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1
Q

Dihydrofolate reductase inhibitors (3):

A

Trimethoprim (microbes), methotrexate (antimetabolite, rapidly prolif cells), pyrimethamine (parasites)

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2
Q

Which structure contains the nerves, arteries, and vessels supplying the ovary?

A

Suspensory ligament of ovary (infundibulopelvic ligament) Ligate during oophorectomy!

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3
Q

Infectious Urethritis tx:

A

Ceftriaxone (gonorrhea) + Doxycycline or macrolide like azithro (chlamydia)

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4
Q

When a study population affects the outcome of the study because they know they are being studied, this is called:

A

Hawthorne effect

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5
Q

A bias that results from selecting hospitalized patients as the control group is called:

A

Berkson’s Bias

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6
Q

Researcher’s beliefs in the efficacy of tx that can potentially affect the outcome are called:

A

Pygmalion effect

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7
Q

Lead-time bias

A

apparent prolongation of survival after applying a screening test

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8
Q

Ototoxic drugs (4)

A

loop diuretics, aminoglycosides, salicylates, cisplatin

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9
Q

Renal Cell Carcinoma origin:

A

epithelium of proximal tubules

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10
Q

Uncal Herniation

A

Medial Temporal Lobe (downwards - transtentorial/central) Compresses: Ipsi CN III - fixed, dilated pupil, down and out gaze Ipsi PCA - Contra homonymous hemianopsia Contra crus cerebri (CP) - ipsilateral paralysis

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11
Q

Cinculate Herniation

A

Subfalcine, under falx cerebri Can compress ACA - contralateral lower limb motor/sensory loss

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12
Q

Cerebellar Tonsillar Herniation

A

into foramen magnum Compress brainstem

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13
Q

Mature Defenses:

A

SASH Sublimation, Altruism, Suppression, Humor

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14
Q

Depression: Neurotransmitter Changes

A

DECREASED NE, 5-HT, DA

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15
Q

VHL associations

A

AD, capillary hemangiolastomas in retina &/or cerebellum, cavernous hemangiomas, pheochromocytomas, congenital cysts in kidney, liver, pancreas, risk for bilateral renal cell carcinoma cs 3, constit expression of HIF (tf) and activ of angiogenic gfs

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16
Q

Tuberous Sclerosis

A

AD, kidney, liver, pancreatic cysts, CNS cortical and subependymal hamartomas, cutaneous angiofibromas (adenoma sebaceum), visceral cysts, renal angiomyolipomas, cardiac rhabdomyomas, seizures, mental retardation, subependymal astrocytomas, ungal fibromas, shagreen patches

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17
Q

Osler-Weber-Rendu syndrome

A

hereditary hemorrhagic telangiectasia AD inheritance of congenital telangiectasias. Rupture may cause epistaxis, GI bleeding, or hematuria

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18
Q

BH4 is cofactor for syth of:

A

Tyrosine (phenylalanine hydroxylase), DOPA (tyrosine hydroxylase), Serotonin (from tryptophan), and NO (from arginine)

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19
Q

Alkaptonuria

A

AR, defic of homogentisic acid oxidase - breaks down homogentisic acid, toxic tyrosine to fumarate degradation byproduct - harmful to bones and cartilage. Dark CT, brown pigmented sclerae, urine turns black on prolonged exposure to air

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20
Q

Which statin is not metabolized by CYP 3A4?

A

Pravastatin

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21
Q

CYP 450 Inducers:

A

Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin

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22
Q

CYP 450 Inhibitors:

A

Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit juice Isoniazid Ritonavir (PIs)

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23
Q

Which BLs are not susceptible to penicillinase?

A

Cephalosporins, carbapenems, and penicillinase-resistant penicillins (nafcillin, methicillin…)

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24
Q

What drugs are effective against Mycoplasma and why can’t you use most others?

A

Anti-ribosomal agents like macrolides, tetracyclines They lack peptidoglycan cell walls, so cell wall syth inhibitors don’t work. They have a single phospholipid bilayer membrane, containing cholesterol

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25
Meds that can prolong QT:
Some Risky Meds Can Prolong QT: Sotalol Risperidone (APDs) Macrolides Chloroquine Protease Inhibitors (-navir) Quinidine (class 1a; also class 3) Thiazides
26
Act on nuclear receptors:
Thyroid hormones, retinoids, PPARs, fatty acids
27
TK Receptors
Insulin, growth factors (epidermal growth factor, TGF-beta) Extracellular ligand binding domain, transmembrane region, and carboxy-terminal domain with TK activity.
28
GPCRs:
Peptide hormones (glucagon, PTH, ACTH, gonadotropins) Hormone binds N terminal, C terminal activates G-protein, which increases second messengers like cAMP by activ. adenylyl cyclase. Also can increase PLC and form IP3 and DAG
29
Cytoplasmic Receptors:
steroid hormones, migrate to nucleus once activated
30
DA agonists for PD:
Ergot: bromocriptine, pergolide Nonergot: pramipexole, ropinirole
31
Amantadine
Enhances effects of endogenous DA, some anticholinergic prop perhaps too Antiviral influenza agent
32
MAO-B inhibitor that delays PD progression:
Selegiline, decreases central DA degradation
33
Findings of DIC:
Prolonged PTT and PT Thrombocytopenia and microangiopathic hemolytic anemia Low fibrinogen Elevated fibrin split pdts (D-dimer) Low factor V and VIII levels
34
Intravascular hemolysis findings:
Decreased haptoglobin Increased LDH, schistocytes, and reticulocytes Urobilinogen in urine
35
Extravascular hemolysis findings
Spherocytes Increased LDH and unconjugated bilirubin, causes jaundice, pigmented gallstones
36
Cryoprecipitate contains:
Factor VIII, XIII, vWF, and fibrinogen
37
NADPH Consumed in:
fatty acid and steroid synthesis, CYP p450 pathway, generation of superoxide in phagocytes So oxidative rxns of HMP shunt are active in liver, adrenal cortex, gonads, adipose, and erythrocytes
38
Insulin MOA:
Inhibits glycogenolysis/gluconeogenesis. Promotes synth of glycogen, TAGs, nucleic acids, and proteins (anabolic) TK receptor causes phosphoryl of insulin receptor substrates, leads to activation of protein phosphatase. Protein phosphatase dephosphorylates glycogen synthase, which ACTIVATES it and promotes glycogen synthesis Also dephosphorylates fructose 1, 6 - bisphosphatase which INACTIVATES it and inhibits gluconeogenesis
39
Positive stranded RNA viruses:
retro, toga, flavi, corona, hepe, calici, picorna
40
Naked DNA viruses:
PAPP Papilloma, Adeno, Parvo, Polyoma
41
Naked RNA viruses:
CPR Hepe Calici, Picorna, Reo, Hepe
42
dsRNA:
Reovirus Naked, linear, icosahedral
43
Which kidney stones precipitate at an increased pH?
Calcium phosphate, struvite CaOxalate, Uric Acid, Cystine all precip at acidic pH
44
Which type of kidney stones are radiopaque?
CaPO4, CaOxalate, Struvite, Cystine
45
Which stones are radiolucent?
Uric Acid = radiolUcent
46
Ketogenic AA's/importance
Leucine and Lysine (lysine is essential) Don't contribute to lactic acidosis because not glucogenic. Contrib towards acetoacetate production. Important for PDH deficiency: give ketogenic diet
47
Tumors that stain positive for keratin:
Epithelial surface origin: carcinoma, mesothelioma, thymoma, sarcomas, trophoblastic, desmoplastic small round cell tumors
48
Cofactors in PDH, Alpha-ketoglutarate DH, and Alpha-ketoacid DH (degrades branched chain AAs, defic causes maple syrup dz):
Tender Loving Care For Nancy TPP, Lipoate, CoA, FAD, NAD
49
Lead Poisoning Tx:
Dimercaprol and EDTA
50
Copper Chelation:
Penicillamine
51
Drugs like Isoniazid that have fast and slow acetylators:
dapsone, hydralazine, procainamide
52
Ulcer vs. Erosion:
Erosion is limited to mucosal layer, doesn't fully extend through muscularis mucosa. Ulcer penetrates through mucosal layer and into submucosal layer.
53
Acyl-CoA dehydrogenase deficiency:
Can't produce ketone bodies during fasting due to impaired beta-oxidation. Can't utilize fats for energy or prod ketone bodies. Gluconeogenesis is impaired during fasting, and glucose consump is increased, causing hypoglycemia
54
Essential Fructosuria:
fructokinase deficiency, AR, benign, frucosuria
55
Fructose intolerance:
Aldolase B deficiency, AR, F-1-P accum, decreases available phosphate, inhibits glycogenolysis and gluconeogenesis Hypoglycemia, jaundice, cirrhosis, vomiting
56
Retroperitoneal organs:
SAD PUCKER Suprarenal glands, Aorta/IVC, Duodenum (2-4 parts), Pancreas (except tail), Ureters, Colon (descending and ascending), Kidneys, Esophagus (lower 2/3), Rectum (lower 2/3)
57
MEN 1:
Parathyroid tumor (hypercalcemia) Pancreatic endocrine tumor (gastrin, ZES, insulinoma, VIPoma) Pituitary adenoma (prolactin, ACTH)
58
MEN 2a:
assoc with ret mutation Medullary carcinoma of thyroid (calcitonin) Pheochromocytoma Parathyroid tumor
59
MEN 2b:
assoc with ret mutation Medullary carcinoma of thyroid Pheochromocytoma Marfanoid habitus/mucosal neuromas
60
Hartnup Disease:
AR, deficiency of neutral AA transporters in PT and on enterocytes. Get neutral aminoaciduria and decreased absorp from gut. Tryptophan-get B3 deficiency, pellagra
61
Renal Tubular Acidosis:
Non-anion gap hyperchloremic metabolic acidosis
62
RTA Type 1:
Distal, urine pH \> 5.5, defect in ability of alpha intercalated cells to secrete H+, don't generate new HCO3-, get metabolic acidosis. Hypokalemia, incr risk of CaPO4 kidney stones (b/c incr urine pH) Causes: ampho B, analgesic nephropathy, congenital anom (obstruction)
63
RTA Type 2:
Proximal, urine pH \< 5.5 (b/c distal segs still can secrete H+). Defect in PT HCO3- reabsorption. Hypokalemia, incr risk for hypophosphatemic rickets Causes: Fanconi syndr (eg. Wilson dz), toxicity to PT (lead, aminoglycosides), MM, CA inhibitors
64
RTA Type 4:
hyperkalemic, pH \< 5.5. Hypoaldosteronism, aldosterone resistance, or K sparing diuretics. Hyperkalemia impars ammoniagenesis in PT, so decr H+ excretion into urine
65
Nitrate poisoning effect by: Tx:
Oxidizing the heme to the ferric (3+) state, get methemoglobinemia Tx: methylene blue
66
Entacapone:
COMT inhibitor, increases bioavailability of levodopa by inhibiting peripheral methylation. Only effective if used with levodopa! also Tolcapone: hepatotoxic, inhibits peripheral and central methylation
67
Crohns Dz most frequently involved site:
Terminal ileum
68
Pleural Effusion: transudate vs exudate
Exudate if pleural:fluid protein \> 0.5 or plural:serum LDH \> 0.6 or pleural LDH \> 2/3 ULN
69
How does GABAa Receptor function?
inhibitory nt, opening Cl- channel to hyperpolarize the postsynaptic cell
70
Caudal regression syndrome
sacral agenesis, anal atresia to sirenomelia
71
maternal diabetes teratogenic effects:
caudal regression syndrome, congenital heart defects (TGV), neural tube defects, macrosomia, hypoglycemia
72
Ebstein anomaly
atrialized RV lithium teratogenic effect
73
Menkes disease
CT dz caused by impaired Cu absorp/transport Get decreased activity of lysyl oxidase (crosslinks tropocollagen) --\>brittle, kinky hair, growth retardation, hypotonia
74
Hypertensive emergency:
180/120 w/ evidence of acute, ongoing target organ damage
75
Urease positive bugs
Cryptococcus, H. pylori, Proteus, Ureaplasma, Nocardia, Klebsiella, S. epidermidis, S. saprophyticus
76
VIPoma
pancreatic tumor secretes VIP watery diarrhea, hypokalemia, achlorhydria (WDHA) -increases intest H2O and electrolyte secretion, increases relax of sm mm and sphincters
77
Parinaud Syndrome
Pineal gland tumor, usually a germinoma Compresses tectal area, dorsal midbrain, above SC paralysis of convergence, upward gaze, absent pupillary light reflex, wide based gait

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