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Mixed Block Notes 1 Flashcards

1
Q

Histology of GBM

A

Necrosis, Hemorrhage, Pallisading pattern

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2
Q

Histology of Meningioma

A

Psammoma bodies (also papillary thyroid carcinoma, serous papillary ovarian adenocarcinoma)

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3
Q

Histology of Oligodendroglioma

A

Fried egg appearance

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4
Q

PCNSL Histology

A

Uniform atypical lymphocytes

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5
Q

Lingual Thyroid

A

Thyroid tissue fails to migrate –> Removal cause hypothyroid

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6
Q

dx of asthma after Methacholine challenge

A

Decr in FEV1 of >20%

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7
Q

Cutaneous Neurofibromas –>

A

NF1 –> Autosomal Dominant (Chr 17)

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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

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9
Q

EKG Triad for WPW

A

Shortened PR, Delta wave, Wide QRS

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10
Q

Linear deposits of Ig along glomerular basement membrane

A

Anti-GBM disease (Goodpasture) = Type 1 RPGN = Crescents on LM

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11
Q

Basement membrane splitting in kidney bx

A

Alport and MPGN Type 1

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12
Q

Uniform, diffuse wall thickening in kidney bx

A

Membranous Glomerulopathy

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13
Q

B6 is an essential cofactor for

A

Transamination and Decarboxylation of Aas, Gluconeogenesis

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14
Q

OAA + Glutamate –>

A

Aspartate and a-KG

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15
Q

Transamination reactions

A

AA and a-keto acid –> Amine transferred to a-keto acid, which becomes AA

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16
Q

Most common form of Galactosemia

A

Galactose-1-P uridyl transferase deficiency

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17
Q

What to check before initiating metformin therapy?

A

Serum Creatinine –> Lactic Acid accumulation (also contraindicated in hepatic dysfunction, CHF, alcoholism, sepsis)

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18
Q

Bloom syndrome is characterized by

A

General chromosomal instability

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19
Q

Ataxia Telangiectasia is characterized by

A

DNA hypersensitivity to ionizing radiation

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20
Q

Cardiac Output equation

A
  1. SV x HR; 2. (O2 consumption) / (AV O2 difference)
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21
Q

TCA cause what heart manifestation

A

Quinidine-like effect: QRS and QT prolongation by inhibiting fast Na channels

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22
Q

Treatment for cardiac TCA overdose

A

Hypertonic NaHCO3: Corrects QRS prolongation, Reverses hypotension, Treats ventricular dysrhythmias

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23
Q

What accounts for awakening from barbiturate anesthesia

A

Redistribution (not elmination)

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24
Q

MOA of Oxybutynin

A

M3 antagonist –> Decr IP3 –> Decr Ca (urge incontinence)

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25
Q

Common causes of myopathy with elevated CK

A

Hypothyroid, Muscular Dystrophy, Inflammatory Muscle Disease, HMG-CoA Reductase inhibitor

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26
Q

Fatiguability, Weight gain, and Myoedema –>

A

Hypothyroid

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27
Q

CK levels in Steroid-induced myopathy

A

Normal

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28
Q

Ciprofloxacin is NOT effective for

A

Anaerobic infections

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29
Q

Ceftriaxone has poor activity against

A

Anaerobes

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30
Q

Azithromycin is used for

A

Chlamydia, Mycoplasma, H flu, Moraxella

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31
Q

Permissive effects of cortisol

A

Incr vascular and bronchial smooth muscle reactivity to catecholamines

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32
Q

Valproate causes what birth defect

A

Neural Tube defects

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33
Q

PYR positive

A

GAS

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34
Q

What molecule is upregulated to mediate Transmigration

A

PECAM-1

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35
Q

Caspofungin is most active against

A

Candida and Aspergillus (not against Mucor or Rhizopus)

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36
Q

Selective Proteinuria

A

Albumin loss with minimal loss of more bulky proteins (IgG, Macroglobulin)

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37
Q

Most selective derminant for size in glomerulus

A

GBM and slit diaphragm (4nm)

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38
Q

Barrier to albumin loss in urine

A

charge selectivity

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39
Q

Tubular proteinuria

A

Presence of low molecular weight proteins in urine that should have been reabsorbed

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40
Q

Overload pronteinuria

A

Normally reabsorbed, smaller proteins exceed reabsorption capacity

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41
Q

Functional proteinuira

A

change in blood flow through glomerulus

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42
Q

Histologic features of Acute Viral Hepatitis

A

Ballooning degeneration, Mononuclear infiltrates, Councilman bodies

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43
Q

Anorexia, nausea, and low grade fever followed by bilirubinuria and R upper quadrant tenderness

A

Acute Hepatitis - most commonly caused by HAV in young adults

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44
Q

Pulmonary Vascular Resistance is lowest when

A

At Functional Residual Capacity (after casual exhalation)

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45
Q

Require cholesterol for growth in acellular media

A

Mycoplasma

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46
Q

MacConkey agar contains ___ to inhibit growth of contaminant

A

Bile

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47
Q

Virulence factor of E coli in neonatal meningitis

A

K1 capsular antigen

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48
Q

Virulence factor of E coli in non-bloody gastroenteritis

A

Heat stable/labile

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49
Q

Virulence factor of E coli in UTI’s

A

P (pyelonephritis) Fimbriae

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50
Q

Na channel binding strength among Class I Anti-arrhythmics

A

1C > 1A > 1B (correlates to use dependence)

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51
Q

MOA of BNP

A

Incr cGMP via GC

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52
Q

Slow acetylation affects which drugs

A

INH, Dapsone, Hydralazine, Procainamide

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53
Q

MOA of Rifampin

A

DNA-dependent RNA synthesis inhibition

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54
Q

Rifampin vs Isoniazid

A

Rifampin is not specific for mycobacteria

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55
Q

99mmTc-pertechnetate scan detects

A

presence of gastric mucosa

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56
Q

Digestive effects after sub-total pancreatectomy

A

Deficient in all digestive enzymes normally secreted by pancrease into duodenum

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57
Q

D-xylose absorption

A

Monosaccharide that can be absorbed direct w/out pancreatic enzymes

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58
Q

oral administration of fixed dose D-xylose

A

Differentiate b/t malabsorption of pancreatic vs GI mucosal etiology

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59
Q

Langhans Cells

A

Multinucleated giant cell with role in Granulomatous inflammation

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60
Q

Raquet-shaped intracytoplasmic granule

A

Birbeck granule in Langerhans cells

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61
Q

Merkel Cells

A

Basal layer neuroendocrine cells with role in touch

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62
Q

Portal triad runs in

A

Hepatoduodenal ligament

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63
Q

Which part of heart injured in stab wound to left 4th intercostal space

A

Right Ventricle

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64
Q

Two important steps in workup of metabolic alkalosis

A

Volume Status, Urine Chloride

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65
Q

Treatment of Vomiting/NG suction Metabolic Alkalosis

A

Isotonic saline for volume and Cl repletion

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66
Q

What leads to metabolic alkalosis that is saline unresponsive

A

Hyperaldosteronism or Hypercortisolism

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67
Q

Low blood-gas partition coefficient means

A

Poor solubility –> Blood saturates quickly –> Fast rise in partial pressure –> Faster brain saturation –> Faster onset time

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68
Q

High blood-gas partition coefficient means

A

High solubility –> Blood saturates slowly –> Delayed rise in partial pressure –> Slow brain saturation –> Slow onset time

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69
Q

Function of BRCA1/2

A

Double strand DNA break repair

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70
Q

Heritability of BRCA mutations

A

Autosomal dominant

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71
Q

Dysfunction in Alkaptonuria

A

Homogentisate Oxidase - Tyrosine to Fumarate

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72
Q

What in urine in Alkaptonuria imparts black color if oxidized

A

Homogentisic Acid

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73
Q

Ochronosis

A

Blue-black pigmentation in Alkaptonuria

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74
Q

Tx for combined absence and tonic clonic

A

Valproate

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75
Q

Tx for Absence Seizures

A

Valproate, Ethosuximide

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76
Q

Ethosuximide is not effective for

A

Tonic Clonic

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77
Q

Chronic effects of Obstructive Sleep Apnea

A

Reflexive systemic and pulmonary vasoconstriction and sympathetic cardiac stimulation –> Pulmonary HTN and Right Heart Failure

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78
Q

Hepatic Angiosarcoma is associated with

A

Arsenic, Thorotrast, Polyvinyl Chloride

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79
Q

CD31

A

PECAM1 –> Leukocyte migration thru endothium

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80
Q

IF microscopy in PSGN

A

Granular deposits of IgG, IgM, C3 = Starry Sky

81
Q

EM in PSGN

A

Subepithelial humps = Antigen-antibody complexes

82
Q

Longer menstrual cycles and irregular bleeding in adolescent

A

Anovulatory cycles due to immature HP-Ovarian axis

83
Q

Transports ammonia from peripheral tissues to kidneys

A

Glutamine –> Glutamate + Free Ammonia Ion

84
Q

Function of N-acetylglutatmate

A

Active Carbamoyl Phosphate Synthetase I in urea cycle

85
Q

Nitrogen atoms in urea cycle are derived from

A

NH3 and Aspartate

86
Q

Rate limiting enzyme in urea cycle

A

Carbamoyl Phosphate Synthetase I (activated by N-acetylglutamate)

87
Q

Causes of HIV esophagitis

A

Candida, HSV1, CMV - Clinically indistinguishable, need endoscope

88
Q

Endoscopic findings in Candidal Esophagitis

A

Patches of adherent gray-white pseudomembranes

89
Q

Endoscopic findings in HSV-1 Esophagitis

A

Small vesicles that evolve into typical “punched out” ulcers

90
Q

Endoscopic findings in CMV Esophagitis

A

Linear ulceration

91
Q

Isospora belli

A

Profuse, watery diarrhea in HIV patients

92
Q

Fever, Generalized LAD, Facial Edema, and Diffuse Morbilliform skin rash 2-8 weeks after drug exposure

93
Q

Common drugs associated with DRESS

A

Anticonvulsants, Allopurinol, Sulfonamides

94
Q

Drug-induced Anti-neutrophil cytoplasmic antibodies

A

Hyperthyroidism meds, Hydralazine

95
Q

Mixed cryoglobulinemia is typically associated with

A

Chronic inflammatory states (SLE, HepC)

96
Q

Purpose of squatting in Tetralogy of Fallot

A

Incr SVR/PVR ratio to prevent bypass of lungs

97
Q

Synthesize dextrans from sucrose? Purpose?

A

Strep viridans –> Adherence to fibrin

98
Q

Why does Strep viridans only bind to damaged endothelium

A

Adheres to fibrin, which is only deposited at sites of damage

99
Q

Colistin kills

A

Gram negatives other than Neisseria

100
Q

Reducing media

A

Used to culture organisms that reduce iron or sulfur

101
Q

Result of incr in Hb saturation at lower oxygen mmHg

A

Erythrocytosis

102
Q

Activated macrophages are necessary for

A

Delayed hypersensitivity reactions, Cytotoxicity against intracellular organisms

103
Q

IL-12 receptor deficiency

A

Severe mycobacterial infections with inability to mount strong cell-mediated granulomatous immune response –> Tx with IFN-g

104
Q

Infused citrate in packed RBCs can cause

A

Hypocalcemia (occurs with 5-6 liters of blood given over 24 hours)

105
Q

6-MP and 6-TG are converted to active metabolites by

106
Q

Degradation of activated 6-MP and 6-TG is done by

A

Xanthine Oxidase, Thiopurine Methyltransferase

107
Q

Why give Allopurinol with 6-MP

A

Prevents inactivation by Xanthine Oxidase and greatly reduces needed dose

108
Q

First line treatment for gestational diabetes

A

Diet then Insulin

109
Q

Korsakoff syndrome is associated with damage to

A

Anterior and Dorsomedial Thalamic Nuclei –> Memory loss and Confabulation

110
Q

Role of microglia in post-infarct repair

A

Move into area 3-5 days after onset of ischemia and phagocytize fragments of neurons, myelin, and necrotic debris

111
Q

How does leptin regulate appetite, metabolism

A

Decr NPY in arcuate nucleus; Stimulates POMC/a-MSH in arcuate nucleus

112
Q

EML4-ALK is seen in ___? Targeted therapy?

A

Non-Small Cell Lung Carcinoma (often nonsmokers with adenocarcinoma) –> Crizotinib

113
Q

Sensorineural hearing loss, Tinnitus, Paralysis of facial muscles, Loss of corneal reflex –>

A

Vestibular Schwannoma affectiing V, VII, VIII –> Cerebellopontine angle

114
Q

Specific symptoms of iron-deficiency anemia

A

Dysphagia, Koilonychia

115
Q

Most common cause of Hydatid Cysts in humans

A

Echinococcus granulosus

116
Q

beta adrenergic activity in coronaries

A

vasodilation

117
Q

Oxygen content in Pulmonary Artery vs Coronary Sinus

A

Lower in coronary sinus because much more O2 used in myocardium than systemically

118
Q

Prior strep infections are evidenced by

A

Anti-Streptolysin, Anti-DNaseB, Anti-Hyaluronidase

119
Q

PYR Positive vs negative

A

GAS, Enterococci are PYR+; GBS, Bovis are PYR-

120
Q

Etiologic agent of scrofula

A

Mycobacterium scrofulaceum

121
Q

MOA of Nacetylcysteine

A

Glutathione substitute, Provides sulfhydryl groups to enhance non-toxic sulfation elimination of acetaminophen

122
Q

Effect of glucocorticoids on liver protein synthesis

A

Incr Gluconeogenic and Glycolytic enzyme synthesis

123
Q

Used to stimulate peristalsis in post-op ileus

A

Bethanechol, also to treat non-obstructive urinary retention

124
Q

Effect of cholinergic agonist on glaucoma

A

Miosis causes iris to move further from cornea –> Widens anterior chamber and allows for better outflow of acqueous humor

125
Q

Kidney histology in chronic transplant rejection

A

Vascular wall thickening, Luminal narrowing, Interstitial fibrosis, Parenchymal atrophy

126
Q

What causes activation of RAS

A

GTP binding

127
Q

NADPH is required as cofactor for

A

FA, Cholesterol, Steroid synthesis

128
Q

MOA of Anastrozole

A

Aromatase inhibitor (+ Letrozole, Exemestane)

129
Q

Bones associated with First Pharyngeal Arch

A

Maxilla, Zygoma, Mandible, Vomer, Palatine, Incus, Malleus

130
Q

Bones associated with Second Pharyngeal Arch

A

Styloid, Lesser Horn of Hyoid, Stapes

131
Q

Muscles associated with Second Pharyngeal Arch

A

Facial Expression, Stylohyoid, Stapedius, Posterior Digastric

132
Q

Neonatal manifestations of Erythroblastosis Fetalis

A

Anemia, Jaundice, Edema, Nucleated RBCs, Extramedullary Hematopoiesis

133
Q

Who gets oral thrush

A

Dentures, DM, Immunosuppressed, HIV

134
Q

What causes problem with Fragile X expansion

A

Hypermethylation (not breakage)

135
Q

What is unique to the duodenum

A

Brunner’s Glands - Located in SUBMUCOSA and secreted bicarb

136
Q

3rd Aortic Arch Derivatives

A

Common Carotid, Prox internal carotid

137
Q

4th Aortic Arch Derivatives

A

True Aortic Arch, Subclavian Arteries

138
Q

6th Aortic Arch Derivatives

A

Pulmonary arteries, Ductus arteriosus

139
Q

Effect of DKA on K

A

Incr excretion, Decr total stores, But increased extracellular

140
Q

Homeless man with increased fatiguability and exertional dypnea, LE edema, decr sensation in periphery + cardiac dilation and incr CO

A

B1 deficiency (Beriberi)

141
Q

Laryngeal edema and difficulty breathing after ACEi is due to

A

Kinin accumulation

142
Q

Long acting benzodiazepines

A

Chlordiazepoxide, Chlorazepate, Diazepam, Flurazepam (Carefully Choose Due to Falls)

143
Q

What are the dimorphic fungi?

A

Blasto, Histo, Paracoccidiodies, Coccidiodes, Sporothrix - Body Heat Purportedly Changes Shape

144
Q

Removal of apical ectodermal ridge from newly formed limb bud

A

Shortened length, Abnormal ventral dorsal

145
Q

Which aortic arch becomes Ductus Arteriosus

146
Q

Refsum’s disease

A

Myelin synthesis due to FA oxidation/synthesis disorder

147
Q

Findings in Sarcoidosis

A

GRAIN - Globulinemia, RA, elevated ACE, Interstitial fibrosis, Noncaseating granulomas

148
Q

pregnant woman hypotensive when supine

A

IVC compression –> lay on left side at night

149
Q

Especially effective CT agent for Hodgkin

A

Vincristine

150
Q

Location of the CTZ

A

Area postrema of the medulla

151
Q

CV manifestations of Turner’s

A

Bicuspid Aortic Valve, Preductal Coarction of Aorta

152
Q

Where is stratified squamous epithelium found in respiratory tract?

A

Oropharynx, Laryngopharynx, Anterior epiglottis, Upper half of posterior epiglottis, True vocal cords

153
Q

MOA of Alpha-Glucosidase inhibitors

A

Prevent disaccharide breakdown in intestine, thus absorption

154
Q

Role of adiponectin in T2DM

A

Low, increased by TZDs

155
Q

Annular pancrease is caused by

A

Abnormal migration (not apoptosis) of ventral pancreatic bud

156
Q

Bilateral lens subluxation, Massive stroke, Old renal infarcts

A

Homocysteinuria

157
Q

Most patients with Homocysteinuria respond dramatically to

A

B6 supplementation

158
Q

Fluoxetine overdose

A

Tachycardia, Drowsiness, Tremor, Vomitting, Nausea

159
Q

Physical exam finding in AV fistula

A

Pulsative mass with thrill on palpation, Auscultation reveals bruit over site

160
Q

SST decreases

A

Secretin, CCK, Glucagon, Insulin, Gastrin

161
Q

AA’s that are metabolized to Propionyl CoA

A

Isoleucine, Valine, Threonine, Methionine

162
Q

L-asparaginase

A

Antineoplastic by lowering circulating asparagine levels (leukemic cells collect asparagine from serum)

163
Q

Symptoms, Signs of congenital hypothyroidism

A

Poor feeding, Prolongued jaundice, Constipation, Hypotonia, Hoarse Cry, Macroglossia, Myxedema, Umblical hernia

164
Q

Which diuretic is used to decrease urine calcium

165
Q

Most common cause of SVC syndrome

A

Bronchogenic Carcinomas

166
Q

Most important HLA association with RA

167
Q

HLA associated with SLE

168
Q

HLA-A3 associated with

A

Primary Hemochromatosis

169
Q

Lambert Eaton vs MG

A

LE doesn not improve with AChEi’s, Strength improves with repeated testing, Enhanced neurotransmission with repetitive stimulation

170
Q

Limited vs Systemic Sclerosis Ab’s

A

Limited associated with Anti-centromere; Systemic with Anti-Topo 1

171
Q

Kernicterus is most likely to affect which parts of CNS

A

Basal ganglia, Thalamus, Cerebellum, Cerebral gray matter, Spinal cord

172
Q

Which hepatitis type is associated with PAN

A

Hep B (Hep C associated with Mixed Cryoglobulinemia)

173
Q

Symptoms of Acute Intermittent Porphyria

A

Abdominal pain, N/V, Peripheral neuropathy, Paralysis, Psychiatric

174
Q

Anti-mitochondrial Ab is a marker for

A

Primary Biliary Cirrhosis

175
Q

Treatment of Lithium-induced DI

A

Amiloride - Blocks channel that lithium uses to enter principal cell

176
Q

SLE on prednisone long term - what vitamin to supplement?

177
Q

Toxicity of Nitrosureas

A

Carmustine –> pulmonary fibrosis

178
Q

Accumulated intermediate in Acute Intermittent Porphyria vs Prophyria Cutanea Tarda

A

AIP = Porphobilinogen, PCT = Uroporphyrinogen

179
Q

MOA of Bacitracin

A

Inhibits transfer of mucopeptides to growing cell wall

180
Q

When do Red Neurons appear after cerebral ischemia?

A

12-24 hours

181
Q

When does liquefactive necrosis appear after cerebral ischemia?

182
Q

What can minors consent to when pregnant?

A

Prenatal care, Dx and Tx of STD’s, Drug and Alcohol Rehab; NOT abortions (or elective non-emergency procedures)

183
Q

Acute transplant rejection is mediated by

A

T cell response against HLA/MHC antigens

184
Q

Symptoms of Systemic Mastocytosis are induced by

A

Histamine releas

185
Q

What is pulsus paradoxis

A

Decr systemic blood pressure during inspiration (incr venous return deviates IV septum toward left and blocks outflow)

186
Q

When does Pulsus Paradoxis occur

A

Acute cardiac tamponade, Constrictive pericarditis, Severe obstructive lung dz, Restrictive CM

187
Q

Most significant factor in Shigellosis

A

Mucosal invasion, not toxin

188
Q

Confusion, Fever, Nausea, Elevated LFT’s four days after anesthesia

A

Massive hepatic necrosis from Halothane

189
Q

Hepatic Granulomatosis is associated with

A

Methyldopa, Hydralazine, Quinidine

190
Q

MOA and use of Primidone

A

First line for benign essential tremor; MOA unknown but metabolizes to phenobarbital

191
Q

Activation of Intrinsic vs Extrinsic pathway

A

Intrinsic by damaged vessel (XII), Extrinsice by tissue damage (TF, VII)

192
Q

Defect and major manifestations of Type 1 Dyslipidemia

A

LPL, ApoC –> Chylomicrons –> Acute pancreatitis, Xanthomas, HSM

193
Q

Defect and major manifestations of Type 2a Dyslipidemia

A

LDL, ApoB-100 –> LDL –> CAD, Corneal Arcus, Tendon Xanthomas

194
Q

Defect and major manifestations of Type 3 Dyslipidemia

A

ApoE –> Chylomicron, VLDL remnants –> CAD, PVD, Xanthomas

195
Q

Defect and major manifestations of Type 4 Dyslipidemia

A

ApoA-V –> VLDL –> Pancreatitis, Obesity, Insulin resistance

196
Q

Purine Antimetabolites

A

6-MP, 6-GP, Fludarabine, Cladribine

197
Q

Use of Cladribine

A

Hairy Cell Leukemia - Resistant to Adenosine Deaminase

198
Q

Bupropion is contraindicated with

A

Anything that can lower seizure threshold (eg electrolyte disorders from bulemia)

199
Q

Good samaritan law

A

Standard of care must be met (meant to protect people, including off duty medical professionals, who help in accidents/emergencies)

Uworld (16 decks)

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