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Caleb's Step 1 > March 19 > Flashcards

March 19 Flashcards

1
Q

Fidaxomicin

A

Treatment for c. diff

macrocyclic antibiotic that inhibits the sigma subunit of RNA polymerase –> CIDAL

coverage more narrow than metro or vanc

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2
Q

First Dose Hypotension

A

ACE Inhibitors (-prils)

Significant hypotension due to loss of vasoconstricting effects of AngII

especially seen in volume depleted pts, like those taking diuretics

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3
Q

Tissue Hypoxia

A

increase in intracellular NADH causes decreased pyruvate dehydrogenase activity and shunting of the pathway towards Lactate production by LDH

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4
Q

Essential Fructosuria

A

aka Benign Furctosuria

Defect in Fructokinase causes consumed fructose to be peed out unchanged

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5
Q

Primary CNS Lymphoma

A

EBV

AIDS and Immunosuppressed

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6
Q

PE effects of ABG (arterial blood gas)

A

PE causes V/Q mismatch

hypoxemia –> increased respiratory drive –> hyperventilation (which doesn’t improve blood oxygenation)

blow off the CO2 without taking up enough O2

decreased PaCO2 and respiratory alkalosis

bicarb is unchanged acutely

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7
Q

Mitral Stenosis

A

Rheumatic Fever

low-pitched diastolic rumble at the apex

can cause hemoptysis due to occlusion at mitral valve and resultant high pulmonary pressure

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8
Q

Peutz-Jeghers Syndrome

A

Autosomal Dominant mutation in STK11 on Chr 19

pigmented mucocutaneous macules (freckles on the lips) and hamartomatous polyps in GI

symp: abd pain, GI bleeds, obstruction

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9
Q

Liposarcoma

A

Scalloping of the nuclear membrane

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10
Q

Pemphigus vulgaris

A

autoantibodies to desmogleins

flaccid bullae

+ Nikolsky

see Ig deposition between keratinocytes
intercellular IgG andC3 in ‘chicken wire’ pattern

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11
Q

Bullous pemphigoid

A

tense bullae with IgG deposition at Basement Membrane

  • Nikolsky

like a bull frog

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12
Q

Pancoast Tumor

A

Apical bronchogenic carcinoma that invades brachial plexus –> clumsy limb

compresses cervical ganglion –> Horner syndrome (miosis, ptosis, anhidrosis)

anisocoria = unequal pupils, like in Horners Syndrome

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13
Q

ADR of Lithium

A

Nephrogenic DI

dysfunction of the collecting tubules - do not respond to ADH/ddAVP

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14
Q

Hypertrophic Cardiomyopathy

A

LV and septum hypertrophy

LW outlet obstruction

ischemia due to immense thickness of myocardium

coronary arteries normal

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15
Q

S2 Heart Sound

A

@ closure of Aortic (A2) and Pulmonic (P2) valves

inspiratory split due to delayed closure of pulmonic valve as blood moves ‘forward’

‘wide S2’ = splitting A2/P2 - seen with Right Bundle Branch Block and Pulmonary Stenosis - prolong RV ejection time

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16
Q

CD40 Ligand Deficiency

A

Hyper IgM syndrome

inability to class switch B-cells 
decreased IgE, IgA, IgG
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17
Q

HNPCC

A

Mismatch Repair Defect.

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18
Q

ADR Tacrolimus

A

Tacrolimus and Cyclosporine are Calcineurin inhibitors

NEPHROTOXIC

renal arteriolar vasoconstriction and obliterative vasculopathy, glomerular scarring

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19
Q

Cyclophosphamide

A

alkylating agent

tx: solid tumor, leukemia, lymphoma

ADR: myelosuppression
hemorrhagic cystitis - prevent with MESNA

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20
Q

N-acetylcysteine

A

liquifies mucus

tx: COPD and CF

also for acetaminophen OD (regenerates glutathione)

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21
Q

Cyclosporine

A

calcinuerin inhibitor - blocks IL-2/mTOR pathway by preventing IL-2 transcription

NEPHROTOXIC

tx: transplant and PAIR diseases

gingival hyperplasia

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22
Q

Metoclopramide

A

D2 antagonist

tx: gastroparesis and antiemetic

Contraindicated in Parkinsons

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23
Q

Alkaptonuria

A

Autosomal recessive defect in Homogentisic Acid Deoxygenase –> impaired tyrosine metabolism

urine turns black on standing

Osteoarthropathy!!

homogentisic acid accumulates in cartilage - ochronosis - gives blue/black pigment

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24
Q

Acute Ischemia

A

depletion of ATP –> dysfunction of Na/K ATPase –> increased K extracellular

Cytoplasmic accumulation of Ca++ is the hallmark of ischemic injury

Normal:
Na outside
K inside

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25
Q

Marfanoid Body Habitus

A

Marfans - normal intellect - upwards lense dislocation (looking up at Mars)

Homocysteinuria - Intellectual Disability + Thrombosis - downward lens dislocation
defective CBS (cystathionine-beta-synthase)

MEN2B - medullary thyroid, pheo, mucosal neuroma

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26
Q

DNA Polymerase

A

Reads 3’-5’
Writes 5’-3’

need a primer at 3’ end to amplify

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27
Q

Peaked T waves

A

Hyperkalemia

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28
Q

Pineal gland tumor

A

upward gaze palsy

absent pupillary light reflex

impaired convergence

mass effect on dorsal midbrain @ superior colliculus

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29
Q

buy AT 30

CCEL at 50

A

Aminoglycosides and Tetracyclines - 30S

Chloramphenicol, Clindamycin, Erythromycin (Macrolides), Linezolid

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30
Q

Fluoroquinolones

A

inhibit DNA gyrase -floxacins

moxi/ciprofloxacin

tendon rupture

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31
Q

Lactase deficiency

A

expression of lactase genes declines with age

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32
Q

Kluver-Bucy Syndrome

A

Lesion of the amygdalae

loss of anger and fear
disinhibition –> inappropriate sexual activity, oral fixation, hyperphagia, placidity, amnesia

associated with HSV-1 encephalitis

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33
Q

Tardive Dyskinesia

A

longterm use of D2 blockers –> upregulation of DA receptors

rhythmic movements of face/lips/tongue + choreoathetoid movement of trunk and extremities

associated with 1st gen antipsychotics
switch tx to clozapine and quetiapine

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34
Q

Saddle embolus

A

decreased CO
increased SVR - systemic vascular resistance
increased Central Venous Pressure

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35
Q

Polio Vaccine

A

Live = Sabin = Oral
gives IgA and IgG immunity
can become virulent :(

Killed = Salk = IM
IgG only
cannot revert to virulence

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36
Q

Functions of Radial Nerve

A

extensor of elbow, wrist, and fingers
supination of forearm
abduction of thumb
sensory to posterior arm/forearm

radial revs the motorcycle

radial injury give wrist drop

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37
Q

Adenovirus

A

dsDNA virus, naked causes URIs

replicates via DNA-dependent DNA polymerase in the nucleus

pink eye, pneumonia, tonsilitis, URI, hemorrhagic cystitis

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38
Q

Rabies

A

Negri bodies - esosinophilic round cytoplasmic inclusions in the hippocampus

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39
Q

Renal Artery Stenosis

A

Afferent arteriole Dilation
Efferent arteriole constriction to maintain GFR

so RBF decreases MORE than GFR

FF = GFR/RBF, this gets bigger!

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40
Q

Synergy of Beta-Lactams and Aminoglycosides

A

Beta-lactams like penicillin disrupt the cell wall and allow aminoglycosides to get IN. and target 30S

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41
Q

Membranous Nephropathy

A

most common Nephrotic in Adults

LM w/ Jones methenamine silver stain –> thickened GBM

capillary loops are thickened and have ‘spike and dome’ due to subepithelial immune complex deposition

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42
Q

Metastasis of Colorectal Cancer

A

Distal rectum and anus drain to internal iliac veins –> caval system –> mets to LUNGs

above dentate line –> superior rectal vein –> portal system –> LIVER mets

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43
Q

Xerosis

A

winter itch - itchy rash dry cracked skin in old people during the winter - put on lotion

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44
Q

Insulin

A

increases Fructose-2,6-bisphosphate and activates PFK-1 –> glycolysis

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45
Q

Glucagon

A

decreases Fruc-2,6-bisphos –> gluconeogenesis

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46
Q

Basic Amino Acids

A

Histadine
Arginine
Lysine

“HAL is so basic”

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47
Q

Acidic Amino Acids

A

Aspartate and Glutamate

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48
Q

Nonpolar Amino Acid

A 
Alanine
Phenylalanine
Valine
Leucine
Isoleucine
Tryptophan
Methionine
Proline
Glycine
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49
Q

Probenecid

A

inhibits renal tubular secretion of penicillin via blockade of the Organic Anion Transporter OAT

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50
Q

UV DNA damage

A

thymine dimers

repaired with Nucleotide Excision Repair

defective in: Xeroderma Pigmentosum
AR
huge risk for cutaneous malig

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51
Q

Follicular Lymphoma

A

t(14:18)

increased Bcl-2 –> increased inhibition of apoptosis

waxing/waning LAD

small lymphocytes with cleaved nuclei

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52
Q

What is in a Neurofibroma?

A

Schwann Cells and Fibroblasts

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53
Q

Complication of Endometriosis

A

Infertility due to scarring

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54
Q

Paclitaxel

A

Microtubule inhibitor blocks @ Mitosis M

same family as Vinblastine and Vincristine

used in stent platelet to inhibit cell division and prevent intimal hyperplasia –> stent restenosis

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55
Q

Increased Urinary Orotic Acid

A

Ornithine Transcarbamoylase Deficiency.

congenital hyperammonemia

56
Q

Consequence of impaired hydroxylation of collagen

A

abnormal triple-helix formation

need to hydroxylate and glycosylate for triple helix

57
Q

Transduction

A

bacterial host DNA mistakenly packaged into bacteriophage –> transmitted to another bacteria and integrated into host DNA

generally @ LYTIC infection (lysis of infected cell)

58
Q

Uncal Hernitation

A

CN III lesion

fixed and dilated pupil on ipsilateral side

due to head trauma

temporal love under tentorium cerebelli

59
Q

Somatic Symptom Disorder

A

Real symptom that causes disproportionate stress/disruption of daily life

OCD about 1 tiny problem - excessive persistent thoughts about symptom(s)

60
Q

Korsakoff Syndrome

A

Memory impairment with CONFABULATION

confabulation = unintentional fabrication of memories (pt believe the lies are true)

thiamine deficiency in alcoholics

61
Q

Mismatch Repair Defect

A

HNPCC

increased micro-satellite instability –> increased cancer incidence

62
Q

Early signs of hypokalemia

A

fatigue
myalgia
muscle cramp
weakness

U waves at EKG

63
Q

Acute Respiratory Distress Syndrome

A

diffuse damage to lung parenchyma causes air spaces to fill with fluids

increased dead space
right-to-left shunting

hypoxemia and hypercapnia

64
Q

Site of Femoral Nerve Block Injection

A

Inguinal Crease

at lateral border of femoral artery

65
Q

ACEi and Renal Perfusion

A

AngII - constricts efferent arteriole
(up at low blood volume, restores GFR)

ACEi reduce AngII - efferent arteriole DILATION
(reduces GFR)

66
Q

Rhomboid-shaped crystals

A

calcium pyrophosphate crystals

but also

uric acid stones

67
Q

Hexagonal stones

A

cystine stones (6stine, have 6 sides)

seen @ cystinuria

defect in PCT, cannot resorb

C - cystine
O - Ornithine
L - Lysine
A - Arginine

68
Q

Coffin lid stones

A

Ammonium magnesium phosphate

caused by infection with urease +
Saph saprophyticus, Klebsiella, Proteus

precipitate at increased pH - alkaline urine

form staghorn calculi

69
Q

Parotitis

A

Inflammation of the Parotid

generally caused by Staph aureus

symp: firm, erythematous pre/post auricular swelling
dx: elevated amylase without pancreatitis (normal lipase_

risk factors: dehydration, intubation, anticholingerics (decreased salivation), dental work

70
Q

Buspirone

A

5-HT1a receptor agonist
Anxiolytic
tx: generalized anxiety disorder

does NOT interact with alcohol
SLOW onset of action takes 1-2 for effect

71
Q

Von Hippel-Lindau Disease

A

mutation at VHL tumor suppresor gene on Chr 3

hemangioblastoma (@cerebellum and retina)
Renal Clear Cell Carcinoma
Pheochromocytoma
cysts in the kidneys and pancreas

72
Q

Fetal Hemoglobin

A

Left shit in the oxygen dissociation curve

like decreased 2,3-BPG

made of 2alpha2gamma

73
Q

Kayser-Fleischer rings

A

Wilson’s Dz

brownish gray-green rings of Cu deposition in the Cornea

74
Q

Lisch Nodules

A

hamartomas in the iris

NF-1 on chr19

75
Q

Fibroadenoma

A

estrogen-sensitive benign breast tumor in young women

solitary, nontender, firm, well-demarcated, spherical nodule

76
Q

Melanoma

A

irregular nuclear contours, hyperchromasia, and round/spindle shape

commonly due to mutation of CDKN2A on Chr9p21 - dysregulation of the cell cycle

77
Q

Basal Cell Carcinoma

A

islands of basaloid tumor cells budding from epidermis or within dermis + nuclear palisading

78
Q

Telencephalon

A

Cerebral hemispheres and lateral ventricles

79
Q

Diencephalon

A

thalamus and 3rd ventricle

80
Q

Mesencephalon

A

Midbrain and aqueduct

81
Q

Metencephalon

A

pons, cerebellum, upper 4th ventricle

82
Q

Myelencephalon

A

Medulla and lower 4th ventricle

83
Q

Rhombencephalon

A

Metencephalon + Myelencephalon

all of brainstem except midbrain

84
Q

Prosencephalon

A

Telencephalon + Diencephalon

all of cerebral cortex

85
Q

Leucine Zipper

A

transcription factor composed of 2 alpha helix that form a dimer

basic amino acids + Leucine every 7th

86
Q

Hodgkin Lymphoma

A

Reed-Sternberg cells - ‘owls eyes’

large cell with abundant cytoplasm, bilobed nucleus, prominent eosinophilic nucleoli

painless LAD
B symptoms

87
Q

Where are nucleotides synthesized?

A

the cytoplasm

88
Q

p57 staining

A

indicates expression of maternal DNA
(paternal p57 is imprinted and silenced)

for differentiation of partial vs complete moles

complete is all paternal, no p57

89
Q

Primary HyperPTH

A

most common = Parathyroid Adenoma

“painful bones, renal stones, psychiatric moans, abdominal groans”

hypercalcemia, depression, fatigue, cardiac valve calcifications

90
Q

Esophageal hiatus

A

esophagus, anterior and posterior trunks of VAGUS

@T10

91
Q

Aortic Hiatus

A

aorta, thoracic duct, and azygos vein

92
Q

Amlodipine and Nifedipine

A

lower systemic blood pressure vasodilating at arterioles –> decreased afterload –> decreased stroke volume –> decreased blood pressure

93
Q

Glucokinase

A

liver and pancreatic beta cells

good for post-prandial uptake of glucose

mutated in MODY

high Km and Vmax than Hexokinase

94
Q

van Gierke Disease

A

Deficiency with Glucose-6-phosphatase

hepatomegaly
fasting hypoglycemia
lactic acidosis
hyperuricemia hyperlipidemia

cannot do gluconeogenesis

“fructose syrup results in lactic acidosis without increase in blood glucose)

95
Q

McArdle Disease

A

Deficiency with glycogen phosphorylase

weakness and fatigue
no rise in blood lactate after exercise

myoglobinuria

96
Q

Pontine hemorrhage

A

pinpoint pupils
loss of horizontal gaze
quadriparesis
decerebrate posturing = extended upper and lower limbs

–> coma –> death.

97
Q

Reactive Arthritis

A

Can’t see = conjunctivitis
Can’t pee = urethritis
Can’t climb a tree = asymmetric oligoarthritis

Chlamydia trachomatis

or GI infection - salmonella, shigella, campy, yersinia

98
Q

What makes bruises look green?

A

heme –> biliverdin via heme oxygenase

99
Q

Blood flow to retina

A

internal carotid –> ophthalmic –> retinal Artery

100
Q

statistic used to compare mean of 2 patient groups?

A

Two-sample t test

101
Q

Thrombocytopenic thrombotic purpura - hemolytic uremic syndrome

TTP-HUS

A

pentad:
platelet activation in arterioles and capillaries
diffuse microvascular thrombosis (@ brain, kidneys, heart)
microangiopathic hemolytic anemia with schistocytes
thrombocytopenia

lethargy, renal failure, anemia, thrombocytopenia, @ GI illness

102
Q

Small cell lung carcinoma

A

clusters/sheets of small ovoid cells with scant cytoplasm and high mitotic count

neuroendocrine tumor
+ chromogranin
+ synaptophysin

centrally located mass associated with smoking

increased ADH, ACTH

103
Q

Giant cell Temporal Arteritis

A

granulomatous inflammation of the media

polymyalgia rheumatica - achy pain in shoulder and hip - seen in 50% of pts

104
Q

Nitroprusside

A

balanced venous and arterial vasodilator

decreased LV preload and afterload

lowers LV end diastolic pressure (preload)
lowers mean systolic intraventricular pressure (afterload)

SV maintained

105
Q

Tx for combined absence and tonic-clonic seizures

A

Valproate

measure LFTs - can cause fatal hepatotoxicity

also GI distress, NT defects, pancreatitis, wt gain

increases Na channel inactivation, increases GABA

106
Q

soft crescendo-decrescendo systolic murmur at apex of left sternal border

A

LV outflow obstruction (due to HCM)

avoid: vasodilators [DHPR Ca channel blockers and nitro] (decreases afterload and causes lower LV volumes which makes obstruction worse)

diuretics - decrease LV venous filling = preload, makes it worse

107
Q

Bartonella henselae

A

“cat-scratch disease’

vesicle –> erythematous papule –> LAD
esp axillary LAD

bacillary angiomatosis - benign capillary skin papule often mistaken for Kaposi but has neutrophils - in immunocompromised pts (CD<500)

108
Q

Pneumococcal vaccines

A

Provide immunity to strep pneumo polysaccharide capsule

Polysaccharide Pneumovax - not strongly immunogenic in children, covers 23 strains, only last ~5years - no mucosal immunity

Conjugate Prevnar -conj to diphtheria protein more efficacious in children and elderly , better immunogenic memory (memory B-cells)

109
Q

Acute Interstitial Nephritis

A

associated with fever, rash, hematuria, azotemia, and CVA tenderness

Hypersensitivity to Drugs that make you
Pee (diuretics)
Pain-free (NSAIDS)
Penicillins and cephalosporins 
PPIs
rifamPin

affects renal interstitium –> edema and WBC recruitment

110
Q

Galactokinase Deficiency

A

less severe than galactose-1-posphate uridyl transferase (presents in neonate with vomiting, lethargy, failure to thrive)

cataracts and reducing substances in the urine

cataracts due to accumulation of galactitol in lens

111
Q

CO Poisoning

A

increase in Carbodyhemoglobin
no change in methemoglobin
no change in PaO2

left shift in HgB O2 dissociation curve - poor tissue offloading

112
Q

LTC4 LTD4 LTE4

A

involved in pathogenesis of Allergic Asthma

cause bronchial constriction, mucosal edema, mucus hypersecretion

synthesized by mast cells, eosinophils, and basophils

receptor antagonists: zafirlukast, montelukast

113
Q

Methadone

A

mu-opiod receptor agonist with a LONG hlaf life

good for treatment of opiate addiction

114
Q

Thiazide diuretics

A

Work at Distal Convoluted Tubule

block Na/Cl symporter

ADR: metabolic alkalosis, hypoK+

hyperglycemia
hyperuricemia
hyperlipidemia
hypercalcemia (with low PTH)

115
Q

Holosytolic murmurs

A

Tricuspid Regurg - increased in intensity with inspiration @

Mitral Regurg - high pitched @ apex, best heard in left lateral decubitus

VSD - best heard at left sternal border @ 3/4 intercostal space

116
Q

Right-sided colon cancers

A

Ascending colon cancers

bulky, increased bleeding –> iron deficiency anemia

117
Q

Left-sided colon cancers

A

Descending colon

smaller, infiltrate colon wall, narrow lumen –> obstruction, distension, nausea, vomiting

118
Q

Differential cyanosis and clubbing

A

Affects lower extremities > upper

without discrepancy of pulse pressures (no coarctation of aorta) = PDA
PDA! - Eisenmenger syndrome

119
Q

Schizophreniform Disorder

A

symptoms of Schizoprenia for 1-6 months

delusions, hallucinations, disorganized speech/behavior, social withdrawal

120
Q

Congenital Rubella

A

microcephaly
cataracts (white pupils)
deafness (sensory-neural)
PDA and pulmonic stenosis

preventable; all women of child bearing age should get the Live Attenuated Vaccine!

kids also get it at 12-15mo and 4-6 years

Rubella is a Togavirus, +ssRNA linear enveloped

121
Q

Parvovirus B19

A

naked linear ssDNA virus

‘slapped cheek’ rash after prodrome of malaise, congestion, HA, fever

replicates in RBC precursors in the bone marrow

can cause aplastic crisis, esp in beta-thalssemia, Hereditary spherocytosis, and HbS

122
Q

Zenker Diverticulum

A

due to cricopharyngeal motor dysfunction

oropharyngeal dysphagia w/ feeling of obstruction

food gets stuck in the pouch –> halitosis

123
Q

flame-shaped hemorrhages

A

severe HTN

124
Q

Enlarged coronary sinus

A

elevated Right Heart pressures secondary to Pulmonary Hypertension

125
Q

Blocks peripheral conversion of T4 –> T3

A

Beta-blockers
PTU (propylthiouracil)
Ipodate (contrast agent)

126
Q

Carcinoid Syndrome

A

neuroendocrine cell proliferation

increased 5-HT and 5-HIAA (5-hydroxyindoleacetic acid)

diarrhea, cutaneous flushing, asthmatic wheezing, tricuspid regurg/pulmonic stenosis, pellagra (niacin deficiency due to increased tryptophan –> 5-HT)

Octreotide to relieve symptoms before

127
Q

ACEi contraindicated in?

A

Bilateral Renal Artery Stenosis

angII constricts efferent arteriole

decreased AngII –> dilated efferent arteriole –> decreased GFR :(

128
Q

Effects of DA at various doses

A

Low: increased GFR, RBF, and Na excretion
Medium: beta1 activity –> increased contractility, pulse pressure, systolic BP
High: alpha1 activity –> increased afterload and decreased CO

129
Q

Variant Angina

A

due to coronary vasospasm - transient seemingly unprovoked angina

provoked by: dihydroergotamine, cigarette smokes, cocaine, amphetamines, triptans,

130
Q

Complications of Rheumatoid Arthritis

A

cervical spine joint destruction –> subluxation of cervical vertebrae (at endotracheal intubation)

131
Q

Complication of Warfarin Therapy

A

Skin necrosis - esp in pts with Protein C and Protein S deficiency

protein C has a short half-life, leads to a transient hypercoag state in first few days of warfarin therapy

132
Q

Cytokeratin

A

epithelial cell marker

133
Q

Active SLE

A

consumption of complement and REDUCED serum complement

134
Q

Segmented Viruses

A

orthomyxo, bunya, arena, rota, reo

capable of reassortment

135
Q

Typical Cardiac Chamber pressures

A

RA: 2-10
RV: 2-25
Pulm Artery: 10-25
Wedge: ~10

Caleb's Step 1 (16 decks)

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