Shit I Forget Flashcards
Hartnup disease
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
How do you distinguish between Fanconi aciduria and Harnup disease?
Harnup has normal urinary levels of proline, hydroxyproline and arginine while Fanconi does not.
Nursemaids elbow?
sudden traction of outstretched, pronated arm of a child. Due to torn annular ligament and child will hold arm in slightly flexed and pronated.
How is colitis associated colorectal carcinoma different from sporadic?
- appears @ younger age
- progresses from flat and nonpolypoid dysplasia
- mucinous with signet rings
- early p53 mutations and late APC (opposite of sporadic)
- proximal colon
- multifocal in nature
How does the carotid sinus work and what cranial nerve innervates it?
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
What inhibits prolactin secretion toward the end of pregnancy?
high levels of progesterone and estrogen
What are the long acting benzodiazepiens?
Careful Carol Does’t Fall
Chlordiazepoxide, Clorazepate, Diazepam, Flurazepam. Less risk of falling but higher addiction potentional than short acting.
Pentazocin?
Opiod that has weak mu agonist effects and weak antagonist effects (can cause withdrawal symtpoms)
Estrogens effect of cholesterol synthesis?
Increases activity of HMG-CoA reductase which increases cholesterol production
7 alpha-hydroxylase?
incoporates cholesterol into bile salts. If suppressed, then excess cholesterol in the bile leading to increased risk of gallstones
MOA of fibrates?
Upregulates LPL and increases TG clearance. Side effect is that it inhibits 7 alpha-hydroxylase which incorporates cholesterol into bile salts
Adenymyosis?
Abnormally enlarged uterus with normal normal appearing endometrial tissue within the myometrium. Dysmenorrhea and menorrhgia
A2-OS interval?
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)
Most common cause of primary adrenal insufficiency?
Autoimmune adrenalitis
Symtpoms of primary adrenal insufficency?
hyponatremia, hyperkalemia, non-anion gap metabolic acidosis (increased H+) with increased Cl- retention to maintain electroneutraility.
Mortality rates of lung cancer
Before 1965, lung cancer wan’t that common. Now it has highest mortality rates in women.
What type of vaccine is for rabies?
killed vaccine
Malignant (atypical) phenylketonuria?
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
How are HbA1C levels affected in diabetics with an anemia?
Low and high turnover states of anemia can affected HbA1C. Higher turnover rate means lower HbA1C levels than actually exist.
Equation for Net flitration pressure in the glomerulus
(PGC-PBS)- (πGC-πBS)
GC= glomerular capillary
BS= bowmans space
Disease of niacin deficiency?
Pellagra (dermatitis, diarrhea, dementia, death).
Does corn have a lot of niacin?
Yes, but exists in an inaccessible form!
Less common associations of Pellagra?
Isoniazid treatment, carcinoid syndrome, and Harnup disease
How does botulinum toxin work at the NMJ?
Inhibitis release of ACh from presynaptic nerve terminals.
What causes the tissue damage seen in abscess formation?
Macrophages and neutrophils release lysosymal enzymes that eat up and digest the bacteria/offending agent but can also cause tissue damage.
Symptoms of ARDS
noncardiogenic pulmonary and interstitial alveolar edema, inflammation and alveolar hyaline membranes.
Major side effect of acyclovir?
obstructive crystalline nephropathy and acute renal failure if not adequately hydrated.
What are 3 common situations for development of avascular necrosis?
Sickle cell, SLE, and high dose steroid therapy/ alcoholism
What seizures does valproic acid treat?
Tonic-clonic and absence, simple and complex.
What are the side effects of thiazides?
hyperGLUC: hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia
Calcineurin?
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.
What can immunosuppressed men or women get from HPV?
Women at greater risk for cervical carcinoma, and men are at a greater risk for anal (MSM) and penile carcinoma.
What will ECG look like for re-entrant circuit?
Shortend PR interval (due to the accessory pathway pre-exciting the venticles), widened QRS complex and a delta wave.
What antibody is indicative of a past HBV infection?
anti-HBcAg IgG (anti-HBsAg will also be positive, but is not specific to past infection. Can indicate vaccination)
What type of vaccine is HBV?
recombinant vaccine that contains HBsAg
How should one address an elderly patient?
Always use Ms. Mrs. or Mr.
What is leukocyte adhesion disorder?
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). **
Actions of BNP (brain natiuretic peptide)?
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.
What is the role of the renin-angiotenin pathway in CHF?
Released in response to decreased CO, causes H2O retention, salt retention, vasoconstriction and deleterios cardiac remodeling.
What are the 2 most common treatments of absence seizures?
Ethosuximide and vaproic acid
When is Na+ conductance the highest during action potential?
At the peak of the action potential.
Defining characterisitics of complete hyatid molar pregnancy?
Super high levels of hCG, “**size greater than dates” uterus, **no fetal tissue - exclusively **trophoblastic tissue, **complete paternal origin. Higher risk for malignancy
What inhaled anesthetic can cause drug-induced liver injury?
halothane
What are the results of halothane induced fulminant hepatitis?
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.
Wilson’s disease characteristics?
Copper is Hella BAD
dec Ceruloplasmin, Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma (HCC)
Hemolytic anemia
Basal ganlgia degereration (parkinsonian symptoms)
Dementia, Dyskinesia, Dysarthria
What does the NIS (sodium-iodide symport) in the thyroid gland transport?
Iodide, and perchlorate/pertechnetate anions which can competively inhbit the uptake of iodide.
what is the most common malignancy associated with asbestos exposure?
Bronchogenic Carcinoma (mesothelioma is still of lower incidence)
What is the function of Major Basic Protein?
Found in eosinophils and functions mainly to kill helminths. Can also cause bronchial epithelial damage in patients with atopic asthma.
What medications can cause hyperkalemia?
Nonselective beta-adrenergic blockers, ACEi, ARBs, K+ spairing diuretics (spironolactone, eplereone, triamterene and amiloride), digoxin, and NSAIDs
What is the major proliferative stimulus for athersclerotic plaque formation?
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.
Contents of fresh frozen plasma?
contains all coagulation factors
Contents of cryoprecipitate?
only cold soluble proteins (factor VIII, fibrinogen, vWF and vitronectin)
Are benzodiazepines used for seizure therapy?
YES! (status epilepticus)
What does the inferior mesenteric artery supply?
distal 1/3 of the transverse colon, sigmoid colon, and rectum.
Defining features of PCP?
violent behavior, nystagmus, most likely to die due to trauma.
What are the groups of subjects in a case-control study?
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.
What are the findings of acute serum sickness?
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.
Where is low frequency sound best detected?
apex of clochlea (contains the basilar membrane) near the helicotrema
Where are high frequency sounds best detected in the ear?
Base of the cochlea near the oval and round windows
What are the occupational sources of lead toxicity?
batteries, alloys, ammunition, mining, smelting, chemical processing, pray painting, radiator repair, and recycling.
What are the sxs of lead poisoning in the first stage of toxicity?
colicky abdominal pain, constipation, headaches, impaired concentration, and deficits in short term memory
What is the presentation of an 11B-hydroxylase deficiency?
XX virulization. low cortisol, low aldosterone, high androgens. Even though low aldosterone, the 11-deoxycorticosterone as mineralocorticoid effects resulting in increased BP
What is the PI3K/Akt/mTOR pathway involved in?
anti-apoptosis, cellular proliferation, and angiogenesis
Describe the mTOR pathway
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.
What cancer drugs inhibit mTOR?
Rapamycin aka sirolimus
What is a common cause of UTIs in people with indwelling catheters?
Pseudomonas- gram negative, nonlactose fermenting, oxidase positivie
Are pulmonary infarcts hemorrhagic or ischemic?
Hemorrhagic due to the dual blood supply
Which valve is affected due to endocarditis from IV drug abuse?
The tricuspid valve (don’t “tri” drugs) then usually cause septic emboli in the lungs.
What organisms cause bacterial endocarditis in IV drug users?
S. aureus, psuedomonas, and candida
What effect do TCA’s have on the heart?
TCA’s have a quinidine type of effect on the heart and can lead to increased QT interval by inhibiting the fast sodium channels
How do you treat a QT prolongation/cardiac dysarrhythmia due to TCAs?
sodium bicarbonate administration–TCAs are weakly acidic
What is the brand name of acetominophen?
tylenol
What antiarrhythmics increase the PR interval?
Beta blockers (class II antiarrhythmics) and Ca channel blockers (class IV antiarrhythmics). Control the rate (will give a reading of the pacemaker = a hump).
Which antiarrhythmics can cause torsades?
Ia and III (increased QT interval)
Which antiarrhythmics control rhythm?
Na channel blockers (Class I) and K+ channel blockers (Class III). (will show an action potential spike for these questions-myocytes)
How does cystic fibrosis affect the pancreas?
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
What patients are suspetible to mucormyocosis?
DM 1 in DKA.
What are the symptoms and treatment of mucormycosis?
facial pain, headache, and black eschar in the nose. Confirm diagnosis wtih a nasal biopsy and treat with debridment and amphotericin B
Histological findings of mucormycosis?
fungi appear as broad, nonseptate hyphae with 90° branching (compared to Aspergillus with septated hyphae and 45° branching)
Symptoms of theophylline toxicity?
abdominal pain, vomiting, cardiac arrhythmias and seizures
Treatment for theophylline overdose?
activated charcol and cathartics, beta blockers to treat the tachyarrhymias, benzos and barbs for the seizures
What does the glomerulus look like in PSGN?
hypercellular with infiltration of leukocytes and endothelial/mesangial cell proliferation
What are Langhans cells?
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
What condition presents with urine discharge from the umbilicus?
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.
What condition presents with meconium discharge from the umbilicus?
a persistant yolk sac (vitelline duct) that connects the small intestine with the the skin at the umbilicus.
What tissues is GLUT-3 found on?
placental and neuronal glucose transport
What are P bodies?
foci within the cytoplasm that are involved in mRNA regulation and turnover. Important for translation regression and mRNA degradation. Sometimes store mRNA
What antibiotic is an analog of D-Ala-D-Ala
Penicillin
What drus are enoxaparin and dalteparin?
Low molecular weight heparins- binds antithrombin III and promotes its activation
What does tPa bind?
Binds plasminogen that is bound to fibrin. Breaks up clots.
What is the efferent limb of the light reflex?
parasympathetic fibers of the oculomotor nerve
What holosystolic murmur increases in intensity on inspiration?
tricuspid regurgitation
Hypocapnia effects on the brain?
cerebral vasoconstriciton and decreased cerebral blood flow. (CO2 is a vasodilator)
What is the most common lung cancer among non-smokers and women?
adenocarcinoma
what causes neonatal retinopathy?
use of concentrated O2 for neonatal respiratory distress syndrome. Can lead to blindness
What is the best indicator of liver damage?
prothrombin time
What cofactor increases in liver disease?
Factor VIII
Aldolase B deficiency treatment?
Fructose metabolism. Need to remove fructose and sucrose from the diet (sucrose = fructose + galactose)
What are the sugars that make up sucrose?
fructose + glucose
What are the sugars that make up lactose?
galactose + glucose
What are the sugars that make up maltose?
glucose + glucose
What biochemical reactions require biotin (B7)?
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
How does CCL4 (carbontetrachloride) cause damage?
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)
Symptoms of Trisomy 13 (Patau)?
bilateral cleft lip, microphthalamos (fucked up eyes), microcephaly, polydactyly, rockerbottom feet (NO SHORTENING OF FINGERS which dinstinguishes from Edwards)
Inheritence pattern of PKU?
autosomal recessive
What diseases are autosomal dominant?
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
What disorders are X-linked recessive?
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.
What type of inflammation is seen in polyarteritis nodosa?
transmural inflammation with fibrinoid necrosis. String of peals appearance
What msucles do the recurrent laryngeal nerve innervate?
all layngeal muscle EXCEPT the cricothyroid (sensory innervation below the vocal cords)
What nerve innervates the cricothyroid muscle?
external branch of the superior laryngeal nerve
What is the function of enteropeptidase?
secreted by the duodenum and cleaves trypsinogen into the activated trypsin.
What heart condition can be precipitated by binge drinking?
A-fib
What are 3 precipitating factors in isolated events of atrial fibrillation??
- binge drinking
- increased cardiac sympathetic tone
- pericarditis
In a healthy individual, is the equilibriation of O2 and CO2 perfusion or diffusion limited?
Perfusion- limited
If you eat a lot of raw egg whites all the time, what deficiency can this lead to?
biotin deficiency (all carboxylase enzymes are out of commission)
Function of peptide YY?
binds to ECLs and inhibits gastrin-stimulated histamine release.
What hormones inhibit gastrin secretion?
Somatostatin, peptide YY, and prostaglandins
If a patient has mitral regurgitation, what factors can be adjusted to decrease the amount of backwards flow and increase forward flow?
decrease the afterload. Treat with a beta blocker!
When is a 3rd heart sound normal?
In children, young adults, and pregnancy
When is an S4 normal?
healthy older adults
When do you hear an S4, and what are the abnormal causes?
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)
When do you hear an S3 and what are the associated abnormal symptoms?
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
What is the equation for diffusion rate?
(concentration difference x SA x solubility)/ thickness x MW
What is the most common cause of a new onset murmur in a young person?
bacterial endocarditis
What is common complication of bacterial endocarditis that involves the kidney?
Renal insufficency due to nephritic syndrome like acute diffuse proliferative glomerulonephritis secondary to ciruclating immune complexes.
What infections are associated with hemagglutinin?
Influenza virus, Measles (rubeola), Mumps, and Parainfluenza.
What is the effect of a RET mutation?
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)
What is lymphogranuloma venerium?
chronic disease of chlamydia trachomatis that is characterized by an intial painless, small ulcer
How do you differentiate between obstructive sleep apnea and Cheyne-Stokes respiration?
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.
What is the equation for GFR?
GFR = UV/P (inulin or creatinine)
V= urine volume flow rate
U= urine concentration
P= plasma concentration
Equation for RPF?
RPF= clearance of PAH
What is the equation for filtration fraction?
FF= GFR/RPF
What causes bruises to turn green?
Heme oxygenase converts heme to biliverdin which gives bruises their green color
What are the symptoms of a glossopharyngeal nerve lesion?
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
Pathogenesis of myasthenia gravis?
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.
If the resting membrane potential is close to the equilibrium potential of an ion, is it more or less permeable to that ion?
More permeable
What is the only type of anemia with an increased mean corpuscular hemoglobin concentration?
Hereditary Spherocytosis. WIll lose its central pallor.
What is the differnce in compliance between acute mitral regurg (ruptured chordae tendinae) and chronic mitral regurg?
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.
What symptoms are seen in acute mitral regurg but not chronic mitral regurg?
acute pulmonary edema
Equation for PPV?
PPV= TP/TP+FP
Equation for NPP?
NPP= TN/TN+FN
Equation for sensitivity?
sensitivity = TP/TP+FN
Equation for specificity?
Specificity = TN/ TN+FP
What is hemorrhagic cystitis?
dysuria, hematuria, and hemorrhage. Most commonly caused by adenovirus and can be a side effect of cyclophosphamide
What can you use in combo with cyclophosphamide to prevent development of hemorrhagic cystitis?
MESNA and aggressive hydration
What is the cause of the common toxicity of cyclophosphamide treatment?
hemorrhagic cystitis- cyclophosphamide is broken down into acrolein which is toxic to uroepithelial cells. Can administer with mesna which binds and inactivates acrolein.
Clinical use of mannitol?
Often used in traumas to control increased intracranial/intraocular pressure or in a drug overdose.
What is a severe toxicity of mannitol treatment
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).
What is nifedipine?
CCB that is specific to the vasculature. NO EFFECT ON THE HEART.
What are Class IV antiarrhythmics?
CCBs
What drugs are the cardiospecific CCBs?
Verapamil and Diltiazem. They decrease conduction velocity and increase PR interval
What are the effects of beta blockers on the heart?
Decreased AV nodal conduction and increased PR interval
In the midaxillary line, where should one perform a thoracocentesis in order to avoid hitting the lungs?
between the 7th and 9th ribs
In the midclavicular line, where should one perform a thoracocentesis in order to avoid the lungs?
between the 5th and 7th ribs
In the paravertebral line, where should one perfrom a throacocentesis in order to avoid hitting the lungs?
between the 9th and 11th ribs
In relation to the ribs, where does the liver lie?
middle axillary line below the 9th rib
What structures run through the hepatoduodenal ligament?
portal triad (portal vein, hepatic artery, and common bile duct)
What can aspergillus cause in an immunocompromised patient?
Fungal rhinositis (just look for the septae, branching at acute angles)
What are the important regulatory factors involved in insulin release from beta cells?
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?
What would a defect in the KATP channel being constantly open lead to?
No insulin release, type II DM. Sulfonylureas target this channel and cause it to close so insulin can be released
In the respiratory tract, where is airway resistance the highest?
In the medium sized bronchi (generations 2-5) due to highly turbulent airflow
What are the metabolic findings of DKA?
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)
Where are Meissner’s and Auerbach’s plexi found?
in the submucosa (Meissner) and muscularis externa (Auerbach). Must take a biopsy at least to the submucosa to see this.
What factors can decrease chances of getting a renal caliculi stone?
Increased fluid intake and increased citrate (citrate binds the free/ionized calcium and prevents it from precipitating).
What are the common causes of metabolic alkalosis?
Vomiting or nasogastric suctioning, thiazide or loop diuretics, mineralocorticoid excess
What 2 important factors should be checked when suspecting a metabolic alkalosis?
Volume status and Chloride concentration
Between which 2 muscles does the median nerve course before entering the wrist?
flexor digitorum superficialis and flexor digitorum profundus muscles
How do eosinophils kill parasites?
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. **
What are the common electrolyte disturbances seen in amphotericin B treatment?
hypokalemia and hypomagnesium due to increased permeability of the distal tubular membrane due to direct nephrotoxic effects of amphoterrible on renal epithelium
What is a major cause of morbidity and mortality in patients recovering from a subarachnoid hemorrhage?
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.
What is alendronate?
a bisphosphonate (end in -dronate)
What are the uricosuric medications?
Increase excretion of uric acid in the urine. Includes probenecid or sulfinpyrazone. Contraindicated in patients who are excreting large amounts of uric acid.
How do you differentiate between schizoaffective d/o and MDD/bipolar with psychotic features?
Schizoaffective: psychosis occurs during AND in the absence of major mood episodes.
MDD/bipolar with psychotic: psychosis occurs exclusively during the mood episodes
What is the definition of hypertensive crisis?
diastolic BP above 130
What is the physiologic response in hypertensive crisis?
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.
Key characterisitic of meningioma?
psammoma bodies
What are the two main buffer systems involved in excretion of acid in the kidney?
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).
Latent period bias?
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.
What does the presence of hemosiderin-labled macrophages in the alveoli signify?
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
What is on the DDX if golden cytoplasmic granules are seen?
lipofuscion or hemosiderin. Differentiate between the two using a Prussian-Blue stain. If hemosiderin, the iron will turn blue black.
How do you differentiate between Berger’s Disease and PSGN?
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
If IgA nephropathy (Berger’s) if associated with extrarenal symptoms, what is it called?
Henoch-Schonlein purpura
What are the common symptoms of vit C deficiency?
no hydroxylation of lysine and proline residues, resulting in bleeding gums, eccymosis, impaired wound healing, and fragile “corkscrew” hair.
What is B6?
pyridoxyl phosphate, required in conversion of glycine+succinyl CoA to ALA (occurs in mitochondria)
What is thymine pyrophosphate?
B1 derivative (TTP) that is necessary for alpha-ketoglutarate dehydrogenase and pyruvate dehydrogenase
What is B7?
biotin, used as a cofactor for carboxylase enzymes. If you eat only egg whites, can get a deficiency in biotin
What drugs exhibit a disulfiram type reaction?
metronidazole, certain cephalosporine, giseofulvin, procarbazine, and 1st gen sulfonylureas
What are the actions of ADH on the medullary collecting duct?
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.
Is lead poisining micro or macrocytic? What cellular features will be seen?
microcytic! hypochromic with basophilic stippling (abnormal aggregation of ribosomes).
What are the lab findings in DIC?
Prolonged PT/PTT, thrombocytopenia and microangiopathic hemolytic anemia, low fibrinogen, D-dimers (elevated fibrin split products), low Factor V and VIII (KNOW THESE)
What type of medication is often for urinary urgency?
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
Where are beta 1 receptors found?
on the cardiac tissue and renal juxtoglomerular cells
Where are nicotinin cholinergic receptors found?
on skeletal muscle at NMJ and on postganglionic neurons in parasympathetic and sympathetic neurons.
When is the first dose of Hib vaccine given?
@ 2 months old. infants protected for first 2 months by mothers IgG if she has the vaccine
What is pulsus paradoxus?
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.
What conditions cause pulsus paradoxus?
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.
What causes a subdural hematoma?
rupture of the bridging veins that bleeds slowly over time. Midline shift
What is ANP?
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.
What is the most common finding of PID?
mucoperulent cervicitis with cervical motion tenderness
How does sildenafil cause increased cGMP levels?
prevents cGMP degradation via inhibition of a phosphodiesterase
How do ANP and NO increased cGMP levels?
increase production of cGMP (this is different from sildenafil)
How do corticosteroids exert their anti-inflammatory effects?
Inhibit phospholipase A2 which inhibits production of leukotrienes and prostaglandins
What drugs are used to decrease ophthalmopathy due to Graves’?
high-dose glucocorticoids like prednisone. Anti-thyroid meds DO NOT reduce the proptosis
What types of viruses are capable of genetic reassortment (shift)?
any segmented viruses
what nerve injury leads to foot drop?
common peroneal
What is the effect of lithium on the kidney?
**lithium-induced nephrogenic diabetes insipidis. **Lithium antagonizes the effects of ADH and prevents the kidneys from concentrating urine.
Why do thiazide diuretics lead to increased lithium levels, but loop diuretics don’t?
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!
Which end of the tRNA molecule does the amino acid attach?
the 3’ end
What are the names of the ergot and non-ergot dopamine agonists?
Ergot: bromocriptine and pergolide
Non-ergot: pramipexole and ropinirole
Are ergot or non-ergot dopamine agonists preferred for Parkinson’s treatment?
Non-ergot (ropinirole and pramipexole)
What is the most common cause of urinary tract obstruction in older males?
BPH
Where is the zone that causes vomiting located?
Chemoreceptor trigger zone in the postrema of the dorsal medulla
What is the most common cause of meningitis in teens?
N. meningitidis
What is the most common cause of meningitis in children >6 months and the elderly (like 30+)?
S. pneumo
What are the most common causes of meningitis in neonates?
Group B strep, E. coli, and Listeria
What is the most common cause of pneumonia in adults 40-65?
S. pneumo followed by H. flu
What is the most common cause of pneumonia in adults 18-40yo?
Mycoplasma, C. pneumo, S. pneumo
What are the most common causes of pneumonia in neonates?
Group B strep > E. coli
Most common causes of pneumonia in children 4 weeks- 18yo?
Runts May Cough Chunky Sputum
RSV, Mycoplasma, C. trachomatis, C. pneumo, S. pneumo
What is a common side effect of MAOi’s?
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.
What is the most common benign tumor of the lung?
Bronchial hamartoma, composed of lung tissue and cartilage that is often calcified on imaging “popcorn calcifications”. Single “coin-lesion”.
What is the most common tumor of the adrenal medulla in kids?
Neuroblastoma
What forms the anterior border of the heart?
right ventricle
What forms the posterior suface of the heart?
left atrium (against the esophagus)
What forms the right border of the heart?
right atrium
What forms the left border of the heart?
left ventricle and left atrium
What forms the superior border of the heart?
great vessels and all chambers
What forms the diaphragmatic surface of the heart?
mainly left ventricles
What is the PYR test?
replaced bacitracin tests, tests to see if enzyme pyrrolidonyl arylamidase is working. Organisms expected to test + are Strep A, Enterococcus, coagulase negative Staph
What is the common cause of death while on TCAs?
cardiogenic shock and V fib. TCAs inhibit fast Na+ channels in the heart muscles which leads to arrhythmias and can cause death
What are the 2 congenital long QT syndromes?
Romano-Ward (no deafness), and Jervell and Lange-Nielsen syndrome (sensorineural deafness)
Hypoxemia?
low PaO2
Hypoxemia due to normal A-a gradient?
Hypoventilation or high altitude (sedation overdose, obesity, scoliosis, myasthenia gravis, sleep apnea)
Hypoxemia due to elevated A-a gradient?
V/Q mismatch (pneumonia, COPD, pulmonary embolism), diffusion limitation (hyaline membrane formation, ARDS), right–>left shunt (congenital abnormalities)
What 3 microbes have vaccines to polysaccharide capsule antigens?
S. pneumo, H. flu type B, and N. meningitidis.
What are the live attenuated vaccinations?
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!
What are the inactivated/killed vaccines?
humoral immunity. Cholera, HAV, polio (salk IM), influenza (IM), rabies
SalK = Killed
RIP HAnah
What are the toxoid vaccines?
tetanus and diphtheria
Recombinant vaccines?
HBV (HbsAg) and HPV (6, 11, 16, 18)
Odds ratio equation?
ad/bc
What is Shaken Baby Syndrome?
subdural hematoma + bilateral retinal hemorrhages
Why are ACE inhibitors contraindicated in renal artery stenosis?
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.
What is congenital torticollis?
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
How does the skin change in normal aging?
thinning of dermis and epidermis with flattening of the dermoepidermal junction, decreased fibroblasts, reduced synthesis and increased breakdown of collagen and elastin fibers
What is presbyopia?
loss of elasticity and sclerosis of the lens leading to decreased accomodation. In the elderly
Where do the leads for a pacemaker go?
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
Which muscle bands contain only thick filaments?
Thick filaments = myosin and are located in the H band.
Which muscle bands contain only thin filaments?
thin filaments= actin. I band
What happens to the FRC in restrictive lung disease?
FRC decreases
Which 3 neurotransmitters require BH4 and dihydropioterin reductase for their production?
- Phenylalanine to dopamine, NE and Epi
- Tryptophan to melatonin and serotonin
- Arginine to NO
What is an AV malformation?
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)
What does a c-ANCA test look like?
stains the cytoplasm, so can see the bulk of the cell and then organelles appear black
What does a p-ANCA stain look like?
Stains around the nucleus, so many consodilatons are around the organelles. Looks less granular than c-ANCA
What is the course of the ureters?
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.
What is the “on phenomenon”?
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
If on an SSRI, use of what other drugs can cause serotonin syndrome?
tramedol, ondansetron, linezolid, triptans, and antidepressants
Which DNA polymerase excises RNA primers?
DNA pol I (has 5’-3’ exonuclease activity).
What is the main adaptive mechanism that prevents reinfection with the same strain of influenza?
anti-hemagglutinin antibodies
CA-125 is a marker of?
Ovarian cancer
Pickwickian Syndrome?
Obesity hypoventilation syndrome. Hypoventilation of the lungs ALL THE TIME. Chronically elevated PaCO2 and depressed PaO2.
What are some common lab finidngs due to chronic hypoxia?
polycythemia, pulm hypertension, right ventricular failure (can’t pump against high pulm pressures)
What are chemoattractants for neutrophils?
n-formylated peptides, leukotriene B4, 5-HETE, C5a
What is a lacunar infarct?
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
What are lipohyalinosis and microatheromas?
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
What is the first step in atherosclerosis development?
Repetitive endothelial cell damage
What can be treated using botulinum toxin?
facial wrinkles, relaxes LES in achalasia, MS and Parkinson’s muscle spasms
What causes release of BNP and ANP?
Ventricular hypertrophy and volume overload
What is atypical depression?
leaden fatigue (arms and legs feel heavy), rejection sensitivity (overly reactive to criticism), mood reactivity (respond positively to good things). Treat with MAOIs
Common complication of gallbladder hypomotility?
Biliary sludge formation. Made of cholesterol monohydrate crystals, calcium bilirubinate, and mucus. Precursor to stone formation.
COmmon causes of HIV-associated esophagitis?
Candida > CMV, HSV
Candida: grey/white pseudomembranes
CMV: linear ulceration, intranuclear and intracytoplasmic inclusions
HSV: punched out ulcers, intranuclear inclusions (cowdry A bodies)
What should you worry about if
What is the only muscle of the tongue not innervated by the hypoglossal?
palatoglossal, CN X
A test that is reproducible and consistent is defined as?
Precision or Reliability
A test that measures exactly what it is supposed to measure, no systemic error is called?
Validity or Accuracy
What tumor stains red with congo red, has polygnol and spindle shaped cells, and surrounded by an amyloid stroma?
Medullary carcinoma of the thyroid
What is the first line drug treatment in a patient with coronary artery disease, heart failure, and HTN?
cardioselective beta blockers
What is the first line medication for essential HTN in the general population?
hydrochlorathiazide
What brain tumor has calcified, cystic tumors in children that are derived from rathke pouch?
Craniopharyngiomas
Equation for RBF?
RPF/1-Hct
What does a VSD murmur sound like?
Harsh, holosystolic that is accentuated with handgrip (inc afterload therefore more blood is pushed through the VSD). Best heard in tricuspid area
What metabolic reactions take place exclusively in the mitochondria?
B-oxidation of fatty acids, ketogenesis, citric acid cycle, parts of the urea cycle (CPS-1 and ornithing transcarboxylase), and pyruvate carboxylation
In what organelle does the HMP shunt (pentose phosphate pathway) take place?
cytoplasm
Adverse effects of digoxin?
Cholinergic effects, bradycardia, blurry yellow light, dec QT, scooping, inverted T wave, prolonged PR, arrhythmia and hyperkalemia
Which nitrate drug has nearly 100% bioavailability when taken orally?
isosorbide dinitrite even though it undergoes extensive first pass metabolism at the liver, it is converted into and active metabolite isosorbide-5-mononitrate
What are the findings in drug-induced interstitial nephritis?
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.
What is the function of Rb?
Active= hypophosphoylated and prevents the cell from progressing form G1–>S
What 2 situations can cause hyperosmotic volume contraction?
DI and profuse sweating, lose hypotonic solution
What is lactulose used for?
to treat hepatic encephalopathy
Does 2,3-BPG increase or decrease Hb affinity for O2?
decreases affinity, therefore shifts the curve to the right
What causes amenorrhea in patients with anorexia?
Fat levels in the body become so low that there is no long pulsatile GnRH release from the hypothalamus.
What congenital disorders are associated with low AFP?
Down Syndrome Trisomy 21
What congenital disorders are associated with high AFP?
neural tube defects, multiple gestations, and abdominal wall defects (gastrochosis)
What are the steps in an acid fast stain?
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
What are the differences in the cell walls between gram + and gram -?
Gram + : large peptidoglycan layer. Contains lipotechoic acid. No outer membrane. Stains purple.
Gram - : small peptidoglycan layer with an outer and inner membrane. Stains pink.
What color is the trachea on CT?
Black! helps to distinguish from the esophagus
In the thorax, what are the landmarks for the esophagus?
Posterior to the trachea and anterior to the vertebral bodies
What is the major determinant of prognosis in urothelial carcinoma?
tumor penetration of the bladder wall (involvement of muscular layer- this is called the rumor stage)
What are the steps of mycobacterium pnemo infection?
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.
What is the action of niacin?
decreases VLDL production in the liver, upregulates HDL synthesis. Side effects: flushing
How do statins work?
Statins downregulate HMG-CoA reductase, and therefore upregulates LDL receptors to take up more LDL from the blood, effectivley lowering serum levels.
What are the major side effects of amphotericin B?
renal toxicity! Can lead to hypokalemia and hypomagnesia
What diseases are assocaited with a delayed closing of PDA?
prematurity, perinatal distress, congenital rubella, and fetal alcohol syndrome
How do NSAIDs and Indomethacin close a PDA?
Prevent the synthesis of PGE1 which keeps the PDA open
What nerves does an upward jerking of the arm cause damage to?
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
Which kidney stones precipitate at high pH?
Ammonium magnesium phosphate and calcium phosphate. Both say phosphate in them!!
Which kidney stones precipitate at low pH?
Calcium oxalate, uric acid, cystine stones
Where does uric acid precipitate in the kidney tubules?
in the distal tubules or collecting ducts because that is where the pH is super low.
In the liver, ovaries, and seminal vesicles, what is sorbitol broken down into?
sorbitol dehydrogenase breaks sorbitol down to fructose
What nerve and artery are damaged if there is a surgical neck of the humerus fracture?
axillary nerve and posterior circumflex artery
Midshaft fracture of the humerus will damage what nerve and artery?
radial nerve and deep brachial artery
Distal humerus/cubital fossa fracture will damage what nerve and artyer?
median nerve and brachial artery
What is coronary steal syndrome?
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.
What are the most important genetic determinants of type I DM?
HLA-DQ and DR (DR3 and DR4)
In osteoporosis, what are the serum levels of PTH and calcium?
They are normal!!!
Key features of Ataxia telangiectasias?
ataxia, telangiectasias and sinopulmonary infections.
Levels of what electrolytes do thiazides decrease?
lower serum potassium, serum sodium, and blood pressure
What is the only non-enveloped, ssDNA virus?
Parvoviridae family. Parvovirus B19 causes erythema infectiosum (fifth disease) aplastic crisis in sickle cell and hydrops fetalis
What is the initiating disorder in Paget’s disease?
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.
Where is the systolic reduction in coronary blood flow the greatest in the heart?
subendocardial myocardium
What is B-glucuronidase?
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.
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?
p-value will be less than 0.05.
What is the main side effect of doxorubicin?
Dose-dependent dilated cardiomyopathy. First get swelling of the sarcoplasmic reticulum and then get death of the myocytes “myofibrillar dropout”
What type of antibiotic is streptomycin?
aminoglycoside that inhibits the 30S subunti.
Which of the HIV structural genes is glycosylated?
*env * is glycoslyated to gp160 and then proteolytically cleaved into gp120 and gp41 in the ER.
Function of gp120?
modulated viral absorption by binding to CD4 receptors.
function of gp41?
transmembrane protein that noncovalently anchors gp120, mediating fusion between viruses or cells
What stabilizes secondary structure of a protein?
Hydrogen bonds. Secondary structure include alpha and beta pleated sheets
What mediates the tertiary structure of a protein?
ionic bonds, hydrophobic interactions, hydrogen bonds and disulfide bonds. Tertiary structrue is the overall shape that a single polypeptide assumes following folding.
2nd most common brain tumor in children and the 1st most common malignant tumor in children is?
Medulloblastoma
What is the 3rd most common brain tumor in children?
ependymomas
What does migratory thromboembolisms make you think?
Cancer of the pancreas, colon, or lung. Adenocarcinomas produce a thromboplastin-like substance which makes the blood hypercoaguable.
What do the parasympathetic fibers of CNIII innervate?
iris sphincter and ciliary muscle (pupil constriction and accomodation)
Weakness in what muscle causes ptosis?
levator palpabrae which is innervated by CNIII
What is are the pressures in the 4 chambers of the heart?
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)
What is the intrapleural pressure at FRC?
-5 cm H2O
What is the intrapleural pressure while inhaling?
-7cm H2O
What is deposited in gout that has negative birefingence?
monosodium urate
What does negative birefingence mean?
when the crystals are parallel to the slow ray, they appear yellow. When perpendicular, they appear blue.
Which GI ulcers are most commonly associated with increased risk of carcinoma?
esophageal, gastric, and colorectal cancers
Is an ulcer of the duodenum likely to become a carcinoma?
NO!
How does amifostine work?
cytoprotective free radical scavenging agent used to decrease the cumulative nephrotoxicity associated wtih platinum-containing agents like cisplatin
What is the difference between epinephrine and glucagon’s actions on different organs?
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
What pathogens are most common for secondary bacterial pneumonia (after influenza)?
- S. pneumo
- S. aureus
- H. flu
Where does the left kidney lie?
immediately deep to the tip of the 12th rib on the left
What are some characteristics of Klebsiella pneumoniae?
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.
What is on the 3’ end of tRNA?
3’CCA molecule
What do the D-arm and T-arm of tRNA contain?
D-arm: dihyrouracil residues
T-arm: thymidine, pseudouridine, and cystidine.
*tRNA is the only RNA molecule to contain thymidine
If multiple ulcers, ulcers refractory to therapy, or ulcers in a weird location (distal duodenum), what should you be thinking the patient has?
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.
Where do peptic ulcers tend to be found?
in the stomach or the first part of the duodenum
What are the findings in chronic organ rejection?
obliterative intimal thickening, tubular atrophy, and interstitial fibrosis.
How does chronic renal failure tend to present?
worsening hypertension, progressive rise in serum creatinine, and proteinuria. Thought to be due to low grade cellular and humoral responses directed against alloantigens.
What are the major symptoms of scalded skin syndrome?
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.
In the respiratory tract, what structures are stratified squamous epithelium?
oropharynx, laryngeopharynx, anterior epiglottis, upper half of the posterior glottis, and vocal folds (true vocal folds). The rest has pseudstratified, columnar mucus secreteing epithelium
What determines the length of action of succinylcholine?
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
What happens if neostigmine is administered to during phase 1 depolarization of succinylcholine?
will actually prolong the time period of depolarization, will NOT reverse it
How does nitroglycerin work?
Primarily a venodilator that decreases preload and decreases myocardial O2 demand, thereby treating angina pectoris
What is hyaline arteriolosclerosis seen in?
Diabetes and long-standing HTN. Can produce glomerular scarring leading to chronic renal failure.
What is Hyperplastic arteriolosclerosis seen in?
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’
What causes claudication?
atherosclerosis of larger vessels.
What is an atheroma?
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
Case fatality equation
fatal cases/ total causes
Why are men with cystic fibrosis infertile?
Have thick sperm secretions and **absent vas deferens bilaterally. **Absent sperm.
Do stop codons code for an amino acid?
No. Instead a release factor binds and promotes separation of ribosomes-mRNA complex and polypeptide
What is the first line treatment for essential tremor?
Primidone and B-blockers (propanolol)
What is the function of primidone?
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.
What is the most common obstructive lesion in females?
imperferate hymen
What are symptoms of an imperforate hymen
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.
What lipid-lowering agent increases TG levels?
bile acid resins (cholestyramine)
What are the steps in adenoma-carcinoma sequence?
APC mutation, K-ras mutation, p53 mutation and increased COX then allow for progression to a carcinoma.
What can impede progression of a adenoma to a carcinoma?
aspirin
What is the half life / elimination equation?
t(1/2)=(Vd x ln 2)/CL
ln2 = 0.7
How do you differentiate between partial and complete central DI?
Complete–add vasopressin and increase osmolarity of urine by 50%
Partial–less than 50% (usually like 10%)
If a mother has HBV, what will the symptoms be in the child?
high viral replication, high risk of chronic infection, and mildly elevated markers of liver injury. High risk of developin HCC
If someone has a super high fever, what is the most important first treatment?
cooling, cold blankets. Take effect immediately. then treat with antipyretics which will also help but take a little more time to kick in.
What syndrome results from superior sulcus tumor?
Horner Syndrome
What syndrome results from a mediastinal mass?
Superior vena cava syndrome
What enzyme has 5’ to 3’ exonuclease activity?
DNA pol I (removes RNA primer)
What enzyme has a 3’ to 5’ exonuclease
DNA pol III
What disease results from a missense mutation?
Sickle cell
What disease results from a frameshift mutation?
Duchenne muscular dystrophy
Eukaryotic DNA pol alpha?
lagging strand and primer
Eukaryotic DNA pol beta and epsilon?
repair DNA
Eukaryotic DNA pol gamma?
mDNA
Eukaryotic DNA pol delt?
leading strang DNA
What disease can be a result of alternative splicing gone wrong?
Beta thalassemia
Is phosphorylated Rb active or inactive?
Inactive. Hypophosphylate Rb does not allow the cell to progress from G1-S until the cell has fixed any mutations in DNA etc.
Free ribosomes make what type of proteins?
cytosolic proteins
I cell disease?
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
What does mannose-6-phosphate on a vesicle normally signal?
Directs vesicle to the lysosomes
What does the peroxisome do?
catabolism of very long chain fatty acids, branched chain fatty acids and amino acids
Proteosome function?
degrades damaged or ubiquitin-tagged proteins. (mutations in this process might have something to do with Parkinsons)
What drugs act on microtubules?
Microtubules Get Constructed Very Poorly
Mebendazole, Griseofulvin, Colchicine, Vincristine/Vinblastine, Paclitaxel
Dynein and kinesin? anterograde or retrograde?
Dynein–> retrograde to microtubule (+ to -)
Kinesin–> anterograde to microtubuel (- to +)
What can be caused by Kartagener syndrome?
Primary ciliary dyskinesia. dynein arm defect Increased risk of ectopic pregnancy,m bronchiectasiss, recurrent sinusitis, and situs inversus
What does vimentin stain for?
connective tissue
What does desmin stain for?
Muscle
What does Cytokeratin sstain for?
epithelial cells
What does GFAP stain for?
neuroglia
What does neurofilaments stain for?
neurons
What is the difference in function between microtubuels and intermediate filaments?
microtubules–movementn
intermediate–structure
What does Ouabain inhibit?
binds K+ site and inhibits APTase
What disease has impaired type I collagen production
osteogenesis imperfecta
What is the mutation in ethlers-danlos?
type III collagen mutation
Menkes disease?
Imparied copper absorption. Decreased lysyl oxidase (Cu is a necessary cofactor), results in kinky hair growth retardation and hypotonia
What is the mutation in classical and vascular types of Ethlers-Danlos?
Classic- type V collagen mutation
Vascular–Type III collagen mutaiton
Hypophosphatemic rickets?
Example of X-linked dominant disorder. increased phosphate wasting at proximal tubule. Rickets-like presentation
Myotonic type I?
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
What is the path of the great saphenous vein?
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.
How does parvovirus B19 present in adults?
Presents like rheumatoid arthritis invovling PIP, metacarpal, knee and ankle joints, except unlike RA it can resolve spontaneously
What is the clinical difference between Tay sachs and Nieman-Pick?
Nieman-Pick has hepatosplenomegaly and Tay Sachs does not.
Describe a granuloma formation?
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.
Where does the psoas muscle lie?
Lies laterally to the vertebra. Inferiorly it combines with the iliacus muscle to form the iliopsoas muscle, which functions in hip flexion.
What happens to your scapula if the accessory nerve is paralyzed?
Trapezius is paralyzed and get lateral winging
What happens to your scapula if you get paralysis of the long thoracic nerve?
serratus anterior no longer working and you get medial winging
Describe the action of NO at smooth muscle.
NO activates guanylate cyclase, which increases cGMP levels and activates myosin-ligh-chain phsophatase (MLCP) and dephosphoylates myosin
What is the function of VIP?
increases intestinal loss of chloride in the stool leading to excess loss of accompanying water, sodium and potassium. Also **inhibits gastric acid secretion. **
How does streptomycin inhibit protein synthesis?
Inhibits formation of the intitation complex by binding the 30S subunit and distorting its shape
What are the main effects of dobutamine on the heart?
increases HR, increases contractility, and increases cardiac conduction velocity. Overall, all of these lead to **increased myocardial O2 consumption. **
What is cystinuria?
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.
What drug reduces prostate size?
Finasteride– a 5 alpha-reductase inhibitor
What is paraneoplastic cachexia?
causes anorexia, malaise, anemia, weight loss and generalized wasting due to underlying chronic disease. Mediated by TNF-alpha (suppresses appetitie in the hypothalamus)
What is kussmal sign?
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
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?
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.
What is the main clinical use of nitrites?
Angina and HF, not used for HTN
Is glucokinase or hexokinase associated with maturity onset diabetes of the young?
Glucokinase
What is a common cause of otitis externa in diabetic patients?
pseudomonas (will see granulation tissue and intact tympanic membrane)
Does Fructose-2,6-bisphosphate have a stimulatory or inhibitory effect on PFK-1?
stimulatory – favors glycosis
What type of a receptor and second messenger does glucagon use?
adenylate cyclase associated with increased cAMP
What converts Fructose-6-phosphate to Fructose-2,6-bisphosphate?
Phosphofructokinase-2
When is phosphofructokinase-2 active?
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. **
When is FBPase-2 active?
Fasting state. When fasting there is increased glucagon release, increased cAMP and increased protein kinase A, increased FBPase-2 which favors **more gluconeogenesis. **
What effects do uremic waste products have on clotting?
Uremic waste products inhibit platelet aggregation and adhesion, leading to an increased bleeding time with normal platelet counts, normal PT and normal PTT
What are the two major effectors of anaphylaxis that are released from mast cells?
histamine and tryptase
What is the water volume status in SIADH?
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)
What are the urine and plasma osmolarity in SIADH?
urine osmolarity > plasma osmolarity
How do you treat orotic aciduria?
uridine monophosphate to bypass the mutated UMP synthase (cannot make UMP)
What do the vitelline veins give rise to?
the veins of the portal system
What do the cardinal veins give rise to?
the veins of the systemic circulation
Common complications of varicose veins?
skin ulcerations, poor wound healing, painful *superficial *thrombosis, stasis dermatitis and superficial infections.
Equation for power?
Power = 1-B
Beta (type II error rate) is the probability of concluding there is no difference between groups when one truly exists.
What is the toxic component of LPS?
lipid A
What part of the basal ganglia becomes degenerated in Wilsons Disease?
the putamen
What is nesiritide?
recombinanat form of BNP that is used for treatment of heart failure
What is varenicline?
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.
What is the most common cause of meconium ileus?
Cystic Fibrosis
What is located posterior to the left atrium and the esophagus?
the descending aorta
What does the vagus send parasympathetic autonomic fibers to?
the heart, lungs, and upper GI
What neurotransmitter does the vagus nerve cause secretion of?
ACh at muscarinic receptors in the heart, lungs and upper GI
What is the first line treatment for acute gouty arthritis?
NSAIDs
What is Primary Central Nervous System Lymphoma?
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.
What steps must be taken in baby born to a mother with active HBV infection?
First give infant passive immunization HBIV and then give active immunization with recombinant HBV vaccination
The presence of which HBV marker in the mothers serum suggests high chance of vertical transmission during pregnancy?
HBeAg
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?
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
Are small or large alveoli more likely to collapse?
small alveoli
What is lactic acidosis?
Increased lactic acid due to overproduction or decreased clearance of lactic acid.
What are the treatments for narcolepsy?
amphetamines modafinil
What disorders exhibit mitochondrial inheritance patterns?
MERF, Leber Optic Neuropathy, and MELAS
What disorders are autosomal recessive?
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
What type of breathing (slow, fast, deep, shallow) in restrictive and obstructive lung disease?
Restrictive: rapid, shallow breathing
Obstructive: slow, deep breathing
What is derived from neural crest cells?
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),
What cells in the lung secrete elastase?
macrophages and neutrophils
What enzyme in the kidney inactivates vitamin D?
24-hydroxylase converts 25, hydroxy Vitamin D to 24,25 hydroxy vitamin D (inactive form) when there is excess vitamin D
What drains the scrotum?
superficial inguinal nodes
What visual field do the meyers loops of the optic radiations carry?
info from the lower retina, the upper visual field. Travel through the temporal lobe
What are the main cells that mediate the damage/inflammation in gout?
neutrophils
What would an endometrial biopsy during an ectopic pregnancy show?
Decidualization of stroma w/o embyronic tissue or chorionic villi
What type of diabetes medication is safe to use in pregnancy?
Normal insulin
Why isn’t a vaccine used as prophylaxis for close contact with someone with meningitis?
N. meningitidis type B is the most common, and there is no good vaccine against it
When can you see a dichorionic/diamniotic pregnancy?
days 0-4 of monozygotes, or just dizygotic pregnancy
WHen does cleavage have to occur for a monochorionic, diamniotic pregnancy?
4-8 days
When does cleavage have to occur for a monochorionic, monoamniotic pregnancy?
days 8-12
When does cleavage have to occur for a monochorioic, monoamniotic conjugated twins to occur?
>13 days
What is the empty can test specific for?
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.
What makes HDV a defective viruses?
Requires coinfection or superinfection with HBV because it needs the HBsAg to coat its viral particles so it can infect other hepatocytes
Triad of toxoplasma gondi TORCH infection?
chorioretinitis, hydrocephalus and intracranial calcifications
What is the classic triad of fat embolism syndrome and when would one expect to see this syndrome?
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)
What is used to treat Restless Leg Syndrome?
Pramipexole or ropinirole- non-ergot dopamine agonists
WHat is the most importatnt criteria in determining cancer prognosis?
The stage of the tumor– what structures it involves (only mucosa, involves muscular layer, involves lymph nodes, etc)
What is the grade of the tumor?
How well differentiated the tumor cells are. Not the most important factor when figuring out prognosis
Is myosin phosphorylated or dephosphorylated when contracting?
Crontraction- phosphorylated (myosin-light-chain kinase)
Relaxation- dephosphorylated (myosin-light-chain phosphatase)
Bioavailability equation
F = (AUC oral drug x IV dose) / (AUC IV drug x oral dose)
What genes are contained in the homeobox?
DNA binding transcription factors that alter the expression of genes involved in morphogenesis.
What type of necrosis is seen in the brain?
liquefactive necrosis. Complete digestion and removal of necrotic tissue with formation of a cystic cavity.
What is the triple test and when is it performed?
Measure AFP, hCG and estriol levels during pregnancy. Should be performed between weeks 16-18 of gestation.
What is the most common cause of elevated AFP levels in the absense of congenital abnormalities?
Underestimation of the gestational age
How are genes inactivated in imprinting?
They become methylated
What becomes inflammed in housemaids knee?
the prepatellar bursa, located between the patella bone and the overlying skin and prepatellar tendon
Why are patients with Crohn’s prone to gallstones?
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
What drugs exhibit antimuscarinic side effects?
H1 blockers (1st gen, diphenhydramine), atropine, TCAs, neuroleptics and antiparkinson drugs
What does RNA pol I make?
rRNA – nucleolus
What does RNA pol II make?
mRNA
What does RNA pol III make?
tRNA
How does the inactivated influenza vaccine provide protection?
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
What is a pancreatic pseudocyst?
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
What is a weird way to measure insulin intolerance in diabetic patients?
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
What are the key growth factors that promote angiogenesis?
FGF-2 and VEGF
What provides the major blood supply to the femoral head and neck?
the medial circumflex artery
What are the most common complications of Factor V Leiden?
- DVT (pulm embolism)
- Cerebral vein thrombosis
- Recurrent pregnancy losses
Toxicity of loop diuretics (furosimide)?
OH DANG
Ototoxicity, Hypokalemia, Dehydration, Allergy sulfa, Nephritis (interstitial), Gout
What is the main virulence factor of mycobacterium tuberculum?
Cord factor, demonstrated by its serpentine growth on medium
What is the function of cord factor?
It inactivates neutrophils, damaging mitochondria and inducing release of tumor necrosis factor
How many half lives does it take a drug to reach steady state (95%) and 90% of steady state?
95%= 4-5 half lives
90%= 3.3 half lives
What is the primary histologic finding in eczematous dermatitis?
spongiosis–epidermal accumulation of edematous fluid in the intercellular spaces
What do the lesions look like in osteitis fibrosa cystica (assocatied with primary hyperparathyroidism)?
osteolytic cysts in long bones, subperiostial erosions, and granular “salt and pepper” skull
Is chloride high in concentration inside the cell or outside the cell?
outside the cell
What is the antidote for arsenic poisoning?
dimercaprol
What drug is used to treat infertility associated with PCOS?
clomiphene – antagonist @ estrogen receptors in the hypothalamus
What is on the differential for acquired night blindness?
- Vitamin A deficiency
- toxic retinopathy due to phenothiazines or chloroquine
- congenital rubella, syphilis or other infections
- diabetic retinopathy
What is liver angiosarcoma?
rare malignant tumor of endothelial origin associated with exposure to arsenic and vinyl chloride. Expresses CD31
How is increased SV shown on a ventricular pressure-volume loop?
Increased width of the loop
What is “hibernation” in reference to the cardiomyocytes?
reversible loss of contractile function due to repetivitive ischemia of cardiac myocytes or persistant hypoperfusion. Reverse with reperfusion.
What effect does too much ammonia have on the astrocytes?
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
What kind of inflammation is seen in Guillan Barre?
endoneural inflammatory infiltrate
What is the only disease that has pretibial myxedema, exophthalmos, periorbital edema, and eye movement limitations?
Graves’
How do you treat loss of consciousness due to hypoglycemia in the hospital vs. nonmedical setting?
nonmedical–IM or SQ glucagon
medical–IV dextrose
Why can’t you start an SSRI until 2 weeks after discontinuing an MAOi?
Need to give sufficient time for the cells to replenish MAO, which is inhibited by MAOi’s. Otherwise patient may go through serotonin syndrome
Which cancers have a BRAF mutation?
melanoma and papillary carcinoma of the thyroid
How many calories does 1g of protein/carbohydrate, fat, and ethanol yield?
protein/carb=4 cals/g
fat=9cals/g
ethanol=7cals/g
What is the mode of inheritance of NF1&2?
autosomal dominant
What drug slows the progression of diabetic nephropathy?
ACEi
What is the histologic appearance of a carcinoid tumor?
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
What are the most common locations of carcinoid tumors?
- ileum
- appendix
- rectum
Why is dietary fructose metabolized the quickest out of the dietary sugars?
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 )
What makes the liver black in Dubin-Johnson syndrome?
epinephrine metabolites within lysosomes
What predisposes a patient to disseminated candidiasis infections?
Neutropenia and inherited impairments in phagocytosis
What is the main muscle involved in the valsalva maneuver?
rectus muscle
What is the treatment for a SVT?
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
What reactions require NADPH?
glutathione reduction in RBCs, fatty acid and cholesterol biosynthesis (reductive reactions)
What is wet age-related macular degeneration?
rapid loss of bision due to bleeding due to choroidal neovascularization caused by VEGF. WIll show a gray/greenish subretinal membrane
How do you treat wet age-related macular degeneration?
anti-vascular endothelial growth factor (ranabizumab and bevacizumab)
What is dry age-related macular degeneration?
deposition of yellowish extracellular material and and beneath Bruch membrane with drusen. gradual vision loss. Tx multivitamen and antioxidants
What is ergonovine?
ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha-adrenergic and serotinergicr receptors. Used to test for Prinzmetal’s angina.
When will a patient most commonly report symptoms if they have Prinzmetal’s angina?
at rest during the night or early morning hours
What lung diseases cause digital nail clubbing?
bronchiectasis, empyema, Cystic fibrosis, lung cancer (large cell), TB, pulm HTN, and others that induce hypoxia
What heart diseases cause digital clubbing?
the 5T’s congenital heart diseases, bacterial endocarditis
What is seen on histology of urticaria (hives)?
dermal edema and lymphatic channel dilation
What is the virulence factor for salmonella that prevents it from being opsonized?
Vi antigen
Why are sickle cell patients more prone to infections with encapsulated bacteria?
They have functional asplenia due to vaso-occlusive reactions that cause infarctions in the spleen.
Which group of antiarrhythmics are use-dependent and rate-dependent?
IC antiarrhymics– block Na+ channels that are firing at a faster heart rate. Therefore they prolong QRS interval more @ high heart rates.
Which class of antiarrhythmics exhibit reverse use-dependence?
class III antiarrhtyhmics. The slower the heart rate, the more prolonged the QRS complex.
What is the first line treatment of PCOS hirsutism?
OCPs
How do OCPs prevent excessive hair growth in PCOS?
OCPs prevent release of LH from the pituitary, which decreases overall androgen production.
What are the phases and ion permeability present in a pacemaker action potential reading?
Phase 0= upstroke, permeable to Ca2+
Phase 3= downstroke, permeable to K+
Phase 4= slow depolarization, permeable to Na+
What is reperfusion injury due to?
- Secondary to free radical damage
- mitochondrial damage
- inflammation
(ultimately due to membrane damage)
What is the most common injury in an acceleration-deceleration car accident?
Tearing of the ligamentum arteriosum which tethers the aortic isthmus to the pulmonary tree.
What amino acids are safe to supplement a child with pyruvate dehydrogenase deficiency?
lysine and leucine, which are the only ketogenic amino acids only
What effects can niacin have on dosing of hypertensive and diabetic drugs?
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.
Where does S. aureus commonly colonize?
the nose
What study uses an exposure odds ratio?
case-control study
What study uses a prevalence odds ratio?
Cross-sectional study
What study uses relative risk measure?
Cohort study.
What is the shine dalgarno sequence?
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.
Why are beta-oxidation blockers thought to be beneficial in stable angina?
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.
Rh antibodies are what class?
IgG
Blood type antibodies are what type of immunoglobulin?
IgM (do not cross the placenta)
Does having a high or low BMI predispose to osteoporosis?
low BMI
What race is least likely to get osteoporosis
African Americans
How do estrogen and progesterone affect gallstone formation?
estrogen increases cholesterol synthesis and progesterone causes gallbladder hypomotility.
What neuropeptides are most commonly lacking in narcolepsy?
hypocretin-1 (orexin A) and hypocretin-2 (orexin B)
What does S-100 tell you about the origin of a cell?
+ if the cell has mesodermal origin
what is rituximab’s MOA?
monoclonal antibody against CD20
What is a toxicity of rituximab?
inc risk of progressive multifocal leukencelphlopathy
What is injured in the unhappy triad?
ACL, MCL and medial meniscus
What type of growth is responsible for long bone growth? What type of growth is responsible for flat bone growth?
Long bone growth- endochondral ossification
Flat bone growth- membranous ossificaiton
What do the lumbricals do?
flex at the MCP joints and extend DIP and PIP joints
Lesion to what nerve gives a winged scapula? What muscle does this nerve innervate
long thoracic nerve– innervates the serratus anterior
What is the tetanus vaccine?
tetanus toxoid which induces humoral immunity specific to the tetanus toxin
Why are calcium oxalate stones common in Crohn’s Disease?
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.
What is the main insult/pathology in ARDS?
diffuse alveolar damage to the endothelial cells (no alveolar destruction)
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?
Globus Hystericus
Excess amounts of what vitamin can be teratogenic? What can it cause?
Vitamin A: causes microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, spontaneous abortion
What cytokines are secreted from ALL T cells?
IL-2, IL-3
What cytokines are secreted from TH1 cells?
IFN-gamma
What cytokines are secreted from TH2 cells?
IL-4, IL-5, IL-10
What structure is most likely to be damaged in a posterior or anterior dislocation of the knee?
popliteal artery
What is the most common cause of endometritis?
bacteroides
What is sublimation?
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)
After a kidney transplant, does the GFR return to normal? (immediately after surgery vs. 6 weeks later)
immediately after surgery= 50% of normal GFR
6 weeks after surgery= 80% of normal GFR
How long do patients need to experience symptoms for them to be considered to have PTSD?
need to have symptoms for at least 1 month
(acute stress disorder= lasts less than a month)
Equation for relative risk?
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)
Equation for number needed to treat (NNT)?
NNT=1/ARR
(ARR= risk of developing disease in intervention - risk of developing disease in control group)
What are the characteristics of a transudate?
Low protein, and low LDH
What is the MOA of oseltamavir?
inhibits neuraminidases of influenza A and B
In the salivary glands, how is saliva modified before it is secreted?
Na and Cl are reabsorbed while K+ and HCO3- are secreted.
What is the equation for false positive rate and false negative rate?
false + rate= 1 - specificity
false - rate= 1 - sensitivity?
In what anemia disorder is the osmatic stability increased in the RBC?
sickle cell disease
What are the metabolic changes associated with DKA?
metabolic acidosis, hyponatremia, hyperkalemia, hyperglycemia, ketonemia. (hyponatremia due to osmostic pull of glucose in the urine leads to inc urine release)
What is the half life, total time of single dose, and what type of an inhibitor are phentolamine and phenoxybenzamine?
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.
What is a common, fatal injury common in premature/low birth weight infants within a few days of being born?
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)
What is the function of palmitoylnation?
it increases the hydrophobicity of the protein.
How does nitroglycerin affect heart rate and ESV?
inc HR (tachy) and dec ESV
What is an SRP?
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
What cells make androgen binding protein, and what is its function?
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.
What uterine ligament runs through the inguinal canal?
the round ligament
What does safranin O stain?
cartilage, mast cell granules, and mucin. Stains them red.
What causes “red-man syndrome” in vancomycin treatment?
If vancomycin is administered too quickly, then it can cause widespread histamine release. This is NOT AN IgE MEDIATED ALLERGIC REACTION.
What does the ventral pancreatic duct give rise to?
Main pancreatic duct and pancreatic head
Where on the arm does injury occur in nursemaids elbow?
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.
What muscles/actions does the obturator muscle innervate?
innervates the hip adductors.
What is the outcome for most patients with HCV?
Most develop stable chronic hep. Less than 1/2 develop cirrhosis and 0-3% develop HCC
If the absense of ADH, where in the tubules will the fluid have the highest osmolarity?
End of the descending loop of Henle.
What is the p-value? What affects the p-value?
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)
What 4 syndromes are a result of hypertensive arteriolosclerosis of the internal capsule?
- Pure motor
- Pure sensory
- Ataxia-hemiplegia syndrome
- Dysarthria-clumsy hand syndrome
What part of the internal capsule is affects in a pure motor hemiparesis?
posterior limb, or basal pons
What part of the itnernal capsule is affected in a pure sensory?
ventroposterolateral/medial of the pons
What part of the internal capsule is affected in ataxia-hemiplegia syndrome?
posterior limb of internal capsule
What part of the internal capsule dysarthria-clumsy hand syndrome?
genu of internal capsule or basal pons
What is the most common cause of a lacunar infarct?
chronic hypertension.
Which part of the stomach is affected in type A (autoimmune) chronic gastritis and in type B (H.pylori) chronic gastritis?
Type A autoimmune- body of the stomach
Type B H. pylori- antrum of the stomach
At which receptors does isoproterenol work?
B1 and B2 agonists (inc contractility of the heart and decreases systemic vascular resistance)
Do fatty streaks occur in the areas where future atherosclerotic plaques will form?
NO
What is deformation?
extrinsic develop destruction that occurs after embryogensis
What is malformation?
Occurs during embryonic period (weeks 3-8) and is an intrinsic disruption (holoprosencephaly)
What are the SGLT-2 inhibitors? What must be monitored before starting one?
canagliflozin and dapagliflozine. They block reuptake of gluocose in the proximal tubules. Must monitor BUN and serum creatinine before initiating treatment
which inhaled anesthetic increases seizure occurance?
Incrases nephrotoxicity?
enflurane - seizure
methoxyflurane - nephrotoxicity
What changes in the genome do the trinucleotide repeats in Fragile X Syndrome cause?
hypermethylation of cytosine bases and inactivation of the FMR1 gene which is required for normal neuronal development. Resulting in mental retardation, etc.
What is Zellweger Disease?
peroxisomal disease where they are unable to form myelin in the CNS. Symptoms include seizures, hypotonia, hepatomegaly, metal retardation, and early death.
What is refsum disease? How do you treat it?
defect in peroxisomal alpha oxidation which leads to a build up of phytanic acid. Treat by restricting chlorophyll in the diet.
What bugs are capible of producing biofilms?
S. epidermidis (prosthetics, catheters)
S. mutans and S. sanguinis (dental plaques)
Pseudomonas (cystic fibrosis pneumonia)
Viridans (endocarditis)
H. flu (non-typeable) (otitis media)
What are some long term sequele of infantile hydrocephalus?
hypertonicity and hyperreflexia due to UMN damage and stretching of the periventricular pyramidal tracts. Can also get visual disturbances and learning disabilities
What two arteries does CNIII course between when it leaves the midbrain?
posterior cerebral artery and superior cerebellar artery
What drug can induce mania in a bipolar patient?
Antidepressantss (TCAs and venlafaxine)
What is DRESS Syndrome?
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
What type of colon polyp can have a cauliflower appearance and cause electrolyte imbalances (hypokalemia) due to secretory diarrhea?
Villious adenomatous polyps
What would a respiratory infection casue in a diabetic patient?
TImes of stress, such as infection, can cause an increase in blood glucose levels causing hyperglycemia.
What is considered a low volume of distribution?
Vd of about 3-5L
What is a C1 esterase inhibitor deficiency? What medication is contraindicated in this deficiency?
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.
What substance accumulates in hepatocytes in HBV infection?
sphere and tubules of HBsAg accumulates in hepatocytes causing a granular, eosinophilic appearance known as ground glass appearance.
Where do the different branches of CNV exit the brain from?
Standing Room Only
Superior orbital fissues - CNV1
Foramen Rotundum - CNV2
Foramen Ovale - CNV3
In what phase is the oocyte arrested after ovulation?
Metaphase of meiosis II. Continues after fertilization.
Which type of breast cancer has pleomorphic cells with areas of central necrosis?
Comedocarcinoma (subtype of DCIS)
Most common location of colorectal carcinoma?
Rectosigmoid> ascending>descending
Diastolic heart failure presents with what changes in EDV, EDP and EF?
Normal EDV and EF
Increased EDP
What is transduction?
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)
What is transformation?
direct uptake of naked DNA from the environment by competent bacteria (S. pneumo, H. flu, Neisseria spp.)
How does timolol treat glaucoma?
dec production of aqueous humor from the ciliary epithelium (beta blocker)
What 2 neurodegenerative d/o have alpha-synuclein inclusions?
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)
What is metoclopramide?
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
Time frame and sxs of Schizoaffective d/o?
at least 2 weeks of stable mood with psychosis. Also need to have a major depressive, manic, or mixed episode.
Difference between bipolar I and II? Tx?
I- at least one manic episode
II- hypomanic and depressive episode
Lithium, valproic acid, carbamazepine, + atypical antipsychotic
Which way do your eyes look if you have a lesion to your PPRF? What about FEF?
PPRF= away from the lesion
FEF= toward the lesion
What is phenotypic mixing?
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.
What is the main cause of valvular calcifications seen in an elderly patient who is pretty healthy?
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.
MOA of oseltamavir?
inhibit influenza neuraminidase, decreasing the release of progeny virus.
What is the most common cardiac manifestation in lupus?
pericarditis
Describe the effects of nitroprusside?
Dilates arteries and veins, so dec preload and afterload while maintaining stroke volume.
