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missed questions Flashcards

1
Q

Lab results for anemia of chronic disease

MCV, serum iron, Ferritin, TIBC, transferrin saturation

A 
MCV: decreased
Serum iron: decreased
Ferritin: increases/N
TIBC: decreased
transferrin saturation %: normal or decreased
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2
Q

Lab results for anemia of iron deficiency

MCV, serum iron, Ferritin, TIBC, transferrin saturation

A 
MCV: D
Serum iron: D
Ferritin: D
TIBC: Inc
Transferrin saturation: D
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3
Q

Lab results for sideroblastic anemia

MCV, serum iron, Ferritin, TIBC, transferrin saturation

A 
MCV: D
Serum iron: inc
Ferritin: inc
TIBC: norm or dec
Transferrin saturation: inc or norm
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4
Q

Lab results for thalassemia

MCV, serum iron, Ferritin, TIBC, transferrin saturation

A 
MCV: dec
serum iron: inc
Ferritin: increased
TIBC: dec
transferrin saturation: inc
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5
Q

what pt will be most likely to have anemia of chronic disease

A

pt with chronic inflammatory disease

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6
Q

tx for sideroblastic anemia

A

pyridoxine (vit B6)

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7
Q

causes of sideroblastic anemia

A

defect in ALA synthase, alcoholism, lead poisoning, isoniazid, vit b6 deficiency

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8
Q

tx for paroxysmal nocturnal hemoglobinuria

A

eculizumab (terminal complement inhibitor)

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9
Q

MOA acute hemolytic transfusion reactions

A

complement activation and cell lysis

type 2 hypersensitivity

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10
Q

sx of acute hemolytic transfusion reactions

A

fever
ab and flank pain
hemoglobinuria

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11
Q

complications of sickle cell

A 
acute chest syndrome 
osteomyelitis
aplastic crisis (parvo B19)
autosplenectomy
folate deficiency 
renal papillary necrosis (hematuria)
vaso-occlusive crises: priapism, necrosis of femoral head, dactylics)
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12
Q

what do you give to pt with active bleed who needs rapid surgical intervention?

A

fresh frozen plasma –> reverses INR bc it has all the coagulation factors

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13
Q

MOA of diamond Blackman anemia

A

defect in eryhtropoesis –> pure red cell aplasia

erythroblasts in bone marrow undergo premature apoptosis

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14
Q

sx of diamond Blackfan anemia

A

anemia
webbed neck
cleft pallet
triphalangeal thumb

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15
Q

what type of of anemia is blackfan diamond

A

macrocytic anemia nonmegaloblastic

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16
Q

3 macrocytic megablastic anemias

A

B12 def
folate def
orotic aciduria

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17
Q

4 macrocytic nonmegablastic anemias

A

diamond blackfan
alcohol use
liver disease
thyroid disease

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18
Q

sx of orotic aciduria

A

failure to thrive
delayed development
anemia that doesn’t approve with supplements of folate and b12

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19
Q

pathophysiology of hereditary spherocytosis

A

AD

defect in ankyrin/spectrin –> RBC cytoskeleton defects

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20
Q

sx of hereditary spherocytosis

A

splenomegaly

increased bilirubin –> jaundice, dark urine

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21
Q

lab findings of hereditary spherocytosis

A 
normocytic anemia
inc Lactate dehydrogenase 
inc reticulocytes 
dec haptoglobin 
inc RDW
inc MCHC
spherocytes, howell-jolly bodies
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22
Q

dx of hereditary spherocytosis

A

osmotic fragility test

dec mean fluorescence in osin 5- maleimide binding

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23
Q

pathophysiology systemic mastocytosis

A

mutations in KIT–> mast cell proliferation and increased expression of mast cell trypase
increased mast cell degranulation –> increase in histamine–> gastric ulceration

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24
Q

sx of systemic mastocytosis

A 
pruritus
Dariers sign: rash or itching when stroke skin. 
gastric ulcers
hypotension and syncope 
itching after hot shower
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25
Q

sx of CLL

A

LAD
hepatosplenomegaly
mild anemia/thrombocytopenia
constitutional symptoms

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26
Q

dx of CLL

A

severe lymphocytosis

smudge cells

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27
Q

complications of CLL

A

increased risk of infections

autoimmune hemolytic anemia

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28
Q

what age does CLL usually affect

A

older adults

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29
Q

MOA of cold autoimmune hemolytic anemia

A

IgM binds RBC –> complement mediated destruction of RBCs

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30
Q

risk factors of cold autoimmune hemolytic anemia

A

mycoplasma pneumonia
infectious mono
CLL

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31
Q

what type of anemia is cold autoimmune hemolytic anemia

A

normocytic

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32
Q

MOA of warm autoimmune hemolytic anemia

A

IgG binds to RBC–> phagocytosis of RBCs

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33
Q

risk factors for warm autoimmune hemolytic anemia

A

SLE
autoimmune
CLL
meds: penicillamine, methyldopa

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34
Q

MOA of HUS

A

shiga toxin producing bacteria: shigella and E. Coli 0157:H7

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35
Q

sx of HUS

A

bloody diarrhea
microangiopathic hemolytic anemia
thrombocytopenia
AKI

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36
Q

dx of HUS

A

schistocytes, increased bleeding time

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37
Q

what type of azotemia does HUS cause

A

intrinsic

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38
Q

lab findings of pre renal azotemia

A

BUN/creatinine >20
urine sodium <20
Fractional excretion of sodium <1%

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39
Q

lab findings of intrinsic azotemia

A

BUN/creatinine <15
urine sodium >40
Fractional excretion of sodium >2%

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40
Q

common precipitants of G6PD deficiency

A

meds: sulfa drugs and antimalarials
Infections
fava beans

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41
Q

classic presentation of G6PD deficiency

A

back or ab pain, jaundice, dark urine days after taking antibiotic

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42
Q

inheritance of G6PD deficiency

A

X linked recessive

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43
Q

blood smear of G6PD deficiency

A

degmacytes (bite cells)

Heinz bodies

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44
Q

MOA heparin induced thrombocytopenia

A

heparin binds to platelet factor 4 –> antibody production–> antibodies bind to platelets–> platelet consumption and activation.

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45
Q

sx of heparin induced thrombocytopenia

A

drop in platelet count by >50%

material or venous thrombosis

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46
Q

tx mild hemophilia A

A

DDAVP (increases vWF–> stabilizes factor 8)

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47
Q

translocation of Burkitts

A

8-14

MYC

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48
Q

complication of mechanical prosthetic valves

A

hemolytic anemia –> schistocytes

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49
Q

3 phases of CML

A

chronic (mature cells proliferate)
accelerated (cryogenic abnormalities accrue)
Blast (immature cells rapidly proliferate)

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50
Q

risk factors for CML

A

ionizing radiation or chemicals like benzene

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51
Q

sx of CML

A

increased WBC, splenomegaly, constitutional symptoms, fever, bone pain, petechiae, anemia, thrombocytopenia, hyperuricemia.
Decreased leukocyte alkaline phosphatase

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52
Q

tx of CML

A

imatinib

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53
Q

MOA of imatinib

A

TKI targets active BCR-ABL fusion protein

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54
Q

pT, pTT, and bleeding time for immune thrombocytopenia purpura

A

pT and pTT normal

BT increased

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55
Q

pentad of TTP

A

fever, neuro issues, thrombocytopenia, MAHA, renal failure

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56
Q

MALT translocation

A

t(11;18)

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57
Q

mutation in DLBCL

A

BCL6

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58
Q

translocation of follicular lymphoma

A

t(14;18)

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59
Q

translocation of mantle cell

A

t(11;14)

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60
Q

how is fanconi anemia inherited

A

autosomal recessive or X linked

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61
Q

clinical manifestations of fanconi anemia

A

pancytopenia, short stature, cafe au last spots or hypo pigmentation, dysplastic thumbs, microcephaly, hypogonadism, developmental delay

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62
Q

causes of pure red cell aplasia

A

thymomas, autoimmune disorders, drug exposure, viral illness, diamond blackfan

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63
Q

moa of abciximab

A

inhibits GP2b/3a

platelets can’t aggregate

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64
Q

glanzmann thrombocytopenia inheritence

A

AR

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65
Q

moa of glanzmann thrombocytopenia

A

defect of GP2b/3a
mucocutaneous bleeding
normal platelet counts, but no aggregation

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66
Q

MOA of bernard-soulier

A

defect in glycoprotein 1b (vWF receptor)

giant platelets

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67
Q

which HL present at younger ages

A

lymphocyte predominant and nodular sclerosis

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68
Q

what pt is most likely to have nodular sclerosing HL

A

young female

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69
Q

who presents with lymphocyte deletion HL?

A

older males with HIV

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70
Q

who presents with lymphocyte predominant HL?

A

young males with cervical or axillary LAD

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71
Q

who presents with lymphocyte rich HL?

A

M>F, older adults

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72
Q

who presents with mixed cellularity HL?

A

males, biphasic incidence

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73
Q

symptoms of ALL

A

fatigue, weakness, SOB, loss of appetite, weight loss, fever, petechiae, purport, gingival bleeding, pallor, frequent infections, splenomegaly, LAD

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74
Q

marker for ALL

A

TdT

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75
Q

markers for B-ALL

A

CD19, CD20

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76
Q

markers for T-ALL

A

CD1, CD2, CD5, CD7

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77
Q

symptoms of multiple myeloma

A

hypercalcemia
renal insufficiency
anemia
back pain

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78
Q

characteristic blood finding in multiple myeloma

A

rouleux formation- stack of RBC

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79
Q

age for CML

A

30-60

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80
Q

translocation in CML

A

t(9;22)

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81
Q

tx of heparin toxicity

A

protamine sulfate

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82
Q

papillary thyroid carcinoma is associated w a history of what

A

head and neck radiation

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83
Q

histo findings of papillary thyroid carcinoma

A

psammoma body, orphan annie eye nuclei

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84
Q

deficiency in what factors leads to prolonged pTT

A

8,9,10,12

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85
Q

deficiency in what factors leads to prolonged pT

A

1,2,5,7,10

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86
Q

how does DLBCL present

A

older person with rapidly enlarging mass

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87
Q

3 most common cancers with psammoma bodies

A

papillary thyroid carcinoma, serous cystadenoma of the ovary, meningiomas

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88
Q

clinical manifestation of selective IgA deficiency

A 
recurrent sinopulmonary infections
autoimmune disorders
giardia infections
allergic disorders
anaphylactic transfusion reactions
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89
Q

warm hemolytic anemia will likely what have positive lab test

A

positive coombs at 37C but not at 4C

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90
Q

what is the reticulocyte index in pts with a myeloproliferative disorder?

A

decreased (<2%)

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91
Q

uses of hydroxyurea

A

myeloproliferative disorders (PV, ET), sickle cell

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92
Q

moa of hydroxyurea

A

increases hemoglobin F, decreased concentration of hemoglobin S

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93
Q

what will shift the oxygen-hemoglobin curve to the right

A

CO2 exposure, acid exposure, increases in 2,3-DPG

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94
Q

what does warfarin do to INR

A

increase it

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95
Q

what can you use for anticoagulation in a pt with a history of heparin induced thrombocytopenia

A

direct thrombin inhibitors- argatroban

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96
Q

lab findings in DIC

A 
increased PT
increased PTT
increased bleeding time
decreased antithrombin 3
decreased platelet count
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97
Q

associated conditions with DIC

A

pancreatitis, lymphoproliferative, myeloproliferative or solid malignancies, severe hepatic failure, sepsis

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98
Q

what is the cause of an elevated BUN:Cr ratio in a pt with multiple myeloma

A

cast nephropathy

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99
Q

what is the monoclonal antibody in waldenstrom macroglobulinemia

A

IgM

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100
Q

clinical features of waldenstrom macroglobulinemia

A 
hyper viscosity syndrome--> headache, blurred vison
peripheral neuropathy 
LAD
hepatosplenomegaly
raynauds
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101
Q

how do you dx waldenstrom macroglobulinemia

A

serum protein electrophoresis

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102
Q

antibodies for polymyositis and dermatomyositis

A

anti-jo 1, anti Mi 2, anti SRP

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103
Q

presentation of AML APL variant

A

life threatening bleeding w features of DIC, recurrent infection, pancytopenia

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104
Q

what is the translocation for AML APL

A

15;17

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105
Q

tx for AML APL

A

all trans retinoid acid

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106
Q

enlarged supraventricular node is suggestive of what type of cancer

A

lymphoma- usually B cell

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107
Q

MOA of phemigus vulgaris

A

IgG antibodies against desmosomes–> loss of cell- cell adhesion–> pacantholysis

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108
Q

how can you dx phemigus vulgaris

A

biopsy with direct immunofluorescence showing antibodies on surface of keratinocytes
net like pattern

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109
Q

what do you see on biopsy for bulls pempihoid

A

immunofluorescence in a linear dermal epidermal distribution

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110
Q

what do you see on biopsy of celiac disease

A

mucosal atrophy, loss of villi, crypt hyperplasia

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111
Q

bulls pemphigoid has what antibodies

A

anti hemidesmosomes

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112
Q

what does basal cell carcinoma look lie grossly

A

non-pigmented, slow growing, non healing ulcer with rolled borders, central crusting, telangiectasis

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113
Q

risk factors for acute gout

A 
diet (high protein foods, high fat)
alcohol 
meds (diuretics, aspirin)
surgery or trauma
underlying chronic medical condition
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114
Q

tx for acute gout

A

1st: NSAID
when can’t use NSAID: colchicine
prednisone if pt has renal disease

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115
Q

clinical presentation for Alpert’s syndrome

A

progressive hearing loss, arthritis, nephritis, before 30

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116
Q

Alports is due to an issue with what

A

type 4 collagen

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117
Q

lesch nyhan is due to deficiency of what

A

HGPRT enzyme- normally channels hypoxanthine and guanine back into synthesis of DNA

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118
Q

dermatographism (stroking skin with firm pressure) is a test for what

A

physical urticaria

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119
Q

sx of acrochordon

A

small benign tumor in areas where skin forms creases: neck, armpit, groin

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120
Q

MOA of fluoroquinolone

A

inhibits DNA gyrase (topoisomerase 2)

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121
Q

side effects of fluoroquinolone

A 
tendon rupture 
GI upset
superinfection
skin rash
headache
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122
Q

MOA of polymyxins

A

binding to cell membrane of bacteria and disrupts their osmotic properties

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123
Q

side effects of polymyxins

A

neurotox

acute RTN

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124
Q

MOA of isoniazid

A

decreased synthesis of mycolic acid

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125
Q

MOA of metronidazole

A

forms toxic metabolites in bacterial cell that damage DNA

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126
Q

side effects of metronidazole

A

HA
metallic taste
disulfiram like reaction

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127
Q

MOA of rifampin

A

inhibits DNA dependent RNA polymerase

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128
Q

how does angiodysplasia present on colonoscopy

A

discolored lesion with vessels that are dilated, thin walled, and without smooth muscle

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129
Q

sx of angiodysplasia

A

asymptomatic, blood per rectum, tachycardia, iron deficient anemia

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130
Q

most common cause of acute cholecystitis

A

gallstone impaction in the cystic duct

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131
Q

presentation of acute cholecystitis

A

RUQ pain, fever, leukocytosis, elevated all phos

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132
Q

risk factors for cholesterol stones

A

obesity, pregnancy, estrogen therapy, chrons, rapid weight loss, gallbladder stasis, advanced age, multiparty.

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133
Q

risk factors for pigment stones

A

chronic hemolysis; hereditary spherocytosis, alcoholic cirrhosis, biliary infections, total parenteral nutritions, chrons, advanced age

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134
Q

causes of dysphagia for solids and liquids

A

achalasia
diffuse esophageal spasm
scleroderma esophageal dysmotility

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135
Q

causes of dysphagia for solids only

A 
EOE
esophageal cancer
esophageal strictures
esophageal webs
plummer vinson
schatzki ring
zenker diverticulum
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136
Q

most common cause for schatzki ring

A

GERD

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137
Q

risk factors for adenocarcinoma of the esophagus

A 
barrets
GERD
obese
smokign
achalasia
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138
Q

risk factors for primary sclerosis cholangitis

A

males with UC
HLA DR3
hypothyroidism

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139
Q

clinical presentation of PSC

A 
severe itching
fatigue
increased direct bilirubin: jaundice, dark urine, white stool
steathorrhea
cirrhosis and portal HTN
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140
Q

dx of PSC

A 
increased direct bilirubin
inc ALK Phos
inc GGT
LF normal
P ANCA
inc IgM
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141
Q

imaging results for PSC

A

beading of intrahepatic or extra hepatic bile ducts

MRCP or ERCP

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142
Q

Biopsy results of PSC

A

onion skin bile duct fibrosis

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143
Q

how does viral infection increases risk of intusseption

A

hypertrophy of Peters patches

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144
Q

sx of small bowel obstruction

A

intermittent cramping ab pain, N/V, high pitched bowel sounds, dilated loops of bowel with air fluid levels

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145
Q

sx of gallstone ileus

A

air in biliary tree

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146
Q

cause of gallstone ileus

A

mechanical obstruction of ileocecal valve secondary to gallstone, erode via cholecystoenteric fistula

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147
Q

sx of ascending cholangitis

A

fever, jaundice, RUQ pain

+/- hypotension and altered mental status

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148
Q

MOA of acute pancreatitis

A

autoactivation of trypsinogen to trypsin

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149
Q

chrons disease characteristics

A

bloody or nonbloody
transmural inflammation
skip lesions
noncaseating granulomas

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150
Q

extra intestinal manifestations of UC and chrons

A 
erythema nodosum
pyoderma gangrenous
uveitis
arthritis
ankylosing spondylitis
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151
Q

sx of erythema nodosum

A

painful inflammation of subQ fat pads over tibia. Painful , palpable nodules

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152
Q

complications of chrons

A 
fistulas
SBO
strictures
kidney stones
gallstones
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153
Q

sx of whipple disease

A 
old men
arthralgia
cardiac issues
neuro symptoms
diarrhea and steatorrhea
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154
Q

dx of whipple

A

PAS positive

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155
Q

causes of ischemic hepatitis

A

cardiac arrest
hypovolemic shock
septic shock
severe intraoperative hypotension

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156
Q

clinical findings of ischemic hepatitis

A

elevated AST and ALT >1000

normal ALP

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157
Q

adverse affects of amiordarone

A 
pulmonary fibrosis
hypothyroidism and hyperthyroid
gray skin deposits 
corneal deposits
hepatic steatosis and cholestatis
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158
Q

how is Dubin Johnson inherited

A

AR

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159
Q

MOA of Dubin johnson

A

defective hepatic excretion of bilirubin

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160
Q

sx of Dubin johnson

A

conjugated hyperbilirubinemia, scleral icterus, jaundice

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161
Q

what can cause a pt with Dubin johnson to become symptomatic

A

birth control

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162
Q

what drug can be used to treat diffuse esophageal spasm and what is ts MOA

A

calcium channel blocker- causes smooth muscle relaxation via inhibition of voltage gated calcium channels

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163
Q

how is wilsons inherhited

A

AR mut in ATP7B

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164
Q

sx of wilsons

A

cirrhosis, acute liver failure, gait issues, tremor, parkinsonism, depression, personality changes, hemolytic anemia

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165
Q

Dx of wilsons

A

inc urinary copper excretion
kayser Fleischer rings on slit lamp examination
copper deposition on liver biopsy

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166
Q

what tumor marker is associated with hepatocellular carcinoma

A

AFP

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167
Q

B HCG is a tumor marker for what

A

germ cell tumors: seminoma, yolk sac, choriocarcinoma

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168
Q

CA19-9 is a tumor marker for what

A

pancreatic adenocarcinoma

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169
Q

CEA is a tumor marker for what

A

colorectal cancer

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170
Q

HER2 is a tumor marker for what

A

breast cancer and gastric adenocarcinoma

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171
Q

what is usually the cause of acute mesenteric ischemia

A

embolic occlusion of the superior mesenteric artery

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172
Q

risk factors for acute mesenteric ischemia

A

A fib
coronary angiography
infective endocarditis
VSD

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173
Q

sx of acute mesenteric ischemia

A

ab pain out of proportion to physical exam
bloody stool
air in bowel wall

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174
Q

risk factors for chronic mesenteric ischemia

A 
HTN
hyperlipidemia
DM
tobacco
CAD
peripheral vascular disease
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175
Q

sx of chronic mesenteric ischemia

A

chronic ab pain, pain associated with oral intake

weight loss

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176
Q

does primary biliary chonalgitis affect intra or extra hepatic bile ducts

A

intrahepatic only

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177
Q

antibody for PBC

A

anti mitochondrial

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178
Q

antibody for PSC

A

p ANCA

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179
Q

biopsy findings for primary sclerosis cholangitis

A

fibrous obliteration of the epithelium and connective tissue replacement in an onion skin pattern

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180
Q

sx of gastrointestinal stroll tumor

A

painless bleeding, anemia, fatigue, SOB, mass in stomach

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181
Q

endoscoptic characteristics of gastrointestinal stroll tumor

A

submucosal location with preservation of overlying muscosa, smooth margins, bulging into gastric lumen

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182
Q

what mutation goes with gastrointestinal stroll tumor

A

GoF in c-KIT protooncogene

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183
Q

sx of biliary atresia

A

dark urine and gray colored stools
elevated direct bilirubin
jaundice

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184
Q

MOA of GVHD

A

donor lymphocytes recognizing host cell antigens as foreign

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185
Q

cause of hereditary pancreatitis

A

AD disorder resulting from mutation of the gene for trypsinogen- can’t be inhibited by PSTI

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186
Q

what layers get herniated in zenkers diverticulum

A

mucosal and submucosal

lacks muscular propria

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187
Q

components of mucosal layer of esophageal wall

A

epithelial cells
lamina propria
muscular mucosa

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188
Q

increased estrogen in cirrhosis can lead to what symptoms

A

gynocomastia
spider nevi
testicular atrophy

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189
Q

MOA of gemfibrozil

A

inhibits cholesterol 7a hydroxylase

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190
Q

side effect of gemfibrozil

A

increased risk of cholesterol gallstones

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191
Q

MOA of acute gastritis

A

inflammation due to neutrophilic infiltration

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192
Q

causes of acute gastritis

A 
NSAIDS
alcohol
smoking
chemo
uremia
trauma
viral infection
ischemia
shock
acids
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193
Q

MOA of achalasia

A

failed LES relaxation and peristalsis of the distal esophageal smooth muscle

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194
Q

sx of pancreatic adenocarcinoma

A

obstructive jaundice
palpable contender gallbladder
migratory thrombophlebitis

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195
Q

complications of CF

A 
pulmonary infections
bronchiectasis
cor pulmonale
obstruction of bile and pancreatic ducts
cirrhosis of liver
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196
Q

cause of hypertrophic pyloric stenosis

A

maternal use of macrolides

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197
Q

MOA of cholesterolosis

A

abnormal deposition of triglycerides and cholesterol into gallbladder mucosa

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198
Q

what disease is described by a coarse and granular mucosa from a strawberry gallbladder

A

cholesterolosis

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199
Q

MOA of bradykinin

A

increases capillary permeability leading to plasma leakage

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200
Q

MOA of angioedema

A

unchecked activation of complement cascade leading to a build up of bradykinin

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201
Q

besides swelling of hand and feet, how can angioedema present

A

fluid accumulation in interstitial- intestinal swelling presenting an colicky abdominal pain

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202
Q

complications of polycythemia vera

A

budd chiari= thrombus in hepatic vein

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203
Q

extra hepatic bile duct presentation of choledochal cysts

A

segmental or cylindrical dilation of common bile duct.
diverticulitis of extra hepatic duct.
cystic lesions that protrude into duodenal lumen

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204
Q

presentation of choledochal cysts

A

pt less than 10 yo, jaundice, recurrent ab pain, RUQ pain right after meals, conjugated hyperbilirubinemia

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205
Q

MOA of caroli disease

A

multifocal segmental dilation of large intrahepatic bile ducts

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206
Q

sx of caroli disease

A

assc with ARPCK, congenital hepatic fibrosis, portal HTN, esophageal varies, ascites

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207
Q

what is a choledochal cyst

A

congenital dilation of the common bile duct

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208
Q

how would you describe a second degree injury to the esophagus due to caustic injestion

A

mucosal and submucosal damage, ulcerations, exudates, vesicle formation

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209
Q

antibody for scleroderma

A

anti-topoisomerase 1 (anti-Scl-70)

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210
Q

antibody for drug induced lupus

A

anti histone

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211
Q

drugs that cause drug induced lupus

A

hydralazine, isoniazid procainanmide, quinidine

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212
Q

antibodies for sjorgens

A

anti La and anti Ro

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213
Q

antibody for SLE

A

anti smith

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214
Q

endoscopy findings of mallory weiss tears

A

focal lesions with normal appearing adjacent mucosa in distal esophagus

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215
Q

common causes of pill induced esophagitis

A 
iron
potassium
vit c
alendronate
risedronate
tetracycline
aspirin
NSAIDs
quinidine
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216
Q

diseases associated with celiacs

A

DM type 1
dermatitis herpetiformis
liver and thyroid disease

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217
Q

how does the alpha 1 antitrypsin protein appear on biopsy

A

magenta granules on PAS stain after diastase digestion

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218
Q

why does pregnancy increase risk of cholesterol gallstones

A

supersaturation of cholesterol in bile bc estrogen increases cholesterol and progesterone decreases bile acid secretion and decreased gallbladder motility.

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219
Q

Moa of bactrim

A

Inhibits dihydropteroate synthase

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220
Q

Moa of rifampin

A

Inhibits DNA dependent RNA polymerase

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221
Q

Moa of fluconazole

A

Blocks conversion of lanosterol to ergosterol

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222
Q

Moa of nystatin

A

Binds ergosterol resulting in formation of pores in fungal membrane

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223
Q

How is nystatin given

A

Topical

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224
Q

Moa of flucytosine

A

Antifungal agent that inhibits DNA and RNA biosynthesis

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225
Q

What nerve is pronator teres syndrome

A

Median nerve

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226
Q

Sx of pronator teres syndrome

A

Pain proximal forearm, pain during day, sensory loss thenar eminence, weakness of thumb opponens

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227
Q

Moa of isoniazid

A

Activated by KatG to prevent synthesis of mycolic acids

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228
Q

Moa of pyramidinqmide

A

Pyrazinoic acid formation collapses transmembrane proton motive force and inhibits enzyme function

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229
Q

Moa of ethambutol

A

Inhibits arabinosyl transferase to stop cel wall production

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230
Q

What motion does Supraspinatus do

A

Abduction

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231
Q

What motion does infraspinatus do

A

External rotation and abduction

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232
Q

WhT motion does teres minor do

A

External rot abduction

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233
Q

What motion does subscapularis do

A

Internal rotation ab and addiction

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234
Q

What type of cancer is Paget’s disease associated with

A

Invasive ductal carcinoma

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235
Q

Typical antipsychotics (5)

A 
Haloperidol
Fluphenazine
Thioridazine
Chlorpromazine
Pimpzide
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236
Q

Atypical antipsychotics

A 
Clozapine
Olabzapine
Risoeridone
Aripiprazole
Quetiapine
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237
Q

antibodies for autoimmune hepatitits

A

ANA or ASMA

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238
Q

what marker will be positive if you have had Hep B vaccine

A

surface antibody

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239
Q

what is a complication of CF (not involving lungs or pancreas)

A

cirrhosis of the liver

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240
Q

how do you treat intussusception in its under 3

A

barium or air enema

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241
Q

cause of intussusception in adults

A

CF, hence-schonlein purport, tumors

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242
Q

what is the most common type of benign liver tumor

A

cavernous hemangioma

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243
Q

histo for liver hemangiomas

A

dilated vascular spaces filled with blood and lined by a single layer of epithelium

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244
Q

hepatic adenomas are associated with what cause

A

oral contraceptives or anabolic steroid use

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245
Q

what is a complication of hepatic adenomas

A

spontaneous rupture- should resect in women of child bearing age due to increased estrogen

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246
Q

clinical features of small bowel obstruction

A

diffuse abdominal pain, hyperactive bowel sounds, abdominal distention

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247
Q

small bowel obstruction X-ray findings

A

dilated loops of bowel and air fluid levels

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248
Q

how is HH inheretied

A

AR

HFE gene on chromosome 6

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249
Q

clinical features of HH

A

new onset diabetes and hyperglycemia, cirrhosis, joint pain, hyperpigmentation, restrictive/dilated cardiomyopathy

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250
Q

adverse effects of NSAIDS

A 
aplastic anemia
interstitial nehpritits
increased risk fo cardiovascular disease
gastric ulcers
renal ischemia
renal papillary necrosis
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251
Q

which type of ulcer has the highest risk of malignancy

A

gastric ulcer

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252
Q

do duodenal ulcers get better or worse with meals

A

pain decreases

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253
Q

what is the main cause of a duodenal ulcer

A

H pylori

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254
Q

how can you confirm a dx of hirschsprung disease

A

rectal suction biopsy

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255
Q

pathophysiology of crigler-najjar type 1

A

No UDP-GT

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256
Q

sx of crigler-najjar type 1

A

severe persistent jaundice at birth, kernicterus- muscle rigidity, seizures

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257
Q

causes of B12 deficiency

A

deficient intake, lack of IF, ill disease

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258
Q

what damage does b12 deficiency have on the spinal tract

A

dorsal column
lateral corticospinal trat
spinocerebellar tract

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259
Q

what does the dorsal column of the spinal cord control

A

proprioception, vibration, light touch

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260
Q

what does the lateral corticospinal tract control

A

muscles

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261
Q

damage to the spinocerebellar tract will cause what issue

A

ataxia

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262
Q

what does the spinothalamic tract do

A

pain and temp

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263
Q

causes of torsades de pointes

A 
hypokalemia
macrolides
class 1A and class 3 antiarrhythmics
antipsychotics
antidepressants
antiemetics (ondansetron)
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264
Q

sx of torsades de point

A

tachycardia
palpitations
dizziness
syncope

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265
Q

sx of first degree heart block

A

bradycardia leading to fatigue, dyspnea, dizziness, syncope

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266
Q

what drugs can cause first degree heart block

A

b blockers and CCB

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267
Q

what does first degree heart block look like on EKG

A

prolongation of the PR interval

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268
Q

EKG findings of cardiac tamponade

A

electrical alternans–> beat to beat alterations in amplitude of the QRS complex

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269
Q

sx of cardiac tamponade

A

Becks triad: hypotension, JVD, muffled heart sounds

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270
Q

risk factors of right sided infectious endocarditis

A

IV drug use

central venous catheter

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271
Q

what organisms cause right sided infectious endocarditis

A

staph aureus
pseudomoas
candida

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272
Q

sx of right sided IE

A

tricuspid regurgitate, fevers and chills, , fatigue

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273
Q

complications of right sided IE

A

pulmonary embolism, lung abscess, bacterial pneumonia

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274
Q

what does tricuspid regard sound like

A

holosystolic murmur heard at the left sternal border, increases with inspiration

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275
Q

complications of left sided heart vegetations

A

enter systemic circulation: stroke, brain abscesses, AKI, acute mesenteric ischemia

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276
Q

what valve is usually affected in left sided IE

A

mitral

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277
Q

where is mitral regard best heard

A

cardiac apex, holosystolic, increases with inspiration

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278
Q

what does mitral valve prolapse sound like

A

mid systolic click followed by a late systolic decrescendo best heard at cardiac apex

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279
Q

what does mitral stenosis sound like

A

opening snap followed by an early diastolic murmur, best heard at cardiac apex

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280
Q

what are laneway lesions associated with

A

left sided IE

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281
Q

sx of mitral valve stenosis

A

dyspnea and worsening exercise tolerance

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282
Q

what is a usual cause of mitral valve stenosis

A

delayed complication of rheumatic heart disease

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283
Q

what are the 7 systolic murmurs

A 
aortic stenosis
pulmonic stenosis
MVP
mitral regurg
tricuspid regurg
hypertrophic cardiomyopathy
VSD
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284
Q

what are the 3 holosystolic murmurs

A

mitral regurg
tricuspid regurg
VSD

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285
Q

what are the 3 diastolic murmurs

A

aortic regurg
mitral stenosis
tricuspid stenosis

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286
Q

what murmur is best heard at right sternal border

A

aortic stenosis

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287
Q

what murmrus are best heard at left sternal border

A 
pulmonic stenosis
tricuspid stenosis
tricuspid regurg
hypertrophic cardiomyopathy
VSD
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288
Q

what murmrus are best heard at the cardiac apex

A

mitral stenosis
mitral regurg
MVP

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289
Q

what murmur is best heard at left infraclavicular area

A

PDA

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290
Q

causes of pulses paradoxous

A

cardiac tamponade, constrictive pericarditis, cariogenic shock, pulmonary embois, asthma, COPD, tension pneumothorax

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291
Q

pluses parvus et tardus (weak pulses ) is assocaited with what

A

aortic stenosis

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292
Q

causes of wide pulse pressure

A

aortic regurg, aortic dissection, PDA, av fistula

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293
Q

sx of renal artery stenosis

A

refractory HTN, abdominal bruits, secondary hyperaldosteronism (inc renin and aldosterone)

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294
Q

what is the most common cause of renal artery stenosis in young women

A

fibromuscular dysplasia

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295
Q

conn syndrome

A

aldosterone producing tumor causes primary hyperaldosteronism

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296
Q

sx of conns syndrome

A

HTN, hypokalemia, metabolic alkalosis, decreased renin levels

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297
Q

sx of pheochromocytoma

A

episodic HTN, headaches, palpitations, and diaphoresis

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298
Q

where are atrial myxomas most commonly located

A

left atrium

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299
Q

complication of atrial myxoma

A

embolic disease, stroke symptoms, AKI, arterial insufficiency, ischemic colitis

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300
Q

what type of murmur do myxomas cause

A

diastolic best heard at cardiac apex

tumor plop

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301
Q

what does histo for an atrial myxoma look like

A

gelatinous material and myxoma cells immersed in glycosaminoglycans

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302
Q

3 common causes of ischemic stroke

A

thrombotic
embolic
hypoxemia

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303
Q

what would a stroke in the right middle cerebral artery present like

A

left sided facial droop, motor and sensory deficits in left upper extremity

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304
Q

what leads correspond to the right coronary artery

A

2,3, aVF

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305
Q

occlusion of the RCA will affect which portion of the heart

A

inferior, right ventricle

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306
Q

what drug should be avoided in RV MI and why?

A

nitrates because the pt is preload dependent, and nitrates cause an abrupt decreases in RV end diastolic volume

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307
Q

pathophysiology of henoch-schonlein purpura

A

IgA immune complex mediated small vessel vasculitis

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308
Q

sx of HSP

A

ab pain, arthralgia, palpable purport, renal disease- hematuria

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309
Q

pts with HLA-B27 associated seronegative spondyloarthropathy usually have what triad of symptoms

A

conjunctivitis, urethritis, arthritis

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310
Q

sx of kawasaki disease

A

conjunctival injection, rash, cervical LAD, oral mucositis, hand/foot edema, fever

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311
Q

what size vessels does kawasaki disease effect

A

medium vessel

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312
Q

when does post strep glomerulonephritis present

A

2-4 wks post infection

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313
Q

symptoms of PSGN

A

periorbital facial edema, cola colored urine, hematuria, nephritic range proteinuria

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314
Q

how does AV block look on EKG

A

dissociation of the atria and ventricles

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315
Q

sx of AV block

A

bradycardia, weakness, fatigue, syncope

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316
Q

pathophysiology of wolff-parkinson-white syndrome

A

abnormal fast accessory conduction pathway from atria to ventricle that bypasses AV node

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317
Q

EKG findings for wolff-parkinson-white

A

delta wave along with widened QRS and short PR interval

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318
Q

EKG findings of hypokalemia

A

flat T waves

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319
Q

what IL do cardiac myxomas produce and what is the affect of this

A

IL6- fever, weight loss

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320
Q

what antibody goes with GPA

A

c-ANCA

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321
Q

sx of GPA

A

bloody nasal discharge, alveolar hemorrhage, glomerulonephritis, upper and lower lung issues

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322
Q

what antibody is present in charge-strauss

A

p ANCA

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323
Q

wide, fixed splitting of S2 is associated with what

A

ASD

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324
Q

paradoxical splitting of heart sounds is associated with what

A

aortic stenosis, LBBB

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325
Q

sx of metrology of fallot

A

pulmonary stenosis, right ventricle hypertrophy, overriding aorta, VSD

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326
Q

clinical sx of tuberous sclerosis

A

cardiac rhabdomyoma, facial lesions, hypo pigmented skin, cortical and retinal hamartomas, renal cysts

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327
Q

cause of concentric hypertrophy of the ventricles

A

chronically elevated blood pressure

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328
Q

MOA of S4 heart sound

A

late diastole, left atrium is forced to push against a stiff left ventricular wall

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329
Q

symptoms fo aortic regurg

A

dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, bounding pulses, head bobbing

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330
Q

what heart finding is assocaited with turners syndrome

A

bicuspid aortic valve or coarctation of the aorta

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331
Q

sx of giant cell arteritis

A

jaw claudication, unilateral headache, visual disturbances, constitutional symptoms, inc ESR, inc C reactive protein

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332
Q

what causes the vision impairment in giant cell arteritis

A

occlusion of the ophthalmic artery

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333
Q

sx of polyarteritis nodosea

A

nonspecific GI complaints, fever, arthralgia, myalgia, weight loss, derm complaints

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334
Q

how would you describe the rash in PAN

A

lacy, non-blanchable rash

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335
Q

what do you find on biopsy of PAN

A

fibrinoid necrosis

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336
Q

what do you find on angiogram of PAN

A

multiple aneurysms

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337
Q

complications of Takayasu arteritis

A

granulomatous thickening of the aortic arch and proximal vessels

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338
Q

what effect does the valsalva maneuver have on MVP

A

increases duration

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339
Q

what does valsalva do to preload

A

decreases

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340
Q

what murmur is a crescendo-decrescendo systolic ejection murmur

A

aortic stenosis

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341
Q

common EKG findings in takotsubo cardiomyopathy

A

ST elevations in leads V1-V4

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342
Q

what is the most reliable test for detecting a repeat MI

A

CK-MB

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343
Q

at 6 days post MI what complication is a pt at risk for

A

cardiac tamponade due to myocardial rupture

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344
Q

what is the marker for congestive heart failure

A

BNP

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345
Q

histo finding of buerger disease

A

intraluminal thrombi within both arteries and veins

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346
Q

what type of pericarditis presents after an MI

A

fibrinous pericarditis

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347
Q

MOA of eccentric hypertophy

A

addition of sacromeres in series leads to ventricular dilation

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348
Q

causes of eccentric cardiomyopathy

A

dilated cardiomyopathy and structural defects that result in chronic elevations in preload

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349
Q

what does inspiration due to right side murmurs

A

increase intensity

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350
Q

what does expiration do to left sided murmurs

A

increase intensity

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351
Q

what the the physiologic effect of hand grip maneuvers

A

increase after load

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352
Q

which murmurs does hand grip increase

A

MR, AR, VSD

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353
Q

which murmurs does hand grip decrease

A

HOCM, AS

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354
Q

what is the physiologic effect of the valsalva phase 2 maneuver

A

decreases left ventricle end diastolic volume (preload)

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355
Q

which murmur does valsalva phase 2 increase

A

HOCm

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356
Q

what is the physiologic effect of standing up

A

decreased preload

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357
Q

what effect does standing up have on HOCM murmurs

A

increased intensity

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358
Q

what is the physiologic effect of rapid squatting

A

increased venous return, increased preload, increased afterload

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359
Q

which murmurs does squatting increase

A

MR, AR, VSD

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360
Q

which murmurs does squatting decrease

A

HOCM, MVP

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361
Q

when does ventricular arrhythmia occur after an MI

A

within 24 hours

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362
Q

when does septal wall rupture occur after MI

A

3-7 days

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363
Q

when does ventricular free wall rupture occur after an MI

A

3-7 days

cardiac tamponade

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364
Q

when does dressers syndrome occur post MI

A

2+ weeks

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365
Q

sx of dressers syndrome

A

dyspnea, pleuritic chest pain, pericardial friction rub, fever, leukocytosis, elevated ESR, diffuse ST segment elevation

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366
Q

what physical exam finding will you see with takayasu arteritis

A

weak upper extremity pulses

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367
Q

sx of takayasu arteritis (12)

A 
constitutional
arthralgia 
absent or weak peripheral pulses
limb claudication
bruits
difference in blood pressure readings between arms
HTN
angina
GI symptoms
Skin lesions (erythema nodosum)
respiratory (chest pain, dyspnea)
neuro (lightheaded)
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368
Q

causes of dilated cardiomyopathy

A

alcohol, cocaine, beriberi, coxsachie B, chagas, doxorubicin

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369
Q

sx of dilated cardiomyopathy

A

arrhythmias, congestive heart failure, enlarged heart

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370
Q

light criteria

A

exudate:
pleural fluid protein/serum protein ratio >0.5.
Pleural fluid LDH/serum LDH ratio > 0.6.
Pleural fluid LDH>2/3 upper limit of normal serum LDH

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371
Q

common causes of exudate pleural effusions

A

infection, malignancy, pancreatitis, rheumatologist disease, trauma

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372
Q

common causes of transudate pleural effusions

A

cirrhosis, heart failure, nephrotic syndrome

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373
Q

what is the pathophysiology of transudate pleural effusions

A

increased hydrostatic pressure, decreased oncotic pressure

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374
Q

3 phases of pertussis

A

catarrhal (1-2 weeks), mild cough and rhinitis
Paroxysmal (2-6 weeks, whooping cough, posttussive emesis)
convalescent (wks-months)

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375
Q

COPD findings on PFT

A

increased RV, increased TLC, decreased FEV1, decreased FEV1/FVC ratio, increased hemoglobin, respiratory acidosis - increased bicarb

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376
Q

sx of pulmonary embolism

A

dyspnea, pleuritic chest pain, tachycardia, lower extremity pain and swelling, obstructive shock

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377
Q

lab findings of pulmonary embolism

A

respiratory alkalosis, hypoxemia, increased D dimer

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378
Q

what does PE look like on xray

A

wedge shaped

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379
Q

how does the body compensate for respiratory alkalosis

A

decreased absorption of bicarb in the kidneys

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380
Q

pathophysiology of chronic bronchitis

A

hypertophy and hyperplasia of mucous secreting glands in bronchi

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381
Q

pathophysiology of emphysema

A

imbalance of proteases and antiprotesases leads to increased elastase activity which leads to loss of elastic fibers

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382
Q

sx of chronic bronchitis

A

productive cough, dyspnea, wheezing, co2 retention (chronic respiratory acidosis), secondary polycythemia

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383
Q

what is bronchiectasis

A

obstructive lung disease characterized by permanently dilated airways

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384
Q

common cause of bronchiectasis

A

chronic infection or obstruction

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385
Q

what happens to the lungs in pulmonary fibrosis

A

fibroblast proliferation and collagen deposition

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386
Q

risk factors for aspiration pneumonia

A

dysphagia, seizures, alcoholism, cardiac arrest, recent intubation

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387
Q

what does X-ray of the lungs in aspiration pneumonia typically look like

A

lobar infiltrate usually in right middle or lower lobe

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388
Q

tx of aspiration pneumonia

A

clindamycin

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389
Q

tx of mild persistent asthma

A

SABA and daily low dose inhaled corticosteroid

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390
Q

MOA of inhaled corticosteroids

A

inhibit NF-kB signaling leading to decrease in transcription of inflammatory cytokines

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391
Q

what is a positive methacoline challenge test

A

20% decrease in FEV1 compared to baseline

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392
Q

definition of mild intermittent asthma

A

<2 days per week

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393
Q

definition of mild persistent asthma

A

> 2 days of daytime symptoms, 3-4 night time symptoms per month

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394
Q

definition of moderate persistent asthma

A

daytime symptoms once per week, night time symptoms 1-2 times per week

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395
Q

definition of severe persistent asthma

A

daytime symptoms multiple times per day, night time symptoms >5 times per week

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396
Q

tx of mild intermittent asthma

A

SABA

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397
Q

tx of mild persistent asthma

A

SABA prn
low-dose ICS qd
leukotriene blocker if ICS doesnt work

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398
Q

tx of moderate persistent asthma

A

SABA prn
low dose ICS + LABA qd
can switch to leukotrine or medium dose ICS

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399
Q

tx of severe persistent asthma

A

SABA prn
medium/high dose ICS + LABA
can switch to: high dose ICS, leukotriene blocker, oral corticosteroids, LAMA, omalizumab, mepolizumab

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400
Q

moa of omalizumab

A

anti IgE

used in refractory asthma

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401
Q

MOA of mepolizumab and reslizumab

A

anti IL5

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402
Q

hypercalcemia is associated with what type of lung cancer

A

squamous cell

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403
Q

what paraneoplastic syndromes are assocaited with small cell lung cancer

A

cushing, lambert eaton, paraneoplastic myelitis, SIADH, subacute cerebellar degeneration

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404
Q

physiologic effects of paraneoplastic production of PTHrp

A

increased production of 1,25-OH-vit d, increased reabsorption of Ca, decreased reabsorption of phosphate, increased bone resorption, increased all phos

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405
Q

what acid base disturbance will pts with chronic bronchitis have

A

respiratory acidosis with metabolic compensation (incr serum bicarb)

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406
Q

centriacinar emphysema is seen in which pts

A

smokers

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407
Q

panacinar emphysema is seen in which pts

A

a1 antitrypsin deficiency

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408
Q

pathophysiology of lambert-eaton syndrome

A

antibodies against presynaptic voltage gated calcium channels

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409
Q

tx of aspirin exacerbated respiratory disease

A

leukotriene receptor antagonist- montelukast

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410
Q

MOA of montelukast

A

inhibits CysLT1

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411
Q

moa of aspirin induced asthm

A

aspirin blocks COX pathways–> up regulation of lipooxygenase pathway–> increased LT

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412
Q

risk factors for focal segmental glomerulosclerosis

A

HIV, black, heroin abuse, sickle cell, morbid obesity, infernon tx

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413
Q

sx of FSGS

A

peripheral edema, proteinuria (>3.5 g/day), decreased albumin, increased risk of infection, hypercoaguable

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414
Q

what do you see on light microscopy of FSGN

A

segmental sclerosis and hyalinosis

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415
Q

what do you see on electron microscopy of FSGS

A

effacement of podocyte foot processess

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416
Q

what do you see on electron microscopy of minimal change disease

A

effacement of podocyte foot processes

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417
Q

what do you see on LM in pts with membranous nephropathy

A

diffuse capillari and glomerular basement membrane thickening

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418
Q

risk factors for membranous nephropathy

A

HBV, HCV, SLE, solid organ tumors, syphilis, NSAID

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419
Q

nephrotic disease

A

FSGS,
membranous,
diabetic glomerulonephropahty, minimal change

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420
Q

nephritic disease

A

PSGN
membranoproliferative glomerulonephritis, aport, diffuse proliferative, IgA nephropathy, , rapidly progressive/crescentic

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421
Q

sx of PSGN

A

2-4 wks post infection. <3.5 g/d proteinuria, HTN, periorbital edema, hematuria

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422
Q

cause of type 1 MPGN

A

HBV, HCV

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423
Q

MPGN on LM

A

splitting of glomerular basement membrane “tram-track” appearance

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424
Q

cause of type 2 MPGN

A

C3 nephritic factor

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425
Q

causes of acute tubular necrosis

A

ischemia or exposure to nephrotoxic substances

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426
Q

what does a BUN/Cr ratio <20 mean

A

intrinsic azotemia

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427
Q

causes of ischemic ATN

A

decreased RBF: severe hypotension, cardiac arrest, trauma, massive GI bleed, sepsis, shock

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428
Q

findings of ATN on UA

A

granular (muddy brown) casts

429
Q

causes of nephrotoxic ATN

A

direct renal injury secondary to exposure to toxic substances

430
Q

what does a BUN/Cr ratio >20 indicate

A

prerenal azotemia

431
Q

EM of membranous nephropathy

A

spike and dome appearance due to subepithelial deposits

432
Q

complications of ARPKD (less severe)

A

renal insifficiency, systemic HTN, congenital hepatic fibrosis

433
Q

dx of ARPKD

A

US- bilateral enlargement of the kidneys

434
Q

what conditions are assocaited with rapidly progressive GN

A

goodpasture, GPA, microscopic polyangitis

435
Q

pathophysiology of alports syndrome

A

mutation in type 4 collagen–> thinning og basement membrane

436
Q

sx of alports

A

glomerulonephritis- hematuria and proteinuria, sensorineural deafness, eye changes - cataracts, lens dislocation

437
Q

berger disease

A

episodic hematuria and nephritic range proteinuria that occurs concurently with a respiratory or GI tract infection

438
Q

where does renal cell carcinoma metastasis to

A

lungs

439
Q

when will you see adults with minimal change disease

A

if they have lymphoma

440
Q

LM of minimal change disease

A

normal

441
Q

envelope or dumbbell stones

A

calcium oxalate

442
Q

wedge shaped prism stones

A

calcium phosphate

443
Q

coffin lid stones

A

sturvite

444
Q

rhomboid or rosette stones

A

uric acid

445
Q

hexagonal stones

A

cystine

446
Q

waxy casts are seen in

A

chronic renal failure

447
Q

RBC casts are seen in

A

ischemia and glomerular nephritits

448
Q

WBC casts are seen in

A

acute pyelonephritis, transplant rejection, tubulointerstitial inflammation

449
Q

bacterial casts are seen in

A

acute pyelonephritis

450
Q

fatty casts are seen in

A

nephrotic syndromes

451
Q

where is the most common site for kidney obstruction in kids

A

ureteropelvic junction

452
Q

MOA of proton pump inhibitors

A

irreversibly inhibit H/K ATPase on luminal surface- inhibits gastric acid secretion

453
Q

what do PPIs end in

A

-prazole

454
Q

what is the role of the H2 Receptor

A

G coupled protein receptor increases concentration of cAMP–> increases H/K ATPase activity

455
Q

how do H2 receptor antagonists work

A

reversible competitive antagonists

456
Q

what do H2 blockers end in

A

-tidine

457
Q

what is misoprostal used for

A

prevents peptic ulcer formation in the setting of NSAID use

458
Q

MOA of sucralfate

A

reacts with hydrochloric acid in stomach to form thick viscous coating that binds to proteins on mucosal surface

459
Q

1st line treatment of GERD

A

PPI

460
Q

what is the cause of priapism

A

lack of input from sympathetic fibers from the prostatic plexus

461
Q

MOA of sildenafil

A

phosphodiesterase inhibitor- increases cGMP–> relaxes smooth muscle via NO

462
Q

what activates the genera sensory fibers of the pudendal nerve

A

touch or pressure on penile skin, glans and urethra

463
Q

what activates somatic fibers from the pudendal nerve

A

sensory input by causing contraction of ischiocavernosus and bulbocavernosus muscles

464
Q

how does penile erection occur

A

parasympathetic fibers from pelvic plexus contribute to cavernous nerves, which travel to the corpora cavernous of the penis and release ACH that causes vasodilation of the helicon arteries

465
Q

what innervates the colon and rectum

A

visceral afferent fibers from the pelvic plexus

466
Q

what type of blood flow do AVFs cause

A

low-resistance, high volume flow of blood between artery and vein

467
Q

Pierre robin syndrome

A

congenital, small lower jaw, downward displacement or retraction of tongue cleft palate.

468
Q

sx of pierre robin syndrome

A

airway obstruction, hypoxia, difficulty feeding, respiratory distress

469
Q

what does the first pharyngeal arch make

A

maxilla, mandible masseter, pterygoids, mylohyoid, cranial nerves V2, V3

470
Q

what does the second pharyngela arch make

A

middle ear, hyoid bone, temporal styloid process, facial muscles, stapedius, platysma, stylohyoid. CN7

471
Q

what does the third pharyngeal arch make

A

stylopharyngess m and glossopharyngeal nerve

472
Q

what does the fourth pharyngeal arch make

A

cricothyroid m, muscles of soft palate, thyroid cartilage, superior laryngeal branch of the vagus n

473
Q

waht does the 6th pharnygeal arch make

A

intrinsic muscles of the larynx, cricoid, arytenoid, corniculate, recurrent laryngeal branch of vagus n

474
Q

what does the first groove make

A

external tympanic membrane

475
Q

what does the 1st pouch make

A

tympanic cavity, mastoid antrum, eustachian tube, tympanic membrane

476
Q

what does the 2nd pouch make

A

tonsillar sinus, tonsillar lymphoid tissue

477
Q

what does the 3rd pouch make

A

inferior parathyroid gland, thymus

478
Q

what does the 4th pouch make

A

superior parathyroid gland, thyroid gland

479
Q

what is an indicator of cerebellar dysfunction

A

dysdiadochokinesia- inability to perform rapid alternating movements

480
Q

what are the 2 most common cerebellar tumors in children

A

pilocytic astrocytoma and medulloblastoma

481
Q

what symptoms will midline cerebellar tumors have

A

gait atazia and nystagmus

482
Q

what does babinksi sign indicate

A

UMN damage to corticospinal tract

483
Q

what does a negative oculocephalic reflex indicate

A

severe brainstem dysfunction

484
Q

what effects does metformin have

A

decreases gluconeogenesis, increases peripheral tissue glucose uptake, and decreases serum free fatty acid concentration

485
Q

acute interstitial nephritis can be caused by a hypersensitivity reaction to what drugs

A

diuretics, PPIs, sulfonamides, NSAIDs

486
Q

what are the rapid acting, short duration diabetes drugs

A

glulisine, aspart, lispro

487
Q

what are the intermediate diabetes drugs

A

insulin, NPH

488
Q

what are the long acting diabetes drugs

A

deter, glargine

489
Q

what do sulfonylureas end in

A

-ide

glyburide, glipizide, glimepiride

490
Q

what do meglitinides end in

A

-glinides

491
Q

what do GLP-1 agonists end in

A

-tide

extenatide, liraglutide

492
Q

what do DDP4 drugs end in

A

-gliptans

493
Q

what do thiazolidinedions end in

A

glitazones

494
Q

what happens to the kidney as you age that reduces the ability to concentrate urine

A

decreased response to ADH

495
Q

what is the affect of decreased renal blood flow

A

stimulates release of renin–> get ang2–> acts on vascular smooth muscle to increases systemic vascular residence–> increased sodium resorption

496
Q

what virulence factor of mycoplasma TB is cytotoxic to macrophages

A

cord factor

497
Q

mutations to what enzyme cause acute intermittent phorphyria

A

porphobilinogen deaminase

498
Q

waht is the cerebellar vermis responsible for

A

controls motor function of axial and proximal limb muscles , body posture and position.

499
Q

what is the self selection method

A

participants pick for themselves if they want to participate

500
Q

what is population based control

A

control group comes form the population you are studying

501
Q

stage of wound healing

A

Early: platelet aggregation and platelet plus formation.
1-2 days: neutrophils and macrophages infiltrate area and release growth factors and cytokines.
day 3: granulation tissue forms collagen. wound contracts.
wks-months: scare formation via MMP

502
Q

what does IL8 do

A

induces chemotaxis of neutrophils and granulocytes

503
Q

what does IL1 do

A

promotes vasodilation, activates osteoclasts, stimulates proliferation of granulocytes

504
Q

what is the role of 5a-reductase

A

catalyzes metabolism of testosterone to DHT

505
Q

what effect does testoserone have on sexual development

A

promotes development of wolffish duct

506
Q

what does the wolffish duct develop into

A

seminal vesicles, epidymitis, vas deferens, ejaculatory duct

507
Q

what does DHT do

A

promotes development of male external genitalia and prostate from the genital tubercle and urogenital sinus

508
Q

presentation of pts with 5a-reductase deficiency

A

look phenotypically female externally or can have ambiguous external genitals. Will have male insides bc of testosterone.

509
Q

what does anti-mullerian hormone do

A

secreted by sertoli cells, suppresses development of paramesonephric duct (which would develop into female internal genital structures)

510
Q

what is the function of actin

A

provides mechanical structure for phagocytes to maintain shape, shuttles enzymes to augment intracellular singling, aids in endocytosis of large particles.

511
Q

what is appropriate compensation in an acute respiratory acidosis

A

for every 10 mmHg increase in CO2, bicarb should increase by 1

512
Q

what is an appropriate compensation in chronic respiratory acidosis

A

for every 10 mmHg increase in CO2, bicarb should increase by 3.5

513
Q

if pH and bicarb are moving in opposite direction, what would this indicate

A

respiratory acid-base disturbance

514
Q

what is winters formula and what do you use it for

A

checks for appropriate compensation.

PCO2= 1.5[bicarb]+8 +- 2

515
Q

lab findings for RTA4

A

hyperkalemia

+ urine anion gap

516
Q

lab findings for RTA type 2

A

hypokalemia, - urine anion gap, proximal

517
Q

lab findings for RTA type 1

A

hypokalemia, + urine anion gap, distal

518
Q

prolactin binds to what type of receptor

A 
prolactin receptor- class 1 cytokine receptor family- spans the plasma membrane. 
has extracellular, transmembrane, and intracellular domain.
519
Q

what hormones bind to nuclear receptors that contain DNA binding domains

A

aldosterone, cortisol, estradiol thyroxine

520
Q

causes of left ventricular hypertrophy

A

chronic HTN, aortic stenosis, coarctation fo the aorta, aortic or mitral valve insufficient, VSD, infiltrative cardiomyopathy ,hypertrophic cardiomyopathy

521
Q

EKG criteria for left ventricular hypertrophy

A

sum of S wave in V2 and R wave in V5 is greater than 35

522
Q

what does fibronectin do

A

component of extracellular matrix

523
Q

what does endothelial nitric oxide synthase do

A

synthesizes NO from L-arginine and oxygen

524
Q

what does NADPH oxidase do

A

helps synthesis hypochlorus acid and ROS in respiratory burst of phagocytosis

525
Q

what does NF-kB do

A

transcription factor that has broad functionality, increased expression of genes implicated in immune response.

526
Q

what structures drain to the para-aortic lymph nodes

A

ovaries, testes, uterus, kidneys,

527
Q

where are lymphatic vessels from the ovaries?

A

suspensatory ligament, runs with ovarian artery and vein

528
Q

what does kaposi look like on histo

A

proliferating spindle cells forming slit like spaces filled with blood

529
Q

what is the role of vitamin E

A

protects erythrocytes and cells from free radical damage

530
Q

sx of vit E deficiency

A

hemolytic anemia, generalized muscle weakness

531
Q

what directly affects cerebral blood flow

A

serum carbon dioxide concentration

532
Q

what does hypocapnia do to cerebral blood flow

A

causes vasoconstriction

533
Q

waht does activated IKK complex do?

A

phosphorylates IkB, which releases NF-kB after undergoing phosphorylation

534
Q

adding more doses to a drug regimen does what to average plasma levels of the drug

A

decreases- less toxic

535
Q

how does endurance exercise affect the heart

A

increased cardiac output and after load

536
Q

how does the heart change in hypertrophic cardiomyopathy

A

LV hypertrophy of septum, reduced LV cavity size, impaired diastolic function, poorly developed coronary network

537
Q

what 3 cancers spread to andrenal glands

A

breast, renal cell, melanoma

538
Q

what cancer most likely goes to the brain

A

lung

539
Q

what cancer goes to vertebral bodies

A

prostate

540
Q

common side effects of bisphosphonates

A

osteonecrosis of the jaw, pill esophagitis, atypical bone fractures

541
Q

what does a positive jaw jerk reflex indicate

A

UMN lesions above the level of the pons

542
Q

jaw jerk reflex

A

afferent trigmeninal fibers from masseter–> V3–> trigeminal mesencephalic nucleus–> v3 efferent–> master causes jaw to close

543
Q

proliferative phase of Hep B

A

viral HbsAg and HbcAg expressed with MHC 1 cells on hepatocyte surface. binding causes hepatocyte damage.

544
Q

where does the thoracic duct drain lymph from

A

left side of body and everything below the belly button

545
Q

how does alcohol inhibit gluconeogenesis

A

alcohol dehydrogenase increases the NADH/NAD+ ratio, inhibits all pathways that need NAD+

546
Q

typical presentation of ABPA

A

recurrent episodes fo fever and bronchial obstruction in a pt with asthma

547
Q

how do you diagnose ABPA

A

serologic testing for titers of IgE and and antibodies to aspergilous, or hypersensitivity skin testing

548
Q

HBsAG presence longer than 6 months

A

chronic infection

549
Q

HBeAg

A

indicates increased viral replication and infectivity

550
Q

Anti-HBc IgM

A

first sign of acute infection, present during window phase

551
Q

Anti-HBe

A

indicates decreased viral replication

552
Q

Anti-HBc IgG

A

not present after vaccination

553
Q

pathogenesis of primary myelofibrosis

A

chronic myeloproliferative disorder with clonal megakaryocytic –> growth factor B–> fibroblasts in BM to produce collagen –> BM fibrosis–> hematopoietic stem cells migrate to liver and spleen–> extra medullar hematopoiesis

554
Q

sx of primary myelofibrosis

A

fatigue, massive splenomegaly, hepatomegaly, cytopenia, dacrocytes (teardrop cells), dry tap

555
Q

MOA amiloride and triamperine

A

ENaC channel blockers in apical membrane of principle cells

556
Q

hyponatremia following subarachnoid hemorrhage

A

excessive ADH

557
Q

primary polydipsia

A

defective central thirst regulation - often seen in psych issues

558
Q

pharmacokinetic changes in heart failure

A

decreased clearance of drugs, impaire/delayed oral drug absorption, impaired IM drug absorption

559
Q

what can prevent apoptosis and erythroblast destruction in folate deficiency

A

thymidine

560
Q

where is the amino acid binding site

A

3’

561
Q

MOA of class 3 antiarrythmics (amiodarone, sotalol, dofetilide)

A

block potassium channels and inhibit outward potassium currents during phase 3 of cardiac action potential

562
Q

corticosteroid effect on WBC

A

increased neutrophils, decreased everything else

563
Q

DNA binding proteins

A

transcription factors, steroid receptors (cortisol, progesterone, aldosterone), thyroid hormone receptor, fat soluble vitamin receptors, DNA transcription and replication proteins

564
Q

parathyroid and glucagon receptors MOA

A

Gs protein coupled receptor increases cAMP

565
Q

growth hormone receptor MOA

A

membrane bound receptor, activates JAK-STAT pathway

566
Q

MOA of intestinal malrotation

A

midgut undergoes incomplete counterclockwise rotation

567
Q

presentation of intestinal malrotation

A

vulvula, intenstinal obstruction due to fibrous bands

568
Q

preeclampsia causes placental ischemia, which leads to what

A

dysregulated vascular tone: vasospasm or vasoconstriction, increased vascular permeability, decreased end organ perfusion

569
Q

sx of age related wet macular degeneration

A

unilateral painless vision loss

570
Q

3 methods of ATP production during intense excercise

A

phosphocreatine shuttle, glycolysis, oxidative phosphorylation

571
Q

waht is the bodies main source of NADPH

A

pentose phospahte pathway

572
Q

what processes have high activity of the pentose phosphate pathway

A

cells exeriencing high oxidative stress, liver and adrenal cortex bc they are involved in synthesis of fatty acids, cholesterol, and steroids, CYP450 metabolism, NADPH for the respiratory burst

573
Q

what are the 4 dopaminergic pathways in the brain

A

mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular

574
Q

tuberoinfundibular pathway

A

connects hypothalamus to to pituitary gland

575
Q

how can antipyscotics cause hyperprolactinemia

A

block tuberoinfundibular pathway (which normally releases dopamine which inhibits prolactin)

576
Q

where is the SA node located

A

junction of right atrium and superior vena cava

577
Q

prolonged HTN can cause what changes to the heart

A

LV hypertophy, dilated cardiomyopathy

578
Q

tx for methotrexate toxicity

A

folinic acid (leucovorin)

579
Q

MOA tamoxifen

A

SERM, antagonist in breast

580
Q

bicalutimide MOA

A

testosterone antagonist

581
Q

danazol MOA

A

androgenic and antiestrogenic

582
Q

cause of intestinal atresia in utero

A

decreased blood supply

583
Q

rate limiting step of the pentose phosphate pathway

A

glucose-6-phospate –> 6-phosphogluconate via G6PD

584
Q

cardiogenic shock

A

decreased CO, increased SVR, increased PCWP

585
Q

hypovolemic shock

A

decreased CO, increased SVR, decreased PCQP

586
Q

septic/anaphylatic shock

A

increased CO, decreased SVR, decreased PCWP

587
Q

neurogenic shock

A

decreased CO, decreased SVR, decreased PCWP

588
Q

obstructive shock

A

decreased CO, increased SVR, variable PCWP

589
Q

cytokines ressponsible for septic shock

A

TNFa, IL-1, IL-6

590
Q

sx of refeeding syndrome

A

arrhythmias, muscle weakness, heart failure

591
Q

what does insulin do to phosphate

A

stimulates redistribution of phosphate from serum to hepatic and skeletal muscle

592
Q

internal redistribution causes of hypophosphorus

A

refeeding syndrome, increased insulin secretion, respiratory alkalosis, hungry bone syndrome (seen after parathyroid surgery)

593
Q

causes of acute serum sickness

A

chimeric monoclonal antibodies, nonhuman Ig (venom)

594
Q

what type of hypersensitivity is acute serum sickness

A

type 3

595
Q

LMN loss

A

paralysis, muscle atrophy, fasiculations

596
Q

cerebrovascular event in the setting of a DVT is suspicious for what

A

paradoxical embolus

597
Q

cause of paradoxical embolus

A

PFO, ASD, VSD, av malformation

598
Q

cephalosporin resistent organisms

A

resistant PCNasew binding proteins: listeria, MRSA, enterococci
no cell wall; mycoplasma, chalmydia

599
Q

histo findings in chronic bronchitis

A

thickened bronchial walls, lymphocytic infiltrate, increasing mucous production, squamous metaplasia

600
Q

symptoms of juvenile myoclonic epilepsy

A

myoclonic seizures, jerky movements of UE, no loss of consciousness, worst right when waking up, provoked by sleep disturbance.

601
Q

tx of juvenille myoclonic epilsepsy

A

valproic acid, levitracicin

602
Q

what is the function of kinesin

A

anterograde transport of intracellular vesicles and organelles towards plus ends of microtubules

603
Q

presentation of edwards

A

microcephaly, microopthalagy, cleft palate, omphacele

604
Q

tx of beta blocker overdose

A

glucagon- increases cardio myocyte activity

605
Q

lab findings of stool in lactose intolerance

A

decreased pH, increased osmolality, increased orogen breath test

606
Q

risk of myopathy with statin use is increased when also given with what drug

A

fibrates

607
Q

CYP450 inducers

A

carbamazepine, st johns wart, barbiturates, phenytoin, rifampin, griseofulvin,modafinil, cyclophosphamide

608
Q

CYP inhibitors

A

amiodarone, cimetidine, grapefruit juice, flouroquinolones, clarithomcycin, azoles,isonizid, ritonavir

609
Q

integrins bind to what things in th extracellular matrix

A

fibronectin, collagen, laminin

610
Q

causes of psychogenic erectile dysfunction

A

recent illness, surgical procedures, loss of loved one

611
Q

role of b-hcg

A

signals corpus luteum to keep making progesterone

612
Q

when is b-hgc first detectable

A

8 days after fertilization

613
Q

inections in which quadrant would result in superior gluteal n injury

A

superomedial butt

614
Q

number need to harm

A

1/ARI

ARI= (rate of adverse effects tx)- (rate adverse effects placebo)

615
Q

what enzyme is responsible for making bruises green

A

heme oxygenase

616
Q

norming aging in the lngs

A

increased lung compliance, decreased total lung system compliance, increased physiologic deadspace

617
Q

what do neutrophils connect to in the rolling phase

A

L-selectin on neutrophils or E-selectin/p-selectin on endothelial cells

618
Q

what initiates tight adhesion and crawling of neutrophils

A

Mac-1 and LFA-1 to ICAM1

619
Q

what is responsible for neutrophil transmigration

A

PECAM-1

620
Q

malingering

A

falsification and exaggeration of medical symptoms to gain an external reward

621
Q

competitive testosterone receptor inhibitors

A

flutamide, cyproterone, spironolactone

622
Q

cause of subclavian steal syndrome

A

stenosis fo subclavian artery proximal to the origin of the vertebral artery

623
Q

sx of subclavian steal syndrome

A

ipsilateral arm ischemia, vertebrobasilar insufficiency (dizziness, HA)

624
Q

waht is the most common cause of fetal unilateral hydronephrosis

A

blockage at the UPJ

625
Q

MOA of cilostazol

A

inhibits platelet aggregation by blocking phosphodiesterase and is a direct vasodilator

626
Q

MOA oc abciximab

A

inhibits platelete aggregation by inhibiting gp2b/3a

627
Q

MOA of argatroban

A

direct thrombin inhibitor

628
Q

tx of PAD

A

cilostazol + aspirin or clopidogrel

629
Q

specialty test for testicular torsion

A

absent creamester m response- testicles don’t elevate when stroking inner thigh

630
Q

free ribosomes translate proteins that are found where

A

cytosol, nucleosol, peroxisome matrix, nuclear endcoded mitochondrial proteins

631
Q

functions of the smooth ER

A

lipid synthesis, detoxifying substances, carbohydrate metabolism

632
Q

IF findings of good pastures

A

linear deposits of IgG

633
Q

thiamine is a cofactor for what enzymes and processes

A

pyruvate dehydrogenase (pyruvate to acetyl coa)
a-ketoglutarate dehydrogenase (citric acid cycle)
BRANCHED CHAIN A KETOacid dehydrogenase (catabolism of branched chain AA)
transketolase (PPP)

634
Q

fracture of the femoral neck increases risk of osteonecrosis due to disruption of what artery

A

medial circumflex femoral

635
Q

waht are the NRTI drugs

A

tenofovir, emtricitabine, lamivudine, abacavir, zidovudine

636
Q

MOA of NRTI

A

inhibits HIV DNA synthesis from RNA template by terminating DNA chain elongation
Competitive nucleoside/tide RT inhibitor

637
Q

MOA and ending of NNRTIs

A

efavirenz, nevirapine

allosteric RT inhibitor

638
Q

MOA and ending of protease inhibitors

A

inhibits HIV polyprotein cleavage

-navir

639
Q

MOA of integrase inhibitors and ending

A

-gravir

inhibits HIV DNA integration into host genome

640
Q

MOA of fusion inhibitors

A

enfuvritide

Inhibits HIV fusion with target cell membrane by binding to HIV gp41

641
Q

Maraviroc MOA

A

inhibits HIV entry by blocking the HIV gp120 allosteric interaction with CCR5

642
Q

side effects of protease inhibitors

A

lipodystrophy, hyperglycemia, inhibition of P450

643
Q

MOA of sirolimus

A

inhibits mTOR–> interrupts IL-2 signal transduction

644
Q

MOA of mycophenalate

A

reversibly inhibits iodine monophosphate dehydrogenase–> blocks purine synthesis

645
Q

MOA of type 1 interferons (alpha and beta)

A

stop protein synthesis of cells infected by viral pathogens

646
Q

MOA of type 2 interferons (gamma)

A

promotes tH1, induces MHC class 2, increases intracellular killing ability of macrophages

647
Q

waht is cushing triad and what does it indicate

A

HTN, bradycardia, irregular respirations

indicates probable brain herniation

648
Q

common causes of acute bacterial prostatitis

A

E coli
klebsiella
proteus
pseudomonas

649
Q

tx of narcolepsy

A

modafinil - stimulant

650
Q

pulmonary actinomycosis cause and sx

A

aspiration

leads to lower lobe consolidations and bronchograms

651
Q

third degree AV block cause and ekg findings

A

block of AV node or bundle of his.

complete dissociation of P waves and QRS

652
Q

where is the respiratory tract does HPV infect and why?

A

true vocal cords, only place with stratified squamous epithelium

653
Q

what does the metanephros become

A

glomeruli, bowmands space, proximal tubules, loop of henge, distal convoluted tubules.

654
Q

waht does the uteric bud become

A

collecting duct, major and minor calyces, ureter, renal pelvis

655
Q

what does telomerase do

A

adds TTAGGG to 3’ end of chromosomes

656
Q

waht innervates the external sphincter

A

pudendal N (s2-4)

657
Q

complication of SAH that occurs 3-12 days post rupture

A

cerebral vasospasm- new focal neurological deficit or change in mental status

658
Q

how do you prevent cerebral vasospasm

A

nimodipine- calcium channel blocker

659
Q

transference

A

unconsciously shifting emotions you had of a person from the past onto another person in the present

660
Q

red man syndrome

A

non allergic drug reaction that occurs when vancomycin is given too quickly

661
Q

MOA of pseudocholinesterase deficiency

A

mutations in BCHE gene- can’t hydrolyze succinylcholine

662
Q

symptoms of pseudocholinesterase deficiency

A

prolonged paralysis after intubation with succinylcholine.

663
Q

MOA of reactivation of HSV1

A

anterograde axonal transport mediated by kinesin

664
Q

MOA of HSV1 infection

A

retrograde axonal transport mediated by dynesin

665
Q

what does FOXP3 do

A

encodes transcriptional regulartor that turns CD4 cells into Treg–> inhibits immune activation

666
Q

FOXP3 drives production of what cytokines

A

IL10
TGFb
CTLA4

667
Q

IPEX

A 
mutations in FOXP3
I: immune dysregulation
P: polyendocrinopathy
E: enterophathy
X: x linked transmission
668
Q

symptoms of IPEX

A

DMT1 as an infant
eczamous dermatitits
autoimmune enteritits

669
Q

waht is the function of type 1 (slow) fibers

A

maintain posture

670
Q

what is the make up of type 1 fibers

A

high myoglobin, lots of mitochondria, low glycogen, aerobic metabolism

671
Q

gestational choriocarcinoma

A

malignant tumor that arises from trophoblasts, usually follows normal pregnancy.

672
Q

sx of gestational choriocarcinoma

A

vaginal bleeding, increased bHCG, uterine enlargement, hematogenous spread to the lungs

673
Q

triad of wernike encaephaopathy

A

oculomotor dysfunction, ataxia, encephalopathy (memory issues)

674
Q

waht is a needed cofactor for collagen synthesis

A

vit C

675
Q

what does vit C do in collagen synthesis

A

hydroxylizes proline and lysine so they can cross link

676
Q

how does hyperthyroid lead to increased HR, tremor, sweating, etc

A

upregulates B adrenergic receptor expression –> leads to increased catecholamine response

677
Q

what is dystrophic calcificatin a hallmark for

A

cell injury and death- occurs in all types of necrosis

678
Q

changes to the lungs in idiopathic pulmonary fibrosis

A

decreased type 1 pneumocytes, increased type 2 pneumocystis, increased fibroblasts, abnormal basement membrane

679
Q

classic presentation of legionaires disease

A

fever, diarrhea, confusion, and cough in an older pt who smokes

680
Q

how does CSF go from the lateral ventricles to the third ventricle?

A

interventricular foramen of monroe

681
Q

how does CSF get from 3rd ventricle to teh 4th

A

cerebral aqueduct

682
Q

what cells are increased in COPD

A

neutrophils, macrophages, CD8 T lymphocytes

683
Q

symptoms of myotonic dystrophy

A

inability to releae hand from doorknob, cataracts, frontal balding, gonadal atrophy

684
Q

who is at risk of warfarin induced skin necrosis

A

pts with a protein C deficiency

685
Q

MOA of ezetimibe

A

decreases intestional absorption of cholesterol by inhibiting NPC1L1 transporter

686
Q

MOA of ranibizumab and bevacizumab

A

inhibit VEGF

687
Q

how does intraductal pappiloma usually present

A

unilateral bloody nipple discharge, usually no masses or axillary nodes

688
Q

what does intraductal papilloma look like on microscopy

A

epithelial and myoepithelial cells lining fibrovascular cores

689
Q

where can enhancers be located

A

upstream, downstream, in introns, literally anywhere

690
Q

clinical features of adenomyosis

A

dysmenorrhead, painful periods, uniformily enlarged uterus, heavy but regular bleeding, uterine tenderness

691
Q

pathophysiology of adenomysosis

A

abnormal collection of endometrial glands and stroma within the myometrium

692
Q

MOA of fidaxomycin

A

inhibits the sigma subunit of RNA polymerase

693
Q

how does helicase dysfunction present clinically

A

growth retardation, photosensitivity, immunodeficiency, facial anomalies

694
Q

blunt trauma to the thoracic aorta is most likely to happen at what location

A

aortic isthmus- tethered by the ligamentum arteriosum so it is not flexible

695
Q

waht is the function of SPINK1

A

inhibits trypsin

696
Q

causes of holoprosencepahly

A

trisomy 13, maternal alcohol use, retinoid acid, sonic hedgehog gene mutations

697
Q

what synthesises factor 8

A

endothelial cells

698
Q

glucocorticoid induced myopathy

A

progressive proximal muscle weakness and atrophy without pain, CK is normal

699
Q

polymyalgia rheumatica

A

muscle pain and stiffnes in shoulder, neck, pelvic girdle, worse in mornign wiht activity. CK is normal

700
Q

inflammatory myopathies

A

proximal muscle wekaness, skin rash and inflammatry arthritis, increased CK

701
Q

statin-induced myopathy

A

proximal muscle weakness, increased CK

702
Q

hypothyroid myopathy

A

muscle pain, cramps, weakness involving proximal muscles, delayed tendon reflexes and myoedema, features of hypothyroid, icreased CK

703
Q

in order for isonazid to be active, it needs what

A

mycobacterial catalsae peroxidase

704
Q

what do spliceosomes do

A

remove introns containing GU at 5’ splice site and AG at 3’ splice sight

705
Q

what do mutations at splice sites result in

A

inappropriate removal of exons and retention of introns

706
Q

function of polyadenelate polymerase

A

polyadenelation of 3’ end of mRNA- stabilizes mRNA and helps it exit the nucleus

707
Q

characteristics of expansive populations

A

high birth rate, high mortality rate, short life expectancy, growing population

708
Q

characteristics of stationary populations

A

decline birth rates, low mortality rates, long life expectancy, stable population

709
Q

characteristics of constrictive population

A

low birth rates, low mortality rates, long life expectancy, declining population

710
Q

clinical features of selective IgA deficiency

A

recurrent sinopulmonary infections, anaphylaxis during infusions, autoimmune diseases, GI infections

711
Q

compensatory mechanisms for hypovolemic shock result in what

A

increased renal reabsorption of sodium, water, chloride, urea, and increased secretion of potassium

712
Q

what metabolism processes occur in the mitochondria

A

fatty acid oxidation, acetyl-CoA production, TCA cycle, oxidative phosphorylation, ketogenesis

713
Q

what metabolism processes occur in the cytoplasm

A

glycolysis, HMP shunt, synthesis of cholesterl, proteins, fatty acids and nucleotides.

714
Q

renal changes expected in pregnancy

A

increased renal blood blow and GFR, decreased serum creatinine.

715
Q

aldolase B deficiency results in waht

A

hereditary fructose intolerance

716
Q

why is prone position best for pts on mechanical ventilation

A

improves V/Q mismatch

717
Q

unique feature of DNA polymerase 1

A

5’ to 3’ exonuclease activity- remove RNA primer and repair damaged DNA strands

718
Q

oculosympathetic pathway

A

increases in dim light- pupil dilation

719
Q

MOA of selevemer

A

non-absorbable anion exchange resin that binds intestinal phosphate to reduce intestinal absorption

720
Q

nephrotic syndrome can lead to what complication

A

renal vein thrombosis

721
Q

Presentation of renal vein thrombosis

A

flank pain, hematuria, elevated lactate dehydrogenase, varoceles due to new hypercoaguable state

722
Q

sick sinus syndrome

A

age related degeneration of the SA node in the right atrial wall.
leads to reduced cardiac output- syncope, lightheadedness, dyspnea, fatigue

723
Q

sick sinus syndrome EKG

A

bradycardia with dropped P waves

724
Q

primary carnitine deficiency

A

muscle weakness, cardiomyopathy, hypoketotic hypoglycemia, elevated muscle triglycerides

725
Q

risk factors for primary psoas abscess development

A

HIV, IV drug use, diabetes

726
Q

where are endotoxins found

A

outer membrane of gram negative bacteria which is composed of LPS

727
Q

what are the 3 regions of LPS

A

O antigen, core polysaccarhide, A antigen

728
Q

what does Lipid A do

A

toxic to mamilian cells, increases release of inflammatory cytokines, leads to progression of septic shock

729
Q

hormonal changes in men as they age

A

decreased total testoserone and free T, increased LH, increased production of testosterone binding hormone

730
Q

teratogenic effects of phenytoin

A

neural tube defect, microcephaly, orofacial clefts, dysmorphic facial features, nail hypoplasia

731
Q

teratogenic effects of lithium

A

ebstein abnormality, nephrogenic DI, hypothyroidism

732
Q

teratogenic effects of valproate

A

neutral tube defefcts

733
Q

teratogenic effects of isotreninoin

A

microcephaly, thymic hypoplasia, small ears

734
Q

teratogenic effects of methotrexate

A

limb and craniofacial abnormalities, neural tube defects, abortion

735
Q

teratogenic effects of ACE inhibitors

A

renal dysgenesis, oligohydraminos

736
Q

teratogenic effects of warfarin

A

nasal hypoplasia, stippled epiphysis

737
Q

waht is responsible for the green color of pus in bacterial infections

A

bacterial myeloperoxidase

738
Q

heterochromatin

A

compact body at the periphery of the nucleus, consists of heavly methylated DNA and deactylated histones which make it transcriptionally deactivated

739
Q

2+ weeks post MI, what type of collagen is increased in the heart to heal it

A

type 1 collagen

740
Q

how is pulse pressure related to aortic compliance

A

inversely related

741
Q

what does doxorubicin do to the heart

A

dilated cardiomyopathy- leads to decompensated heart failure. Increased LVEDP and increased right atrial pressure

742
Q

complications of PTU

A

liver toxicity

743
Q

what meds should you give to a pregnant pt with graves

A

PTU for first trimester and then switch to methimazole.

744
Q

waht does ATP do in cardiac and skeletal muscle contraction

A

release myosin head from actin binding site

745
Q

what 2 immune system compents are responsible for candida infection

A

low T cel count- superficial infection.

Disseminated candida: neutropenia

746
Q

attributable risk in the exposed=

A

100([RR-1]/RR)

747
Q

lab findings in tumor lysis syndrome

A

increased uric acid, potassium, phosphorus, lactate dehydrogenase

748
Q

cause of a flutter

A

reentery circuit in cavotrocuspid isthmus (between IVC and tricupid valve)

749
Q

what supplies blood to proximal ureter

A

renal artery

750
Q

how does posterior hip location present

A

internally rotated, adducted, short, flexed

751
Q

what nerve is vulnerable in a posterior hip dislocation

A

sciatic n

752
Q

complications of hepatic hydrothorax

A

increased intraabdominal pressure forces fluid into the chest cavity and then diffuses through the diaphragm, mainly o the right side.

753
Q

wounds left to heal by secondary intetnion have an increased risk of what

A

overproliferation due to increased VegF

754
Q

amno glycosides (gentamycin) is assocaited with what toxicity

A

ototoxicity and nephrotoxicity

755
Q

MOA of aminoglycosides

A

irreversibly bind 30S subunit- causes genetic code misreading, also impact translocation

756
Q

how do beta blockers treat open angle glaucoma

A

decrease aqueus humor production by the ciliary epithelium

757
Q

what does the musculocutaneous n arise from wand what does it innervate

A

C5-7, lateral cord of brachial plexus.
biceps brachial, brachioradialis.
sensory to lateral arm

758
Q

what causes an S4 heart sound

A

left atrial contraction that forces blood into a poorly compliant left ventricle

759
Q

where does parvoB-19 replicate

A

erythrocyte precursors in the bone marrow

760
Q

pathogenesis of hyper IgE syndrone

A

AD, mutatuos in JAK-STAT pathway- Th17impaired

761
Q

clinical features of hyper IgE

A

cold abcsess, retained primary teeth, eczema, recurrent sinopulmonary infections, dysmorphic faces

762
Q

intracardaic fistulas will show what type of blood flow

A

continuous from aortic root to right ventricle in diastole and systole because pressure in the aortic root is always greater

763
Q

latissimus dorsi innervation and action

A

thoracodorsal n

extension, adduction internal rotation of the humerus

764
Q

deltoid innervation and action

A

axillary n

abduction of the arm

765
Q

infraspinatous innervation and action

A

suprascapular n

externally rotate arm

766
Q

MOA of acyclovir

A

enters host cell and is phosphorylated into acyclovir monophosphate, via virally encoded thymidine kinase

767
Q

most common cause of sporadic encephalitis

A

herpes simplex 1

768
Q

blinding studies are meant to decrease what type of bias

A

observer bias

769
Q

most common cause of coronary sinus dilation

A

elevated right sided heart pressure secondary to pulmonary hypertension

770
Q

changes to the LV volume loop with an AV fistula

A

increased preload, decreased afterload, increased stroke volume

771
Q

heart failure with preserved ejection fraction

A

diastolic dysfunction due to systemic HTN

772
Q

statins

A

inhibit HMG-CoA reductase
decrease LDL and triglycerides
hepatotoxicity and muscle toxicity

773
Q

ezetimibe

A

decreased intestinal cholesterol absorption
decreases LDL
increased hepatotoxicity if given wiht statin

774
Q

Bile acid sequestrants

A

prevent reabsorption of bile acids in the intestine
decreased LDL
Nausea, bloating, cramping, impaired absorption of drug and fat soluble vitamin

775
Q

Niacin

A

decreased fatty acid synthesis, VLDL, HDL clearance.
Decrease LDL, increases HDL
flushing, pruritus, hepatotoxicity, gout

776
Q

fibrates

A

activate PPARa, decreases VLDL synthesis
decreased triglycerides and increased HDL.
muscle toxicity, gallstones

777
Q

failed lateral fusion of paramesonephric ducts

A

bicorne uterus with indentatioan at the center of the fundus

778
Q

what is the SVC derived from

A

cardinal veins

779
Q

what does small cell lung cancer stain positive for

A

neuroendocrine differentiation, CD56, chromogranin, synaptophysin

780
Q

what does presence of vimentin suggest

A

sarcoma

781
Q

symptoms of congenital diaphragmatic hernia

A

severe respiratory disease, pulmonary HTN, absent breath sounds unilaterally.

782
Q

what’s in the hepatoduodenal ligament

A

hepatic artery, portal vein ,, common bile duct

783
Q

MOA of prostacyclin

A

inhibit platelet aggregation and adhesion to vascular endothelium to cause vasodilation

784
Q

sx of hypertrophic osteoarthropathy

A

digital clubbing, painful arthropathy, periostosis, joint effusions, usually in the setting of adenocarcinoma

785
Q

developmental field defect

A

an initial embrylogic defects leads to more malformations of surrounding tis

786
Q

morphologic findings of pulmonary HTN

A

medial hyperthrophy, intimal fibrosis, luminal narrowing

787
Q

Bosentan MOA

A

endothelian receptor antagonist

788
Q

ilioinguinal n

A

runs with the spermatic cord

gives rise to sensory branches: anterior scrotum, base of penis, medial thigh

789
Q

waht does RNA polymerase 1 transcribe

A

ribosomal RNA

790
Q

what does RNA polymerase 2 transcribe

A

messenger RNA

791
Q

what does RNA polymerase 3 transcribe

A

Transfer RNA

792
Q

MOA of amatoxins (mushrooms)

A

get taken up into the liver by OATP and NTCP. Then they bind to DNA dependent RNA polymerase 2, which halts mRNA, resulting in apoptosis

793
Q

what increases in a pts lung who has a pulmonary embolism

A

physiologic dead space

794
Q

if minute volume is unchanged, how does low tidal volume affect the lung

A

increased physiologic dead space

795
Q

what is minute volume

A

tidal volume x respiratory rate

796
Q

mood stabilizers in bipolar disporder and indications

A

lithium: manic and depressive
valproate: manic
carbamazepine: manic
lamotrigine: depressive

797
Q

nontreptonemal serologic tests

A

RPR, VDRL
mix pts serum with cardiolipin-cholesterol-lechtin antigen. Climping or flocculation means there are anticardiolipin antibodies–> secondary syphylus

798
Q

why do pts with crohns get calcium oxalate kidney stones

A

they have malaborption, so the calcium that usually binds to oxalate is making soap bubble with the unabsorpbed fat instead.

799
Q

causes of hypoxemia in the setting of a nomral A-a gradient

A

alveolar hypoventilation, igh altitude

800
Q

histo of spyphillis

A

proliferative endaritis of small vessels with surrounding plasma-cell rich infiltrate

801
Q

cyanosis with a postductal < preductal oxygen saturation is suggestive of what

A

right to left shunt over a PDA

802
Q

staph aureus cytotoxin that causes tissue necrosis

A

panton-valentine leukociden

803
Q

side effects of theophylline overdose

A

seizures and tachyarythmias

804
Q

tx of CMV in pts with aids

A

ganciclovir

805
Q

how doesCMV present in pts with AIDS

A

blured vision, blind spots, flashing lights, yellow-white fluffy retinal lesions with areas of hemorrhage

806
Q

what is the transmembrane domain of G coupled receptors ade up of

A

nonpolar, hydropphobic amino acids (alanine, valine, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, glycine)

807
Q

what tissue can use ketones for energy

A

brain, skeletal muscle, cardiac muscle, kidneys

808
Q

euthyroid sick syndrome

A

low T3, nomral T4 and TSH. pt is sick nd sytokines and infammatory mediators reduce conversion of T4 to T3

809
Q

how do you treat acute intermittant porphyria

A

infusion oh hemin, which down regulates ala synthase

810
Q

what does endothelial nitric oxide synthease do

A

synethesis NO from arginine, O2, NADPH

811
Q

pts with what type of prostate hyperplasia will respond best to finasteride

A

epithelial hyperplasia

812
Q

what is the difference between irritant contact diaper dermatitis and candida dermatitis

A

irritant spares the sin folds

813
Q

cardiac conduction tissue velocity, fast to slow

A

perkinjie , atrial muscle, ventricular muscle, AV node

814
Q

MOA of conegenital umbilical hernias

A

incomplete closure of the umbilical ring, assocaited with owns

815
Q

1st pharyngeal pouch

A

epithelium of middle ear and auditory tube

816
Q

2nd pharyngeal pouch

A

epithelium of palatine tonsil crypts

817
Q

3rd pharyngeal pouch

A

thymus, inferior parathyroid glands

818
Q

4th pharyngeal pouch

A

superior parathyroid glands, ultimobranchial body

819
Q

acute lung transplant rejection

A

perivascular (small lung vessels) and submucosal infiltrate

820
Q

chronic lung transplant rejection

A

submucosal inflammation –> granulation, scarring, bronchioles obliterates, inflammation in walls of small air ways

821
Q

treatment of painful diabetic polyneuropathy

A

SNRI, gabapentoid, TCA

822
Q

what does compeitive inhibition do to Km

A

increases it, keeps vmax the same

823
Q

chloride shift

A

carbonic anhydrase makes H2CO2, then becomes bicarb and H, RBC shifts bicarb out for Cl, so venous cells have more cl compared to arterial

824
Q

causes of polyhydraminos

A

issues with swallowing: GI obstruction, anencaephaly. Increased urine output: high cardiac output.
Maternal diabetes and multile gestations

825
Q

why do pts with cleft palate often have otitis media

A

eustachian tube defects: issue with levator veli palentini and tensor veli palentini

826
Q

concentration dependent killing pattern of antibiotics

A

higher peak compared to minimun inhibitory concentration

827
Q

conductive hearing loss

A

BC>AC

lateralizes to the affected ear

828
Q

what drug properties lead to a low volume of distribution

A

large molecule, bound to protein, hydrophilic (highly charged)

829
Q

what drug properties lead to a high volume of distribution

A

small and uncharged (hydrophobic or lipophilic)

830
Q

which receptors will increase insulin secretion

A

beta 2 , GLP1, M3, glucagon

831
Q

whic receptors will decreae insulin secretion

A

alpha 2, somatostatin 2

832
Q

pros and cons of propofol for anesthesia

A

reduces ariway resistance, but causes vasodilation which results in hypotension and increases serum triglyceriidise and lipase

833
Q

pros and cons of etomidate for anesthesia

A

hemodynamically neutral, but inhibits cortisol which leads to adrenocortical suppresion

834
Q

pros and cons of ketamine for anesthesia

A

preserves respiratory drive and is also for analgesic, stimulates release of catecholamines, but can cause bronchodilationand increased HR

835
Q

inferior alveolar n is a branch of what n and can lead to what deficit

A

V3, loss of sensation in the lower lip, innervates lower teeth

836
Q

what does the dorsal pancreatic bud form

A

tail, body, superior aspect of head, accessory pancreatic duct

837
Q

what does the ventral pancreatic bud form

A

uccinate process, portion of pancreatic head, proximal portion of main pancreatic duct

838
Q

glioblastoma is assocaited with overexpression of what

A

epidermal growth factor

839
Q

manisfestations of aspiration pneumonia

A

lung abscess, fever, cough, foul smelling sputum.

840
Q

main cuse of lung abscesses

A

strict and facultative anarobic oral flora

841
Q

chronic interstitial nephritis

A

patchy interstital inflammation w subsequent tubular atrophy and fibrosis, papillary necrosis, and scarring. kidneys appear shrunken

842
Q

carotid sinus massage

A

increases afferent firing which increases parasympathetic input to the AV node, which cslows the refractory period and conductance

843
Q

spontaneous gas gangrene

A

clostridium septicum, normally in the colonic flora, colonic cancer can result in dissemenated spread

844
Q

carotid sinus hypersensitivity

A

elderly men, overly sensitive baroreceptors that lead to exaggerated vagovagal response, sinus pause and peripheral vasodilation which leads to syncope

845
Q

moa of acyclovir

A

competitive inhibition of viral DNA polymerase, stops viral DNA synthesis

846
Q

physical exam findings in aortic regurg

A

widended pulse pressure, rapid distention and collapse of carotid arteries, “to and fro” bruit over femoral arteries.

847
Q

PD-1

A

on cytotoxic T cells and inhibits their ability to induce apoptosis

848
Q

CTLA-4

A

decreases T cell activation

849
Q

RNA interference

A

short double stranded RNA sequences introduce post-transcriptional gene silencing

850
Q

polysaccharide capsule

A

impedes phagocytosis and complement binding

851
Q

orbitofrontal cortex

A

modulates limbic system- involved in behavior and emotional regulation

852
Q

damage to lateral prefrontal cortex

A

problems with executive functioning, organizing, planning

853
Q

neutrophil elastase

A

protease responsible for extracellular elastin degradation

854
Q

major inhibitor of elastase

A

alpha 1 antitrypsin

855
Q

sx of digoxin toxocity

A

life threatening arythymias, anorexia, N/V, abdominal pain , fatigue, confusion, weakness, color vision changes.

856
Q

pts with what phenotype are more prone to drug induced lupus

A

slow acetylators

857
Q

arterial puncture above the inguinal ligament increases risk forwhat type of hemorrhage.

A

retroperitoneal

858
Q

levels of what hormone increase in menopause and why

A

FSH because the follicles arent responding and there is no negative feedback

859
Q

pierre robinson sequence

A

micrognathia, posterior displacement of the tongue, U shaped cleft palate

860
Q

when do nightmares occur

A

REM sleep- will have voluntary muscle atone

861
Q

snRNP

A

component of splicosome - remove introns from pre-mRNA to form mature mRNA

862
Q

dihydropyradines

A

nifedipine, amlodipine, felodipine.
calcium channel blockers.
affect arterial smooth muscle, little affect on cardiac contractility.

863
Q

nondihydropyradines

A

verapamil, diltiazem.

affect myocardium, slow heart rate and contractility,

864
Q

permissiveness

A

hormone that has no direct affect allows another hormone to have maximal direct affect

865
Q

anesthetics with high tissue solubiltity

A

have large arteriovenous concentration gradients and slower onset of action

866
Q

neoplastic cord compression

A

back pain, LE weakness.

local extension of vertebral metastases into epidural space

867
Q

why do you have to wait 2 weeks after stopping a MAO inhibitor to take an SSRI

A

you have to have time to regenerate MAO or else you can get serotonin syndrome

868
Q

tmporomandibular joint disorder

A

jaw issues and hypersensitivity of the mandibular nerve.

pain with chewing and ear pain wiht tinnitus.

869
Q

MOA of cromolyn

A

inhibit mast cell degranulation.

prevent acute asthma attacks

870
Q

complications of radiation

A

fibrosis and strictures

871
Q

which receptors use Gs

A

glucagon, TSH, PTH

872
Q

rentinitis pigmentosum

A

progressive dystrophy of retina. loss of rods and cones. optic disc pallor, retinal vessel attenuation, pigment accumulation.

873
Q

IL8

A

neutrophil chemotaxis to sites of infection, also causes phagocytosis of neutrophils

874
Q

what does low fecal elastase mean

A

pancreatic insufficiency and can diagnosse chronic pancreatitis

875
Q

mefloquine MOA

A

destroys replicating parasites within red blood cells. Has NO activity against schizonts

876
Q

hypospadias

A

incmplete fusion of urethral folds on ventral aspect

877
Q

epispadias

A

dorsal side, due to abnormal location of genital tubercle

878
Q

what is the best indicatior of severity in pts wiht mitral regurg

A

audible S3

879
Q

S3

A

sudden cessation of blood flow to the left ventricle during the passive filling of diastole

880
Q

what drug class can improve the eye issues in raves

A

glucocorticoids- anti inflammatory

881
Q

what is the best indicatior of severity in pts wiht mitral regurg

A

audible S3

882
Q

S3

A

sudden cessation of blood flow to the left ventricle during the passive filling of diastole

883
Q

what drug class can improve the eye issues in raves

A

glucocorticoids- anti inflammatory

884
Q

familial chylomicronemia syndrome (type 1)

A

defect in lipoprotein lipase and APOC2.
elevated chylomicrons.
acute pancreatitis, lipemia retinalis, eruptive xanthomas

885
Q

familial hypercholesterolemia (type 2)

A

defect in LDL receptor and APOB100.
elevated LDL.
premature atherosclerosis, tendon xanthomas, xanthelasmas.

886
Q

familial dysbetalipoproteinemia (type 3)

A

Defect in APOE.
elevated chylomicron and VLDL remnants.
Premature atherosclerosis, tuboeruptive and palmer xanthomas.

887
Q

familial hypertriglyceridemia (type 4)

A

elevated VLDL.

assocaited with coronary disease, pancreatitis, diabetes.

888
Q

myocardial hybernation

A

state of chronic myocardial ischemia, metabolism and function are reduced to match reduced blood flow to prevent necrosis.

889
Q

risk factors for cataracts

A

older than 60, diabetes, chronic sunlight exposure, tobacco, glucocorticoids

890
Q

causes of mutations in muscular dystrophy

A

deletions resulting in frameshift mutations or nonsense mutations

891
Q

cause of acute dystonia in pts taking first gen antiphyscotics

A

D2 antagonism in the nigrostriatal pathway

892
Q

pts with chronic granulomatous disease are at an increased risk of infection with what type of organisms

A

catalase positive

893
Q

neurotransmitters involved in ADHD

A

norepinephrine and dopamine

894
Q

graft versus host disease

A

donor CD3+ T cells recognize host cells as foreign

895
Q

how do alcohol based disinfectants work against enveloped viruses

A

dissolve their lipid bilayer membranes

896
Q

what 2 parts of the sympathetic NS are innervated by cholinergic instead of adrenergic neurons

A

eccrine sweat glands and adrenal medulla

897
Q

growth promoting effects of gigantism is most liekly do to what hormone

A

IGF-1 released from the liver when GH binds to receptors

898
Q

type B aortic dissections usually occur where

A

clsoe to origin of left subclavian artery

899
Q

signs of inadequate liver function

A

hypoalbuminemia, prolonged pT, elevated bilirubin

900
Q

clear cell carcinoma RCC

A

originates in proximal renal tubules.

Usually a sphere, yellow mass with areas of necrosis and hemorrhage.

901
Q

what does the right coronary artery supply blood to

A

AV, SA nodes, bundle of his, proximal right bundle branch

902
Q

where does the LAD supply blood

A

left and right bundle branch

903
Q

damage to ulnar n

A

issues with wrist flexion and adduction, loss of sensation over 5th finger and hypothenar eminence, clawing of 4/5th digits

904
Q

Rasburicase MOA

A

recombinate urate oxidase, converts uric acid into allantoin

905
Q

cardiac output=

A

HR x SV or

rate of O2 consumption/arteriovenous O2 content difference

906
Q

RAS is active when bound to what protein

A

GTP

907
Q

RAS is inactive when bound to what protein

A

GDP

908
Q

what would RFLP analysis show for a trisomy gained in meiosis 1

A

2 different chromosomes inherited from one parent- 2 homologous chromosomes

909
Q

abiraterone MOA

A

irreversibly inhibits 17 a hydroxyls.

slows growth of prostate cancer

910
Q

how does levels of procalcitonin change in infections

A

bacterial: rise
viral: decrease

911
Q

positive acute phase reactants (levels rise)

A

fibrinogen, c reactive protein, ferritin, hepcidin, ceruloplasmin, haptoglobin, vWF, complement, ESR

912
Q

negative acute phase reactants (levels decrease)

A

albumin, transferrin, transthyretin (prealbumin)

913
Q

colchicine

A

inhibits microtubule polymerization, which disrupts chemotaxis, granulation, and phagocytosis

914
Q

dorsal column

A

vibration, proprioception, fine touch

915
Q

gracile fasiculus

A

medial part of dorsal column, carries information from below T6 (lower half of body)

916
Q

cuneate fasiculus

A

lateral part of dorsal column, carries information from above T6 (upper extremities)

917
Q

transpeptidases

A

penicillin binding protein

918
Q

unilateral cleft lip

A

one of the maxillary prominences fails to fuse with the inter maxillary segment

919
Q

side effects of donepizil and rivastigmine

A

enhanced parasympathetic tone, bradycardia, AV block, decreased cardiac output

920
Q

metabolic alkalosis with low urine chloride

A

saline responsive: vomiting, diuretic overuse

921
Q

metabolic alkalosis with high urine chloride

A

saline unresponsive.
Hypovolemic: bartter and gitlemen
Hypervolemic: excess mineralcorticoid activity

922
Q

thiamine is a cofactor for what

A

pyruvate dehydrogenase, a-ketoglutarate dehydrogenase, transketolase

923
Q

femoral neuropathy

A

quads weakness, loss of patellar reflex, sensory loss over anterior and medial thigh

924
Q

side effects of tricyclics

A

tremor, insomnia, block cardiac fast sodium channels - hypotension, antimusarinic- confusion, urinary retention, constipation. orthostatic hypotension, sedation

925
Q

can autologous stem cell transplant be used on pts with congenital disorders

A

no, because they will still have the mutation

926
Q

recall bias is most likely to hapen in what type of study

A

retrospective ones like case controls

927
Q

first aortic arch

A

part of maxillary artery

928
Q

second aortic arch

A

hyoid artery, stapedial artery

929
Q

third aortic arch

A

common carotid A, proximal internal carotid artery

930
Q

fourth aortic arch

A

on left- aortic arch

on right- proximal right subclavian artery

931
Q

sixth aortic arch

A

proximal pulmonary arteries, on left- ductus arterioles

932
Q

detection of which Ig against a specific organism is diagnositic of a TORCH infection and why

A

IgM because maternal IgM can’t cross the placenta

933
Q

gp120

A

allows HIV to attach to host cells. Binds CD4 and chemokine receptor CCR5, binding exposes gp41

934
Q

gp41

A

mediates viral fusion

935
Q

congenital long QT syndrome

A

mutations in KCNH2 gene. impaired function of voltage gates potassium channels

936
Q

medications that cuaase prolonged QT

A

macrolides, fluoroquinolones, antiemetics, acoles, antipsychotics, TCAs, methadone, class 1A antiarrhythmics, class 3 antiarrhythmics

937
Q

rabies vaccine

A

inactivated vaccine

938
Q

familial dialted cardiomyopathy

A

mutations in TTN gene

939
Q

EBV envelope glycoprotein gp350 binds to what

A

CD21 on B cells, which is the receptor for the Cd3 complement component

940
Q

branches of the common fibular nerve

A

deep: anterior compartment muscle of leg (foot and toe dorsiflexion) and sensory to flip flop area.
superficial: lateral compartment muscles (eversion) and sensory to dorsum of the foot

941
Q

histo of hasimotos

A

lymphoplasmocytic infiltrate with formation of germinal centers

942
Q

what nerve courses over the right atrium

A

right phrenic nerve

943
Q

virchows triad for thrombosis post pregnancy

A
  1. stasis from pregnancy related venous dilation and compression of IVC and iliac veins.
  2. icnreased factors 7,8,10, vWF, fibrinogen.
  3. endothelian damage due to infection
944
Q

sx of ovarian vein thrombosis

A

fever after delivery, abdominal/flank pain, doesnt respond to antibiotics

945
Q

where does left ovarian vein drain to

A

left renal vein

946
Q

where does right ovarian vein drain

A

iVC

947
Q

RB1 gene

A

regulates G1/S checkpoint

948
Q

contrast induced nephropathy

A

diffuse necrosis of proximal tubular cells, muddy brown casts, renal vasoconstriction causing medullary ischemia

949
Q

apixaban MOA

A

blocks Xa, which prevents conversion of prothrombin to thrombin

950
Q

tachyphylaxis of adrenergic agonists

A

receptor inactivation and internalization by arresting

951
Q

contrast induced nephropathy

A

diffuse necrosis of proximal tubular cells, muddy brown casts

952
Q

High grade CIN

A

atypical cells have invaded beyond the lower 1/3 of the cervical epithelium ( to the epithelial surface)

953
Q

IgA nephropathy

A

glomerularnephritis. usualy in older children, post viral infection, have painless hematuria. mesangial hypercellularity with IgA deposits

954
Q

which hep virus has a high mortality rate in women

A

hep E, an unenveloped single stranded RNA

955
Q

sx of congenital hydrocephaly

A

macrocephaly, buldging frontenelle, poor feeding, developmental delay, spacisity and hyperreflexia

956
Q

complication of cysts removal cause by E. granulosus

A

rupture of the cyst can lead to spilling of contents causing anaphylatic shock

957
Q

why can hashimotos cause increased prolactin

A

there is an increase in TRH, and lactotrophs have TRH receptors so there is an increase in release of-prolactin

958
Q

side effects of cutaneous corticosteroid use

A

cutaneous atrophy, teleanctiasias, acne

959
Q

paraneoplastic cerebellar degeneration

A

small cell lung cancer, ovarian, great. dizziness, limg ataxia, dysarthria, vision issues. Antibodies react with tumor cells: Anti yo, anti P/Q, anti hu.

960
Q

eisenmenger syndrome

A

Pressure in right atrium due to ASD backs up ad causes medial thickening of pulmonary vessels, which leasds to pulmonary HTN and a reversal of the shunt, so now oyu have a Right to left shunt that can’t be reversed and get adult onset cyanosis

961
Q

sympatetic opthalmia

A

trauma to one eye causes granulomatous inflammation of both eyes, due to T cell response from previously sequestered antigens

962
Q

histo findings in sporotrix

A

mixed gramulomatous and neutrophilic inflmmaory reaction

963
Q

I cell disease

A

defect in post translational modification i nthe golgi body- can’t be tagged with mannose 6 phosphate- inappropriately get exported into extracellular space

964
Q

hemibalism

A

damage to subthalmic nucleus- results in flailing of arm

965
Q

LMN signs

A

flaccid paralysis, hypotonia, hyporeflexia, muscle atrophy and fasciculation’

966
Q

primary adrenal insufficiency

A

decreased aldosterone: hypovolemia, orthostasis.

decreased cortisol: hypoglycemia, normocytic anemia, eosinophilia, increased ADH

967
Q

UMN signs

A

spastic paralysis, clasp knife rigidity, hyperreflexia, babinksi sign

968
Q

LMN igns

A

flaccid paralysis, hypotonia, hyporeflexia, muscle atrophy and fasciculation’

969
Q

how can you prevent acyclovir nephrotoxicity

A

adequate hydration

970
Q

GBM histo findings

A

pseudopalisating necrosis with capillaries at the periphery- vascular proliferation

971
Q

asbestosis

A

dyspnea on exertion, lower lung zones, pleural plaques, ferruginous bodies featuring fusiform rods with translucent asbestos center and golden brown iron coating. stain positive for cytokeratin and calretinin

972
Q

what jobs have exposure to siica

A

mining, sand blasting

973
Q

sx of silicosis

A

dyspnea on exertion, nodular densitites on XRAY, calcified hilar lymph nodes, birefiringment particles on biopsy

974
Q

asbestosis

A

dyspnea on exertion, lower lung zones, pleural plaques, ferruginous bodies featuring fusiform rods with translucent asbestos center and golden brown iron coating

975
Q

coal workers

A

dyspnea and ill defined exert nodular opacities on xray. histo = accumulations of black, carbon-laden macrophages

976
Q

what conditions promote sickling in sickle cell

A

low oxygen, acididc pH, low blood volume

977
Q

side effects of nitrates

A

headache, cutaneous flushing, lightheadedness, cutaneous flushing, reflex tachycardia

978
Q

adverse effects of inhibition of COX 1

A

gastric ulcers, bleeding

979
Q

causes of congenital hypothyroidism

A

genetic defect in thyroid producing hormone, maternal antithyroid medication (PTU), excessive or deficicent maternal iodine

980
Q

causes of congenital hyperthyroidism

A

transplacental TSH receptor stimulating antibodies

981
Q

retroperitoneal organs

A 
S: suprarenal glands
A: aorta and IVC
D: duodenum (not first part)
P: pancreas (head and body)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: Esophagus
R: rectum
982
Q

small intestine bacterial overgrowth

A

increased vit K and folate, associated with nausea, bloating, abdominal discomfort, malabsorption

983
Q

MOA of CF

A

mutation that impairs post transcriptional processing (improper folding and glycosylation) –> causes it to get degraded so it can’t reach the cell surface

984
Q

MOA of milrinone

A

PDE3 enzyme inhibitor

985
Q

clasp knife spascity

A

initial resistence to passive flexion followed b immediate release of residence

986
Q

pyramidal motor system

A

precentral gyrus –> internal capsule–> spinal cord and brain stem

987
Q

internal capsule stroke

A

usualyl have pure motor weakness affecting contralateral arm, leg, and face

988
Q

complication of hypocitraturia

A

calcium oxalate stones because tcitrate normally binds to ionizsed calcium and prevents formation of stones

989
Q

diastolic BP is directly related to what

A

systemic vascular resistance and arterial blood volume

990
Q

cricithyrotomy requires passage through which structures

A

skin, superficial cervical fascia (platysma and sub q fat), investing and pretracheal layers of deep cervical fasciae, cricothyroid membrane

991
Q

CYP450 inducers

A

barbituates, rifampin, carbamazepine, griseofulvin, chronic alcohol consumption

992
Q

MOA of epi in anaphylaxis

A

binds to adrenergic receptors on mast ells to prevent degranulation, counteracts inflammatory effects via alpha beta stimulation

993
Q

where should you take biopsies of pts wiht celiacs and why

A

duodenum and proximal jenunum because they are msot exposed to gliaden

994
Q

fibroadenoma

A

firm, nontender, well circumscribed, mobile. Estrogen sensitive. myxoid stroma that encircle epithelium lined glands

995
Q

myasthenic crisis

A

low pH, high CO2, low O2, drooping eyelids, respiratory muscle wekaness leading to respiratory failure

996
Q

intraventricular hemorrhage from premautre infants usually originates where

A

germinal matrix

997
Q

intraventricular hemorrhage sx

A

altered level of consciousness, hypotonia, decreased spontaneous movements, buldging anterior frontonelle, seizures

998
Q

complications of thyrotoxicosis

A

HTN, tachycardia, a fib, increased contractility, increased cardiac output

999
Q

mycophenolate MOA

A

inhibits conversion of IMP to GMP, mainly in lymphocytes, causing reduced proliferation of activated lymphocytes

1000
Q

adverse effects of nondihydropyridine calcium channel blockers (diltiazem, verapamil)

A

constipation, AV heart block, brady cadria, worsening of heart failure in pts with left ventricular systolic dysfunction

1001
Q

role of ubiquination

A

antigen processing, muscle wasting, cell cycle regulation, DNA repair, disposal of misfolded proteins

1002
Q

IL6

A

stimulate liver to produce thrombopoietin, which triggers megakaryocyte proliferation and maturation in the bone marrow

1003
Q

tx of complicated empyema

A

drainage wiht use of tPa and DNase to remove pus

1004
Q

what is responsible for granuloma formation

A

Th1 activation- increases macrophages, IL2, interferon gamma

1005
Q

biopsy findings in giant cell arteritis

A

intimal thickening, elastic lamina fragmentation, multicucleated giant cells

1006
Q

MOA fo fenoldopam

A

D1 receptor agonist: increases cAMP–> vasodilation, especially renal vasodilation

1007
Q

causes of hypokalemia due to intracelular shift

A

insulin (DKA tx or refeeding syndrome)
Beta adrenergic activity: drugs (dobutamine, albuterol) or stress related (MI or aclhohol withdrawl)
alkalosis
increased cell produciton

1008
Q

tx of ischemia induced arrythymias

A

class 1B: lidocaine, phenytoin, mexiletine

1009
Q

CD14

A

most sepcific marker for monocyte-macrophage cell lineage

1010
Q

holosystolic murmurs

A

tricuspid regard, mitral regurg, VSD

1011
Q

tricuspid regurg

A

holosystolic murmur, heard at left 2/3 ICS. worse with inspiration

1012
Q

recurrent branch of median n

A

abductor pollicis brevis, flexor pollicis brevis, opponens pollicis

1013
Q

CAAt and TATA

A

initiate transcription - act as binding sites for general transcription factors and RNA polymerase 2

1014
Q

sx of arsenic poisioning

A

garlic breath, vomiting, watery diarreha, QT prolongation, pigmentation changes, neuropathy

1015
Q

tx of aresnic poisioning

A

dimercaprol, DMSA

1016
Q

what is niacin a precursor for

A

NAD and NADP

1017
Q

Colchine MOA

A

binds to tubular and inhibits polymerization into microtubules, - disrupts cytoskeletonfunctions like chemotaxis and phagocytosis

1018
Q

Reid index

A

measures bronchial gland hyperplasia .

=mucous glands/ ( submucosa and lamina propria)

1019
Q

what is niacin a precursor for

A

NAD and NADH

1020
Q

first generation antihistamines MOA

A

antihistamine, anti alpha adrenergic, antimuscarinic, anti serogenic

1021
Q

primary lymph node drainage of female reproductive system

A 
uterus: external iliac
Cervix: internal iliac
vagina: proximal- internal iliac, distal- inguiofemoral.
vulva: inguinofemoral
ovaries: paraaortic
1022
Q

afferent vs efferent limb of carotid sinus

A 
afferent= branch of glossopharyngeal n
efferent= vagus n
1023
Q

type 4 hypersensitivity reaction phases

A

phase 1: cutaneous langerhans take up happens and present them to naive CD4 and CD8 t cells in regional lymph nodes.
phase 2: reexposure: APC present to sensitized t cells

1024
Q

posterior interosseous n

A

innervates muscles involved in finger and thumb extension.

part of deep branch of radial nerve, comes off as radial n passes through supinator muscle

1025
Q

power of a study

A

related to type 2 error- probability that there is no difference between groups when there actually is one
P= 1- B

1026
Q

role of telomerase

A

help maintain telomers in rapidly dividing cells so they don’t cause premature apoptosis

1027
Q

tx of TIA

A

blood pressure control along wiht low dose aspirin

1028
Q

calcitriol

A

active form of vit D, should give to pts post thyroid surgery to increase calcium

1029
Q

how does pleural fluid enter and exit the pleural space

A

enter: intercostal microvessels.
exit: parietal pleural lymphatics

1030
Q

acute spinal cord injury

A

flaccid paralysis with decreased or absent reflexes

1031
Q

how can rheumatoid arthritis affect the spine

A

causes cervical subluxation

1032
Q

kidney response to renal hypoperfusion

A

increase in renin secretion by JG cells which leads to hyperplasia of the JG cells (which are smooth muscle in the afferent article)

1033
Q

histo findings of autoimmune hepatitis

A

lymphocyte and plasma cell infiltration of portal and periporatal regions of the liver

1034
Q

autoimmune hepatitis sx

A

jaundice, hepatomegaly, elevated liver enzymes, anti-smooth muscle antibody

1035
Q

Positive end expiratory pressure ventilation

A

opens collapsed alveoli to reduce intrapulmonary shunting and increase FRC

1036
Q

which monosaccharide is metabolized by the liver the fastest and why

A

fructose, because it bypasses phosphofructoskinase

1037
Q

eculizimab

A

monoclonal antibody, inhibits C5

1038
Q

superficial inguinal ring is the opening of what

A

external oblique muscle aponeruosis

1039
Q

malignant pericardial effusion

A

usually from spread of cancer. subacute- nonspecific symptoms, dyspnea, , chest discomfort. fluid shows hemorrhagic and atypical malignant cells

1040
Q

autoimmune adrenalitis

A

atrophy of adrenal glands bilaterally. skin hyperpigmentation, adrenal insufficiency, acute adrenal crisis

1041
Q

pathophysiology of acetaminophen overdose

A

reduced glutathione–> accumulation of NAPQI –> damage to mitochondria –> oxidative hepatocellular injury

1042
Q

VHL syndrome

A

hemangioblastoma, clear cell reanl ancer, pheochromocytoma

1043
Q

what does the external laryngeal n innervate

A

cricothyroid m

1044
Q

what does the L recurrent laryngeal n innervate

A

posterior cricoarytenoid, lateral cricoarytenoid, oblique arytenoid, transverse arytenoid, thryroarytenoid

1045
Q

Li fraummeni syndrome

A

TP53, sarcomas, brest cancer, brain tumors, adrenocortical carcinoma, leukemia

1046
Q

positive skewed distribution

A

mean is greater than median

1047
Q

what organism can cause hepatic abcsess by hemotogenous spread

A

staph aureus

1048
Q

what organisms cause hepatic abcsess via biliary infections

A

E coli, klebsiella, enterococci

1049
Q

what vitamin deficiency is associated with a worse course of measels

A

vit a

1050
Q

vitamin deficiencies in vegan diet

A

B12, , vit D, calcium, potentially: iodine, iron, zinc

1051
Q

MOA of GLP1 agonosts and DDP4 inhibitors

A

increased glucose dependent insulin release, decrease appetite, decrease gastric emptying, decrease glucagon secretion

1052
Q

risk factors of uric acid kidney stones

A

increased uric acid excretion: gout, myeloproliferative disorders.
increased urine concentration: dehydration.
low urine pH: diarrhea, diabetes

1053
Q

damage to vestibular nuclei CN 8

A

loss of vestibulooculomotor reflex - nystagmus

1054
Q

why do you get incontinence in NPH

A

strecthing of the descendng corticol tract: lack of corticol inhibition; detrusor muscle hyperactivity

1055
Q

acute pericarditis

A

chest pain that is sharp and decreases when leaning forward. friction rub

1056
Q

beta glucuronidase

A

released by injured hepatocytes and bacteria- hydrolyzes bilirubin glucuronides and increases unconjugated bilirubin

1057
Q

complication of kawasaki disease

A

coronary artery aneurysm

1058
Q

measures in COPD

A

residual volume, total lung capacity are increased.

FEV1/FVC decreased

1059
Q

complications of obstructive sleep apnea

A

pulmonary HTN, with right heart failure, systemic HTN, cardiac arrythmias

1060
Q

5a-reductase

A

converts testosterone to DHT

1061
Q

male pseudohermaphredidsm

A

deficiency in 5a reductase type 2: internal genitalia normal bc of testoserone, but external abnormal bc no DHT

1062
Q

angiogenesis

A

stimulated by VEGF and fibroblast growth factor

1063
Q

peri-infarction pericarditis

A

occurs days 2-4 after transmural ST MI

1064
Q

fast and slow acetylation should be considered when giving what drugs

A

isonazid, hydralazine, procainamide, dapsone,

1065
Q

paget disease of the bone

A

enlarged vertebral bodies with corticol thickening of the bone, elevaed alk phos,

1066
Q

acute left ventricular failure

A

can result in pulomary venous HTN and acute pulmonary edema (transudate fluid)

1067
Q

deficiency of thyroxine binding globulin

A

low total T4, normal free T4 and TSH

1068
Q

paroxymal supraventricular tacycardia

A

narrow QRS complx tachycardia wiht regular rhythm and non visible p waves

1069
Q

TB meningitis

A

thick, gelatinou sexudate on base of brian, vasculitis of cerebral arteries, multiple brain infarcts, hydrocephalus

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