PT9

Question 1

Primary cell responsible for inflamm. response in gout

Answer 1

Neutrophils

Question 2

MOA Colchicine

Answer 2

Interferes with MT formation for neutrophil chemotaxis and activation

Question 3

Nucleoside analogs that require viral kinase for activation

Answer 3

Acyclovir, Valacyclovir, Famciclovir, Ganciclovir

Question 4

Nucleotide analogs (do NOT require viral kinase)

Answer 4

Cidofovir, Tenofovir

Question 5

Herpesvirus/VZV strain lacking thymidine kinase

Answer 5

Confers resistance to nucleoSIDE analog antiviral drugs

Question 6

Foscarnet

Answer 6

Pyrophosphate analog
Viral DNA polymerase inhibitor
Does NOT require viral kinase activation
Treats: HSV, CMV (especially retinitis)

Question 7

AA with 3 titratable protons

Answer 7

G.A.L. C.H.A.T
Glutamic acid, Aspartic acid, Lysine
Cysteine, Histadine, Arginine, Tyrosine

Question 8

Celecoxib

Answer 8

Selective COX-2 inhibitor; potent anti-inflammatory effects WITHOUT side effects of bleeding, GI ulceration, and impaired platelet function

Question 9

Examples of NSAIDs (reversibly inhibit COX-1 and COX-2)

Answer 9

Diclofenac, Fenoprofen, Ibuprofen, Indomethacin, Ketorolac, Piroxicam

Question 10

Aplastic anemia

Answer 10

Causes pancytopenia as the bone marrow is replaced by fat cells and fibrotic stroma - characterized by LACK of splenomegaly, low reticulocyte count, pancytopenia

Question 11

Exercise and glucose relationship

Answer 11

Generally associated with lowering blood sugar (in diabetic & non-diabetic people) - increases glucose uptake by muscle cells

Question 12

Exercise and insulin dependent diabetics

Answer 12

Increased glucose uptake via exercise

1. Sensitizes muscle cells to insulin actions
2. Increases insulin-independent glucose uptake into muscles

Normally, dec. glucose will inhib. actions of insulin (prevent further loss) but diabetics who rely on exogenous insulin LACK this fb mechanism

Question 13

Berry aneurysms associated with

Answer 13

Coarctation of the Aorta - HTN created in the branches of aortic arch proximal to the coarct

Question 14

Rifampin MOA

Answer 14

Inhibits bacterial DNA-dependent RNA polymerase - thus preventing transcription of DNA into mRNA

Inhib. bacterial growth but does not cause mycobacteria to lose their acid-fastness

Question 15

Lesions on forehead - sandpaper texture of papules - describes…

Answer 15

Actinic Keratosis - erythematous papules with central scale due to hyperkeratosis; sandpaper texture; common on face, ears, scalp, dorsal arms/hands - chronic sun damage!

Can lead to SCC

Question 16

Greatest prognostic significance for alcoholic liver injury

Answer 16

Prolonged PT & hypoalbuminemia
These are indicators of the liver’s synthetic function (dec. albumin and dec. coagulation factor synth) = signs of liver failure

Question 17

Chronic NSAID use effect on kidneys

Answer 17

Chronic interstitial nephritis - patchy inflammation with fibrosis, necrosis and scarring of papillae, distortion of calyces, tubular atrophy

Question 18

Pre-eclampsia triad

Answer 18

1. HTN
2. edema
3. Proteinuria
   Usually occurs after 20th wk gestation

Question 19

Reye syndrome

Answer 19

Children with febrile illness treated with salicylates
Characterized by:
1. Hepatic failure - microvesicular steatosis, inc. ALT, AST, ammonia, prolonged PT, PTT, NO NECROSIS
2. Acute encephalopathy (due to hyperammonemia)

Question 20

Impetigo causal organisms

Answer 20

1. Staph aureus

2. GAS (Strep pyogenes)

Question 21

What prevents influenza re=infection

Answer 21

Anti-hemagglutinin IgG antibodies in circulation and IgA antibodies in nasopharynx

Question 22

Areas of the brain most vulnerable to global cerebral ischemia (cessation of cerebral blood flow due to cardiac arrest)

Answer 22

1. Hippocampus
2. Neocortex pyramidal cells
3. Purkinje cells of cerebellum

Question 23

Cladribine

Answer 23

Purine analog that is resistant to adenosine deaminase

Question 24

Homocystinuria

Answer 24

Def. of cystathionine synthase - characterized by premature atherosclerosis
How to get rid of homocysteine:
1. conversion to cyteine via cystathionine synthase + cystathionase (require B6)
2. conversion to methionine (requires folate and B12)

Question 25

Lipoic acid is a cofactor for what enzymes

Answer 25

1. PDH - deficiency leads to lactic acidosis
2. Alpha-ketoglutarate DH
3. Branched chain ketoacid DH - deficiency leads to maple syrup urine disease

Question 26

Xeroderma pigmentosa def. in…

Answer 26

AR - defective nucleotide excision repair via UV-specific endonucleases

Question 27

Middle age obese female with fever and prolonged episode of severe RUQ pain after fatty meal ingestion suggests

Answer 27

Acute cholecystitis

Question 28

Male with long history of UC presenting with fatigue and high alk phos suggests

Answer 28

Primary sclerosing cholangitis

Question 29

Older female with weight loss, abd discomfort, jaundice, epigastric mass suggestive of

Answer 29

Pancreatic cancer

Question 30

Classic presentation for primary biliary cirrhosis

Answer 30

Middle age caucasian female with long history of pruritis and fatigue who develops pale stool and xanthelesma

It’s an AUTOIMMUNE destruction of intrahepatic bile ducts

Biopsy: lymphocyte infiltration and granulomatous destruction of interlobular bile ducts

Question 31

Key GF that promote angiogenesis

Answer 31

1. VEGF (not the same thing as EGF)

2. FGF (fibroblast growth factor)

Question 32

Polycythemia vera

Answer 32

95% have mutation in JAK2 gene - Phe replaces a Val and you get hematopoietic cells that are much more sensitive to growth factors (such as EPO)

You’ll see inc. RBC mass, inc. plasma volume, low EPO