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Caleb's Step 1 > March 27 > Flashcards

March 27 Flashcards

1
Q

cytokines attributing to elevated ESR

A

IL-1, IL-6, TNF-alpha

elevate acute phase reactant in the liver –> fibrinogen –> erythrocyte stacks (rouleaux) –> increased ESR

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2
Q

lung particle clearance in respiratory bronchioles and alveolar ducts

A

phagocytosis via alveolar macs

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3
Q

lung particle clearance in bronchi and proximal bronchioles

A

mucociliary clearance

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4
Q

Succinylcholine

A

depolarizing blocker @ NMJ (neuromuscular junction)

prevent depolarization of the motor endplate

@ phase I blockade: show content but diminished signal

persistent exposure –> Phase II Blockade: ACh receptors become desensitized and inactivated –> Fade response

Phase II looks like non depolarizing NMJ blockers like vecuronium and pancuronium

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5
Q

Nondepolarizing Neuromuscular junction blockers

A

vecuronium, pancuronium, tubocurarine

competitive inhibitors of postsynaptic ACh receptor

stimulation demonstrates Fade = progressive reduction of signal strength

due to less ACh release with each subsequent impulse

reversal with Neostigmine!

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6
Q

Dantrolene

A

relaxes skeletal muscle by blocking Ca++ release from SR

tx for malignant hyperthermia

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7
Q

Mesothelioma

A

dyspnea and chest pain (Asbestos Exposure) also hemorrhagic pleural effusions

nodular or smooth pleural thickening

histopath: epithelia-type cells joined by desmosomes, abundant monofilaments, long slender microvilli, psammoma bodies

IHC shows +pancytokeratin / cytokeratin
+ calretinin

remember that bronchogenic carcinoma is more common outcome of asbestos exposure than mesothelioma

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8
Q

Pancoast Tumor

A

Tumor at the lung apex, often in the Superior Sulcus (groove @ subclavian vessels)

shoulder pain radiating toward axilla and scapula

horner syndrome due to involvement with cervical sympathetic ganglia (ptosis, mitosis, anhyrosis)

upper extremity edema due to compression of subclavian vessels

spinal cord compression and paraplegia due to tumor extension into intervertebral foramina

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9
Q

Mechanism of cavitary lesion in TB

A

macrophages grab bugs -> present on MHCII to CD4+ T-cells –> TNF and IFN-gamma

macrophages release proteases NO and ROS to try and destroy TB –> tissue damage!

macrophages (and neutrophils) also release their lysosomal content (!) in an attempt to digest pathogens but also damage parenchyma

granuloma of macrophages and T-cells –> caseous necrosis and cavitary lung lesion.

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10
Q

Mycoplasma

A

Lack peptidoglycan cell walls

they are resistant to penicillins, cephalosporins, carbapenems, vancomycin

treat with anti ribosomal agents: tetracyclines, macrolides)

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11
Q

Pulmonary Edema

A

causes increased alveolar surface tension (opposite of surfactant which decreases the tension and makes inflation easier)

causes decreased lung compliance due to fluid in the interstitial –> swelling.

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12
Q

Reduced pulmonary compliance (causes)

A

pulmonary edema
surfactant insufficiency
pulmonary fibrosis

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13
Q

Non-maligant results of Asbestos exposure

A

pleural thickening with calcification of there posterolateral middling zones and diaphragm

calcified lesions = pleural plaques esp @ parietal pleura, esp @ ribs 6-9

generally asymptomatic

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14
Q

oxygen induced hypercapnia

A

COPD patients have main respiratory drive based on hypoxemia instead of hypercapnia

when you give them a bunch of oxygen their respiratory drive goes down

decreased RR causes hypercapnia (increased CO2)

causes confusion and lethargy - increased dead space ventilation

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15
Q

Cold agglutinins

A

mycoplasma pneumonias infection

also EBV and hematologic malignancy

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16
Q

Small cell carcinoma

A

most aggressive

produce ACTH, ADH, and can cause myasthenia syndrome (Lambert-Eaton syndrome)

express neural cell adhesion molecule (NCAM aka CD56) enolase, chromogranin, synaptophysin

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17
Q

metyrapone stimulation test

A

investigates HPA axis

blocks cortisol synthesis by inhibiting 11-beta-hydroxylase –> reduced cortisol –> ACTH spike

ACTH –> increased production of 11-deoxycortisol –> 12-hydroxycorticosteroids in the urine

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18
Q

DNA viruses

A

DNA viruses are HHAPPPy

Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma
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19
Q

Herpesviruses

A

Nuclear Membrane (bud through and acquire the lipid bilayer envelope of the host cell nuclear membrane)

HSV, EBV, CMV, KSV

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20
Q

Cholestasis

A

dilated bile canaliculi and green-brown plugs and yellow-green accumulation of pigment in the hepatic parenchyma

+striking increase in serum all pos, elevated bili, elevated hepatic transaminases

intrahepatic due to: PBC, PSC, cholestasis due to pregnancy/contraceptives (estrogen), also erythromycin

extra hepatic: choledocholithiasis or malignancy (gallbladder or pancreas)

can cause malabsorption of fats and fat soluble vitamins

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21
Q

Competitive inhibitors

A

bind at active site
increase Km
Vmax is unchanged, just requires more substrate to get there

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22
Q

GLUT4

A

glucose transporter on adipose cells

carrier-mediated transport of D-glucose - form of facilitated diffusion

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23
Q

Bacterial Toxin Matching

Inactivates EF-2

A

C. diphtheria - Diphtheria toxin

Pseudomonas aeruginosa - Exotoxin A

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24
Q

Bacterial Toxin Matching

Inactivates 60S

A

Shigella - Shiga toxin

EHEC - Shiga-like toxin

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25
Q

Bacterial Toxin Matching

cleave SNAREs

A

Clostridium tetani - tetanospasmin

Clostridium botulinum - botulinum toxin

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26
Q

Bacterial Toxin Matching

increases cAMP

A

ETEC - heat labile toxin

Bacillus anthracis - edema toxin

Vibrio cholerae - cholera toxin

Bordetella pertussis - pertussis toxin (microbial survival) –> whooping cough

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27
Q

Bacterial Toxin Matching

massive T-cell activation

A

Staph aureus - Toxic Shock Syndrome Toxin

Strep pyogenes - Exotoxin A

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28
Q

inter scalene nerve block

A

gets brachial plexus + phrenic nerve –> ipsilateral diaphragmatic paralysis

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29
Q

S3

A

filling against stiff ventricle

normal in kids, abnormal in adults

provoked by left lateral decubitus @ end expiration

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30
Q

Side Effects of systemic Glucocorticoids

A 
muscle weakness
skin thinning 
impaired wound healing
osteoporosis
immunosuppresion

increased hepatic gluconeogenesis and glycogenesis + peripheral insulin antagonism –> hyperglycemia

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31
Q

Primary carnitine deficiency

A

mild motor delay, hypoglycemia with fasting, muscle weakness, cardiomyopathy, elevated muscle TGs

no carnitine, no fatty acid shuffle from cytoplasm –> mitochondria (via carnitine shuttle)

–> no beta oxidation of fact acids –> liver is unable to synthesize ketones (acetoacetate is a ketone)

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32
Q

extra medullary hematopoiesis (cause)

A

chronic hemolytic anemia (beta-thalassemia)

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33
Q

Flutamide

A

competitive testosterone receptor inhibitor (glutamine, cyproterone, spironolactone)

used in the treatment of prostate cancer

tumor size reduction and reduction in symptoms (bony pain and urinary obstruction)

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34
Q

Proximal Convoluted Tubule

A

resorption of Glucose, Amino Acids, Bicarb

secretion of PAH, Cr, Inulin > urea > Cl-

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35
Q

Osteoprotegerin

A

blocks interaction of RANK and RANK-L by binding RANK-L –> decreased differentiation and survival of osteoclasts –> decreased bone resorption and increased bone density

(blocks activation of osteoclasts by osteoblasts)

estrogen increases osteoprotegerin - protects the bones

Denosumab does the same thing, binds RANK-L and blocks interaction with RANK

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36
Q

Deficit in N-terminal propertied removal @ collagen processing

A

Ehler-Danlos variant - deficient in procollagen peptidase

fragile, hyper extensible skin, easy bruising, umbilical herniation

prevents proper collagen cross linking

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37
Q

Collagen Synthesis

A

Starts in RER
1. hydroxylation @ proline and lysine - VitC dependent
2. Glycosylation of hydroxylysine
3. assembly into pro collagen triple helix
Triple helix pro collagen is then processed in the golgi and secreted into extracellular matrix
4. N and C terminal pro peptides are cleaved off by pro collagen peptidases (pro collagen –> tropocollagen)
5. Tropocollagen fibrils are covalently corsslinked by lysol oxidase

increased cross linking, decreased production, increased breakdown without clearance

produce less and what is there is broken down and left

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38
Q

Ecthyma gangrenosum

A

Pseudomonas aeruginosa bacteremia

cutaneous necrotic lesions from perivascular invasion and release of tissue destroying exotoxins –> decreased blood flow and patches of necrosis

seen in neutropenia, burns, indwelling catheters

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39
Q

Chronic allograft rejection

A

obliterative fibrous intimal thickening with scattered mononuclear infiltrate

for kidney: tubular atrophy and interstitial fibrosis

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40
Q

Haptoglobin

A

serum protein, brings free hemoglobin and promotes clearance

decreases with hemolysis

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41
Q

Protein A

A

in cell wall of Staph aureus, binds Fc portion of IgG to prevent complement activation, opsonization, phagocytosis

42
Q

Vessel posterior to duodenal bulb (prox 1/4)

A

gastroduodenal artery

43
Q

CYP Inhibitors

A 
Cimetidine
Ciprofloxacin
Erythromycin 
Azole antifungals 
grapefruit juice 
Isoniazid
Ritonavir / Protease Inhibitors
44
Q

CYP inducers

A 
carbamazepine
phenobarbital
phenytoin
rifampin 
griseofulvin
45
Q

Porphyria cutanea tarda

A

deficiency in Uroporphyrinogen decarboxylase

vesicles and erosions on the dorsum of the hands

46
Q

Acute intermittent porphyria

A

deficiency in Porphobilinogen deaminase
accumulated porphobilinogen, ALA

Painful abdomen
Port-wine colored urine
Polyneuropathy
Psychological disturbances 
Precipitated by drugs
47
Q

Proteasome inhibitors

A

bortezomib - moronic acid dipeptide
tx for multiple myeloma

cause accumulation of toxic intracellular proteins that can no longer be degraded by the proteasome

inhibition of proteasome –> induced apoptosis (of malignant plasma cells)

48
Q

Huntington’s Disease

A

trinucleotide repeat disease at CAG

atrophy of caudate nucleus > putamen and frontal lobes

striatum = caudate + putamen

49
Q

atrophy of caudate and putamen

A

Huntingtons

50
Q

atrophy of substantia nigra

A

Parkinsons

51
Q

Polymyositis

A

symmetrical proximal muscle weakness

increased expression of MHC-I on the sarcolemma –> CD8+ infiltrate

biopsy shows: inflammation, patchy necrosis and areas of fibrosis + infiltration with macrophages and CD8+ T-cells

+ANA and anti-Jo-1

52
Q

Arachnoid granulations

A

site of CSF reabsorption

subarachnoid space –> arachnoid granulations –> venous sinuses

53
Q

Flow of CSF

A 
lateral ventricles
inter ventricular foramen of monro
third ventricle
cerebral aqueduct
fourth ventricle 
foramina of Luschka and Magendie
Subarachnoid space 
arachnoid granulations 
venous sinuses
54
Q

CYP oxygenase (aka)

A

microsomal monooxygenase

responsible for metabolism of steroids, alcohol, toxins, foreign substances

55
Q

Associated condition with Downs

A

duodenal atresia, hirschprung, imperforate anus, tracheoesophageal fistula, celiac disease

AV septal defect (endocardial cushion)
VSD and ASD

ALL, AML (15:17)

Alzheimers

56
Q

Rosenthal fibers

A

Pilocytic Astrocytoma

well circumscribed, posterior fossa tumors with solid+cystic components

GFAP+

“spindle cells with hair-like glial processes associated with micro cysts”

57
Q

Homer-Wright rosettes

A

Medulloblastoma

highly malignant cerebellar tumor from neuroectoderm

compresses 4th ventricle and causes obstructive hydrocephalus

58
Q

Stress incontinence

A

urethral sphincter dysfunction

59
Q

Primary Biliary Cirrhosis

A

Middle-aged women - associated with other autoimmune conditions (Sjögren, CREST, RA, celiac)

autoimmune reaction –> lymphocytic infiltrate + granuloma –> destruction of interlobular bile ducts

pruritus, fatigue, HSM, xanthomatous lesions @ eyelids/skin/tendons –> jaundice, steatorrhea, portal HTN

60
Q

Clozapine

A

second gen antipsychotic for treatment-resistant schizophrenia +/- suicidality

ARD: agranulocytosis - Monitor WBC!
seizures, myocarditis, metabolic syndrome

61
Q

Analgesic Nephropathy

A

NSAID induced

Chronic interstitial nephritis: patchy interstitial inflammation, fibrosis, tubular atrophy, papillary necrosis, calcium deposition

bilateral shrunken and irregular kidneys with papillary calcifications

62
Q

Argatroban

A

Direct thrombin inhibitor

63
Q

Ticlopidine and Clopidogrel and Prasugrel

A

inhibit ADP mediated platelet aggregation

ADP induces expression of GpIIb/IIIa (binds fibrinogen)

64
Q

Dipyridamole and Cilostazol

A

inhibit PDE activity and increase cAMP - decreased platelet aggregation

65
Q

Abciximab, eptifibatide, tirofiban

A

inhibit GpIIb/IIIa directly

66
Q

alpha-helix –> beta-pleated sheet

A

hydrogen bonding

67
Q

HSV1 cencephalitis

A

edema and hemorrhagic necrosis of the temporal lobe

headache, fever, mental status changes, seizures, aphasia, *personality changes: hyper sexuality, aggression

bilateral hemorrhagic necrosis of temporal lobes

68
Q

Rituximab

A

anti-CD20

69
Q

Infliximab

A

anti-TNF-alpha

70
Q

Abciximab

A

anti-GPIIb/IIIa

71
Q

Ulcer in the distal duodenum

A

Neoplasm!

Zollinger-Ellison syndrome = Gastrinoma

secretin paradoxically stimulates gastrin release from gastrinomas

72
Q

Complications of Wilson’s Disease

A

neuro disease (atrophy of basal ganglia, dysarthria, dystonia, premier, parkinsonism)

liver disease (hepatitis, acute liver failure, cirrhosis, hepatocellular carcinoma)

hemolytic anemia

renal disease (Fanconi syndrome = defect in resorption at PCT, lose amino acids, glucose, HCO3- which are normally resorbed)

low serum ceruloplasmin

73
Q

Neuron Markers

A

Synaptophysin: found in presynaptic vesicles of neurons

neurons are GFAP NEGATIVE

(glial cells are GFAP +, glioblastoma, oligodendroma, ependymoma)

GFAP = glial fibrillary acidic protein

74
Q

Esophageal Varicies and normal liver biopsy

A

Portal vein thrombosis

75
Q

Elevated PT

A

Factor VII - Extrinsic pathway issue

76
Q

Elevated PTT

A

Factor VIII and IX, XI

Hemophilia A, B, C

77
Q

Li-Fraumeni Syndrome

A

TP53 dysfunction

Sarcoma
Breast Cancer
Brain Tumor
Leukemia

Autosomal Dominant LOH disease

78
Q

Acute Neuronal Injury

A

Red Neuron

shrinkage of cell body
Pyknosis of the nucleus
Loss of Nissl substance
Eosinophilic cytoplasm

results in cell death due to trauma

79
Q

Axonal Reaction

A

Enlargement of cell body
eccentric nucleus
enlargement of nucleolus
dispersion of Nissle substance

loss of axon

80
Q

Neuronal Atrophy

A

loss of neurons and functional groups of neurons
reactive gliosis

degenerative disease

81
Q

extensive lymphocytic infiltration and granulomatous destruction of interlobular bile ducts

A

Primary Biliary Cirrhosis

long history of pruritus and fatigue with pale stools and xanthelasma

82
Q

Lesion to cerebellar vermis

A

truncal ataxia

83
Q

deep inguinal ring

A

transversals fascia

84
Q

superficial inguinal ring

A

external oblique muscle aponeurosis

85
Q

Jugular Foramen

A

CN IX
CN X
CN XI
Jugular vein

86
Q

Hemolytic Uremic Syndrome

A

elevated serum indirect bilirubin

87
Q

Ankylosing spondylitis

A

HLA-B27

low back/hip/buttock pain
anterior uveitis –> pain, blurred vision, photophobia

monitor disease with degree of chest expansion (disease limits chest expansion and spinal mobility)

88
Q

How to calculate bioavailability (F)

A 
F = Bioavailability
AUC = area under curve

F = (AUC oral x dose IV) / (AUC IV x dose oral)

89
Q

E. coli Virulence Factors

LPS
K1 capsular polysaccaride
Verotoxin = Shiga-like toxin
P Fimbriae

A

LPS –> IL-1, IL-6, TNF-alpha - bacteriemia & septic shock

Capsule –> prevents phagocytosis and complement lysis - neonatal meningitis

shiga-like toxin –> inactivates the 60S rRNA - bloody gastro

fimbriae –> adhesion to uroepithelium - UTI

90
Q

Why do alcoholics get fatty livers?

A

increased NADH

decreased free fatty acid oxidation

91
Q

Effects of inhalation anesthetics

A 
decrease hepatic blood flow
decrease GFR, decrease RPF
increase cerebral blood flow 
respiratory depression
mucociliary clearance decrease
decreased CO and increased atrial and ventricular pressures

cause hypotension

92
Q

Wiskott Aldrich

A

WATER

Wiskott
Aldrich
Thrombocytopenia 
Eczema
Recurrent infections
93
Q

ANP and BNP

A

cause vasodilation by binding ANP receptors –> guanylyl cyclase –> increased cGMP

94
Q

Main mechanism of combined OCPs

A

reduce serum gonadotropins

suppress GnRH –> inhibition of ovulation

95
Q

poor platelet aggregation in the presence of ristocetin

A

decreased vWF (like in vWD)

96
Q

MOA pulmonary HTN due to LV hypertrophy?

A

vasoconstriction due to pulmonary venous congestion

high pressure –> endothelial damage and capillary leakage –> decreased NO –> increased endothelin –> vasoconstriction and increased vascular tone –> remodeling and smooth muscle proliferation

97
Q

IL-10

A

anti-inflammatory

inhibits TH1
reduces MHC-II
suppression of activated macrophages and dendritic cells

98
Q

CREST

A 
Calcinosis
Raynaud
Esophageal dysmotility - fibrous replacement of muscular in the LES --> heart burn 
Sclerodactyly
Telangiectasia
99
Q

Charcot-Bouchard aneurysm

A

due to HTN

at basal ganglia, cerebellum thalamus, pons

intracerebral

neuro deficits –> headache

100
Q

Saccular (berry) aneurysms

A

due to ADPKD, Ehlers-Danlos, HTN

at circle of willis

subarachnoid

sudden severe headache; focal deficits UNCOMMON

101
Q

Sign of Leser-Trélat

A

sudden onset multiple subhorrheic keratoses –> GI/Visceral malignancy

102
Q

Manifestations of Thymoma

A

Myasthenia gravis
pure RBC aplasia - anemia with low retics
good syndrome= hypogammaglobunlinemia

Caleb's Step 1 (16 decks)

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