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Stuff I Get Wrong > General > Flashcards

General Flashcards

1
Q

What liver cells can turn into myelofibroblasts and make collagen?

A

Ito (stellate) cells

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2
Q

What does Bevacizumab bind to and what is it’s MOA and common AE?

A

binds to VEGF and inhibits angiogenesis

can cause wound dehisence

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3
Q

IS club foot a malformation or deformation?

A

Club foot is a DEFORMATION

(if you have club foot, you started out formed correctly, but got squished-DE-formation)

(malformation are screwed from the start)

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4
Q

What does urine chem look like in DKA?

A

Urine

pH low

HCO3 Low

H2PO4 HIGH

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5
Q

Fragile X is due to what molecular processes?

A

hypermethaltion of the FMR1 gene (trinucleotide repeat of >200 CGG)

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6
Q

How to differentiate between “invasive” vs. “colonizing” aspergillosis?

A

invasive will have more systemic symptoms, more sick, and sEVERELY immune compromised

Colonozing may occur in previous immunocompromised and be asymptomatic or have hemptysis. “fungus balls” on XR

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7
Q

What disease are target RBCs seen in and why

A

B-thallessmia

due to faulty mRNA formation

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8
Q

What does vWF bind to?

A

Collagen

Sir von Willebrand went to College

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9
Q

What is the MOA of the fibrates?

A

reduces hepatic VLDL prpoduction

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10
Q

What drug will increase CO and RBF at low doses and decrease CO and RBF at high doses

A

Dopamine

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11
Q

ACtin is bound to the structural protein found where?

A

at the Z line (darkest line on EM)

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12
Q

By what mechanism do eosinophils kill parasites?

A

Antibody dependent cell mediated cytotoxicity

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13
Q

Which coagulase negative staph likes to stick to implants and cause sickness?

A

S. epidermidis via an extracellular polysaccharide matrix

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14
Q

How does the respiratory system age?

A

Not well

lung compliance increases

resp. system overall decrases

physiologic dead space increase

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15
Q

Describe Neimann Pick Disease

A

Hepatosplenomegaly

Neuro regression

Cherry red

accumulation of sphingomyelin

(same as Tay Sach minus the HSmegaly, defect in B-hexo)

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16
Q

How does flexing the C spine help with swallowing?

A

displaces larynx superiorly

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17
Q

Where is the SA node?

A

interatrial septm near opening of coronary sinus

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18
Q

Where does lithium cause it’s effects of frequent urination?

A

At the collecting duct

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19
Q

What are the s/s of Erlichea?

A

mulberry inclusions in monocyts

maculopapular rash

white-tailed deer/tick

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20
Q

What are s/s of age-related cataracts?

A

loss of visual acuity

glares around lights at night

loss of red reflex

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21
Q

Emphysema causes what kind of traction in the airway?

A

radial traction

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22
Q

how does BP and PP change between ages 50 and 80?

A

systolic-increases

diastolic-decreases

PP-increases

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23
Q

What type of hepatitis virus affects pregnant women in asia/india, africa and mexico?

A

hep e (unenveloped RNA virus)

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24
Q

phthris pubis, pubic lice, should be treated with what?

A

topical permethrin

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25
Q

Why is the CF cl- channel messed up?

A

due to abnormal post translational processing of transmembrane protein

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26
Q

acute pancreatitis can occur because of activation of what enzyme?

A

trypsinogen

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27
Q

dofetilide can cause what complication?

A

polymorphic ventricular tachycardia (and torsades)

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28
Q

In most states, you should report what to public health officials?

A

HIV diagnoses

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29
Q

Can you date former patients?

A

no

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30
Q

Is it better to call a pt with bad results, or have a sit down visit?

A

Visit

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31
Q

What is the idea behind “double effect”

A

basically, it allows docs to continue to give a morphine drip to a terminally ill patient even at the risk of respiratory depression, sedation and death, because “the intent” wasn’t euthanasia, even if death is the outcome (and desire of the patient)

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32
Q

Should you call the DMV or call the organ tranplant team for a transplant first?

A

transplant team

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33
Q

Is it ethical to receive gifts from pharma?

A

medically related are okay, but otherwise no

The Physician Payments Sunshine Act, part of the Affordable Care Act of 2010, mandates the reporting by pharmaceutical and medical device companies of any meals, gifts, or honorariums (as well as many other things of value) provided to physicians. The reporting, which started in 2014, is to the National Payment Transparency Program of the Centers for Medicare and Medicaid Services. Manufacturers are required to report any payment over $10 in value, or payments to an individual that total more than $100 annually. Educational materials and items that directly benefit patients, or are intended to be used by or with patients, are not required to be reported by the Sunshine Act.

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34
Q

how does lowering the test threshold change the sensitivity/specificity?

Ex: if lvier cancer AFP was 500 but dropped to 400, how does the sen/spec change?

A

Sensitivity increases!

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35
Q

What Act ruled that patients and patient surrogates have the right to remove life sustaining actions ?

A

Cruzan v. Director

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36
Q

Does Medicare cover some people under 65? in what conditions?

What part covers drug cost?

A

Yes, all ages of end stage renal disease (requiring dialysis or transnplant), and certain disabilities like ALS

Medicare part D covers Drugs

(A-hospitAl, B-offices visits?)

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37
Q

What is the correlation coefficient?

A

A value between +1 and -1. The closer to +1, the stronger the positive correlation

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38
Q

In what phase of sleep are K waves and sleep spindles seen?

A

stage 2

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39
Q

What do you need to remember about spinal cord lesions?

A

A hemisection of the spinal cord consists of ipsilateral spastic paralysis below the lesion, ipsilateral loss of touch and vibration sensations below the lesion, and contralateral loss of pain and temperature sensations below the lesion.

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40
Q

what drug alters melanin in the iris?

A

Prostaglandin analogues

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41
Q

A table on sacrum

A
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42
Q

What is the MOA of Varenicline?

A

partial agonist of nAch R

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43
Q

What is the term for hearing colors or seeing sounds and what drug can cause it?

A

Synesthesia, LSD

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44
Q

What muscle and nerve are affected if a pt gets diplopia when they look down?

A

superior oblque, trochlear n.

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45
Q

If pt had a recent miscarriage, pelvic mass and elevated bHCg, what is one possibility?

A

theca lutein cyst

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46
Q

What is the cell change in barrets esophagus

A

columnar replaces squamous, risk of adenocarcinoma

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47
Q

When would you see crescent formation on renal biopsy?

A

RPGN

linear appearance

sx include nephritic syndrome, ankle swelling, fatigue, all ACUTE onset

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48
Q

Calcium efflux from cardiac cells prior to relaxation is primarily mediated by what?

A

Na/Ca Xchanger and SERCA

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49
Q

Describe X-linked Agammaglobulinemia?

A

BTK mutation

sinopulmonary and enteroviruses

Low antibodies, Low B cells

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50
Q

What is the underlying issue:

Woman with progressive dyspnea, RV hypertrophy (>1cm) and sudden death?

A

Pulmonary arterial hypertension

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51
Q

What are the s/s of Porphyria Cutanea Tarda?

What enzyme is deficient?

What builds up?

A

blistering on skin/hands

uroporphryinogen decaboxylase deficiency

Uroporphrynogen III

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52
Q

What class of drugs reduces triglyceride levels the most?

A

Fibrates

acts on PPARa

decreases VLDL synthesis, increases HDL

can cause muscle tox and gallstones

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53
Q

What are some s/s of HPV in the anus?

A

pain, itching, mass, bleeding

ulcerated lesion

prominent keratinization on hist.

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54
Q

If you want to know if a gene is undergoing transcription, what blot test do you get?

A

Northern Blot

(SNOW-DROP), transcription is mRNA

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55
Q

If something sounds like HFM, but is only in the mouth, what could it be?

A

Herpes (HSV1)

dsDNA virus, enveloped

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56
Q

Can bipolar type I diagnoses be made if symptoms have been present for more than 1wk?

What about brief psychotic episode?

A

Yes

Sx have to last >1 day but <1 month and have to resolve

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57
Q

What two Autoimmune disorders are type II HSN?

A

Myasthenia Gravis and Goodpasture’s

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58
Q

If someone has central DI that does not resolve after years, what is likely the damaged area?

A

hypothalamic nuclei

(if it’s in the posterior pituitary, axons tend to regenerate and resolve the dz)

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59
Q

What organ damage occurs with Amphotercin B?

A

Nephrotoxicity

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60
Q

How does carotid massage improve PSVT?

A

increases vagal parasympathetic tone which slows conduction through AV node and prolongs refractory period

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61
Q

What is embryologic source is the anterior pituitary made from?

What about the posterior pituitary?

A

surface ectoderm

neural tube

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62
Q

how does PEEP help in ARDS?

A

Increases functional residual capacity

helps “prop” up the lungs and keeps everything ventilated well

decreases any V/Q mismatching

increases O2 reserve in the lung

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63
Q

When someone has cerebral edema, the goal is the hyperventilate them. Why?

A

Dropped PaCo2 due to hyperventilation causes vasoconstriction in the brain which will lower ICP (help with edema)

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64
Q

What is the purpose of snRRPs?

A

removal of introns from RNA transcripts

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65
Q

What is the disorder if there is a “gap at the tip of the long arm of the X chromosome” ?

A

Fragile X

“broken X”

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66
Q

What is the risk of a humeral surgical fracture?

A

avascular necrosis

radial n. injury is more likely in a mid-shaft injury

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67
Q

What is likely seen in acute hypoparathyroidism (iatrogenic removal)?

A

increased urinary excretion of Ca

pt is hypocalcemic because no more PTH to tell the bones to release Ca, and PTH isn’t around in the kidneys to do reabsorption

also can’t form 1,25 vitamin D

decreased Phosphate reelase from bone as well

All of this is because no PTH

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68
Q

Bloody nipple discharge can be from what?

What is the histology of that?

A

Intraductal papilloma

intraepithelial cells lining fibrovascular cores

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69
Q

CLL is treated with what class of drug and what is the MOA?

A

Blc2 inhibitors

increase activity of caspases

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70
Q

What does it mean if there is a large PO2 gradient and normal PCO2

A

Diffusion impairment

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71
Q

what part of the nephron is impermeable to water?

A

thick ascending loop of henle

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72
Q

Is strep pyogones catalase + or -?

What does the PY in Pyogenes remind you of?

A

catalase negative!!

PYR positive!!

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73
Q

What are some s/s of digoxin toxicity?

A

life threatening arrythymias

color vision alterations

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74
Q

Chron’s disease can lead to bruising. Why?

A

bile acid malabsorption

leads to defieciency of ADEK

Lack of K leads to bruising/bleeding

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75
Q

Describe Pagets disease of the rbeast and underlying issue?

A

ezcematous, crusty lesion

can be invasive ductal carcinoma

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76
Q

If it sounds like carpal tunnel syndrome, but tinnels and phalens are negative, what is it?

A

pronator teres syndrome

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77
Q

Shoulder pain, worse with overhead movement, what muscle is damaged and what movement worsens?

A

supraspinatus, abduction

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78
Q

Which nreve roots are affected in Klumpke palsy?

A

C8-T1

described as hyperextension of the metacarpophalangeal joints and hyperflexion of the interphalangeal joints

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79
Q

What is seen on EEG in sleep walking?

A

delta waves

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80
Q

What happens to REM in narcolepsy?

A

decreased REM latency

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81
Q

during flexion of the SBS, what is the movement of the paired bones and the midline bones?

A

paired bones move into ER

midline bones move into F

SBS rises

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82
Q

what do you give for methanol ingestion and what is it’s MOA?

A

Fomepizole

inhibits alcohol dehydrogenase

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83
Q

A saccular anuerysm in the circle of willis between the anterior communicating artery and the anterior cerebral artery will cause what visual disturbance?

A

bitemporal hemianopia

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84
Q

Where is the piriformis muscle tenderpoint?

A

midpoint between the inferior lateral angle (ILA) of the sacrum and the greater trochanter.

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85
Q

where are the posterior sacral tenderpoints?

A
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86
Q

Describe Perinaud Syndrome?

What can cause it, esp., in young people?

A

impaired vertical gaze

normal to large pupils

light-near dissociation

convergence-retraction nystagmus

eyelid retraction (Collier sign)

pineal gland tumor

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87
Q

What is amaurosis fugax?

A

acute, painless monocular vision loss in the setting of atherosclerosis

described as a curtain coming down over vision

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88
Q

What should you use to treat MAC atypical pna?

A

macrolides

binds to 50S ribosomal subunit

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89
Q

Where is Meckel’s Diverticulum visualized on a technetium scan?

A

right lower abdomen

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90
Q

What common drug can cause blue tinted vision?

A

slidenafil

(inhibits phosphodiesterase 5 and 6 and 6 is a requred in light transformation

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91
Q

Where are AT2-6 TP located?

A

midline at the sternum on the level of the correspoinding rib

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92
Q

If you’re doing a surgery and see something unrelated to the condition that looks sus and you take it out wihtout consent is that bad?

A

YEah, its BADtery

only okay if there is immediate danger

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93
Q

what is a wakefullness promoting agent for narcolepsy?

A

Modafinil

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94
Q

What will acute viscerosomatic TTA feel like?

A

Warm and boggy

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95
Q

What artery causes oculomotor nerve palsy including strabismus, ptosis, and dilation if there is an aneurysm?

A

ipsilateral posterior communicating artery

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96
Q

What test can look for IT band syndrome?

A

Ober test

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97
Q

What are the s/s of retinal artery occlusion?

A

painless loss of monocular vision with associated pale retina with a cherry-red macula seen on fundoscopic examination

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98
Q

what is a common concerning side effect of trazadone?

A

painful erections

5HT2A Receptor inhibitor

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99
Q

What nerve root is the brachioradialis reflex?

A

C6

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100
Q

Furosemide and other loop diuretics have what side effect?

A

hearing loss

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101
Q

what antipsychotic can cause galactorrhea?

A

haloperidol

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102
Q

what cells have foot processes that make up the BBB?

A

astrocytes

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103
Q

what common brain tumor in children often presents in the posterior fossa and can cause noncommunicaitng hydrocephalus?

A

meduloblastoma

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104
Q

What are the visceroscomatics for hyperthyroidism?

A

T1-4

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105
Q

Which drug for myasthenia gravis can exacerbate what underlying condition

A

Pyridostigmine can exacerbate asthma

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106
Q

What common brain tumor in the 50-60 age group has a “fried egg” appearance, aka compact round cells with clear cytoplasm around a dark nucleus?

A

oligodendroglioma

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107
Q

What connective tissue disorder can present with berry aneurysm/increase risk?

A

Erlerhs danlos

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108
Q

In a patient with underlying long QT syndrome (mutation in KCNH2), what type of medication can precipitate syncope and prolonged QT?

A

Macrolides

-mycins

also, fluoroquinolones (-oxacins), antipshycotics and antiemetics

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109
Q

What is the cause of cyanosis in TOF?

A

abnormal neural crest cell migration leads to anterior and cephalad deviation of the infundibular septum during embryogenesis

Results in misaligned VSD and overriding aorta

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110
Q

What signals the hepatocytes to turn pyruvate into glucose?

A

elevated Acetyl CoA levels

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111
Q

Where can RNA polymerase II be located?

A

upstream, downstream, or within the introns of the gene

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112
Q

Statisitically, the closer the AUC is to 1, the ?

A

the more accurate the test

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113
Q

how to statins work?

how do bile acid-binding resins work?

do they increase/decrease liver cholesterol synthesis?

A

statins inhibit HMG COA Reductase

BABR increase synthesis of bile acids which uses up cholesterol stores in the liver

statins decrease synthesis, BABR increase synthesis

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114
Q

What is defective in Familial hypercalcemic hypocalciuria?

What type of receptor is it?

A

CaSR

Gq coupled membrane bound receptor

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115
Q

What occurs to levels of ghrelin, leptin and insulin during a caloric restriction/exercise program resulting in weight loss?

A

Ghrelin increases

Leptin decreases

Insulin decreases

Why?

ghrelin is up due to calorie restriction/hungry

leptin is up because of fasting

insulin down because of weight loss/increased sensitivity

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116
Q

What rib marking does the lung stop?

A

rib 8, midaxillary line

if you do a thoracentesis superior to rib 10 at the MA line, what structure can be hit?

LIVER!

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117
Q

an ischemic stroke affecting the middle cerebellar peduncle, lateral mid-pons region will afect which nerve?

what deficits will occur?

A

Trigeminal N.

contralateral hemiparesis (corticospinal tarct), contralateral lower facial palsy, dysarthria (corticobulbar tract)

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118
Q

bacterial endocarditis after a dental procedure is liekly due to what?

why does it stick to structures?

A

S. viridans

uses dextrans to stick to fibrin and platelets at sites of endothelial trauma (presence of MVP)

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119
Q

a study looking at efficacy, adverse effects in a small number of affected indivuduals is what phase?

A

phase II

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120
Q

Carbemazipine can cause what dyscrasia?

A

drug indcued aplastic anemia

(medication induced adverse effect)

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121
Q

MAOIs work best for what type of depression and what are the features?

A

treatment resistent Major depressive Disorder

mood reactivity

leaden paralysis

increased sleep and apetite

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122
Q

Which NNRTIs do not rqiure intracellular phosphorylation?

A

Nevirapine and Efavirenz

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123
Q

What can help protect against lung infarction in PE?

A

collateral circulation-good ventilation, poor perfusion

(not shunting-shunting occurs with good perfusion but poor ventilation)

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124
Q

If a baby is genotypically male, but has genital anomalies like small phallus, hypospaidias, what is the likely enzyme deficiency?

A

5a-reductase deficiency (cant make tesotsterone into DHT)

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125
Q

Immediately prior to delivery, estrogen increases what?

A

increases upregulation of gap junctions consisting of Connexin-43

helps increase myometrial excitability

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126
Q

a pt has s/s of shock after recent hospitalization for infection. RAP is increased and pulminary capillary wedge pressure is decreased. What is the problem?

A

right ventricular infarct

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127
Q

How do you calculate number needed to treat?

A

1/ARR

ARR=control rate - treatment rate

TR= 10/1000

CR= 25/1000

.025-.01=0.015 or 1.5%

NNT=1/.015=67

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128
Q

S. pyogenes has M protien which is strucuturall similar to what?

A

myosin/tropomypsin

functions to resist phagocytosis

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129
Q

Which factor will change depending on disease prevelence in populations?

A

PPV

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130
Q

what sounds like carpal tunnel but involves a lot of supination motion (screw driver)

A

deep radial nerve compression in supinator m.

will have weak extension and supination/pronation, weak thumb and fingers

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131
Q

know this

A
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132
Q

what are the s/s of arginase deficiency?

A

spastic diplegia

growth delay

abnormal movements

part of urea cycle

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133
Q

what cells fight TB?

A

CD4 and macrophages

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134
Q

DIFFERENTIATE THE KINDS OF SHOCK

A
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135
Q

if it sounds like cryptosporidium, but includes mucosal ulcers, what is it?

A

CMV (herpesvirus)

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136
Q

What is the MOA of protease inhibitors in HIV?

A

inhbit HIV protease from cleaving gag-pol which results in impaired production of functional viral proteins

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137
Q

what does aortic regurgitation sound like?

A

decrescendo at LUSB

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138
Q

(note to self) bitch you better memorize this shit so help me

A
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139
Q

What will CO and VR look like after an MI?

A

CO decreased, VR same

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140
Q

If a kid with a recent infection with abx tx comes back a few weeks later withn puffiness and nephritic syndrome and they show you an EM with a giant dome/dot, what is it?

A

acute PSGN due to IC deposition

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141
Q

How can duloxetine help with pain?

A

inhibits norepinephrine mediated pain pathway

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142
Q

a drug that quiets uterine contractions and causes mydriasis, is what class?

A

A and B adrenergic agonist

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143
Q

How does clavalunic acid given with amoxicillin change the metabolism?

A

decreases amoxicillin cleavage by bacterial cells

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144
Q

during influenza infection, interferons a and B are released that do what?

A

decrease protein synthesis by infected cells

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145
Q

With normal aging, EF can be maintained by what mechanism?

A

mild concentric LVH

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146
Q

gross hematuria in a pt with sickle cell trait and no signs of infection is likely?

A

papillary necrosis

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147
Q

propofol will redistribute where?

A

skeletal muscles (overtime)

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148
Q

which autosomal recessive condition can present with avascular necrosis bilaterally with PAS + staining in a white child?

A

Gaucher disease

(def. in glucocerebrodiase)

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149
Q

which drug, which alters purine metabolism, can change CBC as an adverse effect?

A

azathioprine

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150
Q

what drug has been shown to aggrevate gout?

what drug has been shown to decrease gout attacks (chronic)

A

thiazide diuretics (make sure to stop them)

losartan

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151
Q

to initiate muscle contraction…..

A

calcium binds to troponin, which causes a conformational change in troponin, causing tropomyosin to move and expose the myosin binding sites on actin.

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152
Q

what is the MOA of corticosteroids

A

diffuse through the plasma membrane and bind to intracellular receptors. The receptor-hormone complex then enters the nucleus as a dimer, binds to the glucocorticoid response element, and regulates gene transcription

inhibits the transcription of pro-inflammatory cytokines.

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153
Q

what ligaments are involved in a type II inversion sprain?

A

calcaneofibular and anterior talofibular

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154
Q

what tendon is involved in DeQuerivians tenosynovitis?

A

abductor pollicis longus

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155
Q

how might osteoporotic spinal fractures be described?

A

anterior wedging of the vertebrae

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156
Q

what is one of the motions of the supraspinatus?

A

adduction!

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157
Q

damage of the ulnar nerve will affect what muscle of the theumb?

A

thumb adduction

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158
Q

what can precipitate gout( dug)

A

niacin

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159
Q

what is the PaCO2, pH, and FEV/FVC1 ratio in COPD?

A

PaCO2 increased

pH decreased

(inverse relationship)

FEV/FVC1 ratio is decreased

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160
Q

In a study comparing IV vs. oral bioavailability, how would you calculate it based on AUC?

A
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161
Q

What is familial dilated cardiomyopathy?

A

autosomal dominate defect in TTN which codes for sarcomeric protein titin

can cause sudden death and enlarged heart

can cause thrombus to form

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162
Q

Describe the s/s of intestinal schistosomiasis?

Describe the s/s of hepatic schisotomiasis?

A

diarrhea, abdominal pain, ulceration, iron deficient anemia

hepatomegaly, splenomegaly

fibrosis and portal HTN

tx with praziquantel

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163
Q

Pt comes in with fever, myalgias, malaise, no sore throat.

failure to agglutinate horse erythrocytes

what is the dignosis?

A

CMV mononucleosis

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164
Q

what is the most common pediatric arthythmia?

A

SVT

narrow QRS, P waves burried in QRS

ventricular diastole shortens, CO and SV decrease and can lead to hypotension and s/s of heart failure

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165
Q

What ligament is thickened in spinal stenosis?

A

L. flavum

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166
Q

What are the three phases of acid secretion?

A

Cephalad-triggered by thought/smell of food

Gastric-gastrin/hlc release triggered by food in stomach

intestinal-triggered by protein in duodenum-downregulate acid secretion

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167
Q

Which GLUT is sensitive to insulin and where is it found?

A

only GLUT 4 is sensitive to insulin and it is found on skeletal muscle and adipocytes

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168
Q

how is ARR calculated?

A

ARR= Risk control-Risk treatment

in this case, risk of death control is control deaths/total control and treatment deaths/total treatment

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169
Q

Trendelenburg sign is due to damage of which nerve?

A

Superior gluteal N (medius and minimus, hip stability)

inferior gluteal n. innervates glute max which would mke it hard to climb stairs or stand up if injured

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170
Q

Failure of neural crest cell migration between weeks 8-12 can cause what?

A

Hirshprung’s disease in which the rectum is ALWAYs invovled

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171
Q

If it sounds like TB, it could also be

which is treated with?

which has the MOA?

A

sarcoidosis

glucocorticoids

inhibits migration of neutrophils to inflammatory sites

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172
Q

does angiotensin II constrict the afferent or the efferent arteriole?

A

constrcits the efferent arteriole

which would increase filtration pressure!

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173
Q

what are the stop codons?

A

UAA

UGA

UAG

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174
Q

which substance allows T cells to replicate?

A

calcineurin (elaborates IL2 for T cell proliferation)

targeted by cyclosporine and tacrolimus

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175
Q

Is listeria an intracellular bacteria?

How is it cleared from the body?

A

Yep

cell mediated immune system

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176
Q

which ligament is involved in ovarian torsion?

A

infundibulopelvic ligament (suspensory ligament of the ovary)

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177
Q

describe the airway resistance along the respiratory tract

A
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178
Q

blocking the voltage gated Na channels in axons does what?

A

prevents fusion and release of neurotransmitter vesicles

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179
Q

hereditary hemochromatosis is a defect in which gene

which causes what?

A

HFE gene

liver HFE can’t sense iron, so makes less hepcidin which tells the intestine to absorb more iron from food, where it can then accumulate in the blood and liver (as hemosiderin)

increase intestinal absorption

decreased hepcedin

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180
Q

why would a long standing TIDM patient present with more frequent hypoglycemic episodes?

A

because as the disaese progresses, a-cells become destructed as well which leads to decreased glucagon secration and increased risk of hypoglcemia

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181
Q

describe the difference in urine and serum Osm in central DI, complete and partial nephrogenic DI

A
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182
Q

what virulence factor allows e. coli to cause UTIs?

A

fimbrial antigen

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183
Q

how might parvovirus manifest in an adult

how might parvovirus manifest in a fetus

if given the choice between parvo and CMV, why is parvo better?

A

adult: polyarthralgia
fetus: ascites, hydrops fetalis, pulmonary effusion/hypoplasia

Parvo is the most common infectious agen causing hydrops esp. if mother presents with arthralgias

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184
Q

what are some s/s and background in hep B infection?

A

sexual promiscuity, joint pain, LAD,uritcarial rash, RUQ pain

elevated AST and ALT

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185
Q

what does constrictive pericarditis look like onCT?

A
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186
Q

what structure is the last to disappear in the respiratory tract?

A

cilia (think of having to move things along)

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187
Q

Which bacteria can cause ecythyma granulosa which is characterized by necrotic and ulcerated skin lesions?

A

p. aurginosa

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188
Q

What changes on EKG will be seen after amniodarone treatment?

A

sinus rate-decreased

PR interval-prolonged

QRS-prolonged

QT-prolonged

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189
Q

What region of LNs do T cells normally live in?

A

paracortical region

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190
Q

what is the MOA of abatacept?

A

it is a fusion of CTLA4 and Ig which acts as a brake for the adaptive immune system

it prevents T cell costimulation and allows them to undergo anergy, thus increasing peripheral tolerance (stopping the autoimmune condition from progressing)

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191
Q

what is the cause of exercise associated collapse?

A

reduced preload

basically, after running a half marathon (endurance), if you stop suddenly, the venous return drops dramatically which causes a sudden decrease in preload resulting in hypotension or syncope

put feet above head to help

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192
Q

Is perinaud syndrome caused by a craniopharygnioma or a pinealoma?

A

pinealoma :(

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193
Q

where is the pineal gland??

A
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194
Q

Is this eczema or psoriasis?

what is the histology

A

psoriasis

epidermal hyperplasia

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195
Q

If somone is fructose intolerant, what enzyme might still allow for some fructose metabolism?

A

hexokinase

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196
Q

what is the purpose of a chi squared test?

A

test for an association between two catagorical variables

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197
Q

what cell type has a higher turnover rate, osteocytes, hematopoetic stem cells, or vascular endothelial cells?h

A

hematopoietic stem cells

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198
Q

Lesch Nyhan syndrome is caused by a deficiency in what

which leads to a build up of what?

A

def. in HGPRT

build up of PRPP

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199
Q

how are most foreign particles removed from the resp. tract?

A

phagocytosis

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200
Q

if you BLOCK an a2-adrenergic receptor, will insulin decrease or increase

A

blocking a2R will INCREASE insulin

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201
Q

what acid-base disturbance does vomiting cause?

A

metabolic alkalosis

via loss of H ions

increased renal excretion of H and K (and reabsorption of Na and water to combat dehydraition)

and extracellular K/H exchange

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202
Q

What is the MOA of Methimazole (tx for hyperthyroid)

A

blocks coupling of iodotyrosines

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203
Q

what are the changes in cardiogenic shocK?

A

increased pulmonary capillary wedge pressure

increased central venous pressure

decreased coronary perfusion pressure

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204
Q

is urinary urgency/urge incontinence due to overactice or underactive detrusor m?

A

overactive detrusor m. (aka uninhibited bladder contraction)

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205
Q

in heart failure, will right atrial pressure and left ventricular end diastolic pressure be increased or decreased?

A

both will be increased

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206
Q

T cells prevent __ spread of candida while neutrophils prevent ___ spread of candida?

A

T cells prevent superficial candida spread

neutrophils precent hematogenous spread

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207
Q

what are the s/s of homocysteinuria

A

hypercoaguability

ectopia lentis

intellectual disability

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208
Q

increased pressure on the afferent arteriole of the kidney will cause hyperplasia where?

A

hyperplasia of the modified smooth muscle of the afferent arteriole (the JG cells)

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209
Q

a positive skin lepromin test indicates what about the immune system?

A

Th1 mediated immune reaction

increased IL1 and INFy in the skin lesion

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210
Q

which valve is commonly affected in IVDA and where is it auscultaed?

A

tricuspid valve

C

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211
Q

where is osm highest and lowest along the nephron?

A

highest at the bottom of the loop

lowest at the collecting duct

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212
Q

what a fib drug can cause constpiation and new AV block?

A

diltaizem

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213
Q

what can estimate left atrial pressure?

A

pulmonary artery cath (swan ganz cath)

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214
Q

chest pain and DOE is likely what?

what happens in the alveoli then?

A

acute pulmonary embolism

hyperventilation of the alveoli secondary to hypoxemia

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215
Q

if heparin induces a bleed, what can reverse it?

A

Protamine!

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216
Q

what receptor does NE act on to increase SVR in shock pts?

A

a1 receptors in the blood vessels to increase SVR

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217
Q

does hereditary spherocytosis have an increase MCV or increased MCHC?

A

increased MCHC

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218
Q

if it sounds like a fibroid, but the uterus is uniformly enlarged with tenderness and heavy bleeding, what do you think of?

A

adenomyosis (endometrial glands and stroma wihtin the myometrium)

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219
Q

multiple myeloma can cause lytic bone lesions by

A

loca tumor cell mediated activation of osteoclasts

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220
Q

major antigenic shifts occur via

A

genetic resortment

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221
Q

what kind of HLA match is best for congenital conditions?

A

unrelated matches

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222
Q

a karyotype with 47 chromosomes and a pt with intellectual disability should make you think of?

A

Klinefelters

tall stature, gynecomastia, azoospermia

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223
Q

what marker is highly specific for autoimmune hepatitis?

A

anti-smooth muscle

224
Q

what will change CO and HR but not PaCO2 or PaO2?

A

exercise

225
Q

nasocomial staphylococci infections happen frequently via

A

intravascular catheters

226
Q

Hgb C disease happens because of wht mutation?

A

a missense mutation

227
Q

the right ureter passes imediately anterior to what? t

A

the internal iliac A.

228
Q

If a pt goes cyanotic that does not improve with O2 after getting lidocaine, what is the issue?

A

acquired metheglobinemia

229
Q

what is a microbial component of n. meningitidis?

A

lipo-oligosaccharide

230
Q

what is the PaCO2, pH, and FEv/FVC1 ratio in COPD?

A

PaCO2 increased

pH decresed

(inverse relationship)

ratio-decresed

231
Q

what is the purpose of rhogam

A

prevent sensitization of the mother’s immune system from developing anti-D globulin

(D antigen and Duffy are not the same thing)

232
Q

what is the treatment for Mallasezzia Furfur?

A

Selenium sulfide lotion +/- oral antifungals

233
Q

Besides B27, what else will be positive or negative in ankylosing spondylitis?

A

Negative RF which is an IgM ab directed against the Fc region of IgG ab

therefore, B27+ and IgG-ab -

234
Q

Ribs 8-10 have what sort of motion?

A

bucket handle motion

235
Q

viscerosomatics for sinusitis is where?

A

T1-4

236
Q

Winged scapula (damage to LTN) affect which cervical nerve roots?

A

C5-7

(brachial plexus)

237
Q

which vasculitidie will have elevated eosinophils?

which ANCA will it have?

what are some of the s/s?

A

Churg-Struass (allergic granulomatous angiitis)

P-anca

238
Q

what are the viscerosomatics for the head/neck?

A

T1-4

239
Q

What are the s/s of a right parietal lobe stroke?

(branches of middle cerebral artery)

A

left-sided hemineglect

anosognosia (lack of recognition of a significant disease)

asomatognosia (lack of body awareness)

confusion

agitation

visuospatial

constructional difficulty.

240
Q

can malignant hyperthermia present during or after surgery?

A

Yes, both

241
Q

Where are the anterior Lumbar tenderpoints?

A
242
Q

where are the anterior lumbar tenderpoints?

A
243
Q

IS Turners syndrome due to nondijunction or mullerian agenesis?

A

nondisjunction

244
Q

If a patient has a hx of autoimmune dissease and now they are presenting with s/s of folate or B12 deficiency, what could be happening?

A

could be pernicious anemia, if antibodies to intrinsic factor!

Folate def. tend to occur a bit more acutely (over months) and B12 tends to take years to develop

in the stem, pt had a hx of Hashimoto’s and had years of neuro sx and signs of megaloblastic anemia and the option was folate def. or IF ab. IF ab is better since it took longer to develop and she had hx. of autoimmune dz.

245
Q

What do you use to treat peropheral artery disease?

A

Cilostazol

phosphodiesterase III inhibitor, increases cAMP in PLT to inhibit aggregation, causes vasodilation

246
Q

where does the facial nerve come out of the brain?

A

caudal pons near 4th ventricle

247
Q

Case control studies creat a ___

Cohort studies create a ___

A

odds ratio

relative risk

248
Q

what are acute TTA?

A

Increased muscle tone,

boggy, edematous,

increased temperature,

vascular congestion,

increased tenderness,

moist skin,

persistent erythema, and sharp pain.

249
Q

what are chronic TTa?

A

Ropy,

stringy,

doughy,

flaccidity, diminished muscle tone,

mushy feeling,

fascial contracture,

limited range of motion,

cool temperature,

dry skin, thickening,

pimples present, and dull pain.

250
Q

what hyperthyroid medication is preferred in the first trimester?

What is the MOA?

A

PTU

inhibits thyroid organification and inhibits peripheral conversion

251
Q

what is the triad of Wiskott-Aldrich syndrome?

If stuck between this and Brutons, what might be a hint?

A

Thrombocytopenia leading to increased bleeding time and petechiae, eczema, and recurrent infections because of a decrease in T and B-cells.

Low IgM (brutons will have low everyhting, not just low IgM)

252
Q

Beta thallesemia has a decreased what leading to a relative increase in what?

A

decrese in B chains, so excess of HbA2

253
Q

where is degenerative (type III) spondylolisthesis most liekly to occur?

A

L4-L5

dysplastic (type I) most likely to occur at L5-S1

254
Q

where is the Chapman’s point for angina?

A

2nd ICS near sternum

255
Q

evidence of GI bleeds, recurrent proloned epistaxis, +/- telangiectasias, should prompt what diagnosis?

what else can be present?

A

Oslwer-Weber-Rendu syndrome

dilated blood vessels (AV malformations)

may have iron deficient anemia

256
Q

fast stats chart for calculations

A
257
Q

if pt has polyuria and polydipsia with urine that becomes more concentrated with water deprivation, what is the diagnosis?

A

psychogenic polydipsia

258
Q

how do you tell the difference between a structural scoliosis and a functional scoloiosus?

if it is functional, what could be the cause?

A

In the forward bent position, the patient side bends toward the side of convexity. If the curve resolves, it is flexible and therefore functional. If the curve does not resolve or worsens, the curve is rigid and therefore structural.

short leg syndrome

259
Q

what is the equation for clearance?

A

CL = (0.693 x Vd)/t½.

260
Q

Cervicitis treatment (likely from concurrent gon and clam) should be treated with what?

A

azithromycin (or doxycycline) and ceftriaxone.

The ADC’s of gon and clam

261
Q

what legal procedure created the right for informed consent?

A

Schloendorff v. Society of New York Hospital

262
Q

OCPs increase/decrease the rates of which cancers?

A

increse risk of cervical cancer

decrease risk of endometrial and ovarian cancers

(may be slight increase in breast cancer)

263
Q

Myotonic dystrophy is a trinucleatide repeat in which sequence?

Does it have anticipation?

what are the s/s?

A

CTG

yes

weakness/stiffness in muscles, inverted v-shaped upper lip, family history

264
Q

What is the POSTERIOR chapman’s point for the appendix (question specifically asked for posterior and i answered anterior like a dumbass)

A

The posterior Chapman’s point for the appendix is located on the transverse process of T11. The anterior Chapman’s point for the appendix is the tip of the 12th rib.

265
Q

Where is oxytocin SYNTHESIZED from?

released from?

A

hypothalamus

posterior pituitary

266
Q

what is the treatment for bilateral adrenal hyperplasia?

what is the treatment for primary hyperaldosteronism due to unilateral adenoma?

A

Spironolactone

adrenalectomy

267
Q

what is the relationship between factor V and Protein C?

A

Factor v mutation prevents its inactivation by protein C

268
Q

how is the histology of Ewings sarcoma described?

A

sheets of monotonous, small, round cells with scant cytoplasm with fibrous strands

269
Q

vomiting causes what( acidosis or alkalosis?)

A

alkalosis

270
Q

what sleep stage does enuresis occur?

A

N3-take a pee

271
Q

do lung cancers typically cause B symptoms (fever, night sweats?)

A

no

272
Q

who owns the medical record, patients or healthcare provider?

A

the healthcare provider, but pt’s have a right to see them and ask for a copy (exception is mental health records)

273
Q

what is often concurrent with ADHD, ODD or substance abuse?

A

ODD (most common, best answer)

274
Q

what are the most common s/s of Sturge Weber syndrome?

A

port wine stain

facial, eye, skin CNS hemartomas

seizures

intellectual disability

275
Q

what does mitral regurgitation sound like?

A

blowing, holosystolic murmur with radiation to the axilla

best heard at apex

276
Q

what is the cause of edema in right ventricular heart failure, pressure-wise?

A

increased capilary hydrostatic pressure

277
Q

in a patient with Wernicke’s aphasia, right side visual defect, and right hemineglect, where is the lesion?

A

ischemic stroke involving the inferior division of the left middle cerebral artery (MCA)

278
Q

what supplment has been shown to help in homocysteinuria?

what are some s/s of homocysteinuria?

A

Pyridoxine

vision deficit

bilateral downward dislocated

tall and thin, with long limbs

notable pectus excavatum.

279
Q

how are atnerior thoracic tenderpoints treated?

A

flexion, some sidebending if needed

280
Q

what is the only FDA approved treatment for hyponozites in malaria (recurrent flare prophylaxis)

A

Primaquine

281
Q

what is the go to diagnosis for painless vaginal bleeding, esp in the 2nd trimester?

A

Placenta Previa!

282
Q

what are the s/s of von gierkes?

A

neonatal hypoglycemia, lactic acidosis, hyperuricemia, ketosis, and seizures with following lethargy

in this stem, pt is 10m/o with lethergy, excessive sweating, hepatomegaly and hypoglycemia

283
Q

if someone has elevated liver enzymes, jaundice, what could be going on?

what tumor marker would be elevated?

A

hepatocellular carcinoma

AFP

284
Q

what will be seen on EM with bullous pemphigoid?

A

linear deposits of IgG and C3 at the dermoepidermal junction

285
Q

what is the treatment for epididymidis?

what offten causes epididymidis?

A

ceftriazone and doxycyxline

gon/chlam

remember the ADC’s of gon and clam

286
Q

Memorize this babe

A
287
Q

what two features are highly indicative of a complete mole rather than a partial mole?

A

complete moles will have MARKEDLY elevated HCG and LARGE uterus

partial moles may have enlarged uterus but rarely have super elevated HCGs

288
Q

what is teh V/Q ratio in the lung area affected by pulmonary embolism?

A

The V/Q ratio in an area of lung affected by pulmonary embolism will approach ∞, because alveoli are ventilated, but no perfusion occurs.

289
Q

what type of cancer can elaborate PTHrP?

what will be seen on histolofy?

A

Squamous cell lung cancer of the lung

cells with eosinophilic cytoplasm and keratin pearls

290
Q

what is the build up product in Tay Sachs?

A

gangliosides in lysosomes

(def. in B hexaminodase)

291
Q

Which drug for A fib can cause restrictive lung disease and what is its MOA?

A

Amiodarone (class III antiarrhytmic)

prolongs cardiac action potential

292
Q

which antihypertensive in pregnancy can cause edema and lupus-like syndrome?

A

Hydralazine

293
Q

Which imaging studies will you order for a scoliosis pt?

A

Standing PA and Lateral

294
Q

Does PNC attack the plasma membrane or the cell wall?

A

CELL WALL

295
Q

Which geniculate nucleus functions with hearing?

A

MEDIAL geniculate nucleus

296
Q

secretory vesicles in nerve terminals are managed by what protein?

A

Kinesin

297
Q

If you give an injection in this quadrant, you can hit this nerve and cause what effect?

A

supermedial quadrant injections can hit the superior gluteal nerve and cause trendelenberg effect

298
Q

what are the cephalosporin resistant agents?

A

Listeria

MSRA

Enterococci

(all ressitant to PBP)

atypicals (without cell wall, like chalmydia and mycoplasma)

299
Q

How can hypothyroidism increase choelsterol?

A

hypothyroidism decreases LDL R gene expression

300
Q

What are some key features of SCID?

A

viral/fungal or opportunistic infections, including PCP, failure to thrive, chronic diarrhea

301
Q

In a well fed state, what enzymes are elevated that decreases the ability to undergo beta oxidation of fatty acids?

A

Acetyl CoA carboxylase is elevated which converts ACoA to Malonyl CoA (all elevated) which leads to fatty acid synthesis

302
Q

this confused me

A
303
Q

Does timolol work on the ciliary epithelium or ciliary muscle?

A

EPITHELIUM

304
Q

What is a paired T-test used for?

A

compares the mean of two groups

305
Q

catheterization of the common femoral artery (ABOVE the inguinal ligament) can lead to blood accumulation where?

A

the retroperitoneal space

306
Q

Which bacteria can cause necrotizing PNA and by which virulence factor?

A

Staph A

Leukocidin

307
Q

Glanzman thromboasthenia is defective in what?

what drug is an antagonist of this?

A

GP IIb/IIIa which binds to fibrinogen forming the platlet plug

Abciximab

308
Q

what is the enzymatic repair order for Base Excision Repair?

A

Glycosylase, Endonuclease, Lyase, Polymerase, Ligase

(GELPL)

309
Q

Recurrent diarrhea, 4-5 episodes per day with nocturnal poopin in a diabetic should make you consider what?

(in the absence of other sx)

A

disordered motility of the SI and colon

(chron’s would have stomach pain, mucus/blood, fever, etc)

310
Q

Memorize these ocular palsies

A

pay attention to the wording, they might ask “which muscle is still working” rather than which muscle is daamged

311
Q

What drugs are the beta lactamase inhibitors?

(good for B-lactamase producing bacteroides)

A

Pipercillin-Tazobactam

312
Q

What are the angiotensin II, ANP, and NE levels in heart failure?

A

all elevated

313
Q

What are the features of an HPV wart and what does it look like?

A

epidermal hyperplasia (akanthosis)

hyperkaratosis

papilloma formation

cytoplasmic vacuolation (koilocytosis)

314
Q

Why are elderly people less able to compensate for high altitudes?

A

decreased chest wall compliance and reduced chest wall expansion

decreased alveolar elastic recoil, increased residual volume, decreased FVC

Increased A-a gradient, increased dead space

315
Q

What does nephrotic syndrome with normal glomeruli in a yong person or child indicate?

What does a normal glomeruli look like (efaced foot prciesses on EM)

A

Minimal Change Disease

316
Q

which SITS muscle external rotates the arm?

A

Infraspinatus (INSISTS on ER)

317
Q

a single ring enhancing lesion and seizure in a child could be due to what?

A

recent Otitis Media causing an abscess

Toxoplasmosis usually has MULTIPLE Ring enhancing lesions

318
Q

flushing red skin and treating with inhaled amyl nitrate indicate what?

A

CN toxicity

319
Q

If there is some memory impairment but they can still do NORMAL daily activities and have very slight mental slowing, what is teh diagnosis?

If they do normal acitivities with COMPENSATION and have cognitive decline in >1 domain, what is teh diagnosis?

A

Normal aging

Mild cognitive impairment

320
Q

What part of metabolism does CN block?

What uncouples OxPHOs?

A

It inhibits the electron transport chain

dinitrophenol (DNP)

321
Q

Phenylephrine is an a1 agonist, which means it changes what perameters?

A

increases BP

reflex bradycardia driven by decreased inward Ca current and decreased cAMP

322
Q

memorize acid base disturbances sqaure

A
323
Q

Is FEV1 and FVC both decreased in COPD?

What ratio is increased?

A

yes, and the ratio is decreased

the RV/TLC ratio is increased in COPD

324
Q

what mineral is important to supplement in a gastrojejunostomy?

A

iron, since that is its site of absorption

(duodenum and prox. jejunum)

325
Q

Why does warfarin take several days before it has therapeutic value?

A

You have to burn through all the pre-existing clotting factors

326
Q

Most coagulase negative staphylococci are resistant to what?

what then should they be treated with?

A

Methicillin (MRSA)

Vancomycin

327
Q

Lactase dehydrogenase can be elevated by things other than sepsis. What is one of them?

A

G6PD deficiency

328
Q

CFTR channels are not stimulated by direct cAMP binding, but instead by

A

ATP (they are ATP gated)

329
Q

What are the three ways down’s syndrome can be transferred?

A

Meiotic nondisjunction

unbalanced translocation

Mosaicism

330
Q

how can a robertsonium translocation cause down’s syndrome?

A

basically, part of cr 14 can attach to cr 21 and act like a trisomy, but the person is still 46 XX or 46 XY with a 14;21 translocation

331
Q

why can someone being treated for hyperthyroidism develop severe infections?

A

antithyroid drugs can cause severe agranulocytosis

332
Q

chorea is ____ movement while Hemiballism is a ___ movement

chorea is due to damage where

Hemibalism is due to damage where?

A

chorea is low amplitude

Hemiballism is high amplitude (think throwing a Ball)

chorea is damage to the caudate nucleus

Hemiballism is due to damate in the basal ganglia (lacunar strokes)

333
Q

bruises turn green because heme turns into biliverdin via what enzyme?

A

heme oxygenase

334
Q

OTC deficiency will have a build up of what in the urine? (ornithine transcarbalamlase)

A

orotic acid

335
Q

what happens to the pulse amplitude in cardiac tamponade?

A

drop in pulse amplitude during inspiration

remember pulsus paradoxicus is common in taponade-drop in systolic BP with inspiration

336
Q

chimeric antigen receptor therapy has what two serious side effects?

A

life threatening cytokine storm (prevent with anti il6)

and hypogammaglobulinemia

337
Q

why are eldery patients more likely to become hyperthermic/heat stroke?

A

reduced skin surface to body mass ratio

338
Q

where can you access the great saphenous vein?

A

just inferior to the pubic tubercle

339
Q

endotoxins (LPS) are released from G+ or G-?

staphylococcal scalded skin syndrome is caused by endo or exo toxin?

A

G-, common in septic shock

Exotoxin (G+)

340
Q

Microcytic anemia without iron deficient qualities, constipation, AMS, and construction work leads to the diagnosis of ?

A

lead poisoning with basophilic stipling

341
Q

by what mechanisms does monoclonal ab induce cell death?

A

antibody dependent cellular cytotoxicity using NK and granyzmes

342
Q

what is the most common cause of meningitis in adults of all ages?

what are the csf findings?

A

Strep pneumo

elevated protein, low ish glucose

343
Q

what psych drug is most likely to cause priprism?

A

Trazadone

more like trazaBONE

344
Q

where should ablation be done to treat aflutter?

A

area between the tricuspid valve and IVC in the right atrium

345
Q

which two cholesterol drugs increase CK?

A

statins and fibrates

Saturated Foods raise your CK

346
Q

iron supplements will decrease the absorption of what abx?

what other supplements can decrease absprtion?

A

tetracyclins

fluoroquinolones

levothyroxine (not an abx)

Fe, Ca, Mg, Al

347
Q

what does celiac disease look like on histology?

A
348
Q

fetal hydronephrosis is most likely due to anomaly at what landmark?

A

the UPJ

349
Q

B thallessemia is described as

A

microcytic hypochromic

350
Q

a medial lesion of the dorsal columns (even in the cervical region) would have which effects?

A

compress the gracile fasculus which carries afferent info from below T6

the cuneate fasciculus is lateral and carries afferent info from above T6 (so if the lesion was lateral, there would be UE deficits)

the lesion is medial so there are LE deficits, like loss of vibration from the toes

351
Q

HOw do you calclulate number needed to harm?

A

NNH= 1/ARI or AR

352
Q

how do hookworm infections manifest?

what is the biggest risk?

A

crawl through feet into GI and live forever

iron deficient anemia from blood loss

353
Q

What stays constant with age, LFTs or liver size?

A

LFTs

354
Q

what type of ligand is RANKL?

A

NFKB ligand

355
Q

what is the emboli path for retinal artery occlusoin?

A

Internal carotid artery-opthlamic artery-retinal artery

356
Q

Shingles in which nerve can lead to blindeness?

A

V1 of the trigeminal nerve not opthalmic or optic you dubmass

357
Q

Spore formers, like clostridium or bacillis are resistant to what?

A

heat, must be heated very hot >120’C to kill everything

358
Q

contrast induced nephropathy leads to what histological findings?

A

diffuse necrosis of the proximal tubular cells

359
Q

HIV can lead to what type of anemia?

A

anemia of chronic disease (abnormal iron utiliaztion)

360
Q

ureteral obstruction causes what changes to GFR and FF?

A

both decrease

RPF may transiently increase but over time decreases as well

361
Q

What enzyme deficiency may present similar to G6PD deficiency?

A

glutathione reductase def.

s/s include episodic anemia, jaundice, dark urine, heinz bodies and bite cells

similar because G6PD makes an absence of NADPH, which makes glutathione not work right and glutathione reductase also has glutathione that doesn’t work right??

362
Q

if someone has G6PD def and you give them dapsone, what might happen?

A

enzyme def induced hemolytic anemia

363
Q

if you damage CN 9 will you see hoarseness or loss of sensation to the tonsillar lining?

A

loss of sensation to the tonsillar lining

(hoarseness is mostly CN10)

364
Q

atopic dermatitis is treated with what?

what is the MOA?

A

steriods

inhibit transcription of genes/inflammation

decreases leukotrienes via inhibition of PLA2y

365
Q

which diuretic can prevent kidney stones?

A

hydrochlorothiazide

Get a ThioZIDE or you’ll get a STONE and DIE

366
Q

between what two steps is GTP made in the CAC?

A

Succinyl CoA to Succinate via succinate thiokinase (succhynil coa synthetase)

367
Q

red man syndrome occurs because of what cellular activation?

A

direct mast cell activation

368
Q

calculate Ff

A
369
Q

R-L shunt via PDA will present with

A

differential cyanosis and may be associated with persistent pulmonary HTN of the newborn

370
Q

hyperacusis is associated with which nerve?

A

Facial N.

371
Q

know the contents

A
372
Q

what does subacute combined degeneration from b12 def. look like?

A
373
Q

drugs that dilate coronary arteries can cause what paradoxical effect?

A

worsen areas of ischemic myocardium

374
Q

wit sudden decrease in BP, what does ANP and baroreceptor firing do?

A

ANP and barorecptor firing decrease

375
Q

diabetic retinopathy doesn’t normally manifest with what?

A

acute vision loss (unless evidence of hemorrhage and neovascularization)

acute vision loss is more likely to be retinal a occlusion

376
Q

what is the MOA of rifaximin?

A

decreases intraluminal ammonia production

377
Q

what is responsible for the distal clavicle displacement?

A
378
Q

what connects the osteocytes together?

A

gap junctions

379
Q

where is rrna transcribed?

A

nucleolus

380
Q

what can cause increased anion gap in septic patients?

A

decreased ox phos (lactic acidosis)

381
Q

If someone has TB but it doesn’t show up with TST skin test, why?

A

due to inadequat lymphocytic response (anergy) and this is fairly common

TB tests don’t differentiate between TB mycobacteria and nonTB mycobacteria so that’s not the right answer

382
Q

besides influenze, what other virus can undergo genetic shift?

A

Rotavirus

383
Q

reactive lymphocytes, such as those seen with EBV mono, have what inside them to help kill infected cells?

what do reactive lymphocytes look like?

A

Perforin

384
Q

what is a transient increase seen when starting ACE inhibitors

A

increase in creatinine (usually not a big deal unless >30%)

other effects include hyperkalemia and cough

385
Q

What ab is seen with Polymyositis?

what is it’s other name?

what sort of inflammation will be seen

A

Anti-Jo1

anti-histidyl-tRNA-synthetase

endomesial inflammation (dermatomyositis causes perifascular inflammation)

386
Q

What is another name for anemia of chronic disease?

what are the features?

A

anemia of chronic inflammation

normocytic to slightly microcytic anemia

decreased circ. iron with increased sequestered iron

increased cytokines

387
Q

What enzyme involved in DNA synthesis catalyzes the formaiton of RNA strands? (involves uracil)

A

Primase

388
Q

Which part of the cardiac cycle perfuses the coronary arteries?

A

Diastole (major rate limiting factor to coronary artery perfusion)

389
Q

what cells make EPO?

A

interstitial tubular cells/peritubular fibroblasts

390
Q

which vocal cords do HPV like to infect, true or false cords?

A

True cords!

It’s True, HPV can infect the true vocal cords

391
Q

to pull an undescended teste from the abdomen into the scrote, what layers do you go through?

A

through the superficial inguinal ring which is an opening in the EXTERNAL abdominal oblique aponeurosis

392
Q

What does HBV do that is similar to HIV?

A

undergoes reverse transcription of template RNA to viral DNA

393
Q

What does this image show?

what is depositied there?

what are the sx?

what is the diagnosis?

A

crescent glomerulonephritis

fibrin

acute renal failure and hematuria

rapdily progresive glomerulonephritis

394
Q

What is directive counseling

A

bascially only giving the patient one viable option

like in complete placenta previa and the pt still wants a vaginal delivery, you have to say “yeah the only way to deliver this baby safely is via c/s”

395
Q

What is more accurate in diagnosing gallstones-echogenic US findings or failed gallbladder visualization on radionucleotide biliary scan?

A

failed gallbladder visualization on radionucleotide scan (because the dye can’t get to the gb due to stone obstuctoin)

396
Q

Pt’s with heart failure can be given neprilysin inhibtors (sacubitirl) whihc have what MOA?

A

inhibit neprilysin which is a metalloproteinase that breaks down ANP and BNP

in CHF, you want ANP and BNP around because they shut off RAAS and help wit vasodilation and water excretion, thus decreasing the volume overload

397
Q

What is upregulated by the glitazones?

what is the effect on insulin?

A

GLUT4

Adiponectin

decreases insulin resistance

decreases free fatty acids (puts them into cells, increasing fat mass)

398
Q

If a pt is already withdrawing from opioids, should you give them naloxone or methadone?

A

methadone is the better choice since nalaxone will elaborate worsening withdrawal sx

399
Q

How do beta blockers effect NE and EPI?

A

blck the interaction of NE and EPI with the receptors at the adrenergic synases (post-synaotically)

400
Q

incus and malleus from arch ?

stapes from arch?

A

1

2

401
Q

what is another way of describing BPH?

A

parynchaml pressure atrophy

402
Q

is renal agenesis associated with olighydramnios or polyhydramnios?

what is anencephaly associated with?

A

Oligohydramnios

polyhydramnios

403
Q

if a female baby has clitormegaly and genital ambiguity with high levels of testosterone and no other sx (hyperkalemia, salt wasting, hypertension) what is teh deficiency?

A

aromatase deficiency

can’t convert testosterones into estrogen

404
Q

the pupillary light reflex is associated wit what cn?

what other deficits might be seen?

A

II and III

drooping of the eyelid due to cn III deficit

405
Q

what drugs will have higher hepatic metabolism rather than renal?

A

higher lipophillic content

406
Q

what is the collagen issue in ED?

A

impaired N-terminal pro-peptide removal

407
Q

a defect in Fas will cause what?

A

issues with activcation induced T cell apoptosis

Fas-FasL for death

408
Q

are two slit like openings in the trigone pathologic?

A

no

409
Q

is a pt with mild cognitive impaorment still able to make their own medical decisions?

A

yesp

410
Q

yellow spots on the retina lead to what visual defect?

A

central scotomas

411
Q

graves opthalmopathy is caused by what mechanism?

does thyroid medication improve this sx?

what does?

A

inflammation and T cell acitvation

no

glucocorticoids to decrease inflammation

412
Q

what is cheaper HMO or PPO?

A

HMO

413
Q

does lithium cause SIADH or DI?

What can cause SIADH?

A

DI

Carbemazipine

414
Q

epidural hematomas are located

A

above (epi) the dura and below the bone

415
Q

what are some common exacerbaters of COPD?

A

viral/bacterial illness

pollution/PE

not allergies apparently 0.o

416
Q

what are the sx of superior vena cava syndrome?

A

facial plethora and edema

venous distension

417
Q

SMA1 is defective in what?

what is messed up as a result?

A

SNRPs

spliceosomes (responsible for removing the intron)

418
Q

the collagen that makes up scar tissue in MI remodeling is the same cartilage found where?

A

tendons

419
Q

what is negative selection?

A

it occurs after positive selection and is the process by which T cells possessing TCRs that bind with high affinity to self antigen or self MHC and are eliminated by apopotosis

420
Q

what is the mechanism of cell damage in Reye’s syndrome?

A

mitochondrial damage leading to impaired fatty acid metabolism (hence the microvacuolization)

421
Q

what do ARBs inhibit?

A

angiotensin II so it can’t make aldosterone

so renin, angio I and II are all elevated but aldosterone is low

422
Q

the inguinal femoral nodes consist of which two groups?

A

superficial inguinal and deep femoral nodes

423
Q

amiodarone is a CYP ?

Phenytoin is a CYP ?

A

inhibitor

inducer

424
Q

what condition tends to occur with myasthenia gravis?

that tissue is derived from the same embryologic precurosor as what part of the parathyroid?

can MG have hand weakness too

A

thymoma

inferior parathyroid

yes

425
Q

what enzyme deficiency is seen in Wernicke’s encephalopathy?

A

erythrocyte transketolase def.

426
Q

does tamulososin help with BPH?

what helps reduce BP and BPH?

A

NNOO

Doxazosin

427
Q

where do most anal fissures occur?

A

posterior midline distal to dentate line

428
Q

what indicates CGd?

what is impaired?

A

negative nitrolozine blue test

disaese associated NADPH oxidase

impaired intracellular killing and increased risk of catalase + organisms

429
Q

where in the brain would a lesion cause difficulty with abstraction?

what is abstraction?

A

frontal lobe?

finding similarities between two objects (watch and a ruler)

430
Q

If it’s a question that sounds like MARFANs but they ask you what you would supplement with (vitamin wise) what is the illness???????

what should you supplement?

A

HOMOCYSTEINURIA

Pyridoxine

431
Q

In cardiogenic shock

cardiac contractility

SVR

PASP

(increased or decreased)

A

decreased

increased

increased

432
Q

what issue allows vericocele to develop?

what else can develop from this?

A

failure of the obliteration of the processus vaginalis

INDIRECT hernia

433
Q

is pneumothorax hyperresonant or dull?

is tactile fremitus increased or decreased?

A

hyperresonant

decreased

434
Q

in primary trimester of pregnancy give what for hyperthyroid?

stop it after first tri because of what adverse maernal effect?

A

PTU

hepatotox

435
Q

in obstructive cardiac hypertrophy, what is causing the obstruction?

A

mitral valve leaflet and septium

436
Q

what are the manifestations of fibromuscular dysplasia

A

fibromuscular webs

loss of elastica lamina

renal artery stenosis

classic in younger women

437
Q

what common GERD drug can increase risk of osteoporosis?

A

omeprazole

438
Q

how does mean, median, and mode work with skewing?

A
439
Q

along with the brain and testes, what other site is immunologically privledged?

A

eyes

440
Q

HSV encephalitis will show what on CSF?

what is the moa of the drug to treat?

what is a classic mri finding?

A

high protein, normal glucose

inhibits viral DNA polymerase

bilateral temporal lobe lesions

441
Q

people with ornithine transcolase def. should avoid what?

A

protien in the diet

442
Q

know the conductive vs. sensorineural hearing loss

A
443
Q

glucocorticoids cause apoptosis of what type of allergy=prone cell?

A

eosinophils

444
Q

what is found in cytosol of healthy liver cells?

A

transketolase

445
Q

what does actinomyces look like on lung histolgy?

remember actinomyces israeli will have what characteristics features?

A

ddental caries, jaw trauma, sulfur granules, submandibular swelling, etc.

446
Q

preeclampsia can be caused by decrease of what?

A

decrease VEGF and other proangiopathic features

447
Q

skin retraction in skin cancer is because of what?

A

metastasis to the suspensory ligament

448
Q

looking at a whole population is what kind of study?

cohorts and case control are different because?

A

ecological study

they deal with the individual

449
Q

what is the reid index?

A
450
Q

what sort of deficiency can make someone a slow to wake uper after anesthesia?

A

pseudocholinesterase def. leads to decrease plasma hydrolysis

451
Q

in SE suydnrome, what amino acid is causing the sx?

A

tryptophan

452
Q

what is the determining factor in the severity of Tetrology of Fallot?

A

RVOT obstruction

(right ventricular outflow tract)

453
Q

what can be triggered by severe trauma?

A

myositis ossificans (heterotopic ossification)

made up of benign bone and fibroblasts

454
Q

celiac diseases (anti TTG IgA) can cause what vit. def?

how does this affect the PTH system?

A

vit D def.

increased PTH, decreased Ca and decreased PO

455
Q

in the respiratory mucosa, what are the levels of Na and Cl in CF?

A

increased Na reabsorption

decreased Cl excretion

456
Q

splenic laceration and hemiperutoneam can cause what viseroscomatic symptoms?

A

left shoulder pain, hiccups due to phrenic nerve irritation

457
Q

in areas of immune privlege that demonstrate infection-like processes with multinucleate giant cells, what is going on?

A

T cell repsonse to previously sequestered antigens

458
Q

what part of the immunoglobulin binds to the phagocyte?

A

the constant region of the heavy chain

459
Q

how is the histology and tumor marker of schwannomas described?

A

elongated, wavy nuclei

S100

460
Q

orbital floor injuries injure the infraorbital nerve which will cause which deficit?

A

decreased sensation to upper lip

461
Q

what chemical keeps the coronary artery blood flow constant even when MAP is changing?

A

NO

462
Q

the metanephros gives rise to what?

the ureteric bud gives rise to

A

glomeruli, bowmans space, PCT, LOH, and DCT

everything else

463
Q

what asthma drug inhibits the interaction of inflammatory mediators with cell surface receptors?

A

luekotirene inhibitors

montelukast

464
Q

why does strep pneumo make a green productive cough?

A

myeloproxidases

465
Q

transient global amnesia occurs because of issues in which part of the brain?

A

hippocampus

466
Q

why is MRSA resistant to the cillins?

A

poor interaction with binding proteins (PABAs)

467
Q

what diuretic improves mortality in those with HFrEF?

A

spironolactone

spare the heart from remodeling

468
Q

what is the effect of the post synaptic muscle cell in MG?

A

reduced amplitude of the motor end plate potential

469
Q

what is the moa of pramipexole?

A

directly stimualtes dopamine receptors

470
Q

tickborne illnesses

think systemic sickness with rash after being in the wilderness

most tick or animal illnesses can be treated with what?

A

tetracyclines

inhibit protein synthesis

471
Q

What happens if you give an alcoholic glucose before thiamine?

A

precipiates WE :( burns thru the last of their thiamine and bad stuff happens to the brain :(

472
Q

what findings make you think of pulmonary edema?

A

encorged pulmonary capillaries with pink acellular gunk in the alveoli

can be precipitated by increased alveolar hydrostatic pressure due to left sided heart failure caused by dialted cardiomyopathy caused by alcohol abuse

473
Q

K sparing diuretics are good for HF except

what else is good for Hf in improving mortality?

A

the ones that work on ENaC (triamterone, amiloride)

ACEi, ARBS, Neprilysin i , B blockers

474
Q

What are some things that can cause nonexterional heat stroke and why?

A

amitryptiline can interfere with heat dissipation via inhibited diaphoresis

475
Q

anoxic damage to which portion of the brain can lead to diminished pupillary reflex?

A

upper midbrain

476
Q

small circular DNA that looks like bacteria come from what?

what does that look like on EM?

A

mitochondria

477
Q

Know the cancer tumor markers

remmeber HCC is

A

AFP!

478
Q

reveiw erythrocytosis

A
479
Q

what is a rare emissary vein hemorrhage located?

A

between the periosteum and galea aponeurosis

happens in neonates as they are being born, vacuum deliveries

fluctant mass over scalp and neck

480
Q

decreased sensation to the suprapubic region after a appendectomy is due to damage to what nerve?

A

iliohypogastric n.

481
Q

Dengue fever and Chikungunya fever are transmitted via

A

the aedes mosquito

dengue fever is kinda like a hemorrhagic fever

482
Q

whats better for preventing central line infections?

alcohol handcleansing or chainging cath every 7 days

A

alcohol hand cleansing

483
Q

remember if you think its DI, and ADH is high, which one is it?

do you treat it with desmopressin or HCTZ?

A

nephrogenic ! brain is making ADH

HCTZ

484
Q

deficiency in CD 55 and CD 59 cause what to be more active?

what disease is this seen in?

A

Complement (CD55 and 59 inactivate complement, so without them, complement can go crazt)

PNH where there is a mutation in PIGA, GPI doesn’t work right, and now CD55 and 59 are inactive so complement is crazy making you pee blood at night (this seems fake but okay)

485
Q

which HIV drug is CI in those with HLA B27 serotype?

A

Abacavir

I think this is a sketchy picture with the abra cadabra wizard holding a book with B27 on it ?

486
Q

acute hemolytic transfusion reactions are mediated by what reaction?

A

type II with complement mediated cell lysis

487
Q

After an MI, when there is a new onset systolic murmur that resolves with revascularization, what was the murmur and what was the cause?

A

mitral regurgitation due to infarction of the papillary muscle resulting in hypokinesis and displacement

488
Q

I don’t know how standard deviation works send hlp

A
489
Q

in a hx of artery disease, and the kidneys are different sizes, why?

A

renal artery stenosis

lack of nutrients and oxygen

490
Q

bunesonide is what kind of drug?

what is the MOA?

A

glucocorticoid

binds to cytosolic R and translocates to nucleus and inhibits NFKB which reduces cytokines and TNF a

less systemic side effects, higher first pass metabolism

491
Q

what are the physiologic differences between right and left ventricle?

A
492
Q

what are the two ways to calculate CO?

A
493
Q

what is the presentation for atheroembolic disease?

A

livedo reticularis, blue toe, and AKI after stent placement

494
Q

CGD is an issue in neutrophils, but an issue in what specifically?

A

NADPH oxidase

495
Q

this might be helpful

A
496
Q

how does COPD change lung volumes

A
497
Q

in hypovolemic shock, what gets reabsorbed more?

A

urea

498
Q

G6PD deficiency is part of what pathway?

what is the intermediate between teh reactions catalzyed?

what is that intermediate used in?

A

PPP

NADPH

fatty acid syntehsis

glutathione

499
Q

whazt is the MOA of integrase inhibitors?

A

inhibit production of viral mRNA

500
Q

is x linked recessive disaeses 1/4 chance or 1/8 chance?

A

1/8 chance

501
Q

if someone doesn’t have a cat can they still get toxo?

A

yes through contaminated foods :(

502
Q

If someone wants to know if their negative test result is truely negative, what is the question they are really asking?

A

NPV

503
Q

what eats up the platelets in HIT?

A

splenic macrophages

504
Q

know this

A
505
Q

if someone is deficient in riboflavin, which enzyme is most directly affected?

A

succinate dehydrogenase

506
Q

if you fracture rib 12, what is liekly injured?

A

Da kidney, in’it?

507
Q

is grapefruit juice a cyp inhibitor or inducer?

A

inhibitor

inhibit your sipping (cypping) of gF juice because it is gross and a cyp

508
Q

beta blockers increase what in cardiac myoctes?

A

increase cAMP in cardaic myocyes

509
Q

angina with an increased pressure gradient over teh aortic valve can indicate?

A

aortic stenosis which can cause angina

510
Q

yellow white plaques of the colonic mucosa are indicative of what?

A

c diff

511
Q

recurrent pyelonephritis is often due to what?

uncorrected, what is the sequela?

A

VUR

hypertension (2’), renal scarring at the upper and lower poles

512
Q

remember what migratory thrombophlebetis is associated with?

A

visceral (mucinous) cancers, esp pancreatic, colon and lung

is a hypercoaguability

named Trussous sign after the dr. trussous described it and then later diagnosed it on himself 0.0

513
Q

PECAM1 mediates what action?

A

transmigration

514
Q

what is the relationship between CRT and GFR?

A
515
Q

poorly differentiated prostate tumors have a high or low gleason score?

A

high gleason score

less differentiated-lower score

the higher the gleason, the higher the rate of spread

516
Q

CMV retinitis might look like this

what is it treated with?

A

glancyclovir

517
Q

what does blood flow and VQ ratio look like in the base vs the apex?

A
518
Q

what is locus heterogenity?

A

when two different mutations at differnt loci have similar pheonotypes (different causes of albinism)

519
Q

what is CO, CVP, and PCWP like in an inferior ventricular wall infarct?

A
520
Q

EPO signals via

A

Jak STAT kinse

521
Q

digoxin helps to normalize irregular heart rates via

A

slowing conduction thru the AV node and enhancing parasympathetic tone

522
Q

what causes the vision changes in pre-eclampsia?

A

vasospasm/vasoconstriction

523
Q

describe clasp knife spasciticty?

where should the lesion be found?

A

flexing, meeting resistance, and then resistance is overcome

intenral capsule (pyramidal motor system, UMN lesion)

524
Q

what will be decreased in carnitine deficiency?

A

acetoacetate. i dont get this

525
Q

in tetrahydrobiopterin *BH4) def, what is decreased and what is increased?

A

tryptophan metabolites and phenylalanine are INCREASED

serotonin is decreased

526
Q

prolonged glucocorticoid use does what to the liver?

A

increases liver enzyme/gluconeogenesis/glycogenesis

527
Q

if a diabettic patient with renal failure is persistnently hypoglycemic why?

A

decreased renal clearance of insulin

528
Q

after treating CDI with desmopressin, renal clearance of what will be decreased the most?

A

urea

529
Q

what acute branched gram + can infect IUDs and cause PID?

tx with what?

A

actinomyces isralei

PNC

530
Q

protienuria, myalgias/arthralgias, and pancytopenia can indicate what?

A

SLE type III HSN

531
Q

treating methanol toxicity with fomepizole will do what?

A
532
Q

Kortakoff sounds can indicate?

A

Pulsus peridoxicus in pericardial disease/tamponade

533
Q

what can happen around the infusion site of NE?

waht is the treatment?

A

extravastion and pallor

phetnolamine

534
Q

which is less liekly to cause toursades and QT prolongation, amiodarone or procainamide?

A

amiodarone

535
Q

early onset dementia is assoxi with the following:

late onset demenia/alzhiemers is asox with what?

A

presenillin 1 and 2 and APP on cr. 21

ApoE E4 allele

536
Q

pure red cell aplasia can be assoc with

what does pure red cell aplasia present with?

A

thymoma

low erythrocytes, low reticulocytes

normal thrombocytes and granulocytes

537
Q

a transtentorial (under the tentorium cerebelli) herniation cna cause what pals?

A

cn iii palsy

538
Q

STEMI in II, III and AVF is where?

A

RCA

539
Q

bacteria classes that attack the cell wall

A
540
Q

what is linkage disequilibrium?

A

two genetic loci are said to be in linkage disequilibrium when their respective alleles are inheriteed together int the same gamete (haplotype ) more or less often than expected by chance alone given their individual rfrequencies

541
Q

wwhat is sexreted by SER?

A

hydrophobic compounds including lipids, phsopholipids, steroid hormones, cholesterol derivatives

542
Q

what mechanism does EBV use to cause Burkitt lymphoma?

A

transcription activation

543
Q

what is delayed hemolytic trasnfusion reaction?

A

previous sensitixation to non ABO (or minor) products that causes an anamnestic ab response days to weeks later

may be asxt or have s/s of hemolytic anema and + COOMBs test

544
Q

why can blood transfusions cause acute hypoglycemia and waht is the tx?

A

chelation of Ca from substances in the transfused blood

IV ca gluconurate/chloride

545
Q

what is the order of electrical conduction in the heart?

a 3rd degree AV block will make what the new pacemeaker?

A

SA-AV-His-Purkinje-ventricular myocardium

HIs is the new pacemaker

546
Q

what is the most common source of abberant electrical activity leading to paroxysmal afib?

what is the electrical anomaly comes frm the sa node?

what is the electrical anoamy for monomorphic ventricular tacg?

what site anomaly causes aflutter?

A

the pulmonary veins ???? is UW fucking high?

sinus tach

usually ischemia myocardium or papillary m or RVOT

cavotricuspid isthmus between IVC and CT

547
Q

what is the moa of ankylosing spondylitis?

A

areas of bony erosion and new bone growth

548
Q

in an aortic dissection, giving esmolol functions to what?

A

decrease ventricular contraction velocity (left)

549
Q

proteoglycans causing medial degeneration makes you think of what vascular pathology?

A

aortic dissection with cystic medial degeneration

550
Q

what happens to the alveoli in COPD (obstructive lung dx)?

A

intraalveolar wall destruction

551
Q

beta blockers do what in hyperthyroid state?

A

decrease T4-T3 conversion in the periphery which is why you give it during thyroid storm you absolute donkey

552
Q

In Wilson’s disease, why acn’t copper get out of the body?

A

defective biliary excretion

leads to hepatitis

defective protein is ATpB7

553
Q

What type of esophageal cancer is most common in the proximal 2/3 of hte esophagus?

A

skquamos cell carcina

554
Q

in ARDS, damage to which cell allows proteinaceous material to acumulate?

A

Type I pneumocytes

555
Q

____ drug increases BP and decreases HR?

A

phenylephrine

556
Q

ts in acute decompensated HF usually get treated with which diuretic first?

A

LoOPS

Stuff I Get Wrong (34 decks)

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