Last Push Flashcards
Treating Alzheimer’s with a cholinesterase inhibitor (donepezil, galantamine, rivastigmine) improves memory because of its ability to target synaptic connections between what structures?
Basal forebrain (basal nucleus of Meynert) and neurons in the cerebral cortex
What nerve is most likely to be damaged by a tumor invading the right side of the pericardium?
Right phrenic nerve
What is polyglutamic acid?
Protein capsule of B. anthracis
Do blood vessels have both sympathetic and parasympathetic components?
NO - only sympathetic innervation (either vasoconstriction or lack of vasoconstriction)
How does a carotid massage work?
Increased pressure on carotid baroreceptor leads to increased firing leads to increased AV node refractory period leads to decreased heartrate (bradyarrhythmia)
Why do people pass out from carotid massage?
Bradyarrhythmia NOT blood pressure change
Why do mitochondria encode their own tRNA?
Use a non-standard genetic code
Does CHF lead to transudate or exudate?
Transudate - increased hydrostatic pressure
Which hepatic enzyme is initially activated by exercise to start glycogenolysis?
Phosphorylase kinase
When do we use chi-square vs. ANOVA?
Chi-square means categorical (chi-tegorical) outcomes vs. ANOVA for comparing means of different groups
Surgical neck of the humerus fracture - what nerve is damaged?
Axillary
What is the sensory deficit with damage to the axillary nerve?
Lateral arm
Midshaft fracture of the humerus - what nerve is damaged?
Radial
What is the sensory deficit with damage to the musculocutaneous nerve?
Lateral forearm
What do we use to classify different serogroups of neisseria meningitidis?
Antibodies to capsular polysaccharide
Pancreatic cancer - what is the most common cause of jaundice?
Common bile duct obstruction - leads to both jaundice and pale stool (bile gets into the blood but not the GI tract)
What drug can you use to treat both hypertension and Raynaud’s?
Nifedipine - use calcium channel blockers (dihydropyridine) to treat vasospasm
Oxygen hemoglobin dissociation curve shifts to the right most directly results in?
Release of oxygen in tissue capillaries (decreased affinity for oxygen)
What stimulates VEGF?
Hypoxia
What heart medication has toxicities that are mostly cholinergic mediated?
Digoxin - nausea, vomiting, diarrhea, blurry yellow vision
What are the spirochetes?
Borrelia, leptospirosis, treponema
What causes lyme disease?
Borrelia
What happens to calcium and phosphate levels in chronic renal disease/failure?
Calcium levels go down (from decrease in 1 alpha hydroxylase activity) while phosphate levels go up (from inability to excrete phosphate)
Swelling of cells in the case of ischemic damage is most directly related to?
Decrease in ATP from sarcoplasma reticulum means that Na-K pump can’t work so that Na accumulates in the cell and water moves in and cell swells
Spleen - retroperitoneal?
No so if it’s damaged, blood will be in the abdominal cavity
Tail of the pancreas - retroperitoneal?
No
Retroperitoneal structures?
SAD PUCKER: SVC, aorta, duodenum (2nd - 4th parts), pancrease (except for the tail), ureters, colon (ascending and descending), kidneys, esophagus (lower 2/3), rectum
Plasmids are transferred through what process?
Conjugation
What is ropinirole?
Non-ergot dopamine agonist (selective for D2 receptors)
GI drug that promotes gastric emptying and relieves nausea and vomiting?
Metoclopramide (D2 receptor antagonist)
How does glucagon affect adipocytes in a fasting state?
Activates hormone-sensitive lipase
Catheter to get to the uterus starting at the femoral artery - path?
Femoral artery - external iliac - internal iliac - uterine artery
What happens to lower esophageal sphincter tone in CREST?
Decreases because of atrophy of the muscle - this is why CREST patients are at increased risk for GERD and adenocarcinoma
Methanol poisoning - what enzyme do you want to inhibit?
Alcohol dehydrogenase (with fomepizole)
What is the mechanism by which multiple myeloma patients get hypercalcemia?
Local IL-1 and TNF effects - IL-1 is also called osteoclast activating factor
Baby overreacts to stimuli around him and has marked startle response - mother was using what drug?
Heroin
What structure attaches to the cervical region and extends posteriorly and can be incised in female pelvic surgery?
Uterosacral ligament
What function in mRNA synthesis and processing is likely encoded by the 3’ sequence AATAAA?
Cleavage and polyadenylation
How does gemfibrozil affect simvastatin?
Fibrates inhibit cytochrome p450
What diet is recommended for patients with DM2?
Low-calorie
What does a congenital pharyngo-cutaneous fistula (2nd arch) connect?
Fistula between tonsillar area and lateral neck
What binds GpIIbIIIa?
Fibrinogen
Loud, harsh, high pitched holosystolic murmur that radiates over the precordium and a palpable thrill at the left sternal border?
VSD
Atypical cells in EBV infection?
T lymphocytes (Downey cells)
Increased urine concentrations of dermatan sulfate and heparan sulfate, no corneal deposits - what enzyme is deficient?
Iduronate sulfatase
What do protease inhibitors do in HIV treatment?
Prevent maturation of new viruses (prevent HIV1 protease which cleaves the polypeptide products of HIV mRNA into their functional parts)
What neurotransmitter is released in excess following ischemia and can initiate a receptor-mediated Ca2+ influx that leads to neuronal death?
Glutamate
When a movement is planned but not executed, which brain region shows an increase in activity in functional MRI?
Premotor cortex
What kind of vaccine do we have for Hepatitis B?
Recombinant protein
What cytokines do all T cells secrete?
IL-2 and IL-3
Shoulder injury typically leads to damage of which nerve?
Axillary
What is the normal response of the vestibular apparatus when you instill warm water into the ear?
Nystagmus with a quick phase to the ipsilateral side
Numbness over thenar eminence?
Median nerve
Atrophy of the interosseous muscles?
Ulnar nerve
Decreased strength during extension of the thumb?
Radial nerve
Decreased strength of opposition of the thumb?
Medial nerve
Loss of sensation to the skin covering the dorsum of the hand?
Radial or ulnar nerve
Loss of sensation to the skin of the little finger?
Ulnar nerve
Enlarged lateral ventricles - most likely cause?
Cerebral aqueduct stenosis
Where do we find Lewy bodies in Parkinson’s?
Substantia nigra
HIV patient with 1 cm, irregularly shaped, raised, indurated lesion on the forehead - infection?
HHV-8
Increasing sample size does what to the confidence interval?
Decreases (makes it narrower)
Neutrophils stimulated with opsonized bacteria show decreased production of O2, H2O2, HOCl, OH. What’s the enzyme deficiency?
NADPH oxidase
Which molecules must interact to induce immune cell activation by the superantigen toxic shock syndrome toxin-1?
Class II MHC and T cell receptor
How do the steroid hormones signal?
Transmembrane diffusion and binding of signaling molecule to transcription factor
Diarrhea leads to metabolic acidosis or alkalosis?
Acidosis (you lose bicarb in diarrhea)
What vitamins are required from the diet and function to protect tissues from deleterious effects of free radicals?
Vitamins A, C, and E are antioxidants
Gently tapping over the facial nerve in front of the ear results in reflex contraction of the facial muscles - electrolyte abnormality?
HYPOcalcemia (think muscle spasms - Chvostek’s sign, diarrhea, tetany)
What is the mechanism of action of the azoles?
Inhibits synthesis of ergosterol (part of fungal cell membrane) by inhibiting C14 lanosterol demethylase
What agent inhibits both the production of IL-2 in resting T lymphocytes and the production of gamma-interferon in activated T lymphocytes?
Cyclosporine
What is the most appropriate next step in management after identifying a spontaneous pneumothorax?
Needle aspiration
Which aortic arch develops into the common carotid arteries?
3rd
What do you give to reverse the effects of tubocurarine?
Neostigmine (need ACh to overcome the nicotinic blockade)
ACE inhibitors produce systemic vasodilation by what mechanism?
Decreased degradation of bradykinin which is a vasodilator
What triad of signs and symptoms is most often present in a patient shortly after taking an overdose of heroin?
Coma, miosis, cyanosis
Why do symptoms from Meckel’s diverticulum improve with H2 receptor antagonist therapy?
Meckel diverticulum may contain ectopic acid-secreting gastric mucosa
What enzyme is required for acyclovir to work?
Thymidine kinase
Compared with heparin, what is the advantage of enoxaparin?
Less monitoring required
What age-related anatomic changes contribute to well-maintained cardiac output (compensating for lowered HR) in elderly men?
Cardiac hypertrophy
5 day old newborn cyanotic since birth with soft systolic murmur and a decrease in pulmonary blood flow?
Tetralogy of Fallot
An increase in the serum concentration of which hormone is the most conclusive sign that ovulation has occurred?
Progesterone
During the differentiation of mammary gland alveolar cells in late pregnancy, the hormone that acts synergistically with estrogen is which of the following?
Human placental lactogen
Zinc finger motif on steroid hormone receptor binds specifically to what?
DNA
Why do we get thrombi in the heart in dilated cardiomyopathy?
Larger space –> turbulent flow
What is the cause of pain in MI?
Accumulation of metabolic products in heart tissue
How does arterial PO2 change with exercise?
It doesn’t - expired minute ventilation and cardiac output are unchanged
How does removing the carotid bodies change the ventilatory response to decreasing levels of inspired oxygen?
Gets rid of that response
What hormone will be notably elevated when you transect the pituitary stalk?
Prolactin because there is no more inhibition by dopamine
What is the most likely complication of BPH?
Bacterial cystitis
If we do not treat gonococcal urethritis, what is the most likely complication?
Epididymitis
How do bisphosphonates work?
Inhibits osteoclasts via ingestion of it as a pyrophosphate analog
What are the nitrite negative UTI microbes?
Enterococci or staph saprophyticus
Why is there no vaccine for gonococcus?
High/rapid antigenic variation of pili
All paramyxoviruses contain what two proteins?
Hemagglutinin (allows RBC’s to agglutinate) and F fusion protein (allows for formation of syncytia)
What do RNA viruses show on RPLF gels?
3 fragments
How does H. pylori lead to ulceration?
Elaboration of proteases and ureases with local tissue destruction
What antibody binds F fusion protein?
Pavilizumab
How can we kill C. diff spores?
Autoclave (steam at 121 C for 15 minutes)
When do we get rupture of the papillary muscle post MI?
3-7 days
When do we get rupture of the free wall post MI?
3-14 days
What causes the reaction in the skin after an injection?
Arthus reaction = type III HSR = immune complexes
Where do lower extremity lymphatics drain?
Lateral - popliteal, medial - inguinal
Where does the esophagus blood supply come from?
Upper - inferior thyroid artery, middle - aorta, lower - left gastric
Hereditary porphyrias have what inheritance pattern?
Autosomal dominant
How does vitamin A work as a pharm treatment (mechanism)?
Activation of nuclear gene transcription
What weight loss drug can cause steatorrhea and good changes in lipid studies?
Orlistat
Are case-control studies prospective, retrospective, or both?
Only retrospective
Collapse of the superior half of the right femoral head with preservation of the articular cartilage?
Aseptic necrosis
Hip adductor muscles insert onto the femur from where?
Ischium
What is the mechanism of cisplatin?
Causes crosslinking of DNA
Old man with fever and abdominal symptoms and contrast collects in the colon?
Diverticulitis
Patients with deficiency of myeloperoxidase are unable to produce?
Hydroxy-halide radicals (MPO produces HOCl from H2O2)
What is the function of ribosome peptidyl transferase?
Forms peptide (covalent) bonds between adjacent amino acids during translation of proteins
The amount of calcium sequestration in the sarcoplasmic reticulum is highest when there is a lot or a little stimulation of skeletal muscle?
Little
What is neuropathic pain described as?
Burning
What causes an increased A-a gradient?
May occur in hypoxemia - shunting, V/Q mismatch, fibrosis (usually something is messed up with the diffusion barrier)
Why can deoxygenated blood carry more carbon dioxide than oxygenated blood?
Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin
What does the first aortic arch give rise to?
Maxillary artery (branch of external carotid)
What does the second aortic arch give rise to?
Stapedial artery and hyoid artery
What does the third aortic arch give rise to?
Common carotid and proximal part of the internal carotid (C is the 3rd letter of the alphabet)
What does the fourth aortic arch give rise to?
On the left - aortic arch, on the right - proximal part of the right subclavian artery (4th arch = 4 limbs = systemic circulation)
What does the sixth aortic arch give rise to?
Proximal part of pulmonary arteries and (on the left only) ductus arteriosus
What general tissue do the clefts, arches, pouches give rise to?
CAP = ectoderm, mesoderm, endoderm
Which cleft develops into the external auditory meatus?
1st
What is the mnemonic for thinking about what the branchial arches give rise to?
When at the restaurant of the golden arches, children tend to first chew (1 - muscles of mastication, CN V2 and V3), then smile (2 - muscles of facial expression, CN VII), then swallow stylishly (3 - stylopharyngeus, CN IX), or simply swallow (4 - cricothyroid, CN X) and then speak (6 - recurrent laryngeal branch, CN X)
What is the mnemonic for what the branchial pouches give rise to?
Ear, tonsils, bottom-to-top
Ear (1 - endoderm lined structures of the ear), tonsils (2 - epithelial lining of palantine tonsil), bottom (dorsal 3 - inferior parathyroids), to (ventral 3 - thymus), top (superior parathyroids)
What is the mode of inheritance for cleft lip/palate?
Multifactorial
What is the drug of choice for postpartum hemorrhage?
Oxytocin
What is the difference in mepp vs. epp (end plate potential) and how are they affected in botulinum poisoning?
mepp is the excitation of each unit (i.e. vesicle) of ACh whereas epp is the summation of all the vesicles - so in botulinum poisoning, your mepp should be the same but your epp will be decreased
How does zanamivir work?
Inhibits the release of progeny influenza virus
How does IkB work?
Releases NFkB after undergoing phosphorylation
What are the abnormal lab values for osteoporosis?
NONE! - serum calcium, phosphate, ALP, PTH are all normal
Describe osteoblast vs. osteoclast activity with decreased DEXA bone scan.
Osteoclast increase, osteoblast decrease
Pain reproduced with resisted abduction of the shoulder when the shoulder is abducted 90 degrees and the arm is giving the thumbs down sign?
Supraspinatus (NOT deltoid)
Hypotension leads to increased or decreased carotid sinus baroreceptor activity?
Decreased (think about it as the opposite of the carotid massage)
Do cholinomimetics affect both muscarinic and nicotinic receptors?
No - only muscarinics
What happens to ATP during the first 10-20 seconds of muscle contraction?
Does not fall appreciably because ATP is quickly regenerated from creatine phosphate
What is the immediate treatment for cholinergic poisoning?
Atropine (NOT pralidoxime)
What can technetium 99m pertechnetate identify besides gastric tissue?
Thyroid, testes, RBCs (helps identify ectopic spleen tissue)
If someone stares off into space and does not respond to any questions, is that a simple or complex seizure?
Complex - loss of consciousness
What part of the superior temporal gyrus is Wernicke’s area located on?
Posterior
Coarse facial features, clouded corneas, restricted joint movement, high plasma levels of lysosomal enzymes?
I cell disease - abnormal targeting of enzymes to lysosomes
What happens if you treat salmonella enterica with antibiotics?
Prolonged fecal excretion of the organism
What artery general supplies the posterior surface of the heart?
PDA from the right coronary (assuming individual has right dominant circulation)
What is lentigo maligna?
Melanoma in situ
What causes infertility in PCOS?
Increased estrogen (from adipose tissue) that inhibits FSH
What is additive for malignant hyperthermia when combined with inhaled anesthetics?
Succinylcholine
What is type I error?
You say there is a difference when there isn’t one (alpha = you sAw a difference that did not exist)
What is type II error?
You didn’t see a difference when there was one (beta = Blind to a difference that does exist)
What is power?
1 - beta
Lymphatic drainage - head and neck?
Cervical
Lymphatic drainage - lungs?
Hilar
Lymphatic drainage - trachea and esophagus?
Mediastinal
Lymphatic drainage - upper limb, breast, skin above umbilicus?
Axillary
Lymphatic drainage - liver, stomach, spleen, pancreas, upper duodenum?
Celiac
Lymphatic drainage - lower duodenum, jejunum, ileum, colon to splenic flexure?
Superior mesenteric
Lymphatic drainage - colon from splenic flexure to upper rectum?
Inferior mesenteric
Lymphatic drainage - lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), prostate?
Internal iliac
Lymphatic drainage - testes, ovaries, kidneys, uterus?
Para-aortic
Lymphatic drainage - anal canal (below pectinate line), skin below umbilicus (except popliteal territory)?
Superficial inguinal
Lymphatic drainage - dorsolateral foot, posterior calf?
Popliteal
HLA types for MHC I?
A, B, C
HLA types for MHC II?
DR, DP, DQ
HLA type associated with hemochromatosis?
A3
HLA type associated with psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, reactive arthritis?
B27
HLA type associated with celiac disease?
DQ2/DQ8
HLA type associated with multiple sclerosis, hay fever, SLE, Goodpasture syndrome?
DR2
HLA type associated with DM1, SLE, Graves?
DR3
HLA type associated with rheumatoid arthritis, DM1?
DR4
HLA type associated with pernicious anemia, hashimoto thyroiditis?
DR5
Th1 cells secrete what cytokine?
IFN-gamma
Th2 cells secrete what cytokines?
IL-4, IL-5, IL-6, IL-13
What inhibits the Th1 response?
IL-4 and IL-10 (from the Th2 cell)
What inhibits the Th2 response?
IFN-gamma (from the Th1 cell)
What cytokines do T-regs produce?
IL-10 and TGF-beta to downregulate the immune response
What receptor-ligand interaction is necessary for class switching?
CD40-CD40L (this is defective in Hyper IgM)
What are the cytokines for acute inflammation?
IL-6, IL-1, TNF-alpha, IFN-gamma
What are the anaphylotoxins?
C3a, C4a, C5a
What are the cytokines that are secreted by the macrophages?
Acute inflammation: IL-1, IL-6, TNF-alpha
Chemotactic for neutrophils: IL-8
Th1 response: IL-12
What cells have CD16 and CD56?
NK cells
What cells have CD28?
T cells (binds to B7 on APC)
When do we give passive immunity (preformed antibodies)?
To Be Healed Rapidly: Tetanus toxin, Botulinum toxin, HBV, Rabies
What are the killed virus vaccines?
RIP Always: Rabies, Influenza (injected), Polio (Salk), HAV
What are the live attenuated virus vaccines?
Smallpox, yellow fever, chickenpox, MMR, Sabin polio, influenza (intranasal)
What are the recombinant viral vaccines?
HBV (HBsAg), HPV (types 6, 11, 16, 18)
Anti-cardiolipin, lupus anticoagulant?
SLE, antiphospholipid syndrome
Anticentromere ab?
CREST (limited scleroderma)
Antidesmoglein ab?
Pemphigus vulgaris
What are the definitive ab for SLE?
Anti-dsDNA and anti-Smith
Anti-glutamate decarboxylase ab?
DM1
Anti-hemidesmosome ab?
Bullous pemphigoid
Antihistone ab?
Drug-induced lupus
Anti-Jo1, SRP, Mi-2 ab?
Polymyositis, dermatomyositis
Antimicrosomal, antithyroglobulin ab?
Hashimoto thyroiditis
Antimitochondrial ab?
Primary biliary cirrhosis
Anti-Scl-70 (anti-DNA topoisomerase I) ab?
Scleroderma (diffuse)
Anti-smooth muscle ab?
Autoimmune hepatitis
Anti-SSA, SSB (Ro, La) ab?
Sjogren
Anti-TSH ab?
Graves
IgA antiendomysial, IgA anti-tissue transglutaminase ab?
Celiac
c-ANCA (PR3-ANCA)?
Wegener’s (granulomatosis with polyangiitis)
p-ANCA (MPO-ANCA)?
Microscopic polyangiitis, Churg-Strauss syndrome
Anti-CCP ab (cyclic citrullinated peptide)?
Rheumatoid arthritis
