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Caleb's Step 1 > March 15 > Flashcards

March 15 Flashcards

1
Q

Anticoag therapy in pregnancy?

A

Low-molecular-weight heparins

LMWH: enoxaparin

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2
Q

umbilical hernia in a neonate

A

due to incomplete closure f the umbilical ring & defect at linea alba

associated with:
Down Syndrome
Hypothyroidism
Beckwith-Wiedemann Syndrome

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3
Q

Beckwith-Wiedemann Syndrome

A

Wilms Tumor
Macroglossia
Umbilical Hernia
Organomegaly

WT2 mutation

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4
Q

Arginase Deficiency

A

Arginase is a Urea Cycle enzyme - produces UREA and Ornithine form ARGININE

symptoms of deficiency:
elevated arginine in plasma and CSF
bilateral spastic paresis 
delayed development (cognitive and motor)
growth delay 
normal or mild ammonemia
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5
Q

Class IB Antiarrhythmics

A

Lidocaine, Tocainide, Mexiletine

Bind and block sodium channels with the lowest affinity of Class I (dissociate from channels most rapidly)

highest affinity IC>IA>IB

Prolong phase 0 –> decreased AP duration

Increase QT interval

tx: ventricular arrhythmias,

IB is Best for post-MI

Preferentially effects ischemic and depolarized Purkinje and Ventricular tissues

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6
Q

Speed of Cardiac Conduction at various tissues

A

Purkinje>Atria>Ventricles>AV Node

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7
Q

CXR appears worse than symptoms/patient presents

A

Mycoplasma pneumonia

Walking pneumonia (you feel fine, CXR looks terrible)

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8
Q

Mitral Regurgitation

A

mid-systolic click
mid-to-late systolic murmur

@ apex

squatting increases venous return (more volume decreases valve prolapse)

Marfans, Ehler-Danlos, and OI

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9
Q

Chemotactic for Neutrophils

A

IL-8
Leukotriene B4
C5a

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10
Q

Crohn Disease

A

Transmural inflammation –> Fistula formation

discontinuous lesions from mouth to anus

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11
Q

Adenoma to Carcinoma Sequence

A

Normal Colon -1-> proliferative epithelium -2-> Adenoma -3-> Carcinoma

1 = APC inactivation
2 = K-ras activation - uncontrolled proliferation
3= p53 inactivation - malignant transformation
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12
Q

PGI2

A

inhibits platelet aggregation and adhesion to the vascular endothelium

also vasodilates

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13
Q

PGE2

A

dilates Afferent Arteriole –> increased RBF and GFR

NSAIDS block PGE2 –> Afferent Arteriole Constriction –> decreased GFR

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14
Q

Retinoblastoma

A

associated with osteosarcoma

Chromosome 13

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15
Q

Eosinophils mechanism of action

A

antibody-dependent cell-mediated cytotoxicity

bind Fc of IgE and release Major Basic PRotein and ROS

Parasitic infection –> TH2 differentiation of CD4+ T-cells –> IL-5 release –> recruitment of Eosinophils

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16
Q

Glycogenolysis

A

breakdown of glycogen, occurs at Liver and Muscle

In Muscle:
Muscle contraction –> increased Ca++ –> activation of Phosphorylase Kinase (PK) –> phosphorylation/activation of Glycogen Phosphorylase –> Glycogenolysis (Glycogen –> Glucose-1-P)

In Liver:
Glucagon/Epinephrine –> increased cAMP –> activation of PK –> activation of Glycogen Phosphorylase –> Glycogenolysis

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17
Q

Allopurinol

A

blocks Xanthine Oxidase

enhances conversion of Azathioprine –> Active metabolites –> bone marrow suppression

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18
Q

Cryptorchidism

A

undescended testis

atrophy and necrosis of the seminiferous tubules if left uncorrected

increased risk for testicular cancer

Orchiopexy (moving teste to the scrotal sac) decreases but does not eliminate the risk of cancer

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19
Q

Corynebacterium diphtheriae description

A

nonmotile gram positive rods with polar granules that stain with aniline dyes (methylene blue)

found in clumps ‘chinese characters’

grown on Cysteine-Tellurite agar (forms black colonies) and Löffler medium

+ Elek test (for toxin)

Toxoid Vaccine

coryne = club shaped

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20
Q

C. diphtheriae toxin

A

exotoxin - inhibits protein synthesis via ADP-ribosylation of EF-2 (elongation factor)

same mechanism as Exotoxin A from Pseudomonas aeruginosa

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21
Q

Pineal Gland Mass

A

Obstructive hydrocephalus due to cerebral aqueduct compression
[papilledema, headache, vomiting]

Dorsal Midbrain Syndrome (Parinaud)
[downward gaze preference/limited upward gaze, and bilateral eyelid retraction, and pupils accommodate but don’t react to light]

Most commonly a Germinoma

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22
Q

Lymph Node Anatomy

Cortex

Paracortex

Medullary Sinus

Medullary Cord

A

Cortex - location of Follicles - B-cells (absent in agammaglobulinemia)

Paracortex - T-cells and Dendritic cells (absent in DiGeorge)

Medullary Sinus - reticular cells and macrophages

Medullary Cord - B-cells, plasma cells, macrophages

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23
Q

Treatment of Obstructive Sleep Apnea

A

Hypoglossal Nerve Stimulation - causes tongue to move forward and increases anteroposterior airway diameter

Also: weight loss, CPAP, surgery

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24
Q

Invasive Pulmonary Aspergillosis

A

Patients with profound and prolonged neutropenia

fever, chest pain, dyspnea on exertion, hemoptysis

septate narrow hyphae with acute angle branching

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25
Q

Mitral Stenosis and Hemodynamic Changes

A

Increased Left Atrial Diastolic Pressure

Increased pulmonary capillary wedge pressure

Pulmonary Hypertension

Decreased Pulmonary Vascular Compliance

Right Ventricular Dilation

Functional Tricuspid Regurgitation

normal diastolic pressure of Left Ventricle

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26
Q

Hepatitis C Immune Evasion?

A

Antigenic variation of envelope proteins

due to RNA-dependent RNA polymerase with no proofreading

host antibodies (IgG) lag behind, virus stays one step ahead

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27
Q

Neuronal Length Constant

A

measure of how far along an axon the AP can propagate

decreased with demyelination

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28
Q

Most Common Cause of Cancer Deaths

A

Lung Cancer

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29
Q

Silicosis

A

Dx: birefringent silica particles surrounded by fibrous tissue on histology
(eggshell) calcification of the rim of hilar nodes

Impairs macrophage function

Predisposes to TB infection

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30
Q

Marker of Neural Tube Defect and Ventral Wall Defect (omphalocele)

A

INCREASED AFP

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31
Q

Decreased AFP

A

Trisomy 18 and 21

dating error (mothers with irregular menses make it difficult to know date of late cycle)

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32
Q

Coagulative Necrosis

A

Ischemic Injury

Tissue architecture is preserved, cells are anucleated with eosinophilic cytoplasm

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33
Q

Caseous Necrosis

A

TB infections

also Histoplasma, Cryptococcus, Coccidioides

cheesy tan-white gross appearance

fragmented cells surrounded by macrophages –> granuloma

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34
Q

Fat Necrosis

A

Acute Pancreatitis

chalky-white deposits due to Saponification (fatty acids + calcium)

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35
Q

“worst headache of my life”

A

Subarachnoid Hemorrhage

Saccular (berry) aneurysms

usually at Circle of Willis

associated with Ehlers-Danlos and ADPCKD (polycystic kidney disease)

see hyperdensity/blood in the sulci on CT

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36
Q

Bradykinin

A

Angioedema

Acquired: ACEi (-prils)

Hereditary: C1 esterase inhibitor deficiency (decreased serum C4)

Kallikrein catalyzes Kininogen –> Bradykinin

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37
Q

Ovary Epithelium

A

simple cuboidal

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38
Q

Fallopian Tube Epithelium

A

simple columnar

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39
Q

Cervix
Ectocervix
Endocervix

A

Ectocervix - stratified squamous non-keratinized

Endocervix - simple columnar

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40
Q

Most common cause of Sudden Cardiac Death

A

Ventricular Fibrillation

70% is related to inadequate tissue perfusion due to coronary artery occlusion

this is also how most people die in the first 48 hours post-MI

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41
Q

Atheroembolism

A

occurs following an invasive vascular procedure (angiography/angioplasty)

dislodged cholesterol-containing debris is dislodged from large vessels and caught in small vessels

Acute Kidney Injury (oliguria, azotemia) is the most common result

Biopsy shows cholesterol clefts (lost during tissue prep, just see needle-shaped clefts)

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42
Q

MOA of Beta-Blockers for HTN

A

Reduce cardiac contractility and HR (via beta-1)

Decrease renin release by the kidney

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43
Q

Treatment of Status Epilepticus

A

IV Benzodiazepines

MOA: increase effects of GABA-A –> increased influx of Cl- –> hyperpolarization

GABA = gamma-aminobutyric acid

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44
Q

Alveolar Hyperventilation

A

Indicated by hypocapnia (low PCO2)

Caused by V/Q mismatch –> hypoxemia –> increased respiratory drive –> excessive CO2 excretion from lungs

hypoxemia persists because of V/Q mismatch

could be pneumonia or PE

Hypoventilation = Hypercapnia

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45
Q

Plummer-Vinson Syndrome

A

dysphagia

iron deficiency anemia

koilonychia - spoon shaped nails

shiny red tongue

esophageal web formation

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46
Q

Ivabradine

A

Inhibits Funny Sodium Channels during Phase 4 (slow depolarization phase)

Decrease Heart Rate

No effect on contractility or relaxation

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47
Q

Xeroderma Pigmentosum

A

Disorder of Nucleotide Excision Repair (required for repair of DNA damage by UV)

skin cancers seen as early as age 5-6

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48
Q

Disorder of Nucleotide Excision Repair

A

Xeroderma Pigmentosum

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49
Q

Disorder of DNA Mismatch Repair

A

Lynch = HNPCC

50
Q

Disorder of DNA Crosslink Repair/NHEJ

A

Fanconi anemia

aplastic anemia
short stature
absent thumbs
cafe-au-lait

51
Q

Acute Graft Rejection

A

1-4 Weeks post transplant

dense interstitial infiltrate with many mononuclear cells - usually T-cells sensitized for foreign MHC

52
Q

Very Long Chain Fatty Acid Oxidation Location

A

Peroxisomes

53
Q

Peroxisomal Dz

A

inability to metabolize Very Long Chain Fatty Acids

neurodeficits

improper CNS Myelination

54
Q

Ataxia-Telangiectasia

A

autosomal recessive disorder of NHEJ

ataxia
telangiectasias
recurrent sinopulmonary infections

55
Q

PCP = phencyclidine MOA

A

NMDA antagonist

NMDA = N-methyl-D-aspartate

hallucinations, violent behavior, vertical nystagmus, ataxia

56
Q

Thyroid Peroxidase

A

Thyroglobulin iodination
Iodide oxidation
Coupling of iodized tyrosine residues

antibodies against Thyroid Peroxidase ~90% of Hashimoto Thyroiditis

57
Q

Niacin B3 Deficiency

A

Pellagra
Dermatitis (@ sun-exposed areas)
Diarrhea
Dementia

Obtained in diet
Synthesized from Tryptophan
Necessary for NAD+ and NADH synthesis

Also seen in carcinoid syndrome, prolonged INH therapy, Hartnup Dz

58
Q

Mucociliary Clearance

A

Remove particulate from the lungs

Particles are trapped in mucus and then swept up to pharynx by ciliated cells that line the trachea –> proximal respiratory bronchioles

59
Q

Cough Reflex

A

Afferent carried by Internal Branch of Superior Laryngeal (CNX)

Efferent is also CN X

Internal Branch of Superior Laryngeal can be damaged if things get caught in piriform recess which overlies the N.

60
Q

Gag Reflex

A

Afferent: Glossopharyngeal (CN IX)

Efferent: Vagus (CN X)

61
Q

Vestibulo-ocular Reflex

A

Afferent: CN VIII - Vestibular component

Efferent: CN III, IV, VI

coordinated compensatory eye movement that allows for image stabilization when head moves

62
Q

Corneal Reflex

A

Afferent: Ophthalmic branch of Trigeminal (CN V1)

Efferent: Facial (CN VII)

63
Q

Cerebral Ischemia 3-5days

A

Microglia (monocytes) phagocytize myelin breakdown products and become v. fat with lipids

64
Q

Patellar fracture

A

inability to extend knee against gravity (patellar tendon deficit)

65
Q

Culture Media for C. diphtheriae

A

Cysteine-tellurite agar –> black colonies

Loffler’s medium

66
Q

Rabies Vaccine

A

Inactivated Vaccine

67
Q

Rabies Presentation

A

Insomnia, Headache, Agitation, Dysphagia

Painful spasm, progressive paralysis, coma, death

68
Q

EGFR inhibitor therapy resistance

A

KRAS mutation

normal: EGFR –> KRAS –> cell proliferation

69
Q

Acute Hep B Infection

A

incubation of 30-180 days

joint pain, LAD, pruritic uticarial vasculitis rash, RUQ pain, hepatomegaly

elevated AST/ALT, both 10X normal

70
Q

Vibrio cholerae

A

Oxidase-positive, gram-negative bacilli

grows well on highly alkaline media (TCBS agar)

increased risk of infection in individuals with PPI therapy - V. cholerae is v. acid sensitive usually

71
Q

Angiotensin II

A

systemic vasoconstriction
efferent arteriole constriction
increased aldo secretion

increased GFR

72
Q

ACE inhibitors

A

-prils

efferent arteriolar dilation –> decreased GFR
decreased systemic vascular resistant (vasodilation)

73
Q

Ipratropoium

A

Anticholinergic (derivative of Atropine)

blocks ACh at muscarinic receptors and prevents bronchoconstriction

less effective than beta2 agonists

also reduces PNS stimulation of tracheobronchial submucosal glands –> decreased mucosal production

Ipratropium: Bronchodilate and decrease mucus production

74
Q

Medical Therapy to reduce recurrent adenoma of the colon?

A

COX-2 inhibitors! Aspirin.

decreases polyp formation, colonic adenoma and adenocarcinoma

75
Q

Cephalosporin

A

Inhibits Transpeptidases (a form of penicillin-binding protein)

–> cell wall instability and bacterial cell lysis

Resistance: change in protein structure of transpeptidases/penicilliin-binding proteins

76
Q

Vancomycin

A

binds D-ala residues of Cell Wall Glycoproteins

prevents transpeptidases from forming cross-links

77
Q

DRESS Syndrome

A 
Drug
Reaction with
Eosinophilia and
Systemic 
Symptoms

2-8 weeks after exposure to anticonvulsants (phenytoin and carbamazepine) allopurinol, sulfonamides, vancomycin

symptoms: fever, LAD, facial edema, skin rash

78
Q

Amniotic Fluid Measurement of Lung Maturity

A

Phosphatidylcholine aka Lecithin : Sphingomyelin ratio

stays 1:1 until week 30, then Lecithin goes way up

Sphingomyelin - membrane phospholipid

Phosphatidylcholine (Lecithin) - component of pulmonary surfactant - increases at 30 weeks gestation

Phosphatidylglyceral - component of pulmonary surfactant - increases at 36 weeks gestation

79
Q

Dandy Walker Malformation

A

hypoplasia/absence of Cerebellar Vermis
Cystic dilation of 4th ventricle
Posterior Fossa Enlargement

patients present with skull enlargement and developmental delay

non-communicating hydrocephalus due to atresia of Luschka and Magendie formania

80
Q

Duodenal Peptic Ulcer

A

H. pylori

tx: amoxicillin, clarithromycin, omeprazol

81
Q

Pulmonary side effect of Methotrexate

A

Pulmonary Fibrosis

gradually progressive dyspnea
end-inspiratory crackles at the lung base
‘honeycombing’

PFTs
increased FEV/FVC
decreased lung volumes
decreased FEV
decreased FVC

patchy interstitial lymphocytic inflammation and fibrosis of the alveolar wall

82
Q

Parietal Cells

A

Located in the upper glandular layer of the stomach

Secrete Intrinsic Factor - Binds B12 Cobalamin

83
Q

Autoimmune Gastritis

A

Chronic Atrophic Gastritis

autoimmune destruction of parietal cells –> decreased intrinsic factor –> pernicious anemia

histology: lymphocytic and plasma cell infiltration

84
Q

Pernicious Anemia

A

CD4+ T-cell mediated destruction of parietal cells –> B12 deficiency

macrocytic megaloblastic anemia

paresthesias and degeneration of dorsal column, lateral corticospinal tract, and spinocerebellar tract - due to abnormal myelin

increase serum homocysteine and methylmalonic acid

85
Q

West Nile Virus

A

Flavivirus - ssRNA+ transmitted by mosquito

fever, malaise, headache, myalgia, rash, encephalitis (confusion, altered mental status) and flaccid paralysis

86
Q

Heparin Overdose

A

Protamine

fresh frozen plasma contains antithrombin III - enhances the effects of heparin! :(

87
Q

Warfarin Overdose

A

short-term: Fresh Frozen Plasma

longer: Vitamin K - takes days to work because requires synthesis of new coag factors

88
Q

Tetralogy of Fallot

A

Ventricular septal defect
Overriding aorta
Right ventricular outflow tract obstruction (pulmonary stenosis)
Right ventricular hypertrophy

cyanotic spells that improve with squatting (increases afterload/peripheral systemic vascular resistance)

embryological deviation of the infundibular septum

89
Q

Dairy products –> Meningitis/Encephalitis

A

Listeria monocytogenes

intraceullular gram + bacilli

90
Q

Recombination vs Reassortment

A

Recombination via crossing over - 2 non-segmented viruses infect same cell

Reassortment with SEGMENTED viruses, mix-n-match - 2 segmented viruses infect same cell

91
Q

Granuloma in the media of vessels

A

Giant Cell Temporal Arteritis
Takayasu Arteritis

granulomatous inflammation of the media

92
Q

Secondary (Acquired) Lactase Deficiency

A

Inflammatory - Celiac Dz
Infectious - Giardiasis

damage to microvilli –> abd distentsion, cramping, flatulence, diarrhea

93
Q

Hyperacute Transplant Rejection

A

Time: Minutes to hours

MOA: preformed antibodies / antibody mediated hypersensitivity (Type II via IgG, @ABO or HLA)

Morphology: Mottling and cyanosis
arterial fibrinoid necrosis
capillary thrombotic occlusion

94
Q

Acute Transplant Rejection

A

Time: <6 months

MOA: exposure to donor antigen –> humoral/cellylar activation

Humoral: C4d deposition, neutrophilic infiltrate, necrotizing vasculitis

Cellular: Lymphocytic infiltrate

95
Q

Chronic Transplant Rejection

A

Time: months to years

MOA: low-grade immune response refractory to immunosuppressants

Vascular wall thickening and luminal narrowing
interstitial fibrosis with parenchymal atrophy

96
Q

Substitution of glutamic acid with valine

A

Sickle Cell! HbS

97
Q

Pathogenesis of Congestive Heart Failure

A

1) Decreased CO

2a increased SNS activity
2b increased RAAS activity
2c increased ADH

3a increased heart rate and contractility
3b vasoconstriction
3c increased in extracellular volume

increased hemodynamic stress

increased cardiac remodeling :(

98
Q

Incidence and Deaths of Breast, Lung and Colon cancer

A

Highest Incidence:
Breast>Lung>Colon

Highest Death:
Lung>Breast>Colon

99
Q

Pudendal Nerve

A

S2-S4

Sensory: external genitalia, skin around anus and perineum

Motor: pelvic floor muscles, external anal and urethral sphincters (#continence)

can be damaged at labor causing
fecal and urinary incontinence

100
Q

Effects of Ureter Obstruction (on GFR and FF)

A

Decreased GFR due to increased hydrostatic pressure of Bowman Space

Decreased Filtration Fraction

101
Q

Filtration Fraction

A

FF = GFR/RPF - normal=20%

GFR ~ creatinine or inulin clearance

RPF ~ PAH clearance

Clearance = [urine] x urine flow rate / [plasma]

RBF = RPF/(1-Hct)

102
Q

Tourettes

A

Motor and Vocal tics for > 1 year

103
Q

Mycolic Acids and Acid Fast Staining

A

Mycolic acids @ cell call are the reason that mycobacteria are acid-fast

hold on to carbolfuchsin

Isoniazid inhibits mycolic acid synthesis and decreased staining with acid fast

104
Q

Cerebral Vessel associated with Wernicke aphasia

A

Middle Cerebral Artery

supplies Broca and Wernicke area

105
Q

Wernicke Aphasia

A

Word Salad

Receptive aphasia

well articulated nonsense speech with lack of comprehension

106
Q

Broca Aphasia

A

Broken Boca

comprehension is intact but speech fluency is not

frustrating

107
Q

Axillary Nerve

A

C5 and C6

Motor: deltoid and teres minor

Sensory: skin of lateral shoulder

Damage @ proximal humeral fracture

108
Q

Aortic Stiffening

A

Age related loss of elastin and increased collagen deposition

Causes decreased compliance and elevated pressures during systole (ex. 180/70)

109
Q

Neisseria meningitidis meningitis route of infection

A

pharynx –> blood –> choroid plexus –> meninges

“bean shaped gram negative cocci in pairs”

110
Q

Hereditary Pancreatitis

A

Mutation that prevents trypsin from being inactivated –> pancreatitis

ex. SPINK1 gene mutations

111
Q

Lyme Disease

A

Borrelia burgdorferi via Ixodes tick in NE USA

early: flu-like symptoms and target rash (erythema chronicum migrans)
middle: facial palsy or AV nodal block
late: asymmetric arthritis (single knee joint) and/or subacute encephalopathy
tx: doxycycline or ceftriaxone

112
Q

Varenicline

A

partial agonist of Nicotinic ACh receptors

cessation of tobacco use - decreases withdrawal cravings and reward effects

113
Q

Type I Hypersensitivity Reaction

A

Anaphylaxis and Allergies

Humoral: IgE

Cellular: Basophils and Mast Cells

114
Q

Type II Hypersensitivity Reaction

A

Autoantibodies

Goodpasture and Autoimmune Hemolytic Anemia

Humoral: IgG and IgM autoantibodies and complement

Cellular: NK cells, Eosinophils, Neutrophils, Macrophages

also: Transfusion reactions, bullous pemphigoid, Graves, Guillain-Barre, Myasthenia gravis, pemphigus vulgaris, pernicious anemia, rheumatic fever

115
Q

Type III Hypersensitivity Reaction

A

Immune Complex Deposition

Serum Sickness, Post-Strep Glomerulonephritis, Lupus Nephritis

deposition of antibody-antigen complexes and complement activation

3 things stuck together in type III
Antigen + Antibody + Complement

116
Q

Type IV Hypersensitivity Reaction

A

Delayed type

T-cells and Macrophages

contact dermatitis, poison ivy, TB skin test, graft-vs-host Dz.

4 T’s: T-cells, Transplant rejection, TB skin test, and Touching (contact dermatitis)

117
Q

Medulloblastoma

A

primitive neuroectodermal tumor
sheets of small cells with deeply basophilic nuclei and scant cytoplasm

small round blue dense cells + abundant mitosis
^this differentiates it from pilocytic astrocytoma
undifferentiated and aggressive

cerebellum

118
Q

Pilocytic Astrocytoma

A

most common cerebellar tumor of childhood

Rosenthal fibers and pilocytic astrocytes on histology

low grade and better prog than medulloblastoma

119
Q

Diphenoxylate

A

mu opiate receptor agonist in the GI tract

slows motility

tx for diarrhea

Loperamide works this way too!

120
Q

HER2 Positive breast cancers

A

worse prognosis - poorly differentiated and rapidly growing tumors

tx: trastuzumab

121
Q

Non-Cyanotic Congenital Heart Defects

A

ASD
VSD
PDA
Coarctation of aorta

122
Q

Ventricular Septal Defects

A

small VSD –> loud blowing holosytolic murmur at lower left sternal border

present 4-10 days after birth as PVR declines

often close spontaneously

Large VSD –> heart failure, failure to thrive, diaphoresis with feeding

can progress to pulmonary hypertension and cyanosis –> Eisenmenger syndrome

require surg - early close is key to preventing complications

Caleb's Step 1 (16 decks)

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