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Caleb's Step 1 > March 22 > Flashcards

March 22 Flashcards

1
Q

Origin cells of Renal Clear Cell Carcinoma

A

Proximal rental tubules

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2
Q

What Vitamin do exclusively breast fed babies need supplemented?

A

Vitamin D !

Also K but they get a K shot at birth

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3
Q

Acute hemolytic transfusion reaction

A

Type II Hypersensitivity

IgM/IgG bind foreign cells –>
opsonization and phagocytosis or
complement mediated cell lysis

symp: fever, chills, hypotension, dyspnea, chest/back pain, hemoglobinuria (red/brown urine)

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4
Q

12th rib fracture

A

kidney damage

kidney is immediately deep to 12th ribs

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5
Q

what ribs overlie the spleen

A

Left 9th, 10th, 11th

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6
Q

Fructose-6-phosphate to ribose-5-phosphate

A

Transketolase

generates NADPH

NADPH for glutathione antioxidant
NADPH for fatty acid, cholesterol, steroid synthesis

Glucose-6-phosphate dehydrogenase (G6PD also generates NADPH)

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7
Q

Thayer-Martin Media

A 
Contains: 
vancomycin - inhibits gram +
colistin=polymyxin - inhibits gram -
nstatin - inhibits fungi 
trimethoprim - inhibits proteus

grows Neisseria

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8
Q

Areas of the brain for Deep Brain Stimulation for medically intractable Parkinson Symptoms

A

Subthalamic nucleus
globus pallidus internus

inhibiting there results in thalamo-cortical disinhibition and improved mobility

globus pallidus internus is inhibitory - puts the breaks on

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9
Q

Complication of Measles

A

days: encephalitis
weeks: acute disseminated encephalomyelitis
years: subacute sclerosing panencephalitis (symp: ataxia, myoclonus, visual problems - biopsy shows RNA virus with hemagglutinin)

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10
Q

Intraabdominal Infections (bugs)

A

usually polymicrobial

E. coli
B. fragilis

2 most commonly isolated

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11
Q

Aminoglycosides

A

bacteriocidal inhibition of 30S rRNA

Gentamicin, Neo/Tobra/StreptoMYCIN

good for severe gram - rod infections

ADR: nephrotoxic, ototoxic, neuromuscular blockade, teratogen

resistance: bacterail enzymes that acetylate, phosphorylate, adenylate

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12
Q

Tetracyclines

A

bacteriostatic inhibition of 30S rRNA

Tetra/doxy/minoCYCLINE

Chlamydia, borrelia burgdorferi, Myco pneumoniae

ADR: teeth and bones in children, photosensitivity, GI distress, ‘teratogen’

resistance: decreased uptake, increased efflux with transport pumps

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13
Q

ADRs of TB Treatment

A

Rifampin - GI, rash, red/orange fluids
Isoniazid - neurotoxic (give B6), hepatotoxic
Pyrazinamide - hepatotoxic, hyperuricemia
Ethambutol - optic neuropathy

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14
Q

How is CO preserved in chronic aortic regurg

A

LV hypertrophy and increased LV stroke volume

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15
Q

Pharmacodynamics of Regular Insulin

A

starts in 30 min
peaks in 2-4 hours
lasts 5-8 hours

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16
Q

Serotonin Syndrome

A

Triad:

Autonomic Instability (hyperthermia, hypertension, tachycardia)
Altered Mental Status (agitation/confusion)
Neuromuscular Hypersensitivity (tremor, hyperreflexia, myoclonus)

usually occurs when there is a combo of MAOi + SSRI/SNRI/TCS

Linezolid has MAOi properties, can also do this in the treatment of MRSA

tx: cyproheptadine

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17
Q

Complication of neonatal oxygen supplementation

A

retinal neovascularization that extends into the vitreous (occurs due to local hyperoxia which upregulates VEGF)

aka retinopathy of prematurity

aka retrolental fibroplasia

retinal detachment and blindness are further complications of the neovascularization

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18
Q

Membranous Glomerulopathy

A

Nephrotic

glomerular capillary wall thickening without an increase in cellularity

with silver methenamine stain: irregular spikes protruding from GBM (immune complex deposition)

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19
Q

Winters Formula

A

Used to determine respiratory compensation for metabolic acidosis

Predicted PCO2 = [1.5(HCO3-) + 8] +/- 2

if measured PCO2>Predicted then concomitant respiratory acidosis

if measured PCO2

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20
Q

Cyanide Toxicity

A

from Nitroprusside infusions

symp: altered mental status, seizures, lactic acidosis, bright red venous blood)

tx: sulfur donors - Sodium Thiosulfate
Sodium Nitrite
Hydroxycobalamin - allows for urinary excretion

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21
Q

Tumor Lysis Syndrome

A

occurs with rapid destruction of cancers with rapid cell turnover (lymphoma, leukemia, etc)

huge cell lysis –> hyperkalemia and arrhythmia AND hyperurecemia

tx: aggressive hydration, allopurinol, rasburicase (reduces uric acid levels)

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22
Q 
Carbamazepine
Barbiturates
Phenytoin
Rifampin
Griseofulvin
St. John's wort
Modafinil 
Cyclophosphamide
A

CYP INDUCERS

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23
Q 
Amiodarone
Cimetidine
Fluoroquinolones (-floxacin)
Clarithromycin
Azoles
Grapefruit Juice
Isoniazid
Ritonavir
A

CYP INHIBITORS

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24
Q

Paraaminohippuric Acid (PAH)

A

~RPF

is filtered from glomerular capillaries into Bowman’s space - FILTRATION: cannot be saturated

So at any given concentration a constant proportion of PAH is filtered

it is also secreted into the PCT - SECRETION: carrier enzyme mediated and can be saturated ex. PAH max secretion is 80mg/min

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25
Q

Vagal maneuver

A

Carotid Sinus Massage, Valsalva, cold water immersion

Carotid sinus massage
afferent via glossopharyngeal
efferent via vagus nerve –> SA and AV nodes

increases vagal PNS tone –> slowed conduction through AV node and prolonged AV nodal refractory period

terminates supraventricular tachycardia

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26
Q

Central Retinal Artery Occlusion

A

sudden, painless, permanent monocular blindess

pale retina
cherry red macula (has seperate blood supply)

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27
Q

Glomus tumor

A

bluish neoplasm underneath the nail bed

glomus body = vasculature and smooth muscle cells that shunt blood flow away from skin surface @ cold to prevent heat loss

thermoregulatory

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28
Q

Pterion

A

junction of frontal, parietal, temporal, sphenoid bones

fractures here risk laceration of Middle Meningeal Artery –> Epidural Hematoma (lens shaped)

Middle meningeal artery is a branch of the Maxillary Artery

external carotid –> maxillary –> middle meningeal

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29
Q

Splenic artery (origin and branches)

A

celiac artery –> splenic artery –> (pancreatic, short gastric, Left gastroepiploic) –> spleen organ

gastric tissue supplied by short gastric A. (the fundus of the tummy) is vulnerable to ischemic injury with splenic artery occlusion

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30
Q

Breast Dimpling is a sign of breast carcinoma invasion of the ___?

A

Suspensory ligament of the breast aka Cooper ligament

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31
Q

Acetyl-CoA regulation of Pyruvate metabolism

A

Excess Acetyl-CoA (from fatty acid oxidation)

promotes Pyruvate Carboxylase: pyruvate –> OAA –> glucose

inhibits Pyruvate Dehydrogenase: pyrivate –> Acetyl-CoA –> energy!

Acetyl-CoA is pro-gluconeogenesis
Acetyl-CoA is anti-TCA cycle

32
Q

Golgi Tendon Organ

A

at the junction of muscle and tendon

detect active muscle contraction (insensitive to passive stretching of muscle)

if too much contraction occurs (too much force on the tendon) –> inhibition of muscle contraction! muscle relaxes to prevent tendon rupture

33
Q

McCune-Albright syndrome

A

Mosaicism

constitutive activation of Gs

Precocious puberty, unilateral cafe-au-lait spots, polyostotic fibrous dysplasia (bones look like clouds on xray)

lethal as a germline mutation
survivable due to mosaicism

34
Q

Kallmann Syndrome

A

Defective migration of GnRH cells and formation of olfactory bulb

anosmia (poor sniffer)
failure to complete puberty due to decreased GnRH –> decreased FSH and LH

35
Q

Buprenorphine

A

partial opioid agonist, binds with high affinity and can prevent/dislodge bound opioids

acts as receptor antagonist in the presence of full opioid agonists

can precipitate withdrawal

used in conjunction with methadone

36
Q

Methadone

A

opioid with long half life used to decrease symptoms of withdrawal without giving a ‘high’

37
Q

Nalaxone

A

Narcan

can reverse opioid overdose

38
Q

Naltrexone

A

long-acting opioid antagonist, prevents relapse

can be used in recovering narcotic addiction or alcoholic

39
Q

Gram negative rod
lactose fermenting
indole positive

A

E. coli

40
Q

Gram negative rod
lactose fermenting
indole negative

A

Enterobacter cloacae

41
Q

Topical Vitamin D analogs

A

Calcipotriene Calcipotriol Calcitriol Tacalcitol

activate Vitamin D receptor which is a nuclear transcription factor –> inhibition of keratinocyte proliferation and stimulation of keratinocyte differentiation

tx for psoriasis

42
Q

Auer Rods

A

APML

myeloblasts - large cells with abundant basophilic cytoplasm with auer rods that stain for (myelo)peroxidase

43
Q

Baclofen

A

GABA-B agonist

tx for spasticity @ brain and spinal cord disease (MS patients)

44
Q

Digoxin effects on ANS

A

increases parasympathetic tone –> inhibition of AV node –> decreased HR

45
Q

Cromolyn

A

inhibit mast cell degranulation independent of the stimulus (prevents exocytosis of preformed histamine vesicles)

second line therapy for asthma

46
Q

polyribosylribitol phosphate

A

PRP

component and virulence factor of Haemophilus influenae type b capsule

Hib is the most common cause of epiglottitis (fever, stridor, dyspnea)

47
Q

Paradoxical embolism

A

originate in the systemic circuit –> intracardiac shunt –> arterial circulation –> stroke

intracardiac shunts:
patent foramen ovale
ASD - wide fixed splitting S2 (no change with inspiration
VSD

48
Q

wide splitting S2 that does not change with respiration

A

Atrial Septal Defect

49
Q

Diastolic decrescendo murmur that decreases with nitrates

A

aortic regurg - gets better with decreased afterload

50
Q

ejection systolic murmur that increases on standing

A

hypertrophic cardiomyopathy (worsens due to increased LV outflow tract obstruction)

51
Q

ejection systolic murmur that decreases with standing

A

aortic stenosis

52
Q

pre-systolic murmur that disappears with atrial fibrillation

A

mitral or tricuspid valve stenosis

53
Q

last systolic crescendo murmur with midsystolic click

A

mitral valve prolapse

54
Q

Botulinum toxin

A

inhibits ACh release from the presynaptic nerve - blockade can be overcome via facilitation

nicotinic blockade: flaccid paralysis (diplopia, dysphagia)
muscarinic blockade: dry mouth (hot as a hare, red as a beet, dry as a bone, etc)

3 D’s: Diplopia, Dysphagia, Dysphonia

tx: antitoxin

55
Q

Reactive Arthritis

A

Urethritis, Conjunctivitis, Arthritis
can’t pee, can’t see, can’t climb a tree

associated with HLA-B27

from infections with Chlamydia, Salmonella, Shigella, Yersinia, Campylobacter, Clostridium difficile

56
Q

Myotonic Dystrophy

A

trinucleotide repeat disease (CTG)

myotonia (sustained muscle contraction)
muscle weakness and atrophy (esp Type 1 fibers)
cataracts
frontal balding and gonadal atrophy

57
Q

Atypical depression

A

leaden paralysis - arms/legs feel heavy
mood reactivity - feel better with positive events
rejection sensitivity - hypersensitive to criticism

58
Q

Treatment for Atypical Depression (and treatment-resistant depression)

A

MAOi: Phenelzine, Selegiline, Tranylcypromine

inhibit MAO deamination of 5-HT, NE, DA

ADR: serotonin syndrome, HTN crisis

59
Q

Latissimus dorsi

A

Innervation: Thoracodorsal N.
Actions: extension, adduction, medial rotation humerus

60
Q

CREST syndrome

A

Calcinosis - Ca deposition in soft tissue
Raynaud
Esophageal dysmotility
Sclerodactyly - thickening and tightening of skin @ fingers and toes
Telangiectasia

pulmonary arterial hypertension –> cor pulmonale

anti-centromere antibodies

61
Q

Treatment for Bipolar Disorder

A 
Lithium
Valproate
Quetiapine 
Carbamazepine
Lamotrigine - good for depression prevention
62
Q

Diastolic Heart Failure

A

Normal LV Ejection Fraction
Normal LV End-Diastolic Volume
Increased LV filling pressure

impaired relaxation: ischemic/fibrotic myocardia
ventricular wall stiffness: amyloid deposition, hypertrophy

63
Q

Necrotizing Enterocolitis

A

‘thin curvilinear areas of lucency that parallel the bowel wall lumen’

areas of lucency are gas

occurs in preterm infants

64
Q

anti-inflammatory that does NOT impair platelet aggregation

A

Celecoxib - COX 2 selective

65
Q

Secretin

A

S cells duodenum –> increased pancreatic secretion of bicarb by pancreatic duct cells

released in response to high H+ in the duodenum

66
Q

ADR of mannitol

A

can cause pulmonary edema

67
Q

Ureter is immediately anterior to

A

internal iliac artery

68
Q

Ureter is immediately posterior to

A

gonadal vessels

69
Q

Friedreich Ataxia

A

kyphoscoliosis
high plantar arch
degeneration of the spinocerebellar tract and lateral corticospinal
hypertrophic cardiomyopathy and congestive heart failure

trinucleotide repeat (GAA) of frataxin gene Chr9

Frat bro thats always staggering and falling but has a sweet big heart

Frataxin
Staggering gait
frequent falls
diabetes
hypertrophic cardiomyopathy
70
Q

gliosis

A

astrocytes

71
Q

LH

FSH

A

LH –> Leydig –> Testosterone

FSH –> Sertoli –> inhibin B and ABG

72
Q

Hemolytic Uremic Syndrome

A

microthrombi in small blood vessels

after infection with E. coli O157:H7 or Shigella

73
Q

as RBCs bind O2 they release

A

Haldane effect

H+ and CO2

74
Q

S1-S2

A

tie you shoe

achilles

75
Q

L3-L4

A

kick the door

patellar

76
Q

C5-C6

A

pick up sticks

biceps

77
Q

C7-C8

A

lay them straight

triceps

Caleb's Step 1 (16 decks)

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