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Mixed Blocks Notes 7 Flashcards

1
Q

Treatment of Restless Leg Syndrome

A

(1) Limit alcohol, nicotine, caffeine; (2) Dopamine Agonists (eg pramipexole)

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2
Q

Restless Leg is common in those with

A

Iron Deficiency, CKD, Diabetes

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3
Q

Treatment of Cataplexy

A

Muscarinic Antagonists (narcolepsy)

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4
Q

When does the neural tube form

A

Third week of fetal life

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5
Q

When do the neuropores close

A

Week Four = Anterior on day 25, Posterior on day 27

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6
Q

Tensilon Test

A

Tx of MG pt with Edrophonium (short acting AChEsterase inhibitor); Lack of improvement = cholinergic crisis

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7
Q

What mediates rapid decrease in myocardial calcium before relaxation

A

Na/Ca pump sarcolemmal pump; and Ca-ATPase

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8
Q

Major immune mechanism against Giardia

A

CD4 and IgA

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9
Q

RUQ pain after opiate

A

Biliary colic from contraction of SM cells in sphincter of oddi

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10
Q

Mu opioid effects on Histamine, Parietal Cells

A

Increase histamine (don’t use in hypotension); Decr parietal gastric acid secretion

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11
Q

Non-caseating granulomas - Crohn’s or Ulcerative colitis

A

Crohn’s

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12
Q

Unidirectional enzymes in glycolysis

A

Gluco/Hexokinase, PFK-1, Pyruvate Kinase

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13
Q

F-2,6-BP activates what?

A

PFK1 = Glycolysis

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14
Q

Insulin vs Glucagon effects on PFK1

A

Insulin –> PFK2 –> F-2,6-BP –> PFK-1 = Glycolysis; Glucagon inactivates PFK-2 via phosphorylation

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15
Q

What causes myocardial swelling with ischemia?

A

No ATP to pump Na (Na/K) or Ca (Ca-ATPase) out

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16
Q

Mechanism of nitrites in cyanide poisoning

A

Oxidized iron to Fe3+, which binds and sequesters cyanide, preventing it from binding cytochrome a-a3

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17
Q

What is used beside nitrites in cyanide poisoining

A

Thiosulfate –> Sulfate binds cyanide

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18
Q

Most common cause of aPTT prolongation

A

Lupus anticoagulants

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19
Q

Common findings in PCA stroke

A

(1) Contralateral hemianopia; (2) Contralateral parasthesias and numbness [thalamus]

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20
Q

Cranial Nerves supplied by PCA

A

III and IV

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21
Q

Why gallstones in Crohn’s

A

Can’t resorb bile acids in terminal ileum

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22
Q

Rate limiting step in catecholamine synthesis? What blocks this?

A

Tyrosine Hydroxylase - Metyrosine

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23
Q

What maintains cardiac output in acute/subacute aortic regurgitation

A

HR temporarily, but mainly increased LV preload

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24
Q

Carbamazepine adverse effects

A

(1) BM suppression; (2) Hepatotoxic; (3) SIADH

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25
Q

Drugs that cause SIADH

A

Carbamazepine, Cyclophosphamide, SSRI’s

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26
Q

Allergic contact dermatitis is due to

A

Antigen presentation by Langerhans cell –> CD4 response

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27
Q

Acanthosis

A

Incr in spinosum (think psoriasis)

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28
Q

Hypergranulosis

A

Excessive granulation of s granulosum (think lichen planus)

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29
Q

Max and min pressures in RV, Pulmonary Artery

A

4-25 in RV; 9-25 in PA

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30
Q

Treatment of PSGN

A

Loop diuretics and Vasodilators to relieve edema and hypertension

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31
Q

Most important prognostic indicator in PSGN

A

Age

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32
Q

Osteoporosis tends to affect what bone

A

Trabecular - Vertebral bodies, Neck of femure

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33
Q

what is characteristic of hyperparathyroidism

A

Subperiosteal resorption with cystic degeneration

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34
Q

Vit D bone loss is characterized by

A

Excessive unmineralized osteoid

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35
Q

Osteopetrosis is characterized by

A

Persistance of primary, unmineralized spongiosa in medullary canals

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36
Q

Drugs that cause seizures

A

I BItE my tongue - INH, Buproprion, Imipenem, Enflurane

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37
Q

Most common sites of intracranial hemorrhage

A

Deep brain = Basal ganglia, Cerebellar nuclei, Thalamus, Pons

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38
Q

Cerebral amyloid angiopathy tends to occur in what areas

A

Lobar/cortical parenchyma

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39
Q

Findings with Pulmonary Silicosis

A

Nodular densities and eggshell calcifications

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40
Q

Pulmonar berylliosis findings

A

Resembles sarcoidosis (nodular infiltrates, enlarged lymph nodes, non-caseating granulomas), but is not strongly associated with pleural plaques or effusions

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41
Q

Findings in coal worker’s pneumoconiosis

A

Multiple discrete nodules most prominent in upper lung zones

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42
Q

X ray of hypersensitivity pneumonitis due to inhalation of organic dust

A

Diffuse nodular interstitial infiltrates

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43
Q

Granulomatous destruction of liver bile ducts

A

Primary biliary cirrhosis

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44
Q

Intrahepatic hydatid cysts

A

Echinococcus

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45
Q

Mechanism of gingival hyperplasia with phenytoin

A

PDGF

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46
Q

Phenytoin toxicity mainly effects

A

Cerebellum and vestibular system –> Ataxia, Nystagmus

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47
Q

Systolic ejection murmur that increases with standing? Decreases with standing?

A

Hypertrophic CM - increases; Valvular aortic stenosis - decreases

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48
Q

Wide splitting of S1 accentuated by inspiration

A

Delayed closure of tricuspid = Complete right bundle branch block or tricuspid stenosis

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49
Q

Carboxylation of glutamate residues

A

Vitamin K

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50
Q

Erythropoeisis and peripheral blood smeal in Acute Intermittent Porphyria

A

Erythropoeisis and peripheral blood smear normal

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51
Q

Opiates used for diarrhea

A

Loperamide, Diphenoxylate

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52
Q

Pathogens most responsible for post-flu pneumonia

A

Pneumococcus, S aureus, H flu

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53
Q

Mycobacterium kanasaii symptoms

A

Pulmonary tuberculosis-like symptoms

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54
Q

High intracellular NADH in setting of hypoglycemia

A

Fuel other than glucose is being metabolized

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55
Q

High NADH/NAD+ ratio

A

Pyruvate to lactate and OAA to malate => Inhibits gluconeogenesis

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56
Q

What antibody is rarely seen in drug-induced Lupus

A

Anti-dsDNA (look for anti-histone)

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57
Q

Range for microalbuminuria

A

30-300 ug/mg creatinine

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58
Q

MOA of Adenosine in Supraventricular Tachy

A

Slows conduction thru AV node by hyperpolarizing the nodal pacemaker and conducting cells

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59
Q

All inhalational anesthetics, except what, are respiratory depressants

A

NO

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60
Q

Inhalational anesthetics preferred in pts with asthma

A

Halothane, Sevofluorane - Bronchodilation properties

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61
Q

Inhalational anesthetic effects on hepatic, renal, and cerebral BF

A

Decr hepatic; Incr cerebral; Decr GFR and RPF

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62
Q

Main side effects of bile acid binding resins

A

HyperTG (incr VLDL and TG synthesis), GI upset, Malabsorption, Gallstones

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63
Q

First line treatment of hypertriglyceridemia

A

Fibrates - decr hepatic synthesis

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64
Q

Clinical manifestations of schistosomiasis result from

A

Th2-mediated granulomatous response directed against eggs (with eos and mac’s)

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65
Q

Periportal Pipestem Fibrosis

A

Hepatic schistosomiasis

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66
Q

Echinococcus reservoir

A

Dog

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67
Q

Diphyllobothrium latum comes from

A

Freshwater fish

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68
Q

2,3-BPG only binds to

A

Deoxyhemoglobin

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69
Q

Why doesn’t HbF bind 2,3-BPG as well

A

Serine residues instead of histidine

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70
Q

HbC

A

Glutamic acid –> Lysine = Mild, chronic hemolytic anemia

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71
Q

Directly responsible for intimal thickening in athersclerosis

A

Smooth muscle cells (NOT FIBROBLASTS)

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72
Q

Treatment with Menotropin and hCG

A

Menotropin is human menopausal gonadotropin and acts like FSH; hCG acts like LH surge

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73
Q

Hepatolenticular degeneration

A

(GP and Putamen) Wilson’s disease –> Wing-beating tremor, Psychosis

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74
Q

Burning or stabbing sensation in one half of body

A

Thalamic syndrome

75
Q

Mechanism of Dermatitis Herpetiformis

A

Cross reaction of anti-Gliadin ab’s with Reticulin in epidermal basement membrane

76
Q

Cerebral amyloid angiopathy vs hypertensive hemorrhage

A

Lower mortality rate, More benign clinical course than hypertensive hemorrhage

77
Q

Hematuria and proteinuria in subacute BE

A

Immune complex deposition

78
Q

Bacteriostatic antibiotic that inhibits binding of aminoacyl-tRNA to 30S subunit

A

Tetracyclines

79
Q

What is upregulated after statins lower total serum cholesterol

A

LDL receptor

80
Q

LCAT vs CETP

A

LCAT catalyzes esterification of cholesterol (nascent HDL to mature HDL); CETP transfers cholesterol to other lipoprotein particles

81
Q

Endocrine hormones that increase cAMP

A

FLAT ChAMP CGC - FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, Calcitonin, GHRH, Glucagon

82
Q

Hormones that increase cGMP

A

ANP, BNP, NO (EDRF)

83
Q

Endocrine Hormones that increase IP3

A

GOAT HAG - GnRH, Oxytocin, ADH (V1), TRH, H1, AgII, Gastrin

84
Q

Intrinstic tyrosine kinase receptors

A

Insulin, IGF-1, FGF, PDGF, EGF

85
Q

Receptor-associated tyrosin kinase

A

PIGGLET - Prolactin, Immunomodulators (Cytokines, IFN), GH, G-CSF, EPO, Thrombopoetin - Acidophils and Cytokins

86
Q

Resistant to Ampicillin but sensitive to Ceftriaxone

A

Beta-Lactamase production

87
Q

Meniere’s disease

A

Triad of vertigo, sensorineural hearing loss, tinnitus –> Incr production and/or decr excretion of endolymph

88
Q

Blastomycosis on chest x ray

A

Mimics TB –> Granulomatous nodules

89
Q

Systolic ejectin in aortic stenosis

A

Decr, because it takes longer for valve to open

90
Q

Most common cause of pyridoxine deficiency

91
Q

First line for malignant otitis externa

A

Fluoroquinolone

92
Q

Renal and lungs masses –> Improvement after removing renal mass

A

RCC –> Tx with IL_2

93
Q

Central Venous Pressure and what tend to correlated

A

Pulmonary capillary wedge (at least in septic shock?)

94
Q

Normal CVP and PCWP

A

CVP 2-8; PCWP 2-15

95
Q

Effects of Ia, b, and c on AP conduction conduction velocity

A

Ia slows, Ib no effect, Ic slows

96
Q

Effects of Ia, b, and c on AP duration

A

Ia prolongs, Ib shortens, Ic minimal effect

97
Q

Predominant actions of Class II antiarrhythmics

A

Slow sinus node discharge rate, Slow AV node conduction and prolong refractoriness

98
Q

Predominant effects of Class III antiarrhythmics

A

Prolong AP duration; No effect on conduction velocity

99
Q

Predominant effects of Class IV antiarrhythmics

A

Slow sinus node discharge rate; Slow AV node conduction and prolong refractoriness

100
Q

MOA of Adenosine

A

A1 receptors –> Activates K channels –> incr K conductance –> transient conduction delay thru AV node

101
Q

Digoxin effects on AP duration and QT interval

A

Decr APD, Shorten QT interval

102
Q

C3a stimulates

A

Histamine release –> Permeability, Dilation

103
Q

Platelet Activating Factor causes

A

Platelet agg, Vasoconstriction, Bronchoconstriction, Incr leukocyte adhesion to endothelium

104
Q

Hyperplastic polyps are composed of

A

Well-differentiated mucosal cells that form glands and crypts

105
Q

Hamartomatous polyps are composed of

A

Mucosal glands, Smooth muscle, CT

106
Q

Inflammatory polyps are seen in

A

UC, Crohn’s –> Regenerating intsetinal mucosa

107
Q

Lymphoid polyps are found in

108
Q

4 Non-neoplastic polys

A

Hyperplastic, Hamartomatous, Inflammatory, Lymphoid

109
Q

Symptoms of Diffuse Esophageal Spasm

A

Dysphagia and Chest pain

110
Q

Phosphoglucomutase

A

Glucose 1 6 phosphate

111
Q

Carnitine deficiency

A

Impairs FA transport into mitochondria, restricting ketone body formation

112
Q

Skeletal Muscle Carnitine def symptoms

A

Myoglobinemia, Weakness after exercise, Elevated muscle TG’s, Hypoketonemia

113
Q

Medium Chain Acyl-CoA DH deficiency

A

Hypglycemia, Hypoketonemia

114
Q

Tryptophan is a precursor for

A

Nicotinic Acid, Serotonin, Melatonin

115
Q

Clinical manifestations of Hartnup disease are primarily due to

A

Tryptophan malabsorption –> Niacin deficiency

116
Q

Symptoms of Hartnup

A

Most children asymptomatic –> Can have pellagra-like rashes, photosensitivity, ataxia

117
Q

Urinary excretion of what AA’s is normal in Hartnup

A

Proline, Hydroxyproline, Arginine

118
Q

Thiamine use by the body is maximal in states of

A

Accelerated carb metabolism

119
Q

Pyridoxine def results in

A

Anemia, Peripheral neuropathy, Dermatitis

120
Q

Tocopherol deficiency

A

Vitamin E = Myelopathy and neuro

121
Q

How do Listeria and Shigella survive intracellularly

A

Escape from phagosome into cytosol

122
Q

How does MTB survive intracellularly

A

Blocks fusion of phagosome with lysosome, Inhibits phagolysosome acidification

123
Q

Immune response to Listeria

A

IFNg, TNFb, IL-12 –> Cell mediated response –> macrophage killing

124
Q

Gram negative rod that grows at 4 degrees

125
Q

Uricosuric drugs

A

Probenecid, Sulfinpyrazone

126
Q

Xanthine oxidase inhibitor safer than allopurinol

A

Febuxostat

127
Q

Most common manifestation of CMV in HIV

128
Q

Epispadias results from

A

Faulty positioning of genital tubercle in fifth week of gestation

129
Q

Virus that aquires lipid envelope form nucleus

A

Herpes family

130
Q

Blockade of what receptor inhibits gluconeogenesis, glycogenolysis, and lipolysis

131
Q

Main effect of nitrates in treating angina

A

Reduce preload –> reduce LV volume

132
Q

Herniation causing CN III neuropathy

133
Q

Most common cause of Abetalipoproteinemia

A

LOF mutation in Microsomal TG Transfer Protein (MTP) –> Normally folds apoB and transfers lipids into chylomicros or VLDL

134
Q

Polyol pathway impairment occurs in tissues that

A

Do not rely on insulin for glucose transport (lens, peripheral nerves, kidney, blood vessels)

135
Q

Elevated galactitol

A

Galactosemia –> Cataracts

136
Q

Cross linking of proteins by glycosylation products in vessels facilitates

A

Inflammatory cell invasion, Deposition of LDL –> Atheroscerlosis

137
Q

Skeletal findings in hyperparathyroidism

A

Cortical (compact) bone in appedicular skeletal –> Subperiosteal erosions, Salt-and-pepper skull, Osteolytic cysts (osteitis fibrosa cystica)

138
Q

Disorganized lamellar bone structure in mosaic pattern

139
Q

Osteoid matrix accumulation around trabeculae

A

Vit D deficiency - Excessive unmineralized osteoid with widened osteoid seams

140
Q

Persistence of primary spongiosa in medullary cavity with no mature trabeculae

A

Osteopetrosis –> Accumulation of woven bone, diffuse skeletal thickening

141
Q

Trabecular thinning with fewer interconnections

A

Osteoporosis

142
Q

How do erythrocytes utilize NADPH

A

Maintain Glutathione in reduced state by glutathione reductase

143
Q

What is a Heinz body

A

Denatured Hb from oxidative stress

144
Q

As opposed to serotonin syndrome, NMS is characterized by

A

Absence of myoclonus and presence of rigidity

145
Q

Keratoderma blennorhagicum commonly associated with

A

Reactive Arthritis

146
Q

Mechanism of Pertussis toxin

A

Disinhibits AC via Gi ADP ribosylation –> incr cAMP –> Incr histamine sensitivity and phagocyte dysfunction

147
Q

Direct tissue effects of GH

A

(1) Insulin resistance; (2) Fat utilization; (3) Protein synthesis

148
Q

Indirect tissue effects of GH

A

IGF-1 by liver –> Growth of bone, cartilage, soft tissue

149
Q

GH vs IGF-1 receptor

A

GH is JAK-STAT; IGF-1 is specific receptor TK

150
Q

Main sites of digestion and absorption of dietary lipids

A

Duodenum –> Jejunum

151
Q

How does diet affect calcium stones

A

Low calcium diet actually increases risk; High protein and Na diet increases risk

152
Q

What is recommended for patients with calcium stones who have hyperoxaluria

A

Pyridoxine –> Decreases endogenous oxalate production

153
Q

Vitelline vs Cardinal veins

A

Vitelline form portal; Cardinal form caval

154
Q

PG’s that mediate protection of gastric mucosa

A

PGI2 and PGE2

155
Q

Salicylism

A

Vertigo, Tinnitus, Hearing loss

156
Q

Classic Legionnaires presentation

A

Very high fever in smoker + diarrhea, confusion, cough

157
Q

Coccidiomycosis in immunocompetent

A

Usually asymptomatic

158
Q

Conversion of NE to Epi occurs where? Stimulated by?

A

Adrenal medulla by PNMT - Stimulated by Cortisol (incr PMNT gene expression)

159
Q

COMT converts epi and NE to

A

Metanephrine and Normetanephrine

160
Q

SGLT2 inhibitors

A

Canagliflozin, Dapaglifozin

161
Q

AE’s of SGLT2 inhibitors

A

Urinary tract and Genital mycotic infections; Symptomatic hypotension

162
Q

What should be assessed before starting SGLT2 inhibitors

A

Renal function

163
Q

Which anti-diabetic requires LFT’s

A

Thiaxolidinediones

164
Q

Soft, breathy voice =

A

Vocal cord dysfunction

165
Q

Acid-base abnormality in ATN

A

Retention of H and anions –> high anion gap metabolic acidosis

166
Q

Recovery phase of ATN

A

Profuse diuresis, HypoK/Mg/PO4/Ca

167
Q

Triptan MOA

A

5-HT 1b/d agonists –> Inhibit vasoactive peptides, promote vasoconstriction, block pain pathways

168
Q

Bupropion MOA

A

DA, NE reuptake inhibitor

169
Q

Migraine prophylaxis

A

TCAs, SNRI’s, BB’s, Valproate, Topiramate

170
Q

What cholesterol meds increase bile acid synthesis

A

Binding resins; Fibrates

171
Q

First and second line treatment of AF with RVR

A

CCBs/BB’s, then Digoxin

172
Q

Delayed afterdepolarizations

A

Occur in states of hyperexcitability (eg high intracellular Ca or high catecholamine states) - How digoxin can lead to Vtach

173
Q

Signs of Uncal (transtentorial) herniation

A

CNIII, Contralateral or ipsilateral hemiparesis (crus cerebri), Contralateral homonymous hemianopsia with macular sparing (PCA)

174
Q

Subfalcine herniation sign

A

ACA compression

175
Q

Duret hemorrhage

A

Caudal displacement of brainstem –> Rupture of paramedian basilar artery branches –> Duret

176
Q

Ingestion of what can cause myxomatous degeneration

A

Sweet peas –> Angiolathyrism

177
Q

Incr murmur in HOCM

A

Decrease preload or afterload –> Decr LVEDV and increase outflow obstruction

178
Q

Bile salt deconjugation

A

Colonic bacteria in small intestine –> Steatorrhea due to failure of miscelle formation

179
Q

Final product of FA oxidation that enters CAC

A

Succinyl CoA (from methlymalonyl CoA)

180
Q

Lab findings in SLE

A

Hemolytic anemia, Thrombocytopenia, Leukopenia, Hypocomplementemia

181
Q

Cause of anemia and thrombocytopenia in SLE

A

Type II hypersensitivity

182
Q

Fibrous intimal thickening with endocardial plaques limited to right heart

A

Carcinoid heart disease –> Pulmonic stenosis, Restrictive cardiomyopathy

183
Q

How to grow H flu in sheeps blood agar

A

S aureus –> X factor released by hemolysis, V factor secreted by s aureus

184
Q

Fat embolism syndrome is characterized by

A

pulmonary insufficiency, diffuse neuro impairment, thrombocytopenia, anemia

Uworld (16 decks)

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