qbq new Flashcards
Number needed to treat
Risk that you’ll get disease with placebo (got/total) - risk that you’ll get it without (got/total). 1 divided by that.
There’s a serological test that is negative in 95% of people without a disease. Used this test on 8 samples who don’t have disease, what is probability of getting at least 1 positive?
.98^8 probability of no positives, 1 minus that for probability of at least one
Big organ transplants for GVHD, symptoms?
Liver and BM. Skin, liver, and GI are the big symptoms
Someone has a black eschar thing in nose. You think it’s mucormycosis. How do you dx? And if that comes back positive and you treat for it, what should you give them as a supplement?
Dx with biopsy –> nonseptate hyphae with right angle branching. Treat with amp B. Need to give K and Mg because Amp B is nephrotoxic and increases distal tubular membrane permeability–> hypoK and hypoMg
Wtf is Cheyne Stokes
In CHF. PCO2 allowed to increase too much, then hyperventilate, then too low. Overshooting all over the place
Protein M
Major virulence factor for GAS. Allows strep to inhibit phagocytosis and complement activation so can be free in blood
Streptolysin O
GAS. Kills PMNs and RBCs, but doesn’t have anything to do with resisting phagocytosis. Also antigen for detection
Streptokinase
GAS and meds. In extracellular space: plasminogen –> plasmin to eat up fibrin so strep can move around easier
DNase
GAS. In EC space: depolymerizes DNA in PMNs so can move around easier in tissues. Nothing to do with inhibiting phagocytosis though, that’s all protein M
Mechanism for genetic gestational diabetes
Pancreas has glucokinase, not just liver! How else does the pancreas sense the amount of glucose around? Lets it all in, converts it all to ATP, then the ATP closes the K channel and voltage calcium opens and insulin released! SO if you have a defective glucokinase, not enough insulin!
How does N-acetylcysteine work as a mucolytic?
Cleaves disulfide bonds within glycoproteins –> loosens thick sputum
Main side effect of thiazolidinediones
Don’t use with CHF because increased fluid retention. Remember, these are the PPAR gamma guys for decreasing insulin R via increased adiponectin
Cromolyn sodium blocks asthma how?
Blocks mast cell degeneration! Nedocromil is same class. NOT muscarinic antagonist, that’s ipatropium bromide!
Beta 2 receptors and K levels?
Cause hyperkalemia because K+ can’t go into cells. Insulin does the opposite, puts K+ into cells. BUT beta 2 increases insulin release! Alpha inhibits it.
Acyclovir AE
Nephrotoxic because can crystallize, treat with hydration
What is the vegetation of Staph aureus endocarditis consist of?
Platelet and fibrin deposition because tissue factor activated by bacterial binding
When do astrocytes come in with stroke? What’s before?
2 weeks. Before is microglia (1 week), before that is neutrophils, before that is red neurons (48 hrs)
Borders for thoracentesis in midaxillary, posterior scap, midclavicular
Midaxillary = above 9th rib bc of liver. Post scap = 11. Midclavicular = 7th. Always do on lower border bc artery vein and nerve run on upper border
How many BBB does blasto have?
1.
Hist, cocc, blasto, are all ____ in ambient temp?
Hyphae
Aspergillus = dimorphic? Crypto?
Both no. Asp is only hyphae, crypto is only yeast
How does nocardia stain
Weakly acid fast and gram +
Wtf is transepithelial potential difference
Epi surface compared to fluid. With CF, Cl- trapped inside cell so draws in Na+ –> increased negative charge outside of cell compared to most of the ECF, so increased transepithelial potential difference
Heavy menses, passing clots, palpable mass in abdomen, African American 32 year old woman
Leiomyoma (made of uterine SM)
RAS
GTP-coupled –> signal transmission from cell membrane –> nucleus. Pro-oncogene in MAP kinase pathway
How does lactulose work?
Acidifies gut tube to trap NH4+
Osteomalacia hits what bone deposit?
Osteomalacia –> decreased vit D and increased PTH. Stripping bone down and dumping the excessive unmineralized osteiod around normally mineralized trabeculae
Compact vs spongy bone
Compact (hard) on outside, spongy (cancellous) on inside. Spongy is network of thin bony trabeculae separated by BM spaces.
Lamellar vs woven bone
Lamellar is strong straight parallel. Woven is precursor.
Pt with DM has cramping pain in calf– thinned skin and ulcer on toe, worse with walking
Femoral atherosclerosis. Peripheral artery disease
How/where does HPV replicate?
In nucleus using host enzymes
Where does pox replicate?
In cytosol
Acute onset anemia in African American male treated with a sulfonamide
G6PD
Pre or post ANS demyelinated?
Post
What is standard error?
Stdev/ sqrt (n). Multiple by Z and you get +/- CI
Most common cause of infant pneumonia? Croup?
RSV. Parainfluenza. Both paramyxo.
MHC I vs II
MHC I have TAP to take proteins to ER where MHC I is and then pairs with beta2 microglobulin to take to cell surface. MHC II, antigen loaded following release of invariant chain (clip) in acidified endosome
Decreased taste, burning in mouth, lip dryness in a 39 y/o female with microcytic anemia
Iron def. Don’t get fucked by symptoms
ATP produced by glycolysis vs TCA?
5%. 2 vs 38
White patches of thinned skin involving labia majora
Lichen sclerosis. Autoimmune, can lead to squamous cancer. Use steroids. VS leukoplakia which is white on MUCOSAL surfaces, major not mucosal. And this is thickened, due to EBV
Dark urine in a shocky patient with high WBC, then treated with antibiotics and feels better but creatinine is 3.6. Where is the damage?
ATN, NOT interstitial nephritis. Renal medulla, because most susceptible to ischemia. Could also get damage from aminoglycoside –> nephrotoxin, would ALSO be ATN
What causes Prader WIlli, once and for all
Caused by deletion on dad or from total mom, when DAD is lost. Hungry for dad. So Angelman is wanting mom
What layer of skin = involved in callus
Stratum corneum
Scrotal mass that disappears when lying down
Varicocele
HIV + with proteinuria. Glomerular epithelial enlargement and vacuolization, glomerular cap wall collapse. Tubules show cystic dilation and are filled with proteinaceous material.
FSGS. Heroin, HIV, sickle, think FSGS. The enlargement is of the remaining viable epi cells.
How do you treat pneumothorax?
Chest tube placement. Remember, PEEP can CAUSE it!
Fatigue, conjuctival pallor, white patches in gingiva and buccal mucosa, hemorrhage in eyes. What do you expect to see in blood smear?
Blasts. Acute leukemia. Immune, blood, and platelets knocked out by proliferating blasts, explaining symptoms
Bloody vomiting with hx of alcohol and IV use, decreased BP, abdomen dull to percussion. Decreased Hb, platelets, nl MCV and WBCs. What will the spleen look like?
Enlarged red pulp. Cirrhosis –> congestion –> expansion of red pulp of spleen
Ectopic lens, osteoporosis, MR, thin hair and fine skin, common thromboses
Homocysteinuria–> can’t make cysteine from homocysteine. Also see increased methionine
Where are the GI stem cells?
Crypts of Lieberkuhn
CAAT box is similar to?
TATA. Both are promoters/ transcription initiators located 20-80 bps upstream, act as binding sites for RNA poly II
Vitamin def with easy bruising?
C
Another word for shift in flu?
Genetic reassortment
Pee darkens when pee standing up. Skin is blueish gray. Risks?
Alkaptonuria. Homogentisic acid buildup –> arthritis
Ethanol + amniotic fluid –> foam
Surfactant
DNA poly I v III?
DNA poly III does most of the work. On lagging strand, DNA poly I does primers in between strands, and then ligase seals up what I did and what III did. Poly I also has 5–>3 exonulcease and III has 3–>5 exonuclease
Metoclopromade
For gastroparesis in DM. D2 antagonist that enhances ACh. Don’t use with PD
Which antibiotics inhibit 23rRNA of 50S subunit
Macrolides and clindamycin
What causes lactase def in adults?
Decreased expression
Biochem of tardive dyskinesia
Upreg of DA and decreased ACh
Veins and lymph draining rectum. How could rectal CA spread to the liver?
Sup rectal –> IMV –> portal. Middle rectal –> internal iliac –> caval. Inf rectal –> internal pudendal –> caval. Superior rectum –> inferior mesenteric nodes. Inf rectum –> internal iliac
Which amino acids could hang in the inner core of a phospholipid bilayer?
Hydrophobic: gly, ala, val, leu, ile, phenylala, tryp, meth, proline
Lateral gaze palsy with mucormycosis?
Cavernous sinous thrombosis via facial vein system. VI in cavernous sinus
Mumps and decreased sex drive?
Give testosterone
Lumbar lordosis is caused by…
Contracture of hip flexores
Tumor + nephrotic
Membranous glomerulonephritis
New onset respiratory acidosis/ hypoxemia in a patient on a ventilator
Increased physiologic dead space and/or R-L shunt
Red/blue nodule on bladder with increased frequency, urgency, and dyspareunia.
Endometriosis, risk for infertility.
HIV patient with abdominal pain. On colonoscopy see mucosal erythema, erosions, ulcerations. Histo: enlarged epithelial cells with large ovoid nuclei containing prominent basophilic deposits.
CMV colitis. It’s a thing.
HIV patient presents with watery diarrhea and see basophilic clusters on surface of intestinal mucosal cells
Crypto. Usually CD4 < 200
HIV patient presents with blood diarrhea. On colonoscopy, see friable, inflamed mucosa in rectum and sigmoid and neutrophils in crypt lumen.
UC. Can have more than one thing!
What can you give with niacin to help with an SE?
Aspirin. Flushing and vasodilation secondary to PGD2, aspirin inhibits
Leucovorin
Folic acid
Paclitaxel and coronary stents
Microtubule inhibitor –> stuck in M phase –> prevents intimal hyperplasia with coronary stents
Only RNA viruses that replicate in nucleus
Retro and influenza
Pec mino
Coracoid process of scap to ribs – holds scap against thoracic wall.
Spread of pus along psoas leads to abscess where?
Groin area.
Probenecid
Inhibits reabsorption of uric acid AND inhibits secretion of PCN!
CDKN2A gene mutation on chrom 9p21
Random, I know. p16 –> at risk for melanoma (dysplastic nevus syndrome) because removes inhibition on cyclin dependent kinase 4
Pain with flexing hip against resistance
Iliopsoas test. Psoas is major hip flexor
Construction worker with TMJ that interferes with eating. Difficulty opening and closing jaw
Tetanus –> first symptom is usually lockjaw
Nephrogenic diabetes insipidus and lung tumor?
Squamous cell carcinoma –> PTHrp –> hypercalcemia and too much calcium makes it so you can’t concentrate urine for some reason (not due to osmotic diuresis).
Short alpha helix protein with lots of leucine (every 7th position)
Leucine zipper–> binds transcription factor to DNA.
Which embryo is cerebellum from?
Metencephalon, part of rombencephalon
Caspofungin
Cell wall inhibitor in fungi. Amp B, nystatin and azoles do membrane.
Relative risk reduction
Absolute risk control - absolute risk treatment / absolute risk in control. RRR = difference in risk / control risk
MAC prophylaxis?
Azithromycin
Glands dilated and coiled
Progesterone, proliferative phase. Estrogen = secretory phase
1st line for trigeminal neuralgia?
Carbamazepine, first line for like everything
