate +pyruvate

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124
Q

What does AST catalyze?

A

glutamate + oxaloacetate–>alpha ketoglutarate +Aspartate

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125
Q

name 3 uncoupling agents

A

thermogenin, asprin, and 2,4 dinitrophenol

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126
Q

mutation in von gierke?
mutation in cori
mutation in pompe
mutation in mcardle

A

von gierke: glucose 6 phosphatase

cori: debranching enzyme (1.6 glucosidase)
pompe: lysosomal 1,4 glucosidase
mcardle: glycogen phosphorylase

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127
Q

deficiency in glycolytic enzymes and HMP shunt enzymes will cause hemolytic anemia. What are two classic conditions of these pathways? why does hemolytic anemia happen?

A

glycolysis: pyruvate kinase deficiency… It causes hemolytic anemia because RBCs depend on glycolysis for ATP production…thus no ATP will lead to dysfunctional Na/K ATPase ..thereby causing hemolytic anemia

HMP shunt: missing G6PD, therefore you can’t reduce glutathione, and therefore you can’t reduce the oxidative stress on red cells.

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128
Q

Classic galactosemia. What enzyme is deficient? what are sx?

A

Uridyltransferase deficiency. build up of galactitol, congenital cataracts, failure to thrive, jaundice, hepatomegaly, mental retardation

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129
Q

Galactokinase deficiency? symptoms?

A

infantile cataracts and galacitol buildup. failure to track objects/social smile

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130
Q

Essential fructosemia? sx? enzyme that’s deficient?

A

cannot use fructose as energy and is in urine. otherwise benign.

fructokinase deficiency

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131
Q

Fructose intolerance. What is deficient?

A

ALdolase B

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132
Q

horseshoe kidney can’t go up because what?

A

inferior mesenteric artery

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133
Q

ethanol speeds up which two reactions? why does the body do this with ethanol consumption? what’s the clinical consequence?

A

pyruvate –>lactate, oxaloacetate–>malate

This is done to regenerate NAD from the NADH produced by alcohol DH and acetaledehyde DH

Therefore, gluconeogenesis is inhibited… and pt can be hypoglycemic

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134
Q

why do Kwashiorkor pts have fatty liver changes?

A

body cannot make APOB100 thus fatty acids accumulate

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135
Q

Kwashiorkor sx?

A

edema
anemia–> lack of protein thus can’t keep up with cell division
fatty liver
skin depigmentation/skin lesions

FLAME-fatty liver, anemia, malnutrition, edema

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136
Q

refeeding syndrome. What do you need to watch in these patients?

A

Potassium, phosphate, magnesium.

could lead to arrythmias and neurological abnormalities

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137
Q

Abetalipoproteinemia. What is missing? treatment?

A

missing ApoB48, ApoB100–>cholesterol/fats can’t be packaged into chylomicrons–>steatorrhea/DEAK def/failure to thrive/nightblindness
Tx
vitamin E

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138
Q

weakness, hypotonia, hypoketootic hypoglycemia

A

carnitine deficiency

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139
Q

fatty acid synthesis rate liminting enzyme?

A

Acetyl Coa Carboxylase

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140
Q

fatty acid breakdown rate limiting enzyme?

A

carnitine acyltransferase 1; carnitine palmitoyl transferase 1

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141
Q

ketone body synthesis rate limiting enzyme?

A

HMG CoA synthase

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142
Q

cholesterole synthesis rate limiting enzyme

A

HMG Coa reductase

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143
Q

essential amino acids?

A

PVT TIM HLL

phe, valine, threonine, Tyrptophan, Isoleucine, met, Histidine,leucine, and lysine

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144
Q

Which amino acids are important during periods of growth?

A

Arg His

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145
Q

which AA are important for nuclear localization/histones

A

Arg Lys

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146
Q

arginine derivatives?

A

creatine, urea, nitric oxide (BH4)

147
Q

tryptophan derivatives?

A

serotonin (B6 and BH4)–>melatonin

niacin (B6)

148
Q

histidine direvatives?

A

histamine (B6)

149
Q

Glycine derivatives?

A

porphyrine (B6)–>heme

150
Q

Glutamate derivatives?

A

GABA (B6), Glutathione

151
Q

hypertension drugs in preg?

A

hypertensive moms love nifedipine

Hydralazine, methyldopa, labetalol, nifedipine

152
Q

PKU causes..2

treatment?

A

phe hydroxylase def; BH4 def

avoid Phe and supplement Tyrosine

153
Q

homocysteinuria enzyme deficient?

A

homoecysteine methyltransferase or B12 deficiency (can’t generate methionine form homocystein)

cystathionine synthase or B6 deficiency

154
Q

tall, kyphosis, osteoporosis

mental retardation, atherosclerosis, downward subluxation of lense

A

homocysteine uria

155
Q

Cysteinuria what is the defect?

A

PT reabsorption of Cysteine, Ornithine, Lysine, Arginine

156
Q

maple syrup urine disease…what enzyme is missing? what’s the cofactor?

A 
alpha ketoaciddehydrogenase.
need thiamine (and all of these TLC For Nobody)
157
Q

first pharyngeal arch muscles and nerves?

A

muscles of mastication, mylohyoid, tensor tympani, tensor veli palatini

mandibular and maxillary branches of V

158
Q

mechanism of adenosine?

A

hyperpolarization via increasing outward K flow.

159
Q

where are peyers patches found?

A

ILEUM

160
Q

splenectomy findings 2 histo; 2 presentation

A

Howell jolly bodies, target cells, thrombosis, infection by encapsulated organisms

161
Q

What are the encapsulated organisms?

A 
Strep pneumo
Hemophilus
Neisseria
Salmonella
Klebsiella
Group B strep
162
Q

hyperkalemia on EKG?

A

tall T waves

163
Q

Theophylline antidote?

A

beta blockers

164
Q

Langerhan cell histiocytosis. what markers are present?

A

CD1a; S100

165
Q

which part of antibody is carboxy end, which one is amino?

A

carboxy=Fc region

Amino =variable region

166
Q

what structures hold together the antibody?

A

disulfid bonds

167
Q

whats the normal Kappa to Lambda light chain ratio?

A

2:1

168
Q

whats the normal Kappa to Lambda light chain ratio? what does it mean if this ratio is not 2:1

A

2:1 ; possibly multiple myeloma

169
Q

IgG halflife?

A

21 days

170
Q

whats colostrum?

A

early breast milk

171
Q

whats colostrum?

A

early breast milk, have IgA

172
Q

what is granzyme?

A

Serine protease

173
Q

NK cells kill what kind of cells?

A

cells with low MHCI

174
Q

What enhances NK cell activity?

A

IL2, IL12, IFNbeta, IFN alpha

175
Q

CD16 are found where? what do they do

A

NK, macrophage, neutrophils

ADCC

176
Q

Th1 cells produce what cytokines?

A

IL2 and IFNY

177
Q

Th1 cells are activated by what cytokines

A

IL12

178
Q

Th2 cells produce what cytokines

A

IL2, IL4, IL5, IL10

179
Q

Th2 cells are activated by what cytokines

A

IL4

180
Q

what activates the classical complement pathway?

A

Ab crosslinking

181
Q

What activates alternative complement pathway?

A

complement on its own C3b

182
Q

what activates the classical complement pathway?

A

Ab crosslinking activating C1

183
Q

what does C1 esterase inhibitor do?

A

it inhibits cleavage of C1 thus activation of the classical complement pathway

184
Q

C1 esterase inhibitor deficiency causes what?

A

hereditary angioedema

185
Q

C1 esterase inhibitor deficiency causes what? what is contraindicated in these patients?

A

hereditary angioedema

DO NOT TAKE ACE I

186
Q

C3 deficiency?

A

recurrent strep pneumo/haemophilus infection

and increased risk for Glomerulonephritis (Type III hypersensitivity)

187
Q

decay accelerating factor (DAF) deficiency?

A

paroxysmal nocturnal hemoglobinuria

188
Q

what is the problem in paroxysmal nocturnal hemoglobinuria

A 
missing GPI (CD59) which anchors DAF (CD55) to cell. 
leading to overactive complement destruction of RBC
189
Q

How do you dx nocturnal paroxysmal hemoglobinuria

A

Flowcytometry

Ham’s test

190
Q

How to treat paroxysmal hemoglobinuria?

A

Transfusion, Warfarin, Eculizumab

191
Q

What are three functions of the spleen?

A

store RBC
remove damaged RBC/encapsulated bacteria
sequester platelets

192
Q

Name the encapsulated bacteria

A 
Strep pneumo
Hemophilus influenza
E. coli
Salmonella
Klebsiella
group B Strep
193
Q

macrophages if the joints are called what?

A

A cells

194
Q

monocytes of kidney are called what

A

mesangial cells

195
Q

Eosinophilia in renal biopsy

A

acute interstitial nephritis

196
Q

what causes eosinophilia?

A 
Drugs (NSAIDS, betalactams)
Neoplasms
Allergy/Atopic diseases
Acute interstitial nephritis
Addison's disease
Collagen disease
Parasites
197
Q

what does Cromolyn do?

A

inhibit mast cell degranulation

198
Q

what does IL3 do?

A

stimulates bone marrow

199
Q

action of IFNalpha and beta?

A

antiviral. they promote viral mRNA degradation and inhibit cellular protein syntheis

200
Q

what cytokines are produced by macrophages?

A

IL6, IL1, and TNFa

201
Q

what cytokines are produced by macrophages?

A

IL6, IL1 (fever), and TNFa (shock, leukocyte recruitment)

202
Q

what cytokines are produced by macrophages?

A

IL6, IL1 (fever), and TNFa (shock, leukocyte recruitment), IL8 (neutrophil chemotaxis)

203
Q

neutrophil chemotaxis

A

IL8, C5a, LB4

204
Q

IL12 function?

A

Th1 differentiation, activation of NK cells

205
Q

Aldesleukin

what is it? what’s it used for?

A

Recomb IL2

renal cell carcinoma, metastatic melanoma

206
Q

which cytokine can act like GMCSF?

A

IL3

207
Q

Oprelvekin. what is it? what’s it used for?

A

IL11 derivative; treat thrombocytopenia

208
Q

IFNa analogs can treat what disease?

A 
Hairy cell leukemia
Hep C Hep B
melanoma
Kaposi carcinoma
Genital warts
209
Q

IFNbeta is used to treat what?

A

multiple sclerosis

210
Q

IFNy is used to treat what?

A

Chronic granulomatous disease

211
Q

action of IFNalpha and beta?

A

antiviral. they promote viral mRNA degradation via RNase L and inhibit cellular protein syntheis (protein Kinase)

212
Q

Cyclosporine mechanism? SE?

A

cyclosporin binds cyclophilin and inhibit clcineurine…thus decreasing IL2 production

Nephrotoxicity due to vasoconstriction of renal vessels

213
Q

muromonab? mech?

A

inhibits CD3

214
Q

mycophenylate mech?

A

inhibition of IMP dehydrogenase thus no guanine synthesis

215
Q

Tacrolimus mech?SE?

A

binds FKBP and thus inhibiting IL2 synthesis. neurotoxicity

216
Q

Daclizumab mech?

A

binds CD25 (IL2 receptor on activated T cells)

217
Q

Thalidomide mech?

A

affects TNFalpha. used to treat erythema nodosum leprium.

teratogenic

218
Q

what can you use to treat the diseases involved in PAIR?

A

TNFalpha inhibitors –>infliximab, adalizumab, etandercept

219
Q

what can you use to treat the diseases involved in PAIR?

A

TNFalpha inhibitors –>infliximab, adalizumab, etandercept (decoy receptor)

220
Q

rituximab?

A

CD20 inhibitor NHL

221
Q

BTK gene is what? and what if it’s defective?

A

a tyrosine kinase gene
Bruton’s agammaglobulinemia; x-linked disease
onset about 6 months when maternal passive immunity has worn off

222
Q

pt with no lymphnodes or tonsils? waht is this

A

Bruton’s agammaglobulinemia

223
Q

recurrent mild Sinus and GI infections? pt also has many allergies.

A

selective IgA deficency

224
Q

selective IgA deficiency is at risk for what complication?

A

anaphylaxis with blood transfusions/ other things with IgA

225
Q

recurrent mild Sinus and GI infections? pt also has many allergies.

A

selective IgA deficency

226
Q

chronic mucocutaneous candidiasis cause?treatment?

A

T cell dysfunction; ketoconazole

227
Q

which immunodeficiency causes dissemination of mycobacteria

A

IL12 def

228
Q

IgM hyperglobulimemia, causes?

A

CD40, CD40L, or NEMO deficiency

229
Q

SCID sx quad?

A

recurrent infections, diarrhea, and failure to thrive, no thymic shadow

230
Q

no thymus ddx

A

SCID, di george

231
Q

Wiskott aldrich syndrome triad?

A

Thrombocytopenic purpura
Ezcema on the trunk
Recurrent infection

232
Q

trunkal eczema?

A

Wiskott aldrich

233
Q

ataxia telangiectasia. muatation? triad? risk?

A

ATM gene leading to dsDNA breaks (dsDNA repair defect)
ataxia (poor smooth pursuit), angiomas, and IgA deficiency
risk of leukemia and lymphoma

AFP elevated

234
Q

chedek hagashi. defective gene? sx?

A 
LYST gene defect phagosomes can't fuse to lysosomes. 
Will see giant neutrophilic granules
recurrent infections (skin and URT), partial albinism, neurological sx
235
Q

Hyperimmunoglobulin E syndrome? aka? sx? mutation? and consequence?

A

Job syndrome
Eczema, recurrent Staph aureus abscesses, and coarse facial features
STAT3 mutation–>defecive neutrophil chemotaxis.

236
Q

Hyperimmunoglobulin E syndrome? aka? sx? mutation? and consequence?

A

Job syndrome
Eczema, recurrent Staph aureus abscesses, and coarse facial features, 2 rows of teeth
STAT3 mutation–>defecive neutrophil chemotaxis.

237
Q

2 rows of teeth? dx?

A

job syndrome. hyperimmunoglob E

238
Q

reversible dementia. what is it? what are sx?

A

nl pressure hydrocphalus

wacky, wobbly, wet

239
Q

acidic drug overdose. what do you treat with to trap it in the urine?

A

bicarb…its something that takes up H

240
Q

basic drug overdose. what do you treat with to trap it in urine?

A

ammonium chloride..it’s something that gives off H

241
Q

which drugs are classic acidic drugs?

A

Asprin, Phenobarbital, methorexate

242
Q

which drug is a classic basic drug?

A

Amphetamines

243
Q

0th order kinetics drugs

A

Phenytoin, Asprin, Ethanol

244
Q

drugs that cause flushing?

A

Vancomycin, Adenosine, Niacin, Calcium channel blockers (nifedipine)

245
Q

drugs that can cause vasospasms?

A

cocaine, amphetamines, ergotamines, tryptans

246
Q

drugs that cause dilated cardiomyopathy?

A

doxorubicin, daunorubicin

247
Q

how to treat torsades?

A

IV Mg

248
Q

drugs that can cause thrombocytopenia?

A

HIT, cimetadine

249
Q

drugs that cause agranulocytosis?

A

clozapine, carbamazepine, colchicine,

PTU, methimazole, and Dapsone

250
Q

aplastic anemia

A

chloramphenacol, Bezenes, NSAIDs, PTU, methimazole

251
Q

afib patient with cough sx

A

amiodarone…possible pulmonary fibrosis?

252
Q

pulmonary fibrosis SE drugs?

A

amiodarone, busulfan, bleomycin

253
Q

liver necrosis drugs?

A

Halothane
Acetaminophen
Valproic acid
Amanita toxin

254
Q

hepatitis

A

isonizid

255
Q

Gynecomastia

A 
Spironolactone
Estrogen
Digoxin
Cimetadine
chronic alcoholism/cirrhosis
Ketoconazole
Marijuana
256
Q

tertiary adrenocortical insufficiency SE drugs?

A

withdrawal from corticosteroids

257
Q

hot flashes SE drugs

A

Tamoxifen, clomifene

258
Q

Hypothyroidism SE drugs

A

Amiodarone
Lithium
Sulfonamide

259
Q

drugs inducing gout?

A

Furosemide, thiazide
niacin
cyclosporin
pyrazinamide

260
Q

Gingival hyperplasia SE drugs

A

phenytoin,

Verapamil/nifedapine

261
Q

osteoporosis SE drugs

A

corticosteroid, heparin

262
Q

Photosensitivity SE drugs?

A

sulfonamides,
Amiodarone
tetracycline

263
Q

Steven Johnson’s drugs?

A 
CLEPP and let Steven PAS
carbamazapine
lamotrigine
ethosuxomide
Phenytoin
Phenobarbital
---
Penicillin
Allopurinol
Sulfa drugs
264
Q

SLE drug induced (what are the drugs?)

A 
Sulfonamide
Hydralazine
Isoniazid
Phenytoin
Procainamide
265
Q

Interstitial nephritis SE drugs?

A

Furosemide
NSAIDS
antibiotics

266
Q

Drugs that cause Diabetes insipidus

A

Demeclocycline, Lithium

267
Q

What drugs cause drug induced Fanconi’s?

A

heavy metal exposure, Wilson’s disease, expired tetracycline

268
Q

Drugs causing parkinsonian symptoms?

A

Metoclopramine
Antipsychotics
Reserpine

269
Q

Cinchonism is what? what drugs can cause it?

A

it’s HA with dizziness, tinnitus

Quinidine, Quinine

270
Q

drugs with seizures as side effects?

A 
Tramadol
Imipenem
Isoniazid
metoclopramide
buproprion
benzodiazepine withdrwal
271
Q

Drugs that can cause Tardive dyskinesia

A

antipsychotics

272
Q

neurotoxicity PLUS neurotoxicity SE drugs

A

Cisplatin
Aminoglycoside
Polymyxin

273
Q

nephrotoxic +ototoxic drugs?

A

Aminoglycoside
vancomycin
loop diuretics
Cisplatin

274
Q

Anticholinergic SE drugs?

A 
TCAs
H1 blockers
Atropine
Thioridazine
Chlorpromazine
275
Q

How does strep viridans cause endocarditis?

A

It makes dextran from glucose and adheres to platelet and fibrin…which then sticks on heart valves

276
Q

what are all the diseases strep pyogenes can cause?

A

superficial/pyrogenic: strep pharyngitis, impetigo, cellulitis, erysipelas

Immunogenic/organ specific: rheumatic fever, and poststrep glomerulonephritis

toxin mediated/systemic: Toxic shock-like syndrome, necrolyzing fascitis, scarlet fever

277
Q

Aschoff bodies

A

Rheumatic fever

278
Q

What are the bacteria that can do specialized transduction? what is one thing they have in common?

A 
THESE ARE ALL TOXIN GENES TO BE GAINED!
ShigellA
Botulinum
Cholera tox
Diphtheria tox
Salmonella
Strep pyogenes
279
Q

Group B strep causes what diseases in infants?

A

Meningitis, pneumonia, sepsis

280
Q

subacute endocarditis…nothing is cultured…what is it?

A

HACEK

281
Q

GI bleeding in the elderly. top two causes?

A

colon cancer, angiodysplasia

282
Q

penicillin is mostly used for what gram bacteria?

A

G+

and Neisseria

283
Q

which penicillin type is oral and which is IV?

A

Penicillin V is oral; G is IV/IM

284
Q

Ampicillin and Amoxicillin are the wide spectrum penicillins. What are they used for?

A 
Hemophilus 
E coli
Listeria
Proteus
Salmonella
Shigella
285
Q

which penicillins are resistant to betalactamase?

A

Nafcillin
Oxacillin
Dicloxacillin

286
Q

Mono patient develops a intense rash after abx therapy…what was the drug?

A

Ampicillin/amoxicillin

287
Q

which drugs are usually coupled with betalactamase inhibitors?

A

amoxicillin/ampicillin, ticarcillin/piperacilin

288
Q

pseudomonas treatment?

A

Ticarcillin/piperacilin

289
Q

RBC cast

A

acute glomerulonephritis

290
Q

Downey cells

A

EBV

291
Q

Sixth disease?

A

Roseola HHV6

292
Q

Reovirus…
What are the two in the family
What are the general viral family characteristics

A

Linear DS DNA virus
icosahedron, naked

Rotavirus, Coltavirus

293
Q

when does rotavirus outbreaks occur?

A

winter

294
Q

Colorado tick fever is caused by what?

A

Coltivirus. Wood tick

295
Q

echoviruses outbreaks are when?

A

summer

296
Q

Common Cold

A

Corona virus and Rhino virus

297
Q

high fever, hemorrhagic disease (petechia, purpura, hematemesis) jaundice.. what do you think of?

A

Yellow fever. flavivirus

298
Q

break bone disease with severe retrooral headache?

A

Dengue fever

299
Q

how to test for dengue Hemorrhagic fever?

A

Tournaquette test–>pressure cuff to the point between SBP and DBP…positive if there’s excess petechiae indicating vessel fragility

300
Q

Name the flaviviruses

A 
West Nile, 
Dengue
Yellow fever
Hep C
St. Louis encephalitis
301
Q

headache, malaise, anorexia, flaccid paralysis, alternating consciousness…what do you think of?

A

West Nile

302
Q

how do you diagnose west nile?

A

antiWNV-IgM in CSF

303
Q

encephalitis causing viruses… how are they spread?

A

theyre all arbovirus

304
Q

congenital rubella heart defect?

A

open ductus arteriosus; pulmonic stenosis

305
Q

SARS and MERS are what kind of viruses?

A

Coronavirus

306
Q

Name two retroviruses

A

HIV

HTLV

307
Q

viral cause of anterior horn symptoms?

A

polio

west nile

308
Q

influenza virus belongs to which class?

A

orthomyxo

309
Q

ebola is what viral family?

A

filovirus; negative ssRNA

310
Q

Patients who die of influenza related causes usually die of what?

A

secondary bacterial infections: staph and strep are common

311
Q

live vaccines should not be given to who?

A

Immunocompromised and pregnant

312
Q

VIral illnesses of winter months?

A

Influenza, rotavirus, RSV

313
Q

Summer month viral illnesses?

A

enteroviruses (echovirus, poliovirus, coxackie)

arboviruses (west nile)

314
Q

RSV treatment in children? premies? in immunocompromized?

A

Children–>nothing
Palivizumab–>can be used for prophylaxis in premature infants
Ribavirin–>immunocompromised.

315
Q

Ribavirin mech? use?

A

Guanosine analog;

RSV, Hep c

316
Q

Hep C treatment?

A

interferon alpha, ribivirin

317
Q

which virus class can directly replicate?

A

positive sense RNA

318
Q

Which virus class has RDRP?

A

negative sense RNA

319
Q

giant cell pneumonia

A

measles

320
Q

subacute sclerosing panencephalitis

A

measles

321
Q

vit A treatment for what viral infection?

A

measles

322
Q

what are the 4 classic complications of mumps?

A

parotitis
orchitis
pancreatitis
meningitis

323
Q

DIC causes?

A

STOP Making Thrombi

Sepsis, Trauma, OB procedures, pancreatitis, malignancy, transfusions

324
Q

what does Pol code for?

A

reverse transcriptase and integrase

325
Q

What are the env proteins?

A

p120 which grabs on to TCR and either CCR5 or CXCR4

p41 which allows entry into the cell

326
Q

What is gag protein?

A

p24 which is a capsid protein

327
Q

What is the dx criteria of AIDS?

A

CD4

328
Q

Cotton wool spots on retina

A

CMV retinitis in AIDS pts

329
Q

What is AIDS pt most at risk of when CD4

A

PCP

330
Q

What is AIDS pt most at risk of when CD4

A

Toxoplasma, esophageal candidiasis

331
Q

What is AIDS pt most at risk of when CD4

A

Histoplasma

332
Q

What is AIDS pt most at risk of when CD4

A

MAC, TB

333
Q

Cherry red spot on retina

A

Tay Sach’S
Neiman Pick
Central retinal occlusion

334
Q

What hormone incrases prolactin secretion and what hormone decreases prolactin secretion

A

TRH increases

Dopamin decreases, prolactin also decreases

335
Q

Name 3 prion diseases?

A

Creuzfeld Jakob’s
Gerstmann-Straussler-Scheinker
Kuru

336
Q

superficial vacular proliferation in AIDS pt

A

Bacillary angiomatosis OR Kaposi Sarcoma.

Bacillary angiomatosis will have neutorphilic infiltrate

337
Q

low grade fever, cough, hepatosplenomegaly, and tongue ulcer in AIDS pt

A

Histoplasmosis

338
Q

chronic watery diarrhea in AIDS pt with acid fast cysts in stool

A

Cryptosporidium

339
Q

AIDS pt with demetia

A

HIV itself

340
Q

AIDS pt with encephalopathy

A

PML via JC polyoma virus

341
Q

AIDS pt with meningitis

A

Cyrptococcus

342
Q

reheated meat dishes–>food poisoning.

What organism

A

C. perferingens

343
Q

bloody diarrhea, live abscess, amoeba

A

entamoeba histolytica

344
Q

Pneumonia in children 4week to 2 years. top 4 ddx?

A

RSV
mycoplasma
Chlamydia trachomatis/pneumonia
Strep pneumo

345
Q

neonatal pneumonia ddx

A

Group B strep

e. coli

346
Q

Indinavir specific drug side effect?

A

nephrolithiasis…hematuria

347
Q

HIV positive mother should receive what before delivery (if not already on HAART)?

A

Zidovudine

348
Q

Which NRTI doesn’t need phosphorylation. WHY

A

Tenofovir…because it’s a nucleoTide analog

349
Q

Give how many drugs for occupational exposure to HIV?

A

3 drugs for 4 weeks

350
Q

Which NRTIs is strongly associated with bone marrow suppression? how to you mitigate the effects?

A

Zidovudine; give gCSF and erythropoeitin

351
Q

Didanosine mech? side effect?

A

NRTI for HIV;

SE: pancreatitis and peripheral neuropathy, steatosis

352
Q

What’s SE of Abacavir?

A

HIV NRTI;

life threatening hypersensitivity in pts with certain HLA types

353
Q

Unique SE of Efavirenz?

A

vivid dreams, false positive cannabinoid tests, teratogenic

354
Q

List NRTIs

A

-Vudines
Didanosine
Abacavir
Tenofovir

355
Q

List NNRTIs

A

Nevirapine
Efavirenz
Delavirdine

356
Q

which drug inhibits gp41?

A

Efuvirtide

357
Q

Which drug inhibits viral interaction with gp120?

A

Maraviroc

358
Q

what do bisphosphonates do? SE?

A

inhibitis osteoclast;

esophagitis, jaw necrosis

359
Q

Denosumab. what is it for?

A

RANKL inhibitor for osteoporosis

360
Q

osteoporosis first line therapy?

A

Bisphosponates

361
Q

carbonic anhydrase II mutation?

A

Osteopetrosis

362
Q

Bone in bone appearance

A

osteopetrosis

363
Q

key features of mcune albright syndrome

A

precocious puberty
cafe aulait spots
dysplastic bones (increased collagen)

USMLE (9 decks)

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