High-Yield Misses - UWorld Flashcards
1
Q
Abnormalities involving what structure cause Hypospadias? Epispadias?
A
Hypospadias - Uretheral/Urogenital Folds
Epispadias - Genital tubercle
2
Q
Low levels of what electrolyte can cause hypoparathyroidism?
A
Magnesium (as in prolonged diarrhea)
3
Q
What amino acids should be supplemented with in pyruvate dehydrogenase deficiency?
A
Lysine and Leucine as they are the only purely ketogenic amino acids.
4
Q
Under physiologic conditions, is Cl driven in or out of the cell?
A
It is driven into the cell down its concentration gradient to try and achieve a more negative membrane potential
5
Q
What are the lab values in Osteoporosis?
A
Serum Ca, PO4, ALP, and PTH are all NORMAL!!!
6
Q
What is Atypical Depression?
A
Mood reactivity, leaden fatigue, rejection sensitivity, and increased sleep and appetite (reversed vegetative signs). Rx with MAOI.
7
Q
What is another name for cANCA?
A
PR3-ANCA; Seen in Granulomatosis with Polyangiitis (Wegners)
8
Q
What is another name for pANCA?
A
MPO-ANCA (myeloperoxidase ANCA)
9
Q
What is a risk when starting all antidepressents?
A
Inducing MANIA in susceptible patients (particularly TCAs and venlafaxine)
10
Q
What are the “3 D’s” of Pellagra?
A
Dermatitis (esp in sun exposed areas), diarrhea (epithelial atrophy), and dementia (neuronal degeneration). Niacin is found in the diet or synthesized from tryptophan. (non-absorbable in corn).
11
Q
What is Hartnup Disease?
A
Decreased absorption of tryptophan leading to Pellagra from niacin deficiency.
12
Q
How does carcinoid syndrome cause Pellagra?
A
Increased tryptophan metabolism to 5HT
13
Q
What is a secondary method of diagnosing CF?
A
There is a negative transepithelial potential difference due to increased sodium reabsorption (results from a decreased inhibition of apical Na channels and from intracellular Cl accumulation
14
Q
What are the Down syndrome Pre-natal findings?
A
First Trimester Screen: Serum PAPP-A DOWN, bHCG UP. Increased Nuchal transclucency
Quad ScreeN: Increased Inhibin, Increased HCG, Decreased Estriol, Decreased AFP
15
Q
What are the Prenatal findings in Edwards Syndrome?
A
Trisomy 18.
First Trimester Screen: PAPP-A and bHCG DOWN
Quad Screen: AFP, HCG, estriol DOWN, inhibin normal or down
16
Q
What are the prenatal findings in Patau syndrome?
A
First Trimester Screen PAPPA, bHCG DOWN, Increased Nuchal Translucency
17
Q
What should you consider on a patient on long-term steroids (e.g. SLE patient)?
A
Iatrogenic Cushings Syndrome. Would show bilateral adrenal cortical atrophy.
18
Q
What is a likely consequence of hydrocephalus later in life?
A
Hyperrtonicity and hyperreflexia due to upper motor neuron damage.
19
Q
What is the name and function of the toxin produced by P. aeurginosa?
A
Exotoxin A which inhibits EF-2
20
Q
What reaction is catalyzed by 21-hydroxylase?
A
Progersterone -> 11-Deoxycortisone
21
Q
What gene mutation is commonly carried by melanoma?
A
BRAF B600E. Can use vemurafenib a BRAF kinase inhibitor
22
Q
What electrolyte abnormalities is the patient at risk for in the maintenance and recovery phases of ATN?
A
Maintenance - Hyperkalemia, high anion gap metabolic acidosis, hypocalcemia
Recovery - Hypokalemia (due to brisk diuresis without full tubular function), hypocalcemia
23
Q
What two immunodeficiencies can have lack of thymic shadow?
A
DiGeorge’s Syndrome and SCID
24
Q
What are the three important dopaminergic systems?
A
Mesolimbic-mesocortical: regulates behavior. Schizophrenia associated
Nigrostriatal: Coordinates voluntary movement. Parkinsonism
Tuberoinfundibular: Controls prolactin secretion
25
What is the first glycolytic enzyme in beta cells?
Glucokinase (like the liver, not hexokinase). Inactivating mutations in glucokinase result in mild hyperglycemia that can be exacerbated in pregnancy.
26
What is the allosteric activator of Pyruvate Carboxylase?
Acetyl-CoA
27
What is a key difference in the Sx treated by typical and atypical neuroleptics?
Typical - treat positive symptoms of schizophrenia
| Atypical - treat both positive and negative symptoms
28
What Abx for lung abscess in Alcoholic?
Clindamycin! Remember it covers anaerobes above the diaphragm and also S. pneumoniae. Need to cover anaerobes and aerobic streptoccoci in a lung abscess.
29
What is the characteristic venous blood finding in cyanide toxicity?
Increased SaO2 as oxygen cannot be unloaded in tissues.
30
Where is lung abscess likeley to form with aspiration while supine?
Likely to form in the right lung in the posterior segment of the right upper lobe or superior segment of right lower lobe
31
What is the function of IgA?
It acts to prevent bacterial from adhesing to and penetrating a mucosal barrier. Does not act as an opsonin.
32
What is the most common cause of death in Type 2 diabetics?
Coronary heart disease! (Most common cause of ESRD, but 1/2 of ESRD patients die of cardiac disease)
33
What direction does the PCL run? ACL?
PCL - Medial to Lateral, Anterior to Posterior (from femur to tibia)
ACL - Lateral to medial, posterior to anterior (from femur to tibia).
Remember the tibia is medial
34
What is the anatomical defect in cleft lip?
Failure of fusion of the maxillary and medial nasal processes (primary palate)
35
What is the anatomical defect in cleft palate?
Failure of fusion of the two lateral palatine processes or failure of fusion of lateral palatine processes with the nasal septum or medial palatine process (formation of secondary palate)
36
What enzyme does Etoposide inhibit?
DNA Topoisomerase II (2 makes transient breaks in both DNA strands etoposide inhibits ability to seal the breaks)
37
What drugs inhibit Topoisomerase I?
Irinotecan and Topotecan (normally it makes single strand breaks)
38
Which layer of tissue differentiates an ulcer from an erosion?
Ulcer - penetrate mucosal layer (i.e. goes through muscularis mucosa)
Erosions - Do not fully extend through muscularis mucosa
39
What is the most common cuase of in-hospital death after an MI?
Ventricular failure and Cardiogenic shock
40
What is phenotypic mixing?
Co-infection of a cell by two viruses; Genetic material of one virus gets encapsualted by the proteins of another so it displays the tropism of the other virus (on its next infection ONLY). Note could also be only a mix of surface components, this still allows for infection of new cell types.
41
How do you describe a HBV infected hepatocyte?
Cytoplasm is filled with spherules and tubules of HBsAg, cytoplasm takes on a granular "ground glass" eosinophilic appearance.
42
What is the histologic features of HCV infection?
Lymphoid aggregates within the portal tracts and focal areas of microvesicular steatossis.
43
What is more dangerous, tubular or villous polyp?
Villious! It is a villian!
44
True or false, Larger VSDs usually have softer murmurs?
True! Lower pressure gradient.
45
What explains Thiopental's short duration of action?
It rapidly distributes to the brain but then rapidly re-distributes to the Skeletal Muscle and Fat! The rapid brain/blood clearance leads to rapid recovery from anasthesia
46
What lipid-lowering agent causes hyperuricemia?
Niacin - exacerbates Gout. Other meds that cause gout: HTZ, cyclosporine, PZA.
47
How do you prevent neonatal tetanus?
Immunize mothers with tetanus toxoid so that they can pass the antibodies to their child.
48
What cell membrane forms the outer envelope of herpesviruses?
The nuclear membrane
49
What tumor is chronic lymphedema a risk factor for?
Angiosarcoma (Stewart-Treves Syndrome)
50
What is the difference between a strawberry and a cherry hemangioma?
Strawberry is in infancy, regresses spontaneously at 5-8 years old (bright red near epidermis). Cherry hemangioma is in the elderley, increasing frequency with age, does not regress
51
What nerve is commonly injured in a fibular neck fracture?
Common peroneal nerve! Causes foot-drop (foot is inverted and plantarflexed at rest due to loss of the superficial and deep peroneal nerves respectively). Sensation on Dorsum of Left Foot is lost
52
What cardiac defects are found in Turner's Syndrome?
Bicuspid Aortic Valve and Preductal coarctation of the aorta
53
What meds mask signs of hypoglycemia?
Non-selective beta blockers. Selective at least allow for B2 mediated gluconeogenesis and glycogenolysis and lipolysis. Remember that sweating is cholinergic mediated
54
In the patient with metabolic alkalosis, what test is useful to determine cause?
A Urine CL test and determine volume status.
Urine Cl < 10 = Saline-responsive alkalosis (e.g. vomiting)
Urine Cl > normal = Contraction Alkalosis (e.g. HTZ, furosemide), chloride responsive
Urine Cl > 20 = Saline-resistant metabolic alkalsosis (e.g. Conn Syndrome)
55
At what calcium level does neuromuscular excitability become apparent?
<7.0 mg/dL
56
What is a charcot-bouchard pseudoaneurysm?
Aneurysm associated with chronic HTN usually in small vessels of the Basal Ganglia and Thalamus. Usually secondary to hyaline arteriosclerosis. Rupture leads to intracerebral hemhorrage.
57
What color are cavernous hemangiomas?
Blue. composed of dilated vascular spaces
58
What is the min diastolic pressure for hyperplastic arteriolosclerosis to occur?
>120-130 mmHg
59
What are the important side effects of protease inhibitors?
Lipodystrophy (increased fat on back and abdomen - buffalo hump).
Hyperglycemia and insulin resistance
Inhibition of P-450 (don't give with rifampin), use rifabutin)
Remember all end in "-navir"
60
Name two D2 agonists that are prefered in Parkison's Rx?
Pramipexole and Ropinirole (non-ergot)
61
What does the superior laryngeal nerve innervate?
The cricothyroid muscle. It travels with the superior thyroid artery. The internal branch of this nerve supplies sensation to the larynx above the vocal cords.
All other laryngeal muscles are innervated via the recurrent laryngeal nerve.
62
What is a key side effect of risperidone?
Hyperprolactinemia (remember it is a D2 blocker preventing regulation of prolactin secretion)
63
What is the role of glucagon in beta-blocker OD?
It increases cAMP and increases intracellular Ca release in cardiac myocytes.
64
What phase of meiosis is the oocyte arrested in after ovulation?
Metaphase of meiosis II
65
What patients is invasive aspergillosis more common in?
Neutropenic patients (e.g. leukemia or lymphoma pt)
66
What is Charcot-Marie-Tooth disease?
Mutation of myelin protein that results in a "neural form" of muscular atrophy. Weakness of foot dorsiflexion due to involvement of common peroneal nerve
67
What is Bloom syndrome?
Generalized chromosomal instability, increased cancer susceptibility
68
What is the Haldane effect?
Reverse of the Bohr effect, in the lungs, O2 binding to Hb causes H+ release
69
What is the ABG results in a PE?
The hypoxia due to V/Q mismatch results in hyperventilation = Respiratory Alkalosis with low CO2 and low O2
70
What test has replaced the Bacitracin test?
The PYR test! So S. Pyogenes is PYR + (i.e. Bacitracin +) while S. Agalactiae is PYR -. Furthermore, s. Agalactiae has positive CAMP test.
71
what is the differential for Necrotizing Fasciitis?
S. Pyogenes, S. Aureus, C. Perfringens, S. agalactiae, Aeromonas hydrophila
72
What is the common origin of most paraneoplastic syndromes?
Autoimmune. E.g. paraneoplastic cerebellar degeneration due to anti-Yo (ovary, breast), anti-P/Q (lung), and anti-Hu (lung)
73
What are normal aging changes in the heart?
Decreased LV chamber size (length) and a "sigmoid septum" bulge. Increased connective tissue, and lipofuscin accumulation.
74
What causes an increased ESR?
IL-6 causes APC release from liver (fibrinogen, ferritin, CRP, etc.) and fibrinogen cause sticking of RBCs
75
What is the function of BRCA-1?
Tumor Suppressor, controls cll cycle and plays role in gene repair and transcription?
76
Do fatty streaks always appear where atheromas form later?
No! Fatty streaks often occur in vasculature not prone to atheroma development later in life
77
What nutrient does valproate inhibit the absorption of?
Folate!
78
What is the mechanism of cutaneous vasodilation in antimuscarinic toxicity?
Due to overheating from inhibition of sweat glands -> cutaneous vasodilation
79
How do you hear an S3?
With the bell of the stethoscope over the apex in LLD position.
80
What hypothalmic nucleus regulates circadian rhythm?
The suprachiasmatic nucleus
81
What is the quellung reaction?
Swelling of S. pneumoniae capsule as a result of specific anti-capsular antibodies
82
What is the pathognemonic finding for hepatic schistosomiasis?
Periportal "Pipestem" fibrosis as a result of Th2 mediated immune response against the eggs.
83
What are the diagnostic findings of neurosyphilis?
Positive VDRL and pleocytosis in the cerebrospinal fluid.
84
What organism causes Granuloma inguinale?
Klebsiella granulomatis which has rod-shaped intracytoplasmic inclusions (Donovan bodies)
85
In Fe deficient states, is transferrin increased or decreased?
Transferrin levels are increased
86
What is a common cause of post-influenza pneumonia in the elderley?
Pneumoccocus is the most common cause followed by S. Aureus and H. Flu
87
What type of cells are the atypical lyphocytes seen in EBV infectioN?
CD8+ T Cells
88
What vaccines use a diptheria toxoid in them?
H. Flu and Pneumoccocal polysacharide vaccines use diptheria toxoid conjugates
89
What is the mechanism of hyperoxaluria in Chrons?
Loss of bile acid causes fat malabsorption which saponifies with Ca in the lumen leading to Ca wasting and therefore decreased oxalate excretion as a calcium complex.
90
What is Perinaud Syndrome?
Paralysis of upward gaze due to tectal compression in the midbrain. Usually from a tumor of the pineal region (often a Germinoma).
91
What is the prodromal period of HBV infection characterized by?
It is a Serum-Sickness like picture (in contrast HCV is usually asymptomatic)
92
What is the typical cause of Non-bacterial Thrombotic Endocarditis?
Hypercoagulability e.g. in Cancer
93
What can precipitate Wernicke's Encephalopathy in a Thiamine defficient patient?
GLUCOSE INFUSION!!! Must always give glucose + thiamine in a thiamine deficient patient.
94
At what point is pulmonary vascular resistance lowest?
At the FRC
95
What is the origin of a complete vs. partial mole?
Complete mole is purley paternal in origin (46 XX or XY), partial has both maternal and paternal
96
Which ligament of the uterus contains the uterine artery?
Transverse cervical ligament
97
What lateral eye motion is spared in intra-nuclear opthalmoplegia?
Convergence (bilateral adduction) is spared
98
What is the chronological progression of EtOH withdrawal?
4-5 hours after last drink: tremors
12-48 hrs: ANS dysfunction and GI symptoms
48+ hrs: Tonic Clonic seizures or Delerium Tremens (Flucuating arousal levels, SNS activity, hallucinations)
Subsides by day 4-5
99
What characterizes a positive skew distribution?
Mean > Median, the tail runs off to the right
100
What is caused by a deficiency of C1, 3, 4?
A lupus-like syndrome
101
What is the most commonly injured structure in the rotator cuff?
The supraspinatus tendon, will have a positive Empty-Can test
102
What is the mechanism of HbF's increased O2 affinity?
It lacks + histamine residues to it can't bind the - 2,3-DPG thereby causing a left shift
103
What are the anti-pseudomonal florquinolones?
Ciprofloxacin and Levofloxacin are good for this
104
What is an example of a "respiratory quinolone"?
Moxifloxacin
105
What aminoglycosides have good anti-pseudomonal activity?
Amikacin, Gentamycin, Tobramycin
106
What population is particularly at risk for death with HEV infection?
Pregnant Women
107
What is the order of receptor activation as you increase dopamine dose?
D1 - Increased GFR
B1 - Increased systolic BP
alpha1 - Increased diastolic BP
108
What is Bosentan used to treat?
It is used to treat primary pulmonary HTN (endothelin antagnoist)
109
What are two compounds that build up in MCAD deficiency?
1) Dicarboxylic acidemia/uria
| 2) C8-C10 acyl carnities
110
What is the mechanism of gallstone formation in pregnant women?
Estrogen - increased cholesterol synthesis
| Progesterone - decreased bile acid secretion and slowed GB emptying
111
What are the different types of secretory glands?
Aprocine - secrete into hair follicle (give sent) via merocrine secretion
Holocrine - entire cell is shed (e.g. sebacious glands)
Ecrine sweat glands - merocrine secretion
112
What type of vaccine is the MMR?
Live-attenuated
113
What diseases does BK virus cause?
It results in post-transplant nephropathy or hemhorragic cystitis in immunocoromposied
114
What are two side effects of linezolid?
Optic neuritis and serotonin syndrome
115
What is the characteristics of Acne?
1) Epidermal hyperplasia
2) Increased sebum
3) Inflammation
4) P. Acnes
"Comedonal and inflammatory nodular erruption"
116
What amino acid becomes essential in people with a positive nitrogen balance?
Arginine (needed to make histones)
117
What histologic changes are seen in hepatitis?
Hepatocyte Injury - Ballooning degeneration
Hepatocyte Death - bridging necrosis and fibrosis
mononuclear inflammation in sinusoids and portal tracts
118
What is ruxolitinib?
A JAK2 inhibitor
119
What agar is Nisseria species cultured on?
VCN agar (Vancomycin-Colistin-Nystatin)/Thyer-Martin Agar
120
What part of the urethra is most vulnerable in a pelvic fracture?
Membranous segment. In a stradle injury however, the bulbar urethra is more vulnerable
121
What enzyme converts cholesterol to bile acids?
7-alpha hydroxylase
122
What is Dupuytren's contracture?
Fibroproliverative disease of palmar fascia leading to decreased finger flexibility
123
What is seen in multicystic kidney dysplasia?
There is no pelvocaliceal system
124
What effect does inspiration have on left heart murmurs?
It decreases them
125
What effect does inspiration have on right heart murmurs?
It increases them
126
Why does interstitial lung fluid cause dyspnea?
It decreases the compliance of the lungs
127
What is the major virulence factor for S. pyogenes?
Protein M
128
What is seen on barium esophogram with diffuse esophageal spasms?
A corkscrew esophagus
129
What type of effect does Jimson Weed have on the body?
It is an anticholinergic - "Gardner's Mydriasis"
130
Why does acute Aortic Regurgitation cause pulmonary edema?
B/c the left atrium isn't dilated as it is in chronic
131
What tachyrthmia is EtOH known to precipitate?
Atrial Fibrilation
132
What is Acanthosis?
Increased stratum spinosum thickness
133
What two metabolites are depleted by EtOH that inhibits gluconeogenesis?
Pyruvate and Oxaloacetate
134
What is the rate of maternal-fetal infection with HepB if HBeAg is high?
95% else 20%
135
What is the difference between Entocapone and Tolcapone?
Entocapone - Peripheral COMT inhibitor
| Tolcapone - Peripheral and Central COMT inhibitor
136
What is Danazol used to treat?
Endometriosis and hereditary angioedema
137
How do you differentiate aplastic anemia from myelofibrosis?
Myelofibrosis has splenomegally
138
What is the pathophysiology of C1 esterase deficiency?
Causes increased bradykinin (kallikrien not inactivated), C3a, C5a - Increased permeability
139
What is a Marjolins ulcer?
SCC that develops > 10 years after trauma
140
What is the DDx of pulsus paradoxus?
Tamponade, Constrictive Pericarditis, Restrictive Cardiomyopathy, Severe COPD
141
What determines the ventricular contraction rate in Afib?
The AV node (it gates impulses)
142
What can a "soft breathy voice" indicate?
Vocal cord paralysis
143
What animal is associated with leprosy in the SW US?
Armadillos
144
What is the typical source of bleeding in neonatal IVH?
The germinal matrix (highly vascular)
145
What is a typical presentation of neonatal IVH?
Premature (<32 wks), 5th day of life, bulging fontanelle, deerebrate posturing
146
What are the viral dependent nucleosides?
Acyclovir, Valacyclovir, Famiciclovir, Ganciclovir
147
What are the anti-viral nucleotides?
Cidofovir, Tenofovir
148
What are the symptoms of systemic mastocytosis related to?
Increased histamine secretion (e.g. increased gastric acid secretion)
149
What protein is involved in neutrophil translocation?
PECAM-1
150
What is Zellweger Syndrome?
Peroxisomal disease - unable to form myelin = hypotonia and seizures
151
What is Refsum disease?
Lack of alpha-oxidation.
| Avoid Chlorophyl in diet
152
What species are associated with oysters?
V. Vulnificus (sepsis, 50% mortality)
| V. Parahemolyticus (diarrhea)
153
What should S. Aureus in the urine make you think?
Metastatic Infection
154
What is cladribine used for?
Hairy Cell Leukemia. It is resistant to ADA and penetrates BBB
155
What is fludrabine used for?
It is a purine analog used for CLL
156
What is Dacarbazine?
Methylating agent
157
What two tumors are GFAP positive?
GBM and Ependymomas
158
What are the stages of lobar pneumonia?
Day 1: Congestion (red, heavy, boggy)
Day 2-3: Red hepatization (red, firm)
Day 4-6: Gray heptaization (gray-brown, firm) Neutrophils
Resolution
159
Why are 90% of Anal Fisures at the posterior midline or anal verge?
Less perfusion to these parts
160
Where do the deep inguinal nodes receive lymph from?
Posterior calf and glans penis
161
What is CNS finding in narcolepsy?
Decreased hypocretin-1 in CSF
162
What does 14-3-3 protein in CSF indicate?
CJD
163
Why does restrictive lung disease have increased flow rates?
Increased radial traction on airways
164
What prevents hypernatremia in mineralocorticoid excess?
Aldosterone Escape
165
What artery supplies the diaphragmatic surface of the heart?
Posterior Descending Artery
166
What is Ondine's Curse?
Brainstem respiratory center damage
167
What are dipyramidole and cilostazole (PDE inhibitors) used for?
Intermittent Claudication
168
What differnetiates Meineirs disease from Labrynthitis?
Meineirs disease is recurrent
169
What is chromatolysis?
Changes following axonal injury: cellular swelling, displacement of nucleus, dispersion of Nissel substance
170
Why is it hard to make anti-HCV antibodies?
Hypervariable regions of envelope glycoproteins and RNA Pol lacks 3'-5' exonuclease activity
171
What is a toxicity of phentermine, fenfluramine, dexfenfluramine?
Secondary pulmonary HTN -> cor pulmonale -> arhythmias
172
True or false, MRSA is resistant to carbapenems?
TRUE
173
Are golgi tendon organs sensitive to stretch or contraction?
Contraction
174
Are Muscle Spindles sensitive to stretch or contraction?
Stretch
175
What molecule do almost all transaminases use as their acceptor?
alpha-ketoglutarate -> Glutamate (some give to OXO to make aspartate for urea cycle)
176
What is caudal regression syndrome and what is the main risk factor?
Agenesis of sacrum and occasionally lumbar spine.
| Risk Factor = Poorly controlled maternal diabetes
177
What culture conditions are required for L. Pneumophilia?
L-Cysteine + Buffered Charcol Yeast Extract
178
What is the DDx of pancytopenia without splenomegally?
Severe B12/folate deficiency
Aleukemic leukemia
Myelodysplastic Syndrome
Aplastic Anemia
179
What is a common cause of meningitis in neurosurgery patients?
S. Aureus
180
What do depolarizing blockers show in Train-of-4 testing?
Phase 1 - equal depolarization to all 4 twitches
| Phase 2 - fading response (like non-depolarizing)
181
What does carbofusin stain?
It is an aniline dye that stains mycolic acid in mycobacterium and nocardia
182
What is imperforate anus most commonly associated with?
Other Gu malformations (e.g. renal agenesis, hypospadias, epispadias, exostrophy)
183
Is the mamillary body anterior or posterior on the brain stem?
Anterior
184
What is a microscopy finding of hydatid cysts?
Eggshell calcification
185
Is orotic acid involved in pyrimidine or purine synthesis?
PYRIMIDINE Synthesis
186
What is sampling bias?
Type of selection bias, causes non-random sampling of a target population -> compromised generalizability
187
What is atrition bias a form of?
It is a form of selection bias
188
How do you differentiate the types of esophagitis in HIV+ patients?
Candida - Pseudomembranes
HSV-1 - Small vesicles and punched out ulcers (Cowdry A)
CMV - Linear ulcerations, nuclear and cyto inclusions
189
What bacterium can supply factor X and V for H. flu to grow?
S. Aureus
190
What does PZA work well against intracellular bacteria?
Works best at an acidic pH - in phagolysosomes
191
What is the name of the enzyme deficient in Pompe's disease?
Acid Maltase = Acid alpha glucosidase
192
How does Foscarnet induce hypocalcemia?
1) Chelation
| 2) Renal Mg wasting - decreases PTH
193
What physical exam finding is seen with breast CA invasion of cooper's ligaments?
Skin Retraction
194
True or False, Amiodarone prolongs QT?
True, but much lower risk of Torsades than other Class III
195
What does the V617F JAK 2 mutation cause?
Increased sensitivity to growth factors
196
What two strains cause tertian malaria?
Vivax and Ovale - symptoms every 48 hours
197
What vitamin deficiency can mimic Friedrich's Ataxia?
Vitamin E
198
What molecule is inhibited by Amatoxin?
RNA Pol II
199
Why does exhalation increase the S3 heart sound?
Brings it closer to the chest wall
200
Why can ketamine block morphine tolerance?
Ketamine is NMDA antagonist, NMDA plays a role in morphine tolerance
201
What divides the anterior 2/3 of tongue from posterior 1/3?
The terminal sulcus/foramen cecum
202
What is used to treat Grave's Opthalmopathy?
Glucocorticoids
203
Why do you give atropine with an inferior MI?
b/c SA and AV node are compromised and need to prevent bradycardia
204
True or false, acalculus cholecystitis can occur following ischemia?
True
205
What condition should you suspect in someone with papilledema on Vitamin A or doxycycline?
Pseudotumor cerebri
206
In Dubin-Johnson syndrome, what is the pigment composed of?
Epinephrine metabolites
207
Is Marfan Syndrome associated with Berry Aneurysm?
NO
208
True or false, LEMS often has autnomic symptoms?
True
209
How do beta blockers affect thyroid hormone signaling?
Decrease the conversion of T4 to T3
210
Are the RV changes in pulmonary HTN reversible or not?
Reversible
211
What is a urinary marker of osteoclast activity?
Urinary Deoxypyrindinoline
212
What does pasturella cause?
GNR, causes acute localized soft tissue infection following a bite
213
Can reactive lymphocytes be seen with viruses other than EBV?
YES! e.g. CMV, HBV
214
Why are halothane and sevoflurane prefered in asthmatics?
They have bronchodilator properties
215
What enzyme do fibrates inhibit?
7-alpha hydroxylase - increased gallstone risk
216
What causes pigment stone formation?
Damaged hepatocytes release beta-glucoronidase. Deconjugates bilirubin
217
How do you tell a hypertrophic scar from a keloid?
Hypertrophic scar - organized collagen
| Keloid - disorganized collagen
218
What is osoclonus (non-rhythmic conjugate eye movements)-myclonus syndrome associated with in children?
Neuroblastoma
219
What is letrozole?
An aromatase inhibitor
220
What is the nucleotide sequences that proceed start codon?
CAAT -> TATA -> Start
221
What are classic features of legionella infection?
High Fever + CXR Findings + GI Symptoms
Minimally productive cough
Smoker
Sputum stain negative!
222
What can you treat legionella with?
Resp quinolones: Lefo
| Azithromycin
223
Why do optic tract lesions cause a marcus gunn pupil?
Nasal retinal fibers contribute input to the pretectal nucleus and split prior to entering the LGN
224
What is the capsule of H. Flu composed of?
Polyribosyl-ribitol-Phosphate (PRP)
225
What signals can activate phosphorylase kinase?
cAMP (glucagon/Epi)
Calcium (muscle)
NE binding of alpha1 (Liver)
ADP binding (muscle)
226
What antibodies are indicated in membranous nephropathy?
PLA2R
227
What blood finding can be caused by HCV?
Mixed Cryoglobulinemia
228
What is a "Phlegmasia Alba Dolens'?
Milk leg due to iliofemoral venous thrombosis in a peripartum woman
229
What do you see on EM of a carcinoid?
Dense core granules
230
What is the most common appendiceal tumor?
Carcinoid
231
In general, what states are associated with carpal tunnel syndrome?
Fluid retention
232
What is a papillary fibroelastoma?
It is a heart mass that involves a valve
233
What is tiotropium?
Long acting anticholinergic bronchodilator
234
What tick transmits Ehlercia and Anaplasma?
Ehrlichia - Lone Star Tick (Amblyomma americanum) (S/SW US)
| Anaplasma - Ixodes ticks (NE and pacific)
235
What animal is Ehrliciosis associated with?
Deer and Dogs
236
What cells to Ehrlichia infect and What do Anaplasma infect?
Ehrlichia - Monocytes
| Anaplasma - Granulocytes
237
What can you use to treat Ehrlichia and Anaplasma?
Doxycycline, Minocycline, Rifampin
238
Why can late Ehrlichiosis be a shock-like picutre?
can cause a 30x increase in TNF
239
What does low I-123 uptake suggest?
Thyroiditis while increased suggests graves
240
What is the typical pattern of language development?
```
12 mo - first word
1-2 yrs - 2 word questions
2-3 yrs - lots of words
3-4 yrs - 4+ word sentences, other people understand them
4-5 yrs - clear fluent speach
```
241
What component of TPN is suspected to cause fatty liver?
Linoleic (w-6) acid
242
When do you hear egophony?
In consolidated lungs (e.g. pneumonia)
243
What murmurs are common in pregnancy?
S3, Split S2 (more pronounced with insp.)
| Systolic flow murmurs (e.g. mid-systolic ejection murmur, high output state)
244
What is a good marker of chronic pancreatitis?
Fecal elastase < 200 mcg/g stool
245
What is silver nitrate ointment used to prevent?
Gonnorhea, not good for chlamydia
246
What is a common finding of all Type III HS reactions?
Decreased C3 due to immune complex fixation
247
What is convergent strabismus?
deviation towards the midline
248
What are GABA B receptors linked to?
They are GPCRs that are linked to K channels
249
What area of the brain has increased dopamine in nicotine addiction?
Nucleus Acumbens
250
True or false, atelectasis has a more localized change in breath sounds?
True
251
What are the findings in bronchitis?
Rales/crackles or rhonci, and increased fremitus
252
Which parasite is associated with cutaneous larva migrans?
Ancyclostoma species
253
What is the codon of a splice site?
5' - AG GU - 3'
254
What is used to treat combined absence and tonic-clonic seizures?
Valproate
255
What differentiated conus medularis and cauda equina syndrome?
Conus medularis is damage to sacral cord w/o lumbar nerve root involvement (so limb symptoms involving lumbar reflexes e.g. knee jerk, are absent)
256
What is the typical cause of cauda equina?
Central lumbar disk herniation
257
What happens to reflexes in cauda equina?
They disappear b/c this is an injury of a LMN not an UMN
258
How does glucose inhibit the lac operon?
decreases cAMP. cAMP normally binds CAP which acts as positive regulator of lac operon
259
What is indapamide?
a thiazide diuretic
260
What side dose a STN injury cause hemibalismus on?
Contralateral
261
How do you differentiate vWD from Glanzman's?
Glanzmans - Normal Ristocetin, poor ADP response
| vWD - poor aggregation to ristocetin
262
What molecules do myxomas produce?
VEGF and IL-6
263
What disease has a sandpaper-like rash with circumoral palor?
Scarlet fever
264
What is the histology of PBC?
florid duct lesions - granulomatous destruction of interlobular ducts with M0, lymphs, plasma cells, eos
265
What drug is piphenoxylate mixed with to prevent abuse?
Atropine
266
What is synthetic BNP called?
Nesiritide
267
What is the Hawthorne effect?
Tendancy of a study pop to affect the outcome due to the knowledge they are being studied
268
What cofactors are needed for homocysteine to methionine?
B12/Folate
269
What antimicrobials are sporicidal?
H2O2 and Iodine
270
What procedures is chlorhexidine contraindicated in?
Neuro, ENT, Optho
271
Does the solubility of an anesthetic affect MAC?
No, just onset time
272
What is responsible for the green color of pus and sputum?
Neutrophil MPO which contains heme
273
What causes levido reticularis?
Venule swelling from capillary obstruction
274
What is the histologic features of papillary thyorid CA?
GG nucleus with intranuclear grooving
275
What vaccines use heat-killed bacteria?
Y. Pestis and B. Pertussis
276
What is a sign of atheroembolic disease of renal arteries?
Renal failure and lower limb ischemia following invasive vascular procedure
277
What is the name of the stain used for C. Neoformans?
Mucicarmine
278
What drug is always added to empiric meningitis rx in an infant?
Ampicillin
279
How do TNF, catecholamines, steroids, glucagon, and FFA induce insulin resistance?
Via serine phosphorylation of insulin response elements which inhibits tyrosine phosphorylation by insulin receptor
280
When do myoclonic seizures often occur?
In the morning. Rx valproate
281
What are basic first line seizure drug choices?
Parital: Carbamazepine
Tonic-clonic: Phenytoin, Carbamazepine, valproate
Myoclonic: Valproate
Absence: Ethosuximide, Valproate
282
What is a culture feature of enterohemhorragic E. Coli?
Does not ferment sorbitol and does not produce glucuronidase
283
What is used to treat neonatal opiate withdrawal?
Paregoric/tincture of opium
284
Which organisms favor transformation?
SHiN = S. Pneumoniae, H. flu, Neisseria
285
Which toxins are produced by transduction?
Shiga, Botulinum, Cholera, Diptheria, Erythrogenic toxin of S. pyogenes
286
What diseases can you diagnose with serum electropheresis?
Alpha1-antitrypsin
Brutons Agammaglobulinemia
Multiple Myeloma
287
What type of acid base abnormality is present in Barter syndrome?
Hypokalemic metabolic allkalosis
288
Which amyloid protein is present in familial and senile amyloidosis?
AF amyloid
289
What do you see on histology with OCPs?
Decidualized stroma with inactive glands
290
What type of malaria shows Schuffner dots?
Vivax and Ovale
291
What happens to TPR and CO when an organ is removed?
Increased TPR (loss of a parallel resistor) and decreased CO, BP is same
292
Intoxication with what drug can mimic EtOH withdrawal?
cocaine
293
What skin tumor has pallisading nuclei?
Basal Cell Carcinoma
294
What nerves exit the greater sciatic foramen above and below the piriformis?
Above - Sup. Gluteal
| Below - Inf. Gluteal, Sciatic, Pudendal
295
What defines an exudative effusion?
Fluid/Serum Protein > 0.5
Fluid/Serum LDH > 0.6
LDH > 2/3 normal serum value
296
What CBC is characteristic of hairy cell leukemia?
Pancytopenia
297
Does SSPE affect white and gray matter?
Yes vs. PML which is only white
298
What is the oriT -> Tra associated with?
HfR. Differs from conjugated plasmid in that entire plasmid isn't transfered every time and that it is an episome that must be re-integrated via homologous recomb for stability
299
What amino acid does F. Tularensis require to grow?
Cysteine
300
What states are tularemia associated with?
Arkansas, MO
301
When does the moro reflex dissapear?
5 months
302
When does necrotizing enterocollitis usually occur?
When infant is started on oral foods
303
What mass is associated with excessive fibroblasts?
Desmoids
304
What is the order of importance of gastric CA risk factors?
H. Pylori > Smoking > pernicious anemia > EtOH > Nitrates
305
What cell types are associated with Erythema Multiforme (target lesions) and SJS?
CD8+ are primary involved with some CD4+ help
306
What is the active tension on a muscle equal to?
Active Tension = Total Tension (increased with length) - Passive Tension (decreased with length)
307
What does an ulcer found in the distal duodenum suggest?
Zollinger Ellison Syndrome
308
What is CD31?
PECAM, an endothelial marker
309
Why does nervous system input have little effect on coronary blood flow?
Because NE doesn't act on B2 receptors
310
What is unique about the capsule of H. Flu type B?
It contains PRP and is only capsule serotype with pentose monosacharides. Absorbs factor H which destroys C3b opsonins
311
What stain illuminates Auer Rods?
Peroxidase
312
What is a marker of immature lymphocytes that can be stained for?
Tdt
313
What are the products of the HIV genes?
env -> gp 120/41
gag -> nucleocapsid proteins p24 and p7
pol -> reverse transcriptase, integrase, polymerase
tat/rev -> regulatory required genes
314
What type of vasculitis is associated with antibiotic use?
Microscopic polyangiitis/hypersensitivity angiitis (Type III HS)
315
What does the sodium-cyanide nitroprusside test detect?
SH groups (e.g. cystine in the urine), turns purple
316
Which molecule inhibits the PI3k/Akt/mTOR pathway?
PTEN (removes phosphates from PIP3)
317
Which heart sound is associated with prolonged HTN?
S4
318
What are two symptoms of vitamin D toxicity?
Polydipsia and Anorexia
319
What compound stimulates PMNT to convert NE to Epi?
Cortisol
320
What type of HTN is Esmolol useful for?
Post-operative HTN
321
What is Diazoxide?
It is an arteriole dilator like hydralazine, but it doesn't improve perfusion and can cause reflex SNS activation (like hydralazine)
322
What is the most common benign liver tumor?
Cavernous Hemangioma
323
What is a common cause of death in adult type coarctation of the aorta?
LV Failure, Ruptured AA, ICH
324
Which is more aggresive, Burkit's or Follicular lymphoma?
Burkits is very aggressive and chemo sensitive
| Follicular is indolent and has painless LAD
325
What is the most commonly invovled part of colon for CA?
Recto-sigmoid > Ascending > Descending
326
What does the "crescent sign" on a hip film indicate?
Subchondral collapse following avascular necrosis of the head of the femur
327
What is a globus hystericus?
A lump in the throat
328
What is DNA laddering and when is it seen?
It is fragments of DNA in 180 bases and it seen in Apoptosis
329
What are dicyleliomine and hyoscyamine?
Anti-spasmods with anticholinergic SFX
330
Which supplements can help in hypertrygliceridemia?
Fish oil
331
What nerve is injured with penetrating trauma to popliteal fossa?
Tibial nerve
332
Which bacterium is commonly found in endometritis?
B. frag
333
What is nummular eczema?
Pruritic coin shaped erythematous patches, exacerbated by irritants
334
Is flexor or extensors involved in psoriasis? Atopic dermatitis?
Psoriasis - Extensors
| Atopic dermatitis - flexors
335
Does GFR completely recover with heminephrectomy?
No, can get back to around 80%
336
What are some acquired causes of porphyria cutanea tarda?
aromatic hydrocarbons, HCV, estrogen supplements
337
Which RBC disorders show decreased osmotic fragility?
Sickle cell and Thalasemias
338
What causes abd pain in DKA?
Ileus from carb depletion
339
How does DKA cause hyponatremia?
For each 100 mg/dL increase in glucose, Na drops by 1.6 meq/L due to osmotic dilution
340
What is another word for spina bifida cystica?
Myelomeningocele
341
How does NO affect the heart?
Increased HR and decreased ESV
Decreases ejection time and stroke work
TPR unchanged
342
What is Albright Hereditary Osteodrystrophy?
Skeletal development defects due to end organ resistance to PTH, TSH, LH, FSH
343
What is Allelic Heterogeneity?
Different mutations in the same locus cause similar phenotype
344
What is genetic heterogeneity?
Mutations in different genes cause the same phenotype
345
What is phenotypic heterogeneity?
mutations in the same gene cause different phenotype
346
What is variable expresivity?
Same mutation, different phenotypic severity
347
What is Apert syndrome?
FGFR2 mutation, misense, cr10, syndactyly
348
What chromosome is associated with maturity onset diabetes of the young type 1?
20
349
How do sertoli cells increase the androgen concentration in luminal fluid?
They secrete androgen binding protein
350
Which ganglion is targeted to treat excessive axillary sweat?
T2
351
What does red safrenin O stain?
cartilage, mucin, mast cell granules
352
What is the rate limiting step of dopamine synthesis?
Tyrosine to DOPA
353
What cofactor is needed for dopamine beta hydroxylase?
Cu2+
354
What RNA in humans is transcribed as one piece and then cleaved?
Ribosomal RNA from RNA Pol I. Note that RNA Pol III makes the 5S rRNA
355
Why do meglitinides have a lower risk of hypoglycemia?
They don't stimulate insulin release when glucose is low, unlike sulfonylureas
356
What is the difference between lamellar and woven bone?
Lamellar - regular alignment, mechanically strong
| Woven - immature or pathologic
357
How does follicular thyroid carcinoma present?
As a nodule, see small follicles w and w/o colloid
358
What is Shared Psychotic Disorder?
When it is due to a relationship with someone else and there is no better explanation
359
What are transporters associated with antigen processing?
They bring viral components to the ER to assemble with MHCI
360
What does CD1 do?
Presents lipid containing antigens
361
What does the invariant chain do?
It is removed from MHC II in endocytic compartments (it blocks the binding site till then)
362
What is Lichen Sclerosis?
White patches of thinned skin + pruritis. It is autoimmune against ECMI. Female perineal region. Plaques can coalesce.
Rx: High potency steroids as can lead to SCC
363
What is puromycin?
tRNA analog leads to premature chain termination
364
What should be used for anticoag in valve replacement?
Warfarin + Aspirin
365
What induces COX-2 expression?
Inflammation
366
Which fungus can have a broom like appearance?
Aspergillus as it has septate hyphae with conidophores with a terminal vesicle
367
What glomerular disease is HIV, heroin, and Hbs associated with?
FSGS
| HIV - Collapsing glomerulopathy (form of FSGS). Epithelial cell enlargement and vacuolization
368
What gene is mutated in hand-foot-genital syndrome?
HoxA-13
369
What gene is mutated in wardenburg syndrome (deafness + pigmentation anomalies)?
Pax-3
370
What must be done to diagnose circardian rhythm sleep disorder?
Rule out caffeine use or underlying psych illness
371
When is muscle velocity maxiumum?
No afterload, if passive tension is increased, velocity is decreased
372
A strain of what muscle can avulse the lesser trochanter of the femur?
Psoas
373
What macrolide is least likely to interact with P-450?
Azithromycin
374
What are RS cells derived from?
Post-germinal center B cells (show somatic hypermutation)
375
Which fossa does the foramen spinosum lie in?
Middle cranial fossa
376
What characterizes primary biliary cirrhosis?
Granulomatous inflammation and anti-mitochondrial antibodies
377
What meds are used in HTN in pregnancy?
Methyldopa, labetalol, nifedipine, hydralazine
378
What id dicyclomine?
Antispasmodic, used in IBS. muscharinic blockade and inhibitor of bardykinin induced GI spasms
379
What ion inserts itself into protoporphyrin when there is problems with ferocheletase?
Zn
380
What is the germ tube test for candida?
Formation of pseudohyphae in animal serum
381
What is cincalcet?
It is a calcimimetic agent that increases CaSR sensitivity. Used in secondary hyperparathyroidism
382
Which organism is more destructive, pneumoccocus or Klebsiella?
Klebsiella (currant jelly sputum)
383
How do you calculate the 95% CI?
sample mean +/- Z(SD/sqrt(n))
384
Are the gastric acid secretagogues synergistic?
Yes
385
What disease causes beaded bile ducts?
PSC
386
Does the RER Make proteins for lysosomes? Peroxisomes?
Lysosomes - yes
| Peroxisomes - no
387
Which drugs are beta 1 selective?
A-M
388
What is the ELEK test?
Tests for a toxin-producing strain of C. Diptheria
389
What type of HS is late lyme disease?
Type III
390
Can the cellular changes of necrosis occur after death?
NO
391
Where do the lymphatics of lateral leg drain?
Popliteal nodes
392
What is the Cushing Reflex?
With increased ICP we see increased BP and decreased HR (from barroreceptors and vagal response) to maintain cerebral perfusion pressure (MAP-ICP)
393
What happens to HR with a brain stem injury?
Increases to 100 bpm which is the basal state without PNS tone
394
Differentiate inflammatory breast CA from Pagets
Pagets - Epidermal invasion
| Inflammatory - dermal lymphatic invasion - Peu D'orange
395
What cells have a CD 14 endotoxin receptor?
Macrophages
396
What type of pericarditis is Dresslers?
Fibrinous
397
What vitamin deficiency is seen with broad-spectrum ABX?
Vitamin K
398
What drugs are used for acne?
Doxycycline and Clindamycin
399
What cell exerts master control over Fe absorption?
Hepatic parenchymal cells via hepcidin
400
What is Rasburicase?
It is a recombinant Urate Oxidase that degrades uric acid to allantoin
401
Where does the deep peroneal nerve provide sensation?
Between the great and 2nd toe
402
What does an increased slope of the CV and Venous Return curves indicate?
Decreased TPR
403
Does an acute AV fistula have an increase in MAP?
No, need to wait for renal compensation
404
What is Raltegravir?
Integrase inhibitor
405
What kind of metabolic alkalosis are saline responsive?
H+ loss
| Contraction
406
What benign tumor is pure red cell aplasia associated with?
Thymoma
407
Which artery runs with the radial nerve in the spiral groove?
The deep brachial artery
408
Which rash moves faster, rubella or measels?
Rubella runs faster
409
How does TNF cause insulin resistance?
Causes serine phophorylation of IRS-1
410
What is pantazocine?
Partial agonist and weak antagonist at mu receptors.
411
What causes apple peal atresia?
Spiral like appearance around SMA due to vascular occlusion in utero
412
What is found in maternal serum/amniotic fluid with gastroschesis/omphalocele?
Increased AFP
413
What parasite is associated with larva currens?
Strongyloides Stercoralis
414
What indicates the severity of mitral stenosis?
The A2 to OS interval is inversley proportional to severity
415
What two vasodilators can cause coronary steal syndrome?
Adenosine and dipyridamole
416
What is the finding with ABPA?
proximal bronchietasis
417
What is the microscopic finding in Granuloma Inguinale?
Donovan Bodies in cytoplasm
418
What are chlorpheniramine, and promethazine and hydroxyzine?
First gen H1 blockers
419
What are the symptoms of verapamil toxicity?
AV nodal block + constipation
420
What happens to length and time constants in demyelination?
Length constant decreases
| Probably decreases the time constant due to lower capacitance (impairs temporal summation as things dissipate faster)
421
What are the LVEDP and LVEDV findings in diastolic and systolic HF?
Diastolic: LVEDV normal, LVEDP up, EF normal
Systolic: LVEDV increased, LVEDP increased, EF decreased
422
Which drugs increase the hyperkalemia risk of ACEI?
Non-selective beta blockers
423
What is myc?
A transcription factor
424
What is primidone?
Anti-epileptic, metabolized to phenobarb and PEMA
425
What is a sign of amyloid angiopathy?
Recurrent lobar hemhorrages
426
What is the inheritance pattern of G6PD deficiency, PDH deficiency, PK deficiency?
G6PD - XLR
PDHD - X Dominant
PKD - AR
427
What are the two forms of PDH deficiency?
Metabolic (lactic acidosis) vs. Neurologic (gray matter degn, brainstem necrosis)
428
Which signlaing molecules use a JAK/STAT pathway?
GH, Prolactin, IL-2, Cytokines
429
What are the side effeccts of CCB?
Flushing, Ankle edema
430
What are the subtypes of eczematous dermatitis and what is a common histologic finding
Allergic Contact + Atopic + Drug Related + Photo + Irritant
| Spongiosis
431
When is cheyne-stokes respiration observed?
Cardiac or Neurologic disease
432
What effect can Niacin have on BP, uric acid, insulin?
Increases insulin resistance
Decreases BP (think flushing)
Increases uric acid production
433
What are the side effects of protease inhibitors?
Lipodystrophy, Hyperglycemia, P-450 inhibition
434
What are the findings in glucagonoma?
Necrolytic migratory erythema in groin, hyperglycemia, stomatitis, cheliosis
435
What is required to diagnose atopic dermatitis?
Intense pruritis
436
What is another name for lactose?
Galactosyl-B1,4 glucose
437
What growth factors drive angiogenesis?
FGF and VEGF
438
What growth factor promotes SMC migration into atheromatous plaques?
PDGF and TGF-beta
439
What is tolcapone?
A central + peripheral COMT inhibitor
440
Which rifamycin should be used in patients on HAART?
Rifabutin as it does not induce P-450
441
What is the AML M7 type?
Megarkyoblasts, t(1;22), down syndrome associated
442
What is the pacemaker for the ventricles in 3rd degree heart block?
AV node (45-55 bpm)
443
How does Niacin work?
decreases hepatic TG and VLDL synthesis and suppresses fatty acid release in peripheral tissues
444
What cholesterol med can increase TG?
Bile acid binding resins
445
What must you consider in a patient on steroids?
IATROGENIC CUSHINGS
446
What is the test for gestational diabetes?
OGTT
447
What is a test of concentration? Comprehension?
Concentration - months of year backwards
| Comprehension - following multistep commands
448
Is pseudomonas motile? Oxidase +/-?
Motile, Oxidase +
449
What do you see in Amphotericin renal tox?
Decreased K and Mg due to DCT membrane permeability
450
How do mu receptors work?
Increase K efflux (GPCR) and hyperpolarize
451
What enzyme converts DOPA to Dopamine?
DOPA decarboxylase needs B6
452
What enzyme converts Dopamine to Epi?
Dopamine Beta Hydroxylase needs Vitamin C and Cu
453
What is Aromatic L-amino acid decarboxylase?
DOPA decarboxylase (also converts 5-HTP to 5-HT)
454
Where does HBV get its envelope?
The ER
455
If SNc, Locus Ceruleus, and Vagal Nucleaus Doraslis are all pale, what should you think?
PKU
456
What is myotonia?
Abnormally slow relaxation (e.g. handshake, doorknob grip)
457
What are the signs of myotonic dystrophy?
Myotonia with cataracts, frontal balding, gonadal atrophy. AD disorder
458
What is TIBC proportional to?
Transferrin levels, not % saturation
459
What three chronic myeloproliferative disorders are associated with JAK2 mutations?
Polycythemia Vera
Essential thrombocytosis
Primary myelofibrosis (massive splenomegally)
460
What drub can be used for JAK2 V617F mutations?
Ruxolitinib
461
What is cladribine used for?
Hairy Cell Leukemia (adenosine analog)
462
What can hepatic artery thrombosis lead to in a transplanted liver?
Biliary tree infarction due to severing of collateral blood supply
463
What is the most likely cause of differential cyanosis in an older child?
PDA as a coarctation sever enough to produce this would have been fatal if not corrected in childhood
464
What are the types of non-neoplastic colonic polyps?
Hyperplastic, Hamartomatous, Inflammatory, Lymphoid
465
What can be a cause of paraneoplastic cerebellar degeneration?
Autoimmune in lung, breast, ovary, uterus, lymphoma
466
What liver function abnormalities are seen with actuve liver injury?
Prolonged PT/INR
Increased AlT
Normal: albumin, spleen size, no ascites
467
What molecules are metabolized to propionyl-CoA?
Valine, Isoleucine, Threonine, Methionine, Cholesterol, Odd Chain Fatty Acids
