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Caleb's Step 1 > March 16 > Flashcards

March 16 Flashcards

1
Q

Thiamine B1

A

Function
carbohydrate metabolism
decarboxylation of alpha-keto acids
pyruvate dehydrogenase cofactor

Deficiency:
Dry beriberi - polyneuritis and symmetrical muscle wasting
Wet beriberi - dilated cardiomyopathy, edema
Wernicke-Korsakoff Syndrome - confusion, ophthalmoplegia, ataxia, memory loss (permanent)
damage to mammillary bodies and medial dorsal nucleus of thalamus

tx: glucose AND thiamine

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2
Q

Riboflavin B2

A

Function
FAD

Deficiency
angular cheilosis, stomatitis, glossitis, corneal vascularization
normocytic anemia

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3
Q

Niacin B3

A

Function
NAD/NADP
tx: dyslipidemia (decrease VLDL, increase HDL)
side fx: flushing

Deficiency = Pellagra
dermatitis, dementia, diarrhea, peripheral neuropathy

Tryptophan can be used to synthesize Niacin B3 if not available in diet

Hartnup Disease - autosomal recessive, inability to absorb/resorb neutral amino acids –> tryptophan deficiency and Pellagra

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4
Q

Pyridoxine B6

A

Function
synthesis of heme, niacin, histamine, 5-HT, Epi, NE, DA, GABA

Deficiency
cheilosis, stomatitis, glossitis
convulsions, peripheral neuropathy
sideroblastic anemia due to impaired heme synth

must supplement with INH therapy

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5
Q

Folate B9

A

Function
DNA and RNA synthesis

Deficiency
macrocytic megaloblastic anemia
increased homocysteine
normal methylmalonic acid

acquired due to phenytoin, sulfonamides, methotrexate

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6
Q

Cobalamin B12

A

Function
cofactor for methionine synthase

Deficiency
macrocytic megaloblastic
degeneration of dorsal cloumn, lateral corticospinal, and spinocerebellar tract

increased homocysteine and increased methylmalonic acid

absorbed in the terminal ileum

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7
Q

Ascorbic Acid Vitamin C

A

Function
hydryoxylation of proline and lysine for proper collagen synthesis

Deficiency = Scurvy
petechial hemorrhage, gingival swelling, impaired wound healing, weak immune system

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8
Q

Aschoff Body

A

aka Interstitial Myocardial Granuloma

lymphocytes, macrophages, multinucleated giant cells

Acute Rheumatic Fever related myocarditis post untreated Group A Strep infection

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9
Q

Embryonic Defect: Agenesis

A

Complete absence of an organ

ex. renal agenesis

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10
Q

Embryonic Defect: Association

A

Multiple anomalies with an unknown unifying cause

ex. VACTERL

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11
Q

Embryonic Defect: Deformation

A

Structural abnormality due to extrinsic mechanical force

ex. adhesions causing finger malformations

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12
Q

Embryonic Defect: Dysplasia

A

Abnormal organization/cellular architecture in a tissue

ex. Osteogenesis Imperfecta

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13
Q

Embryonic Defect: Field Defect

A

Initial disturbance causes multiple malformations

ex. holoprosencephaly

can be genetic like DiGeorge or environmental like Accutane - isoretinoic acid

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14
Q

Alpha-1 antitrypsin deficiency

A

Autosomal Dominant

Z-allele - decreased secretion of alpha-1 antitrypsin due to abnormal protein folding

Affects LIVER and LUNGS

Lungs - panacinar emphysema due to unopposed destruction of alveolar walls

Liver - intrahepatocyte accumulation of polymerized misfolded AAT - stain red/pink with acid-Schiff

Pt with wheezing and poor air movement with increase AST and ALT

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15
Q

Midshaft Humerus Fracture

A

Damage:
Deep Brachial Artery
Radial Nerve –> wrist drop = inability to extend forearm (triceps) + cutaneous sensory of dorsal hand, forearm, upper arm

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16
Q

Chronic Granulomatous Disease

A

NADPH oxidase mutation

Dihydrorhodamine flow cytometry test - decreased fluorescence

Nitroblue tetrazolium test - does NOT turn blue

recurrent infection with catalase positive organisms

Candida
Aspergillus
T (no)
Aureus (Staph)
Listeria 
Aeruginosa (Pseudomonas)
Serratia
E. coli
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17
Q

Myeloperoxidase

A

blue-green heme-containing pigment that gives sputum its color

generates HCLO’ from H2O2 +Cl-

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18
Q

3’ end of tRNA

A

CCA

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19
Q

HbF

A

Fetal Hemoglobin

2 alpha
2 gamma

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20
Q

Canagliflozin

Dapagliflozin

A

SGLT2 inhibitors (Sodium GLucose coTransporter 2)

block Glucose/Na resorption from the lumen of the proximal tubule - increase glucose loss in urine

Contraindicated in patients with moderate-to-severe renal impairment

Check BUN and Cr first!

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21
Q

Short Acting Benzodiazepines

A

Half life <6hr

Triazolam, oxazepam, midazolam

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22
Q

Intermediate Benzos

A

Half life 6-24hr

Alprazolam, lorazepam, temazepam

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23
Q

Long Acting Benzos

A

Half life >24hr

Diazepam, Flurazepam, chlordiazepoxide

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24
Q

Urine Electrolytes in DKA pt

A

Urinary Acid Secretion accomplished by
free H+
(NH3 + H+) = NH4+
(PO4– +2H+) = H2PO4

decreased pH
decreased HCO3- (increased bicarb resorption) 
increased H
increased H2PO4
increased NH4+
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25
Q

Metastasis of Prostate Cancer

A

via prostatic venous plexus –> vertebral venous plexus

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26
Q

Most common benign tumor of the breast

A

Fibroadenoma

well demarcated

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27
Q

Most important steps for preventing central venous catheter infections

A

hand hygiene
full barrier precautions
chlorhexidine skin disinfection
removal of catheter when it is no longer needed

femoral vein has higher rate of infection

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28
Q

Hepatitis D

A

dependent on HBV because it needs its viral particles

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29
Q

Colonic Adenoma –> Carcinoma

A

COCKED AK 53

APC
COX-2
KRAS
p53

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30
Q

Effect of Nitrates

A

Venodilators

Decreased: Left ventricular end-diastolic pressure

Decreased: systemic vascular resistance

Increased: Peripheral venous capacitance

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31
Q

Portal Triad Contents

A

Common Bile Duct
Hepatic Artery
Hepatic Portal Vein

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32
Q

Tetanus route

A

Wound –> Motor neuron axon –> spinal cord

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33
Q

Phenylephrine

A

alpha1-agonist

increases peripheral vascular resistance and systolic blood pressure

this causes

reflex bradycardia and decreased pulse pressure

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34
Q

Homocystinuria

A

Autosomal Recessive deficiency of Cystathionine beta-synthase (required pyridoxine B6 cofactor)

dislocated lens (3-10years old)
intellectual disability
marfanoid habitus
thromboemoblic occlusion

restrict methionine

35
Q

Warfarin-induced skin necrosis

A

Occurs in individuals with underlying

Protein C Deficiency
Protein S Deficiency

shortly after starting warfarin

tx: fresh frozen plasma

36
Q

Angiotensin II Receptor Blocker

A

-sartans

increased renin
increased AngI
increased AngII 
decreased Aldo
no change in bradykinin
37
Q

Less addicting sleep aid?

A

Zolpidem

38
Q

alpha-1 adrenergic

A

Organ - Effect

Peripheral vasculature - vasoconstriction - increase BP (systolic)

Bladder - contraction internal urinary sphincter

Eye - mydriasis (constriction of pupillary dilator)

Drugs: phenylephrine, epinephrine, norepinephrine

39
Q

beta-1 adrenergic

A

Increase heart rate, contractility, conductance

Drugs: epinephrine, Dobutamine, Dopamine, Isoproterenol

40
Q

beta-2 adrenergic

A

peripheral vasculature - vasodilation - decrease BP (diastolic)

bronchodilation

isoproterenol, terbutaline

41
Q

Isoproterenol

A

beta-1 = increase cardiac contractility

beta-2 = decrease vascular resistance

42
Q

Clonidine

A

alpha-2 = decreased sympathetic outflow @ CNS = decrease is peripheral vascular resistance, decrease heart rate, decrease blood pressure

43
Q

Hepatic Processing of Bilirubin

A

1) carrier mediated uptake at hepatic sinusoids
2) conjugation with glucuronic acid by UGT (uridine diphosphate-glucuronyltransferase)
3) biliary excretion of water-soluble, nontoxic bilirubin glucuronides

44
Q

Conjugated Bilirubin

A

“Direct Bili”

water soluble

loosely bound to albumin

excreted in the urine

45
Q

Unconjugated Bilirubin

A

“Indirect Bili”

highly unsoluble in water

tightly bound to albumin

toxic

deposits in tissues (brain!)

46
Q

Crigler-Najjar

A

Autosome Recessive lack of UGT enzyme - responsible for conjugating bilirubin

increased levels of circulating toxic unconjugated bilirubin

deposition in the brain causses kernicterus - potentially fatal

kernicterus - muscle rigidity, lethargy, seizures

47
Q

t(14:18)

A

Follicular Lymphoma (b-cells)

18 = overexpression of Bcl-2 which is anti-apoptotic

14 = heavy-chain Ig

painless waxing/waning LAD in adults

48
Q

t(8:14)

A

Burkitt lymphoma

8=c-myc
14= heavy chain Ig

associated with EBV

Jaw lesion in endemic form in Africa

pelvic or abdominal mass in sporadic form

‘starry sky’ appearace = sheets of lymphocytes

49
Q

p53

A

tumor suppressor gene - decreased activity in cancers and tumors

50
Q

Immunity to tetanus toxin

A

circulating antibodies that neutralize it :)

immunization with toxoid

51
Q

Gaucher Disease

A

Autosomal Recessive lysosomal storage disorder common in Jews

beta-glucocerebrosidase deficiency

bone pain, easy bruising and bleeding, pallor and fatigue, hepatosplenomegaly

anemia/thrombocytopenia/leukopenia/pancytopenia
lipid laden macs = crumpled tissue paper

52
Q

Lympatic Drainage of Lower Limb

A

Lateral track –> popliteal and deep inguinal/superolateral LN

medial track –> superficial/superomedial inguinal

53
Q

Lymphatic Drainage: Prostate

A

internal iliac LN

54
Q

Lymphatic Drainage: Scrotum

A

superficial inguinal LN

55
Q

Lymphatic Drainage: Testes

A

para-aortic LN

56
Q

Promoter Region

A

bind RNA Pol II and Transcription Factors directyl

TATA @-25bp
CAAT @ -70-80bp

57
Q

Enhancer Region

A

Bind activator proteins, facilitates interaction with promoter region –> increased rate of transcription

can be up or down stream of gene

within intron or on separate chromosome

58
Q

Familial erythrocytosis

A

reduced binding of 2,3-BPG at beta-globin
increased hemoglobin oxygen affinity - left shift

gamma-globin of fetal hemoglobin also has decreased binding of 2,3-BPG –> increased O2 affinity

59
Q

Sarcoidosis

A

elevated serum calcium
elevated serum ACE

noncaseating granulomas
bilateral hilar adenopathy

in pulmonary - increased CD4+

60
Q

Most likely side effect of SSRIs

A

sexual dysfunction - decreased libido, decreased arousal, anorgasmia

depression, anxiety disorder, bulemia, panic disorder, PTSD, OCD,

61
Q

Minimal Change Disease

A

increased selective filtration of proteins

podocyte foot process fusion –> loss of negative charge –> loss of albumin in the urine aka selective albuminuria

symp: facial puffiness/edema

most common NEPHROTIC dz in children

62
Q

Hemolytic Uremic Syndrome

A

post bloody diarrhea from EHEC (releases shiga-like toxin) or Shigella infection

acute renal failure

anemia, thrombocytopenia

smear: schistocytes

normal coag studies

63
Q

Shiga Toxin

Shiga-Like Toxin

A

Shiga from Shigella
Shiga-like from EHC

inactivate 60S ribosome

precedes hemolytic uremic syndrome

64
Q

Ovarian Torsion

A

sudden-onset unilateral pelvic pain +/- nausea, vomiting, fever

most commonly due to ovarian mass (cyst/neoplasm) which causes ovary to twist

infundibulopelvic ligament aka suspensory ligament of the ovary carries ovarian N. A. V. - becomes occluded in torsion

65
Q

Complication of Left Atrial Enlargement + Atrial Fibrillation

A

thromboembolism, clot develops in Left Atrial Appendage (little cul-de-sac)

cause stroke.

66
Q

Trochlear Nerve (CN IV) Palsy

A

vertical diplopia - most noticable when looking down towards nose

ex. up close reading and walking down stairs (but not a problem when looking up)

superior oblique muscle - causes eye to internally rotate and depress

patients may compensate by tucking in chin and tilting head away from affected eye

67
Q

Actinomyces israelii

A

Gram + anaerobic branching filamentous not acid fast bacteria forms yellow ‘sulfur granules’

oral/facial abscesses

tx: Penicillin

68
Q

Mallory-Weiss Tear

A

Esophageal tear caused by high intra-gastric pressure (vomiting)

may be seen with Metabolic Alkalosis due to loss of H+ during emesis

69
Q

Cells with Neural Crest Origins

A 
Melanocytes
Odontoblasts
Tracheal cartilage 
Enterochromaffin cells
Laryngeal cartilage

Parafollicular C cells
Adrenal Medulla (Chromaffin cells)
Schwann Cells
Spiral Membrane

70
Q

Marker of Osteoblast Activity?

A

bone-specific alkaline phosphatase

71
Q

Haemophilus influenzae type b (Hib) infections

A

meningitis* #1
pneumonia
epiglottitis
sepsis

virulence factor: PRP capsule - acilitates invasion

PRP = polyribosyl ribitol phosphate

72
Q

Hib Vaccine

A

cell wall polysacchride conjugated with protein toxoid from diphtheria or tetanus

given at 2 months

decreases meningitis (also pneumonia, bacteremia, epiglottitis)

73
Q

Thionamides

A

Methimazole and Propylthiouracil

inhibit thyroid peroxidase - impairs iodine organification

Methimazole - teratogenic
PTU - decreased peripheral conversion of T4 –> T3

can cause agranulocytosis - pts taking these meds with signs of infection need WBC count with differential!

74
Q

Congenital Hydrocephalus Symptoms

A

macrocephaly

bulging fontanelle

poor feeding

UMN lesion: muscle hypertonicity. spasticity, hypereflexia

developmental delay

seizures

75
Q

Wolff-Parkinson-White Syndrome

A

accessory AV conduction pathway

recurrent supraventricular tachycardia in an otherwise healthy individual

shortened PR
delta wave at the start of QRS
widened QRS (not using His Purkinje system)
76
Q

Acetazolamide

A

Proximal Convoluted Tubule Diuretic

inhibits carbonic anhydrase –> blocks NaHCO3 (and water) resorption –> decrease in total body HCO3- and alkaline urine

decrease aqueous humor synthesis via inhibition of carbonic anhydrase

tx: glaucoma, altitude sickness, metabolic alkalosis (more HCO3- in the pee)

ACIDazolamide causes ACIDosis

77
Q

Antiretroviral Protease Inhibitors

A

-NAVIR (darunavir, ritonavir, lopinavir)

ARDs: hyperglycemia, CYP450 inhibition, buffalo hump fat deposition

78
Q

Anesthetic with high peripheral tissue uptake

A

large arteriovenous gradient (lungs –> arterial circulation –> uptake by tissues –> venous circulation)

this means that it has high tissue solubility and will have a SLOWER onset of action

low peripheral tissue uptake = low tissue solubility = fast onset

79
Q

Minimal Alveolar Concentration (MAC)

A

Defines POTENCY of an anesthetic

high potency = low MAC

Mac = alveolar concentration required to sedate 50% of general population

80
Q

Migratory thrombophlebitis

A

aka Trousseau Syndrome

indicative of visceral cancers - esp adenocarcinoma of pancreas, colon, and lung

hypercoagulability due to visceral cancer

81
Q

Orthopnea

A

LEFT-sided heart failure

82
Q

Acyclovir

A

guanosine analog that is activated by virally-encoded thymidine kinase

treats: HSV-1, HSV-2, VZV
Ineffective: EBV, CMV

83
Q

Physiologic Changes associated with Exercise

A

Increased HR
Increased SV
Increased CO

vasodilation in active skeletal muscles

Decreased systemic vascular resistance (^)

Caleb's Step 1 (16 decks)

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