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DIT Qs > Qs2 > Flashcards

Qs2 Flashcards

1
Q

Pyruvate kinase deficiency (glycolysis final enzyme)

A

Unable to maintain Na/K ATPase
Hemolytic anemia
RBC swelling/lysis

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2
Q

Hemiballismus is caused by lesion to what part of the basal ganglia?
What kind of stroke?

A

Subthalamic nucleus

Lacunar stroke

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3
Q

Open angle glaucoma
Risk factors
Presentation

A

More common; Bilateral
Over 40, black diabetes
Asx early; reduced peripheral vision later

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4
Q

Acute angle-closure glaucoma
Risk factors
Presentation

A

Emergency
Abrupt onset of pain, nausea, colored halos, rainbows around light
Red teary eye, hazy cornea, mid dilated pupil (not reactive to light, firm to palpation

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5
Q

Retroperitoneal Abdominal Structures

A DUCK PEAR

A 
Adrenal Glands
Duodenum (2,3,4 parts)
Ureters
Colon (descending and ascending)
Kidney
Pancreas
Esophagus
Aorta
Rectum
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6
Q

De novo pyrimidine synthesis RLS

A

CPS2

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7
Q

De novo purine synthesis RLS

A

glutamine PRPP amidotransferase

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8
Q

Glycolysis RLS

A

PFK1

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9
Q

Gluconeogenesis RLS

A

Fructose 1,6 bisphosphatase

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10
Q

Glycogen synthesis RLS

A

Glycogen synthase

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11
Q

Glycogenolysis RLS

A

Glycogen phosphorylase

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12
Q

TCA cycle RLS

A

Icocitrate dehydrogenase

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13
Q

HMP shunt RLS

A

glucose 6 phosphate dehydrogenase

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14
Q

Which cytokines inhibit Th1 cells?

A

IL-10

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15
Q

Flow of aqueous humor

A
  1. Formed in capillary bed of cilliary body
  2. Secreted into posterior chamber
  3. Flows between lens and iris diaphragm
  4. Into anterior chamber
  5. Reabsorbed by canal of schlemm
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16
Q

MOA of metoclopromide

A

Antagonist at dopamine 2 receptor
Serotonin agonist
Increase contractility in the GI tract

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17
Q

Landmark for pudendal nerve block

A

Ischial spine

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18
Q

RLS of carbohydrate digestion

A

Oligosaccharide hydrolases (intestinal brush border)

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19
Q

Vitamin deficiency from Hartnup disease

A

Tryptophan -> Niacin (B3) defciency -> pellagra

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20
Q

Pyruvate dehydrogenase complex cofactors

TLC for nobody

A 
Thiamine (B1, pyrophosphate, TPP)
Lipoic Acid
Coenzyme A
FAD (B2 riboflavin)
NAD (B3 niacin)
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21
Q

Why are alanine and glutamine levels high in blood?

A

They are good carriers of N

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22
Q

What happens in transamination?

A

Transfer of an amino group from an AA to a-ketoglutarate –> forming glutamate
Deaminated AA –> ketoacid (like pyruvate)

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23
Q

How are aminotransferases named?

A

Named by donor of amino group

Alanine aminotransferase converts alanine to pyruvate, forming glutamate

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24
Q

What is required by all aminotransferases (besides substrates)?

A

Pyridoxal phosphate (B6 derivative)

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25
Q

2 most important aminotransferase enzymes? What do they catalyze?

A

Alanine Aminotransferase
Alanine + a-ketoglutarate Glutamate + pyruvate

Aspartate Aminotransferase
Glutamate + oxaloacetate a-ketoglutarate + aspartate

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26
Q

4 fates of pyruvate

A

Oxaloacetate
Acetyl-CoA
Lactate
Alanine

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27
Q

What are indications for Dantrolene?

A

Malignant hyperthermia

Neuroleptic malignant syndrome

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28
Q

Etiology of Acute Pancreatitis

BAD HITS

A 
Biliary
Alcohol
Drugs
Hypertriglyceridemia and hypercalcemia
Idiopathic
Trauma (ERCP)
Scorpion Sting
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29
Q

What cells release renin?

In response to what?

A

Juxtaglomerular cells

In response to decreased blood flow to kidneys

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30
Q

4 uses of NADPH

A

Synthesis of fatty acids and cholesterol
Generation of oxygen free radicals
Protects RBCs from oxygen free radicals
Cytochrome P450

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31
Q

Which tissues use the PPP or HMP shunt?

A

RBCs
Liver
Adrenal Cortex
Mammary Glands (during lactation)

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32
Q

Sx to Classic Galactosemia

A 
Failure to thrive
Intellectual disability
Hepatomegaly
Jaundice
Infantile cataracts
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33
Q

Pancreatic insufficiency presentation

A

Diarrhea
Steatorrhea
Malabsorption and weight loss
Deficiency of ADEK

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34
Q

Sx of serotonic syndrome

A

Muscle rigidity
Hyperthermia
Cardiovascular collapse

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35
Q

RLS for Ketogenesis

A

HMG-CoA synthase

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36
Q

What metabolic condition favors ketogenesis?

A

Production of acetyl CoA from B oxidation of fatty acids exceeds the oxidative capacity of the TCA cycle

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37
Q

What body tissues cannot use ketone bodies?

A

RBCs

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38
Q

What affect does liver metabolism of ethanol have on gluconeogenesis?
What can happen to pt consuming much alcohol in a fasting state?

A

Cannot undergo gluconeogenesis when metabolizing ethanol.

Severe fasting hypoglycemia

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39
Q

Primary energy source if no food in 2 days?

A

Fatty acids

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40
Q

What is the mechanism for hypoglycemia from alcohol on an empty stomach?
NADH shunts pyruvate –>
Oxaloacetate –>
Therefore pyr and oxa not available for

A

Lactate production
Malate production
Not available for gluconeogenesis

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41
Q

What kind of infections often precede Guillain-Barre syndrome?

A

Campylobacter or Herpes

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42
Q

Risk factors for Hepatocellular Carcinoma

A 
Hep B and C
Hemochromatosis
a1-antitrypsin deficiency
Hepatic adenoma
Cirrhosis
43
Q

Sx of TCA overdose

A 
Convulsions
Coma
Cardiotoxicity
Hyperpyexia (fever)
Respiratory depression
44
Q

What apolipoproteins are deficient in abetalipoproteinemia?

A

Apo-B 48 and apo-B 100

45
Q

What gene is mutated in abetalipoprotenemia?

A

MTP gene

46
Q

What are sx and tx of abetalipoproteinemia?

Blood smear?

A

Sx: Steattorhea, failure to thrive
Tx: Vitamin E
Smear: Acanthocytosis (spiked RBCs)

47
Q

What is the substrate and RLS enzyme for cholesterol synthesis?

A

Substrate: Acetyl-CoA
RLS: HMG CoA reductase (statins inhibit)

48
Q

RLS for fatty acid synthesis?

A

Acetyl CoA carboxylase

49
Q

RLS for fatty acid degradation (B-oxidation)?

A

Carnitine acyltransferase-1

carnitine palmitoyl transferase-1

50
Q

Where do fatty acid synthesis and degradation take place?

A

Synthesis: Cytosol
Degradation: Mitochondria

51
Q

ECG changes with MI?

A

ST elevation
T wave inversion
New LBBB
New Q waves

52
Q

Clinical features of neuroleptic malignant syndrome

A 
Delirium
Autonomic instability (tachycardia)
Muscle rigidity
Myoglobinuria
Hyperpyrexia (fever)
53
Q

What gland makes melatonin?

A

Pineal gland

54
Q

RLS for urea synthesis?

A

CPS I

55
Q

CPS I found where and N from where?

CPS II found where and N from where?

A

I: Mitochondria; ammonium
II: Cytosol, glutamine

56
Q

Sx of hyperammonemia

A 
"Hepatoencephalopathy" constellation of sx
Slurring of speech
Somnolence
Vomitting
Cerebral edema
Blurring of vision
57
Q

Dermatologic findings of primary, secondary, and tertiary syphillis

A

1: Painless chancre
2: Maculopapular rash on palms and soles
3: Gummas

58
Q

Anti-HTNs safe in pregnancy?

Hypertensive moms love Nifedipine

A

Hydralazine
Methyldopa
Labetalol
Nifedipine

59
Q

Secretory cells of GI tract G, I, S, D, Parietal cells

A

Gastrin, CCK, Secretin, Somatostatin, Gastric acid/IF

60
Q

Mechanism of melanin

A

Tyrosinase deficiency or defect in tyrosine transport into cell
Or lacking melanocytes (neural crest derivative)

61
Q

Lens subluxation

A

Marfans (upward) and Homocystinuria (downward)

62
Q

What does S-adenosyl-methionine do and for what production is it necessary? What is it made from?

A

Methyl donor
Phosphocreatine and Epinephrine (from NE)
ATP and Methionine

63
Q

Regeneration of methionine requires which vitamin cofactors?

A

Folate a B6?

64
Q

Glaucoma pathogenesis

A

Blockage at canal of Schlemm
Aqueous humor not reabsorbed
Increased pressure
Optic nerve atrophy

65
Q

Aortic dissection presentation, CXR; Tx

A

Tearing chest pain radiating to back
CXR: Mediastinal widening
Tx: Beta blockers

66
Q

What enzymes require Zinc?

A

Carbonic anhydrase

Lactate dehydrogenase

67
Q

Where does mercury (poison) accumulate?

A

Brain and kidney

68
Q

Where (2) do you see acrodynia (peeling of fingertips)?

A

Mercury poisoning and Kawasaki disease

69
Q

From where is an infant likely to get iron poisoning?

A

Prenatal or iron-fortified vitamins?

70
Q

Zinc deficiency sx

A 
Delayed would healing
Decreased immune response
Acrodermatitis enteropathica
Anorexia/diarrhea
Growth retardation
Decreased mental function
Infertilitiy
71
Q

Hypocalcemia sx

A

Tetany and neuromuscular irritability
Chvostek’s sign (tap cheek -> face spasm)
Trousseau’s sign (tighten bp cuff -> carpal spasm)

72
Q

Bluish-colored lines on gingivae

A

Lead poisoning (Burton’s lines)

73
Q

Which cytokine inhibits Th2 cells?

A

Interferon-gamma

74
Q

Bacillus anthracis skin sx

A

Black eschar (necrotic) with edematous ring

75
Q

Common causes of ARDS

A 
Shock
Infection
Toxic gas inhalation
Acute pancreatitis
Aspiration
Heroin overdose
High concentrations of O2
76
Q

R occulomotor nerve damage: what is the light reflex? (Efferent defect)

A

R eye does not respond to light in either eye

L eye constricts with light in either eye

77
Q

Ddx for eosinophilia DNAAACP

A 
Drugs
Neoplasm
Atopic Disease (allergy, churg-straus)
Addison's (primary adrenal insufficiency
Acute interstitial nephritis
Collagen vascular disease
Parasites
78
Q

What substances act on smooth muscle light chain kinase; how does this affect bp?

A

Dihydropyridine CCBs
Epinephrine
Prostaglandin E2
Vasodilation -> decrease BP

79
Q

Enzymes that require thiamine (B1)

ATP

A

Pyruvate dehydrogenase (glycolysis -> TCA)
a-ketoglutarate dehydrogenase (TCA)
Transketolase (HMP shunt)
Branch-chain ketoacid dehydrogenase

80
Q

INH can cause what vitamin deficiencies?

A

INH inhibits B6 and B3

81
Q

What vitamin deficiencies can cause megaloblastic anemia?

A

B9 (folate)

B12

82
Q

Vitamin deficiency: convulsions + irritability

A

Vitamin B6 (GABA production)

83
Q

Where is B12 absorbed in gut?

A

Terminal ileum

84
Q

Which vitamins are used in oxidation/reduction reactions?

A

B2

B3

85
Q

Which vitamins are used in carboxylation reactions?

A

Biotin

K

86
Q

Which vitamins are required for DNA synthesis?

A

B9

B12

87
Q

Most common vitamin deficiency in US

A

B9 folate

88
Q

Dilated cardiomyopathy, edema, polyneuropathy

A

Wet Beri Beri (B1 def)

89
Q

Hypersegmented neutrophils

A

Megaloblastic anemia

90
Q

Derivatives of first branchial arch

A

M’s and T’s
Muscles: Mastication, Mylohyoid, Tensor tympani, Tensor veli palatini
Nerves: Maxillary and mandibular of trigeminal

91
Q

Which AAs found in Elastin?

A

Glycine and Proline

92
Q

MOA of adenosine as an anti-arrhythmic?

A

Increases outward K current
Hypopolarization of cells
Decreases intracellular Ca2+

93
Q

2 yo girl has increased abdominal girth, failure to thrive, skin/hair depigmentation

A

Kwashiorkor

94
Q

Enzyme deficiency in fructose intolerance?

A

Aldolase B

95
Q

Enzyme deficiency in essential fructosuria

A

Fructokinase

96
Q

Classic galactosemia

A

Galactose-1-phosphate uridyltransferase

97
Q

Thyoid cells with optically clear nuclei

A

Papillary carcinoma of thyroid

98
Q

Branching rods with oral infection

A

Actinomyces israelii

99
Q

Eczema, recurrent infection, thrombocytopenia

A

Wiskott-Aldrich syndrome

“WAITER”

100
Q

Hemosiderinuria and thrombosis

A

Paroxysmal nocturnal hemoglobinuria PNH

101
Q

Derivatives of 2nd branchial arch

A

“S”
CN 7: Facial expression
Stapedius and Stylohyoid

102
Q 
Antidote for
Opioids
Benzodiazepines
TCAs
Heparin
Warfarin
Theophyline
A 
Opioid: Naloxone, Naltrexone
Benzodiazepine: Flumazenil
TCA: Sodium Bicarbonate
Heparin: Protamine
Warfarin: Vit K/Fresh Frozen (immed)
Theophyline: B-Blockas
103
Q

How does hyperKalemia affect T waves?

A

Tall peaked T waves

low K: low flat t waves

DIT Qs (3 decks)

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