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Step 1 Smart Book > Last Push > Flashcards

Last Push Flashcards

1
Q

Treating Alzheimer’s with a cholinesterase inhibitor (donepezil, galantamine, rivastigmine) improves memory because of its ability to target synaptic connections between what structures?

A

Basal forebrain (basal nucleus of Meynert) and neurons in the cerebral cortex

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2
Q

What nerve is most likely to be damaged by a tumor invading the right side of the pericardium?

A

Right phrenic nerve

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3
Q

What is polyglutamic acid?

A

Protein capsule of B. anthracis

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4
Q

Do blood vessels have both sympathetic and parasympathetic components?

A

NO - only sympathetic innervation (either vasoconstriction or lack of vasoconstriction)

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5
Q

How does a carotid massage work?

A

Increased pressure on carotid baroreceptor leads to increased firing leads to increased AV node refractory period leads to decreased heartrate (bradyarrhythmia)

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6
Q

Why do people pass out from carotid massage?

A

Bradyarrhythmia NOT blood pressure change

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7
Q

Why do mitochondria encode their own tRNA?

A

Use a non-standard genetic code

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8
Q

Does CHF lead to transudate or exudate?

A

Transudate - increased hydrostatic pressure

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9
Q

Which hepatic enzyme is initially activated by exercise to start glycogenolysis?

A

Phosphorylase kinase

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10
Q

When do we use chi-square vs. ANOVA?

A

Chi-square means categorical (chi-tegorical) outcomes vs. ANOVA for comparing means of different groups

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11
Q

Surgical neck of the humerus fracture - what nerve is damaged?

A

Axillary

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12
Q

What is the sensory deficit with damage to the axillary nerve?

A

Lateral arm

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13
Q

Midshaft fracture of the humerus - what nerve is damaged?

A

Radial

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14
Q

What is the sensory deficit with damage to the musculocutaneous nerve?

A

Lateral forearm

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15
Q

What do we use to classify different serogroups of neisseria meningitidis?

A

Antibodies to capsular polysaccharide

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16
Q

Pancreatic cancer - what is the most common cause of jaundice?

A

Common bile duct obstruction - leads to both jaundice and pale stool (bile gets into the blood but not the GI tract)

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17
Q

What drug can you use to treat both hypertension and Raynaud’s?

A

Nifedipine - use calcium channel blockers (dihydropyridine) to treat vasospasm

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18
Q

Oxygen hemoglobin dissociation curve shifts to the right most directly results in?

A

Release of oxygen in tissue capillaries (decreased affinity for oxygen)

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19
Q

What stimulates VEGF?

A

Hypoxia

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20
Q

What heart medication has toxicities that are mostly cholinergic mediated?

A

Digoxin - nausea, vomiting, diarrhea, blurry yellow vision

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21
Q

What are the spirochetes?

A

Borrelia, leptospirosis, treponema

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22
Q

What causes lyme disease?

A

Borrelia

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23
Q

What happens to calcium and phosphate levels in chronic renal disease/failure?

A

Calcium levels go down (from decrease in 1 alpha hydroxylase activity) while phosphate levels go up (from inability to excrete phosphate)

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24
Q

Swelling of cells in the case of ischemic damage is most directly related to?

A

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

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25
Q

Spleen - retroperitoneal?

A

No so if it’s damaged, blood will be in the abdominal cavity

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26
Q

Tail of the pancreas - retroperitoneal?

A

No

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27
Q

Retroperitoneal structures?

A

SAD PUCKER: SVC, aorta, duodenum (2nd - 4th parts), pancrease (except for the tail), ureters, colon (ascending and descending), kidneys, esophagus (lower 2/3), rectum

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28
Q

Plasmids are transferred through what process?

A

Conjugation

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29
Q

What is ropinirole?

A

Non-ergot dopamine agonist (selective for D2 receptors)

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30
Q

GI drug that promotes gastric emptying and relieves nausea and vomiting?

A

Metoclopramide (D2 receptor antagonist)

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31
Q

How does glucagon affect adipocytes in a fasting state?

A

Activates hormone-sensitive lipase

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32
Q

Catheter to get to the uterus starting at the femoral artery - path?

A

Femoral artery - external iliac - internal iliac - uterine artery

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33
Q

What happens to lower esophageal sphincter tone in CREST?

A

Decreases because of atrophy of the muscle - this is why CREST patients are at increased risk for GERD and adenocarcinoma

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34
Q

Methanol poisoning - what enzyme do you want to inhibit?

A

Alcohol dehydrogenase (with fomepizole)

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35
Q

What is the mechanism by which multiple myeloma patients get hypercalcemia?

A

Local IL-1 and TNF effects - IL-1 is also called osteoclast activating factor

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36
Q

Baby overreacts to stimuli around him and has marked startle response - mother was using what drug?

A

Heroin

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37
Q

What structure attaches to the cervical region and extends posteriorly and can be incised in female pelvic surgery?

A

Uterosacral ligament

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38
Q

What function in mRNA synthesis and processing is likely encoded by the 3’ sequence AATAAA?

A

Cleavage and polyadenylation

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39
Q

How does gemfibrozil affect simvastatin?

A

Fibrates inhibit cytochrome p450

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40
Q

What diet is recommended for patients with DM2?

A

Low-calorie

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41
Q

What does a congenital pharyngo-cutaneous fistula (2nd arch) connect?

A

Fistula between tonsillar area and lateral neck

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42
Q

What binds GpIIbIIIa?

A

Fibrinogen

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43
Q

Loud, harsh, high pitched holosystolic murmur that radiates over the precordium and a palpable thrill at the left sternal border?

A

VSD

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44
Q

Atypical cells in EBV infection?

A

T lymphocytes (Downey cells)

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45
Q

Increased urine concentrations of dermatan sulfate and heparan sulfate, no corneal deposits - what enzyme is deficient?

A

Iduronate sulfatase

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46
Q

What do protease inhibitors do in HIV treatment?

A

Prevent maturation of new viruses (prevent HIV1 protease which cleaves the polypeptide products of HIV mRNA into their functional parts)

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47
Q

What neurotransmitter is released in excess following ischemia and can initiate a receptor-mediated Ca2+ influx that leads to neuronal death?

A

Glutamate

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48
Q

When a movement is planned but not executed, which brain region shows an increase in activity in functional MRI?

A

Premotor cortex

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49
Q

What kind of vaccine do we have for Hepatitis B?

A

Recombinant protein

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50
Q

What cytokines do all T cells secrete?

A

IL-2 and IL-3

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51
Q

Shoulder injury typically leads to damage of which nerve?

A

Axillary

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52
Q

What is the normal response of the vestibular apparatus when you instill warm water into the ear?

A

Nystagmus with a quick phase to the ipsilateral side

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53
Q

Numbness over thenar eminence?

A

Median nerve

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54
Q

Atrophy of the interosseous muscles?

A

Ulnar nerve

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55
Q

Decreased strength during extension of the thumb?

A

Radial nerve

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56
Q

Decreased strength of opposition of the thumb?

A

Medial nerve

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57
Q

Loss of sensation to the skin covering the dorsum of the hand?

A

Radial or ulnar nerve

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58
Q

Loss of sensation to the skin of the little finger?

A

Ulnar nerve

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59
Q

Enlarged lateral ventricles - most likely cause?

A

Cerebral aqueduct stenosis

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60
Q

Where do we find Lewy bodies in Parkinson’s?

A

Substantia nigra

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61
Q

HIV patient with 1 cm, irregularly shaped, raised, indurated lesion on the forehead - infection?

A

HHV-8

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62
Q

Increasing sample size does what to the confidence interval?

A

Decreases (makes it narrower)

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63
Q

Neutrophils stimulated with opsonized bacteria show decreased production of O2, H2O2, HOCl, OH. What’s the enzyme deficiency?

A

NADPH oxidase

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64
Q

Which molecules must interact to induce immune cell activation by the superantigen toxic shock syndrome toxin-1?

A

Class II MHC and T cell receptor

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65
Q

How do the steroid hormones signal?

A

Transmembrane diffusion and binding of signaling molecule to transcription factor

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66
Q

Diarrhea leads to metabolic acidosis or alkalosis?

A

Acidosis (you lose bicarb in diarrhea)

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67
Q

What vitamins are required from the diet and function to protect tissues from deleterious effects of free radicals?

A

Vitamins A, C, and E are antioxidants

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68
Q

Gently tapping over the facial nerve in front of the ear results in reflex contraction of the facial muscles - electrolyte abnormality?

A

HYPOcalcemia (think muscle spasms - Chvostek’s sign, diarrhea, tetany)

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69
Q

What is the mechanism of action of the azoles?

A

Inhibits synthesis of ergosterol (part of fungal cell membrane) by inhibiting C14 lanosterol demethylase

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70
Q

What agent inhibits both the production of IL-2 in resting T lymphocytes and the production of gamma-interferon in activated T lymphocytes?

A

Cyclosporine

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71
Q

What is the most appropriate next step in management after identifying a spontaneous pneumothorax?

A

Needle aspiration

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72
Q

Which aortic arch develops into the common carotid arteries?

A

3rd

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73
Q

What do you give to reverse the effects of tubocurarine?

A

Neostigmine (need ACh to overcome the nicotinic blockade)

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74
Q

ACE inhibitors produce systemic vasodilation by what mechanism?

A

Decreased degradation of bradykinin which is a vasodilator

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75
Q

What triad of signs and symptoms is most often present in a patient shortly after taking an overdose of heroin?

A

Coma, miosis, cyanosis

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76
Q

Why do symptoms from Meckel’s diverticulum improve with H2 receptor antagonist therapy?

A

Meckel diverticulum may contain ectopic acid-secreting gastric mucosa

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77
Q

What enzyme is required for acyclovir to work?

A

Thymidine kinase

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78
Q

Compared with heparin, what is the advantage of enoxaparin?

A

Less monitoring required

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79
Q

What age-related anatomic changes contribute to well-maintained cardiac output (compensating for lowered HR) in elderly men?

A

Cardiac hypertrophy

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80
Q

5 day old newborn cyanotic since birth with soft systolic murmur and a decrease in pulmonary blood flow?

A

Tetralogy of Fallot

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81
Q

An increase in the serum concentration of which hormone is the most conclusive sign that ovulation has occurred?

A

Progesterone

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82
Q

During the differentiation of mammary gland alveolar cells in late pregnancy, the hormone that acts synergistically with estrogen is which of the following?

A

Human placental lactogen

83
Q

Zinc finger motif on steroid hormone receptor binds specifically to what?

A

DNA

84
Q

Why do we get thrombi in the heart in dilated cardiomyopathy?

A

Larger space –> turbulent flow

85
Q

What is the cause of pain in MI?

A

Accumulation of metabolic products in heart tissue

86
Q

How does arterial PO2 change with exercise?

A

It doesn’t - expired minute ventilation and cardiac output are unchanged

87
Q

How does removing the carotid bodies change the ventilatory response to decreasing levels of inspired oxygen?

A

Gets rid of that response

88
Q

What hormone will be notably elevated when you transect the pituitary stalk?

A

Prolactin because there is no more inhibition by dopamine

89
Q

What is the most likely complication of BPH?

A

Bacterial cystitis

90
Q

If we do not treat gonococcal urethritis, what is the most likely complication?

A

Epididymitis

91
Q

How do bisphosphonates work?

A

Inhibits osteoclasts via ingestion of it as a pyrophosphate analog

92
Q

What are the nitrite negative UTI microbes?

A

Enterococci or staph saprophyticus

93
Q

Why is there no vaccine for gonococcus?

A

High/rapid antigenic variation of pili

94
Q

All paramyxoviruses contain what two proteins?

A

Hemagglutinin (allows RBC’s to agglutinate) and F fusion protein (allows for formation of syncytia)

95
Q

What do RNA viruses show on RPLF gels?

A

3 fragments

96
Q

How does H. pylori lead to ulceration?

A

Elaboration of proteases and ureases with local tissue destruction

97
Q

What antibody binds F fusion protein?

A

Pavilizumab

98
Q

How can we kill C. diff spores?

A

Autoclave (steam at 121 C for 15 minutes)

99
Q

When do we get rupture of the papillary muscle post MI?

A

3-7 days

100
Q

When do we get rupture of the free wall post MI?

A

3-14 days

101
Q

What causes the reaction in the skin after an injection?

A

Arthus reaction = type III HSR = immune complexes

102
Q

Where do lower extremity lymphatics drain?

A

Lateral - popliteal, medial - inguinal

103
Q

Where does the esophagus blood supply come from?

A

Upper - inferior thyroid artery, middle - aorta, lower - left gastric

104
Q

Hereditary porphyrias have what inheritance pattern?

A

Autosomal dominant

105
Q

How does vitamin A work as a pharm treatment (mechanism)?

A

Activation of nuclear gene transcription

106
Q

What weight loss drug can cause steatorrhea and good changes in lipid studies?

A

Orlistat

107
Q

Are case-control studies prospective, retrospective, or both?

A

Only retrospective

108
Q

Collapse of the superior half of the right femoral head with preservation of the articular cartilage?

A

Aseptic necrosis

109
Q

Hip adductor muscles insert onto the femur from where?

A

Ischium

110
Q

What is the mechanism of cisplatin?

A

Causes crosslinking of DNA

111
Q

Old man with fever and abdominal symptoms and contrast collects in the colon?

A

Diverticulitis

112
Q

Patients with deficiency of myeloperoxidase are unable to produce?

A

Hydroxy-halide radicals (MPO produces HOCl from H2O2)

113
Q

What is the function of ribosome peptidyl transferase?

A

Forms peptide (covalent) bonds between adjacent amino acids during translation of proteins

114
Q

The amount of calcium sequestration in the sarcoplasmic reticulum is highest when there is a lot or a little stimulation of skeletal muscle?

A

Little

115
Q

What is neuropathic pain described as?

A

Burning

116
Q

What causes an increased A-a gradient?

A

May occur in hypoxemia - shunting, V/Q mismatch, fibrosis (usually something is messed up with the diffusion barrier)

117
Q

Why can deoxygenated blood carry more carbon dioxide than oxygenated blood?

A

Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin

118
Q

What does the first aortic arch give rise to?

A

Maxillary artery (branch of external carotid)

119
Q

What does the second aortic arch give rise to?

A

Stapedial artery and hyoid artery

120
Q

What does the third aortic arch give rise to?

A

Common carotid and proximal part of the internal carotid (C is the 3rd letter of the alphabet)

121
Q

What does the fourth aortic arch give rise to?

A

On the left - aortic arch, on the right - proximal part of the right subclavian artery (4th arch = 4 limbs = systemic circulation)

122
Q

What does the sixth aortic arch give rise to?

A

Proximal part of pulmonary arteries and (on the left only) ductus arteriosus

123
Q

What general tissue do the clefts, arches, pouches give rise to?

A

CAP = ectoderm, mesoderm, endoderm

124
Q

Which cleft develops into the external auditory meatus?

A

1st

125
Q

What is the mnemonic for thinking about what the branchial arches give rise to?

A

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)

126
Q

What is the mnemonic for what the branchial pouches give rise to?

A

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)

127
Q

What is the mode of inheritance for cleft lip/palate?

A

Multifactorial

128
Q

What is the drug of choice for postpartum hemorrhage?

A

Oxytocin

129
Q

What is the difference in mepp vs. epp (end plate potential) and how are they affected in botulinum poisoning?

A

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

130
Q

How does zanamivir work?

A

Inhibits the release of progeny influenza virus

131
Q

How does IkB work?

A

Releases NFkB after undergoing phosphorylation

132
Q

What are the abnormal lab values for osteoporosis?

A

NONE! - serum calcium, phosphate, ALP, PTH are all normal

133
Q

Describe osteoblast vs. osteoclast activity with decreased DEXA bone scan.

A

Osteoclast increase, osteoblast decrease

134
Q

Pain reproduced with resisted abduction of the shoulder when the shoulder is abducted 90 degrees and the arm is giving the thumbs down sign?

A

Supraspinatus (NOT deltoid)

135
Q

Hypotension leads to increased or decreased carotid sinus baroreceptor activity?

A

Decreased (think about it as the opposite of the carotid massage)

136
Q

Do cholinomimetics affect both muscarinic and nicotinic receptors?

A

No - only muscarinics

137
Q

What happens to ATP during the first 10-20 seconds of muscle contraction?

A

Does not fall appreciably because ATP is quickly regenerated from creatine phosphate

138
Q

What is the immediate treatment for cholinergic poisoning?

A

Atropine (NOT pralidoxime)

139
Q

What can technetium 99m pertechnetate identify besides gastric tissue?

A

Thyroid, testes, RBCs (helps identify ectopic spleen tissue)

140
Q

If someone stares off into space and does not respond to any questions, is that a simple or complex seizure?

A

Complex - loss of consciousness

141
Q

What part of the superior temporal gyrus is Wernicke’s area located on?

A

Posterior

142
Q

Coarse facial features, clouded corneas, restricted joint movement, high plasma levels of lysosomal enzymes?

A

I cell disease - abnormal targeting of enzymes to lysosomes

143
Q

What happens if you treat salmonella enterica with antibiotics?

A

Prolonged fecal excretion of the organism

144
Q

What artery general supplies the posterior surface of the heart?

A

PDA from the right coronary (assuming individual has right dominant circulation)

145
Q

What is lentigo maligna?

A

Melanoma in situ

146
Q

What causes infertility in PCOS?

A

Increased estrogen (from adipose tissue) that inhibits FSH

147
Q

What is additive for malignant hyperthermia when combined with inhaled anesthetics?

A

Succinylcholine

148
Q

What is type I error?

A

You say there is a difference when there isn’t one (alpha = you sAw a difference that did not exist)

149
Q

What is type II error?

A

You didn’t see a difference when there was one (beta = Blind to a difference that does exist)

150
Q

What is power?

A

1 - beta

151
Q

Lymphatic drainage - head and neck?

A

Cervical

152
Q

Lymphatic drainage - lungs?

A

Hilar

153
Q

Lymphatic drainage - trachea and esophagus?

A

Mediastinal

154
Q

Lymphatic drainage - upper limb, breast, skin above umbilicus?

A

Axillary

155
Q

Lymphatic drainage - liver, stomach, spleen, pancreas, upper duodenum?

A

Celiac

156
Q

Lymphatic drainage - lower duodenum, jejunum, ileum, colon to splenic flexure?

A

Superior mesenteric

157
Q

Lymphatic drainage - colon from splenic flexure to upper rectum?

A

Inferior mesenteric

158
Q

Lymphatic drainage - lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), prostate?

A

Internal iliac

159
Q

Lymphatic drainage - testes, ovaries, kidneys, uterus?

A

Para-aortic

160
Q

Lymphatic drainage - anal canal (below pectinate line), skin below umbilicus (except popliteal territory)?

A

Superficial inguinal

161
Q

Lymphatic drainage - dorsolateral foot, posterior calf?

A

Popliteal

162
Q

HLA types for MHC I?

A

A, B, C

163
Q

HLA types for MHC II?

A

DR, DP, DQ

164
Q

HLA type associated with hemochromatosis?

A

A3

165
Q

HLA type associated with psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, reactive arthritis?

A

B27

166
Q

HLA type associated with celiac disease?

A

DQ2/DQ8

167
Q

HLA type associated with multiple sclerosis, hay fever, SLE, Goodpasture syndrome?

A

DR2

168
Q

HLA type associated with DM1, SLE, Graves?

A

DR3

169
Q

HLA type associated with rheumatoid arthritis, DM1?

A

DR4

170
Q

HLA type associated with pernicious anemia, hashimoto thyroiditis?

A

DR5

171
Q

Th1 cells secrete what cytokine?

A

IFN-gamma

172
Q

Th2 cells secrete what cytokines?

A

IL-4, IL-5, IL-6, IL-13

173
Q

What inhibits the Th1 response?

A

IL-4 and IL-10 (from the Th2 cell)

174
Q

What inhibits the Th2 response?

A

IFN-gamma (from the Th1 cell)

175
Q

What cytokines do T-regs produce?

A

IL-10 and TGF-beta to downregulate the immune response

176
Q

What receptor-ligand interaction is necessary for class switching?

A

CD40-CD40L (this is defective in Hyper IgM)

177
Q

What are the cytokines for acute inflammation?

A

IL-6, IL-1, TNF-alpha, IFN-gamma

178
Q

What are the anaphylotoxins?

A

C3a, C4a, C5a

179
Q

What are the cytokines that are secreted by the macrophages?

A

Acute inflammation: IL-1, IL-6, TNF-alpha
Chemotactic for neutrophils: IL-8
Th1 response: IL-12

180
Q

What cells have CD16 and CD56?

A

NK cells

181
Q

What cells have CD28?

A

T cells (binds to B7 on APC)

182
Q

When do we give passive immunity (preformed antibodies)?

A

To Be Healed Rapidly: Tetanus toxin, Botulinum toxin, HBV, Rabies

183
Q

What are the killed virus vaccines?

A

RIP Always: Rabies, Influenza (injected), Polio (Salk), HAV

184
Q

What are the live attenuated virus vaccines?

A

Smallpox, yellow fever, chickenpox, MMR, Sabin polio, influenza (intranasal)

185
Q

What are the recombinant viral vaccines?

A

HBV (HBsAg), HPV (types 6, 11, 16, 18)

186
Q

Anti-cardiolipin, lupus anticoagulant?

A

SLE, antiphospholipid syndrome

187
Q

Anticentromere ab?

A

CREST (limited scleroderma)

188
Q

Antidesmoglein ab?

A

Pemphigus vulgaris

189
Q

What are the definitive ab for SLE?

A

Anti-dsDNA and anti-Smith

190
Q

Anti-glutamate decarboxylase ab?

A

DM1

191
Q

Anti-hemidesmosome ab?

A

Bullous pemphigoid

192
Q

Antihistone ab?

A

Drug-induced lupus

193
Q

Anti-Jo1, SRP, Mi-2 ab?

A

Polymyositis, dermatomyositis

194
Q

Antimicrosomal, antithyroglobulin ab?

A

Hashimoto thyroiditis

195
Q

Antimitochondrial ab?

A

Primary biliary cirrhosis

196
Q

Anti-Scl-70 (anti-DNA topoisomerase I) ab?

A

Scleroderma (diffuse)

197
Q

Anti-smooth muscle ab?

A

Autoimmune hepatitis

198
Q

Anti-SSA, SSB (Ro, La) ab?

A

Sjogren

199
Q

Anti-TSH ab?

A

Graves

200
Q

IgA antiendomysial, IgA anti-tissue transglutaminase ab?

A

Celiac

201
Q

c-ANCA (PR3-ANCA)?

A

Wegener’s (granulomatosis with polyangiitis)

202
Q

p-ANCA (MPO-ANCA)?

A

Microscopic polyangiitis, Churg-Strauss syndrome

203
Q

Anti-CCP ab (cyclic citrullinated peptide)?

A

Rheumatoid arthritis

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