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1
Q

Anastrozole

A

Aromatase inhibitor that decreases estrogen

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2
Q

What hormone regulates fetal lung maturity?

A

Cortisol

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3
Q

Diagnosis of DM?

A

Fasting >126
random >200
Elevated HbA1c

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4
Q

Ezetimibe

A

prevents cholesterol absorption at small intestines brush border
(decreases LDL)

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5
Q

How to treat pyruvate dehydrogenase def.

A

increase intake of ketogenic nutrients
Lysine and leucine (purely ketogenic aa)
High fat diet

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6
Q

Signs and symptoms of a Glucagonoma

A 
4 D's:
Dermatitis (necrolytic migratory erythema) 
Diabetes
DVT
Depression
(normochromatic normocytic anemia)
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7
Q

How distinguish DI central from nephrogenic

A

Central responds to ADH (desmopressin test)

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8
Q

What enzyme is used to compensate for fructokinase def.?

A

Hexokinase

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9
Q

Colchicine

A

Acute gout tx

inhibits microtubule polymerization decreasing PMN chemotaxis (decreases LTB4)

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10
Q

Treatment for enterobiasis

A

Abendazole

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11
Q

Treatment for TCAD OD

A

NaHCO3 for widened QRS and ventricular arrhythmias

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12
Q

Drugs that cause lupus erythematous

A

HIP
Hydralazine
Isoniazid
Procainamide

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13
Q

Pathophys of drug induced lupus

A

metabolism by phase II acetylation and some people are slow acetylators

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14
Q

Captopril

A

ACE inhibitor

SE: angioedema so DO NOT USE with C1 esterase inhibitor deficiency

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15
Q

What is the crescent made of in rapidly progressive glomerulonephritis

A

Fibrin, monocytes, parietal cells, macs

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16
Q

Tx for urea acid cycle malfunction

A

protein restriction

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17
Q

What controls ventricular contraction rate during a fib?

A

AV node refractory period

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18
Q

What innervates the Trapezius?

A

CN XI

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19
Q

SCID defect

A

IL-2R gamma chain (x-linked)

Adenosine deaminase def (AR)

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20
Q

Antiphospholipid Ab Syndrome

A

Associated with SLE

increased aPTT, miscarriages, thrombosis, and +RPR

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21
Q

Hardy-weinberg analysis

A

Allele frequency: p (normal) +q(mutant)=1
Phenotypic frequency:
p^2 (freq in normal individuals) +2pq (carrier freq) + q^2 (freq of dz individuals) =1
calculating mutant allele frequency from disease prevalence: sq root (q^2)=q

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22
Q

Anal squamous cell carcinoma + HIV =

A

HPV 16 and 18

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23
Q

MOA of hydroxyurea

A

Increased HbF
sickle cell pain crisis

inhibits ribonucleotide reductase–> decreases DNA synthesis (S phase specific)
Melanoma, CML

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24
Q

Grades channel blockers MOA

A

Tx for sickle cell

inhibits efflux of K and h2o from cell–> prevents dehydration and reduces polymerization of HbS

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25
Where is serotonin released from?
5HT comes from Raphe nuclei
26
where is NE released from?
Locus ceruleus
27
One month old with jaundice, muscle rigidity and lethargy
Crigler Najjar--absent UDP-glucuronosyl transferase Build up of unconjugated (indirect) bilirubin causes Kernicterus
28
JAK2-STAT mutation
Myeloproliferative disorders | Constitutive tyrosine phosphorylation activity
29
Teardrop RBC, hepatosplenomegaly, pancytopenia, STAT +
Primary Myelofibrosis | JAK2 mutation, obliteration of bone marrow
30
Base excision repair
Glycosylases-->Endonucleases-->Lyase-->Polymerase-->ligase
31
Growth factor receptor pathway
PI3K/Akt/mTOR | responsible for cell proliferation
32
Inhaled anesthetic effect on liver
Halothane causes acute hepatitis: prolonged PT
33
Maintenance dose
MD=Cpss x CL/(Bioavailability fraction)
34
Thiamine is a cofactor for...
ATP Alpha-ketoglutarate dehydrogenase Transketolase Pyruvate dehydrogenase
35
Maxillary body necrosis
Wernicke
36
Southwestern
Detects DNA-bound proteins | Transcription factors, nucleases, histones
37
c-Jun and c-Fos
Transcription factors (DNA binding proteins)
38
Ras
porto-oncogene codes for membrane bound G-protein bound to GTP=active bound to GDP=inactive
39
CYP 450 inducers ++
``` Chronic alcohol use St john wort phenytoin phenobarbital Nevi rapine Rifampin Griseofulvin Carbamazepine ``` Chronic alcoholics steal Phen-phen and Never refuse greasy carbs
40
Abacavir
HLA-B*57:01 Type IV hypersensitivity delayed rash
41
Effects of beta blocker on heart conduction
Slows AV node conduction-->increases AV nodal refractory period--> PR interval prolongation
42
Why treat for Group A strep
Prevent acute rheumatic fever and mitral valve damage
43
Amanita phalloides
Amatoxin in mushrooms | bind RNA pol Type II and inhibit mRNA synthesis
44
Garlic breath, vomiting, watery diarrhea QT prolongation,
Arsenic poisoning exposure to insecticides or contaminated water inhibits cellular respiration by messing with pyruvate dehyg.
45
Treatment for arsenic poisoning
Dimercaprol
46
Tx for Lead poisoning
CaNa2 EDTA
47
Treatment for Hepatic encephalopathy
Rifaximin | Lactulose (increased conversion of ammonia to ammonium ions)
48
MOA Rifaxmin
antibiotic that alters GI flora and decreases intestinal production of ammonia
49
Effect of ureter constriction on kidney function
increased hydrostatic pressure in capsule-->Decrease GFR | efferent constriction--> decreased FF
50
tx for cyanide tox
Na thiosulfate, hydroxocobalamin, sodium nitrate
51
Where adenocarcinoma in esophagus
lower 1/3 | barrets esophagus common cause (obesity and GERD too)
52
where squamous cell carcinoma in esophagus?
upper 2/3
53
Rickets effect on bone
excess of unmineralized osteoid matrix
54
cryptococcus morphology
Budding yeast
55
Effect of IgA protease
allows bacteria to adhere to mucosa
56
P bodies
quality control and storage for mRNA in cytoplasm
57
Liver damage due to Hep B from
viral expression of HBsAg and HBcAg with MHC 1 which activates CD8 t cells which damage hepatocytes
58
PDA sound
continuous machine like murmur loudest at S2 | left intraclavicular region
59
EBV on blood smear
See CD8+ T cells because they proliferate more and destroy the infected B cells
60
High Hct with normal RBC mass
Relative polycythemia | causes: dehydration and excessive diuresis
61
High Hct, increased RBC mass, low epo levels
Polycythemia vera | all three cell lines increase
62
High Hct, Increased RBC mass, high epo, saO2
secondary erythrocytosis from hypoxia
63
Hyperphenylalanemia and elevated prolactin
Dihydropteridine reductase deficiency Get downstream deficiencies that lead to neurologic impairment
64
coordination of glycogenolysis and skeletal muscle contraction
Ca release from SR--> stimulates phosphorylase kinase--> phosphorylase glycogen phosphorylase (activate)
65
Defective ApoE
``` Familial dysbetalipoproteinemia (type III hyperlipoproteinemia) elevated Chylomicron and VLDL remnants ``` Palmar xanthomas premature atherosclerosis
66
defective LPL or ApoC2
hyperchylomicronemia (type I) Acute pancreatitis and eruptive xanthomas increased everything
67
Defective LDL receptor
``` familial hypercholesterolemia (type II) premature atherosclerosis and tendon xanthomas ```
68
Increased VLDL
``` Familial hypertriglyceridemia (type IV) pancreatitis ```
69
Cofactors for Pyruvate dehydrogenase
``` Tender Loving Care For Nancy Thiamine Lipoate Coenzyme A FAD NAD ``` (also required for branched chain alpha ketoacid dehyd. and alpha ketoglutarate dehyd)
70
Sorbitol is converted to...
Fructose via sorbitol dehydrogenase
71
Reyes syndrome
Child with viral illness given aspirin Encephalopathy, n/v, and fatty liver Impaired beta oxidation-->impaired fatty acid metabolism in hepatic mitochondria
72
Role of ascorbate
Vit C facilitates Iron absorption by keeping Fe2+ in reduced state cofactor for DA-->NE Hydroxylation of Proline to lysine
73
Beta glucuronidase
hydrolyzes bilirubin glucuronides and increases unconjugated bilirubin. increase leads to pigmented gallstones
74
Cause of pigment stones in gallbladder
Bacterial (e. coli) or helminthic (ascaris lumbricoides, clonorchis sinensis) infect biliary tract--> release of beta-glucuronidase also from hemolytic anemia
75
What is a case-control study asking?
What happened? | Use odds ratio
76
What is a cohort study asking?
who developed the dz? or who will develop the Dz? | use relative risk
77
Buspirone
slow onset of action (2 wks) so no good for panic disorder | partial agonist of 5HT1A receptor
78
Treatment for lung abscess
Clindamycin good for anaerobes and aerobic G+ bugs
79
Ivabradine
Cardiac rate control w/ no effect on contractility or relaxation blocks funny channel in phase 4
80
Osteocytes
connected via gap junctions maintain structure of mineralized matrix and control release of Ca2+ regulate bony remodeling via signaling osteoblasts
81
common cardinal veins become...
SVC and systemic circulation
82
Exercise physiology: effects on blood flow
stimulation of muscle chemo and mechanoreceptors increase symp outflow thus increasing HR and contractility and vasoconstricing unused muscles HOWEVER local metabolite production leads to arteriolar dilation w/in muscles--> decreasing systemic vascular resistance
83
what influences peak bone density?
80% genetic race (AA have stronger bones) environmental
84
Osgood-Schlatter dz
over use of secondary ossification center (apophysis) of tibial tubercle limited leg extension
85
CCA
3'end of tRNA used for recognizing protein | made up of chemically modified bases
86
Umbilical hernia cause
incomplete closure of umbilical ring (defective lines alba) | reducible bulge
87
Effects of renal hypoprofusion
increased renin release from JG cells--> hypertrophy of JG cells
88
Pituitary tumor, parathyroid issues, pancreas tumor
MEN1
89
asymptomatic hypercalcemia or renal stones with bitemporal visual field defects
MEN1
90
Cuboidal or polygonal cells w/ abundant cytoplasm in a kidney tumor
clear cell carcinoma | originate from proximal tubules
91
stimulus control treatment for insomnia
using bed only for sleep go to bed only when tired fixed wake up time leave bed when unable to sleep
92
location of anal fissure
Posterior midline (poor perfusion)
93
Ras-MAP kinase pathway
Growth factor--> Autophos tyrosine residues--> interaction with SOS--> Active Ras (bound to GTP)--> MAP kinase--> transcription Inactive Ras bound to GDP
94
N-myc and C-myc
Transcription factors
95
Cholesterol 7 alpha hydroxylase
Catalyze rate-limiting step in synthesis of bile acids inhibited by Fibrates
96
Ehlers-Danlos dysfunction
Deficiency in pro collagen peptidase impaired N-terminal propeptide removal can't cross link collagen
97
Lynch syndrome (hereditary nonpolyposis colon cancer) cause
Defective DNA mismatch repair AD dz
98
N-acetylcysteine
Treatment for CF and for acetaminophen overdose
99
What causes Giant Cell arteritis?
cell mediated immunity inflammatory infiltrate due to IL-6 tx with steroids and tocilizumab (ab against IL-6)
100
Femoral n. location and injury
in psoas muscle then between psoas and illiacus injury--> weakness of quads (difficulty with stairs and knee buckling) sensory loss over anterior and medial thigh and leg loss of patellar reflexes
101
Kidney compensation for metabolic acidosis
increase HCO3 IN | Increase H+ and H2PO4 OUT
102
Lactase deficiency signs
osmotic diarrhea | decreased pH in stool (bacterial fermentation of lactose)
103
Parietal cell regulation
+ Gastrin, Histamine, ACh | - Prostaglandins, misoprostol, somatostatin
104
parietal cell hyperplasia and enlargement of gastric folds
Zollinger-Ellison
105
Positive empty can test
Supraspinatus | initial arm abduction before deltoid
106
Latanoprost
topical prostaglandin Galcoma tx increases outflow
107
What makes a drug have higher hepatic clearance?
increased lipophilicity and increased volume of distribution lipophilicity makes it easier to enter hepatocytes and allows for a wider distribution (CNS)
108
Tx for alcohol withdrawal
Benzodiazepines (diazepam or chlordiazepoxide)
109
Ecological study
Looking at population data not individuals
110
Homogenous deposition of eosinophilic hyaline material
Hyaline arteriolosclerosis
111
cause of hyaline arteriolosclerosis
poorly controlled HTN and DM
112
onion like concentric thickening
hyperplastic arteriolosclerosis
113
hyperplastic arteriolosclerosis cause
due to malignant HTN
114
proximal muscle weakness (trouble with stairs and standing from sitting), dry mouth and impotence
Lambert-Eaton myasthenic syndromes better with muscle use inhibition of presynaptic Ca channels associated with small cell lung cancer
115
Hydralazine
arteriolar vasodilator leads to decreased SVR but stimulates baroreceptors--> symp stimulation--> RAAS--> sodium and fluid retention also Minoxidil
116
Chronic post mastectomy lymphedema with violaceous nodules
Angiosarcoma
117
Signet ring cells
Gastric adenocarcinoma infiltrate growth into stomach wall--leather bottle stomach Loss of e-cadherin involvement of supraclavicular LN and periumbilical nodes (sister mary joseph)
118
Fixed cecum in URQ and bilious vomiting in first day of life
failure of midgut rotation around SMA intestinal obstruction and midgut volvulus
119
source of gonadal artery
abdominal aorta
120
effect of bile and phosphatidylcholine on gallstones
more bile salt and phosphatidylcholine makes cholesterol more soluble--> decreases risk of gallstones
121
Beta endorphin source
POMC--> just like ACTH and MSH
122
Cross sectional study is what?
Snapshot--> measuring exposures and outcomes at the same time
123
effect of nitroprusside on LV
decrease afterload and preload
124
IgE-independent mast cell activation
Due to drugs (opioids, radio contrast, vanco) degranulation due to PKA and PI3 K diffuse itching and pain, bronchospasm and localized swelling (urticaria)
125
causes of acute pancreatitis
Gallstones | alcoholism-- also find anemia if malnourished
126
Effects of insulin and hydration
increased serum bicarb. Intracellular shift of K+--> decreased serum K+ decreased serum osm
127
Chronic interstitial nephritis and papillary necrosis
NSAID-associated chronic renal injury months after taking NSAID
128
Cause of Mallory-Weiss tears
increased intraabdominal pressure from vomiting or retching can also find hiatal hernias
129
white/yellow pseudomembranes on sigmoidoscopy + abdominal pain and diarrhea
C. Diff from antibiotics cytotoxin A--diarrhea Cytotoxin B--colonic epithelial cell necrosis and fibrin deposition
130
Oliguria after a few days of hospitalization for internal bleeding
ATN
131
Recovery phase of ATN
tubular re-epithelization and recovery risk of hypokalemia
132
Cirrhosis and estrogen
decreased P450 leads to decreased free tosterone/estrogen ratio produces more sex hormone binding protein Get gynecomastia, testicular atrophy, spider angiomata (dilation from estrogen), decreased body hair
133
Liver biopsy with lymphocyte infiltration and granulomatous destruction of interlobular bile duct
Primary biliary cirrhosis autoimmune dz w/ Anti-mitochondrial Ab
134
middle aged woman with pruritus and fatigue w/ pale stools and dark urine
Primary biliary cirrhosis cholestasis-->jaundice, pale stool, dark urine can also get xanthelasma
135
what do you see with reactive lymphoid hyperplasia that makes you suspect malignancy?
Monoclonal T-cell receptor gene rearrangements
136
lung mass, progressive dizziness, limb and truncal ataxia, dysarthria and visual disturbances
Paraneoplastic cerebellar degeneration cerebellar symptoms and small cell lung cancer Autoimmune w/ antibodies against purkinje neurons (Anti-Yo, anti-P/Q, anti-Hu)
137
Location of atherosclerosis
Abdominal aorta>coronary >popliteal>carotid artery
138
Major cause of mortality in lung transplants
bronchiolitis obliterans Chronic rejection--destruction of small airways dyspnea and wheezing
139
PAS stain
Whipple dz | stains glycogen and mucopolysaccharides
140
older man with weight loss, diarrhea, arthritis, fever and adenopathy
Whipple dz foamy macs with PAS+
141
why are reticulocytes blue with wright-giemsa stain?
Residual rRNA
142
Urinary 5-hydroxyindoleacetic acid
Carcinoid syndrome
143
histology of a lung hamartoma
islands of mature cartilage, fat, smooth muscle and clefts lined by respiratory epithelium
144
fluctuating painless lymphadenopathy
Follicular lymphoma indolent non-hodgkin lymphoma from B cells
145
Splenomegaly and pancytopenia in older man
Hairy cell leukemia | Tartrate-resistant acid phosphatase (TRAP)
146
Effects of obesity on the lungs
Restrictive lung disease decreased compliance Decreased ERV and FVC (as well as TLC)
147
third brachial pouch
inferior parathyroid and thymus
148
elevated aldo and renin
Secondary hyperaldosteroninsm causes: renal artery stenosis, diuretics, malignant HTN, Renin secreting tumor (JG cell tumor)
149
Antiviral tx for VZV with resistance
Cidofovir and Foscarnet do not need virus to phosphorylate them
150
Etanercept
TNF-alpha inhibitor tx for moderate to severe RA (along with methotrexate) Acts as decoy receptor -cept--> receptor molecule
151
Raloxifine
SERM that inhibit osteoclast differentiation
152
HTN, Hypokalemia, metabolic alk, decreased renin
Primary hypoaldo
153
Aldo antagonist
Spironolactone, epleronone SE: gynecomastia
154
Tx for delirium
Low dose haloperidol for acute agitation and psychosis
155
most common benign tumor of liver
Cavernous hemangioma--> dilated blood vessels in 30-50yo
156
Inheritance of polycystic kidney dz
AD!! Adults are DOMINANT Babies are NOT
157
-dronate
Bisphosphonates | inhibit osteoclast activity
158
Denosumab
bind RANKL
159
Virus that leads to aplastic crisis in sickle cell pts
Parvovirus B19 | Non enveloped single stranded DNA
160
Proteasome inhibitors
tx for multiple myeloma Bortezomib inhibition leads to cell apoptosis
161
Triptan MOA
postsynaptic serotonin agonist
162
Why give sublingual or rectally?
Avoid high first pass in the liver
163
Pancytopenia, venous thrombosis, hemolytic anemia
``` Paroxysmal nocturnal hemoglobinuria Coombs - CD 55/59 - Cause: increased complement mediated RBC lysis Tx: Eculizumab ```
164
Hemosiderosis
iron buildup in kidney due to chronic hemolysis
165
Actinic Keratoses increase risk of...
Invasive squamous cell carcinoma
166
Colitis associated carcinoma features
multifocal Develop p53 mut EARLY, LATE APC mut progresses from flat and non-polypoid dysplasia
167
Theophylline intoxication
Seizures, tachyarrhythmias, n/v. diarrhea tx: Beta blockers
168
Hepatocyte swelling and cytoplasmic emptying (ballooning)
Acute viral hepatitis | Hepatocyte necrosis and apoptosis
169
Councilman bodies
apoptosis of hepatocytes with cellular shrinkage and nuclear fragmentation with eosinophilia seen in acute viral hepatitis
170
SE Niacin
decreased renal excretion of uric acid-->acute gout flushing, hyperglycemia, hepatotox
171
Dyspnea, chest pain, hemorrhagic pleural effusion, pleural thickening
Mesothelioma long slender microvilli and tonofilaments
172
Pityriasis versicolor
Malassezia sp. stratum corneum, spaghetti and meatballs
173
Autoimmune destruction of melanocytes
Vitiligo
174
Matrix metalloproteinases
wound healing | encourage myofibroblast accumulation at wound edges and tissue remodeling
175
Hospitalized patient with ballooning cells and vacuolar degeneration of proximal tubule cells
ATN ``` Ischemic or nephrotoxic (ethylene glycol) ```
176
Oxalate crystals in tubular lumen
ethylene glycol poisoning high anion gap met. acidosis
177
Trastuzumab
tx for Her2+ breast cancer | blocks activation of tyrosine kinase
178
SE of bile acid-binding resins
GI upset, impaired absorption, hyperTGs
179
beta blockers plus NDHP CCB
additive negative chronotropic effect--> bradycardia and hypotension
180
Pink mesangial matrix overgrowth and glomerular BM thickening
Kimmelstiel-Wilson nodules | DM glomeruli nephropathy

STEP1 Flashcards (9 decks)

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