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Shit I Forget Flashcards

1
Q

Hartnup disease

A

AR disorder, deficiency in neutral amino acid transporters in PCT and enterocytes. Pellagra-like symptoms (dermatitis, diarrhea, demenatia). Treat with high protein disease and nicotinic acid. Can’t absorb tryptophan is the derivative of niacin

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2
Q

How do you distinguish between Fanconi aciduria and Harnup disease?

A

Harnup has normal urinary levels of proline, hydroxyproline and arginine while Fanconi does not.

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3
Q

Nursemaids elbow?

A

sudden traction of outstretched, pronated arm of a child. Due to torn annular ligament and child will hold arm in slightly flexed and pronated.

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4
Q

How is colitis associated colorectal carcinoma different from sporadic?

A
  1. appears @ younger age
  2. progresses from flat and nonpolypoid dysplasia
  3. mucinous with signet rings
  4. early p53 mutations and late APC (opposite of sporadic)
  5. proximal colon
  6. multifocal in nature
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5
Q

How does the carotid sinus work and what cranial nerve innervates it?

A

Carotid sinus is innervated by CNIX and results. If more pressure is applied, then there is increased parasympathetic firing which prolongs AV node refractory period and prevents re-entrant circuits from occuring

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6
Q

What inhibits prolactin secretion toward the end of pregnancy?

A

high levels of progesterone and estrogen

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7
Q

What are the long acting benzodiazepiens?

A

Careful Carol Does’t Fall

Chlordiazepoxide, Clorazepate, Diazepam, Flurazepam. Less risk of falling but higher addiction potentional than short acting.

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8
Q

Pentazocin?

A

Opiod that has weak mu agonist effects and weak antagonist effects (can cause withdrawal symtpoms)

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9
Q

Estrogens effect of cholesterol synthesis?

A

Increases activity of HMG-CoA reductase which increases cholesterol production

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10
Q

7 alpha-hydroxylase?

A

incoporates cholesterol into bile salts. If suppressed, then excess cholesterol in the bile leading to increased risk of gallstones

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11
Q

MOA of fibrates?

A

Upregulates LPL and increases TG clearance. Side effect is that it inhibits 7 alpha-hydroxylase which incorporates cholesterol into bile salts

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12
Q

Adenymyosis?

A

Abnormally enlarged uterus with normal normal appearing endometrial tissue within the myometrium. Dysmenorrhea and menorrhgia

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13
Q

A2-OS interval?

A

Indicated severity of mitral stenosis. The smaller the gap between the opening snap and S2, the more severe the mitral stenosis (due to increasing pressure in the left atrium)

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14
Q

Most common cause of primary adrenal insufficiency?

A

Autoimmune adrenalitis

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15
Q

Symtpoms of primary adrenal insufficency?

A

hyponatremia, hyperkalemia, non-anion gap metabolic acidosis (increased H+) with increased Cl- retention to maintain electroneutraility.

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16
Q

Mortality rates of lung cancer

A

Before 1965, lung cancer wan’t that common. Now it has highest mortality rates in women.

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17
Q

What type of vaccine is for rabies?

A

killed vaccine

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18
Q

Malignant (atypical) phenylketonuria?

A

deficiency of dihydrobiopterin reductase which reduces BH2 to BH4. Necessary for conversion of phenylalanine to tyrosine and tyrosine to dopa. Loss of dopamine and catecholamines that appear downstream

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19
Q

How are HbA1C levels affected in diabetics with an anemia?

A

Low and high turnover states of anemia can affected HbA1C. Higher turnover rate means lower HbA1C levels than actually exist.

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20
Q

Equation for Net flitration pressure in the glomerulus

A

(PGC-PBS)- (πGC-πBS)

GC= glomerular capillary

BS= bowmans space

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21
Q

Disease of niacin deficiency?

A

Pellagra (dermatitis, diarrhea, dementia, death).

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22
Q

Does corn have a lot of niacin?

A

Yes, but exists in an inaccessible form!

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23
Q

Less common associations of Pellagra?

A

Isoniazid treatment, carcinoid syndrome, and Harnup disease

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24
Q

How does botulinum toxin work at the NMJ?

A

Inhibitis release of ACh from presynaptic nerve terminals.

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25
Q

What causes the tissue damage seen in abscess formation?

A

Macrophages and neutrophils release lysosymal enzymes that eat up and digest the bacteria/offending agent but can also cause tissue damage.

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26
Q

Symptoms of ARDS

A

noncardiogenic pulmonary and interstitial alveolar edema, inflammation and alveolar hyaline membranes.

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27
Q

Major side effect of acyclovir?

A

obstructive crystalline nephropathy and acute renal failure if not adequately hydrated.

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28
Q

What are 3 common situations for development of avascular necrosis?

A

Sickle cell, SLE, and high dose steroid therapy/ alcoholism

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29
Q

What seizures does valproic acid treat?

A

Tonic-clonic and absence, simple and complex.

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30
Q

What are the side effects of thiazides?

A

hyperGLUC: hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia

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31
Q

Calcineurin?

A

a protein phosphatase in T cells that is activated upon stimulation of the T cell receptor. Calcinuerin then dephosphorylates NFAT which then enters the nucleus and binds IL-2 promotor, which stimulates activation of more T cells.

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32
Q

What can immunosuppressed men or women get from HPV?

A

Women at greater risk for cervical carcinoma, and men are at a greater risk for anal (MSM) and penile carcinoma.

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33
Q

What will ECG look like for re-entrant circuit?

A

Shortend PR interval (due to the accessory pathway pre-exciting the venticles), widened QRS complex and a delta wave.

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34
Q

What antibody is indicative of a past HBV infection?

A

anti-HBcAg IgG (anti-HBsAg will also be positive, but is not specific to past infection. Can indicate vaccination)

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35
Q

What type of vaccine is HBV?

A

recombinant vaccine that contains HBsAg

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36
Q

How should one address an elderly patient?

A

Always use Ms. Mrs. or Mr.

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37
Q

What is leukocyte adhesion disorder?

A

Phagocyte dysfunction due to a defective LFA-1 integrin (CD18) protein on phagocytes that impairs migration and chemotaxis. Delayed separation of the umbilical cord. Absence of neutrophils at the infection site. **No pus (no neutrophils). **

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38
Q

Actions of BNP (brain natiuretic peptide)?

A

BNP is released from the ventricles in response to stretch as seen in CHF. Leads to diuresis, vasodilation and decreased BP to try and alleviate the symtpoms of CHF.

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39
Q

What is the role of the renin-angiotenin pathway in CHF?

A

Released in response to decreased CO, causes H2O retention, salt retention, vasoconstriction and deleterios cardiac remodeling.

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40
Q

What are the 2 most common treatments of absence seizures?

A

Ethosuximide and vaproic acid

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41
Q

When is Na+ conductance the highest during action potential?

A

At the peak of the action potential.

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42
Q

Defining characterisitics of complete hyatid molar pregnancy?

A

Super high levels of hCG, “**size greater than dates” uterus, **no fetal tissue - exclusively **trophoblastic tissue, **complete paternal origin. Higher risk for malignancy

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43
Q

What inhaled anesthetic can cause drug-induced liver injury?

A

halothane

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44
Q

What are the results of halothane induced fulminant hepatitis?

A

Liver will appear atrophied on autopsy, super high AST/ALT, and prolonged prothrombin time. Liver isn’t making clotting Factor VII which has the shortest half life of all the procoagulant factors.

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45
Q

Wilson’s disease characteristics?

A

Copper is Hella BAD

dec Ceruloplasmin, Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma (HCC)

Hemolytic anemia

Basal ganlgia degereration (parkinsonian symptoms)

Dementia, Dyskinesia, Dysarthria

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46
Q

What does the NIS (sodium-iodide symport) in the thyroid gland transport?

A

Iodide, and perchlorate/pertechnetate anions which can competively inhbit the uptake of iodide.

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47
Q

what is the most common malignancy associated with asbestos exposure?

A

Bronchogenic Carcinoma (mesothelioma is still of lower incidence)

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48
Q

What is the function of Major Basic Protein?

A

Found in eosinophils and functions mainly to kill helminths. Can also cause bronchial epithelial damage in patients with atopic asthma.

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49
Q

What medications can cause hyperkalemia?

A

Nonselective beta-adrenergic blockers, ACEi, ARBs, K+ spairing diuretics (spironolactone, eplereone, triamterene and amiloride), digoxin, and NSAIDs

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50
Q

What is the major proliferative stimulus for athersclerotic plaque formation?

A

Starts with endothelial cell injury, increased endothelial cell injury, increased leukocyte adhesion and altered gene expression. Results in endothelial cell dysfunction, activation of platelets which secrete PDGF which promotes migration of SMCs from the media into the intima where they produce more smooth muscle.

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51
Q

Contents of fresh frozen plasma?

A

contains all coagulation factors

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52
Q

Contents of cryoprecipitate?

A

only cold soluble proteins (factor VIII, fibrinogen, vWF and vitronectin)

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53
Q

Are benzodiazepines used for seizure therapy?

A

YES! (status epilepticus)

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54
Q

What does the inferior mesenteric artery supply?

A

distal 1/3 of the transverse colon, sigmoid colon, and rectum.

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55
Q

Defining features of PCP?

A

violent behavior, nystagmus, most likely to die due to trauma.

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56
Q

What are the groups of subjects in a case-control study?

A

One group of subjects with the disease of interest and another group of subjects without the disease. Can retrospectively investigate if a certain exposure is related to the disease or not.

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57
Q

What are the findings of acute serum sickness?

A

Type III hypersensitivity reaction that leads to low C3 and C4, fever, pruritic skin rash, small vessel vasculitis with fibrinoid necrosis, and massive neutrophil infiltration. Can occur after chimeric medication admimistration such as infliximab.

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58
Q

Where is low frequency sound best detected?

A

apex of clochlea (contains the basilar membrane) near the helicotrema

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59
Q

Where are high frequency sounds best detected in the ear?

A

Base of the cochlea near the oval and round windows

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60
Q

What are the occupational sources of lead toxicity?

A

batteries, alloys, ammunition, mining, smelting, chemical processing, pray painting, radiator repair, and recycling.

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61
Q

What are the sxs of lead poisoning in the first stage of toxicity?

A

colicky abdominal pain, constipation, headaches, impaired concentration, and deficits in short term memory

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62
Q

What is the presentation of an 11B-hydroxylase deficiency?

A

XX virulization. low cortisol, low aldosterone, high androgens. Even though low aldosterone, the 11-deoxycorticosterone as mineralocorticoid effects resulting in increased BP

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63
Q

What is the PI3K/Akt/mTOR pathway involved in?

A

anti-apoptosis, cellular proliferation, and angiogenesis

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64
Q

Describe the mTOR pathway

A

A growth factor binds to its tyrosine kinase receptor causing autophosphorylation of tyrosine kinase residues within the receptor. These activate PIK3 which then phosphorylates PIP2 in the plasma membrane to PIP3. This activates Akt (protein kinase B) a serine/threonine specific kinase. This activates mTOR which translocates to the nucleus and induces gene production for cell proliferation.

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65
Q

What cancer drugs inhibit mTOR?

A

Rapamycin aka sirolimus

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66
Q

What is a common cause of UTIs in people with indwelling catheters?

A

Pseudomonas- gram negative, nonlactose fermenting, oxidase positivie

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67
Q

Are pulmonary infarcts hemorrhagic or ischemic?

A

Hemorrhagic due to the dual blood supply

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68
Q

Which valve is affected due to endocarditis from IV drug abuse?

A

The tricuspid valve (don’t “tri” drugs) then usually cause septic emboli in the lungs.

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69
Q

What organisms cause bacterial endocarditis in IV drug users?

A

S. aureus, psuedomonas, and candida

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70
Q

What effect do TCA’s have on the heart?

A

TCA’s have a quinidine type of effect on the heart and can lead to increased QT interval by inhibiting the fast sodium channels

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71
Q

How do you treat a QT prolongation/cardiac dysarrhythmia due to TCAs?

A

sodium bicarbonate administration–TCAs are weakly acidic

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72
Q

What is the brand name of acetominophen?

A

tylenol

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73
Q

What antiarrhythmics increase the PR interval?

A

Beta blockers (class II antiarrhythmics) and Ca channel blockers (class IV antiarrhythmics). Control the rate (will give a reading of the pacemaker = a hump).

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74
Q

Which antiarrhythmics can cause torsades?

A

Ia and III (increased QT interval)

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75
Q

Which antiarrhythmics control rhythm?

A

Na channel blockers (Class I) and K+ channel blockers (Class III). (will show an action potential spike for these questions-myocytes)

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76
Q

How does cystic fibrosis affect the pancreas?

A

Pancreatic secretions become very viscous and plug the pancreatic ducts so enzymes cannot be secreted. Leads to pancreatic insufficiency and malabsorption with stearohhea and poor weight gain. After severe mucous plugging, the pancreas can eventually atrophy

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77
Q

What patients are suspetible to mucormyocosis?

A

DM 1 in DKA.

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78
Q

What are the symptoms and treatment of mucormycosis?

A

facial pain, headache, and black eschar in the nose. Confirm diagnosis wtih a nasal biopsy and treat with debridment and amphotericin B

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79
Q

Histological findings of mucormycosis?

A

fungi appear as broad, nonseptate hyphae with 90° branching (compared to Aspergillus with septated hyphae and 45° branching)

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80
Q

Symptoms of theophylline toxicity?

A

abdominal pain, vomiting, cardiac arrhythmias and seizures

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81
Q

Treatment for theophylline overdose?

A

activated charcol and cathartics, beta blockers to treat the tachyarrhymias, benzos and barbs for the seizures

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82
Q

What does the glomerulus look like in PSGN?

A

hypercellular with infiltration of leukocytes and endothelial/mesangial cell proliferation

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83
Q

What are Langhans cells?

A

multinucleated giant cells with a horseshoe shaped arrangement of multiple nuceli derived from monocytic cell line that plays a role in granulomatous inflammation. Don’t confuse with Langerhans cells which are dendritis cells int he skin and mucosa that look like a tennis racket #birbeck granules

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84
Q

What condition presents with urine discharge from the umbilicus?

A

Failure of the urachus (remnant of the allontois that connects the bladder with the yolk sac) to obliterate by birth. Connects the bladder and the umbilicus.

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85
Q

What condition presents with meconium discharge from the umbilicus?

A

a persistant yolk sac (vitelline duct) that connects the small intestine with the the skin at the umbilicus.

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86
Q

What tissues is GLUT-3 found on?

A

placental and neuronal glucose transport

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87
Q

What are P bodies?

A

foci within the cytoplasm that are involved in mRNA regulation and turnover. Important for translation regression and mRNA degradation. Sometimes store mRNA

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88
Q

What antibiotic is an analog of D-Ala-D-Ala

A

Penicillin

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89
Q

What drus are enoxaparin and dalteparin?

A

Low molecular weight heparins- binds antithrombin III and promotes its activation

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90
Q

What does tPa bind?

A

Binds plasminogen that is bound to fibrin. Breaks up clots.

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91
Q

What is the efferent limb of the light reflex?

A

parasympathetic fibers of the oculomotor nerve

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92
Q

What holosystolic murmur increases in intensity on inspiration?

A

tricuspid regurgitation

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93
Q

Hypocapnia effects on the brain?

A

cerebral vasoconstriciton and decreased cerebral blood flow. (CO2 is a vasodilator)

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94
Q

What is the most common lung cancer among non-smokers and women?

A

adenocarcinoma

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95
Q

what causes neonatal retinopathy?

A

use of concentrated O2 for neonatal respiratory distress syndrome. Can lead to blindness

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96
Q

What is the best indicator of liver damage?

A

prothrombin time

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97
Q

What cofactor increases in liver disease?

A

Factor VIII

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98
Q

Aldolase B deficiency treatment?

A

Fructose metabolism. Need to remove fructose and sucrose from the diet (sucrose = fructose + galactose)

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99
Q

What are the sugars that make up sucrose?

A

fructose + glucose

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100
Q

What are the sugars that make up lactose?

A

galactose + glucose

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101
Q

What are the sugars that make up maltose?

A

glucose + glucose

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102
Q

What biochemical reactions require biotin (B7)?

A

pyruvate to OAA (pyruvate carboxylase)

acetyl CoA to malonyl CoA (acetyl CoA carboxylase)

propionyl-CoA to methylmalonyl Co-A (propionylCoA carboxylase)

*any reactions that use carboxylase use biotin

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103
Q

How does CCL4 (carbontetrachloride) cause damage?

A

Creation of free radicals while metabolized in the liver (lipid peroxidation). Results in fatty change of the liver and hepatocyte necrosis (radicals cause swelling of the RER and leads to ribosome detachment and decreased protein synthesis= dec apolipoprotein which is meant to transport fat out of the liver= fatty change)

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104
Q

Symptoms of Trisomy 13 (Patau)?

A

bilateral cleft lip, microphthalamos (fucked up eyes), microcephaly, polydactyly, rockerbottom feet (NO SHORTENING OF FINGERS which dinstinguishes from Edwards)

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105
Q

Inheritence pattern of PKU?

A

autosomal recessive

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106
Q

What diseases are autosomal dominant?

A

ADPKD, FAP, Familial Hypercholesterolemia, Hereditary Hemorrhagic Telangiectasia, Hereditary Spherocytosis, Hungtinton disease, Marfan syndrome, MEN, NF1, NF2, Tuberous sclerosis, vHL disease

Dominant Family Men Need Many Hours Hunting, Sleeping and Peering at the TV

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107
Q

What disorders are X-linked recessive?

A

Be Wise, Fool’s GOLD Heeds Silly HOpe

Bruton agammaglobulinemia, Wiskott-Aldrich, Fabry disease, G6PD, Ocular ablinism, Lesch-Nyhan, Duchenne and Bcker, Hunter Syndrome, Hemophilia A and B, Ornitine transcarbamylase deficency.

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108
Q

What type of inflammation is seen in polyarteritis nodosa?

A

transmural inflammation with fibrinoid necrosis. String of peals appearance

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109
Q

What msucles do the recurrent laryngeal nerve innervate?

A

all layngeal muscle EXCEPT the cricothyroid (sensory innervation below the vocal cords)

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110
Q

What nerve innervates the cricothyroid muscle?

A

external branch of the superior laryngeal nerve

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111
Q

What is the function of enteropeptidase?

A

secreted by the duodenum and cleaves trypsinogen into the activated trypsin.

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112
Q

What heart condition can be precipitated by binge drinking?

A

A-fib

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113
Q

What are 3 precipitating factors in isolated events of atrial fibrillation??

A
  1. binge drinking
  2. increased cardiac sympathetic tone
  3. pericarditis
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114
Q

In a healthy individual, is the equilibriation of O2 and CO2 perfusion or diffusion limited?

A

Perfusion- limited

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115
Q

If you eat a lot of raw egg whites all the time, what deficiency can this lead to?

A

biotin deficiency (all carboxylase enzymes are out of commission)

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116
Q

Function of peptide YY?

A

binds to ECLs and inhibits gastrin-stimulated histamine release.

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117
Q

What hormones inhibit gastrin secretion?

A

Somatostatin, peptide YY, and prostaglandins

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118
Q

If a patient has mitral regurgitation, what factors can be adjusted to decrease the amount of backwards flow and increase forward flow?

A

decrease the afterload. Treat with a beta blocker!

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119
Q

When is a 3rd heart sound normal?

A

In children, young adults, and pregnancy

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120
Q

When is an S4 normal?

A

healthy older adults

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121
Q

When do you hear an S4, and what are the abnormal causes?

A

Presents as an atrial gallp sound before S1 as blood is forced into a still ventricle. Abnormal associated conditions include ventricular hypertrophy and acute MI (reduced ventricular compliance)

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122
Q

When do you hear an S3 and what are the associated abnormal symptoms?

A

Ventricular gallop sound heard after S2, during rapid filling of ventricles during diastole and due to turbulent blood flow to the ventricles due to increased blood volume. Hear in CHF, restrictive cardiomyopathy and mitral regurgitation

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123
Q

What is the equation for diffusion rate?

A

(concentration difference x SA x solubility)/ thickness x MW

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124
Q

What is the most common cause of a new onset murmur in a young person?

A

bacterial endocarditis

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125
Q

What is common complication of bacterial endocarditis that involves the kidney?

A

Renal insufficency due to nephritic syndrome like acute diffuse proliferative glomerulonephritis secondary to ciruclating immune complexes.

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126
Q

What infections are associated with hemagglutinin?

A

Influenza virus, Measles (rubeola), Mumps, and Parainfluenza.

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127
Q

What is the effect of a RET mutation?

A

RET is a germline mutation in neural crest cells. RET mutations are seen in MENIIA/B syndromes. Both have pheochromocytoma (chromaffin cells of the adrenal medulla are from neural crest cells) and meduallary carcinoma of the thyroid (parafollicular C cells are from neural crest cells and secrete calcitonin)

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128
Q

What is lymphogranuloma venerium?

A

chronic disease of chlamydia trachomatis that is characterized by an intial painless, small ulcer

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129
Q

How do you differentiate between obstructive sleep apnea and Cheyne-Stokes respiration?

A

OSA: reductions in airflow despite respiratory effort. No cyclic variation in tidal volume.

Cheyne-Stokes: seen in CHF. Describes cyclic breathing where apnea is followed by gradually decreasing tidal volumes until next apneic period.

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130
Q

What is the equation for GFR?

A

GFR = UV/P (inulin or creatinine)

V= urine volume flow rate

U= urine concentration

P= plasma concentration

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131
Q

Equation for RPF?

A

RPF= clearance of PAH

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132
Q

What is the equation for filtration fraction?

A

FF= GFR/RPF

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133
Q

What causes bruises to turn green?

A

Heme oxygenase converts heme to biliverdin which gives bruises their green color

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134
Q

What are the symptoms of a glossopharyngeal nerve lesion?

A

loss of a gag reflex (afferent limb), loss of sensation in the upper pharynx, posterior tongue, tonsils and middle ear cavity, and loss of taste sensation on the posterior 1/3 of the tongue

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135
Q

Pathogenesis of myasthenia gravis?

A

autoantibodies against postsynaptic nicotinic acetylcholine receptors. Binding of the antibodies causes the receptors to be internalized and degraded. Decreased receptors leads to decreased end-plate potential. Since threshold potential is not reached, the muscle cells do not depolarize.

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136
Q

If the resting membrane potential is close to the equilibrium potential of an ion, is it more or less permeable to that ion?

A

More permeable

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137
Q

What is the only type of anemia with an increased mean corpuscular hemoglobin concentration?

A

Hereditary Spherocytosis. WIll lose its central pallor.

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138
Q

What is the differnce in compliance between acute mitral regurg (ruptured chordae tendinae) and chronic mitral regurg?

A

In chronic there is time for the LA to adapt to the increased volume due to regurgitation. The LA dilates and the wall thins, therefore there is an increase in complicance.

In acute regurg, there is no time for LA adaptation and therefore there is no increase in compliance. The extra blood volume results in drastic increase in pressure in the left atrium.

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139
Q

What symptoms are seen in acute mitral regurg but not chronic mitral regurg?

A

acute pulmonary edema

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140
Q

Equation for PPV?

A

PPV= TP/TP+FP

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141
Q

Equation for NPP?

A

NPP= TN/TN+FN

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142
Q

Equation for sensitivity?

A

sensitivity = TP/TP+FN

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143
Q

Equation for specificity?

A

Specificity = TN/ TN+FP

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144
Q

What is hemorrhagic cystitis?

A

dysuria, hematuria, and hemorrhage. Most commonly caused by adenovirus and can be a side effect of cyclophosphamide

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145
Q

What can you use in combo with cyclophosphamide to prevent development of hemorrhagic cystitis?

A

MESNA and aggressive hydration

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146
Q

What is the cause of the common toxicity of cyclophosphamide treatment?

A

hemorrhagic cystitis- cyclophosphamide is broken down into acrolein which is toxic to uroepithelial cells. Can administer with mesna which binds and inactivates acrolein.

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147
Q

Clinical use of mannitol?

A

Often used in traumas to control increased intracranial/intraocular pressure or in a drug overdose.

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148
Q

What is a severe toxicity of mannitol treatment

A

Pulmonary edema. The rapid increase in intravascular volume caused by mannitol can increase the hydrostatic pressure to the point where fluid starts to infiltrate the lungs. Can also worsen brain edema if too much mannitol is used (fluid leaves the cells to enter the increased osmolality of the surrounding plasma which mannitol creates).

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149
Q

What is nifedipine?

A

CCB that is specific to the vasculature. NO EFFECT ON THE HEART.

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150
Q

What are Class IV antiarrhythmics?

A

CCBs

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151
Q

What drugs are the cardiospecific CCBs?

A

Verapamil and Diltiazem. They decrease conduction velocity and increase PR interval

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152
Q

What are the effects of beta blockers on the heart?

A

Decreased AV nodal conduction and increased PR interval

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153
Q

In the midaxillary line, where should one perform a thoracocentesis in order to avoid hitting the lungs?

A

between the 7th and 9th ribs

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154
Q

In the midclavicular line, where should one perform a thoracocentesis in order to avoid the lungs?

A

between the 5th and 7th ribs

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155
Q

In the paravertebral line, where should one perfrom a throacocentesis in order to avoid hitting the lungs?

A

between the 9th and 11th ribs

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156
Q

In relation to the ribs, where does the liver lie?

A

middle axillary line below the 9th rib

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157
Q

What structures run through the hepatoduodenal ligament?

A

portal triad (portal vein, hepatic artery, and common bile duct)

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158
Q

What can aspergillus cause in an immunocompromised patient?

A

Fungal rhinositis (just look for the septae, branching at acute angles)

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159
Q

What are the important regulatory factors involved in insulin release from beta cells?

A

Uptake of glucose stimulates TCA cycle which leads to increased ATP. This increased in ATP causes closure of KATP channels (K+ channels controlled by ATP that allow K+ efflux). Increased K+ in the cell then depolarizes the cell and leads to opening of voltage gated Ca2+ channels and insulin release?

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160
Q

What would a defect in the KATP channel being constantly open lead to?

A

No insulin release, type II DM. Sulfonylureas target this channel and cause it to close so insulin can be released

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161
Q

In the respiratory tract, where is airway resistance the highest?

A

In the medium sized bronchi (generations 2-5) due to highly turbulent airflow

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162
Q

What are the metabolic findings of DKA?

A

Increased anion gap metabolic acidosis with low bicarb (due to buffering) and a respiratory alkalosis (compensatory response to the acidosis- try to blow off CO2- low PCO2)

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163
Q

Where are Meissner’s and Auerbach’s plexi found?

A

in the submucosa (Meissner) and muscularis externa (Auerbach). Must take a biopsy at least to the submucosa to see this.

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164
Q

What factors can decrease chances of getting a renal caliculi stone?

A

Increased fluid intake and increased citrate (citrate binds the free/ionized calcium and prevents it from precipitating).

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165
Q

What are the common causes of metabolic alkalosis?

A

Vomiting or nasogastric suctioning, thiazide or loop diuretics, mineralocorticoid excess

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166
Q

What 2 important factors should be checked when suspecting a metabolic alkalosis?

A

Volume status and Chloride concentration

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167
Q

Between which 2 muscles does the median nerve course before entering the wrist?

A

flexor digitorum superficialis and flexor digitorum profundus muscles

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168
Q

How do eosinophils kill parasites?

A

IgE binds to parasaites and the eosinohpils bind the IgE and release Major Basic Protein to destroy the parasite. This is called **antibody-dependent cellular cytotoxicity. **

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169
Q

What are the common electrolyte disturbances seen in amphotericin B treatment?

A

hypokalemia and hypomagnesium due to increased permeability of the distal tubular membrane due to direct nephrotoxic effects of amphoterrible on renal epithelium

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170
Q

What is a major cause of morbidity and mortality in patients recovering from a subarachnoid hemorrhage?

A

Severe vasospasm can occur 4-12 days post initial insult and results in a spasm of the artery surrounding the injury which leads to cerebral ischemia and new onset of symtpoms.

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171
Q

What is alendronate?

A

a bisphosphonate (end in -dronate)

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172
Q

What are the uricosuric medications?

A

Increase excretion of uric acid in the urine. Includes probenecid or sulfinpyrazone. Contraindicated in patients who are excreting large amounts of uric acid.

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173
Q

How do you differentiate between schizoaffective d/o and MDD/bipolar with psychotic features?

A

Schizoaffective: psychosis occurs during AND in the absence of major mood episodes.

MDD/bipolar with psychotic: psychosis occurs exclusively during the mood episodes

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174
Q

What is the definition of hypertensive crisis?

A

diastolic BP above 130

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175
Q

What is the physiologic response in hypertensive crisis?

A

Acute vascular damage with hyperplastic arteriolosclerosis that presents are onion-like concentric thickening of the walls. Leads to dec GFR, activates RAS, increased fluid uptake, and increase BP. VICIOUS CYCLE.

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176
Q

Key characterisitic of meningioma?

A

psammoma bodies

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177
Q

What are the two main buffer systems involved in excretion of acid in the kidney?

A

HPO42- and NH3.In acidotic situiations, these buffers will exist in the tubular lumen of the kidney and bind H+, forming a compound that is excreted in the urine (levels will be high in the urine).

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178
Q

Latent period bias?

A

Sometimes the initial steps in pathogenesis/exposure to risk factors occur years before there are clinical manifestations of the disease present. Also, risk modifiers may need to be present for a long time before they influence the outcome.

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179
Q

What does the presence of hemosiderin-labled macrophages in the alveoli signify?

A

These are known as siderophages or “heart failure cells”. Indicates chronic elevation of pulmonary hydrostatic pressure which is usually due to left-sided heart failure

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180
Q

What is on the DDX if golden cytoplasmic granules are seen?

A

lipofuscion or hemosiderin. Differentiate between the two using a Prussian-Blue stain. If hemosiderin, the iron will turn blue black.

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181
Q

How do you differentiate between Berger’s Disease and PSGN?

A

Berger’s: occurs a few days after infection, normal complement levels and IgA deposition in the mesangium

PSGN: occurs a few weeks post-infection and decreased complement levels

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182
Q

If IgA nephropathy (Berger’s) if associated with extrarenal symptoms, what is it called?

A

Henoch-Schonlein purpura

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183
Q

What are the common symptoms of vit C deficiency?

A

no hydroxylation of lysine and proline residues, resulting in bleeding gums, eccymosis, impaired wound healing, and fragile “corkscrew” hair.

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184
Q

What is B6?

A

pyridoxyl phosphate, required in conversion of glycine+succinyl CoA to ALA (occurs in mitochondria)

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185
Q

What is thymine pyrophosphate?

A

B1 derivative (TTP) that is necessary for alpha-ketoglutarate dehydrogenase and pyruvate dehydrogenase

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186
Q

What is B7?

A

biotin, used as a cofactor for carboxylase enzymes. If you eat only egg whites, can get a deficiency in biotin

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187
Q

What drugs exhibit a disulfiram type reaction?

A

metronidazole, certain cephalosporine, giseofulvin, procarbazine, and 1st gen sulfonylureas

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188
Q

What are the actions of ADH on the medullary collecting duct?

A

ADH causes reabsorption of water and urea. Urea contributes to maintaining the urea concentration gradient in the medullary interstium that allows the reabsorption of a lot of water, allowing for production of maximally concentrated urine.

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189
Q

Is lead poisining micro or macrocytic? What cellular features will be seen?

A

microcytic! hypochromic with basophilic stippling (abnormal aggregation of ribosomes).

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190
Q

What are the lab findings in DIC?

A

Prolonged PT/PTT, thrombocytopenia and microangiopathic hemolytic anemia, low fibrinogen, D-dimers (elevated fibrin split products), low Factor V and VIII (KNOW THESE)

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191
Q

What type of medication is often for urinary urgency?

A

Muscarinic receptors are located on the bladder (detrusor muscle). If M3 is stimulated, then the detrusor contracts and urine is voided. If M3 is blocked, the urine is retained. Ex: oxybutynin

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192
Q

Where are beta 1 receptors found?

A

on the cardiac tissue and renal juxtoglomerular cells

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193
Q

Where are nicotinin cholinergic receptors found?

A

on skeletal muscle at NMJ and on postganglionic neurons in parasympathetic and sympathetic neurons.

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194
Q

When is the first dose of Hib vaccine given?

A

@ 2 months old. infants protected for first 2 months by mothers IgG if she has the vaccine

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195
Q

What is pulsus paradoxus?

A

Decreased in systolic BP by greater than 10mmHg during inspiration. Can be diagnosed by pumping up the BP cuff, will start to hear Korotkoff sounds first during expiration and as the pressure drops, during the entire breath cycle.

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196
Q

What conditions cause pulsus paradoxus?

A

constrictive pericarditis, acute cardiac tamponade, COPD, Restrictive cardiomyopathy. During inspiration, more blood enters the RA, which normally can expand into the pericardiac space. However in situations where it is restricted, the septum then pushed over into the LA and results in decreased blood filling in the RV, and therefore a decreased systemic BP during inspiration.

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197
Q

What causes a subdural hematoma?

A

rupture of the bridging veins that bleeds slowly over time. Midline shift

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198
Q

What is ANP?

A

secreted by atrial myocytes in response to atrial stretch induced by hypertension and hypervolemia. Causes periopheral vasodilation and increased urinary excretion of water and sodium.

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199
Q

What is the most common finding of PID?

A

mucoperulent cervicitis with cervical motion tenderness

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200
Q

How does sildenafil cause increased cGMP levels?

A

prevents cGMP degradation via inhibition of a phosphodiesterase

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201
Q

How do ANP and NO increased cGMP levels?

A

increase production of cGMP (this is different from sildenafil)

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202
Q

How do corticosteroids exert their anti-inflammatory effects?

A

Inhibit phospholipase A2 which inhibits production of leukotrienes and prostaglandins

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203
Q

What drugs are used to decrease ophthalmopathy due to Graves’?

A

high-dose glucocorticoids like prednisone. Anti-thyroid meds DO NOT reduce the proptosis

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204
Q

What types of viruses are capable of genetic reassortment (shift)?

A

any segmented viruses

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205
Q

what nerve injury leads to foot drop?

A

common peroneal

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206
Q

What is the effect of lithium on the kidney?

A

**lithium-induced nephrogenic diabetes insipidis. **Lithium antagonizes the effects of ADH and prevents the kidneys from concentrating urine.

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207
Q

Why do thiazide diuretics lead to increased lithium levels, but loop diuretics don’t?

A

Thiazides block Na reabsorption in the DCT. The kidney freaks out and therefore increases Na reabsorption in the PCT (more lithium gets reabsorbed too). Loop diuretics however prevent Na reabsorption in the TAL, but Na can still get reabsorbed in the DCT, so the kidney doesn’t freak out and increase Na in PCT. Lithium gets fully excreted by the kidney!

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208
Q

Which end of the tRNA molecule does the amino acid attach?

A

the 3’ end

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209
Q

What are the names of the ergot and non-ergot dopamine agonists?

A

Ergot: bromocriptine and pergolide

Non-ergot: pramipexole and ropinirole

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210
Q

Are ergot or non-ergot dopamine agonists preferred for Parkinson’s treatment?

A

Non-ergot (ropinirole and pramipexole)

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211
Q

What is the most common cause of urinary tract obstruction in older males?

A

BPH

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212
Q

Where is the zone that causes vomiting located?

A

Chemoreceptor trigger zone in the postrema of the dorsal medulla

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213
Q

What is the most common cause of meningitis in teens?

A

N. meningitidis

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214
Q

What is the most common cause of meningitis in children >6 months and the elderly (like 30+)?

A

S. pneumo

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215
Q

What are the most common causes of meningitis in neonates?

A

Group B strep, E. coli, and Listeria

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216
Q

What is the most common cause of pneumonia in adults 40-65?

A

S. pneumo followed by H. flu

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217
Q

What is the most common cause of pneumonia in adults 18-40yo?

A

Mycoplasma, C. pneumo, S. pneumo

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218
Q

What are the most common causes of pneumonia in neonates?

A

Group B strep > E. coli

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219
Q

Most common causes of pneumonia in children 4 weeks- 18yo?

A

Runts May Cough Chunky Sputum

RSV, Mycoplasma, C. trachomatis, C. pneumo, S. pneumo

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220
Q

What is a common side effect of MAOi’s?

A

Hypertensive crisis from ingesting cheeses which contain tyramine (a sympathomimetic). MAOi’s prevent breakdown of neurotransmitters so there are more packaged into vesicles ready for synaptic release. Sxs will include headache, blurry vision, high BP. MAO’s treat atypical depression.

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221
Q

What is the most common benign tumor of the lung?

A

Bronchial hamartoma, composed of lung tissue and cartilage that is often calcified on imaging “popcorn calcifications”. Single “coin-lesion”.

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222
Q

What is the most common tumor of the adrenal medulla in kids?

A

Neuroblastoma

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223
Q

What forms the anterior border of the heart?

A

right ventricle

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224
Q

What forms the posterior suface of the heart?

A

left atrium (against the esophagus)

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225
Q

What forms the right border of the heart?

A

right atrium

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226
Q

What forms the left border of the heart?

A

left ventricle and left atrium

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227
Q

What forms the superior border of the heart?

A

great vessels and all chambers

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228
Q

What forms the diaphragmatic surface of the heart?

A

mainly left ventricles

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229
Q

What is the PYR test?

A

replaced bacitracin tests, tests to see if enzyme pyrrolidonyl arylamidase is working. Organisms expected to test + are Strep A, Enterococcus, coagulase negative Staph

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230
Q

What is the common cause of death while on TCAs?

A

cardiogenic shock and V fib. TCAs inhibit fast Na+ channels in the heart muscles which leads to arrhythmias and can cause death

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231
Q

What are the 2 congenital long QT syndromes?

A

Romano-Ward (no deafness), and Jervell and Lange-Nielsen syndrome (sensorineural deafness)

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232
Q

Hypoxemia?

A

low PaO2

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233
Q

Hypoxemia due to normal A-a gradient?

A

Hypoventilation or high altitude (sedation overdose, obesity, scoliosis, myasthenia gravis, sleep apnea)

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234
Q

Hypoxemia due to elevated A-a gradient?

A

V/Q mismatch (pneumonia, COPD, pulmonary embolism), diffusion limitation (hyaline membrane formation, ARDS), right–>left shunt (congenital abnormalities)

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235
Q

What 3 microbes have vaccines to polysaccharide capsule antigens?

A

S. pneumo, H. flu type B, and N. meningitidis.

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236
Q

What are the live attenuated vaccinations?

A

cellular response. MMR, polio (sabin oral), **influenza (i**ntranasal), vacicella, yellow fever

Live! Come see Small Yellow Chickens get vaccinated with Sabin and MMR! It’s Incredible!

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237
Q

What are the inactivated/killed vaccines?

A

humoral immunity. Cholera, HAV, polio (salk IM), influenza (IM), rabies

SalK = Killed

RIP HAnah

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238
Q

What are the toxoid vaccines?

A

tetanus and diphtheria

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239
Q

Recombinant vaccines?

A

HBV (HbsAg) and HPV (6, 11, 16, 18)

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240
Q

Odds ratio equation?

A

ad/bc

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241
Q

What is Shaken Baby Syndrome?

A

subdural hematoma + bilateral retinal hemorrhages

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242
Q

Why are ACE inhibitors contraindicated in renal artery stenosis?

A

Renal artery stenosis aleady has a low GFR, if you treat with ACEi’s then you lose the constriction of the efferent arteriole and the GFR will fall even more leading to renal failure.

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243
Q

What is congenital torticollis?

A

due to malposition of the head in utero or due to birth trauma. Presents @ 2-4 weeks and the child tilts his chin away from the contorted muscle. Can palpate a soft pass in the lower ridge of the SCM

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244
Q

How does the skin change in normal aging?

A

thinning of dermis and epidermis with flattening of the dermoepidermal junction, decreased fibroblasts, reduced synthesis and increased breakdown of collagen and elastin fibers

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245
Q

What is presbyopia?

A

loss of elasticity and sclerosis of the lens leading to decreased accomodation. In the elderly

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246
Q

Where do the leads for a pacemaker go?

A

1 lead in the right atria, 1 lead in the right ventricle, and another lead in the left ventricular coronary sinus in the atrioventricular groove to allow for pacing of the left ventricle

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247
Q

Which muscle bands contain only thick filaments?

A

Thick filaments = myosin and are located in the H band.

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248
Q

Which muscle bands contain only thin filaments?

A

thin filaments= actin. I band

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249
Q

What happens to the FRC in restrictive lung disease?

A

FRC decreases

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250
Q

Which 3 neurotransmitters require BH4 and dihydropioterin reductase for their production?

A
  1. Phenylalanine to dopamine, NE and Epi
  2. Tryptophan to melatonin and serotonin
  3. Arginine to NO
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251
Q

What is an AV malformation?

A

A route in the vessels that allows blood under arterial pressure to bypass the arterioles and directly enter venous blood. This will cause an increase in preload (more blood in the venous system) and a decrease in afterload (less blood in the arteriole system)

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252
Q

What does a c-ANCA test look like?

A

stains the cytoplasm, so can see the bulk of the cell and then organelles appear black

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253
Q

What does a p-ANCA stain look like?

A

Stains around the nucleus, so many consodilatons are around the organelles. Looks less granular than c-ANCA

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254
Q

What is the course of the ureters?

A

Run under the gonadal arteries and over the common and external iliac arteries. In the true pelvis, the ureters lie anteriolateral to the internal iliac arteries and medial to ovarian vessels. Before enter the bladder, the ureters course under the uterine vessels or the vas deferens.

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255
Q

What is the “on phenomenon”?

A

in parkinson patients, levodopa affects can shift between being really great and not great. They think it is due to progressive nigrastriatal neurodegeneration leading to a decreased therapeutic window for levadopa

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256
Q

If on an SSRI, use of what other drugs can cause serotonin syndrome?

A

tramedol, ondansetron, linezolid, triptans, and antidepressants

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257
Q

Which DNA polymerase excises RNA primers?

A

DNA pol I (has 5’-3’ exonuclease activity).

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258
Q

What is the main adaptive mechanism that prevents reinfection with the same strain of influenza?

A

anti-hemagglutinin antibodies

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259
Q

CA-125 is a marker of?

A

Ovarian cancer

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260
Q

Pickwickian Syndrome?

A

Obesity hypoventilation syndrome. Hypoventilation of the lungs ALL THE TIME. Chronically elevated PaCO2 and depressed PaO2.

261
Q

What are some common lab finidngs due to chronic hypoxia?

A

polycythemia, pulm hypertension, right ventricular failure (can’t pump against high pulm pressures)

262
Q

What are chemoattractants for neutrophils?

A

n-formylated peptides, leukotriene B4, 5-HETE, C5a

263
Q

What is a lacunar infarct?

A

infarct in the basal ganglia, posterior limb of the internal capsule, pons, and cerebellum. Usually occur due to occlusion of artery in setting of diabetes or uncontrolled hypertension

264
Q

What are lipohyalinosis and microatheromas?

A

Involved in lacunar infarct pathogenesis. Lipohyalinosis is vessel destruction with mural foam cells and acutely can include fibrinoid necrosis. Microatheromas are due to accumulation of lipid laden macrophages in intimal layer of the blood vessels

265
Q

What is the first step in atherosclerosis development?

A

Repetitive endothelial cell damage

266
Q

What can be treated using botulinum toxin?

A

facial wrinkles, relaxes LES in achalasia, MS and Parkinson’s muscle spasms

267
Q

What causes release of BNP and ANP?

A

Ventricular hypertrophy and volume overload

268
Q

What is atypical depression?

A

leaden fatigue (arms and legs feel heavy), rejection sensitivity (overly reactive to criticism), mood reactivity (respond positively to good things). Treat with MAOIs

269
Q

Common complication of gallbladder hypomotility?

A

Biliary sludge formation. Made of cholesterol monohydrate crystals, calcium bilirubinate, and mucus. Precursor to stone formation.

270
Q

COmmon causes of HIV-associated esophagitis?

A

Candida > CMV, HSV

Candida: grey/white pseudomembranes

CMV: linear ulceration, intranuclear and intracytoplasmic inclusions

HSV: punched out ulcers, intranuclear inclusions (cowdry A bodies)

271
Q

What should you worry about if

A
272
Q

What is the only muscle of the tongue not innervated by the hypoglossal?

A

palatoglossal, CN X

273
Q

A test that is reproducible and consistent is defined as?

A

Precision or Reliability

274
Q

A test that measures exactly what it is supposed to measure, no systemic error is called?

A

Validity or Accuracy

275
Q

What tumor stains red with congo red, has polygnol and spindle shaped cells, and surrounded by an amyloid stroma?

A

Medullary carcinoma of the thyroid

276
Q

What is the first line drug treatment in a patient with coronary artery disease, heart failure, and HTN?

A

cardioselective beta blockers

277
Q

What is the first line medication for essential HTN in the general population?

A

hydrochlorathiazide

278
Q

What brain tumor has calcified, cystic tumors in children that are derived from rathke pouch?

A

Craniopharyngiomas

279
Q

Equation for RBF?

A

RPF/1-Hct

280
Q

What does a VSD murmur sound like?

A

Harsh, holosystolic that is accentuated with handgrip (inc afterload therefore more blood is pushed through the VSD). Best heard in tricuspid area

281
Q

What metabolic reactions take place exclusively in the mitochondria?

A

B-oxidation of fatty acids, ketogenesis, citric acid cycle, parts of the urea cycle (CPS-1 and ornithing transcarboxylase), and pyruvate carboxylation

282
Q

In what organelle does the HMP shunt (pentose phosphate pathway) take place?

A

cytoplasm

283
Q

Adverse effects of digoxin?

A

Cholinergic effects, bradycardia, blurry yellow light, dec QT, scooping, inverted T wave, prolonged PR, arrhythmia and hyperkalemia

284
Q

Which nitrate drug has nearly 100% bioavailability when taken orally?

A

isosorbide dinitrite even though it undergoes extensive first pass metabolism at the liver, it is converted into and active metabolite isosorbide-5-mononitrate

285
Q

What are the findings in drug-induced interstitial nephritis?

A

Fever, rash, hematuria, pyuria and eosinophils. Occurs after treatment with diuretics, penicillin derivates, sulfonamides and rifampin. Usually occurs 1-2 weeks after starting these drugs. Can progress to renal papillary necrosis.

286
Q

What is the function of Rb?

A

Active= hypophosphoylated and prevents the cell from progressing form G1–>S

287
Q

What 2 situations can cause hyperosmotic volume contraction?

A

DI and profuse sweating, lose hypotonic solution

288
Q

What is lactulose used for?

A

to treat hepatic encephalopathy

289
Q

Does 2,3-BPG increase or decrease Hb affinity for O2?

A

decreases affinity, therefore shifts the curve to the right

290
Q

What causes amenorrhea in patients with anorexia?

A

Fat levels in the body become so low that there is no long pulsatile GnRH release from the hypothalamus.

291
Q

What congenital disorders are associated with low AFP?

A

Down Syndrome Trisomy 21

292
Q

What congenital disorders are associated with high AFP?

A

neural tube defects, multiple gestations, and abdominal wall defects (gastrochosis)

293
Q

What are the steps in an acid fast stain?

A

Apply an aniline dye like carbolfuchsin to a smear and then decolorize with alcohol to reveal whether the organisms present are acid fast or not. This stains the mycolic acid in their wall

294
Q

What are the differences in the cell walls between gram + and gram -?

A

Gram + : large peptidoglycan layer. Contains lipotechoic acid. No outer membrane. Stains purple.

Gram - : small peptidoglycan layer with an outer and inner membrane. Stains pink.

295
Q

What color is the trachea on CT?

A

Black! helps to distinguish from the esophagus

296
Q

In the thorax, what are the landmarks for the esophagus?

A

Posterior to the trachea and anterior to the vertebral bodies

297
Q

What is the major determinant of prognosis in urothelial carcinoma?

A

tumor penetration of the bladder wall (involvement of muscular layer- this is called the rumor stage)

298
Q

What are the steps of mycobacterium pnemo infection?

A

Inspire droplets that are infected, macrophages gulf up the bacteria which grow inside the macrophages unti they lyse and release a bunch of the bacteria. 2-4 weeks later macrophages and T cells become activated and create a granuloma.

299
Q

What is the action of niacin?

A

decreases VLDL production in the liver, upregulates HDL synthesis. Side effects: flushing

300
Q

How do statins work?

A

Statins downregulate HMG-CoA reductase, and therefore upregulates LDL receptors to take up more LDL from the blood, effectivley lowering serum levels.

301
Q

What are the major side effects of amphotericin B?

A

renal toxicity! Can lead to hypokalemia and hypomagnesia

302
Q

What diseases are assocaited with a delayed closing of PDA?

A

prematurity, perinatal distress, congenital rubella, and fetal alcohol syndrome

303
Q

How do NSAIDs and Indomethacin close a PDA?

A

Prevent the synthesis of PGE1 which keeps the PDA open

304
Q

What nerves does an upward jerking of the arm cause damage to?

A

the lower trunk can be damaged (C8-T1) and this can lead to median and ulnar nerve damage which innervates all the intrinsic muscles of the hand

305
Q

Which kidney stones precipitate at high pH?

A

Ammonium magnesium phosphate and calcium phosphate. Both say phosphate in them!!

306
Q

Which kidney stones precipitate at low pH?

A

Calcium oxalate, uric acid, cystine stones

307
Q

Where does uric acid precipitate in the kidney tubules?

A

in the distal tubules or collecting ducts because that is where the pH is super low.

308
Q

In the liver, ovaries, and seminal vesicles, what is sorbitol broken down into?

A

sorbitol dehydrogenase breaks sorbitol down to fructose

309
Q

What nerve and artery are damaged if there is a surgical neck of the humerus fracture?

A

axillary nerve and posterior circumflex artery

310
Q

Midshaft fracture of the humerus will damage what nerve and artery?

A

radial nerve and deep brachial artery

311
Q

Distal humerus/cubital fossa fracture will damage what nerve and artyer?

A

median nerve and brachial artery

312
Q

What is coronary steal syndrome?

A

In coronary artery disease, the arteries distal to the coronary stenosis are already maximally dilated. If administered a coronary artery vasodilator such as adenosine or dipyridamole, the normal vessels will become more dilated and blood will shift to supply that tissue and the tissue that is supply distal to the stenosis will exterience temporary ischemia.

313
Q

What are the most important genetic determinants of type I DM?

A

HLA-DQ and DR (DR3 and DR4)

314
Q

In osteoporosis, what are the serum levels of PTH and calcium?

A

They are normal!!!

315
Q

Key features of Ataxia telangiectasias?

A

ataxia, telangiectasias and sinopulmonary infections.

316
Q

Levels of what electrolytes do thiazides decrease?

A

lower serum potassium, serum sodium, and blood pressure

317
Q

What is the only non-enveloped, ssDNA virus?

A

Parvoviridae family. Parvovirus B19 causes erythema infectiosum (fifth disease) aplastic crisis in sickle cell and hydrops fetalis

318
Q

What is the initiating disorder in Paget’s disease?

A

First the osteoclasts go crazy and break down too much bone (thought to be due to an accelerated rate of bone remodeling because of excessive RANKL and signaling and NFKB activation), then the blasts get activated and start to make a lot of bone really quickly (more quality bone). Then the osteoclasts eventually burn out and there is excessive osteoblast activity building abnormal bone.

319
Q

Where is the systolic reduction in coronary blood flow the greatest in the heart?

A

subendocardial myocardium

320
Q

What is B-glucuronidase?

A

Enzyme that is produced by bacteria or damaged hepatocytes. It unconjugates bilirubin resulting in increased UCG bilirubin which increases the risk of developing brown pigment stones in the gallbladder. Usually due to biliary infection.

321
Q

If given a confidence interval and a relative risk which is within the confidence interval and is greater than 1, what is the p-value?

A

p-value will be less than 0.05.

322
Q

What is the main side effect of doxorubicin?

A

Dose-dependent dilated cardiomyopathy. First get swelling of the sarcoplasmic reticulum and then get death of the myocytes “myofibrillar dropout”

323
Q

What type of antibiotic is streptomycin?

A

aminoglycoside that inhibits the 30S subunti.

324
Q

Which of the HIV structural genes is glycosylated?

A

*env * is glycoslyated to gp160 and then proteolytically cleaved into gp120 and gp41 in the ER.

325
Q

Function of gp120?

A

modulated viral absorption by binding to CD4 receptors.

326
Q

function of gp41?

A

transmembrane protein that noncovalently anchors gp120, mediating fusion between viruses or cells

327
Q

What stabilizes secondary structure of a protein?

A

Hydrogen bonds. Secondary structure include alpha and beta pleated sheets

328
Q

What mediates the tertiary structure of a protein?

A

ionic bonds, hydrophobic interactions, hydrogen bonds and disulfide bonds. Tertiary structrue is the overall shape that a single polypeptide assumes following folding.

329
Q

2nd most common brain tumor in children and the 1st most common malignant tumor in children is?

A

Medulloblastoma

330
Q

What is the 3rd most common brain tumor in children?

A

ependymomas

331
Q

What does migratory thromboembolisms make you think?

A

Cancer of the pancreas, colon, or lung. Adenocarcinomas produce a thromboplastin-like substance which makes the blood hypercoaguable.

332
Q

What do the parasympathetic fibers of CNIII innervate?

A

iris sphincter and ciliary muscle (pupil constriction and accomodation)

333
Q

Weakness in what muscle causes ptosis?

A

levator palpabrae which is innervated by CNIII

334
Q

What is are the pressures in the 4 chambers of the heart?

A

LA: 2-12

LV: 9-130 (similar to the systemic pressure)

RA: 0-12

RV: 4-25 (similar to the pressure in the pulm artery)

335
Q

What is the intrapleural pressure at FRC?

A

-5 cm H2O

336
Q

What is the intrapleural pressure while inhaling?

A

-7cm H2O

337
Q

What is deposited in gout that has negative birefingence?

A

monosodium urate

338
Q

What does negative birefingence mean?

A

when the crystals are parallel to the slow ray, they appear yellow. When perpendicular, they appear blue.

339
Q

Which GI ulcers are most commonly associated with increased risk of carcinoma?

A

esophageal, gastric, and colorectal cancers

340
Q

Is an ulcer of the duodenum likely to become a carcinoma?

A

NO!

341
Q

How does amifostine work?

A

cytoprotective free radical scavenging agent used to decrease the cumulative nephrotoxicity associated wtih platinum-containing agents like cisplatin

342
Q

What is the difference between epinephrine and glucagon’s actions on different organs?

A

Epinephrine works on skeletal muscle, adipose tissue and the renal cortex to increase glucose levels.

Glucagon works mainly on the liver to increase glucogenolysis and gluconeogenesis

343
Q

What pathogens are most common for secondary bacterial pneumonia (after influenza)?

A
  1. S. pneumo
  2. S. aureus
  3. H. flu
344
Q

Where does the left kidney lie?

A

immediately deep to the tip of the 12th rib on the left

345
Q

What are some characteristics of Klebsiella pneumoniae?

A

Typically affects alcoholics. Really thick capsule that is seen as a clear zone on gram stain and causes mucoid growth in culture. Typically affects the upper lobe. Tissue necrosis, early abscess formation, and current-jelly sputum.

346
Q

What is on the 3’ end of tRNA?

A

3’CCA molecule

347
Q

What do the D-arm and T-arm of tRNA contain?

A

D-arm: dihyrouracil residues

T-arm: thymidine, pseudouridine, and cystidine.

*tRNA is the only RNA molecule to contain thymidine

348
Q

If multiple ulcers, ulcers refractory to therapy, or ulcers in a weird location (distal duodenum), what should you be thinking the patient has?

A

Zollinger-Elison syndrome-tumor that secretes gastrin and casues increased gastric acid. These adenocarcinomas typically occur in the pancreas, but can also be seen in the stomach, duodenum, etc.

349
Q

Where do peptic ulcers tend to be found?

A

in the stomach or the first part of the duodenum

350
Q

What are the findings in chronic organ rejection?

A

obliterative intimal thickening, tubular atrophy, and interstitial fibrosis.

351
Q

How does chronic renal failure tend to present?

A

worsening hypertension, progressive rise in serum creatinine, and proteinuria. Thought to be due to low grade cellular and humoral responses directed against alloantigens.

352
Q

What are the major symptoms of scalded skin syndrome?

A

Nikolsky’s sign (skin slipping off with gentle pressure), epidermal necrolysis, fever and pain with a skin rash. Due to exotoxin that cleaves desmoglein in the stratum granulosum.

353
Q

In the respiratory tract, what structures are stratified squamous epithelium?

A

oropharynx, laryngeopharynx, anterior epiglottis, upper half of the posterior glottis, and vocal folds (true vocal folds). The rest has pseudstratified, columnar mucus secreteing epithelium

354
Q

What determines the length of action of succinylcholine?

A

catabolism by plasma cholinesterase, and 1 in 3000 patients have an atypical cholinesterase that breaks succinylcholine down really slowly. Administer neostimgine during phase 2 depolarization to speed up its metabolism

355
Q

What happens if neostigmine is administered to during phase 1 depolarization of succinylcholine?

A

will actually prolong the time period of depolarization, will NOT reverse it

356
Q

How does nitroglycerin work?

A

Primarily a venodilator that decreases preload and decreases myocardial O2 demand, thereby treating angina pectoris

357
Q
A
358
Q

What is hyaline arteriolosclerosis seen in?

A

Diabetes and long-standing HTN. Can produce glomerular scarring leading to chronic renal failure.

359
Q

What is Hyperplastic arteriolosclerosis seen in?

A

malginant hypertension. May lead to fibrinoid necrosis with hemorrhage of the vessel wall. Causes acute renal failure with ‘flea bitten’ appearance. Hyperplasia of smooth muscel in vessel wall ‘onion skin appearance’

360
Q

What causes claudication?

A

atherosclerosis of larger vessels.

361
Q

What is an atheroma?

A

lipid filled intimal plaque that is usually the cause of artery stenosis and leads to claudication symtpoms. Prevent sufficient blood flow during periods of exercise

362
Q

Case fatality equation

A

fatal cases/ total causes

363
Q

Why are men with cystic fibrosis infertile?

A

Have thick sperm secretions and **absent vas deferens bilaterally. **Absent sperm.

364
Q

Do stop codons code for an amino acid?

A

No. Instead a release factor binds and promotes separation of ribosomes-mRNA complex and polypeptide

365
Q

What is the first line treatment for essential tremor?

A

Primidone and B-blockers (propanolol)

366
Q

What is the function of primidone?

A

treats benign essential tremor and is a narrow spectrum anticonvulsant. Its metabolites include phenobarbital and phenylethylmalonamide which also have anti-convulsant effects. Need to check blood levels to make sure these metabolites don’t get too high. Can cause sedation and disorientation if too high.

367
Q

What is the most common obstructive lesion in females?

A

imperferate hymen

368
Q

What are symptoms of an imperforate hymen

A

Female with secondary sex characteristics, amenorrhea and also painful cramps when she should be getting her period, she is having a blockage of menstral stuff.

369
Q

What lipid-lowering agent increases TG levels?

A

bile acid resins (cholestyramine)

370
Q

What are the steps in adenoma-carcinoma sequence?

A

APC mutation, K-ras mutation, p53 mutation and increased COX then allow for progression to a carcinoma.

371
Q

What can impede progression of a adenoma to a carcinoma?

A

aspirin

372
Q

What is the half life / elimination equation?

A

t(1/2)=(Vd x ln 2)/CL

ln2 = 0.7

373
Q

How do you differentiate between partial and complete central DI?

A

Complete–add vasopressin and increase osmolarity of urine by 50%

Partial–less than 50% (usually like 10%)

374
Q

If a mother has HBV, what will the symptoms be in the child?

A

high viral replication, high risk of chronic infection, and mildly elevated markers of liver injury. High risk of developin HCC

375
Q

If someone has a super high fever, what is the most important first treatment?

A

cooling, cold blankets. Take effect immediately. then treat with antipyretics which will also help but take a little more time to kick in.

376
Q

What syndrome results from superior sulcus tumor?

A

Horner Syndrome

377
Q

What syndrome results from a mediastinal mass?

A

Superior vena cava syndrome

378
Q

What enzyme has 5’ to 3’ exonuclease activity?

A

DNA pol I (removes RNA primer)

379
Q

What enzyme has a 3’ to 5’ exonuclease

A

DNA pol III

380
Q

What disease results from a missense mutation?

A

Sickle cell

381
Q

What disease results from a frameshift mutation?

A

Duchenne muscular dystrophy

382
Q

Eukaryotic DNA pol alpha?

A

lagging strand and primer

383
Q

Eukaryotic DNA pol beta and epsilon?

A

repair DNA

384
Q

Eukaryotic DNA pol gamma?

A

mDNA

385
Q

Eukaryotic DNA pol delt?

A

leading strang DNA

386
Q

What disease can be a result of alternative splicing gone wrong?

A

Beta thalassemia

387
Q

Is phosphorylated Rb active or inactive?

A

Inactive. Hypophosphylate Rb does not allow the cell to progress from G1-S until the cell has fixed any mutations in DNA etc.

388
Q

Free ribosomes make what type of proteins?

A

cytosolic proteins

389
Q

I cell disease?

A

Defect in phsophotransferase. Failure of the golgi to phsophrylate mannose residues of glycoproteins, so the proteins are secreted extraceullarly rather than delivered to lysosomes for degradation. High plasma levels of lysosomal enzymes

390
Q

What does mannose-6-phosphate on a vesicle normally signal?

A

Directs vesicle to the lysosomes

391
Q

What does the peroxisome do?

A

catabolism of very long chain fatty acids, branched chain fatty acids and amino acids

392
Q

Proteosome function?

A

degrades damaged or ubiquitin-tagged proteins. (mutations in this process might have something to do with Parkinsons)

393
Q

What drugs act on microtubules?

A

Microtubules Get Constructed Very Poorly

Mebendazole, Griseofulvin, Colchicine, Vincristine/Vinblastine, Paclitaxel

394
Q

Dynein and kinesin? anterograde or retrograde?

A

Dynein–> retrograde to microtubule (+ to -)

Kinesin–> anterograde to microtubuel (- to +)

395
Q

What can be caused by Kartagener syndrome?

A

Primary ciliary dyskinesia. dynein arm defect Increased risk of ectopic pregnancy,m bronchiectasiss, recurrent sinusitis, and situs inversus

396
Q

What does vimentin stain for?

A

connective tissue

397
Q

What does desmin stain for?

A

Muscle

398
Q

What does Cytokeratin sstain for?

A

epithelial cells

399
Q

What does GFAP stain for?

A

neuroglia

400
Q

What does neurofilaments stain for?

A

neurons

401
Q

What is the difference in function between microtubuels and intermediate filaments?

A

microtubules–movementn

intermediate–structure

402
Q

What does Ouabain inhibit?

A

binds K+ site and inhibits APTase

403
Q

What disease has impaired type I collagen production

A

osteogenesis imperfecta

404
Q

What is the mutation in ethlers-danlos?

A

type III collagen mutation

405
Q

Menkes disease?

A

Imparied copper absorption. Decreased lysyl oxidase (Cu is a necessary cofactor), results in kinky hair growth retardation and hypotonia

406
Q

What is the mutation in classical and vascular types of Ethlers-Danlos?

A

Classic- type V collagen mutation

Vascular–Type III collagen mutaiton

407
Q

Hypophosphatemic rickets?

A

Example of X-linked dominant disorder. increased phosphate wasting at proximal tubule. Rickets-like presentation

408
Q

Myotonic type I?

A

CTG trinucleotide repeak in DMPK genes, abnormal expression of myotonin protein kinase which leads to myotonia, muscle wasting, frontal balding, cataaracts, testicular atrophy and arrhythmia

409
Q

What is the path of the great saphenous vein?

A

originates in the medial foot, courses anterior to the medial malleolus, then travels up the medial aspect of the leg and thigh. Drains into the femoral vein near the femoral triangle, a few cm inferolateral to the pubic tubercle.

410
Q

How does parvovirus B19 present in adults?

A

Presents like rheumatoid arthritis invovling PIP, metacarpal, knee and ankle joints, except unlike RA it can resolve spontaneously

411
Q

What is the clinical difference between Tay sachs and Nieman-Pick?

A

Nieman-Pick has hepatosplenomegaly and Tay Sachs does not.

412
Q

Describe a granuloma formation?

A

IL-12 secreted by macrophages and causes T cells to differentiate into Th cells. Th cells produce INF-gamma which activates more macrophages. Macrophages secrete TNF-alpha which further recruits more macrophages and monocytes.

413
Q

Where does the psoas muscle lie?

A

Lies laterally to the vertebra. Inferiorly it combines with the iliacus muscle to form the iliopsoas muscle, which functions in hip flexion.

414
Q

What happens to your scapula if the accessory nerve is paralyzed?

A

Trapezius is paralyzed and get lateral winging

415
Q

What happens to your scapula if you get paralysis of the long thoracic nerve?

A

serratus anterior no longer working and you get medial winging

416
Q

Describe the action of NO at smooth muscle.

A

NO activates guanylate cyclase, which increases cGMP levels and activates myosin-ligh-chain phsophatase (MLCP) and dephosphoylates myosin

417
Q

What is the function of VIP?

A

increases intestinal loss of chloride in the stool leading to excess loss of accompanying water, sodium and potassium. Also **inhibits gastric acid secretion. **

418
Q

How does streptomycin inhibit protein synthesis?

A

Inhibits formation of the intitation complex by binding the 30S subunit and distorting its shape

419
Q

What are the main effects of dobutamine on the heart?

A

increases HR, increases contractility, and increases cardiac conduction velocity. Overall, all of these lead to **increased myocardial O2 consumption. **

420
Q

What is cystinuria?

A

defect of PCT leading to excess loss of COLA (cysteine, ornithine, lysine, arginine). Excess cysteine in the urine can lead to precipitation of hexagonal cysts. The only presenting sxs of this disease is repeated cysteine kidney stones.

421
Q

What drug reduces prostate size?

A

Finasteride– a 5 alpha-reductase inhibitor

422
Q

What is paraneoplastic cachexia?

A

causes anorexia, malaise, anemia, weight loss and generalized wasting due to underlying chronic disease. Mediated by TNF-alpha (suppresses appetitie in the hypothalamus)

423
Q

What is kussmal sign?

A

paradoxical increase in JVP during inspiration. Often seen in constrictive pericarditis because there is restrictive filling of the RV leading to increased JVP during inspiration

424
Q

What function of corticosteroids allows it to treat exophthalmos in Graves’ but, can be seen as a negative trait in the treatment of atopic dermatitis eczema?

A

Corticosteroids decrease production of ECM collagen which decreases exophthalmos, but it also decreases ECM collaged in the skin when used for dermatitis. Leads to dermal atrophy, dry skin and tightening of the skin.

425
Q

What is the main clinical use of nitrites?

A

Angina and HF, not used for HTN

426
Q

Is glucokinase or hexokinase associated with maturity onset diabetes of the young?

A

Glucokinase

427
Q

What is a common cause of otitis externa in diabetic patients?

A

pseudomonas (will see granulation tissue and intact tympanic membrane)

428
Q

Does Fructose-2,6-bisphosphate have a stimulatory or inhibitory effect on PFK-1?

A

stimulatory – favors glycosis

429
Q

What type of a receptor and second messenger does glucagon use?

A

adenylate cyclase associated with increased cAMP

430
Q

What converts Fructose-6-phosphate to Fructose-2,6-bisphosphate?

A

Phosphofructokinase-2

431
Q

When is phosphofructokinase-2 active?

A

Fed state. Insulin is secreted which decreases cAMP and decreased activity of protein kinase A which leads to dephosphorylation of FBPase-2 into PFK-2. PFK-2 stimulates PFK-1 which favors **glycolysis. **

432
Q

When is FBPase-2 active?

A

Fasting state. When fasting there is increased glucagon release, increased cAMP and increased protein kinase A, increased FBPase-2 which favors **more gluconeogenesis. **

433
Q

What effects do uremic waste products have on clotting?

A

Uremic waste products inhibit platelet aggregation and adhesion, leading to an increased bleeding time with normal platelet counts, normal PT and normal PTT

434
Q

What are the two major effectors of anaphylaxis that are released from mast cells?

A

histamine and tryptase

435
Q

What is the water volume status in SIADH?

A

Euvolemic (excess ADH causes increased water uptake and dilutes the sodium. Temporarily increased water volume causes decreased aldosterone release, which furthers the hyponatremia, but leaves the patient euvolemic)

436
Q

What are the urine and plasma osmolarity in SIADH?

A

urine osmolarity > plasma osmolarity

437
Q

How do you treat orotic aciduria?

A

uridine monophosphate to bypass the mutated UMP synthase (cannot make UMP)

438
Q

What do the vitelline veins give rise to?

A

the veins of the portal system

439
Q

What do the cardinal veins give rise to?

A

the veins of the systemic circulation

440
Q

Common complications of varicose veins?

A

skin ulcerations, poor wound healing, painful *superficial *thrombosis, stasis dermatitis and superficial infections.

441
Q

Equation for power?

A

Power = 1-B

Beta (type II error rate) is the probability of concluding there is no difference between groups when one truly exists.

442
Q

What is the toxic component of LPS?

A

lipid A

443
Q

What part of the basal ganglia becomes degenerated in Wilsons Disease?

A

the putamen

444
Q

What is nesiritide?

A

recombinanat form of BNP that is used for treatment of heart failure

445
Q

What is varenicline?

A

Partial agonist @ nicotinic acetylcholine receptors. Competes with nicotine for binding. Causes mild stimulation of the receptors, reducing withdrawal cravings and attenuating the rewarding side effects of nicotine.

446
Q

What is the most common cause of meconium ileus?

A

Cystic Fibrosis

447
Q

What is located posterior to the left atrium and the esophagus?

A

the descending aorta

448
Q

What does the vagus send parasympathetic autonomic fibers to?

A

the heart, lungs, and upper GI

449
Q

What neurotransmitter does the vagus nerve cause secretion of?

A

ACh at muscarinic receptors in the heart, lungs and upper GI

450
Q

What is the first line treatment for acute gouty arthritis?

A

NSAIDs

451
Q

What is Primary Central Nervous System Lymphoma?

A

most common cause of ring-enhancing lesions with mass effect in HIV patients. Usually large and solitary, but can be multiple. **Large cell non-hodgkin lymphoma **caused by EBV.

452
Q

What steps must be taken in baby born to a mother with active HBV infection?

A

First give infant passive immunization HBIV and then give active immunization with recombinant HBV vaccination

453
Q

The presence of which HBV marker in the mothers serum suggests high chance of vertical transmission during pregnancy?

A

HBeAg

454
Q

What is the difference in chances of infection in a baby born to a mother with active infection and non-active infection? What are the chances of it becoming a chronic infection in the child?

A

Active infection in mom– 95% of vertical transmission
Non-active infection– 20% chance of transmission

If baby gets HBV, there is a 90% chance that it will become chronic

455
Q

Are small or large alveoli more likely to collapse?

A

small alveoli

456
Q

What is lactic acidosis?

A

Increased lactic acid due to overproduction or decreased clearance of lactic acid.

457
Q

What are the treatments for narcolepsy?

A

amphetamines modafinil

458
Q

What disorders exhibit mitochondrial inheritance patterns?

A

MERF, Leber Optic Neuropathy, and MELAS

459
Q

What disorders are autosomal recessive?

A

Albinism, ARPKD, CF, all glycogen storage disorders, hemochromatosis, Kartagener syndrome, all mucopolysaccharidoses (except Hunters) PKU, sick cell anemia, sphingolipidoses (except fabrys), thalassemias, classic galactosemia, and Wilson disease

460
Q

What type of breathing (slow, fast, deep, shallow) in restrictive and obstructive lung disease?

A

Restrictive: rapid, shallow breathing

Obstructive: slow, deep breathing

461
Q

What is derived from neural crest cells?

A

Chromaffin cells of adrenal medulla (neuroblastomas, pheochromocytoma), Schwan cells (NF1, NF2), Sturge Weber Syndrome, melanocytes, all PNS neurons, parafollicular cells of the thyroid, bones of the skull, odontoblasts, aorticopulmonary septum, MEN2A, Hirsbrung and Ablinism (due to improper migration of neural crest cells),

462
Q

What cells in the lung secrete elastase?

A

macrophages and neutrophils

463
Q

What enzyme in the kidney inactivates vitamin D?

A

24-hydroxylase converts 25, hydroxy Vitamin D to 24,25 hydroxy vitamin D (inactive form) when there is excess vitamin D

464
Q

What drains the scrotum?

A

superficial inguinal nodes

465
Q

What visual field do the meyers loops of the optic radiations carry?

A

info from the lower retina, the upper visual field. Travel through the temporal lobe

466
Q

What are the main cells that mediate the damage/inflammation in gout?

A

neutrophils

467
Q

What would an endometrial biopsy during an ectopic pregnancy show?

A

Decidualization of stroma w/o embyronic tissue or chorionic villi

468
Q

What type of diabetes medication is safe to use in pregnancy?

A

Normal insulin

469
Q

Why isn’t a vaccine used as prophylaxis for close contact with someone with meningitis?

A

N. meningitidis type B is the most common, and there is no good vaccine against it

470
Q

When can you see a dichorionic/diamniotic pregnancy?

A

days 0-4 of monozygotes, or just dizygotic pregnancy

471
Q

WHen does cleavage have to occur for a monochorionic, diamniotic pregnancy?

A

4-8 days

472
Q

When does cleavage have to occur for a monochorionic, monoamniotic pregnancy?

A

days 8-12

473
Q

When does cleavage have to occur for a monochorioic, monoamniotic conjugated twins to occur?

A

>13 days

474
Q

What is the empty can test specific for?

A

Diagnosis supraspinatus rotator cuff injury- the most common injury of the rotator cuff. Have patient abduct arms to 90 degrees, thumbs down, move arms forward to 30 degrees, and then press down on their arms. If pain is elicited, then it is a supraspinatus injury.

475
Q

What makes HDV a defective viruses?

A

Requires coinfection or superinfection with HBV because it needs the HBsAg to coat its viral particles so it can infect other hepatocytes

476
Q

Triad of toxoplasma gondi TORCH infection?

A

chorioretinitis, hydrocephalus and intracranial calcifications

477
Q

What is the classic triad of fat embolism syndrome and when would one expect to see this syndrome?

A

Occurs after long bone fractures and liposuction. Classic triad includes hyoxemia, neurologic abnormalities, and petechial rash. (bilateral femoral fractures have high chance of getting this)

478
Q

What is used to treat Restless Leg Syndrome?

A

Pramipexole or ropinirole- non-ergot dopamine agonists

479
Q

WHat is the most importatnt criteria in determining cancer prognosis?

A

The stage of the tumor– what structures it involves (only mucosa, involves muscular layer, involves lymph nodes, etc)

480
Q

What is the grade of the tumor?

A

How well differentiated the tumor cells are. Not the most important factor when figuring out prognosis

481
Q

Is myosin phosphorylated or dephosphorylated when contracting?

A

Crontraction- phosphorylated (myosin-light-chain kinase)

Relaxation- dephosphorylated (myosin-light-chain phosphatase)

482
Q

Bioavailability equation

A

F = (AUC oral drug x IV dose) / (AUC IV drug x oral dose)

483
Q

What genes are contained in the homeobox?

A

DNA binding transcription factors that alter the expression of genes involved in morphogenesis.

484
Q

What type of necrosis is seen in the brain?

A

liquefactive necrosis. Complete digestion and removal of necrotic tissue with formation of a cystic cavity.

485
Q

What is the triple test and when is it performed?

A

Measure AFP, hCG and estriol levels during pregnancy. Should be performed between weeks 16-18 of gestation.

486
Q

What is the most common cause of elevated AFP levels in the absense of congenital abnormalities?

A

Underestimation of the gestational age

487
Q

How are genes inactivated in imprinting?

A

They become methylated

488
Q

What becomes inflammed in housemaids knee?

A

the prepatellar bursa, located between the patella bone and the overlying skin and prepatellar tendon

489
Q

Why are patients with Crohn’s prone to gallstones?

A

Terminal ileum is where bile acids are reabsorbed, if inflammed as it is in Crohns, then there is less reabsorption of bile acids. This leads to increased cholesterol that is NOT bound to bile acids, so the gallbladder becomes supersaturated with cholesterol leading to gallstones

490
Q

What drugs exhibit antimuscarinic side effects?

A

H1 blockers (1st gen, diphenhydramine), atropine, TCAs, neuroleptics and antiparkinson drugs

491
Q

What does RNA pol I make?

A

rRNA – nucleolus

492
Q

What does RNA pol II make?

A

mRNA

493
Q

What does RNA pol III make?

A

tRNA

494
Q

How does the inactivated influenza vaccine provide protection?

A

Cells make antibodies to hemaglutinin antigen, which prevents hemaglutinin from binding to siaylated receptors on the host cell membrane. This prevents the virus from entering cells via endocytosis

495
Q

What is a pancreatic pseudocyst?

A

Complication of acute pancreatitis. Pancreatic enzymes get released in acute pancreatitis, and the body tries to wall off the enzymes with granulation tissue that eventually undergoes fibrosis and thickening

496
Q

What is a weird way to measure insulin intolerance in diabetic patients?

A

waist-to-hip ratio. This indirectly measures the visceral fat to subcutaneous fat ratio as the stomach is composed mostly of visceral fat, and hips have only subcutaneous fat. High waist-to-hip ratio often correlates to insulin resistance

497
Q

What are the key growth factors that promote angiogenesis?

A

FGF-2 and VEGF

498
Q

What provides the major blood supply to the femoral head and neck?

A

the medial circumflex artery

499
Q

What are the most common complications of Factor V Leiden?

A
  1. DVT (pulm embolism)
  2. Cerebral vein thrombosis
  3. Recurrent pregnancy losses
500
Q

Toxicity of loop diuretics (furosimide)?

A

OH DANG

Ototoxicity, Hypokalemia, Dehydration, Allergy sulfa, Nephritis (interstitial), Gout

501
Q

What is the main virulence factor of mycobacterium tuberculum?

A

Cord factor, demonstrated by its serpentine growth on medium

502
Q

What is the function of cord factor?

A

It inactivates neutrophils, damaging mitochondria and inducing release of tumor necrosis factor

503
Q

How many half lives does it take a drug to reach steady state (95%) and 90% of steady state?

A

95%= 4-5 half lives

90%= 3.3 half lives

504
Q

What is the primary histologic finding in eczematous dermatitis?

A

spongiosis–epidermal accumulation of edematous fluid in the intercellular spaces

505
Q

What do the lesions look like in osteitis fibrosa cystica (assocatied with primary hyperparathyroidism)?

A

osteolytic cysts in long bones, subperiostial erosions, and granular “salt and pepper” skull

506
Q

Is chloride high in concentration inside the cell or outside the cell?

A

outside the cell

507
Q

What is the antidote for arsenic poisoning?

A

dimercaprol

508
Q

What drug is used to treat infertility associated with PCOS?

A

clomiphene – antagonist @ estrogen receptors in the hypothalamus

509
Q

What is on the differential for acquired night blindness?

A
  1. Vitamin A deficiency
  2. toxic retinopathy due to phenothiazines or chloroquine
  3. congenital rubella, syphilis or other infections
  4. diabetic retinopathy
510
Q

What is liver angiosarcoma?

A

rare malignant tumor of endothelial origin associated with exposure to arsenic and vinyl chloride. Expresses CD31

511
Q

How is increased SV shown on a ventricular pressure-volume loop?

A

Increased width of the loop

512
Q

What is “hibernation” in reference to the cardiomyocytes?

A

reversible loss of contractile function due to repetivitive ischemia of cardiac myocytes or persistant hypoperfusion. Reverse with reperfusion.

513
Q

What effect does too much ammonia have on the astrocytes?

A

Too much ammonia uses up all the alpha-ketoglutamate in the reaction to make glutamine to glutamate. Deficiency of alpha-ketoglutamate leads to no more krebs cycle. Also, inc glutamine causes astrocyte dysfunction

514
Q

What kind of inflammation is seen in Guillan Barre?

A

endoneural inflammatory infiltrate

515
Q

What is the only disease that has pretibial myxedema, exophthalmos, periorbital edema, and eye movement limitations?

A

Graves’

516
Q

How do you treat loss of consciousness due to hypoglycemia in the hospital vs. nonmedical setting?

A

nonmedical–IM or SQ glucagon

medical–IV dextrose

517
Q

Why can’t you start an SSRI until 2 weeks after discontinuing an MAOi?

A

Need to give sufficient time for the cells to replenish MAO, which is inhibited by MAOi’s. Otherwise patient may go through serotonin syndrome

518
Q

Which cancers have a BRAF mutation?

A

melanoma and papillary carcinoma of the thyroid

519
Q

How many calories does 1g of protein/carbohydrate, fat, and ethanol yield?

A

protein/carb=4 cals/g

fat=9cals/g

ethanol=7cals/g

520
Q

What is the mode of inheritance of NF1&2?

A

autosomal dominant

521
Q

What drug slows the progression of diabetic nephropathy?

A

ACEi

522
Q

What is the histologic appearance of a carcinoid tumor?

A

No variation in the size of the tumor cells and they form glands, nests, rows or sheets. Eosinophilic cytoplasm with oval-to-round stippled nuclei

523
Q

What are the most common locations of carcinoid tumors?

A
  1. ileum
  2. appendix
  3. rectum
524
Q

Why is dietary fructose metabolized the quickest out of the dietary sugars?

A

Dietary fructose bypasses the rate limiting step (PFK) of glycosis and enters the pathway as glyceraldehyde-3-phosphate. (F-1-P–> glyceraldehyde via aldolase B, then )

525
Q

What makes the liver black in Dubin-Johnson syndrome?

A

epinephrine metabolites within lysosomes

526
Q

What predisposes a patient to disseminated candidiasis infections?

A

Neutropenia and inherited impairments in phagocytosis

527
Q

What is the main muscle involved in the valsalva maneuver?

A

rectus muscle

528
Q

What is the treatment for a SVT?

A

vagal stimulation (carotid massage or valsalva), which increases the refractory period in the AV node to prevent re-entrant circuit. If that doesn’t work, then treat with adenosine

529
Q

What reactions require NADPH?

A

glutathione reduction in RBCs, fatty acid and cholesterol biosynthesis (reductive reactions)

530
Q

What is wet age-related macular degeneration?

A

rapid loss of bision due to bleeding due to choroidal neovascularization caused by VEGF. WIll show a gray/greenish subretinal membrane

531
Q

How do you treat wet age-related macular degeneration?

A

anti-vascular endothelial growth factor (ranabizumab and bevacizumab)

532
Q

What is dry age-related macular degeneration?

A

deposition of yellowish extracellular material and and beneath Bruch membrane with drusen. gradual vision loss. Tx multivitamen and antioxidants

533
Q

What is ergonovine?

A

ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha-adrenergic and serotinergicr receptors. Used to test for Prinzmetal’s angina.

534
Q

When will a patient most commonly report symptoms if they have Prinzmetal’s angina?

A

at rest during the night or early morning hours

535
Q

What lung diseases cause digital nail clubbing?

A

bronchiectasis, empyema, Cystic fibrosis, lung cancer (large cell), TB, pulm HTN, and others that induce hypoxia

536
Q

What heart diseases cause digital clubbing?

A

the 5T’s congenital heart diseases, bacterial endocarditis

537
Q

What is seen on histology of urticaria (hives)?

A

dermal edema and lymphatic channel dilation

538
Q

What is the virulence factor for salmonella that prevents it from being opsonized?

A

Vi antigen

539
Q

Why are sickle cell patients more prone to infections with encapsulated bacteria?

A

They have functional asplenia due to vaso-occlusive reactions that cause infarctions in the spleen.

540
Q

Which group of antiarrhythmics are use-dependent and rate-dependent?

A

IC antiarrhymics– block Na+ channels that are firing at a faster heart rate. Therefore they prolong QRS interval more @ high heart rates.

541
Q

Which class of antiarrhythmics exhibit reverse use-dependence?

A

class III antiarrhtyhmics. The slower the heart rate, the more prolonged the QRS complex.

542
Q

What is the first line treatment of PCOS hirsutism?

A

OCPs

543
Q

How do OCPs prevent excessive hair growth in PCOS?

A

OCPs prevent release of LH from the pituitary, which decreases overall androgen production.

544
Q

What are the phases and ion permeability present in a pacemaker action potential reading?

A

Phase 0= upstroke, permeable to Ca2+

Phase 3= downstroke, permeable to K+

Phase 4= slow depolarization, permeable to Na+

545
Q

What is reperfusion injury due to?

A
  1. Secondary to free radical damage
  2. mitochondrial damage
  3. inflammation

(ultimately due to membrane damage)

546
Q

What is the most common injury in an acceleration-deceleration car accident?

A

Tearing of the ligamentum arteriosum which tethers the aortic isthmus to the pulmonary tree.

547
Q

What amino acids are safe to supplement a child with pyruvate dehydrogenase deficiency?

A

lysine and leucine, which are the only ketogenic amino acids only

548
Q

What effects can niacin have on dosing of hypertensive and diabetic drugs?

A

Niacin has vasodilatory effects and can also cause insulin resistance. If a patient is also on a hypertensive medication, the dosage may need to be lowered. If the patient is on a diabetes medicaiton, then the dosage may need to be increased.

549
Q

Where does S. aureus commonly colonize?

A

the nose

550
Q

What study uses an exposure odds ratio?

A

case-control study

551
Q

What study uses a prevalence odds ratio?

A

Cross-sectional study

552
Q

What study uses relative risk measure?

A

Cohort study.

553
Q

What is the shine dalgarno sequence?

A

located upstream of the promoter in prokaryotic mRNA. Binds 16s rRNA which contains a complementary sequence to mRNA and allows for initiation of protein synthesis.

554
Q

Why are beta-oxidation blockers thought to be beneficial in stable angina?

A

Beta-oxidation produces more ATP but uses more O2 to do this. In stable angina, there is decreased O2 delivery to the myocardium. If beta-oxidation is limited, then energy production will be shifted toward glucose oxidation which requires less O2, therefore making more O2 available to the myocardium.

555
Q

Rh antibodies are what class?

A

IgG

556
Q

Blood type antibodies are what type of immunoglobulin?

A

IgM (do not cross the placenta)

557
Q

Does having a high or low BMI predispose to osteoporosis?

A

low BMI

558
Q

What race is least likely to get osteoporosis

A

African Americans

559
Q

How do estrogen and progesterone affect gallstone formation?

A

estrogen increases cholesterol synthesis and progesterone causes gallbladder hypomotility.

560
Q

What neuropeptides are most commonly lacking in narcolepsy?

A

hypocretin-1 (orexin A) and hypocretin-2 (orexin B)

561
Q

What does S-100 tell you about the origin of a cell?

A

+ if the cell has mesodermal origin

562
Q

what is rituximab’s MOA?

A

monoclonal antibody against CD20

563
Q

What is a toxicity of rituximab?

A

inc risk of progressive multifocal leukencelphlopathy

564
Q

What is injured in the unhappy triad?

A

ACL, MCL and medial meniscus

565
Q

What type of growth is responsible for long bone growth? What type of growth is responsible for flat bone growth?

A

Long bone growth- endochondral ossification

Flat bone growth- membranous ossificaiton

566
Q

What do the lumbricals do?

A

flex at the MCP joints and extend DIP and PIP joints

567
Q

Lesion to what nerve gives a winged scapula? What muscle does this nerve innervate

A

long thoracic nerve– innervates the serratus anterior

568
Q
A
569
Q

What is the tetanus vaccine?

A

tetanus toxoid which induces humoral immunity specific to the tetanus toxin

570
Q

Why are calcium oxalate stones common in Crohn’s Disease?

A

no bile acid reabsorption in terminal ileum, so fat malabsorption. Excess fat lipids bind the calcium, making oxalate free in the intestine and ready to be absorbed.

571
Q

What is the main insult/pathology in ARDS?

A

diffuse alveolar damage to the endothelial cells (no alveolar destruction)

572
Q

What is it called when someone reports and “lump in the throat” like they can’t swallow, but without accompanying physical, endoscopic or radiologic findings of esophageal obstruction?

A

Globus Hystericus

573
Q

Excess amounts of what vitamin can be teratogenic? What can it cause?

A

Vitamin A: causes microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, spontaneous abortion

574
Q

What cytokines are secreted from ALL T cells?

A

IL-2, IL-3

575
Q

What cytokines are secreted from TH1 cells?

A

IFN-gamma

576
Q

What cytokines are secreted from TH2 cells?

A

IL-4, IL-5, IL-10

577
Q

What structure is most likely to be damaged in a posterior or anterior dislocation of the knee?

A

popliteal artery

578
Q

What is the most common cause of endometritis?

A

bacteroides

579
Q

What is sublimation?

A

replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system (teenager’s aggression toward his father is redirected to perform well in sports)

580
Q

After a kidney transplant, does the GFR return to normal? (immediately after surgery vs. 6 weeks later)

A

immediately after surgery= 50% of normal GFR

6 weeks after surgery= 80% of normal GFR

581
Q

How long do patients need to experience symptoms for them to be considered to have PTSD?

A

need to have symptoms for at least 1 month

(acute stress disorder= lasts less than a month)

582
Q

Equation for relative risk?

A

risk of developing the disease in the exposed group divided by risk of developing disease in the unexposed group.

(risk of developing disease=#developed/total # of ppl in study)

583
Q

Equation for number needed to treat (NNT)?

A

NNT=1/ARR

(ARR= risk of developing disease in intervention - risk of developing disease in control group)

584
Q

What are the characteristics of a transudate?

A

Low protein, and low LDH

585
Q

What is the MOA of oseltamavir?

A

inhibits neuraminidases of influenza A and B

586
Q

In the salivary glands, how is saliva modified before it is secreted?

A

Na and Cl are reabsorbed while K+ and HCO3- are secreted.

587
Q

What is the equation for false positive rate and false negative rate?

A

false + rate= 1 - specificity

false - rate= 1 - sensitivity?

588
Q

In what anemia disorder is the osmatic stability increased in the RBC?

A

sickle cell disease

589
Q

What are the metabolic changes associated with DKA?

A

metabolic acidosis, hyponatremia, hyperkalemia, hyperglycemia, ketonemia. (hyponatremia due to osmostic pull of glucose in the urine leads to inc urine release)

590
Q

What is the half life, total time of single dose, and what type of an inhibitor are phentolamine and phenoxybenzamine?

A

Phentolamine–reversible, competitive inhibitor with a 20 minute half life, total duration of action less than 1 hour

Phenoxybenzamine–non-competitive, irreversible inhibitor, 24hr half life, total duration of action about 3-4 days.

591
Q

What is a common, fatal injury common in premature/low birth weight infants within a few days of being born?

A

Intraventricular hemorrhage. Arises as bleeding in the germinal matrix which is the area of the fetal brain that is highly cellular and vascular, without supporting fibers so they are prone to hemorrhage in a preemie. (after 32 weeks, this area of the brain becomes less vascular)

592
Q

What is the function of palmitoylnation?

A

it increases the hydrophobicity of the protein.

593
Q

How does nitroglycerin affect heart rate and ESV?

A

inc HR (tachy) and dec ESV

594
Q

What is an SRP?

A

signal recognition peptide- hydrophobic-targets proteins to the ER so they can be synthesized a packaged for secretion from the cell. Loss of SRP would lead to buildup of these proteins in the cytosol

595
Q

What cells make androgen binding protein, and what is its function?

A

Sertoli cells. ABP functions to maintain high testosterone levels in the seminiferous tubules. Creates a concentration gradient so more testosterone gets secreted into the tubules.

596
Q

What uterine ligament runs through the inguinal canal?

A

the round ligament

597
Q

What does safranin O stain?

A

cartilage, mast cell granules, and mucin. Stains them red.

598
Q

What causes “red-man syndrome” in vancomycin treatment?

A

If vancomycin is administered too quickly, then it can cause widespread histamine release. This is NOT AN IgE MEDIATED ALLERGIC REACTION.

599
Q

What does the ventral pancreatic duct give rise to?

A

Main pancreatic duct and pancreatic head

600
Q

Where on the arm does injury occur in nursemaids elbow?

A

Head of the radius. Deep radial nerve can get caught here when tugging on a child’s arm, leading to a torn annular ligament and loss of extensor muscles “wrist drop”. No sensory loss.

601
Q

What muscles/actions does the obturator muscle innervate?

A

innervates the hip adductors.

602
Q

What is the outcome for most patients with HCV?

A

Most develop stable chronic hep. Less than 1/2 develop cirrhosis and 0-3% develop HCC

603
Q

If the absense of ADH, where in the tubules will the fluid have the highest osmolarity?

A

End of the descending loop of Henle.

604
Q

What is the p-value? What affects the p-value?

A

Tells you the ability of a study to detect the difference when one really does exist. If the sample size is too small, p-value will not find a statistical difference (will be greater than .05)

605
Q

What 4 syndromes are a result of hypertensive arteriolosclerosis of the internal capsule?

A
  1. Pure motor
  2. Pure sensory
  3. Ataxia-hemiplegia syndrome
  4. Dysarthria-clumsy hand syndrome
606
Q

What part of the internal capsule is affects in a pure motor hemiparesis?

A

posterior limb, or basal pons

607
Q

What part of the itnernal capsule is affected in a pure sensory?

A

ventroposterolateral/medial of the pons

608
Q

What part of the internal capsule is affected in ataxia-hemiplegia syndrome?

A

posterior limb of internal capsule

609
Q

What part of the internal capsule dysarthria-clumsy hand syndrome?

A

genu of internal capsule or basal pons

610
Q

What is the most common cause of a lacunar infarct?

A

chronic hypertension.

611
Q

Which part of the stomach is affected in type A (autoimmune) chronic gastritis and in type B (H.pylori) chronic gastritis?

A

Type A autoimmune- body of the stomach

Type B H. pylori- antrum of the stomach

612
Q

At which receptors does isoproterenol work?

A

B1 and B2 agonists (inc contractility of the heart and decreases systemic vascular resistance)

613
Q

Do fatty streaks occur in the areas where future atherosclerotic plaques will form?

A

NO

614
Q

What is deformation?

A

extrinsic develop destruction that occurs after embryogensis

615
Q

What is malformation?

A

Occurs during embryonic period (weeks 3-8) and is an intrinsic disruption (holoprosencephaly)

616
Q

What are the SGLT-2 inhibitors? What must be monitored before starting one?

A

canagliflozin and dapagliflozine. They block reuptake of gluocose in the proximal tubules. Must monitor BUN and serum creatinine before initiating treatment

617
Q

which inhaled anesthetic increases seizure occurance?

Incrases nephrotoxicity?

A

enflurane - seizure

methoxyflurane - nephrotoxicity

618
Q

What changes in the genome do the trinucleotide repeats in Fragile X Syndrome cause?

A

hypermethylation of cytosine bases and inactivation of the FMR1 gene which is required for normal neuronal development. Resulting in mental retardation, etc.

619
Q

What is Zellweger Disease?

A

peroxisomal disease where they are unable to form myelin in the CNS. Symptoms include seizures, hypotonia, hepatomegaly, metal retardation, and early death.

620
Q

What is refsum disease? How do you treat it?

A

defect in peroxisomal alpha oxidation which leads to a build up of phytanic acid. Treat by restricting chlorophyll in the diet.

621
Q

What bugs are capible of producing biofilms?

A

S. epidermidis (prosthetics, catheters)

S. mutans and S. sanguinis (dental plaques)

Pseudomonas (cystic fibrosis pneumonia)

Viridans (endocarditis)

H. flu (non-typeable) (otitis media)

622
Q

What are some long term sequele of infantile hydrocephalus?

A

hypertonicity and hyperreflexia due to UMN damage and stretching of the periventricular pyramidal tracts. Can also get visual disturbances and learning disabilities

623
Q

What two arteries does CNIII course between when it leaves the midbrain?

A

posterior cerebral artery and superior cerebellar artery

624
Q

What drug can induce mania in a bipolar patient?

A

Antidepressantss (TCAs and venlafaxine)

625
Q

What is DRESS Syndrome?

A

Drug reaction with eosinophilia and systemic symptoms- occurs 2-8 weeks after starting a new drugs, probs due to reactivation of herpesvirus and clonal T-cell expansion that cross-reacts with the drug. Develop fever, rash, lymphadenopathy and facial edema

Due to anticonvulsants and allopurinol

626
Q

What type of colon polyp can have a cauliflower appearance and cause electrolyte imbalances (hypokalemia) due to secretory diarrhea?

A

Villious adenomatous polyps

627
Q

What would a respiratory infection casue in a diabetic patient?

A

TImes of stress, such as infection, can cause an increase in blood glucose levels causing hyperglycemia.

628
Q

What is considered a low volume of distribution?

A

Vd of about 3-5L

629
Q

What is a C1 esterase inhibitor deficiency? What medication is contraindicated in this deficiency?

A

C1 esterase inhibitor deficiency leads to angioedema. C1 esterase inhibitor is supposed to inhibit activation of the classical pathway of complement and also inhibit activaton of kallikrein pathway. If this isn’t being inhibited, then there is a build up of bradykinin which mediates vasodilation and angioedema. ACEi are contraindicated since they inhibit the breakdown of bradykinin into inactive metabolites.

630
Q

What substance accumulates in hepatocytes in HBV infection?

A

sphere and tubules of HBsAg accumulates in hepatocytes causing a granular, eosinophilic appearance known as ground glass appearance.

631
Q

Where do the different branches of CNV exit the brain from?

A

Standing Room Only

Superior orbital fissues - CNV1

Foramen Rotundum - CNV2

Foramen Ovale - CNV3

632
Q

In what phase is the oocyte arrested after ovulation?

A

Metaphase of meiosis II. Continues after fertilization.

633
Q

Which type of breast cancer has pleomorphic cells with areas of central necrosis?

A

Comedocarcinoma (subtype of DCIS)

634
Q

Most common location of colorectal carcinoma?

A

Rectosigmoid> ascending>descending

635
Q

Diastolic heart failure presents with what changes in EDV, EDP and EF?

A

Normal EDV and EF

Increased EDP

636
Q

What is transduction?

A

Bacterial transfer of DNA using bacteriophage. Can occur during lytic phase (random bacterial genes are accidentally packaged into bacteriophage) or during lysogenic phase (select bacterial genes near the viral insertion sites are excised and packaged into virion)

637
Q

What is transformation?

A

direct uptake of naked DNA from the environment by competent bacteria (S. pneumo, H. flu, Neisseria spp.)

638
Q

How does timolol treat glaucoma?

A

dec production of aqueous humor from the ciliary epithelium (beta blocker)

639
Q

What 2 neurodegenerative d/o have alpha-synuclein inclusions?

A

Parkinson Disease and Lewy Body dementia (both inclusions are referred to as lewy bodies. Lewy Body dementia is dementia and hallucinations followed by parkinson symtpoms)

640
Q

What is metoclopramide?

A

D2 receptor antagonist that increases resting tone, LES tone, and inc gastric motility. Used to treat diabetic and post-surgery gastroparesis, antiemetic

Side effect: seizures

641
Q

Time frame and sxs of Schizoaffective d/o?

A

at least 2 weeks of stable mood with psychosis. Also need to have a major depressive, manic, or mixed episode.

642
Q

Difference between bipolar I and II? Tx?

A

I- at least one manic episode

II- hypomanic and depressive episode

Lithium, valproic acid, carbamazepine, + atypical antipsychotic

643
Q

Which way do your eyes look if you have a lesion to your PPRF? What about FEF?

A

PPRF= away from the lesion

FEF= toward the lesion

644
Q

What is phenotypic mixing?

A

2 virus simultaneously infect the same cell, and exchange viral capsid proteins, but maintain their own genetic material. These viruses can then infect cells they previously were unable to infect due to the new capsid proteins, but once they replicate, they will make their own capsid proteins, and the progeny won’t be able to invade certain cells again. Protein coat determines the tropism (infectivity) of the viruses.

645
Q

What is the main cause of valvular calcifications seen in an elderly patient who is pretty healthy?

A

Dystrophic calcification which gets laid down on necrotic cells. Usually occur in a normocalcemic patient. Necrosis occurs due to chronic hemodynamic stress which in a young person leads to aortic sclerosis, but in an old patient leads to calcific aortic stenosis.

646
Q

MOA of oseltamavir?

A

inhibit influenza neuraminidase, decreasing the release of progeny virus.

647
Q

What is the most common cardiac manifestation in lupus?

A

pericarditis

648
Q

Describe the effects of nitroprusside?

A

Dilates arteries and veins, so dec preload and afterload while maintaining stroke volume.

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