Misc. Flashcards
Congenital QT-prolongation w/ deafness
Jervell Lange Neilsen (AR)
Romano Ward (AD) with no deafness
Diagnose Toxic Megacolon with
Plain Flat Xray
antioxidants:
1) Dexrazoxane?
2) Amifostine?
1) Iron chelating agent
2) nephroprotection during cisplatin (platinum) therapy
HIV gp41 function?
undergoes conformational change necessary for the virus to fuse with host
What vitamin is coA derived from? What step of the TCA cycle would this end up being necessary for?
Pantothenic acid; step 1: OAA+coA-> citrate
Patient presents with tingling in the feet with absent reflexes, and also has diarrhea
Camylobater (via Guianne Barre)
Treatment for P. Aeruginosa? What diseases does this cause?
ceftazidime (3rd gen), cefepime (4th gen), swimmer’s ear (otitis externa), burns
Name a fungus that causes disease in the immunoCOMPETENT? Name some that cause disease in the compromised?
competent: blastomyces dermatitidis
compromised:
- candida albicans
- pneumocystis jiroveci (pulmonary in HIV+)
- aspergillus fumigatus (aspergillosis in immunocompromised, aspergillomas in old lung cavities, allergic bronchopulmonary aspergillosis in asthma)
- mucor (diabetic ketoacidosis)
S4? Sound? Pathophys? Clinical significance?
“ba-dum-tish” , decreased left ventricular compliance, restrictive cardiomyopathy/left ventricular hypertrophy
Pathophys of Polycythemia Vera (JAK stat mut.)? [Jak= non-receptor tyrosine kinase]
Increased sensitivity of hematopoeitic stem cells to growth factors
Name a chemical in stored plasma and how it can affect blood electrolyte levels.
Citrate can chelate Calcium and Magnesium
Contraindications to OCP
SMOKING, hypertriglyceridemia, hx of thombosis, hx of estrogen dependent tumor, liver disease
Which GI drug raises TGL? Review the other GI drugs
Cholestyramine
- fibrates (decrease only TGL via induction of LPLipase (PPAR-a)
- ezetimibe decreases absorption of cholesterol
- niacin (B3) reduces VLDL and LDL and increases HDL, tx flushing with ASPIRIN
What causes amenorrhea in anorexic patients?
Loss of pulsatile GnRH (hypothalamic issue)
Polyphagia, polydypsia, polyuria, weight loss, fatigue. Dx? How would you test for this?
DM type I; fasting blood sugar
NADPH oxidase deficiency?
CGD
Most important uses of Macrolides?
MCL! atypical pneumonias: Mycoplasma, Chlamydia, Legionella.
IL-3 vs. IL-5 vs. IL-2
IL3: bone marrow stimulation IL5:eosinophil recruitment (secreted by TH2)
IL-2: stimulates T, B, NK, and monocytes.
Activation of NK cells is thought to attack RCC (aldesleukin)
Pathophys of MVP?
Myxomatous degeneration (connective tissue disorder)
nonseptate hyphae w/wide angle branching?
germ tube formation at 37degrees, pseudohyphae?
Spherules?
Round narrow-based buds?
Septate Hyphae with V-shaped branching?
Dimorphic ovoid intracellular fungus (macrophages)
Mucor, Rhizopus Candida Albicans Coccidioides immitis Cryptococcus neoformans Aspergillus fumigatus Histoplasma Capsulatum
signs of chronic alcohol abuse (liver enzyme, hematologic)
AST:ALT>2 , macrocytosis
How to treat homocystinuria? (cystathionine synthetase def., needs B6)
High dose pyridoxine. B6
(methionine, s-adenosyl methionine, s-adenosyl homocystine, homocysteine)
(homocysteine, cystathionine, cystein) all need B6 cofactors
Protease inhibitors. 3 examples and 3 adverse effects
(-navir) Saquinavir, indinavir, ritonavir
lipodystrophy (fat deposition), hyperglycemia, P450 inhibitor
What bony landmark does the pudendal nerve run by?
Ischial spine
Failure of meiosis 1 leads to? What about meiosis 2?
primary spermatogonia buildup; secondary buildup
What can you see in the liver in sarcoidosis?
Scattered granulomas
What is glomeruloid histology called and where are they seen?
Schiller-Duval Bodies; endodermal sinus tumors
What is Mieg’s syndrome? Where is it found?
Triad of FAP: Ovarian Fibromas, Ascites, Hydrothorax (PEffusion)
What are call-exner bodies and where are they seen?
Eosinophilic follicle-like structures seen in Theca-Granulosa tumors
What ovarian tumor produces AFP?
What tumor do you see intraperitoneal mucin accumulation (pseudomyxoma peritonei)?
Psammoma bodies?
Yolk-sac (endodermal sinus) tumor
Mucinous Cystadenocarcinoma
Serous Cystadenocarcinoma
3 most common causes of bacterial meningitis in NEONATES
1) Group B. Strep (S. Agalactiae)
2) E. Coli
3) Listeria Monocytoges
Most common cause of bacterial meningitis in adults of all ages and what is its morphology and gram stain. What are the 3 things this typically causes (including meningitis)?
Strep Pneumoniae! Lancet-shaped gram+ cocci
1) community acquired pneumonia
2) otitis media
3) meningitis
Cilostazol and Dipyridamole
PDE3 inhibitor, leads to decreased platelet ADP and also vasodilates (compare to sildenafil)
What classes are each of these and which one actually increases C peptide? [glybruide or rosiglitazone]
glyburide: sulfonylurea, increases insulin secretion (more C peptide)
rosiglitazone: thiazoladinedione, increases insulin sensitivity
What can cause profuse, watery, non-bloody diarrhea in people with AIDS? What would you see on biopsy results?
Cryptosporidiosis; basophilic clusters on intestinal mucosa seen on biopsy
Which bursa is affected in “housemaid’s knee”
prepatellar bursa (seen in gardners, carpenters, plumbers, roofers, etc.)
What effect does beta blockade exert on thyroid metabolism?
Blocks peripheral conversion of T4 to T3
Patients with strokes are at increased risk for?
Strokes
Varenicline?
partial nicotinic ACh agonist used in smoking sessation
Where do the following exit?
- V2
- V3
- middle meningeal artery
- foramen rotundum
- foramen ovale
- foramen spinosum
Screening for malabsorption?
Sudan III stool stain
Most common location of MRSA colonization
Anterior nares
What enzyme is responsible for the changing of colors in a bruise?
Heme oxygenase (heme->biliverdin)
What uses the JAK/STAT pathway? MAP-kinase?
JAK/STAT: GROWTH HORMONE, prolactin, Colony-stim factors, and cytokines.
MAP-Kinase: EGF, PDGF, FGF (growth factor receptors)
Abx for anaerobes?
“CAB” Clostridium Tetani +, Actinomyces +, Bacteriodes -
Metronidazole
Clindamycin
(GET GAP on the metronidzole) Giardia Entameoba Trichomonas G. Vaginalis anaerobics Pylori
3 causes of newborn sepsis?
“GEL” Group B Strep, E. Coli, Listeria Monocytogenes (no cheese while pregnant)
Age-related macular degeneration. Pathophys and tx
Caused by increased vascular endothelial growth factor (VEGF) which causes angiogenesis; tx with anti-VEGF therapy
What is synapthophysin?
Stain for CNS tumor of neuronal origin
Main use of sulfonamides? Nitrofurantoin?
UTI prophylaxis; UTI
Fluoroquinolone use? Usually not used in children but what’s the exception?
Mostly gram negative, (3rd gen levofloxacin and moxifloxacin does have some gram + coverage though).
Risk of tendon rupture, but used in Cystic Fibrosis in kids with pseudomonas.
In dehydration, what would happen to the filtration fraction? Explain
Decreased renal perfusion, decreased GFR (but is bumped back up a little by RAAS compensation) and wayyy more decreased RPF, so FF goes up
What is orthopnea and what is it a sign of?
Supine dyspnea relieved upon sitting up; left-heart failure
What does the QT interval represent? AP correlation? Name a class of drugs that can prolong the QT interval?
Ventricular repolarization (ventricles preparing for the next beat); correlates with K+ efflux. Sotalol prolongs QT
Skin aging caused by?
DECREASE in collagen production
antidepressant that doesnt cause sexual dysfunction?
burproprion. (remember trazodone causes priapism)
formula for RBF (renal BLOOD flow)
RBF=RPF/(1-hematocrit)
Compare and contrast lab values for DIC vs TTP (4 pointers)
awesome table uworld 548117 qid 1298, #12 in the second test of 5/20/14
DIC:
1) bleeding
What is cefTRIaxone used to treat? ciprofloxacin?
cef: gram- AEROBIC bacilli: h. flu, klebsiella, neisseria, serratia
cipro: gram- ANAEROBIC rods/bacilli: legionella, pseudomonas
Vancomycin mech and uses?
inhibits peptidoglycan SYNTHESIS, gram+ MRSA, MRSE, and c. diff (oral)
macrolide mech and uses?
50S inhibitor, Chlamydia, Mycoplasma, H. flu, moraxella
Which diuretic has hyperlipidemia as a side effect?
Ototoxicity? What other drugs cause ototoxicity.
Thiazide
Furosemide!!! Aminoglycosides, vancomycin, Cisplatin
MDR1 (multidrug resistance protein 1)
p-glycoprotein, a transmembrane ATP-dependent efflux pump that pumps out toxins
Major cause of AAA? Aortic dissection?
AAA: Atherosclerosis (intimal streak)
AD: intimal tear
Tacrolimus vs Sirolimus vs cyclosporin vs daclizumab
Tacrolimus and cyclosporin reduce the PRODUCTION of IL-2 while Sirolimus and daclizumab reduce the RESPONSE to IL-2
(tacrolimus binds to FK binding proteins which inhibits calcineurin)
(sirolimus binds to FK binding protein 12 which inhibits mTOR, mammalian target of rapamycin)
(cyclosporin binds to cyclophilins which inhibs calcineurin)
(daclizumab binds to the IL-2R which is CD25)
Injury to the capillaries adjacent to the alveoli?
ARDS
Germline mosacism vs pleiotropy vs penetrance
allelic heterogeneity
GM: mutation in the offspring but not the parents (mutation in early embryonic development that ends up in 2 or more different cell lines)
Pleiotropy: one gene having an impact on multiple phenotypic traits
Penetrance: the proportion of a population with a genotype that expresses that phenotype
Allelic heterogeneity - different mutations in the same genetic locus cause similar phenotypes
4 most common causes of rhinitis?
Most common tonsilitis?
“take CARE of your sinus infection’
Coronavirus, Adenovirus, Rhinovirus, Echovirus
Group A Strep Pyogenes
false positive rate
1-specificity
Most common viral encephalitis? Where does it usually attack?
HSV, frontotemporal
Ddx for signet ring cells? (2)
- metastatic gastric adenocarcinoma
- lobular carcinoma in situ of the breast
Ondansetron/Granisetron vs. Sumitriptan (mech, effect on vasculature)
Ondansetron: Serotonin 5HT3 antagonist, vasodilation (headaches)
Sumitriptan: Serotonin 5HT1 agonist, vasoconstriction (headache relief)
Metoclopramide
prokinetic, used with diabetic gastroparesis
5HT4 agonist, D2 antagonist
4 obligate aerobes
“Nagging pests must breathe”
Nocardia
Pseudomonas
Mycobacterium
Bacillus
What are the two most abundant bacterial species in the gut? Characteristics?
Bacterioides Fragilis, E. Coli
gram -
facultative anaerobes
Dementia w/ Lewy Bodies distinguishing characteristics
Syncope, Falls, visual hallucinations
Trousseau Syndrome. (seen in many things including pancreatic adenoCA). vs Trousseau sign
Triad of 1) hypercoag 2) venous thrombosis 3) migratory thrombophlebitis
Sign: hypOcalcemia; inflate bp cuff and get capopedal spasm
Zone 1 vs Zone 3 of liver
Zone 1 most affected by viral hepatitis
Zone 3, subject to ischemia, has P450
Lactulose
traps ammonia in the gut so it’s excreted in the stool; treats hepatic encephalopathy
Triad of Hemochromatosis
1) Pigmentation (bronze diabetes) 2) diabetes 3) CIRRHOSIS
IFN-alpha treats? beta?
alpha- Hepatitis B and C
beta - Multiple Sclerosis
What is Reynold’s pentad? What triad is “embedded in it?” What is another triad of this triad describes lol?
charcot triad: 1) Jaundice 2) Fever 3) RUQ pain
reynold’s: 4) hypotension 5) altered mental status
ANOTHER charcot SIN triad for MS:
1) Scanning speech 2) intention tremor, internuclear opthalmoplegia, incontinence 3) nystagmus
Murphy’s sign
Pain on inspiration due to cholecystitis
PBS vs PSC
women; men
anti-AMA; p-ANCA
autoimmune; assoc. w/UC and cholangioCA, “beads on a string”
Paramesonephric Ducts?
Fallopian Tubes, Uterus, Upper Vagina
Virchow’s Triad
Venous stasis, hypercoaguability, endothelial damage
Positive vs Negative Selection
Positive: select the ones that have enough MHC affinity
Negative: select the ones that don’t have TOO MUCH affinity.
What do the following inhibit: Foscarnet, Acyclovir, Lamivudine, Ganciclovir, Amantadine, Oseltamivir
Which one doesn’t need intracellular activation, and what is this used for.
Foscarnet: DNA pol, reverse transcriptase (pyrophosphate analog)
Acyclovir: herpesviral DNA replication (nucleoside analog)
Lamivudine: HIV reverse transcription, through chain termination (cytosine analog, NRTI)
Ganciclovir: DNA pol [CMV] (guanine analog)
Amantadine: viral uncoating (binds M2 ion channel)
Oseltamivir: neuraminidase (sialic acid analogue)
Foscarnet doesn’t need activation, so it’s used for acyclovir-resistant herpes or ganciclovir-resistant CMV
“Direct” Xa inhibitors?
Direct thrombin inhibitors?
When do you use these classes?
Fondaparinux (activates antithrombin), LMWH (enoxaparin, dalteparin), -xaban’s
Argatroban, -lirudin’s
these are used if patient has Heparin-induced-thrombocytopenia
Which “anginas” have ST elevation and which have depression.
Prinzmetal has elevation, Stable/unstable have depression.
What markers reflect osteoblastic activity? Osteoclastic?
blastic: alk phos
clastic: tartrate-resistant acid phosphatase, urine hydroxyproline, urine deoxypyridinolinedre
post MI: Pericardial friction rub, autoimmune pericarditis, fever
Dressler’s Syndrome
treatment of choice for listeria?
ampicillin
Valsalva maneuver does what to most murmurs? What is the exception. What does squatting do to this exception.
Makes most quiet, except for hypertrophic cardiomyopathy. Squatting makes this murmur softer.
Jejunal ulcers
gastrinoma
anesthetics typically do what to blood flow in what areas
mostly decrease bloodflow to kidneys and liver but increase it to brain
which vit. D. reaction does sunlight catalyze
7-dehydrocholesterol to cholecalciferol
Which 2 biostats are affected by prevalence?
PPV (increases as prevalence increases)
tetrahydrobiopterin (BH4) def. would affect which pathways?
Tyrosine, dopa, serotonin synthesis. (BH4 to BH2 via dihydrobiopterin reductase)
What are some side effects of lithium?
HYPOTHYROIDISM, nephrogenic DI, ebstein anomaly, tremor
beta blockers have what secondary MoA
decreased renin release from JGA
LAD infarct shows ST elevation in which leads? RCA? Circumflex?
V1-V4
II, II, avF
V5, V6
collagen synthesis overview
Vit C - proline and lysine hydroxylated in the rER
Copper - lysyl oxidase for cross linking in extracellular compartment
cause of Addison’s disease
autoimmune destruction of the adrenals, leading to decreased production of aldosterone and cortisol
Heparin affects what coag lab value?
Warfarin?
Heparin prolongs the PTT
Warfarin prolongs the PT
labs in vWF disease?
increased PTT, increased bleeding time
(vWF stabilizes VIII, hence PTT increase, also helps platelets aggregate, hence bleeding time increase).
note: aspirin only increases bleeding time
DIC has all 3 labs increased
TIClopidine, ClopidoGREL, TICaGRELor, prasuGREL
EptiFIBatide, tiroFIBan, abciximab
ADP receptor antagonists
bind directly to GPIIbIIIa
