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Rapid Fire Facts Flashcards

1
Q

Most common cause of neural tube defects

A

Folate deficiency

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2
Q

Most common cause of congenital malformations

A

Alcohol use

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3
Q

Most common cause of mental retardation in US

A

Fetal Alcohol Syndrome

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4
Q

Hyperflexible joints, arachnodactyly, aortic dissection, lens dislocation

A

Marfan’s syndrome (Fibrillin defect)

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5
Q

Hereditary nephritis, cataracts, sensorineural hearing loss

A

Alport syndrome (Collagen IV defect)

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6
Q

Blue sclera, bone fractures

A

Osteogenesis imperfecta (mutation in alpha chain of collagen type I, hydroxylation defect)

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7
Q

Antibodies against presynaptic Calcium channels at NMJ

A

Lambert-Eaton myasthenic syndrome

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8
Q

Most common adrenal tumor

A

Benign, non-functioning adrenal adenoma

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9
Q

Most common tumor of adrenal medulla in adults

A

Pheochromocytoma

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10
Q

Most common tumor of adrenal medulla in kids

A

Neuroblastoma

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11
Q

Most common cause of primary hyperaldosteronism

A

Adrenal adenoma

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12
Q

Medical treatment for hyperaldosteronism

A

Spironolactone, Eplerenone

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13
Q

Medical treatment for pheochromocytoma

A

Phenoxybenzamine (non selective alpha blocker)

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14
Q

Pheochromocytoma, medullary thyroid cancer, hyperparathyroidism

A

MEN2A

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15
Q

Pheochromocytoma, medullary thyroid cancer, mucosal neuroma

A

MEN2B

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16
Q

Adrenal disease with skin hyperpigmentation

A

Primary adrenal insufficiency: Addison’s

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17
Q

HTN, hypokalemia, metabolic alkalosis

A

Hyperaldosteronism; Conn’s syndrome

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18
Q

Painless jaundice

A

Pancreatic cancer

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19
Q

Most common cause of acute pancreatitis

A

Gallstones and alcohol

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20
Q

Most common cause of chronic pancreatitis

A

Alcohol abuse

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21
Q

Severe hyperbilirubinemia in neonate

A

Crigler-Najjar type I

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22
Q

Mild benign hyperbilirubinemia

A

Gilbert syndrome

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23
Q

TG accumulation in hepatocytes

A

Fatty liver disease

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24
Q

Eosinophilic inclusions in cytoplasm of hepatocytes

A

Mallory bodies

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25
Cancer linked closely to cirrhosis
Hepatocellular carcinoma
26
Hepatomegaly, abdominal pain, ascites
Budd Chiari syndrome
27
Green/yellow corneal deposits
Kayser-Fleischer rings (Wilson's disease)
28
Low serum Ceruloplasmin
Wilson disease
29
Cirrhosis, diabetes, hyperpigmentation
Hemochromatosis
30
Anaphylaxis on exposure to blood products with IgA
Selective IgA deficiency
31
Coarse facial features, abscesses, eczema
Hyper IgE syndrome
32
Thrombocytopenia, purpura, infections, eczema
Wiskott Aldrich Syndrome (WATER)
33
Delayed separation of umbilicus
Leukocyte Adhesion Deficiency
34
Neuro defects, partial albinism, recurrent infections
Chediak Higashi syndrome
35
Mucin-Filled cell with a peripheral nucleus
Signet ring cell (seen in gastric adenocarcinoma and lobular carcinoma in situ of breast)
36
Most common type of stomach cancer
Gastric adenocarcinoma
37
Ovarian metastasis from gastric cancer
Krukenburg tumor
38
Gastric ulcerations and high gastrin levels
Zollinger Ellison Syndrome
39
Acute gastric ulcer associated with elevated ICP or head trauma
Cushing ulcer
40
Acute gastric ulcer associated with severe burns
Curling ulcer
41
Retroperitoneal Structures | SAD PUCKER
``` Suprarenal glands Aorta and IVC Duodenum (2nd through 4th parts) Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Esophagus (thoracic portion) Rectum ```
42
What do the following cells secrete? a. G cells b. I cells c. S cells d. D cells e. Gastric parietal cells
a. Gastrin b. CCK c. Secretin d. Somatostatin e. Gastric acid and IF
43
Name of monocytes in other parts of the body a. blood, alveoli, intestines b. connective tissue c. liver d. kidney e. brain f. bone
a. macrophages b. histiocytes c. Kupffer cells d. mesangial cells e. microglia f. osteoclasts
44
Obligate anaerobe bacteria lack a. b.
a. Catalase | b. Superoxide dismutase
45
Obligate AEROBE bacteria are... | Naggy Pests Must Breathe
``` "Naggy Pests Must Breathe" Nocardia Pseudomonas Mycobacterium tuberculosis Bacillus ```
46
What serum antibodies are associated with celiac sprue?
Anti-tissue transglutaminase | Anti-gliadin
47
What organism is associated with Whipple disease?
Tropheryma whipplei (gram positive)
48
Defect in chylomicron exportation
Abetalipoproteinemia
49
Cramping associated with milk products
Lactase deficiency
50
Small intestinal mucosa laden with macrophages in the lamina propria (that are filled with PAS+ granules and rod-shaped bacilli seen by electron microscopy)?
Whipple disease
51
Weight loss, diarrhea, arthritis, fever, adenopathy, hyperpigmentation
Whipple disease
52
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease
53
What are the common causes of small bowel obstruction?
A - Adhesions from previous surgeries (75%) B - Bulge/Hernia (second most common cause) C - Cancer/Tumors (most commonly metastatic colorectal cancer)
54
What heart defect is associated with chromosome 22q11 deletion?
Tetralogy of Fallot, truncus arteriosus
55
What heart defect is associated with down syndrome?
Endocardial cushion defect, ASD, VSD, AV septal defect
56
What heart defect is associated with congenital rubella?
PDA, pulmonary artery stenosis, septal defect
57
What heart defect is associated with Turner syndrome?
Coarctation, aortic root dilation, bicuspid aortic valve
58
What heart defect is associated with Marfan syndrome?
Aortic insufficiency
59
What drugs are used to treat TB?
Rifampin Isoniazid Pyrazinamide Ethambutol
60
Most abundant bacteria in GI tract
1. Bacteroides fragilis | 2. E. coli
61
What is fundamental problem in Hirschsprung Disease?
Neural crest cells fail to migrate to the colon --> missing enteric ganglia//nerve plexuses (Auerbach's and Meissner's plexus)
62
Where in GI tract does endodermal tissue make an abrupt transition to ectoderm?
Pectinate line
63
Most common surgical emergency
Appendicitis
64
Severe RLQ pain with rebound tenderness
McBurney's point seen in Appendicitis
65
What cytokines do TH1 cells make?
IL-2 and IFy
66
What cytokines do TH2 cells make?
IL4, IL5, IL10
67
What five classes of medications are used to treat glaucoma?
``` alpha agonists beta blockers diuretics (acetazolamide, mannitol) cholinergic agonists prostaglandins (prostaglandin F2-alpha) ```
68
What nerve is damaged in wrist drop?
Radial nerve
69
What nerve is damaged in scapular winging?
Long thoracic nerve
70
What nerve is damaged if you are unable to wipe your bottom?
Thoracodorsal nerve
71
What nerve is damaged in loss of forearm pronation?
Median nerve
72
What nerve is damaged in weak external rotation of the arm?
Suprascapular nerve
73
What nerve is damaged in loss of elbow flexion and forearm supination?
Musculocutaneous nerve
74
What nerve is damaged in loss of wrist extension?
Radial nerve
75
Which kind of colonic polyp is considered a precursor for malignancy?
Adenomatous polyps
76
Which colon polyp has most malignant potential?
Villous adenomas
77
What are risk factors for colon cancer?
Adenomatous and serrated polyps, smoking, familial cancer syndromes, IBD, diet of processed meat with low fiber
78
Most common cancer of the appendix
Carcinoid tumor
79
GI hamartomas, hyper pigmentation of the mouth and hands
Peutz-Jeghers syndrome
80
Multiple colon polyps, osteomas, soft tissue tumors
Gardner syndrome
81
"Apple core" lesion on barium enema
Colon cancer
82
What makes Lewy Body Dementia unique?
Visual hallucinations, repeated falls, syncopal episodes
83
Most common cause of acute RLQ pain
Appendicitis
84
Most common cause of acute LLQ pain
Diverticulitis
85
Most common cause of RUQ pain
Cholecystitis
86
Colonoscopy reveals very friable mucosa extending from the rectum to the distal transverse colon
Ulcerative Colitis
87
Most common site of colonic diverticula
Sigmoid colon
88
"String sign" on contrast xray
Crohn's disease
89
"Lead pipe" appearance of colon on contrast x-ray
Ulcerative colitis
90
From what tissue does the spleen arise? | What artery is it supplied by?
Mesoderm | Supplied by foregut (Celiac artery)
91
Common cause of pneumonia in immunocompromised patients
Pneumocystis jiroveci
92
Most common cause of atypical walking pneumonia
Mycoplasma pneumoniae
93
Common cause of pneumonia in alcoholics
Klebsiella pneumoniae (think aspiration)
94
Can cause interstitial pneumonia in bird handlers
Chlamydia psittaci
95
Often cause of pneumonia in person with exposure to bats and bat droppings
Histoplasma
96
Often cause of pneumonia who visited Southern California, New Mexico or West Texas
Coccidioides
97
Pneumonia associated with currant jelly sputum
Klebsiella
98
Causes Q fever
Coxiella burnetii
99
Associated with pneumonia acquired from air conditioners
Legionella pneumophila
100
Most common cause of pneumonia in children 1 year or younger
RSV
101
Most common cause of pneumonia in neonate
Group B Strep or E. Coli
102
Most common cause of pneumonia in children and young adults
Mycoplasma pneumoniae
103
Most common cause of viral pneumonia
RSV
104
Causes wool sorter's disease (life threatening pneumonia)
Bacillus anthracis
105
Common pneumonia in ventilator patients and those with CF
Pseudomonas aeruginosa
106
Pontiac fever
Legionella pneumophila
107
How is hemochromatosis identified on biopsy?
With Prussian blue stain
108
What is the classic triad of hemochromatosis?
Cirrhosis, Diabetes, Hyperpigmentation
109
What causes primary hemochromatosis?
C282Y or H63D mutation on HFE gene | Associated with HLA-A3
110
Treatment for hemochromatosis
Phlebotomy or chelation with deferoxamine/deferasirox/deferiprone
111
What conditions is Primary Biliary Cirrhosis associated with/
CREST, Sjogren syndrome, rheumatoid arthritis and celiac disease
112
What conditions is Primary Sclerosing Cholangitis associated with/
Ulcerative colitis
113
What are the two types of gallstones? Which one is more common? When are each seen?
1. Cholesterol stones (80%); associated with obesity, Crohn disease, advanced age, estrogen therapy, multiparty, rapid weight loss, Native American origin, Clofibrate 2. Pigment stones; seen in patients with chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infections, total parenteral nutrition (TPN)
114
What conditions can gallstones cause?
Cholecystitis, ascending cholangitis, acute pancreatitis, bile stasis, biliary colic, fistula between gallbladder and small intestine
115
What is cholecystitis?
Acute or chronic inflammation of gallbladder; usually from cholelithiasis (gallstones)
116
What is Charcot triad of cholangitis?
Jaundice, fever, RUQ pain
117
What is porcelain gallbladder?
It is a calcified gallbladder from chronic cholecystitis that is usually found incidentally on imaging. Causes gallbladder carcinoma.
118
GET SMASHED
``` Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion stings Hypertriglyceridemia/Hypercalcemia ERCP Drugs ```
119
Clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back, anorexia, nausea, fear of eating, increased lipase (and amylase)
120
Complications of acute pancreatitis
Pancreatic pseudocyst (can rupture and hemorrhage)
121
Chronic pancreatitis presentation
Pancreatic insufficiency --> steatorrhea, fat-soluble vitamin deficiency, diabetes mellitus
122
Marker for pancreatic cancer
CA 19-9
123
Risk factors for pancreatic adenocarcinoma
Tobacco use, Chronic pancreatitis, diabetes, age >50, Jewish and Native American males
124
What is Trousseau syndrome?
Migratory thrombophlebitis (redness and tenderness on palpation of extremities) seen with pancreatic (or GI) malignancy
125
Classic triad of symptoms in MS
Scanning speech, intention tremor, nystagmus
126
Lysosomal storage disorder characterized by accumulation of GM2 ganglioside
Tay-Sach disease
127
Lysosomal storage disorder associated with renal failure
Fabry disease
128
What structures perforate the diaphragm and at what levels?
T8 - IVC T10 - esophagus, vagus nerve T12 - aorta, thoracic duct, azygos vein
129
What histological change takes place in esophagus of smoker?
Squamous becoming columnar; metaplasia
130
What ratio in amniotic fluid indicates fetal lung maturity?
Lecithin to Sphingomyelin ratio > 2.0
131
What nerve is at risk of injury with fracture of shaft of humerus?
Radial nerve
132
What nerve is at risk of injury with fracture of surgical neck of humerus?
Axillary nerve
133
What nerve is at risk of fracture with supracondylar humerus fracture?
Median nerve
134
Nerve and artery injured from shaft humerus fracture?
Radial nerve and deep brachial artery injury
135
Tidal volume?
Air that moves into lung with each quiet inspiration
136
Inspiratory reserve volume
Air that can still be breathed in after normal inspiration
137
Expiratory reserve volume
Air that can still be breathed out after normal inspiration
138
Residual volume
Air in lung after maximal expiration; cannot be measured on spirometry
139
Inspiratory capacity
IRV + TV
140
Functional residual capacity
ERV + RV - volume of gas in lungs after normal expiration
141
Vital capacity
TV + IRV + ERV - maximum volume of gas that can be expired after a maximal inspiration
142
Total lung capacity
IRV + TV + ERV + RV - volume of gas present in lungs after maximal inspiration
143
Physiologic dead space equation
Vd = VT x ((PaCO2 - PeCO2)/PaCO2)
144
What happens to intrathoracic volume when a lung collapses?
Increases
145
What can cause pulmonary hypertension?
COPD, sleep apnea, frequent thromboembolism, mitral stenosis, left to right cardiac shunts
146
What gene is mutated in primary hypertension?
BMPR2 gene that normally inhibits vascular smooth muscle proliferation
147
What drugs can treat pulmonary hypertension?
Bosentan/Ambrisentan Prostaglandin analog (Epoprostenol, iloprost) Sildenafil Nifedipine
148
What is the mechanism of Bosentan?
Antagonist at the endothelin 1 receptor that decreases pulmonary vascular resistance
149
What antibodies are specific for SLE?
Anti-dsDNA antibodies | Anti-Smith antibodies
150
What is mechanism of type IV hypersensitivity
T cells are sensitized and bind antigens and release cytokines
151
Treatment for methemoglobinemia
Methylene blue or Vitamin C
152
Which form of hemoglobin has high affinity for oxygen?
``` R form (relaxed) has high affinity for oxygen T form (taut) has low affinity for oxygen (Tissues) ```
153
What substances shift oxygen dissociation curve to right?
CO2, elevated 2,3DPG, acidosis, exercise and increased temperature
154
What immunodeficiency matches the following: a. neutrophils fail to respond to chemotactic stimuli b. Adenosine deaminase deficiency c. Failure of endodermal development d. Defective tyrosine kinase gene e. Associated with high levels of IgE
a. Job syndrome (hyper IgE) or leuocyte adhesion deficiency syndrome b. SCID c. DiGeorge d. Bruton agammaglobulinemia e. Hyper IgE syndrome
155
What bacterial structure has the following functions; a. mediates adherence of bacteria to the surface of a cell b. protects against phagocytosis c. space between the inner and outer cellular membranes in gram - bacteria d. forms attachment between two bacteria during conjugation e. genetic material within bacteria that contains genes for antibiotic resistance
a. fimbria or pili b. capsule c. periplasm d. sex pilus (F pilus) e. plasmid
156
What structures arise from paramesonnephric ducts?
Vagina
157
What's a normal A-a gradient?
10-15mmHg
158
What are causes of high A-a gradient?
``` high FiO2 Shunting of blood Pulmonary fibrosis V/Q mismatch Advanced age ```
159
Which neurodegenerative disease fits the following: a. senile plaques, neurofibrillary tangles b. presents at birth as "floppy baby" c. lewy bodies
a. Alzheimer disease b. Werdnig-Hoffman disease c. Parkinson's, diffuse lewy body dementia
160
What drugs are composed of antibodies against TNF
Etanercept - not an antibody, TNF inhibitor Infliximab Adalimumab
161
What is the eye palsy associated with MS and internuclear ophthalmoplegia?
- On lateral gaze abducting eye has nystagmus, adducting eye is unable to adduct - Convergence is normal - Medial rectus palsy only shows up during lateral gaze and not with convergence
162
What is the classic presentation of congenital pyloric stenosis?
``` Infant, 2-6 weeks of age First born male Non-bilious projectile vomiting Palpable mass in RUQ, olive-like Hypochloremic metabolic alkalosis ```
163
How does fetal Hgb differ from adult Hgb?
Adult Hgb has higher affinity for 2,3 DPG | Fetal Hgb has higher affinity for O2
164
EKG changes with MI
ST segment elevation of at least 1 mm in 2 contiguous leads T wave inversion New LBBB New Q waves (at least 1 block wide of 1/3 height of total QRS)
165
What serum lab markers are used to diagnose MI?
Troponin I - after 4 hours | CK-MB - after 6-12 hours
166
What is most common lethal complication of MI?
Arrhythmia
167
Chest pain, pericardial friction rub, persistent fever occurring several weeks after an MI?
Dressler syndrome
168
Which hereditary bilirubinemia: a. responds to phenobarbital b. grossly black liver
a. Crigler-Najjar type II or Gilbert syndrome | b. Dubin-Johnson syndrome
169
What is complication of silicosis?
Increases susceptibility to tuberculosis
170
What are pathologic findings of HTN?
Medial hypertrophy, fibrosis of the intimate, arteriosclerosis
171
Where do these spinal tracts cross over? a. dorsal column b. lateral corticospinal tracts c. spinothalamic tract
a. Medulla b. medullary pyramids c. anterior white commissure
172
What drugs interact with CYP450?
``` CRACK AMIGOS Ciprofloxacin Ritonavir Amiodarone Cimetidine Ketoconazole Acute alcohol use Macrolides Isoniazid Grapefruit Juice Omeprazole Sulfonamides ```
173
What is a disulfiram like reaction?
Inhibition of acetaldehyde dehydrogenase --> accumulation of aldehyde Caused by metronidazole, cephalosporins, 1st generation sulfonylureas
174
What are the signs of Right heart failure?
Lower extremity edema, JVD, hepatosplenomegaly
175
What are signs of left sided Heart failure?
Dyspnea on exertion Orthopnea Paroxysmal nocturnal dyspnea
176
a. What are the symptoms of organophosphate poisoning? | b. What are the symptoms of atropine overdose?
a. diarrhea, urination, miosis, bronchospasm, bradycardia, lacrimation, salivation b. increased temp, decreased secretions, constipation, cyclopedia, mydriasis, confusion, disorientation
177
Outline pathway that Gq receptor activates PKC
Gq --> Phospholipase C --> cleaves PIP2 into DAG and IP3. DAG activates Protein Kinase C and IP3 causes an increase in calcium to cause smooth muscle contraction
178
With what type of heart defect would increasing afterload be beneficial?
Any right to left shunt; tetralogy of fallot, trunks arteriosus, transposition of the great vessels, Eisenmenger syndrome (squatting down)
179
What medications improve survival in CHF?
ACE inhibitors ARBs Aldosterone antagonists B blockers
180
What medications provide symptomatic relief in CHF but do not improve survival?
Diuretics Digoxin Vasodilators
181
What medications are used to treat acute heart failure?
Nitrates, Oxygen, Loop diuretics, Inotropes, Positioning
182
What is the mechanism of action of cardiac glycosides like Digoxin?
It inhibits the Na/K ATPase so that Na can't leave the cell --> this inhibits the Na/Ca exchanger so Calcium isn't leaving the cell and Na isn't entering --> Intracellular Calcium increases and causes more muscle contraction
183
What is a cardiac consequence of Lyme disease? What is the vector of Lyme disease? What are other complications of Lyme disease?
AV nodal heart block; Caused by Ixodes scapularis | Bell's palsy, arthritis,
184
Which blood pressure drugs are C/I in patients with a sulfa allergy?
Thiazides and loop diuretics
185
Which beta blockers are: a. B1 (heart) selective b. non selective (B2 in lungs)
a. Starting with A-M b. Starting with M-Z Exceptions are Carvedilol and Labetalol which are both a1 and b1
186
Triad of symptoms for ruptured abdominal aortic aneurysm:
Hypotension, pulsatile abdominal mass, abdominal pain
187
What is the most likely underlying reason for: a. abdominal aortic aneurysm b. thoracic aortic aneurysm
a. Atherosclerosis (smoking, old age, men) | b. Cystic medial necrosis (HTN, Marfan's, bicuspid aortic valve, tertiary syphilis)
188
What drugs have the following S/E: a. Agranulocytosis b. Osteoporosis c. Pulmonary fibrosis d. Gynecomastia e. Photosensitivity f. Drug Induced Lupus
a. PPU, Clozapine, Carbamazepine, Colchizine, Methimazole b. Corticosteroids, Heparin c. Bleomycin, Busulfan, Amiodarone d. Spironolactone, Digitalis, Cimetidine, Chronic alcohol, Ketoconazole, Marijuana e. Sulfonamides, Tetracycline, Amiodarone f. Sulfonamides, Hydralazine, Isoniazid, Procainamide, Phenytoin
189
What adult structures give rise to the: a. 3rd aortic arch b. 4th aortic arch c. 6th aortic arch
a. Common carotid artery and proximal part of internal carotid b. Left - arch of adult aorta, Right - proximal part of R subclavian c. Proximal part of pulmonary arteries and ductus arteriosus
190
What causes edema by increased capillary pressure?
CHF, anything that blocks veins (venous thrombosis, compression of veins)
191
What causes edema by decreased plasma colloid osmotic pressure (decreased plasma proteins)?
Nephrotic syndrome Liver failure Protein deficiency
192
What causes edema by increasing capillary permeability?
Infection Toxins Burns
193
What causes edema by increased interstitial fluid colloid osmotic pressure?
Lymphatic blockage
194
To which category do each of the following drugs belong: a. 6-mercaptopurine b. Celecoxib c. Carmustine d. Doxycycline e. Methotrexate f. Cimetidine g. Mefloquine
a. anti-cancer b. COX2 inhibitor c. Nitrosourea d. Tetracycline antibiotic e. Inhibitor of dihydrofolate reductase f. H2 blocker g. Anti-malarial
195
What is the antidote for copper, gold or arsenic?
Penicillamine
196
What is the antidote for gold, arsenic or mercury?
Dimercaprol, Succimer
197
What is the antidote for tPA or streptokinase?
Aminocaproic acid
198
What is the antidote for Digoxin?
Anti-digoxin antibody fragments
199
What does heart sound S3 represent?
You hear it in early diastole during rapid ventricular filling phase; it is associated with INCREASED FILLING PRESSURE - seen in heart failure or mitral regurgitation and more common in dilated ventricles
200
What does heart sound S4 represent?
Heard in late diastole (atrial kick); represents HIGH ATRIAL PRESSURE; associated with ventricular hypertrophy --> left atrium must push against stiff LV wall
201
Why does normal splitting happen?
On inspiration there is a drop in intrathoracic pressure that causes increased venous return --> increased RV filling --> increased RV stroke volume --> increased RV ejection time --> delayed closure of pulmonic valve
202
Why does wide splitting happen?
It is seen in conditions that delay RV emptying (pulmonic stenosis, right bundle branch block). The delay in RV emptying causes delayed pulmonic sound. Exaggeration of normal splitting.
203
What is fixed splitting? In which conditions is it seen?
Seen in ASD --> left to right shunt --> that increases RA and RV volumes --> increased flow through pulmonic valve such that the pulmonic valve closure is greatly delayed REGARDLESS OF BREATH.
204
a. What causes aortic regurgitation? | b. What are clinical signs of aortic regurgitation?
a. aortic root dilation (syphilis or Marfan's), bicuspid aortic valve, endocarditis, rheumatic fever b. Blowing early diastolic decrescendo murmur; wide pulse pressure, bounding pulses and head-bobbing
205
a. What causes mitral stenosis? | b. What are clinical signs of mitral stenosis?
a. Rheumatic fever, can result in left atrial dilation | b. Follows opening snap (from abrupt half in leaflet motion in diastole)
206
a. What does PDA sound like?
a. Continuous machine-like murmur; loudest at S2
207
What are the diastolic murmurs?
Mitral or Tricuspid stenosis | Aortic or Pulmonic regurgitation
208
What murmurs are heard best in left lateral decubitus position?
Mitral stenosis Mitral regurgitation Left-sided S3 Left-sided S4
209
Outline pathway of phenlalanine to NE
Phenylalanine is converted to Tyrosine (by Phenylalanine hydroxylase) which is converted to L-DOPA (by Tyrosine hydroxylase) which is converted to Dopamine (by Dopamine dexarboxylase that requires B6) which is converted to NE and then Epi
210
Five most common causes of aortic stenosis
``` Bicuspid aortic valve Senile calcification Rheumatic heart disease Unicuspid aortic valve Syphilis ```
211
What heart murmur is associated with weak pulses?
Aortic stenosis
212
Crescendo-decrescendo systolic murmur best heart in the 2nd-3rd right interspace close to the sternum
Aortic stenosis
213
Early diastolic decrescendo murmur heart best along the upper left side of the sternum
Pulmonic regurgitation
214
Late diastolic decrescendo murmur heard best along the lower left side of the sternum
Tricuspid stenosis
215
Pansystolic mumur best heard at the apex and often radiates to the left axilla
Mitral regurgitation
216
Late systolic murmur usually preceded by a mid-systolic click
Mitral valve prolapse
217
Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd left interspaces close to the sternum
Pulmonic stenosis
218
Pansystolic mumur best heard along the left lower sternal border and generally radiates to the right lower sternal border
Tricuspid regurgitation or VSD
219
Rumbling late diastolic murmur with an opening snap, heard loudest in the 5th interspace in the midaxillary line
Mitral stenosis
220
Continous machine-like murmur
PDA
221
High-pitched diastolic murmur associated with a widened pulse pressure
Aortic regurgitation
222
A gardener with diarrhea, miosis, urination and bradycardia. What do they have? What is the mechanism of action?
Organophosphate poisoning. Inhibition of acetylcholinesterase --> excess cholinergic stimulation of the muscarinic receptors
223
What is the mechanism of N-acetyl cysteine when given as an antidote for acetaminophen overdose?
It regenerates glutathione.
224
Which phase of the myocardial action potential causes myocardial contraction?
Phase 2; when there is Calcium influx through voltage gated Ca channels balancing K efflux
225
a. Which phase of the pacemaker action potential is responsible for the upstroke? b. Which ion is responsible?
a. Phase 0 is the upstroke from opening of | b. voltage gated Calcium channels
226
Which ion accounts for automaticity of SA and AV pacemaker action potential?
Slow spontaneous diastolic depolarization as Na conductance increases; when it reaches a threshold the voltage gated Calcium channels open
227
Which phase of the pacemaker action potential determines the heart rate?
Phase 4 (when Na conductance is increasing) in the SA node determines HR
228
What are the four important pharmacokinetic equations?
1. volume of distribution 2. clearance 3. loading dose 4. maintenance dose
229
What G protein class does each receptor stimulate: a. alpha 1 b. alpha 2 c. beta 1 d. beta 2 e. M1 f. M2 g. M3 h. D2
a. alpha 1 - Gq b. alpha 2 - Gi c. beta 1 - Gs d. beta 2 - Gs e. M1 - Gq f. M2 - Gi g. M3 - Gq h. Gi
230
What enzyme is inhibited by the drug Fomepizole
Alcohol dehydrogenase; antidote for methanol or ethylene glycol poisoning
231
How do ALL Class I anti-arrhythmias works?
Decrease slope of phase 0 (Na influx, rapid depolarization)
232
``` What are the: a. class IA anti-arrhythmics b. class IB anti-arrhythmics c. class IC anti-arrhythmics and what is their effect? ```
a. Disopyramide, Quinidine, Procainamide (double quarter pounder) increase AP duration and increase ERP and decrease slope of phase 0 b. Mexiletine, Lidocaine (mayo, lettuce, tomato) decrease AP duration and decrease slope of phase 0 c. Flecainide, Propafenone (fries please) prolongs ERP in AV node but no effect on ERP in purkinje and ventricular tissue, decreases slope of phase 0 depolarization
233
What is the mechanism and time frame of acute transplant rejection?
Cytotoxic T cells react to MHC (Cell mediated) Weeks following transplant
234
Patient with GI bleeding has buccal pigmentation
Peutz-Jeghers syndrome
235
Which immunosuppressant matches each of the following statements? a. precursor of 6-mercaptopurine b. Ab that binds CD3 on T cells c. Ab that binds IL2 on activated T cells d. inhibits inosine monophosphate dehydrogenase e. inhibits calcineurin --> loss of IL2 production --> blockage of T cell differentiation and activation f. metabolized by Xanthine Oxidase - increasing Allopurinol toxicity
a. Azathioprine b. Muromonab c. Daclizumab d. Myocphenolate mofetil e. Cyclosporine f. Azathioprine
236
What are the five 2's of Meckel's diverticulum?
``` First 2 years of life Within 2 feet of ileocecal valve 2 inches in size 2 percent of population 2 possible types of tissue - pancreatic and gastric epithelium ```
237
What is treatment for ZE?
High dose PPIs Sporadic gastrinoma - surgical resection Metastatic gastrinoma - Octreotide
238
Transplant patient is on Cyclosporine; needs to take an anti-fungal for Candida infection. Which would cause Cyclosporine toxicity?
Ketoconazole
239
What is hyper pigmented skin finding on face during pregnancy?
Melasma
240
Woman breast feeding develops red mass over breast. What is diagnosis?
Mastitis - caused by Staph aureus.
241
What muscles and nerves are derived from 4th and 6th branchial arches? a. muscles b. nerves
a. Cricothyroid, Levator veli palatini | b. Branches of recurrent laryngeal and superior laryngeal (vagus branches)
242
What heart defect is associated with the following: a. 22q11 deletion b. congenital rubella c. Turner's syndrome d. Marfan syndrome
a. truncus arteriosus, tetralogy of ballot b. PDA or pulmonary artery stenosis c. coarctation of the aorta and bicuspid aortic valve d. aortic insufficiency
243
Which organisms do not take gram stain?
``` Mycobacterium (high lipid content) Mycoplasma (no cell wall) Treponema Rikettsia (intracellular) Chlamydia (intracellular) Legionella (intracellular) ```
244
What is cause of Duchenne's Muscular Dystrophy
X linked recessive | Deletion of Dystrophin gene
245
Cimetidine - CYP inhibitor or inducer?
CYP450 inhibitor
246
Macrolides - CYP inhibitor or inducer?
Inhibitor
247
Azole antifungals - CYP inhibitor or inducer?
Inhibitor
248
Isoniazid - CYP inhibitor or inducer?
Inhibitor
249
Sulfonamides - CYP inhibitor or inducer?
Inhibitor
250
Grapefruit juice - CYP inhibitor or inducer?
Inhibitor
251
Protease inhibitors - CYP inhibitor or inducer?
Inhibitor
252
Ciprofloxacin - CYP inducer or inhibitor?
Inhibitor
253
Barbiturates - CYP inhibitor or inducer?
Inducer
254
Quinidine - CYP inducer or inhibitor?
Inducer
255
Rifampin - CYP inducer or inhibitor?
Inducer
256
Phenytoin - CYP inducer or inhibitor?
Inducer
257
Griseofulvin - CYP inducer or inhibitor?
Inducer
258
Carbamazepin - CYP inducer or inhibitor?
Inducer
259
Chronic alcohol use - CYP inducer or inhibitor?
Inducer
260
Chronic alcoholics Steal Phen-Phen and Never Refuse Greasy Carbs
``` CYP Inducers Chronic alcohol St. Johns Wort Phenytoin Phenobarbital Nevirapine Rifampin Griseofulvin Carbamazepine ```
261
How does alkalosis affect calcium levels?
Increased pH increases affinity of albumin to bind Ca --> causes hypocalcemia (cramps, pain, paresthesias, carpopedal spasm)
262
Causes of low magnesium
Diarrhea, aminoglycosides, diuretics, alcohol abuse

Step 1 AB (29 decks)

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