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Caleb's Step 1 > March 25 > Flashcards

March 25 Flashcards

1
Q

Acute Respiratory Distress Syndrome (ARDS)

A

injury and inflammation of alveolar pneumocytes and pulmonary endothelium

increased pulmonary capillary permeability –> hyaline membrane formation

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2
Q

Diabetic Nephropathy

A

mesangial expansion
glomerular basement membrane thickening
glomerular sclerosis

Kimmelstiel-Wilson lesion if the sclerosis if nodular

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3
Q

Cardiac Conduction Velocites

A

His-Purkinje 2.2m/s
Atria 1.1m/s
ventricle 0.3 m/s
AV node 0.05m/s

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4
Q

Osteosarcoma

A

bone tumor associated with Paget’s disease of the bone

“mixed lysis and sclerosis with focal periosteal elevation and reactive new bone formation”

mixed radiodense and radiolucent areas
periostal ew born formation
lifting of the cortex

adjacent soft tissue shows “sunburst” pattern of ossification

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5
Q

Dicoumarol

A

vitamin K depletor

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6
Q

MOA Rifampin

A

inhibits mRNA synthesis

via DNA-dependent RNA polymerase

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7
Q

Globus sensation

A

aka Globus hystericus
aka Globus pharyngeus

sensation of “something stuck in the throat: when there isn’t

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8
Q

Endometriosis

A

endometrial glands and stroma out of uterus

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9
Q

Adenomyosis

A

endometrial glands and stroma into myometrium

painful, heavy periods

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10
Q

What vitamin should not be supplemented in pregnancy

A

Vitamin A

can be real teratogenic: abortion, microcephaly, cardiac anomaly

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11
Q

Micturition

A

Stretch of detrusor - pelvic
detrusor contraction - hypogastric
sphincter relaxation - pudendal

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12
Q

Auer Rods

A

t(15:17) APML

tx - all-trans retinoic acid

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13
Q

Chromosomal Translocations

APML
Burkitt Lymphoma
CML
ALL
Follicular
A 
APML - 15:17 #auerrods
Burkitt - 8:14
CML - 9:22 #imatinib
ALL - 12:21
Follicular - 14:18
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14
Q

cytokine exclusive to T-cells

A

IL-2 - only released by T-cells

stimulates growth and differentiation of T, B, NK cels and macrophages

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15
Q

Molluscum contagiosum

A

poxvirus (enveloped linear dsDNA)

flesh colored papules (pruritic) with umbilicated centers contained white, curd-like material

microscopy: large eosiniphilic cytoplasmic inclusions aka cytoplasmic inclusion bodies

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16
Q

Vessel at greatest risk of injury @ Knee Dislocation

A

Popliteal artery is high risk for Anterior and Posterior knee dislocations

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17
Q

Postpartum endometritis

A

occurs after C-section and amniocentesis

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18
Q

Chronic cocaine abuse

A

chronic nasal discharge
atrophic nasal mucosa
perforation of the nasal septum

ulceration/perforation of the palate
oropharyngeal ulcers

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19
Q

Heminephrectomy

A

50% GFR immediately after removal of 1 kidney
65-70% GFR within the first week
80% by 4-6 weeks

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20
Q

Serratus Anterior

A

stabilizes and rotates the scapula upwards

injury causes winging of medial border of the scapula

innervated by the long thoracic nerve

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21
Q

Exocrine pancreatic secretions

A

fixed: High Na, Low K
at low flow: Cl- > HCO3-
at high flow HCO3- > Cl-

stimulate pancreas, shoot out bicarb because we have a big acidic chyme ball incoming

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22
Q

Exocrine salivary secretions

A

fixed: HCO3 > Cl
at low flow: K > Na
at high flow: Na > K

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23
Q

Acute Stress Disorderq

A

PTSD but shorter

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24
Q

Wound Healing 1-3days

A

Inflammatory

cells: platelets, nuetrophils, macs

clot formation, increased vessel permeability, and neutrophil migration

@ day 2 macrophages clear debris

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25
Q

Wound Healing 3days - weeks

A

Proliferative Phase

cells: fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages

deposition of granulation tissue, type III collagen, angiogenesis, dissolution of clot,

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26
Q

Wound Healing weeks - months

A

Remodeling Phase

cells: fibroblasts

replace type II collagen with type I collagen (increases tensile strength of tissue)

via metalloproteinases

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27
Q

overexpressed in a keloid scar

A

PDGF platelet derived growth factor

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28
Q

Erythema multiforme

A

infections and drugs (sulfa and beta-lactam)

macules, papules, vesicles, target lesions

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29
Q

Herpes encepahlitis

A

tends to affect temporal lobe

hallucinations, personality change, delirium

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30
Q

Acute Intermittent Porphyria

A

Autosomal Dominant defect in Porphobilinogen deaminase

abd pain, port-wine colored urine, PBG and ALA in urine, neuro changes (restless, irritable, aggressive)

precipitated by CYP450 inducers: EtOH, smoking

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31
Q

sterile urine cultures and pyuria (puss in the urine)

A

Chlamydia or neisseria g.

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32
Q

Myasthenia gravis

A

fatigable chewing, diplopia, weakness of the face muscles

10% get thymoma

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33
Q

DKA electrolyte changes

A

increase K
decrease Na
increase H
increase ammonia due to muscle degradation

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34
Q

Preoperative medical management of Pheochromocytoma

A

Phenoxybenzamine - alpha adrenergic blocker prevents hypertensive crisis during removal

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35
Q

Intraventricular hemorrhage in a premature infant

A

due to germinal matrix fragility

the germinal matrix @ subependymal zone

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36
Q

Cisplatin

A

ototoxic, damages hair cells in the cochlear membranous labyrinth

tx for: testicular, bladder, ovary, lung carcinoma

cross-links DNA

nephrotoxic, ototoxic, peripheral neuropathy

prevent ADRs: amifostine and hydration

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37
Q

aspirin-exacerbated airway disease

A

dysregulation of arachadonic acid pathway

towards 5-lipoxygenase pathway –> leukotrienes

LTC, LTD, LTE - bronchoconstrictive

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38
Q

Birbeck Granules

A

langerhanscellhistiocytosis

Langerhans cells
S-100+

lytic bone lesion + eczema like rash

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39
Q

Melanin distribution

A

Black - free melanin
Asian - in a melanosome above the nucleus
White - in a melanosome anywhere in the cell

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40
Q

Hemodynamic affects of Nitrates

A

vasodilate –> less preload = Decreased End-Diastolic LV Volume

decreased SV and decreased BP

reflex Tachy, increase HR to preserve CO

41
Q

Histone Acetylation

A

Activates - relaxes DNA coiling and allows for transcription

42
Q

Linker Histone

A

H1

43
Q

Pseudohypoparathyroidism

A

end-organ resistance to PTH

hypocalcemia, hyperphosphatemia, increased PTH

short stature, short fingers, round face

44
Q

Allelic heterogeneity

A

different allele mutations cause same disease presentation

ex. mutations in different exons still make beta-thalassemia

45
Q

Exercise-induced asthma

A

exercise/cold –> shest tightness, wheezing

eosinophils and mast cells –> LTC/LTD/LTE –> bronchospasm and increase bronchial mucus secretion

tx: Montelukast -antileukotriene medication

46
Q

Hereditary Hemochromatosis

A

“Bronze Diabetes”

hyperpigmentation, arthralgia

hepatomegaly –> cirrhosis –> hepatocellular carcinoma

DM & hypogonadism & hypothyroidism

restrictive/dilated cardiomyopathy

excessive iron uptake in the gut

47
Q

Portal Hypertension

A

can cause increased pressure in the splenic vein –> splenomegaly

48
Q

N-terminal peptide signal sequence of mRNA

A

targets to RER

without this you accumulate in the cytosol

49
Q

MSUD

A

deficiency in branched chain alpha-keto acid dehydrogenase - requires Thiamine

pt presents with severe metabolic acidosis and increased amounts of branched-chain alpha-keto acids in the blood and urine

also poor feeding and vomiting

inability to decrease Leucine, Isoleucine, Valine

50
Q

Glucagon

A

Glucagon –> Gs –> adenylate cyclase –> increase cAMP –> PKA –> glycogenolysis and gluconeogenesis

51
Q

Hyperhidrosis

A

increased sympathetic nervous system activity

ANS cholinergic neurons innervate eccrine and apocrine glands

Surgical sympathectomy - cut the sympathetic trunk at T2

Thoracic Sympathetic Trunk!

52
Q

Red Safranin

A

cartilage (collagen type II) = carTWOlage
mast cell granules
mucin
peptidoglycan layer (gram negatives)

53
Q

Gubernaculum remnant in females

A

round ligament attaches uterus to labia majora via inguinal canal

round ligament is covered in broad ligament
round ligament is inferior to fallopian tube

54
Q

Pheo outside of adrenals

A

Paraganglioma

origin: chromaffin cells at the organ of Zuckerkandl (which is a collection of chromaffin cells at the aortic bifurcation)

these secrete epi and norepi

elevated Vanillylmandelic acid (breakdown product)

55
Q

ABG for PE

A

pH increased
CO2 decreased
O2 decreased

56
Q

Pulmonary endothelial dysfunction

A

Pulmonary Arterial Hypertension –> cor pulmonale

57
Q

Uterine Fibroids

A

aka Uterine Leiomyomas - benign

heavy menstrual bleeding due to venous ectasia (dilation) from vasoactive growth factors secreted by the tumors

can also present with an irregular and enlarged uterus

58
Q

Ischemic Colitis

A

crampy abdominal pain, tenderness to palpation, bloody stools

early: mucosal hemorrhage and patchy areas of necrosis
late: bowel wall thickening, edema, and transmural infarction

can be caused by hypoperfusion (shock) or decreased CO (thrombosis and embolism)

59
Q

Why do sclera appear blue in OI?

A

defective type I collagen –> thin sclerae and visible underlying choroid

60
Q

Medium Chain Acyl-CoA Dehydrogenase Deficiency

A

hypoglycemia
hypoketones
hepatomegaly

hypoglycemia after fasting + low ketones = impaired beta-oxidation

most common cause is MCAD deficiency

61
Q

Protein that functions to transduce signals from the cell membrane to the nucleus by activating other molecules?

A

Ras (promotes mitogenesis)

GTP binding protein

proto-oncogene with 1 hit GAIN of function

cholangiocarcinoma
pancreatic adenocarcinoma

62
Q

Osteoarthritis

A

progressive erosion of articular cartilage
pain is worse with activity and at end of the day

increasing age is biggest risk factor
other risk factors: obesity, female, trauma, abnormal joint alignment

63
Q

Carcinoid Syndrome

A

serotonin producing tumor that has metastasized to the liver

flushing, hypotension, diarrhea, bronchospasm, pellagra (all the tryptophan is used to make 5-HT, none left to make niacin)

tx: octreotide

64
Q

Initiation of translation

A

5’ cap of mRNA binds small rRNA –> scanning for AUG start codon

@ apoptosis an alternate method is used
IRES (Internal Ribosome Entry Site) allows rRNA binding and translation in the middle of an mRNA

65
Q

DM medication that induces differentiation of preadipocytes into adipocytes and increased GLUT4 expression on the adipocyte cell membrane

A

Thiazolidinedione

ex. Pioglitazone

decreased insulin resistance via increased GLUT4 (insulin-responsive glucose transporter @ adipocytes and skeletal muscle)

66
Q

most frequently involved site for Crohn’s

A

terminal ileum

67
Q

most frequently involved site for Celiac

A

distal duodenum and proximal jejunum

68
Q

treatment for hyperammonemia

A

lactulose

acidifies gut lumen, NH3 comes in and gets trapped as NH4+ for excretion

69
Q

treatment of acute severe asthma attack

A

Albuterol! beta2-adrenergic agonist

activates G2 –> increased cAMP –> bronchial smooth muscle relaxation

70
Q

Osteomalacia

A

decreased mineralization of Osteoid (generally due to decreased calcium and phosphorus)

causes: VitD deficiency, malabsorption, chronic kidney disease, renal tubular acidosis
symp: bone pain, tenderness, muscle weakness, fractures

71
Q

Li-Fraumeni

A

autosomal dominant early onset malignancies (breast, bone, soft tissue, brain, adrenocortical)

due to inactivating mutation affecting 1 allele

two-hit hypothesis @ tumor suppressor gene (TP53)

other genes and syndromes like this

Lynch - MSH2, MLH1, MSH6
FAP - APC
VHL - VHL
MEN1 - MEN1

activating gain of function mutation seen at
MEN2A - RET gene

72
Q

Papillomavirus

A

HPV

naked circular dsDNA

73
Q

Poxvirus

A

Molluscum Contagiosum

enveloped linear dsDNA virus

74
Q

Polyomavirus

A

JC Virus - Junky Cerebrum (progressive multifocal leukoencephalopathy in HIV

BK virus - Bad Kidney - transplant pateints

naked circular dsDNA

75
Q

ASD murmur

A

fixed splitting of S2

left to right makes the RV receive extra blood, increased pulmonary blood flow, and delayed closure of the pulmonic valve

76
Q

Esophageal aperistalsis

A

Achalasia

absence of esophageal peristalsis in the distal esophagus and tonic LES

77
Q

G6PD deficiency

A

acute onset anemia in an African/Asian/Mediterranean individual

TMP-SMX, other sulfonamides, fava beans

78
Q

Lesion to Broca’s area

A

Broca’s aphasia

inferior frontal gyrus of dominant (usually left) hemisphere

non-fluent, agrammatic, intact comprehension, poor repetition

79
Q

Normally unmyelinated fibers

A

slow pain, heat, olfaction.

autonomic postganglionic nerves

80
Q

Picornavirus

A

positive linear naked ssRNA

P - polio
E - echo (aseptic meningitis)
R - rhino 
C - coxsackie (hand food mouth, meningitis, myocarditis, pericarditis) 
H - HAV
81
Q

MHC class II (HLA-D) antigen presentation

A

Macrophage/Dendritic cell/B-cell = APC

invariant chain brings alpha and beta chains together in the RER

invariant chain @ RER –> golgi –> endocytic compartment –> proteolytic degradation –> exogenous protein is then inserted between alpha and beta chains

Invariant chain is digested by macrophages during antigen presentation

82
Q

Iron Deficiency Anemia

A

hypochromic, microcytic anemia

tongue pain/ burning sensation in the mouth, dry mouth, reduced taste due to atrophy of tongue papillae, alopecia

83
Q

Quellung reaction

A

capsular swelling - for encapsulated bacteria

84
Q

PCOS

A

increased Testosterone

85
Q

PCOS

A

increased Testosterone

86
Q

Pilocarpine

A

Cholinomimetic - acts like ACh

@ eye causes miosis via contraction of pupillary sphincter muscle

stimulator of sweat, tears, saliva

87
Q

Pernicious Anemia

A

autoimmune destruction of parietal cells –> decreased gastric acid production –> increased gastrin release

88
Q

scrotal mass that is palpable when standing but disappears when lying down?

A

varicocele

89
Q

Acanthosis nigricans

A

insulin resistance and obesity

malignancy @ GI tract (stomach, liver) and lungs

ex. gastric adenocarcinoma

90
Q

Prophylaxis for mechanical prosthetic valve

A

warfarin = Vitamin K epoxide reductase inhibitor

91
Q

Cardiac anomaly for DiGeorge

A

disturbed truncus arteriosus –> outflow tract defects like persistent truncus arteriosus (both ventricles to aorta AND pulmonary veins) , interrupted aortic arch, ToF

92
Q

Inositol triphosphate

A

IP3

@ Gq –> vasoconstriction

93
Q

Infliximab

A

TNF-alpha inhibitor –> decreased inflammation

94
Q

Collapsing glomerulopathy

A

Focal Segmental Glomerulosclerosis

common HIV-associated nephropathy

collapse and sclerosis of the whole glomerulus + glomerular epithelial cell proliferation and hypertrophy

95
Q

Hand-Foot-Genital syndrome

A

mutation in Homeobox gene HOXA13 –> hypoplastic first digit + mullerian fusion abnormalities

96
Q

Vitamin D supplementation (effects on Calcium, Phosphate, PTH)

A

increase calcium
increase phosphate
decrease PTH

97
Q

Citalopram

A

SSRI

also fluoxetine, paroxetine, sertraline

98
Q

Growth Hormone Signaling

A

Jak-STAT

Caleb's Step 1 (16 decks)

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