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
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
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
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
5
Q
what pt will be most likely to have anemia of chronic disease
A
pt with chronic inflammatory disease
6
Q
tx for sideroblastic anemia
A
pyridoxine (vit B6)
7
Q
causes of sideroblastic anemia
A
defect in ALA synthase, alcoholism, lead poisoning, isoniazid, vit b6 deficiency
8
Q
tx for paroxysmal nocturnal hemoglobinuria
A
eculizumab (terminal complement inhibitor)
9
Q
MOA acute hemolytic transfusion reactions
A
complement activation and cell lysis
type 2 hypersensitivity
10
Q
sx of acute hemolytic transfusion reactions
A
fever
ab and flank pain
hemoglobinuria
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)
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
13
Q
MOA of diamond Blackman anemia
A
defect in eryhtropoesis –> pure red cell aplasia
erythroblasts in bone marrow undergo premature apoptosis
14
Q
sx of diamond Blackfan anemia
A
anemia
webbed neck
cleft pallet
triphalangeal thumb
15
Q
what type of of anemia is blackfan diamond
A
macrocytic anemia nonmegaloblastic
16
Q
3 macrocytic megablastic anemias
A
B12 def
folate def
orotic aciduria
17
Q
4 macrocytic nonmegablastic anemias
A
diamond blackfan
alcohol use
liver disease
thyroid disease
18
Q
sx of orotic aciduria
A
failure to thrive
delayed development
anemia that doesn’t approve with supplements of folate and b12
19
Q
pathophysiology of hereditary spherocytosis
A
AD
defect in ankyrin/spectrin –> RBC cytoskeleton defects
20
Q
sx of hereditary spherocytosis
A
splenomegaly
increased bilirubin –> jaundice, dark urine
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
22
Q
dx of hereditary spherocytosis
A
osmotic fragility test
dec mean fluorescence in osin 5- maleimide binding
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
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
25
sx of CLL
LAD
hepatosplenomegaly
mild anemia/thrombocytopenia
constitutional symptoms
26
dx of CLL
severe lymphocytosis
| smudge cells
27
complications of CLL
increased risk of infections
| autoimmune hemolytic anemia
28
what age does CLL usually affect
older adults
29
MOA of cold autoimmune hemolytic anemia
IgM binds RBC --> complement mediated destruction of RBCs
30
risk factors of cold autoimmune hemolytic anemia
mycoplasma pneumonia
infectious mono
CLL
31
what type of anemia is cold autoimmune hemolytic anemia
normocytic
32
MOA of warm autoimmune hemolytic anemia
IgG binds to RBC--> phagocytosis of RBCs
33
risk factors for warm autoimmune hemolytic anemia
SLE
autoimmune
CLL
meds: penicillamine, methyldopa
34
MOA of HUS
shiga toxin producing bacteria: shigella and E. Coli 0157:H7
35
sx of HUS
bloody diarrhea
microangiopathic hemolytic anemia
thrombocytopenia
AKI
36
dx of HUS
schistocytes, increased bleeding time
37
what type of azotemia does HUS cause
intrinsic
38
lab findings of pre renal azotemia
BUN/creatinine >20
urine sodium <20
Fractional excretion of sodium <1%
39
lab findings of intrinsic azotemia
BUN/creatinine <15
urine sodium >40
Fractional excretion of sodium >2%
40
common precipitants of G6PD deficiency
meds: sulfa drugs and antimalarials
Infections
fava beans
41
classic presentation of G6PD deficiency
back or ab pain, jaundice, dark urine days after taking antibiotic
42
inheritance of G6PD deficiency
X linked recessive
43
blood smear of G6PD deficiency
degmacytes (bite cells)
| Heinz bodies
44
MOA heparin induced thrombocytopenia
heparin binds to platelet factor 4 --> antibody production--> antibodies bind to platelets--> platelet consumption and activation.
45
sx of heparin induced thrombocytopenia
drop in platelet count by >50%
| material or venous thrombosis
46
tx mild hemophilia A
DDAVP (increases vWF--> stabilizes factor 8)
47
translocation of Burkitts
8-14
| MYC
48
complication of mechanical prosthetic valves
hemolytic anemia --> schistocytes
49
3 phases of CML
chronic (mature cells proliferate)
accelerated (cryogenic abnormalities accrue)
Blast (immature cells rapidly proliferate)
50
risk factors for CML
ionizing radiation or chemicals like benzene
51
sx of CML
increased WBC, splenomegaly, constitutional symptoms, fever, bone pain, petechiae, anemia, thrombocytopenia, hyperuricemia.
Decreased leukocyte alkaline phosphatase
52
tx of CML
imatinib
53
MOA of imatinib
TKI targets active BCR-ABL fusion protein
54
pT, pTT, and bleeding time for immune thrombocytopenia purpura
pT and pTT normal
| BT increased
55
pentad of TTP
fever, neuro issues, thrombocytopenia, MAHA, renal failure
56
MALT translocation
t(11;18)
57
mutation in DLBCL
BCL6
58
translocation of follicular lymphoma
t(14;18)
59
translocation of mantle cell
t(11;14)
60
how is fanconi anemia inherited
autosomal recessive or X linked
61
clinical manifestations of fanconi anemia
pancytopenia, short stature, cafe au last spots or hypo pigmentation, dysplastic thumbs, microcephaly, hypogonadism, developmental delay
62
causes of pure red cell aplasia
thymomas, autoimmune disorders, drug exposure, viral illness, diamond blackfan
63
moa of abciximab
inhibits GP2b/3a
| platelets can't aggregate
64
glanzmann thrombocytopenia inheritence
AR
65
moa of glanzmann thrombocytopenia
defect of GP2b/3a
mucocutaneous bleeding
normal platelet counts, but no aggregation
66
MOA of bernard-soulier
defect in glycoprotein 1b (vWF receptor)
| giant platelets
67
which HL present at younger ages
lymphocyte predominant and nodular sclerosis
68
what pt is most likely to have nodular sclerosing HL
young female
69
who presents with lymphocyte deletion HL?
older males with HIV
70
who presents with lymphocyte predominant HL?
young males with cervical or axillary LAD
71
who presents with lymphocyte rich HL?
M>F, older adults
72
who presents with mixed cellularity HL?
males, biphasic incidence
73
symptoms of ALL
fatigue, weakness, SOB, loss of appetite, weight loss, fever, petechiae, purport, gingival bleeding, pallor, frequent infections, splenomegaly, LAD
74
marker for ALL
TdT
75
markers for B-ALL
CD19, CD20
76
markers for T-ALL
CD1, CD2, CD5, CD7
77
symptoms of multiple myeloma
hypercalcemia
renal insufficiency
anemia
back pain
78
characteristic blood finding in multiple myeloma
rouleux formation- stack of RBC
79
age for CML
30-60
80
translocation in CML
t(9;22)
81
tx of heparin toxicity
protamine sulfate
82
papillary thyroid carcinoma is associated w a history of what
head and neck radiation
83
histo findings of papillary thyroid carcinoma
psammoma body, orphan annie eye nuclei
84
deficiency in what factors leads to prolonged pTT
8,9,10,12
85
deficiency in what factors leads to prolonged pT
1,2,5,7,10
86
how does DLBCL present
older person with rapidly enlarging mass
87
3 most common cancers with psammoma bodies
papillary thyroid carcinoma, serous cystadenoma of the ovary, meningiomas
88
clinical manifestation of selective IgA deficiency
```
recurrent sinopulmonary infections
autoimmune disorders
giardia infections
allergic disorders
anaphylactic transfusion reactions
```
89
warm hemolytic anemia will likely what have positive lab test
positive coombs at 37C but not at 4C
90
what is the reticulocyte index in pts with a myeloproliferative disorder?
decreased (<2%)
91
uses of hydroxyurea
myeloproliferative disorders (PV, ET), sickle cell
92
moa of hydroxyurea
increases hemoglobin F, decreased concentration of hemoglobin S
93
what will shift the oxygen-hemoglobin curve to the right
CO2 exposure, acid exposure, increases in 2,3-DPG
94
what does warfarin do to INR
increase it
95
what can you use for anticoagulation in a pt with a history of heparin induced thrombocytopenia
direct thrombin inhibitors- argatroban
96
lab findings in DIC
```
increased PT
increased PTT
increased bleeding time
decreased antithrombin 3
decreased platelet count
```
97
associated conditions with DIC
pancreatitis, lymphoproliferative, myeloproliferative or solid malignancies, severe hepatic failure, sepsis
98
what is the cause of an elevated BUN:Cr ratio in a pt with multiple myeloma
cast nephropathy
99
what is the monoclonal antibody in waldenstrom macroglobulinemia
IgM
100
clinical features of waldenstrom macroglobulinemia
```
hyper viscosity syndrome--> headache, blurred vison
peripheral neuropathy
LAD
hepatosplenomegaly
raynauds
```
101
how do you dx waldenstrom macroglobulinemia
serum protein electrophoresis
102
antibodies for polymyositis and dermatomyositis
anti-jo 1, anti Mi 2, anti SRP
103
presentation of AML APL variant
life threatening bleeding w features of DIC, recurrent infection, pancytopenia
104
what is the translocation for AML APL
15;17
105
tx for AML APL
all trans retinoid acid
106
enlarged supraventricular node is suggestive of what type of cancer
lymphoma- usually B cell
107
MOA of phemigus vulgaris
IgG antibodies against desmosomes--> loss of cell- cell adhesion--> pacantholysis
108
how can you dx phemigus vulgaris
biopsy with direct immunofluorescence showing antibodies on surface of keratinocytes
net like pattern
109
what do you see on biopsy for bulls pempihoid
immunofluorescence in a linear dermal epidermal distribution
110
what do you see on biopsy of celiac disease
mucosal atrophy, loss of villi, crypt hyperplasia
111
bulls pemphigoid has what antibodies
anti hemidesmosomes
112
what does basal cell carcinoma look lie grossly
non-pigmented, slow growing, non healing ulcer with rolled borders, central crusting, telangiectasis
113
risk factors for acute gout
```
diet (high protein foods, high fat)
alcohol
meds (diuretics, aspirin)
surgery or trauma
underlying chronic medical condition
```
114
tx for acute gout
1st: NSAID
when can't use NSAID: colchicine
prednisone if pt has renal disease
115
clinical presentation for Alpert's syndrome
progressive hearing loss, arthritis, nephritis, before 30
116
Alports is due to an issue with what
type 4 collagen
117
lesch nyhan is due to deficiency of what
HGPRT enzyme- normally channels hypoxanthine and guanine back into synthesis of DNA
118
dermatographism (stroking skin with firm pressure) is a test for what
physical urticaria
119
sx of acrochordon
small benign tumor in areas where skin forms creases: neck, armpit, groin
120
MOA of fluoroquinolone
inhibits DNA gyrase (topoisomerase 2)
121
side effects of fluoroquinolone
```
tendon rupture
GI upset
superinfection
skin rash
headache
```
122
MOA of polymyxins
binding to cell membrane of bacteria and disrupts their osmotic properties
123
side effects of polymyxins
neurotox
| acute RTN
124
MOA of isoniazid
decreased synthesis of mycolic acid
125
MOA of metronidazole
forms toxic metabolites in bacterial cell that damage DNA
126
side effects of metronidazole
HA
metallic taste
disulfiram like reaction
127
MOA of rifampin
inhibits DNA dependent RNA polymerase
128
how does angiodysplasia present on colonoscopy
discolored lesion with vessels that are dilated, thin walled, and without smooth muscle
129
sx of angiodysplasia
asymptomatic, blood per rectum, tachycardia, iron deficient anemia
130
most common cause of acute cholecystitis
gallstone impaction in the cystic duct
131
presentation of acute cholecystitis
RUQ pain, fever, leukocytosis, elevated all phos
132
risk factors for cholesterol stones
obesity, pregnancy, estrogen therapy, chrons, rapid weight loss, gallbladder stasis, advanced age, multiparty.
133
risk factors for pigment stones
chronic hemolysis; hereditary spherocytosis, alcoholic cirrhosis, biliary infections, total parenteral nutritions, chrons, advanced age
134
causes of dysphagia for solids and liquids
achalasia
diffuse esophageal spasm
scleroderma esophageal dysmotility
135
causes of dysphagia for solids only
```
EOE
esophageal cancer
esophageal strictures
esophageal webs
plummer vinson
schatzki ring
zenker diverticulum
```
136
most common cause for schatzki ring
GERD
137
risk factors for adenocarcinoma of the esophagus
```
barrets
GERD
obese
smokign
achalasia
```
138
risk factors for primary sclerosis cholangitis
males with UC
HLA DR3
hypothyroidism
139
clinical presentation of PSC
```
severe itching
fatigue
increased direct bilirubin: jaundice, dark urine, white stool
steathorrhea
cirrhosis and portal HTN
```
140
dx of PSC
```
increased direct bilirubin
inc ALK Phos
inc GGT
LF normal
P ANCA
inc IgM
```
141
imaging results for PSC
beading of intrahepatic or extra hepatic bile ducts
| MRCP or ERCP
142
Biopsy results of PSC
onion skin bile duct fibrosis
143
how does viral infection increases risk of intusseption
hypertrophy of Peters patches
144
sx of small bowel obstruction
intermittent cramping ab pain, N/V, high pitched bowel sounds, dilated loops of bowel with air fluid levels
145
sx of gallstone ileus
air in biliary tree
146
cause of gallstone ileus
mechanical obstruction of ileocecal valve secondary to gallstone, erode via cholecystoenteric fistula
147
sx of ascending cholangitis
fever, jaundice, RUQ pain
| +/- hypotension and altered mental status
148
MOA of acute pancreatitis
autoactivation of trypsinogen to trypsin
149
chrons disease characteristics
bloody or nonbloody
transmural inflammation
skip lesions
noncaseating granulomas
150
extra intestinal manifestations of UC and chrons
```
erythema nodosum
pyoderma gangrenous
uveitis
arthritis
ankylosing spondylitis
```
151
sx of erythema nodosum
painful inflammation of subQ fat pads over tibia. Painful , palpable nodules
152
complications of chrons
```
fistulas
SBO
strictures
kidney stones
gallstones
```
153
sx of whipple disease
```
old men
arthralgia
cardiac issues
neuro symptoms
diarrhea and steatorrhea
```
154
dx of whipple
PAS positive
155
causes of ischemic hepatitis
cardiac arrest
hypovolemic shock
septic shock
severe intraoperative hypotension
156
clinical findings of ischemic hepatitis
elevated AST and ALT >1000
| normal ALP
157
adverse affects of amiordarone
```
pulmonary fibrosis
hypothyroidism and hyperthyroid
gray skin deposits
corneal deposits
hepatic steatosis and cholestatis
```
158
how is Dubin Johnson inherited
AR
159
MOA of Dubin johnson
defective hepatic excretion of bilirubin
160
sx of Dubin johnson
conjugated hyperbilirubinemia, scleral icterus, jaundice
161
what can cause a pt with Dubin johnson to become symptomatic
birth control
162
what drug can be used to treat diffuse esophageal spasm and what is ts MOA
calcium channel blocker- causes smooth muscle relaxation via inhibition of voltage gated calcium channels
163
how is wilsons inherhited
AR mut in ATP7B
164
sx of wilsons
cirrhosis, acute liver failure, gait issues, tremor, parkinsonism, depression, personality changes, hemolytic anemia
165
Dx of wilsons
inc urinary copper excretion
kayser Fleischer rings on slit lamp examination
copper deposition on liver biopsy
166
what tumor marker is associated with hepatocellular carcinoma
AFP
167
B HCG is a tumor marker for what
germ cell tumors: seminoma, yolk sac, choriocarcinoma
168
CA19-9 is a tumor marker for what
pancreatic adenocarcinoma
169
CEA is a tumor marker for what
colorectal cancer
170
HER2 is a tumor marker for what
breast cancer and gastric adenocarcinoma
171
what is usually the cause of acute mesenteric ischemia
embolic occlusion of the superior mesenteric artery
172
risk factors for acute mesenteric ischemia
A fib
coronary angiography
infective endocarditis
VSD
173
sx of acute mesenteric ischemia
ab pain out of proportion to physical exam
bloody stool
air in bowel wall
174
risk factors for chronic mesenteric ischemia
```
HTN
hyperlipidemia
DM
tobacco
CAD
peripheral vascular disease
```
175
sx of chronic mesenteric ischemia
chronic ab pain, pain associated with oral intake
| weight loss
176
does primary biliary chonalgitis affect intra or extra hepatic bile ducts
intrahepatic only
177
antibody for PBC
anti mitochondrial
178
antibody for PSC
p ANCA
179
biopsy findings for primary sclerosis cholangitis
fibrous obliteration of the epithelium and connective tissue replacement in an onion skin pattern
180
sx of gastrointestinal stroll tumor
painless bleeding, anemia, fatigue, SOB, mass in stomach
181
endoscoptic characteristics of gastrointestinal stroll tumor
submucosal location with preservation of overlying muscosa, smooth margins, bulging into gastric lumen
182
what mutation goes with gastrointestinal stroll tumor
GoF in c-KIT protooncogene
183
sx of biliary atresia
dark urine and gray colored stools
elevated direct bilirubin
jaundice
184
MOA of GVHD
donor lymphocytes recognizing host cell antigens as foreign
185
cause of hereditary pancreatitis
AD disorder resulting from mutation of the gene for trypsinogen- can't be inhibited by PSTI
186
what layers get herniated in zenkers diverticulum
mucosal and submucosal
| lacks muscular propria
187
components of mucosal layer of esophageal wall
epithelial cells
lamina propria
muscular mucosa
188
increased estrogen in cirrhosis can lead to what symptoms
gynocomastia
spider nevi
testicular atrophy
189
MOA of gemfibrozil
inhibits cholesterol 7a hydroxylase
190
side effect of gemfibrozil
increased risk of cholesterol gallstones
191
MOA of acute gastritis
inflammation due to neutrophilic infiltration
192
causes of acute gastritis
```
NSAIDS
alcohol
smoking
chemo
uremia
trauma
viral infection
ischemia
shock
acids
```
193
MOA of achalasia
failed LES relaxation and peristalsis of the distal esophageal smooth muscle
194
sx of pancreatic adenocarcinoma
obstructive jaundice
palpable contender gallbladder
migratory thrombophlebitis
195
complications of CF
```
pulmonary infections
bronchiectasis
cor pulmonale
obstruction of bile and pancreatic ducts
cirrhosis of liver
```
196
cause of hypertrophic pyloric stenosis
maternal use of macrolides
197
MOA of cholesterolosis
abnormal deposition of triglycerides and cholesterol into gallbladder mucosa
198
what disease is described by a coarse and granular mucosa from a strawberry gallbladder
cholesterolosis
199
MOA of bradykinin
increases capillary permeability leading to plasma leakage
200
MOA of angioedema
unchecked activation of complement cascade leading to a build up of bradykinin
201
besides swelling of hand and feet, how can angioedema present
fluid accumulation in interstitial- intestinal swelling presenting an colicky abdominal pain
202
complications of polycythemia vera
budd chiari= thrombus in hepatic vein
203
extra hepatic bile duct presentation of choledochal cysts
segmental or cylindrical dilation of common bile duct.
diverticulitis of extra hepatic duct.
cystic lesions that protrude into duodenal lumen
204
presentation of choledochal cysts
pt less than 10 yo, jaundice, recurrent ab pain, RUQ pain right after meals, conjugated hyperbilirubinemia
205
MOA of caroli disease
multifocal segmental dilation of large intrahepatic bile ducts
206
sx of caroli disease
assc with ARPCK, congenital hepatic fibrosis, portal HTN, esophageal varies, ascites
207
what is a choledochal cyst
congenital dilation of the common bile duct
208
how would you describe a second degree injury to the esophagus due to caustic injestion
mucosal and submucosal damage, ulcerations, exudates, vesicle formation
209
antibody for scleroderma
anti-topoisomerase 1 (anti-Scl-70)
210
antibody for drug induced lupus
anti histone
211
drugs that cause drug induced lupus
hydralazine, isoniazid procainanmide, quinidine
212
antibodies for sjorgens
anti La and anti Ro
213
antibody for SLE
anti smith
214
endoscopy findings of mallory weiss tears
focal lesions with normal appearing adjacent mucosa in distal esophagus
215
common causes of pill induced esophagitis
```
iron
potassium
vit c
alendronate
risedronate
tetracycline
aspirin
NSAIDs
quinidine
```
216
diseases associated with celiacs
DM type 1
dermatitis herpetiformis
liver and thyroid disease
217
how does the alpha 1 antitrypsin protein appear on biopsy
magenta granules on PAS stain after diastase digestion
218
why does pregnancy increase risk of cholesterol gallstones
supersaturation of cholesterol in bile bc estrogen increases cholesterol and progesterone decreases bile acid secretion and decreased gallbladder motility.
219
Moa of bactrim
Inhibits dihydropteroate synthase
220
Moa of rifampin
Inhibits DNA dependent RNA polymerase
221
Moa of fluconazole
Blocks conversion of lanosterol to ergosterol
222
Moa of nystatin
Binds ergosterol resulting in formation of pores in fungal membrane
223
How is nystatin given
Topical
224
Moa of flucytosine
Antifungal agent that inhibits DNA and RNA biosynthesis
225
What nerve is pronator teres syndrome
Median nerve
226
Sx of pronator teres syndrome
Pain proximal forearm, pain during day, sensory loss thenar eminence, weakness of thumb opponens
227
Moa of isoniazid
Activated by KatG to prevent synthesis of mycolic acids
228
Moa of pyramidinqmide
Pyrazinoic acid formation collapses transmembrane proton motive force and inhibits enzyme function
229
Moa of ethambutol
Inhibits arabinosyl transferase to stop cel wall production
230
What motion does Supraspinatus do
Abduction
231
What motion does infraspinatus do
External rotation and abduction
232
WhT motion does teres minor do
External rot abduction
233
What motion does subscapularis do
Internal rotation ab and addiction
234
What type of cancer is Paget’s disease associated with
Invasive ductal carcinoma
235
Typical antipsychotics (5)
```
Haloperidol
Fluphenazine
Thioridazine
Chlorpromazine
Pimpzide
```
236
Atypical antipsychotics
```
Clozapine
Olabzapine
Risoeridone
Aripiprazole
Quetiapine
```
237
antibodies for autoimmune hepatitits
ANA or ASMA
238
what marker will be positive if you have had Hep B vaccine
surface antibody
239
what is a complication of CF (not involving lungs or pancreas)
cirrhosis of the liver
240
how do you treat intussusception in its under 3
barium or air enema
241
cause of intussusception in adults
CF, hence-schonlein purport, tumors
242
what is the most common type of benign liver tumor
cavernous hemangioma
243
histo for liver hemangiomas
dilated vascular spaces filled with blood and lined by a single layer of epithelium
244
hepatic adenomas are associated with what cause
oral contraceptives or anabolic steroid use
245
what is a complication of hepatic adenomas
spontaneous rupture- should resect in women of child bearing age due to increased estrogen
246
clinical features of small bowel obstruction
diffuse abdominal pain, hyperactive bowel sounds, abdominal distention
247
small bowel obstruction X-ray findings
dilated loops of bowel and air fluid levels
248
how is HH inheretied
AR
| HFE gene on chromosome 6
249
clinical features of HH
new onset diabetes and hyperglycemia, cirrhosis, joint pain, hyperpigmentation, restrictive/dilated cardiomyopathy
250
adverse effects of NSAIDS
```
aplastic anemia
interstitial nehpritits
increased risk fo cardiovascular disease
gastric ulcers
renal ischemia
renal papillary necrosis
```
251
which type of ulcer has the highest risk of malignancy
gastric ulcer
252
do duodenal ulcers get better or worse with meals
pain decreases
253
what is the main cause of a duodenal ulcer
H pylori
254
how can you confirm a dx of hirschsprung disease
rectal suction biopsy
255
pathophysiology of crigler-najjar type 1
No UDP-GT
256
sx of crigler-najjar type 1
severe persistent jaundice at birth, kernicterus- muscle rigidity, seizures
257
causes of B12 deficiency
deficient intake, lack of IF, ill disease
258
what damage does b12 deficiency have on the spinal tract
dorsal column
lateral corticospinal trat
spinocerebellar tract
259
what does the dorsal column of the spinal cord control
proprioception, vibration, light touch
260
what does the lateral corticospinal tract control
muscles
261
damage to the spinocerebellar tract will cause what issue
ataxia
262
what does the spinothalamic tract do
pain and temp
263
causes of torsades de pointes
```
hypokalemia
macrolides
class 1A and class 3 antiarrhythmics
antipsychotics
antidepressants
antiemetics (ondansetron)
```
264
sx of torsades de point
tachycardia
palpitations
dizziness
syncope
265
sx of first degree heart block
bradycardia leading to fatigue, dyspnea, dizziness, syncope
266
what drugs can cause first degree heart block
b blockers and CCB
267
what does first degree heart block look like on EKG
prolongation of the PR interval
268
EKG findings of cardiac tamponade
electrical alternans--> beat to beat alterations in amplitude of the QRS complex
269
sx of cardiac tamponade
Becks triad: hypotension, JVD, muffled heart sounds
270
risk factors of right sided infectious endocarditis
IV drug use
| central venous catheter
271
what organisms cause right sided infectious endocarditis
staph aureus
pseudomoas
candida
272
sx of right sided IE
tricuspid regurgitate, fevers and chills, , fatigue
273
complications of right sided IE
pulmonary embolism, lung abscess, bacterial pneumonia
274
what does tricuspid regard sound like
holosystolic murmur heard at the left sternal border, increases with inspiration
275
complications of left sided heart vegetations
enter systemic circulation: stroke, brain abscesses, AKI, acute mesenteric ischemia
276
what valve is usually affected in left sided IE
mitral
277
where is mitral regard best heard
cardiac apex, holosystolic, increases with inspiration
278
what does mitral valve prolapse sound like
mid systolic click followed by a late systolic decrescendo best heard at cardiac apex
279
what does mitral stenosis sound like
opening snap followed by an early diastolic murmur, best heard at cardiac apex
280
what are laneway lesions associated with
left sided IE
281
sx of mitral valve stenosis
dyspnea and worsening exercise tolerance
282
what is a usual cause of mitral valve stenosis
delayed complication of rheumatic heart disease
283
what are the 7 systolic murmurs
```
aortic stenosis
pulmonic stenosis
MVP
mitral regurg
tricuspid regurg
hypertrophic cardiomyopathy
VSD
```
284
what are the 3 holosystolic murmurs
mitral regurg
tricuspid regurg
VSD
285
what are the 3 diastolic murmurs
aortic regurg
mitral stenosis
tricuspid stenosis
286
what murmur is best heard at right sternal border
aortic stenosis
287
what murmrus are best heard at left sternal border
```
pulmonic stenosis
tricuspid stenosis
tricuspid regurg
hypertrophic cardiomyopathy
VSD
```
288
what murmrus are best heard at the cardiac apex
mitral stenosis
mitral regurg
MVP
289
what murmur is best heard at left infraclavicular area
PDA
290
causes of pulses paradoxous
cardiac tamponade, constrictive pericarditis, cariogenic shock, pulmonary embois, asthma, COPD, tension pneumothorax
291
pluses parvus et tardus (weak pulses ) is assocaited with what
aortic stenosis
292
causes of wide pulse pressure
aortic regurg, aortic dissection, PDA, av fistula
293
sx of renal artery stenosis
refractory HTN, abdominal bruits, secondary hyperaldosteronism (inc renin and aldosterone)
294
what is the most common cause of renal artery stenosis in young women
fibromuscular dysplasia
295
conn syndrome
aldosterone producing tumor causes primary hyperaldosteronism
296
sx of conns syndrome
HTN, hypokalemia, metabolic alkalosis, decreased renin levels
297
sx of pheochromocytoma
episodic HTN, headaches, palpitations, and diaphoresis
298
where are atrial myxomas most commonly located
left atrium
299
complication of atrial myxoma
embolic disease, stroke symptoms, AKI, arterial insufficiency, ischemic colitis
300
what type of murmur do myxomas cause
diastolic best heard at cardiac apex
| tumor plop
301
what does histo for an atrial myxoma look like
gelatinous material and myxoma cells immersed in glycosaminoglycans
302
3 common causes of ischemic stroke
thrombotic
embolic
hypoxemia
303
what would a stroke in the right middle cerebral artery present like
left sided facial droop, motor and sensory deficits in left upper extremity
304
what leads correspond to the right coronary artery
2,3, aVF
305
occlusion of the RCA will affect which portion of the heart
inferior, right ventricle
306
what drug should be avoided in RV MI and why?
nitrates because the pt is preload dependent, and nitrates cause an abrupt decreases in RV end diastolic volume
307
pathophysiology of henoch-schonlein purpura
IgA immune complex mediated small vessel vasculitis
308
sx of HSP
ab pain, arthralgia, palpable purport, renal disease- hematuria
309
pts with HLA-B27 associated seronegative spondyloarthropathy usually have what triad of symptoms
conjunctivitis, urethritis, arthritis
310
sx of kawasaki disease
conjunctival injection, rash, cervical LAD, oral mucositis, hand/foot edema, fever
311
what size vessels does kawasaki disease effect
medium vessel
312
when does post strep glomerulonephritis present
2-4 wks post infection
313
symptoms of PSGN
periorbital facial edema, cola colored urine, hematuria, nephritic range proteinuria
314
how does AV block look on EKG
dissociation of the atria and ventricles
315
sx of AV block
bradycardia, weakness, fatigue, syncope
316
pathophysiology of wolff-parkinson-white syndrome
abnormal fast accessory conduction pathway from atria to ventricle that bypasses AV node
317
EKG findings for wolff-parkinson-white
delta wave along with widened QRS and short PR interval
318
EKG findings of hypokalemia
flat T waves
319
what IL do cardiac myxomas produce and what is the affect of this
IL6- fever, weight loss
320
what antibody goes with GPA
c-ANCA
321
sx of GPA
bloody nasal discharge, alveolar hemorrhage, glomerulonephritis, upper and lower lung issues
322
what antibody is present in charge-strauss
p ANCA
323
wide, fixed splitting of S2 is associated with what
ASD
324
paradoxical splitting of heart sounds is associated with what
aortic stenosis, LBBB
325
sx of metrology of fallot
pulmonary stenosis, right ventricle hypertrophy, overriding aorta, VSD
326
clinical sx of tuberous sclerosis
cardiac rhabdomyoma, facial lesions, hypo pigmented skin, cortical and retinal hamartomas, renal cysts
327
cause of concentric hypertrophy of the ventricles
chronically elevated blood pressure
328
MOA of S4 heart sound
late diastole, left atrium is forced to push against a stiff left ventricular wall
329
symptoms fo aortic regurg
dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, bounding pulses, head bobbing
330
what heart finding is assocaited with turners syndrome
bicuspid aortic valve or coarctation of the aorta
331
sx of giant cell arteritis
jaw claudication, unilateral headache, visual disturbances, constitutional symptoms, inc ESR, inc C reactive protein
332
what causes the vision impairment in giant cell arteritis
occlusion of the ophthalmic artery
333
sx of polyarteritis nodosea
nonspecific GI complaints, fever, arthralgia, myalgia, weight loss, derm complaints
334
how would you describe the rash in PAN
lacy, non-blanchable rash
335
what do you find on biopsy of PAN
fibrinoid necrosis
336
what do you find on angiogram of PAN
multiple aneurysms
337
complications of Takayasu arteritis
granulomatous thickening of the aortic arch and proximal vessels
338
what effect does the valsalva maneuver have on MVP
increases duration
339
what does valsalva do to preload
decreases
340
what murmur is a crescendo-decrescendo systolic ejection murmur
aortic stenosis
341
common EKG findings in takotsubo cardiomyopathy
ST elevations in leads V1-V4
342
what is the most reliable test for detecting a repeat MI
CK-MB
343
at 6 days post MI what complication is a pt at risk for
cardiac tamponade due to myocardial rupture
344
what is the marker for congestive heart failure
BNP
345
histo finding of buerger disease
intraluminal thrombi within both arteries and veins
346
what type of pericarditis presents after an MI
fibrinous pericarditis
347
MOA of eccentric hypertophy
addition of sacromeres in series leads to ventricular dilation
348
causes of eccentric cardiomyopathy
dilated cardiomyopathy and structural defects that result in chronic elevations in preload
349
what does inspiration due to right side murmurs
increase intensity
350
what does expiration do to left sided murmurs
increase intensity
351
what the the physiologic effect of hand grip maneuvers
increase after load
352
which murmurs does hand grip increase
MR, AR, VSD
353
which murmurs does hand grip decrease
HOCM, AS
354
what is the physiologic effect of the valsalva phase 2 maneuver
decreases left ventricle end diastolic volume (preload)
355
which murmur does valsalva phase 2 increase
HOCm
356
what is the physiologic effect of standing up
decreased preload
357
what effect does standing up have on HOCM murmurs
increased intensity
358
what is the physiologic effect of rapid squatting
increased venous return, increased preload, increased afterload
359
which murmurs does squatting increase
MR, AR, VSD
360
which murmurs does squatting decrease
HOCM, MVP
361
when does ventricular arrhythmia occur after an MI
within 24 hours
362
when does septal wall rupture occur after MI
3-7 days
363
when does ventricular free wall rupture occur after an MI
3-7 days
| cardiac tamponade
364
when does dressers syndrome occur post MI
2+ weeks
365
sx of dressers syndrome
dyspnea, pleuritic chest pain, pericardial friction rub, fever, leukocytosis, elevated ESR, diffuse ST segment elevation
366
what physical exam finding will you see with takayasu arteritis
weak upper extremity pulses
367
sx of takayasu arteritis (12)
```
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)
```
368
causes of dilated cardiomyopathy
alcohol, cocaine, beriberi, coxsachie B, chagas, doxorubicin
369
sx of dilated cardiomyopathy
arrhythmias, congestive heart failure, enlarged heart
370
light criteria
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
371
common causes of exudate pleural effusions
infection, malignancy, pancreatitis, rheumatologist disease, trauma
372
common causes of transudate pleural effusions
cirrhosis, heart failure, nephrotic syndrome
373
what is the pathophysiology of transudate pleural effusions
increased hydrostatic pressure, decreased oncotic pressure
374
3 phases of pertussis
catarrhal (1-2 weeks), mild cough and rhinitis
Paroxysmal (2-6 weeks, whooping cough, posttussive emesis)
convalescent (wks-months)
375
COPD findings on PFT
increased RV, increased TLC, decreased FEV1, decreased FEV1/FVC ratio, increased hemoglobin, respiratory acidosis - increased bicarb
376
sx of pulmonary embolism
dyspnea, pleuritic chest pain, tachycardia, lower extremity pain and swelling, obstructive shock
377
lab findings of pulmonary embolism
respiratory alkalosis, hypoxemia, increased D dimer
378
what does PE look like on xray
wedge shaped
379
how does the body compensate for respiratory alkalosis
decreased absorption of bicarb in the kidneys
380
pathophysiology of chronic bronchitis
hypertophy and hyperplasia of mucous secreting glands in bronchi
381
pathophysiology of emphysema
imbalance of proteases and antiprotesases leads to increased elastase activity which leads to loss of elastic fibers
382
sx of chronic bronchitis
productive cough, dyspnea, wheezing, co2 retention (chronic respiratory acidosis), secondary polycythemia
383
what is bronchiectasis
obstructive lung disease characterized by permanently dilated airways
384
common cause of bronchiectasis
chronic infection or obstruction
385
what happens to the lungs in pulmonary fibrosis
fibroblast proliferation and collagen deposition
386
risk factors for aspiration pneumonia
dysphagia, seizures, alcoholism, cardiac arrest, recent intubation
387
what does X-ray of the lungs in aspiration pneumonia typically look like
lobar infiltrate usually in right middle or lower lobe
388
tx of aspiration pneumonia
clindamycin
389
tx of mild persistent asthma
SABA and daily low dose inhaled corticosteroid
390
MOA of inhaled corticosteroids
inhibit NF-kB signaling leading to decrease in transcription of inflammatory cytokines
391
what is a positive methacoline challenge test
20% decrease in FEV1 compared to baseline
392
definition of mild intermittent asthma
<2 days per week
393
definition of mild persistent asthma
>2 days of daytime symptoms, 3-4 night time symptoms per month
394
definition of moderate persistent asthma
daytime symptoms once per week, night time symptoms 1-2 times per week
395
definition of severe persistent asthma
daytime symptoms multiple times per day, night time symptoms >5 times per week
396
tx of mild intermittent asthma
SABA
397
tx of mild persistent asthma
SABA prn
low-dose ICS qd
leukotriene blocker if ICS doesnt work
398
tx of moderate persistent asthma
SABA prn
low dose ICS + LABA qd
can switch to leukotrine or medium dose ICS
399
tx of severe persistent asthma
SABA prn
medium/high dose ICS + LABA
can switch to: high dose ICS, leukotriene blocker, oral corticosteroids, LAMA, omalizumab, mepolizumab
400
moa of omalizumab
anti IgE
| used in refractory asthma
401
MOA of mepolizumab and reslizumab
anti IL5
402
hypercalcemia is associated with what type of lung cancer
squamous cell
403
what paraneoplastic syndromes are assocaited with small cell lung cancer
cushing, lambert eaton, paraneoplastic myelitis, SIADH, subacute cerebellar degeneration
404
physiologic effects of paraneoplastic production of PTHrp
increased production of 1,25-OH-vit d, increased reabsorption of Ca, decreased reabsorption of phosphate, increased bone resorption, increased all phos
405
what acid base disturbance will pts with chronic bronchitis have
respiratory acidosis with metabolic compensation (incr serum bicarb)
406
centriacinar emphysema is seen in which pts
smokers
407
panacinar emphysema is seen in which pts
a1 antitrypsin deficiency
408
pathophysiology of lambert-eaton syndrome
antibodies against presynaptic voltage gated calcium channels
409
tx of aspirin exacerbated respiratory disease
leukotriene receptor antagonist- montelukast
410
MOA of montelukast
inhibits CysLT1
411
moa of aspirin induced asthm
aspirin blocks COX pathways--> up regulation of lipooxygenase pathway--> increased LT
412
risk factors for focal segmental glomerulosclerosis
HIV, black, heroin abuse, sickle cell, morbid obesity, infernon tx
413
sx of FSGS
peripheral edema, proteinuria (>3.5 g/day), decreased albumin, increased risk of infection, hypercoaguable
414
what do you see on light microscopy of FSGN
segmental sclerosis and hyalinosis
415
what do you see on electron microscopy of FSGS
effacement of podocyte foot processess
416
what do you see on electron microscopy of minimal change disease
effacement of podocyte foot processes
417
what do you see on LM in pts with membranous nephropathy
diffuse capillari and glomerular basement membrane thickening
418
risk factors for membranous nephropathy
HBV, HCV, SLE, solid organ tumors, syphilis, NSAID
419
nephrotic disease
FSGS,
membranous,
diabetic glomerulonephropahty, minimal change
420
nephritic disease
PSGN
membranoproliferative glomerulonephritis, aport, diffuse proliferative, IgA nephropathy, , rapidly progressive/crescentic
421
sx of PSGN
2-4 wks post infection. <3.5 g/d proteinuria, HTN, periorbital edema, hematuria
422
cause of type 1 MPGN
HBV, HCV
423
MPGN on LM
splitting of glomerular basement membrane "tram-track" appearance
424
cause of type 2 MPGN
C3 nephritic factor
425
causes of acute tubular necrosis
ischemia or exposure to nephrotoxic substances
426
what does a BUN/Cr ratio <20 mean
intrinsic azotemia
427
causes of ischemic ATN
decreased RBF: severe hypotension, cardiac arrest, trauma, massive GI bleed, sepsis, shock
428
findings of ATN on UA
granular (muddy brown) casts
429
causes of nephrotoxic ATN
direct renal injury secondary to exposure to toxic substances
430
what does a BUN/Cr ratio >20 indicate
prerenal azotemia
431
EM of membranous nephropathy
spike and dome appearance due to subepithelial deposits
432
complications of ARPKD (less severe)
renal insifficiency, systemic HTN, congenital hepatic fibrosis
433
dx of ARPKD
US- bilateral enlargement of the kidneys
434
what conditions are assocaited with rapidly progressive GN
goodpasture, GPA, microscopic polyangitis
435
pathophysiology of alports syndrome
mutation in type 4 collagen--> thinning og basement membrane
436
sx of alports
glomerulonephritis- hematuria and proteinuria, sensorineural deafness, eye changes - cataracts, lens dislocation
437
berger disease
episodic hematuria and nephritic range proteinuria that occurs concurently with a respiratory or GI tract infection
438
where does renal cell carcinoma metastasis to
lungs
439
when will you see adults with minimal change disease
if they have lymphoma
440
LM of minimal change disease
normal
441
envelope or dumbbell stones
calcium oxalate
442
wedge shaped prism stones
calcium phosphate
443
coffin lid stones
sturvite
444
rhomboid or rosette stones
uric acid
445
hexagonal stones
cystine
446
waxy casts are seen in
chronic renal failure
447
RBC casts are seen in
ischemia and glomerular nephritits
448
WBC casts are seen in
acute pyelonephritis, transplant rejection, tubulointerstitial inflammation
449
bacterial casts are seen in
acute pyelonephritis
450
fatty casts are seen in
nephrotic syndromes
451
where is the most common site for kidney obstruction in kids
ureteropelvic junction
452
MOA of proton pump inhibitors
irreversibly inhibit H/K ATPase on luminal surface- inhibits gastric acid secretion
453
what do PPIs end in
-prazole
454
what is the role of the H2 Receptor
G coupled protein receptor increases concentration of cAMP--> increases H/K ATPase activity
455
how do H2 receptor antagonists work
reversible competitive antagonists
456
what do H2 blockers end in
-tidine
457
what is misoprostal used for
prevents peptic ulcer formation in the setting of NSAID use
458
MOA of sucralfate
reacts with hydrochloric acid in stomach to form thick viscous coating that binds to proteins on mucosal surface
459
1st line treatment of GERD
PPI
460
what is the cause of priapism
lack of input from sympathetic fibers from the prostatic plexus
461
MOA of sildenafil
phosphodiesterase inhibitor- increases cGMP--> relaxes smooth muscle via NO
462
what activates the genera sensory fibers of the pudendal nerve
touch or pressure on penile skin, glans and urethra
463
what activates somatic fibers from the pudendal nerve
sensory input by causing contraction of ischiocavernosus and bulbocavernosus muscles
464
how does penile erection occur
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
what innervates the colon and rectum
visceral afferent fibers from the pelvic plexus
466
what type of blood flow do AVFs cause
low-resistance, high volume flow of blood between artery and vein
467
Pierre robin syndrome
congenital, small lower jaw, downward displacement or retraction of tongue cleft palate.
468
sx of pierre robin syndrome
airway obstruction, hypoxia, difficulty feeding, respiratory distress
469
what does the first pharyngeal arch make
maxilla, mandible masseter, pterygoids, mylohyoid, cranial nerves V2, V3
470
what does the second pharyngela arch make
middle ear, hyoid bone, temporal styloid process, facial muscles, stapedius, platysma, stylohyoid. CN7
471
what does the third pharyngeal arch make
stylopharyngess m and glossopharyngeal nerve
472
what does the fourth pharyngeal arch make
cricothyroid m, muscles of soft palate, thyroid cartilage, superior laryngeal branch of the vagus n
473
waht does the 6th pharnygeal arch make
intrinsic muscles of the larynx, cricoid, arytenoid, corniculate, recurrent laryngeal branch of vagus n
474
what does the first groove make
external tympanic membrane
475
what does the 1st pouch make
tympanic cavity, mastoid antrum, eustachian tube, tympanic membrane
476
what does the 2nd pouch make
tonsillar sinus, tonsillar lymphoid tissue
477
what does the 3rd pouch make
inferior parathyroid gland, thymus
478
what does the 4th pouch make
superior parathyroid gland, thyroid gland
479
what is an indicator of cerebellar dysfunction
dysdiadochokinesia- inability to perform rapid alternating movements
480
what are the 2 most common cerebellar tumors in children
pilocytic astrocytoma and medulloblastoma
481
what symptoms will midline cerebellar tumors have
gait atazia and nystagmus
482
what does babinksi sign indicate
UMN damage to corticospinal tract
483
what does a negative oculocephalic reflex indicate
severe brainstem dysfunction
484
what effects does metformin have
decreases gluconeogenesis, increases peripheral tissue glucose uptake, and decreases serum free fatty acid concentration
485
acute interstitial nephritis can be caused by a hypersensitivity reaction to what drugs
diuretics, PPIs, sulfonamides, NSAIDs
486
what are the rapid acting, short duration diabetes drugs
glulisine, aspart, lispro
487
what are the intermediate diabetes drugs
insulin, NPH
488
what are the long acting diabetes drugs
deter, glargine
489
what do sulfonylureas end in
-ide
| glyburide, glipizide, glimepiride
490
what do meglitinides end in
-glinides
491
what do GLP-1 agonists end in
-tide
| extenatide, liraglutide
492
what do DDP4 drugs end in
-gliptans
493
what do thiazolidinedions end in
glitazones
494
what happens to the kidney as you age that reduces the ability to concentrate urine
decreased response to ADH
495
what is the affect of decreased renal blood flow
stimulates release of renin--> get ang2--> acts on vascular smooth muscle to increases systemic vascular residence--> increased sodium resorption
496
what virulence factor of mycoplasma TB is cytotoxic to macrophages
cord factor
497
mutations to what enzyme cause acute intermittent phorphyria
porphobilinogen deaminase
498
waht is the cerebellar vermis responsible for
controls motor function of axial and proximal limb muscles , body posture and position.
499
what is the self selection method
participants pick for themselves if they want to participate
500
what is population based control
control group comes form the population you are studying
501
stage of wound healing
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
what does IL8 do
induces chemotaxis of neutrophils and granulocytes
503
what does IL1 do
promotes vasodilation, activates osteoclasts, stimulates proliferation of granulocytes
504
what is the role of 5a-reductase
catalyzes metabolism of testosterone to DHT
505
what effect does testoserone have on sexual development
promotes development of wolffish duct
506
what does the wolffish duct develop into
seminal vesicles, epidymitis, vas deferens, ejaculatory duct
507
what does DHT do
promotes development of male external genitalia and prostate from the genital tubercle and urogenital sinus
508
presentation of pts with 5a-reductase deficiency
look phenotypically female externally or can have ambiguous external genitals. Will have male insides bc of testosterone.
509
what does anti-mullerian hormone do
secreted by sertoli cells, suppresses development of paramesonephric duct (which would develop into female internal genital structures)
510
what is the function of actin
provides mechanical structure for phagocytes to maintain shape, shuttles enzymes to augment intracellular singling, aids in endocytosis of large particles.
511
what is appropriate compensation in an acute respiratory acidosis
for every 10 mmHg increase in CO2, bicarb should increase by 1
512
what is an appropriate compensation in chronic respiratory acidosis
for every 10 mmHg increase in CO2, bicarb should increase by 3.5
513
if pH and bicarb are moving in opposite direction, what would this indicate
respiratory acid-base disturbance
514
what is winters formula and what do you use it for
checks for appropriate compensation.
| PCO2= 1.5[bicarb]+8 +- 2
515
lab findings for RTA4
hyperkalemia
| + urine anion gap
516
lab findings for RTA type 2
hypokalemia, - urine anion gap, proximal
517
lab findings for RTA type 1
hypokalemia, + urine anion gap, distal
518
prolactin binds to what type of receptor
```
prolactin receptor- class 1 cytokine receptor family- spans the plasma membrane.
has extracellular, transmembrane, and intracellular domain.
```
519
what hormones bind to nuclear receptors that contain DNA binding domains
aldosterone, cortisol, estradiol thyroxine
520
causes of left ventricular hypertrophy
chronic HTN, aortic stenosis, coarctation fo the aorta, aortic or mitral valve insufficient, VSD, infiltrative cardiomyopathy ,hypertrophic cardiomyopathy
521
EKG criteria for left ventricular hypertrophy
sum of S wave in V2 and R wave in V5 is greater than 35
522
what does fibronectin do
component of extracellular matrix
523
what does endothelial nitric oxide synthase do
synthesizes NO from L-arginine and oxygen
524
what does NADPH oxidase do
helps synthesis hypochlorus acid and ROS in respiratory burst of phagocytosis
525
what does NF-kB do
transcription factor that has broad functionality, increased expression of genes implicated in immune response.
526
what structures drain to the para-aortic lymph nodes
ovaries, testes, uterus, kidneys,
527
where are lymphatic vessels from the ovaries?
suspensatory ligament, runs with ovarian artery and vein
528
what does kaposi look like on histo
proliferating spindle cells forming slit like spaces filled with blood
529
what is the role of vitamin E
protects erythrocytes and cells from free radical damage
530
sx of vit E deficiency
hemolytic anemia, generalized muscle weakness
531
what directly affects cerebral blood flow
serum carbon dioxide concentration
532
what does hypocapnia do to cerebral blood flow
causes vasoconstriction
533
waht does activated IKK complex do?
phosphorylates IkB, which releases NF-kB after undergoing phosphorylation
534
adding more doses to a drug regimen does what to average plasma levels of the drug
decreases- less toxic
535
how does endurance exercise affect the heart
increased cardiac output and after load
536
how does the heart change in hypertrophic cardiomyopathy
LV hypertrophy of septum, reduced LV cavity size, impaired diastolic function, poorly developed coronary network
537
what 3 cancers spread to andrenal glands
breast, renal cell, melanoma
538
what cancer most likely goes to the brain
lung
539
what cancer goes to vertebral bodies
prostate
540
common side effects of bisphosphonates
osteonecrosis of the jaw, pill esophagitis, atypical bone fractures
541
what does a positive jaw jerk reflex indicate
UMN lesions above the level of the pons
542
jaw jerk reflex
afferent trigmeninal fibers from masseter--> V3--> trigeminal mesencephalic nucleus--> v3 efferent--> master causes jaw to close
543
proliferative phase of Hep B
viral HbsAg and HbcAg expressed with MHC 1 cells on hepatocyte surface. binding causes hepatocyte damage.
544
where does the thoracic duct drain lymph from
left side of body and everything below the belly button
545
how does alcohol inhibit gluconeogenesis
alcohol dehydrogenase increases the NADH/NAD+ ratio, inhibits all pathways that need NAD+
546
typical presentation of ABPA
recurrent episodes fo fever and bronchial obstruction in a pt with asthma
547
how do you diagnose ABPA
serologic testing for titers of IgE and and antibodies to aspergilous, or hypersensitivity skin testing
548
HBsAG presence longer than 6 months
chronic infection
549
HBeAg
indicates increased viral replication and infectivity
550
Anti-HBc IgM
first sign of acute infection, present during window phase
551
Anti-HBe
indicates decreased viral replication
552
Anti-HBc IgG
not present after vaccination
553
pathogenesis of primary myelofibrosis
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
sx of primary myelofibrosis
fatigue, massive splenomegaly, hepatomegaly, cytopenia, dacrocytes (teardrop cells), dry tap
555
MOA amiloride and triamperine
ENaC channel blockers in apical membrane of principle cells
556
hyponatremia following subarachnoid hemorrhage
excessive ADH
557
primary polydipsia
defective central thirst regulation - often seen in psych issues
558
pharmacokinetic changes in heart failure
decreased clearance of drugs, impaire/delayed oral drug absorption, impaired IM drug absorption
559
what can prevent apoptosis and erythroblast destruction in folate deficiency
thymidine
560
where is the amino acid binding site
3'
561
MOA of class 3 antiarrythmics (amiodarone, sotalol, dofetilide)
block potassium channels and inhibit outward potassium currents during phase 3 of cardiac action potential
562
corticosteroid effect on WBC
increased neutrophils, decreased everything else
563
DNA binding proteins
transcription factors, steroid receptors (cortisol, progesterone, aldosterone), thyroid hormone receptor, fat soluble vitamin receptors, DNA transcription and replication proteins
564
parathyroid and glucagon receptors MOA
Gs protein coupled receptor increases cAMP
565
growth hormone receptor MOA
membrane bound receptor, activates JAK-STAT pathway
566
MOA of intestinal malrotation
midgut undergoes incomplete counterclockwise rotation
567
presentation of intestinal malrotation
vulvula, intenstinal obstruction due to fibrous bands
568
preeclampsia causes placental ischemia, which leads to what
dysregulated vascular tone: vasospasm or vasoconstriction, increased vascular permeability, decreased end organ perfusion
569
sx of age related wet macular degeneration
unilateral painless vision loss
570
3 methods of ATP production during intense excercise
phosphocreatine shuttle, glycolysis, oxidative phosphorylation
571
waht is the bodies main source of NADPH
pentose phospahte pathway
572
what processes have high activity of the pentose phosphate pathway
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
what are the 4 dopaminergic pathways in the brain
mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular
574
tuberoinfundibular pathway
connects hypothalamus to to pituitary gland
575
how can antipyscotics cause hyperprolactinemia
block tuberoinfundibular pathway (which normally releases dopamine which inhibits prolactin)
576
where is the SA node located
junction of right atrium and superior vena cava
577
prolonged HTN can cause what changes to the heart
LV hypertophy, dilated cardiomyopathy
578
tx for methotrexate toxicity
folinic acid (leucovorin)
579
MOA tamoxifen
SERM, antagonist in breast
580
bicalutimide MOA
testosterone antagonist
581
danazol MOA
androgenic and antiestrogenic
582
cause of intestinal atresia in utero
decreased blood supply
583
rate limiting step of the pentose phosphate pathway
glucose-6-phospate --> 6-phosphogluconate via G6PD
584
cardiogenic shock
decreased CO, increased SVR, increased PCWP
585
hypovolemic shock
decreased CO, increased SVR, decreased PCQP
586
septic/anaphylatic shock
increased CO, decreased SVR, decreased PCWP
587
neurogenic shock
decreased CO, decreased SVR, decreased PCWP
588
obstructive shock
decreased CO, increased SVR, variable PCWP
589
cytokines ressponsible for septic shock
TNFa, IL-1, IL-6
590
sx of refeeding syndrome
arrhythmias, muscle weakness, heart failure
591
what does insulin do to phosphate
stimulates redistribution of phosphate from serum to hepatic and skeletal muscle
592
internal redistribution causes of hypophosphorus
refeeding syndrome, increased insulin secretion, respiratory alkalosis, hungry bone syndrome (seen after parathyroid surgery)
593
causes of acute serum sickness
chimeric monoclonal antibodies, nonhuman Ig (venom)
594
what type of hypersensitivity is acute serum sickness
type 3
595
LMN loss
paralysis, muscle atrophy, fasiculations
596
cerebrovascular event in the setting of a DVT is suspicious for what
paradoxical embolus
597
cause of paradoxical embolus
PFO, ASD, VSD, av malformation
598
cephalosporin resistent organisms
resistant PCNasew binding proteins: listeria, MRSA, enterococci
no cell wall; mycoplasma, chalmydia
599
histo findings in chronic bronchitis
thickened bronchial walls, lymphocytic infiltrate, increasing mucous production, squamous metaplasia
600
symptoms of juvenile myoclonic epilepsy
myoclonic seizures, jerky movements of UE, no loss of consciousness, worst right when waking up, provoked by sleep disturbance.
601
tx of juvenille myoclonic epilsepsy
valproic acid, levitracicin
602
what is the function of kinesin
anterograde transport of intracellular vesicles and organelles towards plus ends of microtubules
603
presentation of edwards
microcephaly, microopthalagy, cleft palate, omphacele
604
tx of beta blocker overdose
glucagon- increases cardio myocyte activity
605
lab findings of stool in lactose intolerance
decreased pH, increased osmolality, increased orogen breath test
606
risk of myopathy with statin use is increased when also given with what drug
fibrates
607
CYP450 inducers
carbamazepine, st johns wart, barbiturates, phenytoin, rifampin, griseofulvin,modafinil, cyclophosphamide
608
CYP inhibitors
amiodarone, cimetidine, grapefruit juice, flouroquinolones, clarithomcycin, azoles,isonizid, ritonavir
609
integrins bind to what things in th extracellular matrix
fibronectin, collagen, laminin
610
causes of psychogenic erectile dysfunction
recent illness, surgical procedures, loss of loved one
611
role of b-hcg
signals corpus luteum to keep making progesterone
612
when is b-hgc first detectable
8 days after fertilization
613
inections in which quadrant would result in superior gluteal n injury
superomedial butt
614
number need to harm
1/ARI
| ARI= (rate of adverse effects tx)- (rate adverse effects placebo)
615
what enzyme is responsible for making bruises green
heme oxygenase
616
norming aging in the lngs
increased lung compliance, decreased total lung system compliance, increased physiologic deadspace
617
what do neutrophils connect to in the rolling phase
L-selectin on neutrophils or E-selectin/p-selectin on endothelial cells
618
what initiates tight adhesion and crawling of neutrophils
Mac-1 and LFA-1 to ICAM1
619
what is responsible for neutrophil transmigration
PECAM-1
620
malingering
falsification and exaggeration of medical symptoms to gain an external reward
621
competitive testosterone receptor inhibitors
flutamide, cyproterone, spironolactone
622
cause of subclavian steal syndrome
stenosis fo subclavian artery proximal to the origin of the vertebral artery
623
sx of subclavian steal syndrome
ipsilateral arm ischemia, vertebrobasilar insufficiency (dizziness, HA)
624
waht is the most common cause of fetal unilateral hydronephrosis
blockage at the UPJ
625
MOA of cilostazol
inhibits platelet aggregation by blocking phosphodiesterase and is a direct vasodilator
626
MOA oc abciximab
inhibits platelete aggregation by inhibiting gp2b/3a
627
MOA of argatroban
direct thrombin inhibitor
628
tx of PAD
cilostazol + aspirin or clopidogrel
629
specialty test for testicular torsion
absent creamester m response- testicles don't elevate when stroking inner thigh
630
free ribosomes translate proteins that are found where
cytosol, nucleosol, peroxisome matrix, nuclear endcoded mitochondrial proteins
631
functions of the smooth ER
lipid synthesis, detoxifying substances, carbohydrate metabolism
632
IF findings of good pastures
linear deposits of IgG
633
thiamine is a cofactor for what enzymes and processes
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
fracture of the femoral neck increases risk of osteonecrosis due to disruption of what artery
medial circumflex femoral
635
waht are the NRTI drugs
tenofovir, emtricitabine, lamivudine, abacavir, zidovudine
636
MOA of NRTI
inhibits HIV DNA synthesis from RNA template by terminating DNA chain elongation
Competitive nucleoside/tide RT inhibitor
637
MOA and ending of NNRTIs
efavirenz, nevirapine
| allosteric RT inhibitor
638
MOA and ending of protease inhibitors
inhibits HIV polyprotein cleavage
| -navir
639
MOA of integrase inhibitors and ending
-gravir
| inhibits HIV DNA integration into host genome
640
MOA of fusion inhibitors
enfuvritide
| Inhibits HIV fusion with target cell membrane by binding to HIV gp41
641
Maraviroc MOA
inhibits HIV entry by blocking the HIV gp120 allosteric interaction with CCR5
642
side effects of protease inhibitors
lipodystrophy, hyperglycemia, inhibition of P450
643
MOA of sirolimus
inhibits mTOR--> interrupts IL-2 signal transduction
644
MOA of mycophenalate
reversibly inhibits iodine monophosphate dehydrogenase--> blocks purine synthesis
645
MOA of type 1 interferons (alpha and beta)
stop protein synthesis of cells infected by viral pathogens
646
MOA of type 2 interferons (gamma)
promotes tH1, induces MHC class 2, increases intracellular killing ability of macrophages
647
waht is cushing triad and what does it indicate
HTN, bradycardia, irregular respirations
| indicates probable brain herniation
648
common causes of acute bacterial prostatitis
E coli
klebsiella
proteus
pseudomonas
649
tx of narcolepsy
modafinil - stimulant
650
pulmonary actinomycosis cause and sx
aspiration
| leads to lower lobe consolidations and bronchograms
651
third degree AV block cause and ekg findings
block of AV node or bundle of his.
| complete dissociation of P waves and QRS
652
where is the respiratory tract does HPV infect and why?
true vocal cords, only place with stratified squamous epithelium
653
what does the metanephros become
glomeruli, bowmands space, proximal tubules, loop of henge, distal convoluted tubules.
654
waht does the uteric bud become
collecting duct, major and minor calyces, ureter, renal pelvis
655
what does telomerase do
adds TTAGGG to 3' end of chromosomes
656
waht innervates the external sphincter
pudendal N (s2-4)
657
complication of SAH that occurs 3-12 days post rupture
cerebral vasospasm- new focal neurological deficit or change in mental status
658
how do you prevent cerebral vasospasm
nimodipine- calcium channel blocker
659
transference
unconsciously shifting emotions you had of a person from the past onto another person in the present
660
red man syndrome
non allergic drug reaction that occurs when vancomycin is given too quickly
661
MOA of pseudocholinesterase deficiency
mutations in BCHE gene- can't hydrolyze succinylcholine
662
symptoms of pseudocholinesterase deficiency
prolonged paralysis after intubation with succinylcholine.
663
MOA of reactivation of HSV1
anterograde axonal transport mediated by kinesin
664
MOA of HSV1 infection
retrograde axonal transport mediated by dynesin
665
what does FOXP3 do
encodes transcriptional regulartor that turns CD4 cells into Treg--> inhibits immune activation
666
FOXP3 drives production of what cytokines
IL10
TGFb
CTLA4
667
IPEX
```
mutations in FOXP3
I: immune dysregulation
P: polyendocrinopathy
E: enterophathy
X: x linked transmission
```
668
symptoms of IPEX
DMT1 as an infant
eczamous dermatitits
autoimmune enteritits
669
waht is the function of type 1 (slow) fibers
maintain posture
670
what is the make up of type 1 fibers
high myoglobin, lots of mitochondria, low glycogen, aerobic metabolism
671
gestational choriocarcinoma
malignant tumor that arises from trophoblasts, usually follows normal pregnancy.
672
sx of gestational choriocarcinoma
vaginal bleeding, increased bHCG, uterine enlargement, hematogenous spread to the lungs
673
triad of wernike encaephaopathy
oculomotor dysfunction, ataxia, encephalopathy (memory issues)
674
waht is a needed cofactor for collagen synthesis
vit C
675
what does vit C do in collagen synthesis
hydroxylizes proline and lysine so they can cross link
676
how does hyperthyroid lead to increased HR, tremor, sweating, etc
upregulates B adrenergic receptor expression --> leads to increased catecholamine response
677
what is dystrophic calcificatin a hallmark for
cell injury and death- occurs in all types of necrosis
678
changes to the lungs in idiopathic pulmonary fibrosis
decreased type 1 pneumocytes, increased type 2 pneumocystis, increased fibroblasts, abnormal basement membrane
679
classic presentation of legionaires disease
fever, diarrhea, confusion, and cough in an older pt who smokes
680
how does CSF go from the lateral ventricles to the third ventricle?
interventricular foramen of monroe
681
how does CSF get from 3rd ventricle to teh 4th
cerebral aqueduct
682
what cells are increased in COPD
neutrophils, macrophages, CD8 T lymphocytes
683
symptoms of myotonic dystrophy
inability to releae hand from doorknob, cataracts, frontal balding, gonadal atrophy
684
who is at risk of warfarin induced skin necrosis
pts with a protein C deficiency
685
MOA of ezetimibe
decreases intestional absorption of cholesterol by inhibiting NPC1L1 transporter
686
MOA of ranibizumab and bevacizumab
inhibit VEGF
687
how does intraductal pappiloma usually present
unilateral bloody nipple discharge, usually no masses or axillary nodes
688
what does intraductal papilloma look like on microscopy
epithelial and myoepithelial cells lining fibrovascular cores
689
where can enhancers be located
upstream, downstream, in introns, literally anywhere
690
clinical features of adenomyosis
dysmenorrhead, painful periods, uniformily enlarged uterus, heavy but regular bleeding, uterine tenderness
691
pathophysiology of adenomysosis
abnormal collection of endometrial glands and stroma within the myometrium
692
MOA of fidaxomycin
inhibits the sigma subunit of RNA polymerase
693
how does helicase dysfunction present clinically
growth retardation, photosensitivity, immunodeficiency, facial anomalies
694
blunt trauma to the thoracic aorta is most likely to happen at what location
aortic isthmus- tethered by the ligamentum arteriosum so it is not flexible
695
waht is the function of SPINK1
inhibits trypsin
696
causes of holoprosencepahly
trisomy 13, maternal alcohol use, retinoid acid, sonic hedgehog gene mutations
697
what synthesises factor 8
endothelial cells
698
glucocorticoid induced myopathy
progressive proximal muscle weakness and atrophy without pain, CK is normal
699
polymyalgia rheumatica
muscle pain and stiffnes in shoulder, neck, pelvic girdle, worse in mornign wiht activity. CK is normal
700
inflammatory myopathies
proximal muscle wekaness, skin rash and inflammatry arthritis, increased CK
701
statin-induced myopathy
proximal muscle weakness, increased CK
702
hypothyroid myopathy
muscle pain, cramps, weakness involving proximal muscles, delayed tendon reflexes and myoedema, features of hypothyroid, icreased CK
703
in order for isonazid to be active, it needs what
mycobacterial catalsae peroxidase
704
what do spliceosomes do
remove introns containing GU at 5' splice site and AG at 3' splice sight
705
what do mutations at splice sites result in
inappropriate removal of exons and retention of introns
706
function of polyadenelate polymerase
polyadenelation of 3' end of mRNA- stabilizes mRNA and helps it exit the nucleus
707
characteristics of expansive populations
high birth rate, high mortality rate, short life expectancy, growing population
708
characteristics of stationary populations
decline birth rates, low mortality rates, long life expectancy, stable population
709
characteristics of constrictive population
low birth rates, low mortality rates, long life expectancy, declining population
710
clinical features of selective IgA deficiency
recurrent sinopulmonary infections, anaphylaxis during infusions, autoimmune diseases, GI infections
711
compensatory mechanisms for hypovolemic shock result in what
increased renal reabsorption of sodium, water, chloride, urea, and increased secretion of potassium
712
what metabolism processes occur in the mitochondria
fatty acid oxidation, acetyl-CoA production, TCA cycle, oxidative phosphorylation, ketogenesis
713
what metabolism processes occur in the cytoplasm
glycolysis, HMP shunt, synthesis of cholesterl, proteins, fatty acids and nucleotides.
714
renal changes expected in pregnancy
increased renal blood blow and GFR, decreased serum creatinine.
715
aldolase B deficiency results in waht
hereditary fructose intolerance
716
why is prone position best for pts on mechanical ventilation
improves V/Q mismatch
717
unique feature of DNA polymerase 1
5' to 3' exonuclease activity- remove RNA primer and repair damaged DNA strands
718
oculosympathetic pathway
increases in dim light- pupil dilation
719
MOA of selevemer
non-absorbable anion exchange resin that binds intestinal phosphate to reduce intestinal absorption
720
nephrotic syndrome can lead to what complication
renal vein thrombosis
721
Presentation of renal vein thrombosis
flank pain, hematuria, elevated lactate dehydrogenase, varoceles due to new hypercoaguable state
722
sick sinus syndrome
age related degeneration of the SA node in the right atrial wall.
leads to reduced cardiac output- syncope, lightheadedness, dyspnea, fatigue
723
sick sinus syndrome EKG
bradycardia with dropped P waves
724
primary carnitine deficiency
muscle weakness, cardiomyopathy, hypoketotic hypoglycemia, elevated muscle triglycerides
725
risk factors for primary psoas abscess development
HIV, IV drug use, diabetes
726
where are endotoxins found
outer membrane of gram negative bacteria which is composed of LPS
727
what are the 3 regions of LPS
O antigen, core polysaccarhide, A antigen
728
what does Lipid A do
toxic to mamilian cells, increases release of inflammatory cytokines, leads to progression of septic shock
729
hormonal changes in men as they age
decreased total testoserone and free T, increased LH, increased production of testosterone binding hormone
730
teratogenic effects of phenytoin
neural tube defect, microcephaly, orofacial clefts, dysmorphic facial features, nail hypoplasia
731
teratogenic effects of lithium
ebstein abnormality, nephrogenic DI, hypothyroidism
732
teratogenic effects of valproate
neutral tube defefcts
733
teratogenic effects of isotreninoin
microcephaly, thymic hypoplasia, small ears
734
teratogenic effects of methotrexate
limb and craniofacial abnormalities, neural tube defects, abortion
735
teratogenic effects of ACE inhibitors
renal dysgenesis, oligohydraminos
736
teratogenic effects of warfarin
nasal hypoplasia, stippled epiphysis
737
waht is responsible for the green color of pus in bacterial infections
bacterial myeloperoxidase
738
heterochromatin
compact body at the periphery of the nucleus, consists of heavly methylated DNA and deactylated histones which make it transcriptionally deactivated
739
2+ weeks post MI, what type of collagen is increased in the heart to heal it
type 1 collagen
740
how is pulse pressure related to aortic compliance
inversely related
741
what does doxorubicin do to the heart
dilated cardiomyopathy- leads to decompensated heart failure. Increased LVEDP and increased right atrial pressure
742
complications of PTU
liver toxicity
743
what meds should you give to a pregnant pt with graves
PTU for first trimester and then switch to methimazole.
744
waht does ATP do in cardiac and skeletal muscle contraction
release myosin head from actin binding site
745
what 2 immune system compents are responsible for candida infection
low T cel count- superficial infection.
| Disseminated candida: neutropenia
746
attributable risk in the exposed=
100([RR-1]/RR)
747
lab findings in tumor lysis syndrome
increased uric acid, potassium, phosphorus, lactate dehydrogenase
748
cause of a flutter
reentery circuit in cavotrocuspid isthmus (between IVC and tricupid valve)
749
what supplies blood to proximal ureter
renal artery
750
how does posterior hip location present
internally rotated, adducted, short, flexed
751
what nerve is vulnerable in a posterior hip dislocation
sciatic n
752
complications of hepatic hydrothorax
increased intraabdominal pressure forces fluid into the chest cavity and then diffuses through the diaphragm, mainly o the right side.
753
wounds left to heal by secondary intetnion have an increased risk of what
overproliferation due to increased VegF
754
amno glycosides (gentamycin) is assocaited with what toxicity
ototoxicity and nephrotoxicity
755
MOA of aminoglycosides
irreversibly bind 30S subunit- causes genetic code misreading, also impact translocation
756
how do beta blockers treat open angle glaucoma
decrease aqueus humor production by the ciliary epithelium
757
what does the musculocutaneous n arise from wand what does it innervate
C5-7, lateral cord of brachial plexus.
biceps brachial, brachioradialis.
sensory to lateral arm
758
what causes an S4 heart sound
left atrial contraction that forces blood into a poorly compliant left ventricle
759
where does parvoB-19 replicate
erythrocyte precursors in the bone marrow
760
pathogenesis of hyper IgE syndrone
AD, mutatuos in JAK-STAT pathway- Th17impaired
761
clinical features of hyper IgE
cold abcsess, retained primary teeth, eczema, recurrent sinopulmonary infections, dysmorphic faces
762
intracardaic fistulas will show what type of blood flow
continuous from aortic root to right ventricle in diastole and systole because pressure in the aortic root is always greater
763
latissimus dorsi innervation and action
thoracodorsal n
| extension, adduction internal rotation of the humerus
764
deltoid innervation and action
axillary n
| abduction of the arm
765
infraspinatous innervation and action
suprascapular n
| externally rotate arm
766
MOA of acyclovir
enters host cell and is phosphorylated into acyclovir monophosphate, via virally encoded thymidine kinase
767
most common cause of sporadic encephalitis
herpes simplex 1
768
blinding studies are meant to decrease what type of bias
observer bias
769
most common cause of coronary sinus dilation
elevated right sided heart pressure secondary to pulmonary hypertension
770
changes to the LV volume loop with an AV fistula
increased preload, decreased afterload, increased stroke volume
771
heart failure with preserved ejection fraction
diastolic dysfunction due to systemic HTN
772
statins
inhibit HMG-CoA reductase
decrease LDL and triglycerides
hepatotoxicity and muscle toxicity
773
ezetimibe
decreased intestinal cholesterol absorption
decreases LDL
increased hepatotoxicity if given wiht statin
774
Bile acid sequestrants
prevent reabsorption of bile acids in the intestine
decreased LDL
Nausea, bloating, cramping, impaired absorption of drug and fat soluble vitamin
775
Niacin
decreased fatty acid synthesis, VLDL, HDL clearance.
Decrease LDL, increases HDL
flushing, pruritus, hepatotoxicity, gout
776
fibrates
activate PPARa, decreases VLDL synthesis
decreased triglycerides and increased HDL.
muscle toxicity, gallstones
777
failed lateral fusion of paramesonephric ducts
bicorne uterus with indentatioan at the center of the fundus
778
what is the SVC derived from
cardinal veins
779
what does small cell lung cancer stain positive for
neuroendocrine differentiation, CD56, chromogranin, synaptophysin
780
what does presence of vimentin suggest
sarcoma
781
symptoms of congenital diaphragmatic hernia
severe respiratory disease, pulmonary HTN, absent breath sounds unilaterally.
782
what's in the hepatoduodenal ligament
hepatic artery, portal vein ,, common bile duct
783
MOA of prostacyclin
inhibit platelet aggregation and adhesion to vascular endothelium to cause vasodilation
784
sx of hypertrophic osteoarthropathy
digital clubbing, painful arthropathy, periostosis, joint effusions, usually in the setting of adenocarcinoma
785
developmental field defect
an initial embrylogic defects leads to more malformations of surrounding tis
786
morphologic findings of pulmonary HTN
medial hyperthrophy, intimal fibrosis, luminal narrowing
787
Bosentan MOA
endothelian receptor antagonist
788
ilioinguinal n
runs with the spermatic cord
| gives rise to sensory branches: anterior scrotum, base of penis, medial thigh
789
waht does RNA polymerase 1 transcribe
ribosomal RNA
790
what does RNA polymerase 2 transcribe
messenger RNA
791
what does RNA polymerase 3 transcribe
Transfer RNA
792
MOA of amatoxins (mushrooms)
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
what increases in a pts lung who has a pulmonary embolism
physiologic dead space
794
if minute volume is unchanged, how does low tidal volume affect the lung
increased physiologic dead space
795
what is minute volume
tidal volume x respiratory rate
796
mood stabilizers in bipolar disporder and indications
lithium: manic and depressive
valproate: manic
carbamazepine: manic
lamotrigine: depressive
797
nontreptonemal serologic tests
RPR, VDRL
mix pts serum with cardiolipin-cholesterol-lechtin antigen. Climping or flocculation means there are anticardiolipin antibodies--> secondary syphylus
798
why do pts with crohns get calcium oxalate kidney stones
they have malaborption, so the calcium that usually binds to oxalate is making soap bubble with the unabsorpbed fat instead.
799
causes of hypoxemia in the setting of a nomral A-a gradient
alveolar hypoventilation, igh altitude
800
histo of spyphillis
proliferative endaritis of small vessels with surrounding plasma-cell rich infiltrate
801
cyanosis with a postductal < preductal oxygen saturation is suggestive of what
right to left shunt over a PDA
802
staph aureus cytotoxin that causes tissue necrosis
panton-valentine leukociden
803
side effects of theophylline overdose
seizures and tachyarythmias
804
tx of CMV in pts with aids
ganciclovir
805
how doesCMV present in pts with AIDS
blured vision, blind spots, flashing lights, yellow-white fluffy retinal lesions with areas of hemorrhage
806
what is the transmembrane domain of G coupled receptors ade up of
nonpolar, hydropphobic amino acids (alanine, valine, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, glycine)
807
what tissue can use ketones for energy
brain, skeletal muscle, cardiac muscle, kidneys
808
euthyroid sick syndrome
low T3, nomral T4 and TSH. pt is sick nd sytokines and infammatory mediators reduce conversion of T4 to T3
809
how do you treat acute intermittant porphyria
infusion oh hemin, which down regulates ala synthase
810
what does endothelial nitric oxide synthease do
synethesis NO from arginine, O2, NADPH
811
pts with what type of prostate hyperplasia will respond best to finasteride
epithelial hyperplasia
812
what is the difference between irritant contact diaper dermatitis and candida dermatitis
irritant spares the sin folds
813
cardiac conduction tissue velocity, fast to slow
perkinjie , atrial muscle, ventricular muscle, AV node
814
MOA of conegenital umbilical hernias
incomplete closure of the umbilical ring, assocaited with owns
815
1st pharyngeal pouch
epithelium of middle ear and auditory tube
816
2nd pharyngeal pouch
epithelium of palatine tonsil crypts
817
3rd pharyngeal pouch
thymus, inferior parathyroid glands
818
4th pharyngeal pouch
superior parathyroid glands, ultimobranchial body
819
acute lung transplant rejection
perivascular (small lung vessels) and submucosal infiltrate
820
chronic lung transplant rejection
submucosal inflammation --> granulation, scarring, bronchioles obliterates, inflammation in walls of small air ways
821
treatment of painful diabetic polyneuropathy
SNRI, gabapentoid, TCA
822
what does compeitive inhibition do to Km
increases it, keeps vmax the same
823
chloride shift
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
causes of polyhydraminos
issues with swallowing: GI obstruction, anencaephaly. Increased urine output: high cardiac output.
Maternal diabetes and multile gestations
825
why do pts with cleft palate often have otitis media
eustachian tube defects: issue with levator veli palentini and tensor veli palentini
826
concentration dependent killing pattern of antibiotics
higher peak compared to minimun inhibitory concentration
827
conductive hearing loss
BC>AC
| lateralizes to the affected ear
828
what drug properties lead to a low volume of distribution
large molecule, bound to protein, hydrophilic (highly charged)
829
what drug properties lead to a high volume of distribution
small and uncharged (hydrophobic or lipophilic)
830
which receptors will increase insulin secretion
beta 2 , GLP1, M3, glucagon
831
whic receptors will decreae insulin secretion
alpha 2, somatostatin 2
832
pros and cons of propofol for anesthesia
reduces ariway resistance, but causes vasodilation which results in hypotension and increases serum triglyceriidise and lipase
833
pros and cons of etomidate for anesthesia
hemodynamically neutral, but inhibits cortisol which leads to adrenocortical suppresion
834
pros and cons of ketamine for anesthesia
preserves respiratory drive and is also for analgesic, stimulates release of catecholamines, but can cause bronchodilationand increased HR
835
inferior alveolar n is a branch of what n and can lead to what deficit
V3, loss of sensation in the lower lip, innervates lower teeth
836
what does the dorsal pancreatic bud form
tail, body, superior aspect of head, accessory pancreatic duct
837
what does the ventral pancreatic bud form
uccinate process, portion of pancreatic head, proximal portion of main pancreatic duct
838
glioblastoma is assocaited with overexpression of what
epidermal growth factor
839
manisfestations of aspiration pneumonia
lung abscess, fever, cough, foul smelling sputum.
840
main cuse of lung abscesses
strict and facultative anarobic oral flora
841
chronic interstitial nephritis
patchy interstital inflammation w subsequent tubular atrophy and fibrosis, papillary necrosis, and scarring. kidneys appear shrunken
842
carotid sinus massage
increases afferent firing which increases parasympathetic input to the AV node, which cslows the refractory period and conductance
843
spontaneous gas gangrene
clostridium septicum, normally in the colonic flora, colonic cancer can result in dissemenated spread
844
carotid sinus hypersensitivity
elderly men, overly sensitive baroreceptors that lead to exaggerated vagovagal response, sinus pause and peripheral vasodilation which leads to syncope
845
moa of acyclovir
competitive inhibition of viral DNA polymerase, stops viral DNA synthesis
846
physical exam findings in aortic regurg
widended pulse pressure, rapid distention and collapse of carotid arteries, "to and fro" bruit over femoral arteries.
847
PD-1
on cytotoxic T cells and inhibits their ability to induce apoptosis
848
CTLA-4
decreases T cell activation
849
RNA interference
short double stranded RNA sequences introduce post-transcriptional gene silencing
850
polysaccharide capsule
impedes phagocytosis and complement binding
851
orbitofrontal cortex
modulates limbic system- involved in behavior and emotional regulation
852
damage to lateral prefrontal cortex
problems with executive functioning, organizing, planning
853
neutrophil elastase
protease responsible for extracellular elastin degradation
854
major inhibitor of elastase
alpha 1 antitrypsin
855
sx of digoxin toxocity
life threatening arythymias, anorexia, N/V, abdominal pain , fatigue, confusion, weakness, color vision changes.
856
pts with what phenotype are more prone to drug induced lupus
slow acetylators
857
arterial puncture above the inguinal ligament increases risk forwhat type of hemorrhage.
retroperitoneal
858
levels of what hormone increase in menopause and why
FSH because the follicles arent responding and there is no negative feedback
859
pierre robinson sequence
micrognathia, posterior displacement of the tongue, U shaped cleft palate
860
when do nightmares occur
REM sleep- will have voluntary muscle atone
861
snRNP
component of splicosome - remove introns from pre-mRNA to form mature mRNA
862
dihydropyradines
nifedipine, amlodipine, felodipine.
calcium channel blockers.
affect arterial smooth muscle, little affect on cardiac contractility.
863
nondihydropyradines
verapamil, diltiazem.
| affect myocardium, slow heart rate and contractility,
864
permissiveness
hormone that has no direct affect allows another hormone to have maximal direct affect
865
anesthetics with high tissue solubiltity
have large arteriovenous concentration gradients and slower onset of action
866
neoplastic cord compression
back pain, LE weakness.
| local extension of vertebral metastases into epidural space
867
why do you have to wait 2 weeks after stopping a MAO inhibitor to take an SSRI
you have to have time to regenerate MAO or else you can get serotonin syndrome
868
tmporomandibular joint disorder
jaw issues and hypersensitivity of the mandibular nerve.
| pain with chewing and ear pain wiht tinnitus.
869
MOA of cromolyn
inhibit mast cell degranulation.
| prevent acute asthma attacks
870
complications of radiation
fibrosis and strictures
871
which receptors use Gs
glucagon, TSH, PTH
872
rentinitis pigmentosum
progressive dystrophy of retina. loss of rods and cones. optic disc pallor, retinal vessel attenuation, pigment accumulation.
873
IL8
neutrophil chemotaxis to sites of infection, also causes phagocytosis of neutrophils
874
what does low fecal elastase mean
pancreatic insufficiency and can diagnosse chronic pancreatitis
875
mefloquine MOA
destroys replicating parasites within red blood cells. Has NO activity against schizonts
876
hypospadias
incmplete fusion of urethral folds on ventral aspect
877
epispadias
dorsal side, due to abnormal location of genital tubercle
878
what is the best indicatior of severity in pts wiht mitral regurg
audible S3
879
S3
sudden cessation of blood flow to the left ventricle during the passive filling of diastole
880
what drug class can improve the eye issues in raves
glucocorticoids- anti inflammatory
881
what is the best indicatior of severity in pts wiht mitral regurg
audible S3
882
S3
sudden cessation of blood flow to the left ventricle during the passive filling of diastole
883
what drug class can improve the eye issues in raves
glucocorticoids- anti inflammatory
884
familial chylomicronemia syndrome (type 1)
defect in lipoprotein lipase and APOC2.
elevated chylomicrons.
acute pancreatitis, lipemia retinalis, eruptive xanthomas
885
familial hypercholesterolemia (type 2)
defect in LDL receptor and APOB100.
elevated LDL.
premature atherosclerosis, tendon xanthomas, xanthelasmas.
886
familial dysbetalipoproteinemia (type 3)
Defect in APOE.
elevated chylomicron and VLDL remnants.
Premature atherosclerosis, tuboeruptive and palmer xanthomas.
887
familial hypertriglyceridemia (type 4)
elevated VLDL.
| assocaited with coronary disease, pancreatitis, diabetes.
888
myocardial hybernation
state of chronic myocardial ischemia, metabolism and function are reduced to match reduced blood flow to prevent necrosis.
889
risk factors for cataracts
older than 60, diabetes, chronic sunlight exposure, tobacco, glucocorticoids
890
causes of mutations in muscular dystrophy
deletions resulting in frameshift mutations or nonsense mutations
891
cause of acute dystonia in pts taking first gen antiphyscotics
D2 antagonism in the nigrostriatal pathway
892
pts with chronic granulomatous disease are at an increased risk of infection with what type of organisms
catalase positive
893
neurotransmitters involved in ADHD
norepinephrine and dopamine
894
graft versus host disease
donor CD3+ T cells recognize host cells as foreign
895
how do alcohol based disinfectants work against enveloped viruses
dissolve their lipid bilayer membranes
896
what 2 parts of the sympathetic NS are innervated by cholinergic instead of adrenergic neurons
eccrine sweat glands and adrenal medulla
897
growth promoting effects of gigantism is most liekly do to what hormone
IGF-1 released from the liver when GH binds to receptors
898
type B aortic dissections usually occur where
clsoe to origin of left subclavian artery
899
signs of inadequate liver function
hypoalbuminemia, prolonged pT, elevated bilirubin
900
clear cell carcinoma RCC
originates in proximal renal tubules.
| Usually a sphere, yellow mass with areas of necrosis and hemorrhage.
901
what does the right coronary artery supply blood to
AV, SA nodes, bundle of his, proximal right bundle branch
902
where does the LAD supply blood
left and right bundle branch
903
damage to ulnar n
issues with wrist flexion and adduction, loss of sensation over 5th finger and hypothenar eminence, clawing of 4/5th digits
904
Rasburicase MOA
recombinate urate oxidase, converts uric acid into allantoin
905
cardiac output=
HR x SV or
| rate of O2 consumption/arteriovenous O2 content difference
906
RAS is active when bound to what protein
GTP
907
RAS is inactive when bound to what protein
GDP
908
what would RFLP analysis show for a trisomy gained in meiosis 1
2 different chromosomes inherited from one parent- 2 homologous chromosomes
909
abiraterone MOA
irreversibly inhibits 17 a hydroxyls.
| slows growth of prostate cancer
910
how does levels of procalcitonin change in infections
bacterial: rise
viral: decrease
911
positive acute phase reactants (levels rise)
fibrinogen, c reactive protein, ferritin, hepcidin, ceruloplasmin, haptoglobin, vWF, complement, ESR
912
negative acute phase reactants (levels decrease)
albumin, transferrin, transthyretin (prealbumin)
913
colchicine
inhibits microtubule polymerization, which disrupts chemotaxis, granulation, and phagocytosis
914
dorsal column
vibration, proprioception, fine touch
915
gracile fasiculus
medial part of dorsal column, carries information from below T6 (lower half of body)
916
cuneate fasiculus
lateral part of dorsal column, carries information from above T6 (upper extremities)
917
transpeptidases
penicillin binding protein
918
unilateral cleft lip
one of the maxillary prominences fails to fuse with the inter maxillary segment
919
side effects of donepizil and rivastigmine
enhanced parasympathetic tone, bradycardia, AV block, decreased cardiac output
920
metabolic alkalosis with low urine chloride
saline responsive: vomiting, diuretic overuse
921
metabolic alkalosis with high urine chloride
saline unresponsive.
Hypovolemic: bartter and gitlemen
Hypervolemic: excess mineralcorticoid activity
922
thiamine is a cofactor for what
pyruvate dehydrogenase, a-ketoglutarate dehydrogenase, transketolase
923
femoral neuropathy
quads weakness, loss of patellar reflex, sensory loss over anterior and medial thigh
924
side effects of tricyclics
tremor, insomnia, block cardiac fast sodium channels - hypotension, antimusarinic- confusion, urinary retention, constipation. orthostatic hypotension, sedation
925
can autologous stem cell transplant be used on pts with congenital disorders
no, because they will still have the mutation
926
recall bias is most likely to hapen in what type of study
retrospective ones like case controls
927
first aortic arch
part of maxillary artery
928
second aortic arch
hyoid artery, stapedial artery
929
third aortic arch
common carotid A, proximal internal carotid artery
930
fourth aortic arch
on left- aortic arch
| on right- proximal right subclavian artery
931
sixth aortic arch
proximal pulmonary arteries, on left- ductus arterioles
932
detection of which Ig against a specific organism is diagnositic of a TORCH infection and why
IgM because maternal IgM can't cross the placenta
933
gp120
allows HIV to attach to host cells. Binds CD4 and chemokine receptor CCR5, binding exposes gp41
934
gp41
mediates viral fusion
935
congenital long QT syndrome
mutations in KCNH2 gene. impaired function of voltage gates potassium channels
936
medications that cuaase prolonged QT
macrolides, fluoroquinolones, antiemetics, acoles, antipsychotics, TCAs, methadone, class 1A antiarrhythmics, class 3 antiarrhythmics
937
rabies vaccine
inactivated vaccine
938
familial dialted cardiomyopathy
mutations in TTN gene
939
EBV envelope glycoprotein gp350 binds to what
CD21 on B cells, which is the receptor for the Cd3 complement component
940
branches of the common fibular nerve
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
histo of hasimotos
lymphoplasmocytic infiltrate with formation of germinal centers
942
what nerve courses over the right atrium
right phrenic nerve
943
virchows triad for thrombosis post pregnancy
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
sx of ovarian vein thrombosis
fever after delivery, abdominal/flank pain, doesnt respond to antibiotics
945
where does left ovarian vein drain to
left renal vein
946
where does right ovarian vein drain
iVC
947
RB1 gene
regulates G1/S checkpoint
948
contrast induced nephropathy
diffuse necrosis of proximal tubular cells, muddy brown casts, renal vasoconstriction causing medullary ischemia
949
apixaban MOA
blocks Xa, which prevents conversion of prothrombin to thrombin
950
tachyphylaxis of adrenergic agonists
receptor inactivation and internalization by arresting
951
contrast induced nephropathy
diffuse necrosis of proximal tubular cells, muddy brown casts
952
High grade CIN
atypical cells have invaded beyond the lower 1/3 of the cervical epithelium ( to the epithelial surface)
953
IgA nephropathy
glomerularnephritis. usualy in older children, post viral infection, have painless hematuria. mesangial hypercellularity with IgA deposits
954
which hep virus has a high mortality rate in women
hep E, an unenveloped single stranded RNA
955
sx of congenital hydrocephaly
macrocephaly, buldging frontenelle, poor feeding, developmental delay, spacisity and hyperreflexia
956
complication of cysts removal cause by E. granulosus
rupture of the cyst can lead to spilling of contents causing anaphylatic shock
957
why can hashimotos cause increased prolactin
there is an increase in TRH, and lactotrophs have TRH receptors so there is an increase in release of-prolactin
958
side effects of cutaneous corticosteroid use
cutaneous atrophy, teleanctiasias, acne
959
paraneoplastic cerebellar degeneration
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
eisenmenger syndrome
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
sympatetic opthalmia
trauma to one eye causes granulomatous inflammation of both eyes, due to T cell response from previously sequestered antigens
962
histo findings in sporotrix
mixed gramulomatous and neutrophilic inflmmaory reaction
963
I cell disease
defect in post translational modification i nthe golgi body- can't be tagged with mannose 6 phosphate- inappropriately get exported into extracellular space
964
hemibalism
damage to subthalmic nucleus- results in flailing of arm
965
LMN signs
flaccid paralysis, hypotonia, hyporeflexia, muscle atrophy and fasciculation'
966
primary adrenal insufficiency
decreased aldosterone: hypovolemia, orthostasis.
| decreased cortisol: hypoglycemia, normocytic anemia, eosinophilia, increased ADH
967
UMN signs
spastic paralysis, clasp knife rigidity, hyperreflexia, babinksi sign
968
LMN igns
flaccid paralysis, hypotonia, hyporeflexia, muscle atrophy and fasciculation'
969
how can you prevent acyclovir nephrotoxicity
adequate hydration
970
GBM histo findings
pseudopalisating necrosis with capillaries at the periphery- vascular proliferation
971
asbestosis
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
what jobs have exposure to siica
mining, sand blasting
973
sx of silicosis
dyspnea on exertion, nodular densitites on XRAY, calcified hilar lymph nodes, birefiringment particles on biopsy
974
asbestosis
dyspnea on exertion, lower lung zones, pleural plaques, ferruginous bodies featuring fusiform rods with translucent asbestos center and golden brown iron coating
975
coal workers
dyspnea and ill defined exert nodular opacities on xray. histo = accumulations of black, carbon-laden macrophages
976
what conditions promote sickling in sickle cell
low oxygen, acididc pH, low blood volume
977
side effects of nitrates
headache, cutaneous flushing, lightheadedness, cutaneous flushing, reflex tachycardia
978
adverse effects of inhibition of COX 1
gastric ulcers, bleeding
979
causes of congenital hypothyroidism
genetic defect in thyroid producing hormone, maternal antithyroid medication (PTU), excessive or deficicent maternal iodine
980
causes of congenital hyperthyroidism
transplacental TSH receptor stimulating antibodies
981
retroperitoneal organs
```
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
small intestine bacterial overgrowth
increased vit K and folate, associated with nausea, bloating, abdominal discomfort, malabsorption
983
MOA of CF
mutation that impairs post transcriptional processing (improper folding and glycosylation) --> causes it to get degraded so it can't reach the cell surface
984
MOA of milrinone
PDE3 enzyme inhibitor
985
clasp knife spascity
initial resistence to passive flexion followed b immediate release of residence
986
pyramidal motor system
precentral gyrus --> internal capsule--> spinal cord and brain stem
987
internal capsule stroke
usualyl have pure motor weakness affecting contralateral arm, leg, and face
988
complication of hypocitraturia
calcium oxalate stones because tcitrate normally binds to ionizsed calcium and prevents formation of stones
989
diastolic BP is directly related to what
systemic vascular resistance and arterial blood volume
990
cricithyrotomy requires passage through which structures
skin, superficial cervical fascia (platysma and sub q fat), investing and pretracheal layers of deep cervical fasciae, cricothyroid membrane
991
CYP450 inducers
barbituates, rifampin, carbamazepine, griseofulvin, chronic alcohol consumption
992
MOA of epi in anaphylaxis
binds to adrenergic receptors on mast ells to prevent degranulation, counteracts inflammatory effects via alpha beta stimulation
993
where should you take biopsies of pts wiht celiacs and why
duodenum and proximal jenunum because they are msot exposed to gliaden
994
fibroadenoma
firm, nontender, well circumscribed, mobile. Estrogen sensitive. myxoid stroma that encircle epithelium lined glands
995
myasthenic crisis
low pH, high CO2, low O2, drooping eyelids, respiratory muscle wekaness leading to respiratory failure
996
intraventricular hemorrhage from premautre infants usually originates where
germinal matrix
997
intraventricular hemorrhage sx
altered level of consciousness, hypotonia, decreased spontaneous movements, buldging anterior frontonelle, seizures
998
complications of thyrotoxicosis
HTN, tachycardia, a fib, increased contractility, increased cardiac output
999
mycophenolate MOA
inhibits conversion of IMP to GMP, mainly in lymphocytes, causing reduced proliferation of activated lymphocytes
1000
adverse effects of nondihydropyridine calcium channel blockers (diltiazem, verapamil)
constipation, AV heart block, brady cadria, worsening of heart failure in pts with left ventricular systolic dysfunction
1001
role of ubiquination
antigen processing, muscle wasting, cell cycle regulation, DNA repair, disposal of misfolded proteins
1002
IL6
stimulate liver to produce thrombopoietin, which triggers megakaryocyte proliferation and maturation in the bone marrow
1003
tx of complicated empyema
drainage wiht use of tPa and DNase to remove pus
1004
what is responsible for granuloma formation
Th1 activation- increases macrophages, IL2, interferon gamma
1005
biopsy findings in giant cell arteritis
intimal thickening, elastic lamina fragmentation, multicucleated giant cells
1006
MOA fo fenoldopam
D1 receptor agonist: increases cAMP--> vasodilation, especially renal vasodilation
1007
causes of hypokalemia due to intracelular shift
insulin (DKA tx or refeeding syndrome)
Beta adrenergic activity: drugs (dobutamine, albuterol) or stress related (MI or aclhohol withdrawl)
alkalosis
increased cell produciton
1008
tx of ischemia induced arrythymias
class 1B: lidocaine, phenytoin, mexiletine
1009
CD14
most sepcific marker for monocyte-macrophage cell lineage
1010
holosystolic murmurs
tricuspid regard, mitral regurg, VSD
1011
tricuspid regurg
holosystolic murmur, heard at left 2/3 ICS. worse with inspiration
1012
recurrent branch of median n
abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
1013
CAAt and TATA
initiate transcription - act as binding sites for general transcription factors and RNA polymerase 2
1014
sx of arsenic poisioning
garlic breath, vomiting, watery diarreha, QT prolongation, pigmentation changes, neuropathy
1015
tx of aresnic poisioning
dimercaprol, DMSA
1016
what is niacin a precursor for
NAD and NADP
1017
Colchine MOA
binds to tubular and inhibits polymerization into microtubules, - disrupts cytoskeletonfunctions like chemotaxis and phagocytosis
1018
Reid index
measures bronchial gland hyperplasia .
| =mucous glands/ ( submucosa and lamina propria)
1019
what is niacin a precursor for
NAD and NADH
1020
first generation antihistamines MOA
antihistamine, anti alpha adrenergic, antimuscarinic, anti serogenic
1021
primary lymph node drainage of female reproductive system
```
uterus: external iliac
Cervix: internal iliac
vagina: proximal- internal iliac, distal- inguiofemoral.
vulva: inguinofemoral
ovaries: paraaortic
```
1022
afferent vs efferent limb of carotid sinus
```
afferent= branch of glossopharyngeal n
efferent= vagus n
```
1023
type 4 hypersensitivity reaction phases
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
posterior interosseous n
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
power of a study
related to type 2 error- probability that there is no difference between groups when there actually is one
P= 1- B
1026
role of telomerase
help maintain telomers in rapidly dividing cells so they don't cause premature apoptosis
1027
tx of TIA
blood pressure control along wiht low dose aspirin
1028
calcitriol
active form of vit D, should give to pts post thyroid surgery to increase calcium
1029
how does pleural fluid enter and exit the pleural space
enter: intercostal microvessels.
exit: parietal pleural lymphatics
1030
acute spinal cord injury
flaccid paralysis with decreased or absent reflexes
1031
how can rheumatoid arthritis affect the spine
causes cervical subluxation
1032
kidney response to renal hypoperfusion
increase in renin secretion by JG cells which leads to hyperplasia of the JG cells (which are smooth muscle in the afferent article)
1033
histo findings of autoimmune hepatitis
lymphocyte and plasma cell infiltration of portal and periporatal regions of the liver
1034
autoimmune hepatitis sx
jaundice, hepatomegaly, elevated liver enzymes, anti-smooth muscle antibody
1035
Positive end expiratory pressure ventilation
opens collapsed alveoli to reduce intrapulmonary shunting and increase FRC
1036
which monosaccharide is metabolized by the liver the fastest and why
fructose, because it bypasses phosphofructoskinase
1037
eculizimab
monoclonal antibody, inhibits C5
1038
superficial inguinal ring is the opening of what
external oblique muscle aponeruosis
1039
malignant pericardial effusion
usually from spread of cancer. subacute- nonspecific symptoms, dyspnea, , chest discomfort. fluid shows hemorrhagic and atypical malignant cells
1040
autoimmune adrenalitis
atrophy of adrenal glands bilaterally. skin hyperpigmentation, adrenal insufficiency, acute adrenal crisis
1041
pathophysiology of acetaminophen overdose
reduced glutathione--> accumulation of NAPQI --> damage to mitochondria --> oxidative hepatocellular injury
1042
VHL syndrome
hemangioblastoma, clear cell reanl ancer, pheochromocytoma
1043
what does the external laryngeal n innervate
cricothyroid m
1044
what does the L recurrent laryngeal n innervate
posterior cricoarytenoid, lateral cricoarytenoid, oblique arytenoid, transverse arytenoid, thryroarytenoid
1045
Li fraummeni syndrome
TP53, sarcomas, brest cancer, brain tumors, adrenocortical carcinoma, leukemia
1046
positive skewed distribution
mean is greater than median
1047
what organism can cause hepatic abcsess by hemotogenous spread
staph aureus
1048
what organisms cause hepatic abcsess via biliary infections
E coli, klebsiella, enterococci
1049
what vitamin deficiency is associated with a worse course of measels
vit a
1050
vitamin deficiencies in vegan diet
B12, , vit D, calcium, potentially: iodine, iron, zinc
1051
MOA of GLP1 agonosts and DDP4 inhibitors
increased glucose dependent insulin release, decrease appetite, decrease gastric emptying, decrease glucagon secretion
1052
risk factors of uric acid kidney stones
increased uric acid excretion: gout, myeloproliferative disorders.
increased urine concentration: dehydration.
low urine pH: diarrhea, diabetes
1053
damage to vestibular nuclei CN 8
loss of vestibulooculomotor reflex - nystagmus
1054
why do you get incontinence in NPH
strecthing of the descendng corticol tract: lack of corticol inhibition; detrusor muscle hyperactivity
1055
acute pericarditis
chest pain that is sharp and decreases when leaning forward. friction rub
1056
beta glucuronidase
released by injured hepatocytes and bacteria- hydrolyzes bilirubin glucuronides and increases unconjugated bilirubin
1057
complication of kawasaki disease
coronary artery aneurysm
1058
measures in COPD
residual volume, total lung capacity are increased.
| FEV1/FVC decreased
1059
complications of obstructive sleep apnea
pulmonary HTN, with right heart failure, systemic HTN, cardiac arrythmias
1060
5a-reductase
converts testosterone to DHT
1061
male pseudohermaphredidsm
deficiency in 5a reductase type 2: internal genitalia normal bc of testoserone, but external abnormal bc no DHT
1062
angiogenesis
stimulated by VEGF and fibroblast growth factor
1063
peri-infarction pericarditis
occurs days 2-4 after transmural ST MI
1064
fast and slow acetylation should be considered when giving what drugs
isonazid, hydralazine, procainamide, dapsone,
1065
paget disease of the bone
enlarged vertebral bodies with corticol thickening of the bone, elevaed alk phos,
1066
acute left ventricular failure
can result in pulomary venous HTN and acute pulmonary edema (transudate fluid)
1067
deficiency of thyroxine binding globulin
low total T4, normal free T4 and TSH
1068
paroxymal supraventricular tacycardia
narrow QRS complx tachycardia wiht regular rhythm and non visible p waves
1069
TB meningitis
thick, gelatinou sexudate on base of brian, vasculitis of cerebral arteries, multiple brain infarcts, hydrocephalus
