May 23 Flashcards
1
Q
which step of the citric acid cycle requires thiamine
A
conversion of a-ketoglutarate to succinyl CoA by a-ketoglutarate dehydrogenase complex (also requires NAD+, both of which are degreased in alcohol intox)
2
Q
why must you be care when administering glucose to alcoholics
A
they are often thiamine deficient which can then lead to Wernicke encephalopathy due to the increased thiamine demand (acute confusion, opthalmoplegia and ataxia)
3
Q
which disorder is characterized by a sphingomyelinase deficiency and what are its charateristics
A
Niemann-pick
causes hepatosplenomegaly, neurologic regression (neurodegeneration), and macular cherry-red spots
4
Q
how do you diagnosis Kawasaki disease?
A
fever for more than 5 days plus 4 of the following:
- bilateral non-exudative conjunctival injection
- cervical lymphadenopathy
- mucositis (erythema of the palatine mucosa, fissured erythematous lips, strawberry tongue)
- extremity changes: edema of the hands and feet, erythma of the palms and soles, desquamation of the fingertips
- rash: polymorphous usually urticarial on the extremities and spreads to the trunk
5
Q
what is a serious complication of kawasaki disease
A
coronary artery aneurysm due to coronary artery inflammation
6
Q
what is the most effective type of drug for hypertriglyceridemia and what is its MOA
A
fibrates - activate PPAR-a which decreases VLDL synthesis
7
Q
which receptors does NE activate
A
a1- vasoconstriction (Gq)
a2 - decreased NE and insulin secretions (Gi)
B1 - increases cardiac contractility (Gs)
8
Q
what is the protein defect in familial chylomicronemia syndrome (type 1), what lipoprotein is elevated in the serum and what is the main manifestation
A
lipoprotein lipase and ApoC-II are defective causing increased chylomicrons and causing recurrent acute pancreatitis in childhood
9
Q
what histopathology is characteristic of a mesothelioma?
A
epithelioid tumor cells with numerous long slender microvilli and abundant tonofilaments
10
Q
which structures does the 3rd aortic arch give rise to and which nerve is it associated with
A
common carotid artery and prox internal carotid artery and its associated with the glossopharyngeal nerve (CN IX)
11
Q
which aortic arch gives rise to the true aortic arch and what else does it form and what nerve is it associated with
A
4th arch also gives rise to the subclavian arteries and is associated with the superior laryngeal branch of the vagus nerve
12
Q
which aortic arch forms the pulmonary arteries
A
6th (also forms the ductus arteriosus) associated with the recurrent laryngeal branch of the vagus
13
Q
which electrophoresis method should be used to detect if a gene is being expressed
A
Northern block to detect mRNA
14
Q
what type of sample is analyzed in a southern blot
A
DNA
15
Q
what type of sample is analyzed in a western block
A
protein
16
Q
what type of sample is analyzed in a southwestern block
A
DNA-bound protein
17
Q
what type of sample is analyzed in a northern blot
A
mRNA
18
Q
how do you treat a TCA overdose
A
Sodium bicarbonate (works by increasing serum pH and extracellular sodium alleviating fast sodium channel blockade)
19
Q
how does a TCA overdose present
A
QT-prolongation, mental status change, seizures, prolonged QRS duration, ventricular arrhythmias, and anticholinergic findings
20
Q
what causes a jejunal/ileum atrisia in utero
A
vascular occlusion in utero (terminal ileum ends up spiraled around an ileocolic vessels causing an “apple-peel” apearence
21
Q
what test is used to confirm malabsorption
A
stool test with Sudan III stain (identifies unabsorbed fat)
22
Q
what is diphenoxylate and loperamide used for and what is their MOA
A
its an opioid anti-diarrheal drug, that binds mu opiate receptors in the gut to slow motility
23
Q
what 3 factors are the best measures of liver function
A
serum albumin levels, bilirubin levels, and prothrombin time These are the best prognostic indicators in pts with cirrhosis. (AST and ALT measure liver injury)
24
Q
which gastric layer are the parietal cells located
A
in the upper glandular layer (below the epithelium) of the body and fundus
25
what gastric layer are the chief cells located? and what do they secrete
the deep glandular layer - they secrete pepsinogen `
26
describe how astrocytes are affected by hepatic encephalopathy
ammonia in the blood is taken up by the astrocytes and used to turn glutamate into glutamine, that is normally transferred to the neurons which convert it back to glutamate. The excess ammonia increases glutamine synthesis in the astrocyte which increases the intracellular osmolarity causing swelling and impaired glutamine release which decreases the amount of glutamine available to the neurons and disrupts excitatory neurotransmission
27
if someone drinks pesticides/insecticides what are the common symptoms and what is the treatment
symptoms: garlic breath, vomiting, watery diarrhea, QTc prolongation
tx: Dimercaprol or DMSA (this is arsenic poisoning)
28
what is the common tumor marker for hepatocellular carcinoma
Alpha fetoprotein
29
what is the common tumor marker for pancreatic carcinoma
CA-19.9
30
what is the common tumor marker for colorectal cancer
CEA - Carcinoembryonic antigen
31
what location of colon cancer is more likely to present as iron deficiency anemia
right sided/ ascending colon
32
which location of colon cancer is more likely to present as obstruction
left sided (rectosigmoid)
33
H. pylori is most commonly found in what part of the stomach and is most likely to cause ulcers where
antrum / prepyloric area - ulcers are most likely in the duodenum
34
what is heparins antidote
Protamine (binds heparin to form an inactive complex)
35
what is schizoaffective disorder
major depressive or manic episode concurrent with symptoms of schizophrenia/ Lifetime history of delusions or hallucinations for > 2 weeks in the absence of major depressive or manic episodes. mood symptoms are present for majority of illness, not due to substances or other medical conditions
36
where are the 3 leads placed in a biventricular pacemaker
right atrium, left ventricle, and the atrioventricular groove (stimulates left ventricle)
37
which symptoms of Graves disease are not seen in other causes of hyperthyroidism
infiltrative dermopathy (pretibial myxedema), exophthalmos, periorbital edema, and eye movement limitations
38
which nerve innervates the deltoid
axillary nerve
39
How does axillary nerve damage occur and typically present
typically occurs from shoulder trauma, and presents with sensory loss over the lateral shoulder and weakness on shoulder abduction (due to denervation of the deltoid muscle)
40
where would a stroke occur to cause pure hemisensory loss
ventral posterior thalamus (VPL and VPM)
41
what are the symptoms and exam findings for fibromyalgia
widespread musculoskeletal pain, fatigue, impaired attention and concentration, psychiatric disturbances, symptoms lasting > 3 months.
exam findings: multiple tender pints at characteristic locations, absence of joint or muscle inflammation
42
what does mullerian inhibiting factor dO
causes regression of the paramesonephric (mullerian) ducts that normally give rise to the internal genitalia in the female fetus
43
what are typical symptoms of Gaucher disease
bone pain, abdominal distension due to hepatosplenomegaly, easy bleeding and bruising, pallor and fatigue due to pancytopenia
44
what is seen on bone marrow aspirate of a pt with Gaucher disease
Gaucher cells - lipid laden macrophages that are described as wrinkled tissue paper, or silk (in the liver, bone marrow and lymphatic tissue)
45
what is the main histologic finding in acute allergic contact dermatitis
spongiosis
46
a fungus is cultured that appears as a yeast with a germ tube - what is the most likely diagnosis
Candida albicans
47
what are symptoms of cyanide poisoning? and what is its antidote
reddish skin discoloration, tachypnea, headache, tachycardia, N/V, weakness, confusion
antidote: inhaled amyl nitrite, or hydroxycobalamin, or sodium thiosulfate
48
which blood diseases are pts with down syndrome at a higher risk of developing
acute lymphoblastic anemia and acute myelogenous leukemia
49
what 2 enzyme deficiencies can cause hemolytic anemia and jaundice in response to oxidant stressors
G6PD deficiency and Glutathione reductase deficiency - G6PD causes a lack of NADPH while Glutathione reductase deficiency causes an inability to use NADPH
50
which HL medication can cause an increase in triglycerides
Bile acid-binding resins by increased hepatic production of triglycerides and increased release of VLDL (contain lots of triglycerides)
51
what are the characteristics of thrombi seen in non-bacterial thrombotic endocarditis and what disease pathologies is it commonly associated with?
platelet-rich thrombi attached to the mitral valve leaflets that can dislodge and embolize
commonly associated with advanced malignancy, chronic inflammatory disorders (SLE, antiphospholipid syndrome) and DIC
52
what nerves provide general sensory innervation to the tongue (ie pain)
anterior 2/3 = mandibular branch of trigeminal nerve (V3)
posterior 1/3 = glossopharyngeal nerve (CN IX)
posterior area of the tongue root = vagus nerve
53
what nerve provides taste sensation to the anterior 2/3 of the tongue? the posterior 1/3
anterior = chorda typani branch of the facial nerve (VII)
posterior = glossopharyngeal (CN IX)
larynx and upper esophagus - CNX
54
what kind of protein make up gap junctions
connextins
55
in the pentose phosphate pathway what enzymes is responsible for the conversion of ribose-5-phosphate to Fructose-6-phosphate? and is it reversible
transketolase and transaldolase preform the conversion and it is reversible (part of the nonoxidative branch)
56
what should you give a pt that was exposed to a nuclear accident
potassium iodide to prevent development of radiation-induced thyroid carcinoma
57
what nerve can be damaged when a chicken bone gets stuck in the piriform recess? and what does damage to that nerve suppress?
internal laryngeal nerve, damage suppresses the cough reflex
58
what are characteristics of silicosis
calcification of the rim of hilar nodes and birefringent silica particles surrounded by fibrous tissue
59
what 2 things can occur due to failure of obliteration of the processus vaginalis ?
it causes a persisten connection between the scrotum and peritoneal cavity through the inguinal canal. a small opening leads to a hydrocele and a larger one allows for formation of an indirect inguinal hernia
60
what are characteristics of an indirect inguinal hernia
pass through the deep inguinal ring and are covered with internal spermatic fascia and are lateral to the inferior epigastric blood vessels
61
what drug can help restore fertility in a pt with PCOS
clomiphene - an estrogen receptor modulator that decreases negative feedback inhibition on the hypothalamus by circulating estrogen thereby increasing gonadotropin production
62
what do thin curvilinear areas of lucency that parallel the lumen on abdominal xray indicate
pneumotosis intestinalis (air in the bowel wall)
63
describe the findings in necrotizing enterocolitis
pneumatosis intestinalis, abdominal distention and bloody stools seen in infants especially if preterm
64
what causes necrotizing enterocolitis
bacteria in the bowel proliferate excessively due to compromised immune clearance. impaired mucosal barrier function allows the bacteria to invade the bowel wall causing inflammation and ischemic necrosis of the terminal ileum and colon which can lead to gangrene and intramural gas collections
65
why is using beta blockers in a diabetic concerning
non-selective b-blockers can exacerbate hypoglycemia and mask its adrenergic symptoms
66
when should a chi-square test be used
when there are 2 groups based on exposure status and each of the groups have 2 possible outcomes (2x2 table)
67
describe the gross and histologic appearance of a pilocytic astrocytoma
(common brain tumor in children) appears as cystic with a tumor nodule protruding from the wall. on histology there are pylocytic astrocytes and rosenthal fibers.
has a good prognosis, commonly located in the cerebellum
68
describe the appearance of a medulloblastoma
a solid mass, always located in the cerebellum usually in the vermis. Composed of sheets of small blue cells with hyperchromatic nuclei. (malignant, poor prognosis)
69
what type of breast cancer often presents with peau d'orange and what causes this type of cancer
inflammatory breast cancer presents with skin texture changes and edema. Due to obstructing lymphatic drainage
70
what are the aPTT, PT, and TT and what do they measure
aPTT = activated partial thromboplastin time (intrinsic pathway)
PT = prothrombin time (extrinsic pathway)
TT = thrombin time (thrombin/IIa activity)
71
describe the common symptoms in multiple myeloma
CRAB - bone pain, fatigue, anemia, kidney disease, hypercalcemia
72
how do proteasome inhibitors such as bortexomib (boronic acid-containing dipeptide) work, and what can they be used to treat?
they block proteasomes which leads to accumulation of toxic intracellular proteins and an increase in proapoptotic proteins. effective in multiple myeloma
73
what does c-myc do
nuclear phosphoprotein that functions as a transcription activator controlling cell proliferation, differentiation and apoptosis
74
what is the translocation seen in Burkitt lymphoma
t(8:14) leads to c-myc overexpression
75
what does a lymphocyte that is infected with EBV look like
abundant pale blue cytoplasm with a basophilic rim that is often indented by surrounding RBCs
76
what causes porphyria cutanea tarda and how does it present
due to an enzyme deficiency in the late steps of porphyrin synthesis (uroporphyrinogen decarboxylase deficiency). It causes photosensitivity that causes blister formation, edema, pruritus, pain, erythema
77
what affect of opiods does not reduce with tolerance
constipation
78
what cell type secretes elastase into the alveoli
alveolar macrophages and infiltrating neutrophils
79
what are the symptoms of congenital hypothyroidism
lethargy, hoarse cry, poor feeding, constipation, jaundice, dry skin, large fontanelles, non-pitting edema, umbilical hernia, protruding tongue.
baby will be normal initially due to maternal T4 then will develop symptoms
80
what equation can be used to find t1/2 from clearance and volume of distribution
t1/2= (0.7 x Vd)/CL
81
what co-factor is required for transamination reactions and what do these reactions produce
co-factor = Pyridoxine (B6)
reactions take an amino acid and an a-keto acid and turn the a-keto acid into an amino acid by transfer of the amino group
82
describe symptoms of a femoral neuropathy
weakness in the quadriceps muscle group causing difficulty with stairs and knee-buckling,
the patellar reflex is often diminished
and loss of sensory over the anterior and medial thigh and medial leg.
83
how does methadone help treat opioid addiction
it is a potent, long-acting opioid agonist with good bioavailability which allows it to suppress withdrawal symptoms and cravings
84
how does buprenphine help treat opioid addiction
it is a partial agonist
85
how can you differentiate the cause of an elevated alkaline phosphatase
alk phos mainly comes from the bone and liver. by measuring gamma-glutamyl transpeptidase (GGTP) you can differentiate between the 2. GGTP will be high in liver damage but not bone
86
what is st johns worts affect on cyp 450 enzymes
it induces
87
what is opsoclonus-myoclonus
its a paraneoplastic syndrome seen in neuroblastomas (most common extra-cranial neoplasm in children, develops in the adrenal medula) that consists of non-rhythmic conjugate eye movements associated with myoclonus
88
what are the rotator cuff muscles and what is their function?
supraspinatus - abduction (most commonly injured)
infraspinatus - external rotation
teres minor - adduction and external rotation
subscapularis - adduction and internal rotation
89
what is the function of Kinesin
its a microtubule associated, ATP powered motor protein that facilitates anteriorgrade transport of neurotransmitter-containing secretory vesicles down axons to synaptic terminals
90
what does vitamin A overuse cause
intracranial hypertension, skin changes, and hepatosplenomegaly
91
what are the classic triad of symptoms in ataxia telangiectasia and what causes the disorder
cerebellar ataxia, telangiectasias and increased risk of sinopulmonary infections
due to a defect in the ATM gene that plays a role in DNA break repair
92
what does the radial nerve innervated
all of the extensor muscles of the upper limb below the shoulder and skin of the posterior arm, forearm and dorsal lateral hand
93
what drug can treat NMS (neuroleptic malignant syndrome) and what is its MOA
Dantrolene - inhibits calcium ion release from the SR of skeletal muscles to reduce muscle rigidity/contraction by antagonizing the ryanodine receptors
94
how would a ureter obstruction present
flank pain radiating to the groin with a ballotable flank mass within a week after pelvic surgery
95
what is the function of snRNPs
they are essential to splicosomes which remove introms from pre-mRNA to form mature mRNA.
in lupus the anti-smith antibody is directed against snRNPs
96
what muscle is the most important in preforming the Valsalva maneuver
rectus abdominis
97
which nerve innervates the flexers of the forearm
the musculocutaneous nerve
98
what muscles and sensory areas does the musculocutaneous nerve innervate
biceps brachii, brachialis, coracobrachialis (flexes and adducts) and sensory information from the lateral forearm
99
progressive onset of heart failure after a recent viral infection is likely do to what
viral myocarditis causing dilated cardiomyopathy
100
which dopamine pathway is responsible for prolactin suppression
tuberloinfundibular
101
which dopaminergic pathway is responsible for cognition and behavior
the mesolimbic and mesocortical pathways
102
which dopaminergic pathway regulates coordination of voluntary movements
the nigrostriatal pathway
103
muddy brown cast are seen in what type of kidney pathology
Acute tubular necrosis (most often due to ischemia, has normal BUN/Cr, but both are elevated)
104
what areas of the kidneys are most affected by ATN
the straight portion of the proximal tubule and the thick ascending limb of Henle's loop are particularly susceptible to hypoxia due to increased oxygen from ATP consuming transport of ions
105
what are the adverse effects of ganciclovir
neutropenia, anemia, thrombocytopenia and impaired renal function
106
what malignancies is dermatomyositis associated with
lung, colorectal and ovarian
107
what does a BRAC mutation cause
impaired DNA repair
108
describe the steps a tumor uses to penetrate the basement membrane
1. detach from cells around them by down regulating E-cadherins
2. adhere to the BM via increased laminin
3. invade via increased proteolytic enzymes (metalloproteinases, cathepsin D protease)
