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Smart Book 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

What causes polyhydramnios?

A

anencephaly and GI obstruction

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2
Q

oral macrocyclic antibioic that has becteriocidal activity and minimal absorption for C. Diff?

A

Fidaxomicin

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3
Q

Bacterial vaginosis diagnostic test?

A

KOH prep (whiff test)

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4
Q

Rifampin - MoA

A

inhibition of bacterial DNA-dependent RNA polymerase

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5
Q

How do alcohols act as disinfectants?

A

Disruption of cell membranes and protein denaturation

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6
Q

Probability that a female sibling of a male affected by an X-linked recessive disease will give birth to an affected child?

A

1/8

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7
Q

Factors required for osteoclast differentiation?

A

M-CSF and RANK-L (receptor for activated nuclear factor kappa B ligand), TGFbeta

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8
Q

Histone acetylase

A

Relaxes DNA coiling, allowing for transcription

“Histone acetylation makes DNA Active”

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9
Q

What are the adverse affects of Clozapine?

A

Agranulocytosis, neutropenia,

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10
Q

Most important thing for making a diagnosis of tetanus?

A

History and physical diagnosis, no toxoid screen is available

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11
Q

How does glucagon function?

A

stimulated G-protein on hepatocytes -> increased cAMP -> protein kinase A -> activates glycogen phosphorylase -> decreases fructose-2,6-bisphosphate levels

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12
Q

Intraductal papilloma- sign, cause

A

blood-tinged nipple discharge, caused by poliferation of papillary cells with a fibrotic core

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13
Q

Vertebral subluxation

A

vertebral malalignment -> can lead to paralysis with decreased or absent reflexes below the level of the compression

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14
Q

Galactokinase deficiency-

A

Cataracts, rarely pseudotumor cerebri

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15
Q

Side effects of Chloramphenicol during pregnancy?

A

“grey” baby syndrome

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16
Q

How to minimize type II errors?

A

Increased number, instrument sensitivity

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17
Q

What happens 2-4 weeks after infections with TB?

A

interferon secretion by activated T-lymphoctes

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18
Q

Painful ulcers on the tongue, gingiva, swollen gums, and certival lymphadenopathy

A

gingivostomatitis- primary infection if herpes simplex virus

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19
Q

Burkitt lymphoma translocation and function

A

t(8:14)

c-Myc a nuclear phosphoroprotein that functions as a transcription activator controlling cell proliferation, differentiation, and apoptosis

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20
Q

Leuprolide-MoA

Pulsitative? Constant?

A

gonadotropin-releasing hormone analog

Pulse-promoted LH and FSH

Chronic- reduces LH, FSH

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21
Q

How do alpha-1 blockers treat BPH

A

Promote smooth muscle relaxation -> increased urine flow through bladder, prostate

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22
Q

What organ produces EPO?

A

Liver

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23
Q

Function of helicase?

A

unwinds the double stranded DNA @ replication fork

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24
Q

Hemoglobin A2

A

alpha2, gamma 2

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25
Q

Shortness of breath soon after MI-pathology? Chronically?

A

Initially- tranudate accumulating in the alveolar lumen

Chronic- numerous hemosiderin-ladened macrophages in alveoli

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26
Q

Myelofibrosis

A

Replacement of the bone marrow by fibrosis -> causes Dacrocytes (abnormally shaped RBCs)

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27
Q

Beta-thalasemia minor vs major

A

Minor increased HbA2, lower Hb A

Major, no HbA, very high HbA2

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28
Q

What dopmine pathway supplies the pituitary?

A

Tuberoinfundibular

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29
Q

Drugs that will improve survival in patients with heart failure

A

Beta blockers (carvedilol, metropolol), ACE-I, ARBS, aldosterone antagonists

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30
Q

Confounding

A

exposure-disease relationship is muddled by the effect of an extaneous factor assoicated with both exposure and disease

“kids with bigger shoe sizes have higher IQ’s, however, it is a difference in age.

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31
Q

What other findings are associated with alchohol induced acute pancreatitis?

A

Mean corpuscular voluume of 108 fl, think folate deficiency

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32
Q

What are the retroperitoneal structures?

A

SAD PUCKER

Suprarenal

Aorta and IVC

Duedenum (except 1st part)

Pancreas (head and body)

Ureters

Colon (Ascending & descending)

Kidneys

Esophagus

Rectum (mid-distal)

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33
Q

Side affects of antidepressents?

A

induction of mania, especially if family history is positive

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34
Q

Etoposide-MoA

A

targets topoisomerase II, transient breaks in both strands (positive and negative supercoiling), vs, 1, which only nick single strand (negative supercoiling

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35
Q

Lysyl Oxidase

A

strengthens extracellular collagen fibers by mediating cross-link formation

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36
Q

What nerves can be affected by cerebellopontine angle schwannomas?

A

CN VII, CN V, CV VIII

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37
Q

How to hypertriglycerides cause acute pancreatitis?

A

Triglycerides > 1000 mg/dL exceeds binding capasity of albumin -> direct injury to pancreatic acinar cells

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38
Q

Permissiveness

A

One hormone allows another to exert its maximal effort

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39
Q

What affect do granulomatous diseases have on calcium?

A

Granulomatous disease increase PTH-conversion due to expression of 1-alpha-hydroxylase on activated marcophages

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40
Q

How do tumor cells develop resistance to chemotherapy?

A

multidrug resistance 1 gene- APT-dependent efflux pump

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41
Q

Budding yeast with thick capsule-systemic risk?

A

meningoencephalitis

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42
Q

Palpable gallbladder and extensive calcification? Risk?

A

Porcelain gallbladder, increased risk for chronic cholecystitis

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43
Q

Severe fatique, splenomegaly, bone marrow fibrosis? Receptor?

A

STAT/JAK2, primary myelofibrosis

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44
Q

McCune-Albright syndrome

A

GNAS gene encoding stimulatory alpha subunit og G protein, cafe-au-tait spots, endochrine abnormalities, fibrous dysphagia

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45
Q

Signs of hypercalcemia

A

mental status changes, muscle weakness, constipation, polyuria/polydipsia, and dehydration

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46
Q

optimal site for femoral nerve block?

A

Inguinal crease at the lateral border of the demoral artery

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47
Q

Signs of Bell’s palsy?

A

Sudden onset of unilateral facial paralysis (impaired eye closure, eyebrow sagging, inabilty to smile, disappearance of the nasolabial fold)

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48
Q

cause of calcium deposits in acute pancreatitis?

A

digestion of adipose cells by lipase -> fatty acids that bind calcium salts

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49
Q

What type of defect in pyloric stenosis?

A

Primary developmental defect

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50
Q

What cells are derived from neural crest cells?

A

MOTEL PASS

Malenocytes, odontoblasts, tracheal cartilage, enterochromaffin cells, laryngeal cartilage, parafollicular cells fo the thyroid, adrenal medulla and all ganglia, scwann cells, and spiral membrane

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51
Q

Exposure odds ratio

A

Compared odds of exposure of people with the disease to those without

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52
Q

Fever, cough, rhinorrhea, conjunctivitis in an unvaccinated child

A

Think measles, also develop a maculopapular exanthem (vesicular rash) that starts on face and spreads down

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53
Q

How can you reduce apoptosis due to folic acid deficiency?

A

supplement with thymidine, to increase dTMP production

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54
Q

Diffuse, medium-sized lymphocytes and a high poliferation index

A

EBV

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55
Q

Enlarged cells with intranuclear inclusion

A

CMV

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56
Q

Where does deep brain stimulation for parkinson’s disease work?

A

globus pallidus internus or subthalamic nuclei -> thalamo-cortical disinhibition

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57
Q

Myelinated myelinated afferents

A

Pain, temp, sensory

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58
Q

How to you treat mild hypoglycermia?

A

Seetened fruit juice

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59
Q

Clusters of gram-positive cocci on gram stain suggests?

A

Staphylococcal species

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60
Q

Enzymes inhibited by lead

A

Ferrochekatase and delta-aminolevulinic acid -> elevated zinc protoporphyrin

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61
Q

What enzyme inactivated 6-MP? activates?

A

Inactives- Xanthine Oxidase

Activates - HGPRT

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62
Q

How is glucose transported into cells?

A

Facilitated diffusion -> preferential for D-glucose

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63
Q

Acquired thrombocytopenia

A

epistaxis, ecchymoses, marked thrombocytopenia

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64
Q

Taxols-MoA

A

Hyperstabilize microtubules in M phase so miotic spindles cannot break down

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65
Q

Social anxiety disorder

A

marked anxiety about more than 1 situation for longer than six months

Fear of humiliation/embarrassment

Sociation situations are avoided, or endured with intense distress

Marked impairment

Tx-SSRI, SNRI, beta blocker (performance-only)

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66
Q

Signs of meurocysticercosis?

A

South and Central America

Presents with seizures

Diagnosis CT/MRI- cysts, scolex

Tx- albendazol

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67
Q

Signs of lead poisoning?

A

Long-standing behavioral problems, developemental delay/regression, financially-restricted in deteriorating human houses prior to 1978

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68
Q

tingling, difficulty concentrating, recurrent episodes of nonspecific abdominal pain? Cause? Treatment?

A

Acute intermittent porphyria, caused by porphobilinogen deaminase deficiency

Tx- infuse hemin, which downregulated hepatic aminolevulinate synthase or glucose

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69
Q

Keratoses- tranformation

A

Invasive squamous cell carcinoma

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70
Q

erythema, scaling, and subsequent hyperpigmentation

A

Xeroderma pigmentosum -cause by a decreased ability to repair DNA following damage by UV light

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71
Q

Risk with Familyial chylomicronemia syndrome (type 1)

A

Acute pancreatitis, lipemia retinalis, eruptive skin zanthomas, hepatosplenomegaly

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72
Q

Smooth muscle cells in the afferent renal flow

A

Guxtaglomerular apparatus cells (macula densa and JG cells)

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73
Q

Subacute sclerosing panencephalitis?

A

Cause by absent matrix protein, causes accumulation of viral nucleocapsid within neurons -> inflammation, gliosis

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74
Q

INF-gamma release assays?

A

Test for latent T-B infections by measure the tesponse to

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75
Q

Hyperplastic arteriolosclerosis

A

results from diastolic pressures > 120-130 mm Hg, presents as onion-like concentric thickening of the walls of the arterioles due to laminated smool muscles cells and reduplicated BM

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76
Q

Axonal reaction signs?

A

cellular edema (rounded cell), niddl substance becomes fine, granular and dispersed throughout cytoplasm

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77
Q

When someone has desires about a physician, what should you do?

A

Ask a chaperone to join them

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78
Q

How does right ventricular myocardial infarction present?

A

hypotension, elevated jugular venous pressure and clear lungs

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79
Q

When does aortic stenosis occur in patients with a bicuspid aortic valve?

A

> 50 years of age

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80
Q

Folinic acid, alternative name?

A

Leucovorin

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81
Q

Stem cells fo the lungs?

A

Type 2 pneumocytes

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82
Q

Phentolamine-MoA

A

Alpha receptor blocker, counteracts an alpha agonist

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83
Q

How does end-organ hypoperfusion lead to lactic acidosis?

A

decreased tissue oxygenation -> decrease oxidative hosphorylation -> increased NADH -> shunting of pyruvate to latate

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84
Q

hemiballism

A

flinging of the limbs

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85
Q

Mutation that causes paroxysmal nocturnal hemoglobinuria?

A

PIGA -> synthesize GPI anchor protein -> attach CD55, CD59

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86
Q

Cholchicine-MoA, SE

A

inhibits mucrotubular polymerization -> disrupts chemotaxis, phagocytosis, and degranulation

Also reduces the formation of leukotriene B4

SE- nausea, diarrhea

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87
Q

Concentric hypertrophy- sign? Cause?

A

Sign- increased wall thicknesss, myocardial mass, enlarged left atrium

Cause- long-standing hypertension

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88
Q

Polyarteritis nodosa-associations

A

Hepatitis B

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89
Q

Vsalproate - teratogenic affects

A

Neural tube defects

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90
Q

Capitation

A

A payor pays a fixed, predetermined fee to cover all the medical services required by a patient-similar to how a HMO works

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91
Q

Vesciculoulcerative lesions at the enterance to the vagina? Tx?

A

Herpes, tx- acyclovir

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92
Q

Echinocandins-examples, MoA, Use

A

“fungin”

Inhibit cell wall synthesis by inhibiting synthesis of beta-glucan

Use: Invasive aspergillosis, Candida

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93
Q

antibodies that react with the alpha3 chain of collagen type IV? Clincal manifestations?

A

goodpasteur syndrome, hemoptysis, oliguria

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94
Q

What causes an increased ESR?

A

Acute phase proteins -> fibrinogen caues erythrocytes to form stacks (roueaux) that sediment at a faster rate than individual erythrocytes

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95
Q

Warfarin- teratogenic effects

A

nasal hypoplasiaa, stippled epiphysis

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96
Q

Vincristine, MoA

A

Disruption of neuronal microtubules -> stops organelle transport between body and axons (Acts in S phase)

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97
Q

Philadelphia chromosome

A

t(9:22) BCR-ABL (tyrosine kinase activity

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98
Q

how to ACE inhibtors cause hyperkalemia?

A

inhibition of angiotensin II -> decreased aldosterone secretion

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99
Q

Drugs that when combined with ACE-inhibitors can lead to hyperkalemia?

A

Amiloride, triamterene, spironolactone, or K+ supplementation

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100
Q

What can better transition a patient from hospital to home with improved adherence?

A

Checklist

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101
Q

Cushing’s ulcers

A

Elevated ICP -> increased direct vagus nerve stimulation -> Ach release )> hypersecretion of gastric acid

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102
Q

“clasp-knife” spasticity

A

Upper motor neuron lesion -> internal capsule damage (stroke)

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103
Q

Side effects of Statins?

A

Hepatotoxicity, muscle toxicity

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104
Q

What type of receptors are nicotininc receptor?

A

ligand-gated ion channels

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105
Q

Long-term effect of CKD?

A

increased phosphate, decreased calcium -> increase PTH -> osteodystrophy

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106
Q

Signs of tetenus?

A

paroxysmal involuntary muscle contractions involving jaw, neck, and trunk

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107
Q

Signs of esophagus squamous cell carcinoma? Prognosis?

A

dysphagia, fatique, retrosternal discomfort, weight loss

*look for keratin pearls

Prognosis? Poor

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108
Q

HIV-infected patient with sensory atacia and argyll-robertson pupils?

A

Tabes dorsalis, treponema pallidum

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109
Q

Mood symptoms in schizophrenia?

A

Absent

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110
Q

Physiological shunt

A

Area that is well perfused but underventilated

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111
Q

What is the role of CD40?

A

Allow for class switching

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112
Q

Where is the superior gluteal nerve located?

A

Uppermedial portion of butt

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113
Q

Arginase -

A

enzyme that produces urea and ornithine from arginine

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114
Q

Left-sided lesions vs right-sided lesions in the frontal lobe

A

Right- disinhibited behavior

left-executive function

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115
Q

Well-demarcated, scaly erythematous plaques involving extensory surface? Increased risk for?

A

Psoriasis

increased risk for psoriatic arthritis, Inc. risk with HLA-B27

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116
Q

Decreased potassium outflor and resultant prolongation of the action potential, risk of death?

A

Ventricular tachycardia and sudden death

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117
Q

How are triglycerides processed?

A

Colipase displaces bile salts from MiCells, pancreatic lipase attached to the surface and digests the Mucell

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118
Q

Foremen rotundum

A

Maxillary deivision fo the trigeminal nerve

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119
Q

Anti-cardiolipid antibodies

A

Antiphospholipid antibody syndrome -> recurrent venous thrombosis and/or pregnant loss

Can occur with SLE

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120
Q

Where are extended-spectrum beta-lactamase genes located? Alternative Tx?

A

Plasmids, treat with Carbapenems

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121
Q

Foscarnet

A

used for ganciclovir-resistent CMV, can chelate calcium, and renal wasting of magnesemia -> seizure risk

MoA- bind with viral-encoded enzymes: DNA polymerase, RNA polymerase, reverse transcriptase

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122
Q

How does a L-type calcium channel blocker affect skeletal muscle?

A

Extracellular channel is blocked, so no calcium influx into the cell. However, calium influx still occures becuase of the interaction between the l-type Ca2+ receptor and RYR1 receptor

Thus, no affect on skeletal muscle contraction

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123
Q

Cyanide poisoning cs Chronic Blood Loss?

A

Cyanide - normal Oxygen content

Anemia- low oxygen content

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124
Q

Complications of N meningitidis bacteremia?

A

Sepsis (sppoking fevers, chilld, arthralgias) and Waterhouse-Friderichsen syndrome (adrenal gland destruction, DIC, and shock)

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125
Q

Signs of iron deficiency?

A

Plumber-Vinson syndrome, dysphagia, iron deficiency anemia, koilonychia (spoon-shaped nails), shiny red tongie (papillae atrophy)

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126
Q

Hageman factor

A

Factor XII of the clotting cascade

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127
Q

How do you medically treat gallstones when surgery has been declined?

A

Hydrophilic bile acids

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128
Q

Agammaglobulinemia

A

B-cell defects that can manigfest with recurrent sinopulmonary bacterial infections -> no opportunistic infections

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129
Q

Epithelial ovarian cancer signs:

A

ascities, bowel obstruction, ovarian mass

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130
Q

What is the confirmatory test to diagnose Strongyloidiasis?

A

Rhaboitiform larvae in the stool

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131
Q

Effects of high levels of ammonia?

A

vomiting and confusion/coma

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132
Q

What defect allows acute bacterial access to the kidneys?

A

Vesicoureteral reflex

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133
Q

Treatment for restless leg syndrome

A

avoid aggravating factors (alcohol)

Support measures (leg massage

Dopamine agonists (pramipexole)

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134
Q

Signs of decompensated congestive heart failure

A

exertional dyspnea, orthopnea, bibasilar crackles, elevated JVP, lower extremity edema

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135
Q

Obsessive-compulsive disorder

A

Recyrrent, intrusive anxiety-provoking thoughts, urges, or images

time consuming

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136
Q

Where is type IV collagen found?

A

Basement membrane

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137
Q

non-rhythmic conjugate Opsoclonus-myoclonus conjugate eye movement

A

Neuroblastoma

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138
Q

Major depressive order- signs

A

>/= 2 weeks

Must have 5 of the following:

  • Depressed mood, loss ofinterest of pleasure,
  • changes in appetite or weight
  • insomnia or hypersomnia
  • pschomotor retardation
  • low energy
  • poor concentration
  • thoughts of worthlessness
  • recurrent thoughts of death of suicide

No history of mania or hypomania

Not due to substance or medical condition

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139
Q

Haptoglobin

A

binds free hemoglobin and reduced renal excretion of free hemoflobin preventing tubular injury

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140
Q

Which factors can activate complement?

A

IgM, IgG

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141
Q

Risks for transitional cell carcinoma of the bladder

A

smokers, occupation exposure to dyes, textiles, leather

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142
Q

Glucose urine dipstick

A

Uses glucose oxidase to ascertain the presence of urinary glucose, will not react to fructose or galactose

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143
Q

Where does reactived TB affec the lungs? Primary?

A

Upper lobes-2ndary

Lower lobes-1ary

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144
Q

Rb mutation risks?

A

osteosarcoma, other sarcomas (only if familial

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145
Q

What are the steps in repairng UV-associated damage to DNA?

A

Recognition (endonuclease), single stand cleavage, damaged DNA is discarded, DNA repair (polymerase), remaining gap sealed (ligase)

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146
Q

Determinant of symptom severity in Tetrology of Fallot?

A

Right ventricular outflow tract obstruction

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147
Q

DKA- signs

A

Kassmaul breathing, renal failure

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148
Q

Neuroblastoma-Characteristics

A

@ years of age,

solid sheets of small cells with dark nuclei and scant nuclei

Retroperitoneal mass

Dumbell tumor on mets

N-myc amplification

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149
Q

Allergic bronchopulmonary aspergillosis

A

hypersensitivity reaction to aspergillus, high serum IgE, and eosinophilia -> leads to bronchiectasis

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150
Q

pOLYARTHERITIS NEDOSA- signs?

A

Systemic, muscular, Gi symptoms, with biopsy showing transmural inflammation of the arterial wall with fibroid necrosis

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151
Q

Gram-positive cocci in chains after cystoscopy?

A

Enterococcus- gamma hemolysis of blood agar

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152
Q

What is effect modification

A

effect of an exposure on an outcome is modified by another variable

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153
Q

Pyridoxine deficiency

A

sideroblastic anemia, neurologic deficits, dermatitis, involved in the first step of heme synthesis

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154
Q

Sharp pain and bright red rectal bleeding on defectation? Location?

A

Anal fissure, occur distal to dentate line

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155
Q

How does bulimia nervosa affect bicarb?

A

Increases, along with pH,

Also see decreased K+, with normal anion gap

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156
Q

Finasteride-MoA, Tx

A

decreases conversion of peripheral testosterone to dihydrotestosterone via inhibition of 5-alpha-reductase Tx-BPH

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157
Q

Malingering

A

Falsification of exaggeration of symptoms to obtain external incentives (secondary gain)

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158
Q

What conversion pathway is deficientin alkaptouria?

A

Tyrosine to Fumarate

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159
Q

What are the class III antiarrhythmic drugs?

A

Amiodarone, sotalol, dofetilide, Ibutalide

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160
Q

How to calculate number needed to treat?

A

1/Attribultable risk (difference in percentage)

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161
Q

Drugs that cause pancytopenia

A

cabamazepine, chloramphenicol, suldonamides

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162
Q

Ethosucimide-MoA

A

T-type Ca2+ channel blocker

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163
Q

Incidence

A

Number of new cases divided by the populaton at risk

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164
Q

Reliability-definition

A

consistently provides the same value when measuring a fixed entity

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165
Q

What is the continued risk associated with a subarachnoid hemorrhage?

A

Vasospasm, rebleeding (lesser risk)

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166
Q

chalky white lesions in the mesentery with fat cell destruction and calcification?

A

Acute pancreatitis

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167
Q

Clinical signs of endometriosis?

A

Dysmenorrhea, pelvic pain, dyspareunia, ingertility

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168
Q

How to you treat severe hypoglucemia?

A

Intramuscular glucagon kits or byccal glucose paste (as last resort)

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169
Q

Signs of alcohol withdrawal? Tx?

A

tremulousness, agitation, elevated pulse and BP 48 hours following admission

Tx-long-acting Benzodiazapines (diazapam, chlordiazepoxide)

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170
Q

Straining on urination

A

Bladder outflow obstruction

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171
Q

What causes acute dystonic reactions?

A

D2 antagonism in the nigrostriatal pathway -> decreased dopamine with causes excess cholinergic activeity -> M1 activation

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172
Q

What does filtered fraction equal?

A

GFR/RPF

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173
Q

How can humans contract Bacillus anthracis?

A

Contact with infected animals

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174
Q

MAOI-names; MoA

A

Phenelzine, tranylcypromine, selegilinel used treatment-resistant depression

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175
Q

Multinucleated giant cells occur in

A

herpes infections (such as shingles)

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176
Q

Diagnosis of cardiac temponade?

A

ECG- low voltage QRS complexes

Chest x-ray- enlarged water-bottle-shaped heart

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177
Q

Signs of anaplastic tumors

A

loss of cell polarity, with disruption of normal architecture

Significant veriation in the shape and size of cells

Disproportionately large nuclei

Abnormal mitotic figures

Giant, multinucleated giant cells

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178
Q

Prolyl hydroxylase

A

hydroxylation of proline on procollagen chains,, forms stabilized collagen chain

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179
Q

Ulcerative Cholitis light microscopy findings:

A

Diffuse inflammation of the colon, limited to mucosa and submucosa, no granulomas

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180
Q

Signs of arginase deficiency? Treatment?

A

Spastic dipiegia, abnormal movements, growth delay, increased arginine levels

Tx- low protein diet

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181
Q

Polycystic ovary syndrome

A

Hirsutism, acne, androgenic alopecia, menstrual irregularities, polycystic ovaries, glucose intolerance, obesity

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182
Q

Cryptorchidism- hormone abnormalities?

A

Decreased inhibitin

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183
Q

What artery supplies the SA? AV?

A

Right coronary artery

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184
Q

Cause of unilateral fetal hydronephrosis?

A

Ureteropelvic junction -> palpable abdominal mass and enlarged kidney

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185
Q

How does tuberculoid leprosy present?

A

intact cell mediated immunity (Th1), mild skin plaques, hypopugmentation, hair follicle loss, and focally decreased sensation

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186
Q

Long-term risk of varicose veins?

A

Skin ulcerations

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187
Q

Pathological presentation of reye’s syndrome on the liver?

A

Microvescivular steatosis

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188
Q

Where are M2 receptors located?

A

Heart

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189
Q

Zero-order kinetics vs. First-order kinetics

A

Zero-order- same amount metabolized no matter the concentration

First-order- same proportion metabolized, no matter the amount

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190
Q

High potency first generation antipsycholitcs

A

Names: haloperidol, fluphenazino

AE- acute dystonia, asathisia, parkinsonism

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191
Q

Sentinel event

A

Enexpected occurrence involving death of serious physical inhury (suicide, full-term infant death)

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192
Q

Where are endotoxins location?

A

outer membrane of gram-negative bacteria, called LPS

Three regions- o-antigen, core polysaccharides, and Lipid A (toxic properties -> sepsis)

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193
Q

siderophages

A

hemosiderin laden macrophages

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194
Q

Junctional nevi

A

aggregated of nevus along the dermoepidermal junction (appear flat)

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195
Q
A

Saddle pulmonary embolus -> caused by hypercoagulable state

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196
Q

Bones of the wrist

A

So long to the pinky, Here Comes The Thumb

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197
Q

Polymyositis antibodies

A

ANA, anti-Jo-1 (histidyl-tRNA sunthetase)

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198
Q

Treatment for bipolar disorder?

A

Valproate, lithiu, . and quetiapine

Lamotrigine (prevents depression more than mania)

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199
Q

DiGeorge Syndrome- Cardiac Abnormalties

A

Tetralogy of Hallot, interrupted aortic arch

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200
Q

Adult-type coarctation of the aorta- risks

A

berry aneurysms, aortic arch hypertension

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201
Q

CD14 marker? Describe?

A

Monocyte/Macrophage, large cells with abundent pale cytoplasm

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202
Q

What can low testosterone cause?

A

Gynocomastia, ED

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203
Q

Lipid-lowering agent that prevents future CV events?

A

Statins

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204
Q

Stop the spread of methicillin-sensitive staphylococcus aureus?

A

Hand hygiene

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205
Q

What does the capsule do in E. Coli?

A

K-1 capsule -> Meningitis

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206
Q

Disease? Presentation?

A

Gaucher cell, Gaucher disease

Presentation: bone pain, easy bruising and bleeding, hepatosplenomegaly

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207
Q

Family history of a bleeding disorder?

A

von Willebrand disease

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208
Q

Cause of ecthyma gangrenosum?

A

P aeruginosa bacterium

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209
Q

Alpha fetoprotein is a common tumor marker for what cancers?

A

Hepatocellular carbinoma, Germ cell tumors

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210
Q

What cells are involved in Ulcerative Cholitis?

A

Th2 cells

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211
Q

Cause? Surgical risk?

A

Echinococcus granulosus-> rupture of cysts can cause anaphylaxis

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212
Q

Tuberous Sclerosis-Cardiac defects

A

Valvular obstruction due to cardiac rhabdomyomes

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213
Q

Flutamide-MoA

A

competitive testosterone receptor inhibitor

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214
Q

Ethosuximide-MoA

A

blocks T-type Ca2+ channels that trigger and sustain rhythmical burst discharges in thalamic neurons

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215
Q

What effect does a decreased IP3 have on later protein activation?

A

Decreased protein kinase C

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216
Q

Where are central lines inserted to? Derivation?

A

Into the superior vena cava; derived from the cardinal veins

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217
Q

kidney shaped organisms located in polymorphonuclear leukocytes?

A

N. Gonorrhoeae

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218
Q

Nonncleoside reverse transcriptase inhibitors Are they phosphorylated?

A

Nevirapine and Efacirenz Do not require activation via intracellular Phosphorylation

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219
Q

Organophosphate poisoning antidote?

A

Atropine, pralidoxime

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220
Q

Schizoid personality characteristics?

A

Prefers to be a loner, detached, unemotional

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221
Q

ACE-inhibitor, first dose hypotension

A

In patients taking diuretics, the addition of an ACE-I may lead to volume depletion from diuretics volume depletion and lack of PVR

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222
Q

How does glucose affect insulin release?

A

Glucose enters beta cells-> increased ATP -> closure of K+ channels -> depolarization of caclium channel -> increase in Calcium -> insulin release

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223
Q

Schitzotypal persaonality

A

Eccentric, odd thoughts, perceptions & behavior

Magical thinking (superstitiousness, clairvoyance)

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224
Q

Monospot test

A

agglutination on horse/sheep erythrocytes positive for EBV

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225
Q

Signs of embolism? Cause, post surgery?

A

blue toe, livedo reticularis, with normal peripheral pulses

Cause- atheroembolic disease -> cholesterol containing debris gets lodges in smaller vessels

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226
Q

In what order are vessels affected in atherosclerosis?

A

Abdominal, coronary, popliteal, internal carotids, circle of willis

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227
Q
A

Ecthyma Gangrenosum

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228
Q

How to communicate medicine delivery

A

Durg, dose, route

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229
Q

Uncontrolled diabetic mother, affect on child

A

Beta cell hyperplasia -> hyperinsulemia at birth

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230
Q

Where are M1 receptors located?

A

Brain

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231
Q

Signs of vWF disease?

A

increased bruisability and mucosal bleeding, due to inability to form initial platelet plug -> dental surgery

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232
Q

Dystonia

A

neurological movement disorder characterized by sustained involuntary muscle contractions

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233
Q

How do first generation antihistamines act?

A

Agonist at H1, antagonist at muscarinic 3 (m3_ receptors

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234
Q

Penetration through the fourth intercostal space (nipple) @ left sternal border?

A

Right ventricle myocardium

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235
Q

Turner syndrome: signs

A

Streak ovaries, bicuspid aortic valve, coarctation of the aorta, short stature, shield chest, webbed neck

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236
Q

What causes an umbilical hernia in an infant?

A

Incomplete closure of the umbilical ring

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237
Q

When does liquefaction occur?

A

Brain infarct, bacterial abscess

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238
Q

Jervell and Lange-Neilsen syndrome

A

AR, congenital QT prolongation with neurosensory deafness

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239
Q

Transpeptidases

A

Penicillin-binding protein that function to cross-link peptidoglycan in the bacterial cell wall

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240
Q

Diffuse fibrous thickening and distortion of the mitral valve leaflets?

A

Mitral stenosis, think Rheumatic fever

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241
Q

What does a deficiency in enteropeptidase cause?

A

Protein and fat malabsorption -> diarrhea, failure to thrive and edema

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242
Q

How does morphine act?

A

Stimulates G-protein receptors that activate potassium conductance -> hyperpolerization of cells, terminating pain signal

Also activate adenylyl cyclas, inhibt calcium conductanc, and inhiition of transmitter release

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243
Q

What is the karyotype of a complete mole?

A

46, XX

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244
Q

Dissociative amnesia

A

inability to recall important personal infomration (trauma); not explained by another disorder

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245
Q

Tumor, Correct statement

A

Cavernous Hemangioma- most common benign tumor

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246
Q

What is the most important risk for UTI with catheter insertion

A

Duration of catheterization

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247
Q

Whilms tumor

A

nephroblastoma, children 2-4, palpable flank mass

microscopic sample resembles primitive metanephric tissue

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248
Q

What enters the eye through the superior orbital fissure?

A

trochlear nerve (IV) abducens nerve (IV), and superior ophthalmic vein, CNIII

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249
Q

What does the vaccine target in H. influenze?

A

Hib capsid, not encapsulated can still be infected

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250
Q

Chronic granulomatous disease-most common infections

A

Catalase-positive organisms (S. Aureus, Burkholderia cepacia, Serratia marcescens, nocardia, aspergillus

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251
Q

Tx for combined tonic-clonic/absence seizures?

A

Valproate acid

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252
Q

Keratoses-light microscopy

A

hyperkeratosis, parakeratosis, atypical keratinocytes

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253
Q

Signet-ring carcinoma

A

cells that do not form glands, but contain abundant mucin and push the nucleus to one side, diffuse involvement, and a loss of E-cadherin

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254
Q

Phenotypic mixing

A

host cell is coinfected with 2 viral strains and the progeny contain unchanged parental genome from one strain and nucleocapsid for another. Next generation will revert.

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255
Q

Viral dependent nucleosides?

A

Acyclovir, calacyclovir, famciclovir, ganciclovir

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256
Q

Prevelence

A

Number of persons with a disease dividied by the total population at a specific time point

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257
Q

Antibody that causes tinnitus and hearing loss? MoA

A

Aminoglycosidse, also nephrotoxic

Irreversibly bind to 30s, causing genetic code misreading, and effects translocation

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258
Q

Dactylitis

A

Painful swelling of the hands and feet; common presentation of sickle cell disease in children

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259
Q

What type of damage does carbon tetrachloride cause?

A

free radical injury -> via free radical generation via lipid peroxidation

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260
Q

Dimished first heart sound with an apical holosystolic murmur radiating to the axilla? Treatment?

A

Mitral reguritation,

tx- reduce left ventricular afterload

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261
Q

Epithelial ovarian cancer- risk reduction

A

OTC, breastfeeding, tubal ligation

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262
Q

thick, brownish-yellow fluid rich in cholesterol in the brain? Derivation of?

A

Craniopharyngioma, arise from Rathke’s pouch (precursor to anterior pituitary

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263
Q

What type of receptors are muscarininc?

A

Second messenger (m1 + m1 are IP3, M2 is CAMP)

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264
Q

What hemoglobin has decreased interaction with 2,3-BPG?

A

fetal hemoglobin (hemoglobin F)

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265
Q

Signs of carcinoid syndrome?

A

Flushing, watery diarrhea, bronchospasm,valvular fibrous plaques

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266
Q

What canges does UV light introduce into the skin?

A

Pyrimidine-pyrimide dimers

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267
Q

Claudication ? Cause?

A

muscle pain with exercise that receeds when rested; caused by decreased blood flow due to artery constriction

cause: Atherosclosis of larger arteries (lipid filled intimal plaque)

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268
Q

Elderly patient with dementia and hemiparesis, think

A

Dysphagia -> aspiration pneumonia

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269
Q

How converts triglycerides in the fat into glycerol and fatty acids?

A

Hormone sensitive lipase

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270
Q

Side effects of COX 1 inhibition?

A

Gastric ulceration, increased beeding

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271
Q

How does human placental lactogen (somatomammotropin_ cause insulin resistance in a pregnant woman?

A

Secreted by synchrotrophoblast -> increased shunting of carbs to glucose, also stimulated pancreastic beta cell insulin production (when insufficient, this causes diabetes)

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272
Q

What is the first step in catecholamine synthesis?

A

Tyrosine to DOPA (via tyrosine hydroxylase)-rate limiting step

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273
Q

Pheneizine-MoA

A

monoamine ocidase inhibtor

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274
Q

How is glycogen broken down in muscles?

A

Hlycogen phosphorylase a, which is activated by phosphorylase kinase (PK). In skeletal muscle, calcium can activate PK -> glycogen breakdown

This is in contrast to the liver where epinepghrine and glucagon activate PK via increased cAMP

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275
Q

Physiological respose to pulmonary embolism?

A

Hyperventilation -> respiratory alkylosis, decreased Co2, but normal HCO3 until about 48 hours have passed

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276
Q

Elderly person with “intracytoplasmic granules that are tinged yellowish-brown”?

A

Lipofuscin, caused by lipid oxidation

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277
Q

Only product that is overexpressed in a hypothalamus lesion?

A

Prolactin

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278
Q

Treatment sfor bipolar disorder?

A

Lithiu, , valproate, and Lamotrigine

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279
Q

What cells are involved in the pathogenesis of Chron’s disese?

A

Th1 cells, which form granulomas

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280
Q

Cause of death in athletes under age 35? histology?

A

Cardiomyopathy (massive cardiac hypertrophy) -> ventricular fibrillation

Irregular shaped myocytes and arrangements

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281
Q

Lung mass, cerebellar symptoms and Purkinge cell degeneration

A

paraneoplastic cerebellar degeneration

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282
Q

How do the ovaries drain?

A

left ovarian -> left renal vein

right ovarian -> IVC

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283
Q

RNA polymerase I, II, III

A

I- ribosomal

II-messenger, snRNA

III-transfer, ssribosomal

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284
Q

Obsessive-compulsive personality disorder

A

lifelong pattern on insistence on control, orderliness and perfections and does not involve compulsions

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285
Q

Accuracy-definition

A

gives a measurement close to the actual value

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286
Q

How do activated macrophages cause increased calcium?

A

Secretion of 1-alpha-hydroxylase

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287
Q

Recurrent C. Diff infections and predisposed to reoccurances, tx? MoA?

A

Fidaxomicin (bacteriocidal, inhibits sigma subunit of RNA polymerase -> decreased protein synthesis and cell death

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288
Q

Where is type I collagen found?

A

Dermis, bone, tendons, ligaments, dentin, cornea, blood vessels, scar tissue

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289
Q

What biochemically occurs leading to DKA?

A

Triglycerides in adipose tissue are phosphorylated by glycerol-3-phosphate via glycerol kinase -> energy and glucose

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290
Q

Wernicke encephalopathy- damage

A

Hemorrhage and necrosis in the mammillary bodies and periaqueductal gray matter

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291
Q

What organ is least likely to infact?

A

Liver, dual supply of arteries (inferior phrenic, adrenal, intercostal arteries, etc.)

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292
Q

Bacteria that cause transient bacteremia after dental procedures? How do they binds to heart valves?

A

Strep Viridans, bind to fibrin and platelet aggregates on damages portions of valve

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293
Q

Histological findings for asporation pneumonia?

A

inglammation and a foreign body response with giant cells

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294
Q

Cause of Hepatocelluar carcinoma worldwide

A

Hepatitis B

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295
Q

Tetrology of Fallot-signs

A

VSDRight ventricular outflow tract obstruction, right ventricular hypertrophy

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296
Q

Galactose-1-phosphate uridyl transferase deficiency

A

Vomiting, feeding intolerance, neonatal jaundice, and death (if untreated) soon after breast feeding is intiated.

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297
Q

What is constant in ARDS?

A

Pulmonary capillary wedge pressure

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298
Q

Penetration at the left sternal border, 2nd intercostal space?

A

Pulmonary trunk

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299
Q

Primary biliary cholangitis- manifestations

A

fatigue, itching, and hepatomegaly ANA-titers are positive

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300
Q

Signs of septic shock

A

Fever, leukoctosis, hypotension, tachycardia

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301
Q

What else is derived from the same precursor at ACTH? parent protein?

A

beta-endorphin, derviced from proopiomelancortin (POMC)

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302
Q

What cells are present during chronic inflammation?

A

Macrophages/monocytes/lymphocytes/fibroblasts

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303
Q

Kappa receptor affects?

A

Miosis, dysphoria, sedation

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304
Q

Smith protein-function

A

complexes with small nuclear RNA in the cytoplasm -> forming small nuclear ribonucleoproteins

=> Removal of introns from RNA transcripts

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305
Q

Takayasu arteritis

A

< 4- years old, giant cell aortic lesions

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306
Q

Paraneoplastic cerebellar degeneration-cause

A

Cross reaction with purkinji neuron antigens, specifically anti-Y, P/Q, and Hu

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307
Q

How to treat hemophilia acutely?

A

Administration of thrombin, will lead to blood clotting

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308
Q

asymptomatic patient with a history o an inborn error of sugar metabolish?

A

essential fructosuria- fructokinase deficiency

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309
Q

What causes congenital torticollis?

A

breech delivery, malposition of the head in tero-caused by fibrosis of the SCM

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310
Q

What is HSP?

A

Boys 2-10, preceeded by viral/streptococcal URI

IgA-mediated leokocytoclastic vasculitis

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311
Q

Cause of Sepsis

A

TNF alpha -> activated marcophages

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312
Q

infant with lactic acidosis and neurological deficits, think? Tx?

A

Pyruvate dehydrogenase deficiency, tx. in a ketogenic diet

Lysine and leucine are strickly ketogenic and cannot be made into pyruvate, decreasing symptoms

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313
Q

Epicanthal folds, upslanting palpeebral fissures, protruding tongue and excessive skin at nape of neck?

A

Down syndrome

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314
Q

Describe a reticoulocytes?

A

Larger and bluer than a mature RBC, lacks nucleaus, but contains a mesh-like (reticular) network of residual ribosomal RNA, which appears aftee the wright stain

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315
Q

SCID signs

A

Failure of T-cell development, with B-cell dysfunction

Recurrent severe viral, fungal, opportunistic infections, failre to thrive, chronic diarrhea

Tx- stem cell xplant

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316
Q

Leukemoid Reaction

A

reactive increase in the white blood cell count, which can mimic leukemia; removal of the underlying cause will correct it

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317
Q

Where is the chemreceptor trigger zone located?

A

Doral surface of the medulla at the caudal end of the fourth ventricle

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318
Q

Test to determine if the means of two groups are equal?

A

Two-sample t test

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319
Q

Phenytoin- teratogenic effects?

A

Neural tube deefects, orofacial clefts, microcephaly, nail or digit hypoplasia

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320
Q

Pseudomonas aeruglinosa-Exotoxin A MoA

A

Inactivation of EF-2 via ribosylation -> inhibted host cell protein synthesis

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321
Q

Which cells in males produces testosterone?

A

Leydig cells

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322
Q

Overdose of vitamin C

A

Galse-negative stool guaiac, diarrhea, abdominal bloating

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323
Q

What is your primary concern when an elderly patient comes in with exxhymoses in various stages of healing on the upper extremities?

A

Address their safety

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324
Q

What forms an AV shunt?

A

AV fistula 0> allows blood to directly enter the benous system

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325
Q

What direction of Hep C has no proof-reading?

A

3’-5’ exonuclease activity

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326
Q

What affect does cholestyramine have on hepatid cholesterol synthesis?

A

increases it

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327
Q

Crest components

A

Calcinosis, Raynaud phenomenon, esophageal dysmotility (fibrous replacement of the muscularis in the lower esopghagus), sclerodactyly, telangiectasia

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328
Q

Persistent hypotension despite rapid infusion

A

Cardiogenic shock

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329
Q

How long does it take for warfarin’s effect to kick in? Why?

A

Several days

Long half-life of facotr II (antithrombin)

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330
Q

New onset of anxiety with no prior psychiatric history and prominent physicial finding on examination suggets

A

Anxiety due to a general medical condition

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331
Q

Pneumocystic pneumonia and painful oral ulcers, think?

A

HIV

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332
Q

Hybernating myocardium

A

Chronic myocardial ischemia, -> decreased contractility and left ventricular dysfunction

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333
Q

Linear IgG and C3 deposits on immunoflourescent microscopy of the renal?

A

Goodpasteur

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334
Q

Lateral force leads to widening of the medial joint line?

A

MCL damage

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335
Q

Synaptophysin

A

transmembrane glycoprotein found int he presynaptic vescicles of neurons, neuroectodermal and neuroendocrine cells

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336
Q

Ciprofloxacin

A

fluoroquinolone class of antibiotics, interact with DNA gyrase

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337
Q

equation for sensitivity?

A

TP/(TP+FN_

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338
Q

Tamoxifen

A

Treatment for Er or PR tumor expression, a selective estrogen receptor modulator

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339
Q

What does the smooth ER do?

A

Synthesize steroids and phospholipid biosynthesis

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340
Q

Follicular lymphoma-translocation

A

t(14:18), BCL2

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341
Q

Diagnostic test for Trichomonas vaginalis?

A

Saline microscopy (wet mount)

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342
Q

VHL signs

A

capillary hemangioblastomas in the retina and/or cerebellum, congenital cysts and/or neoplasms in the kidney, liver, pancreas; increased risk for RCC

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343
Q

Bacterial resistance to cephalosporins?

A

Modification of PBP

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344
Q

TGF-beta -MoA

A

Promote the differentiation of fibroblasts into myofibroblasts

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345
Q

Large individual with chronic, mild dyspnea and fatique?

A

Chronic hypoventilation due to obesity

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346
Q

Rifaximin- MoA

A

nonabsorbable antibiotic that alters GI flora to decrease intestinal production and absorption of pneumonia

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347
Q

Increased blood ammonia and orotic acid excretion in urine. defect?

A

Ornithine transcarbamylase

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348
Q

What is required for the fusino and release of neurotransmitter vescibles into the synaptic cleft? Drug example?

A

Voltage-gated ion channels

Gabapentin

349
Q

Homocystinuria-treatment

A

pyridoxine (B6) which is a cofactor for the deficient enzyme cystathioinine beta synthase

350
Q

What is the only affect of Grrave’s disease not relieved by beta blockers?

A

Exophthalmos

351
Q

What cell type produces interferon-gamma?

A

T-cells and NK cells

352
Q

Nests of uniform round cells with inconspicuous nucleoli and few mitotic figures at the basal portion of the epi and upper dermis?

A

Compound melanocytic nevus

353
Q

Ornithine transcarbamylase-action

A

catalyzes the combination of ornithine and carbamoyl to form citrulline in the urea cycle.

354
Q

How to calculate total filration rate of a substance

A

Inulin clearance X ([plasma substance A])

355
Q

History of prolonged bleeding following procedures and spontaneous hemorrhage into joints?

A

Hemophilia (related to either VIII or IX

356
Q

Side effects of aminoglycosides during pregnancy?

A

Ototoxiicity, vestibulotoxicity

357
Q

What type of receptors are hormone receptors?

A

G-protein activated

358
Q

Cause of renal size differences in individuals at risk for athersclerosis?

A

Renal artery stenosis

359
Q

What zone of the adrenal glands is affected in cushings?

A

Zone gasciculate

360
Q

Where is type III collagen found?

A

skin, lungs, interstines, blood vessels, bone marrow, lymphatics, granulation tissue

361
Q

What is a Ghon complex?

A

lower lung lobe lesion with ipsilateral hilar adenopathy, associated with primary TB

362
Q

Stages of lobar pneumonia

A
  1. congestion - vasodilation, exudate contains bacteria
  2. red hepatization 0> exudate contains erythrocytes, neytrophils, fibrin
  3. grey hepatization -> exudate contains disintegrated RBC, neutrophils, fibrin
  4. Resultion - enzymatic digestion of exudate
363
Q

Prazosin- MoA

A

alpha 1 adrenergic blocker causes vasodilation and reflexive tachycardia

364
Q

What two things should you check when metabolic alkylosis is a concern?

A

Urine chloride, volume status

365
Q

Effect of alpha1 -adrenergic agonist on the heart?

A

Increased vagal stimulation -> decreased pacemaker activity

366
Q

Why are piperacillin and tazobactam linked?

A

stops pipercilin destruction via beta-lactamase

367
Q

Ischemic preconditioning

A

Brief, repetitative episodes of myocardial ischemia followed by reperfusion protect the myocardium from prolonged episodes of ischemia

368
Q

How to decreased renal plasma flow and increase filtration fraction?

A

Constriction of the efferent arteriole

369
Q

Precision- definition

A

low level of variability when used to assess a fixed entity

370
Q

What are the characteristics of S. Pneumoniae?

A

gram-positive, lancet-shaped cocci, bile soluble

371
Q

Uncomplicated umbilical hernias are associated with?

A

Down Sydrome, hypothyroidism, Beckwith-Wedemann syndrome

372
Q

Upper extremily numbness, tingling, and weakness with upper extermity edema

A

Thoratic outlet syndrome- salene triangle, cause by cervical rib or muscle deformity

373
Q

Klinefelter syndrome

A

47, XXY- mental retardation, tall stature, gynecomastia, azoospermia

374
Q

Actions of Cholinergic antagonists?

A

Increase GI smooth muscle tone -> nausea, vomitin, cramps, diarrhea, decrease heart rate, atopic baldder (non-obstructive urinary retention

375
Q

Thyroid Peroxidase- function

A

Thyroglobulin iodination forms (T3/T4)

376
Q

Depersonalization/derealization disorder

A

Feeling of detachment from or being on outside observer of one’s self

eperiencing surroundings as unreal

**Intact reality testing**

377
Q

Sustained generalized tonic-clonic convulsions without fully regaining consciousness between episodes? Treatment? MoA?

A

Status epilepticus

Tx- intravenous benzodiazepam (lorazepam); Enhances post-synaptic chloride influx

378
Q

First step in management of a request for opiod medication?

A

Confirmation of the patient’s prescription history

379
Q

Epithelial ovarian cancer- marker

A

CA-125

380
Q

Preferred vein for bypass grafting?

A

internal mammary artery

381
Q

Sertoli-Leydig tumor

A

Ovarian tumor that presents with large adnexal mass with amenorrhea and virilization by a rare sex-stromal tumor

382
Q

What causes anaphylactic reactions?

A

Mast cell and basophil degranulation -> histamine and tryptase release (mast cell specific)

383
Q

Signs on heroin withdrawal

A

nausea, vomiting, abdominal cramping, muscle arches,

See dilated pupils, yawning, lacrimation on PE

384
Q

Cardiac abnormalities in Marfan syndrome?

A

Cystic medial necrosis (aortic dissection & aneurysm) and Mitral valve prolapse

385
Q

Transthyretin

A

Protein tetramer produced int eh liver to carrier thyroxine and retinol, mutations can lead to amyloid protein in the myocardium

386
Q

Lesion at or above the red nucleus

A

Decorticate (flexor) posturing descending inhibition of th red nucleus

damage is @ pons

387
Q

Cyclosorin-MoA

A

inhibts nuclear factor of activated T cells, blocking IL-2

388
Q

Temporomandibular disorder?

A

unilateral jaw pain that worsens with jaw movement, headache, and derangement, pathologic contraction of the muscles of mastication, and/or hypersensitivity of the nerve that supply the jaw

Caused by mandibular devision of trigeminal nerve

389
Q

Irregular spijkes protruding from the glomerular basement membrane in the kidney? Characteristics?

A

Membranous glomerulopathy

diffuse thickening of capillary wall on light microscopy wihtout an increase in cellularity

390
Q

Subungual splinter hemorrhages?

A

Associated with microemboli, usually caused by subacute endocarditis

391
Q

Homocystinuria-presentation

A

ectopia lentis, intellectual disability, marfanoid havitus

392
Q

How do you stop increased HCL output from vagal, histamine and gastrin pathways?

A

Give them a proton pump inhibitor, H2 blockers only stop gastric acid secretion in histamine and gastrin, not vagal

393
Q

Patient with history of rheumatic fever, nor presenting with exertional duspnea and diastolic murmer

A

Mitral stenosis (problem opening valve)

394
Q

hypochromic, microcytic anemia, cause?

A

Iron deficiency

395
Q

Dengue fever- mulitiple infections

A

Recovery from an infection leads to life-long immunity, however, secondary infection (with a different serotype can cause more severe illness

396
Q

How does UV light lead to wrinkles?

A

decreased collagen fibril production -> upregulation of metalloproteinases

397
Q

What x-ray signs would establish a cholecystoenteric histula?

A

Air in the biliary tree (pneumobilia) from interstinal gases

398
Q

Where is collagen synthesized?

A

RER, hydroxylation in the cisternae of the RER

399
Q

Trazodone - MoA and side effects

A

MoA- serotonin modulator (antagonized post-synaptic serotonin receptor and inhibits reuptake Side effects0 priapism (persistent erection > 4 hours

400
Q

Effects of prolactinoma?

A

hypogonadism, anovlation, amenorrhea -> breast milk discharge

401
Q

Suspect abuse in a patient, what is your top priority? Questions to ask?

A

interview alone to avoid intimidation

Questions: 1. Do you feel safe where you live?

  1. Who prepares your meals
  2. Who handles your checkbook
402
Q

Sings of ARDS

A

Acute respiratory failure, bilateral opacities (hypoxemia, etc.)

403
Q

Common cause of aspectic meningitis?

A

enterovisures (Echo, coxsachievirus, poliovirus

404
Q

older child/ younger adult with edema, hematuria and proteinuria following skin or pharyngeal infection

A

post-streptococcus glomerulonephritis -> electon-dense deposits on the epithelial side of the basement membrane

405
Q

What does a capsule do?

A

Protects the organisms from opsonization

406
Q

What is another name for an anterior prolapse?

A

Cystocele

407
Q

Vision problem, difficulty chewing, trouble speaking that are worse at the end of the day

A

Myasthenia gravis- Type II hypersensitivity

408
Q

Test used to check ACTH response in adrenal glands?

A

Adrenocorticotropic hormone stimulation test

409
Q

Sign of renal vein thrombosis?

A

membranous nephropathy, flank pain, hemoturia, right-sided varicocele

410
Q

Selective arteriolar vasodilators: types, MoA

A

hydralazine, minoxidil MoA- reducing systemic vascular resistance -> baroreceptor stimulation leads to reflex sympathetic activation -> increased sodium and fluid retention

411
Q

Cf-Most common cause of death

A

Pneumonia

412
Q

Bile acid-binding resins- side effects

A

“chol-“ drugs, increase triglycerides by releasing of triglyceride heavy VLDL into circulation

413
Q

Rapidly spreading pruritic rash with erythematous papules and excoriations on the extremities

A

Scabies or Sarcoptes Scabiei mites and eggs

414
Q

Where does the left gastric artery run?

A

Along the lesser curvature of the stomach

415
Q

What is the most important muscle involved in the Valsalva maneuver

A

Rectus Abdominalis

416
Q

What is the important component of a newborn screening test?

A

High sensitivity- a negative diagnosis helps rule out the test- better to catch more false positives than have a false negative

417
Q

What occupies the cavernous sinus?

A

Structures relating to eye movement

418
Q

Electrolyte that can cause muscle weakness?

A

Hypokalcemia

419
Q

Enzyme deficiency in porphyria cutanea tarda

A

Uroporphyrinogen decarboxylase

420
Q

how does normal CSF flow?

A

choroid plexuss (lateral 3rd and 4th) -> lateral ventricles, interventricular foramen on monro -> third ventrical -> cerebral aquaduct -> fourth ventricle -> Luschka, magendie -> subarachnoid space -> arachnoid granulations -> Venous system

421
Q

Isotretinoin-teratogenic effects

A

microcephaly, thymic hypoplasia, small ears, hydrocephalus

422
Q

Ions permeable with a negative equilibrium?

A

Potassium, chloride

423
Q

Effects of a noncompetitive inhibitor or irreversible competitive inhibitor on Vmax?

A

Reduces the maximum effect

424
Q

Sign of secondary hyperaldosteronism

A

Increased Renin and Increased aldonsterone

425
Q

Inspissated mass

A

dehydrated meconium

426
Q

Cause of Annular pancreas

A

abnormal migration of the ventral pancreatic bud

427
Q

Side effects of TCA

A

confusion, constipation, acute urinary retention

428
Q

How much of a coronary artery lumen must be clocked for stable angina?

A

>750%

429
Q

Parvovirus - in fetus

A

pleural effusions, pericardial effusions, ascites -> fetal hydrops

430
Q

Hernia below the inguinal ligament?

A

Femoral hernia

431
Q

Most common site of rupture in a blunt aortic injury?

A

Aortic isthmus (site where the ligamentus arteriosum is located

432
Q

How long does a loss of contractility take during total ischemia

A

about 60 seconds

433
Q

How to treat agitation and psychosis associated with delirium?

A

Haloperidol in low doses

434
Q

Most common locations for breast cancer to spread?

A

Bone, brain, liver, lung

435
Q

Persistent processus vaginalis-signs

A

outpouching of the peritoneum, leaving bowel contents in the inguinal canal

436
Q

What proteins are involved with hemidesmosomes?

A

Integrins

437
Q

Dopmine pathway for coordination of coluntary movement?

A

Nigrostriatal

438
Q

Side effect of EPO stimulation?

A

Hypertension, due to increase blood viscosity from increased RBC and increased risk of thromboembolic events

439
Q

Subclavian steal syndrome

A

Severe stenosis of the proximal subclavian artery -> reversal of contralateral vertebral artery to the ipsilateral side

Sides- exercise-induced fatique

440
Q

Most usedul measure for assessing the defree of mitral stenosis?

A

A2 to opening snap interval (increase distance, decreased severity)

441
Q

Basal cell carcinoma-Presentation

A

pearly papules with central depression of ulceration

442
Q

Vitamin essential for transamination and decarboxylation of amino acids (ntrogen transfer)

A

Pyridoxine (anything with alpha-keto

443
Q

What proteins are involved in tight junctions?

A

Claudins, occludin

444
Q

What promotes the contraction of the gallbladder?

A

CCK from the small intestine

445
Q

Inceased aldosterone syndrome name?

A

Conn’s Disease

446
Q

ACE inhibitors - teratogenic effects

A

Renal dysgenesis, oligohydramnios

447
Q

Schizophrenia vs schizophreniform-time frame

A

Schizophrenia- > 6 months

Schizophreniform >1 month to < 6 months

448
Q

Spinal stenosis vs. disk herniation

A

Disk herniation will present with back pain, stenosis will not. L5-S1 stenosis affects L5, herniation affects S1

449
Q

Wen taking a long-acting benzo ,what should be avoided?

A

1st generation antihistamined (chlorpheniramine). alcohol, barbs, and other CNS depressents

450
Q

Pathogenesis of HIV-associated dementia?

A

Inflammatory activation of microglial cells -> form microglial nodules -> multinucleated giant cells-> cytokine excretion

451
Q

Clinical manifestations of Factor I leiden

A

DVT, cerenral vein thrombosis,receurrent pregnancy loss

452
Q

What vitamin is depleted in measles and should be supplemented?

A

Vitamin A -supplementation should be done to reduce comorbidities (ocular complications, diarrhea, pneymonia, recovery time and length of hospital stay

453
Q

Oral vs rectal drug administration?

A

Increased bioavailability due to less first-pass metabolism rectally

454
Q

CMV-related risks in infants exposed to the virus in utero

A

Chorioretinitis, sensorneural deafness, seizures, jaundice, hepatomegaly, microcephaly

455
Q

Acute cerebellitis?

A

Post-viral cerebellar ataxia,

cause in children 2-3 weeks following varicella, measles, EPV

456
Q

Drugs that interfere with cell membrane ergosterol incorporation

A

Amphotericin B, nystatin, azoles

457
Q

What inhibits platelet aggregation and adhesion to the vascular endothelium?

A

Prostacyclins

458
Q

Granulosa cell tumor- clinical features

A

inc. estrogen, inhibit with large, unilateral adnexal mass

459
Q

Long term effect of diabetes on the gut?

A

Decreased motility

460
Q

Risk in CD18 deficiency?

A

Persistent leukocytosis

461
Q

Development of atherosclerotic plaque?

A

Endothelial damage -> macropage invasion -> platelet adhesion -> smooth mscle cell migation -> lipid debris

462
Q

Pepsin- activitation and function

A

Activated in stomach -> starts the degredation of proteins for future digestion

463
Q

Failure of prothrombin time to correct with vitamin K supplements?

A

Liver disease

464
Q

Enkephalins, endorphins, dynorphins

A

Endogenous opiod peptides, part of the bodies natural opiod system

465
Q

Side effects of Trimethoprim/sulfamethoxazole during pregnancy?

A

Neural tube defects

466
Q

What parts of the spinal cord are affect in ALS?

A

Lateral corticospinal tract (spasticity and hyperreflexia) anterior horn -> flaccid paralysis, atrophy, fascivulation

467
Q

Right-sided enlargement of the scrotum, with fluid collection?

A

Indirect inguinal hernia (through patent process vaginalis)

468
Q

Physiological decor receptor for decreasing binding of RANK-L to RANK

A

Osteoprotegerin

469
Q

Low-potency 1st generation antipsychotics

A

Names: chlorpromazine, thiondazine

AE- sedation, anticholinergic , orthostatic hypotension

470
Q

What can be detected by a radiolabled DNA strand?

A

Things that bind (N-myc)

471
Q

most common cause of bladder outflow obstruction?

A

BPH -> urine backup -> parenchymal pressure atrophy in the renals

472
Q

Tzanck smear

A

genital herpes simplex virus

473
Q

How to test concentration in an elderly individual

A

Reciting months of the year backwards

474
Q

Negative agglutination twice spaced apart, think

A

CMV

475
Q

High grade CIN

A

atypical cells have invaded beyond the lower one-third of the cervical epithelium

476
Q

What proteins are involved in Gap junctions?

A

Connexins

477
Q

What type of disturbances are seek in DKA?

A

Metabolic acidosis- low pH, low HCO3-

478
Q

What happens during the first week after exposure to TB?

A

Intracellular bacterial proliferation

479
Q

Signs of 17alpha-hydrozylase deficiency in males? Female?

A

Phenotypically female at birth, females develop normally; however puberty leads to the failure to develop secondary sex characteristics

Excessive mineralocorticoids by adrenals leads to hypertension

480
Q

Progressive fatigue and heart palpitations, think

A

anemia

481
Q

What type of receptors are in neurons?

A

voltage-gated

482
Q

Signs of PKU

A

high phenylalanine -> disrupts neuronal and glial deelopment and lead to progressive neurological deterioration -> hpotonia, dystonia, seizures

483
Q

Progressive ddyspnea and sudden death and atypical chest pain with ventricular hypertrophy

A

Pulmonary arterial hypertrophy

484
Q

Methotrexate- teratogenic effects

A

lumb & craniofacial abnormalities, neural tube defects, abortion

485
Q

Organism?

A

Coccidioides Immitis, endemic to the desert areas of the US and mexico

Culutre on Sabouraud media

486
Q

Cause of non-bacterial thrombotic endocarditis?

A

Advanced Malignancy, chronic inflammatory disorders (SLE, etc.)

487
Q

Where are normetanephrine and metanephrine created?

A

Chromaffin cells of the adrenal medulla

488
Q

How does blood reach the retinal artery?

A

Internal carotid, ophthalmic arter-> retinal

489
Q

How to calculate the positive predictive value?

A

TP/TP+FP)

490
Q

What enzymes are found in the cytoplasm?

A

Glycolysis, fatty acid synthesisi, pentose phosphate pathway

491
Q

How to detect fructose in the urine?

A

Copper reduction test

492
Q

Where does most of the water get absorbed at in the nephron?

A

Proximal tubules

493
Q

Statistical Power

A

(1-beta) study’s ability to detect a difference when one exists

494
Q

Where does lithium affect the kidney?

A

Colelcting ducts

Antagonizes vasopressin (ADH)

495
Q

What gets deposited in multiple myeloma?

A

Ig light chains (also known as amyloid type AL (primary)

496
Q

Measles virus-description

A

enveloped, single stranded RNA virus, which encodes viral hemoagglutinin (cell surface adhesion) and matrix protein (assembly)

497
Q

Paranoid personality disorder

A

Pervasive pattern of distrust, and suspiciousness, beginning in early adulthood

498
Q

c-ANCA

A

cytoplasmic- antineutrophil cytoplasmic antibody

499
Q

Patient wants to cancel the surgery after anesthesia, how to respond?

A

Ask and address the concerns

500
Q

Inner necrosis, with pseudopalisading cells in the brain?

A

Glioblastomia multiforme

501
Q

How does gluconeogenesis get generated during fasting?

A

Increased Acetyl-CoA inhibits pyruvate dehydrogenase and upregulates pyruvate carboxylase

502
Q

What causes black stones?

Stone type?

A

Chronic hemolysis (sickle cell, spherocytoisi), or ileal diseas)

cause by increased enterohepatic cycling of bilirubin (unconjugated)

Calcium bilirubinate

503
Q

INF-gamma function

A

Secreted by activated T-cells; recruits leokocytes and activates phagocytosis

504
Q

What is the role of the pudendal nerve?

A

Innervation of the perineal region

arises from s2-s54 and controls the pelvic floor as well as external urethral and anal sphincter; can lead to fecal incontinence and urinary incontinence

505
Q

Parinaud syndrome

A

Tumor of the pineal gland that causes the inability to look upwards

506
Q

What do the vitelline veins form?

A

Portal system

507
Q

Fungus branching at acute angles with septations

A

Aspergllus

508
Q

Enzyme essential for the conversion of fructose-6-phosphate to ribose-5-phosphate?

A

Transketolase

509
Q

Cause of maturity onset diabetes in the young?

A

Mutation in glucokinase

510
Q

In patients that have a total gastrectomy, what needs to be supplemented?

A

B12, intrinsic factor can no longer be produced

511
Q

Young man with dyspnea on exertion and decreased exercise tolerance and central obesity?

A

obesity-related restrictive lung disease

512
Q

How does alcohol lead to hypoglycemia?

A

Ethanol processing -> increased NADH/NAD+ ratio -> shuts down gluconeogenesis -> hypoglycemia

513
Q

Lack of anal sphincter contaction- nerve involvement?

A

S4

514
Q

Patients receiving parenteral nutrition through catheter are at risk for? morphology?

A

Candida, pseudohyphae with blastoconidia

515
Q

What are berry aneurysms associated with?

A

Ehlers-Danlos syndrome and ADPKD

516
Q

What are the stop codors

A

UAA, UAG, UGA

517
Q

How does the botulism toxin act?

A

Blocks release of Ach into the neuromuscular junction, toxin in heat tabile

518
Q

Neurokinin 1 receptor antagonists?

A

Aprepitant, Fosaprepitant

519
Q

Phenoxybenzamine

A

Alpha blocker

520
Q

QT-interval prolongation in a young child

A

Congenital QT-interval prolonation-> mutations in potassium of sodium channels. Assocated with neurosensory deafness

Increased risk of Torades de Pointes

521
Q

Buspirone

A

Non-benzo anxolytic used to treat GAD, slow onset of action, lacks muscle relaxant, or anticonvulsant properties and carries no risk of dependence

522
Q

Dopamine receptor antagonists (antiemetic)

A

rochlorperazine, metaclopramide

523
Q

Kallikrein

A

converts kininogen to bradykinin

524
Q

What should all breast cancers be tested for?

A

HER2, associated with very aggressive forms

525
Q

Function of Folic acid?

A

DNA single carbon donor required for purine and pyrimidine )Thymidine) bases incorporated into DNA

526
Q

How to you culture H. Influenza?

A

Grow them around streaks of S. aureus, which provides NAD+ (factor V) and hematin (factor X) from the lysis of RBCs

527
Q

DIC during pregnancy?

A

Cause by tissue factor (thromboplastic) found in the placental trophoblast -> released during placental injury -> activates complement cascade

528
Q

What male cells secrete testosterone?

A

Leydig

529
Q

Brown, firm colored spleen?

A

Remnants of autosplenectomy (hemosiderosis)

Cause by vascular occlusion

530
Q

Respiratory signs characteristic of asthma

A

Normal chest x-ray, eosinophils in sputum, reduced FEV1

531
Q

What sugar can bypass phosphofructokinase and undergo faster metabolism?

A

Fructose, doe snot have to meet PFK-1

532
Q

Anemia with schistocytes, thrombocytopenia

A

Thrombotic thrombocytopenic purpura, decreased ADAMTs13 leading to large vWF multimers -> microvascular platelet-rich thrombi

533
Q

Delusional disorder vs. paranoid personality disorder?

A

Delusion -> behavior not obviously bizarre, ability to function other than delision, not due to substance abuse

Paranoid- ppervasive pattern of suspiciousness or odd beliefs

534
Q
A
535
Q

Minimal change disease is what type of category?

A

Selective - certain size protein can get through

536
Q

Diagnosis and microscopic characteristics?

A

Seborrheic Keratosis

Small cells resembling basal cells with variable pigmentation, hyperkeratosis, and keratin containing cysts

537
Q

Best treatment for pulmonay infections and abscesses in an alcoholic?

A

Clindamycin

538
Q

Mxogatous changes

A

weakening of connective tissue-> aortic dissections and aortic aneurysms

539
Q

What is G6PD the rate limiting enzyme for?

A

Coversion to 6-phosphogluconate (first step in the pentose phosphate pathway

540
Q

Norepinephrine extravasation

A

Interse alpha receptor mediated vasoconstriction which can lead to local tissue necrosis; counter acted by a alpha channel blocker, phentolamine

541
Q

Foamy macrophages packed with both rod-shaped vacilli and PAS-positive diastase-resistant granules

A

Tropheryma whippelii

542
Q

Closely packed, small, round, neoplastic cells in bone

A

Ewing Sarcoma

543
Q

What proteins are involved with adherens junctions?

A

Cadherins

544
Q

Light microscope findings in Chron’s disease?

A

Transmural inflammation and noncaseating granulomas

545
Q

Hemosiderosis

A

complex of ferritin found within cells and is unavailable for acccess to the body

546
Q

Latanoprost-MoA

A

prostaglandin for glaucoma -> increase outflow

547
Q

Signs of vitamin A overdose?

A

Alopecia, dry skin, hyperlipidemia, hepatotoxicity, papilledema, visual difficulties

548
Q

Signs of chronic gastritis

A

mucosal inflammation leading to atrophy, with hypergastrinemia

549
Q

Gram-negative, pink-colored mucoid colonies on MacConkey’s agar

A

Klebsilla, E. Coli, Enterobacter

550
Q

Signs of T. whippelii infection?

A

middle-aged caucasian males, presenting as malabsorption with diarrhea and weight loss

551
Q

Reversal agent for Heparin?

A

Protamine

552
Q

How do you diagnose thiamine deficiency?

A

baseline erythrocyte transketolase activity is low, but increases after the addition of thiamine

553
Q

Where does the great saphenous vein located?

A

medial side of foot -> anterior to medial malleolus, and up the medial aspect of the leg, just inferolateral to the pubic tubercle in dives to join the femoral vein

554
Q

Left vertebral artery- retrograde flow

A

blockage in the left subclavian

555
Q

Bacterial recombination

A

gene exchange that occurs through crossing over of double stranded DNA molecules

556
Q

Where is the caudate located?

A

Inferolateral walls of the anterior horns of the lateral ventricles

557
Q

How does total parenteral nutrition cause gallstones?

A

lack of enteral passage of food into the duedenum fails to trigger release of cholecystokinin leading to contraction of the gallbladder -> niliary stasis

558
Q

How does N. meningitidis spread?

A

Via respiratory droplets; where theyy invade the epithelium and gain access to the vasculature

559
Q

VIPoma-signs

A

diarrhea (persists with fasting), achlorhydrai and hypokalemia

560
Q

What infections are found in HIV patients with a T-cell count less than 50? Tx?

A

Mycobacterium avium complex; grows well at higher temperatures

Tx- Azithromycin

561
Q

Where are M3 receptors located?

A

Peripheral vasculature, lung, bladder, eyes, gastrointerstinal , skin

562
Q

Global payment

A

arrangement in which an insurer pays a provider a single payment to cover all expenses associated with an incident of care (think elective surgery, where pre- and post- op are also covered

563
Q

How does fragile X cause symptoms?

A

>200 CGG repeats -> FMR1 hypermethylation -> inactivated FMR1 -> inhibits neural development

564
Q

Factitious disorder

A

deliverate induction of infection without obvious external rewards

ARE AWARE OF THE SYMPTOMS

565
Q

ulcerative mass on the anus?

A

Think cancer, specifically HPV

566
Q

Precursor to Uroporphyrin?

A

Succinyl CoA

567
Q

Chikungunya Fever? Vector?

A

Februile illness with flu-like symptoms, with prominent polyarthralgia/arthiritis and diffuse maculopapular rash.

Spread by Aedes Aegypti

568
Q

Functions of protein A

A

virulence factor that forms part of the outer layer of S aureus, binds the Fc portion of IgG antibodies @ complement-binding site

569
Q

Burkholderia cepacia

A

Aerobic gram-negative bacillus found in aquatic environments and colonized fluids in the hospital

catalase positive

570
Q

Glanzmann thrombinasthenia

A

Fialure of platelet to platelet aggregation due to decreased Gp IIb/IIIa

aggregated with ristocetin

571
Q

What clotting factors are produced in the liver?

A

2, 7 (shortest half-life), 9, 10

572
Q

How to chronically elevated fatty acids lead to insulin resistance?

A

Impair insulin-dependent glucose uptake and increase hepatic gluconeogenesis

573
Q

History of HIV, 2 ring-enhancing focal lesions (with mass effect), edema in right frontal lobe? Tx?

A

Toxoplasma gondii

Pyrimethamine and sulfadiazine

574
Q

What is the normal lining of the bronchi?

A

Pseudostratified ciliated columnar

575
Q

Canagliflozin-MoA, SE

A

MoA- SGLT2 inhibitor

SE-UTI and genital mycotic infections, symptomatic hypotension, renal impairment

576
Q

Adherence to collagen?

A

S. Aureus virulence factor

577
Q

In the setting of an infection-> hypotensino, tachycardia, tachypnea, and markedly elevated or decrease body temp

A

Septic shock

578
Q

How to calculate bioavailability?

A

(Area under the oral curve X dose) divided by (area under the IV curve x Dose)

579
Q

Cauda equina sundrome

A

Compression of spinal nerve roots

presents with severe bilateral radicular pain, saddle anesthesia and hyporeflexia

580
Q

Metalloproteinases

A

Activated macrophages infiltrate atheroma, and cause the breakdown of extracellular matrix proteins (collagen), destabilizing the plaque

581
Q

Potential complications of acute pancreatisit?

A

Leakage of pancreatic secretions into the peripancreatic space -> inflammatory reaction in the walls -> pseudocyst formation -> fibrous and granulation tissue

582
Q

Where do H. pylori occupy?

A

Antrum of stomach (prepyloric area)

583
Q

Atelectasis? Cause?

A

Complete of partial collapse of a lung

Contraction-secondary to radiation

584
Q

lithium - teratogenic effects

A

Ebstain anomaly, nephrogenic diabetes insipidus, hypothyroidism

585
Q

Six-sided crystals?

A

Citrate crystals -> Increased COLA amino acids in urine

586
Q

What do the “-ravir” drugs for HAART therapy target?

A

messenger RNA transcriptoin (integrase inhibitor)

587
Q

Signs of acute rheumatic fever

A

Migratory arthritis, pancarditis, sydenham chorea, erythema marginatym (JONES criteria)

588
Q

What is stress-related mucosal disease?

A

Acute gastric mucosal defects that develop in response to severe physiological stress (shock burns, sepsis, etc.)

589
Q

Laboratory finding of Sarcoidosis?

A

hypercalcemia/hypercalciuria, elevated ACE level

590
Q

Side effects of SSRI?

A

sexual dysfunction

591
Q

Does does eosinophil enter the bronchial wall in asthmatics?

A

Recruited by IL-5 released by allergen-activated Th2 cells

592
Q

Acute symmetric arthralgia/arthritis with or without rash in adults working at a school?

A

Parvovirus

593
Q

Signs of cocaine withdrawal?

A

intense psychomotor retardation, severe depression

594
Q

Acanthosis nigricans

A

Bands in axilla, other skin folds suggesting insulin resistance - >

595
Q

Latent period - studies?

A

timelapse from initial exposure to clinically apparent disease

596
Q

Why is a two week window needed after MAOI dicontinuation?

A

Provide time to regenerate MAO A and B to normal levels

597
Q

Treatment for chemotherapy, development of frequent urination, suprapublic pain, dysuria, progressive hematuria

A

Treated with cyclophosphamide (or analog) -> metabolized in the kidney to acrolein, which is topic to uroepithelial cells and cause cause death with long-term exposure

598
Q

Signs of hyperaldosterism

A

hypertension, hypokalemia, metabolic alkalosis and decreased renin activity

599
Q

Cardiac abnormalities in Tyrner syndrome?

A

Aortic coarctation, bicuspid aortic valve

600
Q

Leukotrienev B4-moA

A

Metabolite of arachidonic acid -> stimulated neutrophil migration to the site of inflammation

601
Q

Hypertrophic cardiomyopathy sound?

A

harsh crescendo-decreshendo murmur heard best at the apex and lower sternal border

602
Q

What is the MoA of enoxaparin

A

Binds antithrombin III; then binds to factor Xa, stopping the convertion of prothrombin to thrombin

603
Q

Morphology of Cryptococcus Neoformans?

A

Yeast only!

round or oval encapsulated cells with narrow-based buds

604
Q

Organism associated with animal waste with severe headaches and pneumonia?

A

Q fever, coxiella burnetii

605
Q

Side effects of Niacin?

A

decreased renal exceretion or urin acid -> acute gouty arthritis

606
Q

Azoles- MoA, SE

A

MoA- supress the synthesis of ergosterol

SE- cytocrome p450 inhibitor

607
Q

Long-term effects of hypogonadism?

A

Low estrogen -> vaginal dryness and low bone denisty

608
Q

Alport Syndrome? Cause?

A

eye problems, sensorineural deafness, and nephritis

“can’t see, can’t pee, can’t hear a bee”\

Type IV collagen defect

609
Q

Use for gamma-glutamyl transpeptidase?

A

Determine origin of elevated alkaline phosphatase (hepatic vs. bony)

610
Q

GI abnormalities associated with Down syndrome

A

Duodenal Atresia

611
Q

What proteins are involed with Desmosomes

A

Desmogleins, desmoplakin

612
Q

Thickened heart valves, with multiple small vegetations on both surfaces, “wire-loop” structures in flomerular capillary

A

SLE, verrucous endocarditis (Libman-Sacks)

613
Q

List anti-oncogenes? Functions?

A

Tumor supression, APC, BRCA1, RB, TP53

614
Q

Warfarin interaction?

A

St. John’s wart -> decreased efficiency

615
Q

What happens to Rb in order to progress from G1 to S?

A

Growth factors -> activation of cyclin D, cyclin E and cyclin kinase 0> RB hyperphosphorylation -> inactivation and release of E2F transcription factor

616
Q
A

A. Globus Pallidus- basal ganglia

B. putame - medial to the insula and lateral to the globus pallidus and internal capsule

C. internal capsule

D. Caudate nucleus

E. Amygdala

617
Q

Treatment for HER2-positive cancer?

A

Treastuzumab, a tryosine kinase, which downregulates cellular proliferation and promotes cellular apoptosis via binding to an extracellular domain on the HER2 receptor

618
Q

HUS

A

microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency

619
Q

What causes the outflow ventricular obstruction in interventricular hypertrophy?

A

Mitral valve leafnet and interventricular septum

620
Q

Signs of noncommunicating hydrocephalus?

A

Headaches, increased ICP

621
Q

How do loops cause hearing loss?

A

Inhibition of Na/K/2Cl transporters in the inner ear, usually at higher dosages with preexisting CKD, rapid intravenous administration, orwhen used in concert without agent that cause ototoxicity

622
Q

How is epinephrine produced?

A

Norepinephrine in converted to epiinephrine via phenylethanolamine-N-methyltransferase (which is upregulated by cortisol

623
Q

Legg-Calve-Perthes disease

A

young children isolated idiopathic osteonecrosis of the hip

624
Q

What drugs are metabolized by jetatic N-acetyltransferase?

A

Isoniazid and sulonamides - increased toxicity

625
Q

Myotonia?

A

abnormally slow relaxation of muscles (loosening one’s grip after shaking hands, inability to release a doorknob)

AD inheritance, CTG repeat for myotonia-protein kinase

626
Q

Where are dietary lipids absorbed in the interstinal track?

A

jejunum via passive absorption

627
Q

Complications of measles?

A

Encephalitis (days), acute disseminated encephalomyalitis (weeks), subacute sclerosis panencephalitis (years)

628
Q

Bacterial vs virus meningitis?

A

Viral- WBC <500, normal glucose, protein < 150

Bacterial- WBC >1000, <45 glucose,

629
Q

site effects of “navir” drugs?

A

metabolic complications (lipodystrophy, duslipidemia, insulin resistence

630
Q

NNRTI- common side effects

A

abrupt-onset flu-like symptoms, abdominal pain, fever, hepatic failure

631
Q

Uterine prolapse?

A

Uterus slips and enters the vagina

632
Q

Disorders that can cause Xanthomas?

A

obstructive biliary lesions, primary biliary cirrhosis, primary or secondary hyperlipidemia

633
Q

Fibrates-MoA

A

Upregulat lipoprotein lipase, and inhibit cholesterol 7alpha- hydroxylase

634
Q

G-protein-dependent phospholipase C pathway?

A

GTP -> IP3 -> increased intracellular Ca2+

635
Q

Cheyne-stokes breathing can be seek with which conditions?

A

CHF -> buildup of CO2 stimulated the breathng centers -> leads to overcorrect, stop breathing again

636
Q

Anti-inflammatory agent that does not interfere with platelet aggregation?

A

Celecoxib (Cox 2 inhibitor)

637
Q

Wernicke encephalopathy- signs?

A

Ophthalmoplegia, ataxia, and confusion -> coma -> death

638
Q

Meniere Disease

A

unilateral hearing loss @ tinnitus cause by increased pressure and volume in endolymph

639
Q

viral-independent viral nucleotides

A

Cidofovir, tenofovir

640
Q

what is the function of enteropeptidase?

A

jejnal brush border enzymes responsible for the activation of trypsinogen to trypsin

641
Q

Recombination

A

exchange of genes between 2 chromosomes by crossing over within homologous regions

642
Q

Granulomatous inflammation of the media of a vessel

A

temporal arteritis

643
Q

Signs of hereditary fructose deficiency? Cause?

A

vomiting and hypoglycermia 30 minutes after fructose ingestion (honey, fruits, vegetables), failure to thrive, hepatomegaly

Cause- Aldolase B deficiency

Hypoglycemia caused by intracellular accumulation of fructose-1-phosphate and depletion of inorganic phosphate

644
Q

Side effects of tetracyclines during pregnancy?

A

Teeth staining

645
Q

Where is PAH absorbed in the nephron?

A

It is not absorbed, concentration is lowest in Bowman’s space

646
Q

Atypical depression

A

mood reactivity, leaden paralysis, rejection sensitivity, increase sleep and apetite

647
Q

how do neural cells migrate in GI development?

A

Caudally, as such, rectum is ALWAYS involved

648
Q

Buerger’s disease

A

AKA- thromboangitis vasculitis of medium and small-sized arteries- extends into contiguous veins and nerves

649
Q

How does dehydration afffect the kidney filtration concentration

A

PCT will by isotonic (free flow)

Macula Densa - hypotonic (increased reabsorption of sodium with water)

Medullary CT- hypertonic (increased secretion of solutes to get more water)

650
Q

How to calculate positive predictive value?

A

True positive/(True positive + false negative)

651
Q

Mucosal tear without acute inflammation

A

Mallory Weiss, retching/vomiting

652
Q

Harnup disease

A

Enterocyte apical transport proteins involved in the absorption of tryptophan is defective -> decreased niacin deficiency

653
Q

Blepharosparm

A

involuntary forcible closure of the eyelids (starts with uncontrollable blinking)

654
Q

Glisson’s capsule

A

Capsule of the liver, made from fibrin

655
Q

Cause of atrialization of the right ventricle?

A

Lithium (ebstein abnormality)

656
Q

Pulmonary hypertension-signs

A

Second heart sounds with right-sided heart failure due to cor pulmonale

657
Q

Function of Sertoli cells

A

secrete mullerian-inhibiting factor -> absence leads to the development of female internal genitalia (paramesonephrid ducts develop)

658
Q

Dermatitis herpetiformis-age?

A

4-5th decade of life on buttocks and extensor surface

659
Q

Intranuclear acidophilic inclusion in the brain

A

HSV

660
Q

What surfaces to streptococcus adhere to?

A

Heart valves with preexisting endothelial damage

661
Q

How does SIADH affect the electrolytes?

A

hyponatremia, decreased plasma osmolarity, increased urine osmolarity, normal body fluid volume

662
Q

46, XX t(14:21)

A

unbalanced Robertsonian translocation

663
Q

hard nodules over the DIP bilaterally with moderate severe morning stiffness?

A

Osteoarthritis

664
Q

Causes of acute pancreatitis?

A
  1. Recent ERCP
  2. Drugs
  3. Infections
  4. Hypertriglyceremia
  5. Structural abnormalities
  6. Surgery
  7. Hypercalcenua
665
Q

Migratory throbophlebitis, concern?

A

visceral cancer -> paraneoplastic syndrome concern

666
Q

Cause of keyloid scaring

A

Overexpression of TGF beta -> scar extends beyond borders -> raised, painful puritic lesions

667
Q

How to approach an angry patient?

A

acknowledge the anger and defuse the situation

668
Q

third heart sound and recent MI?

A

Decompensated heart failure

669
Q

What are the tragets of HAART therapy?

A

Reverse transcriptase and protease

670
Q

Possible cause of postprandial voluminous diarrhea and weight loss

A

Short bowel syndrome -> vitamin 12 deficiency

671
Q

Pseudocholinesterase deficiency

A

Abnormally slow breaking down of anesthesia

672
Q

Prolonged PTT, PT, normal thrombin time?

A

Aoixaban rivaroxaban

673
Q

Schizoaffective disorder

A

Major depressive or manic episodes with concurrent symptoms of schizophrenia AND >/= 2 years of delusions of hallucinations in the absence of major depressive of manic episodes

674
Q

What is tetrahydrobiopterin a cofactor for?

A

Synthesis of serotonin and DOPA

675
Q

What causes the green color during the recovery from a hematoma?

A

Heme oxygenase (from macrophages) -> biliverdin (green pigment), carbon monoxide, and ferric iron

Biliverdin is reduced by biliverdin reductase to the yellow pigment, bilirubin, which is bound to albumin and transported to the liver

676
Q

What pouch do the superior parathyroid glands come from?

A

4th pharyngeal pouch

677
Q

Where does the fourth heart sound occur?

A

Prior to S1

678
Q

How do TCA work? Risk of death?

A

inhibit the reuptake of NE and 5_HT via the inhibition of the fast sodium channel

Risk of death: cardiac arrhythmias -> death

679
Q

Signs of B6 deficiency

A

anemia, peripheral neuropathy, dermatitis

680
Q

Biotin deficiency: Enzymes

A

Pyruvate carboxylase - pyruvate to oxaloacetate

Acetyl-CoA carboxylase- Acetyl-CoA to malomyl-CoA

Propionul-CoA carboxylase - Propionul-CoA to methylmalonyl-CoA

681
Q

What two effects does desmopressin therapy have?

A

Increases circulating factor VIII and vWF to stop bleeding (hemophilia A and Type 1 con willebrand disease) Binds V2 receptor in renal cells leading to increased aquaporin channels, increasing water reabsorption and decreasing urine output

682
Q

Curling Ulcers

A

Ulcers arrising in proximal duodenim in association with severe trauma/burms

683
Q

Pancreatic calcification, think?

A

Chronic alcohol abuse

684
Q

Furosemide?

A

Loop diuretic, blacks Na-k-2Cl

685
Q

elevated periosteum and sunburst pattern?

A

osteosarcoma- new women bone is being developed

686
Q

Equation for specificity?

A

TN/(TN+FP)

687
Q

Bipolar I versus Bipolar II

A

Bipolar I - manic episodes (severe, 1 week, marked impairment in social or occupational functioning, psychotic features)

Bipolar Type II (less sever, >/= 4 days, no psychotic conditions)

688
Q

What forms the right-sided bulge in the chest on X-ray

A

Right atrium

689
Q

Thromboxane A2-moA

A

vasoconstriction and platelet aggregation

690
Q

What does glucose-6-phosphate dehydrogenase catalyze?

A

First step in the pentose-phosphate pathwa -> produces 2 NADPH while converting glucose-6-phosphate into ribulose-5-phosphate

691
Q

Romano=Ward Syndrome

A

AD, QT prolongation without neural deafness

692
Q

Myasthenia gravis antibodies?

A

antibodies against acetylcholine receptors

693
Q

How do you treat pulmonary hypertension?

A

Bosartan (endothelian-1 antagonist)

694
Q

How does alcohol kill viruses?

A

Disrupts viral envelope

695
Q

How does precocious puberty affect children?

A

Lead to shorter height due to the action of sex steroids on the long bone epiphyseal plate

696
Q

Where is type II collagen found?

A

Cartilage, vitreous humor, nucleus pulposus

697
Q

Hydroxyurea- MoA

A

Increased fetal hemoglobin sunthesis -> protects against polymerization of sickle cells

698
Q

What seizure types can use Valproic acid?

A

Tonic-clonic, myoclonic

699
Q

What do diabetes “glit” drugs bind to?

A

PPAR-gamma, an intracellular nuclear receptor

700
Q

Brain tumor iwth whirled pattern?

A

Meningioma

701
Q

Delirium

A

Acute changes in cognition and behavior

702
Q

What does the Meningitis vaccine contain?

A

Capsular polysaccharides

703
Q

What does an increase in enzymes responsible for DNA synthesis signify?

A

Transition from G1 to S

704
Q

Drugs that cause a decreased heart rate

A

Beta-blockers, non-dihydropyridine receptors, cardiac glycosides, amiodarone, sotatol, cholengeric antagonists

705
Q

Where do dihydropyridines act?

A

Vascular smooth muscle, “-dipine” drugs

706
Q

Where are cavernous hemangiomas located?

A

Brain parenchyma above the cerebellar tentorium

707
Q

Dubin Johnson syndrome

A

detect in hepatic excretion of bilirubin glucuronides due to mutation in canalicular membrane transport protein

Labs: increased direct (conjugated) hyperbilirubinemia, other labs normal

Stress brings on jaundice

708
Q

How do you calculate the probability of getting at least 1 positive test result in an experient

A

p = 1-(%of the time the test is negative) ^ (# of tests)

709
Q

Chronic granulomatous disease-risks

A

recurrent bacterial and fungal infections due to impained NADPH oxidase

710
Q

How does glactose-1-phosphate uridyl transferase deficiency present?

A

Jaundice, vomiting, hepatomegaly, renal dysfunction,

711
Q

Treatment options available for Conn’s syndrome (hyperaldosterism)

A

spironolactone and Eplerenone

712
Q

Bilateral knee swelling (as a child) with exertional dyspnea, think?

A

Rheumatic fever with mitral regurgitation

713
Q

What infection can cause primary pericarditis?

A

Coxsackie

714
Q

What are the clinical findings of preeclampsia?

A

New-onset elevated blood pressure at >/= 20 weeks, proteinuria (or signs of end organ damage)

715
Q

Recurrent HSV infection treatment?

A

Calacyclovir

716
Q

Haloperidol

A

1st generation antipsychotic and potent D2 blocker

717
Q

Bluish lesion under the right index finer that is extremely painful to touch? origin?

A

Glomangioma-modified smooth muscle cells

Thermoregulation

718
Q

Reducing nausea from gastrointestinal irritation? Vestibular?

A

5-HT receptor antagonists-GI

H1 receptor antagonists - Vestibular

719
Q

Oxidase-positive colonies that do not germent lactose? tx?

A

Peudomonas aeruginosa

Tx: Cephalosporins (cefepime and ceftazidime)

720
Q

Intradermal nevi

A

Epidermal nests have been lost, dermal nevus cells lose tyrosinase activity and produce little to no pigment

721
Q

Bilobed nuclei with large eosinophilic granules

A

Eosinophils

722
Q

Amniotic fluid embolism?

A

Caused by trauma, fluid containing arachidonic acid metabolites -> occlusion and vasospasm of the maternal pulmonary circulation -> left heart failure-> cardiopulmonary arrest

723
Q

Foreman ovale

A

Mandibular branch of the trigeminal nerve

724
Q

Where to external hemorrhoids drain?

A

Internal pudendal vein tributaries (inferior rectal veins)

725
Q

Dissociated identity disorder

A

marked discontinuity in identy and loss of personal agency with fragmentation into more than 2 personality states

726
Q

What causes granuloma formation?

A

CD4 T-lymphocyte reaction that causes damage and cavitation

727
Q

VATER Syndrome

A

V- vertebrae

A- imperforate anus

TE - tracheoesphogeal fistula

R - Renal abnomalities

L - limb abnormalities

728
Q

Eplerenone

A

aldosterone antagonist (similar to spironolactone)

729
Q

What does C1 inhibitor deficiency cause?

A

Cleaving of C2 and C4 and inhibtion of kallikrein-induced convesion of kiniogen to bradykinin

730
Q

What causes a mahority of overdoses in the US?

A

Opiods (including heroin)

731
Q

What is placed on the 5’ cap on RNA stands?

A

methylguanosine triphosphate

732
Q

vibrio vulnificus- characteristics

A

Gram negative, lactose fermenting organism

733
Q

Where are cGMP-gated sodium channels used?

A

Vision

734
Q

Effect of low-dose dexamethasone? High dose?

A

Does not change for any type of cushings, only ectopic,

High dose only supresses pituitary

735
Q

Sudden onset of syncopal edisodes, think?

A

Cardiac arrhythmia, affected by K+ channels (genetically)

736
Q

Organism causing pneumonia in alcoholics

A

Klebsiella

737
Q

What structure lies anterior to the right renal artery?

A

IVC

738
Q

How to test for malabsorption?

A

Sudan III stain- identifies unabsorbed fat and confirm malabsorption

739
Q

Similar pathogenesis to Giant cell arteritis (temporal)?

A

Takaayasu arteritis, medial granulmoas

740
Q

Headache, retro-orbital pain, high-frade feer and joint and muscle pain with skin rash, and thrombocytopenia after travel to Brazil?

A

Dengue fever

741
Q

Most common cause of Osteomyelitis in children

A

S. aureus- hematological spread

742
Q

What is the problem with Friedreich ataxia?

A

decreased FXN expression 0> decreased mitochondrial energy and increased oxidative stress, resulting in degeneration of neural tracts and peripheral nerves

Specifically, spinocerebellar and lateral corticospinal tracts (gait ataxia)

Ldegeneration of dorsal solumns and dorsal root ganglia (loss of position and vibration

Hypertrophic cardiomyopathy, and CHFF

Diabetes

743
Q

cyanotic spells, improve with squatting, systolic murmur

A

Tetralogyof Fallot, caused by abnormal neural cell migration to anterior and cephalad deviation of the infundibular septum

744
Q

What is responsible for a majority of drug metabolism?

A

Cytochrome P450 enzyme

745
Q

Granulosa cell tumors

A

Yellow, lipid filled cells, in post menopausal women( Call-exner bodies) with coffee bean nuclei

746
Q

Bacterial transformation-definition

A

uptake of naked DNA by a cell

747
Q

Newer generation of antihistamines

A

Loratadine, cetirizine, do not cross blood-brain barrier

748
Q

Denosumab- MoA

A

Inhibits the RANK/RANK-L interactions -> increased bone density

749
Q

What is stimulus control for insomnia?

A

Usened only for sleep and sexual activity; leave bed when unable to sleep and go to another room, fixed wake-up times (including weekends)

750
Q

Skin lesion on upper eyelid

A

Xanthelasma

751
Q

Clomiphene- MoA

A

selective estrogen receptor modulator - Tx for PCOD

752
Q

What is the function of the ulnar nerve?

A

Wrist adduction

753
Q

Thyroid nodue containing clusters of overlapping cells with large nuclei containing sparse, finaly dispersed chromatin?

A

Papillary carcinoma (orphan annie eye)

754
Q

What promotes the formation of gallstones?

A

High levels of cholesterol with decreased bile salts and phosphatidylcholine (which increase solubility of cholesterol)

755
Q

How does hypertension arrive in a cresh patient?

A

sclerosis of everything -> sclerosis in the lungs -> pulmonary hypertension

756
Q

Lung transplant with bronchial obstruction, dyspnea, dry cough?

A

Chronic rejection

757
Q

Choline O-acetyltransferase

A

Synthesizes ACh

758
Q

Cause of decerebrate posturing?

A

Extensor posturing- loss of descending excitation to the upper lumb flexors via the rubrospinal tract (at or below the red nucleus)

Damage is @ the pons

759
Q

Spherocytes-MCHC

A

Increased, due to the smaller size

760
Q

How long for a first-order kinetics drugs to reach steady state?

A

4-5 half-life

761
Q

selective media containing vancomycin, collistin, nystatin, trimethoprim? Grows?

A

Thayer-martin, grows N. Gonorrheae

762
Q

Uticaria

A

“Hives” transient hypersensitivity, due to IgE-mediated degranulation -> causes edema of the superficial dermis

763
Q

Acyclovir- MoA

A

Inhibits via reverse transcriptase via competing with deoxyguanosine triphosphate

764
Q

Glioblastoma: characteristics

A

most common primary cerebral neoplasm in the cerebral hemisphere

large tumors causing mass effect, can see “butterfly glioma”

Necrosis and hemorrhage

Poor prognosis

765
Q

Oral thrust, interstitial pneumonia, severe lymphopenia in first year of life

A

Vertical transmission of HIV-1, treat with prenatal antiretroviral therapy

766
Q

In hypoxia conditions, what glycolysis component is shunted?

A

Pyruvate -> lactic acid inseat of Acetyl -CoA because of a build up of NADPH

767
Q

Common asthma allergens

A

Animal dander, dust mites, cockroaches, pollens and molds

768
Q

What does prussian blue stain detect?

A

Intracellular iron

769
Q

Cyclothymic disorder

A

2 years of fluctuating, mild hypomanic and depressive symptoms that do not meet criteria for hypomanic episodes or major depressive

770
Q

Signs of Dengue fever

A

Flu-like febrile illness with marked myalgias, retro-orbital pain, rash (white islands in a sea of red)

Travel to mexico/endemic area

771
Q

Signs of syringomyelia?

A

Loss of upper extremilt pain and temperature sensation, and extremity weakness

772
Q

c-ANCA is associated with what type of kidney formation?

A

Creascentic glomerulonephritis (rapidly progressing glomerular nephritis

773
Q

Down syndrome- cardiac defects

A

Endocardial cushion defects

774
Q

igE-independent mast cell degranulations?

A

Morphine, radiocontrast, etc.,

775
Q

What should be removed in aldolase B deficiency?

A

Fructose and sucrose

776
Q

What spinal tracts are affected in B12?

A

Dorsal columns, lateral corticospinal, axonal degeneration of peripheral nerves

777
Q

Harsh ejection systemolic murmur at the base of the heart, radiating to the neck

A

Aortic valve stenosis

778
Q

What are the functions of ACE-inhibitors?

A

Systemic vasodilation

Dilation of glomerular efferent arteriole (reduction in GFR, dec. perfusion with dilated vascular size)

Decreases adrenal aldosterone secretion

779
Q

Webbed neck..association

A

Turner Syndrome - 46, XO

780
Q

What connects the vagina to the anus?

A

Perineal body

781
Q

Mu receptor effects?

A

Respiratory & cardiac depression

782
Q

What type of transmembrane is CFTR?

A

ATP gated ion channel

783
Q

Ducts distended by pleomorphic cells with prominent central necrosis without externtion beyond the ductal basement membrane

A

Ductal carcinoma in site (microcalcification are encountered on mammography)

784
Q

Kawasaki disease? Risk for?

A

Medium sized arteries in young children of Asian ethnicity.

Fever for >/= 25 days plus 4 of the following

  • bilateral conjunctival injection
  • Cervical lymphadenopathy,
  • mucositis (strawberry tongue)
  • extremity changes
  • rash

Increased risk for development of coronary artery aneurysm from inflammation

785
Q

factors that can lead to vitamin B12 deficiency?

A

Long-tern vegan diet (years, not months)

786
Q

What do proto-oncogenes do?

A

stimulate cell proliferation, and their over expression (activation) leads to increased cellular proliferation and neoplastic growth

787
Q

Signs of scurvy

A

Gingival swelling and perifolllicular hemorrhages and coiled hairs

788
Q

How to AV shunts affect preload and afterload?

A

Increase preload, decrease afterload

789
Q

How to calculate RPF

A

PAH clearance - (urine [PAH] X urine flow rate)/ plasma (PAH)

790
Q

Hashimoto thyroiditis-hormone changes

A

Increased TSH, Decreased T4, nomral T3(which is converted in peripheral tissues

791
Q

What drug provides a signifiant reduction in triglycerides? Side effects?

A

Fibrates

Side effects: muscle toxicity, gallstones

792
Q

MoA of calcipotriene

A

(topical vitamin D analog)m actuvate the vitamin D receptor (nuclear transcription factor) andd cause inhibition of keratinocyte proliferation

793
Q

How to caoculate half-life

A

(0.7 x volume of distribution)/CL

794
Q

How to revent hemorrhagic cystitis associated with nitrogen mustard-based chemotherapy?

A

Mesna and aggressive hydration

795
Q

Hemorrhagic lymphocyte pleoctosis, increased protein, normal glucose?

A

Herpes simplex virus encephalitis

796
Q

What nerve enters through the foramen rotundum?

A

CN V2 (maxillary

797
Q

What type of immunity is antitoxin?

A

passive immunity

798
Q

Signs of spinal stenosis? Cause?

A

bilateral pain provoked by walking, relieved by leading on something with normal strength

Cause- degeneration of spinal cord leading to ligamentum flavum hypertrophy

799
Q

Ulcers in ZE?

A

extend beyond duodenal bulb and are refractory to therapy

800
Q

Name some alpha-1 blockers

A

Doxazosin, Prazosin, Terazosin

801
Q

What arteries supply the ureter -proximal? Distal?

A

Renal artery-proximal

Common iliac, internal iliac, and superior vesical artery-distal (not retained in X-plant

802
Q

Hepatic changes in hepatitis?

A

Apoptosis of heratocytes, periportal inflammatory infiltration

803
Q

Fatique, weakness, itching, cause?

A

uremia toxins secondary to progressive chronic kidney disease

804
Q

Signs of HSP?

A

GI pain, hematemesis, IgA nephropathy, papable purpura in the buttocks and lower extremities, self-limited migratory arthalgias/arthritis

805
Q

How do corticosteroids affect neutrophils?

A

Cause demargination removal of neutrophils from the edge of blood vessels and release them into circulation

806
Q

Cause gram-positive bacteria to swell in hypotonic solutions

A

Interference with cell wall synthesis ->cephalosporins, vancomycin, penicillins

807
Q

What can relieve carple tunnel syndrome?

A

Longitudinal incision through the transverse carpal ligament (flexor retinaculum)

808
Q

Very large cells with over 100 nuclei?

A

Osteoclasts in Paget’s disease

809
Q

How to diagnose type I diabetes?

A

Hemoglobin A1c > 6.5% or fasting glucose >/= 126

810
Q

COX1 vs COX2 expression

A

Cox1 - norrmmal function tissues

COX2-expressed at sites of inflammation

811
Q

Nigrostriatal degeneration in parkanson disease results in?

A

Excessive excitation of the globus pallidus interbus by the subthatamic nucleus, which causes excessive inhibition of the thalamus

812
Q

Delta receptor use?

A

Antidepressant effects

Analgesia

813
Q

Lambert-Eaton antibodies?

A

against pre-synaptic calcium channels

814
Q

Folate deficiency, level of methylmalonic acid is?

A

normal

815
Q

What does fluid infusion do the volume-pressure loop

A

Rightward extension of the filling portion, and increased maximal pressure

816
Q

Immune complex vasculitis with igA and c3?

A

Henoch-Scholein purpura

Presents with purpuric rash, colicky abdominal pain and polyarthralgia

817
Q

With a build u of 17-hydroxyprogesterone, where is the defect?

A

21-hydroxylase

818
Q

What are the effects of exogenous steroids?

A

Decreased gonadotropin, leading to infertility

819
Q

Signs of cardiac tamponade?

A

Jugular venous distention, hypotension, diminshed heart sounds, pulsus paradoxus

820
Q

Schiztophrenia-characteristics

A

Fixed delusions, frank hallucinations

821
Q

Name the potassium sparing diuretics.

A

Spironolactone and Eplerenone, Triamterene, Amiloride

822
Q

Near-miss

A

medical error recognized before any harm has been done

823
Q

What is associated with delirium?

A

Waxing and waning levels of consciousness, hallucinations

824
Q

Heredity bleeding disorder

A

Von Willibrand Factor

825
Q

How does long-term use of Levadopa affect movement?

A

Long-term use leads to On-Off phenomenon that causes fluctuations in movement ability over time, as the therapeutic windows narrows due to natural of levodopa-induced nigrostriatal degeneration

826
Q

Types of lymphocytes

A

B-cells and T-cells, NK cells

827
Q

What structure contains dihydrouridine, ribothymidine, pseudoridine?

A

tRNA, 3’ end has a CAA sequence used for recognition

828
Q

What can a double blind study prevent?

A

Observer bias

829
Q

Elderly person with hematuria suggests…

A

renal or urothelial neoplasm

830
Q

Anaplasia of epithelial cells with invasion into the stroma

A

Epithelial ovarian cancer

831
Q

Sertoli cells-function

A

Facilitate spermatogenesis Produce inhibit in response to FSH

832
Q

Post-warfarin- reversal agent?

A

Protein C deficiency,

Warfarin initiation leads to a drop in factor VII and protein C

Tx- remove warfarin, and adminster fresh frozen plasma

833
Q

Where does chromosome segregation occur during anaphase?

A

Primary spermatocyte

834
Q

Function of BCL2

A

Cell death cascade

835
Q

What receptors are involved in stimulating the vomiting reflex?

A

m, muscarinic, D, dopaminergic, h, histaminic (DHM)

When those do not work,neurokinin 1 receptor antagonists can work

836
Q

Signs of tanstentorial herniation?

A

Ipsilateral oculomotor nerve compression - fixed and dilated pupil

Ipsilateral posterior cerebral artery compression (contralateral homonmous hemianopsia with macular sparing

Compression of contralateral corticospinal tracts

Brainstem hemorrhages (duret hemorrhage)- basilar artery

837
Q

Postprandial rapid fluid shifts- cause? Signs?

A

Gastric bypass or damage to the pyloric sphincter

Postprandial nausea, voliting, cramps, viarrhea, and vasomotor symptoms (diaphoresis, flushihng)

838
Q

Hear tfilaure in the setting of recent viral infection, think?

A

Dilated cardiomyopathy caused by viral myocarditis

839
Q

Pathology of Raynaud phenomenon

A

increased deposition of collagen in tissues

840
Q

Pulmonary hypertension: pathogenesis?

A

Passive increase in pulmonary capillary and arterial pressure caused by pulmonary venous congestion

841
Q

Wheel-like shaped virus? Structure?

A

Rota virus

842
Q

Hypertension in a women > 20 weeks pregnancy?

A

Pre-eclampsia

843
Q

Highest incidence of cancer in woman?

A

breast

844
Q

Drugs to manage drug-induced parkinsonism

A

Trihexyphenidyl, denztropine

845
Q

KRAS

A

Proto-oncogene

846
Q

What can reverse methotrexate toxicity?

A

Folininc Acid

847
Q

Heparin-induced thrombocytopenia

A

iGG antibodies against heparin-bound platelet factor 4 _> activates platelets

848
Q

Spinocerebellar tract?

A

Proprioception from the body to the cerebellum

849
Q

What type of antibody is the anti-RH immune globulin?

A

IgG anti-D -> opsonize Rh+ fetal erythrocytes, administered @ 28 weeks

850
Q

What is inhibited in drug-induced parkinsonism?

A

Nigrostriatal pathway (D2 blockade)

851
Q

Mutations in CML?

A

CHr 9:22, which causes a tyrosine kinase activation (BCR-ABL)

852
Q

Phenoxybenzamine-moA

A

irreversible alpha 1 and alpha 2 inhibitor

853
Q

SIADH- effect?

A

Excessive water absorption by the kidneys, -> hypervolemia -> sodium loss by the kidneys

854
Q

Poorly developed sexual characteristics, cannot smell? mutation?

A

Kallman syndrome, failure of GnRH-secreting neurons to migrate from origin in the olfactory to the hypothalamus

Muataion KAL-1, GFGR-1

855
Q

Preventable adverse event?

A

harm to a patient via act of commission or omission, rather than from the underlying disease

856
Q

Eczema after environmental exposure in a child?

A

Atopic dermatitis, seen with allergic rhinitis, asthma (allergic triad)

857
Q

Pure red cell aplasia

A

hypoplasia of marrow erythroid elements due to inhibition of prythropoietic precursors by igG autoantibodies or cytotoxic T-lymphocytes

Associated with Thymomas and lymphocytic leukemias or parvo

858
Q

Signs of hyperaldosterism, Na, K, H level?

A

normal Na reabsorption, increased K+, H+ exceretion,

859
Q

How does digoxin slow ventricular rate?

A

enhances vagal tone -> slows AV node

860
Q

What causes the removal of RNA primers and the replacement with DNA?

A

DNA polymerase I (5’-3’ exonuclease activity)

861
Q

Sudden, involuntary contraction of a major muscle group

A

Acute dystonic reaction (4 hours-4 days after the initiation of antipsychotic medications)

862
Q

PCA infarct on vision?

A

homonymous hemianopia (same side of both eyes)

863
Q

Risks in pregnant mother with diabetes?

A

Transient hypoglycemia for the first several days

864
Q

How to calculate the net excretion of a substance?

A

(Inulin clearance X Plasma [Substance A]) - (Tubular absorption of substance A)

865
Q

Lepromatous leprosy-presentation

A

Weak cell mediated immunity (Th2), leads to myobacterium dissemination -> diffuse skin thickening, plaque-like hypopiigmentation, leonine facies, paresis, regional ansthesia,, testicular destruction, blindness

866
Q

Small white spots with an erythematous base on buccal musosa?

A

Koplok spots (associated with measles)

867
Q

Widespread narrowing of the renal arterioles with deposition of homogeneous, glassy material in the subendothelial space that stains pink with PAS?

A

Diabetes Mellitus

868
Q

Bacterial DNA polymerase 1- unique features

A

5’-3’ exonuclease activity to remove the RNA primer created by RNA primase and repair DNA sequences

USMLE (2 decks)

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