Mixed Block Notes 3 Flashcards

1
Q
A
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2
Q

Defect in Chediak-Higashi

A

Phagosome-Lysosome fusion –> Recurrent pyogenic infections with Staph and Strep

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3
Q

Features of Chediak-Higashi

A

Immunodef, Albinism, Neurologic (nystagmus, cranial neuropathies)

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4
Q

Phosphorylation of NRTI’s vs NNRTI’s

A

NRTI’s must be phosphorylated

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5
Q

Most important mechanism of lead poisoning

A

Affinity for sulfhydryl groups –> Inhibition of d-ALA dehydratase and ferrochetolase

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6
Q

Formation of d-ALA

A

Succinyl-CoA and Glycine via Pyridoxal Phosphate cofactor

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7
Q

Cause and manifestation of acute serum sickness

A

Type 3 (IC deposition) –> Fever, Pruritic skin rash, Arthralgias, Fibrinoid necrosis, Hypocomplementemia

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8
Q

Serum sickness can be caused by

A

Chimeric monoclonal Ab’s, Nonhuman Ig’s, Nonprotein drugs (eg penicillin, cefaclor, bactrim)

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9
Q

Osteolytic phase of Paget’s is due to excess

A

RANK signaling, NFKB activation

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10
Q

Pattern of bone in Osteoblast phase of Paget’s

A

Dense, hypovascular, mosaic pattern of lamellar bone with irregular, haphazardly oriented sections separated by prominent cement lines

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11
Q

What stimulates Inhibin B secretion

A

FSH stimulation of Sertoli cells

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12
Q

MOA of trihexyphenidyl

A

centrally-acting anti-muscarinic

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13
Q

Anti-cholinergics such as benztropine and trihexyphenidyl should be avoided in elderly patients, esp with

A

BPH, Angle-Closure Glaucoma

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14
Q

S-100 protein function

A

Homodimeric calcium-binding proteins, important for protein p-lation, cell growth, and differentiation

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15
Q

S-100 marks what cells

A

Neural Crest (melanocytes, Schwann), Langerhans and other dendritic

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16
Q

DLCO depends on

A

Thickness and total SA of alveolar capillary membrane, Hematocrit, Total volume of pulmonary capillary blood

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17
Q

DLCO in emphysema vs chronic bronchitis

A

Reduced in Emphysema, Normal in CB

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18
Q

Mechanism of Bohr effect

A

CO2 –> H+ and HCO3+ –> H+ binds histidine side chains of Hb –> Stabilize deoxygenated form of Hb

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19
Q

What happens to H+ and HCO3 in RBC from CO2

A

H+ binds Hb; HCO3 exchanged for Cl (Cl enters)

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20
Q

Which step of Glycolysis utilizes NAD+

A

G3P –> 1,3-BPG

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21
Q

When is FADH2 produced

A

During conversion of succinate to fumarate

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22
Q

Synthesis of Carnitine

A

Lysine + Methionine via Vit C cofactor

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23
Q

Citrate is formed from

A

Condensation of Acetyl CoA w/ OAA

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24
Q

Heart Failure definition

A

(1) Cannot pump enough blood to meet demand; or (2) Can onliy do so from elevated ventricular filling pressure

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25
Q

Diarrhea in pellagra results from

A

Columnar epithelium atrophy

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26
Q

NAD functions as a coenzyme for

A

Dehydrogenases involved in metabolism of fats, carbs, and amino acids

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27
Q

Niacin can be synthesized endogenously from

A

Tryptophan

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28
Q

Populations that primarily subsist on __ are prone to developing pellagra

A

Corn (niacin in corn is bound and unabsorbable)

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29
Q

Pellagra is less commonly seen in what patient populations

A

Carcinoid, Prolonged INH, Hartnup (more commonly in alcoholics and chronic disease)

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30
Q

Arginine is a precursor of

A

NO, Urea, Ornithine, Agmatine, Creatine

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31
Q

Orotic acid is a precursor of

A

Pyrimidine

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32
Q

Ab-dependent cellular cytotoxicity is defense against

A

Virus, Parasite

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33
Q

Function of MPO

A

Hypochlorite from H2O2 and Chlorine

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34
Q

Testicular feminization syndrome =

A

Complete Androgen Insensitivity = Absent Wolffian and Mullerian structures

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35
Q

Pulmonary hypertension is usually found in patients with

A

Scleroderma

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36
Q

H1 receptors are found in

A

Vascular endothelium, Bronchial smooth muscle

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37
Q

5 important classes of meds with Anti-muscarinic effects

A

Atropine, TCA’s, H1 blockers, Neuroleptics, Anti-Parkinson - NATHA

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38
Q

MOA of Ribavirin

A

Nucleoside antimetabolite - (1) Lethal hypermutation, (2) Inhibit RNA polymerase and IMP DH (depleting GTP), (3) Defective 5’-cap formation on viral mRNA, (4) Modulating a more effective immune response

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39
Q

Bone turnover is regulated by ratio of

A

RANKL to OPG - incr when RANK-L high and OPG low

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40
Q

How does PTH activated Osteoclasts

A

Stimulates Osteoblasts to upregulate RANKL and secrete M-CSF –> Osteoclast maturation

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41
Q

Function of Osteoprotegrin

A

Decoy RANK-L receptor

42
Q

Arachnodactyly, Scoliosis, and Aortic Root Dilatation are signs of

A

Marfan

43
Q

Macroorchidism, Large Jaw, and Intellectual disability are signs of

A

Fragile X

44
Q

Top 3 causes of meningitis in neonates

A

GBS, E coli, Listeria

45
Q

Courses between Biceps brachii and Coracobrachialis

A

Musculocutaneous

46
Q

Courses between Flexor Carpi Ulnaris and Flexor Digitorum Profundus in forearm

A

Ulnar

47
Q

Courses between Flexor Digitorum Profundus and Flexor Digitorum Superficialis

A

Media N

48
Q

Substrate for PRPP synthetase

A

Ribose-5-Phosphate

49
Q

Gout occurs with increased frequency in patients with activating mutations of

A

PRPP Synthetase

50
Q

First line for Acute Gouty Arthritis

A

NSAIDs (Colchicine second)

51
Q

How does pregnancy affect gallstones?

A

Estrogen-induced cholesterol hypersecretion (HMG CoA Reductase); Progesterone reduces bile acid secretion and slows gallbladder emptying

52
Q

Fluid-filled cavitiy in liver + Fever, Chills, RUAbdominal Pain

A

Most likely bacterial abscess in developed nation

53
Q

Pyogenic bacteria most commonly gain access to liver via

A

Biliary tract, Portal vein pyema, Hepatic artery

54
Q

How does RBC carry CO2

A

15% as carbamate on Hb, Remained as bicarb ion w/in RBC

55
Q

Diuretic often used in management of Cerebral edema and Incr ICP

A

Mannitol

56
Q

Overaggressive treatment with osmotic diuretic therapy

A

Excessive volume depletion and eventual hypernatremia

57
Q

Osmotic diuretics should be used cautiously in what patients

A

CHF, Pre-existing pulmonary edema

58
Q

Spironolactone side effects

A

Hyperkalemia, Gynceomastia, Decr libido, Erectile dysfunction

59
Q

The risk of statin myopathy is increased when

A

Fibrates and/or Niacin also used

60
Q

Drugs that can cause myopathy

A

SGFC PHIN - Statins, GC’s, Fibrates, Colchicine, Penicillamine, Hydroxychloroquine, IFNa, Niacin

61
Q

MOA of Fenodolpam

A

Benazepine derivative of DA –> Selective DA-1 agonist with no effect on alpha or beta receptors

62
Q

Stimulation of DA receptors in kidneys

A

Improves RBF and Na and Water excretion

63
Q

Fenoldopam is indicated for

A

Short term management of severe HTN

64
Q

Use and risk of Nitroprusside

A

Most effective agent for most cases of HTN emergency –> Cyanide toxicity

65
Q

Vimentin is a marker for

A

Mesenchyme

66
Q

Chromogranin A

A

Neuroendocrine tumors

67
Q

Imperforate anus is most commonly associated with

A

GU malformation - VACTERL (vertebral, anal atresia, cardiac anomalies, TE fistula, esophageal atresia, renal anomalies, limb anomalies)

68
Q

Fibrinous pericarditis is most commonly caused by

A

MI, RF, Uremia; Also viral

69
Q

Pericardial knock

A

Brief, high frequency, precordial sound heard shortly after S2 in constrictive (chronic) pericarditis

70
Q

Heme in the liver is synthesized for

A

CYP450 system

71
Q

Acute Intermittent Porphyria can be precipitated by

A

Phenobarbital, Griseofulvin, Phenytoin, Low calorie diet, Alcohol –> All decr hepatic heme –> Incr ALA synthase activity

72
Q

Heme synthesis enzymes inhibited by lead

A

ALA dehydratase, Ferrochetolase

73
Q

Influenza vaccine induces

A

Neutralizing antibodies against Hemagglutinin

74
Q

Why don’t killed vaccines stimulate CD8 response

A

They don’t enter host cell for MHC Class 1 presentation

75
Q

Sensory nerve to parietal pleura

A

Phrenic to Diaphragmatic and Mediastinal; Intercostal to remainder

76
Q

Superficial Inguinal Nodes drain

A

Nearly all cutaneous lymph from umbilicus to feet, including external genitalia and anus

77
Q

Lymph from Glans penis and cutaneous portion of posterior calf drain into

A

Deep inguinal lymph directly (bypassing superficial)

78
Q

Effect of cyanide poisoining

A

Inhibits cytochrome C oxidase - SaO2 of venous blood increases due to failure of oxygen unloading

79
Q

Crescents of RPGN are composed of

A

Proliferated glomerular parietal cells, Monocytes, Macrophages, Fibrin

80
Q

Inactivated HFE increases iron by

A

(1) Incr DMT1 on enterocytes; (2) Decr hepcidin –> Incr ferroportin expression

81
Q

Atypical antipsychotics most and least likely to cause EPS

A

Clozapine least likely, Risperidone most likely

82
Q

Top 3 risk factors for Coronary Heart Disease

A

Noncoronary Athersclerotic Disease, Diabetes Mellitus, CKD

83
Q

Pineal Tumors most commonly cause

A

Parinauds, Precocious puberty, Obstructive hydrocephalus

84
Q

Short acting insulins

A

Lispro, Aspart, Glulisine

85
Q

When to use regular insulin

A

DKA

86
Q

What accounts for delayed onset of regular insulin

A

Dimer and hexamer formation (short acting are monomers)

87
Q

NPH insulin works by

A

Crystalline suspension with protamine and zinc –> Delays absorption

88
Q

Detemir insulin works by

A

FA bound to lysine –> Binds albumin and slowly dissociates

89
Q

MAOi’s

A

MAO Takes Pride In Shanghai = Tranylcypromine, Phenelzine, Isocarboxazid, Selegline (B selective)

90
Q

SSRI’s

A

Flashbacks Paralyze Senior Citizens = Fluoxetine, Paroxetine, Sertraline, Citalopram

91
Q

SNRI’s

A

Venlafaxine, Duloxetine

92
Q

How quickly after ischemia does loss of contractility occur in cardiomyocytes?

A

60 seconds

93
Q

At what timepoint is myocardial ischemia irreversible

A

30 minutes

94
Q

Ligands for Receptor Tyrosine Kinase vs JAK/STAT

A

Growth Factors bind RTKs; JAK/STAT bound by Cytokines, Growth Hormone, Prolactin, IL-2, EPO

95
Q

Microscopy of Membranous Glomerulopathy

A

LM - Mesangial proliferation; IF - Ig and C3; EM - Spike and Dome

96
Q

T-ALL is most likely to present

A

Anterior Mediastinal mass that compresses great vessels and esophagus

97
Q

EKG progression of Acute Transmural Infarct

A

Peaked T waves –> STE –> Q waves

98
Q

Imaging in Gallstone Ileus shows

A

Intestinal gas (obstruction), Air in biliary tree

99
Q

Boerhaave Syndrome

A

Transmural tear (vs Mallory Weiss which is mucosal)

100
Q

Cricopharyngeal motor dysfunction occurs due to

A

Diminished relaxatin of pharyngeal muscles during swallowing

101
Q

Renal consequences of Ethylene Glycol ingestion

A

Oxalate crystals, Tubular epithelial damage (ballooning and vacuolar degeneration mostly in PCT)