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1
Q

Pathogenesis of centiacinar emph

A

release of proteinases (esp elastase) from infiltrating neutrophils and alveolar macrophages

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2
Q

paranoid personality vs delusional disorder

A

paranoid= pervasive pattern of suspicions or odd beliefs (no delusions)

delusional = delusion(s) for at least 1 month; subtypes: erotomanic, grandiose, jealous, persecutory, & somatic

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3
Q

caudal regression (sacral agenesis –> LE paralysis and and urinary incont)

A

poorly controlled maternal diabetes

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4
Q

cocaine + fetus

A

vasocontriction –> insufficient blood flow –> spontaneous abortion, intrauterine growth retardaion, placental abruption, and/or prematurity

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5
Q

rubella (maternal URI) + fetus

A

mental retardation, heart defects

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6
Q

vit A + fetus

A

craniofacial abn, posterior fossa CNS defects, auditory defects, abn of great vessesl (similar to DiGeorge)

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7
Q

Fe def anemia + fetus

A

growth restriction

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8
Q

Fe most important during which part of preg

A

2nd half - blood volume expands considerably

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9
Q

dorsal panc bud

A

body, tail, most of head, accessory duct (Santorini)

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10
Q

ventral panc bud

A

uncinate, inf/post head, major panc duct (of Wirsung)

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11
Q

Disseminated mycobacterial disease in infancy or early childhood

A

INF-gamma

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12
Q

Lower resp infx + Giardia

A

X-linked aggammaglobinemia; B-cell immunodeficiency - issue in maturation of B cells

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13
Q

Infx with encapsulated org; reccurent N. meningitidis/N. gonorrhoeae

A

C3 deficiency

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14
Q

Delayed separation of umbilical cord

A

Leukocyte adhesion deficiency - defect in CD18 (integrin component - adherence/transmigration)

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15
Q

Reccurrant cutaneous infx withoug pus formation, poor wound healing

A

Leukocyte adhesion deficiency (CD18 - intgrin)

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16
Q

Gram negative kindey-shaped cocci

A

N. Men

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17
Q

Virulence factor correlated to morbidity/mortality of N. Men

A

Meningococccal lipooligosaccharide

differs from LPS b/c lacks repading O antigen

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18
Q

Cheyne stokes description

A

cyclic - gradually increasing tidal volume then gradually decreasing tidal volume then apnea… repeat

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19
Q

Cheyne stokes a/w

A
  • Cadiac disease (advanced CHF)

- Neurologic (stroke, brain tumor, trauma)

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20
Q

Cheyne stokes etiology

A

slow resp feedback loop w/ enhanced response to CO2;

slow to respond –> max CO2 –> hyperventilate -> drop CO2 –> stop breathing

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21
Q

Prox tubule curve…

A

(Pic)

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22
Q

Fragile X - etio

A

increased CGG repeats on long arm of X –> hypermethylation of cytosine bases –> gene inactivation (FMR-1)

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23
Q

mental retardation, facial dysmorphism, macroorchidsm

A

Fragile X

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24
Q

CF Chloride channel -( ___ gated)

A

ATP- gated

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25
Q

thrush, otitis media, bronchilitis, chronic loose stools, absence of thymic shadow, no other structural anomalies

A

SCID

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26
Q

ataxia - telangiectasia symp

A

sinopulmonary infx

+ ataxia, telangiectasias

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27
Q

oculocutaneous albanism, pyogenic infx, progressive neuro dysfx

A

chediak-higashi

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28
Q

severe bacterial and fungal infx

A

chronic granulomatous dis

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29
Q

congenital heart dis, dysmorphic facies, hypocalciemia

A

Di George

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30
Q

Sever bacterial/viral, chronic diarrhea, mucocutaneous candidiasis

A

SCID

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31
Q

recurrent neisseria infx

A

CD5, CD6, CD7, CD8, or CD9 def

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32
Q

reccurant infx that worsen with age, easy bleeding, eczema

A

Wiskott-Aldrich

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33
Q

Pure sensory stroke

A

Thalmus

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34
Q

Lesion to internal capsule

A

motor def

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35
Q

Lesion to caudate nucleus

A

transient hemiparesis + frontla lobe symptoms (forgetfullness, abulia, inattentivess) +/- agitation, psychosis, choreoathetosis, dyskinesias

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36
Q

Lesion to the thalamus

A

total sensory loss to contralateral side, proprioception loss can lead to difficulty walking/falls; NO motor deficits

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37
Q

Lacunar infarctions

A

small vessel liphyalinosis and atherosclerosis of deep brain structures

risks - uncontrolled htn and DM

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38
Q

P/V loop mneumonic (starting at lower right)

A

MAAM

COCO

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39
Q

“opening snap”

A

mitral stenosis

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40
Q

glucocortocoid-induced mypopathy

A
  • progressive prox muscle WEAKNESS AND ATROPHY W/O PAIN
  • LE more
  • CK norm
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41
Q

polymyalgia rhumatica

A
  • prox muscle PAIN & STIFFNESS
  • worse in morning and w/activity
  • CK norm
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42
Q

Inflam myopathies (polymyo/dermatomyo)

A
  • prox muscle weakness
  • SKIN RASH & INFLAMMATORY ARTHRITIS may be present
  • CK up
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43
Q

statin-induced myopathy

A
  • prox muscle pain/weakness usually within weeks to months after starting a statin
  • CK up
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44
Q

hypothyroid myopathy

A
  • prox muscle pain/cramps/weakness
  • delayed reflexes
  • myodema
  • CK up
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45
Q

facial dysmorphia, cleft palate, ch22 deletion on long arm

A

DiGeorge

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46
Q

MC route of HepB infx in developed countries

A

unprotected sex (>70%)

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47
Q

Hep C risk of infx via sex (high or low)

A

low

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48
Q

Lipid-lowering drug that raises TGs

A

Bile acid-binding resins:

  • cholestyramine
  • colestipol
  • colesevelam
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49
Q

ragged red skeletal muscle fibers + lactic acidosis + neuormusc lesions (familial);

name + genetics

A

mitochondrial encephalomyopthy

heteroplasmy - coexisitance of both mutated and nml versions of mitochondrial genomes inan individual cell

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50
Q

CMV immunocompetent

A

subclinical or mono

*monospot negative

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51
Q

CMV immunocompromised

A

severe retinitis, pneumonia, esophagitis, colitis, and/or hepatitis

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52
Q

check to prevent mammilary body destruction

A

erythrocyte transketolase activity

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53
Q

X linked PRPP def (what organs affected)

A

joints

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54
Q

Acute gout tx targets what cells

A

neutrophils

  • NSAIDs inhibit
  • colchicine inhibits neutrophil chemotaxis and phagocytosis via preventing microtubule formation
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55
Q

Blocking CD19 on B lyphocytes would prevent inx with what virus

A

EBV

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56
Q

attach to erythroid cells via blood group P antigen

A

Parvo B19

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57
Q

requires contact with glycosaminoglycan chains on host cell surface proteoglycans to enter cell

A

herpesviruses

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58
Q

rodlike fibers project from base are responsible for mediating adsorption into host

A

adenovirus

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59
Q

CD21 mediated entry into host cell

A

EBV

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60
Q

Hemorrhage post temporal bone fracture - b/w which layers

A

Bone and Dura

Epidural hematoma

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61
Q

LOC, lucid state, LOC

A

EPIdural hematoma

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62
Q

Biconvex pattern of blood

A

EPIdural hematoma

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63
Q

Epidural hematoma

A
  • middle meningeal ARTERY
  • b/w skull and dura
  • lucid interval–> LOC
  • biconvex hematoma
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64
Q

Subdural hematoma

A
  • bridging VEINS
  • b/w dura and arachnoid
  • gradual onset of h/a and confusion
  • cresent shaped
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65
Q

Subarachnoid hem

A
  • aneurysm or AV malform of ant and post communicating ARTERIES
  • b/w arachnoid and pia
  • severe h/a, fever, nuchal regididty
  • blood in basal cisterns
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66
Q

PE blood gases

A

hypoxemia –> hypervent–> low CO2–>resp alkalosis
(pH high, O2 low, CO2 low, bicarb low)

  • O2 impared by V/Q mismatch
  • CO2 more dependent on total lung ventilation
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67
Q

MCC of death in DM

A

Coronary Artery Disease (MI)

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68
Q

Highest risk factors for Coronary Heart Disease

A
  • Noncoronary athersclerotic disease
  • DM
  • Chronic kidney disease
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69
Q

psychotropic drug that can cause hypothyroidsm

A

Lithium

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70
Q

Salmonella virulence factor in sickle cell osteomyelitis

A

Resistance to opsonization

- sickle cell pts have functional asplenia

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71
Q

Leukomoid reaction vs Chronic myelogenous leukemia

A

Neutrophil alkaline phosphatase:
leukomoid rx: nml or up
CML - decreased

72
Q

Increased metalloproteinase activity

A

contracture

functions to degrate collagen and other proteins; encourages myofibrolast accumulation

73
Q

selective for ischemic myocardial tissue

A

Lidocaine (type 1B antiarrhyth)

specifically binds to rapidly depolarizing and deparized cells

74
Q

Med management of V tach

A

amioderode

75
Q

Sucrose
Lactose
Maltose

A

sucrose: fructose + glucose
lactose: galactose + glucose
maltose: 2glucose

76
Q

cell body rounding, peripheral displacement of nuclei, dispersion of Nissl substance to periphery of cell

A

axonal reaction

vs wallerian degeneration - axon that lost connection

77
Q
  • apoptosis of hepatocytes
  • acinar necrosis
  • mononuclear inflammatory inflitration
A

viral hepatitis

78
Q

cetrilobular congestion (liver)

A

RHF

79
Q
  • bile duct destruction
  • periductal granulomatous inflm
  • bile duct proliferation
A

Primary biliary cirrhosis

80
Q

Location of hernias relative to inferior epigastric vessles

A

Order lateral to medial:

  • indirect inguinal hernia
  • inferior epigastric vessels
  • direct inguinal hernia
81
Q

ganglionic receptors

A

nicotinic

Ach

82
Q

Sympathetic receptors in renal vasculature

A

D1

according to uworld chart

83
Q

sympathetic receptors on sweat glands

A

M

Ach

84
Q

skeletal muscle somatic nerve receptors

A

nicotinic

Ach

85
Q

increased ADH will decrease excretion of…

A

Urea

86
Q

Flow in relation to radius

A

Flow directly proportional to the vessel radius raised to the FOURTH power

i.e. a decrease in flow by a factor of 16 (1/16th)= decrease in radius of 50% (1/2)

87
Q

Immunocomp
Brain Mass
EBV+ cells

A

Primary CNS lymphoma

  • MC cns tumor in immunosuppresed
  • ususally B-cells
  • diffues large B MC subtype
  • CD20+ CD79a+
88
Q

MAP Kinase pathway

A 
growth factor ligand binding to receptor tyrosine kinases -->
auto-phos of receptor -->
SH2 domain protiens/SOS proteins --->
Ras activation -->
[Ras/GDP = inactive; 
Ras/GTP = active]
Ras begins phosphorylation cascade -->
activates Raf kinase -->
activates MAP kinase -->
MAP kinase enters nucleus (infl gene transcription)
89
Q

Increased elastic resistance (pulmonary fibrosis, pulm edema, ARDS) – effect on breaths per minute

A

rapid shallow breaths minimize work due to elastic resistance

90
Q

Increased air flow resisitance (asthma, COPD) – effect on breaths per minute

A

slow deep breaths minimize work due to air resistance

91
Q

decreased GFR, hyperkalemia in pt with hyperchol, diabetes, htn… what drug

A

ACE inhib (e.g. lisinopril)

SE:
decreased GFR
hyperkalemia
cough
angioedema
92
Q

glucagon actions

A
  • increase urea production
  • increase ketoacid production by adipocytes

(increases gycogenolysis, gluconeogen, lipolysis)

93
Q

lewey bodies composed of…

A

alpha-synuclein

CYTOPLASMIC inclusions in parkinsons and lewey body dementia

94
Q

Negri bodies

A

rabies

round eiosinophilic CYTOPLASMIC inclusions

  • pyramidal neurons in hippocampus
  • perkinge cells in cerebellum
95
Q

Pick bodies

A

cytoplasimic
cortical neurons
FTD (Pick’s disease)

96
Q
  • Abd pain
  • Abd distention
  • Fever
  • Diarrhea
  • Decreasing BP/Increasing HR (signs of shock)
A

Toxic Megacolon
(possible)

  • common complication of IBD (UC&raquo_space; crohns)
  • dx: Xray
97
Q

work via increasing cGMP (endog)

A

NO (primarily responsible for erection)

ANP

98
Q

Poststrep glomerulonephritis

IF

A

granular
IgG
IgM
C3

(in mesangium and basement memrane - “starry sky”)

99
Q 
child
periorbital edema
cola-colored urine
oliguria
high BP
A

PSGN

will also show red cell casts in urine and mild proteinuria

ASO+
decreased C3

100
Q

hypercellular glomeruli

dx and mech

A

PSGN

leukocyte (neutrophils an monocytes) infiltration and mesangial/endothelial cell proliferation

101
Q

subepithelial humps

A

PSGN

102
Q

C1q deposits (kidney)

A

MPGN type 1

103
Q

subendothelial deposits

A

MPGN type 1

104
Q

lupus nephritis - where are the IgE deposits

A

confined to capillary wall - a/w poor prognosis

105
Q

first sign of uncal herniation

+ other signs

A

fixed and dilated pupil on same side as lesion

“down and out” +ptosis

ipsilateral paralysis of both oculomotor muscles, contra or ipsi hemiparesis, and contra hom/hemi w/ macular sparing may occur

106
Q

uncal hernia compresses what cranial nerve

A

CN III

oculomotor

107
Q

only HIV gene product that is gycosylated

A

env gene polyprotein product:

glycosylated to pg160 –> cleaved w/in ER and golgi to form envelope proteins gp120 and gp41

108
Q

where is gp160 cleaved into gp120 and gp41

A

ER and golgi

109
Q

where are the pol gene protein products cleaved

A

in virion during maturation

110
Q

infliximab started –>

  • joint pain
  • pruritic skin rash
  • scattered fibrinoid necrosis and neutrophil infiltration involving small blood vessels
A 
Serum sickness
(type III hypersens)
  • reaction to nonhuman proteins –> vasculitis from tissue depo of immune complexes
  • will also sho low serum C3 and C4
111
Q

increases marginalization

A

increased vascular leakage –> hemoconcentration and decreased wall shear stress –> improves contact of neutrophils with endothelial lining

112
Q

sialylated carb groups: Sialy Lewis X or PSGL-1
+
L-selectin (neutrophils) or
E-selectin/P selectin on endothelial cells

A

Rolling

113
Q 
CD18 integrins (Mac-1 and LFA-1)
\+ ICAM-1 (intercellular adhesion molecule) on endothelial cells
A

Tight adhesion and crawling

114
Q

platelet endothelial cell adhesion molecule (PECAM) at peripheral intercellular junctions of endothelial cells

A

Transmigration

115
Q

between what two stages does activation of leukocytes occur

A

rolling and tight adhesion/crawling

116
Q

ethnicities at increased risk of osteoporosis

A

white
hispanic
asian

117
Q

elderly patient with gross hematuria (2)

A

renal or urothelial neoplasm

118
Q

all staph are catalase ____

all strep are catalase ___

A

staph = cat +

strep = cat (-)

119
Q

mannitol fermentation

A

staph aureus

120
Q

novobiocin resistant

A

staph saprophyticus

121
Q

s. epidermidis = “_____ straph”

A

coagulase negative

122
Q

drugs that inhibit dihydrofolate reductase

3

A

trimethoprim
methotrexate
pyrimethamine

123
Q

How is DKA usually compensated

A

Respiratory compensation (hyperventilation)

124
Q

DKA + norm-ish CO2

A 
respiratory failure
(superimposed respiratory acidosis)
125
Q

Substances that play a role in allergic asthma AND have pharm receptor ANTagonists
(that offer clear therapeutic benefit)

A 
Ach
Leukotries
- LTC4
- LTD4
- LTE 4
126
Q

thickened brochial walls
neutrophil infiltration
mucous gland enlargement
squamous metaplasia

A

chronic bronchitis

127
Q

sulfhydryl group donor = antitode for what

why?

A

acetaminophen

  • most metabolized by liver by sulfation and glucuronide conjugation (becomes saturated in overdose)
  • remainder P450–> toxic NAPQI (n-acetyl-p-benzoquinoneimine)
128
Q

two mechanisms of N-acetyl cysteine in tx of tylenol tox

A
  • acts as glutathione substitue and binds to toxic metabolite (NAPQI_
  • provides sulfhydryl groups to enhance non-toxic sulfation elimination
129
Q

Fluctyosine target

A

(anti-fungal)

DNA/RNA synth

130
Q

Caspogungin target

A

(anti-fungal)
cell wall

*active against candida and aspergillus

131
Q

Amph B target

A

(anti-fungal)
cell membrane
binds to ergosterol

132
Q

Nystatin target

A

(anti-fungal)
cell membrane
binds to ergosterol

133
Q

Azoles target

A

(anti-fungal)
cell membrane
inhibit synth of ergosterol

134
Q

Griseofulfin target

A

(anti-fungal)
interferes with microtubules

*accumulates in keratin-containing tissues

135
Q

ethambutol

SEs

A

optic neuritis –> color blindness
central scotoma
decreased visual acuity

(may be reversible)

136
Q

CBC should be monitored with what drugs

A
  • chloramphicol
    (aplastic anemia)
  • dapsone
    (agranulocytosis)
  • TMP-SMX
    (megoloblastic anemia)
137
Q

apocrine vs eccrine (merocrine) sweat glands

vs holocrine

A

apocrine: secrete membrane bound vesicles into hair follicles
eccrine: secrete fluid directly to the skin serface
holocrine: sebaceous glands, secretory cells breakdown to release entire contents of cell

138
Q

anastrozone

A

selective aromatase inhibitor

also letrozole, exemestane

139
Q

ketoconazole - anti androgen effect mech

A

inhibits production

140
Q

tastuzumab mech

A

inhib epidermal growth factor and HER2/neu pathways –> apoptosis of breast cancer cells

141
Q

activation of HER2/neu receptor leads to activation of…

A

tyrosine kinase

142
Q

child under 2

currant jelly stool

A

intussusception

143
Q

hemophilia lab

A

prolonged PTT

normal PT, TT, and bleeding time

144
Q

ST elevation in leads I and V3-V6

location

A

anterolateral left ventricle

often a/w prolonged, burning substernal pain

145
Q

Indwelling catheters –> UTI

opportunistic

A

psuedomonas
enterococcus
other staph
fungal

146
Q

non-lactose fermenting
gram negative rod
oxidase positive

A

psuedomonas

147
Q

lactose fermenting
gram negative rod
extensive abx resistance

A

enterobacter

148
Q

activity increases risk of plaque rupture

A

metalloproteinases (from inflamatory macrophages)

–>degrades collagen and reduces strength of fibrous cap

149
Q

Lipid (TGs, cholesterol, phospholipids):
digestion
absorption

A

digested: duodenum
absorbed: jejunum

150
Q 
medically treated hyperthyroidsm (e.g. graves) 
\+
fever
\+
sore throat
A

thionamide-induced agranulocytosis!!

thionamides:
methimazole
propylthiouracil

stop drug and get white blood cell count with differnential to confirm dx

151
Q

elderly woman with osteoporosis -

what are her PTH, calcium, and phosphate levels

A

normal

152
Q

Low renin hypertension
(with normal creatinine)

Na, K, HCO3 levels

A

primary hyperaldo –>

  • normal Na
  • hypokalemia
  • met alk (high bicarb)
153
Q

intracranial calcified cystic mass filled with think brownish fluid rich in cholesterol

A

craniopharyngioma

derived from remnants of rathke’s pouch

154
Q

IgG4 ab against the phospholipase A2 receptor (PLA2R)- a transmembrane protein on podocyes is a/w

A

idopathic membranous nephropathy

155
Q

streptokinase

A

thrombolytic that converts plasminogen into plasmin

foreign protein dervived from streptococci and can induce hypersensitivity rx

156
Q

musculocutaneous sensory innervation

A

lateral forearm

157
Q

isoniazid is structurally similar to…

A

pyridoxine (B6)

competes for binding sites –> defective sythesis of neurotransmitters like GABA

158
Q

chlorpheniramine

A

1st gen antihistamine
can be be very sedating b/c block central and periph H1

other 1st gen: diphenhydramine, promethanzine, hydroxyzine

159
Q

cyanide tox antidote stategies (3)

A

1) direct binding of cyanide ions (hydroxocobalamin)
2) induction of methemoglobinemia (sodium nitrite)
3) use of detoxifying sulfer donors (sodium thiosulfate)

160
Q

corneal reflex (af/ef)

A

af: CN V
ef: CN VII

161
Q

Rhumatoid factor

A

IgM against Fc component of self IgG

162
Q

HSP mech

A

leukocytoclastic vasculitis

deposition of IgA-containing immune complexes

163
Q

polymyositis mech

A

overexpression of MCH I on sarcolemma –> infiltration with CD8+ T lymphocytes and myoctye damage

164
Q

pertussis toxin mech

A

AB exotoxin

stimulates intracellular G-proteins to increase cAMP –>

  • increased insulin production
  • lymphocyte and neutrophil dysfunction
  • increased sensitivity to histamine
165
Q

acquire their envelope from host NUCLEAR membrane (not plasma membrane)

A

herpes viruses

e.g. cytomegalovirus

166
Q

G6PD def:

G6P —-X—->?

A

6-phosphogluconate

167
Q

thyrotoxicosis histo

A

mixed cellular infiltration with occasional multinucleate giant cells

(often after viral infx)

aka: granulomatous thyroiditis or Quervain’s thyroiditis

168
Q

Hep B damage etio

A

CD8+ T cells destroy infected hepatocytes (respond to HBsAg and HBcAg on cell surface)

Note: antibodies bind to free HBsAb and neutralize by preventing Ag from interacting with hepatocyte

NO direct cytotoxic effect

169
Q

Two phases of Hep B

A

proliferative: active infection
integrative: incorporated in host genone; liver damage tapers off, but risk of cancer remains elevated

170
Q

toxic component of LPS

A

lipid A

171
Q

Lipid A mech

A

activation of macrophages –> widespread realease of IL-1 and TNF-alpha –> shock

(fever, hypotn, diarrhea, oliguria, vasc compromise, DIC)

172
Q

sharp pain in neck/shoulder
worse on inspiration

pain mediated by?

A

phrenic nerve

irritation of mediastinal or diaphragmatic parietal pleura—> referred pain in the C3-C5 dist

173
Q

type of nerve that innrvates parietal pleura

A

somatic sensory (allows for sharp/localized pain)

174
Q

Torsades de pointes precipitated by what meds

A

(drugs that prolong the QT interval)

antiarrhythmics:

  • sotalol
  • quinidine
  • procainamide
  • disopyramide
  • ibutilide
  • dofetilide

TCAs

Phenolthiazines

175
Q

strongest and most predictible effects on the inflammatory component of asthma

A

corticosteroids

e.g. Fluticasone

176
Q

line the wall of old cerebral infarct

A

astrocytes

Uworld (9 decks)

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