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Random Facts 1 Flashcards

1
Q

Nerve affected:

  • Decreased sensation palm and 3rd digit
  • Weakness wrist and finger extension
  • Biceps and Brachioradialis DTR normal
  • Triceps reflex diminished
A

C7

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2
Q

Ligamentum Flavum

A

Runs inside spinal canal
Posterior (just under spinous process
Thickening can stenose spinal cord

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3
Q

Nerve that supplies sensation to TMJ

A

Mandibular Nerve (CN V3)
Also supplies floor of mouth, anterior tongue, lower face
Tensor Veli Palatini and Tensor Tympani (ear pain, muffled hearing)
Contraction of pterygoids (jaw pain)

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4
Q

1st Aortic Arch –> adult derivative

A

Part of maxillary Artery

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5
Q

2nd Aortic Arch –> Adult derivative

A

Hyoid Artery

Stapedial artery

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6
Q

3rd Aortic Arch –> Adult derivative

A

Common Carotid Artery

Proximal Internal Carotid Artery

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7
Q

4th Aortic Arch –> Adult derivative

A

On LEFT: Aortic Arch

On RIGHT: Proximal R Subclavian Artery

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8
Q

6th Aortic Arch –> Adult derivative

A

Proximal Pulmonary arteries

On LEFT: Ductus Arteriosus

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9
Q

Most likely site of obstruction in unilateral fetal hydronephrosis

A

Ureteropelvic junction

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10
Q

Confounding definition in regards to experiments

A

When a perceived assoc btw an exposure and an outcome is actually explained by a confounding variable assoc w both the exposure and the outcome

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11
Q

Polyhydramnios

A

Excessive accumulation of amniotic fluid
Increased abd circumference not matching age
Fetal GI obstruction or Anencephaly –> impaired swallowing
High fetal cardiac output –> Increased urination

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12
Q

Amyloid

A

B-pleated sheets
Congo red staining
Apple green birefringence in polarized light

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13
Q

Primary Amyloidosis

A

Systemic deposition
AL amyloid from Ig Light Chain
Assoc w plasma cell dyscarasias
Kidney most commonly involved organ

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14
Q

Secondary amyloidosis

A

Systemic deposition
AA amyloid from SAA (acute phase reactant)
Chronic inflammatory states

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15
Q

Familial Mediterranean Fever

A

Dysfunction of neutrophils
Autosomal recessive
Fever and inflammation –> SAA –> AA amyloid

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16
Q

Clinical presentation of amyloidosis

A 
Nephrotic syndrome (most common)
Restrictive cardiomyopathy
Arrhythmia
Tongue enlargement
Malabsorption
Hepatosplenomegaly
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17
Q

Senile Cardiac Amyloidosis

A

Non-mutated transthyretin deposits

Usually asymptomatic

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18
Q

Familial Amyloid Cardiomyopathy

A

Mutated transthyretin deposits
Restrictive cardiomyopathy
African americans

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19
Q

Dialysis assoc Amyloidosis

A

B2-microglobulin deposits in joints

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20
Q

Medullary carcinoma of thyroid

A

Calcitonin deposits within tumor

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21
Q

Acetoacetate can spontaneously convert to _____ causing a fruity breath

A

Acetone

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22
Q

ACTH is inhibited by

A

Cortisol

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23
Q

Antidote for Digoxin toxicity

A

Digoxin Ab Fragments

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24
Q

B-hCG expected to see an intrauterine pregnancy

A

1500

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25
Q

Bacteria with Exotoxins

A 
Corynebacterium diphtheria
Pseudomonas aeruginosa
Shigella
E.coli
Bacillus anthracis
Vibrio cholera
Clostridium
Strep pyogenes
Staph aureus
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26
Q

Carcinoid Syndrome Rule of Thirds

A

1/3 metastasize
1/3 present w secondary malignancy
1/3 are multiple

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27
Q

Causes of Restrictive Cardiomyopathy

A 
Amyloidosis
Sarcoidosis
Hematochromatosis
Lysosomal Storage diseases
Myocardial Fibrosis (radiation, scleroderma)
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28
Q

Characteriatics of Exotoxins:

A

High virulence with Low concentration
Induce high-titer antibodies (anti-toxins)
Toxoids can be used as vaccines
NOT heat stable

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29
Q

Characteristics of Endotoxins

A 
Adverse effect intensity is low
Clinical effects are fever, shock, DIC
Heat stable (100 deg C for 1 hr)
Induce TNF, IL-1, IL-6
NO vaccines available because poor antigenicity
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30
Q

Diagnosis of Prinzmetal Angina

A

CORONARY ARTEROGRAPHY

  • Recurrent CP at rest
  • Transient ST elevation on ECG
  • No high grade coronary artery stenosis on angiography
  • no coronary obstructions makes the diagnosis
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31
Q

Diagnostic for PID

A

Cervical motion tenderness (chandelier sign)

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32
Q

Ectopic Pregnancy risk factors

A 
Previous ectopic
History of infertility
Previous tubal surgery
PID
Smoking
Advanced maternal age
IUD/ tubal ligation
Hx ruptured appendix
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33
Q

Endometriosis

A

Responds to cyclic hormones
Form chocolate cysts on ovaries
Form catamenial pneumothorax in lungs

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34
Q

Vagus Nerve

A
  • Swallowing
  • Elevates soft palate
  • Keeps uvula midline
  • Talking
  • Cough reflex
  • Parasympathetics to thoracoabdominal viscera
  • Monitoring aortic arch
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35
Q

Serum marker for Seminoma

A

Alk Phos

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36
Q

Screening test for Kartagener’s Syndrome

A

Decreased Nasal Nitric Oxide

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37
Q

Reyes Syndrome is aka

A

Hepatoencephalopathy

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38
Q

Rate limiting enzyme of ketogenesis

A

HMG-CoA Synthase

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39
Q

Rate limiting enzyme in cholesterol synthesis

A

HMG-CoA Reductase

Inhibited by statins

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40
Q

Neuroendocrine tumor marker (Ex. carcinoid, insulinoma, gastrinoma…)

A

Chromogranin

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41
Q

Oxytocin is stored in the

A

Posterior pituitary

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42
Q

Oxytocin stimulates

A 
Milk ejection (breast)
Uterine contraction
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43
Q

Presentation of Prinzmetal Angina

A

Pain at rest
Occurring at night
Indistinguishable from classic angina

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44
Q

Symptoms of Carcinoid Syndrome

A 
B-FDR
Bronchospasm
Flushing
Diarrhea
R valvular disease
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45
Q

Kidneys are located at spinal levels

A

T12-L3

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46
Q

Treatment for Carcinoid Syndrome

A

Surgical resection

Somatostatin Analog

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47
Q

Treatment for ruptured esophageal varicies

A

Octreotide (somatostatin analog, splanchnic vasoconstriction)
Rubber band ligations (prevent bleeding)

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48
Q

TSH is inhibited by

A

Somatostatin

T3/T4

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49
Q

Tumor marker for Endodermal Sinus Tumor (Yolk Sac Tumor)

A

AFP

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50
Q

Urine Ketone test assesses

A

Acetoacetate

NOT B-hydroxybutarate

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51
Q

Kehr’s Sign

A

Pain that radiates to shoulder

Sign of perotinitis

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52
Q

LH in women acts on _____ to produce _____

A

Theca lutein cells
Produce estrogen and progesterone
and stimulates ovulation, helps form corpus luteum

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53
Q

LH is inhibited by increased levels of

A

Progesterone (women)

Testosterone (men)

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54
Q

Main ketone bodies

A

Acetoacetate

B-hydroxybutarate

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55
Q

Major risk factor for Prinzmetal Angina

A

Smoking

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56
Q

Auditory sensation goes to which thalamic nuclei

A

Medial geniculate nucleus

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57
Q

Visual sensation goes to which thalamic nuclei

A

Lateral Geniculate Nucleus

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58
Q

Motor to the body goes to which thalamic nucleus

A

Ventral Lateral Nucleus

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59
Q

Facial sensation goes to which thalamic nuclei

Body sensation goes to which thalamic nuclei

A

Ventral Postermedial Nuclei

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60
Q

Iron Deficiency Anemia

A 
Pica
Hypovolemia (hemorrhoids)
Brittle nails
Angular cheilitis
Microcytic
Tx: Iron replacement, colonoscopy to r/o CA
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61
Q

Treatment for Tyl overdose or inhaled drug to loosen mucus plugs

A

N-acetylcysteine

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62
Q

Mechanism of Action of Benzos

A

Increased FREQ of GABAa receptor Cl channel opening

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63
Q

Mechanism of action of Barbiturates

A

Increased DURATION of GABAa receptor Cl channel opening
CNS depression
Resp depression
CV depression

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64
Q

ACE inhibitors are contraindicated in pregnancy bc

A 
Teratogenic
Use Methyldopa (a2-agonist) instead
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65
Q

Syncope in positive G forces

A

4-6 G
Forces pool blood in abd and legs
Not returned to heart
Hypoperfusion of brain

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66
Q

Dorsal Root Ganglia derive from ______ embryological tissue

A

Neural crest (from ectoderm)

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67
Q

Presentation of PCP intoxication

A 
Sympathomimetic
Psychosis
Superhuman strength
Hallucinations
Vertical and Horizontal Nystagmus
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68
Q

Chemo agent responsible for restrictive lung disease

A

Bleomycin

Induces free radicals to interfere w DNA structure

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69
Q

Most common renal malignancy in adults

A 
Renal Cell Carcinoma
Deletion of genes on Ch 3 (assoc w VHL)
-hematuria
-flank pain
-palpable flank mass
-yellow tumor
-clear cells
*can be sporadic or hereditary
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70
Q

Mechanism of Factor V Leiden

A

Mutation produces Factor V that cannot be degraded by Protein C

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71
Q

Pulmonary diseases with increased Reid Index

A

COPD

  • Emphysema
  • Chronic Bronchitis
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72
Q

Neoplasm responsible for

ACTH –> Cushing’s

A

Small Cell Lung CA

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73
Q

Neoplasm responsible for

PTH-related peptide –> Hypercalcemia

A

Squamous Cell Lung CA

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74
Q

Neoplasm responsible for

Erythropoietin –> Polycythemia

A 
"possibly really high hematocrit"
Pheochromocytoma
Renal Cell Carcinoma
Hepatocellular Carcinoma
Hemangioblastoma
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75
Q

Neoplasm responsible for

ADH –> SIADH

A

Small Cell Lung CA

Intracranial CA

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76
Q

Viral illness assoc w Burkitt Lymphoma

A

EBV
Neoplasm of mature B cells
Starry Sky appearance

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77
Q

T cells are found in the _____ of the spleen

A

PALS and White Pulp

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78
Q

B cells are found in the _____ of the spleen

A

White Pulp

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79
Q

Compliment deficiency seen with

Frequent Neisseria infections

A

C5- C9

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80
Q

Compliment deficiency seen with

  • Frequent pyogenic RTIs
  • Increased frequency of type 3 hypersensitivity reaction
A

C3

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81
Q

Compliment deficiency seen with

Paroxysmal Nocturnal Hemoglobinuria

A

CD55, CD59
Prevents compliment from attacking RBCs
DAF

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82
Q

Function of LH in men

A

Acts on leydig cells to produce testosterone

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83
Q

LH release is stimulated by

A

Pulsatile release of GnRH

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84
Q

Hydratidiform mole is the most common precursor of what malignancy

A

Choriocarcinoma
High B-Hcg
*make sure B-Hcg returns to zero bc any remaining mole could –> choriocarcinoma

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85
Q

Most common form of adrenal hyperplasia

A

21a-hydroxylase deficiency

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86
Q

Hormone levels altered in 21a-hydroxylase deficiency

A

Decreased aldosterone
Decreased cortisol
Increased sex hormones

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87
Q

Clinical manifestations of 21a-hydroxylase deficiency

A

Hypotension
Volume depletion
Hyperkalemia bc decreased aldosterone
Masculinizing effects in fems bc increased androgens

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88
Q

Mechanism of Scopolamine

A

Anticholinergic

Antagonist of M1 muscarinics

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89
Q

Mechanism of Promethazine

A

Antagonist Histamine receptors

Antagonist D2 receptors

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90
Q

Mechanism of Prochlorperazine

A

D2 antagonist

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91
Q

Mechanism of Metocloparmide

A

D2 antagonist

Prokinetic in GI system

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92
Q

Mechanism of Ondansetron

A

5HT3 blocker

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93
Q

Mechanism of Methylphenidate

A

Indirect sympathomimetic

Releases stored catecholamines

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94
Q

1st line treatment for ADHD

A

Stimulants (methylphenidate, dextroamphetamine)
SNRI (atomoxetine)
If insomnia –> clonidine

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95
Q

Kid with

High fever –> Rash –> Fever resolves with appearance of rash

A 
HHV-6
Roseola
-lacy rash
-rash spares face
-Tx is supportive
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96
Q

Mechanism of Strichnine

A

Glycine Antagonist

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97
Q

Mechanism of Tetanus toxin

A

Binds Renshaw cells

Blocks inhibitory function of glycine and GABA

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98
Q

Mechanism of Black widow spider toxin

A

Excessive release of Ach

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99
Q

Mechanism of Botulinum toxin

A

Inhibits release of Ach

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100
Q

Oligohydramnios

A

Decreased amniotic fluid/ fetal urine production
Placental insufficiency
Bilat renal genesis
Posterior urethral valves (males)

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101
Q

Polyhydramnios

A

Increased fetal urine/ amniotic fluid
Decreased fetal swallowing
GI obstruction
Anencephaly

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102
Q

Potter Sequence

A

Bilateral Renal Agenesis
Oligohydramnios
Congenital Malformations
POTTER: palm hypoplasia, oligohydramnios, twisted skin, twisted face, extremity deformity, renal agenesis

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103
Q

Risk factors for osteosarcoma

A 
Bone infarcts
Radiation
Paget's disease
Familial Retinoblastoma (mutated Rb gene)
Male
10-20 yrs old
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104
Q

Efferent fibers that carry input from brain to influence outer hair cells of the cochlea

A

Olivocochlear Bundles
Results in contraction of OHCs –>
Stiffening of cochlear basilar membrane –>
Sensitizes inner hair cells to particular frequency

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105
Q

Result of damaged Outer hair cells of the cochlea

A

Wide deflection of basilar membrane

Hearing loss

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106
Q

I Cell Disease

A

Defect in N-acetylglucosaminyl-1-phosphotransferase
Mannose 6 is not phosphorylated
Proteins are secreted extracellularly rather than to lysosomes
-Coarse facial features
-Failure to thrive
-Cognitive impairment
-Corneal clouding

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107
Q

Clathrin

A

Tag directing golgi –> plasma membrane or endosome

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108
Q

COPI

A

Tag directing golgi –> endoplasmic reticulum

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109
Q

COPII

A

Tag directing endoplasmic reticulum –> golgi

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110
Q

Zellweger Syndrome

A

Autosomal recessive
Mutated PEX gene
Defective peroxisome function
Increased Very Long chain fatty acids (VLCFAs)
Hypotonia, seizures, hepatomegaly, early death

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111
Q

Adrenoleukodystrophy

A

X-linked recessive
Mutated ABCD1 gene
No B-oxidation
Impaired transport of VLCFAs to peroxisome
Increased VLCFAs in brain, adrenals, testes
-cognitive impairment
-adrenal insufficiency

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112
Q

Ubiquitin

A

Tag for degradation in proteosomes

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113
Q

Kartagener’s Syndrome

A 
Autosomal recessive
Defective dynein arm (retrograde axonal t/p)
Immotile cilia
Infertility/ ectopic
Bronchiectasis
Situs Inversus
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114
Q

Mannose 6 Phosphate

A

Golgi Tag for degradation in the lysosome

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115
Q

Desmin

A

Intermediate filament found in muscle cells –> rhabdomyosarcoma

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116
Q

Vimentin

A

Intermediate filament found in mesenchymal tissue –> sarcoma
Secures organelles inside cytosol
Provides resistance to mechanical stress

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117
Q

GFAP

A

Intermediate filament found in neuroglia –> astrocytoma

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118
Q

Scurvy

A

VitC deficiency
Decreased collagen hydroxylation
-swollen gums
-poor wound healing

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119
Q

Osteogenesis Imperfecta

A 
AutoDOM (COL1A1 and COL1A2)
Decreased normal procollagen (type 1)
-frequent fractures (weak bones)
-blue sclera (translucent connective tissue, veins more prominent)
-hearing loss (ossicles)
-abn teeth
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120
Q

Ehlers-Danlos Syndrome

A 
Procollagen peptidase (terminal cleavage) or Lysyl oxidase (cross-linking) deficiency
Classic Type (stretchy skin, hyper mobile, easy bruising, Type V collagen affected)
Vascular Type (aneurysms, muscle rupture, Type III collagen affected)
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121
Q

Menkes Disease

A 
X-linked recessive
Defective Menkes protein (ATP7A)
Impaired Copper absorption
Cu cofactor for lysol oxidase (last) step of collagen cross-linking
-growth retardation
-brittle hair (kinky hair)
-hypotonia
*ATP7B is Wilson Disease
*no bone deformity
*not hyper extensible
*presents in infancy
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122
Q

Marfan Syndrome

A

Defective fibrillin-1 (FBN1) –> defective scaffolding for elastin synthesis
Weak connective tissue
Heart (cystic medial necrosis, MVP), cataracts, periosteum, pectus excavatum/ carinatum
UPWARD subluxation of lens (down in homocystinuria)

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123
Q

Blotting techniques detect _____

A 
SNoW DRoP
Southern- DNA
Northern- mRNA
Western- Proteins
Southwestern- DNA binding proteins
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124
Q

Antiviral Mechanism of Interferons

A

Induce viral defenses
RNA protein kinase (degrades viral RNA)
Trigger apoptosis
Influence macrophages/ dendritic cells

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125
Q

Vanco is good for

A

Multidrug resistant organisms (MRSA, enterococci)

2nd line for Diff (after metronidazole)

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126
Q

Mechanism of Vanco resistance

A

Vanco binds D-ala D-ala to inhibit cell wall synthesis
When D-ala D-ala –> D-ala D-LAC
Vanco cant bind

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127
Q

Gastrinoma + kidney stones + hypogonadism

A

Multiple Endocrine Neoplasia 1 (MEN1)

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128
Q

Clomiphene

A

Given for PCOS
Induces ovulation
Estrogen antagonist –> increases LH/ FSH

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129
Q

Bedbugs transmit what diseases

A

No transmission to humans

Local allergic reaction

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130
Q

ICAM-1

A

Receptor on vascular endothelials
Binds neutrophil LFA-1 (integrin)
Aids in extravasation

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131
Q

PECAM-1

A

Receptor on vascular endothelials

Aids in neutrophil/ monocyte/ platelet diapedesis from vascular compartment

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132
Q

Neutrophil chemotactic factors

A

C5a
IL-8 (continued inflammation)
LTB4
Kallikrein

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133
Q

_____ and _____ cannot use ketones

A

RBCs (lack mitochondria, no TCA)

Hepatocytes (produce the ketones)

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134
Q

Ketogenesis is unregulated during

A

Intense gluconeogenesis
Oxaloacetate is depleted (1st step of TCA)
Acetyl-CoA shunted to ketone formation
Ex. type 1 dm

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135
Q

High _____ in alcohol intoxication inhibits conversion of Malate to _____

A

High NADH
Inhibits Malate –> Oxaloactate
Inhibits TCA cycle
Accumulation of Acetyl-CoA –> ketone pathway

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136
Q

Zinc deficiency

A 
Decrease in adult hair (pits, pubic, face)
Immunesuppression
Hypogonadism
Dysguesia (distorted taste)
Anosmia (loss of smell)
Perioral and Buttock rash
Predispose alcoholics to cirrhosis
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137
Q

Acrodermatitis enteropathica

A

Inherited zinc deficiency

Perioral and buttock rash

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138
Q

Vit B1 (thiamine)

A

Cofactor for dehydrogenases and transketolase

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139
Q

Vit B1 (thiamine) deficiency

A

Wernicke-Korsakoff syndrome
Seen in alcoholism and malnutrition
Oculomotor dysfunction, ataxia
Chronic –> Korsakoff (amnesia, confabulation, apathy)
Affects mammary Bodies (high metabolic demand)

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140
Q

Vit B2 (riboflavin)

A

Cofactor for dehydrogenases

Necessary for FAD synth

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141
Q

Vit B2 (riboflavin) deficiency

A

Cheilosis

Corneal vascularization

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142
Q

Vit B3 (niacin)

A

Cofactor for dehydrogenases
Necessary for NAD synth
Derived from tryptophan
Assoc w Hartnup Disease

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143
Q

Vit B3 (niacin) deficiency

A

3 Ds of Pellagra
Diarrhea
Dermatitis
Dementia

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144
Q

Vitamin B3 (niacin) toxicity

A

Facial flushing due to PGs

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145
Q

Vit B5 (pantothenic acid)

A

Cofactor for dehydrogenases

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146
Q

Hartnup Disease

A

Deficiency of neutral AA transporters (tryptophan) in kidney and sm intestine
Elevated neutral AA levels in serum
No Tryptophan –> No Niacin

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147
Q 
Vit B5 (pantothenic acid)
Vit B7 (biotin)
deficiency
A

Dermatitis
Alopecia
Enteritis

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148
Q

Vit B6 (pyridoxine)

A

Cofactor for

  • transaminases
  • cystathionine synthase
  • DOPA decarboxylase
  • Serotonin synth
  • Niacin synth
  • GABA synth
  • heme synth
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149
Q

Vit B6 (pyridoxine) deficiency

A

Peripheral neuropathy

Isoniazid induces deficiency

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150
Q

Vit B7 (biotin)

A

Cofactor for carboxylases

Avidin in egg whites binds biotin

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151
Q

Vit B9 (folate)

A

Converted to Tetrahydrofolate

Found in green leafy veggies

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152
Q

Vit B9 (folate) deficiency

A

Megaloblastic anemia
Increased homocysteine
Normal methylmalonic acid levels

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153
Q

Vit B12 (cobalamin)

A

Cofactor for methionine synthase and
Methylmalyonyl-CoA mutase
Found in animal products

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154
Q

Vit B12 (cobalamin) deficiency

A

Megaloblastic anemia
Increased homocysteine
Increased methylmalonic acid
Subacute combined degeneration

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155
Q

Vit A

A 
Vision
Differentiation of specialized epithelials
Isotretinoin treats cystic acne
All-trans retinoid acid treats APL
Required for maturation of immune cells
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156
Q

Vit A deficiency

A

Night blindness
Dry skin
Metaplasia –> Thin squamous conjunctiva –> Keratomalacia
Immune cells trapped in blast state –> Myelocytic Leukemia

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157
Q

Vit A toxicity

A

Increased ICP

Dry skin

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158
Q

Vit D

A

Ca and phosphate regulation

Formed in UV exposed epithelium

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159
Q

Vit D deficiency

A

Rickets
Osteomalacia
*defective mineralization of osteoid

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160
Q

Vit E

A

Protects RBCs from free radicals

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161
Q

Vit E deficiency

A

Anemia (not macrocytic, MCV <100)

Neurological deficits

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162
Q

Glycolysis

A

Glucose –> pyruvate
Occurs in cytoplasm
Generates ATP and NADH

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163
Q

Maturity Onset Diabetes of the Young

is a deficiency of _____ function

A

Glucokinase

No glycolysis

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164
Q

Post-Strep Glomerulonephritis

A

Coca-Cola colored urine
Subepithelial humps (lumpy bumpy)
+ antiDNAase titer
+ streptolysin O titer

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165
Q

IgA GlomeruoNephropathy

A 
After URI
Purpura on buttock/ legs (henoch)
aka Buerger disease
Mesangial deposits of IgA
RBC Casts
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166
Q

Alport Syndrome

A 
Defect in type IV collagen
X-linked inheritance
Thinning and Splitting of BM
Cataracts
Isolated Hematuria
High freq hearing loss
"cant see, cant pee, cant hear a high c"
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167
Q

Granulomatosis w polyangitis

A 
Nasal granulomas
Pulmonary infultrates
Hematuria
\+ c-ANCA
aka Wegners
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168
Q

Eosinophilic granulomatosis w polyangitis (Churg-Strauss)

A

Sm-Med Vessel Vasculitis
Involves nasal passages
Assoc w late-onset asthma, rhinosinusitis
+ p-ANCA
Peripheral EOSINOPHILIA
Mononeuritis multiplex due to epieneural vessels
Biopsy: granulomas

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169
Q

Goodpasture’s syndrome

A

Microscopic Hematuria
Pulmonary infiltrates
Type 2 Hypersensitivity
+ Anti-GBM Ab

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170
Q

Fetal Hb

A

2 a and 2 y

Does not bind well to 2,3 BPG

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171
Q

Myoglobin

A

Single peptide
1 heme
High affinity for oxygen

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172
Q

Serotonin Syndrome presentation

A

3 As

  • increased neuromuscular Activity
  • Autonomic stimulation
  • Agitation
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173
Q

Treatment for Serotonin Syndrome

A

Cyproheptadine (5HT2 antagonist)
Benzos (muscles, seizures, agitation)
Fluids

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174
Q

Mechanism of Benzos and Barbiturates

A

Increase GABA
Benzos: inc fred
Barbs: inc duration

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175
Q

Presentation of Benzo or Barbiturate use

A 
CNS depression
Dizziness
Slurred speech
Resp depression
Nystagmus
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176
Q

Reversal Agent for Benzos or Barbiturates

A

Flumazenil

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177
Q

Mechanism of LSD

A

Stimulates 5HT receptors

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178
Q

Mechanism of Cocaine

A

Inhibits catecholamine reuptake

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179
Q

Mechanism of amphetamines

A

Increases catecholamine release

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180
Q

Intrinsic Apoptotic Pathway

A 
Increased BAX (pro-apoptotic)
Decreased Bcl-2 (anti-apoptotic)
Increase in mitochondrial permeability -->
Cyt C release-->
Activation of caspases
*Bcl-2 is 4 letters = live
*BAX is 3 letters = die
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181
Q

Extrinsic Apoptotic Pathway

A 
Signal from outside cell
TNF receptor - TNFa
CD95 (FasR) - FasL
Binding of TNFa/ FasL activate caspases
Cytotoxic T cells release perforin (perforates) and granzyme B (activates caspases)
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182
Q

DiGeorge Syndrome

A 
22q11 micro deletion
Affects 3rd and 4th pharyngeal pouches
Abn face and cardiac
Thymic aplasia (3rd pouch)
T cell deficiency
Parathyroid aplasia (hypoCa)
Recurrent fungal infections
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183
Q

Which cranial nerve nuclei receives fibers from carotid baroreceptors?

A

Nucleus Tractus Solitarius- Caudal

thru glossalpharyngeal nerve

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184
Q

Popcorn-like calcifications on lung tumor

A 
Hamartoma
"popcorn is good"
Benign
Composed of fat, connective tissue, cartilage
Well-circumscribed
Peripherally located
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185
Q

Substrate for gluconeogenesis

A

Alanine

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186
Q

BCAA increased in maple syrup urine disease

A

Valine
Leucine
Isoleucine

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187
Q

Precursor of homocystene

A

Methionine

Assoc w endothelial damage and atherosclerosis

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188
Q

Precursor of serotonin, niacin, melatonin

A

Tryptophan

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189
Q

AAs that stimulate growth hormone and insulin

A

Arginine

Histidine

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190
Q

Precursor of NO

A

Arginine

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191
Q

Pediatric with Flank Mass

A

Wilm’s Tumor (nephroblastoma)

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192
Q

WAGR

A 
Deletion of WG-1 tumor suppressor gene
W-wilms tumor
A-aniridia
G-genitourinary malformation
R-mental/motor retardation
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193
Q

C3b

A

Opsonin

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194
Q

C5a

A

Neutrophil chemotaxis

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195
Q

Hereditary Spherocytosis

A 
Defect in RBC cytoskeleton proteins
Spectrin, Band 3, Pallidin, Ankyrin
Dx: Osmotic fragility test
Microcytic round RBCs
NO CENTRAL PALOR
Increased mean corpuscular Hb
Increased RDW
Extravascular hemolysis
NEG Coombs
Splenomegaly, Gallstones
Aplastic Crisis
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196
Q

Urge Incontinence

A

Uninhibited bladder contraction

Detrusor overactivity

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197
Q

Stress incontinence

A

Involuntary leak of urine due to increased abd pressure

Decreased support and function of urinary sphincter

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198
Q

Overflow incontinence

A

Incomplete bladder emptying
Bladder outlet obstruction
Neurogenic bladder
Impaired detrusor contractility

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199
Q

Organ failure after a transplant is a type _____ hypersensitivity

A

Type 4- delayed
Chronic rejection
T cell and Ab mediated vascular damage
Obliterative vascular fibrosis

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200
Q

PPAR-y

A

Peroxisome Proliferator-activated Receptor-y
Nuclear receptor and Transcription factor
Found in adipose
Role in adipocyte differentiation

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201
Q

Thiazolidinediones (TZDs)

A

Diabetes meds
Bind PPAR-y
Improve insulin sensitivity

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202
Q

MOA Disulfiram

A

Inhibits acetaldehyde dehydrogenase

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203
Q

Meds w disulfiram like effect

A

Metronidazole
Certain cephalosporins
Griseofulvin
1st Gen Sulfonylureas

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204
Q

Half lives to reach steady state

A

4-5

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205
Q

T 1/2 equation

A

CL

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206
Q

a1 antagonists can treat

A

HTN
Urinary retention in BPH
Ex. Terazosin, Prazosin, Doxazosin

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207
Q

Hansen Disease (Leprosy)

A

Mycobacterium Leprae
Armadillos
Coolest parts of body (Skin, Superficial nerves)

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208
Q

Obligate Anaerobes lack

A 
Superoxide dismutase (oxygen radicals --> water and peroxide)
Catalase (peroxide --> water and oxygen)
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209
Q

Bicornate uterus is due to

A

incomplete fusion of paramesonephric ducts (aka muellerian ducts)

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210
Q

Paramesonephric ducts (muellerian ducts) form

A

Fallopian tubes
Uterus
Upper vagina

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211
Q

Primary oocyte arrested in _____ until ovulation

A

PrOphase I until Ovulation

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212
Q

Primary oocyte arrested in _____ until fertilization

A

Metaphase II until fertilization

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213
Q

Kallmann Syndrome

A

Anosmia
Hypogonadism
-decreased GnRH in hypothalamus
-no secondary sex characteristics

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214
Q

DiGeorge Syndrome

A

3rd and 4th branchial pouches fail to devo
Aplasia of thymus and parathyroids
22q11 Deletion
Cleft palate, Abn face, Heart and Great Vessel defects
Tetany (no PTH –> hypoCa)
Recurrent infections (no thymus –> no mature T cells)

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215
Q

Primary amenorrhea

A

Never menstruated

  • turner syndrome
  • imperforate hymen
  • androgen insensitivity
  • mullerian duct genesis
  • delayed puberty
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216
Q

Secondary amenorrhea

A

Menstruated previously then stopped

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217
Q

Post-Traumatic vulvar hematoma

A

Saddle trauma/ Sexual assault

Bulb of vestibule- highly vascular erectile tissue under labia majora

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218
Q

Amygdala receives inputs from

A

Limbic cortex
Neocortex of parietal, temporal, occipital
Auditory and Visual areas

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219
Q

Amygdala sends output to

A

Back to cortical areas that sent input
Hippocampus (memory)
Septum
Thalamus and Hypothalamus

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220
Q

Stimulation of Amygdala

A 
Memory and Emotion
Arterial BP and HR
GI motility and secretion
Defecation or Micturition
Pupillary dilation or constriction
Piloerection
Sexual Responses
Secretion of Ant Pituitary hormones
Licking, Chewing, Swallowing
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221
Q

What prevents mast cell degranulation

A

Cromolyn Sodium

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222
Q

Hypertrophic Cardiomyopathy

A

Genes encoding Sarcomere proteins
AutoDOM
Decreased compliance
Affects LV –> diastolic dysfunction
Decreased CO (decreased filling and compliance)
Functional Aortic Stenosis (hypertrophic septum)

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223
Q

Notochord

A

Mesoderm

Stimulates neural tube development

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224
Q

Neural Tube

A

Ectoderm

Neural plate

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225
Q

Cell types that do NOT require insulin for glucose uptake

A 
Neurons
RBC
Intestines
Cornea
Kidney
Liver
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226
Q

VitD to active form

A

VitD –> Liver –> 25 D –> kidney –> 1,25 D

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227
Q

VitD helps prevent osteoporosis by

A

Stimulating Ca and phosphate absorption in gut

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228
Q

Von Gierke Disease

A

Glucose-6-Phosphatase deficiency
Cannot break G6P from glycogen into glucose
NO GLUCONEOGENESIS
Glycogen accumulation

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229
Q

Presentation of Von Gierke Disease

A 
Hypoglycemia
Lactic acidosis
Glycogen accumulation
PAS + (stains glycogen)
High triglycerides
Hyperuricemia
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230
Q

Patients with Von Gierke Disease must avoid

A

Fructose and Galactose

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231
Q

Cori Disease

A

Glycogen debranching enzyme deficiency
Breaks a-1,6 linkages
Glycogen accumulates
GLUCONEOGENESIS INTACT

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232
Q

Presentation of Cori Disease

A

Ketoacidosis
Glycogen accumulates
PAS + (stains glycogen)

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233
Q

Gaucher Disease

A

Lysosomal storage disease

Glucocerebrosidase deficiency

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234
Q

Tx of Gaucher

A

Recombinant Glucosecerebrosidase

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235
Q

Presentation of Gaucher Disease

A

Pancytopenia
Lipid laden macrophages (crumpled tissue paper)
Hepatosplenomegaly
Bone disease

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236
Q

Krabbe Disease

A

Lysosomal storage disease
Galactocerebrosidase deficiency
Psychosine accumulation
Globoid cells on nerve biopsy

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237
Q

Presentation of Krabbe Disease

A

Oligodendrocyte destruction
Peripheral neuropathy
Optic atrophy
Developmental delay

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238
Q

Turner Syndrome

A 
45 XO genotype
Ovarian dysgenesis
Lymphatic blockage
Bicuspid Aortic valve
Aortic coarctation
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239
Q

Presentation of Turner Syndrome

A 
Webbed neck
Shield chest
Swollen hands/feet
Short stature
Low estrogen
High LH and FSH
Horseshoe kidney
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240
Q

Patau Syndrome

A

Trisomy 13

Meiotic non-disjunction

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241
Q

Presentation of Patau Syndrome

A 
Cleft lip/palate
Polydactyly
Microcephaly
Holoprosenencephaly (hemispheres don't separate)
Cutis aplasia (skin or bone missing)
Microphthalmia
Polycystic kidney disease
Rocker-bottom feet
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242
Q

Mother’s labs in Patau Syndrome

A

1st trimester: low B-hcg

2nd trimester: all normal

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243
Q

Rett Syndrome

A 
X-linked Dominant (boys die in utero)
MECP2 gene
Regression of motor/ verbal abilities (age 1-4)
Growth failure
Seizures
Stereotyped hand wringing
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244
Q

Cri-du-chat Syndrome

A 
Deletion of short are of Ch 5
Microcephaly
Epicanthal folds
Intellectual disability
Ventricular Septal Defect
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245
Q

Communicating Hydrocephalus

A

Arachnoid granulations do NOT absorb CSF properly
Too much fluid
Arachnoid scaring after meningitis
Increased ICP, papilledema, herniation

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246
Q

Non-Communicating Hydrocephalus

A

Stenosis of aqueduct of Sylvius
Colloid Cyst
Tumor

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247
Q

Ex Vacuo Ventriculomegaly

A 
Looks like increased CSF
Brain tissue smaller than normal
ICP normal
Rest of NPH triad absent
Seen in alzheimers, HIV, pick's, huntington's
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248
Q

Warthin’s tumor

A

Benign
Cystic salivary gland tumor
Heterotopic lymphoid tissue inside gland tissue
Can form germinal centers

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249
Q

Myotonic Muscular Dystrophy

A 
AutoDOM
CTG trinucleotide expansion DMPK gene
Aches and weakness
High arched palate
Cognitive impairment
Can have frontal balding, bilateral cataracts
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250
Q

Seborrheic Keratosis

A

Immature keratinocytes

Small keratin filled cysts

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251
Q

Resistance to fluoroquinolones

A

Mutation of DNA gyrase/ topoisomerase
Decreased outer membrane permeability
Increased expression of efflux pumps (plasmid)

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252
Q

Polycythemia Vera

A

Mutation JAK2

uncontrolled EPO proliferation

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253
Q

Secondary Polycythemia

A

Due to hepatocellular carcinoma or exogenous EPO intake
Increased EPO
Increased RBC mass

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254
Q

Mutated Rb gene increases risk of

A

Osteosarcomas

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255
Q

Mechanism of Oxytocin

A

Activation of Phospholipase C

Treats post-partum hemorrhage

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256
Q

Mechanism of
Darunavir
Ritonavir

A

Inhibition of HIV enzyme protease

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257
Q 
Osteitis deformans
(Paget disease)
A 
Idiopathic bone remodeling
Overlying erythema
Hearing loss (ossicles)
Thick sclerotic bone
Easily Fractures
Mosaic patter of lamellar bone (unsealed cement lines)
Bone pain
Increased hat size
Lion faces
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258
Q

Oxybutynin

A

Muscarinic antagonist
Treats overactive bladder
Adverse anticholinergic effects

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259
Q

Carcinoid Syndrome

A 
Watery diarrhea
Crampy abd pain
Cutaneous flushing w eating or emotions
Asthma attacks
Tricuspid regurg
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260
Q

Carcinoid tumors puts patients at risk for

A

Pigmented dermatitis

Increased serotonin metabolism depletes tryptophan precursors of niacin

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261
Q

Lysyl oxidase uses _____ as a cofactor

A

Copper

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262
Q

Neuroleptic Malignant Syndrome is treated with

A

Dantrolene- Ryanodine receptor blocker
Prevents rhabdo
Benzos for agitation

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263
Q

If metabolic alkalosis, order _____ next

A

Urine Chloride

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264
Q

Bevacizumab

A

For Renal Cell Carcinoma
For Neovascular macular degeneration
Risk of GI bleed, HTN heart failure, thrombosis

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265
Q

Membranous Nephropathy

A 
Caucasians
Thick basement membrane on H/E
Subepithelial Anti-PA2 Ab deposition
Granular Immunofluorescence
Spike and Dome on EM
Assoc w HepB/HepC, solid tumors, lupus, drugs (NSAIDs, penicillamine)
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266
Q

Mechanism of Fibrates

A 
Activate PPAR-a
Increase LPL activity
Increased TG clearance
Increased HDL production
Risk of gallstones
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267
Q

Live vaccines

A

Varicella
Yellow fever
MMR

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268
Q

Ranolazine

A

Increased cardiac oxygen efficiency
Tx refractory angina
Inhibits Na influx
Inhibits FA degradation

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269
Q

Craniopharyngiomas

A 
Benign tumors
In sella turcica
Arise from Rathke pouch
Calcifications and Cystic
Cholesterol crystals
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270
Q

Particles between ____ in size are most likely to be eliminated by the mucociliary escalator

A

> 2 micrometers

*< 2 micrometers cleared by alveolar macrophages (ex. asbestos bodies)

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271
Q

Lambert-Eaton Syndrome

A

Assoc w Small Cell Lung CA
Auto Ab to VG Ca channels at NMJ
Impairs Ach release
Strength improves w exercise

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272
Q

Budd-Chiari Syndrome

A

Hepatic Vein Obstruction
Hepatocellular hypoxia
Nutmeg liver

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273
Q

Heme is synthesized in

A

Mitochondria

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274
Q

Cryptococcus

A

Sabouraud agar
+ latex agglutination
India ink- clear halo
Mucicarmine- red inner capsule

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275
Q

Uhthoff phenomenon

A

Tingling sensation
Exacerbated by hot shower
Seen in MS

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276
Q

CSF and MRI findings in Multiple Sclerosis (MS)

A

Ig bands on CSF immunofixation

Periventricular sclerotic plaques

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277
Q

Meningioma

A 
From Arachnoid cells
Benign
Spindle-shaped
Whorled pattern
Compress structures
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278
Q

Phenoxybenzamine

A

Blocks a1 and a2 receptors

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279
Q

Lomustine

A

Alkylating chemo drug
Nitrosourea
Inhibits DNA replication
Creates cross-links in DNA strands

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280
Q

Trigeminal N exits skull thru

A

Foramen ovale

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281
Q

Prolonged/ Rapid administration of Nitroprusside can cause

A 
Cyanide poisoning (ams, abd pain, flushing)
Tx Hydroxycobalamin
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282
Q

Wide split S2

A

Pulmonary hypertension

Hereditary form is from abn BMPR2 gene (predisposes endothelial and smooth muscle proliferation)

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283
Q

Mechanism of Metronidazole

A

Free radical metabolites damage bacterial DNA

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284
Q

Stim of B-1 receptors in JGA incudes

A

Renin release

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285
Q

Ribavirin

A

Tx HepC, RSV
Nucleoside analog
Acts on both RNA and DNA viruses
For HepC always w other med

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286
Q

E.coli is heat _____

A

Labile

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287
Q

Refsum Disease

A

Autosomal Recessive
No a-oxidation
Phytanic Acid (BCFA) —-X—-> Pristanic Acid
Scaly skin, Ataxia, Short 4th toe
Impaired vision (night blind) and hearing
Peripheral neuropathy
Epiphyseal dysplasia
Tx: diet (no seafood, grass feeders or their milk), plasmaphoresis

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288
Q

Leuprolide

A 
Long-acting GnRH agonist
Tx androgen sensitive prostate CA
Decreased GnRH receptor -->
Decreased FSH/LH -->
Initial transient increase testosterone
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289
Q

Trousseau Syndrome

A

Recurrent DVT in different veins
Simultaneous thrombophlebitis
R/O Visceral malignancy (pancreatic)
Due to production of procoagulants by malignant cells

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290
Q

Carcinoma in situ of skin

A

Irreversible nuclear changes in the stratum basale

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291
Q

Filariasis

A 
Dx blood smear at night
India
Wuchereria bancrofti
Thread-like larvae from female mosquito
Tx diethylcarbamazine
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292
Q

MAP=

A

1/3 (sBP + (2 x dBP))

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293
Q

Cardiac Output (CO) =

A

=MAP/ SVR

=SV x HR

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294
Q

End Diastolic Volume (EDV)=

A

SV + ESV

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295
Q

Ejection Fraction=

A

SV / EDV

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296
Q

Budesonide

A

Inhaled glucocorticoid

Tx asthma

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297
Q

Central Cord Syndrome

A 
Cape-like distribution
Absent temp sensation
Normal fine touch
Syringomyelia secondary to whiplash
Risk of Horner Syndrome
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298
Q

Intervertebral disks derive from

A

Notochord

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299
Q

Phenylketonuria

A 
Deficiency of phenlyalanine hydroxylase
Cannot convert phenylalanine to tyrosine
Pale skin
Light blue eyes
Eczematous extensors
Intellectual disability
Seizures
Mousy/ Musty urine
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300
Q

Tuberous Sclerosis

A 
Subependymal giant cell astrocytoma
Shagreen patches
Ash-leaf spots
Benign cysts
Renal cell carcinoma
Angiofibromas around nose and cheeks
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301
Q

Lisch nodules

A 
Ophthalmologic finding in Neurofibromatosis 1
Cafe au lait spots
Neurofibromas
Optic gliomas
Seizures
Cognitive deficits
Soft tissue sarcomas
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302
Q

Vestibular Schwannoma

A

Brain tumor assoc w Neurofibromatosis 2

Bilateral involvement

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303
Q

Peutz Jeghers syndrome

A 
AutoDOM
Hyperactive serine-threonine kinase
Gain of function of STK11 on Ch19
Hamartomatous tumors
Mucocutaneous hyperpigmentation
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304
Q

Peutz Jeghers Syndrome increases risk for _____

A

Cancers

  • Colorectal
  • Pancreatic
  • Ovarian
  • Breast
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305
Q

Machine-like murmur

A 
Patent ductus arteriosis
6th embryonic aortic arch
L --> R shunting
Heard at L infraclavicular
Tx: indomethacin (PGE2 inhibitor)
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306
Q

Alprostadil

A

Prostaglandin E1

Congenital heart defects (PDA, transposition, tetralogy)

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307
Q

Aminoglycosides are inactivated by

A

Phosphorylation

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308
Q

Nerve that runs between superficial and deep flexor digitorum

A

Median

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309
Q

Pufferfish

A

Tetrodotoxin

Decrease permeability to Na ions

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310
Q

Phosphoenolpyruvate Carboxykinase (PEPCK)

A

Enzyme of gluconeogenesis

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311
Q

Least oxygenated blood in the body can be found in

A

Coronary Sinus

Cardiac myocytes pull O2 efficiently

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312
Q

NO release results in

A

Increased cGMP –> vasodilation

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313
Q

Adenosine

A

Vasodilator

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314
Q

Layer of cardium most susceptible to ischemia

A

Subendocardium

Vessels are outside the myocardium

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315
Q

Most effective lipid lowering drug for preventing future CV events

A

Statins

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316
Q

BPH _____ risk of prostate CA

A

Does NOT increase

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317
Q

Barrett’s Esophagus

A

Reflux causes lower esophagus squamous –>
Columnar non-ciliated mucinous
Can progress to adenocarcinoma

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318
Q

Apocrine Metaplasia of Breast _____ risk of CA

A

Does NOT increase

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319
Q

t(15,17)

A

Mutated Retinoic Acid (VitA) receptor
Immune cells trapped in blast state
Myelocytic Leukemia
Tx: Atrol (all trans retinoic acid)- binds mutated receptor

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320
Q

Myositis Ossificans

A

Muscle turns to bone during healing

Form of menenchymal metaplasia

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321
Q

Dilation Cardiomyopathy

A 
All chambers dilated
Systolic dysfunction
Mitral/ Tricuspid Regurgitation (ring stretch)
Arrhythmia (conduction system stretch)
Tx: transplant
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322
Q

Loeffler Syndrome

A

Eosinophilic infiltrate w inflammation of heart walls
Fibrosis of endo/myocardium
Restrictive cardiomyopathy

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323
Q

Most common Primary Cardiac Tumor in adults

A 
Myxoma
Benign mesenchymal proliferation
Gelatinous appearance
Pedunculated mass in LA
Causes syncope due to mitral valve obstruction
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324
Q

Most common Primary Cardiac Tumor in children

A

Rhabdomyoma
Benign hamartoma of cardiac muscle
Assoc w tuberous sclerosis
Usually in ventricle

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325
Q

Metastisize to Heart

A

More common than primary of heart
From breast, lung, melanoma, lymphoma
Affects pericardium (effusion)

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326
Q

Carbon Monoxide poisoning

A

Cherry-picking red skin

Headache (early sign)

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327
Q

Methemoglobinemia

A 
Fe in heme is oxidized to Fe 3+
Fe 3+ cannot bind O2
PaO2 normal
SaO2 decreased
Due to oxidant stress, newborns
Cyanosis w chocolate colored blood
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328
Q

Treatment for Methemoglobinemia

A

IV methylene blue
Reduces Fe 3+ to Fe 2+
Fe 2+ binds oxygen

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329
Q

Decreased ATP creates cellular injury

A

No Na/K pump
Na retained –> hypertonic swelling
No Ca pump (increased cytosolic Ca)
Anaerobic glycolysis –> acidosis

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330
Q

Pyknosis

A

Cell shrinking

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331
Q

Karyorrhexis

A

Nucleus breaks into pieces

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332
Q

Karyolysis

A

Nuclear pieces broken into building blocks

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333
Q

Coagulative Necrosis

A 
Remains firm
Cell shape and organ structure preserved
Nucleus disappears
Ischemic infarcts (except brain)
Infarct often wedge shaped and pale
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334
Q

Red infarction

A

When blood re-enters a loosely organized tissue that has experienced an ischemic infarct

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335
Q

Liquifactive Necrosis

A

Enzymatic lysis of cells/ proteins
Complete removal of tissue w cystic cavity formed
Release of lysosomal enzymes from damaged cells
Brain infarctions (glial cells)
Abscesses (PMNs)
Pancreatitis (pancreatic enzymes)

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336
Q

Gangrenous Necrosis

A

Coagulative necrosis that resembles mummified (dry) tissue
Ischemia of lower limb or GI
If superimposed infection –> liquefactive –> wet gangrene

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337
Q

Caseous Necrosis

A

Cottage cheese appearance
Coagulative and liquefactive necrosis
Granulomatous inflammation (TB, fungal)

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338
Q

Fat Necrosis

A

Chalky white appearance (deposition of Ca)
Saponification- released FAs bind Ca
Due to trauma (breast), Pancreatic enzyme

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339
Q

Saponification

A 
Dystrophic calcification
Ca binds dying tissue
Normal Serum Ca and Phosphate
Psamomma bodies --> tumor cells outgrow blood supply and die
Metastatic Ca
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340
Q

Fibrinoid necrosis

A 
Damage to blood vessel wall
Leak of proteins into wall
Bright pink staining
Malignant HTN or Vasculitis
Young woman: Pre-eclampsia- placental vessels affected
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341
Q

Bacteria of Necrotizing Fasciitis

A

S.pyogenes (GAS)
S.aureus
C.perfringens
Polymicrobial

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342
Q

Case Fatality Rate

A

Fatal cases / Total people w disease

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343
Q

Kinesin

A

Microtubule assoc motor protein
Anterograde transport
Required in reactivation of latent HSV to get viral particles from neurons to ganglia in skin and oral mucosa

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344
Q

Spectrin

A

Cytoskeletal protein along membrane
Maintains shape of RBCs
Defects –> elliptocytosis, spherocytosis

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345
Q

Lamin

A

Protein that forms fibrillar network lining inside of nuclear envelope
Structural supporte
Organize genome
Regulate gene expression

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346
Q

Dynein

A

Microtubule motor protein
Retrograde axonal transport
Move organelles toward nucleus
Allows latency of HSV (t/p to sensory ganglia)

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347
Q

What makes me think Lupus

A

Glomerulonephritis
Photosensitive skin rash
Arthralgias
Young woman

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348
Q

Marker of Lupus

A

Anti-Phospholipid Ab
Can cause PTT prolongation, false + RPR/VDRL
Increased risk for thromboembolism and recurrent pregnancy loss

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349
Q

Heme synthesis occurs in

A

Mitochondria and Cytoplasm of RBCs

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350
Q

Edwards Syndrome

A 
Trisomy 18 (meiotic non-disjunction)
Growth retardation
Micrognathia
Prominent occiput
Low ears
Heart defects
Renal deficits
Limited hip abduction
Clenched hands w overlapping fingers (hypertonia)
Rocker-bottom feet
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351
Q

Methotrexate

A

DMARD for RA

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352
Q

Side effects of Methotrexate

A

Stomatitis
Bone marrow suppression
Liver function abnormalities

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353
Q

Hydroxychloroquine

A 
For RA and Lupus
Irreversible retinopathy (monitor during tx)
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354
Q

Superantigens bind to

A

MHC-II of APCs without processing

Nonspecifically activate T cells

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355
Q

Superior Mesenteric Artery Syndrome

A

Transverse duodenum trapped between SMA and aorta
Partial intestinal obstruction
Aortomesenteric angle decreases (fat, lordosis, surgical correction of scoliosis)

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356
Q

Hemolytic Uremic Syndrome (HUS)

A

AKI, Hemolytic Anemia, Thrombocytopenia
Decreased Hb and platelets
Increased bleeding time, LDH, bilirubin, BUN, Cr

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357
Q

Terbinafine

A

For dermatophytosis

Inhibits synthesis of fungal membrane ergosterol by suppressing SQUALENE EPOXIDASE

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358
Q

Drug concentration

A

Drug dose / Vd

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359
Q

Derivatives of Pharyngeal Arch 1

A 
Muscles of mastication (master, temporalis, pterygoids)
Maxilla
Mandible
Malleus and Incus
Trigeminal Nerve
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360
Q

Derivatives of Pharyngeal Arch 2

A 
Muscles of facial expression
Styloid process
Facial Nerve
Stapes
Lesser horn of hyoid
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361
Q

Derivatives of Pharyngeal Arch 3

A

Stylopharyngeus

Greater horn of hyoid

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362
Q

Derivatives of Pharyngeal Arches 4 and 6

A

Pharyngeal and Laryngeal muscles

Cricoid and Thyroid Cartilages

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363
Q

Treacher-Collins Syndrome

A

Impaired 1st and 2nd pharyngeal arch development

Hypoplasia of mandibular and zygomatic bones

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364
Q

Familial Hypocalciuric Hypercalcemia

A

Benign
AutoDOM
Defective Ca sensing receptors (GPCRs) in the parathyroid and kidneys
Normal VitD

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365
Q

Primary site of ribosome synthesis and assembly

A

Nucleolus

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366
Q

Mitochondrial Dysfunction Symptoms

A

Myopathy
Nervous system dysfunction
Lactic acidosis
RAGGED RED FIBERS on muscle biopsy

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367
Q

Where is the most highly oxygenated blood in the fetus

A

Umbilical vein –> ductus venous –> IVC

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368
Q

Gag reflex

A

CN 9-10

Sensory fibers Pteragopalatine branch of Trigeminal

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369
Q

Corneal Reflex

A

No true blood supply
Sensory- Nasociliary Nerve branch from CN V1
Motor- Facial Nerve to orbicularis oculi

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370
Q

Taste sensation to anterior 2/3

A

Chordae tympani branch of facial n

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371
Q

Muscles of mastication innervated by

A

motor branches of CN V3

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372
Q

Apo A-1

A

Activates LCAT

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373
Q

Apo B-48

A

Mediates chylomicron secretion from enterocytes

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374
Q

Apo B-100

A

Lipoproteins that come from liver

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375
Q

____ up-regulates HMG-CoA Reductase

A

Estrogen
Increased cholesterol
Gallstones

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376
Q

_____ is a complication of Parenteral Nutrition (TPN)

A

Gallstones (no fat to duodenum, no CCK, GB stasis)

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377
Q

Bile acids are reabsorbed in the _____

A

Terminal ileum

*affected by Crohn’s

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378
Q

____ Km = _____ affinity

A

Low Km = High affinity for substrate

*and vice versa

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379
Q

Low Vmax of Hexokinase in skeletal muscle prevents

A

Cells from hoarding too much glucose

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380
Q

High Km of Glucokinase in liver

A

Low glucose utilization
Glucose spared for tissues
Wont bind glucose until levels very high

381
Q

High Vmax of Glucokinase in liver

A

Faster processing of glucose –> g6p

382
Q

Low Km of Hexokinase in skeletal muscle

A

Rapid glucose utilization for energy

383
Q

Hexokinase

A

In most tissues (NOT pancreatic B cells)
Inhibited by g6p
NOT induced by insulin
Low Km and Vmax

384
Q

Glucokinase

A

In pancreatic B cells and liver
NOT inhibited by g6p
Induced by insulin
High Km and Vmax

385
Q

How glucokinase causes insulin release

A 
Glucose --> g6p --> ATP
ATP inhibits K channels
Increased intracellular K --> cell depolarization
Opens Ca channels --> Ca influx
Ca dependent insulin release
386
Q

Tetracyclines interact with _____ to form _____

A

Polyvalent cations (Fe, Ca, Al, Mg)
Form chelate complexes in the GI tract
–> decreased drug absorption
*Fluoroquinolones and Thyroxine also susceptible to chelation

387
Q

Vitamin B12 Deficiency presents with

A 
Megaloblastic anemia (impaired DNA synth)
Neuro deficits (impaired myelin synth)
Degeneration of dorsal columns and LCST
Elevated Methylmalonic Acid and Homocysteine
388
Q

Vitamin B3 can be synthesized endogenously from _____

A

Tryptophan

VitB3 essential component of NAD and NADP

389
Q

Low Dose Dopamine infusion

A

Stimulates D1 receptors in renal and mesenteric vasculature –> vasodilation

390
Q

Increasing doses of Dopamine

A

Stimulate B1 and a1 receptors
Increased cardiac output
Elevated TPR
Highest doses –> increased afterload can decreased cardiac output

391
Q

Plasmodium infection

A

Malaria

RBCs w multiple small signet rings

392
Q

_____ is required to kill Plasmodium vivax and Plasmodium ovale liver hypnozoites

A

Primaquine

393
Q

Referred otalgia

A

CN 5, 7, 9, 10
Tumors in hypopharynx, larynx, base of tongue
Sensory contributions from CN 9, 10

394
Q

Osler-Weber-Rendu Syndrome (Hereditary Hemorrhagic Telangiectasia)

A

AutoDOM

Telangiectasias on skin and mucous membranes

395
Q

UV-induced DNA Damage

A

Pyrimidine dimers

Recognized by endonuclease complex –> nicks damaged strand on both sides of dimer

396
Q

Rapid infusion of Vanco can lead to

A 
Direct activation of mast cells
Massive release of histamine
Red Man Syndrome
Seconds- Minutes
Not IgE mediated
Tx: Resume Vanco infusion slower
397
Q

Tibial Nerve functions

A

Weak plantarflexion, inversion, and toe flexion

Sensory of sole

398
Q

Cross-Sectional Study

A

Snapshot (does NOT follow over time)
Prevalence (NOT indigence)
Correlation (NOT causation)

399
Q

Cohort Study

A

2 groups followed over time (non-exposed control)
Starting point = Exposure
Measures Incidence –> determines Relative Risk
Retrospective or Prospective

400
Q

Case-Control Study

A

2 groups: cases and non-diseased controls
Starting point = Diseased (cases)
Non-diseased controls prevent confounding
Who was exposed in both groups –> Odds Ratio

401
Q

Randomized Controlled Trial

A 
Studies disease treatment
Random assortment to test or control group
Single or Double blinding
Identifies Causation
Time-consuming and expensive
402
Q

Crossover Study identifies

A

Causation

403
Q

Substances that increase Surfactant Synth

A

Cortisol

404
Q

Substances that Decrease Surfactant Synth

A

Insulin

*maternal DM –> fetal hyperglycemia –> increased insulin –> decreased surfactant –> NRDS

405
Q

Lecithin : Sphingomyelin Ratio

A

Used to determine maturity of fetal lungs
Lecithin and Sphingomyelin components of surfactant
[Lecithin] increases w maturity
[Sphingomyelin] stays constant
Ratio > 2 = mature lungs
Ratio < 2 = immature lungs

406
Q

Testicular artery branches from _____ and supplies _____

A

From aorta

Supplies Testes

407
Q

Pampiniform plexus drains into ____

A 
Testicular veins (R to IVC, L to L Renal vein)
Decreased drainage --> varicocele
L Renal Cancer can cause L varicocele
408
Q

Ovarian Arteries branch from ____

A

Aorta

409
Q

Ovarian Veins drain into _____

A

R to IVC, L to L Renal vein

Septic Pelvic Thrombophlebitis –> ovarian vein thrombosis

410
Q

JVP order of waves

A 
A-wave
C-wave
X-wave
V-wave
Y-wave
411
Q

JVP A-wave

A

Atrial contraction
Absent in a-fib
Peaked in pulmonary HTN or 3rd deg block

412
Q

JVP C-wave

A

Tricuspid Closure

413
Q

JVP X-wave

A

Atrial releaXation
Increased in a-fib
Increased in Tricuspid Regurg (IVDU, S.aureus)

414
Q

JVP V-wave

A 
Atrial Filling ("Villing")
Followed by Tricuspid Opening
415
Q

JVP Y-wave

A

Atrial emptYing
Increased in pulmonary HTN or 3rd deg block
Decreased in Tricuspid Regurg (IVDU, S.aureus)

416
Q

Eyes point to _____ in Frontal Eye Field lesions

A

Ipsilateral side to lesion

417
Q

Broca’s Area

A

Motor Speech

418
Q

Wernicke’s Area

A

Sensory Speech

419
Q

Functions of Angular Gyrus

A

Distinguishing L from R
Identifying fingers on the hand
Math
Writing

420
Q

Angular Gyrus lesion

A

Loss of function if dominant hemisphere (Gerstman’s Syndrome)
Hemispatial neglect if damaged in non-dominant hemisphere

421
Q

Superior Temporal Gyrus contains

A

Primary auditory cortex

Wernicke’s Area

422
Q

Uncus

A

Assoc w seizures

Can compress CN 3 during uncal herniation

423
Q

Fusiform Gyrus

A

In temporal lobe
Btw hippocampus and Inferior temporal gyrus
Facial recognition (prosopagnosia)

424
Q

Internal Capsule contains

A

Axons from Primary Motor Cortex

425
Q

Anterior 2/3 of Posterior Limb of Internal Capsule

A

Motor axons of Corticospinal Tract (CST)

426
Q

Posterior 1/3 of Posterior Limb of Internal Capsule

A

Sensory fibers of Thalamocortical Tract

427
Q

Genu of Internal Capsule

A

Motor fibers of Corticobulbar Tract

428
Q

Corynebacterium Diphtheria

A 
Resp infection
Primary virulence: toxin (acts locally)
Cervical lymphadenopathy
Pharyngeal exudates
Coalescing pseudomembrane
Complications: myocarditis, neuro toxicity
429
Q

Lithium toxicity

A 
Confusion, ataxia, neuromuscular excitability
Due to volume depeletion
Due to med interactions
-Thiazides
-ACE inhibitors
-NSAIDs
430
Q

Teriparatide

A 
Recombinant PTH analog
Increases osteoblast activity > osteoclasts
Net increase in bone formation
Increased bone resorption
Increased serum Ca
Increased URINE Phosphate EXCRETION
431
Q

Ethosuximide

A

1st line for absence seizures

Prevents neuronal burst firing of Thalamic T-Ca channels

432
Q

5 major causes of hypoxemia

A 
Alveolar Hypoventilation
Low partial pressure of inspired oxygen
Ventilation-Perfusion Mismatch
Diffusion Impairment
R to L shunting
433
Q

A-a gradient with:

  • Alveolar Hypoventilation
  • Low partial pressure of inspired oxygen
A

Normal

434
Q

Most common primary bone tumor in children and young adults

A 
Osteosarcoma
Arises near metaphases of long bones
Slowly worsening pain
Soft tissue swelling
Lytic bone lesions on XR
Biopsy: spindle-shaped cells that generate osteoid, thin trabecular of neoplastic bone
435
Q

Th2 cells release

A 
IL-4
Induces T cells --> Th2 cells
Promotes growth of B cells
Promotes IgE --> IgG
Aint Too (T cells) proud 2 (Th2) BEG (B, IgE, IgG) 4 (IL-4) work
436
Q

Th1 Cells release

A

IFN-y
Stimulates macrophages
Inhibits differentiation of Th2 cells
Activates NK cells

437
Q

IL-5

A

From macrophages
Promotes growth and diff of B cells
Enhances switching to IgA
Stimulates growth and diff of eosinophils

438
Q

IL-2

A

Stimulates growth of Th cells and Cytotoxic T cells

439
Q

IL-8

A

Main chemotactic factor for neutrophils

“clean up in aisle 8”

440
Q

TNFa

A

Activates endothelium and vascular leak

441
Q

IL-3

A

Supports growth and diff of stem cells in bone marrow

442
Q

IL-12

A

Induces differentiation

Activates NK cells

443
Q

IL-10

A

Modulates inflammatory response
Decreases MHC class 2 and Th1 cytokines
Inhibits macrophage and dendritic cells
Secreted by T reg and Th2 cells

444
Q

IL-1

A

Fever
Acute inflammation
Induces chemokine secretion

445
Q

IL-6

A

Fever

Stimulates APPs

446
Q

Arsenic poisoning

A

Garlic odor
SCC of skin, lung CA, liver angiocarcinoma
Tx: Dimercaprol

447
Q

Micturition center of the brain

A

Medial Frontal

Supplied by Anterior Cerebral Artery

448
Q

Must monitor _____ when treating a pt with Amiodarone

A 
LFTs (hepatotoxicity)
PFTs (pulmonary fibrosis)
TFTs (thyroid dysfunction bc contains iodine)
*other less common side effects:
-Corneal deposits
-Neuro probs
-Constipation
-Photosensitivity
-Blue-Gray Skin (iodine accumulation)
449
Q

Composition of bone

A

30% matrix (collagen, chondroitin sulfate, hyaluronic acid)
70% Crystalline salts (Ca, phosphate-hydroxyapatite)
Ions and metals conjugated to hydroxyapatite

450
Q

Potassium-Sparing Diuretics

A 
"Potassium takes a SEAT"
Spironolactone
Eplerenone
Amiloride
Triamterene
451
Q

Mechanism of
Spironolactone
Eplerenone

A

Aldosterone receptor antagonists in principle cells of collecting duct

452
Q

Mechanism of
Amiloride
Triamterene

A

Block Na Channels in principle cells of collecting duct

453
Q

Organization of Lateral CorticoSpinal Tract (LCST)

A

Arms are medial

Legs are lateral

454
Q

MHC I molecules are found

A

all nucleated cells

455
Q

MHC II molecules are found

A

only on APCs

456
Q

Gower Sign

A

Using arms to stand up
Proximal leg weakness
Seen in Muscular Dystrophy

457
Q

Cheyne-Stokes Respirations

A

Cycles of:

  • Apnea and hypercapnia
  • Hyperventilation and hypocapnia
458
Q

Dressler Syndrome

A

Pericarditis 2-4 weeks after MI

459
Q

Osmotic Demyelination Syndrome

A

Na corrected too quickly
Diplopia
Paralysis (locked-in syndrome)

460
Q

Nutmeg Liver

A

Hepatic congestion

  • R sided HF
  • Budd Chiari
461
Q

Prion Diseases

A

Crutzfeld-Jacob Disease
Bovine Spongiform Encephalopathy (mad cow)
Kuru

462
Q

Oral antibiotic to treat MRSA or VRE instead of IV vancomycin

A

Linezolid

463
Q

Beers Criteria

A

List of 50+ meds to avoid in geriatrics

  • Increased risk of side effects or
  • Decreased efficacy in elderly
464
Q

Branchial Cleft Cysts

A

Lateral neck

Do NOT move w swallowing

465
Q

Thyroglossal Duct Cysts

A

Midline Neck

MOVE w swallowing

466
Q

Pyramidal Lobe of thyroid

A

Persistant thyroglossal duct

467
Q

Chronic Granulomatous Disease

A

Poor O2 dependent killing
Lack NADPH Oxidase
Increased susceptibility to catalase + orgs (neutralize scrounged H2O2)

468
Q

Auspitz Sign

A

Bleeding spots when scales are scraped off

Indicative of psoriasis

469
Q

Lead poisoning

A 
Basophilic stippling
Wrist drop
Confusion
Blue gingiva
Tx: EDTA or Succimer
Tx kids w severe poisoning: Dimercaprol + Succimer
470
Q

Hepatic Ito/ Stellate Cells

A

In space of disse
Store fat, VitA
Produce matrix
Activated by damage to liver

471
Q

Hepatic Zone 1

A

1st in blood flow

Most affected by viral hepatitis

472
Q

Hepatic Zone 3

A 
Last in blood flow
Highest concentration of P450 enzymes
Most affected by:
-ischemia
-toxic metabolites bc metabolized from zone 1-2
473
Q

Hepatic Zone 2

A

Most prone to damage from yellow fever

474
Q

Hepatic blood flow

A

Zone 1-3

475
Q

Hepatic Bile Flow

A

Zone 3-1

476
Q

Spleen embryology

A

From dorsal mesentery of stomach
From mesoderm
Shares blood supply w stomach (endodermal)

477
Q

Pancreas Embryology

A

Derived from endoderm
Arises from Hepatic Diverticulum in ventral distal foregut
Dorsal pancreatic bud on dorsal foregut (body and tail, accessory duct)

478
Q

Hepatic Diverticulum gives rise to

A

Liver
GB and biliary tree
Ventral pancreatic bud –> head and main duct

479
Q

Glossitis

A

Beefy red tongue

VitB12/ Fe deficiency

480
Q

Vertical Nystagmus is specific to

A

Central vertigo

Vertical and horizontal together = PCP

481
Q

Kidney converts Calcidiol to

A

Calcitriol
In proximal tubule via 1-a-hydroxylase
Stimulated by PTH

482
Q

Dopamine in the Kidney

A 
Secreted in PCT
Promotes natriuresis
Dilates arterioles
Increases GFR
*at high doses acts as vasoconstrictor
483
Q

Side Effects of Loop Diuretics

A 
OHH DAANG
Ototoxicity (loop earrings hurt ears)
Hypokalemia
Hypomagnesemia
Dehydration
Allergy to sulfa
Alkalosis (metabolic)
Nephritis (interstitial)
Gout
484
Q

CD14

A

Present on macrophages
Recognizes PAMPs
Activation –> NF-kB

485
Q

PGE2 mediates

A

FEEEver

Pain

486
Q

LTB4 mediates

A

Chemotaxis of PMNs

Activation of PMNs

487
Q

LTC4
LTD4
LTE4

A

Mediate:

  • vasoconstriction
  • bronchospasm
  • vascular permeability
488
Q

Triggers of mast cell degranulation

A

C3a and C5a
Trauma
Cross-linking IgE surface Ag

489
Q

Hageman Factor

A

Proinflammatory protein
Made in liver
Activated upon exposure to subendothelial/ tissue collagen
Activates coagulation/ fibrinolytic systems, complement, Kinin system

490
Q

Mechanism of fever

A

Macrophages release IL-1 and TNFa
Increase COX activity in perivascular cells of hypothalamus
PGE2 raises temp set point

491
Q

Weibel-Palade Bodies

A

von Willebrand Factor
P-selectin
*mediated by histamine

492
Q

E-selectins are mediated by

A

IL-1

TNFa

493
Q

Selectins bind

A

Sialyl Lewis X on leukocytes

Results in rolling of leukocytes

494
Q

Leukocyte Adhesion Deficiency

A

Autosomal recessive

Defect of interns (CD18)

495
Q

Leukocyte Adhesion Deficiency Presentation

A

Delayed separation of umbilical cord
Increased circulating PMNs
Recurrent bacterial infections that lack pus

496
Q

Chediak-Higashi Syndrome

A

Autosomal recessive
Mutated Lysosomal Trafficking Regulator (LYST)
LYST required by granulocytes to make granules
PROTEIN TRAFFICKING defect
Microtubules not constructed properly
Impaired phagolysosome movement

497
Q

Chediak-Higashi Syndrome Presentation

A 
Increased pyogenic infections
Neutropenia
Giant granules in leukocytes
Defective hemostasis
No melanin transport --> Albinism
Peripheral neuropathy (no proteins to neurons)
498
Q

Nitroblue Tetrazolium Test

A

Screen for CGD
Blue: NADPH oxidase converts O2
Colorless: NADPH oxidase defect

499
Q

MPO deficiency

A

Defective H2O2 –> HOCl
Risk for Candida
Normal NBT test

500
Q

Defining characteristic of a granuloma

A

Epitheliod Histiocyte Accumulation (macrophages w abundant pink cytoplasm)

501
Q

Caseating granulomas

A

TB (AFB stain)

Fungus (GMS silver stain)

502
Q

Granuloma formation

A

Macrophages present MHC II to CD4 T cells
Secrete IL-12 to diff Th1
Th1 secretes IFNy which converts macrophages to epithelioid histiocytes

503
Q

Severe Combined Immunodeficiency (SCID)

A

Defective cell mediated and humoral immunity
Defective:
-Cytokine receptors
-Adenosine Deaminase (accumulated products toxic to lymphocytes)
-MHC II
Recurrent infections (inc opportunistic)

504
Q

SCID treatment

A

Sterile isolation
Stem cell transplant
Avoid live vaccines

505
Q

X-linked (Bruton) Agammaglobulinemia

A

Complete lack of Ig
Disordered B cell maturation
Naive B cells do NOT mature to plasma cells
Mutated Bruton Tyrosine Kinase

506
Q

Presentation of

X-linked (Bruton) Agammaglobulinemia

A

After 6 mo of life
Bacterial, Enterovirus, Giardia infection
Avoid live vaccines

507
Q

Common Variable Immunodeficiency (CVID)

A

Low Ig
B cell/ Th cell defects
Bacterial, Enterovirus, Giardia infections
Occurs late in childhood
Increased risk for autoimmunity and lymphoma

508
Q

Hyper-IgM Syndrome

A

No CD40 2nd signal
No cytokines produced for Ig class switch
Low IgA, IgG, IgE
Pyogenic and Mucosal infections

509
Q

Wiskott-Aldrich Syndrome Triad

A

Thrombocytopenia (bleeding)
Eczema
Recurrent infections (defective humoral and cellular immunity)

510
Q

Wiskott-Aldrich Syndrome Defect

A

Mutated WASP protein

X-linked

511
Q

C5-C9 deficiency increases risk for

A

Neisseria infections

512
Q

C1 inhibitor deficiency

A

Hereditary angioedema

513
Q

SLE

A 
Type II (cytotoxic)
Type III (Ag-Ab complex)
Death: Renal damage and infection
Diffuse proliferative glomerulonephritis
Cardiac, CNS, Joints, Blood cells, Rash
514
Q

Libman-Sacks Endocarditis

A

Sterile Vegetations on both sides of valves
Inflammatory activation in response to deposition
Assoc w Lupus
Result: mitral regurgitation

515
Q

Diagnosis of Lupus

A 
AntiNeutrophil Ab (ANA)
Anti-dsDNA (highly specific)
516
Q

Drug Induced Lupus

A

Anti-Histone Ab

  • Hydralazine
  • Procainamide
  • Isoniazid
  • remove drug cures
517
Q

Antiphospholipid Syndrome

A

Assoc w lupus
AutoAb against proteins bound to phospholipids
Anticardiolipin (false VRDL) and Lupus Anticoagulant (false PTT elevation, hyper coagulable, lifelong anticoagulation) are most common

518
Q

Sjogren Syndrome

A

Autoimmune destruction of lacrimal and salivary glands
Type 4 hypersensitivity with fibrosis
Dry eyes and mouth

519
Q

Diagnosing Sjogren Syndrome

A 
AntiNeutrophil Ab (ANA)
ANITRIBONUCLEOPROTEIN Ab (Anti-SS-A, Anti-SS-B)
520
Q

Sjogren Syndrome increases risk for

A

B cell Lymphoma

*unilateral enlargement of parotid late in disease

521
Q

Scleroderma

A

Autoimmune tissue damage
Activation of fibroblasts
Deposition of collagen (fibrosis)
Diffuse or localized

522
Q

Diffuse Scleroderma

A

Skin and early visceral involvement
Esophagus commonly affected
ANA and Anti-DNA topoisomerase I (Scl-70) Ab

523
Q

Localized Scleroderma

A

Skin and late visceral involvement

CREST Syndrome

524
Q

CREST Syndrome

A 
Calcinosis/ anti-Centromere Ab
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasias
525
Q

Mixed Connective Tissue Disease

A

Lupus, Systemic Sclerosis, Polymyositis

Ab against U1 Ribonucleoprotein

526
Q

Alkylating agents increase risk for

A

Leukemia/ Lymphoma

*side effect of chemotherapy

527
Q

Nitrosamines increase risk of

A

Stomach carcinoma (intestinal)

  • smoked foods
  • Japan
528
Q

Naphthlamine increases risk for

A 
Urothelial carcinoma (bladder)
*cigarette smoke
529
Q

Vinyl Chloride increases risk for

A 
Angiosarcoma of liver
Occupational exposure (PVC)
530
Q

Polycyclic hydrocarbons

A

In cigarette smoke

Highly carcinogenic

531
Q

Oncogenic Viruses

A

EBV (nasopharyngeal, Burkett, CNS lymphoma)
HHV-8 (kaposi)
HBV and HCV
HPV

532
Q

Ionizing radiation

A 
AML
CML
Papillary carcinoma of thyroid
Generates hydroxyl free radicals
*Nuclear reactors and radiotherapy
533
Q

Non-ionizing radiation

A 
UVB (most common)
BCC
SCC
Melanoma
Pyrimidine dimer nicks in DNA normally excised by endonuclease
534
Q

PDGF-B over expression leads to

A

Astrocytoma

535
Q

ERBB2 (HER2/ neu) receptor is blocked by

A

Trastuzumab
Disrupts cell signaling and encourages apoptosis
HER2 preserves cardiomyocytes
Trastuzumab can be cardiotoxic

536
Q

KIT Growth Factor receptor mutation leads to

A

GI stromal tumor

537
Q

c-myc
N-myc
L-myc

A

Nuclear regulators of transcription

538
Q

c-myc mutation

A

t(8,14) of Ig Heavy Chain
c-myc overexpression (transcription activator)
Burkitt lymphoma “starry sky”
Aggressive

539
Q

N-myc amplification mutation leads to

A

Neuroblastoma

*N = neuroblastoma

540
Q

L-myc amplification leads to

A

Small cell lung carcinoma

*L = lung

541
Q

Cyclin D is associated with

A

t(11,14) of Ig Heavy chain
Overexpression allows unregulated progression G1 –> S Phase
Mantle cell lymphoma (next to node follicle)

542
Q

CDK4 amplification mutation is associated with

A

Melanoma

543
Q

S-100 staining

A

Melanoma

544
Q

Seeding of body cavities

“omental caking” is characteristic of

A

Ovarian Carcinoma

545
Q

Vessel injury immediate response

A

Vasoconstriction
Mediated by:
-Endothelin
-Nervous system

546
Q

ITP

A 
Autoimmune IgG against platelet Ag (GpIIb/IIIa)
Ab produced by plasma cells in spleen
Thrombocytopenia (platelets consumed)
PT/PTT normal
Increased magakaryocytes
547
Q

Acute form ITP

A

In children
After virus or immunization
Self-limited

548
Q

Chronic form ITP

A

Adults (women child bearing age)
Thrombocytopenia in offspring
Anti-platelet IgG crosses placenta
Assoc w lupus

549
Q

Treatment of ITP

A 
Corticosteroids
Children respond well
Adults have early response and often relapse
IVIg
Splenectomy (source of Ab)
550
Q

Labs of TTP and HUS

A 
Thrombocytopenia
Increased bleeding time
Normal PT/PTT
Anemia w Schistocytes
Increased megakaryocytes
551
Q

Treatment of TTP

A

Plasmaphoresis (remove auto-Ab)

Corticosteroids

552
Q

Bernard-Soulier Syndrome

A 
Genetic GP1b deficiency
Impaired platelet adhesion to vWF
Thrombocytopenia
Enlarged platelets (immature)
B.S = big suckers
553
Q

Glanzmann Thrombasthenia

A

Genetic GIIb/IIIa deficiency
Impaired platelet aggregation
No fibrinogen linking

554
Q

Uremia disrupts platelet function

A

Both adhesion and aggregation

555
Q

Clinical features of Secondary Hemostasis Pathology

A

Deep tissue bleeding into muscles and joints

Rebleeding after surgical procedures

556
Q

PT measures

A

Extrinsic and Common Pathways
Coumadin/ Warfarin Effect
Effect of liver failure on coagulation

557
Q

PTT measures

A

Intrinsic and Common Pathways

Heparin effect

558
Q

_____ activates factor 12

A

Subendothelial Collagen

559
Q

_____ activates factor 7

A

Tissue Thromboplastin

560
Q

Coagulation Factor Inhibitor Disorder

A

Ab against coagulation factor
Anti-FVIII most common
PTT does NOT correct w mixing study (w normal plasma, PTT will correct in hemophilia A)
Ab binds added normal factor 8

561
Q

Most common inherited coagulation disorder

A

Von Willebrand Deficiency

AutoDOM

562
Q

Lab findings of vWF disorder

A

Increased bleeding time
Increased PTT (vWF stabilizes factor 8, subclinical)
Normal PT
Abn ristocetin test

563
Q

Treatment of vWF disease

A

Desmopressin

Increases vWF release from Weibel-Palade bodies

564
Q

Vitamin K Deficiency

A

Disrupts y-carboxylation of factors 2, 7, 9, 10, C, and S
Newborns
Long-term ABX
Malabsorption of fat soluble vits

565
Q

Vitamin K is activated by

A

Epoxide Reductase (liver)

566
Q

Mechanism of Coumadin/ Warfarin

A

Inhibition of epoxide reductase

No activation of Vitamin K

567
Q

Heparin-Induced Thrombocytopenia (HIT)

A

Hep-PF4 Complex destroyed in spleen

Platelet fragments activate remaining platelets –> thrombosis

568
Q

DIC

A

Inappropriate activation of coagulation cascade

Consumption of platelets and factors –> bleeding

569
Q

Lab findings in DIC

A 
Decreased platelets (consumed)
Increased PT/PTT
Decreased fibrinogen (consumption)
Microangiopathic hemolytic anemia
Elevated d-dimer
570
Q

Treatment of DIC

A

Treat underlying cause
Blood products
Cryoprecipitate

571
Q

tPA converts

A

Plasminogen –> plasmin

Which then lyses fibrin and serum fibrinogen

572
Q

Molecule that inactivates plasmin

A

a2-antiplasmin

*reduced production in cirrhosis

573
Q

Complication of radical prostatectomy

A

Release of urokinase activates plasmin –> bleeding

574
Q

Lab findings in disorders of Fibrinolysis

A

Increased bleeding time (plasmin inhibits aggregation)
Normal platelet count (low in DIC)
Increased PT/PTT (plasmin cleaves coag factors)
Increased fibrin split products WITHOUT d-dimer (clot never formed)

575
Q

Treatment of fibrinolysis disorders

A

Aminocaproic acid
Blocks activation of plasminogen
No plasmin formation

576
Q

Cartilage is made of type _____ collagen

A

2

577
Q

Rheumatoid Arthritis is associated with HLA_____

A

HLA-DR4

*and IgM against Fc portion of IgG (RF)

578
Q

Complication of Rheumatoid Arthritis

A

Secondary Amyloidosis

Chronic inflammation–> SAA –> AA

579
Q

Ankylosing Spondyloarthritis

A 
SI joints and spine
Young males
LBP
Fusion of vertebrae (bamboo spine)
Uveitis and Aortitis
HLA-B27
580
Q

Reiter Syndrome

A

Arthritis, Urethritis, Conjunctivitis (see, pee, climb tree)
Young males
Weeks after GI or Chlamydia infection

581
Q

Most common bugs of septic arthritis

A

N. gonorrhoeae

S.aureus

582
Q

Glioblastoma

A 
Aggressive brain tumor
Gradual HA, seizure, neuro probs
Assoc w mutated Epidermal Growth Factor
CAN cross midline (butterfly glioma)
Typically located in hemispheres
583
Q

Lab findings in Lactose Intolerance

A

Increased breath hydrogen
Reduced stool pH (acidic)
Elevated stool osmolality

584
Q

Treatment for Trigeminal Neuralgia

A

Carbamazepine

585
Q

Pancreatic Islet Amyloid Deposition

A

T2DM
HLA Class II
Leukocyte infiltration of islet (insulitis)
Ab against islet Ag in T1DM

586
Q

Vitiligo

A

Loss of melanocytes
Common w autoimmune disorders
Patches of hypopigmentation

587
Q

Mechanism of tocolysis (inhibition of uterine contraction) medications

A

B2 adrenergic stimulation

588
Q

Mechanism of Methotrexate and 5-FU

A

Inhibition of thymidylate formation

*methotrexate is overcome by N-Formyl-THF supplement

589
Q

Inhibin B is produced by

A

Granulosa cells

590
Q

BRCA genes encode for

A

dsDNA repair proteins

591
Q

Mechanism of Mifepristone

A

Inhibition of progesterone receptors

592
Q

Aromatase

A

Expressed in granulosa cells

Converts things to estrogens

593
Q

Mesonephric (Wolffian) Duct develops into

A 
SEED
Seminal vesicles
Epididymis
Ejaculatory duct
Ductus deferens
594
Q

PID complications

A

Ectopic

Fitz-Hugh-Curtis (liver capsule inflammation)

595
Q

Choriocarcinoma

A

Cytotrophoblasts and syncytiotrophoblasts WITHOUT chorionic villi
Develops after complete moles, abortion, pregnancy
Highly vascular and invasive
Round lung opacities
+ urine preg test

596
Q

HPV infection –> E7 production –> Inhibited Rb –>

A

E2F transcription factors promote G1 –> S phase are inhibited by Rb
Increasing G1 to S transition
E6 binds and inactivates p53

597
Q

Breastmilk becoming thinner and whiter after delivery is due to

A

Decreased progesterone

598
Q

Adenomyosis

A

Endometrial tissue within uterine wall
Menorrhagia and dysmenorrhea
More common in multiparous women

599
Q

Acute Stress Disorder

timeline

A

3 days to 1 month

600
Q

Malignant Hyperthermia

A 
Anesthetics (succs, gasses)
Unregulated passage of Ca from SR into cell
Sustained muscle contraction
Hypercarbia
Hyperthermia
Acidosis
601
Q

N. mengitidis vaccine

A 
Ab against polysaccharide capsule
Quadrivalent (ACYW)
Recombinant proteins (B)
602
Q

Elevated Alk Phos should be followed up by _____ test to determine if bone or biliary tract

A

y- glutamyl transferase (GGTP)

*not present in bone

603
Q

Non-selective B-Blockers can exacerbate _____

A

Hypoglycemia

and mask hypoglycemic symptoms mediated by NE/Epi

604
Q

Gloms Tumor (glomangioma)

A

Benign
Small and tender
Red-blue lesion under nail bed
Originates from smooth muscle cells that control thermoregulatory functions of dermal gloms bodies

605
Q

Adverse Effects of

Theophylline

A

Seizures (death)

Tachyarrhythmias

606
Q

Mechanism of Etoposide

A

Chemotherapy
Inhibits sealing activity of Topoisomerase II
Chromosomal breaks accumulate in dividing cells

607
Q

Alkaptonuria

A

Autosomal recessive
Deficiency of homogentisic acid dioxygenase (tyrosine metabolism)
Excess homogentisic acid
Diffuse blue-black deposits in connective tissues
Sclera and Ear Cartilage hyperpigmentation
Osteoarthropathy of spine and Lg joints

608
Q

Capecitabine

A

Metabolized to 5FU

609
Q

Nucleus pulposus is rich in type _____ collagen

A

Type II collagen

610
Q

The lens of the eye is rich in type _____ collagen

A

Type IV collagen

611
Q

Reticular fibers (skin, vessels, uterus) are abundant in type _____ collagen

A

Type III collagen
Produced by myofibroblasts
Same cells responsible for wound contraction

612
Q

Reportable Diseases

A 
HepA / HepB
Syphilis
Gonorrhea
MMR
Tuberculosis
Salmonellosis
Shigellosis
E.Coli (think food outbreaks)
AIDS (not HIV)
Varicella
Meningitis
613
Q

What classifies one as an emancipated minor?

A 
Homeless
Parent (i.e. 16yo mother)
Married
Military
Finically independent
High School Graduate
614
Q

What medical circumstances do minor not need parental consent?

A

emergency care
STIs
substance abuse
prenatal care

615
Q

How long does a physician have to release records when requested by a patient?

A

30 days

616
Q

Competency vs Capacity

A

Competency= legal definition
Capacity= medical definition
Both refer to ability to make decisions on their own

617
Q

2 components of an advance directive

A
  1. Living will

2. Durable power of attorney

618
Q

Power of attorney disagrees with the patients living will

A

Living will must ultimately be honored
Meet with family and discuss
Providing supportive care and review living will
If conflicts arise consult ethics committee

619
Q

Fidelity

A

Loyalty and/or promise-keeping

Duty to be loyal or keep promises

620
Q

Vicarious liability

“respondeat superior”

A

Strict, secondary liability
“respondeat superior” - the responsibility of the superior (or any 3rd party that has a duty to control) for the acts of their subordinate
Employer responsible for employee actions

621
Q

3 types of torts

A
  • intentional torts
  • negligence
  • strict liability
622
Q

EMTALA

A

Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay

623
Q

Requirements of EMTALA

A
  1. Examination and treatment cannot be denied or delayed to inquire about payment. Must post patient rights
  2. If emergency exists, treatment must be provided until stabilized.
  3. Hospitals with specialized capabilities are obligated to accept transfers from hospitals who lack the capability
  4. Must report any time it has received an individual who has been transferred in an unstable emergency medical condition from another hospital violating EMTALA
624
Q

ERISA

A

The Employee Retirement Income Security Act of 1974

Protection for individuals within retirement and health plans

625
Q

NMHPA

A

Newborns’ and Mothers’ Health Protection Act of 1996
Length of time a mother and newborn child are covered for a hospital stay in connection with childbirth
No less than 48 hours following a vaginal delivery or
96 hours following a delivery by cesarean section

626
Q

Res ipsa loquitur

A

“scalpel left behind”

No explanation required to show surgeon was negligent

627
Q

Drug Trials

A 
Phase I safety 
Phase II involves subjects with disease 
Phase III large scale testing 
Phase IV post release surveillance 
Phase V long term data
628
Q

Healthcare Integrity and Protection Data Bank (HIPDB)

A

Government program that the collects and discloses users negative information on health care practitioners, including malpractice awards, loss of license or exclusion from participation in Medicare or Medicaid

629
Q

Medicare Part A

A

Hospital Insurance
Hospital, SNF, home health, hospice
Free if paid SS for 10 yrs

630
Q

Medicare Part B

A

Medical Insurance
Doctors visits, Preventative, Equipment, Outpatient, Labs, XR, mental health, ambulance
Monthly premium charged

631
Q

Medicare Part C

A

Allows private health insurance companies to provide Medicare benefits
Medicare Advantage plans

632
Q

Medicare Part D

A

Outpatient Prescription Drug Coverage

Provided only through private insurance companies w government contracts

633
Q

Informed consent

A
  • Diagnosis
  • Risks and Benefits
  • Alternative Treatments
634
Q

tort of negligence

A

4 D’s

  • Duty owed
  • Duty Breached
  • Damage to patient
  • Direct causation
635
Q

Fibromuscluar Dysplasia

A 
Developmental defect of vessel wall
Thickening of md-lg arteries (renal)
Young females
Fibromuscular webs
Noninflammatory, Nonatherosclerotic
Alternating luminal stenosis and aneurysmal dilation (string of beads)
Loss of elastic lamina
Resistant HTN 
Can involve CNS
636
Q

Atherosclerosis

A 
Intima affected
Md-Lg vessels
Plaque obstructs flow
Necrotic lipid core
Fibromuscluar cap
Calcification
637
Q

Arteriolosclerosis

A

Sm vessels
Thickening of wall
Hyperplastic or Hyaline

638
Q

Monckeberg Medial Sclerosis

A

Calcification of the media
Vascular pattern on XR
Non-obstructive
Subclinical

639
Q

Typically require _____% blood vessel blockage before symptoms

A

70%

640
Q

Hyaline ArterioloSclerosis is caused by

A

Benign HTN

Diabetes (NEG–> leakage of proteins)

641
Q

Hyperplastic Arteriolosclerosis is caused by

A

Malignant HTN

Onion-skinning appearance

642
Q

Most common complication of Aortic Dissection and cause of death

A

Pericardial Tamponade

643
Q

Indicators of thrombus occurring before death

A

Lines of Zahn (RBC-fibrin-RBC-fibrin…)

Attachment to vessel wall

644
Q

ATIII deficiency _____ cause a rise in PTT during Heparin administration

A

Will NOT
Limited ATIII to activate
Give coumadin to maintain anticoagulation

645
Q

Caisson Disease

A

Chronic decompression sickness

Gas emboli causes multifocal ischemic necrosis of bone

646
Q

Amniotic Fluid embolus can cause DIC

A

Amniotic fluid rich in thromboplastin
Activates coagulation cascade
Embolus contains fetal squamous cells and keratin debris

647
Q

A-a Gradient

A

PAlveoli O2 - Parteries O2

Normal 5-15 mmHg

648
Q

Causes of Hypoxemia (low PaO2) without increased A-a Gradient

A

Hypoventilation

High Altitude

649
Q

Right Shift of Hb Dissociation Curve

A 
*need O2 now, taut form*
Heat
H+
CO2
High Altitude
2,3 BPG
650
Q

Left Shift of Hb Dissociation Curve

A 
*bind O2, relaxed form*
Low CO2
Low H+
Cold temp
Low 2,3 BPG
651
Q

Inflammatory Bowel Disease (IBD)

A

Chronic, Relapsing
Abn immune response to flora
Bloody diarrhea
Includes UC and Crohns

652
Q

Ulcerative Colitis

A 
Mucosal and submucosal ulcers
Begins at rectum (LLQ)
Extends to any level up to cecum
CRYPT ABSCESSES
Lead pipe appearance
Toxic megacolon and Carcinoma
*smoking protects against UC
653
Q

Ulcerative Colitis is associated with

A

Primary Sclerosing Cholangitis
and
p-ANCA

654
Q

Crohn’s Disease

A 
Full thickness inflammation
Knife-like fissures
Mouth to Anus
Skip lesions
Terminal ileum most common (RLQ)
Rectum least common
LYMPHOID GRANULOMAS
Cobblestoning
Creeping fat and Strictures (string sign)
*smoking increases risk of Crohn's
655
Q

Crohn’s Disease is associated with

A 
Malabsorption
Ca Oxalate stones
Fistulas
Carcinoma (if colon involved)
Ankylosing spondylitis
Migratory polyarthritis
Uveitis
Erythema nodosum
656
Q

0-4 hours after MI

A

No visible change

657
Q

4-12 hours after MI

A

Wavy fibers

Narrow, Elongated myocytes

658
Q

12-24 hours after MI

A

Myocyte hypereosinophilia w pyknotic (shrunken) nuclei

659
Q

1-3 days after MI

A 
Coagulation necrosis (loss of nuclei and striations)
Prominent neutrophilic infiltrate
660
Q

3-7 days after MI

A

Disintegration of dead neutrophils and myofibers

Macrophage infiltration at border

661
Q

7-10 days after MI

A

Robust phagocytosis by macrophages

Beginning of granulation tissue at margins

662
Q

10-14 days after MI

A

Well-developed granulation tissue w neovascularization

663
Q

2 weeks - 2 months after MI

A

Progressive collagen deposition and scar formation

664
Q

Mechanism of metformin

A

Inhibits mitochondrial glycerophosphate dehydrogenase and complex I
Upregulates AMP-activated protein kinase

665
Q

Effects of metformin

A

Decreased hepatic glucose production
Decreased intestinal glucose absorption
Increased peripheral glucose uptake
Decreased lipogenesis

666
Q

Side effects of Metformin

A

Diarrhea
Lactic acidosis
Vit B12 deficiency

667
Q

Anticoagulation for Preggos

A

Heparins do NOT cross placenta

Enoxaparin (LMWH)

668
Q

Treatment of Acute Simple Cystitis

A

Nitrofurantoin or

TMP-SMX

669
Q

Warfarin blocks _____

A

Epoxide Reductase
Lowers reduced VitK
Prevents y-carboxylation of VitK dependent clotting (2, 7, 9, 10)
Only blocks generation of new clotting factors
Effect is delayed 3-5 days until existing clotting factors are consumed

670
Q

Treatment for CMV Colitis and Retinitis

A

Ganciclovir
Blocks viral DNA polymerase (lesser extent host too)
Hematologic side effects (neutropenia, anemia, thrombocytopenia)

671
Q

Whipple disease

A

Tropheryma whippelii
Systemic illness involving Sm Intestine, Joints, CNS
Enlarged, Foamy Macrophages packed w:
-bacilli
-PAS +
-Diastase resistant granules
*CAN of whipped cream: cardiac, arthopathy, neuro

672
Q

_____ are earliest and most sensitive nutrient affected in malabsorption

A

Fats

Test w Assay of Stool w Sudan III Stain (IDs unabsorbed fat)

673
Q

Pathogenesis of Wilson Disease

A

Autosomal recessive
Mutated ATP7B
Hepatic Cu accumulation leaks out
Deposits in tissues

674
Q

Diagnosis of Wilson Disease

A

Decreased Ceruloplasmin
Increased urinary copper excretion
Kayser Fleischer rings
Increased Cu on liver biopsy

675
Q

Treatment of Wilson Disease

A

Chelators (D-penicillamine, Trientine)

Zinc (interferes w copper absorption)

676
Q

Microscope findings of Herpes Zoster (shingles)

A

Intranuclear inclusions in Keratinocytes

Multinucleated giant cells

677
Q

Acute Myeloblastic Leukemia (AML)

Microscope findings and Mutation

A 
Auer rods (eosinophilic intracytoplasm rods)
t(15,17)
678
Q

Hematologic malignancy or rapid cell turnover increases risk for _____ after cytotoxic chemotherapy

A

Electrolyte abnormalities

  • Hyperphosphatemia
  • Hyperkalemia
  • Elevated LDH
679
Q

Mechanism of Digoxin

A 
Rate control in Afib
Positive Inotrope in Heart Failure
Decreased AV node conduction
Increases Vagal tone
Inhibition of Na-K ATPase Pump
680
Q

Eosinophilic Esophagitis

A

Chronic Th2 mediated d/o
Triggered by food Ag
Eosinophilic infiltration of esophageal mucosa
M > f
More common w hx of atopic conditions
Dysphagia, Reflux, Vomiiting, Pain, Food Impaction

681
Q

Streptococcus gallolyticus (S.bovis)

A

Endocarditis and Bacteremia
Assoc w GI lesions (colon CA)
If detected in blood culture, must workup for colon CA

682
Q

Primary routes of elimination of

Senescent Ceruloplasmin and Unabsorbed Cu

A

Secreted into bile

Excreted in stool

683
Q

Achondroplasia

A 
Impaired cartilage proliferation at growth plate
Activating mutation of FGFR3
AutoDOM or Adv paternal age
Most commonly sporadic
Short extremities
Normal head and chest
Dwarfism
684
Q

Osteopetrosis

A

Thick heavy bone
Inherited defective bone resorption
Prone to fractures
Poor osteoclast function
Carbonic Anhydrase II mutation
Lack of acidic environment for resorption
Anemia, Thrombocytopenia, Leukocytopenia
Extramedullary hematopoiesis
Vision and Hearing impaired (compress CNs)
Hydrocephalus
Renal Tubular Acidosis (carbonic anhydrase deficiency)

685
Q

Treatment for Osteopetrosis

A

Bone marrow transplant

686
Q

Rickets

A 
Defective osteoid mineralization
Low VitD in children
Pigeon Breast Deformity
Frontal Bossing
Leg bowing (w devo of walking)
Rachitic Rosary (deposition of osteoid at costochondrial junction)
687
Q

Osteomalacia

A 
Defective osteoid mineralization
Low VitD in adults
Weak bone, Increased fractures
Decreased Ca and Phosphate
Increased PTH and Alk Phos
688
Q

Alkaline Phosphatase is present whenever _____

A

There is activation of osteoBLASTS

Alkaline environment allows calcification of osteoid

689
Q

Labs in Osteoporosis (Ca, Phosphate, PTH, AlkPhos)

A

All normal

690
Q

Labs in Osteogenesis deformans (Paget Disease)

A

Isolated elevated AlkPhos

691
Q

Treatment for Osteogenesis Deformans (Paget Disease)

A

Calcitonin (opposite of PTH)

Bisphosphonates

692
Q

Complications of Osteogenesis Deformans (Paget Disease)

A

High Output Cardiac Failure (bone remodeling –> AV shunts –> increased work)
Osteosarcoma

693
Q

Osteomyelitis affects _____ in children

A

Metaphysis

694
Q

Osteomyelitis affects _____ in adults

A

Epiphysis

695
Q

Vaginal Adenosis

A

Persistence of columnar epithelium in upper 1/3 of vagina

In utero exposure to DES

696
Q

Clear Cell Adenocarcinoma

A

Malignant proliferation of glands w clear cytoplasm

Complication of DES vag adenosis

697
Q

Embryonal Rhabdomyosarcoma

A

Malignant proliferation of immature skeletal muscle

Grape-like mass protruding from vagina or penis

698
Q

Microscopy of Embryonal Rhabdomyosarcoma

A

Rhabdomyoblasts have:

  • cytoplasmic cross striations
  • Positive staining for destin and myoglobin
699
Q

MaLLory- Weiss

A 
Longitudinal Lacerations of GE junction
Alcoholics, Bulemics
Failed relaxation of LES
Caused by increased abd pressure
Mucosa and submucosa only
700
Q

PLUMmer-Vinson

A

PLUMber DIES
Triad of Dysphagia, Iron deficiency anemia, Esophageal webs, increased risk Squamous cell carcinoma
May be assoc w glossitis

701
Q

Pancreatitis _____ levels of fecal elastase

A

Decreases

702
Q

Ribosome biogenesis occurs within the _____

A

Nucleolus

703
Q

Caseating granulomas of TB are almost always

A

Surrounded by Lg epithelioid macrophages
Pale pink granular cytoplasm
CD14 surface marker

704
Q

Leptin

A

Produced by adipocytes (proportionally)
Acts on arcuate nucleus of hypothalamus
Inhibits Neuropeptide Y (decreases appetite)
Stimulates a-MSH (increases satiety)
Mutations result in hyperphagia and obesity

705
Q

Most common cause of bloody nipple discharge

A

Intraductal Papilloma

Papillary cells w fibrovascular core

706
Q

Most common side effects of ADHD meds

A

Decreased appetite

Insomnia

707
Q

The _____ gives rise to the glomeruli, Bowman’s space, proximal tubules, loop of Henle, and DCTs

A

Metanephros (metanephric blastema)

708
Q

The ____ becomes the collecting system of the kidney, major and minor calyces, renal pelvis, and ureters

A

Ureteric Bud

709
Q

Trichrome Stain identifies

A

Collagen

710
Q

Chronic Kidney disease can cause hyperphosphatemia

A

Decreased renal excretion of phosphorus
Dietary phosphorus restriction or
Oral phosphate binders (Sevelamer)

711
Q

Zinc-finger motifs

A

Chains of AA bound around Zn atom via linkages w Cysteine and Histidine
Recognize DNA sequences
Alter activity of target genes
Affect Steroids, Thyroid hormone, Fat-Soluble Vits

712
Q

Mechanism of ADHD meds

A

Stimulants

Increase availability of NE and DA in prefrontal cortex

713
Q

Chvostek Sign

A

Facial muscle spasm

Indicates hypocalcemia

714
Q

Trousseau sign

A

Carpopedal spasm

Indicates hypocalcemia

715
Q

Iron absorption takes place in the

A

Duodenum and Proximal jejunum
Gastric bypass can result in:
-iron deficiency anemia
-malabsorption of VitB12, folate, VitADEK, Ca

716
Q

Function of Type II pneumocytes

A

Regeneration of alveolar lining following injury

Surfactant production

717
Q

DNA binding proteins

A

Transcription factors (myc, CREB)
Steroid receptors (cortisol, aldosterone, progesterone)
Thyroid hormone receptor
Fat-Soluble Vitamin receptors (VitD, retinoid acid)
DNA transcription and replication proteins

718
Q

Adverse Effects of Clomiphene

A

Hot flashes
Ovarian enlargement
Multiple pregnancy
Visual disturbances

719
Q

TamoxifEN

A

Estrogen antagonist at breast and uterus
Agonist at bone
Increased risk of T–> Thrombus, EN–> endometrial CA
Prevents recurrence of ER/PR + BCA

720
Q

Raloxifene

A 
Estrogen antagonist at breast and uterus
Agonist at bone
Risk of thrombosis
NO RISK of endometrial CA
Treats osteoporosis
721
Q

Pheochromocytoma

A

Tumor of adrenal medulla
Derived from chromatin cells (neural crest)
Secrete catecholamines and EPO
Relapses and remits

722
Q

Treatment for PHEochromocytoma

A

PHEnoxybenzamine
Irreversible a-agonist first to avoid hypertensive crisis
*follow w B-blockers

723
Q

Diagnostic Features of subarachnoid bleed

A

Rupture of aneurysm

Bloody/ yellow LP

724
Q

Straddle injury

A 
Affects anterior (bulbar) urethra
Blood in scrotum
725
Q

Pelvic Fracture

A

Affects (membranous) urethra
Blood in retropubic space and up abdomen
Prostate pushed superiorly and feels boggy

726
Q

_____ tend to be resistant to outliers

A

Modes

727
Q

Acute Intermittent Porphyria

A 
Defective Porphobilinogen Deaminase
Abd pain, neuropathy, psych
Increased Ur Porphobilinogen
Defective heme synth
Toxic heme precursors accumulate
728
Q

Neruofibromatosis 1

A 
Mutated NF1 (ch17)
Neurofibromas
Cafe-au-lait spots
Pheochromocytomas
Optic gliomas
Pigmented iris hamartomas
729
Q

Von Hippel Landeau Disease

A 
Inactivation of VHL gene (ch3)
Renal Cell Carcinomas
AutoDOM
Pheochromocytomas
Hemangioblastomas (cerebellum)
730
Q

Duchenne Muscular Dystrophy

A 
X-linked recessive
Mutated dystrophin
Progressive weakness
Low-Proximal to Upper-distal
Dilated cardiomyopathy
Elevated CK
731
Q

Becker Muscular Dystrophy

A 
X-linked Recessive
Mutated dystrophin
Progressive weakness
Low-Proximal to Upper-distal
Dilated cardiomyopathy
Elevated CK
732
Q

Dystrophin

A

Found in muscle

Anchors actin to ECM

733
Q

Calf Pseudohypertrophy

A

Seen in dystrophies
Connective and Adipose tissue replace muscle
Enlarged appearing muscles

734
Q

Cystic Fibrosis

A 
Autosomal recessive
Deletion of Phe508
Impaired glycosylation and folding of CFTR gene
Mutated ATP gated Cl channel
No Cl secreted in GI and lungs
No Cl reabsorbed in sweat glands
735
Q

Clearance Equation

A

C= UV/P

U= ur concentration
V= ur volume/time
P= plasma concentration
736
Q

Renal Plasma Flow Equation

A

RPF = MAP / RVR
or
RPF = Cpah

RVR= renal vascular resistance

737
Q

MAP equation

A

MAP = CO x TPR

738
Q

Cpah

Clearance of PAH

A

Upah x V / Ppah

  • approximates Renal Plasma Flow (RPF)
  • PAH is freely filtered, actively secreted, and NOT absorbed
739
Q

Renal Blood Flow Equation

A

RBF = RPF / (1-hct)

740
Q

GFR Equations

A 
GFR= Uinulin x V / Pinulin
GFR= Ucr x V / Pcr
GFR= Kf [(Pgc-Pbs)-(OPgc-OPbs)]
  • same as clearance equation
  • Inulin freely filtered, NOT secreted or absorbed
  • Creatinine less accurate but endogenous
741
Q

Creatinine slightly _____ estimates GFR

A

Overestimates

*Small portion is secreted into nephron

742
Q

Filtration Fraction Equation

A

FF= GFR/ RPF

743
Q

Filtered Load or
Filtration Rate
Equation

A

FL= GFR x [plasma]

744
Q

Excretion Rate Equation

A

Excretion= Filtered Load - Net Reabsorption Rate

Net Reabsorption = Reabsorption - Secretion

745
Q

Fractional Excretion Equation

A

FEna = Excreted/ Filtered

746
Q

Henderson-Hasselbalch

Equation

A

pH= 6.1 + log [HCO3] / (0.03 x PCO2)

747
Q

Anion Gap Equation

A

AG= Na - (Cl + HCO3)

748
Q

Winters Formula

A

PCO2= 1.5 [HCO3] + 8 +/- 2

749
Q

Renal Tubular Acidosis-

Type I

A 
No Acid Secretion
Defective a-intercalated cells in Collecting Duct
Increased Ur pH (CaPO4 stones)
Serum pH acidic
HypoKalemia
750
Q

Renal Tubular Acidosis-

Type II

A

No Basolateral Bicarb Reabsorption
Acidic urine
Serum pH acidic
Caused by Fanconi or CA inhibitors

751
Q

Renal Tubular Acidosis-

Type IV

A

Hypoaldosteronism/ Aldosterone Resistance
HyperKalemia
Serum pH acidic
Ur pH acidic (decreased NH3 synth)

752
Q

Fanconi Syndrome

A

Proximal Tubule doesn’t reabsorb

Cause of Type II RTA

753
Q

Lactate is essential for the regeneration of NAD+ for _____

A

glyceraldehyde-3-phosphate dehydrogenase

Catalyzes glyceraldehyde-3-phosphate –> 1,3-bisphosphoglycerate

754
Q

Atracurium is a unique anesthetic in that it _____

A

Has organ independent elimination

Primarily enzymatic hydrolysis

755
Q

Hodgkin Lymphoma

A

Cervical LAD
B-Symptoms
HyperCa (paraneoplastic production of 1,25-VitD)
CD15/CD30 +
Reed-Sternberg Cells (owl eyes, bilobed nuclei)

756
Q

Kawasaki Disease

A 
Med vessel vasculitis (cardiac)
CRASH and BURN (fever)
Conjunctivitis
Rash
Adenopathy (cervical)
Strawberry tongue
Hands/Feet (desquamation)
757
Q

Treatment of Kawasaki Disease

A

ASA (decrease clots, inflammation)

IVIG

758
Q

Temporal Arteritis

A

Lg vessel vasculitis (temporal, ophthalmic)
aka Giant Cell Arteritis
Immune complex deposition
Joint pains
Headache and eye symptoms
Biopsy: segmental damage, granulomas, fibrosis

759
Q

Polyarteritis Nodosa

A

Med vessel vasculitis
Cycle: Thrombosis –> Aneurysm –> rupture –> healing
Biopsy: fibrinoid necrosis
Beads on a string pattern
Affects all organs
Poly ARTERitis NOdosa- Pulmonary ARTERies NOT damaged

760
Q

Treatment of Polyarteritis Nodosa

A

Steroids (inhibit inflammatory cytokines)

Cyclophosphamide (damages DNA, slows rapid division)

761
Q

Thromboangiitis Obliterans

A 
aka Buerger disease
Sm and Med Vasculitis
Assoc w smoking
Claudication and Autoamputation
Narrowing of blood vessels
Increased sensitivity to cold
762
Q

Henoch-Schonlein Purpura

A 
Sm vessel Vasculitis
IgA immune complex deposition
Assoc w URIs
Palpable leg and buttock purpura
Joint pain, hematuria, hematochezia
Most common vasculitis of children
Tx steroids
763
Q

Monoclonal Gammopathy of Undetermined Significance (MGUS)

A 
Plasma Cell Dyscarasia
Asymptomatic form of Multiple Myeloma
Still producing other blood cells
Can progress to Multiple Myeloma
Extra proteins --> RF, anemia, thrombocytopenia, lytic lesions, hyperCa
764
Q

Symptoms of Multiple Myeloma

A 
CRAB
HyperCa
Renal Failure
Anemia/ thrombocytopenia
Bone lesions/ pain
765
Q

Treatment for Influenza

A

NA inhibitors- block virion release

Ex. Oseltamivir, Zanamivir

766
Q

Avoid the use of __(herbal supplement)___ with aspirin

A 
Ginko Biloba
Garlic
Ginger
Ginsing
Turmeric
Willow
*antiplatelet properties
767
Q

Tay-Sachs

A 
Hexoseaminidase A deficiency --> GM2 Ganglioside in lysosomes --> neurodegeneration
Autosomal recessive
Ashkenazi Jews
Cherry red spot on macula
Lysosomes with "onion skin"
NO HEPATOMEGALY (like niemann-pick)
768
Q

Amaurosis Fugax

A

Sudden painless vision loss
Spontaneous recovery (seconds to minutes)
Occlusion of central retinal artery, carotid stenosis, temporal arteritis
Self limiting

769
Q

Pediculosis capitis

A

Head Lice
Pruritis
Tx: permethrin

770
Q

Trichophyton
Microsporum
Epidermophyton

A

Dermatophytes
Branching septet hyphae on KOH prep w blue stain
Microsporum visualized w woods lamp
Tx: azoles

771
Q

Onychomycoses

A

Dermatophyte infection of the nails

Tx: terbinifine, griseofulvin

772
Q

Side effects of Griseofulvin

A

GI

773
Q

Increased dosing of anesthesia in alcoholics is due to

A

Ethanol oxidizing system (CYP450 2E1) or

cross-tolerance

774
Q

Medications known to cause photosensitivity

A 
Tetracyclines (DOXYCYCLINE)
Thiazides
Sulfonamides
Amiodarone
Fluoroquinolones
Retinoids
NSAIDs
Griseofulvin
Grazoprevir
775
Q

Technetium-99m Scintigraphy

A

Radioactive substance injected

Shows metabolic activity

776
Q

Corneal and Lacrimation reflexes are carried on nerves

A

Afferent: CN V1 (ophthalmic branch)
Efferent: CN VII
*loss of lacrimal reflex does not stop emotional tears

777
Q

Tinea capitis causes alopecia via

A

Hair shaft breakage

778
Q

Nominal Scale

A

names
NOT numbers
No order

779
Q

Ordinal scale

A

Ranking

Ex. hot, hotter, hottest

780
Q

Interval scale

A

Ordered numbers

Ex. temperature

781
Q

Ratio scale

A

Ordered numbers

Zero is meaningful

782
Q

Antiarrhythmic for Hyperthyroidism

A

Amiodarone

-K channel blocker

783
Q

Childhood rash with lesions of different stages of healing

A

Varicella- Zoster (chickenpox)

784
Q

Grave’s Disease

A

Thyroid-stimulating Ig (IgG crosses placenta)
Dermal fibroblasts (pretibial myxedema, GAGs)
Orbital Fibroblasts
Osmotic muscle swelling (GAGs)
Assoc HLA DR3/ B8

785
Q

Aortic stenosis is associated with _____ blood vessels

A

Torturous blood vessels

Angiodysplasia

786
Q

Palmar erythema and Spider angiomas in the presence of cirrhosis are the direct result of

A

Increased estrogen

787
Q

Gilbert Syndrome

A 
Inherited hyperbilirubinemia
Autosomal recessive
Mutated UGT1A1 gene
Decreased UDP-glucuronosyltransferase
Increased unconjugated bilirubin
Jaundice during stress
788
Q

Caput Medusae is a dilation of _____

A

Superior Epigastric Veins

789
Q

Alcohol damages _____ hepatocytes

A

Centrilobular

*contain highest concentration of CYP450 enzymes

790
Q

Aflatoxin exposure leads to _____

A

Hepatocellular Carcinoma
GC –> TA transversion on Codon 249
Interferes w transcription of p53

791
Q

Pinealoma

A

Childhood tumor of dorsal midbrain
Compresses pretectal region (vertical gaze palsy)
Proximal to aquaduct (hydrocephalus)
Most common type is germinoma (secreted hCG and testosterone)

792
Q

Rb gene mutation increase risk for _____

A

Osteosarcomas

793
Q

Focal Segmental GlomeruloSclerosis (FSGS)

A 
Hispanics and African Americans
Usually idiopathic
Assoc w HIV, heroin, SCD
Pink sclerosis on H/E
Effacement of foot processes on EM
No IC deposits (neg immunofluorescence)
794
Q

_____ is the progression of Minimal Change Disease when it doesn’t respond to Corticosteroids

A

Focal Segmental GlomeruloSclerosis (FSGS)

795
Q

Focal Segmental GlomeruloSclerosis has a _____ response to steroids

A

Poor response to steroids

Progresses to CRF

796
Q

Membranoproliferative Glomerulonephritis

A 
Thick capillary membranes on H/E
Tram-Track appearance
IC deposition --> Granular Immunofluorescence
2 types based on location of deposits
Nephrotic or Nephritic
797
Q

Membranoproliferative Glomerulonephritis Type 1 Immune complex deposit location

A

Subendothelial
Assoc w HepB/ HepC
More often assoc w tram-tracks

798
Q

Membranoproliferative Glomerulonephritis Type 2 Immune complex deposit location

A

Basement membrane

C3 Nephritic Factor (AutoAb, stabilizes C3 convertase, over-activation of compliment)

799
Q

Diabetic Nephrotic Syndrome

A

Non-enzymatic Glycosylation of basement membrane
Sclerosis of mesangium
Kemmelstiel-Wilson Nodules
Progression slowed by ACE inhibitors

800
Q

Nephrotic vs Nephritis

A 
Nephrotic
- Proteinuria 3.5+
- Hyopalbuminemia
- Hypercoagulable
- Hyperlipid and hypercholesterol
Nephritic
- Proteinuria less than 3.5
- Inflammation and bleeding
- Periorbital edema and HTN
- RBC casts
801
Q

Post Strep GlomeruloNephritis (PSGN)

A 
Nephritic syndrome
M protein virulence factor
Hematuria (cola colored)
IC deposits (granular immunofluorescence)
Subepithelial "humps" on EM
802
Q

Rapidly Progressive GlomeruloNephritis (RPGN)

A

Nephritic Syndrome
Crescents in Bowmans space
Crescent made of fibrin and macrophages
IF helps resolve etiology

803
Q

Linear Immunofluorescence of glomerulus

A

Ab to glomerular BM
Goodpasture’s syndrome
Hematuria
Hemoptysis

804
Q

Negative Immunofluorescence of Glomerulus

A

Pauci-Immune
Wegner Granulomatosis (c-ANCA, sinusitis)
Microscopic polyangitis (p-ANCA)
Churg-Strauss (p-ANCA, eosinophils, asthma)
Test for ANCA

805
Q

Granular Immunofluorescence glomerulus

A

PSGN
Diffuse Proliferative GN
Membranous GN
Membranoproliferative GN

806
Q

_____ increases the likelihood of angiomyolipoma, a hamartoma of blood vessels, sm muscle, and adipose

A

Tuberous Scleroses increases risk of antiomyolipoma

807
Q

Most common malignant renal tumor in children

A 
Wilms Tumor
Composed of blastema, primitive glomeruli and tubules, and stroma
Hematuria
HTN (renin secretion)
WT1 mutation (WAGR)
808
Q

Beckwith-Weidemann Syndrome

A

Wilms tumor
Neonatal Hypoglycemia
Muscular hemihypertrophy
Organomegaly (tongue)

809
Q

Risk Factors for urothelial tumors

A

Cigarette smoking
Naphthylamine
Azo dyes
Long term Cyclophosphamide or Phenacetin

810
Q

Urothelial Carcinoma

A 
Painless hematuria
Flat initiation (early p53 mutations, high grade --> invasion)
Papillary initiation (low grade --> high --> invasion)
Often recur (field defect)
811
Q

Risk factors for Squamous Cell Carcinoma of bladder

A

Must first develop metaplasia of squamous cells
Chronic cystitis
Schistosoma hematobium
Prolonged nephrolithiasis

812
Q

Risk factors for Adenocarcinoma of the bladder

A

Urachal remnant (bladder dome)
Cystitis glandularis
Exstrophy

813
Q

Most common cause of endocarditis

A

Strep viridans
Low Virulence
Only infects damaged valves
Vegetations do NOT destroy valve

814
Q

Most common cause of endocarditis in IVDU

A

Staph aureus
High virulence
Infects normal Tricuspid
Lg Vegetations destroy valve

815
Q

Most common cause of endocarditis in prosthetic valves

A

Staph epidermiditis

816
Q

Most common cause of endocarditis with colorectal carcinoma

A

Strep bovis

817
Q

HACEK Organisms

A

Endocarditis w NEG cultures

  • Hemophilus
  • Actinobacillus
  • Cardiobacterium
  • Eikenella
  • Kingella
818
Q

Drugs that cause AIN

A

5 Ps

  • Pee (diuretics)
  • Pain (NSAIDs)
  • PCNs and CePhalosporins
  • PPIs
  • RifamPin
819
Q

Reticular Activating System (RAS)

A 
Reticualr formation (alertness)
Locus cerulean (NE)
Raphe nuclei (serotonin)
820
Q

Elevated AFP seen in

A

Neural tube defect

Anterior abd wall defect

821
Q

The presence of _____ distinguishes nephritic from nephrotic syndrome

A

Hematuria (present in nephritis)

Suggests glomerular inflammation and injury

822
Q

_____ accelerates atherosclerosis

A

Smoking
Stimulates vasoconstriction
Induces prothrombotic state
*most important intervention to lower risk of MI

823
Q

Vena Cava opening in diaphragm

A

T10

Contains IVC

824
Q

Aortic hiatus in diaphragm

A

Contains:

  • aorta
  • thoracic duct
  • azygos vein
825
Q

Esophageal hiatus in diaphragm

A

Contains:

  • esophagus
  • anterior and posterior trunks of Vagus Nerve
826
Q

Elastin is fond in

A 
Skin
Lungs
Lg arteries
Elastic ligaments
Ligamenta flava
Vocal cords
827
Q

Elastin = _____ + _____

A

Tropoelastin + Fibrillin

Rich in NON-HYDROXYLATED proline, glycine and lysine residues

828
Q

Elastin changes with aging

A

Decreased dermal collagen and elastin
Decreased synth of collagen fibrils
CROSSLINKING REMAINS NORMAL

829
Q

Buspirone

A 
Non-benzodiazepine anxiolytic
For generalized anxiety disorder
Slow onset of action
Lacks muscle relaxant and anticonvulsant properties
No risk of dependence
830
Q

Hydralazine

Mechanism of Action

A

Direct peripheral vasodilator
Prefers arteriolar smooth muscle
Increases intracellular cGMP
Decreases afterload and BP

831
Q

Side effects

Hydralazine

A

Headache (vasodilation)
Tachycardia (reflex sympathetics)
Peripheral edema (hydrostatic presssure, Na retention, fluid extravasation)
*reduced by administering w B-blocker and/or diuretic

832
Q

Absent vas deferens

A

Cystic fibrosis

*results in azoospermia and infertility

833
Q

Octreotide

A

Somatostatin analog
Inhibits release of GH
Tx for acromegaly (or hypophysectomy)

834
Q

Treatment for acromegaly

A

Octreotide (somatostatin analog, inhibits GH)
Cabergoline (DA agonist)
Pegvisomant (GH receptor antagonist)

835
Q

Pleomorphic cells forming psuedopalisades

A

Glioblastoma multiforme

  • malignant brain tumor from astrocytes
  • pseudopalisades migrate away from central necrosis
836
Q

Butorphanol

Pentazocine

A

Synthetic opioid agonist
Partial agonist at mu receptors
Can precipitate opioid withdrawal in heavy opioid users

837
Q

Lymphogranuloma Venereum

A

Necrotizing granulomatous inflammation of inguinal lymphatics and nodes
STD (chlamydia L1-L3)
Heals w fibrosis
Perianal involvement –> rectal strictures

838
Q

Precursor lesions for penile SCC

A 
Bowen Disease (shaft)
Erythroplasia of Queyrat (glans)
Bowenoid Papulosis (reddish papules)
839
Q

Bowens Disease

A

Precursor lesion for penile SCC
Leukoplakia
Basement membrane NOT invaded

840
Q

Erythroplasia of Queyrat

A

Precursor lesion for penile SCC
Erythroplakia
On glans penis

841
Q

Bowenoid Papulosis

A

Precursor lesion for penile SCC

Like Bowen but does NOT progress to invasion

842
Q

Mumps can cause

A

Parotiditis
Meningitis
Pancreatitis
Orichitis

843
Q

Granulomatous Orichitis

A

Necrotizing? Think TB

NonNecrotizing? Think autoimmune

844
Q

Testicular varicocele

A

More common Left
Assoc w L Renal Cell Carcinoma (blocks spermatic vein)
Accumulation of warm blood –> infertility

845
Q

Hydrocele

A

Fluid in tunica vaginalis
In infants –> impaired closure (processus vaginalis)
In adults –> blocked lymph drainage

846
Q

IVDU infective endocarditis affects tricuspid valve which leads to _____

A

PE

847
Q

Spinal Stenosis

A

Lumbar most common
Posture dependent LE pain, numbness, weakness
Most common cause is degeneration of spine
Leads to: Canal narrowing (disc herniation, ligament flavor hypertrophy, osteophytes)

848
Q

Vomiting Reflex

A

CRTZ in Area Postrema and
Nucleus Tractus Solitarious

Both located in Dorsal Medulla at
Caudal end of 4th Ventricle

849
Q

Area Postrema has a weak BBB

A

Activated directly by toxins

Activated indirectly by ascending afferents from bowel wall (chemo release of 5HT)

850
Q

Antipsychotics block D2 receptors in _____ pathway

A

Mesolimbic

851
Q

D2 Block in Tuberoinfundibular pathyway

A

Galactorrhea

Amenorrhea

852
Q

Only nerve thru obturator foramen

A

Obturator Nerve
Adduction
Sensory to distal medial thigh

853
Q

ACL damaged by _____ or _____

A

Internal rotation or Valgus Stress

Leads to rapid hemarthrosis

854
Q

VPL receives information from _____ and sends information to the cortex

A

Spinal Thalamic Tract

Dorsal Columns

855
Q

VPM receives information from _____ and sends information to the cortex

A

Trigeminal pathway

856
Q

Lacunar Infarcts

A

Lenticulostriate Arteries (of MCA)
Sm vessel occlusion due to lipohyalinosis and microatheromas
Risks: DM and HTN

857
Q

Location of most gastric ulcers

A

Lesser curve

BTW body and antrum

858
Q

Pudendal nerve

A

Stretched during labor (stress on pelvic floor) –>
Weakness of perineal muscles –>
Fecal/ Urinary incontinence, pain, sexual dysfunction

859
Q

_____ sense RNA viruses bring along all of their own RNA polymerases

A

Negative Sense RNA

All single stranded (except reoviruses)

860
Q

Esophageal webs increase risk for

A

Esophageal SCC

861
Q

_____ free radical is the most damaging

A

OH

862
Q

Free radicals cause damage by

A 
Peroxiding lipids (membranes)
Oxidizing DNA and proteins
863
Q

Most common cause of unilateral fetal hydronephros

A

Uteropelvic junction

864
Q

_____ in case-control studies controls confounding

A

Matching

865
Q

Local defense against Candida

A

T cells (common in HIV because decreased T cells)

866
Q

Systemic defense against Candida

A

Neutrophils (common in neutropenic)

867
Q

X-inactivation

A

Barr Body –>
Heavy methylation/ deacetylated histones –>
Low transcription activity

868
Q

CGD patients at risk for _____ organisms

A

Catalase +

869
Q

SRY gene codes for _____

A

Testes Determining Factor

870
Q

Sertoli Cells produce

A

Anti-mullerian Hormone

871
Q

Leydig Cells produce testosterone which _____

A

differentiates Wolfian ducts

872
Q

DHT differentiates _____

A

External genitals (male)

873
Q

Adenomyosis

A

Glandular tissue in myometrium
Enlarged uterus
Normal endometrium

874
Q

Gene enhancers (bind activators) and silencers (bind repressors) are located

A

anywhere within the gene

875
Q

Promoters are located

A

25 -75 bases upstream
Required for transcription
Examples: CAAT, TATA, pribnow
Rich in Adenine and Thiamine

876
Q

Hereditary Fructose Intolerance

A

Aldolase B deficiency

877
Q

Classic Galactosemia

A

Galactose 1 Phosphate Uridyl transferase deficiency

878
Q

Essential Fructosuria

A

Fructokinase deficiency
Asymptomatic, Benign
Glucosuria (reducing sugar and unmetabolized fructose)

879
Q

A-flutter

A

Reentrant circuit
Cavotricuspid Isthmus of R atrium
Between Tricuspid and IVC

880
Q

Reactive (Atypical) Lymphocytes

A

Activated in intracellular infection
Lg scalloped abundant cytoplasm
Diagnostic of mono
Granules contain perforins

881
Q

Failed closure of Omphalomesenteric (Vitelline) duct

A

Normally closes 7th week

Causes enterocysts and Meckel Diverticula

882
Q

MAC

A

Minimal alveolar concentration
Measure of anesthetic potency (1 / MAC)
Concentration at which 50% unresponsive (ED50)

883
Q

_____ encode DNA binding transcription factors that have role in segmental organization of embryo along craniocaudal axis

A

HOX genes

884
Q

If HbA cannot bind 2,3 BPG for O2 unloading

A

It resembles HbF (inability to bind 2,3 BPG)

885
Q

Neprilysin

A

Breaks down ANP and BNP

886
Q

Transcatheter Aoritic Valve Implant

A

Treats Aortic Stenosis

Complication: Aortic Regurgitation (poor seal of prosthetic valve to annulus)

887
Q

Uterine proliferation but no embryonic/ trophoblastic tissue (villi)

A

Ectopic pregnancy

888
Q

_____ artery supplies AV node

A

Dominant Coronary artery

889
Q

p53 induces _____ which then inactivate _____

A

p53 incudes p21 —> inactivates CDKs

890
Q

Rb mutations cause

A

Osteosarcoma and Retinoblastoma

891
Q

Cyclin _____ + CDK _____ phosphorylate Rb

A

Cyclin D + CDK 4
Releasing it from E2F
Unbound E2F allows progression thru S phase

892
Q

Cyclin _____ + CKD _____ allow progression thru S phase

A

Cyclin E + CDK 2

893
Q

Limiting reagent in alcohol metabolism

A

NAD +

894
Q

NAD regeneration

A

Pyruvate –> Lactate (glycolysis)
Oxaloacetate –> Malate (TCA, when no gluconeogenesis)
*can cause hypoglycemia

895
Q

Increased NADH promotes

A

Dihydroxyacetone Phosphate –>
Glycerol 3 Phosphate –>
Glycerol 3 Phosphate + FAs –>
Triglycerides

896
Q

Increased NADH downregulates

A

TCA cycle –>

Aceytl-CoA shunted to ketones

897
Q

Depression Symptoms

A 
DIGS CAPES (5/9 for 2+ weeks)
Depressed mood
Interests
Guild
Sleep disturbance
Concentration
Appetite changes
Psychomotor agitation
Energy fatigue
Suicidal
898
Q

Persistent Depressive Disorder

A

2 symptoms
2+ years
No less than 2 months

899
Q

Treatment of DVT

A

Unfractionated/ LMW Heparin
Coumadin after a few days

or Factor Xa medication (rivoroxiban, apixaban, dabgatron)

900
Q

MEN 1

A

Menin Gene

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic Tumors

901
Q

MEN 2a

A

RET gene
Parathyroid hyperplasia
Medullary Thyroid Carcinoma
Pheochromocytoma

902
Q

MEN 2b

A 
RET gene
Mucosal Neuromas
Marfanoid habitus
Medullary Thyroid Carcinoma
Pheochromocytoma
903
Q

Enzyme elimination of free radicals

A

O2 — superoxide dismutase —>
O2- — catalase —>
H2O2 — glutathione perosidase —>
OH —> H2O

904
Q

CCl4

A 
Cause of free radical injury
Dry cleaning industry
Converted to CCl3 in p450 system
Hepatocellular damage --> decreased apolipoproteins
Fat gets in liver, cant get out
Fatty Changes
905
Q

Reperfusion Injury

A

Cause of free radical injury

Reperfusion inflammatory cells + dead tissue + O2 = free radicals

906
Q

Biliary Atresia

A

Failure to form
Obstruction in 1st 3 months
Jaundice, Cirrhosis, Conjugated Bilirubin

907
Q

Cholelithiasis

A 
Supersaturation of cholesterol/ bilirubin
or
Decreased phospholipids/ bile acids
or
Stasis (increases risk of bacteria)

Ex. Cholestyramine binds bile acids (risk for stone)

908
Q

Cholesterol Gall Stones

A 
Radiolucent
Yellow
Risks:
-age, estrogens
-increased HMG-CoA Reductase
-Crohn's (decreased salt/ acid reuptake)
-Cirrhosis (decreased bile salts)
-Clofibrate (increased HMG)
-Native american
909
Q

Bilirubin Stones

A 
Radio-opaque
Black
Risks:
-Extravascular hymolysis
-Biliary infection --> deconjugates bilirubin
910
Q

Chronic Cholecystitis

A

Rokitansky-Ascholff Sinus formation
GB mucosa dives down into smooth muscle
Porcelain GB (calcification) –> cancer
Tx: remove it

911
Q

Elderly woman w new onset cholecystitis

A

Think GB adenocarcinoma

912
Q

Bilirubin is metabolized by

A

Macrophages of reticuloendothelial system

913
Q

Urobilinogen

A

Conj Bilirubin in bile –> intestines –> urobilinogen
Makes stool brown
Reabsorbed into blood
Filtered by kidney –> yellow urine

914
Q

Pigmented gallstones

A

Increased conjugated bilirubin in bile

915
Q

Dark urine

A

Due to urobilinogen
Not unconjugated bilirubin
Unconjugated bilirubin is NOT water soluble

916
Q

Jaundice of newborn

A 
Decreased UGT -->
Increased unconjugated bilirubin --> 
Fat soluble
Deposits in basal ganglia (kernicterus)
Tx: phototherapy (does NOT conjugate, makes unconjugated bilirubin soluble)
917
Q

Crigler-Najjar Syndrome

A

Absence of UGT
Increased unconjugated bilirubin
Kernicterus

918
Q

Dubin-Johnson

A 
No bilirubin canicular transport protein
Autosomal recessive
Increased CONJUGATED bilirubin
DARK LIVER (epinephrine metabolites)
Rotor syndrome (no dark urine/ liver)
919
Q

Drugs that target Microtubules

A 
"Microtubules Get Constructed Very Poorly"
Mebendazole
Griseofulvin
Colchicine
Vincristine
Paclitaxel
920
Q

Dynein moves _____

Kinesin moves _____

A

Dynein: Retrograde, + —> -
Kinesin: Anterograde, - —> +

“kin go out, dying to come back home”

  • Negative Near Nucleus
  • Positive end Points to Periphery
921
Q

Lesch-Nyhan Syndrome

A 
X-linked recessive
Absent HGPRT
Defective purine salvage
Orange sand in urine
HGPRT acronym:
-Hyperurecemia, Gout
-Pissed off (aggressive, self-mutilation)
-Retardation
-dysTonia
922
Q

Genetic code is Unambiguous

A

Each codon = 1 AA

923
Q

Genetic code is Degenerate/ Redundant

A

Each AA = multiple codons

924
Q

Wobble Position

A

3rd in codon
1st in anticodon
doesn’t change anything

925
Q

Bloom Syndrome

A

Deficient Helicase
BLM gene mutation
Autosomal recessive
Growth retardation, immunodeficient, photosensitive

926
Q

TATA Boxes are found in _____

A

Promoters and

Origins of Replication

927
Q

Mechanism of:
Irinotectan
Topotectan

A

Inhibit topoisomerase I in eukaryotes

“I can = IrinoteCtAN”

928
Q

Mechanism of:
Etoposide
Teniposide

A

Inhibit topoisomerase II in eukaryotes

“side” “2 sides to everything”

929
Q

Mechanism of Floroquinolones

A

Inhibit topoisomerase II (DNA gyrase) and topoisomerase 4 in prokaryotes

“4-oquinolones)

930
Q

DNA polymerase 3

A

Prokaryotes only
Elongates 5’ –> 3’
3’ –> 5’ exonuclease activity

931
Q

Labs in DKA
_____ Glucose
_____ K
_____ Sodium

A

High glucose
High K
Low Sodium

932
Q

Side effect of Cisplatin

A

Ototoxicity to hair cells in labyrinth

933
Q

Cardiovascular effects of Nitroglycerin administration
_____ HR
_____ EDV

A 
Increased HR
Decreased EDV (ventilation)
934
Q

Allelic Heterogeneity

A

Different mutation of same gene locus cause similar phenotypes

935
Q

En-FU-virtide

A

HIV drug
Inhibits gp41 (no entry)
Inhibits FUsion

936
Q

Cold dry air in asthmatics

A

Triggers inflammation
Mast cells/ Eosinophils –>
Cysteinly containing LTs –>
Bronchospasm, secretion, edema

937
Q

Leukast medication mechanism

A

Cysteinyl Leukotriene Antagonists

938
Q

Maravi-ROC

A

HIV drug
Binds CCR5
Inhibits DOC-king

939
Q

“MDs fix complaints” –>

“MGs fix complaints”

A

IgM and IgG fix complement

940
Q

Pompe

A

1st and 4th letters are P
a-1,4-glucosidase
NO hypoglycemia

941
Q

Lactulose

A

Tx for hepatic encephalopathy

Converts ammonia –> ammonium

942
Q

Rifaximin

A

Tx for hepatic encephalopathy

Decreases intraluminal ammonia production

943
Q

Branches of Celiac Trunk

A

L gastric artery
Splenic artery
Common Hepatic artery

944
Q

Prevalence

A

Total population

945
Q

Incidence

A

Those at risk

946
Q

Relative Risk

A

C/(C+D)

*in very low prevalence RR = OR

947
Q

Odds Ratio

A

C/D

*in very low prevalence RR = OR

948
Q

Attributable Risk

A

A C
—- - ——
(A+B) (C+D)

*incidence of exposed - incidence of unexposed

949
Q

Absolute Risk Reduction

A

C A
—– - ——
(C+D) (A+B)

*Have disease but no intervention (risk in control) MINUS have disease and received intervention (risk in experimental group)

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