Mixed Block Notes 1 Flashcards
1
Q
Histology of GBM
A
Necrosis, Hemorrhage, Pallisading pattern
2
Q
Histology of Meningioma
A
Psammoma bodies (also papillary thyroid carcinoma, serous papillary ovarian adenocarcinoma)
3
Q
Histology of Oligodendroglioma
A
Fried egg appearance
4
Q
PCNSL Histology
A
Uniform atypical lymphocytes
5
Q
Lingual Thyroid
A
Thyroid tissue fails to migrate –> Removal cause hypothyroid
6
Q
dx of asthma after Methacholine challenge
A
Decr in FEV1 of >20%
7
Q
Cutaneous Neurofibromas –>
A
NF1 –> Autosomal Dominant (Chr 17)
8
Q
Widened QRS converts to narrow during tachyarrhythmia in WPW b/c
A
accessory pathway no longer pre-excites but instead forms re-entrant circuit
9
Q
EKG Triad for WPW
A
Shortened PR, Delta wave, Wide QRS
10
Q
Linear deposits of Ig along glomerular basement membrane
A
Anti-GBM disease (Goodpasture) = Type 1 RPGN = Crescents on LM
11
Q
Basement membrane splitting in kidney bx
A
Alport and MPGN Type 1
12
Q
Uniform, diffuse wall thickening in kidney bx
A
Membranous Glomerulopathy
13
Q
B6 is an essential cofactor for
A
Transamination and Decarboxylation of Aas, Gluconeogenesis
14
Q
OAA + Glutamate –>
A
Aspartate and a-KG
15
Q
Transamination reactions
A
AA and a-keto acid –> Amine transferred to a-keto acid, which becomes AA
16
Q
Most common form of Galactosemia
A
Galactose-1-P uridyl transferase deficiency
17
Q
What to check before initiating metformin therapy?
A
Serum Creatinine –> Lactic Acid accumulation (also contraindicated in hepatic dysfunction, CHF, alcoholism, sepsis)
18
Q
Bloom syndrome is characterized by
A
General chromosomal instability
19
Q
Ataxia Telangiectasia is characterized by
A
DNA hypersensitivity to ionizing radiation
20
Q
Cardiac Output equation
A
- SV x HR; 2. (O2 consumption) / (AV O2 difference)
21
Q
TCA cause what heart manifestation
A
Quinidine-like effect: QRS and QT prolongation by inhibiting fast Na channels
22
Q
Treatment for cardiac TCA overdose
A
Hypertonic NaHCO3: Corrects QRS prolongation, Reverses hypotension, Treats ventricular dysrhythmias
23
Q
What accounts for awakening from barbiturate anesthesia
A
Redistribution (not elmination)
24
Q
MOA of Oxybutynin
A
M3 antagonist –> Decr IP3 –> Decr Ca (urge incontinence)
25
Common causes of myopathy with elevated CK
Hypothyroid, Muscular Dystrophy, Inflammatory Muscle Disease, HMG-CoA Reductase inhibitor
26
Fatiguability, Weight gain, and Myoedema --\>
Hypothyroid
27
CK levels in Steroid-induced myopathy
Normal
28
Ciprofloxacin is NOT effective for
Anaerobic infections
29
Ceftriaxone has poor activity against
Anaerobes
30
Azithromycin is used for
Chlamydia, Mycoplasma, H flu, Moraxella
31
Permissive effects of cortisol
Incr vascular and bronchial smooth muscle reactivity to catecholamines
32
Valproate causes what birth defect
Neural Tube defects
33
PYR positive
GAS
34
What molecule is upregulated to mediate Transmigration
PECAM-1
35
Caspofungin is most active against
Candida and Aspergillus (not against Mucor or Rhizopus)
36
Selective Proteinuria
Albumin loss with minimal loss of more bulky proteins (IgG, Macroglobulin)
37
Most selective derminant for size in glomerulus
GBM and slit diaphragm (4nm)
38
Barrier to albumin loss in urine
charge selectivity
39
Tubular proteinuria
Presence of low molecular weight proteins in urine that should have been reabsorbed
40
Overload pronteinuria
Normally reabsorbed, smaller proteins exceed reabsorption capacity
41
Functional proteinuira
change in blood flow through glomerulus
42
Histologic features of Acute Viral Hepatitis
Ballooning degeneration, Mononuclear infiltrates, Councilman bodies
43
Anorexia, nausea, and low grade fever followed by bilirubinuria and R upper quadrant tenderness
Acute Hepatitis - most commonly caused by HAV in young adults
44
Pulmonary Vascular Resistance is lowest when
At Functional Residual Capacity (after casual exhalation)
45
Require cholesterol for growth in acellular media
Mycoplasma
46
MacConkey agar contains ___ to inhibit growth of contaminant
Bile
47
Virulence factor of E coli in neonatal meningitis
K1 capsular antigen
48
Virulence factor of E coli in non-bloody gastroenteritis
Heat stable/labile
49
Virulence factor of E coli in UTI's
P (pyelonephritis) Fimbriae
50
Na channel binding strength among Class I Anti-arrhythmics
1C \> 1A \> 1B (correlates to use dependence)
51
MOA of BNP
Incr cGMP via GC
52
Slow acetylation affects which drugs
INH, Dapsone, Hydralazine, Procainamide
53
MOA of Rifampin
DNA-dependent RNA synthesis inhibition
54
Rifampin vs Isoniazid
Rifampin is not specific for mycobacteria
55
99mmTc-pertechnetate scan detects
presence of gastric mucosa
56
Digestive effects after sub-total pancreatectomy
Deficient in all digestive enzymes normally secreted by pancrease into duodenum
57
D-xylose absorption
Monosaccharide that can be absorbed direct w/out pancreatic enzymes
58
oral administration of fixed dose D-xylose
Differentiate b/t malabsorption of pancreatic vs GI mucosal etiology
59
Langhans Cells
Multinucleated giant cell with role in Granulomatous inflammation
60
Raquet-shaped intracytoplasmic granule
Birbeck granule in Langerhans cells
61
Merkel Cells
Basal layer neuroendocrine cells with role in touch
62
Portal triad runs in
Hepatoduodenal ligament
63
Which part of heart injured in stab wound to left 4th intercostal space
Right Ventricle
64
Two important steps in workup of metabolic alkalosis
Volume Status, Urine Chloride
65
Treatment of Vomiting/NG suction Metabolic Alkalosis
Isotonic saline for volume and Cl repletion
66
What leads to metabolic alkalosis that is saline unresponsive
Hyperaldosteronism or Hypercortisolism
67
Low blood-gas partition coefficient means
Poor solubility --\> Blood saturates quickly --\> Fast rise in partial pressure --\> Faster brain saturation --\> Faster onset time
68
High blood-gas partition coefficient means
High solubility --\> Blood saturates slowly --\> Delayed rise in partial pressure --\> Slow brain saturation --\> Slow onset time
69
Function of BRCA1/2
Double strand DNA break repair
70
Heritability of BRCA mutations
Autosomal dominant
71
Dysfunction in Alkaptonuria
Homogentisate Oxidase - Tyrosine to Fumarate
72
What in urine in Alkaptonuria imparts black color if oxidized
Homogentisic Acid
73
Ochronosis
Blue-black pigmentation in Alkaptonuria
74
Tx for combined absence and tonic clonic
Valproate
75
Tx for Absence Seizures
Valproate, Ethosuximide
76
Ethosuximide is not effective for
Tonic Clonic
77
Chronic effects of Obstructive Sleep Apnea
Reflexive systemic and pulmonary vasoconstriction and sympathetic cardiac stimulation --\> Pulmonary HTN and Right Heart Failure
78
Hepatic Angiosarcoma is associated with
Arsenic, Thorotrast, Polyvinyl Chloride
79
CD31
PECAM1 --\> Leukocyte migration thru endothium
80
IF microscopy in PSGN
Granular deposits of IgG, IgM, C3 = Starry Sky
81
EM in PSGN
Subepithelial humps = Antigen-antibody complexes
82
Longer menstrual cycles and irregular bleeding in adolescent
Anovulatory cycles due to immature HP-Ovarian axis
83
Transports ammonia from peripheral tissues to kidneys
Glutamine --\> Glutamate + Free Ammonia Ion
84
Function of N-acetylglutatmate
Active Carbamoyl Phosphate Synthetase I in urea cycle
85
Nitrogen atoms in urea cycle are derived from
NH3 and Aspartate
86
Rate limiting enzyme in urea cycle
Carbamoyl Phosphate Synthetase I (activated by N-acetylglutamate)
87
Causes of HIV esophagitis
Candida, HSV1, CMV - Clinically indistinguishable, need endoscope
88
Endoscopic findings in Candidal Esophagitis
Patches of adherent gray-white pseudomembranes
89
Endoscopic findings in HSV-1 Esophagitis
Small vesicles that evolve into typical "punched out" ulcers
90
Endoscopic findings in CMV Esophagitis
Linear ulceration
91
Isospora belli
Profuse, watery diarrhea in HIV patients
92
Fever, Generalized LAD, Facial Edema, and Diffuse Morbilliform skin rash 2-8 weeks after drug exposure
DRESS!!!
93
Common drugs associated with DRESS
Anticonvulsants, Allopurinol, Sulfonamides
94
Drug-induced Anti-neutrophil cytoplasmic antibodies
Hyperthyroidism meds, Hydralazine
95
Mixed cryoglobulinemia is typically associated with
Chronic inflammatory states (SLE, HepC)
96
Purpose of squatting in Tetralogy of Fallot
Incr SVR/PVR ratio to prevent bypass of lungs
97
Synthesize dextrans from sucrose? Purpose?
Strep viridans --\> Adherence to fibrin
98
Why does Strep viridans only bind to damaged endothelium
Adheres to fibrin, which is only deposited at sites of damage
99
Colistin kills
Gram negatives other than Neisseria
100
Reducing media
Used to culture organisms that reduce iron or sulfur
101
Result of incr in Hb saturation at lower oxygen mmHg
Erythrocytosis
102
Activated macrophages are necessary for
Delayed hypersensitivity reactions, Cytotoxicity against intracellular organisms
103
IL-12 receptor deficiency
Severe mycobacterial infections with inability to mount strong cell-mediated granulomatous immune response --\> Tx with IFN-g
104
Infused citrate in packed RBCs can cause
Hypocalcemia (occurs with 5-6 liters of blood given over 24 hours)
105
6-MP and 6-TG are converted to active metabolites by
HGPRT
106
Degradation of activated 6-MP and 6-TG is done by
Xanthine Oxidase, Thiopurine Methyltransferase
107
Why give Allopurinol with 6-MP
Prevents inactivation by Xanthine Oxidase and greatly reduces needed dose
108
First line treatment for gestational diabetes
Diet then Insulin
109
Korsakoff syndrome is associated with damage to
Anterior and Dorsomedial Thalamic Nuclei --\> Memory loss and Confabulation
110
Role of microglia in post-infarct repair
Move into area 3-5 days after onset of ischemia and phagocytize fragments of neurons, myelin, and necrotic debris
111
How does leptin regulate appetite, metabolism
Decr NPY in arcuate nucleus; Stimulates POMC/a-MSH in arcuate nucleus
112
EML4-ALK is seen in \_\_\_? Targeted therapy?
Non-Small Cell Lung Carcinoma (often nonsmokers with adenocarcinoma) --\> Crizotinib
113
Sensorineural hearing loss, Tinnitus, Paralysis of facial muscles, Loss of corneal reflex --\>
Vestibular Schwannoma affectiing V, VII, VIII --\> Cerebellopontine angle
114
Specific symptoms of iron-deficiency anemia
Dysphagia, Koilonychia
115
Most common cause of Hydatid Cysts in humans
Echinococcus granulosus
116
beta adrenergic activity in coronaries
vasodilation
117
Oxygen content in Pulmonary Artery vs Coronary Sinus
Lower in coronary sinus because much more O2 used in myocardium than systemically
118
Prior strep infections are evidenced by
Anti-Streptolysin, Anti-DNaseB, Anti-Hyaluronidase
119
PYR Positive vs negative
GAS, Enterococci are PYR+; GBS, Bovis are PYR-
120
Etiologic agent of scrofula
Mycobacterium scrofulaceum
121
MOA of Nacetylcysteine
Glutathione substitute, Provides sulfhydryl groups to enhance non-toxic sulfation elimination of acetaminophen
122
Effect of glucocorticoids on liver protein synthesis
Incr Gluconeogenic and Glycolytic enzyme synthesis
123
Used to stimulate peristalsis in post-op ileus
Bethanechol, also to treat non-obstructive urinary retention
124
Effect of cholinergic agonist on glaucoma
Miosis causes iris to move further from cornea --\> Widens anterior chamber and allows for better outflow of acqueous humor
125
Kidney histology in chronic transplant rejection
Vascular wall thickening, Luminal narrowing, Interstitial fibrosis, Parenchymal atrophy
126
What causes activation of RAS
GTP binding
127
NADPH is required as cofactor for
FA, Cholesterol, Steroid synthesis
128
MOA of Anastrozole
Aromatase inhibitor (+ Letrozole, Exemestane)
129
Bones associated with First Pharyngeal Arch
Maxilla, Zygoma, Mandible, Vomer, Palatine, Incus, Malleus
130
Bones associated with Second Pharyngeal Arch
Styloid, Lesser Horn of Hyoid, Stapes
131
Muscles associated with Second Pharyngeal Arch
Facial Expression, Stylohyoid, Stapedius, Posterior Digastric
132
Neonatal manifestations of Erythroblastosis Fetalis
Anemia, Jaundice, Edema, Nucleated RBCs, Extramedullary Hematopoiesis
133
Who gets oral thrush
Dentures, DM, Immunosuppressed, HIV
134
What causes problem with Fragile X expansion
Hypermethylation (not breakage)
135
What is unique to the duodenum
Brunner's Glands - Located in SUBMUCOSA and secreted bicarb
136
3rd Aortic Arch Derivatives
Common Carotid, Prox internal carotid
137
4th Aortic Arch Derivatives
True Aortic Arch, Subclavian Arteries
138
6th Aortic Arch Derivatives
Pulmonary arteries, Ductus arteriosus
139
Effect of DKA on K
Incr excretion, Decr total stores, But increased extracellular
140
Homeless man with increased fatiguability and exertional dypnea, LE edema, decr sensation in periphery + cardiac dilation and incr CO
B1 deficiency (Beriberi)
141
Laryngeal edema and difficulty breathing after ACEi is due to
Kinin accumulation
142
Long acting benzodiazepines
Chlordiazepoxide, Chlorazepate, Diazepam, Flurazepam (Carefully Choose Due to Falls)
143
What are the dimorphic fungi?
Blasto, Histo, Paracoccidiodies, Coccidiodes, Sporothrix - Body Heat Purportedly Changes Shape
144
Removal of apical ectodermal ridge from newly formed limb bud
Shortened length, Abnormal ventral dorsal
145
Which aortic arch becomes Ductus Arteriosus
Sixth
146
Refsum's disease
Myelin synthesis due to FA oxidation/synthesis disorder
147
Findings in Sarcoidosis
GRAIN - Globulinemia, RA, elevated ACE, Interstitial fibrosis, Noncaseating granulomas
148
pregnant woman hypotensive when supine
IVC compression --\> lay on left side at night
149
Especially effective CT agent for Hodgkin
Vincristine
150
Location of the CTZ
Area postrema of the medulla
151
CV manifestations of Turner's
Bicuspid Aortic Valve, Preductal Coarction of Aorta
152
Where is stratified squamous epithelium found in respiratory tract?
Oropharynx, Laryngopharynx, Anterior epiglottis, Upper half of posterior epiglottis, True vocal cords
153
MOA of Alpha-Glucosidase inhibitors
Prevent disaccharide breakdown in intestine, thus absorption
154
Role of adiponectin in T2DM
Low, increased by TZDs
155
Annular pancrease is caused by
Abnormal migration (not apoptosis) of ventral pancreatic bud
156
Bilateral lens subluxation, Massive stroke, Old renal infarcts
Homocysteinuria
157
Most patients with Homocysteinuria respond dramatically to
B6 supplementation
158
Fluoxetine overdose
Tachycardia, Drowsiness, Tremor, Vomitting, Nausea
159
Physical exam finding in AV fistula
Pulsative mass with thrill on palpation, Auscultation reveals bruit over site
160
SST decreases
Secretin, CCK, Glucagon, Insulin, Gastrin
161
AA's that are metabolized to Propionyl CoA
Isoleucine, Valine, Threonine, Methionine
162
L-asparaginase
Antineoplastic by lowering circulating asparagine levels (leukemic cells collect asparagine from serum)
163
Symptoms, Signs of congenital hypothyroidism
Poor feeding, Prolongued jaundice, Constipation, Hypotonia, Hoarse Cry, Macroglossia, Myxedema, Umblical hernia
164
Which diuretic is used to decrease urine calcium
Thiazides
165
Most common cause of SVC syndrome
Bronchogenic Carcinomas
166
Most important HLA association with RA
HLA-DR4
167
HLA associated with SLE
HLA-DR2/3
168
HLA-A3 associated with
Primary Hemochromatosis
169
Lambert Eaton vs MG
LE doesn not improve with AChEi's, Strength improves with repeated testing, Enhanced neurotransmission with repetitive stimulation
170
Limited vs Systemic Sclerosis Ab's
Limited associated with Anti-centromere; Systemic with Anti-Topo 1
171
Kernicterus is most likely to affect which parts of CNS
Basal ganglia, Thalamus, Cerebellum, Cerebral gray matter, Spinal cord
172
Which hepatitis type is associated with PAN
Hep B (Hep C associated with Mixed Cryoglobulinemia)
173
Symptoms of Acute Intermittent Porphyria
Abdominal pain, N/V, Peripheral neuropathy, Paralysis, Psychiatric
174
Anti-mitochondrial Ab is a marker for
Primary Biliary Cirrhosis
175
Treatment of Lithium-induced DI
Amiloride - Blocks channel that lithium uses to enter principal cell
176
SLE on prednisone long term - what vitamin to supplement?
VITAMIN D
177
Toxicity of Nitrosureas
Carmustine --\> pulmonary fibrosis
178
Accumulated intermediate in Acute Intermittent Porphyria vs Prophyria Cutanea Tarda
AIP = Porphobilinogen, PCT = Uroporphyrinogen
179
MOA of Bacitracin
Inhibits transfer of mucopeptides to growing cell wall
180
When do Red Neurons appear after cerebral ischemia?
12-24 hours
181
When does liquefactive necrosis appear after cerebral ischemia?
1-2 weeks
182
What can minors consent to when pregnant?
Prenatal care, Dx and Tx of STD's, Drug and Alcohol Rehab; NOT abortions (or elective non-emergency procedures)
183
Acute transplant rejection is mediated by
T cell response against HLA/MHC antigens
184
Symptoms of Systemic Mastocytosis are induced by
Histamine releas
185
What is pulsus paradoxis
Decr systemic blood pressure during inspiration (incr venous return deviates IV septum toward left and blocks outflow)
186
When does Pulsus Paradoxis occur
Acute cardiac tamponade, Constrictive pericarditis, Severe obstructive lung dz, Restrictive CM
187
Most significant factor in Shigellosis
Mucosal invasion, not toxin
188
Confusion, Fever, Nausea, Elevated LFT's four days after anesthesia
Massive hepatic necrosis from Halothane
189
Hepatic Granulomatosis is associated with
Methyldopa, Hydralazine, Quinidine
190
MOA and use of Primidone
First line for benign essential tremor; MOA unknown but metabolizes to phenobarbital
191
Activation of Intrinsic vs Extrinsic pathway
Intrinsic by damaged vessel (XII), Extrinsice by tissue damage (TF, VII)
192
Defect and major manifestations of Type 1 Dyslipidemia
LPL, ApoC --\> Chylomicrons --\> Acute pancreatitis, Xanthomas, HSM
193
Defect and major manifestations of Type 2a Dyslipidemia
LDL, ApoB-100 --\> LDL --\> CAD, Corneal Arcus, Tendon Xanthomas
194
Defect and major manifestations of Type 3 Dyslipidemia
ApoE --\> Chylomicron, VLDL remnants --\> CAD, PVD, Xanthomas
195
Defect and major manifestations of Type 4 Dyslipidemia
ApoA-V --\> VLDL --\> Pancreatitis, Obesity, Insulin resistance
196
Purine Antimetabolites
6-MP, 6-GP, Fludarabine, Cladribine
197
Use of Cladribine
Hairy Cell Leukemia - Resistant to Adenosine Deaminase
198
Bupropion is contraindicated with
Anything that can lower seizure threshold (eg electrolyte disorders from bulemia)
199
Good samaritan law
Standard of care must be met (meant to protect people, including off duty medical professionals, who help in accidents/emergencies)
