Mixto 2 Flashcards
1
Q
Consider Antisocial personality disorder if
A
> 18 yo
Evidence of conduct disorder before 15yo
2
Q
Testo, DHT and AMH effect on male genital formation
A
Testo-> Wolffian duct to int male genitalia development
DHT -> ext male genitalia devp
AMH-> suppresses int male geniatalia
3
Q
Pt with cyanotic after Invasive vasc procedure (angiography), think of
A
Cholesterol (needle-shaped) containing debris that obstruct arteries
4
Q
HLA class l vs ll (disease association)
A
HLA class ll -> RA, DM I, celiac disease
HLA class l-> Ankylosing spondylitis, reactive arthritis, arthritis with inflammatory bowel disease, and psoriatic arthritis
5
Q
Leptin fx is
A
Decrease food intake
6
Q
Gabapentin mec
A
Inh presynaptic Ca channels
7
Q
First mediator to make effect in type l hypersensitivity
A
Histamine
8
Q
CCK fx
A
Pancreatic secretion
Gallbladder contraction
Oddi sphincter relax
Decrease gastric emptying
9
Q
Expected number of words by 18mo old
A
3 or more + dada and mama
10
Q
Expected number of words by age 2
A
2 Word phrases
11
Q
Wiskott-Aldrich sd features
A
Recurrent infections that worsen with age
Easy bleeding
Eczema
12
Q
Chédiak-Higashi sd features
A
• Oculocutaneous albinism
• Pyogenic infections
• Progressive neurologic dysfunction
13
Q
DiGeorge sd features
A
• Congenital heart disease
• Dysmorphic facies
・Hypocalcemia
14
Q
Power formula
A
1 - Error type ll
15
Q
Elastin properties are due to
A
Interchain cross-links involving lysine
16
Q
A
17
Q
Lamgerhans cells are
A
Dendritic cells, antigen presenting, interact with T cells. Have racquet shape and intracytoplasmic granules
18
Q
HBeAg, anti-HBc mean
A
1)Increased replication and infectivity
2) no replication, low infectivity
19
Q
A
20
Q
HBsAg vs AntiHBsAg
A
1) first marker to appear after HBV inoculation
2) successful HBV vaccination
21
Q
Isolated hand twitching that progressed to bilat tonic-clonic seizure is characteristic of ___ and it comes from ___
A
Focal-onset seizure
A single hemisphere
22
Q
Polyarteritis nodosa key Words
A
Fibrinoid necrosis in medium-sized musc arteries (kidneys, skin, brain, gastrointestinal tract)
Presents with tissue ischemia/bleeding
23
Q
Mucormycosis features
A
Caused by Mucor, Rhizopus and Absidia.
Associated to DKA, immunosuppressed.
Presents with paranasal sts (peri orbital pain, headache, discharge)
Nonseptate hyphae with 90 degrees branch
24
Q
Chest XR findings in viral pericarditis
A
Enlarged globular cardiac silhouette with clear lung fields
25
M protein is a virulence factor that prevents ipsonization used by
Group A strep
26
Major virulence factor in gram-Neg rods
Lipopolysaccharide endotoxin
27
The use of fibrinolytic (thrombolytic) agents like alteplase, tenecteplase or streptokinase can cause
Reperfusion-related arrhythmia
28
Abdo Ao aneurysm vs Acute mesenteric ischemia
AAA: acute severe abdo pain, syncope, hypotension, shock. Smoking, male, >60yo
AMI: severe abdo pain but minimal tenderness, no shock/hypotension
29
Fibular neck fracture will likely cause
Common fibular nerve damage:
-unable to evert foot, loss of sensation on foot dorsum (superficial branch)
-unable to dorsiflex foot and toes (deep branch)
30
Opioid antagonists that doesn’t cause withdrawal sts
Methylnaltrexone
31
32
33
What’s Hawthorne effect in statistics?
tendency of study subjects to change their behavior as a result of their awareness (observer effect)
34
What’s Pygmalion effect in statistics?
researcher's beliefs in the efficacy of treatment can potentially affect the outcome
35
What’s Berkson’s bias in statistics?
Selection bias
36
37
Why is there a relationship between sarcoidosis and kidney stones?
Increased alpha-1- hydroxylase activity -> increases 1-25 hydroxy Vit D
38
Meningococcemia main complications
Septic shock
DIC (petechial rash, mucous memb bleeding and venipunture bleeding)
Waterhouse-Friderichsen sd: Adrenal hemorrhage/ adrenal insufficiency
39
Facial nerve injury central vs peripheral
Peripheral affects forehead
Central (UMN) spares forehead musc
40
Facial nerve innervates
Face musc
Ant 2/3s taste of tongue
Parasympathetic innerv to lacrimal, submandibular and sublingual salivary glands
Stapedius musc in ear
41
Bell palsy is
Complete ipsilat facial nerve palsy
Rel to reactivation of HSV
42
Main features Yolk sac tumor
SAC:
Schiller Duval bodies (glomeruli-like figures)
Alpha-feto protein (AFP) increased
Children affected most commonly
43
From all germ cell tumors, which is not associated to high AFP or hCG
Teratoma
44
Dextromethorphan is a common ingredient of antitussives which blocks N-methyl-D-aspartate (NMDA) causing dissociation, which other substance is similar ?
Ketamine
45
In menopause, most common sts are ___ rather than ___
Vasomotor (hot flashes, night sweats) rather than mood or libido changes
46
Attention-deficit/hyperactivity disorder (ADHD) TTO
Hyperactivity predominance-> treat with dopamine
Inattention predominance -> treat with Norepinephrine
47
Ovarian hormone secreating tumor features
Granulosa tumor and Tecoma will secrete female hormones and alter menstrual cycle.
Sertoly and leydig tumor will have high Testosterone but no 17-ketosteroids (not adrenal related)
48
49
Maximal incidence of recurrent disease acceptable Formulation
(100 - Drug rate) x Standard rate
50
51
Acute vs delayed transfusion Rx
Acute: Rx against ABO products
Delayed: Rx against minor RBC antigens
52
Endurance training affects type ___ fibers which have a lot of ___
I
Mitochondria
53
Resistance training (weight lifting) amplifies type __ fibers which have low___
II
Mitochondria (glycolytic)
54
Obturator nerve damage impaires
Thigh adduction
55
Poxvirus features
Shiny round Papules on trunk and face (children) on genitals/groin (adults) and widespread (immunocompromised)
** microscopy: circles filled with pink litte balls (eosinophilic bodies)
56
Hardy-Weinberg equilibrium is about___ . Rules are
-Genetic variation remains consistent when there are no disturbing factors
-no mut, random mating, no migration, no natural selection, large population needed
57
Febrile gastroenteritis (watery diarrhea) and gram-positive rod, think of __. Major virulence factor
Listeria M
Cytotoxic created pores in phagosomes (reqs CD8 resp)
58
Pte with 1 or more maniac episodes are diagnosed with
Bipolar I disorder
59
Blood supply to ureters
Prox: renal artery
Distal: int iliac and sup vesical arteries
60
Decrease integrin expression (typical in malignancies ) will affect binding to ___
Fibronectin
61
Pearly mass behind tympanic mb, think of___. This is made of__
Cholestoma
Squamous cell debris
62
Neuraminidase inhibitor (oseltamivir) impair
Virion particle release
63
Pt with HiV and multiple nodules that bleed a lot when squeezed, HHV-8 is neg, think of
Bartonella h
64
Crossover studies
Subjects receive 2 or more sequence tto
65
If after vasopressin is administered, urine osmolality remains the same, think of
Primary polydipsia
66
Coag factor Vlll binds
Factor laxa and X to create factor Xa
67
Papillary thyroid carcinoma biopsy
Branching papillae
psammoma bodies (concentric calcifications)
Nuclei with dispersed chromatin
Nuclear grooves and intranuclear inclusions
68
Subacute granulomatous Thiroiditis (de quervain) features
Post infection
High T3 and T4
High TGb
Low iodine uptake
Mixed cell infiltrate + giant cells +disrupted follicles on biopsy
69
Graves’ disease biopsy
Follicular hyperplasia with tall cells projecting into follicular lumen
70
Hashimoto’s diseases biopsy
Lymphocytic infiltrate active with germinal centers
71
Most common cause of primary adrenal insufficiency
Autoimmune adrenalítis
72
Primary adrenal insufficiency key feature
Hyperpigmentation
(Not seen in 2ary due to tumor)
73
Glucokinase deficiency are one cause of__, characterized by
MODY
Mild hyperglycemia worsened by pregnancy-induced insulin resistance
74
Leuprolide mec
GnRH analogue that first stimulates and then down regulates production of LH
75
Permanent central Diabetes insipidues occurs as injury to
Hypothalamic nuclei
*damage to post pituitary is transient due to regeneration capacity
76
77
78
Deficiency of which enzyme is associated with abnormal male ext genitalia
5a-reductase
79
Which enzyme def is associated with female virilization
Aromatese (forms estrogens from androgens)
80
Rapid acting insulins are
Lispro and aspart
*postpandrial hyperglycemia
81
Long acting insulins are
Degludec
Detemir
Glargine
82
Weight loss hypoglycemics
GLP-1 agonists
SGLT-2 inhibitors
83
Pt with severe sistemic illness, low T3, normal/low TSH, normal thyroid physical exam, think of
Euthyroid sick sd
84
Boy with normal secundary characteristics but abnormal genitalia
5a-reductase def
85
Female looking male pt with abnormal genitalia (blind vagina)
17 a-hydroxylase def
86
If 2-6 fructose biphosphate is increased, ___ pathway will too because___
Glycolisis
It increases PFK-1
87
Thyroid peroxidase (TPO) fx
Iodide oxidation
TGb iodination
MIT-DIT DIT-DIT coupling
88
Glupizide is a __ which means it acts via __
Sulfonylurea
K channel inhibition -> depol-> Ca increases -> insulin secretion
89
PCSK9 inh like Evolocumab help statins via
Decrease of LDL-R degradation-> more LDL-R on cells -> more LDL uptake in liver
90
Menopause average age is __, confirmed with high levels of __
51
FSH
91
Urine turned black when left exposed to air, think of __ which affects conversion of __ into__
Alkaptonuria/homogentisic acid accumulation
Tyrosine into fumarate
92
Cushing sd + high/normal ACTH. Differential dg and tests
Pituitary adenoma: if ACTH is suppressed after high dose dexametasone.
Ectopic tumor: if still remains the same after dexametasone test
93
Effect of glucocorticoids on Graves ophthalmopathy
Anti-inflam
94
CF is associated to ___ due to pancreatic fibrosis
Diabetes
95
Aluminum hydroxide effects
pH increase
Constipation
96
97
98
Esophagus irrigation
Prox: thyroid artery
Mid: thoracic Ao branches
Distal: left gastric artery
99
Lynch sd features
Hereditary nonpolyposis colon cancer
Due to defective nucleotide mismatch repair system (mut genes MSH2 and MLH1)
100
Infant with descending weakness, absent gag reflex, history of honey consumption, think of __. *Mec__
Infant botulism by Clostridium b
*toxin blocks presynaptic ACh release.
101
Extensive noncaseating hepatic granulomas, think of
Hepatic sarcoidosis
102
Pseudomembranous colitis features
Adherent yellow pseudomemb
By C. difficile
103
104
Gilbert Sd features
Decrease UDP UGT activity but not absent
Mild jaundice
Provoked by stress
No tto needed
105
106
Increased and incomplete relaxation of LES, think of
LES
107
Hyperammonia effect on encephalopathy and key elevated molecule
Excess NH3 -> excess *glutamine* production to bind -> less glutamate synthesis-> disruption of excitatory conduction
108
Hepatic abscess in the USA are rare but when seen, they’re usually caused by
Bacterial infections
109
Acute viral hepatitis B histopathologic findings
Panlobular lymphocytic inflam
Cytotoxic T cells
Eosinophilic round bodies
110
Crohn disease is associated to gallstones because of
inflamof the terminal ileum causes decreased bile acid reabsorption -> bile acid wasting in feces.
111
Superficial inguinal nodes drain
Most cutaneous lymph from umbilicus down including anal orifice
112
Graft versus host disease is similar to primary biliary cholangitis because
It’s immune mediated
Destructs intrahepatic drugs after bone marrow transplant
113
Most specific ultrasound findings in cholecystitis__. If not clear, try___
-gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy sign.
-Failed gallbladder visualization on
radionuclide biliary scan
114
Vit K def impaires __
Gamma carboxylation of coag factors
115
Pancreatic ductal adenocacinoma is caused by a mut of
KRAS gene
116
Well demarcated liver mass, nodular with a central, gray-white, depressed stellate scar from which fibrous septa radiate to the periphery, think of
Focal modular hyperplasia (benign)
117
118
What happens when there’s testicular trauma?
Damage to blood-testis barrier (sertoli cells + tight junctions) -> antisperm antibodies
119
Homeobox gene (body pattering and positioning reg) mechanism
Coded transcription factors that bind regulatory regions on DNA
120
deficiency of IL-12 receptors on naive T cells prevents
differentiation into Th1 cells -> no IFN-gamma -> no macrophage and CD8 activation
121
IL-4 deficiency prevents
Formation of Th2 cells is-4 -> no B cell differentiation -> no production of immunoglobulins.
122
Porphyria is characterized for a deficiency of___
Porphobilinogen deminase
123
Porphyria is treated with heme infusion which downreg
Aminolevulinate synthase
124
When studying the *difference* of two groups, istatistically significant means that
The confidence interval doesn’t pass 0 (null value)
125
Statins mec
Inhibition of HMG-CoA reductase -> less cholesterol synthesis-> more LDL receptors-> more uptake of circulating LDL
126
Tetanus mec
Puncture wound-> presynaptic terminal lower motor neurons -> retrograde axonal transport-> ant horn -> toxin blocks inhibitory neurons -> spasmodic contractions
127
Only tissue where there increase in vasc resistance when O2 goes down ___. This prevents ___
Lungs (hypoxic vasoconstriction)
Perfusion wasting
128
129
Androgen insensitivity sd features
Androgen receptor dysfunction (high LH and testosterone, normal FSH)
Complete: female body and genitalia
Partial: undervirilization, gynecomastia, oligospermia
130
Pool/beach fungus
Malassezia versicolor (pityriasis)
131
Which adverse effect persist even after weeks of opioid tto ?
Constipation
Miosis
132
Amyloid seen under polarized light looks __ but in Alzheimer’s it looks
Apple-green
Yellow-green
133
Aggregates of tau protein in brain, think of
Pick bodies from frontotemporal dementia (Pick disease)
134
Huntington disease affects
Caudate nucleus
135
Intracel eosinophilic inclusions composed of alpha-synuclein (lewy bodies), think of
Párkinson
136
137
Xeroderma pigmentosum features
Failure to repair DNA damage by UV-rays (thymine dimers) via specific nuclease
138
Suspect Pancoast tumor when there is
Unilat upper limb pain (compression braquial plexus)
Areflexic weakness
Ipsilat ptosis/miosis (autonomic injury)
139
2 key factors for osteoclast differentiation un Paget’s disease
Macrophage colony-stimulating factor (M-CSF) and receptor for activated nuclear factor kappa-B ligand (RANK-L),
140
What can help with empyema after chest tube drainage
Fibrinolytic agent + deoxyribonuclease
Surgical drainage
141
142
Which Folate derívate is crucial for nucleic acid synthesis and to prevent apoptosis
Thymidine
143
Sporotricosis (rose disease) histopathologic finfings
Mixed granulomatous and neutrophilic inflammatory reaction
144
Sts in Myasthenia Gravis can be explained by
Reduced amplitude of motor end plate potential (post synaptic musc cell)
145
Drugs used in muscarinic toxicity
Glycopyrrolate
Hyoscyamine
Propanthrline
146
Mononucleosis (EBV) features
Fever + fatigue + lymphocytosis + splenomegaly
Transmitted via saliva (kiss disease)
147
Attention deficit medication
Stimulants: methylphenidate, amphetamines
Non-stimulants: atomoxetine**
148
149
Genetic features of down sd
Trisomy- meiotic non disjunction
Unbalanced translocations
Mosaicism (some cells have the trisomy, some others do not)
150
Pyridoxine (B6) is needed in
Transaminayion and decarboxylation of aa
Gluconeogenesis
NTs, heme and histamine synthesis
151
Biotin (B7) is a cofactor of
Carboxylase enzymes
*pyruvate (gluconeo)
*acetyl-CoA (fatty acid synthesis)
*propionyl-Coa (fatty acid oxidation)
152
153
Contact dermatitis features
Hair dye or other alkergenics
Type lV hypersensitivity
Phase 1/sensitization: langerhan cells take haptens and present them to naive T cells
Phase 2/ elicitation: CD8+ activate and release interferon gamma when happen is reexposed
154
2nd generation antipsychotics have less___ than high potency 1st generation (haloperidol)
Extrapyramidal sts
155
Pt with generalized rash + lymphadenopathy + corkscrew-shaped organism on dark microscopy, think of
Secondary syphilis
156
Penicillin in syphyliis mec
disrupts cell wall synthesis by inhibiting transpeptidase, necessary for cell wall cross-linking.
157
Salicylate toxicity is treated with HCO3 because
It converses it to lipophobic salicylate ion (Sal-) and traps it in the bloodstream
It increases its expretion in urine
158
Dopamine dose dep effect
Low dose: increases cardiac output and renal blood flow (beta 1adrenergic receptor stimulation)
High dose: opposite (alpha1 stimulation)
159
Opioid toxicity will occur if there is a problem with ___ elimination bc metabolites start to accumulate
Renal
(Metabolized in liver but excreted renally)
160
Niacin (B3) is req in reactions that use
NAD and NADP
161
Marker of monocyte-macrophages in TB granulomas
CD14
162
Branching, filamentous gram positive with similar TB presentation, think of
Nocardia
163
Nocardia key features
Branching filaments + my colic acid wall (partially acid-fast staining)
164
Embryologic development probs in Tetralogy of Fallot
Abnormal neural crest cell migration -> ant and cephalad deviation of the infundibular septum = malaligned ventral septal defect and overriding aorta.
165
Transpeptidases are
A type of PBP targeted by penicillins and cephalosporins
166
ATB that binds to cell wall glycoproteins
Vancomycin
167
ATB that interfere with DNA replication binding to ADN gyrase
Fluoroquinolones
168
Optimal site for femoral nerve block in case of quadricep injury
Right bellow inguinal ligament
169
Pudendal nerve block site for vaginal delivery
Ischial spine tip
170
Lung biopsy with large, rounded, well-circumscribed “cannonball” cell, probable metastasis from ___
Kidney
* Renal clear cell carcinoma
171
Long term OCPD complication
Secundary polycythemia (increasing EPO)
172
E.coli and Shigella have in common ___, capable of ___
Shiga Toxin
Ribosomal 60S subunit inactivation-> Protein synthesis inhibition
173
V. Cholerae infection mec
increases intracellular cAMP in intestinal mucosal cells -> decreased absorption and increased secretion of Na+, Cl- and water.
174
Pseudomonas infection mec
inhibition of elongation factor 2 -> no protein synthesis
175
Right ovarian vein drains into__
Left drains into__
Thrombosis is most common in__
IVC
Left renal vein
Right ovarian vein
176
Low cortisol, low ALD, high 17-hydroxyprogesterone, think of
Congenital adrenal hyperplasia (low 21-hydroxylase)
177
Recurrent Respiratory infections + congenital absence of vas deference, think of
Cystic fibrosis
178
Complicated delivery using vacuum assistance can cause__ due to damage to ___
Subgaleal hemorrhage
Emissary veins (hemorrhage between periosteum and galea aponeurosis)
179
Infantile hemangioma features
Common
Bright red plaque
Days or weeks after birth
Benign proliferation of endothelial cells
Increases its size and then regresses
180
Zoloidem and eszopiclone are
short-acting nonbenzodiazepine hypnotic agent.
GABA A agonists
Used for sleeping problems
181
182
183
hemorrhage and necrosis in the mammillary bodies and periaqueductal gray matter, think of
Wernicke encephalopathy.
184
Thiamine (B1) is a cofactor of
Pyruvate DHG
Alpha-ketoglutarate DHG
Branched alpha ketoacid DHG (needed for aa)
Transketolase
185
186
Old age changes in respiratory system
Decreased chest wall compliance/mobility
Decreased alveolar elastic recoil
Increased alveolar-arterial O2 gradient
Increased dead space
187
Preeclampsia widespread endothelial dysfunction, vasospasm, microthrombi deposition can produce
Seizures
Renal insufficiency
DIC
188
FOXP3 function
Converts CD4 into regulatory T cells -> failure keeps immune activation going
189
190
Nitrates must be given in intervals throughout the day because of
Tolerance development
191
Opioid induced constipation can be treated with
Methylnaltrexone (does no cause withdrawal sts)
192
Bisacodyl and senna help with constipation vía
Enteric nerve stimulation-> increasing peristalsis
193
Why does preeclampsia cause vascular dysfunction?
early cytotrophoblast invasion is abnormal-> maternal spiral arteries underdeveloped-> not good perfusion to placenta -> low VEGF -> endothelial dysfunction
194
Tetanus vaccine mec
Humoral antibody response neutralizes bacterial products
195
Failed obliteration of allantois leads to
Patent urachus and urine leakage from umbilicus
196
N. meningitidis virulence factor responsable for severity (sepsis)
Lipo-oligosaccharide
197
Coxiella features
Q fever (lobar consolidation pneumonia is primary sign)
Animal waste inhalation
Severe debilitating retroorbital headaches
198
199
Most common cause of retina artery occlusion
Atherosclerosis in the internal carotid
200
Pseudogout key features
High WBC count with neutro predominance
Rhomboid shaped calcium pyrophosphate crystals
Blue when parallel, yellow when perpendicular
201
DNA mismatch repair defect is associated with
hereditary nonpolyposis colorectal cancer (HNPCC, or Lynch syndrome).
202
Nucleotide excision repair failure is associated with
Xeroderma pigmentosum
203
Inherited (not acquired) p53 mutations are associated with
Li-fraumeni sd
204
Superficial vs deep fibular nerve
Superficial everts the foot
Deep dorsiglexes foot and toes
205
Primary ciliary dyskinesia/Kartagener sd associated diseases
Respiratory infections, bronchiectasis (dilated bronchioles)
Infertility
Situs inversus (organs in opposite sites)
206
Listeria features
Flagellar tumbling motility
Reproduces in the cold
Transmuted by consumption of contaminated food
207
Medication induced esophagitis
Tetracyclines
Aspirin
NSAIDs
Biphosphonates
208
Protein A is a wall component of
Staph A
209
M Protein is a wall component of
Strepto pyogenes
210
Toxin A/lecithinase is a virulence factor of
Clostridium perfringens
211
Trehalose dimycolate is a major virulence factor of
M. tuberculosis
212
Locked-in sd is associated with
Osmotic desmyelination
Infarction
213
Class l antiarrythmic effect on Na and K channels
IA: blocks Na, blocks K (most extended)
IB: weak Na block, shortens repol (very short Na plateau, Thinnest curve)
IC: Strong block Na, very little effect on K.
214
Quinidine, procainamide and disppyramide are
Class IA antiarrythmics
215
Lidocaine and mexiletine are tú
Class lB antiarrythmics
216
Flecainide and propafenone are
Class lC antiarrythmics
217
Organophosphate toxicity or cholinesterase inhibitors toxicity can be treated with atropine. However, it has no effect on ___ meaning ___ can persist
Nicotinic receptors
Muscle paralysis, weakness and fasciculations
218
Pt with DM and overflow urinary incontinence. Cause?
loss of autonomic afferent innervation -> inability to sense a full bladder.
Loss of efferent fibers to the bladder -> incomplete emptying. (Increase postvoid residual volume test)
219
TTN gene mutation will likely cause impairs titin protein in charge of binding myosin to z discs. This will likely cause
Familial dilated cardiomyopathy
220
Dilated cardiomyopathy features
Heart failure sts
Due to direct insult (infection, toxicity or disease) to myocardium -> decreases ventricular contractility
221
SatO2 in right heart vs left heart
Right: 70% (SVC, RA, RV, Pulm a)
Left: 96% (LA,LV, Ao)
222
Higher SatO2 on right heart, think of__ likely due to ___ which produces___ , best heard in__
Left to right shunt
Ventricular septal defec
Holosystolic murmur
Lower left sternal border
223
Atrial septal defect
High SatO2 in SVC, RA and RV have the same Sat
Fixed splitting of S2
224
1 or 2 month old baby with dark urine, acholic stools, high direct bilirubin and GGT, hepatomegaly, think of
Biliary atresia/obstruction of extrahepatic bile ducts
225
Hirschprung disease features
NB with bilious emesis after feeding (failure to pass meconium)
Abdo distension with active bowel sound
**Forceful gas/stool expulsion, megacolon (main difference with other similar diseases)
Neural crest cell migration failure -> aganglionic rectosigmoid
226
Young woman with eye pain worsened by eye movement, decreased vision and optic disc swelling, think of ___. Suspect ___ as main origin of the disease.
Optic neuritis
Multiple sclerosis
227
Multiple sclerosis diagnosis
• Episodic/progressive symptoms disseminated over time & space
• Hyperintense lesions/ demyelinating periventricular plaques
• Oligoclonal IgG bands on cerebrospinal fluid analysis
228
Glucosuria begins with a serum glucose of ___
200 mg/dL
229
Diastolic blood pressure is directly related to ___. During exercise this goes down and so does DBP
Systemic vascular resistance
230
Piriform recess protects the internal laringeal nerve. Injury to this area will likely affect
Afferent limb of cough reflex
231
Low fecal elastase, Sudan staining (+), OH abuse, foul smelling stools, diarrhea, epigastric pain after eating, think of
Pancreatic insufficiency
232
Pterygoid musc innervation
Mandibular nerve (CN V3)
233
West Nile virus features
Replicates in birds, transmitted by mosquitoes
Flu-like sts, meningitis/encephalitis, asymmetric weakness
234
Cleft lip and palate is associated to recurrent otitis media due to
Levator or tensor of veli palatini dysfunction-> Eustachian tube dysfunction
235
Attention deficit desorder features
Innattention and or hyperactivity in 2 or more settings (school and home)
Sts before age 12
236
Drug induced parkisonism (antipsychotics or antiemetics) is best treated with
Central antiACh like benztropine or trihexyphenidyl
237
HSV-1 and 2 and VZV are susceptible to acyclovir because
They have viral phosphorylating enzyme which activates the drug
238
Fructokinase deficiency dg test
Glucose oxidase (-)
Copper reduction (+)
239
Fanconi sd affects
Proximal tubule
240
HBV like HIV has
Reverse transcriptase activity
241
Dengue shock sd is due to
Infection either different viral serotype
242
Anti-Rh (D) immunoglobulin is a product consists of
IgG
243
Pts with cryptorchidism have higher risk for which type of malignancy ?
Testicular seminoma
244
Corynebacterium diphtheriae features
Gram positive
Bacillus
Diphtheria sd
Becomes toxigenic thanks to phage conversion (lysogenic bacteriophage)
AB toxins halt protein synthesis
245
Majority of anal fissure occur in
Posterior midline distal to dentate line
246
Pt recovering from sepsis can’t be disconnected from ventilator due to chest wall weakness, think of
Critical illness neuromuscular weakness due to peripheral axon degeneration and loss of myosin (atrophy)
247
Genitals effect due to complete androgen insensitivity sd
Internal genitals absent
Female external genitals
248
ANOVA/ analysis of variance is used in studies that
Compare 3 o more groups
249
Beta-2 agonists help with broncocontriction vía
Increasing cAMP-> smooth muscle relaxation
250
VPH virulence factor
Production of E6 (blocks p53) and E7 (blocks Rb) -> altogether inhibit cell cycle regulation
251
Plasmodium ovale and vivax req use of primaquine to prevent
Disease relapse during dormant phase within hepatocytes
252
Pharmacokinetic vs phamacodynamic tolerance
Kinetic: has to do with ADME: Absorption, distribution (plasma or fat) metabolism (P450c) or excretion problems
Dynamics: has to do with drug target problem (receptor or intracell signaling)
253
Kid with cognitive/behavioral problems + musc weakness + family member with musc weakness, think of
Myotonic dystrophy (trinucleotide repeat expansion)
254
What’s main risk factor for pelvic organ prolapse
Vaginal delivery-> injury to pundendal nerve -> no innervation to pelvic floor muscle
255
Pulm embolism causes what type of hypoxemia?
Ventilation/perfusion mismatch
*typically has respiratory alkalosis
256
Gastrojejunostomy will req __ supplementation
Iron
257
Tto of agitation and psychosis associated with delirium
Haloperidol
258
Neoplasm under nail, suspect ___ or ___
Melanoma (pigmentation rel)
Glomus tumor (thermoregulation rel)
259
Which parasites have Loos cycle
Strongyloides
Toxocara canis and gatis
Ascaris L
Ancylostoma
Trichuris trichuria
260
Benign paroxysmal positional vertigo is caused by
Debris in semicircular canals
261
Elevated endolymphatic pressure, think of
Ménière disease
262
Zero vs first order kinetics
Zero: constant amount of drug is metabolized and excreted (line)
First: Fixed proportion of drug is metabolized (curve)
263
Pt with clicking noise when chewing +headache +neck stiffness, think of ___ caused by__
Temporomanfibular joint sd by maser yet and pterygoid spasms
264
What’s 2nd leading cause of lung cancer in the US?
Radon found in contaminated groundwater affecting basements of houses
265
Montelukast (-lukasts) mec of action
Antagonist of leukotriene receptors
266
Pt with ptosis, dysphagia, dry mouth after tasting canned food, think of __ which impaires ___
Botulism
ACh release
267
268
H. influenzae features
Oxidase positive
Gram-negative coccobacillus
Some strains don’t have capsule -> cause otitis, sinusitis, bronchitis
Type b- has capsule -> causes epliglotitis
269
270
Only thiamine-dependent dehydrogenase in the TCA
Alpha-ketoglutarate
271
Elderly female, groin pain, one femur shorter than the other, leg laterally rotated, think of
Femoral neck fracture
272
Sciatic nerve function and mucs innervated
Extends the hip and Flexes the knee
Semimembranosus, semitendinosus and biceps femoralis (long and short head)
273
Elderly pt with shortened leg and medially rotated, think of
Posterior hip dislocation
274
Nerves responsable for wrist drop and foot drop respectively
Radial and common peroneal/fibular
275
What structures are affected in Trendelenburg gait ?
Superior gluteal nerve -> musc gluteus medius and minimus
276
Which nerve is affected in trendelenburg gait, the one on the dropping hip or the one on the rising hip ?
Rising hip
277
Physiologic response to altitude
Increased pulm arterial resistance
Increased cardiac output
Decreased plasma volume
Increased renal HCO3 synthesis
Resp alkalosis-> Hb curve to the left (increased O2 uptake)
278
Minutes following a burn, ___ is released from ___
Histamine
Mast cells
279
CD55 and CD59 deficiency is associated with
Paroxysmal nocturnal hemoglobinuria
280
E Coli virulence factors
Lipopolysaccharide -> sepsis
K1 capsule-> neonatal meningitis
Shiga toxin-> enterohemorrhagic
Heat-stable or labile toxins -> enteroroxigenic (cholera like)
P-fimbrias -> UTI
281
Which nerve is at risk of being injured during appendicectomy
Ant branch of illiohypogastric nerve
282
Alzheimers occurs due to decrease___ due to deficiency of___
ACh
Choline acetyltransferase
283
First line Tto for attention-deficit hyperactivity disorder ___. Most common adverse effects are
Methylphenidate and amphetamines (psycostimulants)
Less appetite, weight loss and insomnia
284
Diuretic that increases survival in HF
Spironolactone
*less effect from ALD -> improves ventricular remodeling
285
Which structure is responsible for sudden muscle relaxation ?
Golgi tendon organ
286
287
Excess varus laxity, think of ___ tear. This is in charge of preventing ___
LCL
Hyper adduction
288
__ prevents hyper abduction of leg at knee. If there is excess valgus laxity, suspect
MCL
MCL tear
289
Meniscus tear key words
Knee pain with locking specially when squatting or twisting.
Mcmurry test
290
Most common injured ligament in an ankle sprain
Ant inf talofibular ligament (inward sprain)
291
Which musc abducts the arm?
Supraspinatus
292
Which muscs adduct the arm ?
Teres minor
Subscapularis
293
Which musc externally rotate the arm
Infraspinatus (mainly in adduction)
Teres minor (mainly in abduction)
*one compensate the other if one fails
294
The external auditory canal is innervated by ___ with the exception of the posterior part innervated by__
Auriculotemporal branch of the Trigeminal
Vagus nerve (only part of the ear that causes vasovagal response)
295
296
What part of the ear does the facial nerve innervate?
Stapedius
297
Which musc are responsible for closing and opening the jaw?
Lat pterygoid muscs
298
Pathway for a cardiac catheterization
Femoral a -> external illiac-> common illiac -> Ao
299
Puncture above inguinal ligament increases the risk of hemorrhage in___
Retroperitoneal space
300
Decreased blood flow in spermatic cord is likely due to a problem with the Gonadal arteries, which arises from___.
Abdo Ao
301
302
Lateral leads (l and aVL) ST elevations, think of ___ occlusion which originates from__
Left circumflex artery
Left main coronary artery
303
Ant chest lead (V1-V4) correspond to __ artery which supplies to
Left ant descending
Ant ventricle and interventricular septum
304
Inferior chest leads (ll, lll, aVF) correspond to __ artery which supplies___
Right coronary artery
Right ventricle and inf left ventricle
305
Severe constipation + occasional fecal incontinence and history of vehicle collision, think of
Conus medularis (sacral spinal cord injury)
306
Pt with involuntary,large amplitude movement of arm and history of HTN, DM. Think of __ due to ___ in ___
Hemiballism
Lacunar stroke
Subthalamic nucleus (inh nucleus Pallidus Inter is -> no inhibition of Thalamus-> excess mov)
307
In the absence of findings upper UTI signs but presence of gross hematuria, think of
Renal papillary necrosis
308
Obstruction of which vein will cause face, neck and arm swelling? brachiocephalic vein or subclavian or axillary vein will cause
Brachiocephalic. The other two do not affect the face
309
Glossopharyngeal
Elevate larynx during swallowing (stylopharyngeus musc)
Taste and sensory fx on post 1/3 tongue
Tonsils sensory fx
Afferent portion gag reflex
Parotid gland secretion
310
incision at the 5th intercostal space in the midaxillary line could injure __ musc
Serratus ant
311
Most common compression of median nerve Is between ___. The other possible compression is between __\
Two heads of pronator teres muscle (due to excess pronation. Ex: playing tenis)
Flexor digitorum superf and profundus
312
Wound in 4th intercostal space, next to sternal border will hurt __
Right ventricle
*left ventricle is midclavicular
313
Pt with head trauma + talk and die phenomena, think of ___ due to___ located in __
Epidural hematoma
Middle meningeal artery (comes from maxillary that comes from ext carotid)
Foramen spinosum
314
Pt with shear injury (shaken baby sd) + crescent shaped mass on MRI, think of ___ due to__
Subdural hematomas
Tearing of bridging veins
315
Pt with Marfan sd or ADPKD , altered mental status, parenchymal bleed, MRI shows blood following sulci and gyri, think of___ due to ___
Subarachnoid hemorrhage
Rupture of berry aneurysm (in any communicating/ Willis polygon)
316
Contact lenses nerve injury__ and common infection organism __
Ophthalmic branch of the Trigeminal (V2)
Pseudomonas
317
Pharyngeal arch associated to CN Vll
2nd pharyngeal arch
318
Pharyngeal arch associated to CN V
1st pharyngeal arch
319
Bell palsy associated organisms?
Hiking history: Borrelia B/ Lyme disease (intracel spirochete)
No hiking history: HSV
320
Pharyngeal arch associated to CN lX
3rd pharyngeal arch
322
Jugular foramen craneal nerves
IX, X, Xl
323
40-50 year old pt with aggressive behavior + writhing body movements + flailing arms + intermitent smile + similar family history, think of
Huntington’s
*trinucleotide repeat is CAG, anticipates with every new generation (anticipation)
324
15 yo male with broad-based gait, diabetes, scoliosis, loss of sensation in his feet and HCM, think of
Friedrich’a ataxia
*trinucleotide repeat is GAA
325
30 year old male is off-balance + hair loss + failure to relax after shaking Dr. hand, think of
Myotonic Dystrophy
*trinucleotide repeat is CTG
326
A patient with intellectual disability. Big ears + gonadal enlargement. Think of
Fragile X
*trinucleotide repeat is a CGG
327
Dopamine pathways disease association
Mesolimbic-> Reg behavior-> schizophrenia, psychosis
Nigrostriatal-> coordinated movement-> Parkinson, Wilson’s, Lewy body dementia
Tuberoinfundibular -> D2 inhibition of prolactin -> antipsychotics (risperidom), metoclopramide
328
Young female with focal neurological deficit, think of __ and if on top of that she has eye problems, consider
Multiple sclerosis
Optic neuritis (if Afferent pupillary light reflex defect) or intranuclear ophthalmoplegia (if inability to look medially upon contralat gaze)
329
Port-wine stain on face in trigéminas distribution + tram-track calcifications
Sturge Weber
330
Ataxia telangectasia mec
Defective dsDNA break repair
331
Brain tumors in children vs adults
Adults: supratentorial.
1.metastasis, 2. gioblastoma, 3. meningioma, 4. schwanomma.
Children: infratentorial
1. Astrocytoma, 2. medulloblastoma, 3. ependymoma
331
Brain mass crossing mid-line + pseudo-palisading tumor. Think of
Glioblastoma multiforme
332
Loss of pain and temperature Ipsilat in face and contralat in body, think of __ or __ stroke.
PICA (has dysphagia, hoarseness or decreases gag, affects lat medulla) o
AICA (has facial droop, affects lat pons)
333
Pernatal HBV infection high risk marker
HBeAg (high viral replication and infectivity)
334
Middle age man with steatorrhea, abdo pain + arthralgias + dementia + macrophages filled with inclusions positive for acid-schiff stain, think of
Whipple disease by Tropheryma whipplei
335
Cyanide disrupts which part of the electron transporter chain?
Complex IV (cytochrome c oxidase)
336
Blood type A or B develope ___ antibodies, AB develops ___ and O develops ___
A : antiB (IgM)
B: antiA (igM)
AB: none
O: antiA and antiB (IgM and IgG)
337
Pt with neurological st not explained pathophysiologically or without anatomical correlation, think of
Conversion disorder/ functional neurological st disorder
338
Baby boy with thickened bladder wall, vesicoureteral reflux and hydronephrosis, this is likely do to___
persistent urogenital mb (common cause is post urethral valve)
339
Primary Tto for acute opioid intoxication is ___ however it reqs redosing because___
Naloxone
It’s a short acting opioid antagonist and most opioid take long to be cleared out
340
Rate-limiting enzyme in de novo fatty acid synthesis
Acetyl-CoA carboxylase
341
Late complication of radiation
Fibrosis
342
TRH effect on prolactin
Increase its secretion
343
Chronic Oh use leads to ___ and ___ receptors
Downregulation of GABA A
Upregulation of NMDA
344
Pt with hypoxemia, increased A-a gradient, no response to 100% O2, think of ___. Best Tto is
Intrapulm shunt
Positive end expiratory pressure (PEEP)
345
Child with arm trauma after being pulled by the arm. Think of ___ ligament tear. Make ___ or ___ maneuver to correct
Annular
Hyperpronation or
flexion and supination
346
Loperamide mec of action
Binds to mu receptors and inhibits ACh release from myenteric plexus -> slows peristalsis
347
Glucocorticoids inhibits
Nuclear factor kappa B (NF-kB)
348
-xaban anticoagulants affect the conversion of ___ to ___ by blocking ___
Prothrombin to thrombin
Xa
349
Mutation order in colorectal adenoma to carcinoma formation
1.APC inactivation
2. Methylation abnormalities
3.COX2 overexpression
4.KRAS activation
5.DCC inactivation
6.p53 inactivation
350
HIV pt with ascites and large mass in **small intestine**, think of which organism?
EBV (Burkitt lymphoma affects gastrointestinal track)
351
Which chemotherapy agent is associated with causing cancer?
Cyclophosphamide (bladder ca)
352
In metabolic alkalosis HCO3 is __ because ___
High because Cl depletion impairs HCO3 excretion
353
Which antihistaminics have antiACh side effects
1st generation
354
Which abdominal pathology is associated with acute respiratory syndrome (ARDS)
Pancreatitis (enzymes released-> neutros infiltration->edema, inflam and fibrin deposits in alveolar mb)
355
Pt on antipsychotics (haloperidol,sertralin) develops fever, confusion and diffuse rigidity without clonus. Think of
Neuroleptic malignant sd
356
Baby boby with hyperuricemia + self mutilating behavior. Think of__ . Hyoeruricemia is due to ___. This is compensated by __ enzyme
Lesch Nyhan sd
Mutation of Hypoxanthine-guanine PRT
Phosphoribosyl pyrophosphate amidotransferase
357
Complications of Primary cytomegalovirus in babies
chorioretinitis , sensorineural deafness, seizures, jaundice, hepatomegaly, splenomegaly, and microcephaly.
358
Fragile X sd occurs due to expansion of a repetitive sequence in __ gene
FMR1
359
360
Treat severe or refractory Neuroleptic malignant (antipsychotics OD) sd with __. Mec is ___
Dantrolene
Inhibits Ca+2 release from sarcoplasmic reticulum via antagonism of ryanodine
361
Avoiding using trailing zeros (decimals) and abbreviations helps reducing
Transcription errors
362
363
Pts with DM and painful neuropathy can be treated with
Gabapentinoid (gabapentina, pregabalina)
SNRI (duloxetina, venlafaxina)
Antidepresivos (tricyclics)
364
Pharyngeal pouches structures associated
1st: ear and mastoid air cells
2nd: tonsil
3rd: inf parathyroid and thymus
4th: sup parathyroid and thyroid
365
Retinopathy of prematurity (abnormal retinal vascularization) can be exacerbated if
NB is exposed to O2 supplementation
366
ACh colinesterase (donepezil or rivastagmine) are associated with __ because they enhance ___
Vasovagal syncope, bradycardia and AV block
Parasympathetic tone
367
Bromocriotine and pramipexole are both___. Levodopa on the other hand ___
Dopamine agonists (directly stimulate dopamine receptors).
Replaces dopamine depletion
368
369
UMN lesion sts
Increased deep tendon reflexes (3+)
Increased tone
Babinski (+)
Spastic paresis
Clasp knife spasticity
**everything is UP in upper motor neuron problems
370
LMN lesion sts
Fasciculations
Atrophy
Flaccid paralysis
**everything is LOW in lower motor neuron problems
371
Opsonings responsable for e inflam and edema
C5a and C3a
372
Pt with soft mobile nontender subcutaneous mass/masses, stable or slow growth, think of ___ made of
Lipoma
Mature adipocytes arranged in lobules and separated by fibrous septa
373
Fetal Hb is made of 2 alpha chains and two __ chains
Gamma
374
Which hormones are mediated by JAK/STAT pathway
EPO, prolactin, GH, theombopoietin
375
Hypertrophic cardiomyopathy is product of a mut that affects __ and ___
Beta-myosin heavy chain
Myosin-binding prot C
376
H. pylori virulence factor
Urease splits gastric urea into ammonia (NH3) and CO2 -> pH increase -> survives
377
Tumors marking positive for cytokeratin, desmin and vimentin have origins from
Epithelial cells
Muscle cells
Mesenchymal
378
S100 (+) think of
Melanocytic neoplasms
379
Medication that promotes hyperthermia
Anticholinergics (amitriptyline)
Sympathomimetics (cocaine, amphetamines)
D2 antag (haloperidol, chlorpromazine)
Diuretics
380
Northerm blot vs western vs southern
N: detects mRNA
W: detects proteins
Southern: detects DNA
381
Female pt with 20-40 years old with severe RV hypertrophy, progressive dysnea and sudden death, think of
Pulmonary arterial hypertension
382
NB with deep sacral pit and hair tuft over midline lumbosacral region, think of ___ which is caused by__
Spina bífida occulta
Failure of vertebral arch fusion
383
Thick-walled spherules packed with endospores (balls filled with little balls) + pt has hilar adenopathy and lung infiltrate, think of
Coccidioides
384
Rotavirus features
Age<5 yo
Abrupt onset vomiting
Watery diarrhea
Blunting of the villi in the duodenum and prox jejunum
385
Fluoroquinolones mec of action
Inhibit bacterial DNA topoisomerase and gyrase
386
Doxycycline mec of action
Disrupts 30S ribosomal subunit
387
Azothromycin and chloramphenicol mec of action
Inhibit 50S ribosomal subunit
388
Small cell cancer (from lung, breast, ovary,utero) is associated with __ , this is due to __
paraneoplastic cerebellar degeneration (ataxia, dysarthria, visual problems)
Immune response
389
All patients with major depressive episode should be screened for ___ before tto
History of mania
390
ATBs that target cell wall of bacteria are
Penicillins, vancomycin, cephalosporins, carbapenems
391
Penicillins, vancomycin, cephalosporins, carbapenems are not useful on Mycoplasma because ___. Must treat with __
They lack cell wall
Bacterial ribosomal blockers (macrolides and tetracyclines)
392
Crucial component for peptidoglycan synthesis in bacteria
Glycosytransferase
393
Fat redistribution is a common side effect of
Antiretroviral therapy
394
Tto for pulmonary arterial hypertension
Bosentan (endothelin antagonist)
395
Baby with Triad (cataracts + sensorineural hearing loss + patent ductus arteriosus) think of ___. Prevent with
Congenital rubella
Live attenuated vaccine prior to conception
396
Monoamine oxidase inhibitor/MAOis (phenelzine or tranylcypromine) are reserved for___
Tto resistant major depressive disorder or with atypical features like mood reactivity, leaden paralysis, rejection sensitivity or increase sleep and appetite
397
398
Urease positive organisms like ___ or ____ , ___ pH,
H.pilory
Proteus
Increase
399
Most common UTI agents and their key difference
E.Coli does not produce nitrites, E faecalis does.
400
Major mec for Shigella ATB resistance
Conjugation
401
Asplenic pts must vaccinate against ___ because
Encapsulated bacteria (Strep pneumo, H. influenzae, N. meningitidis)
They can only be cleared by the spleen
402
Organism associated to cat scratch vs cat feces contact
Bartonella
Toxoplasma
403
Acyclovir mec of action
Competes for viral DNA polymerase
404
Viral proteases inhibitors are important in
HIV and HCV
405
Pelvic inflam disease is associated to which organism?
Chlamydia
N. gonorrhoeae
406
Ectopic pregnancy main risk factor is __ caused by __
Tubal scarring
N. gonorrhoeae or Chlamydia t
407
To prevent tetanus in neonate __
Vaccinate mom with inactivated vaccine
408
Pt with groin pain, not painful ulcers and intracytoplasmic inclusion bodies, think of
Chlamydia
409
Enterococcus features
Gram +
Catalase negative
Gamma hemolytic (no hemolysis)
Grows in saline and bile
Most common gram + UTI cystoscopy can cause enterococcal endocarditis
410
Ring shaped intraerytrhocytic parasite
Babesia (Protozoa)
411
Mulberry-shaped, intracytoplasmic inclusions or morulae in monocytes, think ok
Ehrlichia
412
Corynebacterium features
Diphtheriae
Gram +
No capsule
AB exotoxin (B affects prot synthesis)
Sore throat, fever, pharyngeal exudates
Brain and heart main complications
413
Profilaxis for close contacts in Meningitis
Rifampin, ceftriaxone and criprofloxacine
414
Cryptococcus n and cryptosporidium are usually associated with
Meningoencephalitis in AIDS
High volume diarrhea and biliary disease in AIDS
415
Pt with sickled-shaped RBC in blood smear + fever, chills and leukocytosis. Think of
Encapsulated organism (due to possible asplenia due to sickle cell anemia)
416
Painless genital ulcer, think of
Syphilis by treponema p
Granuloma inhíbame by Klebsiella
Lymphogranuloma v by Chlamydia
417
Which virus has the capacity of inducing indefinite proliferation of B cells ? Which test is dg?
EBV
Heterophile antibodies
418
P. Falciparum has more parasitemia and therefore more severe than ovale, malariae or vivax because
It affects RBC of all ages while malariae affects only old RBC and the other 2 affect only young and large RBC
419
Pt with fever, just returned from Africa or south America and has positive Giemsa stained. Think of
Malaria
420
Pt with hemorrhagic bullae ,Gram (-) and history of being in recent contact with salt water (ocean) or ingestion of raw oysters.Think of ___. Pts with ___ have higher risk
Vibrio vulnificus
Liver diseñas or iron overload
421
Parvovirus key words
“Slapped-cheek” flushed, red.
sDNA
Replication in erythrocyte precursor in bone marrow
422
Pt with minor laceration on the skin, inflam sts, gram (+) and PYR (+) but coagulase and catalase (-). Think of ___ infecting via
Strepto pyogenes (necrotizing fasciitis)
Hyaluronidase and streptokinase production
423
424
Most common congenital heart defect is ___. It’s main risk in adulthood is ___
Bicuspid aortic valve
Ao stenosis
425
Pt with recurrent sinopulm infections + failure to thrive and low immunoglobulin levels (all types). Think of ___ which affects__
X-linked agammaglobulinemia
Maturation of B cells (look for CD19, 20, 21 absence in cells)
426
Low total thyroxine but normal free T4, think of
TBG deficiency
427
Antipsychotic most important side effects
Extrapiramidal
Tardive dyskinesia
Nueroleptic malignant sd
428
429
Omeprazol blocks what type of transport ?
Primary active transport (H-K bomb used atp)
430
Cimetidine is a ___ which acts decreasing ___
H2 antagonist
intracell cAMP
431
Soldenefil is used for __ and __ whose mec of action is
Penile disfunction
Pulmonary hypertension
Upregulation of cGMP
432
433
Direct vs indirect inguinal hernia location
Direct -> into ext ingunal ring -> abdo
Indirect-> into int inguinal ring -> scrotum
434
Which pneumoconioses is very similar to sarcoidosis?
Berylliosis (both have noncaseating granulomas)
435
Stellae shaped granulomas, think of
Cat-scratch disease by Bartonella
436
437
Ovoidal or spherical nodules in the peripheral mesangium. Think of
Diabetes Mellitus
*Kimmelstiel-Wilson nodules in nodular glomerulosclerosis
438
Medullary tumors origen depending on location
-Intramedullary: primary tumors
-Intramural *extramedullary*: meningiomas, schwannomas, neurofibromas.
-extradural: metastases
439
Carbonic anhydrase inhibitors (ex acetazolamide) mec
Block NaHCO3 reabsorption in proximal tubule -> increased urinary HCO3 excretion
440
6-18 month old baby girl who initially had normal development and then regressed (can’t talk, can’t walk, has microcephaly) think of
Arrested brain sd (Rett sd) by MECP2 mut
441
Microcytic anemia + High HbA2 + target and hypochromic RBCs, think of __. It occurs due to __
Beta thalassemia trait
Point mut -> faulty mRNA or early translation termination
442
Biopsy findings in poststrepto glomerulo nephritis
IgG and C3 granular deposits
443
Minimal change glomerulonephriris biopsy
Podocyte effacement
444
Several fleshy, raised, soft cutaneous tumors + pigmented spots on trunk. Think of ___ which derived from __ cells
Cutaneous neurofibromas
Schwann
445
Which anti epileptic is used to prevent seizure recurrence
Na channel inhibitor, Phenytoin
446
447
Homocytenurias enzyme deficiency
Methionine and cysteine synthases
448
Hexagonal kidney stones, think of
Cystinuria
449
Systemic 1 carnitine deficiency will cause
Long chain fatty acids to accumulate and cause toxicity
450
Glucagon activates ___ which releases lipids
Hormone sensible lipase
451
Insulin activates __ which breaks down kilomichrones and makes TG
Lipoprotein lipase
452
