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STEP1 Flashcards > Pharm and week 2 review (8/18) > Flashcards

Pharm and week 2 review (8/18) Flashcards

1
Q

Half life equation

A

t half= 0.7* Vd/ CL

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2
Q

Where is elastase produced in the lungs?

A

Macrophages and neutrophils

balanced by serum and tissue protease inhibitors

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3
Q

What is the effect of excess elastase activity in the lungs?

A

emphysema

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4
Q

paramesonephric duct is also called

A

mullerian duct

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5
Q

Law of conservation of mass

A

total flow=flow velocity x cross section area=constant

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6
Q

IL-12 does what?

A

stimulate Th1–> IFN gamma, IL-2–> macs and CD8 t cells

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7
Q

breakdown of odd chain FA, branched chain aa (valine, isoleucine), threonine, methionine leads to production of what?

A

propionic acid

can eventually enter TCA cycle as succinyl CoA

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8
Q

CGG repeat

A

Fragile X

Hypermethylation of FMR1 gene

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9
Q

Cystic hygroma and bilateral extremity swelling with decreased femoral pulses in a baby

A

Turners syndrome

loss fo paternal X

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10
Q

Reactive arthritis signs and symptoms

A

Can’t pee, Can’t see, can’t climb a tree + sacroilitis (HLA-B27 association)

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11
Q

Psychosis during depressed episode

A

Major depressive disorder w/ psychotic features

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12
Q

Psychotic symptoms +/- mood disorder

A

Schizoaffective disorder

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13
Q

Dystrophic calcification

A

Ca deposition in abnormal (injured or necrotic) tissues
localized calcification (aortic stenosis)
Nl levels of Ca

damage can be from aging

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14
Q

local calcification of abnl tissue with normal Ca levels

A

Dystrophic calcification

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15
Q

Canagliflozin

A

SGLT2 inhibitor that blocks reabs of glucose in PCT

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16
Q

Contraindication for SGLT2

A

Renal impairment

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17
Q

what is in the femoral ring?

A

Lymphatics coming out of femoral canal

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18
Q

what is in the femoral sheath?

A

Femoral artery, vein, lymphatics

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19
Q

from lateral to medial what is the femoral triangle

A

Nerve, Artery, Vein, lymphatics (NAVeL)

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20
Q

effects of a chronic AV shunt on the heart

A

increased CO output
decreased total peripheral resistance
increased mean systemic pressure (renal retention)

Acute AV shunt no change in mean systemic pressure

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21
Q

Effects of pulmonary fibrosis on breathing?

A

rapid shallow breaths

increase elastic resistance

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22
Q

Immune SE of corticosteroids

A

Neutrophilia–> demargination
Immunosuppression
Increased risk of infection

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23
Q

Fever, generalized lymphadenopathy, facial edema, skin rash, eosinophilia + drugs

A

Drug reaction with eosinophilia and systemic symptoms (DRESS)

phenytoin, allopurinol, sulfonimides
2-8 wks after

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24
Q

Viral reassortment

A 
only in segmented viruses
BOAR
Bunyavirus
Orthomyxovirus 
Arenavirus
Reovirus
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25
Q

mutation in hemochromatosis

A

C282Y on HFE gene–> increases iron absorption in intestines
decreases hepatocyte hepcidin synthesis

HLA-A3

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26
Q

parotid gland hypertrophy with low body weight

A

Anorexia of the binging and purging flavor

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27
Q

parotid gland hypertrophy with normal body weight

A

Bulimia

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28
Q

Majority of OD deaths

A

opioids

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29
Q

Reaction formation

A

responding in a manner opposite one’s actual feelings

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30
Q

Tx for mycobacterium avium

A

Azithromycin + rifavutin or ethambutol

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31
Q

fever, wt loss, diarrhea, anemia, hepatosplenomegaly, elevated alkaline phosphatase and lactate dehydrogenase, bacteria grows well at high temp

A

Mycobacterium avium

CD4 count

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32
Q

Proglitazone MOA

A

PPAR gamma binding

nuclear transcription regulator increases insulin sensitivity

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33
Q

tx for essential tremor

A

propranolol

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34
Q

Thiopental

A

Barbiturate
short acting general anesthetic
high lipid solubility so rapidly redistributed from brain to skeletal muscle and fat

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35
Q

cause of SE from Niacin

A

Prostaglandins (PGD2 and PGE2) cause flushing, warmth, itching

tx: aspirin

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36
Q

Diuretic that improves survival in pts with CHF + decreased EF

A

SPIRONOLACTONE

k sparing and improved remodeling of ventricles

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37
Q

Chlordiazepoxide

A

Benzo used for alcohol withdrawal

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38
Q

Chlorthalidone

A

Thiazide

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39
Q

Metabolic effects of Thiazide

A 
HyperGLUC
Glycemia 
Lipidemia (decreased insulin secretion increased resistance)
Uricemia 
Calcemia

Hypo natremia –> inhibition of Na/Cl in DCT
Hypokalemia–> K wasting

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40
Q

patient with treated symptomatic coronary artery dz with myopathy

A

statin induced myopathy

esp when used with vibrates or niacin

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41
Q

SE of CCB

A

Peripheral edema, dizziness or lightheadedness, constipation

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42
Q

Amlodipine

A

CCB that acts on vascular SM

tx for HTN

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43
Q

Triamterene

A

diuretic
blocks Na+ channels in cortical collecting tubule
K sparing

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44
Q

tx for trauma pt who is obtunded with HTN

A

Mannitol

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45
Q

Tx for decompensated systolic HF

A 
beta blocker (carvedilol) 
decrease work and after load
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46
Q

beta blocker treatment for glaucoma

A

decrease aqueous production by ciliary epithelium

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47
Q

Tx for Psoriasis that activates a nuclear transcription factor

A

Topical Vit D analogs

calcipotriene, calcitriol, tacalcitol

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48
Q

Calcipotriene

A

Tx for psoriasis
activates a nuclear transcription factor
inhibit keratinocyte proliferation and stimulate keratinocyte differentiation

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49
Q

SE of glyburide

A

hypoglycemia

sulfonyurea (inhibit ATP depends K channels in beta cells leading to exocytosis of insulin)

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50
Q

SE of long term use of omeprazole

A

decreased Ca abs–> osteoporotic hip fracture

decrease serum Mg+

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51
Q

Ribavirin MOA

A

interfere with duplication of viral genetic material

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52
Q

SE of mu opioid (morphine)

A

smooth muscle contraction of the sphincter of Oddi
increases common bile duct pressure

also addiction, constipation, pin point pupils

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53
Q

effect of rat poison

A

super warfarin (brodifacoum)
deplete vitamin K clotting factors–> like warfarin toxicity
Tx: FFP

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54
Q

Medial hypertrophy in lung vessels, intimal fibrosis, luminal narrowing

A

Idiopathic pulmonary arterial HTN–BMPR2 gene

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55
Q

TX for pulmonary arterial HTN

A

Bosetan
endothelin receptor antagonist
vasodilator–> decreases PA pressure and decreases hypertrophy

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56
Q

interstitial myocardial granuloma with plump macrophages and increased cytoplasm.

A

Aschoff bodies with anitschkow cells

Rheumatic fever–> young kid with myocarditis

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57
Q

Fibular neck fracture

A

injured common peroneal n.

PED= Peroneal Everts and Dorsiflexes
Foot dropPED

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58
Q

Knee trauma

A

Tibial n. injury

TIP
Tibial Inverts and Plantarflexes
can’t stand on TIP toes

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59
Q

RA antibodies

A 
Anti-CCP (anti-cyclic citrullinated peptide) 
Rheumatory factor (IgM anti IgG)
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60
Q

disease frequency in hardy weinberg

A

q^2

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61
Q

Interferon alpha and beta

A

Interfere with viruses
prime uninfected cells for viral defense
halt protein synthesis in uninfected cells

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62
Q

Interferon gamma

A

Th1 differentiation, increased expression of class II MHC APC, Improves intracellular killing by macs

produced by T cells and NK cells

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63
Q

Cause of pulses paradoxus with no pericardia effusion or constrictive pericarditis

A

Asthma and COPD

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64
Q

Down regulation of gastric acid production?

A

Intestinal infuence
peptide YY binds ECL
somatostatin and prostaglandins

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65
Q

Dyspnea, tachypnea, prolonged expiration, bilateral wheezing

A

obstructive pulmonary disease exacerbation

Tx; Beta agonist increases cAMP

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66
Q

Carbon tetrachloride

A

Free radical injury to liver (H2O2)

lipid per oxidation

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67
Q

where are intracranial schwannomas located?

A

cerebellopontine angle–> between cerebellum and lateral pons

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68
Q

Buprenorphine

A

partial opioid agonist

precipitates withdrawal

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69
Q

Uncle herniation effects

A 
Down and out (oculomotor nerve palsy) 
Blown pupil (dilated pupil)
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70
Q

Anxious, fearful of rejection, wants relationships, timid

A

Avoidant personality

71
Q

How to test for fat malabsorption?

A

Sudan III stain of stool

72
Q

Causes of SCC of the esophagus

A

Alcohol use, tobacco, smoked foods

73
Q

Borderline personality disorder

A

SPLITTING
unstable relationships and mood
impulsive, self-mutilitation, emptiness

74
Q

Colorectal, endometrial, ovarian cancer

A

Lynch syndrome

75
Q

mutation in lynch syndrome

A

MSH2 and MLH1

76
Q

Excessive emotions, attention seeking, sexually provocative, overtly concerned with appearance

A

histrionic personality disorder

77
Q

Hormone sensitive lipase

A

degrades TGs stored in adipocytes
creates FFA and glycerol

activated by stress hormones (starvation)
inhibited by insulin

78
Q

NF kappa B

A

controls transcription, cytokine production, cell survival

79
Q

osteoclasts histology

A

multinucleate (2-5)

100s of nuclei in paget’s

80
Q

Receptor activation of NF kappa B ligand

A

RANKL–> differentiation of osteoclasts

81
Q

Differentiation of osteoclasts

A

RANK-L and Mac colony stimulating factor

82
Q

Osteoprotegerin

A

OPG
decoy receptor decrease binding of RANK-L to RANK
decreases differentiation of osteoclasts
increase bone density

83
Q

late muscle changes in Duchenne muscle dystrophy

A

muscle in distal extremities replaced by fat and connective tissue (pesudohypertorphy)

84
Q

Thinning of glomerular BM

A 
Alport syndrome (type 4 collagen)
hearing loss, ocular abnormalities, hematuria, progressive renal insuff
85
Q

Nesiritide

A

Synthetic BPN
dilates arterioles and veins
increase cGMP in smooth muscle
decrease after load and preload

86
Q

Use of clevidipine

A

HTN emergency

87
Q

equations for CO

A

SVxHR

=(rate O2 consumption)/(arterial O2 content - venous O2 content)

88
Q

calculation of MAP

A

CO x TRP=2/3 diastolic + 1/3 systolic

89
Q

Ejection fraction eq

A

EF=SV/EDV= (EDV-ESV)/EDV

90
Q

SE of Doxorubicin

A

Dilated cardiomyopathy prevent with dexarzoxane

91
Q

Nitrates effect

A

VENOdilator, decrease LVEDP and preload

92
Q

Cilostazol

A

Phosphodiesterase III inhibitor
increases cAMP in plts inhibits plt aggregation
vasodilator
tx for claudication

93
Q

Statin MOA

A

block HMG-CoA reductase leads to increased surface expression of LDL receptors

94
Q

Dilated cardiomyopathy

A 
ABCCCDHS
Alcohol abuse
(wet) Beri Beri
Chagras 
Chronic Cocaine use
Chagas Dz
Doxorubicin toxicity 
Hemochromatosis 
Sarcoid
95
Q

Causes of restrictive cardiomyopathy

A

diastolic dys
sarcoid, amyloid, post radiation
loftier syndrome (endomyocardial fibrosis w/ eosinophilic infiltrate)

96
Q

DNA polymerase I

A

Degrades RNA primer

97
Q

Which direction are deoxynucleotides added

A

3’end so building from 5 to 3

reading original strand 3 to 5

98
Q

where are GI stem cells

A

Crypts of liberkuhn

99
Q

Von Gierke enzyme

A

G6Pase

100
Q

Enlarged hilar lymph nodes on CXR, elevated ACE and scattered granulomas in liver

A

Sarcoidosis

arthralgia

101
Q

D cells in pancreatic islet and gut mucosa

A

Produce somatostatin

102
Q

Diret inguinal hernia cause

A

breakdown of transversals fascia

older men

103
Q

DIP joint pain, hard, bony enlargement of joints, brief morning stiffness

A

Osteoarthritis

DIP nodules–heberden
PIP nodules–bouchard nodes

104
Q

Paranoid personality disorder vs. delusional disorder

A

Paranoid–pattern of suspiciousness or odd beliefs w/ no clear delusions

Delusional disorder–one or more delusions for >1mo. Otherwise normal behavior

105
Q

Acute morbidity due to rheumatic fever

A

Pancarditis (inflammation of the endocardium myocardium and epicardium)

106
Q

Associations with coarctation of the aorta

A

Turners, bicuspid aorta, other heart defects, Berry aneurysms of the circle of willis

107
Q

Cause of death in adult type coarctation of aorta

A

HTN associated complications

LV failure, ruptured dissecting aortic aneurysm, intracranial hemorrhage

108
Q

Effects of efferent arteriole constriction on GFR and FF

A

GFR increases
RPF decreases
FF increases

109
Q

Hematuria, mild proteinuria and Discrete subepithelial humps on EM (recently treated for sore throat)

A

Post streptococcal glomerulonephritis

M protein
cola-colored urine
granular IF–lumpy bumpy deposits of IgG and C3

110
Q

Schizoid vs. avoidant

A

Schizoid–voluntary withdrawal

Avoidant–Desires contact anxious about rejection and socially inhibited

111
Q

CYP450 inhibitors

A 
AAA RACKS IN GQ Mag
Acute Alcohol Abuse
Ritonavir
Amiodarone
Cimetidine
Ketoconazole 
Sulfonamides
INH
Grapefruit juice
Quinidine 
Macrolide's (minus azithro)
112
Q

Neural crest cell derivatives

A 
MOTEL PASS
Melanocytes
Odontoblasts
Tracheal cartilage 
Enterocromaffin cells
Laryngeal cartilage 
Parafollicular cells 
Adrenal medulla 
All ganglion
Schwann cells
Spiral membrane (heart)
113
Q

fever, puritic skin rash and arthralgias 7-14d after exposure

A

Acute serum sickness
Type III hypersensitivity rxn

Decreased C3

small vessel vasculitis w/ fibrinoid uncross and PMNs

114
Q

Type III hypersensitivity rxn

A

Immune complex
deposition of Ab-Ag complexes
leads to localized complement consumption–> decreased serum C3

115
Q

AG resistance

A

amino glycoside modifying enzymes that attach chemical groups and decrease ability of drug to bind to ribosomes

116
Q

Effects of myasthenia gravis on conduction

A

Autoantibodies against postsynaptic nicotinic ACh receptors

Reduced motor end plate potential

117
Q

CN VII function

A

Motor for face
parasymp LACRIMAL, submandibular and sublingual glands
taste of anterior 2/3 of tongue
somatic-pinna and external auditory canal

118
Q

COPD effect on kidney

A

Hypoxia stimulates erythropoietin production

119
Q

Iliohypogastic n

A

Risk of damage during appendectomy

L1
motor to anterolateral ab wall
sen. suprapubic region

120
Q

Ilioinguinal n.

A

follows spermatic cord through superficial inguinal ring

sensation to upper and medial thigh and part of genitals

121
Q

hypotension, distended neck veins, distant heart sounds

A

Beck’s triad

Cardiac tamponade

+pulsus paradoxus

122
Q

increased JVD with inspiration

A

Kussmaul sign

impaired filling of RV
causes: constrictive pericarditis, restrictive cardiomyopathies, RA or RV tumors

123
Q

Smooth area of the ventricles comes from

A

Bulbus cordis

124
Q

the trabeculated parts of the right and left ventricles comes from

A

Primitive ventricle

125
Q

What disease is associated with sterile small vegetation’s made up of platelet rich thrombi on the mitral valve

A

Advanced malignancy (adenocarcinoma)
or hyper coagulable states
antiphospholipid syndrome
SLE (libman-sacks endocarditis)

126
Q

Treatment for acute obstructive pulmonary exacerbations

A

Beta 2 adrenergic agonist

increases intracellular cAMP
Bronchial smooth muscle relaxation

127
Q

ACE inhibitor side effect for people with HF or on diuretics

A

1st dose hypotension and syncope

High plasma renin activity
removal of Ang II vasoconstriction–> drop in BP

128
Q

Appearance of pulsus paradoxus on physical exam

A

Due to cardiac tamponade

Drop in pulse amplitude during inspiration

129
Q

Beat to beat variation in pulse amplitude

A

Pulsus alternans

Severe LV dysfunction

130
Q

Electrical alternans

A

beat to beat variation in QRS amplitude on ECG due to swinging motion of hear in pericardial fluid due to effusion or tamponade

131
Q

Vasculitis with granulomatous inflammation of the media

A

Giant cell arteritis

takayasu arteritis

132
Q

Systolic pressure gradient between the LV and aorta is suggestive of…

A

LV outflow tract obstruction (aortic stenosis)

remember that dilated cardio myopathy is a diagnosis of exclusion

133
Q

Pathogenesis of IE

A

first disruption of normal endocardial surface

Second focal adherence of fibrin and plts making a sterile fibrin-plt nidus.

134
Q

migratory septic arthritis in a 25yo

A

Nisseria gonococci

135
Q

tx: nisseria gonococci

A

Ceftriaxone

136
Q

Causes of infectious arthritis

A

S. aureus, streptococcus, Nisseria gonorrhoeae

migratory and asymmetric

sinusitis, tenosynovitis, dermatitis

137
Q

Vd equation

A

Vd=(amount of drug in body)/(plasma drug concentration)

138
Q

Loading dose calculation

A

LD=Cp x Vd/F

139
Q

First line for otitis externa

A

Fluoroquinolone’s (ciprofloxacin)

140
Q

primary amyloidosis

A

AL amyloid made up of ig light chain

seen in multiple myeloma (abnormal plasma cell dyscrasia)

141
Q

Secondary amyloidosis

A

AA amyloid
Serum amyloid-associated protein (SAA)

increased by chronic inflammation (autoimmune states, TB, RA), malignancy and familial mediterranean fever

142
Q

Multiple myeloma

A 
CRABB
hyperCalcemia
Renal involvement (Bence-Jones casts from high ig in the urine, nephrocalcinosis, metastatic)
Anemia 
Bone lytic lesions 
Back pain

Monoclonal M protein

Rouleaux formation–stacking of RBCs

143
Q

recurrent bacterial infections and no tonsils

A

X-linked (Bruton) agammaglobulinemia

Defect in BTK tyrosine kinase–> no B cell maturation

decreased Ig of all classes

144
Q

Tetany (hypocalcemia), recurrent viral/fungal infections, ToF

A

Thymic aplasia
DiGeorge syndrome

absent thymic shadow on CXR
decreased T cells

145
Q

airway and GI infections, autoimmune diseases, atopy

A

Selective IgA deficiency

decreased IgA with normal IgG and IgM
Anaphylaxis to IgA containing products

Type I hypersensitivity rxn

146
Q

Effect of strenuous exercise on blood gas content

A

skeletal muscle removes more O2–>decreased O2 in venous blood

Muscle produces more CO2–> increased CO2 in venous blood supply

Increased CO2 in venous blood leads to decreased venous pH

147
Q

Kinesin function

A

move from negative to + end (anterograde) of microtubule carrying vesicles and organelles away from cell body to nerve terminal

+ end is far away

148
Q

PCP MOA

A

N-mentyl-D-aspartate receptor antagonism

agitation, hallucinations, violent behaviors
Horizontal AND vertical nystagmus

disorientation and memory loss

149
Q

Diagnosis of Mucormycosis

A

Mucosal biopsy

150
Q

Causes of elevated CK and myopathy

A 
Inflammatory myopathy (polymyositis-prox ask weakness)
Statin-induced myopathy (weeks to months after starting statin)
Hypothyroid myopathy (hypothyroid features, delayed tendon reflexes and myoedema)
151
Q

which enzyme determines the rate of glycolysis

A

phosphofructokinase

152
Q

which non-glucose monosaccharide enters the glycolytic pathway downstream of phosphofructokinase?

A

Fructose

allows for rapid metabolism

converted to F1P–>glyceraldehyde–> G3P–>–>pyruvate

153
Q

Histology of acute organ rejection

A

interstitial lymphocytic infiltrates

154
Q

What is the purpose of giving fluids in hypovolemic shock?

A

Increase volume–> increase preload–> increase myocardial stretch–> increase stroke volume

155
Q

Cancers associated with hereditary retinoblastoma

A

Soft tissue sarcoma
Osteosarcoma (distal femur, proximal tibia, proximal humerus)
melanoma
Brain cancers

156
Q

Cause of Zener Diverticulum

A

abnl spasm or diminished relaxation of cricopharyngeal muscles while swallowing

increased pressure leads to herniation through pharyngeal mucosa through zone of muscle weakness–>false diverticulum

157
Q

Live attenuated oral (sabin) poliovirus vaccine vs. inactivated Salk

A

Sabin greater mucosal secretory IgA immune response

better protection at the site of viral entry

158
Q

chalky white lesions on mesentery with fat cell destruction and Ca2+ deposition

A

Acute pancreatitis

Acute interstitial pancreatitis–> edematous with Ca deposition

Necrotizing pancreatitis–> chalky white fat necrosis + hemorrhage

159
Q

Heme-positive stools and noncaseating granuloma in colonic mucosa

A

Crohn dz

+ transmural inflammation
Cobblestone appearance
skip lesions

160
Q

Microscopic morphology of ulcerative colitis

A

Crypt abscesses and ulcers, bleeding, NO granulomas

161
Q

Follow up for elevated alk phos

A

Gamma glutamyl transferase (GGTP)

162
Q

Abetalipoproteinemia

A

AR inability to synthesize apoB–> can not transport lipids from small intestine into blood–> enterocytes with clear or foamy cytoplasm

Clinical: first year malabsorption, low TG and cholesterol and NO chylomicrons or VLDL or apoB

Neurologic abnormalities (ataxia, retinitis pigmentosa)

Spiky blood cells (acanthocytes)

163
Q

source of and cancer from G to T mutation in gene p53 associated with moldy grains

A

Aspergillus flavus and Aspergillus parasiticus grown on corn, soy and peanuts–> aflatoxins–> HCC

164
Q

Gallbladder hypomotility risk factors

A

Pregnancy
rapid wt. loss
high spinal cord injuries
prolonged use of TPN or octreotide

165
Q

Effect of gallbladder hypomotility

A

usually gallbladder reabsorbs water from bile so w/ bile stasis get bile concentration–> accumulation of particulate material–> biliary sludge

166
Q

Black pigmented gallstones

A

chronic hemolytic anemia (SC) and increased enterohepatic cycling of bilirubin (crohn)

167
Q

brown pigmented gallstones

A

increased amount of unconjugated bili from biliary tract infections (microbes producing beta glucuronidases)

168
Q

Esophageal cancer prognosis

A

poor

169
Q

solid food dysphagia, retrosternal discomfort, wt. loss in older man (>50) who smokes

A

Esophageal SCC

see keratinization and intercellular bridges

170
Q

Right sided colon cancer

A

exophytic masses, iron deficiency anemia (fatigue, pallor) from bleeding. Also wt. loss, anorexia, malaise

171
Q

Left sided colon cancer

A

infiltrating mass, partial obstruction, colicky pain, hematochezia, Apple core lesion.

172
Q

What lines a pancreatic pseudocyst?

A

Fibrous and granulation tissue

173
Q

abdominal wall pain, chronic diarrhea, wt. loss, regular alcohol use, calcification in the epigastric area

A

Chronic alcoholic pancreatitis

alcohol induced secretions of protein-rich fluids–> precipitate in duct–> duct plugs that calcify

174
Q

what is worse Villous colonic polyps or Tubular polyps?

A

Villous

STEP1 Flashcards (9 decks)

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