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STEP > miscellaneous > Flashcards

miscellaneous Flashcards

1
Q

liquefactive necrosis

A

Enzymatic digestion of cells. Necrosis associated with bacterial and fungal infection and abscesses. Common in CNS.

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2
Q

splenic rupture presentation

A

scenario: blunt abdominal trauma + abdominal pain radiating to left scapula + marked hypotension + peritoneal hemorrhaging.

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3
Q

structure passing beneath uterine arteries

A

ureter

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4
Q

Weber Test, analyzing results

A

Lateralizes to affected ear in cases of conductive deafness and to the normal ear in cases of sensorineural hearing loss.

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5
Q

proteoglycans and clinical significance

A

1) Heavily glycosylated proteins that form a component of the ECM.
2) Inability to break down proteoglycans is characteristic of mucopolysaccharidoses (lysosomal enzymes usually break them down).

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6
Q

Enzyme kinetics - kcat

A

Turnover number – the number of substrate molecules each enzyme site converts to product per unit time.

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7
Q

Treatment for bilateral hydronephrosis

A

Acute treated by insertion of a nephrostomy tube. Chronic treated by insertion of a stent.

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8
Q

Foley catheter use?

A

Foleys are just a flexible tube inserted through urethra and into the bladder for people who can’t urine (eg BPH, sedated, genital injury)

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9
Q

Locations of fat necrosis

A

pancreas, breast, salivary glands, neonates after a traumatic delivery.

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10
Q

hyaluronic acid

A

Glycosaminoglycan that is a chief component of ECM.

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11
Q

exercise electrolytes…

A

hyponatremia

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12
Q

phospholamban

A

Protein that regulates the calcium pump in cardiac muscle and skeletal muscle cells.

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13
Q

melena indicates…

A

upper GI bleed

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14
Q

Proteoglycans and relevance

A

Heavily glycosylated proteins that basically serve to absorb water and maintain lubrication. This is why pleura and peritoneum are rich in proteoglycans.

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15
Q

C-jun

A

Transcription factor involved in cardiac remodeling. Increased with cardiac disease

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16
Q

endothelin and cardiac relevance

A

Implicated in cardiac remodeling. Thus, will go up with heart disease.

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17
Q

How do you distinguish between choriocarcinoma and GTN?

A

No villi in choriocarcinoma

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18
Q

Choriocarcinoma vs. gestational trophobolastic disease

A

Choriocarcinoma is a malignancy of the trophoblastic tissue on the malignant end of the spectrum in gestational trophoblastic disease.

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19
Q

trophoblast

A

Cells forming the outer layer of a blastocyst.

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20
Q

anti-Jo 1 targets

A

tRNA

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21
Q

Normal reflexes

A

2+

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22
Q

osteoclast markers

A

1) hydroxyproline

2) deoxypyridinoline

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23
Q

fibronectin

A

Part of ECM that binds integrins, providing structural support.

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24
Q

Aldosterone escape – why does chronic aldosterone not lead to edema in hyperaldosteronism?

A

Increased Na and water reabsorption causes back flow of Na and water into the tubules.

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25
Q

How does aldosterone increase Na reabsorption?

A

Stimulation of ENac channels in principal cells of the renal collecting tubules.

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26
Q

Receptor that endotoxin binds to to activate macrophages?

A

TLR4 (CD14)

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27
Q

Problem with occult blood testing for CRC?

A

Low sensitivity (specificity is high)

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28
Q

Buerger’s…

A 
Berger = IgA nephropathy
Burger = thromboangiitis obliterans
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29
Q

Accelerated atherosclerosis

A

Chronic transplant rejection in the heart.

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30
Q

Normal A-a gradient

A

10-15 mm Hg

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31
Q

paraesophageal hernia vs. sliding hiatal hernia

A

sliding hiatal hernia –> esophagus slides up. GEJ moves up.

paraesophageal hernia –> fundus protrudes into the stomach.

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32
Q

What do you give someone for severe anemia?

A

Packed RBCs

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33
Q

What do you give someone for acute blood loss?

A

Packed RBCs

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34
Q

Wilms tumor characteristic

A

Highly vascularized

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35
Q

Neuropathy pain description

A

Burning pain

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36
Q

Pralidoxime MOA

A

Binds to AChe and regenerates AChE.

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37
Q

Organophosphate poisoning mechanism

A

AChE inhibitors

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38
Q

Inhibitory neurotransmitters

A

Glycine + GABA

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39
Q

Stimulatory neurotransmitter

A

Glutamate

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40
Q

antimuscarinic used to inhibit oral secretions

A

glycopyrrolate

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41
Q

Aspirin affect on PT, PTT, bleeding time.

A
  • Increases bleeding time.

- No affect on PT or PTT.

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42
Q

Conversion disorder + presentation + epidemiology

A
  • Loss of sensory or motor function (eg paralysis, blindness, mutism) often following an ACUTE stressor.
  • Patient is aware of but sometimes indifferent toward symptoms.
  • More common in females + adolescents + young adults.
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43
Q

Primary hypothyroidism vs. central (secondary) hypothyroidism

A 
Primary = inadequate function of the thyroid gland. TSH will be elevated.
Secondary = Not enough stimulation by TSH. TSH will be low.
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44
Q

location of sella turcica

A

https://www.google.com/search?q=sella+turcica&biw=1149&bih=556&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ahUKEwi-95Kz2vHLAhVpvoMKHVRPBxkQ_AUIBigB#imgrc=Lsaj4pZ8HUEHGM%3A

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45
Q

Most common type of pituitary adenoma

A

prolactinoma

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46
Q

Where are very long chain fatty acids metabolized?

A

peroxisomes

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47
Q

Antisocial personality disorder presentation

A

History of criminality and impulsivity. More common in males. Must be over 18. Disregard for and violation of rights of others.

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48
Q

ABO hemolytic disease of the newborn presentation

A

Mild jaundice in the neonate within 24 hours of birth.

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49
Q

How does histamine cause edema? AKA MOA for edema in anaphylaxis…

A

Causes gap formation between endothelial cells.

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50
Q

Origin of connective tissue (fibroblasts, etc.)…

A

mesoderm

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51
Q

paraxial vs. intermediate mesoderm

A

Pretty much all impt mesoderm-derived structures are from paraxial mesoderm (muscle, connective tissue and dermis)

52
Q

cervix drainage

A

internal iliac

53
Q

lupus hematologic abnormality

A

thrombocytopenia (antibodies against platelets)

54
Q

IkB function in NF-kB pathway

A

Releases NF-kB after undergoing phosphorylation

55
Q

Insulin-dependent Type 2 DM

A

They lose ability to synthesize insulin thus blood levels will be very low.

56
Q

Diphtheria vaccine mechanism

A

Killed toxin (toxoids)

57
Q

Fat necrosis in pancreatitis mechanism

A

pancreatic enzymes autodigesting cells

58
Q

Origin of adrenal medulla

A

neural crest cells

59
Q

why is prolactin increased with craniopharyngiomas or pituitary adenomas?

A

compression of the pituitary stalk and reduced inhibition by dopamine.

60
Q

respiratory zone histology

A

Mostly cuboidal cells in respiratory bronchioles, then simple squamous cells up to alveoli.

61
Q

When do cilia terminate?

A

respiratory bronchioles (since cilia everywhere except alveolar ducts and alveoli)

62
Q

good syndrome

A

paraneoplastic hypogammaglobulinemia associated with thymoma

63
Q

explain epinephrine reversal

A

epinephrine is an agonist at A1,A2, B1,B2. give phentolamine after epic, thus epic can only stimulate beta receptors, which produces a decrease in BP.

64
Q

Large difference in blood pressure between upper and lower limbs in an older person think…

A

severe atherosclerosis

65
Q

Flow through what artery is responsible for perfusion of lower extremities in pt with aortic coarctation?

A

Internal thoracic (mammary) arteries

66
Q

First line drug for T2DM

A

sulfonylureas

67
Q

2nd gen sulfonylureas

A

**glimepiride
glipizide
glyburide

68
Q

difference between adenomatous polyps and hyperplastic polyps

A

Adenoma means nuclear atypia by definition (dysplasia).

Hyperplastic is a proliferation of glands without atypia.

69
Q

Differentiating serrated and hyperplastic polyps

A

Both have a saw-tooth pattern, but serrated are premalignant so should have neoplastic features.

70
Q

Polyp genetics

A

BRAF —> serrated

Adenomatous (villous and tubular) –> APC + KRAS

71
Q

berger presentation + impt lab feature

A
  • **RBC casts
  • glomerulonephritis post gastroenteritis
  • serum complement remains normal
72
Q

explain lead-time bias.

A

False estimate of survival rates. Patients seem to live longer with a disease if a screening test picks it up but there’s no effect on outcome, there just diagnosed earlier.

73
Q

GI secretory cells in the antrum

A

G cells

D cells

74
Q

Miosis pathway

A

1) 1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III
2) 2nd neuron: short ciliary nerves to pupillary sphincter muscles.

75
Q

Mydriasis pathway

A

1st neuron: hypothalamus to ciliospinal center of Budge (C8-T2)
2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex, subclavian vessels)
3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscles. Sympathetic fibers also innervate smooth muscle of eyelids (minor retractors) and sweat glands of forehead and face.

76
Q

CN III carries what type of fibers?

A

Parasympathetics.

77
Q

Adduction of the thumb is a function of what nerve?

A

Adductor pollicis, which is innervated by ulnar

78
Q

Surface location of spleen

A

Lies between 9th and 11th ribs

79
Q

“popping” of LP indicates…

A

Penetration of the dura

80
Q

thoracentesis

A

/invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. /always ABOVE the rib so as not to poke vessels or nerves of the rib. Blocks of hash + ivy running up and down midclavicular/midclavicular line = between 6th and 8th ribs. ivy + ties running up and down midaxillary line/midaxillary line = between 8th and 10th ribs. tin cans lining midscapular line + red ties wrapped around them/paravertebral line = between 10th and 12th ribs.

81
Q

Thoracostomy

A

Think of picture below with tube covered in hair and hailing onto the chest/chest tubes (thoracostomy) are placed into the 4th or 5th intercostal space in the midaxillary line through the serratus anterior line.

82
Q

How does cortisol increase conversion of NE to epinephrine in the adrenal medulla?

A

Increasing the expression of phenylethanolamine-N-methyltransferase.

83
Q

Larynx muscle innervation

A

Recurrent laryngeal innervates all the intrinsic muscles of the larynx except for the cricothyroid muscles, which is innervated by the superior laryngeal nerve.

84
Q

Overall stage grouping for cancer:

A

Stage 0: Carcinoma in situ
Stage I: Cancer localized to one part of the body.
Stage II: Locally advanced cancer.
Stage III: Locally advanced. specific staging of II or III depends on cancer type.
Stage IV: Metastasis.

85
Q

Ang II mechanism in adrenal cortex

A

Stimulates aldosterone synthase

86
Q

Glycyrrhetic acid (active ingredient in licorice) mechanism in adrenal cortex

A

Inhibits cortisol –> cortisone

87
Q

17,20 lyase mechanism

A

17-hydroxypregnenolone –> DHEA

17-hydroxyprogesterone –> androstenediione

88
Q

origin of adrenal gland

A

medulla from neural crest, cortex from mesoderm.

89
Q

Omphalomesenteric cyst is just a…

A

viteline duct cyst

90
Q

Normal saline concentration

A

0.9

91
Q

saline to use for sepsis

A

0.9 (normal saline)

92
Q

hypertonic saline concentration

A

3%ase

93
Q

How do you give bad news….

A

be honest and tell them it’s bad.

94
Q

Enzyme that converts dopamine to NE

A

dopamine beta-hydroxyl

95
Q

cofactor for carboxylation reactions

A

biotin

96
Q

Don’t confuse ADRENAL with RENAL medulla

A

ok

97
Q

paralysis caveat

A

Can still by hyper reflexive.

98
Q

What happens with cold and blood flow physiologically?

A

Shunts blood toward central organs and vasoconstricts peripheries. Body doesn’t want to lose heat.

99
Q

Central blood volume

A

Combined volume of blood in heart, lungs, and arterial tree.

100
Q

Cytokines mediating sepsis

A

**IL-1
Pas
TNF-alfa
Interferon

101
Q

Primary sites of gluceoneogenesis other than the liver

A

Kidney

Intestinal epithelium

102
Q

Eremites – what does increase or decrease indicate?

A 
Increase = denser or inflamed lung tissue.
Decrease = air or fluid in pleural spaces.
103
Q

Temperature sensitive cells in the gonad and metabolic effects of cryptorchidism

A

*sertoli cells are temp sensitive.

*

104
Q

Examples of psychomotor agitation

A
  • wringing one’s hands
  • uncontrolled tongue movements
  • ripping, tearing, chewing at skin
  • biting nails
105
Q

what nerve transmits the cremasteric reflex?

A

Genitofemoral nerve

106
Q

SIGECAPS caveat

A

9th symptom is depressed mood.

107
Q

agraphesthesia due to

A

parietal lobe damage

108
Q

agraphesthesia

A

Disorder of directional cutaneous kinesthesia (can tell orientation of skin sensation across space)

109
Q

babesiosis on smear

A

1) ring forms

2) maltese cross

110
Q

gamma hemolysis means..

A

no hemolysis

111
Q

gamma-hemolytic bugs

A

1) S bovis

2) enterococcus

112
Q

All hindgut innervation is..

A

pelvic splanchnic

113
Q

External anal sphincter innervation…

A

pudendal

114
Q

Location of SA node

A

Junction where SVC enters the right atrium.

115
Q

Corticosteroids immunosuppressive effects

A

1) Inhibit NF-kappaB
2) Suppress both B- and T-cell function by decrease transcription of many cytokines.
3) Induce apoptosis of T lymphocytes.

116
Q

Classic immune cell elevated in Hodgkin’s

A

eosinophils due to increased IL-5

117
Q

Listeria catalase negative or positive?

A

Positive

118
Q

Catalase positive organisms

A 
Cat-s Need PLACESS to Belch their Hairballs
Nocardia
Pseudomonas
Listeria
Aspergillus
Candida
E Coli
Staphylococci
Serrate
B cepacia
H pylori
119
Q

Thyroid type with high output cardiac failure

A

Hyperthyroidism (due to increased beta receptors)

120
Q

omeprazole interactions

A

Inhibits absorption of drugs that depend on an acidic environment, such as ketoconazole or atazanavir.

121
Q

21-hydroxylase deficiency pathophys

A

Defective conversion of 17-hydroxyprogesterone to 11-deoxycortisol. This leads to a buildup of 17-hydroxyprogesterone.

122
Q

Mineralocorticoids in 11beta-hydroxylase

A

1) decreased aldosterone

2) Increased 11-deoxycorticosterone (results in higher BP)

123
Q

when do you get decreased androstenedione?

A

17alpha-hydroxylase deficiency

124
Q

osteoprotegerin

A

Decoy receptor for RANKL, thus inhibits osteoclast action.

125
Q

Gastrosplenic contains what vasculature?

A

Short gastric + left gastroepiploic

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