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STEP 1 RECALL > Quick Associations > Flashcards

Quick Associations Flashcards

1
Q

Best screening test for ACROMEGALY

A

Somatomedin-C (IGF-1)

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2
Q

Failure to appropriately concentrate the urine

A

DIABETES INSIPIDUS (inadequate ADH or failure of kidneys to respond to ADH)

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3
Q

Antimicrosomal and anti thyroglobulin antibodies

A

High in chronic lymphocytic thyroiditis (HASHIMOTOS)

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4
Q

Thyroid stimulating immunoglobulin (TSIG)

A

High in Graves’ disease

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5
Q

Labs in Graves’ disease (TSH , T4 level?)

A

Low TSH, HIGH T4 … And high TSIG

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6
Q

Autoimmune, PAINLESS thyroiditis

A

Chronic lymphocytic thyroiditis (ie: HASHIMOTOS)

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7
Q

Viral thyroiditis, very very PAINFUL , elevated ESR

A

Subacute granulomatous thyroiditis (de Quervains)

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8
Q

Elevated TSH is diagnostic for ——?

A

HYPOTHYROIDISM

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9
Q

Breast milk is low in what 2 vitamins?

A

D & K (breastfed babies need sunlight or vit D supplement ,,,and a vit K injection at birth)

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10
Q

An ovulated egg is arrested in what phase until fertilization?

A

Metaphase of Meiosis 2. (Until it “Met” a sperm)

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11
Q

What is the relationship btw confidence interval, RR and p- value?

A

RR> 1 means the exposure IS associated with the dz. A C.I. Of 95% – to be significant must NOT contain the null value of 1.0 When the 95% C.I. lacks 1.0 , this means that the p-value must be < 0.05 and the association is significant

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12
Q

Pregnant woman with low grade fever, maculopapular rash spreading from head to trunk and extremities, post-auricular lymphadenopathy….

A

Think MEASLES (rubeola), or GERMAN MEASLES (rubella) Rubella– particularly assoc with post-auricular lymph nodes Puts mom at risk for polyarthralgias and fetus at risk for deafness/ cataracts

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13
Q

What kind of epithelial lining do ovaries have?

A

Simple cuboidal (“germinal epithelium”)

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14
Q

The ovaries and testicles lymph drain to ——–??

A

Para- aortic lymph nodes

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15
Q

Lymph from the scrotum drains to the ——?

A

Superficial inguinal nodes

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16
Q

Purulent urethritis indicates chlamydia or N. gonorrhoeae and can ascend to cause PID–> what is the correct treatment?

A

Third gen cephalosporin + azithromycin or doxycycline (Treatment of gonorrhea always include tx for chlamydia too!)

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17
Q

What is 1st line tx for HTN in a pregnant woman?

A

Methyldopa

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18
Q

The only four situations where you can disclose patient information without their consent…?

A

1- when you suspect child or elder or spousal abuse 2- when the pt has had a gunshot or stabbing injury 3- when the pt has a reportable communicable disease 4- when a pt threatens to kill/ harm someone else and has means to do so

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19
Q

Marker for astrocytes

A

GFAP

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20
Q

CA-125 is a marker for—-?

A

Ovarian cancer ( but not very specific– it’s good for monitoring progression of the cancer, not screening for it)

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21
Q

Call-Exner bodies

A

Granulosa cell tumors (“Call your GRAN-E”)

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22
Q

Pt. with new onset achalasia, megacolon, megaureter… From Central or South America …

A

CHAGAS disease (Trypanosoma cruzi)

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23
Q

Child with fever, malaise, pharyngitis, generalized vesicular and pruritic rash, most lesions have crusted over within 6 days

A

Chicken pox (Varicella Zoster)

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24
Q

Children in daycare with dysuria, hematuria (UTI) ….most common viral cause ?

A

Adenovirus (Most common viral cause of acute hemorrhagic cystitis in kids)

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25
Q

Pt in septic shock from E.coli…. Which bacterial factor is responsible for the condition of the pt ?

A

Lipid A (the toxic component of LPS–> endotoxin) Lipid A causes activation of macrophages–> release of IL-1 and TNF-alpha–> signs of shock

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26
Q

Which cytokine (IL-?) is responsible for antibody isotype (class) switching??

A

IL-4

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27
Q

Which bacteria is the most common cause of osteomyelitis in pts with sickle cell disease??

A

Salmonella (These pts have functional asplenia, so are at risk to encapsulated bacteria)

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28
Q

Inflammatory arthritis after chlamydia infection…

A

Reiters syndrome

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29
Q

Hypokalemia can cause ——?

A

Muscle weakness

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30
Q

Right sided endocarditis

A

Typically IV DRUG users, caused by S. aureus

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31
Q

Most common type of collagen in the body, found in tendon, ligaments, bone, dentin, cornea, blood vessels, scar tissue…

A

TYPE 1 collagen

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32
Q

Type of collagen in basement membranes? Associate with what syndrome?

A

Type 4 Alport’s syndrome

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33
Q

Type of collagen associated with osteogenesis imperfecta and scar tissue long after a heart attack

A

Type 1

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34
Q

Type of collagen in cartilage, nucleus pulposus and vitreous humor

A

Type 2

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35
Q

Type of collagen associated with Ehlers Danlos syndrome And found in skin, lungs, intestines, blood vessels…

A

Type 3

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36
Q

Strep bovis septicemia or endocarditis, associated with??

A

COLON CANCER

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37
Q

Gray sub-retinal membranes, vision loss

A

Wet Age related Macular degeneration Wet= neovascularization / new blood vessels

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38
Q

Which vessels are most susceptible to the effects of Nitroglycerin?

A

The large veins

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39
Q

What substance would provide the fastest reversal of the effects of Warfarin?

A

Fresh frozen plasma (contains all coagulation factors) Vitamin K would also reverse warfarin effects, but slower, because it requires time for clotting factor resynthesis..

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40
Q

Frothy, foamy urine..

A

PROTEINURIA or bile salts in the urine

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41
Q

Treatment for systemic fungal infections …

A

Amphotericin B

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42
Q

Protein that is responsible for anterograde transport (moving intracellular vesicles and organelles toward the + end (rapidly growing end) of microtubules) — ie: away from the nucleus

A

Kinesin

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43
Q

Protein that is responsible for retrograde transport (moving items back toward the nucleus (- end of microtubules) )

A

Dynein

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44
Q

Lung abscess in an alcoholic patient Cause? Treatment?

A

Anaerobes, treat with Clindamycin

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45
Q

Pustules that spread and infect several hair follicles Cause? Treatment?

A

Skin infections are often caused by penicillinase producing S. aureus Treat with Nafcillin, Methicillin, or Oxacillin ((For MRSA use Vancomycin))

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46
Q

Nausea and vomiting 1 hour after a meal…. Cause & tx?

A

So soon after a meal suggests food poisoning from a pre-formed exotoxin, commonly the heat stable S. aureus Treat with fluids, supportive care (not ABX because it is toxin mediated illness))

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47
Q

Facial swelling and dark urine after a recent skin infection… Cause & tx?

A

Post-streptococcal glomerulonephritis after a streptococcal skin infection Tx is supportive, usually resolves on own

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48
Q

Long term effect of topical corticosteroid use on skin?

A

Decrs collagen production and glycosaminoglycans, leads to atrophy of the dermis w/ loss of collagen, drying, cracking, tightened skin Atrophic striae may also be found

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49
Q

Flat red skin lesion with central clearing …what bacteria?

A

Borrelia burgdorferi (cause Erythema Chronicum Migrans– the classic lesion of Lyme disease)

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50
Q

Pt with palmoplantar erythematous macular or petechial rash that spreads proximally to the trunk, with headache, fever, red eyes… Bacteria? Tratment?

A

Tick borne Rickettsia rickettsiae ( causing Rocky Mountain Spotted Fever) Treat with Doxycycline

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51
Q

Regional lymphadenopathy, malaise and fever after a cat scratch or bite…

A

Gram negative Bartonella henselae ( Cat Scratch Fever)

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52
Q

Hemorrhages, subperiosteal hemotomas, gingival swelling/ painful gums, hemarthralgias … What vitamin is likely deficient??

A

Ascorbic acid (vit C) – Scurvy Cannot be made in the body, must get from diet (Deficiencies common in the elderly, alcoholic, poor)

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53
Q

Autoantibodies to the hemidesmosomes along the basement membrane of the dermal/ epidermal junction

A

Bulbous pemphigoid

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54
Q

Pt with diffuse skin erythema, epidermis comes off easily with gentle pressure….cause? Endo or exotoxin?

A

Staph Scalded Skin Syndrome (SSSS) caused by the exfolatin exotoxin of certain Staph. species, mostly in infants and kids,( “Nikolsky’s sign” = sloughing of skin with gentle pressure)

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55
Q

What type of cells have intracytoplasmic granules that look like tennis raquets?

A

Langerhans cells - APCs of the skin and mucous membranes, derived from myeloid cell line, contain “Birbeck granules”

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56
Q

Warty papules on skin of middle aged person (any color) that look “stuck on” ( could be scraped off)

A

Seborrheic keratosis

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57
Q

Defective Intestinal and renal absorption of tryptophan— what is this disease and what causes it?

A

Hartnup Disease (defective absorption of tryp leads to Niacin (B3) deficiency and symptoms of Pellagra) -dementia/ ataxia - diarrhea - dermatitis

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58
Q

PABA esters protect skin from what kind of UV radiation?

A

UVB only

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59
Q

dimpling of the skin on the breast & nipple inversion – indicates ?

A

infiltration of the suspensory ligament (Cooper’s ligament)

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60
Q

peau d’ orange indicates___?

A

lymphatic obstruction – assoc with inflammatory breast cancer

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61
Q

ABX needed to treat beta-lactamase producing bacteria?

A

an antibiotic + a Beta-lactamase inhibitor (Tazobactam, Sulbactam or Clavulinic Acid)

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62
Q

What is the correct order of progression of mutations responsible for the development of colon adenocarcinoma? (the adenoma –> carcinoma sequence)?

A

APC tumor suppressor gene (dev of polyps) –> K-Ras mutation (polyp growth) –> p53 mutation (malignant transformation to carcinoma)

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63
Q

DNA methylation –> does what to transcription level?

A

Methylation is assoc with LOW TRANSCRIPTIONAL activity (heterochromatin)

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64
Q

Loop diuretics (like Furosemide) have what major side effects?

A

OTOTOXICITY (hearing loss) , HYPO-kalemia, -magnesia & -calcemia , decr GFR, volume depletion, hypotension..

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65
Q

what is most commonly injured when the humerus is dislocated anteriorly?

A

the axillary nerve –> resulting in deltoid paralysis and loss of sensory over the deltoid muscle , the shoulder will also appear flettened bc the humeral head has been displaced

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66
Q

what is the mechanism of Colchicine & what is it indicated for?

A

inhibition of microtubules –> binds to tubulin, impairs leukocyte (neutrophil) migration & phagocytosis –> reducing inflammation in ACUTE GOUTY ARTHRITIS ((diarrhea is a common side effect))

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67
Q

trabecular thinning with fewer interconnections

A

Osteoporosis

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68
Q

more metabolically active than long bones–osteoporosis typically involves this kind of bone

A

trabecular bone, aka spongy / cancellous bone, (makes up most of axial skeleton)

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69
Q

bone type that is very strong, serves as mechanical support and sites of muscle attachment , makes up most of the appendicular skeleton

A

cortical bone (long bones)

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70
Q

marked osteoclastic activity followed by osteoblastic activity –> net result is formation of abnormal bone (mosaic pattern of lamellar bone with the sections linked by cement lines)

A

Paget’s dz of the bone

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71
Q

Hyperparathyroidism causes osteoclasts to resorb bone –> primarily involves what type of bone?

A

Cortical bone (long bones)– classic is subperiosteal thinning of long bones

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72
Q

increased deposition of unmineralized osteoid – characteristic of ??

A

Vitamin D deficiency (b/c you need Vit D to absorb Calcium & Phos)

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73
Q

child with poor wound healing, late separation of the umbilical cord, recurrent skin infection with NO pus & gingivitis/periodontitis –> what is the diagnosis?

A

Leukocyte Adhesion Deficiency – autosomal recessive absence of CD18 –> can’t form INTEGRINS –> leukocytes cannot roll, adhere, or extravasate (hence NO pus)

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74
Q

late separation of the umbilical cord

A

Leukocyte adhesion deficiency (CD18 / Integrin defic)

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75
Q

this deficiency allows all bacteria to stay alive in phagocytes

A

Myeloperoxidase

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76
Q

this deficiency allows some organisms (catalase negative) to stay alive in phagocytes

A

NADPH oxidase deficiency –> causes Chronic granulomatous disease **Absence of NADPH oxidase = inability to form H2O2 so MPO has no substrate! (organisms that are catalase positive, however, make their own H2O2 and can be acted upon by MPO & killed)

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77
Q

Transcobalamin II is a carrier protein for —-?

A

B12 from the Ileum

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78
Q

Ceruloplasmin is a carrier protein for _______ & is low in ____________ disease

A

copper , Wilson’s dz

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79
Q

homeless/alcoholic with swollen gums, bruising, nosebleeds, hyperkeratosis, poor wound healing

A

SCURVY – vitamin C deficiency leads to inability to hydroxylate the proline & lysine residues of pro-collagen–> decr collagen = decr strength of blood vessel walls & other connective tissue ((even worse bleeding & bone deformities are seen in kids with Scurvy)

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80
Q

during skeletal muscle contraction, Calcium binds to ________?

A

Troponin C

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81
Q

pt with nodule containing long yellow crystals , neg birefringent under polarized light–> what are these crystals?

A

Monosodium Urate crystals (acute attack of Gout)

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82
Q

what kind of crystals are seen in pseudogout?

A

Calcium pyrophosphate – will appear as blue rhomboid crystals, positively birefringent, commonly affects the knee

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83
Q

young man with chronic low back pain, morning stiffness better with activity & HLA-B27 + , RF -

A

Ankylosing Spondylitis

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84
Q

sustained, involuntary muscle contractions

A

Dystonia (ex: Cervical dystonia is called Torticollis)

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85
Q

Which diuretic can also cause an INCREASE in calcium absorption at the DCT and therefore decr the risk of osteoporosis and renal stones ??

A

HCTZ (Thiazide diuretics) –((loop diuretics do the opposite and would increase the risk for osteoporosis))

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86
Q

RANK receptor / RANK ligand

A

assoc with osteoclasts, bone resorption (low estrogen states –> more RANK –> resorption of bone)

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87
Q

what ligament is affected in a radial head subluxation (yanking of a child’s arm)

A

annular ligament

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88
Q

diabetic pt with fever, flank pain, pain when walking –> pt lies supine in fetal position, resists extension of his leg

A

r/o Psoas Abscess (risk factors include DM, HIV, IV drug use, immunosuppressed)

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89
Q

“moldy” grains in China associated with G —> T mutations in p53 gene

A

Aflatoxin B1 from moldy peanuts, soy or corn –> highly associated with hepatocellular carcinoma

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90
Q

alveolar cells with ‘golden cytoplasmic granules’ that turn dark blue w/ Prussian blue staining –> what are the granules & what is the dz?

A

Hemosiderin (iron) , associated with Left sided heart failure macrophages eat the iron that is leaked out of congested capillaries (“heart failure cells”)

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91
Q

AST higher than ALT

A

alcoholic hepatitis

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92
Q

ALT >> AST

A

acute viral hepatitis

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93
Q

patient with bilateral femur fractures with acute onset hypoxemia, petichiae & confusion

A

fat emboli in the pulmonary microvasculature

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94
Q

male infertility, situs inversus, recurrent sinusitis & bronchiectasis

A

Kartagener’s syndrome (dynein defect)

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95
Q

peaked T waves on EKG

A

Hyperkalemia ( at risk for ventricular arrythmias)

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96
Q

virus associated with mono, nasopharyngeal carcinomas and Burkitt’s lymphoma

A

EBV

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97
Q

the main mechanism of excess copper removal from the body is ___________

A

hepatic excretion into bile

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98
Q

black pigment gallstones

A

chronic extravascular hemolysis (ie: sickle cell, B-thalassemia & spherocytosis)

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99
Q

keratin pearls

A

SCC

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100
Q

the most important environmental risk factor for pancreatic cancer

A

smoking!

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101
Q

acute onset heart failure after a viral infection

A

suspect viral myocarditis

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102
Q

enzyme that converts cholesterol to bile acids

A

7- alpha hydroxylase

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103
Q

bruising, bleeding, immature myeloid cells with Auer rods , t (15:17)

A

Acute Promyelocytic Leukemia (M3) AML –> treat with ATRA

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104
Q

what is deposited within Bowman’s space in RPGN?

A

Fibrin

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105
Q

thyroid nodule with calcified structures & ground glass appearance

A

Papillary carcinoma (w/ Psammona bodies)

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106
Q

sudden cardiac death in a young athlete

A

hypertrophic cardiomyopathy

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107
Q

deficiency of CD 55 & 59 is diagnostic

A

Paroxysmal nocturnal hemoglobinuria (PNH) – can’t inactivate complement , recurrent thrombosis, hemolytic anemia, pancytopenia

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108
Q

antibodies against alpha3 chain of Type IV collagen _____ associated with ?

A

Goodpasture’s syndrome – anti-GBM antibodies –> develop RPGN and hemoptysis

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109
Q

child with retinoblastoma is at a great risk for what other type of neoplasm?

A

Osteosarcoma

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110
Q

ANP and sildenafil both act on what second messenger system?

A

cGMP

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111
Q

drug of choice for oropharyngeal candidiasis?

A

Nystatin (“swish & swallow” agent)

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112
Q

Pt with colicky abd pain, constipation, HA, impaired short term memory, wrist or foot drop, microcytic anemia with basophilic stippling

A

Lead poisoning

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113
Q

Mechanism by which cells become resistant to chemotherapy drugs?

A

ATP dependent transporter (they pump the drugs out of the cell)

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114
Q

drugs that block the Na-Cl symporters in the DCT causing more Na, Cl and water excretion, but can also cause incrs Calcium absorption & hyperuricemia

A

Thiazide diuretics

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115
Q

Carbonic anhydrase inhibitors work at what part of the nephron?

A

PCT (they incrs bicarb excretion)

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116
Q

side effects of Methotrexate?

A

stomatitis, hepatotoxicity (elevated LFTs) , myelosuppression (incrs risk for infection)

117
Q

Spironolactone mechanism and side effects?

A

K+ sparing diuretic, causes gynecomastia and testicular atrophy in men (blocks androgen receptors) , may be used to treat Hirsutism in females

118
Q

What is the recommendation for pregnant women who have positive Group B strep cultures from 35-37 wga?

A

intrapartum penicillin or ampicillin

119
Q

Chronic lung transplant rejection (months to years later) affects what part of the lungs mainly?

A

inflammation of the small bronchioles (“bronchiolitis obliterans”) contrasts to chronic rejection of an abdominal organ which presents with vascular obliteration

120
Q

hemolytic anemia, thrombocytopenia & acute renal failure (oliguria, hematuria) in a child

A

Hemolytic Uremic Syndrome (most cases due to E. coli or Shigella dysentery)

121
Q

What are three most common causes of cancer in US women? What are the three most deadly cancers in US women in order?

A

Incidence: Breast, Lung, Colon Deaths: Lung, Breast, Colon

122
Q

trachea deviated toward the opacified hemithorax on XRAY

A

lung volume loss / atelectasis ((ie: tumor blocking the main bronchus on that side))

123
Q

trachea deviated away from the opacified lung on XRAY

A

large pleural effusion (something pushing the trachea away)

124
Q

A child with a Strawberry Hemangioma – what do you tell the parents?

A

It is a benign congenital tumor made of capillaries, it will grow in proportion to the child for a few years and then regress (most gone by age 7)

125
Q

early diastolic murmur heard at the left sternal border

A

Aortic regurgitation

126
Q

(9:22) translocation leads to the ________ oncogene which codes for a fusion protein with constitutive _______ activity

A

BCR-ABL gene –> tyrosine kinase activity uncontrolled –> proliferation of granulocytic precursors –> CML

127
Q

t (14:18)

A

follicular lymphoma , overexpression of the anti-apoptotic protein Bcl2

128
Q

t( 11:14)

A

Mantle cell lymphoma, cyclin D1 overexpressed – promotes G1 –> S phase of cell cycles

129
Q

What is on chromosome 14 that gets translocated in follicular , burkitt’s & mantle cell lymphomas??

A

the Immunoglobulin heavy chain

130
Q

t (8:14)

A

Burkitt’s lymphoma – c-myc overexpression, activates transcription (fast growing tumors)

131
Q

pt with hemoptysis, HTN, hematuria and a + c-ANCA , but absence of immune deposits

A

Wegener’s –a Rapidly progressive (crescentic) glomerulonephritis (absence of immune deposits r/o goodpastures)

132
Q

EBV envelope glycoprotein gp350 binds to the complement receptor on ________ called _________

A

CD21 on B cells

133
Q

Inflammatory bowel disease that can involve the entire GI tract from mouth to anus and commonly causes fistulas b/c it causes transmural (full thickness) inflammation

A

Crohn’s disease

134
Q

lack of aldosterone and cortisol (upper 2 adrenal cortex layers) – what enzyme is lacking?

A

21-hydroxylase – most common form of CAH —-> ( or less commonly 11-beta hydroxylase)

135
Q

lack of cortisol and androgens (lower 2 layers of adrenal cortex)

A

17- alpha hydroxylase – these have HTN and hypokalemia

136
Q

fever, rash & oliguria 1-3 weeks after an B-lactam antibiotic (or sulfa, NSAID, rifampin or diuretics)

A

Drug induced acute interstitial nephritis

137
Q

ascending muscle weakness after recovery from respiratory or GI infection (esp Campylobacter) or after immunization

A

Guillain-Barre syndrome – DTR disappear, ascending weakness

138
Q

phospholipase C cleaves phospholipids to form ___ & ____

A

IP3 & DAG –> which causes Ca++ to increase in the cell & activates PkC

139
Q

Left shift on an Oxygen dissociation curve?

A

increased pH (basic) , decr 2,3 DPG, or decreased temp (hypothermia) ((INCREASED AFFINITY of Hb for OX)) —-((LEFT = Hb releasing O2 more in the LUNGS))

140
Q

Right shift on an Oxygen dissociation curve?

A

decreased pH, incrs 2,3 DPG, or increased temp (( Hb releasing O2 more in the tissues)) Decrs affinity for O2

141
Q

Why is pus from a bacterial infection green?

A

MPO is a blue/green heme based pigmented molecule – so when it is breaking down all this bacteria and making pus

142
Q

adult onset asthma, eosinophilia, mono or polyneuropathy, pulmonary infiltrates and paranasal sinus abnormalities

A

Churg-Strauss vasculitis

143
Q

What is the afferent nerve at the carotid sinus baroreceptor ??

A

Herings nerve ( branch of Glossopharyngeal CN IX)

144
Q

Overdose of the TCA Amytriptyline can cause symptoms similar to ____________

A

Atropine (( Anytriptyline blocks muscarinic receptors))

145
Q

this drug inhibits the reuptake of Norepinephrine at the synaptic cleft

A

Cocaine or Tricyclic antidepressants

146
Q

It is common for people over 70 or 80 to have HTN, especially high systolic pressure ((Isolated systolic HTN)) , why?

A

Loss of aortic compliance as you age (aortic stiffening)

147
Q

Formula for Mean Arterial Pressure

A

MAP = CO x TPR

148
Q

What is derived from the common cardinal veins?

A

SVC

149
Q

Murmur with an ‘opening snap’ early in diastole

A

Mitral stenosis

150
Q

a young woman with RVH – what is the most likely cause?

A

Primary pulmonary HTN –> idiopathic in young people, leads to cor pulmonale

151
Q

How long after total ischemia do the myocytes stop contracting ?

A

about 60 seconds –> they run out of ATP & start to accumulate toxins (however, if ischemia is reversed within 30 mins, the function can be restored)

152
Q

Exercising muscle releases adenosine, ATP, K+, CO2 & Lactate –> what do these all do?

A

Local Vasodilation –> to lower systemic resistance

153
Q

A shortened PR interval could indicate ___?

A

the PR interval represent the conduction through the AV node –> if this is shorter than normal you could have an accessory conduction pathway that is bypassing the AV node & causing arrhythmias (ie: WPW syndrome)

154
Q

characteristic EKG of a pt with WPW syndrome

A

Short PR interval, wide QRS, and a delta wave (early upslope of the QRS complex)

155
Q

EKG with narrow QRS & no P waves

A

Atrial fibrillation (“irregularly irregular with no P waves”

156
Q

How do you treat a-fib?

A

B-blockers, calcium channel blockers or digoxin AND warfarin (prevent clots!)

157
Q

PR interval longer than 200 msec & otherwise asymptomatic

A

1st degree AV block

158
Q

progressive lengthening of the PR interval until a beat is dropped (“going, going, gone”)

A

2nd degree – Mobitz Type 1 (Wenkebach) AV block

159
Q

Normal PR intervals with random dropped QRS complexes

A

2nd degree block -Mobitz Type 2

160
Q

In a patient with a-fib, what determines the rate of ventricular contraction??

A

the AV node refractory period ( the atrial myocytes are contracting wildly and on their own at a very fast rate…so the refractory period of the AV node is what determines how often one of the chaotic atrial contraction impulses is let through) – Most atrial impulses are actually not let through, or else the ventricular rate would be much higher!

161
Q

Which has less oxygen content, the pulmonary artery or the coronary sinus?

A

The coronary sinus ( the cardiac muscle extracts 90- 100% of the O2 from coronary flow)`

162
Q

Which part of the heart is most prone to ischemia?

A

the endocardium (force of contraction is highest here)

163
Q

Why don’t calcium channel blocker drugs (verapamil) affect skeletal muscle too?

A

b.c skeletal muscle does not have to rely on extracellular calcium (it has calcium from the t-tubules and intracellular SR)

164
Q

Three major causes of Aortic Stenosis

A

Bicuspid aortic valve, calcifications, or rheumatic heart disease

165
Q

Wide splitting of S2 that does not vary with respirations

A

indicates a congenital ASD

166
Q

early diastolic decrescendo murmur decreased by amyl nitrate

A

Aortic regurg

167
Q

lat diastolic murmur eliminated by a-fib

A

Mitral / tricuspid stenosis

168
Q

what ion is responsible for the slow phase 4 depolarization of the SA & AV node tissue

A

Na+ (inward sodium “funny” current)

169
Q

in most people the SA & AV nodes are supplied by branches of what artery?

A

RCA (right coronary artery)

170
Q

what is the most posterior chamber of the heart?

A

Left Atrium (enlargement can cause dysphagia or hoarseness)

171
Q

a wide pulse pressure is indicative of _____?

A

Aortic regurgitation (or decr compliance of the aorta)

172
Q

S1 heart sound =

A

mitral & tricuspid valve closure

173
Q

S2 heart sound =

A

aortic & pulmonic valve closure

174
Q

S3 heart sound =

A

physiologic in young & pregnant –> pathologic in elderly –> associated with increased volume / filling pressure

175
Q

S4 heart sound =

A

always pathologic –> “atrial kick” in late diastole, assoc with LVH , high atrial pressure against hypertrophic left ventricle wall

176
Q

JVP waves : the “a wave” =

A

atrial contraction

177
Q

JVP waves: the “c wave” =

A

RV contraction

178
Q

Normal S2 splitting – why?

A

because the aortic valve closes before the pulmonic valve (inspiration increases the diference)

179
Q

Wide S2 splitting cause

A

pulmonic stenosis or RBBB (takes longer than normal for the pulmonic valve to close)

180
Q

Fixed S2 splitting (regardless of breathing)

A

associated with an ASD

181
Q

Paradoxical splitting (pulmonic valve closes before aortic)

A

caused by anything that delays the aortic closure –> aortic stenosis, LBBB

182
Q

Valsalva will increase your perception of which murmur?

A

Mitral Valve Prolapse (you are decreasing venous return, so most murmurs will actually decrease in intensity but MVP will be louder

183
Q

Inspiration increases the intensity of sounds from which side of the heart?

A

Right side

184
Q

Squatting / hand gripping increases the intensity of which murmur?

A

Mitral or tricuspid regurgitation (moves that increase TPR) – expiration will also increase intensity of all Left sided sounds

185
Q

most frequent valvular lesion, late systolic crescendo murmur with a mid-systolic click

A

Mitral prolapse

186
Q

high pitched, blowing diastolic murmur, wide pulse pressure, bounding pulses & head bobbing

A

Aortic regurgitation

187
Q

opening snap, late diastolic rumbling

A

Mitral stenosis (assoc with rheumatic fever)

188
Q

continuous machine like murmur

A

PDA

189
Q

the plateau in cardiac myocyte AP is due to influx of _________

A

Calcium (phase 2 plateau) – allows for myocytes to contract at the same time

190
Q

cardiac myocytes are electrically coupled by _______

A

gap junctions

191
Q

U wave on an EKG

A

hypokalemia or bradycardia

192
Q

treatment of Torsades de pointes

A

Magnesium Sulfate

193
Q

Lyme disease can cause what type of heart block

A

3rd degree (complete) heart block

194
Q

p waves & QRS complexes are present but they are completely dissociated

A

3rd degree heart block ( need a pacemaker)

195
Q

What organ gets the largest share of Cardiac output?

A

LIVER

196
Q

Pulmonary cap wedge pressure is a good measurement of which heart chamber?

A

Left Atrium

197
Q

man with confusion, lethargy and an anion-gap metabolic acidosis

A

DKA – give insulin & normal saline

198
Q

Which cells are responsible for stimulating the proliferation of an atherosclerotic plaque? (calling other cells to the scene?)

A

Platelets —> they respond to the endothelial cell injury and release PDGF & TGF-beta

199
Q

List the cardiac tissues in order of fastest to slowest conduction velocity

A

Purkinjie –> Atrial muscle –> Ventricular muscle –> AV node

200
Q

a decrease of systolic BP > 10mmHg upon inspirtaion

A

“pulsus paradoxus” –> indicates constrictive pericarditis, tamponade, restrictive cardiomyopathy …

201
Q

triad of muffled heart sounds, elevated JVP & profound hypotension =

A

pericardial tamponade

202
Q

What type of cell is directly responsible for the intimal thickening in people with atherosclerosis?

A

Smooth muscle cells

203
Q

What are the possible causes of an anion-gap metabolic acidosis?

A

MUDPILES Methanol Uremia (renal failure) DKA Propylene glycol Isoniazid Lactic Acidosis Ethylene glycol Salicylates (Aspirin)

204
Q

autosomal dominant condition with telangiectasias on the skin and mucous membranes & sometimes in the brain, liver, spleen –> predisposed to bleeding (epistaxis, GI bleeds, etc..)

A

Osler-Weber-Rendu Syndrome (“Hereditary Hemorrhagic Telangiectasis”)

205
Q

0-4 hours post MI changes

A

minimal to no changes

206
Q

4-24 hours post MI changes

A

coagulation necrosis, edema, hemorrhage, “wavy fibers”

207
Q

1-5 days post MI changes

A

neutrophils infiltrate (inflammatory stage) –> biggest risk is fibrinous pericarditis at this stage

208
Q

5-10 days post MI changes

A

Macrophages come in – phagocytize dead cells –> biggest risk is rupture of free wall or papillary muscles

209
Q

10-14 days post MI changes

A

granulation tissue begins, neovascularization

210
Q

1-2 months post MI changes

A

collagen deposition , scarring, fibrosis –> biggest risk is aneurysm, mural thrombus or Dressler syndrome at this point

211
Q

Renal artery stenosis in an otherwise healthy 20-30 year old woman –> with “string of beads” renal artery

A

Fibromuscular dysplasia

212
Q

Marked, one-sided kidney atrophy

A

renal artery stenosis (look for HTN & abd bruits)

213
Q

a pt with prolonged QT interval is at risk for _________ & what is happening to their outward K+ current (phase 3 repol)

A

at risk for Torsades de pointes, their outward K+ current is slower / decreased, so that the repol phase is slower and prolonged (QT int)

214
Q

tumor that is CD31 + and is associated with polyvinyl chloride, thorotrast & arsenic exposure

A

Liver angiosarcoma (rare, aggressive liver tumor) *CD31 is PECAM1 – functions in leukocyte migration thru endothelial cells

215
Q

Most common congenital heart defect in Turner’s syndrome?

A

Bicuspid aortic valve

216
Q

Drug used to close a PDA

A

Indomethacin (an NSAID, inhibits PGE2)

217
Q

PDA is most closely associated with what illness?

A

Congenital Rubella or prematurity

218
Q

Most common form of cardiomyopathy

A

dilated cardiomyopathy

219
Q

Causes of Dilated cardiomyopathy

A

-genetic (AD) -myocarditis (Coxsackie A or B) -alcohol abuse -cocaine or other drugs -pregnancy

220
Q

Asymmetrical septal hypertrophy and dynamic ventricular outflow tract obstruction are characteristic of ______

A

Hypertrophic cardiomyopathy (common cause of sudden death in young athletes –> the huge septum and the mitral valve leaflets block the left ventricular outlfow)

221
Q

what is Kussmaul’s sign?

A

a paradoxical increase in JVP when the patient breaths in (it should usually decrease upon inspiration) –> this indicates constrictive pericarditis

222
Q

What drugs can cause a “lupus like syndrome” – ie: drug induced lupus?

A

it’s not “HIPP” to have lupus Hydralazine Isoniazid Procainamide Phenytoin

223
Q

new onset lupus symptoms + anti-histone antibodies

A

Drug induced lupus (Hydralazine & Procainamide have highest risk)

224
Q

Common side effects of all nitrates

A

Headache, flushing (due to the vasodilatory effects)

225
Q

Drugs that slow AV nodal conduction

A

Ca+ channel blockers (verap & diltiazem), Beta blockers & Digoxin) – can all cause slower heart rate

226
Q

Which test should you routinely monitor for a patient on Warfarin?

A

Prothrombin (PT) time (extrinsic path)

227
Q

Which test should you monitor for a person on unfractionated Heparin?

A

PTT ((“Hep = PTT”)) – intrinsic path

228
Q

Vitamin K dep clotting factors

A

Factors II, VII, IX and X and protein C & S

229
Q

combined use of a beta blocker & a non-dihydropyridine Ca++ channel blocker (verapamil or diltiazem) can have what effect??

A

Additive neg chronotropic effect –> severe bradycardia and hypotension

230
Q

What is the drug of choice for beta-blocker overdose?

A

Glucagon –> it increases cAMP and increases the Ca++ release in the cell –> increasing HR & contraction

231
Q

Why does amenorrhea occur in women who are anorexic?

A

loss of GnRH pulses from the hypothalamus after the body fat falls below a certain critical level

232
Q

unable to release handshake easily, cataracts, & frontal baldness

A

Myotonic Dystrophy

233
Q

inheritance pattern of Myotonic dystrophy

A

Autosomal dominant, CTG repeats

234
Q

hearing loss from loud noises is a result of damage to the ___________

A

hair cells of the Organ of Corti —-(shearing forces of the tectorial membrane damage the hair cells)

235
Q

What should you do 1st for a child with hyperpyrexia (ie: 107 degrees)

A

1- cool with cold blankets, cool saline bags, cold water enemas 2- Acetaminophen

236
Q

Subdural hematoma is a rupture of the _______ , classically in the elderly after minor trauma

A

bridging cortical veins

237
Q

in DCIS, the _________ layer of the duct is uninvolved

A

basal, myoepithelial layer

238
Q

serum ______ should be monitored in a pt at incrs risk for Choriocarcinoma

A

B-hCG

239
Q

bilateral absence of the vas deferens in a young male

A

Cystic Fibrosis

240
Q

B12 deficiency effects on spinal cord —(“Subacute Combined Degeneration”)

A

1- Dorsal Column degeneration 2- Lateral Corticospinal Tract degeneration 3- Degen of peripheral nerves causes…. 1- loss of sensory 2- UMN signs (spastic paresis, hyperreflexia) 3- Numbness / paresthesias -Called “combined” b/c it effects both ascending & descending tracts!

241
Q

deficiency of Arylsulfatase A–> leading to accumulation of cerebroside sulfate

A

Metachromatic leukodystrophy

242
Q

Middle meningeal artery is a branch of the :

A

Maxillary artery (which is a branch of the External carotid)

243
Q

understimulation of ______ receptors causes orthostatic hypotension

A

alpha-1 (a1 vasoconstriction prevents cerebral hypoperfusion upon standing)

244
Q

pt. nasal ulcers and renal failure – has antibodies against ________

A

neutrophils! (Wegener’s has a + C- ANCA)

245
Q

IL-12 deficiency

A

can’t differentiate T cells into Th1 –> can’t fight off MYCOBACTERIA

246
Q

what is a Choriocarcinoma made up of – histologically

A

proliferation of both cytotrophoblasts and syncytiotrophoblasts (no villi )

247
Q

Neurons with rounded cell bodies, nuclei & nissl substance displaced peripherally

A

“Axonal reaction” – the axon has been severed & the cell body is reorganizing to try to regenerate the axon

248
Q

Polyarteritis nodosa is associated with a _________ infection in 10-30% of the cases

A

Hepatitis B

249
Q

Pt with symptoms of mono, but the patient’s serum fails to agglutinate sheep erythrocytes ..what is causal agent?

A

CMV -negative Monospot test

250
Q

a stroke at the VPL or VPM of the thalamus would produce pure _______ symptoms

A

Sensory only

251
Q

stroke at the posterior limb of the internal capsule

A

only motor hemiparesis

252
Q

nerve that supplies innervation to the lacrimal glands

A

CN VII

253
Q

brain tumor with psammoma bodies

A

Meningioma

254
Q

What (besides hydration) can help prevent kidney stones?

A

Potassium Citrate solution (citrate binds to the free ionized calcium, preventing precipitation)

255
Q

Neuraminidase inhibitors (Oseltamivir) prevent the virus from ____________

A

exiting the host cell and releasing virions

256
Q

a small blue tumor under the fingernail is derived from what kind of tissue ?

A

Glomus tumor --> from the modified smooth m. cells (“Glomus bodies”) that control **thermoregulation in the tips of fingers, toes & ears **

257
Q

recurrent small “lobar” hemorrhagic strokes in different lobes of the brain – usually a result of ___________

A

Amyloid Angiopathy (in elderly with beta amyloid deposits)

-(more benign than the larger hemorrhagic strokes from HTN)

258
Q

low levels of the stimulatory neurotransmitter Orexin (hypocretin) causes _________

A

Narcolepsy

259
Q

1st line tx for Narcolepsy

A

Modafinil

  • non amphetamine stimulant
260
Q

Pt with recurrent renal stones, addition of sodium cyanide & sodium nitroprusside to his urine turns the urine red/purple….

A

**Cystinuria **

  • the pt has an inborn error of metabolism (Cystinuria)
  • hexagonal crystals in urinalysis
  • tx = Alkalinize the urine
261
Q

Treatment for TCA side effects (Convulsions, Coma, Cardiac arrythmias)

A

Sodium Bicarb

262
Q

loss of neurons in the anterior horn –> UMN or LMN lesion?

A

**LMN **

  • the cell bodies of the anterior horn cells are LMNs
263
Q

What feature of Methadone warrants using it for Heroin addiction treatment?

A

It has a long half-life –> prolonged effects that help prevent withdrawal symptoms in heroin dep patients

264
Q

The low-affinity nature of __________ is what allows the characteristic “rolling” action attributed to leukocytes

A

Selectins

265
Q

A person with this pneumonia probably lacks _____ immunity

A
  • CMV pneumonia (note the nuclear AND cytoplasmic inclusions)
  • lack of T-cells / cell mediated immunity
266
Q

A person in a deep coma will have a high or low Glasgow Coma Scale # ??

A

The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

267
Q

which “- encephalon” structure does the Cerebellum and 4th ventricle develop from? (Malformed in Dandy Walker syndrome)

A

Metencephalon

268
Q

Two main things that aid Diphtheria toxin in attcking the host

A

1- low extracellular **iron **

2- Lysogenic phage that encodes the toxin **

269
Q

Fiber type grouping indicates ________

A

Muscle fiber type grouping occurs following denervation and reinnervation, the muscle fiber assumes the type determined by its new motor neuron

270
Q

Phosphorylation usually occurs on _______________________residues

A

serine, threonine, tyrosine and histidine residues

271
Q

When is the maximun flow through the coronary arteries?

A

EARLY DIASTOLE

272
Q

Thyroid nodule with + **calcitonin **

A

Medulllary thyroid cancer

273
Q

Mechanism of Botulism toxin

A

gets into nerve terminal, cleaves SNARE proteins, prevenst Ach vesicles from being secreted

274
Q

a Low Fecal Elastase test indicates _____________

A

pancreatic insufficiency

275
Q

function of IL-10

A

ANTI-inflammatory cytokine

-downregs MHC II, Th1 and macrophages

276
Q

rash on palms and feet, vomiting and liver damage in a child (after a viral illness)

A

**Reye’s Syndrome **

  • parent’s may have given ASA
  • causes Fatty damage to the liver
277
Q

mechanism of nicotine

A
  • binds to nicotinic acetylcholine receptors (esp in brain)
  • increases the levels of several neurotransmitters
  • increased levels of dopamine in the reward circuits of the brain are responsible for the apparent euphoria and relaxation, and addiction caused by nicotine consumption
278
Q

screening test for Chronic Granulomatous Dz

A

Nitroblue tetrazolium test

  • abnormal : does not turn blue
279
Q

What structures run through the Cavernous Sinus?

A
  • Internal Carotid artery
  • CN II, IV, V1, V2, and VI
280
Q

Symptoms of Kawasaki Dz

A
  • fever
  • strawberry tongue
  • swelling of hands & feet
  • desquamation of finger tips
  • rash / erythema all over / red conjunctiva
  • coronary aneurysms *
281
Q

loss of E-cadherin would allow _________

A

cancer to invade the basement membrane (mets)

282
Q

elevated AFP can indicate what kind of cancers?

A

hepatocellular carcinoma OR germ cell (nonseminoma) testicular carcinoma

283
Q

enzyme that removes Thymine dimers after UV damage

A

**UV- Endonuclease **

(defective NER is seen in Xeroderma pigmentosum)

284
Q

conversion of NE —–> EPI occurs in adrenal medulla by the enzyme ____________

A

Phenylethanolamine-N-methyltransferase (PNMT)

285
Q

Amatoxins (found in Death cap mushrooms) effect what cell enzyme & product?

A

RNA pol II –> mRNA synthesis

286
Q

the RLS of the Urea cycle is activated by ________

A

N-acetylglutamate (NAG)

  • activates CPS I
287
Q

why do you get wrinkles as you age?

A

decreased synthesis of collagen and elastin (despite a good diet w/ all the vitamins!)

288
Q

“FABGUT”

-what are the life threatening enzyme deficiencies for Fructose & Glucose pathways

A

life threatening Fructose pathway defect –> Aldolase B

life threatening Glucose pathway defect –> **galactose 1- uridyl transferase **

289
Q

How can TNF-alpha cause Insulin resistance?

A

it phosphyrylates Serine residues –> inhibits Insulin from phosphorylating Tyrosine …

STEP 1 RECALL (12 decks)

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