Rapid Facts from Q banks Flashcards
0
Q
What is the formal name for eczema? What’s poison ivy like skin conditions? What’s different?
A
Atopic dermatitis is eczema. It’s severe in infants and lichenification and less severe in elder kids and adults.
Contact dermatitis–usually acute, where as atopic is more chronic onset
1
Q
What is the most sensitive indicator of recent alcohol use?
A
Serum gamma glutamyl transferase (GGT) (also called gamma glutamyl transpeptidase) is the most sensitive indicator of recent alcohol use. It is elevated in 80% of alcohol-related disorders and is usually the first index to react; therefore, it can be used for the above purposes. Other drugs (e.g., barbiturates, phenytoin) can also increase serum GGT levels. It should also be noted that in DSM-5, patients are diagnosed with alcohol use disorder, alcohol intoxication, or alcohol withdrawal.
2
Q
Pneumonia in chronic alcoholic?
Tx?
A
Klebsiella. Also in DM and CoPD.
Tx with 3rd gen cephalosporin-
3
Q
Salmon Colored rash with silvery scale; pt also has JOINT disease
A
Psoriasis
4
Q
Metalloproteinases are involved in what way in cancer
A
invasion
5
Q
Loss of Ecadherin; gain of Laminin
A
Tumor invasion initial events
6
Q
Antiplatelet therapy when ASA cannot be used
A
Clopidogrel
7
Q
Two primary cell types for heme synthesis; what are they used for?
A
hepatocytes–>p450; erythrocytes–>hemoglobin
8
Q
What prevents mature erythrocytes from heme synthesis
A
loss of mitochondria
9
Q
Major regulating step of glycolysis?
A
PFK1
10
Q
Lipid A on LPS in Gram negative
A
ex: e coli; septic shock by activating neutrophils/granulocytes
11
Q
whats the goal of urea cycle
A
make ammonia to urea
12
Q
Thiazides act on what channel? It causes elevation in? contraindications
A
Na/Cl channel and causes elevation of glucose, calcium, uric acid…don’t use in gout, hypercalcemia pt, and diabetic pts
13
Q
Hb A2 subunits?
A
Alpha2 delta2
14
Q
Vasculitis in graft vessels
A
acute rejection
15
Q
fibrosis and thickening of graft vessels
A
chronic rejection
16
Q
Three key associations of Conn’s
A
HTN, hypokalemia, metabolic alkalosis (alkalosis may lead to paresthesia/weakness)
17
Q
How does Hep B help Hep D?
A
Hep D needs to be coated with Hep B surface antigen in order to infect hepatocytes
18
Q
nl GFR
A
125
19
Q
Filtration Fraction
A
GFR/RPF
20
Q
on-off phenomenon
A
parkinson’s disease; cycles of relief with Levodopa. Relief is not consistent and therapeutic periods decrease as time progresses due to Nigrastriatal degeneration
21
Q
Caudate degeneration
A
Hungtington’s; CAG loss of GABA
22
Q
Locus ceruleus?
Raphe nucleus?
Red Nucleus?
Nucleus basalis of Meynert?
A
NE, 5HT, upper extremity motor coordination; Ach
23
Q
2 tissues that cannot use ketone bodies for enegery. why?
A
- RBC–>no mitochondria for ketone oxidation
- hepatocytes–> don’t have succinyl CoA-acetoacetate CoA transferase (thiophorase) to convert acetoacetate to acetoacetyl coA
24
What are the two ketone bodies?
acetoacetate and beta hydroxybutyrate made from FA; then converted to Acetyl CoA in periphery
25
Familial Chylomicronemia syndrome. mutation? accumulation? symptom?
LPL and ApoCII mutation; accumulates chylomicrons; ; acute pancreatitis risk/xanthomas/retinalis/hepatosplenomegaly; CHILDREN!
26
milky plasma; low LPL
familial chylomicronemia
27
Familial hypercholesterolemia. Mutation? accumulation? symptoms/risk?
LDLR or ApoB mutation; accumulation of LDL; at risk for premature CAD/xanthomas
28
Familial Dysbetaproteinemia. Mutation? accumulation? risk?
ApoE mutation; accumulation of chylomicrons and VLDL remnants;
29
Familial Hypertriglyceridemia. mutation? accumulation? risk?
ApoA-V mutation; accumulation of VLDL; increased pancreatitis/and DM
30
Asthmatic using steroid inhaler; proximal bronchiectasis; high IgE and eosinophilia
Allergic bronchopulmonary aspergillosis
31
Berkson's bias
selection bias by selecting hospitalized patients as control group
32
Power; definition; how to increase power?
ability of a study to ID difference when the difference truly exists; increase sample size
33
Entecapone; use; mechanism
used for adjunct therapy in Parkinson's; COMT inhibitior-->increases amount of Dopamine entering brain.
34
fulminant hepatitis in pregnant woman
HepE
35
Why can you not use betalactams against chlamydia trachomatis
It doesn't have a cell wall. Tx: doxycycline/macrolides
36
pneumonia, finger clubbing, steatorrhea
cystic fibrosis (F508) (steatorrhea-->DEAK deficiency)
37
baby lack of meconium passage
cystic fibrosis (F508)
38
```
Down syndrome associations:
neurology
cardio
GI (2)
endocrine (2)
Cancer
joint
```
- early onset alzheimer
- cards: ASD/VSD
- GI: hirshprung/duodenal atresia
- Endo: T1DM; hypothyroid
- acute leukemia
- atlantoaxial instability
39
anemia/reticulocytosis; jaundice; dark urine post dapsone
G6PD
40
G6PD oxidative stresses that are NOT drugs
1. Fava beans
2. Infection
3. DKA
41
G6PD oxidative stress drugs
1. antimalarials
2. Dapsone
3. sulfamethoxazole-trimetheprim
42
Vitamin D toxicity
hypercalcemia/calcium deposition; kidney STONES!
43
2 classic signs of long thoracic nerve/ Serratus anterior injury
winged scapula
inability to abduct arm above horizon (from ground to horizon is via supraspinatus and deltoid)
MASTECTOMY
44
granulomas in carotid/temporal arteries' media?
temporal/giant cell arteritis
45
granulomas in arotic arch media?
takayasu arteritis-->asian woman pulseless disease.
46
lung cancer with necrosis/cavitation and hypercalcemia
squamous cell carcinoma
47
Lung cancer with clubbing and hypertrophic osteoarthropathy?
Adenocarcinoma (women non smoker, peripheral)
48
Lung cancer with gynecomastia/galactorrhea?
Large cell carcinoma ( peripheral)
49
VACTERL
vertebral, anal atresia, tracheoesophageal fistrula, renal limbs
50
imperforate anus most likely to see what other anomalies?
urinary tract abnormalities including renal
51
First order kinetics-->how long will drug reach steady state?
4-5 half lives
52
squamous cell metaplasia in CF patient
vitamin A deficiency due to steatorrhea
53
Ig heavy chain is on what chromosome?
14
54
Nasal polyp in child
CF
55
Cri du chat mutation
Ch 5 short arm deletion
56
Paradoxical split causes (2)
aortic stenosis or left bundle branch block
57
Black liver
Dubin Johnson; Direct bilirubinemia (conjugated; can't get out)
58
If you're given PaCO2; how do you figure out PAO2?
PAO2=150 (PaCO2/0.8)
59
What are three common lung parameters that increase in smokers
compliance and residual volume in emphysema; PAO2-PaO2 gradient
60
painful oral ulcers in IV drug user who is HIV positive
Kaposi Sarcoma
61
Kaposi Sarcoma disease process;
HHV8 in HIV
1. painful oral ulcers
2. blue-brown skin rashes on extremities
3. GI/lung lesions in later stage
62
Kaposi Sarcoma Histology
spindle cell proliferation, endothelial cell proliferation, extravasation of RBCs, inflammation
63
Fructose metabolism 2 enzymes
Fructose--(Fructokinase)-->Fructose 1 phosphate--(aldolase)-->Glyceraldehyde-->enter into glycolysis
64
HBV vaccinated individual serotype?
anti-HBsAg antibodies; nothing else
65
Window period of HBV infection... Definition? Marker?
the period when surface ag is no longer detectable, but Anti-HBsAg antibodies are not measurable. The marker is Anti-HBcAg antibodies HBcAg is in the envelop and not detected)
66
What's the significance of HBVeAg and anti-HBVeAg
indicates presence of HBV DNA
Antibodies indicate low replication and infectivity; if antigen is present for more than 3 months it means establishment of chronicity
67
Strong humeral response is linked to which kind of T cell? cytokines?
Th2; IL5 (IgA); IL4 (IgE)
68
Which type of T cells are seen in sarcoidosis? which cytokines are prevalent?
Th1 repsonse; IL2, IFNY (macrophages!)
69
1 gram of fat is how many calories?
9 cal
70
1 gram protein is how many calories?
4 cal
71
I gram of carbohydrate is how many calories?
4 cal
72
1 gram of ethanol is how many calories?
7 cal
73
4 physician payment strategies? what do they mean?
capitation: fixed amount per enrollee-->encourages preventative treatments
Fee for Service: entices physicians to do more tests/procedures
Discounted Fee for service: the discount is for the patients for expensive procedures, thus physicians are less likely to order excessive expensive tests
Salary: no financial risk for the physician based on practice. physician is unlikely to increase/decrease testing or increase/decrease enrollees
74
LMN lesion signs in upper extremities; UMN lesion signs in lower extremities; scoliosis
Syringomeylia
75
Spinal cord section with lateral horns
T1- L2
76
Spinal cord section with large ventral horn
Lumbar and Sacral
77
Spinal cord section that's ovoid with a lot of white matter
cervical
78
Spinal cord section that has prominent ventral and dorsal roots
lumbar
79
How to avoid tolerance to nitrates
give small doses throughout day with "nitrate free periods"
80
How is bipolar with psychotic features different from schizoaffective disorder
Bipolar with psychotic features/major depression with psychotic features only have psychosis when mood abnormalities are occuring
81
What is schizoaffective disorder; what is it? DSM5 criteria?
mood disorder plus signs of schizophrenia; can have psychotic episodes without mood disorder
DSM5:
-episodes of major depression or mania
-> or equal to 2 weeks of psychosis without mood disturbance
-mood disturbance is present for majority of illness
-no induced by drugs
82
Immune mediators of septic shock
IL1, IL6, TNFa
83
Cresenteric/rapidly progressive glomerulonephritis three types
Type I anti GBM good pasture with IgG and C3 deposits
Type II immune mediated IgA (Henoch Scholein)/SLE/post strep (lumpy bumpy)
Type III ANCA
84
PDA heart sound
continuous murmur loudest during S2
85
Reassortment
when segmented viruses infect a cell and the segments mix to produce a new combo (influenza A)
86
Foscarnet mechanism; Side Effects
pyrophosphate analog that chelates calcium; hypocalcemia/hypomagnesia
87
Acyclovir side effects
neurotoxicity, nephrotoxicity, tremors/delirium
88
Lamivudine mechanism; Side effects
reverse transcriptase inhibitor; peripheral neuropathy and lactic acidosis
89
HIV patient with visual problems; cause?
CMV retinitis; treat with Gancyclovir, Foscarnet, and Cidoforvir
90
What is confidence interval; what is null value?
CI of 95 is if a study is done 100x, 95 times would be within the range; null value value of 0 indicates no statistical significance
91
patients with low acetylating drug inactivators are affected by what kind of drugs?
Isoniazid, Dapsone, procainamide, hydralazine
92
Sarcoidosis/Hodgekins lymphoma with hypercalcemia. why?
increased T cell activity-->activated macrophages and alpha 1 hydroxylase-->increased vitamin D levels
93
Pin worm treatment? if pregnant?
Albendazole; Pyrantel pamoate
94
EML4-ALK fusion gene
non-small cell lung cancers resulting in constitutive Tyrosine kinase activity
95
Recurrent lobar strokes in elderly that are not severe
cerebral amyloid angiopathy
96
Honey Comb lungs
idiopathic pulmonary fibrosis
97
Breast Biopsy with myxoid stroma and squished epithelia lined ducts
Fibroadenoma
98
When is betahCG detectable in maternal serum?
after day 6 (8-11 days); implanatation must occur prior
99
Heparin mechanism?
increases Antithrombin III activity
100
Attributable Risk?
Exposed with dz/all exposed-not exposed with dz/all not exposed
101
Increase in portal system pressure will cause increased drainage in which veins to produce the following?
1. esophageal varices
2. caput medusa
3. Hemorrhoids?
1. L gastric Vein -->esophageal veins
2. Paraumbilical vein-->super/inferior epigastric vein
3. Superior rectal vein -->inferior/middle rectal vein
102
Oseltamivir
| Mechanism
It's a neuraminidase inhibitor and thus prevent the newly synthesized virion from budding off the host cell
103
Enfevirtide
| mechanism; what is it used for?
prevents Influenza A/B from penetrating host cell
104
At FRC what is the intrapleural pressure? what is the intrapulmonary pressure?
Intrapleural is negative (about -5); intrapulmonary is 0-->thus no airflow
105
Osmotic fragility test is used to diagnose what? how does this test work?
dx for spherocytosis (hereditary spherocytosis due to ankryin/spectrin abnl); cell will lyse when put in hypotonic solution
106
femoral head necrosis, episodic thrombosis, spleen infarcts are indicative of what disease?
Sickle Cell Anemia
107
Frothy Urine
Protein or bile acids
108
Lipid and glycogen filled cells upon renal biopsy
Clear cell carcinoma of the kidneys; arises from renal tubular cells
109
What are two side effects of Fibrates such as Gemfibrozil
1. increased chance of myopathy/hepatotoxicity when used in conjunction with statins
2. increased risk for gall stones due to increased excretion of cholesterole in bile
110
Which statin is the worst for myopathic SE?
Simvastatin
111
Theophylline mechanism?
decrease phosphodiesterase activity thereby increasing cAMP-->bronchodilation
112
Epinephrine's effect what receptors? on HR, SBP, and DBP?
Epi acts on alpha 1, alpha 2, beta 1, and beta 2.
increases HR via Beta 1
increases SBP via beta 1 and alpha 1
decrease DBP at low doses via beta 2
increases DBP at high doses via alpha 1
113
Isoproterenol
| mehcanism?
beta 1 and beta 2 nonselective AGONIST!!! NOT NOT NOT ANTAGONIST
114
Phenylephrine
| mechanism?
selective alpha AGONIST-->thus increasing BP
115
malaria treatment? first line?
chloroquine is first line... however mefloquine or some other quine if resistant
116
Normal filtration fraction
20%
117
RFP equation
use clearance of PAH
| UV/P
118
Two ways of calculating GFR
```
UV/P for either creat or inulin
or Kf (difference in hydrostatic pressure- difference of oncotic pressure)
```
119
What happens to GFR and FF if ureter is obstructed?
both decreases
120
ApoA-1 function
LCAT activation to esterify cholesterol
121
ApoB48 function
chylomicron assembly; on chylomicrons
122
ApoB100 function
on LDL particles for uptake into extrahepatic cells
123
ApoCII function? deficiency?
activate Lipoprotein LIpase (LPL); deficiency is Chylomicronemia
124
ApoE3 and ApoE4 function? deficiency disease?
uptake of chylomicrons and VLDL remnants; deficiency=dysbetalipidemia
125
elevated alkine phosphatase differential organs
liver, bone, placenta, (intestines, kidney, leukocytes)
126
Blood/Gas partition coefficient; what does it mean if it's high? what does it mean if it's low?
If high it means gas likes the blood thus more soluble;
If it's low it means it easily separates out of blood... thus low solubility;
In inhaled anesthetics; low blood/gas partition=concententrates to brain more quickly
127
What is a inhaled anesthetic with low blood/gas partition coefficient? How soluble is it? fastness of onset?
NO, it's very non soluble thus fast onset
128
What is an inhaled anesthetic with high blood/gas partition coefficient? how soluble is it? fastness of onset?
Halothane; it's very soluble therefore slow onset
129
Anti inflammatory cytokines
TGFbeta; IL10
130
If patient cannot consent, has no proxy, and no family members. If a friend claims to know the pt's wishes...what do you do if pt needs emergent care?
Give emergent care
131
Pathogenic process of Giardia? How does immune response act against it?
Giardia attaches to microvilli and thus causes atrophy/damage to duodenum/jejunum.
IgA prevents adherence
132
Standard Error-What is it? How to calculate?
variability due to sampling rather than study of the entire population...which would then be Standard deviation; calculate by SD/sqrt(n)
meaning if sample size increases SE decreases
133
Standard Deviation and Standard Error... what's the difference?
Standard deviation is the variability of a entire population. Standard Error is SD taking in to account of sampling error-->thus SE=SD/sqrt(n)
134
What is the Z score for calculating Confidence interval? for 95%? 99%?
95%=1.96
| 99%=2.58
135
How to calculate Confidence interval?
CI=mean+/-Z(SE)
OR
Cl=mean+/-Z(SD)
136
Which enzymes of heme synthesis are inhibited by lead?
ALAD; ferrochetalase
137
Acute Intermittent Porphyria can be caused by which drugs and what kind of lifestyle things?
```
phenobarbital
phenytoin
griseofulvin
alcohol
low caloric diet
```
138
Why can Acute Intermittent porphyria improve with heme administration
Heme feeds back to inhibit ALAS thus decreasing the accumulation of Aminolevulinic acid and porphobilinogen
139
superior laryngeal nerve courses with what? innervates what m?
superior laryngeal artery and innervates cricothyroid m
140
5 hydroxyindolacetic acid elevation?
excess serotonin break down product...maybe carcinoid syndrome
141
mast cell content
histamine, tryptase
142
Carotid baroreceptors are innervated by what nerve?
| Aortic baroreceptors are innervated by what nerve?
Carotid=herring's nerve (Glossopharyngeal)
| Aortic=vagus nerve
143
neck stimulation-->syncope; why?
stimulation of nerve of herring Glossopharyngeal nerve thus baroreceptor activation-->vasodilation and syncope
144
coin lesions with popcorn calcifications in lung
hamartoma
145
pulmonary chondroma
lung hamartoma; characterized by cartilage
146
Statins SE
myopathy; hepatotoxicity
147
Meyer's loop. What is it; connects what structures?
genu of the optic radiation; connects lateral geniculi to visual centers in occipital lobe
148
pruitic red papules/vesicles on flexor surfaces
BUZZ WORDS: WEBBING OF FINERS/LINEAR BURROW
| scabies!
149
flagellated skin discoloration and pulmonary fibrosis in cancer patient
Bleomycin
150
uncomfortable sensation in BLE when falling asleep; better with stretching. Diagnosis? Common causes? Treatment?
dx: restless leg syndrome
causes: iron deficiency, uremia, DM
treatment: dopamin agonists
151
liver failure post general anesthesia?
Halothane (or sevoflurane and isoflurane) causing massive hepatic necrosis
152
microvesicular hepatic fatty change
Reye syndrome
153
Treatment for enuresis
Avp
Imipramine
Indomethacin
154
Treatment for enuresis
Avp
Imipramine
Indomethacin
155
What drugs can worsen ischemic region perfusion during an MI
drugs that selectively dilate coronary arteries; Dipyridamole and adenosine
This allows healthy vessels to dilate and thus "steal" the limited blood going to ischemic regions via collaterals
156
What is phenotypic mixing
protein of other virus is packaged into progeny, but no genetic material exchanged...thus the next generation of progeny will NOT have trait
157
7 year old post recent infection/vaccination/hypersensitivity has nephropathy; what is it most likely? How do you dx? what do you see?
minimal change; do EM--> you see podocyte foot effacement
158
CNIII courses between which two arteries?
PCA; SCA at level of midbrain
159
irregular EKG with no p-waves and narrow QRS complex
Afib (along with low amplitude fibrillary waves)
160
What is the ventricular rate in Afib?
about 70-190 BPM; atria is firing rapidly due to reentry, and impulses travel to ventricles via AV node at irregular rates and timing is dictated by repolarization rate of AV node
161
Most common ectopic site of conduction in afib?
pulmonary artery
162
Length constant of impulse propagation; what does it mean
how long impulse goes before decreasing to 37% of its original amplitude; better insulation increases length constant
163
Time Constant of impulse propagation. what does it mean
how long it takes to change the membrane potential; increase means slower propagation
164
allergic asthma histo findings
eosinophilia and charcot leyden crystals
165
In liver failure; which clotting factor deficiency is apparent first? WHy?
Factor VII; due to shortest T1/2
166
pt with jaundice, elevated PTT and AST, N/V fever very severe; History of surgery 1 week PTA
What's the dx? Histo?
hepatic necrosis due to Halothane
| Necrosis AND inflammation with atrophy
167
Tryptophan makes what
Niacin/NAD, Serotonin, Melatonin
168
Hartnup disease
defective renal absorption of tryptophan-->Pellagra;
(Proline/Arginine levels are nl)
Tx: high protein diet/NAD replacement
169
Lac operon components and function
| What leads to activation of lac operon?
I=regulatory; synthesizes inhibitory protein that binds O
P=promoter
O=operator; allows binding of inhibitory protein
Z=beta galactosidase
Y=permease
A= ...
activates when glucose is NOT present THUS increased cAMP; and when lactose is present
170
Three types of benign Colon polyps?
| 2 types of malignant?
hamartoma, lymphoid (children), hyperplastic
| tubular adenoma, villous adenoma
171
allopurinol; mech
inhibits xanthine oxidase
172
mania treatment 4
lithium, valproate, cabamazepine, olanzepine
173
What are NNRTIs? whats special about them? name 3
nonnucleoside reverse transcriptor inhibitor without need for phosphorylation;
nevirapine, efavirenz, delaviradine
174
pulmonary hypertension
| Demographic; mutation; symptoms
women 20-40; BMPR2 mutation; dyspnea and exercise intolerance
PLEXIFORM LESIONS
175
How do you treat pulmonary hypertension
lung transplant for definitive cure;
| Bosetan-= endothelin receptor antagonist-->prevents vasoconstriction
176
Child with nephropathy that recently had an infection;
| ddx: how to distinguish IgA nephropathy and post strep GN
IgA is days after, IgA present; mesangial dense chunks on EM
Post strep is weeks after, C3 is low, lumpy bumpy on light microscopy; subepithelial lumps on EM
177
Henoch Scholein-->systems involved
renal, skin, GI
178
histone core; what's in it?
| what's out side of it?
(2A, 2B, 3,4) x2 are inside
| H1 is OUTSIDE
179
tRNA-binding site for proteins
3' CCA
180
tRNA structure and unique features
Structure:
- 3' end is acceptor site with CCA recognition -->binds proteins
- L arm is D loop
- R arm is TpsyC loop; with small variable loop above
- codon recognition is the top loop
- It has modified bases such as dihydrouracil
- it's about 80 bp
181
HIV env processing
env is glycosylated to 160 and then chopped into gp41 and gp120
182
Bilat shoulder and pelvic muscle stiffness, fever, weight loss, elevated ESR. What is this? what is this associated with?
Polymyalgia rheumatica; associated with temporal arteritis
183
CD8 infiltration and destruction of myocytes due to increased MHCI on myocytes
Polymyositis
184
Internal Capsule stroke sx
```
contralateral loss of motor function arm, leg, face.
contralateral hyperspasticity (clasp knife spasticity-->resistance then weakness upon further resistant application)
```
185
MI with bradycardia
| Treatment?
infarct of R coronary artery -->infarction of SA node.
| Atropine-Block vagal stimulation to increase HR
186
What does mydriasis do to the angle of the anterior chamber?
decreases the angle...thus can block canal of schlem and cause glaucoma
187
PAH
what does it measure?
How is it processed in the kidney?
It measures RPF
It is freely filtered at the glomerulus and then actively secreted by carrier enzymes in tubules... carrier enzymes can be saturated
188
PT is prolonged by what drug
PTT is prolonged by what drug
What prolongs both?
Warfarin (PT)
Heparin (PTT)
any Xa inhibitors (Rivaroxaban, Apixaban, Fondaparinux)
189
Breast fed infants need supplementation of what vitamins?
Vitamin D and K
190
What are simple/complex seizures
simple=no LOC +postictal
| complex LOC +postictal
191
no B cells, T cells are present; what's the disease?
Bruton's agammaglobulinemia
192
Calmodulin and Myosin light chain kinase are only in what kind of muscle?
smooth
193
pure alpha 1 agonist's affect on SBP/DBP and HR?
SBP and DBP will rise-->increase vagal tone-->HR will fall
194
Which anti arrythmic drug is associated with prolongation of QT wave but very little risk of Torsades?
Amiodarone
195
Which class is Amiodarone? how does it work?
It's class III thus it inhibits outward K flow... allowing prolongation of repolarization
196
First dose hypertension is associated with what drug? what are predisoposing factors?
ACE I;
| hyponatremia, hypovolemia, high renal aldosterone level, heart failure, renal disease
197
hyperammonia is associated in depletion of what?
glutamate in CNS-->taken up/build up of Glutamine in astrocytes and causes astrocyte swelling
alpha-ketoglutarate depletion inhibits glutamine to be converted back to glutamate
198
Infant with head to oneside, cries when positioned to opposite side. Large lump on lateral neck
congenital torticollis due to malpositioning
199
common organisms that will contaminate culture... but does not necessarily indicate disease?
Candida albicans; Staph Epidermidis
200
Bacterial pharyngitis=what organism?
Strep A
201
Syphilis specific test
FTA-ABS
202
Childhood Paramyxovirus infection can predispose one to what disease in adulthood?
Paget's disease
203
Gluconeogenesis upregulation via intracellular receptor binding..?
cortisol;
| Glucagon and NE bind G proteins
204
Schistoma hemotobium?
Schistoma masoni/Japoni?
What is the carrier animal
larva incubate in freshwater snails -->penetrate skin-->mature in liver-->migrate to intestines
Schistoma hematobium--> lays eggs in bladder causing pain and bleeding/scaring
Schistoma masoni/japoni--> lays eggs in liver/intestines-->shed in stool
205
What is the effect of rapid heart rate on coronary blood flow?
decreases coronary blood flow, because of the REDUCED time in diastole
206
xray findings of englarged heart, increased vascular shadowing of the lungs, Kerley B lines, and pleural effusion at the bases...dx?
L ventricular failure
207
Steady incidence of a disease over time, but increased prevalence means what?
Improved quality of care thus prolonging the course of a disease
208
Ballooning degeneration indicates what?
hepatocyte injury ex...hepatitis A
Bridging necrosis=hepatocyte death
209
5 hydroxyindolacetic acid is breakdown product of what? increased in serum indicates what?
5HT/serotonin...thus increased 5hydroxyindolacetic acid in serum may indicate carcinoid
210
Simulating factors for Osteoclasts (2)
RANKL and M-CSF
211
Hep C has a lot of diversity in its envelope glycoprotein...why?
lacks 3'-5' exonuclease
212
Trigeminal Neuralgia-->treatment?
Carbamazepine (FIRSTLINE)
213
Sudden onset of tingling in one arm that subsides. What is this?!
TIA! ASA prophylaxis duh!
214
Theophylline mechanism? side effects?
phosphodiesterase inhibitor. Side effects like strong caffeine tachyarrhythmia, diarrhea, abd pain, seizures
215
CD4<50 HIV pt is susceptible to what?
MAC
216
HIV pt with hepatosplenomegaly, anemia, elevated alkaline phosphatase, elevated lactate dehydrogenase. What organism? what CD4 count? what treatment
MAC, Azithromycin, CD4 50
217
which lipid lowering drugs increase risk of stones?
Fibrates and Cholestyramine; because they increase bile cholesterol content
218
TB treatment?
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
(RIPE)
219
Aminoglycoside mechanism?
micins
| -inhibits 30S
220
Clomiphene-->mechanism
| use?
use: fertility issues/PCOS
| inhibits estrogen feedback at the thalamus...thus increasing GnRH pulsing and thus increasing fertility
221
What's the difference between CML and AML?
CML=many bands and immature cells, but blasts20%
222
Li Fraumeni tumor types
leukemia, sarcoma, brain, breast, adrenal
223
Type II pneumocytes functions
surfactant secretion; regeneration of alveolar lining
224
"atypical lymphocytes" on histology associated with what? lymphocytes are peusdopoding to the surrounding RBCs
mononucleosis
225
How can you tell ALL vs AML on histo?
Auer rods
226
What are important components of surfactant? what does the ratio to sphinogmyelin indicate
lecithin (Dipalmitoyl phosphatidylcholine) and phosphatidylglycerol
Lecithin/Spingomyelin >2 indicates lung maturity
227
What is hypoxemia? what are 4 major causes of it?
low PO2 in the arterial system;
| causes: hypoventilation, diffusion defect, VQ mismatch, R to L shunting
228
dry cough with hypercalcemia and elevated ACE?
sarcoidosis
229
custard/mayo food poisoning
staph aureus
230
undercooked beef food poisoning
HUS/ecoli
231
HUS three hallmark sx
hemolytic anemia, thrombocytopenia, and renal insufficiency
232
result of enteropeptidase deficiency?
Trypsinogen cannot be converted to trypsin. thus chymotrypsinogen, carboxypeptidase, elastase are also not activated
233
Nitroprusside effects vasculature how?
decreases afterload AND preload via vasodilation
234
HPV histology
Koilocytes
235
Chronic prednisone user undergoes surgery is at risk for what?
Adrenal insufficiency; thus prophylaxis should be given with a large dose of corticosteroids
236
cirrhosis induced increased estrogen levels. sx?
spider angiomas, palmar erythema, gynecomastia, hairloss, and testicular atrophy
237
endothelial/intima injury in atherosclerosis leads to vascular thickening...what mediates this?
SMC migration/collagen synthesis
238
Diphenhydramine inhibits what receptor?
H1
239
What drugs have antimuscarinic side effects?
```
atrophine
H1 receptor blockers,
traditional antipsych meds
TCA
antiparkinsonians
```
240
What's the most common spread modality of childhood osteomyelitis?
Where does it attack?
hematogenous;
| metaphysis
241
Number needed to harm equation
NNH=1/Attributable Risk
242
Attributable risk? what is it? how to calculate
difference in the chance of disease with exposure versus disease without exposure;
disease in all exposed-disease in all unexposed
243
Urea cycle produces urea and ornithine from what?
ammonia and arginine
244
Only a few organisms needed for infection.
Campylobacter, Shigella, Enteromoeba histolytica, Giardia
245
What kind of fetal morphology defect process is holoprosencephaly?
malformation; defect is in the tissue
| others include--> anencephal, congenital heart disease, polydactyly
246
Potter's syndrome is an example of what kind of fetal morph defect?
deformation- the fact that the baby is squished
| Sequence-the fact that the renal agenesis led to malformation of lungs/oligohydramnios
247
amniotic band syndrome is an example of what kind of fetal morph defect?
disruption
248
Mucormycosis treatment
amphotericin B
249
Amphotericin B side effects
nephrotoxicity-->monitor hypokalemia/hypomagnesia
250
Diabetic drugs ending in Flozin...what's the mechanism
Ex: canagliflozin;
| inhibits sodium-glucose cotransporters 2 in kidneys to decrease reabsorption
251
Acute Tubular Necrosis (ATN) stages
initial->ischemic injury occurs
maintenance--> cast forms oligouria occurs, electrolyte abnl due to retention
recovery -->vigorous diuresis-->loss of electrolytes/dehydration
252
muddy brown cast
acute tubular necrosis
253
Kussmal sign (NOT the breathing) is a sign of what?
constrictive pericarditis
254
pericardial knock
constrictive pericarditis
255
how is tetanus diagnosed?
hx and presentation. ONLY
256
Thiazide side effects.
hyperurecemia, hyperglycemia, hyperlipidemia, hypercalcemia,
hypotension, hypokalemia
257
Halothane side effects
hepatic necrosis; malignant hyperthermia
258
```
malignant hyperthermia;
causal agent?
what's the defect?
lab abnormalities?
treatment?
```
- cause: inhaled general anesthetics (halothane; succinylcholine)
- defect: ryanidine receptors
- labs: K increase, CK increase, myoglobin increase
treatment: dantrolene
259
```
Post brain ischemic damage...
when do you see red neurons?
when do you see necrosis/neutrophils
when do you see macrophages
when do you have macroscopic liquifactive changes?
whend do you see glial scars?
```
```
Red neurons- 12-24 hous
necrosis/neutrophils 24-72 hours
macrophages appear...about 3-5 days
macroscopic changes can be seen 1-2 weeks
gilal scars can be seen 2 weeks on
```
260
suprachiasmatic nuclei function
circadian rythm
261
supraoptic nuclei funciton
ADH and oxytocin
262
anterior nucleus of hypothalamus function?
| posterior nucleus of hypothalamus function?
dissapates heat-->lesion=hyperthermia
| conserve heat-->lesion=hypothermia
263
ventromedial nucleus of hypothalamus?
| lateral nucleus of hypothalamus
ventromedial-->lesion leads hyperphagia and weight gain
| lateral -->lesion leads to weight loss
264
Cystic degeneration of the Putamen is which neurodegenerative disease?
Wilson's disease
265
Increased COX2 in patient with history of adenomatous polyp is at risk for what?
Recurrence of adenoma/adenocarcinoma; thus ASA is protective
266
adenoma carcinoma sequence for colon cancer
1. APC inactivation
2. COX2 over expression/hypermethylation
3. kras activation; DCC inactivation; p53 inactivation
4. other abnl build up
267
bitemporal heminopsia makes you think of what??
prolactinoma
268
prolactinoma's effect on LH/FSH, testosterone/estrogen, and GnRH
all are suppressed
| (remember GnRH is also supporessed since prolactin usually suppresses ovulation via GnRH supp during pregnancy
269
aspiration while supine affects which portions of lung
posterior segment of the upper R lobe/superior segment of R lower lobe
270
patient with myopia improves in far sighted vision in mid40s. what is this due to?
Development of presbyopia (inability for lens to focus on near obj)...thus in away balances out myopia....
This is due to decreased collagen in the lens
271
Injury of what nerve leads to hyperacusis
Stapedius nerve of the facial nerve
272
How do you calculate RPF?
Renal plasma flow=(1-Hct)(Renal blood flow)
273
spongiform gray matter changes
Creuzfeld Jakob's
274
Colchicine SE?
N/V abd pain, diarrhea
275
Insomnia tx that causes priapism?
Trazadone
276
pt with malabsorption and papulovescicular rash in linear pattern?
dermatitis herpetiformis
277
which IL helps class switch to produce IgE?
IL4
278
Maintenance dose equation?
(Cplasma at steady statex CL)/bioavailability fraction
be careful of the time unit though
279
How to calculate halflife?
(0.7 x Vd)/CL
280
How to calculate loading dose?
(Vd x Cplasma at steady state)/bioavailability fraction
281
how does renal/hepatic disease affect loading dose and maintenance dose?
loading is the same
| maintenance is decreased
282
oral candidiasis tx?
nystatin
283
motion sickness is treated with what classes of drugs?
antimuscarinic or antihistamines (with antimuscarinic action)
284
Mousy/musty odor in infant dx?
PKU
285
sumatryptan mechanism?
5HT1B/1D agonist on postsynaptic R
286
Nitroprusside + AMS +lactic acidosis
Cyanide poisoning as Nitroprusside is metabolized to cyanide and NO...
287
Cyanide poisoning/Nitroprusside poisoning
sodium thiosulfate
288
Fructose can enter glycolysis via which two pathways?
1. Fructokinase; aldolase; triokinase
| 2. Hexokinase
289
Clinical signs of Sarcoidosis?
```
Schaumann calcifications
Astroid bodies/ACE increase
Respiratory/renal disease
Calcium increase
Ocular lesions
Immune granulomas
D increase/Diabetes insipidus
Osteopathy
Skin erythema nodosum
Intrastitial pulmonary fibrosis
Seventh nerve palsy
```
290
liver abscesses in developing countries are likely what?
| developed countries?
entamoeba/echinococcal--developing
| bacteria such as staph
291
Fetal Adrenal gland structure and what does it secret?
inner fetal zone only secrets androgens (due to lack of 3 beta hydroxysteroid converting of pregnenolone to progesterone)
Adult zone in the periphery will secret cortisol, but in small amounts. fetal cortisol secretion is increased by CRH
maternal and fetal cortisol contributes to lecithin secretion
292
Lecithin increase in late pregnancy is stimulated by what primarily? other things?
cortisol primarily
other things: prolactin, insulin, sex hormones, thyroid hormone, and catecholamines
293
esophageal cancer associated with dysphagia is more likely squamous? or adenocarcinoma?
squamous...adenocarcinoma would be too far down for dysphagia sensations.
294
firstline treatment for acute gout? what if they're contraindications? what are some contraindications?
NSAIDs... give colchicine if contraindicated via renal disease or peptic ulcer
295
Fibrates mechanism? SE?
Fibrates inhibit 7alpha hydroxylase thus decreasing cholesterol conversion to bile acid.
thus increase of cholesterol..leads to gallstones
296
mRNA synthesis is accomplished by which polymerase?
RNA pol II
297
Where is TATA box in relation to the coding sequence?
about 25 bp before
298
How does IL2 act to counter cancer?
It stimulates primarily T cells and NK cells to kill cancer cells.
It also stimulates B cells and monocytes
299
How are osteoblasts connected to each other? why are they connected so?
gap junctions; to exchange info on metabolic components... thus monitoring calcium levels...etc
300
direct hernia... what is at fault for its occurrence?
weak/breakdown of transversalis fascia
301
stab wound to L 5th intercosytal space at sternal border? mid clavicular?
sternal border-->R ventricle
| mid clavicular-->L ventricle; but MORE LIKELY the L lung OVERLAYING the heart
302
pattern of ventilation versus perfusion from lung apex to base?
both incrase as gets closer to base, but perfusion increases much more than ventilation
303
3 zones of lung perfusion
Zone 1: no perfusion under nl circumstance because alveolar pressure is greater than blood
Zone 2: arterial pressure can over come alveolar pressure in systole -->periodic perfusion
Zone 3: constant perfusion bc arterial pressure is always larger than alveolar
304
What are PTH and calcium like in primary osteoporosis?
NORMAL!!!!!!!!!
305
What does S4 sound like?
a presystolic sound occuring right before S1
306
Where/when is S4 best appreciated?
apex during expiration while pt is decubitus
307
if pt lacks PDH... what kind of diet should they follow?
ketogenic diet
308
Which are the soley ketogenic amino acids?
Leucine and lysine
309
Which amino acids are both glucogenic and ketogenic?
phenylalanine, isoleucine, tryptophan
310
What is the difference between glucogenic/ketogenic amino acids?
glucogenic amino acids feed into glycolysis or TCA cycle; ketogenic are precursors of acetoacetate
311
What test is able to distinguish between the two types of leprosy? why can this work?
Lepromin test is to test for Th1 response against M leprosy
Tuberculoid type will develop induration due to strong Th1 response
Lepromatous leprosy will not react to Lepromin test because it has weak Th1 response and some Th2 response.
312
```
Orotic aciduria
What is accumulating?
What is the defect?
sx?
tx?
```
orotic acid accumulation due to mutation of OMP decarboxylase and orotate phosphoribosyl transferase thus cannot convert orotic acid to UMP;
sx include: neuro sx, hypochronic megaloplastic anemia, and growth retardation
313
What is Gardner's mydriasis? tx?
antimuscarinic effects from Jimson weed poisoning... it's the same sx as atropine over dose....
Treat with Physostigmine
314
sx of lead poisoning?
| blood smear findings
COLICKY abd pain, constipation, HA, decreased memory
Bruton's line
peripheral neuropathy causing Wrist/foot drop
hypocrhomic anemia with basophlic stippling
315
Acute effect on CBC with corticosteroid administration
Increased neutrophil due to demarginalization;
| Decreased everything else; lymphocytes, monocytes, eosinophils, basophils
316
which adrenergic receptor increase insulin secretion; which decreases it?
alpha2 decreases insulin
| beta 2 increases insulin
317
sharp chest pain that gets slightly better when pt leans forward?
pericarditis
318
What is the most common cardiac manifestation of SLE?
pericarditis
319
bacteroides treatment?
piperacillin tazobactam
320
what is an add on to therapy that prolongs pt's life in Stage 3 and 4 Heart failure?
spironolactone/eplerenone
| -->inhibition of aldosterone (which has cardiac remodeling properties)
321
WBC cast?
pyelonephritis
322
```
Cardiac associations
1Down syndrome
2DiGeorge
3Friedreich's ataxia
4Marfan
5Tuberous sclerosis
6Turner's
```
1: ASD ostium primium; AV regurgitation
2. Tetralogy of Fallot; aortic arch abnormalities
3. Hypertrophic cardiomyopathy
4. cystic medial necrosis of the aorta
5. rhabdomyoma-->valve obstruction
6. aortic coarctation
323
gamma hemolytic, grows on saline and bile salt agar. pyrrolidonyl arylamidase positive.
What organism is this? where does it reside?
enterococcus; resides in nl flora of GU and GI system
324
allergic asthmatic with frequent excerbations and poor lung functioning. Uses steroid inhaler and short acting beta agonist already. Have tried long acting beta agonist as well... What is the best next add on?
Omalizumab. IgE antibody
325
lower trunk of brachial plexus carries nerves from which spinal levels?
C8-T1
| ALL innervate intrinsic muscles of the hand
326
10 years after radical mastectomy...what cancer is the patient at risk of?
lymphangiosarcoma __>endothelia of lymphatics
327
Insulin acts at tyrosine Kinase R... What are its down stream actions?
activation of glycogen synthase
| and protein phosphatase (which inactivates glycogen phosphatase)
328
how to assess severity of mitral stenosis with auscultation?
interval between A2 and snap opening... shorter is worse meaning more pressure
329
Major functions of HMG shunt
produce Ribose-5-phosphate and NADPH for reduction power
330
does DDAVP cuse significant vasoconstriction?
no because it does not strongly activate V1
331
How does DDAVP relieve minor bleeding in vWB disease patients?
it induces endothelial cells to release vWBF
332
Von Willebrand factor interacts with what clotting factor?
non covalently stabilizes factor VIII
333
What is cord factor?
TB virulence factor that inactivates neutrophils, damages mitochondria and increases TNF
334
myoclonic seizures with exercise
Myoclonic epilepsy with ragged red fibers (MERRF) mitochondrial disease
335
Leber hereditary optic neuropathy. mode of transmission?
mitochondrial
336
beta lactams are irreversibily binding to what?
they bind penicillin binding proteins such as Transpeptidase that crosslinks the peptidoglycan...NOT the cell wall itself.
337
which diuretic causes the most amount of water loss? thiazides versus loop?
loop
338
Pituitary apoplexy? how to differentiate from berry aneurysm?
apoplexy occurs ususaly in a background of exisitng adenoma... Thus pt is more likely to have both chronic (including bilat temporal hemianopsia, decreased libido, and cardiovascular collpase due to adrenal insuff) and acute symptoms
berry aneurysm rupture is mostly just acute symptoms
339
satellite phenomenon?
when haemophilus only grows near beta hemolytic staph aureus because it supplies NAD (factor V) to haemophilus
340
how many liters is the plasma compartment?
3-5 L
341
Why does cholera produce "rice water stool"?
It is milky in color because of the mucin and sloughed off epithelial cells
342
acute viral hepatitis.. histology findings
balloon degeneration, counsilman bodies, mononuclear infiltrates
343
gag proteins? (HIV)
p24 and p7
344
env proteins?
p41, p120
345
pol protein?
reverse transcriptase
346
which genes are required for viral gene synthesis in HIV?
rev, tat, reverse trascriptase
347
which cytokines are secreted by Th2 in differentiation of IgE
IL4 an IL13
348
What does Rinne test for? What does it mean when the sound is louder on the mastoid than air?
test for whether there's a neurosensory or conduction error. Nl should have louder in air...
If louder on mastoid -->conduction defect
If not heard on mastoid-->neurosensory defect
349
What does weber test test for?
Determines which side hearing defect is on.
- If conduction defect is present abnormal side will be louder because that's the only thing they'll be hearing
- if it's neurosensory then the abnormal side will be quieter.
350
what diarrheal agent can be transmitted both from uncooked foods and domestic animals?
campylobacter
351
which enteritis agent causes pain that mimics appendicitis?
Campylobacter
352
what is the difference between an ulcer and erosion?
erosion does NOT penetrate muscularis mucosa...ulcers do.
muscularis mucosa is apart of the mucosa. underneath is submucosa
353
What is winter's formula? what does it predict
PaCO2=1.5bicarb+8+/-2
it predicts respiratory compensation in the event of metabolic acidosis. If PCO2 is much different than prediction... it is likely that there's respiratory contribution to metabolic derrangement too...
-->ex: DKA metabolic acidosis, may lead to pulmonary edema causing compounded respiratory acidosis
354
Naloxone what is it's mechanism? what is it used for?
opioid receptor blocker (all three receptors). used for opiod drug OVER DOSE (Heroin is an opioid)
355
What is Flumazenil? What is it used for?
Benzodiazepine receptor blocker. Used for Benzo overdose
356
diarrhea, rhinorrhea, sneezing, pupillary dilation, nasal stuffiness, N/V denotes withdrawal from what substances?
Opioids
357
Pt with dyspnea and elevated liver enzymes; Acid schiff stain pink granules
alpha 1 antitrypsin disease
358
How to treat opiod withdrawl in infant?
| How to treat opioid withdrawal in adult?
- Infant Tincture of opium
| - adult: methadone/ buprenorphine and PENTAZOCINE (partial agonist)/ Suboxone (buprenorphine+naloxone
359
Status epilepticus. What is this? how to treat?
tonic clonic seizure lasting more than 30 minutes or continuous seizure episodes without regaining consciousness.
Treatment: 1. lorazepam + phenytoin
2. add phenobarbital
3. intubate and put on general anesthesia
360
Pol gene mutation accomplishes what for the virus?
| env gene mutation accomplishes what for the virus?
pol mutation results in drug resistance
| env gene results in hiding from immune system
361
what are 4 major ways of cellular signalling receptors?
-steroid R, channel R, G protein, enzyme linked
362
what's different about MAPK pathway and JAK/STAT?
| what things are signalled through which receptor?
MAPK is receptor tyrosine kinase (with intrinsic enzyme activity)
-All the growth factors!
JAK/STAT is receptors linked to other things with tyrosine kinase activity
- IL2
- prolactin
- Growth hormone
- Cytokines
363
accumulation of proprionic acid indicates missing what enzyme? which amino acids will worsen the disease?
missing proprionyl coA carboxylase which converts proprionyl coa to malonylcoa.
Ile, Met, Val, Thr will make proprionyl coa levels even higher thus worsening the disease
364
premature baby, intracranial hemorrhage?
germinal matrix bleeding in to ventricle
365
cardinal vein becomes what
SVC
366
Vitellin vein becomes what?
portal vein system
367
tetrahydrobiopterin is a cofactor for synthesis starting with which amino acids?
tryptophan and phenylalanine
368
anti centromere and anti topoisomerase I
systemic scleroderma; Calcinosis, Raynaud, Esophageal dysmobility, Sclerodactyly, Telangiectasia (CREST)
369
anti dsDNA
SLE primary
370
anti histone
drug induced SLE; Procainamide, hydralazine, isoniazid, phenicillinamine
371
anti phospholipid associated with what?
hypercoagulability and miscarriages
372
is Rheumatic fever associated with impetigo or pharyngitis or both?
what about post-strep glomerulonephritis?
rheumatic fever only occurs with pharyngitis;
post strep glomerulonephritis can occur with either impetigo OR pharyngitis (think kidney has to finely filter all blood, versus heart is only affected by what's hear in large quantities)
373
What is alveolar ventilation? what's the forumla?
alveolar ventilation is amount of air breathed (minute ventilation) without the deadspace in 1 minute.
alveolar ventilation=(tidal vol-deadspace) x breaths/minute
versus minute ventilation=tidal vol x breaths/min
374
what is anatomic deadspace?
| what is physiologic deadspace?
anatomic dead space is the airway-->the part that doesn't take part in gas exchange
physiologic dead space=anatomic dead space +parts of lung that's not well perfused for gas exchange.
=tidal vol x (PaCO-PECO)/PaCO
375
shock, hypoglycemia, hyponatremia, hyperkalemia...what do you think of?
adrenal crisis
376
Misoprostol mechanism? use?
prevention of NSAID induced ulcers... it's an Prostaglandin E1 analog
377
epigastric pain that is alleviated with food
ulcer, treat with abx
378
H pylori treatment
Tetracycline, clarithromycin, amoxicillin, metronidazole
379
Pioglitazone acts on what receptor? what does it increase?
PARR-y; increase of adiponectin
380
What is the drug of choice for Hairy Cell leukemia? what is it's mechanism? what's special about it?
Cladribine--> a purine analog that causes chain termination
| It cannot be broken down by adenosine deaminase thus can reach high levels in plasma. Renal excretion in original form.
381
deQuervain's subacute granulomatous thyroiditis sx/findings?
post viral infection, pain/"discomfort", decreased iodine uptake, incrased ESR
382
What hormones have intracellular receptors? which are nuclear and which are cytoplasmic that migrate to the nucleus?
T3 and T4 have intranuclear receptors
| Glucocorticoids, mineralocorticoids, sex hormones will bind intracytoplasmically and migrate to nucleus
383
Eclampsia treatment?
Magnesium sulfate
384
which step in glycolysis needs NAD?
Where is NAD needed in TCA?
How is NADH recycled back to NAD?
glyceraldehyde 3 phos conversion to 1,3 bisglyceraldehyde. via glyceraldehyde phosphate dehydrogenase.
TCA req it both going from Isocitrate to alpha ketoglutarate an continuing to succinyl coa
rcycled in electron chain transport OR anaerobic respiration
385
B27 HLA type diseases are associated with what musculoskeletal findings? respirtory? cardiac?
enthesopathy (tendonitis), restricted breathing due to costovertebral/costosternal joint immobility, aortic insufficiency due to aortitis.
386
will you see RF in B27 diseases?
no
387
what are c-Jun and c-Fos?
transcription factors that bind leucine zipper
388
gap between first and second toe
Down syndrome
389
polar granules in gram positive bacteria in clusters resembling V/Y shape
Diphtheria
390
which kidney stones are radiolucent?
Uric acid ONLY
391
Which vitamins in excess can cause renal stones?
D, C
392
What substances/conditions can precipitate calcium stones?
| Treatment?
ethylene glycol, vitamin C, and crohn's disease
| Treat with thiazide and citrate
393
which kidney stones precipitate at low pH?
uric acid and cysteine
394
CCK is made by what cells? where?
I cells in the duodenum/jejunum, secreted upon sensing fats
395
What is "reverse T3"
It's an inactive metabolite of T4
396
What is Nesiritide? what cellular effect does it have? what is it used for?
It's an analog of ANP/BNP, it promotes both veno and arterial dilation. It increases cGMP.
Used for L ventricular dysfunction induced cardiac failure
397
ESRD... what happens to phosphate? calcium? PTH?
increased phosphate and decreased vitamin D-->decreased calcium-->increased PTH...can cause bone abnormalities
398
Steven Johnsons is associated with what neuro drugs?
Phenytoin, phenobarbital, carbamazepine, and lamotrigine
399
Where is ANP produced? Where is BNP produced? in what condition is BNP produced?
ANP is from atria; BNP is produced by ventricle in response to stress and volume overload (pathogenic hypertrophy)
400
Which viruses bud off using host cell membranes?
Herpes family viruses
401
Digoxin is eliminated how? what are toxicity side effects?
renal elimination; SE: visual/color changes, N/V, abd pain, diarrhea, fatigue, dizziness, delirium, confusion, junctional escape beats/vtach/fib
402
What is Varenicline?
partial agonist of the nicotinic ach receptor. Thus relieving cravings and yet will bring down the effect if pt smokes
403
What is Quellung reaction?
Its using antibodies to detect capsules of organisms causing pneumonia
404
Spironolactone what are all the things it does?
It inhibits aldosterone R inhibitor, also decreases cardiac fibrosis.
Also inhibits testosterone
405
which antivirals depend on viral thymidine kinase for phosphorylation?
Famcyclovir
Acyclovir
Gancyclovir
--->AKA ALL THE VIRS
406
Afib treatment first line?
| Second line?
firstline is calcium blockers and betablockers
| second line is digoxin
407
Digoxin toxicity treatment?
- GI activated charcol
- Insulin, hemodialysis
- Digoxin fragment antibodies
408
How is K affected in usage of Digoxin?
Digoxin binds to the K receptor of Na/K ATPase...thus
toxicity...you often see hyperkalemia
however, hypokalemia may potentiate a patient in having side effects
409
IL12 what does it do? What if it's deficient what infections do you get? how do you fix it?
without IL12 T cells cannot become Th1 cells thus no IFNY will be present to activate macrophages...
Thus, these patients are prone to mycobacterial infections.... because you can't keep them in the granulomas
410
pt with hx of hyperlipidemia and CAD, extreme pain 30-40 min post meal. weight loss hx. mucosal and villi atrophy on endoscopy
celiac/SMA/IMA atherosclerotic plaques can block off blood flow. worst 30 minutes post meal due to increased cardiac demand
411
night blindness
zinc or vitamin A def
412
painful papulovesicular rash with central clearing and center is bronze colored and indurated. Located on extremities, face, and groins. Pt also has glossitis/chelitis
What is this called? what are some ddx?
this is called necrolytic migratory erythema. Due to hyperglycemia... Thus could be seen in uncontrolled DM or glucagonoma
413
Aflotoxin. Which strain is the worst? what does it cause genetically and molecularly?
B1 is the worst. causes G-T transversion in the p53 gene.
414
psuedomonas first line treatment?
| second line?
first line is Ticarcillin and piperacilin
| second line is ceftazidime and cefapime
415
Shigatoxin in shigella and EHEC action?
inhibits 60S subunit in human cells leading to cell death
416
Which e.coli does not ferment lactose?
EHEC
417
investigator's decision is influenced by prior knowledge of exposure. What kind of bias is this?
Observer's bias
418
young patient presenting with tetany. History show recurrent infections. Labs show hypocalcemia. Pt also has cardiac abnormalities... what is this?
DiGeorge
419
ataxia, loss of fine sensation/proprioception, and big heart? what is the genetic defect
Friedrich's ataxia. chromosome 9 GAA triplet repeat. progresive disease
420
Galactose metabolism
Galactose --(galactokinase)--> Galactose-1-phosphate--(uridyltransfrerase)--->glucose-1-phosphate
421
classic galactosemia is missing what enzyme
uridyl transferase.
422
blancheable nests of capillaries on skin, ataxia, and frequent pneumonias. What is this? what is the defect?
Atxia Telangiectasia
ATM gene mutation--> failure to mend double stranded breaks
Triad: Ataxia, IgA deficiency, Angioma
- increased AFP
- decreased IgA, IgG, IgE, lymphopenia
423
What are two common mutations that causes SCID?
IL2R gamma chain; adenosine deaminase
424
String sign
Crohn's narrowing of lumen
425
culture negative endocarditis
HACEK organisms- Haemophilus, actinobacillus, Cardiobacterium, eikinella, Kingella
Others include bartonella, Coxiella, histo, mycoplasma, chlamydia
426
what are the sources of ATP for myocytes? what is the main source? which one is more energy efficient and why?
myocytes get energy from glycolysis, glucose oxidation, and FA oxidation.
Main source is FA oxidation but it is least efficient since it needs more O2 for every ATP generated. Therefore when O2 is comprmised it may be mroe efficient to induce heart to use more glucose derived resources
427
CD14
monocytes
428
mononucleiosis
| What organism, what cells are infected, what cells are abnl?
EBV infect B cells, CD8 T cells are abnormal
429
What is cardiac stunning?
short term ischemic event that leads to transient loss of contractility that quickly recovers
430
What is cardiac preconditioning
heart gaining resistance to ischemia from recurrent exposures to ischemia
431
What is cardiac hibernation
long term exposure to ischemia inducing heart to decrease in contractility by down regulating contractile elements (calcium channels/beta adrenergic R) and increase relaxation elements (NOS, TNFalpha). However, if blood supply is reestablished, contraction will be regained
432
```
What is the renal handling of (in PT)...
PAH
Creatinine?
Inulin?
urea
Na/Cl
bicarb
glucose/proteins?
```
PAH is freely filtered and secreted (approximates renal plasma flow)
creatinine is freely filtered and sliiiiightly secreted
inulin is freely filtered and not secreted or reabs
urea is freely filtered and poorly slightly reabsorbed...but to a lesser extent where it still accumulates in the tubules
Na/Cl moves largely with water in the proximal tubule
bicarbis actively reabsorbed due to CA
protein and glucose are almost all reabsorbed
433
Pulsus parvus et tardus
slow rise of carotid pulse in systole... indicative of aortic stenosis
434
RPGN...what cells/proteins do you expect to find?
macrophages, glomerular parietal cells, and fibrin!
FIBRIN is the crest
435
name 3 betalactamase inhibitors
clavulanic acid, sulbactam, tazobactam
436
increased PRPP activity is putting pt at risk for what?
Gout
437
Gower hemoglobin.
| When is it produced? what are subunits? where is it produced?
embryonic Hb zeta2epsilon2-->yolk sac
438
Signs of Kwasaki disease?
```
Children of asian decent; vasculitis of medium sized vessels
fever for >5 days plus...4 of these
conjunctivitis
mucositis -strawberry tongue
cervical lymphadenopathy
edema, erythema, desquamation of BUE/BLE
rashes diffusely
```
439
What are kids with Kwasaki disease at risk for?
coronary aneurysm
440
1 year old oral thrush and progressive lymphopenia born to IV drug user mother... what does the baby have? how could this have been prevented?
HIV, vertical transmission could be reduced by prenatal zidovudine
441
what is alpha interferon used to treat?
Hep B/C, condyloma accuminatum
| hairy cell leukemia, and kaposi sarcoma
442
All of the cranial nerves are covered by oligodendrocytes except for which one? what is it covered by?
II -->schwan cells
443
verocay bodies
Schwanoma findings --> non nucleated areas (eosinophilic) dispersed in antoni A pattern cells
444
pancreatic exocrine enzymes are involved in digestion of what?
proteins, fats, and carbohydrates
445
Describe sweat gland adrenergic stimulation
preganglionic neuron release Ach to stimulate postganglionic. post ganglionic ALSO release Ach to stimulate the sweat glands
THIS IS ADRENERGIC NOT PARA
446
high QRS voltage
cardiomyocyte hypertrophy
447
action of bradykinin?
vasodilator, increase permeability, mediates pain
448
ACE I SE?
cough, angioedema
renal insufficiency, hyperkalemia,
hypotension
teratogen
449
what is different about phenoxybenzamine vs phentolamine?
phenoxybenzamine is irreversible
phentolamine is reversible
both are nonselective alpha inhibitors
450
polyuria/polydypsia in bipolar pt?
nephrogenic diabetes insipidus.
```
Lithium
Movement (tremor)
Nephrogenic DInsipidus
HypOthyroidism
Pregnancy (Ebstein)
```
451
Genetic torsades diseases; how to differentiate?
Jervall and Lange-Nielson: deafness with torsades
Romano-Ward: no deafness
both are defective Ik channel
452
mutations in beta chain of myosin?
hereditary hypertrophic myopathy
453
Torsades de pointe causal drugs
Party at Soto with Queen, clean queen, Risky Mac, Teasing with Thighs
Sotalol, Quinidine, chloroquine, Rispiradone, Macrolides, Protease inhibitors, thiazides
454
ectopic pregnancy treatment of choice <6weks
Methotrexate
455
Sulfonamide mechanism?
Folate precursor, PABA, analog...thus inhibiting prokaryokte folic acid synthesis
456
```
What colored granules are...
Lipofuscin
hemosiderin
melanin
glycogen
hyaline
```
lipofuscin-yellow brown (lipid oxidation)
hemosiderin-brown (or red on prussian blue)
melanin-dark brown/black
glycogen-clear (like clear cell renal carcinoma)
hyaline-glassy solid pink
457
why do babies of DM mothers experience postpartum transient hypoglycemia?
hyperglycemia bit maternal insulin DOES NOT cross placenta. Thus baby secrets a lot of insulin. Once the high glucose source is withdrawn... baby becomes hypoglycemic
458
which two bones articulate with radius?
Which bone articulates with the thumb
which bone articulates with middle finger?
scaphoid and lunate
thumb-->tripezium
middle finger-->capitate
