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Step 1 AB > Rapid Fire Facts > Flashcards

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
Q

Cancer linked closely to cirrhosis

A

Hepatocellular carcinoma

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26
Q

Hepatomegaly, abdominal pain, ascites

A

Budd Chiari syndrome

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27
Q

Green/yellow corneal deposits

A

Kayser-Fleischer rings (Wilson’s disease)

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28
Q

Low serum Ceruloplasmin

A

Wilson disease

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29
Q

Cirrhosis, diabetes, hyperpigmentation

A

Hemochromatosis

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30
Q

Anaphylaxis on exposure to blood products with IgA

A

Selective IgA deficiency

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31
Q

Coarse facial features, abscesses, eczema

A

Hyper IgE syndrome

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32
Q

Thrombocytopenia, purpura, infections, eczema

A

Wiskott Aldrich Syndrome (WATER)

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33
Q

Delayed separation of umbilicus

A

Leukocyte Adhesion Deficiency

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34
Q

Neuro defects, partial albinism, recurrent infections

A

Chediak Higashi syndrome

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35
Q

Mucin-Filled cell with a peripheral nucleus

A

Signet ring cell (seen in gastric adenocarcinoma and lobular carcinoma in situ of breast)

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36
Q

Most common type of stomach cancer

A

Gastric adenocarcinoma

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37
Q

Ovarian metastasis from gastric cancer

A

Krukenburg tumor

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38
Q

Gastric ulcerations and high gastrin levels

A

Zollinger Ellison Syndrome

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39
Q

Acute gastric ulcer associated with elevated ICP or head trauma

A

Cushing ulcer

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40
Q

Acute gastric ulcer associated with severe burns

A

Curling ulcer

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41
Q

Retroperitoneal Structures

SAD PUCKER

A 
Suprarenal glands 
Aorta and IVC
Duodenum (2nd through 4th parts)
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus (thoracic portion)
Rectum
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42
Q

What do the following cells secrete?

a. G cells
b. I cells
c. S cells
d. D cells
e. Gastric parietal cells

A

a. Gastrin
b. CCK
c. Secretin
d. Somatostatin
e. Gastric acid and IF

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43
Q

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

a. macrophages
b. histiocytes
c. Kupffer cells
d. mesangial cells
e. microglia
f. osteoclasts

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44
Q

Obligate anaerobe bacteria lack
a.
b.

A

a. Catalase

b. Superoxide dismutase

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45
Q

Obligate AEROBE bacteria are…

Naggy Pests Must Breathe

A 
"Naggy Pests Must Breathe"
Nocardia
Pseudomonas
Mycobacterium tuberculosis
Bacillus
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46
Q

What serum antibodies are associated with celiac sprue?

A

Anti-tissue transglutaminase

Anti-gliadin

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47
Q

What organism is associated with Whipple disease?

A

Tropheryma whipplei (gram positive)

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48
Q

Defect in chylomicron exportation

A

Abetalipoproteinemia

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49
Q

Cramping associated with milk products

A

Lactase deficiency

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50
Q

Small intestinal mucosa laden with macrophages in the lamina propria (that are filled with PAS+ granules and rod-shaped bacilli seen by electron microscopy)?

A

Whipple disease

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51
Q

Weight loss, diarrhea, arthritis, fever, adenopathy, hyperpigmentation

A

Whipple disease

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52
Q

Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies

A

Celiac disease

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53
Q

What are the common causes of small bowel obstruction?

A

A - Adhesions from previous surgeries (75%)
B - Bulge/Hernia (second most common cause)
C - Cancer/Tumors (most commonly metastatic colorectal cancer)

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54
Q

What heart defect is associated with chromosome 22q11 deletion?

A

Tetralogy of Fallot, truncus arteriosus

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55
Q

What heart defect is associated with down syndrome?

A

Endocardial cushion defect, ASD, VSD, AV septal defect

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56
Q

What heart defect is associated with congenital rubella?

A

PDA, pulmonary artery stenosis, septal defect

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57
Q

What heart defect is associated with Turner syndrome?

A

Coarctation, aortic root dilation, bicuspid aortic valve

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58
Q

What heart defect is associated with Marfan syndrome?

A

Aortic insufficiency

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59
Q

What drugs are used to treat TB?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

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60
Q

Most abundant bacteria in GI tract

A
  1. Bacteroides fragilis

2. E. coli

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61
Q

What is fundamental problem in Hirschsprung Disease?

A

Neural crest cells fail to migrate to the colon –> missing enteric ganglia//nerve plexuses (Auerbach’s and Meissner’s plexus)

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62
Q

Where in GI tract does endodermal tissue make an abrupt transition to ectoderm?

A

Pectinate line

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63
Q

Most common surgical emergency

A

Appendicitis

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64
Q

Severe RLQ pain with rebound tenderness

A

McBurney’s point seen in Appendicitis

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65
Q

What cytokines do TH1 cells make?

A

IL-2 and IFy

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66
Q

What cytokines do TH2 cells make?

A

IL4, IL5, IL10

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67
Q

What five classes of medications are used to treat glaucoma?

A 
alpha agonists
beta blockers
diuretics (acetazolamide, mannitol)
cholinergic agonists
prostaglandins (prostaglandin F2-alpha)
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68
Q

What nerve is damaged in wrist drop?

A

Radial nerve

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69
Q

What nerve is damaged in scapular winging?

A

Long thoracic nerve

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70
Q

What nerve is damaged if you are unable to wipe your bottom?

A

Thoracodorsal nerve

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71
Q

What nerve is damaged in loss of forearm pronation?

A

Median nerve

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72
Q

What nerve is damaged in weak external rotation of the arm?

A

Suprascapular nerve

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73
Q

What nerve is damaged in loss of elbow flexion and forearm supination?

A

Musculocutaneous nerve

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74
Q

What nerve is damaged in loss of wrist extension?

A

Radial nerve

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75
Q

Which kind of colonic polyp is considered a precursor for malignancy?

A

Adenomatous polyps

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76
Q

Which colon polyp has most malignant potential?

A

Villous adenomas

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77
Q

What are risk factors for colon cancer?

A

Adenomatous and serrated polyps, smoking, familial cancer syndromes, IBD, diet of processed meat with low fiber

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78
Q

Most common cancer of the appendix

A

Carcinoid tumor

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79
Q

GI hamartomas, hyper pigmentation of the mouth and hands

A

Peutz-Jeghers syndrome

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80
Q

Multiple colon polyps, osteomas, soft tissue tumors

A

Gardner syndrome

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81
Q

“Apple core” lesion on barium enema

A

Colon cancer

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82
Q

What makes Lewy Body Dementia unique?

A

Visual hallucinations, repeated falls, syncopal episodes

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83
Q

Most common cause of acute RLQ pain

A

Appendicitis

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84
Q

Most common cause of acute LLQ pain

A

Diverticulitis

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85
Q

Most common cause of RUQ pain

A

Cholecystitis

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86
Q

Colonoscopy reveals very friable mucosa extending from the rectum to the distal transverse colon

A

Ulcerative Colitis

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87
Q

Most common site of colonic diverticula

A

Sigmoid colon

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88
Q

“String sign” on contrast xray

A

Crohn’s disease

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89
Q

“Lead pipe” appearance of colon on contrast x-ray

A

Ulcerative colitis

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90
Q

From what tissue does the spleen arise?

What artery is it supplied by?

A

Mesoderm

Supplied by foregut (Celiac artery)

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91
Q

Common cause of pneumonia in immunocompromised patients

A

Pneumocystis jiroveci

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92
Q

Most common cause of atypical walking pneumonia

A

Mycoplasma pneumoniae

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93
Q

Common cause of pneumonia in alcoholics

A

Klebsiella pneumoniae (think aspiration)

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94
Q

Can cause interstitial pneumonia in bird handlers

A

Chlamydia psittaci

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95
Q

Often cause of pneumonia in person with exposure to bats and bat droppings

A

Histoplasma

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96
Q

Often cause of pneumonia who visited Southern California, New Mexico or West Texas

A

Coccidioides

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97
Q

Pneumonia associated with currant jelly sputum

A

Klebsiella

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98
Q

Causes Q fever

A

Coxiella burnetii

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99
Q

Associated with pneumonia acquired from air conditioners

A

Legionella pneumophila

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100
Q

Most common cause of pneumonia in children 1 year or younger

A

RSV

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101
Q

Most common cause of pneumonia in neonate

A

Group B Strep or E. Coli

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102
Q

Most common cause of pneumonia in children and young adults

A

Mycoplasma pneumoniae

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103
Q

Most common cause of viral pneumonia

A

RSV

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104
Q

Causes wool sorter’s disease (life threatening pneumonia)

A

Bacillus anthracis

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105
Q

Common pneumonia in ventilator patients and those with CF

A

Pseudomonas aeruginosa

106
Q

Pontiac fever

A

Legionella pneumophila

107
Q

How is hemochromatosis identified on biopsy?

A

With Prussian blue stain

108
Q

What is the classic triad of hemochromatosis?

A

Cirrhosis, Diabetes, Hyperpigmentation

109
Q

What causes primary hemochromatosis?

A

C282Y or H63D mutation on HFE gene

Associated with HLA-A3

110
Q

Treatment for hemochromatosis

A

Phlebotomy or chelation with deferoxamine/deferasirox/deferiprone

111
Q

What conditions is Primary Biliary Cirrhosis associated with/

A

CREST, Sjogren syndrome, rheumatoid arthritis and celiac disease

112
Q

What conditions is Primary Sclerosing Cholangitis associated with/

A

Ulcerative colitis

113
Q

What are the two types of gallstones? Which one is more common? When are each seen?

A
  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
Q

What conditions can gallstones cause?

A

Cholecystitis, ascending cholangitis, acute pancreatitis, bile stasis, biliary colic, fistula between gallbladder and small intestine

115
Q

What is cholecystitis?

A

Acute or chronic inflammation of gallbladder; usually from cholelithiasis (gallstones)

116
Q

What is Charcot triad of cholangitis?

A

Jaundice, fever, RUQ pain

117
Q

What is porcelain gallbladder?

A

It is a calcified gallbladder from chronic cholecystitis that is usually found incidentally on imaging. Causes gallbladder carcinoma.

118
Q

GET SMASHED

A 
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hypertriglyceridemia/Hypercalcemia
ERCP
Drugs
119
Q

Clinical presentation of acute pancreatitis

A

Epigastric abdominal pain radiating to back, anorexia, nausea, fear of eating, increased lipase (and amylase)

120
Q

Complications of acute pancreatitis

A

Pancreatic pseudocyst (can rupture and hemorrhage)

121
Q

Chronic pancreatitis presentation

A

Pancreatic insufficiency –> steatorrhea, fat-soluble vitamin deficiency, diabetes mellitus

122
Q

Marker for pancreatic cancer

A

CA 19-9

123
Q

Risk factors for pancreatic adenocarcinoma

A

Tobacco use, Chronic pancreatitis, diabetes, age >50, Jewish and Native American males

124
Q

What is Trousseau syndrome?

A

Migratory thrombophlebitis (redness and tenderness on palpation of extremities) seen with pancreatic (or GI) malignancy

125
Q

Classic triad of symptoms in MS

A

Scanning speech, intention tremor, nystagmus

126
Q

Lysosomal storage disorder characterized by accumulation of GM2 ganglioside

A

Tay-Sach disease

127
Q

Lysosomal storage disorder associated with renal failure

A

Fabry disease

128
Q

What structures perforate the diaphragm and at what levels?

A

T8 - IVC
T10 - esophagus, vagus nerve
T12 - aorta, thoracic duct, azygos vein

129
Q

What histological change takes place in esophagus of smoker?

A

Squamous becoming columnar; metaplasia

130
Q

What ratio in amniotic fluid indicates fetal lung maturity?

A

Lecithin to Sphingomyelin ratio > 2.0

131
Q

What nerve is at risk of injury with fracture of shaft of humerus?

A

Radial nerve

132
Q

What nerve is at risk of injury with fracture of surgical neck of humerus?

A

Axillary nerve

133
Q

What nerve is at risk of fracture with supracondylar humerus fracture?

A

Median nerve

134
Q

Nerve and artery injured from shaft humerus fracture?

A

Radial nerve and deep brachial artery injury

135
Q

Tidal volume?

A

Air that moves into lung with each quiet inspiration

136
Q

Inspiratory reserve volume

A

Air that can still be breathed in after normal inspiration

137
Q

Expiratory reserve volume

A

Air that can still be breathed out after normal inspiration

138
Q

Residual volume

A

Air in lung after maximal expiration; cannot be measured on spirometry

139
Q

Inspiratory capacity

A

IRV + TV

140
Q

Functional residual capacity

A

ERV + RV - volume of gas in lungs after normal expiration

141
Q

Vital capacity

A

TV + IRV + ERV - maximum volume of gas that can be expired after a maximal inspiration

142
Q

Total lung capacity

A

IRV + TV + ERV + RV - volume of gas present in lungs after maximal inspiration

143
Q

Physiologic dead space equation

A

Vd = VT x ((PaCO2 - PeCO2)/PaCO2)

144
Q

What happens to intrathoracic volume when a lung collapses?

A

Increases

145
Q

What can cause pulmonary hypertension?

A

COPD, sleep apnea, frequent thromboembolism, mitral stenosis, left to right cardiac shunts

146
Q

What gene is mutated in primary hypertension?

A

BMPR2 gene that normally inhibits vascular smooth muscle proliferation

147
Q

What drugs can treat pulmonary hypertension?

A

Bosentan/Ambrisentan
Prostaglandin analog (Epoprostenol, iloprost)
Sildenafil
Nifedipine

148
Q

What is the mechanism of Bosentan?

A

Antagonist at the endothelin 1 receptor that decreases pulmonary vascular resistance

149
Q

What antibodies are specific for SLE?

A

Anti-dsDNA antibodies

Anti-Smith antibodies

150
Q

What is mechanism of type IV hypersensitivity

A

T cells are sensitized and bind antigens and release cytokines

151
Q

Treatment for methemoglobinemia

A

Methylene blue or Vitamin C

152
Q

Which form of hemoglobin has high affinity for oxygen?

A 
R form (relaxed) has high affinity for oxygen
T form (taut) has low affinity for oxygen (Tissues)
153
Q

What substances shift oxygen dissociation curve to right?

A

CO2, elevated 2,3DPG, acidosis, exercise and increased temperature

154
Q

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

a. Job syndrome (hyper IgE) or leuocyte adhesion deficiency syndrome
b. SCID
c. DiGeorge
d. Bruton agammaglobulinemia
e. Hyper IgE syndrome

155
Q

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

a. fimbria or pili
b. capsule
c. periplasm
d. sex pilus (F pilus)
e. plasmid

156
Q

What structures arise from paramesonnephric ducts?

A

Vagina

157
Q

What’s a normal A-a gradient?

A

10-15mmHg

158
Q

What are causes of high A-a gradient?

A 
high FiO2
Shunting of blood
Pulmonary fibrosis
V/Q mismatch
Advanced age
159
Q

Which neurodegenerative disease fits the following:

a. senile plaques, neurofibrillary tangles
b. presents at birth as “floppy baby”
c. lewy bodies

A

a. Alzheimer disease
b. Werdnig-Hoffman disease
c. Parkinson’s, diffuse lewy body dementia

160
Q

What drugs are composed of antibodies against TNF

A

Etanercept - not an antibody, TNF inhibitor
Infliximab
Adalimumab

161
Q

What is the eye palsy associated with MS and internuclear ophthalmoplegia?

A
  • 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
Q

What is the classic presentation of congenital pyloric stenosis?

A 
Infant, 2-6 weeks of age
First born male
Non-bilious projectile vomiting
Palpable mass in RUQ, olive-like
Hypochloremic metabolic alkalosis
163
Q

How does fetal Hgb differ from adult Hgb?

A

Adult Hgb has higher affinity for 2,3 DPG

Fetal Hgb has higher affinity for O2

164
Q

EKG changes with MI

A

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
Q

What serum lab markers are used to diagnose MI?

A

Troponin I - after 4 hours

CK-MB - after 6-12 hours

166
Q

What is most common lethal complication of MI?

A

Arrhythmia

167
Q

Chest pain, pericardial friction rub, persistent fever occurring several weeks after an MI?

A

Dressler syndrome

168
Q

Which hereditary bilirubinemia:

a. responds to phenobarbital
b. grossly black liver

A

a. Crigler-Najjar type II or Gilbert syndrome

b. Dubin-Johnson syndrome

169
Q

What is complication of silicosis?

A

Increases susceptibility to tuberculosis

170
Q

What are pathologic findings of HTN?

A

Medial hypertrophy, fibrosis of the intimate, arteriosclerosis

171
Q

Where do these spinal tracts cross over?

a. dorsal column
b. lateral corticospinal tracts
c. spinothalamic tract

A

a. Medulla
b. medullary pyramids
c. anterior white commissure

172
Q

What drugs interact with CYP450?

A 
CRACK AMIGOS
Ciprofloxacin
Ritonavir
Amiodarone
Cimetidine
Ketoconazole
Acute alcohol use
Macrolides
Isoniazid
Grapefruit Juice
Omeprazole
Sulfonamides
173
Q

What is a disulfiram like reaction?

A

Inhibition of acetaldehyde dehydrogenase –> accumulation of aldehyde
Caused by metronidazole, cephalosporins, 1st generation sulfonylureas

174
Q

What are the signs of Right heart failure?

A

Lower extremity edema, JVD, hepatosplenomegaly

175
Q

What are signs of left sided Heart failure?

A

Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea

176
Q

a. What are the symptoms of organophosphate poisoning?

b. What are the symptoms of atropine overdose?

A

a. diarrhea, urination, miosis, bronchospasm, bradycardia, lacrimation, salivation
b. increased temp, decreased secretions, constipation, cyclopedia, mydriasis, confusion, disorientation

177
Q

Outline pathway that Gq receptor activates PKC

A

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
Q

With what type of heart defect would increasing afterload be beneficial?

A

Any right to left shunt; tetralogy of fallot, trunks arteriosus, transposition of the great vessels, Eisenmenger syndrome (squatting down)

179
Q

What medications improve survival in CHF?

A

ACE inhibitors
ARBs
Aldosterone antagonists
B blockers

180
Q

What medications provide symptomatic relief in CHF but do not improve survival?

A

Diuretics
Digoxin
Vasodilators

181
Q

What medications are used to treat acute heart failure?

A

Nitrates, Oxygen, Loop diuretics, Inotropes, Positioning

182
Q

What is the mechanism of action of cardiac glycosides like Digoxin?

A

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
Q

What is a cardiac consequence of Lyme disease? What is the vector of Lyme disease?
What are other complications of Lyme disease?

A

AV nodal heart block; Caused by Ixodes scapularis

Bell’s palsy, arthritis,

184
Q

Which blood pressure drugs are C/I in patients with a sulfa allergy?

A

Thiazides and loop diuretics

185
Q

Which beta blockers are:

a. B1 (heart) selective
b. non selective (B2 in lungs)

A

a. Starting with A-M
b. Starting with M-Z
Exceptions are Carvedilol and Labetalol which are both a1 and b1

186
Q

Triad of symptoms for ruptured abdominal aortic aneurysm:

A

Hypotension, pulsatile abdominal mass, abdominal pain

187
Q

What is the most likely underlying reason for:

a. abdominal aortic aneurysm
b. thoracic aortic aneurysm

A

a. Atherosclerosis (smoking, old age, men)

b. Cystic medial necrosis (HTN, Marfan’s, bicuspid aortic valve, tertiary syphilis)

188
Q

What drugs have the following S/E:

a. Agranulocytosis
b. Osteoporosis
c. Pulmonary fibrosis
d. Gynecomastia
e. Photosensitivity
f. Drug Induced Lupus

A

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
Q

What adult structures give rise to the:

a. 3rd aortic arch
b. 4th aortic arch
c. 6th aortic arch

A

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
Q

What causes edema by increased capillary pressure?

A

CHF, anything that blocks veins (venous thrombosis, compression of veins)

191
Q

What causes edema by decreased plasma colloid osmotic pressure (decreased plasma proteins)?

A

Nephrotic syndrome
Liver failure
Protein deficiency

192
Q

What causes edema by increasing capillary permeability?

A

Infection
Toxins
Burns

193
Q

What causes edema by increased interstitial fluid colloid osmotic pressure?

A

Lymphatic blockage

194
Q

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

a. anti-cancer
b. COX2 inhibitor
c. Nitrosourea
d. Tetracycline antibiotic
e. Inhibitor of dihydrofolate reductase
f. H2 blocker
g. Anti-malarial

195
Q

What is the antidote for copper, gold or arsenic?

A

Penicillamine

196
Q

What is the antidote for gold, arsenic or mercury?

A

Dimercaprol, Succimer

197
Q

What is the antidote for tPA or streptokinase?

A

Aminocaproic acid

198
Q

What is the antidote for Digoxin?

A

Anti-digoxin antibody fragments

199
Q

What does heart sound S3 represent?

A

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
Q

What does heart sound S4 represent?

A

Heard in late diastole (atrial kick); represents HIGH ATRIAL PRESSURE; associated with ventricular hypertrophy –> left atrium must push against stiff LV wall

201
Q

Why does normal splitting happen?

A

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
Q

Why does wide splitting happen?

A

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
Q

What is fixed splitting? In which conditions is it seen?

A

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
Q

a. What causes aortic regurgitation?

b. What are clinical signs of aortic regurgitation?

A

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
Q

a. What causes mitral stenosis?

b. What are clinical signs of mitral stenosis?

A

a. Rheumatic fever, can result in left atrial dilation

b. Follows opening snap (from abrupt half in leaflet motion in diastole)

206
Q

a. What does PDA sound like?

A

a. Continuous machine-like murmur; loudest at S2

207
Q

What are the diastolic murmurs?

A

Mitral or Tricuspid stenosis

Aortic or Pulmonic regurgitation

208
Q

What murmurs are heard best in left lateral decubitus position?

A

Mitral stenosis
Mitral regurgitation
Left-sided S3
Left-sided S4

209
Q

Outline pathway of phenlalanine to NE

A

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
Q

Five most common causes of aortic stenosis

A 
Bicuspid aortic valve
Senile calcification
Rheumatic heart disease
Unicuspid aortic valve
Syphilis
211
Q

What heart murmur is associated with weak pulses?

A

Aortic stenosis

212
Q

Crescendo-decrescendo systolic murmur best heart in the 2nd-3rd right interspace close to the sternum

A

Aortic stenosis

213
Q

Early diastolic decrescendo murmur heart best along the upper left side of the sternum

A

Pulmonic regurgitation

214
Q

Late diastolic decrescendo murmur heard best along the lower left side of the sternum

A

Tricuspid stenosis

215
Q

Pansystolic mumur best heard at the apex and often radiates to the left axilla

A

Mitral regurgitation

216
Q

Late systolic murmur usually preceded by a mid-systolic click

A

Mitral valve prolapse

217
Q

Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd left interspaces close to the sternum

A

Pulmonic stenosis

218
Q

Pansystolic mumur best heard along the left lower sternal border and generally radiates to the right lower sternal border

A

Tricuspid regurgitation or VSD

219
Q

Rumbling late diastolic murmur with an opening snap, heard loudest in the 5th interspace in the midaxillary line

A

Mitral stenosis

220
Q

Continous machine-like murmur

A

PDA

221
Q

High-pitched diastolic murmur associated with a widened pulse pressure

A

Aortic regurgitation

222
Q

A gardener with diarrhea, miosis, urination and bradycardia. What do they have? What is the mechanism of action?

A

Organophosphate poisoning. Inhibition of acetylcholinesterase –> excess cholinergic stimulation of the muscarinic receptors

223
Q

What is the mechanism of N-acetyl cysteine when given as an antidote for acetaminophen overdose?

A

It regenerates glutathione.

224
Q

Which phase of the myocardial action potential causes myocardial contraction?

A

Phase 2; when there is Calcium influx through voltage gated Ca channels balancing K efflux

225
Q

a. Which phase of the pacemaker action potential is responsible for the upstroke?
b. Which ion is responsible?

A

a. Phase 0 is the upstroke from opening of

b. voltage gated Calcium channels

226
Q

Which ion accounts for automaticity of SA and AV pacemaker action potential?

A

Slow spontaneous diastolic depolarization as Na conductance increases; when it reaches a threshold the voltage gated Calcium channels open

227
Q

Which phase of the pacemaker action potential determines the heart rate?

A

Phase 4 (when Na conductance is increasing) in the SA node determines HR

228
Q

What are the four important pharmacokinetic equations?

A
  1. volume of distribution
  2. clearance
  3. loading dose
  4. maintenance dose
229
Q

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

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
Q

What enzyme is inhibited by the drug Fomepizole

A

Alcohol dehydrogenase; antidote for methanol or ethylene glycol poisoning

231
Q

How do ALL Class I anti-arrhythmias works?

A

Decrease slope of phase 0 (Na influx, rapid depolarization)

232
Q 
What are the:
a. class IA anti-arrhythmics
b. class IB anti-arrhythmics
c. class IC anti-arrhythmics 
and what is their effect?
A

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
Q

What is the mechanism and time frame of acute transplant rejection?

A

Cytotoxic T cells react to MHC
(Cell mediated)
Weeks following transplant

234
Q

Patient with GI bleeding has buccal pigmentation

A

Peutz-Jeghers syndrome

235
Q

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

a. Azathioprine
b. Muromonab
c. Daclizumab
d. Myocphenolate mofetil
e. Cyclosporine
f. Azathioprine

236
Q

What are the five 2’s of Meckel’s diverticulum?

A 
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
Q

What is treatment for ZE?

A

High dose PPIs
Sporadic gastrinoma - surgical resection
Metastatic gastrinoma - Octreotide

238
Q

Transplant patient is on Cyclosporine; needs to take an anti-fungal for Candida infection. Which would cause Cyclosporine toxicity?

A

Ketoconazole

239
Q

What is hyper pigmented skin finding on face during pregnancy?

A

Melasma

240
Q

Woman breast feeding develops red mass over breast. What is diagnosis?

A

Mastitis - caused by Staph aureus.

241
Q

What muscles and nerves are derived from 4th and 6th branchial arches?

a. muscles
b. nerves

A

a. Cricothyroid, Levator veli palatini

b. Branches of recurrent laryngeal and superior laryngeal (vagus branches)

242
Q

What heart defect is associated with the following:

a. 22q11 deletion
b. congenital rubella
c. Turner’s syndrome
d. Marfan syndrome

A

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
Q

Which organisms do not take gram stain?

A 
Mycobacterium (high lipid content)
Mycoplasma (no cell wall)
Treponema 
Rikettsia (intracellular)
Chlamydia (intracellular)
Legionella (intracellular)
244
Q

What is cause of Duchenne’s Muscular Dystrophy

A

X linked recessive

Deletion of Dystrophin gene

245
Q

Cimetidine - CYP inhibitor or inducer?

A

CYP450 inhibitor

246
Q

Macrolides - CYP inhibitor or inducer?

A

Inhibitor

247
Q

Azole antifungals - CYP inhibitor or inducer?

A

Inhibitor

248
Q

Isoniazid - CYP inhibitor or inducer?

A

Inhibitor

249
Q

Sulfonamides - CYP inhibitor or inducer?

A

Inhibitor

250
Q

Grapefruit juice - CYP inhibitor or inducer?

A

Inhibitor

251
Q

Protease inhibitors - CYP inhibitor or inducer?

A

Inhibitor

252
Q

Ciprofloxacin - CYP inducer or inhibitor?

A

Inhibitor

253
Q

Barbiturates - CYP inhibitor or inducer?

A

Inducer

254
Q

Quinidine - CYP inducer or inhibitor?

A

Inducer

255
Q

Rifampin - CYP inducer or inhibitor?

A

Inducer

256
Q

Phenytoin - CYP inducer or inhibitor?

A

Inducer

257
Q

Griseofulvin - CYP inducer or inhibitor?

A

Inducer

258
Q

Carbamazepin - CYP inducer or inhibitor?

A

Inducer

259
Q

Chronic alcohol use - CYP inducer or inhibitor?

A

Inducer

260
Q

Chronic alcoholics Steal Phen-Phen and Never Refuse Greasy Carbs

A 
CYP Inducers
Chronic alcohol
St. Johns Wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine
261
Q

How does alkalosis affect calcium levels?

A

Increased pH increases affinity of albumin to bind Ca –> causes hypocalcemia (cramps, pain, paresthesias, carpopedal spasm)

262
Q

Causes of low magnesium

A

Diarrhea, aminoglycosides, diuretics, alcohol abuse

Step 1 AB (29 decks)

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