Missed Questions_NTK Flashcards
The binding of what receptor to its ligand downregulates the immune response against tumor cells by inhibiting cytotoxic T cells.
programmed death receptor 1 (PD-1) to its ligand (PD-L1)
Many types of cancers evade the immune system by increasing expression of PD-L1. Monoclonal antibodies blocking PD-1 help prevent T cell inhibition and promote apoptosis of tumor cells.
What molecular mediator is responsible for the intracellular effects of the G protein-mediated adenylate cyclase second messenger system. Hormone receptors that use this system include the TSH, glucagon, and PTH receptors.
Protein kinase A
Protein kinase A is responsible for the intracellular effects of the G protein-mediated adenylate cyclase second messenger system. Hormone receptors that use this system include what receptors?
TSH, glucagon, and PTH receptors.
What is Schizoid vs. Schizotypal?
Schizoid: prefers to be a loner, detached, unemotional.
Schizotypal: eccentric; odd thoughts, perceptions, and behaviors
Regardless of the patient’s hydration status, the majority of water reabsorption in the nephron occurs in the ____________ passively with the reabsorption of solutes.
PCT
The Aedes aegypti mosquitoes can transmit the viruses that causes what two infectious disease?
dengue fever and chikungunya.
Buzz words:
Soil and Pigeon Droppings == ?
Crytococcuccus neoformans
What are the only cells within the atherosclerotic plaque capable of synthesizing structurally important collagen isoforms and other matrix components.
Vascular smooth muscle cells (VSMCs)
What nerve provides cutaneous sensation to the posterior external auditory canal via its small auricular branch.
The vagus nerve
Sensation to the rest of the canal is from the mandibular division of the trigeminal nerve.
Sensation to the rest of the canal is from what nerve.
mandibular division of the trigeminal nerve
What is the hepatitis B virus (HBV) replication sequence?
The hepatitis B virus (HBV) replicates via the following sequence:
double-stranded DNA → +RNA template → double-stranded DNA progeny.
Although it is a DNA virus, HBV replicates via reverse transcription.
What Virus has the following sequence:
Single-stranded DNA → double stranded DNA template → one-stranded DNA progeny.
Parvo B19!
The only ssDNA virus!!!
What virus has the following replicative sequence:
double-stranded DNA → double-stranded DNA templete → double stranded DNA progeny
Adenovirus, herpesvirus, and poxvirus.
What is the DOC used in HIV+ patients as prophylaxis against Pneumocystis jiroveci pneumonia and Toxoplasma gondii infections.
Trimethoprim-sulfamethoxazole
What process can Ethanol inhibits and can cause hypoglycemia once hepatic glycogen stores are depleted.
Gluconeogenesis
Raltegravir is an integrase inhibitor that disrupts HIV genome integration, which means what?
Prevention of the synthesis of viral mRNA.
Integration of double-stranded HIV DNA into the host cell’s chromosomes is necessary to induce viral gene expression and prevent degradation of the viral genome.
Crohn’s disease presents as what type of diarrhea?
secretory
____________ infection can cause a serum sickness-like syndrome with joint pain, lymphadenopathy, and a pruritic urticarial rash. Other features may include right upper quadrant pain, hepatomegaly, and elevated hepatic transaminase levels.
Acute hepatitis B
Which SERM has an ADR of endrometrial hyperplasia and carcinoma?
Tamoxifen
What is the classic presentation of RIGHT-sided colon cancers?
Vs. Left-sided colon cancers?
Right-sided colon cancers usually grow as exophytic masses and present with occult bleeding and symptoms of iron deficiency anemia.
Left-sided colon cancers tend to infiltrate the intestinal wall and encircle the lumen, causing a change in bowel habits (eg, constipation) and symptoms of intestinal obstruction (eg, abdominal pain, distension, nausea/vomiting).
What are the symptoms of intestinal obstruction?
abdominal pain, distension, nausea/vomiting
What functions to remove RNA primers in bacterial replications?
DNA polymerase I functions to remove RNA primers (via 5’ to 3’ exonuclease activity) and replace them with DNA (via 5’ to 3’ polymerase activity).
DNA polymerase I is the only bacterial DNA polymerase that possesses 5’ to 3’ exonuclease activity.
Epistaxis is commonly caused by irritation of the highly vascular mucosa of what/where?
the anterior nasal septum. The anterior nasal septum contains the Kiesselbach plexus.
The anterior ethmoidal, sphenopalatine, and superior labial arteries anastomose @ ???
Kiesselbach Plexus; in the anterior nasal septum
The interstitial and alveolar edema and exudate formation in acute respiratory distress syndrome results from increased pulmonary capillary permeability.
This leads to what?
This leads to decreased lung compliance, increased work of breathing, and worsened ventilation to perfusion mismatching.
The pulmonary capillary wedge pressure is typically normal.
Atropine is indicated for the treatment of bradycardia as it decreases vagal influence on the SA and AV nodes. A common side effect of Atropine ==?
increased intraocular pressure. It may precipitate acute closed-angle glaucoma in susceptible individuals.
Schistocytes sugguests what?
Schistocytes suggest microangiopathic hemolytic anemia (eg, hemolytic-uremic syndrome [HUS], thrombotic thrombocytopenic purpura [TTP], disseminated intravascular coagulation [DIC]) or mechanical damage [eg, prosthetic valve]).
What is the major difference between DIC and HUS microangiopathic hemolytic anemia?
DIC has the coagulation system activated.
HUS does not i.e. will have normal PT/aPTT times.
Immunosuppressed/immunocompromised pt. with linear ulceration on upper endoscopy; what is the causative bug?
CMV
How does the amino acid Alanine relate to Fructose-2,6-bisphosphate?
2,6-bisphosphate levels). Insulin causes activation of PFK-2, leading to increased fructose 2,6-bisphosphate levels and augmented glycolysis. High concentrations of fructose 2,6-bisphosphate also inhibit gluconeogenesis, leading to decreased conversion of alanine and other gluconeogenic substrates to glucose.
What other microbe, other than Toxo, can cause brain abcesses?
Nocardia spp.
Pulmonary nocardiosis can present as cavitary pneumonia (often misdiagnosed as tuberculosis); branching gram-positive organisms are seen on sputum examination.
Lab Findings of absent T cells and hypogammabloulinemia is suggestive of what immunodef. disease?
Severe combined immune deficiency; combined T and B cell dysfunction.
**Thymic shadow is not usually present d/t severe T cell def.
The quantity and functioning of T cells is generally not affected, so an absent thymic shadow is unlikely; and there is insuffience production of mature B cells.
This is a classic description of immuno-def syndrome.
X-linked (Bruton’s) agammagloubulinemia
Croup (laryngotracheobronchitis) ==> ???
Parainfluenza virus is a common cause of croup (laryngotracheobronchitis), which presents with a “barky,” seal-like cough and inspiratory stridor.
Although parainfluenza can cause bronchiolitis, it is less common than RSV.
Viral bronchiolitis is a lower respiratory tract infection that usually occurs before age 2 and is most commonly caused by what pathogen?
respiratory syncytial virus (RSV).
Infants born to HBeAg-positive mothers have a high risk of acquiring perinatal hepatitis B virus (HBV) infection. Infected neonates have high levels of HBV replication and are at high risk for chronic infection, but are usually asymptomatic or have only mildly elevated liver function tests.
What would be the results of the viral labs on the infant?
(+) HBeAg
What causes the second most common cause of ring-enhancing lesions with mass effect in HIV pt.?
Primary central nervous system lymphoma (PCNSL); EBV
Classically, large, solitary lesions are more likely to suggest PCNSL rather than toxoplasmosis; however, multiple lesions (as seen in this patient) are also common in PCNSL
Primary CNS lymphoma is typically composed of what type of immune cells?
B Lymphocytes
HIV-associated esophagitis can be caused by what pathogens? (3)
- Candida albicans
- HSV-1
- CMV
The most common eye-related complication of congenital cytomegalovirus infection is ____________.
chorioretinitis
How does the body use triglycerides in adipose tissues to make glucose?
Via Glycerol Kinase
Glycerol produced by the degradation of triglycerides in adipose tissue can be used by glycerol kinase in the liver and kidney to synthesize glucose during gluconeogenesis.
Glycerol Kinase
@Liver.
Turns Glydersol into Glycerol 3-phosphate, which gets made into DHAP –> which can enter either glycolysis or gluconeogenesis.
What is triad of Sx in congential toxoplasmosis?
Hydrocephalus, intracranial calcifications and chorioretinitis form the classic triad of congenital toxoplasmosis.
in utero (transplacental infection)
During times of starvation, what enzyme provides substrates for hepatic gluconeogenesis and ketone body formation?
Hormone-sensitive lipase is found in adipose tissue, where it functions to drive the breakdown of stored triglycerides into free fatty acids and glycerol.
Acyl-CoA dehydrogenase and associated pathology.
Impaired β-oxidation of fatty acids causes hypoglycemia after prolonged fasting and inappropriately low levels of ketone bodies. Acyl-CoA dehydrogenase catalyzes the first step in the β-oxidation pathway and is the most commonly deficient enzyme.
MCAD is an enzyme aka as???
Acyl-CoA Dehydrogenase
Hb with a high affinity for O2 have a decrease P_50 that is represented by a __________ shift in the oxygen dissocation curve.
Hb w/ high affinity for Oxygen = Left-shift of curve.
The reduced ability to release oxygen within the peripheral tissues leads to renal hypoxia, increased erythropoietin synthesis, and compensatory erythrocytosis.
What is a physiological response in a pt. with hemoglobin with high affinity for Oxygen.
Compensatory erythrocyotsis.
Low oxygen levels stimulate the kidneys to increase erythropoietin synthesis, which results in a compensatory erythrocytosis that helps maintain normal oxygen delivery. Therefore, patients with high oxygen affinity hemoglobins are typically asymptomatic.
Hypoxia-induced hemolysis ==> ???
Sickle cell disease can result in hypoxia-induced hemolysis due to the ability of deoxygenated hemoglobin S to polymerize and cause excessive erythrocyte sickling and irreversible cell membrane damage. The oxygen dissociation curve for hemoglobin S is shifted to the right (↓ oxygen affinity) due to the stabilizing effects of polymerization on the deoxygenated form.
Heme oxygenase ==> ???
Heme oxygenase converts heme to biliverdin, a pigment that causes the greenish color to develop in bruises several days after an injury.
The greenish color that develop in bruises several days after an injury, d/t ==> ???
Heme oxygenase
Tissue hypoxia in septic shock impairs what biochem process?
Oxidative Phosphorylation (Electron Transport chain)
Lactic acidosis in septic shock results from tissue hypoxia, which impairs oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis. Hepatic hypoperfusion also contributes to the buildup of lactic acid as the liver is the primary site of lactate clearance.
Brown pigment gallstones are composed of what?
calcium salts of unconjugated bilirubin and arise secondary to bacterial or helminthic infection of the biliary tract. pigment stones.
What enzyme released by injured hepatocytes and bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin?
Beta-glucuronidase
What forms the caseating granulomas ~w/ Mycobacterium tuberculosis infections?
Macrophages that were activated by CD4+ Th1 cells.
**the Macrophages, once active, turn into Langerhan Cells
def. in Galactokinase = what Sx?
Cataracts
Ovoid cells within Macrophages == ?
Histoplasma capsulatum is a dimorphic fungus located intracellularly within macrophages. It affects the lungs and reticuloendothelial system. It is present in bird and bat droppings, and is endemic to the Mississippi and Ohio River basins.
Multinucleated spherules == ?
Spherules packed with endospores are found in Coccidioides immitis infection.
Like Histoplasma, Coccidioides can cause pulmonary disease in immunocompetent individuals.
Coccidioides is endemic to the southwestern U.S. and is not associated with cave exploration.
Cave exploration == ?
Histoplasma capsulatum is a dimorphic fungus that is found as a mold in soil. It is also present in bird and bat droppings, and is endemic to the Mississippi and Ohio River basins. Patients may report a history of exploring caves (exposure to bats) or cleaning bird cages or coops.
Budding Yeast with a thick capsule == ?
Cryptococcus neoformans takes the form of a budding yeast with a thick capsule.
This yeast also grows abundantly in soil containing bird (pigeon) droppings. However, this fungus tends to cause disease (meningoencephalitis and pulmonary disease) in the immunocompromised.
Pseudohyphae and blastoconidia == ?
Candida species are yeasts that form pseudohyphae. Blastoconidia are spores that grow as buds on the fungal hyphae. Candida infection is usually not associated with pulmonary infiltrates or lymphadenopathy.
Septate hyphae with dichotomous branching == ?
Aspergillus fumigatus causes pulmonary disease in immunocompromised patients. This fungus is seen in tissue sections as septate hyphae with V-shaped branching.
Conversion of phenylalanine to tyrosine is defective in what disease?
PKU
phenylketonuria and usually occurs due to a defect in phenylalanine hydroxylase. Undiagnosed and untreated phenylketonuria results in significant intellectual disability not seen in this patient.
Alkaptonuria is an autosomal recessive disorder of _________ metabolism.
tyrosine
What is ‘ochronosis’ and what disease is it ~w/ ???
“ochronosis,” a blue-black pigmentation most evident in the ears, nose, and cheeks, and ochronotic arthropathy, which typically manifests during adulthood.
Conversion of tyrosine to fumerate is fucked in what disease?
Alkaptonuria; lack of Homogenistisc acid dioxygenase.
Leads to accum. of Homogentisate.
what is a near-miss in terms of medical errors?
A near miss is a medical error that is recognized before any harm is done to the patient (eg, a patient is prescribed a lethal dose of medication, but the error is caught by the pharmacist).
A patient that has been harmed by the delay in appropriate diagnosis and treatment is considered an ADVERSE EVENT.
What is a preventable adverse event?
A preventable adverse event is defined as injury to a patient due to failure to follow evidence-based best practice guidelines.
What is a sentinel event?
A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury (eg, inpatient suicide, death of a full-term infant, retained object after surgery) that requires immediate investigation.
An inpatient physician’s failure to note and address the abnormality is a ____________ error that resulted in delayed diagnosis
Preventable medical error
An allergic reaction to a medication in a patient with no known history of drug allergies is what type of medical error?
Non-preventable adverse event
Lesion to what part of the brain more often is associated with apathy and right-sided lesions with disinhibition.
left-sided frontal lobe;
RIGHT sided lesions are ~w/ disinhibited behavior
Patients injury to what part of the brain often experience executive dysfunction and personality changes secondary to impairment of the organizational, restraint, and motivational systems.
Frontal lobe
Psychotic symptoms occur exclusively during mood episodes, describes what psych disorder?
major depressive or bipolar disorder
For diagnosis of schizoaffective disorder, what must occur?
psychosis must occur in the absence of major mood episodes, but mood symptoms must be present for most of the illness.
How is Schizopherniform disorder related to schizophrenia?
Schizophreniform disorder has the same symptoms as schizophrenia (eg, delusions, hallucinations, disorganized speech and behavior, negative symptoms), but the duration is >1 month and <6 months.
What type of insurance plan has low monthly premiums, low copayments and deductibles, and low total cost for the patient?
A health maintenance organization (HMO)
How should doctors response to a pt.’s disclosure of past sexual abuse?
Physicians should respond to disclosure of past sexual abuse with empathy and concern.
“That sounds like an awful experience; are you comfortable talking about it?”
What type of dev. defect is described as multiple malformations that occur secondary to an embryonic disturbance in an adjoining group of cells
A developmental field defect
_______________ describes abnormal organization of cellular architecture within a tissue. Osteogenesis imperfecta, a skeletal disorder characterized by brittle bones that fracture easily, occurs with dysplasia of connective tissue due to absent or abnormal type I collagen.
Dysplasia
In terms of embryological defects, what are deformations?
Deformations are fetal structural anomalies that occur due to extrinsic mechanical forces. The pressure applied by the uterus is one of the most common deforming forces. For example, uterine constraint on a fetus in breech position can cause developmental dysplasia of the hip, a condition marked by abnormal development of the femoral-acetabular junction and subsequent hip instability.
In addition to determining the patient’s volume status, what other lab is helpful in the determination of the cause of metabolic alkalosis.
measuring the urinary chloride concentration.
Metabolic alkalosis is characterized by a high arterial blood pH, HCO3-, and pCO2. Vomiting/nasogastric suctioning and thiazide/loop diuretic use cause volume and Cl- depletion, resulting in metabolic alkalosis that is saline-responsive. In contrast, hyperaldosteronism leads to metabolic alkalosis that is saline-unresponsive.
Hepatitis B virus does not have a cytotoxic effect itself; however, the presence of viral HBsAg and HBcAg on the cell surface stimulate what host cells to destroy infected hepatocytes.
cytotoxic CD8+ T lymphocytes
___________ disorder involves a persistent pattern of violating major societal norms or the rights of others. Behaviors include aggression toward people and animals, deceitfulness or theft, destruction of property, and serious violation of rules.
Conduct
What causes the conversion of 7-dehydrocholesterol to cholecalciferol (vitamin D3) in the skin.
Sunlight exposure catalyses
What drug can cause “first-dose hypotension” ?
ACEi
Vasoconstriction caused by α1-adrenergic agonists does what to the BP and afterload?
Vasoconstriction caused by α1-adrenergic agonists increases blood pressure and cardiac afterload, requiring increased myocardial effort to expel the blood.
Blanching of a vein into which norepinephrine (NE) is being infused together with induration and pallor of the tissues surrounding the IV site are signs of NE extravasation and resulting vasoconstriction. Tissue necrosis is best prevented by local injection of what drug?
phentolamine; an alpha1 blocking drug.
What is Calcium gluconate used for?
servere hypocalcemia?
What does neprilysin metabolize?
Endogenous natriuretic peptides.
neprilysin inhibitors improve outcomes in Pt. with CHF
What enxyme does the oxidation of iodide to iodine,
the iodination of thyrogloublin tyrosine residues
and the iodotyrosine couplinf reaction that forms T3 and T4
Thyroid peroxidase.
What is the diuretic of choice to improve survival in Pt. with CHF and reduced Left Ventricular EF.
MC receptor antag. (Spironolactone, eplerenone.
What is the genome of the virus that can cause vesicles on the lips and hard palate, fever, LAD, in a Peds pt.?
HSV-1 ==> gingivostomatitis.
env. dsDNA virus
Lymphatic drainage of the rectum proximal to the nal dentate line occurs via what lymph nodes?
inferior mesentaric and internal iliac lymph nodes.
What is the Tx of postpartum blues?
benign; self-limiting.
What is a skin manifestation that is ~w/ PBC?
Xanthelasma, d/t to 2/2 hyperlipidemia.
PBC is a cholestatic condition with the potential to cause hypercholesterolemia.
How does Glucagon increase SA node firing at the heart?
Glucagon –> GPCR –> activation of AC –> increase intracellular cAMP –> increase Ca2+ release from intracellular stores ==> increase SA node firing.
In pt. with no hX of head trauma, what association if involved in increased risk of intracranial hemorrhage?
Adult-type coarctation of the aorta.
MOA of Rivaroxaban?
direct Factor Xa inhibitor; used in venous thromboemolism and a-fib.
Lymphocytes with ctiplasmic projection ==> ???
hairy cell leukemia,
“dry tap of bone marrow”
What is the patho of an S4 heart sound?
S4: diastolic heart sound immeditatel before S1.
S4 heard in Pt. with reduced ventricular complicance (hypertensive heart diease, aortic stenosis, HCM)
it is d/t a sudden rise in end-diastolic pressure following atrial contraction.
what heart sound is d/t the sudden rise in end-diastolic pressure following arterial contraction?
S4;
increase stiffness of the left ventricular wall.
MOA of Enoxaparin?
LMWH that function slike heparin in that it binds and ACTIVATES ATIII.
bounding perpheral pulses and head-bobbing with each heartbeat = ?
Aortic regurg; also has wide pulse pressure.
What is the change in physiology of Aortic regurg?
increase total stroke volume with abrupt distension and rapid falloff of peripheral arterial pulses == WIDE PULSE PRESSURE
Systolic HTN in the upper ext and dminished/delyaed femoral pulses == ?
Coarctation of aorta
a small pulse amp (pulsus parvus) with a delayed peak and slower upstoke of the arterial pulse (pulsus tardus) is known as what and d/t to what?
Severe aortic stenosis; d/t diminished SV & prolonged ejection time.
What is the ADR with excessive Mannitol use?
Pulm Edema
small/constricted pupils (miosis) & RR = 10/min ==> ???`
Opioid overdose
what bug is transmitted via eating shellfish?
Vibrio
Ketones bodies synthesis is increased during starvation; can Ketone Bodies be used to make glucose?
HELLLLLS NOOOOOOOOO
decreased CCK release leads to what?
biliary statsis; CCK responsible for gallbladder contraction
What is the negative finding that can be used to dX cystic fibrosis?
in resp. and intestinal epithelial, fucked CF protein ch. reduces luminal chloride secretion; increase Sodium and water absorption ==> dehydrated mucus and more negative transepiT potential difference.
Crohn’s diz ios ~w/ what type of kidney stones?
Oxalate; fat malabs. leads to loss of bile acids, which will bind Calcium and the complex will be excreted. This leaves free oxalate to be absorbed and form stones.
chronic use of opioids leads to the dev. of tolerance to analgesics effects and most ADRS, except for what?
Miosis and consitpation
decrease free T/estrogen ratio (increase estrogen) in liver cirrhosis leads to what Sx?
gynecomastia, testicular atrophy, decrease body hair, spider angiomata.
DIC & hemorrhagic destruction of bilateral adrenal glands ==> ???
Waterhouse-friderichsen sydn. d/t meningococcal sepsis.
What vasculitis is commonly ~w/ Myocardial infarctions?
Kawasaki’s
what is a common extradermal manifestation of scleroderma?
Pulm. HTN
