General 4 Flashcards
acute tubular necrosis will have what type of casts?
can be caused by
muddy casts
inraoperative iscemia
what does histoplasma look like inside macrphage?
what is the MOA of patiromer?
echanges Ca for K in the intestine to increase K loss
when are delta waves seen on EEG?
N3 during night terrors
what part of vit D metabolism does the sun do?
7-decholesterol to D3
how does an AV fistula change the PV loop?
which is elevated in hemophilia a and b, PT or PTT?
PTT is proloned
what is the workup for giant cell arteritis?
ESR and temporal a biopsy
what happens when you start a pt with bilateral renal stenosis on ace inhibitiros?
pts with BRAS are a dependent on AgII to cocnstrict the efferent renal artery so that they can maintain GFR
when ACEi are started, RBF decreases, GFR decreases and FF decreases and can lead to renal failure, tho most pts can toelratee
damage to the dominant parietal lobe/angular gyrus manifests as what?
if leptin R is knocked out, what will be high?
BMI and leptin levels, because no receptors to modualte the acticity
blanching erythema in the minutes following a superifical burn are due to what?
mast cells releasing histamine
know it bbbbb
diastolic heart failure can be caused by
decreased ventricular compliance and is characterized by normal LV EF, normal LVEDV and icnreased LV ED P
caused by hypertension, obesity and infiltratigve disroders like transthyretin-induced amyloidosuis, sarcoidosis
isoniazid must be processed by what in order for the drug to be activated
mycobacterial catalase peroxidase
left ventricular gallops, etierh S3 or S4 are best heard when
at the end of expiration at the cardiac apex
factor Xa inhbitors *Xaban* MOA
inhibit Xa thus blocking prothrombin to thrombin (II-IIA)
a midsystolic click probably indicates what?
mitral valve prolapse
snapping of the cordae tendidae
usually a defect in CT like in Marfans. ED, or OI
all of the chronic myeloproliferative disorders (PV, ET, PMF) except CML, have what receptor defect?
JAK2
atopic dermatitis
LOF in fillagrin leading to increased water loss and inflammation
causes dry skin and pruritis and can appear lichenified
foamy macrophages with acid fast bacilli
MAC
etoposide inhibits which topoismoerase?
topoisomerase II
what are teh effects of dobutamine?
B1 agonist
positive iontropy and cronotropy
increased CO
mild vasodialtion
increased O2 consumption (not ideal)
G6PD def is what kind of inheritance?
XL recessive
what is heteroplasmnu
mixing of multiple genetics
like females in mtDNA mutations aren’t as effected as males
colitis assox cancer is from what kind of mutation?
early p53
late APC
or multifocal
Wernicke’s aphasia is from a vessel damage wher?
MCA vessel damage
what part of the bladder is more likely to rupture in trauma?
bladder dome
LPS on g- bacgteria like e coli bind to what?
TLRs
high pulses in UE and low pulses in LE means
what is a compensation for this?
coarctaion of the aorta
collateral circulation leadnig to a continuous murmur in the back
HIV transmembrane protiens
retroperitoneal hematoma can look like
these can compress the femoral n leading to anterior thigh loss of sensation
highly proliferative cells like___
are more prone to
intestinal crypt cells
ionizing radiation becayse they don’t have as much time to repair the dna
how does a hyperthyroid state lead to bone loss?
titration curvee for substances in the kidney
glucose is fully reabsorbed in the PCT until it reaches it max cncetration at 200. once there, it will be excreted
what are some common clinical manifestations of hemocrhomatosis
arthritis
what does pcp look like with methamene silver stian?
what two factors likely have a strong role in development of LV hypertropyhy?
endothelin and AGII due to HTN
if the TIA has resolved, do you give TPA?
NO
primary therapy is secondary prevention with antiplatlet drugs like ASAs or clopidogrel and statins
JAK is a ___ tyrosine kinase
cytoplasmic
dermatomyositis can be a sign of what?
underlyinh malignancy, including ovarian adenocarcinoma
in cirrhosis leading to ascites, portal hypertension leads to splanich vasodilation leading to activation of
what drug to give?
RAAS causing vasoconstriction from ANG and fluid and Na retenion from aldosterone
giving spironolactone, an aldosterone inhibitor, can reduce fluid overload
why do glucocorticoids cause bone loss?
decreases osteoblast precurosr cell proliferation and diferentiation
and increases rankl and rank to increase bone reabsorption
diffuse axonal injury can occur when there is
shearing and disruption of the white matter tracts
bacteria in endocarditis like to attach to what?
fibrin deposits from prevously damaged calves
calcified focus (ghon focus) is characterisitic of
PRIMARY TB infeciton
what might neurocystocosis look like?
ventricular action potential and ekg corespondance
the borh and haldane effect
HFpEF due to left ventricular diastolic dysfunction
whaat do gaucher cells look like?
what is the molecular structure of collagen made of
Gly-X-Y so glycine is the most abundant substance
where is blood oxygen the lowest?
in the coronary sinus and in the heart in general since there is a ton of oxygen extration in the myocardium
what is a common cause of congenital goiter with high TSH and low T4
what is a common cause of congenital goiter with low TSH and high T4?
genetic defect in thyroid hormone production
maternal intake of PTU
iodine deficiency
transplacental TSHR stimulating Ab (grave’s dx)
someone has a ruptured cerebral anueyrsm and a heart defect. What is the heart defect?
coarctation of the aorta
salicylate tox can have a mixed acid-base disturbance due to the resp alkalosis and met acidosis so levels can be
normal ish pH
lowish HCO3 due to met acid
low paco2 due to resp compensation for the met acid and resp alkalosis
if someone has a drop in contractility and EF with dobutamine stress test, what does that mean?
fixed atherosclerotic lesion limiting blood flow
what is effect modification?
when the effect of an exposure on an outcome is modified by another variable
can identify this using stratified analysis
what is angle closure glaucoma?
what meds can cause this?
space between the cornea and iris is narrowed, limiting the flow of aqeous humor out of the anterior chamber and raising the pressure
those that cause mydriasis such as alpha adrenergic agonists and anticholinergics
what schistosomiasis can cause hepatosplenomegaly, portal hypertension, fever, diarhea
hepatic schistosomiasis
common in africa and asia
infantile hemangiomas ___ before they regress?
enlarge before they regress
dexrtromethrophan when combined with SSRIs/SNRIs or overdosed can cause
can also cause resp depression or NDMDA receptor inhibitoin and cause hallucinations
SERotonin snydrome
chimeric ab can cause
how is it resolved
serum sickness
phagocytes eat up the IC
verapmil works great on the heart but not the skmuscle. why?
skeletal m has litlte dependence on extracellular calcium
xerdoerma pigmentosum is deficient in
which requires
nucleotide excision repair
endonuclease
___ is more likely than bacterial infection to be the inciting agent of appendcitis
lumen obstruction (fecalithi)
what is AV nodal reentrent tachycardia?
in a niacin def, which enzymes will be effected?
in lactose intolerance the stool pH will be
the breath H will be
low
high
review
BNP is released based on wht?
ventricular wall stretch and strain increase tgat occyrs with volume overload
BNP and ANP are then secreted by the atira to stimulate vasodilation and salt and water excretion to alleviate volume overload
flate or b12 def leads to a defect in what
purine/pyridine bases
what is the most common cause of spontaneous lobar hemorrhage in the elderly, esp parietal and occupial?
cerebral amyloid angiopathy
memorize
most cases of glioblastoma are associated with what mutation
EGFR
liposacrcomas are made of what?
lipoblasts, non-membrane bound cytoplasmic lipid that shifts causing scalopping
in addition to werenickes and korsakoffs syndrome in alcoholics, what else can occur?
alcohol related cerebellar degeneration
involves teh vemis
s/s include ataxia, unsteadiness, tremor, but no signs of confabulation, confusion, or other assox s.s of WK
what are the s/s of wernickes?
what are the s/s of korsakoffs?
encephalopathy, oculomotor dysfunction, ataxia
issue is in mamillay body
lesions in the anteiror and medial thalami with amnesia, confabulation and preserved long term memory
what is a possible pbscure cause for rectal bleeding?
meckel’s diverticulum with heterotopic gastric mucosa that can ulcerate and bleed
what is the cause of wide split S2?
RBBB, pulmonic valve stenosus, pHTN, can delay pulomnic valve closure causing a delay between aortic valve closing and pulmonic valve closing, widdening the split that is most prominent in inspiration and lasts throughout expiraiton
what GI drug should never be used in Parkinson’s pts and why?
Metoclopramide as it can exacerbate or brng on de novo parkinson’s with EPS due to it’s antagonistic effects on D2R
explain the pathophysiology of hypothamic amenorrhea?
usually a really atheltic female who has a low BMI, low fat, low leptin which leads to a decrease in GnRH which decreases LH/FSH and low estrogen.
Low estrogen leads to bone loss, early osteoporosis and decreased peak bone density
hey guess what.
know the difference between marfans and homocysteinuria
ITS NEVER MARFANS
homocysteinuria will be more likely to have intellectual disabilities, thrombosis
Marfans more likely to have aortic rood dilataion
N meningitis has what
N gonorrhea has what
a capsule
no capsule, but pili and htat is its’ virualence factor
what is the MOA of vangalcyclovir and gancyclovir
blocks DNA chain elongation
what is the mechanism by which pathogens under antigenic shift
reassortment
knwo
where do stem cells of SI epithelium come from?
crypts of leberkuhn
what is the primary cell type in the nodules of a cirrhotic liver?
hepatocytesl (not stellate)
differentiate between splenic sequestration crisis and asplenic crisis
what is the mechanism of tardive dyskinesia from prlonged antipsychotic use?
long term blcokade of DR leads to upregulation of the R
what are the s/s of dopamine beta hydroxylase deficiency
impaired sympathetic adrenergic activity with normal parasympathetic and cholinergic activity
presents with postural hypotenison, exercise intoleracne, nasal congestion and erectile issues
massive saddle pulmonary emboli causes waht type of shock?
obstructive shock
increase in CVP, decrease CO, increase in SVR
know
what is skewed x inactivation?
one X is turned off in every cell of a woman, but some women have skewed x inactivation, where the x defect may be more prominent
renal afferent arteriolar dilation increases what?
renal efferent arteriolar constriction increases what?
GFR and RBF
GFR at the expense of RBF, therefore FF (GFr/RBF) increases
what is the venous drainage of the rectum above and below the dentate line?
above the dentate line is the superior rectals which drain into the portal system via inferior mesentaeroc
below the dentate line is the inferior rectals which drains systemically via the internal iliac
what does xerosis look like, what is a triggeer and what is the treatment
winter itch, worse with cold weather, use lukewarm bathing and aggressivr emolients
more bc
giving probenicid with PNC does what?
inhibits renal tubular secretion of PNC
spider angiomas occur because of excess of what?
excess estrogen
primary ovarian insufficiency occurs by a process of
follicular atresia, a type of apoptosis
coating a stent in sirolimus is for what purpose?
to avoid intimial hyperplasia by reducing smooth muscle proliferation thru mTOR inhibition
failure of ____ leads to failure of tripple helix formaiton and stabiliaztion by ___
proline hydroxylation; pro-alpha chains
uncal or transtetnorial herniation will compress what?
oculomotor n.
decrease in ___ functuon can lead to osteoporosis?
ovarian
remember, hyperthryoid can lead to bone reabsorption, but not hypothyroid
girls with 17-hydroxylase deficiency will have low levels of what?
low renin levels.
can make aldosterone, so feedback inhibtion will lower renin
if someone is an autosomal recessive gene carrier, they are unaffecte,d but may have
decrease activity in that gene
if you think someone has rhabdo, bty they are on loop diuretics, what might they actuallt have?
hypokalemia secondary to loops
check electrolytes rather thanCK
a psoas abscess can spread pus and infection into which space?
the groin
what are the affects of ANP, AngII and aldosterone with sacubitril-valsartan therapy
increased ANP, decresaed aldosteorne, increased ANGII
hiv drug mOAS
what syndrome is assoz with mutations in CDKN2A on cr9p21
dysplastic nevus syndrme
(predisposed to melanoma)
what is the normal LV repsonse to exervie?
the first step of pyrimidine syntheis occurs where?
in the cytppasm
alcohol induced cardiomyopathy is a type of what
dilated cardiomyopathy
antifungal targets
what is the MOA of tretinoins/retinoids?
normalize keratin
decrease epithelial cohesiveness
stmulate stem cell mitosis
what is the effect of dihydro CCB?
decrease arteriolar resistance
decrease afterload and BP
increase SV and CO
decrease cardiac work
pompe dx is a defect in which organelle?
lysosomes
know
psammoma bodies are found in what type of ovarian tumor?
serous cystadenocarcinoma
warfarin skin necrosis is due to what?
reduced protein C levels
what class of drigs will affect the phase 0 of cardiac myocytes?
procainamide (class I antiarthyrmics) prolong phase 0, rosk of QT prolongation and toursades
the immiediateness of type I HSN is due to mast cells or IgE?
IgE ab
what is ogilive syndrome?
pseudoobstruction of the large intestine
days to weeks post op
dilation of the cecum and LI
popliteal A aneurytsm can compress which nerve and cause what problems?
compress the tibial n and cause issues with inverting and platnar flexing the foot
meningioma is due to a mutation in
a tumor supressor gene
(NF2 or DAL1)
the most common cause of type 4 RTA is
hypoaldosteronism
what is tropical spastic paresis?
caused by HTLV1
causes pins and needles in LE, sexual dysfunction, bladder problems
sclerotic lesions with increased radionnucleotirde uptake indicates what?
osteoBLASTIC lesions
often metastatic prostatic adenocarcinoma
lead poisoning does what to ox phos?
uncouples ox phos
what do cysteine stones look like?
hexagons
which drug is more likely to cause hyperkalemia, lisinopril or metoprolol?
lisinopril
what is this a picture of?
a choolesterol ebolus
it a complication of coronary angiography
what cell secretes IL8?
macrophages
what does proliferative endometrium look like?
what is the response during the proliferative phase?
straight glands from estrogen
granulosa cells are responding to FSH
zeel neilson stain means
what is proohylaxis for MAC at cd count less than 50?
acid fast
azithromcin
high afp wtihout hcg means what tumor?
what is a special feature of this type of tumor?
yolk sac tumor
schiller duval bodies look like glomeruli
what is the only class of alyklating agents that can cross the BBB?
nitrosureaus,
includes carmustine (stines, and streptosozin)
what is teh histological change in edema of atopic dermatitis?
spongiousus
what are the s.s of sick sinus syndrome?
palpiations and syncope due to dysfunction at SA node
EKG may be normal or banormla
what ype of lung cancer can elaborate ACTH and give the appearance of cushing’s syndrome?
small cell carcinoma
what cell type would be seen in broncheoalveolar lavage in Sarcoidosis?
CD4 T cells
what is the morphology of pasturela?
gram - non spore former coccobacillus
what histologyical finding is often seen in chronic asthma
what is an association that is often seen in tampinade?
curshman spirals
pulsus paridoxicus
can be seen in copd or chronic ashtma
what type of cancer is positive for calretinin?
mesotheliuoma
know
ehat electrolyte abn of calcium can cause prolonged QT and sz?
hypocalcemia
PSGN has ___ in C3 levels?
can MCD present aftera URI?
decrease in C3, increase in ASO ab titers
yep
ankylosing spondylitis can presetn with wht ype of murumr?
aortic regurg high pitched blowing early diastolic decrescnefo at lsb
lesions ___ cause contralateral hemiballism
subthalamic nuclei
whats atrial flutter look like?
a stroke from a fib is due to emboli or thrombi?
emboli
testicular seminomas are positive for what?
ckit and placental alkalinephosphatase
Pas + epithelial crests in the kidney can be from
goodpastures
sturge webber effects what size vessels?
small capillaries
calcium ox stones normally have what calcium levels in the blood and urine?
normal serum ca and high urine ca
pts with aml are likely ot have high levels od what in urine if undergoing tumor lysis syndrome
uric acid
deletion in 1p19q means what brain tumor
olgiodendroglioma
clear cytoplasm (fried egg or chicken wire)
s/s of carcinoid syndrome and hormone elaborated?
diarrhea, sob, wheezing, telenagiectasias, murmur
serotonin
what is the treatment for TCA overdose when EKG changes are present
NaHCO2
(super prlonged QRS on TCA overdose_
when MIF is present from the sertoli cells, what happens to the mullerian ducts
degenerate but mau remain as vestigial apendix testes
what muscles are innervated by the median n?
abductor pollicis brevis,
opponens pollicis
flexor pollicis brevis,
lateral 2 lumbrical muscles
what is pay-for-performance?
value based payment model that is based on quality and cost measurement
Thoracic outlet syndrome is due to compression of the nv bundle between
anterior and middle sclane
anti ccp will be + in
RA
what is in the nodules in patients with familial dysbetalipoproteineima?
cholesterol laden macrophages
whats the best treatment for aortic stenosis
percutaenous valve replacement
what lung volume is decreased in restrictive lung dz?
residual volume
example: sarcoidosis
what artery is lesionsed in laterall medullary (wallenbrug) syndrome?
PICA
superior mesenteric ganglion pressure (release) is good for whwat
constpiatoin
inhibitory pressure but its a “release”
baggy groin and eye issues and its a parasite?
onchocericosus
which HLA for MS?
HLA DR2
remmeber 2 letters in MS
which HLA for goodpastures and SLE?
DR3
remember 3 letters in SLE
and goodpastures
which HLA with DMTI?
which HLA with RA?
HLA Dr4
remember 4 letters in DMTI and R looks like a 4
which HLa with nephrotic syndrome?
HLA DR7
which HLA with MG and Graves?
HLA B8
there be 8 GRAVES in my Gravis Yard
