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MUST MEMORIZE Flashcards

1
Q

What are the five GI associations with Down syndrome?

A

Hirschsprungs, TE fistula, annular pancreas, celiacs disease, duodenal atresia

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2
Q

What would a quad screen for down syndrome show?

A

increased beta hCG, increased inhibin A, decr alpha FP, decr estriol

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3
Q

What are unique findings for edwards syndrome?

A

Hands (clenched), jaw (small), ears (low set), head (large posterior)

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4
Q

What are the GI associations in edwards syndrome?

A

Malrotation, meckels

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5
Q

What are the unique side effects of patau’s syndrome?

A

holoProsenchephaly (can actually also be seen in edwards), cleft liP/Palate, polydactyly, decrease PAPPA

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6
Q

What are the GI associations with patau’s?

A

umbilical hernia, omphalocele, pyloric stenosis

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7
Q

What is CATCH22?

A 
for 22q11 deletion syndrome
Cleft palate
Abnormal facies
thymic aplasia
Cardiac defects (the trunc falls from 22 to 11)
Hypocalcemia (parathyroid aplasia)
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8
Q

Important things about vitamin A

A

Deficiency-> night blindness and dry skin
Excess -> HSM, skin, neuro (incl incr intracranial pressure), arthralgia, vision problems
Teratogen
Treats MEASLES and AML (APL 15:17)
Nuclear receptor

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9
Q

What four enzymes use B1 (thiamine)

A 
Maple syrup give me ATP
alpha ketoacid dehydrogenase
alpha ketogluterate dehydrogenase
transketolase
pyruvate dehydrogenase
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10
Q

What happens in riboflavin (B2) deficiency?

What enzyme need B2

A

2 Cs of B2
Cheilosis and corneal vascularization
Succinate dehydrogenase (succinate -> fumarate)

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11
Q

What cholesterol drug is best at increasing HDL?

A

Niacin

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12
Q

What is the precursor to niacin and what cofactor is needed?

A

Tryptophan and B6

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13
Q

What are they symptoms of niacin deficiency?

A

The 3 D’s of B3

Diarrhea, Dermatitis, Dementia (ataxia), +/- death

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14
Q

What can vitamin E deficiency cause?

A

E is for erythrocytes -> anemia (hemolytic d/t incr fragility)

Friedrich’s like neuro problems: demyelination of the posterior columns and spinocerebellar tracts

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15
Q

What are the functions of zinc/ things are absent with zinc deficiency?

A 
2 senses, 3 H's
Smell 
Taste
Hypogonadism
Hair
Healing of wounds
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16
Q

what are the ketogenic aminoacids?

A

Leucine, lysine (used for PDH deficiency)

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17
Q

What are the essential amino acids

A

PVT TIM HALL

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18
Q

What are hydrophobic amino acids

A

GAV LIP TMP

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19
Q

What cofacto are needed for transamination reactions (transfer of NH3)?

A

B6

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20
Q

What cofactor is needed for lactic acid dehydrogenase?

A

B3

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21
Q

What are the symptoms of PKU

A 
Musty or mousy smell
seizures
eczema
fair skin
mental retardation if not caught earlyq
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22
Q

What enzyme controls conversion of NE to E and what regulates it?

A

PNMT, positively regulated by cortisol.

SAM is a necessary cofactor

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23
Q

Whats the saying for homocystinuria?

A

Is kinda RETARDED to be a TALL, HOMO with AKO- osis and lens subluxation.

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24
Q

What is the saying for fabrys disease?

A

Alpha gal’s always look FAB break hearts on their TRIcycles until they crash because of their painful neuropathy and get a kidney shot.

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25
Q

What are the essential fatty acids?

A

Linoleic, linolenic

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26
Q

What is the function of apoE

A

remnant uptake via remnant receptors (on everything except LDL)

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27
Q

What is the function of apoA1

A

Activates LCAT (put A1 steak sauce on a cat)

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28
Q

What is the function of apoCII?

A

LPL cofactor

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29
Q

What is the function of apoCIII?

A

Inhibits LPL

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30
Q

What is the function of apoB48?

A

Chylomicron secretion from intestinal epithelial cells

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31
Q

What is the function of apoB100?

A

Binds LDL receptor

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32
Q

What is deficient in Type1 dyslipidemia and what are symptoms?

A

Deficient LPL or CII
So you get build of chylomicrons
Causes pancreatitis HSM, HSM, and pruritic xanthomas but no atherosclerosis

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33
Q

What is deficient in type IIa dislipidemia? symptoms?

A

Familial hypercholesterolemia
LDL receptor is deficient
Excess LDL/ cholesterol
Xanthomas (tendon, eyes), atherosclerosis, heart disease

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34
Q

What is deficient in type III dislipidemia? symptoms?

A

ApoE is type threeeeee
Deficient apoE3/4
Chylomicron remnants build up, these are cholesterol rich so similar presentation to type IIa
Xanthomas (tendon, eyes), atherosclerosis, heart disease

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35
Q

What is the problem in type IV dyslipidemia? symptoms?

A

Familial hypertriglyceridemia
Hepatic over secretion of VLDL
Pancreatitis

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36
Q

What is the problem in abetalipoproteinemia? Symptoms?

A

MTP mutation causes decreased B48 and B100 so you get less chylomicron and VLDL secretion.

Lipid accumulation in enterocytes
Presents within a few months: failure to thrive, steatorrhea, acanthocytosis (spiky RBCs), ataxia, night blindness

Vit E helps restore lipoproteins

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37
Q

What is the ABCDEFG of Corynebacterium diphtheriae

A 
ADP ribosylating
Beta phage
Cysteine-tellurite agar, Cardiac problems
Dont scrape
EF2/ Elek's toxin test
F- pharyngitis with pseudomembranes
Granules (red/ blue)
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38
Q

What is the most important treatment to give immediately when someone has diphtheria?

A

Antitoxin antibody!! then also give penicillin and toxoid vaccine

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39
Q

How do you diagnose tetanus vs botulism vs difficile?

A 
Tetanus= history and physical
Botulism= assays for toxin or organism
Difficile = stool toxin assay (via PCR)
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40
Q

What drugs can treat Pseudoinfections?

A 
Ticarcillin, piperacillin
Ceftazidime (3rd gen), cefepime (4th gen)
Aminoglycosides (only GAT of GNATS)
Ciprofloxacin or levofloxacin
Aztreonam
Imipenem, Meropenem
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41
Q

What is the virulence factor of E. coli that causes cystitis/ pyelonephritis?

A

Fimbrae

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42
Q

What is the virulence factor of E. coli that causes pneumonia/ neonatal meningitis?

A

K capsule

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43
Q

What is the virulence factor of E. coli that causes septic shock?

A

LPS

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44
Q

Whats the difference between EHEC and EIEC

A

EIEC is invase + shiga like toxin
EHEC is not invasive but has shiga like toxin

Shiga like toxins cleaves 60s

EHEC causes HUS -> acute renal failure, anemia, thrombocytopenia

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45
Q

How can EHEC be differentiated from the rest of the E. coli

A

Does NOT ferment sorbitol. Does NOT produce glucoronidase

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46
Q

E. coli Tx?

A

TMP-SMX or fluoroquinilones

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47
Q

VDRL detects Ab’s that react to beef cardiolipin. What things give false positive VDRLs?

A 
VDRL
Viruses (mono, hepatitis)
Drugs
Rheumatic fever
Lupus/ leprosy
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48
Q

Treponema pertenue

A

Causes Yaws -> many keloids that cause disfigurement, VDRL positive but not an STD

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49
Q

Brucellosis

A

Brucella species in unpasteurized cheeses

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50
Q

Campylobacter

A

Bloody diarrhea from pets/ livestock

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51
Q

Severe interstitial pneumonia after parrot/ bird contact

A

Psittacosis -> chlamydia psittaci

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52
Q

Q fever

A

Coxiella burnetti from cattle amniotic fluid

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53
Q

Tularemia

A

Francisella tularensis from rabbits

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54
Q

Leptospira

A

animal urine

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55
Q

Pasteurella mutocida

A

Animal bites (dog, cat) -> cellulitis and osteomyelitis

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56
Q

Bartonella

A

Cat scratch fever -> self resolving. can lead to bacillary angiomatosis in immunocompromised

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57
Q

Rickettsia rickettsii

A

Rocky mountain spotted fever. Dermacentor tick bite -> causes Rash on Derma center of palms and soles

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58
Q

Yersinia enterocolitica

A

Pet feces. common outbreaks in day cares. Mimic crohns or appendicitis

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59
Q

Yersinia pestis

A

From fleas/ prairie dogs -> bubonic plague/ black death. Painful lymphadenitis, sepsis, DIC, PAINFUL ulcer surrounded by black hemorrhagic purpura

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60
Q

Spirillum minus

A

Rat bites

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61
Q

Raw oyster consumption

A

Vibrio parahaemolyticus -> cholera like watery diarrhea

Vibrio vulnificus -> sepsis w/ 50% mortality

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62
Q

What are the treatments for PCP?

A

1) TMP-SMX
2) Pentamidine
3) Dapsone

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63
Q

What are the treatments for sporothrix?

A

Itraconazole or potassium iodide

You must plant the rose InTRA POT.

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64
Q

What are the live, attenuated vaccines? How do they help the immune system? Drawbacks?

A 
Live for one night only! See SMALLL YELLOW CHICKENs get vaccinated with Sabins and MMR! It's INcredible
Small pox
Yellow fever
Chickenpox (VZV)
Sabin's polio
MMR
Influenza intranasal

Provide humoral and cell mediated immunity
Possible to revert to virulent form.

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65
Q

What are the killed vaccines? How do they help the immune system? Drawbacks?

A 
RIP Always
Rabies 
Influenza (injected)
Polio (SalK = Killed)
A -> HAV

Provide humoral response, but no cell mediated response.

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66
Q

What DNA virus is ssDNA?

A

Parvoviridae = part of a virus

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67
Q

What RNA virus is dsRNA?

A

Reoviridae = repeatovirus

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68
Q

What is the only diploid virus?

A

Retroviruses -> have 2 exact copies of ssRNA molecules

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69
Q

Where do DNA viruses replicate? Exceptions?

A

Nucleus. Except poxvirus -> cytoplasmic factory!

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70
Q

Where do RNA viruses replicate? Exceptions?

A

Cytoplasm. Except retroviruses and influenza viruses.

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71
Q

What are the naked viruses (no envelope)?

A 
Give PAPP smears and CPR to a naked Hepe.
PAPP= DNA
Polyomavirus
Adenovirus
Parvovirus
Papillomavirus
CPR = RNA
Calicivirus
Picronavirus
Reovirus
Hepevirus (also RNA) = Hep E
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72
Q

Of enveloped viruses, herpesvirus is the only one to do what?

A

Bud from the nuclear membrane (most bud from plasma membrane) -> they will have an envelope with phospholipid composition similar to the nuclear membrane.

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73
Q

What can adenovirus cause?

A 
#1 cause of hemorrhagic cystitis in kids
febrile pharyngitis
conjunctivits
pneumonia
Gastroenteritis

Common in military barracks and college campuses

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74
Q

What family does HBV belong to?

A

Hepadnavirus- DS partial circular DNA

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75
Q

Other than Hepadnavirus, what other DNA viruses are DS circular?

A

Papovaviridae -> Polyomavirus (JC and BK viruses) and Papillomavirus (HPV)

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76
Q

What viruses are in the poxvirus family?

A

Smallpox
Vaccinia- milkmaids blisters
Molluscum contagiosum- flesh dome lesions with central dimple.

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77
Q

What are the negative stranded RNA viruses?

A

In the orthopedics arena, it is paramount to file down bunyans rabidly
Orthomyxovirus (influenza- segmented)
Arenaviruses
Paramyxoviruses (Parainfluenza, RSV, Measles, Mumps)
Filoviruses (Fucked with Filo -> ebola and shit)
Bunyaviruses
Rhabdoviruses

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78
Q

What are the segmented RNA Viruses?

A

BOAR
Bunyaviruses, Orthomyxoviruses, Arenaviruses, Reoviruses

Only these can undergo REASSORTMENT because reassortment involves transfer of entire segments

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79
Q

What viruses are picornaviruses?

A

PERCH on a peak (pico)
Enteroviruses -> fecal oral transmission and cause GI disease: Polio, Echovirus, Coxsackievirus, HAV

Coxsackievirus and Echoviruses are common causes of aseptic meningitis -> fever, photophobia, painful extra-ocular movements

Rhinovirus, not fecal oral b/c acid labile -> common cold (>100 serotypes).

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80
Q

What are the findings of yellow fever (a flavivirus)?

A

Transmitted by Aedes mosquito

1) Liver disease- jaundice (flavi means yellow)
2) Hemorrhagic disease: epistaxis, menorrhagia, hematuria, easy bruising, GI bleeding (black vomitus -> “coffee ground emesis”)
3) High fever
4) Renal disease
5) Unique tongue- red on tip and sides, but whited coated center

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81
Q

Important points about rotavirus

A

A reovirus (dsRNA)
Major cause of infantile diarrhea worldwide
Daycare centers and kindergartens
Villous destruction/ atrophy -> lose Na+ and K+ -> diarrhea
ROTA = right out the anus
WINTER MONTHS, GREENISH DIARRHEA

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82
Q

What are findings in Rubella infection in children and in congenital rubella?

A

Rubella is a togavirus

Children- arthralgias, postauricular adenopathy, fever, fine truncal rash that starts on head and moves down to trunk but spares hands and feet.

Congenital- blue berry muffin appearance (extramedullary hematopoiesis), blindness, deafness, Cardiac (PDA or pulmonary artery stenosis)

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83
Q

Paramyxovirus

A

PaRaMyxovirus -> NONSEGMENTED (different than orthomyxoviruses)
Parainfluenza- croup. Barking, brassy, seal like cough.
RSV- resp. tract infection in infants
Measles, mumps
All contain F (fusion protein)- causes epithelial cells to fuse into multinucleated giant cells.
Palivizumab is monoclonal Ab against F protien -> prevents pneumonia from RSV in premature infants

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84
Q

Measles

A

NONSEGMENTED
3 C’s- cough, coryza, conjunctivitis
Maculopapular rash that starts on head and spreads downward (INCLUDES HANDS AND FEET)
Koplik spots on buccal mucosa (red w/ white center)

SSPE (subacute sclerosing panencephalitis) is rare sequellae. No Ab to M-component of virus (caused by a verison of measles without M-component). Thought virus is not completely killed and several years later will get SSPE. Fatal.

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85
Q

Mumps

A 
No rash
POM-poms
Parotitis = mump
Orchitis -> swollen testes
Meningitis (tropism for empendymal cells lining ventricles)
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86
Q

Rabies

A

Bullet shaped.
Negri bodies (cytoplasmic inclusions in purkinje cells). Binds to nicotinic ACh receptors and travels retrograde up nerves to CNS.
Distance of innoculation site determines length of incubation (asymptomatic phase where it replicates in muscle first)
Symptomatic phase: agitation, photophobia, hydrophobia (fear of water, foamy mouth, hypersalivation) -> paralysis, coma, death.
Bat, raccoon, skunk, coyotes > dog bites.

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87
Q

What is the mechanism of resistance for MRSA?

A

Altered PBP

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88
Q

What is the only cephalosporin that can treat MRSA?

A

Ceftaroline is terrible news for MRSA

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89
Q

What drugs do aminopenicillins (amoxicillin, ampicillin) cover that penicillin does not?

A 
HELPSS kill enterocytes
Haemophilus
E. coli
Listeria 
Proteus
Salmonella 
Shigella
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90
Q

What can the carboxypenicillins be used for (ticarcillin, piperacillin, carbenicillin)?

A

Pseudomonas! and G. neg rods

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91
Q

Both carboxypenicillins and aminopenicillins need to be given with what?

A

Beta lactamase inhibitor -> Clavulanate, tazobactam, sulbactam

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92
Q

What are first gen cephalosporins used for?

A

G+ plus PEcK
Proteus
E. coli
Klebsiella

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93
Q

What are second gen cephalosporins used for?

A 
HEN PEcKS and G+
Haemophilus
Enterobacter
Nisseria
Proteus
E. coli
Klebsiella
Serratia
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94
Q

What does aztreonam (a monobactam) treat?

A

Gram negatives rods only -> E. colli, Klebsiella, PSEUDO, Serratia

These are synergistic with aminoglycosides
No cross reactivity to penicillins

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95
Q

What is the biggest toxicity of carbapenem (imipenem, meropenem)

A

SEIZURES!

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96
Q

Vanco important facts

A

blocks D-ala D-ala precursor.
Gram + only!
Drug of choice for empiric endocarditis tx
C. diff
Diffuse flushing (Red man)- caused by histamine!
NOT many other problems:
Nephrotoxicity, ototoxicity, thrombophlebitis
D-ala D-lac is mechanism or resistance

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97
Q

What is the only protein synthesis inhibitor that is bacteriocidal?

A

Aminoglycosides

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98
Q

What are the two drugs that affect the initiation complex of bacterial ribosomes

A

Aminoglycosides- bind 30s

Linezolid- binds 50s (23s)

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99
Q

What drugs are aminoglycosides? Which can be used to treat pseudo?

A 
Ami02glycosides GNATS
Gentamycin
Neomycin
Amikacin
Tobramycin
Streptomycin

Only GAT can treat pseudo

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100
Q

What are the side effects of aminoglycosides?

A 
caNNOT treat anaerobes
Nephrotoxicity
Neuromuscular blockade
Ototoxicity
Teratogen
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101
Q

What is the mechanism of resistance for aminoglycosides?

A

Acetylation, phosphorylation, adenylation

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102
Q

What four drugs are ototoxic and nephrotoxic?

A

Vanco, aminoglycosides, Loops, Cisplatin

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103
Q

Mechanism of action of tetracycline

A

Blocks incoming tRNA (t for t) on 30s

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104
Q

What dietary supplements can limit effect of the tetracyclines?

A

Divalent cations (milk, antacids, iron supplements) b/c they inhibit gut absorption of tetracyclines

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105
Q

What are the uses for tetracyclines?

A 
VACUUM THe BedRoom
V. cholera
Acne
Chlamydia
Ureaplasma
Urealyticum
Mycoplasma pneumoniae
Tularemia
H. pylori
Borrelia
Rickettsia
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106
Q

What is the mechanism of resistance to tetracyclines

A

Efflux pumps

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107
Q

What is the mechanism of action for macrolides and mechanism of resistance?

A

MacroSLIDES like MJ
Binds 23s and block translocation
Methylation of 23s = resistance

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108
Q

Uses of macrolides?

A

Mac CAPS
Chlamydiae
Atypical Pneumonias
Strep (pen allergy)

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109
Q

Side effects of macrolides?

A 
MACRO
Motility issues (diarrhea!)
Arrhythmia (prolonged QT)
Cholestatic hepatitis (acute)
Rash
eOsinophilia
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110
Q

What cephalosporins cover pseudo?

A

Ceftazidime (3rd gen) and Cefepime (4th gen)

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111
Q

What is the saying for chloramPHENicol?

A

ChoramPHENicol defends against SHiN meningitis by blocking 50s peptidyltansferase but can cause APLASTIC anemia and GREY baby syndrome

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112
Q

What is the mechanism of action of clindamycin and what does it treat?

A

Blocks 50s translocation
Anaerobes above the diaphragm
TREATMENT OF CHOICE FOR ASPIRATION PNEUMONIA OR LUNG ABSCESS

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113
Q

What is the mechanism of action of Sulfonamides?

A

PABA analogs that block dihydropteroate synthase which is a precursor reaction to make tetrahydrofolate. Synergistic with the DHFR inhibitors.

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114
Q

What are the side effects of sulfonamides?

A

Hypersensitivity rxns, photosensitivity, hemolysis in G6PD, nephrotoxicity

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115
Q

What are the uses for TMP-SMX?

A

A bunch of abbreviations:

UTIs
Salmonella/ Shigella (S/S)
PCP
MRSA

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116
Q

What does metronidazole treat

A

GET GAP on the metro

Giardia, entamoeba, trichamonas, Gardnerella, Anaerobes, H. Pylori

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117
Q

What is the unique side effect for metronidazole

A

Disulfiram like reaction!!!

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118
Q

What is the mechanism of action of isoniazid?

A

Decreased synthesis of mycolic acids. First needs to be activated by KatG (bacterial catalase-peroxidase)

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119
Q

Side effects of isonizid?

A

INH injures neurons and hepatocytes (INH INH) and drug induced lupus! Give vit. B6 to prevent neurotoxicity

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120
Q

What is unique about isoniazid metabolism?

A

Acetylation!!! Fast vs slow acetylators

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121
Q

What are the 4 R’s of rifampin?

A

RNA polymerase inhibitor, Revs up P450, red orange body fluids, rapid resistant when solo treatment

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122
Q

What can Rifampin be used for as a prophylactic agent?

A

H. flu and N. meningitis (Rifampin prophylaxis against SHiN!!!!)

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123
Q

What is needed for pyrazinamide to be effective?

A

Acidic environment!

Works inside macrophage phagolysosome

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124
Q

What are the side effects of pyrazinamide?

A

Gout and hepatotoxicity

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125
Q

What is the mechanism of ethambutol?

A

Decreased carbohydrate metabolism by blocking arabinosyltransferase

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126
Q

Side effects of ethambutol?

A

Optic neuropathy (decr visual acuity and red green color blindness)

Also peripheral neuropathy

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127
Q

What is the drug of choice for prophylaxis against meningococcal infection?

A

Cipro

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128
Q

what eye drops or given to newborns to treat gonococcal or chlamydial eye infection?

A

Erythromycin

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129
Q

What is the prophylaxis for PCP and Toxo in HIV patients?

A

TMP-SMX

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130
Q

What is the prophylaxis for Histo in HIV patient?

A

Itraconazole

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131
Q

what is the prophylaxis for MAC in HIV patients and at what CD4 count?

A

Azithromycin at <50

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132
Q

What are the treatments for MRSA?

A

Vanco > Ceftaroline or Linezolid

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133
Q

What are the treatments for VRE?

A

Linezolid and streptogramins (pristin drugs)

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134
Q

What drugs are resistant to ESBL?

A

Imipenem and meropenem

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135
Q

Where do the “fungin” drugs work?

A

Fungins (caspofungin) work the farthest out. Inhibit beta glucan synthesis of the cell wall.

Good for invasive ASPergillus (cASPofungin)
SE: histamine induced flushing (Fungins flushing)

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136
Q

MOA of amphotericin and nystatin

A

Bind ergosterol and TEAR holes STAT!

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137
Q

SE of amphotericin

A

Has some effect on cholesterol (even tho relatively ergosterol specific)

NEPHROTOXICITY -> leads to loss of Mg+/K+ -> arrhythmias

Others: fevers/ chills, acute infusion reactions (phlebitis, hypotension, anemia)

Limit toxicity by supplementing K+/Mg2+ and lots of hydration

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138
Q

MOA and SE of Azoles

A

Blocks ergosterol synthesis (from lanosterol) by inhibiting P450.

Miconazole and Clotrimazole are topical agents.

SE: gynecomastia (inhibits testosterone synthesis, esp ketoconazole) and inhibition of P450 system

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139
Q

MOA of Terbinafine and Naftifine

A

Ihibit squalene epoxidase (thereby blocking production of squalene from cholesterol)

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140
Q

Use of Terbinafine and Naftifine

A

Topical for Fungal nail infections (onychomycosis)

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141
Q

MOA/ use/ SE for Griseofulvan

A

Interferes with MICROTUBLES of fungi thereby inhibiting mitosis

Deposits in nails -> oral treatment for nails, superficial infections, ringworm

Teratogen, carcinogen, hepatotoxicity
INDUCES P450 system

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142
Q

What is the mechanism of action of Chlorquine?

A

Blocks heme detoxification (heme polymerase). Widespread falciparum resistance, must use other drug.

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143
Q

What is the mechanism of action of ribavirin? toxicity? use?

A

Tyrion (teratogen) is an IMP (blocks IMP dehydrogenase) likes Ribs (ribavirin)

Used for RSV and Hep C

Teratogen and hemolytic anemia

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144
Q

What is the MOA of oseltamivir and zanamivir?

A

Block neuraminidase (release of progeny virus)

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145
Q

What is the mechanism of amantidine even tho widespread resistance? Toxicity?

A

Block hemagglutinin (viral fusion). Also cause Dopamine release so can be used for parkinsons. Cause livedo reticularis

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146
Q

Acyclovir, valcyclovir, famciclovir MOA, use, toxicity

A

Phosphorylated by viral thymidine kinase
Block DNA polymerase
Used for HSV and VZV (no effect on CMV)
Only block active replication, not latent virus
Crystaline nephropathy (aggressive hydration)

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147
Q

Ganciclovir, valganciclovir

A

Use for CMV, phosphorylated by CMV kinase
blocks DNA polymerase
SE: Neutropenia and thrombocytopenia, RENAL TOXICITY

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148
Q

Foscarnet

A

Pyrophosphate analog
Inhibits DNA polymerase at different site, no viral activation is needed
CMV retinitis for failed ganciclovir or HSV with failed acyclovir
Nephrotoxic, Seizures (foscarnet is a Ca++ chelator and causes nephro Mg++ wasting)

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149
Q

Cidofovir

A

Inhibits viral DNA polymerase
Does not need to be activated
CMV retinitis for failed ganciclovir or HSV with failed acyclovir
Nephrotoxic (saline + probenacid limits)

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150
Q

What are the side effects of protease inhibitors (-navir)

A

GI disturbance, hypergylcemia, hyperlipidemia, and cushinglike fat redistribution

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151
Q

What protease inhibitors have special side effects?

A

Rotinavir- pancreatitis, cyp3A4 inhibition
“Rotinavir rocks the pancreas and CYP450s”

Idinavir- nephropathy, hematuria, nephrolithiasis
“Idinavir invades the urinary tract and causes problems”

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152
Q

What is the only NRTI that doesnt need to be phosphorylated?

A

Tenofovir

Tenofovir has enof to be active

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153
Q

What NRTIs have additional action against hep B

A

TEL them it also works against hep B
Tenofovir
Emtricitabine
Lamivudine

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154
Q

What are the general side effects of NRTIs

A

Lactic acidosis

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155
Q

What is the unique SE of Abacavir

A

A for allergy (hypersensitivity) but no lactic acidosis

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156
Q

What SE is unique for Zidovudine?

A

Dives into the bone marrow and GI

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157
Q

What SE are seen with Didanosine, Stavudine and Zalcitabine?

A

Did Stav and Zal cite the pacreatitis and peripheral neuropathy they caused?

Didanosine and Stavudine also cause hepatic steatosis

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158
Q

What are the NNRTIs

A

Nevir Efa Dela
Nevirapine
Efavirenz
Delavirdine

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159
Q

What are the SE of the NNRTIs

A

Norths NED lacts a head and got a rash
Lactic acidosis and rash
Efavirenz also efs your head and efs you on a drug test

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160
Q

What drug is an HIV integrase inhibitor?

A

Raltegravir

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161
Q

Maraviroc MOA, SE

A

CCR5 inhibitor- blocks binding and gp120 conformational change. Only works on early virus (R5)

SE: CCR and 5 shits in the liver
Cough
CV events
Rash
Hepatotoxicity
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162
Q

Enfuvirtide MOA, SE

A

enFuvirtide, Fusion inhibitor, gpFortyone

Hypersensativity, severe injection site rxns, bacterial pneumonia

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163
Q

What are IFN alpha, gamma, and beta used for? SE

A

IFN alpha- Hep B/C, Kaposi’s
IFN beta- MS
IFN gamma NAPDH oxidase deficiency

SE: neutropenia, myopathy

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164
Q

Antibiotics to avoid in pregnancy

A 
SAFe Children Take Really Good Care
Sulfonamides- kernicterus
Aminoglycosides- ototoxicity
Fluoroquinilones- cartilage damage
Clarithromycin- embryotoxic
Tetracycline- teeth, bones
Ribavirin
Griseofulvin
Chloramphenicol- grey baby
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165
Q

What is MHC I pared with? MHC II?

A

I- beta 2 microglobulin

II- invariant chain that needs an acidified endosome to be released. Without release -> no MHC II on APC’s`

166
Q

What are the two primary opsonins against bacteria?

A

IgG and C3b

167
Q

What causes happens in C1 esterase inhibitor deficiency and what is contraindicated?

A

This is hereditary angioedema. Build up of bradykinin. ACE inhibitors are contraindicated.

168
Q

What are the examples of the type 4 hypersensitivity?

A

Hashimoto’s Minnesota Sweathearts PP’D like DM1 after Contact Vs Host GB packers b/c (Hep) they had IBD and Sarcoidosis.

Hashimotos
Minnesota Sweethearts= multiple sclerosis
PPD= PPD TB skin test
DM1
Contact dermatitis
Graft vs host disease
GB= Guillain Barre
b/c = Hep B and C
IBD
Sarcoidosis
169
Q

What are the examples of type 3 hypersensitivity?

A 
Arthus Serum helps me SLEePPP in my Rheum
Arthus reaction
Serum sickness
SLE
Poststreptococcal glomerulonephritis
Polyarteritis nodosa
hypersensitivity Pneumonitis
Rheumatoid Arthritis
170
Q

What is the MOA of cyclosporine and SE?

A

Binds cyclophilins, blocks calcineurin, no IL2 or IL2R production

Nephrotoxicity (prevent with mannitol)
Gingival hyperplasia, Hirsutism
HyperTLG (triglyceride, glycemia, lipidemia)

171
Q

MOA and SE of Tacrolimus

A

Binds FK-binding protein and inhibits calcineurin
blocks IL2 and cytokine secretion

Nephrotoxicity and peripheral neuropathy

172
Q

MOA and SE of Sirolimus

A

Inhibits MTOR -> Inhibits T cell response to IL2 (inhibits T cell proliferation)

SE: Thrombocytopenia, leukopenia

173
Q

What is the MOA of Daclizumab?

A

Monoclonal Ab against IL2 receptor (CD25) on activated T-cells

174
Q

MOA and SE of Muromonab?

A

Ab against CD3 blocking signal transduction in T cells

SE cytokine release syndrome and hypersensitivity

175
Q

Muromonab

A

Ab against CD3

Transplants

176
Q

Daclizumab

A

Ab against IL-2 receptor (CD25)

Kidney transplants

177
Q

Basiliximab

A

Ab that blocks IL-2 receptor

Kidney transplants

178
Q

Bevacizumab

A

Ab against VEGF

Used for CRC and RCC

179
Q

Oprelvekin

A

IL-11 used for thrombocytopenia

180
Q

Filgastrim

A

GCSF

181
Q

Sargramostim

A

CMCSF

182
Q

Aldesleukin

A

recombinant IL2

RCC and metastatic melanoma

183
Q

Cetuximab

A

Ab against EGFR

Stage 4 CRC, Head and neck cancer

184
Q

Natalizumab

A

Ab against alpha 4 integrin

MS, Crohns

185
Q

Denosumab

A

Ab against RANK-L

Osteoporosis

186
Q

Omalizumab

A

Ab against IgE Fc

Allergic asthma

187
Q

Alemtuzumab

A

Ab against CD52

CLL

188
Q

Pavalizumab

A

Ab against RSV F protein

RSV prophylaxis in premature infants (esp winter months)

189
Q

What does vinyl chloride, thorotrast, or arsenic exposure cause?

A

Angiosarcoma

Arsenic can also cause Sq. cell cancer in the skin

190
Q

What does carbon tetrachloride exposure cause?

A

Centrilobular necrosis and fatty change via lipid peroxidation

191
Q

Nitrosamine exposure can cause…..

A

Gastric cancer

192
Q

Naphthaline (analine) dyes and mothballs can cause….

A

Transition cell carcinoma

193
Q

Radon can cause….

A

Lung cancer

194
Q

What characteristics give a drug a low volume of distribution?

A

Large, charged, hydrophilic, or protein bound

195
Q

What is a low volume of distribution?

A

Blood volume (4-8 liters)

196
Q

What is a medium volume of distribution?

A

Extracellular fluid volume (14-16 liters) b/c 70 kg man x 20% (60:40:20 rule) = 14 liters

197
Q

What characteristics give a drug a medium volume of distribution?

A

Small hydrophilic

198
Q

What is a large volume of distribution?

A

All tissues (around 40L)

199
Q

What characteristics give a drug a high volume of distribution?

A

Small LIPOPHILIC molecules, esp if bound to TISSUE protein

200
Q

What are the direct cholinergic agonists?

A

Bethanechol, carbechol, methacholine, Pilocarpine

201
Q

What are the acetlycholinesterase inhibitors?

A

Neostigmine, pyridostigmine, physostigmine, edrophonium, donepezil, galantamine, rivastigmine

202
Q

What is the treatment for cholinesterase poisoning?

A

Atropine and pralidoxime (regenerates active AChE)

203
Q

Fetal erythropoiesis:

A 
Young liver synthesizes blood
Yolk sack- 3-10 wk
Liver- 6wk- birth
Spleen- 15-30 wk
Bone marrow: 22wk - adult (occurs the the ribs, sternum, pelvis, skull, vertebrae)

Up to age 25, also have erythropoiesis occurring in the tibia and femur

204
Q

What does AFIB look like on ECG?

A

Irregularly irregular (talking about the RR interval) with no discernible P waves

205
Q

What does atrial flutter look like on ECG?

A

Lots of P waves with regular RR intervals.

Sawtooth waves, flutter waves

206
Q

What is seen on ECG with 1st degree heart block?

A

Consistently prolonged PR interval

Generally asymptomatic

207
Q

What is seen on ECG with 2nd degree, Mobitz type 1 AV block?

A

Wenckebach. Warning
Progressively lengthening PR until beat is dropped (P wave not followed by QRS.)
Generally asymptomatic

208
Q

How do you determine heart rain on ECG?

A

300/ # of big boxes

209
Q

What defines sinus bradycardia?

A

Less than 60 bpm (RR > 5 big boxes on ECG)

210
Q

What is seen on ECG with 2nd degree, Mobitz type 2 AV block?

A

Nonconducted P waves. No lengthening of PR interval. Simply dropped beats. Often 2:1 ratio (P waves to QRS complexes).

Often treated with a pacemaker

211
Q

What is seen on ECG with 3rd degree heart block?

A

Atria and ventricles beat independently of one another. No relation to P wave and QRS complexes on ECG.

Tx= pacemaker

212
Q

What are the 5 causes of early cyanosis (blue babies)?

A 
5 T's (R-> L shunts)
Transposition of the great arteries
Truncus arteriosus
Tetralogy of Fallot
Tricuspid atresia
Total anomalous pulmonary venous return
213
Q

What are the causes of late cyanosis? Blue kids

A

VSD> ASD > PDA
Since these are initially L-R until pulmonary resistance become too high. Then Eisenmengers syndrome and cyanosis in kids (ie blue lower extremities for PDA in a child)

214
Q

What is seen in tetralogy of Fallot?

A 
Improper neural crest migration
PROV
Pulmonary stenosis
RVH -> boot shaped heart
Overriding aorta
VSD

Cyanotic spells improved with squatting (incr vasc resistance)

215
Q

What is heart condition is maternal diabetes associated with? What is necessary for life with with this condition?

A

D-Transposition of the great vessels
D for diaebetes (maternal)
One of the aorticopulmonary septum problems (not the Trunc falls from 22 to 11), therefore all thats left is transposition.
Failure of the AP septum to spiral
Neural crest migration failure
VSD necessary for life
Death within months w/o surgical correction

216
Q

Infantile coarctation

A

Preductal
A/w Turners syndrome
Disparity between pulses in UE and LE
No cyanosis

217
Q

Adult coarcation

A

Distal to ductus
a/w bicuspid valve
Upper extremity HTN with LE HOTN and weak pulses
Notching of the ribs

Coarctation is a/w berry aneurysms that are prone to rupture due to the high pressure

218
Q

What is the treatment for isolated systemic hypertension? ie 170/70 -> common in elderly

A

Diabetic: ACEI/ARB

Non-diabetic: DHP CCB or Thiazide

219
Q

When do you see hyaline arteriolosclerosis?

A

Essential HTN or diabetes

Homogenous deposition of eosinophilic deposition in media

220
Q

When do you see hyperplastic arteriolosclerosis?

A

Malignant HTN

Onion skinning d/t concentric layers of media smooth muscle

221
Q

What cells directly respond to intimal (endothelial) injury?

A

Smooth muscle cells proliferate to make a neointima

222
Q

What substances causes smooth muscle cell migration in the formation of atherosclerotic plaque? What cells release these substances?

A

PDGF and FGF

Released by macrophages, endothelial cells and platelets

223
Q

What is the most common cause of abdominal aortic aneurysm?

A

Atherosclerosis

Abdominal aorta is the most common place for atherosclerotic involvement, followed by carotids.

Most abd. aortic aneurysms occur in male smokers > 50 y/o

224
Q

What are the main causes of thoracic aortic aneurysm and aortic dissection?

A

HTN and Marfans

225
Q

What is the intiating factor in aortic dissection?

A

Intimal tear

226
Q

What is the initiating factor in atherosclerosis and what is the earliest lesion?

A

Initiating factor = Endothelial dysfunction

First lesion = intimal fatty streak

227
Q

What is the presentation of aortic dissection?

A

Sudden onset severe chest pain radiating to the back
High blood pressure
CXR shows mediastinal widening and abnormal aortic contour

228
Q

What is the presentation for cardiac tamponade?

A

Low blood pressure, fast heart rate (makes sense), muffled heart sounds, incr JVP, pulsus paradoxus (incr of greater than 10mmHg on inspiration)

EKG- electrical alternans- beat to beat variations of QRS amplitude

229
Q

What are the 3 highest risk factors for coronary artery disease?

A

non coronary atherosclerotic disease
CKD
Diabetes

230
Q

What is the most common cause of death in diabetes patients?

A

Coronary heart disease!!

231
Q

In a STEMI, how long does it take to lose contractility in affected area?

A

60 sec! even tho ATP will appear high

Need to repurfuse within 30 min to gain some contractility back in this area

232
Q

What is the presentation of acute pericarditis?

A

Sharp pain worsened by inspiration
Relieved by sitting up and sitting forward!!
Widespread ST segment elevation
Friction rub on heart auscultation

233
Q

What is the cause of raynauds syndrome? Tx?

A

Arteriolar vasospasm worsened by cold temperature or emotional stress
Tx- aspirin, DHP CCB, sildenafil

234
Q

What are similarities of the Large vessel vasculitis diseases (temporal arteritis and Takayasu’s)?

A

Elevated ESR, Granulomatous thickening, Tx = corticosteroids

235
Q

Polyarteritis nodosa

A

Spares the lungs!
Hep B
Abd. pain, peripheral neuropathy
Cutaneous eruptions- livedo reticularis
TRANSMURAL inflammation and fibrinoid necrosis
Aneurysms and constrictions on arteriorgram
Tx- corticosteroids and cyclophosphamide

236
Q

Kawasakis

A

Coronary anuerysms
Asian children
Motorcycles use hands and feet -> erythema, peeling skin
Lips/ oral mucosa/ strawberry tongue
Cervical lymphadenitis
Tx IV immunoglobulin and ASPIRIN (to prevent MI’s even though Reye’s is possible)

237
Q

Lung kidney and skin vasculitis, no granulomas, p-ANCA

A

Microscopic polyangitis

238
Q

Upper and lower airway disease, granulomas, glomerulonephritis, c-ANCA

A

Wegener’s

239
Q

Churg strauss

A

IgE, eosinophilia, asthma
Peripheral neuropathy
p-ANCA
granulomas

240
Q

Henloch schonlein

A

1) kids
2) palpable purpura on legs/ buttocks
3) recent URI
4) IGA and C3 COMPLEX deposition
5) IgA nephropathy -> renal disease
6) Arthralgia (knee classically)
7) Abd. pain

241
Q

Where does angiosarcoma occur and due to what exposures?

A

Head neck breast and liver
Radiation, thorotrast
arsenic, vinyl chloride

242
Q

What does sturge weber disease present like?

A

Port wine stain, ophthalmic division distribution on face

AVM, seizures, glaucoma, MR, hemiplegia

243
Q

What is the mechanism of DHP CCBs

A

Dilate arteriolar sm. muscle (decr afterload) and dilate coronaries

244
Q

What cholesterol drug has the best effect on LDL?

A

Statins

245
Q

What is the mechanism and side effects of statins?

A

Inhibit HMG CoA reductase.

SE: hepatotoxicity

Myalgias, mypathies, rhabdomyolisis

246
Q

What are the mechanisms of action of niacin? SE?

A

Inhibits lipolysis and VLDL secretion

SE: Flushing (reduced with aspirin)
Hyperglycemia (acanthosis nigricans) and hyperuricemia

Myositis (but not as bad as statins or fibrates)
Cholesterol gallstones (but not as bad as fibrates or bile acid resins)
247
Q

What is the unique effect of bile acid resins (cholestyramine)?

A

slightly increase triglycerides

248
Q

Bile acid resins SE

A

Tastes bad
GI discomfort
Cholesterol gallstones**

249
Q

What is the main use for fibrates?

A

Decrease triglycerides!!!

250
Q

What is the MOA of fibrates and what are the SE?

A

Upregulate LPL

Myositis, Hepatoxicity (similar to statins, can be bad when combined)

** Gallstones: fibrates block 7 alpha hydroxylase conversion of cholesterol into bile acids. This causes cholesterol excess in gallbladder

251
Q

Whats unique about class IC antiarrhythmics?

A

Dissociate from sodium channel the slowest due to strongest binding. Makes them the most USE DEPENDENT

252
Q

What are the main side effects of quinidine?

A

Prolonged QT -> Torsades.
Thrombocytopenia
Cinchonism: headache, tinnitus

253
Q

What is the main use and side effect of procainamide?

A

Use- WPW

SE: Drug induced lupus (anti histone Ab)

254
Q

What antiarrhythmics are reverse use dependent?

A 
Class III- K+ blocker (AIDS)
Amiodarone
Ibutilide
Dofetilide
Sotalol
255
Q

What is the drug of choice for abolishing SVT?

A

Adenosine

SE= flushing, hypotension, chest pain

256
Q

Mg++

A

Effective in torsades, digoxin toxicity and eclampsia seizures

257
Q

Thyroid gland is derived from what tissue?

A

Endoderm

258
Q

What can get damaged in a superior artery ligation?

A

Ext. branch of the superior laryngeal nerve -> cricothyroid muscle

259
Q

What can get damaged in a inferior artery ligation?

A

Recurrent laryngeal nerve (innervates all laryngeal muscles other than cricothyroid -> can cause horseness. Also innervates sensation below the vocal cords)

260
Q

Where are the adrenal cortex and medulla derived from?

A

Cortex- mesoderm

Medulla- neural crest

261
Q

What is responsible for fetal lung production and surfactant production?

A

Cortisol from the placental and fetal thyroid (inner active zone)

262
Q

What factors cause HYPERPLASIA of the cortex?

A

AngII-> Glomerulosa

ACTH -> fasciculata and reticularis

263
Q

What is well developed in adrenal cells?

A

Smooth ER -> needed for steroid synthesis!

Liver (detoxification) and gonads (steroids) also have well developed smooth ER

264
Q

What shares alpha units with beta hCG?

A

beta hCG causes a Terrible Fucking Life
TSH
FSH
LH

265
Q

Where is the posterior pit derived from?

A

Neuroectoderm

266
Q

What is stored in the posterior pit?

A

ADH (AVP) and Oxytocin

These are made in the hypothalamus and carried to the posterior pit via neurophysins

267
Q

Where is the anterior pit derived from?

A

Rathkes pouch-> oral ectoderm (surface ectoderm)

268
Q

Hormones of the anterior pit. Which are basophils, which are acidophils

A

FLAT PiG
Basophils = FLAT
Acidophils = PiG

269
Q

What types of cells are in Islets of langerhans and where is each located?

A 
Alpha cells (glucagon)- outer rim
Beta cells (insulin)- central
Delta cells- somatostatin (interspersed)
270
Q

What tissues have insulin independent glucose uptake?

A

BRICKL
BR- brain, RBCs- GLUT1
ICKL- intestine, cornea, Kidney, Liver- GLUT2

271
Q

What tissues have insulin dependent glucose uptake? What transporter?

A

Adipose and skeletal muscle

GLUT4

272
Q

What do beta 2 agonists and alpha 2 agonists do to insuline levels?

A

Beta 2- raise

Alpha 2- lower

273
Q

What is the MOA and uses of diazoxide?

A

Opens K+ channels which relaxes vasc. sm. muscle
-Can be used in malignant HTN

Opening K+ channels in beta pancreatic cells also decreases insulin release. Can be used in insulinoma

274
Q

What hypothalamic hormones regulare prolactin secretion from the anterior pit? What are the effects of prolactin?

A

Dopamine is a negative inhibitor
TRH increased prolactin release
Estrogens also stimulate prolactin secretion

Prolactin stimulates mil production and inhibits GnRH

275
Q

What are the functions of cortisol?

A 
BBIIG
Blood pressure- upregulates alpha1
Bone- decreases formation
Inflammatory- inhibits PLA2, neutrophilia (inhib adhesion) decr histamine, eosinophils, decr IL2
Insulin resistance
Gluconeogenesis (stimulates)
276
Q

How does PTH stimulate osteoclasts?

A

Increased M-CSF and RANK-L by osteoblasts

277
Q

What is the derivative of parafollicular cells (C cells) of the thyroid?

A

Neural crest

278
Q

What endocrine hormones use cAMP

A

anything that ends in H (except GnA1Tr) and hCG
hCG
calcitonin
glucagon

279
Q

What hormones use IP3

A 
GOAT HAG which includes GnA1Tr
GnRH
oxytocin
ADH V1
TRH
Histamine (H1)
Ang II
Gastrin
280
Q

What hormone use cGMP

A

NO, ANP

281
Q

What hormones use a steroid receptor?

A 
VETTT CAP
Vit D
Estrogen
Testoterone
T3/T4 (nuclear receptor!!)
Cortisol
Aldosterone
Progesterone
282
Q

What endocrine hormones use an intrinsic tyrosine kinase (receptor tyrosine kinase)?

A 
Growth hormones
Insulin
IGF-1
FGF
PDGF
EGF

This uses the MAP kinase pathway

283
Q

Insulin signaling leads to what

A

activation of protein phosphatase 1

activation of serine kinases which phosphorylate IRS-1

284
Q

What are the endocrine hormones that use receptor associated tyrosine kinase (non receptor)

A

PIG
Prolactin
Immunomodulators (cytokines)
GH

JAK/STAT pathway

285
Q

What blocks iodine entry into follicular thyroid cells via competitive inhibition?

A

Perchlorate, pertechnetate

286
Q

How would a patient in Primary hyperaldosteronism (Conn syndrome) present

A

Hypertension (but not hypernatremia d/t escape from aldo)
Hypokalemia -> muscle weakness
Hypokalmeic alkalosis -> parasthesias
LOW plasma renin

287
Q

What are the causes of primary adrenal insufficiency?

A

Addison needed to stop at the ATM
Autoimmune
TB
Metastasis (esp lungs)

288
Q

How would primary adrenal insufficiency present?

A

Hypotension, hypocholremia, metabolic acidosis, hyperkalemia

Weakness, fatigue, anorexia, weigh loss, skin hyperpigmentation*

289
Q

Adrenal neuroblastoma

A 
N-myc
Occurs in adrenal medulla of children
Less likely for episodic HTN
HVA in urine (dopamine breakdown product)
Tumor marker = bombesin
IHC stain: neurofilament stain
Homer wright pseudorosettes
290
Q

Whats not revved up in hyperthyroidism?

A

Cholesterol -> hypocholesterolemia!

Opposite is true for hypothyroidism -> hypercholesterolemia

291
Q

What is a unique possibility in hypothyroidism?

A

Hypothyroid myopathy

incr’d CK, muscle pain, proximal muscle weakness, cramping

292
Q

What is the presentation of cretinism? THINK! you always miss this one

A 
6 P's and jaundice
Potbellied
Pale
Puffy face
Protruding umbilicus (umbilical hernia****)
Protuberant tongue (macroglossia****)
Poor feeding
Jaundice
Constipation
293
Q

De Quervain’s subacute granulomatous thyroiditis

A 
After a flu like illness
Granulomatous inflammation
Incr ESR
Jaw pain
Very painful thyroid
"Mixed cellular infiltration with multinucleated giant cells"
294
Q

Riedel’s thyroiditis

A

Rock hard thyroid, painless
Can extend into local structures
IgG4 related
Macrophages and eosinophils

295
Q

What would the thyroid follicles look like histologically in Graves

A

Abnormal shape with scalloping

296
Q

What causes the proptosis in Graves

A

Fibroblasts responding to the cytokines secreted by TH1 cells

297
Q

Whats unique about hyperparathyroidism caused by kidney disease

A

The kidneys cant activate Vit. D or trash phosphate

Hyperphosphatemia

298
Q

Albright’s hereditary osteodystrophy

A 
PseudohypOparathyroidism
Auto Dom kidney unresponsiveness to PTH
Shortened 4th/5th digits
Hypocalcemia
Elevated PTH causes osteitis fibrosa cystica
299
Q

What is the most common cause of death in acromegaly?

A

Heart failure (GH causes growth of internal organs)

300
Q

How does the body respond to SIADH

A

The body will be retaining a bunch of water so the body decreases aldosterone to maintain near normal volume status (HYPONATREMIA)

301
Q

What is found in the Hepatoduodenal ligament?

A

I can the portal triad in HD

302
Q

What is found in the Falciform ligament?

A

Ligamentum teres

303
Q

What is found in the Gastrohepatic ligament?

A

It is on the lesser curve of the stomach and contains the gastric arteries

304
Q

What is found in the Gastrocolic ligament?

A

Found on the greater curvature/ transverse colon and contains the gastroepiploic arteries

305
Q

What is found in the Gastrosplenic ligament?

A

Short gastrics, gastroepiploic vessels

306
Q

What is found in the splenorenal ligament?

A

Splenic artery and vein

307
Q

What are the signs of kernicterus?

A

Billirubin deposits in the basal ganglia and causes:
Athetoid writhing cerebral palsy (uncontrolled limb movements)
Hearing loss

308
Q

Focal nodular hyperplasia

A

Central stellate scar

309
Q

Cavernous hemangionma

A

Most common benign liver tumor

Cavernous blood filled cavities lined by single layer of epithelium

310
Q

Hepatic adenoma

A

Benign

ORAL CONTRACEPTIVES OR STEROIDS

311
Q

Angiosarcoma

A

Malignant. Arsenic, polyvinyl chloride, thorotrast

312
Q

What are the unique features of primary biliary cirrhosis?

A

AMA (anti mitochondrial antibodies)
Middle aged females with new onset PRURITIS
Xanthelasma (d/t incr cholesterol) -> cutaneous eye lid lesion with foam cells
Lymphocytic infiltrate + GRANULOMAS

313
Q

What are the unique features of Primary sclerosing cholangintis?

A 
Onion Skinning bile duct fibrosis
Deading of the bile ducts on ERCP
Commonly men in 40s
Hyper IgM
a/w ulcerative cholitis
Incr cholangiocarcinoma risk
314
Q

What is a unique complication of pancreatitis?

A

Pseudocyst formation- lined by granulation tissue, not epithelium. Can rupture and hemorrhage

315
Q

What is the mechanism of ondansetron (also granisetron)?

SE?

A

5HT3 antagonist -> antiemetic

SE:
Constipation (opposite of serotonin syndrome)
Headache (opposite of sumatriptan)

316
Q

What is the mechanism of action of metoclopramide?

A

D2 antagonist. 5HT4 agonist
Helps you shit (esp post surgery or diabetic gastroparesis), antiemetic

Increases parkinsonism effects.
Contraindicated in small bowel obstruction patients, Parkinsons disease, or seizure history -> lower seizure threshold)

317
Q

What are races are more prone to the thalassemias?

A

Asian- cis alpha gene deletion
Africans- trans alpha gene deletion
Mediterranean- Beta thalassemia

318
Q

What is the major finding in beta thal minor?

A

Increased HbA2 > 3.5%

319
Q

What is the major finding in beta thal major?

A

No HbA! Mainly HbF

320
Q

What enzymes does iron inhibit? What else does it inhibit?

A

Ferrochelatase and ALAD -> impaired heme synthesis

Also inhibits rRNA degradation -> basophilic stippling

321
Q

What does LEAD stand for in lead poisoning?

A

Lead lines,
Encephalopathy, Erythrocyte basophilic stippling
Abdominal pain, anemia (sideroblastic -> ferochelatase is in the mitochondria)
Drops (foot and wrist), eDta, Dimercaperol

322
Q

What are the causes of sideroblastic anemia?

A

Alcohol, lead, isoniazid, ALAS enzyme defect

323
Q

What is the side effect of doxorubicin and danorubicin? How is it prevented?

A

Cadiotoxicity (dilated cardiomyopathy)

Dexrazoxane

324
Q

What are the MOAs of bleomycin and busulfan? SE?

A

Bleeeeeeeomycin makes freeeeee radicals
Busulfan alkalates DNA

Pulmonary fibrosis

325
Q

What cancer drugs cause hemorrhagic cystitis? How would you prevent?

A

Cylcophosphamide, ifosfamide (prodrugs; alkylating agent)

Prevent with mesna

326
Q

Putting nitro on your mustang will rock your brain

A

Nitrosureas
-mustines
Cross BBB, treat brain tumors, CNS toxicity

327
Q

Vincristine, Vinblastine

A

M phase
Inhibit microtubule formation
Vincristine- neurotoxicity
Vinblastine blasts the bone marrow

328
Q

Paclitaxol

A

M phase
“Its taxing to stay polymerized”
Hyperstabilize microtubules, preventing breakdown

329
Q

What are the side effects of cisplatin and carboplatin? Prevention?

A

Nephrotoxicity and ototoxicity

Prevent nephro with amifostine and chloride diuresis

330
Q

What is the mechanism of etoposide and teniposide?

A

Inhibit topoisomerase II -> double strand breaks**

331
Q

What is the mechanism of action of Trinotecan and tropotecan?

A

inhibit topoisomerase I -> single strand breaks**

332
Q

How des prednisone and prednisolone work as anti cancer agents?

A

Induce apoptosis

333
Q

What are the side effects of glucocorticoids?

A 
CHIPA CHIPO 
Cushing like symptoms
Hypertension
Immunosuppression
Peptic ulcers
Acne
Cataracts
Hyperglycemia
Insomnia
Psychosis
Osteoporosis
334
Q

Rotator cuff tendons and actions

A 
SITS
Supraspinatus- abducts initial 10 degrees
Infraspinatus- laterally rotates
Teres minor- laterally rotates, adducts
Subscapularis- medially rotates, adducts
335
Q

What is the saying for the wrist bones?

A 
So Long To Pinky Here Comes The Thumb
Scaphoid
Lunate
Triqetrium
Pisiform
Hamate
Capitate
Trapezoid
Trapezium
336
Q

What is the most common fractured carpal bone? Leads to what injury?

A

Scaphoid

Avascular necrosis

337
Q

Dislocation of what bone may cause carpal tunnel syndrome?

A

Lunate

338
Q

What can cause avascular necrosis of the femoral head?

A

Sickle cell, steroids, SLE, alcoholism

Femoral neck fraction (fall on hip w/ osteoporosis) -> can injure medial femoral circumflex

339
Q

What muscle provides the brachial plexus protection?

A

Subclavius

340
Q

What things can cause autoimmune hemolytic anemia?

A

Warm (IgG)- alpha methyldopa, CLL, SLE

Cold (IgM)- CLL, Mycoplasma pneumonia, infectious mononucleosis

341
Q

Lichen planus

A

Saw tooth lymphocytic infiltrate at dermal epidermal junction

Purple and Pruitic

Hep C

342
Q

Pityriasis rosea

A

Hearld patch on head/ neck that then spreads down the body. Plaques with collarette scale. Self resolving

343
Q

As a sunscreen, avobenzene blocks…

A

UVAI and UVAII

344
Q

As a sunscreen PABA esters block….

A

UVB

345
Q

As a sunscreen zinc oxide blocks…

A

UVAI, UVAI, UVB

346
Q

What levels of skin are affected by SSSS and SJS/TEN?

A

SSSS affects the stratum granulosum only and sluffing off of only the upper layers of the epidermis occurs

SJS/TEN affects the epidermal dermal junction

347
Q

Basal cell carcinoma

A 
Most common, least likely to metastasize
Shiny/ pearly ulcer with rolled borders
Upper lip
Locally invasive
Palisading nuclei in dermal nests
348
Q

Squamous cell carcinoma (of skin)

A

Lower lip
Ulcerative red lesions with FREQUENT SCALE
KERATIN PEARLS

349
Q

Melanoma

A

Least common but most likely to metastasize
S100+
Neural crest origin
Loves to metastasize to the brain
Activating mutation of BRAF kinase (BRAF V600E)
Excision. If metastatic Vemurafenib

Dysplastic nevus syndrome- nest of nevomelanocytees at the dermoepidermal junction. 9p21 mutation

350
Q

Never give a patient with gout ______?

A

Aspirin (decreases renal clearance of uric acid)

351
Q

The Prosencephalon yields what

A

Telencephalon-> cerebral hemispheres (other stuff)

Diencephalon-> Thalamus (second brain)

352
Q

Mesencephalon yields what?

A

Midbrain

353
Q

The Rhombencephalon yields what?

A

Metencephalon -> Pons and Cerebellum

Myelencephalon -> Medulla (very myelinated)

354
Q

What is associated with anencephaly?

A

Maternal diabetes type 1

355
Q

What are the medications for essential tremor?

A

Essential tremor is a rapid tremor of the head, hands, arms or voice that occurs during movement and at rest.

Family history. Often self medicate with ETOH
BETA BLOCKERS (drug of choice) or PRIMIDONE (anticonvulsant)
356
Q

Medial medullary syndrome

A

Ant. Spinal Artery
Tongue towards
Contralateral proprioception
Contralateral weakness

357
Q

What do both Lateral medullary and Later pontine syndromes have in common?

A

Vertigo, nausea and vomiting
Ataxia
Ipsilateral horners
Ipsilateral face pain and temp

358
Q

Lateral medullary syndrome (Wallenburg’s)

A

PICA
Dont PICA horse that cant eat (hoarseness and dysphagia)
Contralateral body pain and temp (checker board)

359
Q

Lateral Pontine syndrome

A

AICA
Facial droop means your AICA’s pooped

Ipsilateral deafness/ tinnitus
Ipsilateral face paralysis
Ipsilateral lacrimation and salivation defects
Ipsilateral loss of taste from anterior 2/3 of tongue
Ipsilateral loss of corneal reflex

360
Q

Webers syndrome (midbrain)

A

contralateral hemiparesis

Ipsilateral CNIII palsy

361
Q

What is pseudotumor cerebri and is it treated?

A

Headaches in a young obese female.
No ventricular dilation on CT, but elevated CSF pressure
Tx- acetazolamide is first line

362
Q

What is the jingle for the reflexes?

A 
S1,2 buckle my shoe
L3,4 kick the door
C5,6 pick up sticks
C7,8 lay them straight
L1,2 picks your nuts up for you
S3,4 anal winks galore
363
Q

Increased CSF protein with normal cell count

A

Guillain Barre (acute inflammatory demyelinating polyradiculopathy)

364
Q

What can trigger Guillain Barre?

A

CMV and campylobacter jejuni

365
Q

What is the presentation of fanconi’s syndrome

A

Metabolic acidosis with hypokalemia and Rickets

366
Q

What are the four causes of renal papillary necrosis (hematuria and proteinuria)?

A

Diabetes
Chronic NSAIDs or aspirin or acetaminophen
Acute pyelonephritis
Sickle cell anemia AND TRAIT!

367
Q

What are the values for prerenal azotemia?

A

Urine osmolality > 500
Urine Na < 40
Fe Na < 1%
Serum BUN/Creatinine >20%

This happens when the kidneys arent getting enough blood flow. They are still able to concentrate the urine. Extra BUN is getting reabsorbed with the water increasing the ratio (normally 15%). Fractional excretion of sodium is also very low.

368
Q

What are the side effects of loop diuretics?

A 
OH DANG
Ototoxicity
Hypokalemia
Dehydration 
Allergy (sulfa)
Nephrotoxic (interstitial nephritis)
Gout
369
Q

What is the main side effect of mannitol?

A

Pulmonary edema

370
Q

What are the side effects of Thiazides?

A

Hypokalemic metabolic acidosis, hyponatremia, sulfa allergy

hyperGLUC
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
371
Q

What is the triad for preeclampsia?

A

HTN, proteinuria, edema (esp hands and face)

If seizures are also present = ecclampsia

372
Q

What 4 things is abrubtio placenta associated with?

A

Smoking
HTN
Cocaine
DIC

373
Q

Whats the main clinical difference between placenta previa and abrubtio placenta?

A

Abruptio placenta is usually seen in the third trimester and is PAINFUL. +/- bleeding

Placenta previa is PAINLESS BLEEDING during any trimester (a painless preview)

374
Q

What ovarian germ cell tumor is a/w Turner syndrome?

A

Dysgerminoma

375
Q

Key features of Yolk sac tumor

A

Elevated AFP
Yellow, friable mass
Most common in young children
Schiller Duval bodies (resemble glomeruli)

376
Q

Sarcoma botryoides

A

Cluster of grapes mass that hangs out of the vagina of girls < 4.

Spindle shaped tumor cells that are desmin and myogenin positive.

377
Q

Breast mass with yellow or bloody nipple discharge

A

Intraductal papilloma
Fibrovascular projections lined with both layers of epithelium (columnar epithelial cells and myopeithelial cells)
Benign

378
Q

Phyllodes tumore

A 
Large mass of CONNECTIVE TISSUE
Leaf like projections
Late (postmenopausal)
Latino
Can have necrosis and hemorrhage
Benign
379
Q

Seminoma testicular tumor

A 
Fried egg appearance
By far most common testicular tumor
Transillumination test positive (cannot be transilluminated)
Incr Placental Alk phos (PLAP)
Good prognosis
380
Q

Embrynal carcinoma (of testicle)

A 
Glandular/ papillary
Hemorrhage and necrosis
Aggressive primitive cells
Hematogenous spread
Painful
Usually mixed with other tumor types
381
Q

Most common testicular tumor > 60 y/o

A

Metatstatic lymphoma. Aggressive. often bilateral

382
Q

What causes primary pulmonary HTN?

A

Inactivating mutation in BMPR2. Normally limits smooth muscle proliferation

383
Q

What is the key feature of a fat embolus

A

bone breaks and petechial rash!! also can result from liposuction

384
Q

Silicosis

A

Upper lobes
Egg shell calcifications of hilar lymph nodes
Disrupts Macrophage phagolysosomes -> incr TB risk
Incr risk of bronchogenic carcinoma
Birefringent silica particles
Foundries, sandblasting, mines

385
Q

Abestosis

A

Worsk best at the BOTTOM of the lung
Ivory white calcified pleural plaques (pathognomonic)
Asbestos bodies (golden brown ferruginous dumbells)
Bronchogenic > mesothelioma
Shipbuilding, roofing, plumbing

386
Q

Lung adenocarcinoma

A

Peripheral (large adeno’s peripheral)
Not related to smoking
k-ras mutations (activating)
hypertrophic osteoarthropathy -> clubbing and arthritis

387
Q

Squamous cell carcinoma of the lung

A

Central (S- cells are central)
Cavitation, neCrosis, Cigarettes, hyperCalcemia (PTHrp)
Keratin pearls

388
Q

Small cell carcinoma of the lung

A 
Central (S- cells are central)
Many paraneoplastic syndromes
L-myc amplification
Small blue neuroendocrine cells (NEUROFILAMENTS)
Inoperable, tx with chemo
389
Q

Large cell carcinoma of the lung

A

Peripheral (large adenos peripheral)
Large, undifferentiated cells, poor prognosis
Remove surgically
larGe -> gynecomastia and galactorrea, pleomorphic Giant cells with leukocyte fragments in cytoplasm

390
Q

Carcinoid

A

Not a/w smoking
Good prognosis
BFDR
Neuroendocrine stains (chromogranin positive)

391
Q

What childhood rash spares the hands and feet?

A

Rubella

392
Q

What childhood rash spares the face?

A

Scarlet fever from strep pyogenes

393
Q

Drugs that cause agranulocytosis

A

Agranulocytosis could certainly cause pretty major damage

Carbamazepine
Clozapine
Colchicine
PTU
Methimazole
Dapsone
394
Q

Drugs that cause aplastic anemia

A

Cholaramphenicol, benzene, NSAIDS, PTU, methimazole

395
Q

Drugs that cause hemolysis with G6PD

A 
Hemolysis IS PAIN
Isoniazid
Sulfonamides
Primaquine
Aspirin
Ibuprofen
Nitrofurantoin

Also dapsone, napthalene, fava beans

396
Q

Drugs that cause megaloblastic anemia

A

Having a BLAST with PMS
Phenytoin
Methotrexate
Sulfa drugs

397
Q

Drugs that cause acute cholestatic hepatitis/ jaundice

A

Erythromycin

398
Q

Drugs that cause hypothyroidism

A

Lithium, amiodarone, sulfonamides

399
Q

Drugs that cause gingival hyperplasia

A

Phenytoin, cyclosporine, verapamil

400
Q

Drugs that can cause gout

A

Furosemide, thiazides, niacin, cyclosporine

401
Q

Drugs that cause myopathies

A 
Fish N CHIPS Give you myopathies
Fibrates
Niacin
Colchicine
Hydroxychloroquine
Interferon alpha
Penicillamine
Statins
Glucocorticoids
402
Q

Drugs that can cause Stephens Johnson syndrome

A 
Steven Johnson gave me a PEC SLAPP
Penicillin
Ethosuximide
Carbamazepine
Sulfa drugs
Lamotrigine
Allopurinol
Phenytoin
Phenobarbital
403
Q

What can give you acquired fanconi’s syndrome?

A

Expired tetracycline

404
Q

What drugs can give you acute interstitial nephritis

A

Methicillin
NSAIDS
Furosemide

405
Q

What drugs can cause SIADH

A

Carbamazepine and cyclophosphamide

406
Q

What drugs are likely to cause seizures

A 
With seizures, I BITE My tongue
Isoniazid
Bupropion
Imipenem/ Cilastin
Tramadol
Enflurane
Metoclopramide
407
Q

What drugs can cause disulfiram like reaction

A

Metronidazole
Certain cephalosporins
1st gen sulfonylureas (tolbutamide, chlorpropamide)

408
Q

What drugs are nephrotoxic and ototoxic?

A

Vancomycin, aminoglycosides, loops, cisplatin

409
Q

What drugs can cause massive hepatic necrosis

A 
HAVAc
Halothane
Amanita phalloides
Valproic acid
Acetaminophen
410
Q

What drugs are sulfa drugs

A 
Popular FACTSSS
Probenacid
Furosemide
Celecoxib
Thiazides
Sulfonamide antibiotics
Sulfasalazine
Sulfonylureas
411
Q

What are two tocolytic drugs (reduce uterine contractions)?

A

Ritrodrine, Terbutaline (Beta 2 agonists)

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