Rapid Facts from Q banks 3 Flashcards
highly eosinophilic glomerulus is indicative of what?
Drug induced glomerulonephritis
-NSAIDS, diuretics, betalactams
what does post strep glomerulonephritis look like on light microscopy?
hypercellular
fetal alcohol syndrome–>cardiac defect?
VSD
Primary sclerosing cholangitis is most likely to happen in M or F? what other disease is it associated with?
Men, ulcerative colitis
Athelete with amenorrhea secondary to low body weight… What is a serious complication that can result…and why you might want to treat them with pulsatile GnRH?
osteoporosis
high fever, confusion, pneumonia, diarrhea, hyponatremia
legionaires disease
Why is Legionella hard to stain?
it doesn’t stain well and because it’s facultative intracellular
Why do you see hyponatremia with legionellaires disease?
It’s because it can cause SIADH and it also affects renal sodium reabsorption
macrophages recruit cells to form granulomas via what cytokine?
TNFalpha
describe stimulus control method of treating insomnia?
bed=sleep. Don’t do anything in bed if you’re not sleeping or sexing.
If you can’t sleep, get out of bed
What is sleep hygiene method of treating insomnia?
sleep hygiene=forming good patterned behavior.
no caffeine, alcohol, large meals, exercise before bed.
regular sleep schedule…etc
what are the positive sx of schizophrenia. How long must sx be present before dx?
6 months+ =schizophrenia.
positive sx: hallucinations, delusions, disorganized speech.
two classic symptoms of carpal tunnel?
thenar atrophy; loss of sensation to the median distribution
vaginal bleeding, lung metastases, high hCG. what is this?
choriocarcinoma
vaginal bleeding, cough/lung masses, high hCG. what is this?
choriocarcinoma
complete mole karyotype
partial mole karyotype?
complete=46XX or 46 XY (all from paternal)
partial=69XXX, or 69 XXY
ADH binds V1 and V2 receptors. what are their actions?
V1=vasoconstriction and prostaglandin release
V2=antiduretic
ADH inserts aquapoins and what else?
passive urea transporters
with massive packed RBC transfusions…what might the patient experience and why?
hypocalcemia due to calcium chelating citrate
hyperkalemia because of the leaked potassium from stored RBC
C1 inhibitor deficiency… what should you not give the pt (drug wise?)
ACE I..high risk of angioedema
Why is C1 inhibitor deficiency associated with angioedema?
C1 inhibitor inhibits C1 as well as Kallikrein which converts Kininogen to Bradykinin
chronic nose bleeds, heavy menstrual cycles…etc ddx?
this is a platelet aggregation defect if it’s mucocutaneous.
ddx: vWBF def, Bernard-Soulier, Glanzman
vWBf prolongs what?
VIII
vWBf prolongs what?
VIII as it is attached to it as a carrier protein
cardiac tamponade triad?
muffled/distant heart sound, hypotension, Jugular venous distension
If a tRNA is charged with a wrong amino acid what happens?
The AA-tRNA synthase is very accurate and usually fixes things very quickly. However. if this is not done…then the wrong AA will be incorporated
DNA glycolase…what is this?
base excision repair mechanism
Whaat is Kozac sequence?
GccRgcc that is right before AUG…serves as transcription initiator
beta thalassemia…what’s the deletion?
Kozac sequence that is flanking the AUG start codon of the beta chain…Thus no beta chain is synthesized
beta thalassemia…what’s the deletion?
Kozac sequence that is flanking the AUG start codon of the beta chain…Thus no beta chain is expressed
in hemolysis…do you think the haptoglobin will be high or low?
Low! because it’s all taken up and gotten rid of by the spleen
carbon tetrachloride. what kind of toxicty? how is it mediated?
hepatotoxicity. mediated by ROS–>lipid peroxidation and mitochondrial damage
Whipple’s disease; what do you see microscopically?
magenta staining on PAS
Psoas muscle where is it what does it do?
Origin is in the Lspine/ribs and it inserts on the trochanter of the hips. It’s job is to flex the leg
Amphotericin B mechanism?
binds ergosterol
Terbinafine mechanism?
binds squalene epoxide which synthesizes ergosterol
Caspofungin is used for what? what does it inhibit?
It’s used for candida and aspergillus.
It inhibits beta 1,3 D glucan
Certolizumab. What is this?
anti TNF alpha without the Fc region of the receptor.
What is Auspitz sign?
When psoriatic plaques are removed…. the underlying skin may show peticheal rashes of neutrophilic clusters…Munro microabscesses
Pneumonitis Jirovecii is likely in HIV pts what what CD4 count?
Phospholipase A2 receptor IgG antibodies are associated with what renal disease?
membraneous nephropathy
mixed cryoglobulinemia is associated with what hepatic disease?
Hep C
Neonate with jaundice, severe anemia, and fetal hydrops, nucleated erythrocytes, high extramedullary hematopoeisis… waht is this potentially?
erythrocytosis fetalis
Thiosulfate citrate bile salt agar (TCBS)
good for vibrio (very acid labile)
the major factor leading to hepatocarcinoma in HBV is..?
integration in to genome.
the major factor leading to hepatocarcinoma in HBV is..?
DNA integration in to genome.
47, XXX clinical features?
Clinically silent, may have lower IQ
What does PAS stain? what if you see PAS in GI?
glycogen, Whipple disease
What does PAS stain? what if you see PAS in GI?
glycogen, Whipple disease (PAS the sugar and whipped cream)
What is Ziehl-Neelsen stain?
carbofuscin stain for mycolic acid.
Giemsa Stains what organisms?
chlamydia, borrealia, rickettsiae, trypanosome, plasmodium
mucicarmine stain. what org?
cryptococcus
What is hepcidin. where is it produced? what does it do?
Produced by hepatocytes… overall decreases iron in circulation. once bound transferrin are degraded, ferritin hold on to iron, and GI absorption is decreased
failure of fusion of maxillary promenince will cause what? not what?
cleft lip. NOT cleft palate
TSST Staph aureus causes toxic shock syndrome… What cells does this act through?
It crosslinks MHCII and TCR.
what’s the most specific test for rheumatoid arthritis?
anti-cyclic citrulinated protein
In metabolic acidosis…How might the kidneys try to compensate?
It will increase reabsoption of Bicarb, it will increase secretion of H+, and it will increase reabsorption of buffers (phosphate and ammonia)
What are the important acid buffers of the urinary system?
bicarb, Phosphate, ammonia
In which GI segment do you find peyer’s patches?
Ileum
Where are Brunner’s glands. what’s their purpose.
Duodenum. secret alkaline mucus to neutrolize stomach acid
what nerve passes through foramen ovale?
V3
What two things are in the optic canal?
optic nerve, ophthalmic artery
What passes through foramen lacerum?
internal carotid artery
What passes through the superior orbital fissure?
III, IV, V1, VI, and superior opthalmic vein
What nerve passes through the inferior orbital fissure?
V2
What kind of hemoglobin polymerizes in sickle cell disease?
deoxygenated. NOT
recurrent thrombophlembitis. WHAT DO YOU THINK OF?!
Trousseau’s syndrome. CANCER>esp visceral…like pancreatic cancer
Donovan Bodies
Intracytoplasmic cysts–>Klebsiella inguinale
painless inguinal sore. what could it be?
granuloma inguinales (klebsiella inguinale), treponema, chlamydia
If untreated klebsiella inguinale can block lymphatic drainage and cause what?
elephanitis.
Clinical course of chlamydia?
painless ulcers that progress to painful lymphadenopathy and ulceration
name the dimorphic yeasts
histo, blasto, cocci, paracocci, sprothrix
vomiting, lethargy, failure to thrive with galactose. what is this most likely?
galactose 1 UDP transferase deficiency. Most common.
classic galactosemia is less severe with cataracts
How does NADPH help protect RBCs?
they reduce glutathione… thus reducing ROS from erythrocytes
antibodies against PRP indicates possible infection with what organism?
Hemophilus influenza
malignant pustule is associated with what kind of infectionus organism?
bacillus anthracis
osteomyelitis in healthy children. what organism?
staph aureus
increased ACTH induces enlargement of adrenal glands. is this hypertrophy or hyperplasia
mainly hyperplasia
Baclofen mechanism?
induces GABAb channel. thus relaxing muscles
Succinycholine side effects?
over either PNS or SNS stimulation
malignant hyperthermia
hyerkalemia (because it just opens nAchR to both Na and K)
fx of femoral neck is most likely to injur which artery?
medial femoral circumflex artery
which artery has a branch that supplies the proximal part of the femoral head?
obturator
hydrochlorothiazide is first lin in essential HTN in what kind of patients?
general population and osteoporosis
How does thiozolidadinones work?
They activate intracellular PARRY receptors…and the complex activate genes such as adiponectin…in general thus increasing peripheral sensitivity to insulin
What is exenatide?
GLP analog
what does GLP do?
it is glucagon like polypeptide. it increases satiety, increases insulin secretion, and decreases gastric emptying
which three drugs have the most effect on lithium metabolism?
Thiazides, NSAIDS, and ACEI
enoxaparin mechanism
binds ATIII and increases binding to Xa thus less IIa is created.
anaplasia. what does it mean?
lack of differentiation
In a situation of renal hypoperfusion. Which cells are likely to hypertrophy?
JG cells of the AFFERENT renal artery, because that’s where the JG cells are located
which two GU related bacteria lack peptidoglycan?
Chlamydia, ureaplasma
LPS is associated with which gram stain bacterias?
negative
Teichoic acid is associated with which gram stain bacteria?
positive
which gram stain bacteria have betalactamase? where is it located?
negative. in the periplasmic space
COPD pt with MI. which beta blockers are good for this pt?
nonselectives…A through M.
oligoclonal band on electrophoresis is associated with what?
MS
acetyl coA increases gluconeogenesis by allosterically activating what enzyme?
pyruvate carboxylase
dental work related endocarditis…what org?
viridans
hoarsness can be caused by dilatation of which heart chamber most often?
L atrium
which drugs can cause night blindness?
phenothiazines, chlorquine
neuro sx and elevated liver enzymes… what do you think this might be? how to confirm?
Wilson’s diease. LOOK FOR kayser fleisher ring
why is anecephaly associated with polyhydraminios?
decreased fetal swallowing
name the 5 cyanotic congenital heart conditions
Tetrology of Fallot Transposition of the great vessels Trucus arteriosus Tricuspid atresia Total anomalous pulmonary venous return
why does squattin make tetrology pts feel better?
increased systemic resistance allows increased pressurein aorta thus pushing more blood (via ductus arteriosus) to pulmonary circulation
what are the three potassium blocking antiarrhythmics?
Sotalol, Amiodarone, and Dofetalide
elastase in the lung is expressed by what cells?
macrophages, and neutrophils
middle mengingeal artery is a branch of what artery?
maxillary artery
swan cathe Pressure max=8; min=0
which compartment of the CV are you in?
R atrium
swan cath pressure max=25; min=4
which compartment of the CV are you in?
R ventricle
swan cath pressure max=25; min=8
which compartment of CV are you in
pulmonary artery
swan cath pressure max=130; min=9
which compartment of CV are you in?
L ventricle
swan cath pressure max=12; min=2 which compartment of CV are you in?
L atrium
pigmented gallstones and aplastic anemia due to Parvovirus B19 is commonly seen in patients with what heme disorder?
spherocytosis
what is the postptrandial alkaline tide?
It is the surge of plasma HCO3- post a meal and rise in Cl- due to increased acid secretion
high amount of what secreted components will decrease the likelihood of cholesterol crystal precipitation?
bile salts and phosphotidylcholine
cholesterol conversion to bile acids… then to bile salts by conjugation to what substances?
glycine and taurine
why is HbF left shifted?
It doesn’t bind as well to 2,3 DPG…because it has a serine instead of histadine in the 2,3DPG binding spot.
deamination of bases is carried out by which mechanism of repair? what are the steps
base excision. Glycosylase removes base endonuclease/lyase cuts polymerase fills it in ligase seals
name two substances that can kill spores. How do they kill?
hydrogen peroxide and iodine. ROS and halogenation
How does alcohol based disinfectants kill?
disruption of membranes
What is chlorhexidine? how does it work?
Disinfectant–> works by dirupting membranes and coagulation ofcytoplasm
Treatment for Strongyloides?
Ivermectin
Which form of Strongyloides is infective?
Which form is in the stool?
filariform is infective
rhabdoform is in the stool
parasite adults and eggs are seen generally seen only in biopsy
What is pinworm’s actual name?
enterobius vermicularis
Why might a patient experience fat/skin necrosis about 1 day after warfarin therapy?
protein C rapidly reduces (also factor VII)… thus there may be transient hypercoagulability
what is serum sickness/ what causes it?.. what are the symptoms?
type III hypersensitivity due to either using nonhuman serum or monoclonal antibody therapy (inflixamab)… sx include vasculitis, skin rash, fever, arthralgia post therapy. ALSO LOW SERUM complements!
What is unique about plasmodium vivax and ovale that is different from plasmodium falciprium? How do you treat those?
vivax and ovale have ability to establish chronic hepatic infection. Thus, you need more than just the regular treatment. first line=chloroquine, but for vivax/ovale you must add primaquine.
Primaquine does NOT work in intraerythrocyte forms.
fever every 48 hours… what is this?
plasmodium vivax/ovale
atropine overdose… what do you treat with? why?
physostigmine because it crosses BBB
Essential tremor first line treatment (2)
primidone and propranolol
What is primidone used for? what is one of it’s metabolites?
essential tremor; phenobarbital
what are the symptoms of Atypical depression? what kind of antidepressant that is not often used is used as adjunct therapy?
mood reactivity, hypersensitivity to criticism, increased sleep/appetite, very heavy arms/legs (laden fatigue)
-MAOI are sometiems used as adjunct
Warfarin use; esp in pt of advanced age, DM, alcoholism,HTN …falling due to buckling knees…what is the dx?
retroperitoneal hematoma; which would press on the posas major… and thus the femoral nerve.
The branches of what nerve comes out between iliacus and poas?
Femoral n
poly arteritis nodosa occurs in what sized. histo? vessels?
small to medium sized.
transmural inflammation/fibrinoid necrosis
polyarteritis nodosa sx?
fever, abd pain, peripheral neuropathy, fatigue, weightloss
What infection is associated polyarteritis nodosa?
Hep B
salt and pepper skull upon x-ray…what do you think of?
primary hyperparathyroidism
high calcium; low phosphate…what do you think of?
primary hyperparathyroidism
duodenal ulcer. what two things do you think of?
H. pylori; NSAID
TdT is a marker for what?
TdT is a marker for lymphoid origin cells
mature B cell leukemia (SLL/CLL) markers?
CD19 and CD5
lecithinase of C. perferingens…what is lecithinase also called?
phospholipase C OR alpha toxin
what happens to salts in nephrotic syndromes?
retention due to RAS system
nephrotic syndrome can lead to increased cholesterol/triglycerides, LDL/VLDL…etc why?
this is due to increased lipoprotein synthesis (due to protein loss) by liver, and LPL decrease.
what’s different between primary infection and reactivation of HSV1
gingivostomatitis is primary infection. it tends to be in young children and mostly in the mucosal membranes
Reactivation is mostly on the lips and face
what was the umbilical vein?
ligamentum teres
umbilical arteries originate from where?
internal iliac arteries
p value is the same thing as what?
alpha error
Is the Salk vaccine for poliomyelitis live attenuated? or is it killed?
Killed. Sabin is live
What are 4 big causes of metabolic alkalosis?
Vomiting
Diuretic use
antacid use
Hyperaldosteronism
assessing pt with metabolic alkalosis…what do you want to assess first?
fluid status and urine Cl for differential
generalized anxiety disorder has to be symptomatic for how long?
6 months
when does delirium tremens onset?
48-72 hours post last drink
What is the first sx of alcohol withdrawal?
Tremors
What is tachyphylaxis? what are two drugs with prominent tachyphylaxis? How do you sustain the drug’s effectiveness?
rapid tolerance of the drug, thus deeming it ineffective
alpha agonist nasal congestants
nitroglycerine
you should take drug free periods to maintain drug effectiveness
Rebound Rhinorrhea…what is this?
tachyphylactic reaction to prolonged alpha agonist use for nasal decongestion. NE is depleted, thus vessels redilate and pt could e (but not necessarily) experiences rhinorrhea
what is the etiology of pt with Trendelenberg sign?
medial gluteal nerve injury. Lesion is on the opposite side as the hip drop
resting cell membrane potential is mainly due to K permeability. What is the ion that contributes the most next?
Na
Loop diuretics inhibit NaKCl symporter. What else does it do?
It stimulates prostaglandin release thus causing vasodilation and increasing renal blood flow…
why is brown fat brown?
it has a lot of mitochondria
How does ASD lead to Eisenmanger syndrome?
Pulmonary vessels will be under increased pressure…thus will hypertrophy and eventually shunt will reverse to R to L leading to late onset cyanosis
Wide fixed S2 that doesn’t change with breathing is what?
ASD
When is the physician able to share info about the patient without explicit consent?
If the patient is present and doesn’t object when physician has given them a chance to say “don’t preceed”
If the patient is not present and via judgement of doc that its in pt’s best interest to share… such as MI pt who’s wife is on scene without ID
what three conditions most contribute to elevated BUN
renal failure, heart failure, dehydration
hepatic encephalopathy is due to increased what in the blood? how does it pertain to encephalopathy?
Increased ammonia in the blood… It affects brain by increasing inhibitory neurotransmission and decreasing excitatory
in hepatic encephalopathy…what can precipitate/exacerbate it?
increased GI intake of ammonia; or increased cell breakdown products such as in GI bleeding
WHat kinds of things signal through the Jak Stat pathway?
growth hormones, cytokines, erythropoietin
Glucagon, PTH, and TSH acts through what receptor?
G protein Gs
where is bar body found?
periphery of nucleus
where is the most prominent effect of Hansen’s disease seen?
leprosy likes colder temperatures.. thus it often most affect eyes, digits, testes, peripheral nerves
diphtheria is what shape and what gram stain?
rod; gram +
diphtheria strains can gain virulence via what mechanism?
phage lysogenic specialized transduction
what is minimal alveolar concentration of a inhaled anesthetic? How does it relate to potency?
MAC is the percentage of the anesthetic is in the mixture to induce effect in 50% of the population (ED50%)… the lower the MAC the more potent the drug is
which two things can activate classical complement pathway?
IgG and IgM
is IgG or IgM better at activating complement
IgM
C1 binds Ig to activate classic complement pathway… where does it bind?
C1 binds the Fc region of Ig NEAR THE HINGE not the END
lump in breast that changes with menstrual cycle… what is this
fibrocystic changes
What is the mutation in Facto V Leiden?
Glu to Arg mutation of Protein C…thus cannot cleave factor V and increased thrombosis risk
What are the three major complications of Factor V Leiden?
DVT, cerebral vein thrombosis, spontaneous abortions
polyethylene glycol has what kind of GI effect
osmotic laxative
second hand smoke increases what risk?
asthma
asthma pts may have imbalance of T cells… which is predominant
Th2
What is inherited pancreatitis…what is defective here?
Inherited defect either in Trypsinogen (less to being inactivated) or decreased SPINK (which prevents trypsinogen premature activation)….
Therefore Typsin is prematurely activated and is resistant to being inactivated…causing pancreatitis
Name three betalactamase inhibitors
clavulanic acid
tazobactam
sulfabactam
Dilated coronary sinus indicates what?
R heart pressure is increased. Potentially pulmonary hypertension or L to R shunt or pulmonic valve stenosis
Pinealoma…what are three common manifestations?
Parinaud’s syndrome
hydrocephalus due to blockage of the cerebral aqueduct
Precocious puberty–> pinealoma often secret gonadotropins
pt with angiomyolipoma and subependymoma… what is this
tuberous sclerosis
are long acting or short acting benzos more addictive
short acting
are long acting or short acting benzos more associated with day time drowsiness?
long acting
Name three short acting Benzos
Oxazepam
Alprazolam
Triazolam
Name three medium acting benzos
Lorazepam
Estazolam
Temazepam
Name 4 long acting benzos
chlordiazepoxide
chlorazepate
diazepam
flurazepam
name the 4 types of thyroid carcinomas?
Papillary
Follicular
Anaplastic
Medullary
How to distinguish follicular adenoma and follicular carcinoma of the thyroid?
Must do biopsy…fine needle aspiration is NOT ok… because the only difference is capsullar invasion
if fetus is Rh+ and mother is Rh-…when is most likely for mother to be exposed to fetal blood and mount a response in subsquent pregnancies?
in late gestation, especially during delivery
Rh Allloimmunization
How do you prevent mother developing Rh antibodies during first pregnancy with Rh positive baby?
Give mother IgG anti-Rh. This will bind the fetal RBCs that cross into maternal circulation. However, not a significant amount will cross to the fetus!
What is Carcinoembryonic Antigen used for (CEA)
monitoring colorectal cancer
What is CA125 used for?
monitoring ovarian cancer
What is the drug of choice for patient with both absence seizures AND Tonic clonic seizures?
Valproic acid
what type of seizure is carbamazepine preferable?
preferred in partial complex. can also be used for generalized tonic clonic
What type of seizure is phenytoin prefered?
tonic clonic and status epilepticus
What is a serious side effect of carbamazepine?
agranulocytosis
In consensus pupillary reaction… which nucleus receives sensory information?
Pretectal nucleus
In consensus pupillary reaction…which nucleus sends out motor information? to where?
Edinger Westfal nucleus –>ciliary ganglion –>ciliary muscle
pt with mitral valve endocarditis experiences stroke. What are the two likely causes? what’s more likely?
Mitral valve prolapse, rheumatic heart disease
mitral valve prolapse is more common leading to Native Valve Bacterial Endocarditis
intrahepatic hydatid cyst is associated with what?
ecchinococcus
confusion in elderly male with bacteremia. What is likely the source of infection
UTI.
What exactly causes overweight individuals to be resistant to Insulin?
High Free FA and triglycerides
could be due to increased serine phosphorlyation similar to TNFa, glucagon, and glucocorticoids
What do you use to treat increased intracranial pressure?
Mannitol
Name a serious side effect of Mannitol?
Pulmonary edema… occurs due to increased volume in vessels… thus increasing hydrostatic pressure
How does sulfonylurea work?
It binds KATP channel in beta pancreatic cells… closing the channel–>depolarization and insulin release.
Insulin is released from depolarization of beta cells… what comes before this starting with glucose entry?
Glucose enters cell –>glyclysis–>ATP –>bind to KATP channel–>closure of K channels
stimulation of transcription factor PARRy… leads to what?
Increased adiponectin
Increased GLUT4
Increased fatty acid transport proteins
Increased insulin receptor substrates
what are the DM drugs that do not cause hypoglycemia?
Metformin–>regulates gluconeogenesis and glucose related factors
Thiozolidodindiones–>increased peripheral sensitivity to insulin via upregulating PARRy related factors
posterior 1/3 of tongue. what nerve is responsible for taste? what nerve is responsible for sensation? what nerve is responsible for motor?
Taste: IX, X
Sensation: IX, X
motor: XII (X is pharynx)
Anterior 2/3 of tongue. What nerve is repsonsible for taste? what nerve is responsible for sensation? what nerve is reponsible for motor?
taste: VII
sensation V3
motor: XII
histo: packed follicles with normal lymph node architecture, centrocytes “cleaved” small cells,
Follicular lymphoma BCL2; t14;18
Pt with recurrent otitis media dies after blood transfusion…why?
Pt has deficiency in IgA…and often these patients will have IgG against IgA…thus transfusion lead to anaphylaxis.
If parent of child wants to leave AMA when the child has a condition that could kill him/her…what should you do?!
First explain to the parents why they need to stay.
If it doesn’t work you need to bring this to court.
DO NOT DC PT!!!
acute movement side effect of atypical anti psychotics?
acute dystonia (hrs to days)
Longterm movement side effect of atypical antipsychotics?
Tardive dyskinesia
Akathesia. what is this/what caues it?
restlessness, can occur anytime
When does parkinsonian sx develop in the timeline of antipsych use?
Parkinsonian sx weeks to months
acute dystonia (hrs to days) Tardive dyskinesia (long term)
What does Leptin do?
It decreases appetite by decreasing neuropeptide Y and increasing alphaMSH
amphotericin B SE?
nephrotoxicity–>hypokalemia/hypomagnesia–>cardiac abnl
4 year old M with signs of puberty. elevated 17hydroxlyprogesterone and testosterone. Everything else normal. What is the dx?
nonsalt wasting type of 21 hydroxylase deficiency
why exactly does adrenal hyperplasia occur in 21 hydroxylase deficiency?
no cortisol production leads to increased ACTH stimulation… thus increasing adrenal mass…
The point of treating with cortisol replacement is in part to down regulate ACTH
schistocytes are seen when?
microangiopathic hemolytic anemia (DIC, TTP, HUS, malignant HTN, metastatic carcinoma
OR mechanical destruction: prostetic heart valve, calcified valves
schistocytes in elder adult with neurologic symptoms…ddx?
Thrombotic thrombocytopenic purpura (TTP)
schistocytes in child
HUS
rapid correction of hyponatremia could result in what?
central pontine myelinolysis
Rapid correction of hypernaturemia could result in what?
cerebral edema
dietary lipid is digested where/how? where is it absorbed?
It’s digested in the duodenum with help of bile acids… then it’s absorbed in the Jejunum.
Where is DEAK vitamins absorbed?
Jejunum
How are hydroceles formed (Testes)
open processus vaginales… leading to fluid accumulation
What occurs in adaptation to high altitude?
increased 2,3BPG and R shifts the curve
When does S3 occur?
-low pitched right after S2
when pressure of filling blood exceeds the capacity of the ventricle.
- rapid filling in elevated compliance
- dilated cardiomyopathy–>rapid filling into over filled ventricle
Temporal arteritis has similar morphology to what other vasculitis?
Takayasu. Both have giant cells (temporal or aorta/pulm arch)
WIlson’s disease is associated with atrophy of what CNS part?
Basal ganglia due to oxidative damage
EGFR1 mutation?
lung adenocrcinoma
WT1 is it a tumor suppressor or protooncogene?
tumor suppressor
VHL is it a tumor suppressor or protooncogene?
tumor suppressor
What is BRCA1/2’s functional role
DNA repair of double stranded breaks
What is the pulmonary wedge pressure in ARDS? why?
normal. because wedge pressure measures L atrial pressure. If this is increased, it would suggest cardiogenic pulmonary edema rather than ARDS
Dx delusion disorder. how long does sx have to be?
1 month
What is a method to terminate SVT without meds or cardioconversion
val salva
If alveolar and tracheal PO2 is about the same. what do you think is the problem?
perfusion mismatch
Which conditions will make the lungs diffusion dependent rather than perfusion dependent?
Ephysema, pulmonary fibrosis, high intensity workout
acute stress disorder becomes PTSD after what amount of time?
1 month!!!
SE of isoniazid?
neuronal toxicity; hepatotoxicity
isoniazid mechanism?
inhibits mycolic acid synthesis;
must be activated by catalase in the bacteria (KatG encodes)
what is kernicterus?
unconjugated bilirubin deposits in the brain causing encephalopathy…such as in Crigler Najjar
what is the mutation in Dubin Johnson’s?
MRP2; transporter for conjugated bilirubin
What can lead to deconjugation of bilirubin? what is the clinical result of this?
high numbers of anaerobes or Staph aureus. This causes lipid malabsorption. NO LIVER PROBLEMS or BILIRUBIN PROBLEMS!
patient with hyperthyroidism being treated with … develops oral ulcers and infections with fever… what do you need to think about?
agranulocytosis.
why is nafcillin preferred than penicillin in treating staph aureus?
nafcillin is penicillinase stable… and most staph aureus species have penicillinase
What kind of vaccine is MMR?
live attenuated
opioid related miosis is mediated through which receptor stimulation?
kappa
opioid related antidepression effect is through which receptor stimulation?
delta
opioid related constipation is achieved through which receptor?
mu
name the betalactamase stable penicillins
Nafcillin, Oxacillin, Dicloxacillin, methacillin (not used in people. only in the lab)
proprionyl coA is converted to Methylmalonyl coA via what? what happens to the methylmaloyl coa?
proprionyl CoA carboxylase.
then the methylmalonyl coA isomerizes to succinyl coA and enters TCA
long term PPI use can predispose you to what
osteoporosis
Why do you inject nonlabeled B12 in to the blood with the oral radiolabeled B12 in Schillings test?
to make sure that the ingested labeled B12 will be excreted by creating B12 excress
at what spinal levels does IVC split into iliac?
L4-L5
What do you use bisphosphonates to treat?
Osteoporosis, Paget’s, and hypercalcemia associated with malignancy
follicular thyroid cancer. mutation?
Ras
anaplastic thyroid cancer. mutation?
p53
uncal herniation could cause what visual defect?
It could compress on PCA thus creating contralateral honoynmous hemianopsia with macular sparing
Pt with aortic stenosis presents with pulmonary edema with afib onset. why is this happening?
a fib means the L atrium is not pumping and thus decreasing L ventricular preload. Since it’s not squeezing as much the blood backs up in the lung because the ventricle is very poor at contracting due to severe hypertrophy
Ureter passes behind what and over what?
beneath gonadal arteries and over interal iliacs
VIPoma symptoms? what cells are they?
pancreatic islet cells.
Watery Diarrhea Hypokalemia Achlorhydria
CCK action? what cells produce cck?
duodenal I cells produce cck in response to fats; gall bladder contraction, increase pancreatic enzymes, and decrease stomach emptying
most common causes of otitis media?
strep pneumo,
Hemophilus,
Moraxella
cholestyramine should not be used in patients with what?
hypertriglyceridmia
What is the superficial cervical fascia
superficial fat and platysma
High dose of folate in a pt with seizure history who is medically treated? what happened?
high folate displace phenytoin thus causing seizure
ventral pancreatic bud becomes what?
the uncinate process and the main pancreatic duct
what gene is mutated in Paroxysmal Nocturnal Hemaglobinuria?
PIGA
What is the molecular defect in paroxysmal nocturnal hemaglobinuria?
GPI linker is missing so that CD55 and CD59 are not on cells to prevent complement attack
What are some complications of Paroxysmal nocturnal hemoglobinuria?
thrombotic complications (ex: bud chiari) due to hemolysis and factor release; aplastic anemia/pancytopenia
what lab abnormalities are seen in vWF D?
prolonged bleeding time;
abnormal ristocetin
and increased PTT due to factor VIII deficiency
what is ristocetin?
It activates platelet GP1b on platelets so that VWBF can bind
How is preprocollagen, procollagen, and tropocollagen different from eachother?
Preprocollagen is freshly synthesized single strands within the cell.
Procollagen is without the ER targeting seuence, and it is glycosylated/hydroxylated in the cell. then exported
Procollagen is cleaved to form tropocollagen inthe extracellular space. it is insoluble. These are linked together via lysyl oxidase
what type of diarrhea does VIP cause?
secretory
sandpaper like rash in a young child
scarlet fever
what is the rash called in parvovirus B19?
erythema infectiosum
what is the difference between COX 1 and COX 2?
COX 1 is constitutive and COX2 is only expressed in situations of inflammation
what are three treatments for Alzheimer’s disease?
- anticholinesterases (Donepezil, Rivstigmine, galantine)
- NMDA antagonists (Memantine)
- antioxidants (Vit E/Tocopherol)
insertion of central venous catheters. what are the safety guidelines?
- washhands/ sanitizers
- use full barriers during insertion
- disinfect skin with chlorhexidine
- avoid femoral sites
- remove when not needed.
what do patients with atopic dermatitis often have?
allergic rhinitis
asthma
This is the “allergy triad”
What is the mechanism of Ticlodipine?
ADP receptor blocker on platelets thereby inhibiting GPIIb/IIIa. Like Clopidogrel
abciximab targets what?
GPIIbIIIa
what does cilostazol do? what’s another drug in this category?
phosphdiesterase inhibitor that increase cAMP level. thus not allowing platelet to be activated and also acts as a vasodilator.
Dipyridamole
How does cAMP level correlate with platelet activation?
decreased cAMP leads to platelet activation
what are the sideeffects of loop diuretics?
Ototoxicity Hypokalemia Dehydration Allergy (Sulfa) Nephrotoxicity Gout
what drugs cause ototoxicty/nephrotoxicity??
Aminoglycosides
Cisplatin
Loop diuretics
vancomycin
Side effects of Thiazides?
hypokalemia, hyponatremia, hypomagnesia
Hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia (hyperGLUC)
cholestyramine binds what?
it binds bile acids
bilobed neutrophils post chemotherapy. what is this?
pseudo pelger huet anomaly
what is myelophthisic anemia?
anemia due to space occupying lesion
tongue claudications and scalp tenderness with hair brushing. morning stiffness. what is this?
temporal arteritis
Side effect of dimercaperol?
nephrotoxicity; hypertension
phlegmasia alba dolens. what is this?
white leg due to thrombosis of the iliofemoral veins in pregnancy when the gravid uterus presses down PLUS hypercoagulability
Varicose veins predispose pt to what complication?
skin ulceration/infections/superficial thromboses
summer month; child with pharyngitis and conjunctivitis
adenovirus
meningitis post exposure to mouse urine. what is this disease? what kind of virus is it?
lymphocytic choriomeningitis virus (LCV);
arena virus
what is the presentation of pericaditis?
sharp pleuritic pain radiating to the neck worse with swallowing. better with leaning forward.
Pericarditis post MI?
localized will self resolve; onset 2-4 days after MI
autoimmune 1 week post MI onset is dressler’s
what structures are drained to the paraaortic lymph nodes?
testes/ovaries, kidneys, urterus
What structures are drained to the internal iliac nodes?
bladder, prostate, lower rectum above the pectinate line, vagina
Henoch-Scholein sx? What is it caused by?
palpable purpura on BLE, nephritis, arthralgias, and GI discomfort.
This is mediated by IgA deposition in the vessels.
if you see lower extremity cyanosis without BUE cyanosis…what is this?
patent PDA… with Eisenmenger.
This is NOT coarctation as coarctation does not lead to cyanosis, just weak pulses.
immingrant child/teen with new cyanosis due to heart problems
this is Eisenmanger’s due to L to R shunt that has reversed to R to L shunt.
cardiac tamponade due to wall rupture ususally occurs on which day post MI?
This usually occurs4-7 days after MI when the tissue is completely dead and degraded by neutrophilic infiltrate. rupture can cause tamponade and lead to systemic hypotention thus death
pain in long bone in young boy. what are two can’t misses?
Osteomyelitis-staph via hematogenous spread
osteosarcoma
which diabetic drugs do not increase insulin secretion?
metformin, glitazones, acarbose, dietary modifications
what kind of tremor do parkinson pts have
resting tremor
What kind of tremor do essential tremor pts have?
postural tremor
typical antipsychs block what receptors
d2
atypical antipsychs block what?
d2, H1, alpha1, and Serotonin2
tremor with holding positions. family history. tremor decreases with EtOH. what is this? waht’s the treatment?
Essential Tremor. Use nonselective Beta blockers, primidone
isolated cardiac amyloidosis
ANP
Isolated pancreatic amyloidosis
amylin
Isolated thyroid amyloidosis
calcitonin
isolated pituitary amyloidosis
prolactin
why do men have higher hct count?
androgens! thus steroid abuse can elevate hct
how does childhood HAV most likely present?
anicteric. no jaundice
aversion to smoking with acute illness. waht is this?
Hep A in adults
tyrosinease deficiency
albinism
what is the reason why you don’t want to use asprin in gout?
Because it’s antiuricosuric, and only slightly uricosuric at high doses
why is the SNS overly activated in DKA?
despite glucagon induced hyperglycemia/lipolysis in DKA, the body is in a hypoglycemic state due to inability to take in glucose. thus… SNS is activated due to NE, cortisol, GH, and glucagon upregulation… which all worsens the hyperglycemia
ornithine and citrate of the urea cycle, which is in the cytoplasm which is in mito?
Ornithine in mito; citruline in cyto
what is the hCG level at the end of pregnancy?
low. It falls after about 10 weeks
4 year old with arm extended and pronated. refuse to move it. no bruising. dx?
nursemaid’s elbow. subluxation of ulna out of annular ligament
what’s the difference between Topo I and topo II?
Topo I –>single stranded cleavage to release negative coils
TopoII–>ds cleavage to release both positive and negative coils
Podophyllin and Etoposide. mech? use?
both are Topo II inhibitors of the lyase activity. thus cannot heal DNA breaks.
Podophyllin -for genital warts
etoposide- for cancer (lung, testicular)
mechanism of Irinotecan
topo I inhibitor
What is the sequence TTAGGG
telomere!
What are the two subunits of telomerase? what kind of enzyme is telomerase
it has TERT-transcriptase and TERC- built in RNA sequence.
It’s a RNA dependent DNA pol
egg shell calcifications in the liver–>rupture leads to anaphylaxis. what is this?
Ecchinococcus
monitor what with Clozapine?
CBC
which antipsych drugs are mostly associated seizure SE?
TCA and buproprion
corneal reflex is mediated by what nerves?
afferent V1; efferent VII
cranial nerve III palsy sx?
eye lid droop
loss of pupillary reaction
down and out eyes
Why might a sickle cell pt have macrocytic anemia?
high cell turnover leading to folate deficiency
alcoholic with macrocytic anemia…what is likely the missing supplement?
folate. cobalamine deficiency is not as common in alcoholics as folate
daptomycin mechanism? what class is it used against?
It depolarizes cell membrane. Gram positives
What are the three treatments for MRSA?
Vancomycin, Daptomycin, Linezolid
which antibiotic is associated with pulmonary distress and elevated CK levels?
daptomycin
which antibiotic is associated with optic neuritits and thrombocytopenia?
Linezolid; also associated with serotonin syndrome
what are two ways to calculate Cardiac output?
CO=HRxSV
CO=O2 consumption/A-V gradient O2
diabetic who is well adhering to treatment develops hypoglycemia…what do you think preceipitated this?
exercise…leads to a drop in glucose levels… usually insulin would stop secreting to prevent further drop, but diabetics have exogenous insulin
what may precipitate hyperglycemia in diabetics?
stresses…such as infections, pain, sleep deprivation. stress up regulates catecholamines/corticosteroids…increased gluconeogenesis leads to too much sugar for how much insulin is administered
schizophrenic patient develops amenorrhea post treatment. why?
treatment with antipsychs –>iinhibition of D2 receptors… thus releasing prolactin from inhibition. Excess prolactin will cause inhibition of FSH and LH
what is different about hepatitis C and hepatitis B on histology?
C will have central macrovesicular steatosis with aggregating lymphocytes.
B will have cells with granules of surface antigen/ have ground glass appearance
what is in the Thyar Martin agar?
Vancomycin, Colistin, and Nystatin
which rRNA is not made in the nucleolus?
5S rRNA
Fabry’s disaese…what is missing?
alpha galactosidase A
without surfactant do you expect smaller or larger alveoli to collapse first?
smaller ones will due to la place’s law…2T/r… smaller R means larger pressure and thus will divert air to larger alveoli
what can trigger cataplexy?
joking/positive emotinos
low hypocretin. ddx? where is the hypocretin secreted from?
narcolepsy; secreted from lateral hypothalamus
which prostacyclins are antagonistic of TXA
prostacyclin I2 abd H2
which prostacyclins inhibit gastric acid secretion
PGE2
polyvinyl chloride, arsenic leads to which kind of cancer? what’s the tumor marker?
liver angiosarcoma; CD31 PECAM
XIIa. what are the two functions?
XIIa activates XIa; it also activates Kallikrein,..which intern activates Plasminogen to plasmin
kallikrein action?3
actionvates plasmin and bradykinin; neutrophil chemotaxis
bradykinin function?
vasodilation/increase permeability; mediates pain
What does protein C do?
It inactivates factors 5 and 8
Heparin can cause what side effects?
HIT; bleeding; OSTEOPOROSIS
in HIT what do you do?
stop heparin; give warfarin and direct thrombin inhibitors
what is the difference between heparin and LMWH
LMWH inactivates Xa versus Heparin inactivates Thrombin and Xa via potentiating antithrombin
How do you calculate compliance?
Vol/Pressure=compliance
what are three ways CO2 is transported in the blood?
dissolved, bound to Hb, mostly as HCO3
CO2 produced by the tissue is converted to HCO3 how? and how is HCO3 converted back to CO2 at the lungs?
RBCs convert CO2 to HCO3 at the level of the tissue via carbonic anhydrase. and is extruded from the RBC in exchange for chloride
same thing happens at the lungs.
In exercise, what happens to the venous vessels, arterioles, skeletal arteries?
everything vasoconstricts, except for muscle arteries relax due to local modulation
what locations do steps of the collagen synthesis process occur?
hydroxylation and glycosylation and tiplet formation are in RER. then golgi does nothing but secrete it. in the EXTRACELLULAR SPCE is where the cleavage and lysyl oxidation occurs
what molecules are glycosylated to collagen?
glu and galactose
necrotizing fasciitis ddx?
strep pyogenes, staph aureus, strep perferingens
oval fat bodies/maltese cross in urine
nephrotic syndrome
why nephrtic pt is more prone to…
infections?
thrombosis?
loss of immunoglob and antithrombin
clostridum dificil treatment
- Metronidazole
- vanco if severe
- fidaxomicin if recurrent
What are advantages of Fidaxomicin in severe C. Diff tx?
it has minimal systemic absorption;
It is very narrow spectrum
meningiomas are from what structure?
arachinoid villi
