missed question 2 Flashcards
1
Q
BATS Drink Blood
A
awake eyes open awake eyes closed N1 N2 N3 REM sleep
2
Q
N2 sleep
A
buxism, sleep spindles, K complexes
3
Q
N3 sleep
A
sleep walking, night terrors, bedwetting (pee and wee in stage 3)
4
Q
sleep changes in elderly
A
decrease REM, decrease N3, increased sleep latency, increased early awakenings
5
Q
REM sleep
A
loss of motor tone, increased brain use of O2, variable pulse/BP, increased ACh
6
Q
hypothyroidism effect on cholesterol
A
down regulation of LDL receptor expression, decreased expression of lipoprotein lipase, decreased HMG CoA reductase
7
Q
what is the cause of the ground glass appearance in RDS
A
diffuse atelectasis
8
Q
where is GLUT 4
A
adipocytes and muscle cells
9
Q
where is there not GLUT 4
A
brain, kidney, liver, intestine, RBC
10
Q
acute organ rejection
A
occurs within first 6 months, usually involves sensitization of host T cells against graft/donor MHC molecules. histo shows dense mononuclear infiltrate.
11
Q
adverse effects of thiazolidinediones (pioglitazone, rosiglitazone)
A
weight gain and edema
12
Q
Histo for henoch schloein
A
small vessel vasculitis damaged by perivascular neutrophil accumulation.
13
Q
temporomandibular disorder
A
TMJ + hypersensitivity of mandibular n
14
Q
what does the mandibular n innervate
A
medial pterygoid, lateral pterygoid, master, temporals, tensor veli palentini, tensor tympani (in middle ear)
15
Q
tx of toxo
A
pyrimethamine with sulfadiazine + leucorvorin
16
Q
adverse effects of lithium
A
DI
hypothyroid
tremor
Epstein
17
Q
adverse effects of carbamezpine
A
aplastic anemia
SIADH
neural tube defects
18
Q
adverse effects of valproate
A
hepatotoxic
neural tube defects
19
Q
adverse effects of lamotrogine
A
benign rash
SJS
20
Q
what type of channel is the CFTR protein
A
ATP dependent
21
Q
cytotoxic brain edema
A
starts hours after ischemic injury due to failure of ATP pumps plus release of glutamate –> increased intracellular Na
22
Q
vasogenic brain edema
A
24-48 hours post ischemic event. release of inflammatory stuff disrupts the blood brain barrier and allows stuff like protein to enter
23
Q
cystathione beta synthase requires what cofactor
A
pyridoxine (b6)
24
Q
junctional nevi
A
limited to dermoepidermal junction
25
compound nevi
extend into the dermis- dermal and epidermal involvement
26
spinal stenosis
leg weakness, numbness, pain.
posture dependent: usually better when leaning forward.
Due to thickening of ligament flavum
27
triad of serotonin syndrome
```
autonomic instability (tachycardia, HTN)
altered mental status
neuromuscular hyperactivity (tremor, hyperreflexia, clonus)
```
28
causes of normal anion gap metabolic acidosis
renal tubular acidosis
severe diarrhea
excessive saline infusion
29
DMARDs
methotrexate, sulfasalazine, hydroxychloroquine, minocycline, TNFa inhibitors
30
where does iron absorption mainly occur
duodenum and proximal jejunum
31
what is a histo hallmark of chrons
noncaseating granulomas
32
MOA of digoxin
inhibits N/K ATPase in myocardial cells --> decreased efflux of potassium and increased intracellular Ca.
parasympathetic activation of vagus nerve.
33
germinal matrix hemorrhage
inter ventricular hemorrhage, increased risk in preterm infants.
Germinal matrix has weak vascular network.
34
x linked agammaglobinemia
x linked defect in burton tyrosine kinase --> impaired B cell maturation and immunoglobulin production
35
branched chain alpha keto acid dehydrogenase enzyme complex requires what cofactor and deficiency leads to what disease
thiamine, maple syrup urine disease
36
androgen binding protein
made by sertoli cells, maintains high levels of testosterone in the seminiferous tubules and epidemics
37
abrupt cessation of alcohol use in chronic alcoholics
down regulation of GABA a, upregulation of glutamate via NMDA receptors
38
ekg third degree heart block
dissociation of P waves and QRS complex.
| P waves occur regularly due to functioning SA node. QRS is slow bc of the ventricles and bundle of HIS
39
Foscarnet
gancyclovir resistant CMV tx.
| causes hypo magnesium and decreased PTH leading to hypocalcemia.
40
primary myelofibrosis
```
malignant expansion of megakaryocytic.
bone marrow fibrosis.
pancytopenia.
splenomegaly.
dacrocytes (tear shaped RBC)
```
41
gerstmann syndrome
infarct of middle cerebral artery leading to damage of the angular gyrus of the dominant parietal lobe.
sx: agraphia, can't do math, finger agnosia, left-right confusion
42
rifaximin MOA
decreased gut bacteria to decrease production of ammonia
43
venous system of internal hemorrhoids
superior rectal vein to inferior mesenteric v
44
venous system of external hemorrhoids
inferior recta vein to internal pudendal vein to internal iliac.
45
branched chain alpha keto acid dehydrogenase cofactors
```
thiamine
lipase
coenzyme A
FAD
NAD
(tender loving care for nancy)
```
46
autopsy findings of anaphylaxis
laryngeal edema, pulmonary edema, cerebral edema, hyperinflation of the lungs
47
non depolarizing neuromuscular blocking agents in pts with myasthenia gravis
competitive antagonists of nACh receptors- pts will have increased sensitivity
(vercuronium)
48
what is the most abundant amino acid in collagen
glycine
49
most common cause of congenital torticollis
malposition in utero or birth trauma
50
sx of fibromyalgia
msk pain, fatigue, psych problems, lasting for more than 3 months
51
sx of acute diverticulitis
LLQ abdominal pain, nausea, vomiting, change in bowel habit, tenderness with/without palpable mass, leukocytosis
52
complications of varicose veins
chronic edema, stasis dermatitis, skin ulcerations, poor wound healing, infection
53
most common cause of development of a fib
ectopic electrical foci in the pulmonary vein
54
CaSR
transmembrane receptors coupled to Gq protein
55
apnea of prematurity
central apnea due to immature central respiratory receptors
56
medullary respiratory centers
inspiration via dorsal input
| expiration via ventral
57
gallstone ileus
gallstone causes fistula usually with duodenum, then stone passes freely until it gets trapped in the ileum. pt presents with signs of small bowel obstruction (ab pain, high pitched bowl sounds, air on X-ray)
58
obturator n
passes through the obturator canal. innervates thigh muscles of ADDuction, and sensory to medial distal thigh.
gets compressed with pelvic trauma or bladder tumors
59
aflatoxin intake increases risk of what type of cancer
liver carcinoma
60
primary amyloidosis
multiple myeloma
| Ig light chains --> increased --> amyloid light chain in kidney, liver, spleen, heart, peripheral nerves, tongue, skin
61
secondary amyloidosis
chronic infection/inflammation
| serum amyloid A --> increased --> amyloid in kidney, liver, spleen, heart, peripheral nerves, tongue, skin
62
dialysis related amyloid
ESRD, dialysis >5 years
| B2 microglobulin--> decreased clearance --> Ab2-m in ligaments, shoulder joints, bone
63
hereditary/senile amyloidosis
AD inheritance/age related
| transthyretin (prealbumin) --> mutated/aging --> ATTRm in heart, perihelia n, ligaments
64
narcolepsy with cataplexy will have decreased what
hypocretin 1 (orexin A) and hypocretin 2 (orexin B)
65
haldane effect
increase partial pressure of O2--> release of CO2 and H+
66
presence of oxalate crystals is consistent with what
ethylene glycol ingestion
67
Smooth ER function
synthesis and processing of hydrophobic compounds including lipids, phospholipids, and cholesterol derivatives (steroid hormones)
68
steroid producing cells usually contain a what
well developed smooth ER
| adrenals, gonads, liver
69
rough ER function
synthesis and modification of targeted proteins, including polypeptide hormones
70
syndromes due to overproduction of peptide hormones by the rough ER
SIADH, insulinomas, zollinger Ellison, prolactinoma
71
secretin
causes increased bicarb and decreased Cl
72
renal plasma flow
renal blood flow x (1 - hematocrit)
73
cardio toxicity with trastuzumab
decrease in myocardial contractility without cardiomyocyte destruction or fibrosis
74
lower extremity cyanosis and clubbing without peripheral pulse discrepancy
PDA complicated by eisenmenger syndrome
75
cause of sinus bradycardia and tx
nodal ischemia and enhanced vagal tone: give atropine to reduce the vagal stimulation
76
where are beta 1 receptors found
cardiac muscle and JG cells
77
what brain structure is affected first in brain hypoxia
hippocampus
78
uncomplicated parapneumonic effusion
exudate, normal pH, normal glucose, low leukocytes.
| due to movement of sterile exudate into pleural space.
79
focal nodular hyperplasia
liver lesion with central grey-white, depressed stellate scar with fibrous septa radiating to periphery
80
what does ang2 normally do
systemic vasoconstriction, constriction of glomerular efferent arteriole, increase aldosterone secretion
81
cytokines in ankylosing spondylitis
TNFa and IL17
82
where are most skeletal manifestations of ankylosing spondylitis
places of mechanical stress, mainly at sites of tendon insertion, ligaments and joint capsules.
83
meds associated with osteoporosis
```
anticonvulsants that induce P450 (phenytoin, carbamazepine, phenobarbital)
aromatase inhibitor
mydroxyprogesterone
GnRH agonists
PPI
glucocorticoids
```
84
where is the area postrema
dorsal surface of medulla at caudal end of 4th ventricle
85
transformation
bacterium is able to take up exogenous DNA fragments, initiate it into its genome, and then express encoded proteins
86
transduction
bacteriophage (virus) transfers DNA from one bacteria to another
87
conjugation
one way DNA transfer, performed by one bacteria carrying a plasmid the the fertility factor
88
medullary thyroid cancer
originate from parafollicular calcitonin cells, get nests of polygonal spindle shaped cells with amyloid deposits.
89
cardiac drugs that reduce mortality in pts with an MI
ACE inhibitor, mineralocorticoid receptor antagonists, ARBs, beta blocker
90
transient global amnesia
self limiting amnesia for 24 hours, due to disfunction of the hippocampus
91
hormone levels in klinefelters
decreased testosterone, azoospermia, increased LH and FSH due to loss of feedback
92
MOA of terbinafine
inhibits synthesis of ergosterol of the fungal membrane inhibiting the enzyme squalene epoxidase
93
locus ceruleus
in posterior rostal pons near the lateral floor of the fourth ventricle. secretes NE.
controls RAS, sleep wake, autonomics (BP control)
94
what does porcelain gallbladder increase the risk of
adenocarcinoma of the gallbladder
95
what marker correlates with osteoblast activity
alkaline phosphatase
96
brachiocephalic v obstruction
only affects unilateral: UE and face swelling
97
most common cause of liver metastasis and how does it spread
colon cancer: through portal venous system
98
anterior dislocations of humerous
usually happen to an external rotated and abducted arm, damages the axillary n. get flattened deltoid and loss of sensation over lateral shoulder
99
common trigger of COPD exacerbation
viral or bacterial infections
| rhinovirus, influenza, H flu, strep pneumo, morazella catahharalis
100
neuroleptic malignant syndrome
due to antipsychotic meds. hyperthermia, severe muscular rigidity, altered mental status, autonomic dysfunction.
due to dysregulation of dopamine
101
abruptio placentae
premature separation of placenta from uterus. abdominal pain, bleeding, tender, firm uterus
102
letrozole MOA
inhibits aromatase and suppreses ovarian estradiol production
103
acute hemolytic transfusion reactions are what type of hypersensitivity
type 2: complement mediated
104
where does post transcription modification of collagen occur
RER, uses vit C as a cofactor.
105
drugs for migraine prevention
anticonvulsants (topiramate and valproate), beta blockers, antidepressants (tricyclics or venlafaxine)
106
levels of what hormone are decreased in septic shock
vasopressin
107
insulin affect on lipid levels
increases lipoprotein lipase, decreases sensitivity of hormone sensitive lipase
108
tx opioid withdrawal
methadone or morphine
109
Potts disease
years after TB infection. Fevers and worsening back pain. get spinal abscess and contiguous bone destruction
110
pathophysiology of pulmonary fibrosis
increased lung elastic recoil and widened airspaces due to radial traction by surrounding fibrotic tissue
111
pediculins humans capitis
head lice
112
why are DMT1 pts who take endogenous insulin at a greater risk of hypoglycemia
can't regulate exogenous insulin the same way and after time they also develop alpha cell failure which leads to decreased glucagon secretion
113
bevacizumab MOA
binds VEGF, inhibits angiogenesis.
| can impair maintenance phase of wound healing bc of no blood supply.
114
glomus body
thermoregulation
115
late stage radiation dermatitis
fibrosis, homogenization of dermal collagen due to fibroblast activation by TGFb, vascular damage leads to ulceration, telangiectasis
116
intercostobrachial n
originates from 2nd intercostal lateral cutaneous branch and innervates skin of axilla and medial arm
117
how does n meningitis reach the meninges
nasopharynx --> blood stream --> choroid plexus --> meninges
118
antibody dependent cellular toxicity
monoclonal IgG binds to surface antigen --> NK cell binds Fc portion of IgG using CD16 --> NK releases granules --> apoptosis
119
causes of left shift
decreased H+, decreased 2,3 BPG, decreased temp
| increased oxygen affinity
120
temporal lobe epilepsy
focal seizures with impaired awareness. usually blank stare with automatisms (lip smacking, hand wringling). usually due to hippocampus issues. usually have aura (epigastric pain, olfactory issues)
121
anterior compartment of the leg
deep perineal n, anterior tibial A and V
122
factor 5 leiden
thrombophilia- hypercoaguable.
123
marker for disease progression in patients wiht ALS
decreased vital capacity of the lung --> respiratory failure
124
where in the bone does osteomyelitis infect
long bone metaphysis - highly vascular with slow flowing sinusoids
125
alkaptonuria
AR.
| defect in tyrosine metabolism (tyrosine to fumarate impaired)
126
anal fissures
bright red blood and rectal pain. longitudinal tear in anal canal distal to the dentate line, most often at posterior midline of anal verge
127
tx of anorexia nervosa
CBT, nutritional rehab, olanzepine
128
tx of bulimia
CBT, nutritional rehab, SSRI (fluoxetine)
129
common fibular (perineal N)
dorsiflexion, eversion, sensory to lateral calf and dorsal surface of foot
130
tibial n
plantar flexion, inversion, sensory to plantar surface of foot, achilles reflex
131
what enzymes is biotin a cofactor for
pyruvate carboxylase
acetyl coa carboxylase
propionyl coa carboxylase
132
histo of respiratory bronchioles and alveoli
macrophages
133
dextrans
facilitate adhesion of strep to fibrin--> attach to fibrin platelet aggregates
134
what artery supplies the anterior wall of the right ventricle
right marginal
135
posterior descending artery
posterior 1/3 of IV septum
inferior wall of left ventricle
posterior walls of ventricles
posteromedial papillary muscle
136
left circumflex artery
lateral and posterior wall of left ventricle
| anterolateral papillary muscle
137
left anterior descending artery
anterior 2/3 of IV septum
anterior wall left ventricle
anterolateral papillary muscle
138
subfalxin hernitaiton
cingulate gyrus herniates under falx cerebri.
| contralateral leg weakness
139
uncle herniation
uncut (medial temporal lobe) under the tentorium cerebelli.
| dilated fixed pupil, contralateral hemiparesis (early), ipsilateral hemiparesis (late)
140
tonsillar herniation
cerebellar tonsils through foramen magnum.
| coma, loss of CN reflexes, flaccid paralysis, respiratory arrest
141
sx of pneumothorax
shortness of breath, chest pain, decreased breath sounds unilaterally, subcutaneous crepitus, hypotension, tacky, tracheal shift
142
manifestations of west nile
fever, flu like illness, can get near issues: meningitis, encephalitis, flaccid paralysis.
bird vectors
143
what changes occur immediately after closure of a PDA
increased LV after load, decreased LV preload
144
what maintains glucose levels during meals
glycogenolysis (first 12-18 hours of fasting) and gluconeogenesis
145
which parameter in ARDS will be normal, and helps distinguish it from cariogenic pulmonary edema
pulmonary capillary wedge pressure
146
suprachiasmic nucleus
circadian rhythm and pineal gland
147
first generation antihistamines
hydroxyzine, promethazine, chlorpenarmine, diphenhydramine
148
2nd generation antihistamines
loraditizine, cetirizine
149
marijuana intox
conjunctival injection (red eye), tachycardia, increased appetite, dry mouth
150
what conditions increase risk of reactivation Tb
chronic kidney disease, poorly controlled diabetes.
151
increased tactile fremitus
consolidation
152
neuroma
mess up in nerve regeneration: results in disorganized mass of axonal processes, schwann cells, vascular hyalinization, and fibrosis
153
chronic axonal injury/inflammation
increases expression of voltage gates sodium channels
154
cholangiocarcinoma histo
adenocarcinoma with cuboidal or columnar cells w prominent nucleoli arranged in glandular structures, + mucin producing, + desmoplastic response
155
metalloproteinases
degrade extracellular matrix, help tumor cells invade the basement membrane
156
tryptophan is a precursor for what
niacin, serotonin, melanin
157
Hartnup disease
AR- mutations affecting the neutral amino acid transporter. especially can't transport tryptophan, which makes niacin which makes NAD.
pt with niacin deficiency: pellagra like skin eruptions, and cerebellar ataxia
158
which muscles attach to the lateral epicondyle and what is their function
extensor carpi radialis brevis and extensor digitorum
| wrist flexion
159
alkaptopruia manifestations in adulthood
arthritis, deposits of homogentistic acid in sclera and ear cartilage (blue-black)
160
ornithine translocase deficiency
can't get ornithine back into the mitochondria for the urea cycle. ammonia accumulates in the blood- hyperreflexia, lethargy, vomiting, seizures.
tx is limit protein intake
161
symptoms of ascending aortic dissection
sudden sharp chest pain, blood pressure asymmetry, can go on to cause tampanade
162
subacute granulomatous (de Quervian) throiditits
usually follows viral infection.
increased T3/4, increased thryoglobin, decreased TSH and radioactive uptake.
Painful diffuse goiter
163
elastase
contained in macrophages and neutrophils.
164
invasive pulmonary aspergilous
fever, chest pain, cough, dyspnea, hemoptysis
165
minimal alveolar concentration
correlates to potency. the higher the MAC, the less potent a drug is.
decreases with age and body temp
166
peripheral zone of the prostate
where most prostate cancer is- close to rectum so pts undergo transracial ultrasound guided biopsy
167
most likely predisposing factor to infective endocarditis
developed country: mitral valve prolapse
| underdeveloped: rheumatic heart disease
168
what type of patients are at greatest risk of EBV associated cancer
HIV patients
169
IgA protease
promotes adherence to mucosa
170
hormone sensitive lipase
catalyzes metabolism of stored triglycerides into free fatty acids and glycerol
171
spinal muscular atrophy
mutations in SMN1 gene--> issue with snRNA in LMN--> degeneration of anterior horn
172
stasis dermatitis
erythema, induration, fibrosis, deposits of hemosideran --> manifests as red/brown discoloration
173
thyrotropin receptor antibody
graves disease
174
thyroid peroxidase antibody
hashimoto, postpartum thyroiditis, silent thyroiditis, some graves patents.
175
patiromer MOA
binds colonic potassium in exchange for calcium
176
obesity hypoventilation syndrome
hypoxemia, hypercapnia, normal A-a gradient, chronic fatigue, dyspnea, OSA
177
REM sleep behavior disorder
alpha synuclein neurodegenerative disorder
178
stimulation of what nerve might improve OSA
hypoglossal- pushes the tongue forward giving more space
179
postmenopause osteoporosis
thinning of trabecular bone with loss of interconnecting bridges
180
bone disease due to hyperparathyroidism
increased bone resorption in cordical bone with subperiosteal thinning and cystic degeneration
181
complications of high volume blood transfusions
excess citrate chelates calcium, causing hypocalcemia
182
what is the most significant risk factor for catheter associated UTI
duration of catheter use
183
PCN moa
b-lactam that disrupts cell wall synthesis by inhibiting transpeptidase, a bacterial enzyme necessary for cell wall cross-linking
184
causes of renal papillary necrosis
sickle cell, drug induced (NSAID), DM, pyelonephritis and UTI.
185
virulence of listeria
listeriolysin O: generates pores in phagosome so it escapes cytoplasm and avoids lysosome.
actin-based transcellular spread.
infections are controlled mainly by the cytotoxic T cell response
186
complete AV canal defect
osmium primum ASD, VSD, and single AV valve.
| most common in down syndrome.
187
abetalipoprotinemia
impaired formation of apoB containing lipoproteins.
| first year of life: malabsorption, neuro abnormalities
188
pathologic brain findings in MS
depletion of oligiodendricites
189
where is epinephrine produced
adrenal medulla
190
DNA binding protein
c-JUN, c-FOS
191
pathogenesis of minimal change disease
immune dysfunction --> over production of glomerular permeability factor --> damaged podocyte --> foot process effacement and loss of anionic properties --> selective albuminemia
192
raphe nuclei
serotonin releasing neurons
193
highly proliferative cells
hemotapoietic stem cells, skin cells, gonads, intestinal crypt stem cells
194
lipid lowering drug for preventing cardiovascular events
statins (HMG CoA reductase inhibitors)
195
complications of obstructive sleep apnea
pulmonary HTN, HTN
196
associated conditions of celiacs
other autoimmune disorders, T cell lymphoma
197
BCL2
prevents signals from activating the intrinsic apoptotic cascade , mediated by release of cytochrome C and subsequent activation of capsases
198
Tx of UTI
bactrim or nitrofuritonin
199
myositis ossificans
formation of lamellar bone in extra skeletal tissues. triggered by trauma.
benign metaplastic bone with surrounding fibroblast proliferation.
200
tx of carcinoid syndrome
ocreotide
201
what enzyme is deficient in ehlers danlos and what is its normal function
pro collagen peptidase- cleaves terminal pro peptidase in extracellular space
202
how does T3 lead to osteoporosis
increases bone respiration, stimulates osteoclasts, increased release of calcium
203
which pulmonary function value remains increased once you have ARDS
Alveolar-arterial oxygen difference
204
side effect of halothane
hepatitis
205
epidermolysis bullosa
inheritable skin disorder. mutations involving intraepidermal and dermoepidermal adhesion complexes.
usually due to mutations in keratin genes
206
how does prostate cancer spread to the bone
hematogenous thought the prosthetic venous plexus
207
IgA nephropathy
nephritic, normal levels of complement, recurrent hematuria,
208
the beta subunit of hemoglobin is most similar to what
myoglobin- so they will have similar curves
209
phospholipase A2 receptor antibodies
membranous nephropathy
210
what gets injured in an anterolateral displacement distal humoral fracture
radial n
211
cause of primary spontaneous pneumothorax
rupture of apical sub pleural blebs
212
Vit D analog MOA in psoriasis
activate vit D receptor--> inhibition of T cell and keratinocyte proliferation
213
acute viral hepatitis histo
spotty necrosis with ballooning degeneration, eosinophilic apoptotic hepatocytes, mononuclear cell infiltrates
214
retinal artery occlusion
painless vision loss. thromboembolus from internal carotid --> ophthalmic artery --> retinal artery
215
alveolar ventilation
(tidal volume - dead space volume) x breaths/min
216
internal laryngeal n
controls cough reflex. gets injured when stuff gets stuck in piriform recess
217
medium chain acyl-CoA dehydrogenase deficiency
after significant fast: hypoketoic hypoglycemia (no acetoacetate), mild hepatomegaly, liver dysfunction
218
adverse effect of methadone
QT prolongation
219
stages of pages disease of the bone
1. osteolytic (osteocytes)
2. mixed
3. osteosclerotic (osteoblasts)
220
cause of diabetic mononeuropathy
ischemic nerve damage
221
cause of HbC and HbS
missense mutation
222
risk factors of uterine sarcoma
tamoxifen use, postmenopausal, pelvic radiation
223
bone marrow of older pts vs younger pts
increased fat and decreased mass
224
pure red blood cell aplasia has been associated with what cancers
thymomas and leukemias
225
what heart structure is immediately anterior to the esophagus
left atrium
226
MOA of caspofusion
block glucagon synthesis which inhibits cell wall synthesis
227
cause of gestational thrombocytopenia
expansion of plasma volume and increased platelet sequestration
228
what spinal tracts are affected in friedrichs ataxia
spinocerrobellar, lateral corticospinal, dorum columns
229
acute allergic contact dermatitis
type 4 hypersensitivity.
| has spongiosis and accumulation of edema fluid
230
maintenance dose
Css x CL x dosing interval
| steady state plasma concentration x drug clearance
231
what can you give a diabetic pt with gastroparesis if they can't take metoclopramide
erythromycin - activates motilin receptor
232
stable angina
restricted coronary blood flow due to fixed atherosclerotic plaque that obstructs >70% of lumen
233
carbon monoxide poisoning
increases carboxyhemoglobin, decreased oxygen carrying capacity and oxygen content, has no effect on dissolved amount of oxygen (PaO2)
234
effects of heparin
prolonged thrombin time, prolonged PTT, decreased activity of factor Xa
235
uterine fibroid
discrete, yellow-grey tumors. monoclonal proliferation of monocytes and fibroblasts
236
granulose cell ovarian tumor
increased estrogen, increased inhibin, call-exner bodies, yellow theca cells with lipids
237
most susceptible places to atherosclerosis
lower abdominal aorta and coronary arteries
238
acquired methemoglobinemia
cyanosis that doesn't improve with oxygen. due to topical anesthetic or dapsone. heme ions are oxidized and unable to bind oxygen
239
HIV associated dementia
subcortical dementia with mood, attention, memory, and psychomotor dysfunction. change to viral tropism to microglia and macrophages.
240
histo of aortic dissection
cystic medial degeneration
241
histo of subacute granulomatous thyroiditis
mixed, cellular infiltration with occasional multinucleate giant cells
242
why can patients with lactate dehydrogenase deficiency not do glycolysis
they can't regenerate NAD+ from NADH
243
when dermatomyositis is diagnosed what should you look out for
occult malignancy
244
why can pts wth granulomatous disease or NHL have hypercalcemia
PTH independent activation of 1a-hydroxylase in macrophages
245
axonal reaction
axon gets severed- cell body shows signs of edema: peripheral displacement of nuclei, dispersion of Kissel substance to the periphery
246
what causes increased insulin resistance in pregnancy
human placental lactogen
247
damage to what areas would result in complete hemisensory loss
ventral posterior lateral nucleus and ventral posterior medial nucleus of the thalamus
248
aromatase inhibitors
anastrozole, letrozole, exemestane
249
hydralazine, minodoxil MOA
selective arteriolar vasodilators: lower BP by lowering SVR but get reflex sympathetic innervation: increased CO and activation of RAAS.
250
assessment to test for concentration
ask pt to recite months of the year backwards
251
drugs with non-IgE mediated effect
opioids
vanco
radioiodine contrast
mast cell degranulation
252
primary somatosensory cortex
controls sensory information to the contralateral side of the body (post central gyrus)
253
risk factors of gastricadenocarcinoma
high salt diet, N-nitro containing foods, H pylori, autoimmune gastritis, obesity
254
intestinal type gastric adenocarcinoma
ulcerated mass with irregular or heaped up edges.
| glandular structures with cuboidal or columnar like intestinal cells
255
diffuse type gastric adenocarcinoma
plaque like infiltration of stomach; lintitis plastia
| signet ring cells without glandular structures
256
why is DIC a common complication of sepsis
lipopolysaccharide is a procoagulant that triggers the coagulation cascade
257
cysticercosis
ingestion of taenia solieum- fecal oral
| get cysts in brain- can manifest as seizures
258
cause of progressive valvular calcification
fibroblasts differentiate into osteoblast like cells
259
kidney complications of BPH
increased hydrostatic force needed --> hydronephrosis --> parachymal atrophy and scarring leaking to CKD
260
where do most pancreatic cancers arise from
pancreatic ductal system
261
BRCA
DNA repair gene
262
asbestos exposure
insulation, shipbuilding, drywall workers.
| pleural plaques with calcifications
263
what is the most common cause of bacterial meningitis in adults
strep pneumo
264
propofol
highly lipophilic GABA agonist used for long term sedation.
| adverse: hypotension
265
etomidate
GABA agonist, hemodynamically neutral. causes adrenalcortico suppression
266
ketamine
NMDA antagonist. preserves respiratory drive and is also sympametetic
267
tx of tinea pedis
topical antfungals: miconazole, clotrimazole, terbinafine, tolnaftate
268
mannitol MOA
increases plasma osmolarity--> pulls water into plasma --> decrease serum sodium concentration -> increase renal blood flow --> increased GFR and RBF
269
where do the testis drain
para-aortic
270
histo of acute viral hepatitis
hepatocyte necrosis (cellular swelling) and apoptosis with mononuclear infiltrate
271
clinical use of lactated ringer and normal saline
volume resusitation (isotonic)
272
use of dextrose 5% and .45 saline
free water deficit (hypotonic)
273
HPV viral oncogenes
E6- p53
| E7- Rb
274
chronic granulomatous disease increases risk of infection with what type of organisms
catalase positive
275
CYP3A4 inhibitors
fluconazole, voriconazole, ketoconazole, ciprofloxacin, clarithromycin, cimetidine, fluvoxamine.
276
pudendal n
pelvic floor muscles, external urethral and anal spinchters
277
tension from what muscle would cause a distal clavicle fracture
deltoid
278
brain imaging of huntingtons disease
enlargement of frontal horns of lateral ventricle
279
Cytokerratin
marker for epithelial derived tumors
280
pemphigus vulgaris
LM: intraepithelial cleavage with detached keratinocytes, and retained keratinocytes along basement membrane
281
adverse effect of calcineruin inhibitors (cyclosporine, tacrolimus)
increase BUN and Creatinine, renal arteriolar constriction--> HTN --> obliterative vasculopathy
282
common triggers of drug induced hemolysis
anti-inflammatories, PCN, cephalosporins
