Mixed Block Notes 2 for import Flashcards
1
Q
Laplace’s Law
A
P=2T/r
2
Q
Uptake of unconjugated bililrubin occurs via
A
Organic Anion Transporting Polypeptide (OATP) - passive
3
Q
Conjugated bilirubin is secreted from hepatocytes via __? This is blocked in __?
A
MRP2 (active organic anion transporter) - Criggler-Najjar, Rotor
4
Q
Concentration of Bicarb along Proximal Tubule
A
Actively reabsorbed due to Carbonic Anhydrase –> Acetazolamide causes excretion
5
Q
How to differentiate MAC from MTB in HIV patient
A
MAC has anemia, HSM, incr ALP/LAD due to widespread involvement of RES; Also grows well at 41degC
6
Q
Prophylaxis and treatment of MAC
A
Proph with Azithromycin; Tx with Azith + Ethambutol or Rifampin
7
Q
Absence of ganglion cells in colonic wall causes
A
affected segment to narrow (can’t relax)
8
Q
Which parts of GI tract are always involved in Hirschprung
A
Since NCC’s migrate caudally, rectum always involved
9
Q
How does metabolism of drug relate to drug-induced lupus?
A
Slow acetylators more likely (hydralazine, procainamide)
10
Q
Most liver hydrolysis involve what enzymes
A
Amidase, Esterase
11
Q
When is Exenatide used?
A
(GLP-1) Suboptimal glucose control in patients already on Metformin and Sulfonylureas
12
Q
Ventricular response to AF is dependent on
A
Transmission through AV node
13
Q
What types of viral genomic material can be individually infective?
A
Positive Linear ssRNA
14
Q
Interstitial pneumonia in transplant patient
A
CMV
15
Q
Treatment of C. diphtheria
A
Antitoxin –> Penicillin or Erythromycin –> DPT vaccine
16
Q
Most common cause of death from C diph
A
Cardiomyopathy
17
Q
Features of Cutaneous Neurofibromas
A
Rubbery, Buttonholing
18
Q
Features of Wiskott-Aldrich
A
Thrombocytopenic Purpura, Eczema, Recurrent infections
19
Q
Acute Narrow Angle Glaucoma is often precipitated by
A
Anticholinergics –> Anterior chamber narrows, obstructing trabecular meshwork
20
Q
Confirmatory test for calculus cholecystitis
A
HIDA scan (not ultrasound)
21
Q
Stool osmotic gap? What increase?
A
Colonic fermentation products –> Increased when poorly absorbable substances present (lactose)
22
Q
Nonpolar Aliphatic Hydrophobic AA
A
VIP GAL - Valine, Isoleucine, Proline, Glycine, Alanine, Leucine
23
Q
Aromatic Hydrophobic AA
A
Try Trippin w/ Phenytoin - Tyrosine, Tryptophan, Phenilalanine
24
Q
Basic/Positive AA’s
A
Shallow HAL is positive - Hystidine, Arginine, Lysine
25
Acidic/Negative AA's
Glutamate, Aspartate
26
Hydrophilic uncharged AA's
Come, Take My GAS! - Cysteine, Threonine, Methionine, Glutamine, Asparaine, Serine
27
When is Arginine essential?
During + nitrogen balance
28
Non-lactose fermenting, Oxidase negative organism in Sickle Cell Osteomyelitis
Salmonella
29
Oxidase Positive bugs
Vibrio, Pseudomonas, Campylobacter, Helicobacter, Neisseria, Moraxella, Legionella
30
Main virulence factor of S aureus in osteomyelitis
Adhesion to collagen
31
Apo E4 predisposes to
Late-onset familial Alzheimer's
32
Hypertrophic CM trait
AD - Beta myosin heavy chain
33
MOA and use of Dezrazoxane
Iron chelating agent to prevent cardiotoxicity from Anthracyclines
34
Location of 5-HT3 receptors implicated in chemo n/v
Peripherally in presynaptic nerve terminals of vagus in GI, Centrally in CTZ and Solitary nucleus/tract
35
Loop diuretics stimulate release of
Prostaglandins --> incr renal BF
36
Most common benign tumor of breast
Fibroadenoma (<35, often bilateral, cyclinc)
37
Fibroadenoma histology
Cellular, often myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces
38
Function of vWF
Platelet adhesion by crosslining GpIb with exposed collagen underneath damaged endothelium
39
Secondary role of vWF
Carrier protein for factor VIII
40
Proteins C and S act to inactivate
V and VIII
41
Thrombin is produced from Prothrombin by
Activated Factor X
42
Growth Hormone binds to a __ receptor
JAK-STAT
43
Lecithin-Sphingomyeline Ratio is a marker for
Lung maturity (>1.9 = mature)
44
Mechanism of methicillin resistance
Alterations in PBP2a (also affects cephalosporins)
45
Immunity to reinfection by influenza is mediated by
Circulating antibodies against Hemagluttinin
46
Tumor originating from collecting duct cells
Renal Oncocytoma
47
Transitional cell tumors of pelvis are often what morphology
Papillary
48
Niacin-induced flushing is mediated by
Prostaglandins
49
___ reduces pain by decreasing level of substance p in PNS
Capsaicin
50
Clinical uses of Valproate
Anticonvulsant (absence, myoclonic, grand mal) AND mood stabilizer (acute mania, bipolar)
51
Anticonvulsants used as mood stabilizers in bipolar
Valproate, Carbamazepine, Lamotrigene
52
Carbamazepine indications
Trigeminal Neuralgia, Manic episodes, Partial and generalized seizures
53
MOA and use of Olanzapine
second gen antipsychotic
54
QT interval reflects
Myocyte AP duration
55
Two congenital syndromes that cause QT prolongation
1. Jervell Lange-Nielson (AR, neurosensory deafness); 2. Romano-Ward (AD, no deafness)
56
Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of ox phos are though to cause
Genetic Dilated CM's
57
Mutations of calcium-binding SR protein might underly
Arrhythmogenic RV Cardiomyopathy --> Progressive fibrofatty replacement of RV
58
Extramedullary hematopoesis is most frequently associated with
Chronic Hemolytic Anemias (eg beta thal)
59
Pentazocine
Opioid narcotic designed to produce analgesia with little to no abuse potential (weak antagonist at mu)
60
Short-acting benzos
ATOM - Alprazolam, Triazolam, Oxazepam, Midazolam
61
Long-acting benzos
Choose Carefully Due to Falls - Chlordiazepoxide, Chlorazepate, Diazepam, Flurazpam
62
Malabsorption, Diarrhea, PAS-positive granules in intestinal macrophages
WHIPPLES DISEASE - Tropheryma whippelii
63
Recurrent infections with Strep pneumo, H flu, and Moraxella indicate
Humoral immunodeficiency
64
Pneumocystis and chronic mucocutaneous candidiasis indicate
T cell deficiency
65
Immotile cilia syndrome presents in newborn period with
Respiratory distress --> Recurrent Otitis Media, Bronchitis, Sinusitis (opprotunistic infections like PCP unusual)
66
Agammaglobulinemia means susceptible to
Extracellular, encapsulated bacteria
67
Exchange of viral dna in coinfection by non-segmented viruses
Recombination
68
Viral phenotypic mixing
Coinfection leads to one virus with nucleocapsid protein from another
69
AE's of TZD's
Weight gain, edema, CHF
70
Damage to the Caudate is associated with
Transient hemiparesis and frontal lobe symptoms such as inattentiveness, abulia, forgetfulness
71
Compression fracture in elderly woman --> Calcium and PTH?
Normal
72
Driver of respiratory function in COPD vs normal
pO2 in COPD vs pCO2 normally --> Supplementary O2 in COPD will lead to respiratory suppression and coma
73
Main toxin of C perf
Lecithinase (phopholipase C, alpha toxin)
74
Insular cortex is associated with
Integrating body states w/ emotions (limbic); ANS control; Conscious experience of visceral sensations
75
Damage to internal vs external Globus Pallidus
Internal --> Excessive movement; External --> Decreased
76
Role of D arm of tRNA
Dihydrouracil residues --> Helps facilitate correct tRNA recognition by proper Aminoacyl tRNA synthetase
77
Role of T arm of tRNA
Binding tRNA to ribosomes
78
Only RNA that contains thymidine
T RNA
79
NE to Epinephrine requires
SAM - PNMT enzyme
80
BH4 is required for synthesis of
Tyrosine, DOPA, Serotonin, Prolactin
81
Winter's Formula
PaCO2 = (1.5*HCO3) + 8 +/- 2
82
Media for growing V cholerae
Alkaline - extremely acid sensitive organism
83
Mechanism of hepatocyte damage in Hep B
CD8 response to viral antigens on cell surface
84
Regulatory HIV genes required for replication
Tat, Rev
85
Structural HIV genes
Gag, Pol, Env
86
Products of Gag, Pol, Env genes in HIV
Gag - p24, p7; Pol - RT, Integrase, Protease; Env - gp120, gp41
87
Function of HIV nef gene? Rev? Tat?
Nef - Downregulate CD4 and MHC 1; Rev - Transport of unspliced viral transcripts out of nucleus; Tat - Protein that transcriptionally activates other viral genes
88
Features of Colitis-associated CRC vs sporadic
(1) younger; (2) Flat or non-polypoid dysplastic precursor; (3) Mucinous and/or signet ring morphology; (4) early p53 and late APC - opposite of sporadic; (5) proximal colon; (6) Multifocal
89
MOA of Varenicline
Partial agonist at nicotinic ACh receptor
90
Pentamidine is used for
Prophylaxis and tx of PCP
91
Nifurtimox is used for
Chagas treatment
92
Normal alveolar pO2
104 mmHg (if higher, poor perfusion)
93
When is O2 equilibration diffusion-limited
Emphysema, Fibrosis, Very high blood flow (ie exercise)
94
A, I, and H bands
A is thick myofilament, I is Actin only, H is Myosin only
95
Pharmacodynamic Drug Antagonism
Drug can antagonize or prevent effect of another drug or endogenous substance
96
Pharmacokinetic drug interaction
eg CYP inducers
97
Treatment of recurrent C diff colitis
Fidaxomicin
98
MOA of Fidaxomicin
Inhibits sigma subunit of RNA polymerase; Less effect on normal flora; Poor oral
99
Most common cystic fibrosis mutation and result
dF508 --> Impaired post-translational processing and results in proteasome degradation
100
AA's with three titratable protons
Acidics, Basics, CT = Glutamate, Aspartate, Histidine, Arginine, Lysine, Cysteine, Tyrosine
101
Salicylate acid base disorder
(1) Rapid respiratory depression causing alkalosis; (2) A few hours later metabolic acidosis
102
Effect of ANP on kidney, Adrenals, BVs
Dilates afferent arterioles, Inhbitis Na reabsorption, Restrict aldosterone secretion, cGMP-mediated veno- and arteriodilation
103
Type of MI usually associated with Bradycardia
Inferior - SA/AV nodal branch block
104
ANS drug that can cause Glaucoma
Atropine --> Midriasis --> Narrowing of anterior chamber
105
Anti-mitochondrial Ab's
Primary biliary cirrhosis
106
Anti-Smith Ab's
Anti-snRNP = Specific for SLE
107
Rapid atrophy and shrinkage of liver on autopsy
Halone-induced liver failure
108
Shortest half life pro-coagulant factor
Factor VII (PT)
109
What enzyme produces urea in Urea cycle
Arginase (Arginine --> Urea + Ornithine)
110
Excessive amounts of Orotic acid are usually found in
OTC deficiency, Citrullinemia, Arginosuccinate aciduria
111
Low levels of C1 esterase inhibitor
Hereditary Angioedema
112
Mechanisms of C1 esterase inhibitor
Inhibit C1 --> Activated C1; Inactivates Kallikrein (which converts Kininogen to Bradykinin)
113
16S rRNA function
Component of 30S subunit --> Expresses sequence complementary to Shine-Dalgarno in all prokaryotic mRNA
114
23S rRNA function
Peptidyltransferase - Peptide bond formation
115
Pontiac Fever
Legionella --> Acute, flu-like, self-limited disease
116
Features of Legionnaire's Disease
Recent expsoure to contaminated water, Pneumonia, High Fever; Sometimes GI, Relative bradycardia, neurologic
117
Most common lab finding in Legionnaire's
Hyponatremia
118
Bilateral ACA occlusion
LE motor, Behavioral (abulia), Urinary incontinence
119
Spread of H flu vs N meningitidis to meninges
H flu uses lymphatics, N men is hematogenous, Both from Pharynx
120
MOA of Organophosphates
AChE inhibitors
121
Bromoacetylcholine MOA
Inhibits Choline Acetyltransferase
122
Nicotininc receptor antagonists
Pancuronium, Tubocurarine
123
Hemicholinium MOA
Choline import into presynaptic terminal
124
Train of Four seen in Non-depolarizing blockade
eg Tubocurarine - Slanted within group, Group increases each 4
125
Train of Four seen in Depolarizing blockade
Equal within group, Group increases each four (phase 1) --> Resembles slanting of non-depolarizing in phase 2
126
Neostigimine in Phase 1 vs 2 of Succinylcholine NMB
Augments blockade in Phase 1, Reverses it in Phase 2
127
Duration of Succinylcholine action depends on
Diffusion out of NMJ and metabolism by plasma cholinesterase
128
Nitrate with best bioavailability
Isosobide Mononitrate
129
Hep B Window Period
Time lag betwee HBsAg disappearing and Anti-HBs appearing
130
Most specific marker for diagnosis fo acute Hep B
Anti-HBc IgM --> Present in window period
131
Vitamin E deficiency manifestations
Neuromuscular disease (myopathy, ataxia, pigmented retinopathy, dorsal column) and Hemolytic anemia
132
Vitamin E primarily serves to
Protect fatty acids from oxidation --> Neurons and erythrocytes most susceptible
133
Vitamin C excess
Nausea, Abdominal pain, Diarrhea, Stones
134
Physostigmine vs Neostigmine and Edrophonium
Neostigimine and Edrophonium are Quaternary Amines and can't cross BBB
135
Tarry stool and fatigue are seen with what CT agents
Alkylating agents (upper GI bleed)
136
Abdominal pain and jaundice may be seen with what CT agent
Mercaptopurine (cholestasis and hepatitis)
137
Flagellate skin discoloration is seen with what CT agent
Bleomycin (along with pulmonary fibrosis)
138
Nitroblue Tetrazolium testing
Properly functioning PMNs produce ROS that reduce yellow NBT to dark blue formazan that precipitates within the cells
139
DHR flow testing
NADPH oxidase shows decr fluorescence
140
NBT and DHR testing in MPO deficiency
Normal
141
Pyruvate kinase deficiency is a common cause of
Chronic Hemolytic Anemia
142
Ortner Syndrome
Mitral Stenosis --> LA enlargement --> Impingement on Recurrent Laryngeal N
143
Location of Glut-2
Regulation of Insulin Release --> Hepatocytes, Beta cells, Renal tubular cells, Small intestine
144
Location of Glut-3
Placenta, Neurons
145
What is commonly found regarding uterus on vaginal vaginal examination in Endometriosis
Nodularity of uterosacral ligaments, Fixed retroversion of uterus
146
Ectopic endometrial tissue secretes
PG's --> Interfere with ovulation and tubal function --> Infertility
147
Adenomyosis
Presence of endometrial glands w/in uterin myometrium (presents with bleeding, painful menses, and enlarged uterus unlike endometriosis)
148
When to give Ribavirin with RSV?
Confirmed, severe RSV at risk for dz progression (immunodeficiency, prematurity, cardiopulmonary disease)
149
Mechanism of Shiga-like toxin
AB - A subunit prevents binding of tRNA to 60S ribosomal subunit
150
Bactrim is drug of choice for
Pneumocystis jiro, Toxoplasma, Nocardia
151
Hyoscyamine
Anti-muscarinic to counteract AChEi in Myasthenia Gravis
152
Side effects of Thiazide Diuretics
Hyper Glycemia Lipidemia Uricemia Calcemia
153
Medication-induced fat redistribution
Corticosteroids, HAART (Protease inhibitors)
154
Chronic Eosinophilic Bronchitis in asthmatics involves
Bronchial wall infiltration by numerous activated eosinophils in response to IL-5 by allergen-activated TH2 cells
155
Class 3 Anti-arrhythmics
Amiodarone, Ibutilide, Dofetilide, Sotalol
156
Which vitamin supplement should be given to child with Measles
Vitamin A - Reduces time to recovery from pneumonia and diarrhea, as well as risk of death
157
Which HIV drug to give to pregnant women
Zidovudine
158
Protein secondary structure is due to
Hydrogen bonds (Tertiary due to ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds)
159
E coli aquired ability to form pili via
Conjugation
160
Strep pneumo aquired capsule via
Transformation
161
Function of Thyroid Peroxidase
Oxidize inorganic iodide to organic iodine; Formation of monoiodotyrosine and diiodotyrosin; Coupling of these to iodotyrosines
162
Lab studies in HUS
Only bleeding time elevated
163
Bacitracin MOA
Prevents mucopeptide transfer into growing cell wall
164
Trimpethroprin, Methotrexate, and __ inhibit DHFR
Pyrimethamine
165
Important Bactrim AE's
Hyperkalemia, Megaloblastic Anemia
166
Serotonin Syndrome effects
HARM - Hyperthermia, ANS instability, Rigidity, Myoclonus
167
Drugs that precipitate Serotonin Syndrome
TTYL - Tramadol, Triptans, trYcyclics, Linezolid
168
Features of Myotonic Dystrophy
Frontal balding, Gonadal atrophy, Arrhythmia (My toupe, my testicles, my ticker); sustained grip, type 1 fiber loss
169
Most important signalers in Coronary autoregulation
Adenosine, NO
170
What causes NO release in coronaries
Pulsatile stretch, Flow shear stress
171
What subtype not stimulated by NE
Beta 2
172
Skeletal Muscle Depolarization -->
L-type channel-RyR mechanical coupling (no significant flux of Ca across L-type Ca channel) --> RyR1 opening --> Binds Troponin C
173
Cardiac Muscle Depolarization -->
L-type Ca influx on PM --> RyR2 opening
174
Smooth Muscle Depolarization -->
v-gated L type Ca influx --> Calmodulin (no troponin) --> Myosin light chain kinase --> P-lation of myosin
175
Nonselective beta blocker with a1 blocking activity
Labetolol
176
Systemic sequelae with Diphtheria
Myocarditis, Heart Failure, Neurotoxicity
177
EKG leads for LAD
V1-V3
178
Type 3 collagen is found in
Granulation tissue, Skin, Lungs, Blood vessels
179
Bell vs Diaphragm
Bell = Low freq; Diaphragm = High
180
S3 on end expiration
More audible, Heart closer to chest wall
181
Localized amyloidosis confined to cardiac atria
ANP-derived (elderly)
182
Prolyl Hydroxylase -->
Proline on Procollagen --> Stable triple helix
183
Lysyl Hydroxylase -->
Stronger
184
Bepridil
CCB - Second line anti-anginal drug
185
Loud P2 =
Pulmonary hypertension
186
Kussmaul =
Paradoxical rise in JVP during inspiration
187
Don't use DPH-CCB with
Acute Coronary Syndrome (reflex tachycardia)
188
Digoxin toxicity
Hyperkalemia, Vision, N/V/D
189
Afib with RVR: tx -->
CCBs, BBs, then Digoxin second line
190
Lidocaine is for what arrhythmias
Ventricular, not Atrial
191
Mechanism of Fibrates
Peroxismal Proliferator-Activated Receptor Alpha --> LPL activity increase --> Decr TB, Raise HDL
192
How do assess severity of Mitral Regurg
Presence of S3 gallop
