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Uworld > * Second Pass Facts > Flashcards

* Second Pass Facts Flashcards

1
Q

types of symptoms not improved with addition of carbidopa to levodopa

A

central (e.g. anxiety, behavioral)

actually worsen due to increased central avail of l-dopa

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2
Q

sorbitol to what in lens of healthy

A

Fructose

(by sorbitol dehydrogenase)

[glucose –> sorbitol by aldose reductase]

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3
Q

bounding pulses,
carotid pulsations,
head-bobbing

A

aortic regurgitation

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4
Q

Bcl-2

A

ANTI-apoptotic

increased in follicular cell lymph

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5
Q

loss of sensation of 5th digit;

nerve?

A

ulnar

sensation of medial 1/2 of hand

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6
Q

disaccharride containing fructose

A

sucrose

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7
Q

gait instability,
degen of posterior columns and spinocerebellar tracts

(gen and vit def)

A

Friedreich ataxia

Vitamin E deficiency

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8
Q

Cornybacterium get ability to make pseudomembrane via

A

phage conversion–>

exotoxin production

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9
Q

Rabies bind to which receptor

A

Ach (nicotinic)

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10
Q
  • skin/resp infxs
  • light skin/hair
  • horiz nystag
  • giant cytoplasmic granules in neutrophils/monocytes

Disorder?

A

Chediak-Higashi

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11
Q

psammoma bodies;

adult brain tumor

A

Meningioma

arise from arachnoid villi

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12
Q

decreases crystalization in urine

A

increased citrate

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13
Q

acidic ph - stone types

A

uric acid
cystine
calcium OXalate

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14
Q

type of necrosis in MI

A

coag necrosis

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15
Q

pneumonia agent that needs a complex acellular medium enriched with cholesterol in order to grow

A

mycoplasma pneumoniae

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16
Q

ApoE 3&4

A

Chylomicron and VLDL remnant uptake

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17
Q

ApoA-1

A

LCAT activation

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18
Q

ApoB-48

A

chylomicron assembly in intestine

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19
Q

ApoB-100

A

LDL particle uptake by EXTRAhepatic cells

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20
Q

ApoC-II

A

LPL activation

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21
Q

Oral bioavailability calculation

A

Area under oral curve DIVIDED by area under IV curve

curve of serum concentration after admin

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22
Q

common resp infx in CF

A

pseudomonas

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23
Q

bisphosphoglycerate mutase

A

makes 2,3 BPG in erythrocetes

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24
Q

lupus + false positive RPR/VDRL + increased aPTT

A
  • recurrent miscarriages
  • venous and arterial thromboembolism

(antiphospholipid Ab aka lupus anticoagulant –> HYPERcoaguable state in vivo)

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25
Q

sudden muscle relaxation reflex

A

golgi tendon

arranged in series

(very sensitive to tension, NOT to passive stretch)

1b sensory –> inhib interneuron

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26
Q

maintains muscle length

A

muscle spindles (intrafusal muscle fibers)

arranged in parallel

mediates stretch reflex–> causes cntx

1a sensory –> alpha motor neuron

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27
Q

myotatic reflex (aka deep tendon reflexes) mediated by…

A

muscle spindles

cause contraction

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28
Q

highest oral bioavail nitrate

A

isosorbide mononitrate

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29
Q

difference in effect of therapy/risk modifiers on based on time exposed due to…

A 
latent period
(initial steps of pathogenesis occur long before clinical manifestations)
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30
Q

HbF last until when

A

~6 months (gradual change)

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31
Q

non-typable Hflu cause…

A

otitis media
sinusitis
bronchitis

(part of normal upper resp tract)

nontypable = no capsule

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32
Q

cytokines released during tissue injury that DOWN-regulate infl

A

TGF-B

IL-10

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33
Q

Volatile anestetic effects

A

increase cerebral blood flow (increases ICP)

myocardial depression, hypotension, resp depression, decreased renal fx

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34
Q

malignant htn vessel process

A

onion-like concentric thickening of arteriolar walls

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35
Q

mucous secreting cauliflower-like mass in colon

A

villous adenoma

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36
Q

hiccups, shoulder pain -

which nerve roots

A

C3-C5

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37
Q

spleen of sickle cell firm and brown

A

vascular occlusions –> infarcts –> eventual autosplenectomy

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38
Q

IV MRSA abx –> muscle pains/increased CK

mech of drug?

A

maintenance of membrane potential (depolarization) and inhib DNA/RNA/protein synth

Daptomycin

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39
Q

Facial nerve (CN VII)sensory

A

somatic - pinna and external auditory canal

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40
Q

Facial nerve (CN VII) autonomic

A

parasymp to lacrimal, submandibular, and sublingual glands

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41
Q

mass in rt temportal lobe –> what visual defect?

A

contralateral SUPERIOR quadrantanopia

[ “Try the pie in the SKY” - Temporal = upper

“Leave the Poop on the GROUND” - Parietal = lower”]

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42
Q

holosystolic murmer that increases in intensity on inspiration

A

tricuspid regurg

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43
Q

sweat glands of axillae are what type of glands

A

apocrine

sweat secreted in membrane bound vesicles into hair follicles

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44
Q

length of phase 1 depolarizing blockade

of succinylcholine

A

20 mins (depends on metabolism)

enhanced by neostigmine in phase 1, counteracted in phase 2

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45
Q

histoplama histology

A

ovoid cells within macrophages

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46
Q

symptoms of septic shock

A

TNF- alpha

and IL 1 and IL 6

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47
Q

Toxic Shock - what cells?

A 
T lymphocytes (--> IL2)
Macrophages (--> IL1 and TNF)
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48
Q

pioglitazone mech

A

transcription modulation

increase adiponectin

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49
Q

nephrotic syndrome with underlying malignancy suggests…

A

membranous glomerulonephropathy

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50
Q

nephrotic syndrome with diffuse increased thickness of glomerular basement membrane w/o increased cellularity

A

membranous glomerulonephropathy

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51
Q

membranous glomerulopathy –> left vericocele

etio?

A

loss of antithrombin III –> hypercoag –> renal vein thrombosis

(flank pain, hematuria, vericocele)

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52
Q

MC lung cancer in
non smokers
women

A

adenocarcinoma

form glandular or papillary structures

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53
Q

lamellar bodies of type II pneumocytes

A

release pulmonary surfactant

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54
Q

maculopapular rash head–> trunk WITH postaruicular lymphadenopthy

A

Rubella

Toga Virus

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55
Q

IL2 –> what cells

A
  • Th cells
  • monocytes
  • NK cells
  • T cells (to make INF gamma)
  • B cells (increase division)
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56
Q

ulcer through posterior wall of duodenal bulb - what vessel?

A

gastroduodenal

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57
Q

bias - know you’re being observed

A

Hawthorne

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58
Q

bias - only hosp pts

A

Berkson

selection bias

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59
Q

present in 90% of hashimoto’s pts

A

anti- thyroid peroxidase

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60
Q

lupus pt + cushinoid features… what do the adrenals look like?

A

bilateral cortical atrophy

taking exogenous glucocorticoids

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61
Q

NF 1 and NF 2 genetics/inheritance

A

Autosomal Dom

NF1 - 17
NF2 - 22

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62
Q

tx vasospasm 4-12 days post SAH

A

nimodipine

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63
Q

immunocompromised pt with skin lesions that are ulcerated in appearance w/ occasional necrotic center (looks kinda like kaposi) -
what bacteria

A

psuedomonas aeruginosa

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64
Q

neutropenia = at risk for what kind of bacteria

A

gram neg

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65
Q

opiods + biliary colic - mech?

A

contraction of smooth muscles in sphincter of oddi

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66
Q

glucocorticoids acutely increase what kind of cell in serum

A

neutrophils (demarginalization)

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67
Q

adult brain tumor with focal necrosis and hemorrhage

A

glioblastoma multiforme

  • from astrocytes
  • MC
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68
Q

adult brain tumor - well circumscribed gray mass, possibly with calcifications

A

oligodendrogiomas

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69
Q

excess copper - med?

A

penicillamine (chelator)

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70
Q

hypothalamic nuclei involved in circadian rhythm regulation

A

suprachiasmatic

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71
Q

ethambutol SE

A

optic neuritis –>

  • color blindness
  • central scotoma
  • decreased visual acuity
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72
Q

Abs specific for SLE

A

anti-dsDNA (60% have)

anti-Smith/anti snRNP (20-30% have)

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73
Q

polyethylene glycol similar to what pathophys

A

lactase deficiency (osmotic laxative/osmotic diarrhea)

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74
Q

gray discoloration of macula w/adjacent hemorrhage

dx and tx target

A

age-related macular degeneration
(wet subtype)

tx: target VEGF

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75
Q

dry age related macular degen

A

gradual vision loss (difficulty driving/reading)

drussen depoits w/ pigment abnormalities on fundoscopy

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76
Q

recurrent severe nosebleeds +

telangectasias on oral/nasal mucosa, face, and arms (e.g.)

A

Osler-Weber-Rendu syndrome

AD - hereditary hemorrhagic telangiectasia

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77
Q

barroreceptor firing rate when high pressure

A

increases!
(ah! so high!!)

–> increases PARAsymp invluence on heart and vessels, prolongs AV node refractory period

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78
Q

side effects of thiazolidinediones (TXDs)

e.g. pioglitazone

A

fluid retention –> wt gain and edema

**can exacerbate underlying CHF

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79
Q

End-stage renal disease - metabolic derangement

A

renal osteodystrophy

  • hypocalcemia via renal retention of phosphate and decreased renal synth of calcitriol
  • hypocalcemia + resultant hyperPTH –> osteodystrophy
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80
Q

Left border of heart

A

LV forms apex and reaches as far as the 5th intercostal space at the left midclavicular line

(all other chambers to the rt of midclavic line)

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81
Q

stab through 5th intercostal space at midclav line - what hit?

A

lung
(overlies much of anterior heart)

  • possibly LV if DEEP enough
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82
Q

XX ambig genitalia with hypokalemia and high BP

A

11-beta

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83
Q

markers indicative of small cell carcinoma (lung)

A 
neuroendocrine markers
(neurofilaments, neurosecretory granules)

tumor of neuroendocrine origin

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84
Q

env gene mt induced by

A

evasion of host neutralizing antibodies

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85
Q

pol gene mt induced by

A

anti-retroviral meds

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86
Q

small yellow retinal lesions in macula- expected visual defect?

A

central scotoma

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87
Q

positive “whiff” test

A

bacterial vaginosis

clue cells

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88
Q

yellow-green foamy foul-smelling discharge

A

trichomonas

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89
Q

failure of recanalization mechanism of atresia where in GI

A

duodenum only!

distal to duodenum= vascular accidents in utero

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90
Q

psoriasis med that activates nuclear transcription factor

A

topical vit D analogs –> inhibit keratinocyte prolif and stim differentiation

calcipotriene
calcitriol
tacalcitol

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91
Q

psoriasis med that blocks NFAT from entering nucleus –> decreases prod and release of IL2

A

cyclosporine

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92
Q

bisphosphonates are structural analogues of…

A

pyrophosphate

component of hydroxyapatite

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93
Q

PR interval

A

beginning of atrial depolarization to beginning of ventricular depolarization

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94
Q

chronic lymphedema = risk for…

A

angiosarcoma
(Stewart-Treves syndrome)

multiple firm violaceous nodules

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95
Q

Diffusion capacity in COPD

A

decreased (due to destruction of alveoli and adjoining capillary beds)

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96
Q

antiarrhythmic that increases AP duration and decreases phase 0 slope

A

Class 1A

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97
Q

Class of Type 1 antiarrhythmics that has strongest effect on phase 0

A

1C

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98
Q

class of type 1 that has weakest effect on phase 0

A

1B

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99
Q

where does V3 exit skull

A

foramen ovale

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100
Q

where does V2 exit skull

A

foramen rotundum

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101
Q

steroid use signs

A
  • increased hematocrit
  • soft small testes
  • acne
  • hepatic abnormalities
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102
Q

induces secretion of bicarb rich/chloide poor fluid from pancreas

A

secretin

from S endocrine cells in duodenum

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103
Q

biggest O2 difference from aorta

A

coronary sinus

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104
Q

When do microglia appear (post ischemia)

A

3-5 days

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105
Q

What cells form the glial scar post ischemic infarct

A

astrocytes

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106
Q

medullary thyroid cancer histo

A

nests of polygonal cells with congo red-positive deposits

extracellular deposits of amyloid formed by calcitonin

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107
Q

enzyme detected in inflammatory cells (e.g. machrophages) during inflammatory response but not detectable in most normal tissues

A

COX- 2

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108
Q

induces production of HbF

A

hydroxyurea

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109
Q

prevents efflux of K and water from cells, preventing dehydration of erythrocytes and reducing sickling

A

calcium dependent potassium (Gardos) channel blockers

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110
Q

incidence - when calculating don’t forget to account for what in the population

A

people who already have the disease (subtract from pop)

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111
Q

methotrexate leads to build of what

A

DIhydrofolate POLYGLUTAMATE

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112
Q

Amph B electrolyte disturbances and etio

A

hypoK
hypoMg

due to distal tubular membrane permeability (disfx)

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113
Q

Beta 2 microglobulin

A

MHC I

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114
Q

dobutamine

- mycardial O2

A

increases myocardial O2 consumption

increases HR, contractility, conduction velocity - beta1 agonist

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115
Q

apoptotic hepatocytes - histo

A

shrink
nuclear frag
intensely eosinophilic

“acidophil bodies”
“councilman bodies”

(due to acute viral hepatitis)

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116
Q

elastases produced from what cells; what inhibits

A

infiltrating neutrophils
- inhib by serum alpha-1 antitrypsin

and alveolar macrophages
- inhib by tissue inhibitors of metaloproteinases (TIMPs)

  • can degrade eachother’s (not their own) inhibitors
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117
Q

prevent acidification of lysosomes in APC –> ?

A

impaired interaction w/ Tcells b/c low expression of MHC II

load antigen in endosome/lysosme or phagosome/lysosome fusion

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118
Q

where is MHC I loaded

A

RER

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119
Q

genetic defect in ataxia-telangiectasia

A

Auto Recessive
mt in ATM gene
(DNA break repair)

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120
Q

cortisol receptor location

A

intracellular

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121
Q

superficial inguinal lymph nodes drain…

A

all cutaneous lymph from umblilicus to feet

including external genitalia and anus to dentate

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122
Q

prostate drains to what lymph nodes

A

internal iliac

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123
Q

lymph from bladder…

A

superior –> external iliac

inferior –> internal iliac

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124
Q

charcot-bouchard aneurysm

A
  • due to chronic hypertension

- deep brain structures (not lobar)

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125
Q

cerebral amyloid angiopathy

A
  • beta amyloid deposition in walls of small/medium arteries –> weaken

MCC of spontaneous lobar hemorrhage in elderly (usu same protein as in alzh)

(not a/w systemic amyloidosis)

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126
Q

Lesch-Nyhan inheritance

A

XR

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127
Q

Classical galactosemia inheritance

A

AR

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128
Q

Rapid plasma decay of barbituate-like IV anesthetic (e.g. thiopental) due to

A

redistribution into other tissues throughout body

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129
Q

CD55

CD59

A

CD55 - accelerates complement decay
CD59 - inhibits MAC

(deficiency usually due to lack of GPI anchor)

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130
Q

kid w/ URI –> STRIDOR vs WHEEZING

A

Stridor

  • croup (laryngotraceitis)
  • parainfluenza virus (paramyxo)

Wheezing

  • bronchiolitis
  • RSV
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131
Q

poor feeding
hypotonia
cardiomegally
enlarged PAS+ lysosmes in muscle

A

acid alpha-glucosidase deficiency

Pompe disease

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132
Q

BRAF mt

A

melanoma

protein kinase

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133
Q

dilates veins
dilates arterioles
promotes diuresis

(endog)

A

BNP

both ANP and BNP activate Guanylate cyclase

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134
Q

bile acids reabsorbed from…

A

terminal illium

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135
Q

location of thyroid hormone receptors

A

intra-Nuclear

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136
Q

valproate teratogenic effects

A

neural tube defects
(valproate inhibits intestinal folic acid absorbtion)

e.g. - menigocele

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137
Q

ACL/PCL locations

A

APEX
-Anterior cruciate runs Posteriorly and inserts on EXternal femoral epicondyle

PAIN
- Posterior cruciate runs Anteriorly and inserts on INternal epicondyle

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138
Q

delusional d/o vs paranoid personality d/o

A

paranoid personality d/o = pervasive pattern of suspiciousness w/o clear delusions
(no clear delusions in personality d/o)

NB: delusional d/o must have delusions for at least 1 mo
(no clear bizarre behavior apart from delusion)

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139
Q

recurrant neiserria infx

A

complement def

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140
Q

drug that causes priaprism

not ED drug

A

trazodone
- for pts with depression and insomnia

(contraindicated in adolescent boys)

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141
Q

MC site of hematogenous osteomyelitis

A

(MC in children)

usually affects metaphysis of long bones

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142
Q

isoniazid SE

A

hepatoxicity

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143
Q

FIRST step in coronary disease involves what cells

A

endothelial

begins with endothelial dmg

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144
Q

location of atherosclerosis

A

large elastic arteris and large/medium muscular arteries

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145
Q

half life

A

t(1/2)= 0.7(Vd)/(Cl)

146
Q

noncoronary atherosclerotic disease, DM, and CKD are at some risk for ______ as _____

A

CV events as pts with known coronary heart disease

147
Q

MCC of death in DM

A

MI

coronary heart disease

148
Q

choriocarcinoma (histo)

A

abnl prolif of both cyto and syncytiotrophoblasts

no villi

149
Q

foot drop

A

common peroneal

150
Q

order of enzymes in synth

A

17
21
11

17 - (over to cortisol/androgens)
21 - (down to pre aldo and pre cortisol)
11 - (down to aldo and cortisol)

151
Q

Niacin antilipid action

A

inhibit VLDL production (liver)
- partially due to suppression of FFA release from periph tissue

used to increase HDL

152
Q

Inulin estimates …

PAH estimates….

A

inulin - GFR

PAH - PLASMA renal flow

153
Q

uses CD21 to invade cells

A

EBV

complement receptor

154
Q

Lynch syndrome mech (mt)

A

Auto Dom

DNA mismatch repair defect

(hereditary nonpolyposis colon cancer)

155
Q

nipple inversion

A

suspensory ligament infiltration by invasive breast cancer

156
Q

OS on cath tracing of mitral stenosis

A

when ventricular pressure drops below atrial pressure (early diastole)

157
Q

drug –> liver abnormalities and oral ulcers

A

methotrexate

158
Q

possible sickle cell + gross hematuria

A

papillary necrosis

159
Q

delayed separation of umbilical cord

A

defect in integrins

leukocyte adhesion deficiency

  • Auto Recessive
  • absence of CD18 –> inability to synthesize integrins
160
Q

recurrent skin infections WITHOUT pus formation

A

leukocyte adhesion deficiency

AR mt-> absence of CD18 –> no integrins

161
Q

high levels of prolactin –> what risk for women

A

osteoporosis

high PRL –> hypogonadism –> low estrogen –> accelerated bone loss

162
Q

Why are Chlamydia trachomatis and Ureaplasma urealyticum (causes of NGU) not effectively treated by penicillins/cephalosporins?

A

Chlamydia lacks peptidoglycan w/in cell wall

Ureaplasma lacks cell wall entirely

163
Q

DKA with normal CO2

A

respiratory failure

164
Q

Apoliprotein E-4 increases risk for…

A

Alzheimer (late onset familial)

165
Q

Risks for early onset Alzheimer

A 
APP (ch 21)
Presinillin 1 (ch 14)
Presinillin 2 (ch 1)
166
Q

budding yeast forms with thick capsules

A

cyrptoccocus

usu causes meningitis (dx w/india ink) but can also cause pneumonia (dx with mucicarmine staining)
(in immunocompromised)

167
Q

fetal lung maturity ratio

A

Lecithin (phosphadidylcholine):
sphyingomyelin

L/S >= 2 (mature)

168
Q

tx of toxo

A

pyrimethamine
sulfadiazine

(TMP-SMX)

(can sub clindamycin for sulfadizine if sulfa allergy)

169
Q

Primary central nervous system lymphoma (cell origin/association)

A

B cell origin
EBV

similar lesions to toxo, but more commonly a single lesion (though can have multiple)

170
Q

mifipristone

A

anti-progestin

171
Q

hydrophobic (non-polar) amino acid residues

A 
valine
alanine
isoluecine
methionine
phenylalanine

(typically in transmembrane domains of alpha helices)

172
Q

pramipexole

A

stimulates dopamine receptors

173
Q

classes of dopamine agonists

A

ergot:

  • bromocriptine
  • pergolide

non-ergot:

  • pramipexole
  • ropinirole
174
Q

pt in adrenal crisis - tx

A

corticosteroids

response to vasopressors usually subobtimal

175
Q

HbC more mild than HbS bc…

A

HbS allows hydrophobic interaction among hemoglobin molecules

(leads to polymerization)

176
Q

Same in HbS, HbC, and HbA

A

binding affinity for O2 and 2,3 DPG

NB: does NOT result in significant change in folding

177
Q
  • skin anesthesia
  • hypopigmentation
  • bacterial invasion of Schwann cells
A

Mycobacterium leprae

178
Q

d-xylose

A

monosaccharide

i.e. does not need enzymes to be absorbed but can be decreased in malabsorption (like celiac)

179
Q

pt with aggetation/agression —> tx and cooperative —> high fever, confusion, muscle rigidity

A

neuroleptic malignant syndrome 2/2 tx w/ haloperidol

180
Q

caclified cystic mass in young (is)

A

craniopharyngioma

cyst fluid rich in cholesterol

181
Q

maximum stool osmolality

A

max approaches serum osmolality

normal stool osmolar gap = 50-100
accounts for non-electrolyte osms

182
Q

Lactase-def labs after lactose challenge

A
  • increased stool osmotic gap
  • increased breath hydrogen content
  • decreased stool pH
183
Q

5-HIAA

5-hydroxyindoleacetic acid

A

serotonin metabolite

184
Q

prevents renal impairment from tumor lysis syndrome (can happen during chemotherapy)

A

rasburicase

  • urate oxidase
  • uric acid –> allantoin (exreted in urine)

allopurinol

185
Q

tumor lysis syndrome characterized by…

A

LOW calcium
HIGH phosphate
HIGH potassium
HIGH uric acid

186
Q

fever
pharyngitis
rash (blanches?)
strawberry tongue

A

scarlet fever

caused by pyrogenic exotoxins

187
Q

which receptors prevent cerebral hypoperfusion upon standing

A

alpha 1

188
Q

inhibition of saturation of long, branched lipids–> inhibits what bacteria

A

mycobacterium

mycolic acid= long branched saturated fatty acids

189
Q

TB drug structurally similar to pyridoxine

A

isoniazid

190
Q

transient tingling that fully resolves within minutes… tx

A

probably a TIA (if other things ruled out)

start with asprin (risk of GI bleeding)

191
Q

HBV helps HBD with what

A

coating of viral particles –> allows it to infect hepatocytes

(coating done by HBsAg)

192
Q

munro microabsesses

A

(in psoriasis)

spongiotic clusters in superficial dermis and parakeratotic stratum corneum

193
Q

what complement protein is usually normal in PSGN

A

C4

decreased C3 and total compliment levels

194
Q

recurrent mycobacterium infx

A

interferon gamma signalling pathway d/o

195
Q

used post SAH

A

nimlodipine
(calcium channel blocker)

to prevent vasospasm

196
Q

CMV esoph findings

A

linear ulceration

both intranuc and cytoplamic inclusions

197
Q

ACA occlusion

A

contralateral motor and sensory deficits of LOWER extremities, behavioral changes, and urinary incont

198
Q

glyburide

A

sulfonurea

- increases insulin secretion

199
Q

no apparent liver disease w/ mild unconj hyperbilirubinemia when triggered by a stressor

A

Gilbert

200
Q

pneumococcal vaccine type for old

A

outer polysacharide

201
Q

H2O deprivation test cutoff to be considered “complete” central DI

A

> 50% increase in urine osm = complete central

> 10% increase in urine osmolarity after vasopressin suggests central DI

202
Q

deposits in PSGN

A

C3
IgG
IgM

in mesangium and BM

“starry sky”

203
Q

main virulence factor in shigella infx

A

invasion of mucosa

M cells that overlie Peyer’s patches

204
Q

substances involved in path of asthma that have therapeutically beneficial pharm antagonists

A

LTC4
LTD4
LTE4
Ach

205
Q

mech of increased expiratory flow rates in pulmonary fibrosis
(when corrected for low lung volume)

A

increased elastic recoil –> increased radial traction on airways –> decreased airflow resistance

206
Q

P bodies

A

cytoplamic proteins that regulate mRNA translation and degredation

207
Q

MC CV manifestation of SLE

A

pericarditis

208
Q

enzyme that increases carcinogen’s effect

A

microsomal monooxygenase

*most carcinogens enter body in inactive state (pro-carcinogens) and are converted to active metabolite by cyp450 oxidase system

209
Q

superior sulcus tumors (pancoast tumors) a/w

A
  • rib destruction
  • atrophy of hand muscles
  • pain in C8, T1, and T2 nerve root dist
  • edema of upper extremity (compr of subclavian)
  • Horner

*severe pain in shoulder that radiates toward axilla and scapula is MC presenting symp

210
Q

Remember DM and Beta blockers….

A

Non selective or B2 antag
- decrease
glucagon secretion –> may cause hypoglycemia in pts with DM

  • beta blockers ALSO decrease/mask symptoms of hypocglycemia
211
Q

Serum marker that increases risk of vertical transmission of Hep B

A

HBeAg

212
Q

Meds with antimuscarinic (anticholinergic) effects:

A

atropine

TCAs (e.g. amitryityline)

H1 blockers (e.g.diphenhydramine)

neuroleptics

antiparkinson drugs

213
Q

double vision while walking down stairs

A

trochlear nerve

vertical diplopia most noticable when affected eye looks toward nose - e.g. reading or walking down stairs

214
Q

Histo for contact dermititis

A

spongiosis

fluid in intercellular spaces - blisters

215
Q

pulsus paradoxus

A

decrease SBP >10 w/insp

increased RV volume pushes septum into LV b/c no room in pericardium to expand

a/w constrictive pericarditis, severe obstructive lung disease, restrictive cardiomyopathy, (acute cardiac tamponade)

216
Q

black necrotic eschar in nasal cavity

A

mucor or rhyzopus

*esp in setting of DKA

217
Q

age of aoritic stenosis symptom presentation

A

7th decade -
senile calcific aortic degen

6th decade -
congenital bicuspid valve

symptoms (SAD): exertional syncope, angina, dyspnea

218
Q

Hflu vaccine type

A

cell wall polysacharide conjugated with protein toxoid from diptheria or tetanus

(can be given as early as 2mo)

219
Q

tyrosine kinase receptor

fx (generally)

A

accelerate cell proliferation

responds to growth factors

220
Q

IV acyclovir SE

A

crystalline nephropathy

need ensure adequate hydration

221
Q

Dyspnea 2/2 HF caused by

general

A

decrease in lung compliance due to fluid accumulation in lung interstitium

222
Q

Drugs with predominantly hepatic clearance (spare kindeys) tend to…

A
  • be highly lipophilic

- high volume of distribution

223
Q

Potency of inhaled anesthetic correlates to…

A

Minimal alveolar concentration
(inversely proportional)

(concentration that renders 50% of pts unresponsive to painful stimuli)

  • dependent on body temperature
  • decreases with increasing pt age
  • UNrelated to sex, ht, wt of pt
224
Q

hyperacusis nerve/muscle

A

stapedius muscle and nerve

(branch of facial)

?:
tensor typani
inserts on maleus (incrases tension on tympanic membrane)
- V3 (mandibular trigem)

225
Q

How long from onset of total ischemia to loss of cardiomyocyte contractility

A

w/in 60 seconds

irreversible after about 30 mins

226
Q

Cherry red macula symp in lysosomal storage disease

A

Tay-Sachs
(no hepatosplenomeg)

Niemann- Pick
- hepatoslenomeg

227
Q

Langhans giant cell

A

(NOT langERhans)

activated macrophages (epitheliod cells) that have multiple nucelii organized peripherally in the shape of a horsoe

no specific finding in granulomatous conditions

228
Q

Filtration fraction

A

FF= GFR/renal PLASMA flow

229
Q

gene mt required for emergence of adenomatous polyps from normal mucosa

A

APC

  • tumor suppressor
  • regulates cell growth and CELL ADHESION

(K-ras –> unregulated proliferation)

230
Q

Insulin triggers tyrosine kinase which triggers…

A

protein phosphatase

231
Q

Preterm infants at life-threatining risk of what vit deficiency

A

Vit K

232
Q

factor V Leiden

A

factor V resists cleavage by protein C

a/w risk of deep VENOUS (not arterial) thrombosis
i.e. not splenic infarcts

233
Q

amyloid in old cardiac atria

A

ANP

  • misfolded -> beta sheets
  • senile cardiac amyloidosis –> may increase risk of aFib
  • incidence >90% in 9th decade
234
Q

neurologic symptoms that worsen with heat exposure

A

MS

235
Q

pain shooting down posterior thigh/leg = what nerve root

A

S1

will also have diminished ankle jerk reflex

236
Q

location of promoter

A

25-70 bp upstream

237
Q

prevents dissemination of candida

A

neutrophils

T-cells for superficial

238
Q

synaptophysin

A

protein in presynaptic vesicles of neurons, neuroendocrine, and neuroectodermal cells

239
Q

fexofenadine

A

2nd generation anti histamine

240
Q

hydroxyzine
promethazine
chlorpheniramine
diphenhydramine

A

1st gen antihistamines

241
Q

glomerular crescent = deposition of what

A

fibrin!

also glomerular parietal cells, monocytes, macrophages

242
Q

Anticonvulsants + mood stabilizers

A

Valproate
Carbamazepine
Lamotrigine

(valproate is the MC used for seizure prophylaxis)

243
Q

terbinifine

A

inhib squalene epoxidase

used for tx of dermatiphytosis

244
Q

progressive supranuclear palsy

A

form of parkinsonism from degen of midbrain and frontal subcortical white matter

falls, exec function loss, vertical gaze palsy

abnormally phos tau

245
Q

vit –> intracranial htn

A

Vit A

also –> hepatosplenomegaly and skin changes

246
Q

nerves often affected by acoustic neuromas

A

(schwanomma that usu occurs at cerebellopontine angle b/w cerebellum and lateral pons and arises from CN VIII)

  • CN VII (facial)
  • CN V (trigem)
247
Q

met process a/w drug induced lupus

A 
liver acetylation
(slow acetylators = higher risk)
248
Q

cortical atrophy + enlarged vetricles

A

hydrocephalus ex vacuo

no increased ICP

249
Q

blood gas in PE

A

LOW PaO2
LOW PaCO2
(norm?) HCO3

HIGH ph (respiratory alk)

250
Q

testicular malignancy can also cause…

A

paraneoplastic hyperthyroidism

if secreting hCG –> similar to TSH

251
Q

stool findings in secretory diarrhea

A

mucous and some shed epithelial cells

NO leukocytes/blood (inflammatory)

252
Q

tx cryptococcal meningitis

A

amph B

253
Q

Cl channel affected by benzos, barbituates, and etoh

A

GABA (A)
(inhibitory receptor)

benzos and zolpidem:
- allosterically binds

(others bind to different components)

254
Q

tx of seratonin syndrome

A

cyproheptadine

antihistamine with ant-serotenergic properties

255
Q

Wilsons

A

Kayser-Fleisher ring

Basal ganglia atrophy –> neuropsychiatric complications

256
Q

damaged in chronic rejection of lungs

A

small airways
—> brochiolitis obliterans syndrome)

(vs vessels in acute rejection)

257
Q

a/w nasopharyngeal carcinoma

A

EBV

258
Q

weird looking lymphocytes w/ abundant blue cytoplasm w/ basophilic rim that’s indented by neighboring RBCs

A

EBV
(infectious mono)

***CD 8 T cells
(B cells small portion of smear)

abundant cytoplasm + lack of nuclear changes distinguish them from hematologic malig

259
Q

candida skin test - what cells

A

CD4 T
CD8 T
NK cells

260
Q

oculomotor findings w/ wern-kors

A

horizontal nystagmus

bilateral abducens palsy

261
Q

diaphragmatic surface of heart supplied by…

A

Posterior descending artery
- 90% from RCA

(Inferior wall of left ventricle)

262
Q

stop codons

A

UGA
UAA
UAG

263
Q

N. meningitidis vaccine

A

capsular polysaccharides

264
Q

tx of bradycardia –> eye pain

A

atropine

acute closed angle glaucoma

265
Q

tx for giardia

A

metronidazole

266
Q

acute leukemia that presents as anterior mediastinal mass

A

T-cell
ALL

(can cause resp symp, dysphagia, or SVC syndrome)

267
Q

contain TdT

A

B and T cell

ALL

268
Q

B cell markers

A

CD 10
CD 19
CD 20

269
Q

T cell markers

A 
CD 2
CD 3
CD 4
CD 5
CD 7
CD 8
270
Q

chemo —> hemorrhagic cystitis

what drug/what prevention

A

cyclophosphamide
ifosfamide
—> toxic metabolite acrolein

prevent:
-mesna
(sulhydryl cmpd binds acrolein in urine)

  • also aggressive hydration and bladder irrigation
271
Q

Deficiency in:
C1 esterase inhibitor

Don’t give:

A

ACE inhib

-pril

272
Q

high gastrin - which MEN

A

MEN 1

pancreatic gastrin secreting tumor

273
Q

MEN 1

A

Parathyroid –> hypercalcemia

Pancreatic –> gastrin

Pituitary –> PRL, ACTH

274
Q

MEN 2A

A

Parathyroid –> hypercalcemia

Pheochromocytoma

Medullary thyroid (calcitonin)

275
Q

MEN 2B

A

Pheochromochytoma

Medullary thyroid

Mucosal neuromas (oral, etc)

Marfanoid habitus

276
Q

Indicates irreversible myocardial cell injury

A

mitochodondrial vacuolization

(means they’re unable to make ATP_

277
Q

c-myc

A

transcription activator

controls prolif, diff, apop

(overactivation –> high mitotic intex)

278
Q

dmg to what structure will cause permenant central DI

A

hypothalamic nuclei

paraventricular and supraoptic

279
Q

tibial nerve sensory

A

sole of foot

280
Q

can’t stand on tip toes

A

tibial nerve

digital flexor os toes and flexors of lower leg

281
Q

deletion of single nucleotide

A

frameshift

282
Q

before giving entanercept

A

PPD skin test

283
Q

mech of adenosine

A

(like ACh)

  • acts on phase 4
  • activates K+ channels and prolongs K+ flow –> membrane pot remains negative for longer period
  • inhbits L-type Ca++hannels (longer to reach threshold)
  • reduces rate of spontaneous depolarization
284
Q

MCC of aseptic meningitis

A

enterovirus

  • coxsackie
  • echo
  • polio

**Fecal/oral route
(but do not typically cause gastroenteritis)

285
Q

what part of GI tract has ramified, tubular glands in submucosa that contain alkaline secretions (ph 9)

A

duodenum

286
Q

Brunner’s glands

A

-submucosa of duodenum

287
Q

Peyers patches

A

ilium

288
Q

N-acetylcysteine use in CF

A

cleaves disulfide bonds w/in mucus glycoproteins

loosens thick sputum

289
Q

Beta blockers and thyrotoxicosis

A
  • decrease sympathetic adrenergic symptoms

- decrease rate of periferal conversion of T4 –> T3

290
Q

decreased outward K and prolonged APs…. most likely to suffer what

A

torasades

and sudden death

291
Q

CXR:

  • unilateral pulmonary opacification
  • deviation of mediastinum toward opacified lung
A

obstx in mainstem bronchus

–> lung collapse

292
Q

% of coronary vessel obst –> symptoms

A

75%

293
Q

increase insulin resistance in overweight pts

A

FFA

serum trigycerides

294
Q

vitamin def associated with TB

A

pyridoxine (B6)

isoniazid similar and competes

295
Q

PECAM (platelet endothelial cell adhesion molecule)

A

transmigration

296
Q

rolling

A

L- selectin (neutrophils)

E/P selectin (endothelial cells)

(loose binding of sialated carb - e.g. sialyl lewis/PSGL)

expression greatly increased by cytokines

297
Q

Tight adhesion/crawling

A

Integrins (neutrophils)
- CD18

ICAM (endothelial cells)

298
Q

steps of getting leukocytes to tissue

A 
marginalization
rolling
activation
tight adhesion/crawling
transmigration
299
Q

musculocutaneous nerve

A
  • flexion of arm at elbow
  • supination
  • lateral forarm (sensory)
300
Q

directly behind esophagus

A

descending aorta

301
Q

neurophysin

A

carrier molecule for posterior pituitary stuff from the hypothal
(oxytocin and ADH)

302
Q

wet
wacky
wobbly

A

normal pressure hydroceph

303
Q

non enveloped
single stranded
DNA

A

parvo

304
Q

acute arthritis w/ opaque exudate high in neutrophils and intracellular organisms

A

(in sexually active young adults)

  • bacterial/septic arthritis
  • Niesseria gonorrhoeae
305
Q

antiarrythmic sodium channel binding strength

A

1C > 1A > 1B

  • 1C = most use dependance

1B has the least use dependence

i.e. the shorter binding means less time to accumullate effect

306
Q

MCC of death in Marfans

after infancy

A

aortic dissection

cystic medial degeneration

307
Q

blanching of tissue during norepi infusion - tx?

A

phentolamine

308
Q

vessels spared in PAN

A

pulmonary

309
Q

cystic tumor in cerbellum of child

  • spindle cells
  • hair-like glial processes
  • ROSENTHAL FIBERS
  • granular eosinophilic bodies
A

pilocytic astrocytoma

310
Q

“holiday heart syndrome”

A

excessive etoh —> a fib

  • irreg’ly irreg
  • no P waves
  • varying R-R intervals
311
Q

anticonvulsant that can –> bone marrow suppression

A

carbamazepine

blood counts should be watched

312
Q

check if suspect B12 def

A

serum methylmalonic acid

increased

313
Q

tx of organophosphate poisoning with only atropine leaves pts at risk for..

A

muscle paralysis

*add pralidoxime

314
Q

Granuloma formation (e.g. sarcoid) mediated by what cells/cell products

A

TH1
IL 2
INF gamma

315
Q

genetic predisposition to hyperglycemia in pregnancy - mt in what enzyme

A

gluckokinase

(sensor w/in beta cells)

mt –> mild hyperglycemia that can be exacerbated during preg

316
Q

withdrawl symptom:

yawining

A

opiods

heroin

317
Q

fungal drug that inhibits CYP450 met of other drugs

A

azoles

318
Q
  • bilateral hearing loss
  • bump on tibia
    bx: cells with over 100 nuclei, tartrate-resistant acid phosphotase positive
A

Paget’s disease of the bone

huge cells with many many nuclei = overactive osteoclasts

NB: osteoclasts stim by M-CSF and RANK-L (from blasts)

319
Q

Long QT interval (hereditary)

–> what else may pt also have

A

neurosensory deafness

  • mutation in genes coding for potassium of sodium channels

Jervell and Lange-Nielsen syndromes

320
Q

mech of glucagon reversal of beta-blockers

A

acts on g protein receptor

—>increases intracellular cAMP

—> increases release of intracellular calcium during muscle contraction

—-> increases HR and contractility

321
Q

side effects of protease inhib

A

hyperglycemia

lipodystrophy

drug/drug interactions (inhib cyp450)

322
Q

muscarinic receptors on endothelial cells

A
  • promote release of NO (EDRF) —> activates g-cyclase –> decreases calcium concentration
323
Q

midshaft humerus fractures - artery/nerve?

A
  • deep brachial artery
  • radial nerve

(supracondylar a/w brachial artery)

324
Q

diabetic mononeuropathy of CN III

A

central ischemia
–> affects somatic nerve fibers but spares peripheral paraympathetic

= down and out gaze but normal light/ accommodation reflexes

325
Q

aneurymal compression of CN III

A

affect superficial parasympathetic efferents first and spare deeper motor (extraocular mvmts)

early: dilated pupil and loss of accommodation

late; ptosis and opthalmoplegia

326
Q

GTP formed in what stage of TCA

A

succinyl- CoA –> succinate

327
Q

pure motor hemiparesis

location

A

posterior limb of internal capsule

or basal pons

328
Q

pure sensory stroke

A

ventroposterolateral (VPL)
or
ventetroposteromedial (VPM)

thalmus

329
Q

ataxia-hemiplegia syndrome

A

posterior limb of internal capsule

or basal pons

330
Q

dysarthria - clumsy hadn syndrome

A

genu of the internal capsule

or basal pons

331
Q

stage vs grade

A

stage - how much the tumor spreads

grade - degree of differentiation

332
Q

duodenal ulcer - tx for long term relief

A

abx

333
Q

colorectal carcinoma from IBD vs sporadic

A

IBD:

  • multifocal
  • younger
  • from flat dysplasia
  • mucinous/signet ring
  • early p53/late APC
  • proximal colon (esp chrohns or concurrent PSC)
334
Q

NE–> what receptors

A

alpha 1/2
beta 1

**little on B2

(therefore only alpha on vessels)

335
Q

calcineurin

A

essential protein in activation of IL-2

activation blocked by cyclosporine and tacrolimus

336
Q

site of greatest degree of atrophy in Alzheimer’s

A

hippocampus

337
Q

short term diabetic neuropathy tx that should be used with caution in pts with BPH

A

TCAs
(e.g. amitriptyline)

anticholinergic properties

338
Q

low pitched holosystolic murmer that accentuates w/increased afterload (e.g. handgrip)

A

VSD

NB: ASD’s will NOT be holosystolic (may have midsystolic pulmonic ejection murmur)

339
Q

myotonic dystrophy

A

AD d/o
- trinuclotide repeats in myotia-protein kinase gene

sustained muscle contraction + weakness/atrophy

cataracts, frontal balding, gonadal atrophy

340
Q

CD14

A

macrophages

341
Q

Catalase positive organisms (5)

[predom infx in chronic granulomatous disease)

A
  • Staph aureus
  • Burkholderia cepacia
  • Serratia marcescens
  • Nocardia
  • Aspergillus
342
Q

Most renal cell carcinomas from where

A

proximal tubule (epitheilial cells)

gross: golden yellow mass

343
Q

induce EPO

A

renal cortical cells sense hypoxia and synth epo

344
Q

predom cell in sarcoid granulomas

A

CD 4 T

345
Q

supplies blood to upper ureter

prox 1/3

A

renal artery

346
Q

pigment in dubin johnson

A

epinepherine metabolites

347
Q

absence + tonic clonic

med

A

valproate

348
Q

time minimum for persistent depressive disorder (dysthymia)

A

persistent depressed mood with >/= 2 depressive symptoms, lasting >/= 2 years

no symptom free periods > 2months

(1 yr in children/adolescents)

*specifiers : pure, w/ intermittent or persistent MD episodes

349
Q

what is right beneath the 12th rib on the left

A

left kindey

350
Q

sythetic T3’s effect on rT3

A

decreased

decreases T4 and synthetic can’t be coverted to rT3

351
Q

patients with sarcoidosis or other granulomatous diseases are prone to hyper______

A

hypercalcemia
secondary to high levels of active vit D

(?why)

352
Q

beta blockers tx glaucoma by

A

blocking production of aqeous humor from ciliary epithelium

353
Q

hemibalism

A

subthalamic nucleus damage

contralateral

354
Q

crescentic glomerulonephritis w/o immunoglobulin or complement

A

“pauci immune”

  • ANCA
355
Q

twinning timeline

A

0-4d = di/di

4-8d = mono/di

8-12 = mono/mono

(>13d = conjoined)

356
Q

vomiting center

A

dorsal surface of medulla at caudal end of 4th ventricle

“area postrema” - gets blood from fenestrated vessesl

357
Q

brain tumor - necrosis and vascular proliferation

A

glioblastoma

358
Q

mech of non-bacterial thrombotic endocarditis (NBTE)

A
  • often involves hypercoagulable state
  • e.g. cancer (marantic endocarditis)
  • patho ~Trousseau’s syndrome (migratory thrombophlebitis)
359
Q

childhood osteomyelitis

A

staph aureus

360
Q

Kid:

  • non-rhythmic conjugate eye movements
  • myoclonus

(opsoclonus-myoclonus syndrome)

A

neuroblastoma

*MC extracranial childhood cancer

adrenal medulla
N-myc (more copies)
small blue round cells

361
Q

uniformly enlarged uterus with normal endometrial glands

A

adenomyosis

  • endometrial glandular tissue in MYOmetrium

Uworld (9 decks)

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