FA, Rx, UW Flashcards
Chromosome 3
VHL, Renal Cell Carcinoma
Chromosome 4
ADPKD (PDK2), achondroplasia, Huntignton
Chromosome 5
Cri-du-chat syndrome, FAP
Chromosome 6
Hemochromatosis (HFE)
Chromosome 7
Williams syndrome, CF
Chromosome 9
Friedreich ataxia
Chromosome 11
Wilms tumor, Beta-globin gene defects (e.g. Sickle cell)
Chromosome 13
Patau syndrome, Wilson disease, RB, BRCA2
Chromosome 15
Prader-Willi, Angelman, Marfan
Chromosome 16
ADPKD (1), alpha-globin defects
Chromosome 17
NF Type 1, BRCA1, p53
Chromosome 18
Edwards Syndrome
Chromosome 21
Down syndrome
Chromosome 22
NF Type 2, DiGeorge Syndrome (22q11)
What is Hartnup disease?
An autosomal recessive deficiency of Tryptophan; results in pellagra-like symptoms.
Nondisjunction that produces trisomies occurs specifically at which stage of Meiosis 1/2?
Anaphase
Which cancer is associated with t(8;14)?
Burkitt lymphoma (c-myc activation)
Which cancer is associated with t(9;22)?
CML(BCR-ABL hybrid), ALL (less common, poor prognostic factor)
Which cancer is associated with t(11;14)?
Mantle cell lymphoma (cyclin D1 activation)
Which cancer is associated with t(14;18)?
Follicular lymphoma (BCL-2 activation)
Which cancer is associated with t(15;17)?
APL (M3 type of AML)
Which type of DNA repair mechanism is impaired in xeroderma pigmentosum?
Nucleotide excision repair
Goodpasture’s Syndrome has autoantibodies against what?
Anti-glomerular basement membrane (Type IV collagen)
What type of DNA repair mechanism is defective in Lynch Syndrome (HNPCC)
Mismatch repair
Fragile X syndrome is which tirnucleotide repeat, and is characterized by what phenomenon?
CGG repeat; hypermethylation of the FMR1 gene resulting in decreased expression
Which conditions result in a microcytic anemia?
Microcytic = MCV < 80fL
- SALTI
- Sideroblastic
- Anemia of chronic disease
- Lead poisoning
- Thalassemias
- Iron deficiency (late)
Where does collagen synthesis, hydroxylation, and glycosylation take place?
In the Rough ER
Where does collagen triple helix formation take place?
In the rough ER (hydrogen and disulfide bonds)
Where does cleavage of the C- and N- terminals of collagen take place?
In the extracellular space –> forms tropocollagen
A patient with increased lactic acid levels in the setting of acute mesenteric ischemia, most likely has decreased activity in which enzyme?
Pyruvate dehydrogenase
- Someone with mesenteric ischemia has inadequate O2 delivery to the intestinal tissues, which means that the accumulation of NADH under hypoxic conditions inhibits pyruvate dehydrogenase.
Which enzymes in glycolysis and the TCA produce NADH from NAD?
The dehydrogenases:
- Pyruvate dehydrogenase
- Isocitrate dehydrogenase
- Alpha ketoglutarate dehydrognase
Which cofactor is needed for transamination and decarboxylation reactions?
B6 (pyridoxine)
An inability to transport ornithine into the mitochondria indicates what disorder?
Ornithine translocase deficiency, which precipitates a defect in the hepatic urea cycle. Tx: protein restriction
Biotin is a cofactor for which enzymes?
The carboxylases:
- Pyruvate carboxylase (Pyr–>OAA)
- Acetyl-CoA Carboxylase (Acetyl-CoA–> Malonyl CoA)
- Propionyl-CoA carboxylase (Propionyl-CoA–>Methylmalonyl-CoA)
Of the non-glucose monosaccharides (mannose, fructose, galactose), which one bypasses phosphofructokinase?
Fructose
What are homeobox genes?
Homeobox (Hox) genes encode DNA-binding transcription factors. Mutations in Hox genes cause the genes for different appendages to be transcribed in the wrong places (because the Hox genes are expressed at the wrong time/place).
How does carbon monoxide (CO) impact hemoglobin?
CO competitively binds iron present in heme proteins. It has no impact on the partial pressure of O2.
Which type of factor has Zinc-finger domains?
Intracellular receptors (e.g. steroids, thyroid hormone, fat-soluble vitamin receptors)
Infusion of hemin (heme) for treatment of AIP, causes downregulation of what enzyme?
ALAS (aminolevulinate synthase) - the rate-limiting enzyme in the heme synthesis pathway
True or False? Patients with aldolase B deficiency can tolerate sucrose?
False. Sucrose is composed of glucose and fructose (which can’t be broken down in patients with aldolase B deficiency).
How can fibrates cause cholecystitis?
Fibrates inhibit cholesterol 7alpha-hydroxylase which is the rate-limiting enzyme in the synthesis of bile acids. Without bile acids, decreased cholesterol solubility in bile favors cholesterol stone formation.
How do the shapes of the hemoglobin and myoglobin dissociation curves differ?
The Hg curve is sigmoid in shape (due to positive cooperativity with O2 binding); the myoglobin oxygen dissociation curve is hyperbolic, because it only has a single heme group, and doesn’t have heme-heme interactions/facilitation.
Which findings are seen in Fabry disease?
X-linked Recessive
Early: 1. Hypohidrosis, Angiokeratomas, Peripheral neuropathy
Late: Renal Failure, LVH
FABRY ACC
- Febrile episodes (hypohidrosis)
- Angiokeratomas
- Burning pain (peripheral neuropathy)
- Renal failure
- Young death
- Alpha-galactosidase A (deficient enzyme)
- Cardiovascular disease
- Ceramide trihexosidase (buildup product)
Which findings are seen in Tay-Sachs disease?
“Tay’s not heppy about developing a crush on his OG eX Amanda”
- Not Heppy = NO hepatosplenomegaly
- Developmental delay
- CRush = Cherry Red spot
- O = onion skinned lysosomes
- G = GM2 ganglioside
- X Amanda - HeXosaminidase A
Which findings are seen in Krabbe disease?
“GOD, you’re so Kabbe”
- G = galactocerebrosidase/globoid cells
- O = Optic atrophy
- D = developmental delay
Which findings are seen in Niemann-Pick disease?
“Niemann-picked up his heppy, neurotic father from central spot station”
- Hepatosplenomegaly
- Foam cells
- Neurodegeneration
- Cherry-red spot
- Sphingomyelin/ase
Which findings are seen in Hurler syndrome?
- Corneal cLouding (HurLer)
- GargoLylism
- HSM
- alpha-L-iduonidase deficiency
Which findings are seen in Hunter syndrome?
- NO corneal clouding (there is no “L” in “Hunter”)
- Aggressive behavior (Hunters are aggressive)
- Iduronate sulfatase deficiency
Which congenital disorder of predisposes patients to E. coli sepsis?
Classic galactosemia (deficiency in galactose-1-phophate uridyltransferase). Presents with failure to thrive(soon after the onset of infant feeding, within days), jaundice, Hepatomegaly, infantile cataracts.
What is cretinism and what are its clinical features?
Cretinism = congential hypothyroidism
- 6 P’s:
- Pot-bellied
- Pale
- Puffy-faced
- Protruding umbilicus
- Protuberant tongue
- Poor brain development
Which hormones are coupled to cAMP?
FLAT ChAMP
- FSH
- LH
- ACTH
- TSH
- CRH
- hCG
- ADH
- MSH
- PTH
Which hormones are coupled to cGMP?
BAD GraMPa (vasodilators)
- BNP
- ANP
- EDRF (NO)
Which hormones are coupled to IP3?
GOAT HAG
- GnRH
- Oxytocin
- ADH (V1)
- TRH
- Histamine
- ATII
- Gastrin
Which hormones are intracellular receptors?
(Steroid hormones): PET CAT on TV
- Progesteron
- Estrogen
- Testosterone
- Cortisol
- Aldosterone
- T3/T4
- Vitamin D
Which hormones are coupled to a receptor tyrosine kinase?
Growth Factors
- Insulin
- IGF-1
- FGF
- PDGF
- EGF
Which hormones are coupled to a nonreceptor tyrosine kinase?
PIGGLET - uses JAK/TAT pathway
- Prolactin
- Immunomodulators (e.g. IL-2, IL-6)
- GH
- G-CSF
- Erythropoietin
- Thrombopoietin
Which cell-surface marker is associated with plasma cells?
CD27
Which cell-surface marker is associated with B cells?
CD19, 20, 21, 40
Which cell-surface markers are associated with NK cells?
CD56, CD16
What is the CD4 cell surface marker associated with?
Regulatory and Helper T cells
Which cell-surface markers are associated with regulatory T cells?
CD3, CD4, CD25 and FOXP3 (transcription factor)
Ebstein Barr virus affects which cells?
Infects B cells (but peripheral smear features reactive/atypical cytotoxic T cells)
Recipient’s cytotoxic T-lymphocytes destroy the graft within weeks to months of the transplant:
Acute graft rejection
Vessel occlusion, ischemia, or fibrinoid necrosis, occurring within minutes to hours after a transplant:
Hyperacute graft rejection
Donor peptides being displayed by recipient antigen-presenting cells, resulting in interstitial fibrosis, atherosclerosis, and vanishing bile duct syndrome:
Chronic organ rejection
Which cell type is associated with CD34?
Pluripotent stem cell (Stimulated by G-CSF) –> G-CSF is often given to patients who have experienced myelosuppression as a result of chemotherapy.
Which vasculitis is associated with asthma, sinusitis, skin nodules or purpura, peripheral neuropathy (eg, wrist/foot drop)?
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) - pANCA/MPO
What is the classic pentad of thrombotic thrombocytopenic purpura (TTP) and what is it caused by?
TTP is a platelet disorder that is due to inhibition or deficiency of ADAMTS 13 (vWF metalloprotease) –> reduced degradation of vWF multimers (therefore more clotting)
- Microangiopathic hemolytic anemia (MAHA)
- Thrombocytopenia (because platelets are being used up to form the clot)
- Neurologic abnormalities
- Renal abnormalities
- Fever
What is the drug of choice for diagnosing myasthenia gravis?
Edrophonium (irreversible acetylcholinesterase inhibitor with a short duration of ~10-20 minutes)
What is the classic triad of acute graft-versus-host disease (GVHD)?
Dermatitis, hepatitis (elevation in liver enzymes), and gastroenteritis
Antimicrosomal autoantibodies
Hashimoto’s Thyroiditis
What is the triad (quad) of Plummer Vinson syndrome?
(IDEA)
- Iron-deficiency anemia
- Dysphagia
- Esophageal webs
- Atrophic glossitis
What is the most common cause of death in infants born with congenital diaphragmatic hernia?
Pulmonary hypoplasia
What treatment should be immediately initiated for heparin-induced thrombocytopenia (HIT)?
A direct thrombin inhibitor such as argatroban
What is the mechanism of superantigens causing shock? (e.g. Staph aureus -TSST1 and Strep pyogenes-Exotoxin A)
Both involve binding to MHC II (remember exotoxins) and TCR outside of the antigen binding site, and cause an overwhelming release of IL-1, IL-2, IFN-gamma and TNF-alpha.
Acute hemolytic transfusion reaction (anti-ABO antibodies) is what type of hypersensitivity reaction?
Type II
Which cell types are involved in delayed-type hypersensitivity reactions?
CD4+ T lymphocytes and macrophages
What is the mechanism by which eosinophils are involved in host defense during parasitic infection?
Antibody-dependent cell-mediated cytotoxicity, in which they recognize antibodies bound to the parasitic organism and release enzymes from their cytoplasmic granules.
ALK mutation
Oncogene:
Receptor tyrosine kinase –> lung adenocarcinoma
BCR-ABL mutation
Oncogene:
Tyrosine kinase –> CML, ALL
BCL-2 mutation
Oncogene:
Anti-apoptotic molecule –> follicular and diffuse large B cell lymphoma
APC
Tumor suppressor gene:
Negative regulator of Beta-catenin/WNT pathway –> Colorectal cancer (assoc. w/ FAP)
BRCA1/BRCA2
Tumor suppressor:
DNA repair protein –> breast, ovarian and pancreatic cancer
BRAF
oncogene; serine/threonine kinase; involved in melanoma and non-Hodgkin lymphoma
c-kit
oncogene; cytokine receptor; involved in gastrointestinal stromal tumors (GIST); mutation indicates good candidacy for imatinib tx
c-myc
oncogene; ch. 8; transcription factor; involved in Burkitt lymphoma [t(8;14)]
HER2/neu
oncogene; tyrosine kinase; involved in breast, ovarian, and gastric carcinomas; mutation indicates good candidacy for trastuzumab
L-myc
oncogene; transcription factor; involved in lung tumors (small cell)
N-myc
oncogene; transcription factor; involved in neuroblastoma
KRAS
oncogene; GTPase; colon, lung, and pancreatic cancer
RET
oncogene; receptor tyrosine kinase; involved in MEN 2A (medullary thyroid cancer, pheochromocytoma, parathyroid hyperplasia) and 2B (medullary thyroid cancer, pheochromocytoma, mucosal neuromas), medullary thyroid cancer
DCC
tumor suppressor gene; “deleted in colon cancer”
DPC4/SMAD4
tumor suppressor gene; “deleted in pancreatic cancer”
MEN1
tumor suppressor gene; ch. 11; menin; involved in MEN1 (parathyroid adenoma, pituitary adenoma, enteropancreatic tumors)
NF1
ch. 17; tumor suppressor gene; neurofibronin, Ras GTPase activating protein; involved in neurofibromatosis type 1
NF2
ch. 22; tummor suppressor gene: Merlin (schwannomin) protein; involved in neurofibromatosis type 2
PTEN
tumor suppressor gene; Tyrosine phophatase of PIP3 (e.g. protein kinase B [AKT] activation); involved in breast cancer, prostate cancer, endometrial cancer
Rb
tumor suppressor gene; inhibits E2F blocking G1–>S phase; involved retinoblastoma and osteosarcoma
TP53
tumor suppressor gene; p53, activates p21, blocks G1–>S phase; involved in most human cancers, Li-Fraumeni Syndrome (a.k.a. SBLA cancer syndrome: sarcoma, breast, leukemia, adrenal gland)
TSC1
tumor suppressor gene; hamartin protein; involved in tuberous sclerosis
TSC2
tumor suppressor gene; tuberin(2berin) protein; involved in tuberous sclerosis
VHL
tumor suppressor gene; inhibits hypoxia inducible factor 1a; involved in von Hippel-Lindau disease (chr. 3)
WT1
tumor suppressor gene; transcription factor that regulates urogenital development (Wilms tumor - nephroblastoma)
What are psammoma bodies and which neoplasms are associated with them?
Psammoma bodies are laminated, concentric spherules with dystrophic calcifications. The cancers in which they are seen can be remembered by the mnemonic “PSaMMoma”:
- Papillary carcinoma of the thyroid
- Serous papillary cystadenocarcinoma of the ovary
- Meningioma
- Mesothelioma
alkaline phosphatase
- metastases to bone or liver, Paget disease of bone, seminoma (placental ALP)
- must exclude hepatic origin by checking LFTs and GGT levels
CA-125
ovarian cancer
CA 19-9
pancreatic adenocarcinoma
CA 15-3/CA 27-29
breast cancer
alpha-fetoprotein
- hepatocellular carcinoma
- hepatoblastoma
- yolk sac (endodermal sinus) tumor
- mixed germ cell tumor
- normally made by fetus, transiently elevated in pregnancy
- high levels associated = neural tube and abdominal wall defects
- low levels = down syndrome
beta-hCG
- hydatidiform moles
- choriocarcinomas (gestational trophoblastic disease)
- testicular cancer
- mixed germ cell tumor
- produced by syncytiotrophoblasts of the placenta
calcitonin
medullary thyroid carcinoma
CEA
major: colorectal and pancreatic cancers
minor: gastric, breast and medullary thyroid carcinomas
chromogranin
neuroendocrine tumors
PSA
prostate cancer
S-100
melanoma (and other neural crest tumors including schwannomas)
What is P-glycoprotein?
A transmembrane ATP-dependent efflux pump that is also known as multidrug resistance protein 1 (MDR1). Classically seen in adrenocortical carcinoma but can also be expressed by other cancer cells.
What are common metastases to the brain?
Lung > Breast > Melanoma, Colon, Kidney
What are common metastases to the liver?
Colon»_space; Stomach > Pancreas
What are common metastases to bone?
Prostate, breast > Lung, Thyroid, Kidney
Which cardiac anomaly results in a loud S1, a wide, fixed split S2?
Atrial septal defect (ASD)
Which neoplasm commonly presents with DIC?
AML (especially M3 subtype)
Spindle-shaped smooth muscle cells is most associated with which neoplasm?
Leiomyosarcoma
Which neoplasm is characterized on histology as having large, halo-like cells, and what is there an increased risk for?
Paget disease of the nipple presents with characteristic large, halo-like cells on histologic exam, and carries a high risk of underlying in situ or invasive ductal carcinoma.
What is TRAP and what is it associated with?
TRAP = tartrate-resistant acid phosphatase and is associated with Hairy Cell Leukemia
What is the mode of inheritance of glucose-6-phosphate dehydrogenase deficiency?
X-linked recessive
What causes a porcelain gallbladder, and what does this manifestation have an increased risk for?
Chronic cholecystitis; increased risk for gallbladder adenocarcinoma
What is the equation for the half-life of a drug eliminated via first-order pharmacokinetics?
t1/2 = (0.693 x Vd)/CL
What is the equation used to calculated oral bioavailability?
F = AUC (oral) / AUC (IV)
What is the equation for loading dose?
Loading dose = (Cp x Vd) / F
- Cp = target plasma concentration
- Vd = volume of distribution
- F = oral bioavailability
What is the equation for maintainence dose?
Maintenance dose = (Cp x CL X τ) / F
- Cp = target plasma concentration
- CL = clearance
- τ = dosage interval (time between doses)
- F = oral bioavailability
Which anti-arrhythmics can lead to torsades de pointes?
“Type 1A and III prolong QT”
- e.g. Type IA Quinidine, Procainamide, Disopyramide
- e.g. Type III Ibutilide
What is bethanechol and what is it commonly used for?
Bethanechol is a cholinomimetic that stimulates muscarinic receptors, but has no effect on nicotinic receptors. It is commonly used for postoperative ileus and neurogenic bladder.
What are all the clinical uses of somatostatin (octreotide)?
Acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices.
What is the MOA of fibrates (e.g. gemfibrozil)?
Gemfibrozil is a fibrate that stimulates synthesis of lipoprotein lipase by activation of the PPAR-a protein. In turn, lipoprotein lipase increases hydrolysis of triglycerides and VLDL, which ultimately results in decreased triglyceride and LDL levels
What is the MOA of nitroglycerin?
Vasodilate by NO in vascular smooth muscle in cGMP and smooth muscle relaxation. Dilate veins»_space; arteries –> decrease preload (and therefore decrease myocardial oxygen demand).
What is the mechanism of toxicity of acetaminophen overdose?
Acetaminophen metabolite (NAPQI) depletes glutathione and forms toxic tissue byproducts in liver. N-acetylcysteine is antidote—regenerates glutathione.
What is the MOR of aminoglycosides?
The mechanism for aminoglycoside resistance is covalent modification via acetylation, adenylation, or phosphorylation.
What are the most common chelators used for lead poisoning?
Dimercaprol, EDTA, or succimer
Which chelator is commonly used for copper toxicity?
Penicillamine (can also be used for lead poisoning)
Which SERM carries an increased risk of endometrial cancer, and which one does not?
Tamoxifen increases risk of endometrial cancer.
Raloxifene does not, so you can “relax”
What are the mechanisms of action of tiotropium and ipratropium bromide?
They are M3 muscarinic antagonists.
Which HIV drugs can cause gastrointestinal intolerance and lipodystrophy?
Protease inhibitors (e.g. lopinavir-ritonavir, amprenavir, nelfinavir, indinavir, and saquinavir).
Which drugs increase the risk of digoxin toxicity?
Drugs that displace digoxin from tissue-binding sites, and clearance (eg, verapamil, amiodarone, quinidine)
What are signs of a salicylate overdose?
Salicylate (aspirin) overdose causes tinnitus; a combined metabolic acidosis (late) and respiratory alkalosis (early) will also develop.
What is the most common manifestation of amiodarone toxicity?
Hypothyroidism
(Pulmonary fibrosis, hepatotoxicity, and bluish skin discoloration are other less common, classic manifestations of amiodarone toxicity)
What is the mechanism of action of entacapone?
Entacapone is a COMT inhibitor that increases the bioavailability of levodopa by inhibiting its peripheral methylation.
Adding allopurinol to the treatment regimen of someone being treated with antimetabolites, will do what to the concentration of which metabolites?
Adding allopurinol to the regimen of a patient being treated with azathioprine and 6-mercaptopurine, will cause an increase in their concentration (because allopurinol inhibits xanthine oxidase, which prevents their metabolism).
What is the antidote for serotonin syndrome?
Cyproheptadine
Which antihypertensive agent(s) can most successfully prevent progression to diabetic nephropathy?
ACE inhibitors and ARBs
What is the MOA of digoxin in initiating ventricular rate control?
Digoxin is used for ventricular rate control in atrial fibrillation as it decreases atrioventricular nodal conduction by increasing parasympathetic vagal tone.
What is the most common adverse side effect of thrombolytic use (e.g. alteplase)
Hemorrhage
What is the most serious complication/ADR of metformin use?
Lactic acidosis (therefore contraindicated in patients with renal insufficiency)
What is the most common cause of bloody nipple discharge and how is it described histologically?
Intraductal papilloma is the most common cause of bloody nipple discharge; it is often described as a proliferation of papillary cells in a cystic wall or duct, that may contain focal atypia.
What is the initial drug of choice for status epilepticus?
Benzodiazepines (e.g. lorazepam)
What is the preferred treatment for restless leg syndrome?
Dopamine agonists (e.g. ropinirole, pramipexole)
What are symptoms of digoxin toxicity?
Most common: life-threatening arrhythmia
GI: anorexia, nausea and vomiting, abdominal pain
Neurologic: fatigue, confusion, weakness, color vision alterations
What is the mechanism by which niacin causes cutaneous flushing? What can b given to patients to reduce this SE?
- Niacin increases prostaglandin release
- Give NSAIDs
Which class of lipid-lowering agents causes an increase in TG synthesis?
Bile acid resins (e.g. chlestyramine, colestipol, colesevelam)
Long term survival in patients following heart failure due to left ventricular dysfunction, is most improved with use of:
beta blockers
What effect do corticosteroids have on neutrophils, eosinophils and lymphocytes?
Corticosteroids cause neutrophilia, eosinopenia and lymphopenia. Corticosteroids cause neutrophilia by decreasing the activation of neutrophil adhesion molecules, therefore impairing migration out of the vasculature into sits of inflammation. The eosinopenia and lymphopenia are caused by sequestration in lymph noeds and apoptosis, respectively.
What are some of the applications and ADRs of clonidine?
Clonidine is an alpha-2 agonist that decreases sympathetic outflow from the central nervous system.
Uses: hypertensive urgency (when refractory to other agents)
ADRs: CNS depression, bradycardia, hypotension, respiratory depression, miosis, rebound hypertension (with abrupt cessation)
What are some of the applications and ADRs of alpha-methyldopa?
The only actual implication for alpha-methyldopa is for hypertension in pregnancy.
ADRs: Direct Coombs (+) hemolysis - autoimmune hemolytic anemia; SLE-like syndrome (drug-induced lupus confirmed with positive anti-histone).
Which drugs are inducers of CYP450?
CHRONIC ALCOHOLics STeal PHEN-PHEN and NEver Refuse GReasy CARBS:
- Chronic alcohol use
- St. John’s wort
- Phenytoin
- Phenobarbital
- Nevirapine
- Rifampin
- Griseofulvin
- Carbamazepine
Which drugs are inhibitors of CYP450?
SICKFACES.COM
- Sodium valproate
- INH
- Cimetidine
- Ketoconazole
- Fluconazole
- Acute alcohol abuse
- Chloramphenicol
- Erythromycin (macrolides)
- Sulfonamides
- Ciprofloxacin
- Omeprazole
- Metronidazole
Pt with depression takes an SSRI. What is the typical suffix for this class of drug?
-etine (eg, fluoxetine)
A man with hyperlipidemia takes an HMG-CoA reductase inhibitor. What is the typical suffix for this class of drug?
-statin (eg, atorvastatin)
A pt takes an antibiotic that functions as a transpeptidase inhibitor. What is the typical suffix for this class of drug?
-cillin (eg, ampicillin); binds penicillin-binding protein
A pt takes a drug for erectile dysfunction that inhibits PDE-5. What is the typical suffix for this class of drug?
-afil (eg, sildenafil)
A pt receives an inhaled general anesthetic. What is the typical suffix for this class of drug?
-ane (eg, halothane)
A pt takes a benzodiazepine. What are the 2 typical suffixes for this class of drug?
-azepam (eg, diazepam) or -zolam (eg, alprazolam)
A pt takes a drug for a fungal infection that inhibits ergosterol synthesis. What is the typical suffix for this class of drug?
-azole (eg, ketoconazole)
A pt takes an antibiotic that inhibits protein synthesis and discolors teeth. What is the typical suffix for this class of drug?
-cycline (eg, tetracycline)
A pt receives a local anesthetic. What is the typical suffix for this class of drug?
-caine (eg, lidocaine)
A pt w/HIV takes a protease inhibitor. What is the typical suffix for this class of drug?
-navir (eg, ritonavir)
A pt w/CHF takes a β-blocker. What is the typical suffix for this class of drug?
-olol (eg, propranolol)
A pt w/schizophrenia takes a typical antipsychotic. What is the typical suffix for this class of drug?
-azine (eg, thioridazine)
A pt receives a barbiturate for sedation during a procedure. What is the typical suffix for this class of drug?
-barbital (eg, phenobarbital)
A pt w/Tx-resistant depression takes tricyclic antidepressants. What is the typical suffix for this class of drug?
-triptyline (eg, amitriptyline) or -ipramine (eg, imipramine)
A pt w/DM takes an angiotensin-converting enzyme (ACE) inhibitor. What is the typical suffix for this class of drug?
-pril (eg, captopril)
A pt w/asthma takes a β2-agonist. What is the typical suffix for this class of drug?
-terol (eg, albuterol)
A pt w/GERD takes an H2-antagonist. What is the typical suffix for this class of drug?
-tidine (eg, cimetidine)
A pt w/growth hormone deficiency takes a pituitary hormone as therapy. What is the typical suffix for pituitary hormones?
-tropin, (eg, somatotropin)
A pt w/prostatic hyperplasia takes an α1-antagonist. What is the typical suffix for this class of drug?
-zosin (eg, prazosin)
A pt w/DM takes a PPAR-γ activator. What is the typical suffix for this class of drug?
-glitazone (eg, rosiglitazone)
A pt w/osteoporosis is prescribed a bisphosphonate. What is the typical suffix for this class of drug?
-dronate (eg, alendronate)
A pt w/GERD takes a proton pump inhibitor. What is the typical suffix for this class of drug?
-prazole (eg, omeprazole)
A pt w/glaucoma takes a prostaglandin analog. What is the typical suffix for this class of drug?
-prost (eg, latanoprost)
A pt w/HTN takes an angiotensin-II receptor blocker. What is the typical suffix for this class of drug?
-sartan (eg, losartan)
A pt w/urinary retention after surgery takes a cholinergic agonist. What is the typical suffix for this class of drug?
-chol (eg, bethanechol, carbachol)
A pt undergoing surgery receives a nondepolarizing paralytic. What are 2 typical suffixes for this class of drug?
-curium (eg, atracurium) or -curonium (eg, vecuronium)
A pt w/myasthenia gravis takes an AChE inhibitor. What is the typical suffix for this class of drug?
-stigmine (eg, neostigmine)
A pt w/migraines takes a 5-HT1B/1D agonist. What is the typical suffix for this class of drug?
-triptan (eg, sumatriptan)
A pt w/a herpes infection takes an antiviral DNA polymerase inhibitor. What is the typical suffix for this class of drug?
-ovir (eg, acyclovir)
A pt w/HTN starts taking a dihydropyridine Ca2+ channel blocker. What is the typical suffix for this class of drug?
-dipine (eg, amlodipine)
A pt w/atypical pneumonia takes a macrolide antibiotic. What is the typical suffix for this class of drug?
-thromycin (eg, azithromycin)
A pt w/the flu receives a neuraminidase inhibitor. What is the typical suffix for this class of drug?
-ivir (eg, oseltamivir)
A pt w/pinworms receives an antiparasitic/antihelminthic agent. What is the typical suffix for this class of drug?
-bendazole (eg, mebendazole)
A pt w/atrial fibrillation starts taking a direct factor Xa inhibitor. What is the typical suffix for this class of drug?
-xaban (eg, apixaban, edoxaban, rivaroxaban)
A pt w/a recent kidney transplant takes a chimeric (human-mouse) monoclonal Ab. What is the typical suffix for this class of drug?
-ximab (eg, rituximab); suffix for chimeric human-mouse monoclonal Ab
A pt w/a recent kidney transplant takes a humanized mouse monoclonal Ab. What is the typical suffix for this class of drug?
-zumab (eg, bevacizumab); suffix for humanized mouse monoclonal Ab
A pt w/chronic myelogenous leukemia starts taking a tyrosine kinase inhibitor. What is the typical suffix for this class of drug?
-tinib (eg, imatinib)
How do the alkylating agents cyclophosphamide and ifosfamide cause hemorrhagic cystitis? What is it treated with and what is the MOA of that drug?
The condition is a result of the renal excretion of acrolein, a hepatic metabolite of these drugs.
Treat with mesna - a sulfhydryl compound that is oxidized to an inactive form but is reactivated in the kidney. Once in the urine, it binds to acrolein to form an inert compound that is excreted, preventing toxic exposure to the bladder epithelium.
At what point after ischemia to the myocardial tissue does myocyte injury become irreversible?
Myocyte injury becomes irreversible after about 20 minutes of oxygen starvation.
What is the MOA of cromolyn?
“Lynn’s Bee Control”
- Prevents mast cell degranulation, inhibiting the release of histamine.
What is the MOA of macrolides?
Macrolides act on the bacterial 50s ribosomal subunit and block translocation (specifically by binding to the 23S rRNA)
Which lab and exam findings might suggest multiple myeloma?
CRAB
- HyerCalemia
- Renal involvement
- Anemia
- Bone lytic lesions/back pain
What is MGUS?
Monoclonal Gammopathy of Undetermined Significance:
- An idiopathic, monoclonal expansion of plasma cells (M spike); asymptomatic but can lead to multiple myeloma in 1-2% of patients each year
- No CRAB findings
What is the first-line treatment for antipsychotic-induced acute dystonia and for most other EPSs associated with antipsychotic medications?
Anticholinergic agents, such as benztropines, are the first-line treatment. Anticholinergics are often given prophylactically with the initial administration of antipsychotics to prevent the onset of acute dystonia.
What are some signs and symptoms of hypoglycemia?
- Neurogenic Symptoms:
- Adrenergic (catechol mediated): tremor, palpitations, anxiety
- Cholinergic (ACh-mediated): cold sweats, hunger, paresthesias
- Neuroglycopenic Symptoms (due to low glucose in the brain):
- General weakness, confusion, drowsiness, syncope, difficulty speaking, blurry vision
What is Liddle Syndrome?
Liddle syndrome is a genetic condition characterized by a GOF mutation in the epithelial ENaC on the collecting tubule, leading to early hypertension characterized by low levels of renin and angiotensin due to negative feedback. Reabsorption of sodium without an accompanying anion creates a negative electrical gradient across the luminal membrane, causing increased secretion of potassium and hydrogen ions; this results in hypokalemia and metabolic alkalosis (note the patient’s elevated pH and bicarbonate levels). Liddle syndrome is commonly treated with a diuretic that inhibits ENaC, such as triamterene or amiloride.
Which major complication can arise from use of oral or IV corticosteroids, such as methylprednisolone, a common treatment for ulcerative colitis flares?
Avascular necrosis (esp. of femoral head).
Other complications include:
abdominal striae and increased girth, suppression of the hypothalamic-pituitary-adrenal axis, hyperglycemia, osteoporosis, moon facies, buffalo hump, immunosuppression, and impaired wound healing
What is the gold standard chemotherapy regimen for treating Hodgkin lymphoma?
The AVBD protocol:
- Adriamycin (doxorubicin)
- Bleomycin
- Vinblastine
- Dacarbazine
In which form of IBD are non-caseating granulomas seen?
Chron Disease
Graves’ disease is an example of which type of hypersensitivity?
Type II
Goodpasture Syndrome is an example of which type of hypersensitivity?
Type II:
anti-glomerular basement membrane antibodies (anti-GBM Ab), are autoantibodies against the alpha 3 chain of type IV collagen found in the glomerular basement membrane and pulmonary capillary membrane.
Which portal ↔ systemic shunt is responsible for esophageal varices?
Left gastric ↔ azygos vein
Which portal ↔ systemic shunt is responsible for caput medusae varices?
Paraumbilical ↔ small epigastric veins of the anterior abdominal wall
Which portal ↔ systemic shunt is responsible for anorectal varices?
Superior rectal ↔ middle and inferior rectal
A Pancoast Tumor can cause what spinal cord lesion, and consequently which syndrome?
Pancoast tumor can impinge on the stellate ganglion causing Horner Syndrome (ptosis, miosis, anhidrosis).
What is the pathophysiology of proteinuria seen in minimal change disease?
Disruption of the filtration barrier which is composed of heparan sulfate (negatively charged molecule which repels other (-) charges [e.g. albumin]).
What happens to TBG (thyroid-binding globulin) in states of high estrogen (e.g. pregnancy, OCP use)?
TBG increases, which causes total T4 to increase.
FREE T4 remains unchanged (due to normal negative feedback).
What is the difference between Langerhans cells and Langhans “giant” cells?
Langhans giant cells are found in granulomatous lung disease, whereas Langerhans cells are found specifically in pulmonary Langerhans cell histiocytosis.
How does succinylcholine differ from pancuronium, tubocurarine, and vecuronium?
Succinylcholine is a depolarizing NMJ blocker; therefore with the TOF test (train-of-four) it first exhibits an equal (lower across the board) attenuation of the motor endplate’s response to stimulation, followed by a faded phase II response.
Pancuronium, tubocurarine and vecuronium are all non-depolarizing, which means that they block pre-synaptic ACh release, thus resulting in an immediate faded TOF response.
What is the first-line treatment for an acute attack of gouty arthritis?
NSAIDs
Which of the lipid-lowering agents can precipitate gouty arthritis?
Niacin - via increased renal excretion of uric acid
What is octreotide and what is it used for?
Octreotide is a somatostatin analog, and is often used to treat the symptoms of carcinoid syndrome (e.g. secretory diarrhea).
What are symptoms of alcohol withdrawal and how is it treated?
Alcohol withdrawal symptoms:
- 3–36 hours: minor symptoms similar to other depressants: anxiety, tremor “the shakes”, sweating
- 6–48 hours: withdrawal seizures
- 12–48 hours: alcoholic hallucinosis
- 48–96 hours: delirium trmns
Treatment: benzodiazepines! (esp. long-acting due to self-tapered withdrawal effect: chlordiazepoxide, lorazepam, diazepam)
What is the mechanism by which nitrates causes vasodilation?
Nitrates (e.g. nitroglycerin, isosorbide dinitrate, isosorbide mononitrate) activate guanylyl cyclase which subsequently increases cGMP and causes dephosphorylation of myosin light-chain kinase (causes smooth muscle relaxation).
Which of the antibiotics has weak MAO inhibitor activity? What is a potential ADR.
Linezolid
Can cause serotonin syndrome.
What are the 4 “P’s” that can be used to treat thyroid storm?
- Propranolol (for adrenergic effects and prevents peripheral conversion of T4 to T3)
- Propylthiouracil (also blocks T4 to T3)
- Prednisolone
- Potassium iodide
What is the MOA of oseltamivir?
Oseltamivir (Tamiflu) is a neuraminidase inhibitor. It can be used to treat or prevent the flu by inhibiting the release of newly formed virions.
Why are tricyclic anti-depressants contraindicated in the elderly?
TCADs have strong anticholinergic effects (e.g. confusion, urinary retention, constipation), which can exacerbate those caused by comorbid conditions (e.g. BPH, dementia).
Which anesthetics exhibit hepatotoxicity?
Halogenated inhaled anesthetics (e.g. halothane, enflurane).
Which infection are HIV (and immunocompromised) patients at increased risk for if their CD4+ count is < 50? What is the best prophylactic treatment?
Mycobacterium avium complex.
Prophylaxis: macrolide (e.g. azithromycin)
Which lipid-lowering agent class is the most protective of cardiovascular events?
Statins (HMG-CoA reductase inhibitors)at is
What is the best measure/estimator of GFR?
Inulin clearance. Inulin is only filtered at the glomerulus, it is neither secreted nor reabsorbed.
Creatinine is often used clinically because it is easier to measure; however, it slightly overestimates GFR because it is also secreted. (CREatinine is seCREted).
What is the equation for RBF?
RBF = renal blood flow –> it is the amount of blood (i.e. RBCs only) that is flowing through the kidney. If we know renal plasma flow (includes RBCs and ECF plasma) we can calculate RBF. RBCs = Hct, therefore plasma = 1-Hct.
RBF = RPF/(1-Hct)
What is filtration fraction and what is a normal value?
FF = GFR/RPF
Normal: 20%
At what plasma concentration of glucose can one begin to observe glucosuria in an adult?
200 mg/dL
The PCT of the nephron exhibits nearly 100% reabsorption of which two substances?
Glucose and Amino Acids
Where and how does PTH affect solute reabsorption on the nephron?
- PO4^3-: PTH inhibits Na+/PO4^3- cotransport in the PCT
- Ca2+: PTH increases Ca2+/Na+ exchanger activity on the basolateral side of the DCT
What do RBC casts indicate?
Glomerulonephritis, malignant HTN
What do WBC casts indicate?
Tubulointerstitial inflammation, acute pyelonephritis, transplant rejection.
What do fatty casts indicate?
Nephrotic syndrom
What do granular (“muddy brown”) casts indicate?
Acute tubular necrosis
What do waxy casts indicate?
End-stage renal disease/Chronic renal failure
What do hyaline casts indicate?
Nonspecific; can be a normal finding and is often seen in concentrated urine samples
What is the most common cause of primary nephrotic syndrome in Caucasian adults?
Membranous nephrophathy
What do Kimmelstiel-Wilson bodies classically indicate?
Diabetic glomerulonephropathy
What is the WAGR complex?
Related to Wilms tumor/chr 11:
- Wilms tumor
- Aniridia (absence of iris)
- Genitourinary malformations
- Retardation/intellectual disability
What may painless hematuria indicate?
Transitional cell carcinoma (bladder cancer)
- There are no casts because the cancer occurs after the kidneys
- Associated with Pee SAC:
- Phenacetin
- Smoking
- Aniline dyes
- Cyclophosphamide (hemorrhagic cystitis)
What does an increased BUN/Cr ratio indicate?
Pre-renal azotemia
- Hypotension/dehydration lowers the RBF, which lowers GFR. In an attempt to conserve water, H2O reabsorption (and subsequently BUN) is increased. (Also results in an decreased FENa since the kidney reabsorbs more Na along with water and other solutes)
What does a decreased BUN/Cr ratio indicate?
Intrinsic renal failure
- An intrinsic issue with the kidney (e.g. tubular necrosis, ischemia/toxins) impairs the kidneys ability to reabsorb BUN. (Also results in an increased FENa since the kidney is unable to reabsorb Na)
What is acute interstitial nephritis (tubulointerstitial nephritis)?
A drug induced nephritis characterized by interstitial renal inflammation. Pyuria is seen with eosinophils, due to the fact of this being a Type I hypersensitivity reaction. Common culprits include: NSAIDs, diuretics, penicillins, PPIs, rifampin.
How does ADPKD lead to berry aneurysms?
ADPKD is characterized by polycystic kidneys which secrete excess renin and subsequently cause hypertension. This HTN can increase development/risk of aneurysms. Most causes of death from ADPKD are related to HTN.
Which vitamin can cause pseudotumor cerebri?
Vitamin A
Vitamin A is a precursor to CSF production. Therefore, in excess, it can produces pseudotumor cerebri.
Which class of diuretics is sulfa based? Which is the exception that can be used in patients with a sulfa allergy?
Loop diuretics e.g. furosemide, bumetanide, and torsemid are all sulfa basd.
Ethacrynic acid, is a nonsulfonamide inhibitor.
Goodpasture Syndrome is an example of which type of nephritic syndrome?
Rapidly progressive (crescentic) glomerulonephritis.
What drug should be given with chemotherapy to prevent tumor lysis syndrome?
Allopurinol - it prevents the conversion of purines to uric acid.
What is first-line treatment for an uncomplicated UTI in a patient with a sulfa allergy?
Nitrofurantoin (If not allergy, use TMP-SMX)
Episodic gross hematuria that is concurrent with a respiratory or GI infection is likely indicative of?
IgA nephropathy (Berger disease) - the most common cause of nephropathy worldwide
What is Conn syndrome and what is the best treatment?
Conn Syndrome is primary hyperaldosteronism. Treated with an aldosterone antagonist (e.g. spironolactone).
Where in/from the kidney is renin secreted?
Juxtaglomerular cells in the tunica media of the afferent arteriole.
Which immunosuppressant is classically nephrotoxic?
Cyclosporin - MOA: inhibits calcineurin by binding/enhancing cyclophilin. By preventing IL-2 transcription, T-cell activation is effectively blocked.
Nephotoxicity likely occurs due to impairment of endothelial cell function, leading to reduced production of vasodilators (prostaglandins and nitric oxide) and enhanced release of vasoconstrictors (endothelin and thromboxane) –> reduces RBF.
What happens to the afferent and the efferent arterioles in states of severe volume depletion?
Both the afferent and efferent arterioles constrict –> sympathetic response to preserve blood pressure.
What are the “4” symptoms of hypercalcemia?
“Stones, bones, groans and psychiatric overtones”
- Stones = kidney stones
- Bones = bone pain due to increased turnover
- Groans = abdominal pain
- Psychiatric overtones = anxiety, altered mental status
What are the equations for CO (cardiac output)?
CO = SV x HR
CO = (rate of oxygen consumption) / (arterial oxygen - venous oxygen)
What is the equation for stroke volume?
SV = EDV - ESV
SV = CO/HR
(HR can be estimated by the RR ratio, which is 60/RR in sec/beat)
How does Cushing disease differ from Cushing syndrome?
Cushing disease refers specifically to a ACTH-secreting pituitary adenoma.
Cushing syndrome refers to the general symptoms of cortisol excess (HTN, weight gain, moon facies, abdominal striae, truncal obesity, buffalo hump, etc.)
How can you distinguish Wilms tumor from a Neuroblastoma on palpation?
WilmS tumor is Smooth and unilateral
NeuroBlastoma is Bumpy/irregular and can cross the midline
What happens if you removal the adrenal glands of a patient who has a ACTH-secreting pituitary adenoma?
This is the pathophysiology of Nelson Syndrome
Removal of the adrenal glands in someone who has Cushing’s Disease, removes the negative feedback on the pituitary, causing pituitary hypertrophy and increased mass effect (headache, hyperpigmentation, bitemporal hemianopia).
Patient is presenting with euvolemic hyponatremia. What is the the most likely diagnosis and what is the pathophysiology of this condition?
SIADH (Syndrome of inappropriate antidiuretic hormone secretion)
- Excessive free water retention, with continued Na+ excretion
- The body responds to water retention with a decrease in aldosterone and increase in ANP and BNP –> kidneys will secrete Na+ since water will follow, which corrects the volume status; however, this doesn’t correct Na+ lvels
- Hyponatremia must be corrected slowly to prevent osmotic demyelination syndrome
- Treatmnt: fluid restriction, salt tablets, conivaptan (VAsoPression ANtangonists)
What are the 4 ways to diagnose diabetes mellitus?
- Hemoblogin A1C ≥ 6.5%
- Fasting glucose (8-hour) ≥ 126 mg/dL
- 2-hour Oral Glucose Tolerance Test (OGTT) ≥ 200 mg/dL
- Random glucose ≥ 200mg/dL with symptoms
Describe the type and presentation of the neuroendocrine tumor associated with pancreatic alpha cells?
Glucagonoma
Presents like diabetes. 4 D’s:
- Diabetes (hyperglycemia due to excess glucagon)
- Dermatitis (necrolytic migratory erythema)
- Declining weight
- DVT
Describe the type and presentation of the neuroendocrine tumor associated with pancreatic beta cells?
Insulinoma
Presents with hypoglycemia. Symptomatic patients will have low blood glucose and increased C-peptide (vs. exogenous insulin). 10% associated with MEN1.
Describe the type and presentation of the neuroendocrine tumor associated with pancreatic delta cells?
Somatostatinoma
Presents with an overproduction of somatostatin which basically halts the entire digestive system (i.e. prevents/downregulates secretion of secretin, insulin, glucagon, CCK, gastrin and GIP). This can lead to steatorrhea and gallstones (from decreased CCK), and achlorhydria (low H+ production from decreased secretin).
Which Vitamin deficiency may be present with Carcinoid syndrome?
Vitamin B3 - can cause pellagra
Remember, carcinoid syndrome results in excess 5-HT production. Since Tryptophan is a precursor to both serotonin and niacin, carcinoid syndrome shunts all of the Tryptophan into making serotonin, causing a relative deficiency of B3.
Which tumors are associated with MEN1?
MEN1 = menin gene (Chr 11 tumor suppressor)
3 P’s:
- Pituitary adenoma
- Pancreatic endocrine tumors (e.g. ZE, insulinomas, VIPomas)
- Parathyroid adenomas
Which tumors are associated with MEN2A?
RET mutation - receptor tyrosine kinase: 2 P's: - Pheochromocytoma - Pituitary adenoma - Medullary thyroid carcinoma
Which tumors are associated with MEN2B
RT mutation; associated with Marfinoid habitus 1 P: - Pheochromocytoma - Medullary thyroid carcinoma - Mucosal neuromas
Which diabetes drug produces modest weight loss and is often considered the safest? What is the MOA of this drug?
Insulin
MOA: prevents gluconeogenesis, increases glycolysis and increases insulin sensitivity via peripheral glucose uptake.
ADR: can cause GI and lactic acidosis (due to decreased conversion of lactate to glucose in the liver via the cori cycle, which leads to a build up of lactate in muscle).
Which drug class does the drug tolbutamide belong to and what is this class’ MOA?
Tobutamide and other “ides” = sulfonylurea
MOA: increase endogenous insulin release by close the K+ channel in the beta cell membrane (depolarization leads to increase insulin release via Ca2+ influx)
What drug class does pioglitazone belong to and what is it’s MOA?
“Glitazones” aka thiazolidinediones
MOA: increase insulin sensitivity in peripheral tissue via upregulation of PPAR-γ (perioxisome proliferated-activated R gamma)
ADR: weight gain (via decreased leptin), edema, HF
How do the sulfonylureas and the meglitinides differ?
They have the same MOA (bind and inhibit the K+ channel) but bind at different sites.
What drug class does exenatide belong to and what is it’s MOA?
GLP-1 analog
MOA: increase glucose-dependent insulin release
What drug class does saxagliptin belong to and what is it’s MOA?
Saxagliptin = Onglyza a DPP-4 inhibitor
MOA: DPP-4 is an enzyme that normally deactivates GLP-1; therefore by inhibiting DPP-4, these drugs increase glucose-dependent insulin release. They are weight neutral!
What drug class does pramlintide belong to and what is it’s MOA?
PrAMLINtide is an AMYLIN analog.
MOA: Decrease gastric empyting and glucacong release
What drug class does canagliflozin belong to and what is it’s MOA?
Sodium-glucose co-transporter 2 (SGLT2) inhibitor
MOA: block reabsorption of glucose in PCT (“lozin” glucose in the urine –> can cause UTI/yeast infections)
What drug class does acarbose belong to and what is it’s MOA?
α-glucosidase inhibitor
MOA: inhibit intestinal brush-border α-glucosidase leading to decreased intestinal absorption (decrease post-prandial hypoglycemia)
What are the two most commonly thioamides are how do they work? How do they differ?
PTU (propylthiouracil) and methimazole are both used to treat hyperparathyroidism by blocking thyroid peroxidase. They work by inhibiting the oxidation of iodide and organification/coupling of iodine.
PTU also blocks 5’-deiodinase and is safe to use in Pregnancy.
Methimazole is teratogenic.
ADRs: agranulocytosis, aplastic anemia, hepatotoxicity
What are the most common manifestations of prolactinoma or hyperprolactinemia in female vs. male patients?
Males: present with diminished libido
Females: present with amenorrhea
Hypercalcemia is a known paraneoplastic syndrome, most commonly associated with which cancer?
Squamous cell carcinoma of the lung
Which cartilage, muscles and nerves does the 1st pharyngeal arch give rise to?
All of the “M’s”
Cartilage:
- Maxillary process → Maxilla, zygoMatic bone
- Mandibular process → Meckel cartilage → Mandible, Malleus and incus, sphenoMandibular ligament
Muscles:
- Muscles of Mastication (temporalis, Masseter, lateral and Medial pterygoids), Mylohyoid, anterior belly of digastric, tensor tyMpani, anterior 2/3 of tongu
Nerves:
- CN V2 (Maxillary branch) and V3 (Mandibular) (“chew”)
Which cartilage, muscles and nerves does the 2nd pharyngeal arch give rise to?
All of the “S’s”
Cartilage:
- Reichert cartilage: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
Muscles:
- Muscles of facial expreSSion, Stapedius, Stylohyoid, platySma, posterior belly of digastric
Nerves:
- CN VII (S = seven) (facial expreSSion) Smile
Which cartilage, muscles and nerves does the 3rd pharyngeal arch give rise to?
Cartilage:
- Greater horn of hyoid
Muscles:
- Stylopharyngeus (think of styloPHARYNGEus innervated by glossoPHARYNGEalnerve)
Nerve:
- CN IX (STYLo-pharyngeus)swallow STYLishly
Which cartilage, muscles and nerves do the 4th and 6th pharyngeal arches give rise to?
Cartilage:
- Arytenoids, Cricoid, Corniculate, Cuneiform, Thyroid (used to sing and ACCCT)
Muscles:
- 4th arch: most pharyngeal constrictors; cricothyroid, levator veli palatini
- 6th arch: all intrinsic muscles of larynx except cricothyroid
Nerves:
- 4th arch: CN X (superior laryngeal branch) simply swallow
- 6th arch: CN X (recurrent laryngeal branch) speak
What is necrolytic migratory erythema, and which neuroendocrine tumor is it classically seen in?
Necrolytic migratory erythema is a characteristic skin finding, identified by the pruritic and painful, small erythematous plaques typically affecting the face, perineum, and extremities, in patients with a glucagonoma.
Which acid suppressing agent used to treat GERD, has unfortunate anti-androgenic side effects? Which drug, with the same MOA can ben given instead?
Cimetidine (an H2 blocker) can cause decreased libido, gynecomastia, and impotence.
Ranitidine, is also an H2 blocker but doesn’t have antiandrogenic side effects.
What is the mechanism of contraction bands seen on histology following an acute MI?
Contraction bands can be seen within the first 24 hours of an MI, in the setting of reperfusion injury which generates free radicals and causes hypercontraction of myofibrils through increased free calcium reflux.
Which mnemonic describes the presentation of von Hippel-Lindau disease?
HARP:
- Hemangioblastomas (often described as highly vascular with hyperchromatic nuclei)
- Angiomatosis
- Renal cell carcinomas (bilateral)
- Pheochromocytomas
How can sarcodosis leader to hypervitaminosis D and hypercalcemia?
The macrophages responsible for the non-caseating granulomas contain 1α-hydroxylase activity, which converts Vitamin D to the active form and subsequently causes calcium reabsorption.
Medullary thyroid cancer is a malignancy of which cells? What are these cells derived from?
Medullary thyroid cancer = malignancy of the parafollicular C cells
These cells are derived from neural crest cells
What is the name of the gene regulated by PPAR-γ that is responsible for increasing insulin sensitivity when treated by a glitazone drug?
Adiponectin
Which lipid-lowering class is the most effective at treating hypertriglyceridemia? What is the MOA?
The fibrates
Fibrates upregular PPAR-alpha and increase the transcription of lipoprotein lipase, which increases the degradation of TGs circulating in chylomicrons and VLDL
What is the single-most preventable cause of death in the United States?
Smoking/tobacco cessation
Patient presenting with hypogonadism, anosmia and delayed puberty most likely has what?
Kallmann syndrome - an absence of GnRH secretory neurons in the hypothalamus due to defective migration from the olfactory placode.
What is the MOA of ezetimibe?
Ezetimibe prevents cholesterol absorption at small intestine brush border.
Describe the mechanism of pretibial myxedema in Graves disease:
Antibodies against the thyrotropin receptor causes an accumulation of glycosaminoglycans and adipogenesis.
