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Smart Book Flashcards

1
Q

What vitamin deficiencies can lead to an increased homocysteine level? What is produced? Risk from high homocysteine?

A

1) B12, B9 leading to methionine (methionine synthase)
2) B6 leading to cystathionine (cystathionine synthase)
3) Thrombosis

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2
Q

What can nitrites be used to treat? How?

A

cyanide poisoning by inducing methhemoglobinemia. Fe3+ binds cyanide more avidly than mitochondrial enzymes

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3
Q

Synthesis of what molecules require NADPH?

A

Cholesterol, fatty acids, steroids (reductive biosynthesis)

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4
Q

Derivatives of 1st pharyngeal arch?

A

CN 5, mandible, maxilla, zygoma, incus, malleus

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5
Q

Derivatives of 2nd pharyngeal arch?

A

CN VII, stapes, styloid process, lesser horn of hyoid

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6
Q

Which histone serves as a linker?

A

H1

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7
Q

Percents of first 3 stdev?

A

68%, 95%, 99.7% (note: consider both sides)

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8
Q

Two causes that vertically shift the meeting point of the cardiac function and venous return curves?

A

Exercise and AV shunt

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9
Q

What is the major factor that increases risk for chronic HBV infection?

A

Age

infants>children>adults

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10
Q

What do you give for prophylaxis of MAC in HIV patients?

A

Azithromycin

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11
Q

What do you suspect with an infant in respiratory distress that was preceded by cold-like symptoms.

A

Bronchiolitis: think RSV

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12
Q

Differentiate malformation, deformation and disruption

A

1) Malformation- primary intrinsic defect
2) Deformation- deformed by external mechanical forces
3) Disruption- secondary breakdown of previously formed structure

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13
Q

Describe the role of CFTR in sweat glands and Resp/GI glands in a CF patient

A

Sweat: dec. salt absorption (hyperosmolar sweat)

GI/Resp: dec. Cl- secretion, inc. Na+/H20 reabsorption leads to thick mucus

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14
Q

What nucleotide is decreased in folate deficiency? Enzyme?

A

dTMP, thymidylate synthase

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15
Q

MOA of azoles, nystatin, amphotericin B, and capsofungins

A

1) Azoles: inhibit ergosterol synthesis
2) Nystatin/Ampho B: inhibit ergosterol incorporation (holes in membrane)
3) Capsofungin: inhibit cell wall glucans
Note: first two are in the cell membrane, NOT WALL

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16
Q

Which part of the intestines is always involved in Hirschsprung disease?

A

Rectum- it is the stoppage of downward migration of neural crest

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17
Q

Which anti-lipid agent can cause gout?

A

Niacin

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18
Q

What builds up in methylmalonic acidemia?

A

propionyl CoA

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19
Q

What interleukin is associated with allergic asthma?

A

IL-5 (eosinophil chemoattractant)

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20
Q

Name two aldosterone antagonists that can be used to treat Conn’s syndrome.

A

Spirinolactone and eplerenone

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21
Q

Where is hepcidin produced?

A

Liver

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22
Q

Describe the roles of TXA2 and PGI2 (prostacyclin)

A

TXA2- vasoconstriction and promotes platelet aggregation

PGI2- vasodilation and inhibits aggregation

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23
Q

Association with caudal regression syndrome?

A

Maternal diabetes (poorly controlled)

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24
Q

What is the T-cell area of a lymph node?

A

Paracortex (B cells are cortex and follicles)

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25
Q

What organism grows green on EMB agar? What is it’s number one virulence factor in infections?

A

E. coli. Fimbriae

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26
Q

What do the pol and env genes code for in HIV?

A

pol- reverse transcriptase

env- structural glycoproteins

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27
Q

How does digoxin help control a. fib?

A

Vagus stimulation (PSNS rate control)

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28
Q

What processes occur in the cytosol? (3)

A

Glycolysis, fatty acid synthesis, pentose phosphate pathway

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29
Q

Where does decarboxylation of pyruvate occur?

A

Mitochondria

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30
Q

Neurological symptoms without neuro cause?

A

Conversion disorder

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31
Q

What aortic arch is a PDA derived from?

A

6th

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32
Q

What causes the flushing with niacin?

A

PGs (thus can be treated with NSAIDS)

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33
Q

Does epi stimulate or inhibit insulin secretion? Blockade of what receptor can reverse this?

A

It inhibits (alpha 2> beta 2), but with alpha 2 blockade, B-2 takes over and increases insulin

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34
Q

What muscle relaxant is dangerous in hyperkalemia situations since it can cause K+ release?

A

Succinylcholine

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35
Q

What is the major association with pulsus paridoxicus?

A

cardiac tampanade

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36
Q

What omentum contains the hepatogastric and hepatoduodenal ligament?

A

Lesser omentum

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37
Q

Where does capping, poly A tail addition, and splicing of introns happen to RNA?

A

Nucleus

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38
Q

What does SIADH cause in respect to sodium level?

A

EUVOLEMIC hyponatremia (transient hypervolemia only)

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39
Q

What is the role of interferon alpha and beta? What stimulates release?

A

Viral infection stimulates release and causes increased apoptosis and decreased protein synthesis in infected cells and “primes” surrounding cells to do the same

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40
Q

What drugs are associated with 1st dose hypotension?

A

ACE inhibitors

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41
Q

What substance is an allosteric activator of gluconeogenesis?

A

Acetyl-CoA

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42
Q

What arteries accompany the external superior laryngeal nerve and the recurrent laryngeal nerve?

A

Ext. Sup. Laryngeal: superior thyroid artery

Recurrent: Inf. thyroid artery

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43
Q

Hypotonia in all four limbs, cardiomegaly, glycogen inlysosomes?

A

Popme disease: acid alpha glucosidase

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44
Q

Inhibition of what pathway has a role in Parkinson and Alzheimer diseases?

A

Ubiquitin/proteasome pathway

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45
Q

What is bortezomib? What cancer does it work for?

A

Multiple myeloma cells are susceptible to proteasome inhibition because they make tons of protein. Bortezomib does this and causes apoptosis (not decreased protein synthesis)

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46
Q

What structure in the brain is preferentially affected in Wilson’s disease?

A

Putamen (basal ganglia)

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47
Q

Normal range for pulmonary artery pressure?

A

10-25 mmHg

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48
Q

What is the defect in XP?

A 
Endonuclease defect (AR)
Note: 3'-->5' exonuclease is DNA polymerase proofreading
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49
Q

What is anti-Jo-1 antibody?

A

Polymyositis (anti-histidyl tRNA synthetase)

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50
Q

What if a patient has psychosis, but only in MDD episodes?

A

MDD with psychotic features

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51
Q

What roles do estrogen and progesterone play in pregnancy gallstones?

A

Estrogen: cholesterol hypersecretion
Progesterone: gallbladder hypomobility

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52
Q

How can triglycerides contribute to gluconeogenesis? First step?

A

Glycerol is gluconeogenic

Glycerol–> glycerol-3-phosphate by glycerol kinase in the liver

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53
Q

Which node is near the orifice of the coronary sinus?

A

AV node

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54
Q

What do you give for serotonin syndrome?

A

Cyproheptadine (antihistamine with anti-serotenergic properties)

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55
Q

How is CFTR regulated?

A

ATP gated membrane channel

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56
Q

Which step in the krebs cycle produces FADH2?

A

Succinate to fumarate by succinate dehydrogenase

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57
Q

Which treatment for hyperlipidemia can increase TGs?

A

Cholestyramine (bile acid resins)

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58
Q

What arteries do the ureters pass anterior to in order to reach the pelvis?

A

Iliac arteries (internal in true pelvis)

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59
Q

Where and what is the enzyme that activates trypsin?

A

Enteropeptidase is in the brush border of the jejunum

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60
Q

What might a cavernous hemangioma cause?

A

Intracerebral bleed and seizure

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61
Q

What is the number one treatment for uncomplicated UTI?

A

Bactrim (TMP-SMX)

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62
Q

What is needed for the reaction catalyzed by PEPCK to occur? Where is it produced?

A

GTP, produced in the Kreb’s cycle by succinyl CoA synthetase (succinyl CoA to succinate)

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63
Q

Drug if you have absence seizures and tonic clonic?

A

Valproate

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64
Q

Interstitial myocardial granuloma? Cause?

A

Aschoff body, found in myocarditis due to acute rheumatic fever

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65
Q

Name two drugs that share a MOA with methotrexate.

A

1) Trimethoprim

2) Pyrimethamine

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66
Q

MOA of SMX?

A

Dihydropteroate synthetase inhibitor

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67
Q

MOA of milrinone?

A

PDE-3 inhibitor. Arterial dilation via up cAMP and increases cardiac contractility

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68
Q

How does pyruvate kinase deficiency manifest?

A

Hemolytic anemia due to glycolysis failure and low ATP. This also causes splenomegaly from removing the damaged erythrocytes

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69
Q

Name the two arteries previous to the retinal artery in the branching scheme

A

Internal carotid–> ophthalmic–> retinal

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70
Q

How do fibrates cause gallstones?

A

Inhibit cholesterol 7 alpha hydroxylase (the rate limiting step in bile acid synthesis)

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71
Q

Treatment for HIT?

A

Direct thrombin inhibitors (argatroban, bivalirudin, dabigatran)

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72
Q

How do exercise and low weight cause amenorrhea?

A

Hypogonadotropic (loss of pulsatile GnRH)

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73
Q

What cytokine causes keloid/scar formation?

A

TGF-B

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74
Q

Joint laxity, hyperextensible skin, tissue fragility

A

Ehlers danlos (collagen problem probably with crosslinking)

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75
Q

As antiarrhytmics, what interval do Beta blockers prolong?

A

Increase the length of the PR interval, phase 4

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76
Q

What anti-epileptic causes gingival hyperplasia? How?

A

Phenytoin–> PDGF–> gingival hyperplasia

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77
Q

What are BRCA 1/2?

A

Tumor suppressor genes involved in DNA repair

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78
Q

What form of bias is loss of follow up?

A

Selection bias (attrition bias more specifically)

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79
Q

Can severely anemic people become cyanotic?

A

No.. Cyanosis indicates the presence of deoxygenated hemoglobin that gives a blue appearance. There is not enough hemoglobin for this in anemic people

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80
Q

What nerve innervates the parotid gland?

A

CN IX

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81
Q

What is mesalamine used for?

A

UC treatment

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82
Q

What is a specific marker for mast cell activation?

A

Tryptase

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83
Q

What is a cytologic side effect of ganciclovir? What increases the likelihood of it?

A

Neutropenia, increased risk with concurrent TMP-SMX

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84
Q

Palpable but nontender gallbladder?

A

Courvoisier sign, pancreatic cancer

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85
Q

What type of HSR is a scabies infection? Where are the lesions?

A

Type IV, flexor surfaces or wrists, lateral fingers and finger webs

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86
Q

What is the result of hyperventilation on cerebral blood flow and ICP?

A

Decreased CO2 leads to decreased cerebral blood flow and ICP

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87
Q

What is low CO2 always a sign of?

A

Hyperventilation

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88
Q

Effect of inhaled anesthetics on cerebral blood flow?

A

Increased (pretty much depresses everything else)

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89
Q

What is the effect of class IA, IB and IC antiarrhytmics on AP length?

A

IA: prolongs
IB: shortens
IC: no change

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90
Q

What is the relationship between pressure required to keep a sphere open and its radius?

A

Inverse relationship

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91
Q

What can HPV infect in the upper body?

A

True vocal cords (squamous cell carcinoma)

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92
Q

What prevents local candida infection? Systemic?

A

Local: T cells
Systemic: Neutrophils

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93
Q

What gives elastin its springy properties?

A

Cross-links

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94
Q

What should you avoid with HOCM patients?

A

Anything that decreases LV volume (decreased afterload or preload)- e.g. nitrates

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95
Q

What is the role of cord factor in TB?

A

Inactivates neutrophils, damages mitochondria and decreases TNF release

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96
Q

What is the interaction between beta blockers and thyroid hormones?

A

Beta blockers decrease peripheral conversion of T4 to T3 and decrease sympathetic effects

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97
Q

What is the eventual cause of astrocyte injury in hepatic encephalopathy?

A

Glutamate + NH4+–> Glutamine
Too much glutamine leads to swelling of astrocytes and decreased glutamate in neurons. This causes injury and decreases excitatory neurotransmission

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98
Q

What should you instantly associate with PAN?

A

Hepatitis B (transmural fibrinoid necrosis of medium vessels but sparing pulmonary vessels)

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99
Q

Two enzyme deficiencies that can cause increased orotic acid? How do you distinguish?

A

OTC deficiency (XLR) and ump synthetase deficiency. If also high ammonia, it is OTC deficiency

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100
Q

What is the inheritance of hereditary spherocytosis?

A

AD (kinda in line with the structural defect thing)

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101
Q

What is enfuvirtide? What does it bind?

A

Fusion inhibitor that binds GP41

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102
Q

actinic keratoses can progress to what?

A

SCC of skin

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103
Q

ATN with vacuolar degeneration of PT cells and calcium oxalate crystals

A

Ethylene glycol ingestion

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104
Q

What antilipid drug can cause gout?

A

Niacin

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105
Q

What causes the S4 heart sound?

A

Blood flow into a stiff ventricle

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106
Q

What is MMA in the process of converting?

A

Branched chain AAs, threonine, methionine and odd chain FA–> Propionyl CoA–> MMA–> Succinyl CoA in Krebs

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107
Q

What enzyme converts MMA to succinyl CoA?

A

methylmalonyl CoA mutase

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108
Q

Nerve that does suprapubic and gluteal sensation? May be injured in abdominal surgery.

A

Iliohypogastric nerve

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109
Q

What IL should you immediately associate with eosinophils?

A

IL-5

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110
Q

What is the catalase positive infection not in sketchy?

A

Burkholderia cepacia

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111
Q

What is Conn’s syndrome?

A

Aldosterone secreting tumor (use spironolactone or eplerenone)

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112
Q

What form of payment is a predetermined fee for everything? What about a single payment for all expenses with an incident of care (e.g. surgery)

A

Capitation, Global payment

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113
Q

What is the #1 E. coli virulence factor?

A

P. fimbriae

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114
Q

Neuro symptoms incompatible with a neuro disease

A

Conversion disorder

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115
Q

Which aortic arch creates proximal pulmonary arteries?

A

6th

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116
Q

What is the normal response of insulin with Epi? Which sympathetic receptors increase release and which decrease it?

A

Decreased (alpha 2 action is greater than beta 2). Gs, Gq increase release of insulin usually, Gi inhibits it

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117
Q

What abnormality must you check before administering succinylcholine?

A

Hyperkalemia (it causes K+ release)

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118
Q

What are the two most important opsonins?

A

C3b and IgG

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119
Q

MOA of rifampin?

A

Inhibits DNA-dependent RNA polymerase

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120
Q

What is the one muscle in the vocal region supplied by the external laryngeal nerve? What are the rest supplied by?

A

Cricothyroid, recurrent laryngeal nerve (internal laryngeal only does sensory above vocal folds)

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121
Q

Is parvovirus single or double stranded?

A

SINGLE. SINGLE. SINGLE. SINGLE

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122
Q

Mild, non-progressive hyperglycemia that often is noted in pregnancy? What causes it?

A

Glucokinase deficiency can cause maturity-onset diabetes of the young (MODY)

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123
Q

Wrinkled tissue paper macrophages? Enzyme?

A

Gaucher- beta-glucocerebrosidase

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124
Q

What is cutis aplasia? What causes it? Summarize the effects of the cause in one word.

A

Cutis aplasia is focal skin defect of the scalp. Patau syndrome. Midline defects (Trisomy 13)

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125
Q

What type of glands are: sweat glands, mammary glands, salivary glands, sebaceous glands?

A

Sweat, Salivary: merocrine (exocytosis)
Mammary: apocrine (vesicles)
Sebaceous: holocrine

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126
Q

Call-exner body in ovarian tumor

A

Granulosa cell tumor (yellow)

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127
Q

What is dry beriberi?

A

Thiamine deficiency causes symmetrical peripheral neuropathy

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128
Q

What are the major electrolyte effects of amphotericin B toxicity?

A

Decreased magnesium and increased potassium

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129
Q

MOA of ribavirin?

A

Kinda like aciclovir for RNA polymerase (guanosine analog)

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130
Q

What binds in rolling?

A

Selectins to sialy lewis X

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131
Q

What binds in tight binding?

A

CD18 (integrins) to ICAM

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132
Q

Increased gastric acid secrtion, flushing, hypotension, pruritis, urticaria?

A

Increased histamine possibly due to systemic mastocytosis (KIT mutations)

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133
Q

What is the relative color and depth of chief cells to parietal cells?

A

Parietal: Shallow and pink (acidophilic)
Chief: Deep and purple (basophilic)

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134
Q

Where does a herpesvirus derive its envelope?

A

Host nuclear membrane

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135
Q

What two pathways is dihydrobiopterin reductase important for?

A

1) Phe–>tyrosine–> dopa–>catecholamines

2) Tryptophan to serotonin

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136
Q

Cleft lip when maxillary prominences fail to fuse with what?

A

Medial nasal prominences

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137
Q

What is the timing of an acute transplant rejection?

A

weeks to 6 months (not super fast)

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138
Q

How do you detect strongyloides stercoralis?

A

Larvae in stool

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139
Q

Which hepatitis may present like serum sickness?

A

Hep. B

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140
Q

What is the MOA of buspirone? Why do you use it?

A

5HT-1A partial agonist used for GAD (slow onset of action)

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141
Q

What does ciprofloxacin do to p450?

A

Inhibitor

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142
Q

What does AA is required to secrete acid from kidney when stimulated by acidosis?

A

Glutamine–> glutamate + NH3

This NH3 can combine with H+ and secrete it in the urine

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143
Q

Where does nitroprusside act?

A

Veno and arterial dilator

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144
Q

What is the best indicator of severe mitral regurgitation?

A

S3 heart sound (high filling pressure)

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145
Q

If you see herpetic gingivostomatitis (in mouth), what do you know?

A

This is a primary infection

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146
Q

What causes Gram (-) sepsis?

A

Lipid A from LPS

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147
Q

What on x-ray forms the right heart border?

A

Right atrium

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148
Q

What do protease inhibitors due to labs? P450?

A

Inhibit p450 and can cause hyperglycemia

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149
Q

Diabetes, necrolytic migratory erythema, anemia.

A

Glucagonoma

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150
Q

What part of the heart is lateral to the midclavicular line?

A

None

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151
Q

What if you see AChE on amniocentesis?

A

Suspect neural tube defect.

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152
Q

What is the main difference in the immunity provided by the two polio vaccines?

A

Better IgA response from the oral (sabin) live attenuated vaccine

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153
Q

What factor mediates smooth muscle migration into the intima in atherosclerosis?

A

PDGF (platelets also release TGF-B)

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154
Q

What is downstream of RAS often?

A

MAPK

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155
Q

What is the mechanism of calcium sensing receptors on the parathyroids (or anywhere else)?

A

G-protein coupled

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156
Q

What are two PYR positive bacteria?

A

Strep. pyogenes and enterococcus

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157
Q

What is a major functions of pyridoxine?

A

Transamination and decarboxylation

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158
Q

What are the three pairs in transamination?

A

glutamate and alpha-KG
Alanine and pyruvate
Aspartate and oxaloacetate
Note: the AAs are always on opposite sides

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159
Q

MOA of terbinafine

A

Inhibits squalene epoxidase and thus decreases fungal membrane ergosterol

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160
Q

Can repetitive nerve stimulation help with botulism?

A

Yes

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161
Q

With liver injury, what can cause pigmented bile stones (enzyme)?

A

Injured hepatocytes and bacteria can release beta-glucuronidase and unconjugate bilirubin

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162
Q

What is the repeat with fragile X? What is the mechanism of pathogenesis?

A

CGG repeats cause hypermethylation and inactivation of FMR1

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163
Q

What is the substance that suppresses GnRH?

A

Prolactin

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164
Q

What drug kills malaria hypnozoites? What strains of malaria make this a concern?

A

Primaquine for P. vivax or P. ovale

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165
Q

What do you suspect with an increased bleeding time in a patient with renal dysfunction and high BUN?

A

Uremia can cause qualitative platelet dysfunction and isolated increase in bleeding time (isolated in the realm of hematologic labs)

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166
Q

What type of amyloid is associated with dialysis?

A

Beta-2 microglobulin–> possible bilateral carpal tunnel

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167
Q

Which sulfonylureas have the highest incidence of hypoglycemia?

A

Long acting ones. Since the first gen. arent really used any more, this means the -rides

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168
Q

What nerve causes a winged scapula? Muscle?

A

Serratus anterior and long thoracic nerve (lateral thoracic artery)

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169
Q

How long can cardiomyocytes keep contracting after the onset of ischemia?

A

Less than a minute

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170
Q

Most often cause of DIC in pregnancy?

A

Release of tissue factor (thromboplastin) from an injured placenta

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171
Q

What is an important part of Huntington pathogenesis?

A

Histone deacetylation

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172
Q

What is P-glycoprotein?

A

A product of human MDR1 gene that codes for a transmembrane ATP-dependent efflux pump

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173
Q

Best anticoagulation in pregnancy?

A

LMWH (e.g. enoxaparin)

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174
Q

What cancer is associated with Paget disease of bone?

A

Osteosarcoma

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175
Q

What if you see 180 base pair fragments?

A

Apoptosis- this is called DNA laddering

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176
Q

What are the only cells that produce IL-2?

A

T lymphocytes

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177
Q

What is the primary concern of injury with knee dislocations? Describe the arrangement of the nerve, artery and vein in the popliteal fossa.

A

Artery injury

Superficial to deep is nerve, vein, artery

178
Q

How long must it have been to diagnose PTSD?

A

At least 1 month

179
Q

What is the state of glucose, Na+ and K+ in DKA?

A

Glucose and K+ are high (total K+ body store actually low) and sodium is low

180
Q

What is the test for antigens that is based on a color change?

A

ELISA

181
Q

What directs preproinsulin to ER?

A

N-terminal peptide. It is cleaved at the ER to form proinsulin which is cleaved to insulin and C-peptide in secretory granules

182
Q

What thalassemia is associated with pregnancy loss?

A

Alpha thal., Hb Barts (gamma chain tetramer) and hydrops fetalis

183
Q

What allows local testosterone concentration to be high enough for sperm production in the testicles?

A

Sertoli cells secrete ABP

184
Q

What acid-base disorder will be present with a PE?

A

Respiratory alkalosis

185
Q

What is the normal method of initiating translation? Alternate? What type of cells do the alternate?

A

Normal: small ribosomal subunit binds 5’ cap and scans for Kozak (euk.) or Shine-Dalgarno (prok.) sequence
In apoptotic cells internal ribosome entry is an alternate method where a distinct sequence (usually in the 5’ NTR) allows translation to begin.

186
Q

What two things does PPAR-gamma upregulate?

A

Glut-4 and adiponectin (increases insulin sensitive adipocytes)

187
Q

Which hereditary cancer syndrome is AD with an oncogene rather than an TSG?

A

MEN2 (RET)

188
Q

Slow speech of primarily nouns/verbs is called what? Associated with what aphasia?

A

Agrammatism- Broca

189
Q

What are the only efferent nerves that are unmyelinated? Name 3 sensory that are.

A

Efferent: Postganglionic autonomic neurons
Sensory: slow pain, heat, and olfaction

190
Q

Relation of standard error to STdev?

A

SE=Stdev/square root of #

191
Q

What is the main thing to think about in PCOS? Effect on LH and FSH?

A

Increased LH–> increased androgens–> peripheral estrogen conversion–> decreased FSH

192
Q

What are the two antibiotic classes that work at the 30s ribosomal subunit?

A

Aminoglycosides and tetracyclines

193
Q

What does not transilluminate in the testes and enlarges with standing?

A

Varicocele

194
Q

What is leuprolide?

A

GnRH analog

195
Q

Splenomegaly, pancytopenia, and skeletal destruction such as bone pain and AVN?

A

Gaucher (MOST COMMON LSD), Beta-glucocerbrosidase

196
Q

Cool clammy skin with increased heart rate?

A

Hypovolemic shock (e.g. hemorrhage)

197
Q

What is the effect of skeletal muscle preload and afterload on contraction velocity?

A

Like the heart. Increased preload causes increased velocity, increased afterload decreases it

198
Q

Where does the maxillary sinus exit to?

A

The middle meatus in the semilunar hiatus

199
Q

Cafe-au-lait spots

A

NF (also neurofibromas and CNS neoplasms that are typically schwann cells)

200
Q

What is a cholesteatoma?

A

Squamous cell debris that makes a mass behind tympanic membrane and can erode ossicles (actually no fat or cholesterol)

201
Q

What two cell types do superantigens interact with?

A

APCs and T-cells and activate them

202
Q

What is the one drug that can slow the heart rate with No effects on cardiac contractility or relaxation?

A

Ivabradine

203
Q

Post transfusion fever, chills, hypotension, and hemoglobinuria

A

Acute Hemolytic Transfusion reaction (type II HSR)

204
Q

What is the intrapleural pressure at FRC?

A

Around -5 (always has to be negative to prevent lung collapse

205
Q

What causes insulin resistance in pregnancy?

A

hPL (helps to decrease FA stores and increases serum glucose to provide for growing fetus)

206
Q

Is Hep. B cytotoxic?

A

No, but CD8 lymphocyte response leads to hepatocyte destruction

207
Q

Anticholinergic findings, wide QRS, mental status changes? Treatment?

A

TCA poisoning likely. NaHCO3 for cardiac problems (increases sodium to overcome competitive rapid sodium channel blockade and increases pH which makes TCA bind less avidly)

208
Q

What does ustekinumab target? What is it used for?

A

IL-12 and IL-23 which decreases TH1 and TH17 cell activation. Used for psoriasis

209
Q

What is the mutation in Rett syndrome?

A

Girls… X-linked MECP2 (usually de novo)

210
Q

What receptors does dantrolene target?

A

Ryanodine

211
Q

What is nesiritide?

A

Recombinant BNP

212
Q

What can the result of BPH be on the renal interstitium?

A

Atrophy due to persistently elevated back-pressure

213
Q

Where do you find enhancers and silencers? Promoters?

A

Promoters are directly upstream but enhancers and silencers can be anywhere

214
Q

What is lost in Hartnup disease?

A

Tryptophan

215
Q

Do you include cartilage in Reid index measurement? What is normal?

A

No, 0.4

216
Q

What do peripheral and central chemoreceptors sense?

A

Peripheral (carotid body): PO2

Central: sense pH (indirect CO2 sensing)

217
Q

Is it normal for candida to be in the oral cavity?

A

Yes, not infective levels, but yes

218
Q

Tinnitus plus hearing loss

A

Meniere disease

219
Q

Major potential side effect of linezolid?

A

Serotonin syndrome

220
Q

What should you think of with fainting? What part of the ear?

A

Vasovagal syncope. CN X does sensation for the posterior external ear canal (anterior is CN5)

221
Q

What causes alcohol induced steatohepatitis?

A

Excess NADH causes a decrease in FFA oxidation (no reducing agents left after oxidizing alcohol)

222
Q

What does IL-12 do?

A

Stimulates Th1 cells

223
Q

How is glucose maintained after 24 hours of fasting?

A

Gluconeogenesis (out of glycogen)

224
Q

Most common assosiation with erythema multiforme?

A

HSV

225
Q

What is the main determinant of secondary structure?

A

Hydrogen bonds hydrogen bonds hydrogen bonds

226
Q

What produces beta hCG?

A

Syncytiotrophoblast

227
Q

What if you see gas in the biliary tree?

A

Gallstone ileus (made it to ileum)

228
Q

What is the #1 risk factor for aortic dissection?

A

Hypertension

229
Q

Major side effect of antithyroid drugs?

A

Agranulocytosis

230
Q

What is the normal A-a gradient?

A

5-15 mmHg

231
Q

What is the effect of glucocorticoids on liver gluconeogenesis and glycogenesis?

A

Increases both

232
Q

What STD is a spirochete?

A

Syphilis

233
Q

Does glucose cross placenta? Insulin?

A

Glucose yes, insulin no

234
Q

What are the two names for the ligament that contains the ovarian vasculature?

A

Suspensory/ infundibulopelvic ligament

235
Q

Can you have tourette with only motor OR vocal tics?

A

No, chronic tic disorder

236
Q

Which rRNA molecule is not transcribed in the nucleolus?

A

5s subunit

237
Q

What is the inheritance of Leber hereditary optic neuropathy? What is it?

A

Mitochondrial

238
Q

What is the major pathogenesis for shigella? The toxin?

A

Not the toxin but cellular invasion

239
Q

What causes S3 in a nutshell?

A

Imbalance between force of blood into ventricle and ventricle compliance (forceful filling, non-compliance, flow into overfilled ventricle)

240
Q

Watery Diarrhea, Hypokalemia, Achlorhydria

A

VIPoma

241
Q

What does hCG most resemble? A close second that can cause effects?

A

LH, TSH which can manifest as hyperthyroid signs and symptoms

242
Q

Cataracts, frontal balding, small testicles. What else will you see? Inheritance?

A

Myotonic dystrophy. Will also see myotonia, AD defect with trinucleotide repeat on MPK gene (CTG)

243
Q

What causes reticulocytes to be blueish?

A

residual rRNA

244
Q

What causes finger drop without wrist drop?

A

Supinator canal radial nerve injury

245
Q

Where do lysine, isoleucine, methionin, and tyrosine enter the TCA cycle?

A

Ile, Met–> succinyl CoA
Leucine–> acetyl CoA
Tyrosine–> fumarate

246
Q

MOA of ATRA in APML?

A

Causes differentiation of promyelocytes meaning an increase in transcription and probably some acetylation

247
Q

Which increases potency of anesthetics vs. which increases speed between lipid solubility and blood solubility

A

Increased lipid solubility causes increased potency

Decreased blood solubility causes rapid on/off

248
Q

What enzyme can cause lengthened time of anesthesia?

A

Pseudocholinesterase

249
Q

What cells undergo meiosis one and two in spermatogenesis?

A

Meiosis I: Primary spermatocytes

II: Secondary spermatocytes

250
Q

What are the two starting substrates for protoporphyrin synthesis?

A

Succinyl CoA and glycine

251
Q

What causes a lacunar infarct?

A

Small vessel occlusion (uncontrolled HTN and DM are RFs)

252
Q

What are three differences in colocrectal cancer that arises from UC?

A

Early p53 mutations, late APC mutations, multifocal

253
Q

Where are complement proteins synthesized?

A

Liver

254
Q

Encephalitis, meningitis, flaccid paralysis and rash?

A

west nile virus

255
Q

Is alcohol metabolism reductive or oxidative?

A

Oxidative (depletes NAD+)

256
Q

What upregulates ALAS? Downregulates?

A

Up: p450 inducers
Down: heme and glucose

257
Q

Name three major enzymes that require tetrahydrobiopterin as a cofactor?

A

Hydroxylases

Phenylalanine hydroxylase, tyrosine hydroxylase, tryptophan hydroxylase

258
Q

Orphan annie eye cancer?

A

Papillary cancer of the thyroid. (Pick this unless hematogenous spread or amyloid)

259
Q

What is a drug that ends in -gravir? -navir?

A 
Gravir= integrase inhibitor
navir= protease inhibitor
260
Q

Where in a cell are VLCFA and branched fatty acids metabolized?

A

Peroxisomes

261
Q

Life expectancy required for hospice?

A

less than 6 months

262
Q

What ligament has the uterine vasculature in it?

A

Cardinal ligament

263
Q

How is liver metabolism related to drug-induced lupus?

A

Linked to drugs metabolized by N-acetylation in the liver (slow acetylators are at greater risk)

264
Q

Retro-orbital pain, joint/muscle pain, fever, headache

A

Dengue fever (mosquito)

265
Q

What is the role of glucose in the Lac operon?

A

Low glucose leads to an increase in cAMP–> increase in CAP which increases binding and activation at the promoter

266
Q

Which things in muscle detect changes in length and force, respectively.

A

Golgi tendon organ: force

muscle spindle: length (in parallel)

267
Q

What part of the aorta is likely severed in trauma? Where is it?

A

Isthmus. Just distal to subclavian where the ligamentum arteriosum attaches

268
Q

What is the pterion? Why is it significant?

A

Part of skull where frontal, parietal, temporal and sphenoidal bones meet. It is often fractured in epidural hematomas (MMA is right under it)

269
Q

Two possible side effects of Epo therapy?

A

Increased risk for HTN and thromboembolic events

270
Q

What pathway does PTEN inhibit? What is the normal result of this pathway?

A

mTOR pathway. mTOR translocates to nucleus and leads to gene transcription

271
Q

Is using the subclavian or femoral entry site for venous catheters more likely to cause infection?

A

Femoral is more likely to lead to infection

272
Q

What is the best indicator for the degree of mitral stenosis?

A

A2 to opening snap time interval

273
Q

What causes urine to turn black on standing? Pathway?

A

Buildup of homogentisic acid due to homogentisic acid dioxygenase. This is in the pathway of tyrosine metabolism to fumarate

274
Q

How do you tell if something messed up in meiosis I or II?

A

I: heterozygous mistake
II: double homozygous

275
Q

Association with renal angiomyolipoma?

A

Tuberous sclerosis

276
Q

What inhibits mitochondrial carnitine acetyltransferase and thus beta oxidation?

A

Malonyl CoA from fatty acid synthesis in cytosol

277
Q

Pseudopallisading brain cancer?

A

GBM

278
Q

Upper and lower pole atrophy and scarring in kidney is strongly suggestive of what?

A

Vesicoureteral reflux

279
Q

Big virulence factor for salmonella?

A

Vi antigen (capsule)

280
Q

What is the effect of restrictive lung disease on radial traction on the airways?

A

Increases with restrictive lung disease allowing for supernormal expiratory rates when adjusted for lung volume

281
Q

What vitamin will be depleted with chronic hemolysis?

A

Folate: macrocytic change can occur

282
Q

Where do positive and negative thymocyte selection happen in the thymus?

A

Positive: cortex
Negative: medulla

283
Q

What happens at the baroreceptor when blood pressure drops?

A

Less stretch–> less firing–> less inhibition on the SNS

284
Q

What often causes deep parenchymal hemorrhage in the brain?

A

Charcot-Bouchard aneurysm (burst with HTN)

285
Q

What does C1 esterase inhibitor do besides stop complement?

A

Blocks bradykinin production

286
Q

Match OR and RR with Case Study and Cohort

A

Cohort: RR
Case: OR

287
Q

Pattern of breathing that slowly increases and decreases cyclically?

A

Cheyne-Stokes breathing which is indicative of advanced congestive heart failure

288
Q

Anemia, but normal labs as far as size and reticulocytes go. What causes it?

A

PRCA. Thymoma, lymphocytic leukemias, parvovirus B19 (Inhibition of erythropoietic precursors by IgG autoantibodies or cytotoxic T cells)

289
Q

What three molecules can integrins bind to to help cells bind to ECM?

A

Collagen, fibronectin, and laminin

290
Q

What is the major virulence factor of H. influ type b?

A

Capsule (Polyribosylribitol phosphate- PRP)

291
Q

What is the MOA of PCP?

A

NMDA antagonist

292
Q

What drug blocks chemo-induced vomiting by indirectly decreasing substance P release? How does it work?

A

Aprepitant is an NK1 antagonist. Normally NK-1 stimulates substance P release.

293
Q

Bacterial overgrowth causes deficiency of most vitamins except?

A

Vitamin K and folate

294
Q

What is St. John’s Wort to p450?

A

Inducer

295
Q

What part of the kidney gives rise to clear cell carcinoma?

A

PCT epithelium

296
Q

What removes the RNA primer in prokaryotes? How?

A

DNA polymerase I removes the RNA primer with a 5’ to 3’ exonuclease

297
Q

Which diabetes is associated with HLA DR3 and DR4? Amyloid? What is the amyloid?

A

HLA- DM I

Amyloid is amylin in DM II

298
Q

What does tourniquet sign suggest? What is the deal with the first infection?

A

Dengue hemorrhagic fever. The first infection is often asymptomatic, secondary infection with another serotype is more severe

299
Q

Difference in Hawthorne effect and Berkson’s bias?

A

Hawthorne is when subjects change behavior due to knowledge of being watched, Berkson’s bias is getting patients out of the hospital (less healthy)

300
Q

What is responsible for IL-2 anti-cancer activity?

A

Activation of NK and T cells

301
Q

What is the relation between NF-KB and LPS?

A

Normally, NF-KB is latent in cells and bound to its inhibitor (I-KB). LPS destroys I-KB which causes inflammation and cytokine release via NF-KB activation

302
Q

What vessel causes AVN of the femoral head?

A

Medial circumflex artery (posterior circumflex is in the shoulder accompanying the axillary artery)

303
Q

What is most of the diaaphragmatic heart surface?

A

Inferior wall of left ventricle (supplied by PDA usually from RCA) (Think in IVF myocardial infarction)

304
Q

Fabry disease: What is the buildup and enzyme deficiency? What kills them?

A

alpha-galactosidase A deficiency with a buildup of globotriaosylceramide. Killed by RENAL or CV disease

305
Q

What do you suspect if you see varicies but a normal liver biopsy?

A

Pre-hepatic congestion such as portal vein thrombosis

306
Q

What arteries are ligated to stop uterine bleeding in emergency?

A

Internal iliac

307
Q

Relationship between flow and radius?

A

Flow is inversely proportional to radius to the fourth power

308
Q

What are, and what causes decorticate and decerebrate lesions?

A

Decorticate: flexed upper extremities. Lesion is above red nucleus (midbrain) which disinhibits the rubrospinal tract which causes flexion.
Decerebrate: lesion below red nucleus cuts off the rubrospinal tract leading to unopposed extensor action

309
Q

Is fidaxomycin bactericidal or static?

A

Bactericidal with minimal systemic absorption

310
Q

Where is uric acid most likely to precipitate in kidney? Why?

A

Acidic environment of distal tubules and collecting duct.

311
Q

Where does pyruvate go in hypoxia?

A

Shunted to lactate by lactate dehydrogenase to replenish NAD+

312
Q

What is carboxyhemoglobin?

A

CO bound Hb

313
Q

What nerve is under the piriform recess in the pharnyx?

A

Internal laryngeal nerve (afferent cough reflex)

314
Q

Hypotonia, umbilical hernia and protruding tongue in baby?

A

Congenital hypothyroidism

315
Q

With increased ACTH does the adrenal undergo hyperplasia or hypertrophy?

A

Hyperplasia

316
Q

What two drugs do you give for status epilepticus? Why?

A

Benzo to stop immediate seizure, phenytoin to stop recurrent seizures

317
Q

Triad of hypercoagulability, pancytopenia, and hemolytic anemia. Genetics?

A

PNH: PIGA gene for the GPI anchor (DAF CD55)

318
Q

What can alcohol abuse do to the RBCs?

A

Macrocytosis (not even necessarily vitamin related but often are folate deficient if long term users)

319
Q

What metabolizes natriuretic peptides? What class of proteins is this in?

A

Neprilysin which is a metalloproteinase

320
Q

Anti-Yo, Anti-Hu, Anti-P/Q antibodies

A

Subacute cerebellar degeneration with probable small cell lung cancer

321
Q

MOA of fibrates? Fish oils?

A

Fibrates: PPAR-alpha activators to increase LPL activity and decrease hepatic VLDL production
FIsh oils: Decrease VLDL production and inhibit Apo B production

322
Q

What causes TTP?

A

ADAMTS13 deficiency

323
Q

Granules in neutrophils? Why?

A

In leukemoid reaction there are Dohle bodies (granules) in neutrophils

324
Q

What forms the superficial and deep inguinal rings?

A

Superficial: External oblique aponeurosis
Deep: Transversalis fascia

325
Q

What do you use to treat restless leg syndrome?

A

Dopamine agonists such as ropinirole and pramipexole

326
Q

Marfanoid habitus, lens subluxation, thrombosis. Problems possible?

A

Homocyteinuria

1) Decreased cystathionine synthase to cystathionine (B6)
2) Decreased folate or B12 with methionine synthase

327
Q

What is the MOA of amatoxins from mushrooms?

A

RNA polymerase II inhibitor

328
Q

What type of blood in mothers causes fetal hemolysis? What kind doesn’t? Why?

A

Type O mothers produce IgG antibodies that can affect fetus while Type A or B mothers produce IgM antibodies that cannot cross the placenta

329
Q

What causes outflow obstruction in HOCM?

A

Abnormal motion of the anterior mitral valve leaflet toward the hypertrophied septum

330
Q

Describe renal osteodystrophy.

A

Kidney disease causes decreased calcium and increased PO4. This causes secondary hyperparathyroidism

331
Q

What part of the spine is affected by RA? OA?

A

RA: cervical
OA: Lumbar

332
Q

What is the relationship of the descending thoracic aorta and the esophagus?

A

Desc. thoracic aorta

333
Q

What cephalosporins treat pseudomonas?

A

Cefipime, ceftazidime

334
Q

Mononuclear, sudden and painless blindness

A

Central retinal artery occlusion

335
Q

Hyperpigmentation, hypotension, fever. Treatment?

A

Acute Adrenal Insufficiency. Treat with immediate glucocorticoids and aggressive fluids

336
Q

Fibrous bone dysplasia, endocrine abnormalities, and unilateral cafe au lait spots. Defect? What makes it survivable?

A

McCune Albright. Mutation affecting G protein signaling. Only survivable if after fertilization mosaicism

337
Q

Soft tissue malignancy with scalloping of nuclear membrane

A

Liposarcoma

338
Q

What parts of the brain atrophy in chronic alcoholism?

A

Anterior lobes and cerebellar vermis (looks almost like parkinson disease)

339
Q

Brisk and painless lower GI bleed in infant

A

Meckel

340
Q

What is the state of the coronary arteries in HOCM?

A

Normal

341
Q

What part of the body is affected in alkaptonuria?

A

Joints: homogentisic acid is toxic to cartilage

342
Q

Why does lactose intolerance develop in older people?

A

Gene expression gradually declines

343
Q

Hypersexuality, put things in mouth..

A

Kluver-Bucy: Bilateral amygdala destruction (temporal lobe)

344
Q

MOA of orlistat?

A

Intestinal lipase inhibitor causing down fat absorption and weight loss

345
Q

Spikes in kidney biopsy?

A

Membranous glomerulonephritis

346
Q

What type of receptor is composed of 7 alpha helical transmembrane proteins?

A

G-protein coupled receptors

347
Q

Isolated hypertension in young teen girl with no virilization?

A

Possible 17 alpha hydroxylase deficiency

348
Q

What may accelerated atresia cause? What type of process is it?

A

Premature ovarian failure. Apoptotic

349
Q

How do parathyroid anomalies affect bone density?

A

Really not very much at all

350
Q

Cramps, myalgia, fatigue in a patient with a loop diuretic.

A

Check potassium deficiency

351
Q

What syndrome is associated with a CDKN2A mutation?Chromosome?

A

Dysplastic nevus syndrome (leads to melanoma). c9p21

352
Q

What hormone is responsible for maintaining sodium levels in the body? For example, keeping it level even if you eat 5x more

A

ADH

353
Q

Chromosomes for p53, RB, BRCA-1, BRCA-2

A

p53 and BRCA-1 on c17

RB and BRCA-2 on c13

354
Q

What is the function of a leucine zipper?

A

Eukaryotic transcription factor class (dimers with 2 alpha helical domains)

355
Q

Which type of molar pregnancy is completely from the male? p57 positive?

A

Complete: 46c, sperm to empty egg, p57 negative
Partial: 47, two sperm to non empty egg, p57 positive

356
Q

Where does purine and pyrimidine synthesis occur?

A

Cytosol

357
Q

What causes MODY? Meds?

A

AD glucokinase deficiency. No meds required and is not insulin dependent

358
Q

Hypoglycemia, lactic acidosis, hyperlipidemia, hyperuricemia. Describe

A

Von Gierke= glucose-6 phosphatase deficiency

359
Q

What is the most common benign liver tumor? Rule for treatment?

A

Cavernous hemangioma. Do not biopsy

360
Q

Absent thumbs with aplastic anemia?

A

Fanconi anemia

361
Q

Why can axonal regeneration not occur in the CNS? What is different in the PNS?

A

CNS persistence of myelin debris, secretion of neuronal inhibitory factors and glial scarring (astrocytes)
PNS: schwann cells sense degeneration, degrade myelin and recruit macrophages. They also secrete trophic factor to cause growth cone formation

362
Q

Most important part of diphtheria treatment? Most often cause of death?

A

Passive IVIG, cardiomyopathy

363
Q

Which class of anti-arrhythmics have strong use dependence? WHich have “reverse” use dependence?

A

Class IC stong, Class III reverse

364
Q

First line tx for essential tremor?

A

Propranolol

365
Q

What is dobutamine?

A

Beta one agonist (isoproterenol is B1=B2)

366
Q

What type of inflammation leads to an AAA?

A

Transmural inflammation

367
Q

Low levels of what can cause calcium kidney stones? High levels of what can cause calcium stones in Crohns?

A

Low citrate can cause stones. In Crohns, high oxalate causes it.

368
Q

What are the numbers for Z scores with 95% and 99% CIs? Is it with SEM or STdev?

A 
95%= mean +/- 1.96 * SEM
99%= mean +/- 2.58 * SEM
369
Q

What if you see increased B-hCG and inhibin A in amniocentesis?

A

Down syndrome (nothing is increased with Patau or Edwards)

370
Q

Where is urea absorbed in kidney?

A

Only in medullary segment of CD

371
Q

Halo around eye?

A

Glaucoma

372
Q

How does Crohns cause kidney and gallstones?

A

Kidney stones: hyperoxaluria (in a healthy bowel, Ca binds oxalate in the gut and they are excreted. In Crohns, Ca complexes with unabsorbed fat and oxalate is absorbed)
Gallstones: Bile acid wasting/ dec. reabsorption

373
Q

What is the relationship between nephrotic syndrome and sudden onset abd/flank pain, hematuria and right sided varicocele?

A

You may lose ATIII in nephrotic syndrome–> hypercoagulability–> right renal vein thrombosis with extension into the IVC

374
Q

Name the four parts of the body affected by Henoch-Schonlein purpura

A

Skin, Kidney, GIT, JOINTS

375
Q

What gene in HIV is proteolytically cleaved in the ER and golgi?

A

env gene (gp 120 and gp 41)

376
Q

Where is the most airway resistance? Least?

A

Most: 2nd- 5th gen bronchi
Least: small airways/bronchioles

377
Q

Major prognostic factor in urothelial carcinoma?

A

Tumor penetration of bladder wall

378
Q

If there is a mutation in what, anti-EGFR therapy is obsolete.

A

KRAS (transcription factor downstream)

379
Q

Differential clubbing and cyanosis without BP or pulse discrepancy?

A

PDA complicated by eisenmenger syndrome

380
Q

What causes wet, age related macular degeneration?

A

Retinal hypoxia–> VEGF–> neovascularization with leaky vessels

381
Q

Opsoclonus-myoclonus syndrome is with what?

A

Neuroblastoma

382
Q

What effect does estrogen have on thyroid hormone levels?

A

It increases total levels due to increased thyroid binding globulin, but free levels are still the same

383
Q

What is osteitis fibrosa cystica?

A

Caused by hyperparathyroidism. Subperiosteal erosions and brown bone tumor cysts

384
Q

Where does the shoulder most often dislocate? Nerve at risk?

A

Anterior, axillary

385
Q

What layer is absent in psoriasis?

A

Granulosum

386
Q

What enzyme allows for fructokinase deficiency to be benign?

A

Hexokinase. May phosphorylate fructose to F-6-P

387
Q

What substance correlates closely with meningococcal toxic effects and prognosis?

A

LOS

388
Q

Brain tumor that is biphasic and S100 (+)?

A

Schwannoma

389
Q

What is first line for moderate to severe alcohol use disorder to decrease craving?

A

Naltrexone (decreases rewarding and reinforcing effects)

390
Q

What is the effect of PGs on aqueous humor?

A

Increases outflow

391
Q

Ovarian cancer with each tumor marker.

1) LDH, B-hCG
2) AFP
3) CA-125

A

1) Dysgerminoma
2) Yolk sac
3) Epithelial (e.g. cystadenocarcinoma)

392
Q

What do many cancer cells upregulate to evade apoptosis?

A

Programmed death receptor 1 ligand (PD-1). When the T-cell receptor (PD-1) binds this, the immune response is downregulated

393
Q

What is the conversion of glucose in the lens that can cause cataracts?

A

1) Glucose–> sorbitol by aldose reductase (buildup of sorbitol makes cataracts)
2) Sorbitol–> fructose by sorbitol dehydrogenase (the lens doesn’t have much of this

394
Q

What does grapefruit juice do to p450?

A

Inhibits

395
Q

What synthesizes NO?

A

Arginine+O2–> NO2 via NO sythase (eNOS)

396
Q

What is a mechanism by which mu opiod receptors can block pain?

A

Increased K= efflux–> hyperpolarization and blocking of pain transmission

397
Q

How do Beta blockers lower blood pressure?

A

Decrease renin release from the JGA via B1

398
Q

Which type of leprosy has a positive skin test?

A

Tuberculoid, lepromatous leprosy does not since it is primarily a humoral reaction

399
Q

What mutation can cause PAH?

A

BMPR2

400
Q

Where are nosebleeds usally located?

A

Anterior nasal septum (Kiesselbach plexus- ant. ethmoidal, sphenopalatine, and superior labial artery anastamosis)

401
Q

What does myelin do to the time constant and length constant with nerve transmission?

A

Lowers time constant, increases length constant

402
Q

What two hepatitis viruses are spread via fecal-oral transmission?

A

A & E

403
Q

What is edrophonium?

A

Tensilon, short acting AChE inhibitor

404
Q

At what lung volume is pulmonary resistance at its lowest?

A

FRC

405
Q

What type of gastric adenocarcinoma forms a projection?

A

Intestinal. Diffuse forms thickened walls (linitis plastica)

406
Q

What is danazol?

A

Partial androgen agonist

407
Q

What does ANCA stand for?

A

Anti-neutrophilic cytoplasmic antibody

408
Q

What should you associate with pseudohyphae with blastoconidia?

A

Candida

409
Q

What finding in the brain is relatively specific to HIV associated dementia?

A

Microglial nodules (Neuronal damage is likely due to cytokine release)

410
Q

Most common predisposing condition for native valve infective endocarditis in developed nations?

A

Mitral valve prolapse

411
Q

Where and in what population will you most often see hematogenous osteomyeitis?

A

Children in the metaphysis of long bones (slower blood flow and capillary fenestrae)

412
Q

What sequences help to initiate translation in eukaryotes and prokaryotes?

A

Eukaryotes: Kozak
Prokaryotes: Shine-Dalgarno

413
Q

Non-smoker with lung cancer

A

Adenocarcinoma every time

414
Q

Levels for thracocentesis?

A

Mid-clavicle: ribs 6-8
Mid-axilla: ribs 8-10
Paravertebral: ribs 10-12

415
Q

What are three options to treat cyanide toxicity? Note: this is not carbon monoxide

A

1) Nitrite to induce methhemoglobinemia
2) Hydroxycobalamin (direct CN- binding)
3) Sodium thiosulfate

416
Q

How does the body get rid of copper?

A

Secretes into bile and eliminates in stool

417
Q

What is familial chylomicronemia caused by?

A

Defective LPL or Apo CII (cofactor for LPL)

418
Q

Epistaxis and many telangiectasias. Inheritance?

A

Osler-Weber-Rendu Syndrome= hereditary hemorrhagic telangiectasia (AD)

419
Q

Scoliosis is a hint for what spinal cord injury?

A

Syringomyelia

420
Q

What is the genetic predisposition to cervical cancer?

A

None, no genetic component

421
Q

IgG4 to PLA2

A

Membranous nephropathy

422
Q

What vitamin deficiency can closely mimic Friedreich ataxia?

A

Vitamin E

423
Q

What will you see on histology with a hypersensitivity to intradermal tobacco extract?

A

Buerger’s disease (thromboangiitis obliterans) segmental vasculitis extending into contiguous veins and nerves

424
Q

Marker for hepatocellular carcinoma? Colorectal cancer?

A

AFP, CEA

425
Q

Posture dependent LE pain and paresthesia

A

Spinal stenosis. Narrowing of spinal canal due to disc herniation, ligamentum flavum hypertrophy or osteophyte formation

426
Q

Bands that connect right colon to RLQ peritoneum passing across duodenum and causing obstruction?

A

Midgut malrotation

427
Q

What is the serum sodium level in hyperaldosteronism?

A

Normal- aldosterone escape

428
Q

What does the vitelline duct connect?

A

Ileum to umbilicus

429
Q

What type of hypertrophy is caused by aortic regurgitation?

A

Eccentric (expansion)

430
Q

What genetic cancer syndrome deals with a ubiquitin ligase component?

A

VHL

431
Q

What hormone will be at a high level 1 hr post exercise?

A

VEGF (GH during)

432
Q

N-acetylglucosamine 1-phosphatase?

A

I cell disease

433
Q

What drugs do PPIs notably decrease absorption of?

A

Azoles

434
Q

What causes paradoxical splitting?

A

aortic outflow problems

435
Q

Which two blood pressure meds may cause lipid abnormalities?

A

Thiazides and beta blockers

436
Q

What if you see a starving person with maintained glucose levels and positive ketones?

A

Breakdown of adipose tissue by hormone sensitive lipase

437
Q

Garlic odor? Treatment?

A

Arsenic poisoning, dimercaprol

438
Q

Infarction of renal cortex with medulla sparing? Association?

A

Diffuse cortical necrosis often with DIC.

Oliguria, anuria, uremia

439
Q

G subtypes with D1 and D2?

A

S and I

440
Q

What is the cause of endocardial cushion defects with down syndrome?

A

Failure of neural crest migration

441
Q

Whitish, needle shaped crystal in urine?

A

Orotic acid

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