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Caleb's Step 1 > March 17 > Flashcards

March 17 Flashcards

1
Q

IL-4

A

B-cell switch to IgE

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2
Q

IL-5

A

B-cell switch to IgA

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3
Q

ADR of Lithium

A

Hypothyroid
DI
Tremor
Ebstein Anomaly (congential cardiac defect)

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4
Q

ADR of Digoxin

A

Neuro: color vision changes, weakness, confusion, fatigue

GI: nausea, vomiting, abd pain

Cardiac: arrhythmia! (any kind, esp ventricular)

precipitated by: hypokalemia, hypovolemia, renal failure

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5
Q

Burkitt Lymphoma

A

t(8:14)
8 = c-Myc - overexpression, oncogene promotes tumor growth

African type - jaw mass
sporadic - abdominal/pelvic mass

starry sky appearance on histology

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6
Q

Strep Viridans

A

synthesizes dextrans from sucrose

allows adhesion at Fibrin-Platelet aggregates

adheres to pre-existing valvular lesions –> endocarditis

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7
Q

Galactosemia

A

galactose-1-phosphate uridyl transferase deficiency is most common

inability to convert Galactose-1-phosphate –> glucose-1-phosphate

symp: jaundice, vomiting, hepatomegaly, E. coli sepsis, cataracts, hemolytic anemia

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8
Q

INH-induced Neuropathy

A

due to competition with and deficiency of Pyridoxine B6

defective synthesis of GABA and increased urinary loss of B6

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9
Q

Angiogenesis (2 substances)

A

VEGF (vascular endothelial growth factor)
FGF-2 (fibroblast growth factor-2)

IL-1 and IFN-gamma are pro-inflammatory cytokines that can increase VEGF to indirectly promote angiogenesis

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10
Q

Cord Factor in mycobacterium

A

Virulence factor!

mycobacteria without cord factor are not pathogenic

actions: inactivates neutrophils, damages mitochondria, induces release of TNF

causes TB to grow in ‘thick rope-like cords in a twisted serpentine pattern”

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11
Q

mRNA detection

A

Northern Blot

assess gene expression

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12
Q

Müllerian aplasia

A

aplasia = defective development or congenital absence

variable uterine development with a short vagina/no upper vagina

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13
Q

Cardiac Tamponade

A

pericardial effusion

Beck triad: hypotension, elevated JVP, muffled heart sounds

decreased systolic pulse pressure during inspiration due to increased venous return to RV which compresses LV

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14
Q

Chancroid

A

Haemophilus ducreyi

multiple deep painful ulcers with gray.yellow exudate at base

inguinal LAD

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15
Q

Cranial nerve effected by parotid gland tumor?

A

Facial Nerve CNVII courses through the parotid gland

can cause facial droop (CN VII = muscles of facial expression)

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16
Q

Influenced by disease PREVALENCE

A

positive and negative predictive value

NOT: sensitivity, specificity, nor likelihood ratio

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17
Q

Obturator Nerve

A

L2-L4
thigh adduction
injury @ pelvic surgery

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18
Q

Femoral Nerve

A

L2-L4
flexion of thigh, extension of leg
sensory over medial leg, knee
injury @ iliopsoas (hematoma or abscess)

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19
Q

Common Peroneal Nerve

A

L4-S2
foot eversion, doriflexion, toe extension
sensory over lateral lower leg and dorsum
injury @ fibular neck fracture

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20
Q

Tibial Nerve

A

L4-S3
foot inversion, plantar flexion, toe flexion
sensory of soles of feet
injury @ knee trauma

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21
Q

Superior Gluteal

A

L4-S1
stabilizes pelvis
injury @ upper medial gluteal (injection)

Trendelenburg gait - contralateral hip drops and patient leans towards side of lesion

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22
Q

Gallstones

Cholesterol?
Bile Acids?
Phosphatidylcholine?

A

cholesterol UP
bile acids DOWN
phosphatidylcholine DOWN

bile is supersaturated with cholesterol and precipitates out :(

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23
Q

Carotid Sinus Innervation

A

Afferent - glossopharyngeal nerve CN IX
Efferent - vagus nerve CN X

pressure @ carotid sinus –> increase in PNS and decrease in SNS –> bradycardia, hypotension and even syncope (carotid sinus hypersensitivity)

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24
Q

Pt with mono-like illness but negative heterophile antibody test?

A

CMV! especially in immunocompetent patients

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25
Q

Atropine Overdose

A

give physostigmine

crosses CNS to relieve all symptoms (dry as a bone, red as a beet, mad as a hatter, hot as a hare)

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26
Q

Terbinafine MOA

A

inhibits squalene epoxidase –> cannot produce Ergosterol

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27
Q

Timolol ophthalmic drops MOA

A

decreases aqueous humor production by ciliary epithelium

acetazolamide does this too

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28
Q

Drugs that increase outflow of aqueous humor

A

muscarinic agonists: pilocarpine, carbachol - increase outflow at trabecular

prostaglandin agonists = PGF2alpha - latanoprost, travoprost

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29
Q

Drugs that decrease aqueous humor production

A

timolol

acetazolamide

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30
Q

MOA IFN-alpha and IFN-beta

A

secreted in response to viral infection

decrease/stop protein synthesis of infected and nearby cells (autocrine/paracrine)

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31
Q

Results of defective ApoE3 and ApoE4

A

decreased clearance of chylomicrons and VLDL –> elevated cholesterol and TGs

eruptive palmar xanthomas (yellow nodules/papules) and premature atherosclerosis

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32
Q

Chronic Alcoholic Pancreatitis

A

abdominal pain, chronic diarrhea, weight loss due to exocrine insufficiency and malabsorption

xray shows calcifications in the apigastric area

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33
Q

Dietary Energy

A

Protein - 4cal/1g
Carbs - 4cal/1g
Fats - 9cal/1g
Ethanol - 7cal/1g

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34
Q

Anaplastic Features

A 
loss of cell polarity
pleomorphism - high variation in cell size and shape
high N:C ratio
lots of mitotic figures 
giant multinucleated cells
35
Q

Effect of Nitrite Exposure

A

converts Fe2+ hemoglobin –> Fe3+ methemoglobin

Methemoglobin cannot carry oxygen, causes dusky skin discoloration

decreases oxygen carrying capacity, oxygen content, and bound fraction of oxygen

partial pressure of oxygen (oxygen dissolved in the plasma, regardless of hemoglobin content/status) remains normal

36
Q

Contra-indication for fibrate therapy?

A

gallstones!

fibrates inhibit bile acid synthesis –> decreased cholesterol solubility –> increase precipitation of cholesterol and gall stone formation

37
Q

Lesch-Nyhan

A

X-linked Recessive deficit in HGPRT (decreased purine salvage)

see increased PRPP (phosphoribosyl pyrophosphate amidotransferase) due to increased de-novo purine synthesis

symp: dystonia, developmental delay, self-mutilation, hyperuricemia, ‘orange sand BM’

38
Q

Uric acid precipitation

A

collecting ducts due to low urine pH

uric acid precipitates in an acidic environment

tx - urine alkalinization - acetazolamide

39
Q

Hemolytic disease of the newborn

A

erythroblastosis fetalis

destruction of fetal RBCs by maternal IgG due to Rh incompatibility

positive direct Coombs test (autoimmune hemolysis)
anemia
jaundice
hydrops fetalis (massive edema) 
extramedullary hematopoiesis
40
Q

COPD and Respiratory Drive

A

Chronic hypercapnia –> blunted PaCO2 response

decreased PaO2 becomes the main respiratory drive; detected by the carotid and aortic bodies

PaCO2 detected by central chemoreceptors in the medulla by decreased pH in the CSF

41
Q

Superior Orbital Fissue

A 
carries: 
Occulomotor Nerve (CN III) 
Trochlear Nerve (CN IV) 
Ophthalmic Nerve (CN V1) 
Abducens Nerve (CN VI) 
Superior ophthalmic vein

lesion here would cause loss of corneal blink reflex and inability to adduct eye

42
Q

alpha unit of hCG is similar to

A

LH

also FSH

43
Q

Staph aureus food poisoning

A

due to ingestion of lots of preformed exotoxin from picnic/potluck mayo containing foods

rapid onset (<6hrs) nausea, vom, abd cramps

also poultry, egg, meat, tuna, and dairy foods

44
Q

Hypophosphorylated Rb protein

A

prevention of G1/S cell cycle transition

45
Q

Urodynamic changes in MS

A

bladder hypertonia and poor distensibility due to loss of inhibition

urge incontinence and OAB aka spastic bladder

46
Q

IgA nephropathy

A

painless hematuria 5-7 days post URI

deposition of IgA complexes in the mesangium

LM - mesangial hypercellularity

IF - IgA in the mesangium

Henoch-Schönlein purpura if extra-renal symptoms: abd pain, arthralgia, palpable purpura

47
Q

Short acting insulins

A

Lispro
Aspart
Glulisine

peak in 0.5-3hours

given just pre-meal

48
Q

MOA of hydroxyurea in HbS patients

A

increases hemoglobin F synthesis

MOA unknown :D

49
Q

First Generation H1 blockers

A

hydroxyzine, promethazine, chlorpheniramine, diphenhydramine

sedative and contraindicated in older patients due to fall risk

tx: allergy, motion sickness, sleep aid

50
Q

Newer H1 blockers

A

Loratadine, cetirizine, fexofenadine

non sedating and good for the treatment of allergy!

51
Q

Tx for anaerobic pneumonia (due to aspiration)

A

Clindamycin!

52
Q

Drugs related to Drug-Induced Lupus Erythematosus

SLE-like syndrome

A

Drugs that are metabolized by N0acetylation in the liver

Isoniazid
Procainamide
Hydralazine

(also:Phenytoin, Sulfa drugs)

53
Q

Hydralazine

A

increases cGMP in smooth muscle –> vasodilation arterioles>veins (reduces afterload)

given with beta-blockers to prevent reflex tachy

54
Q

MOA External beam radiotherapy

A

causes dsDNA breaks

55
Q

Manifestation of Hyperestrinism in Liver Cirrhosis

A

gynecomastia
testicular atrophy
decreased body hair
spider angiomata (estrogen is arteriolar dilator)

56
Q

Osteodystrophy

A

long-term complication of chronic renal disease

derangements in Ca and Phos –> increased PTH –> osteopenia and osteomalacia

57
Q

Site of obstruction in fetal unilateral hydronephrosis

A

Ureteropelvic junction

58
Q

Most common cause of viral meningitis?

A

Enteroviruses (coxackievirus A, poliovirus, echovirus)

aka aseptic meningitis

59
Q

Atrial Natriuretic Peptide

A

Kidney: dilates afferent arteriole –> increased GFR –> increased urinary output
AND inhibits renin secretion

Adrenal Gland: decreases aldosterone secretion

Blood Vessels: relaxes smooth muscle –> vasodilates

ANP broken down by neprilysin

60
Q

Resistance in Parallel

A

1/Rtotal = 1/R1 + 1/R2 ..etc

61
Q

Prophylaxis for HIV CD4 < 200

A

TMP-SMX or dapsone for PCP pneumonia and toxo ghondi

62
Q

Prophylaxis for HIV CD4 < 50

A

Azithromycin + Rifambutin for MAC

63
Q

Glossopharyngeal Nerve CN IX

A

Sensory: tympanic membrane, tonsils, and posterior 2/3 of tongue (taste and touch) and gag reflex

Motor: stylopharyngeus

carotid body and carotid sinus

64
Q

Aortic Arch Derivatives

1
2
3
4
6
A 
1 = maxillary "maximal is first"
2 = stapedial (stapedial is second)
3 = Common Carotid (and prox internal carotid)
4 = aortic arch and prox R. subclavian 
6 = pulmonary arteries and ductus arteriosus
65
Q

How are viral proteins prepared for presentation on MHC-I

A

via ubiquitin ligase –> ubiquitin protease

66
Q

Anterolateral humeral fracture (distal)

A

radial nerve injury

67
Q

Anteromedial humeral fracture (distal)

A

median nerve injury

brachial artery injury

68
Q

Fragile X syndrome

A

FMR1 gene on X chromosome

long, narrow face
prominent forehead and chin
large testes
hyperlaxity of joints of the hand

developmental delay (speech and motor) 
ADHD, anxiety, autism spectrum
69
Q

Nerve injured during thyroidectomy

A

external branch of superior laryngeal - innervates cricothyroid muscle

runs with superior thyroid artery and vein

70
Q

Response to High Altitude

A

decreased PO2 –> decreased PaO2

increased ventilation –> decreased PaCO2

decreased PaCO2 –> respiratory alkalosis

respiratory alk –> increased pH

increased RR, increased EPO, increased 2,3 BPG, increased renal excretion of HCO3-

71
Q

Class III Antiarrhythmics

A

Decreased function of voltage gated potassium channels in cardiac myocytes

prolonged QT and prolonged action potential duration

can degenerate into torsades de pointes or v. fib

ex. Amiodarone, Ibutilide, Sotalol

72
Q

Central Obesity and Pulmonary Function

A

Restrictive Lung Dz

Decreased: FEV, FVC, ERV, TLC
unchanged: RV

73
Q

Fructose 2,6-bisphosphate

A

Activates PFK1 –> increased glycolysis

inhibits gluconeogenesis

74
Q

Aminoglycosides

A

Inhibit @ 30S –> bacteriCIDAL

good for gram negative rods (esp Pesudomonas)

ARDs: nephrotoxic, ototoxic, teratogen, tendon rupture

(-mycin/micin) - gentamicin, neomycin, tobramycin

75
Q

ADR of Tamoxifen

A

Endometrial hyperplasia and carcinoma
Hot Flashes
VTE (venous thromboembolism)

76
Q

MOA Benzodiazepines

A

increase FREQUENCY of Cl- channel opening

“I want benzos all the time”

77
Q

MOA Barbiturates

A

increase DURATION of Cl- channel opening

barbitDURates

78
Q

Rivaroxaban

A

Factor Xa inhibitor

rivaroXaban also apiXaban

79
Q

Direct thrombin IIa inhibitors

A

Dabigatran, argatrobam, bivalirubin

80
Q

Wright-Giemsa stain

A

used to visualize reticulocytes, picks up rRNA

81
Q

Age-Related Macular Degeneration

A

gradual vision loss due to chronic oxidative damage

grayish discoloration of the macula with areas of adjacent hemorrhage

Tx: VEGF inhibitors (bevacizumab, ranibizumab)

82
Q

Meconium ileus

A

Cystic Fibrosis

obstructs at ileum

83
Q

Acute vs Chronic Pericarditis

A

Acute
friction rub

Chronic
friction rub
3rd heart sound
pulsus paradoxus - drop in systolic >10 on inspiration
kussmaul sign - increased JVP with inspiration

increase venous return with inspiration

Caleb's Step 1 (16 decks)

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