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STEP 1 RECALL > Quick Associations 2 > Flashcards

Quick Associations 2 Flashcards

1
Q

A girl with Turner’s syndrome –> high or low gonadotropin levels (LH & FSH) ?

A

will have high LH & FSH but streak ovaries and therefore need donor oocytes to try to become pregnant

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2
Q

Catalase +, Coagulase negative bacteria that cause endocarditis on prosthetic valves

A

Staph. epidermidis (treat with Vanc)

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3
Q

Fat cells that contain multiple fat droplets and numerous mitochondria per cell, seen in babies

A

Brown fat – used for heat production! ((the ox phos and ETC in these cells is uncoupled so all energy produced is not made into ATP but instead dissipated as HEAT))

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4
Q

What protein is used in brown fat to uncouple the oxidative phos and ETC?

A

Thermogenin

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5
Q

Most carcinogens enter the body as pro-carcinogens and are converted to carcinogens by ________________

A

cytochrome P450 Monooxygenase enzymes

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6
Q

Why is someone on TPN who had a jejunal resection at increased risk for gallstones?

A

the lack of enteric stimulation –> decreased CCK secretion –> biliary stasis

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7
Q

________ in erythrocytes converts CO2 & water into bicarb

A

Carbonic anhydrase

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8
Q

temporal arteritis is characterized by what kind of inflammation

A

granulomatous of the media w/ fragmentation of the internal elastic lamina ((treat asap w/ steroids to prevent blindness!))

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9
Q

autosomal recessive disorder of tyrosine metabolism that results in a buildup of Homogentistic acid –which turns urine black after sitting out and attaches to collagen making the ears & nose appear blue/black

A

Alkaptonuria (defect of Homogentisate oxidase enzyme) –> in the tyrosine —> Fumarate pathway

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10
Q

a defect in phenylalanine –> tyrosine pathway

A

PKU (phe hydorxylase defect)

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11
Q

What is the mechanism of methicillin resistance? (ex: MRSA)

A

the bacteria alter the penicillin binding proteins (makes them resistant to all beta - lactams)

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12
Q

What is the mechanism of resistance of Staph aureus (non MRSA) to beta lactams?

A

produces beta-lactamase ( an enzyme that degrades the beta lactam ring)

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13
Q

Acanthosis nigricans assoc with?

A

Insulin resistance (DM, Obesity, acromegaly) and rarely GI malignancies

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14
Q

Why are pregnant women or women on OCP’s more likely to develop gallstones?

A

Estrogen –>increases cholesterol synth & secretion

Progesterone –> slows GB emptying & reduces bile acid secretion

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15
Q

CD3 is found on what cells?

A

T cells (needed for T cell receptors) –> anti CD3 antibody drugs can be used to inhibt T cells in acute rejection of kidneys, heart and liver transplants

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16
Q

older man who worked in a rubber/textile/ or leather plant for 30 years, now experiencing new onset gross hematuria, serum creatinine is normal

A

transitional cell carcinoma

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17
Q

HTN with low plasma renin activity and pt is feeling weakness / paresthesias

A

Primary hyperaldosteronism (normal Na levels due to “aldosterone escape”, low K+ , and high bicarb)

hypokalemia = weakness & paresthesias

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18
Q

Side effects of SSRI’s (sertraline, fluoxetine, citalopram, etc…)

A

Sexual dysfunction!

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19
Q

Pts with essential fructosuria cannot metabolize Fructose in the normal pathway (via Fructokinase) , but they can still put it into the glycolysis pathway via what enzyme?

A

Hexokinase

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20
Q

Pt with hx of hyperlipidemia has severe pain 40-60 minutes after eating, weight loss, pain not relieved by antacids

A

atherosclerosis of the mesenteric arteries –> they can’t dilate in response to incrs blood demand after meals, leading to intestinal ischemia & pain

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21
Q

Activation of which enzyme is primarily responsible for the damage done in acute pancreatitis?

A

Trypsin (once activated, it activates other pancreatic enzymes and can auto-activate more trypsin)

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22
Q

What is the most common and 2nd most common form of cancer in children?

A

1- Leukemia

2- Brain neoplasms (Pilocytic astrocytoma is most common, Medulloblastomas are 2nd most)

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23
Q

Most common location for Pilocytic Astrocytoma

A

mostly in the Cerebellum – looks like a cystic mass with a tumor nodule sticking off of it – pretty good prognosis

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24
Q

most common malignant brain tumor in kids, only in the cerebellum (mostly vermis) –> solid with sheets of small round blue cells – poor prognosis

A

Medulloblastoma

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25
Q

Anti-gliadin antibodies, loss of intestinal villi

A

Celiac dz

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26
Q

Aldolase B deficiency

A

causes life threatening hereditary fructose intolerance

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27
Q

Vitamin associated with maintaing specialized epithelium (acinar cells, etc…)

A

Vitamin A

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28
Q

Deficiency of this vitamin can cause infertility

A

Vitamin E

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29
Q

Treatment of acute Diphtheria infection

A

1- Diphtheria antitoxin (passive immunization)
2- Penicillin or Azithro
3- DPT vaccine

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30
Q

insomnia, agitation, dysphagia, headaches, coma after cave exploring

A

Rabies encephalitis

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31
Q

Stop codons

A

UAA, UGA, UAG

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32
Q

Type of diabetes associated with DKA

A

Type 1 (autoimmune)

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33
Q

Formula for Renal Plasma Flow (RPF)

A

Use the Clearance of PAH :

RPF = Urine PAH x Flow / Plasma PAH

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34
Q

Formula for Renal BLOOD Flow

A

RPF / (1 - Hematocrit)

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35
Q

Most fluids and solutes are reabsorbed in what part of the nephron?

A

PCT (fluid is absorbed isosmotically in the PCT –> no concentration or dilution occurs)

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36
Q

In a dehydrated state the kidney will concentrate the urine to a max of ___mOsm/L — but it must put out at least .5 L / day to get rid of metabolic wastes (so will lead to death if you go to long without water)

A

1200 mOsm/L – does this via ADH acting on the collecting duct to cause water conservation

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37
Q

The ________ of the nephron is impermeable to water

A

Ascending limb of the loop of Henle & the early distal tubule

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38
Q

Pt will 2 month history of weight loss, polydipsia, fruity urine

A

DKA

low pH
low bicarb – anion gap metabolic acidosis
low PaCO2 – resp alkalosis (compensatory)

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39
Q

A substance that constricts the efferent arteriole in the glomerulus will have what effect on GFR and Filtration Fraction?

A

-efferents constricted will INCREASE GFR and decrease RPF therefore –>INCRS FF

FF = GFR / RPF

ex: Angiotensin II would do this

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40
Q

ADH acts on what part of the nephron specifically ?

A

the medullary portion of the collecting duct (it increases the permeability to water by adding porins to the CD)

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41
Q

Where is Renin made and secreted and under what circumstances?

A

the JG apparatus, in response to decreased renal arteriole pressure & increased renal sympathetic discharge (**there are Beta 1 receptors on the JG apparatus!)

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42
Q

Mechanism of loop diuretics

A

inhibit Na-K-2Cl symporters in the thick ascending loop of Henle (essentially cause the excretion of these)

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43
Q

Pt presents hyperventilating (resp alkalosis) and then later enters into an anion gap metabolic acidosis

A

Aspirin overdose – ASA directly stimulates the breathing center in the brain (low pCO2) and then hours later you get a metabolic acidosis due to the organic acid build up in the blood… (low bicarb)

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44
Q

Pt with a tear at the gastro-esophageal junction & history of alcoholism –> what kind of metabolic disturbance is going on?

A

Mallory-Weiss tears from vomiting –> loss of acid in vomit causes a metabolic alkalosis

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45
Q

This substance is filtered, secreted by the PCT, but not reabsorbed – so the concentration of it rises as it goes throughout the nephron

A

PAH

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46
Q

Which part of the nephron is the primary site of K+ regulation?

A

the Cortical Collecting Duct

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47
Q

Aldosterone acts on the _______ to cause reabsorption of ____ & _____ and loss of ____ & ______

A

reabsorbs Na+ and water at the expense of K+ and H+

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48
Q

ADH (vasopressin) causes an increase in water reabsorption and _____ reabsorption from the PCT

A

Urea

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49
Q

This substance is filtered only, NO reabsorption or secretion

A

Inulin – that’s why it’s used to measure GFR

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50
Q

The descending loop of Henle causes the urine to become ______

A

hyperosmotic (hypertonic) –> it is permeable to water but not solutes so as the loop moves down into the kidney medulla where the interstitium is more concentrated, water leaves the loop –> concentrating the urine

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51
Q

Selective proteinuria

A

Albumin loss without the loss of the ‘bulkier’ proteins like IgG and macroglobulins

(ex: Minimal change dz)

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52
Q

Filtration barrier in the glomerulus is made up of?

A

1- Fenestrated endothelium of arterioles
2- GBM
3- Epithelial cells (foot processes)

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53
Q

What is the main thing keeping Albumin from being filtered

A

The negative charge on the GBM and foot processes that repel the negatively charged Albumin ((not it’s size, it could fit through the slits))

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54
Q

Massive proteinuria (> 3.5 gm/day), edema, hyperlipidemia

A

Nephrotic syndrome

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55
Q

Cystic dilations of the medullary collecting ducts in the kidney

A

Medullary sponge kidney –> pretty benign, cause unknown, can develop hematuria or kidney stones

(stones are # 1 complication )

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56
Q

1 cause of Chronic Renal Failure

A

Diabetes

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57
Q

Hematuria, proteinuria, RBC casts and “hypercellular glomeruli” on microscopy

A

Post-strep glomerulonephritis

  • will have high ASO titers and low C3
  • subepithelial humps
  • usually after throat or skin infection
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58
Q

Anti- GBM antibodies

A

Goodpastures syndrome –> renal failure, hemoptysis, crescents

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59
Q

Calcium oxalate crystals in the urine

A

Ethylene glycol ingestion (produces an anion gap metabolic acidosis)

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60
Q

Renal Clear cell carcinoma originates from what cell type

A

the PCT cells –> will appear golden/yellow grossly due to high fat content

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61
Q

When blood flow is compromised, what parts of the nephron are at most risk for low perfusion

A

Structures out in the medulla -> the PCT & thick ascending loop of Henle

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62
Q

Muddy brown casts in the urine

A

Acute Tubular Necrosis

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63
Q

bilateral flank masses (cysts) at birth or early in life, enlarged kidneys at birth

A

ARPKD

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64
Q

microscopic cysts in kidneys at birth that grow over time, can be clinically silent, some pts have flank pain, HTN, hematuria, renal failure slowly progresses over 10-20 yrs, also at risk for cerebral aneurysms

A

ADPKD

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65
Q

Most common nephrotic in white adults, assoc w/ Solid Tumors, hepatitis B or C, SLE or drugs, shows “spike & dome” appearance & capillary wall thickening

A

Membranous glomerulopathy – due to immune complex deposition (IgG)

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66
Q

Multiple Myeloma signs & symptoms

A

Constipation (hypercalcemia)
Renal failure
Anemia (fatigue)
Bone pain (usually back & ribs)

-**Bence-Jones (light chains) & Tamm Horsfall proteins show up as eosinophilic casts (pink on H&E, not eosinophils the cells..)

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67
Q

Why do pts with nephrotic syndrome also get hyperlipidemia?

A

The liver tries to compensate for the massive loss of albumin but can’t keep up so it ramps up production of other proteins too (including lipoproteins)

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68
Q

A baby born with no kidneys dies 12 hours after birth –> what is the cause of death?

A

Lung immaturity

-Potters syndrome from bilateral renal agenesis –> oligohydraminos –> no urine output, no lung development in utero

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69
Q

diffuse effacement of the foot processes of the glomerulus on EM

A

Minimal change dz –> treat with corticosteroids

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70
Q

linear deposits of IgG & C3 along the GBM

A

Goodpasture’s –> a form of RPGN, will see crescents

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71
Q

IgA mediated vasculitis in children after a URI –> abdominal pain, joint pain, palpable purpura, hematuria

A

Henoch-Schonlein Purpura

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72
Q

Types of Rapidly Progressive Glomerulonephritis (all are crescentic)

A

Type 1 - anti-GBM ab’s, (Goodpastures), linear deposits of IgG & C3
Type 2 - immune complex mediated, subepithelial humps (Post-strep glomerulonephritis, SLE, IgA nephropathy or Henoch Schonlein)
Type 3 - ‘pauci immune’ (no IgG or complement deposis), + ANCA (mostly Wegeners)

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73
Q

Patient with colon cancer and new endocarditis, what bacteria ?

A

Strep. bovis

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74
Q

Endocarditis that is culture-negative – which bacteria?

A 
Haemophilus
Actinobacillus
Cardiobacterium 
Eikenella
Kingella

“HACEK”

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75
Q

subacute bacterial endocarditis after dental work

A

S. viridans

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76
Q

Sudden cardiac death right after an MI is most likely caused by _____________

A

an arrhythmia (most likely V. fib)

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77
Q

Trousseau syndrome

A

migratory thrombophlebitis seen in patients with disseminated cancer (tumor releases pro-coagulants)

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78
Q

autosomal recessive long QT syndrome that is associated with neurosensory hearing loss - can lead to sudden death

A

Jervell & Lange-Nielsen syndrome – problem with the K+ channels in the ear and cardiac muscle

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79
Q

chest pain on exertion relieved by rest, how much of the artery is blocked by plaque?

A

at least 70% – stable angina happens when a vessel is > 70% clogged

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80
Q

Pt in a MVA with blunt trauma develops sever hypotension, JVD and his systolic BP falls 15 mmHg with each inspiration …

A

pulsus paradoxus, hypotension and JVD suggest something constricting the heart –> after a MVA, you should consider cardiac tamponade

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81
Q

young child with migratory arthritis 3 weeks after an untreated sore throat –> IF she were to die, what would be the most likely cause?

A

Myocarditis – the cause of death if you die from Acute Rheumatic Fever

  • assoc with Aschoff bodies & “Anitschkow” cells (caterpillar cells)
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82
Q

yellow-brown pigment found in cells of older people, made from lipid peroxidation & free radical injury (common in the heart & liver of aging or sick / malnourished people)

A

Lipofuscin

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83
Q

STEMI in leads II, III & aVF –> which artery is probably occluded?

A

Right Coronary Artery — the posteroinferior wall of the heart is usually supplied by the posterior descending branch of the RCA

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84
Q

STEMI in leads V1 - V4 , what artery is most likely occluded?

A

the LAD (anterior /septal region)

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85
Q

STEMI in leads V5 - V6 & 1 & aVL, what artery occluded?

A

lateral circumflex (branch of the LCA)

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86
Q

STEMI in V1-V6 and 1 & aVL , which artery?

A

Left coronary artery (before it branches)

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87
Q

In older people (70’s & older), what predisposes the aortic valve to calcifications?

A

Necrosis of the tissue / cell injury (injury -> necrosis -> dystrophic calcifications)

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88
Q

congenital defect in the lower interatrial septum is associated mostly with what congenital dz?

A

Down Syndrome (endocardial suchion defects are common ((like ostium primum ASD))

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89
Q

cardiac anomalies associated with DiGeorge syndrome

A

Tetrology of Fallot or aortic arch defects

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90
Q

Hypertrophic cardiomyopathy is associated with a mutation affecting what structures?

A

the sarcomere proteins (myosin, troponin, etc…)

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91
Q

Dilated cardiomyopathies are assoc with mutations affecting what structures?

A

cytoskeletal proteins

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92
Q

most common cause of mitral stenosis

A

rheumatic heart dz ((usually starts as regurgitation and progresses to stenosis))

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93
Q

Kussmaul’s sign indicates

A

constrictive pericarditis (( an increase in JVP upon inspiration ))

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94
Q

vegetations on BOTH sides of a valve indicate

A

non-infectious “Libbman- Sacks” endocarditis –> assoc with Lupus

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95
Q

Painless, hemorrhagic macules on the soles & palms

A

Janeway lesions (septic microemboli assoc with bacterial endocarditis)

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96
Q

Painful red lesions on fingers & toes

A

Osler’s nodes (Osler = Ouch!) – also associated with bac endocarditis

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97
Q

chest pain that is reversible, relieved by nitro, and occurs at rest

A

UNstable angina (ST depression to just endocardial ischemia)

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98
Q

Angina that involves coronary vasospasm

A

Prinzmetal’s angina (ST elevation due to transmural ischemia)

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99
Q

mainstay of treatment fot heart failure

A

ACE inhibitors

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100
Q

heart defect associated with fetal alcohol syndrome

A

VSD

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101
Q

heart defect assoc with maternal diabetes

A

Transposition of the great arteries

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102
Q

caused by molecular mimicry of the bacterial M protein (which mimics a lot of human proteins)

A

Acute rheumatic fever

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103
Q

low voltage EKG with diminished QRS amplitude

A

Restrictive cardiomyopathy

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104
Q

most common adult primary heart tumor

A

Myxoma , “pedunculated mass” in the left atrium , benign

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105
Q

most common childhood primary heart tumor

A

Rhabdomyoma, benign hamartoma, assoc with Tuberous Sclerosis

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106
Q

prognosis of colorectal carcinoma is mainky determined by ___

A

stage (not grade)

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107
Q

benign hypopigmented patches caused by the fungus Malassezia furfur

A

Tinea versicolor – KOH prep reveals “spaghetti & meatballs” appearance on light microscopy

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108
Q

Homeobox genes (Hox genes) code for what kind of proteins ?

A

transcription factors – play a role in morphogenesis

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109
Q

apical displacement of the tricuspid valve, atrialization of the right ventricle and huge right atrium

A

Ebstein’s anomaly – assoc with Lithium use

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110
Q

child w/ fever, dysphagia, drooling, anxious, dyspnea , inspiratory stridor

A

Epiglottitis — could be prevented with the Haemophilis influenza type b vaccine

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111
Q

Hepatic encephalopathy will cause a decrease of _____ & ______ in the brain

A

alpha-ketoglutarate and glutamate , which inhibits the kreb cycle (glutamine accumulates causing astrocyte swelling)

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112
Q

Hand flapping in a pt with cirrhosis and testicular atrophy

A

asterixis

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113
Q

where are steroid hormones made (which organelle)?

A

Smooth ER

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114
Q

drug that inhibits the synthesis of guanine and is used for Hepatitis C and RSV

A

Ribavirin

115
Q

defect in Fibroblast growth factor 3 (FGF3) will cause

A

achondroplastic dwarfism

116
Q

secreted by parafollicular C-cells in the thyroid in response to high blood calcium

A

Calcitonin

117
Q

what happens to c-peptide after it is cleaved from pro-insulin in the pancreatic B-cell golgi?

A

it is packaged in secretory granules and secreted in equimolor concentrations with insulin ((it is used to distinguish Type 1 from type 2 diabetes b/c it represents the amount of insulin you have))

118
Q

In the migration of neural crest cells to the intestine, which segment will recieve innervation last in development?

A

the rectum ((the NCCs migrate caudally –> so the rectum is always the last to get them and is always involved if the baby has Hirschsprung’s))

119
Q

African american female with hilar adenopathy, pulmonary infiltrates and non caseating granulomas

A

Sarcoidosis –driven by TH1 cells, IL-2 & IFN-gamma (which stimulate more TH1 and macrophages)

120
Q

drug of choice for treating trigeminal neuralgia (tic douloureux)

A

Carbamazepine (reduces Na+ channel recovery and therby reduces neuronal firing)

121
Q

child w/ large tonsils, cannot isotype switch antibodies

A

Hyper IgM syndrome

122
Q

Fungal infection strongly assoc with DKA

A

Mucormycosis

123
Q

Most dangerous side effect of Amphotericin B

A

Nephrotoxicity — decreases GFR and also directly toxic to tubules (can lead to hypokalemia and arrhythmias)– also look out for hypomagnesemia

124
Q

Side effects of ACE inhibitors

A 
Cough -- most common 
Angioedema -- life threatening*
Proteinuria
Taste changes
HypOtension 
Fetal renal damage 
Rash
incrs Renin 
Low AG II 
HypERkalemia
125
Q

Type of bias that occurs when the investigator’s decision is affected by prior knowledge of the exposure status

A

Observer bias

126
Q

Post-strep glomerulonephritis is an example of a Type ______ hypersensitivity reaction

A

Type III –Immune complex mediated

127
Q

Side effects of Mannitol (an osmotic diuretic)

A

Pulmonary edema, dehydration

-pulmonary edema is caused by the rapid rise in plasma volume due to the drug pulling water out of cells and reducing intracranial pressure

128
Q

IV acyclovir can cause crystalline nephropathy – but can be prevented by ____

A

adequate hydration (fluids!!)

129
Q

Spironolactone can increase overall survival from CHF how??

A

antagonizes aldosterone and aldosterone is known to cause ventricular remodeling and cardiac fibrosis in CHF patients

130
Q

Which population should receive reduced doses of renally cleared medications to prevent toxicity?

A

the elderly — there is a decrease in renal clearance / function as we age (be aware that there is not always a concomiant increase in Creatinine in elderly b/c as their renal function is decreasing , so is their muscle mass…)

131
Q

the loss of E-cadherin is associated with ______

A

cancer metastasis —> E-cadherin helps cells stay together

132
Q

what is Calcineurin?

A

a protein in T cells that is needed for the activation of IL-2 –> growth of T-cells

133
Q

dz in which ceramide trihexoside accumulates in tissues–> leading to dark red rash btw umbilicus & knees (angiokeratomas), neuropathic pain & and renal failure

A

Fabry’s disease

134
Q

man with recurrent kidney stones, besides hydration, what drug can help prevent recurrances?

A

HCTZ –thiazide diuretics decrease renal Calcium excretion

135
Q

Calcineurin (T-cell) inhibitors used to prevent graft rejection

A

Cyclosporine & Tacrolimus

136
Q

drug of choice for acute CHF – b/c they provide maximun diuresis in shortest amount of time

A

Loop diuretics

137
Q

IBD that involves only the colon / rectum, has mucosal/submucosal inflammation, main symptom is bloody diarrhea

A

Ulcerative Colitis

138
Q

Which vitamin has been shown to improve the outcome of measles?

A

Vitamin A

139
Q

Bacteria that substitute D-lactate for D-alanine in the formation of the cell wall are resistant to ______

A

Vancomycin

140
Q

Type II error (Beta)

A

saying that there is no difference when there really is one (Beta)

141
Q

Power of a study

A

the probability of seeing the difference when one truly exists (Power = 1 - Beta)

142
Q

findings of a subdural hematoma and bilateral retinal hemorrhages in a baby

A

Shaken baby syndrome –> report to state protective agency

143
Q

damage to this nerve will result in the loss of the ‘knee jerk’ patellar reflex

A

Femoral (L2-4)

144
Q

symptoms of a right sided colon mass

A

usually an exophytic mass –> anemia (from bleeding), fatigue/ pallor, anorexia, malaise, weight loss…

145
Q

symptoms of a left sided colon mass

A

tend to infiltrate the wall –> obstruction, tenesmus, ribbon stools, N/V/Constipation..

146
Q

Risk factors for Osteoporosis

A 
Smoking
Menopause
Corticosteroids 
Physical Inactivity
Caucasians
Low body weight / BMI
Alcohol use
147
Q

The receptors for PTH are on _________

A

Osteoblasts –> which then turn on RANK –> activates osteoclasts to start resorbing bone and increasing serum calcium

148
Q

patient who works around goat wool and develops hemoptysis, wide mediastinum..

A

Pulmonary Anthrax

149
Q

gram + rods that form “medusa head” colonies and posses an antiphagocytic D-glutamate capsule

A

Bacillus anthracis

150
Q

gram negative bacteria that have an IgA protease which helps them get into mucosal tissues

A

Neisseria gon. and menin.

151
Q

Name 2 ANTI-inflammatory cytokines

A

TGF-beta and IL-10

152
Q

What test differentiates Strep from Staph?

A

Catalase test (Strep = catalase negative) , (Staph = catalase +)

153
Q

What is the ONLY coagulase + Staph species?

A

S. aureus

154
Q

Pt has hypothyroidism (w/ low T4 and low TSH) – is this Primary or Secondary hypothyroidism?

A

Secondary –> problem is the pituitary

155
Q

pt with schizophrenia – treatment ?

A

Olanzapine (or another antipsychotic)

156
Q

Pt gets exposed to Radioactive iodide –> what can you give them to protect their thyroid ?

A

K+ iodide

157
Q

Senile osteoporosis –> high or low turnover?

A

Low turnover

  • Osteoblasts low
  • Osteoclasts normal or high
158
Q

Post-menopausal osteoporosis –> high or low turnover?

A

High turnover

  • osteoblasts & clasts are high
  • bone is lost b/c formation can’t keep up with absorption
159
Q

What kind of receptors are the T3 & T4 hormone receptors?

A

nuclear / retinoid X binding to DNA

160
Q

glycine & GABA are _____ neurotransmitters & glutamate is a _________ nt

A

inhibitory , excitatory

161
Q

Diseases caused by S. aureus preformed EXOTOXIN

A

1- TSS
2- SSSS
3- Gastroenteritis (food poisoning)

162
Q

1 gram protein or carbohydrate = ___ calories
1 gram fat = ___calories
1 gram ethanol = ___ calories

A

1 gram protein or carbs = 4 cals
1 gram fat = 9 cals
1 gram ethanol = 7 cals

163
Q

_____________ has a very low infectious dose –> as few as 10 organisms can cause disease (although usually more)

A

Shigella

  • other organisms that can infect at low #’s:
  • Campylobacter (500 organisms)
  • E. histolytica & Giardia (1 organism)
164
Q

infant w/ vomiting, lethargy, jaundice shortly after beginning breastfeeding

A

Classic galactosemia (most common form)

  • lack of galactose-1-phos uridyl transferase
165
Q

hormone made by cells in the duodenum that increases bicarb secretion from the pancreas

A

Secretin

-stimulated by acidity (HCL)

166
Q

pathogenic mechanism of Shigella

A

mucosal invasion

  • invades M cells in peyers patches and causes bloody diarrhea
  • also releases Shiga toxin –inhibits protein synthesis
167
Q

the best way to determine if a certain gene is being expressed in tissue is to analyze the presence of ______________ by _______ blot

A

mRNA by Northern blot

(mRNA –> protein) = being expressed

168
Q

What is the best way to destroy Hepatitis A on contaminated fomites or in water?

A

Boiling for 1 minute

(Hep A is fecal-oral) – can also use UV light, bleach or chlorination

169
Q

_______ is only capable of infecting when encapsulated with HBsAG

A

hepatitis D (delta agent)

170
Q

a woman with HepB is most likely to pass it to her baby if she is _______ positive

A

HBeAg (the envelope)

-HBeAg is a marker of increased infectivity and replication

171
Q

Which enzyme in the TCA cycle has Thiamine as a cofactor?

A

alpha-ketoglutarate DH

a-kg to succinyl coA

172
Q

enzyme that is SPECIFIC to the liver that breaks down glycerol

A

Glycerol kinase

173
Q

alpha- glucosidase deficiency in an infant

A

Pompe’s disease

-glycogen storage dz type 2

  • cardiomegaly**
  • hepatomegaly
  • macroglossia, severe MR
  • glycogen accumulates in lysosomes
174
Q

glycogen phosphorylase deficiency in an infant

A

McArdle’s disease

-glycogen storage dz type V

  • muscle glycogen phosphorylase defic
  • weakness / fatigue when exercise **
  • blood lactate levels don’t rise after exercise
175
Q

deficiency in Glucose - 6 phosphatase in an infant

A

von Gierke’s disease

  • most common glycogen storage dz (Type 1)
  • hepatomegaly
  • fasting hypoglycemia (seizures)
  • hyperuricemia
  • hyperlipidemia
176
Q

glycogen debranching enzyme deficiency

A

Cori’s or “forbes’ disease

  • glycogen storage dz type III
  • hepatomegaly
  • growth retardation**
  • hypoglycemia
  • hyperlipidemia
  • muscle weakness
177
Q

a tumor in the 3rd part of the duodenum is at risk for penetrating into what vessel?

A

the SMA

178
Q

pt with severe hypoglycemia but high hepatic intracellular NADH —> where is the liver getting it’s energy?

A

hypoglycemia in the setting of high NADH = the liver is getting energy from something other than glucose

-Ethanol is an example (alcoholics)

179
Q

What CANNOT use ketone bodies for energy?

A

RBC’s and Hepatocytes

180
Q

LOCAL defense against candida is done by _____ and SYSTEMIC defense is done by ______

A

Local –> T-cells (ie: HIV pts usually have localized candida)

Systemic –> Neutrophils (neutropenic pts can have systemic)

181
Q

a bleeding ulcer at the posterior duodenal bulb is most likely to penetrate what artery?

A

gastroduodenal artery

182
Q

delta - aminolevulinic acid is elevated in patients with _______

A

lead poisoning

and Pyridoxal phosphate is a necessary cofactor for it so it also elevated

183
Q

technitium -99 scan shows the presence of __________

A

ectopic gastric epithelium

will help identify Meckel’s diverticulum which often has ectopic gastric mucosa

184
Q

which part of the intestine is the main site of Lipid absorption?

A

JEJUNUM

185
Q

psoriasis can be associated with

A

deforming joint disease (psoriatic arthritis)

186
Q

BRAF mutation (w/ Valine 600 replaced by glutamate) is seen in patients with ______

A

Melanoma

187
Q

a chronic inflammatory skin condition associated w/ several environmental factors (foods, irritants..), intensely pruritic & associated with asthma & allergic rhinitis

A

Atopic Dermatitis (aka “Eczema’)

  • cannot be diagnosed unless itchy!
  • Eczema + Allergic Rhinitis + Asthma = the “Allergic Triad”
188
Q

histological changes seen in Urticaria

A

dermal edema + dilated lymphatics (no changes in epidermis)

189
Q

most common site for bullae of Pemphigus vulgaris

A

Mouth / mucosal surfaces

-Bullous pemphigoid spares the mouth/ mucosa

190
Q

axillary lymph node dissection after mastectomy predisposes you to chronic lymphedema & development of ________

A

angiosarcoma (Stewart-Treves syndrome)

191
Q

What is Vitiligo?

A

autoimmune destruction of melanocytes

192
Q

Most common sites of fracture in osteoporosis

A

1- vertebral crush fractures
2-femoral neck
3- Colle’s fracture (distal radius)

193
Q

Achondroplasia inheritance pattern

A

Autosomal dominant activating mutation of FGFR3 –(but most are sporadic mutations)

194
Q

increased Alk phos in bone disease (ie: Paget’s) indicates_______

A

increased osteoblast activity

195
Q

soap bubble tumor of the epiphysis

A

Giant Cell tumor (osteoclastoma) – benign

196
Q

11:22 translocation

A

Ewing’s Sarcoma – small round blue cell tumors, in diaphysis of long bones, malignant

197
Q

autoantibodies to ribonucleoproteins (SS-A and SS-B)

A

Sjogren’s syndrome

198
Q

Anti-Jo-1 antibodies

A

Dermatomyositis / Polymyositis

199
Q

drugs highly associated w/ SJS

A

Bactrim, Dilantin

200
Q

‘sawtooth’ infiltrate of lymphocytes at the dermal/epidermal junction , this dz also highly assoc w/ Hep C

A

Lichen planus

201
Q

S-100 tumor marker

A

Melanoma

202
Q

drugs that end in ‘-dronate’

A

block osteoclasts

bisphosphonates used for Paget’s, osteoporosis, hypercalcemia

203
Q

unique toxicity side effect of bisphosphonates

A

osteonecrosis of the jaw, and esophagitis

204
Q

landmark for doing a pudendal nerve block

A

ischial spines

205
Q

What can be used to treat the side effects of Myasthenia gravis drugs (like pyridostigmine)?

-diarrhea, nausea, sweating, cramping…

A

Pyridostigmine is a cholinesterase inhibitor (leading to increased Ach effects throughout the body)

-you can use an antimuscarinic agent like Scopolamine –> it treats only the side effects & doesn’t counter -stigmine’s effects on muscle b/c the muscle receptors are nicotinic cholinergic and Scopolomine blocks the muscarinic receptors only….

206
Q

what nerve supplies the gluteus medius & minimus?

A

Superior gluteal n

207
Q

test you must perform on your patient before starting them on any TNF-alpha inhibitors

A

PPD skin test (check for latent TB that could become reactivated)

  • TNF-a inhibitors:
  • etanercept, infliximab & adalimumab
208
Q

what is the primary abnormality in Paget’s dz of the bone?

A

Osteoclasts– bone resorption

209
Q

inheritance pattern of Osteogenesis imperfecta?

A

Autosomal dominant

210
Q

plasma protein that binds free Hb to prevent it’s renal excretion

A

Haptoglobin

-decrs in hemolytic anemias

211
Q

young african american child with bilateral swollen & painful hands & feet

A

Dactylitis (a result of of sickle cell disease seen in young children)

212
Q

Hydralazine & Procainamide are metabolized in the liver by________

A

phase II - N acetylation

slow-acetylators develop Lupus like syndrome more often

213
Q

anti-centromere antibodies are specific for

A

CREST syndrome

  • Scl-70 AB’s are specific for systemic Scleroderma
214
Q

drugs that are more __________ are preferentially processed in the liver (rather than kidney)

A

Lipophilic / good CNS penetration / high Vd

215
Q

infant with testes but underdeveloped external male genetalia…which enzyme is deficient?

A

5-alpha-reductase

can’t convert testosterone —> DHT

216
Q

man with tinnitus & vertigo is found to have bilateral acoustic schwannomas —> a mutation on chromosome ____ is likely

A

Auto. dom. mutation of NF-2 tumor suppressor gene on chromosome 22 (codes for ‘merlin’ protein)

-bilateral acoustic schwannomas are classic in NF-2 (Central neurofibromatosis)

217
Q

renal cysts, hemangioblastomas of the cerebellum, bilateral renal cell carcinoma…

A

VHL – mutation on chromosome 3

218
Q

prolactin is under tonic suppression by ______ from the ________

A

Dopamine from the hypothalamus

219
Q

what is the best initial treatment for extreme hypoglycemia

A

IM shot of glucagon in an emergency

IV dextrose once you get to hospital

220
Q

drug for isolated systolic HTN with main side effect of peripheral edema (ankle swelling) and flushing

A

Amlodipine

221
Q

what does the mutation in CF actually do to the CFTR protein?

A

the Phe deletion causes abnormal post-translational processing so it never even gets to the cell surface – it gets degraded

222
Q

Symptoms of Vitamin E deficiency

A

degeneration of dorsal columns, peripheral nerves, cerebellar tracts..

-mimics Friedrich ataxia

223
Q

long-branched lipids that contain about 90 carbons— in a bacterial cell

A

Mycolic acid in Mycobacterium (what makes them “acid fast”)

224
Q

rupture of a berry aneurysm causes a ___________ hemorrhage

A

subarachnoid hemorrhage

225
Q

after starting this HTN drug, you can expect the patient’s serum creatinine to increase by up to 30%

A

ACE inhibitors – b/c they prevent AgII from constricting the efferent arteriole, therby decreasing GFR

226
Q

serotonin releasing neurons are ONLY found in the ____________

A

Raphe nuclei of the brainstem (axons then project all over the CNS releasing Serotonin)

227
Q

urine draining from the umbillicus of a neonate suggests persistant __________

A

patent urachus / allantois remnant

228
Q

meconium draining from the umbillicus of a neonate indicates persistant ________

A

yolk sac / vitelline duct

229
Q

Apolipoprotein E4 is associated with ______

A

late onset Alzheimer’s

230
Q

mood stabilizers

A

Lithium, Valproate, Carbamazepine

231
Q

the shortest acting benzodiazepine – to prevent excessive fatigue

A

Triazolam or alprazolam

232
Q

failure of neural crest cells to migrate to the truncal and bulbar ridges of the truncus arteriosus and the bulbus cordis can lead to ____, _____ or _______

A
  • Tetrology of Fallot
  • Truncus Arteriosus
  • Transposition of the Great Vessels
233
Q

too rapid correction of hyponatremia can cause _________

A

osmotic demyelination syndrome (central pontine myelinolysis) –> spastic quadriplegia

234
Q

if the sup. laryngeal nerve is damaged in thyroid surgery –> what muscle will lose innervation?

A

Cricothyroid muscle

recurrent laryngeal n. supplies all the other larynx muscles

235
Q

drugs that are associated with fat redistribution from extremities to trunk

A

HIV protease inhibitors and long-term glucocorticoid use

236
Q

a common complication of venous stasis/ varicose veins

A

venous stasis ulcers (usually on the medial malleolus)

237
Q

a woman with significantly increased amniotic fluid –> baby is at risk for _____

A

anencephaly or GI obstruction (decrs fetal swallowing)

238
Q

elevated acetylcholinesterase and AFP in amniotic fluid __________

A

neural tube defects

239
Q

______ is believed to increase Insulin resistance in overweight people

A

increased Free fatty acids & Trigs

240
Q

serous fluid collects within the tunica vaginalis

A

Hydrocele

241
Q

most common cause of fetal hydronephrosis

A

inadequate recanalization of the ureteropelvic junction (junction of kidney & ureter)

242
Q

this vitamin should NOT be taken by pt’s on Levodopa b/c it decreases it’s effectiveness

A

B6

243
Q

drugs that can improve both the + and - symptoms of Schizophrenia

A

Second gen (Atypical) antipsychotics

-it’s not typical for “OLd CLOsets to QUietly RISPer from A to Z”

244
Q

what is the RLS in the conversion of Acyclovir to it’s active triphosphate form

A

monophosphorylation by the viral Thymidine Kinase

245
Q

best area on body to measure to get an idea of Insulin resistance

A

Waist-to-hip ratio (helps determine visceral fat)

246
Q

mechanism of Mifepristone

A

anti-progestin drug (5X stronger affinity for progesterone receptor than progesterone)

247
Q

mechanism of Phentolamine

A

alpha blocker

248
Q

Which anti-fungal drugs act against the cell membrane (ergosterol)?

A
  • Amphotericin B
  • Nystatin
  • Azoles
249
Q

inheritance pattern of G6PD deficiency

A

X-linked recessive

250
Q

FTA-ABS test is specific for _________

A

Syphilis

251
Q

Polycythemia vera is associated with a mutation in ______________

A

Jak 2 - NON receptor tyrosine kinase

252
Q

pt with sickle cell & gross hematuria

A

renal papillary necrosis

253
Q

paralysis of upward gaze (parinaud syndrome) is characteristic of a _______________ lesion

A

dorsal midbrain around the pineal gland

254
Q

this drug act to prolong both the PT & PTT time

A

FondaparinuX

-direct factor Xa inhibitor

(remember b/c factor X is the intersection of the intrinsic & extrinsic pathways so this drug will prolong BOTH PT & PTT)

255
Q

best diet alteration for diabetes improvement

A

low-calorie (better than low carb)

256
Q

most important risk factor for gastric adenocarcinoma

A

diet (smoked foods, nitrosamines), blood type A, H. pylori or autoimmune gastritis

(NOT SMOKING)

257
Q

when you have a mitochondrial disease, why are there varying presentations?

A

Heteroplasmy :a mixture of more than one type of an organellar genome within a cell or individual.

258
Q

pt with MR, night blindness, chronic diarrhea, weakness, ataxia, steatorrhea…

A

Abetalipoproteinemia

-lack of ApoB-100 & B-48 = can’t absorb fat or fat soluble vitamins and all the consequences from that

259
Q

Mechanism of Macrolide antibiotics

(ie: Erythromycin)

A

blocks translocation of the amino acid chain on the 50s subunit rRNA (“macroSLIDES”)

260
Q

pathogenesis of sickle cell anemia

A

HbS point mutation in Beta chain (glutamic acid –> valine), low O2 state or dehydration precipitates sickling –the deoxy Hb polymerizes to make sickle shape)

261
Q

what is the function of the poly-A tail

A

protects the mRNA strand until it gets out of the cell (gets degraded from the poly-A tail and up)

262
Q

function of peptidyl transferase

A

making the covalent peptide bonds btw amino acids on a growing peptide

263
Q

causes your body to absorb too much iron from the food you eat

A

Hereditary hemochromatosis

264
Q

drug therapy that you can use for Hepatic encephalopathy

A

Lactulose

-b/c it renders the ammonia inabsorbable by converting it to ammonium (NH4), and increase transit of bowel content through the gut.

265
Q

ligament that attaches to the cervix and then goes posteriorly

A

Uterosacral ligament

266
Q

effect of Cushing’s ACTH on the adrenal cortex

A

hyperplasia

267
Q

which structure assists in producing new bone after a fracture (ex: clavicle fx)

A

The periosteum

-contains the progenitor cells for osteoblasts, chondroblasts and fibroblasts

268
Q

“Hot T-Bone stEAk”

A 
IL-1 --- fever
IL-2 -- stimulates T cells
IL-3 -- stimulates bone marrow
IL-4 -- stimulates IgE
IL-5 -- stimulates IgA

IL-8 – recruits neutrophils (clean up on ‘aisle 8’)

269
Q

What is the most likely explanation for prolonged, ABX resistant colonization of a CF patient w/ Pseudomonas

A

the Pyocyanin toxin made by Pseudomonas…

270
Q

virulence factor of N. gonorrhea

A

pili, opa proteins

271
Q

function of Neuraminidase inhibitors

A

block the function of the viral neuraminidase protein, thus preventing the virus from reproducing by budding from the host cell.

272
Q

which interleukin is also called ‘osteoclast activating factor’ and is involved in bone resorption

A

IL-1

273
Q

Bence-Jones proteins

A

multiple myeloma

274
Q

most grave effect of Metformin overdose

A

Lactic acidosis

275
Q

which tissue proliferates in a hydatidaform mole?

A

trophoblastic tissue (what would have become the placenta)

276
Q

What is the most commonly used drug for infertility?

also used for PCOS

A

Clomiphene

(SERM) that increases production of gonadotropins by inhibiting negative feedback on the hypothalamus.

277
Q

True or False – regular menses means regular ovulation

A

FALSE

-women undergoing anovulation still have (more or less) regular periods. In general, patients only notice that there is a problem once they have started trying to conceive.

278
Q

Effects of a Beta-2 agonist

A

Smooth muscle relaxation (bronchial dilation, uterine dilation, relaxes GI tract & relaxes detrusor)

279
Q

child dies from mycobacterial infection, had brother who also died from this… what is missing?

A

INF-gamma receptors (can’t call macrophages)

280
Q

mechanism of Cisplatin

A

crosslinks DNS

very effective at treating testicular CA

281
Q

child dies from mycobacterial infection, had brother who also died from this… what is missing?

A

INF-gamma receptors (can’t call macrophages)

281
Q

child dies from mycobacterial infection, had brother who also died from this… what is missing?

A

INF-gamma receptors (can’t call macrophages)

282
Q

mechanism of Cisplatin

A

crosslinks DNS

very effective at treating testicular CA

282
Q

mechanism of Cisplatin

A

crosslinks DNS

very effective at treating testicular CA

STEP 1 RECALL (12 decks)

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