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
2
Q
What can nitrites be used to treat? How?
A
cyanide poisoning by inducing methhemoglobinemia. Fe3+ binds cyanide more avidly than mitochondrial enzymes
3
Q
Synthesis of what molecules require NADPH?
A
Cholesterol, fatty acids, steroids (reductive biosynthesis)
4
Q
Derivatives of 1st pharyngeal arch?
A
CN 5, mandible, maxilla, zygoma, incus, malleus
5
Q
Derivatives of 2nd pharyngeal arch?
A
CN VII, stapes, styloid process, lesser horn of hyoid
6
Q
Which histone serves as a linker?
A
H1
7
Q
Percents of first 3 stdev?
A
68%, 95%, 99.7% (note: consider both sides)
8
Q
Two causes that vertically shift the meeting point of the cardiac function and venous return curves?
A
Exercise and AV shunt
9
Q
What is the major factor that increases risk for chronic HBV infection?
A
Age
infants>children>adults
10
Q
What do you give for prophylaxis of MAC in HIV patients?
A
Azithromycin
11
Q
What do you suspect with an infant in respiratory distress that was preceded by cold-like symptoms.
A
Bronchiolitis: think RSV
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
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
14
Q
What nucleotide is decreased in folate deficiency? Enzyme?
A
dTMP, thymidylate synthase
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
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
17
Q
Which anti-lipid agent can cause gout?
A
Niacin
18
Q
What builds up in methylmalonic acidemia?
A
propionyl CoA
19
Q
What interleukin is associated with allergic asthma?
A
IL-5 (eosinophil chemoattractant)
20
Q
Name two aldosterone antagonists that can be used to treat Conn’s syndrome.
A
Spirinolactone and eplerenone
21
Q
Where is hepcidin produced?
A
Liver
22
Q
Describe the roles of TXA2 and PGI2 (prostacyclin)
A
TXA2- vasoconstriction and promotes platelet aggregation
PGI2- vasodilation and inhibits aggregation
23
Q
Association with caudal regression syndrome?
A
Maternal diabetes (poorly controlled)
24
Q
What is the T-cell area of a lymph node?
A
Paracortex (B cells are cortex and follicles)
25
What organism grows green on EMB agar? What is it's number one virulence factor in infections?
E. coli. Fimbriae
26
What do the pol and env genes code for in HIV?
pol- reverse transcriptase
| env- structural glycoproteins
27
How does digoxin help control a. fib?
Vagus stimulation (PSNS rate control)
28
What processes occur in the cytosol? (3)
Glycolysis, fatty acid synthesis, pentose phosphate pathway
29
Where does decarboxylation of pyruvate occur?
Mitochondria
30
Neurological symptoms without neuro cause?
Conversion disorder
31
What aortic arch is a PDA derived from?
6th
32
What causes the flushing with niacin?
PGs (thus can be treated with NSAIDS)
33
Does epi stimulate or inhibit insulin secretion? Blockade of what receptor can reverse this?
It inhibits (alpha 2> beta 2), but with alpha 2 blockade, B-2 takes over and increases insulin
34
What muscle relaxant is dangerous in hyperkalemia situations since it can cause K+ release?
Succinylcholine
35
What is the major association with pulsus paridoxicus?
cardiac tampanade
36
What omentum contains the hepatogastric and hepatoduodenal ligament?
Lesser omentum
37
Where does capping, poly A tail addition, and splicing of introns happen to RNA?
Nucleus
38
What does SIADH cause in respect to sodium level?
EUVOLEMIC hyponatremia (transient hypervolemia only)
39
What is the role of interferon alpha and beta? What stimulates release?
Viral infection stimulates release and causes increased apoptosis and decreased protein synthesis in infected cells and "primes" surrounding cells to do the same
40
What drugs are associated with 1st dose hypotension?
ACE inhibitors
41
What substance is an allosteric activator of gluconeogenesis?
Acetyl-CoA
42
What arteries accompany the external superior laryngeal nerve and the recurrent laryngeal nerve?
Ext. Sup. Laryngeal: superior thyroid artery
| Recurrent: Inf. thyroid artery
43
Hypotonia in all four limbs, cardiomegaly, glycogen inlysosomes?
Popme disease: acid alpha glucosidase
44
Inhibition of what pathway has a role in Parkinson and Alzheimer diseases?
Ubiquitin/proteasome pathway
45
What is bortezomib? What cancer does it work for?
Multiple myeloma cells are susceptible to proteasome inhibition because they make tons of protein. Bortezomib does this and causes apoptosis (not decreased protein synthesis)
46
What structure in the brain is preferentially affected in Wilson's disease?
Putamen (basal ganglia)
47
Normal range for pulmonary artery pressure?
10-25 mmHg
48
What is the defect in XP?
```
Endonuclease defect (AR)
Note: 3'-->5' exonuclease is DNA polymerase proofreading
```
49
What is anti-Jo-1 antibody?
Polymyositis (anti-histidyl tRNA synthetase)
50
What if a patient has psychosis, but only in MDD episodes?
MDD with psychotic features
51
What roles do estrogen and progesterone play in pregnancy gallstones?
Estrogen: cholesterol hypersecretion
Progesterone: gallbladder hypomobility
52
How can triglycerides contribute to gluconeogenesis? First step?
Glycerol is gluconeogenic
| Glycerol--> glycerol-3-phosphate by glycerol kinase in the liver
53
Which node is near the orifice of the coronary sinus?
AV node
54
What do you give for serotonin syndrome?
Cyproheptadine (antihistamine with anti-serotenergic properties)
55
How is CFTR regulated?
ATP gated membrane channel
56
Which step in the krebs cycle produces FADH2?
Succinate to fumarate by succinate dehydrogenase
57
Which treatment for hyperlipidemia can increase TGs?
Cholestyramine (bile acid resins)
58
What arteries do the ureters pass anterior to in order to reach the pelvis?
Iliac arteries (internal in true pelvis)
59
Where and what is the enzyme that activates trypsin?
Enteropeptidase is in the brush border of the jejunum
60
What might a cavernous hemangioma cause?
Intracerebral bleed and seizure
61
What is the number one treatment for uncomplicated UTI?
Bactrim (TMP-SMX)
62
What is needed for the reaction catalyzed by PEPCK to occur? Where is it produced?
GTP, produced in the Kreb's cycle by succinyl CoA synthetase (succinyl CoA to succinate)
63
Drug if you have absence seizures and tonic clonic?
Valproate
64
Interstitial myocardial granuloma? Cause?
Aschoff body, found in myocarditis due to acute rheumatic fever
65
Name two drugs that share a MOA with methotrexate.
1) Trimethoprim
| 2) Pyrimethamine
66
MOA of SMX?
Dihydropteroate synthetase inhibitor
67
MOA of milrinone?
PDE-3 inhibitor. Arterial dilation via up cAMP and increases cardiac contractility
68
How does pyruvate kinase deficiency manifest?
Hemolytic anemia due to glycolysis failure and low ATP. This also causes splenomegaly from removing the damaged erythrocytes
69
Name the two arteries previous to the retinal artery in the branching scheme
Internal carotid--> ophthalmic--> retinal
70
How do fibrates cause gallstones?
Inhibit cholesterol 7 alpha hydroxylase (the rate limiting step in bile acid synthesis)
71
Treatment for HIT?
Direct thrombin inhibitors (argatroban, bivalirudin, dabigatran)
72
How do exercise and low weight cause amenorrhea?
Hypogonadotropic (loss of pulsatile GnRH)
73
What cytokine causes keloid/scar formation?
TGF-B
74
Joint laxity, hyperextensible skin, tissue fragility
Ehlers danlos (collagen problem probably with crosslinking)
75
As antiarrhytmics, what interval do Beta blockers prolong?
Increase the length of the PR interval, phase 4
76
What anti-epileptic causes gingival hyperplasia? How?
Phenytoin--> PDGF--> gingival hyperplasia
77
What are BRCA 1/2?
Tumor suppressor genes involved in DNA repair
78
What form of bias is loss of follow up?
Selection bias (attrition bias more specifically)
79
Can severely anemic people become cyanotic?
No.. Cyanosis indicates the presence of deoxygenated hemoglobin that gives a blue appearance. There is not enough hemoglobin for this in anemic people
80
What nerve innervates the parotid gland?
CN IX
81
What is mesalamine used for?
UC treatment
82
What is a specific marker for mast cell activation?
Tryptase
83
What is a cytologic side effect of ganciclovir? What increases the likelihood of it?
Neutropenia, increased risk with concurrent TMP-SMX
84
Palpable but nontender gallbladder?
Courvoisier sign, pancreatic cancer
85
What type of HSR is a scabies infection? Where are the lesions?
Type IV, flexor surfaces or wrists, lateral fingers and finger webs
86
What is the result of hyperventilation on cerebral blood flow and ICP?
Decreased CO2 leads to decreased cerebral blood flow and ICP
87
What is low CO2 always a sign of?
Hyperventilation
88
Effect of inhaled anesthetics on cerebral blood flow?
Increased (pretty much depresses everything else)
89
What is the effect of class IA, IB and IC antiarrhytmics on AP length?
IA: prolongs
IB: shortens
IC: no change
90
What is the relationship between pressure required to keep a sphere open and its radius?
Inverse relationship
91
What can HPV infect in the upper body?
True vocal cords (squamous cell carcinoma)
92
What prevents local candida infection? Systemic?
Local: T cells
Systemic: Neutrophils
93
What gives elastin its springy properties?
Cross-links
94
What should you avoid with HOCM patients?
Anything that decreases LV volume (decreased afterload or preload)- e.g. nitrates
95
What is the role of cord factor in TB?
Inactivates neutrophils, damages mitochondria and decreases TNF release
96
What is the interaction between beta blockers and thyroid hormones?
Beta blockers decrease peripheral conversion of T4 to T3 and decrease sympathetic effects
97
What is the eventual cause of astrocyte injury in hepatic encephalopathy?
Glutamate + NH4+--> Glutamine
Too much glutamine leads to swelling of astrocytes and decreased glutamate in neurons. This causes injury and decreases excitatory neurotransmission
98
What should you instantly associate with PAN?
Hepatitis B (transmural fibrinoid necrosis of medium vessels but sparing pulmonary vessels)
99
Two enzyme deficiencies that can cause increased orotic acid? How do you distinguish?
OTC deficiency (XLR) and ump synthetase deficiency. If also high ammonia, it is OTC deficiency
100
What is the inheritance of hereditary spherocytosis?
AD (kinda in line with the structural defect thing)
101
What is enfuvirtide? What does it bind?
Fusion inhibitor that binds GP41
102
actinic keratoses can progress to what?
SCC of skin
103
ATN with vacuolar degeneration of PT cells and calcium oxalate crystals
Ethylene glycol ingestion
104
What antilipid drug can cause gout?
Niacin
105
What causes the S4 heart sound?
Blood flow into a stiff ventricle
106
What is MMA in the process of converting?
Branched chain AAs, threonine, methionine and odd chain FA--> Propionyl CoA--> MMA--> Succinyl CoA in Krebs
107
What enzyme converts MMA to succinyl CoA?
methylmalonyl CoA mutase
108
Nerve that does suprapubic and gluteal sensation? May be injured in abdominal surgery.
Iliohypogastric nerve
109
What IL should you immediately associate with eosinophils?
IL-5
110
What is the catalase positive infection not in sketchy?
Burkholderia cepacia
111
What is Conn's syndrome?
Aldosterone secreting tumor (use spironolactone or eplerenone)
112
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)
Capitation, Global payment
113
What is the #1 E. coli virulence factor?
P. fimbriae
114
Neuro symptoms incompatible with a neuro disease
Conversion disorder
115
Which aortic arch creates proximal pulmonary arteries?
6th
116
What is the normal response of insulin with Epi? Which sympathetic receptors increase release and which decrease it?
Decreased (alpha 2 action is greater than beta 2). Gs, Gq increase release of insulin usually, Gi inhibits it
117
What abnormality must you check before administering succinylcholine?
Hyperkalemia (it causes K+ release)
118
What are the two most important opsonins?
C3b and IgG
119
MOA of rifampin?
Inhibits DNA-dependent RNA polymerase
120
What is the one muscle in the vocal region supplied by the external laryngeal nerve? What are the rest supplied by?
Cricothyroid, recurrent laryngeal nerve (internal laryngeal only does sensory above vocal folds)
121
Is parvovirus single or double stranded?
SINGLE. SINGLE. SINGLE. SINGLE
122
Mild, non-progressive hyperglycemia that often is noted in pregnancy? What causes it?
Glucokinase deficiency can cause maturity-onset diabetes of the young (MODY)
123
Wrinkled tissue paper macrophages? Enzyme?
Gaucher- beta-glucocerebrosidase
124
What is cutis aplasia? What causes it? Summarize the effects of the cause in one word.
Cutis aplasia is focal skin defect of the scalp. Patau syndrome. Midline defects (Trisomy 13)
125
What type of glands are: sweat glands, mammary glands, salivary glands, sebaceous glands?
Sweat, Salivary: merocrine (exocytosis)
Mammary: apocrine (vesicles)
Sebaceous: holocrine
126
Call-exner body in ovarian tumor
Granulosa cell tumor (yellow)
127
What is dry beriberi?
Thiamine deficiency causes symmetrical peripheral neuropathy
128
What are the major electrolyte effects of amphotericin B toxicity?
Decreased magnesium and increased potassium
129
MOA of ribavirin?
Kinda like aciclovir for RNA polymerase (guanosine analog)
130
What binds in rolling?
Selectins to sialy lewis X
131
What binds in tight binding?
CD18 (integrins) to ICAM
132
Increased gastric acid secrtion, flushing, hypotension, pruritis, urticaria?
Increased histamine possibly due to systemic mastocytosis (KIT mutations)
133
What is the relative color and depth of chief cells to parietal cells?
Parietal: Shallow and pink (acidophilic)
Chief: Deep and purple (basophilic)
134
Where does a herpesvirus derive its envelope?
Host nuclear membrane
135
What two pathways is dihydrobiopterin reductase important for?
1) Phe-->tyrosine--> dopa-->catecholamines
| 2) Tryptophan to serotonin
136
Cleft lip when maxillary prominences fail to fuse with what?
Medial nasal prominences
137
What is the timing of an acute transplant rejection?
weeks to 6 months (not super fast)
138
How do you detect strongyloides stercoralis?
Larvae in stool
139
Which hepatitis may present like serum sickness?
Hep. B
140
What is the MOA of buspirone? Why do you use it?
5HT-1A partial agonist used for GAD (slow onset of action)
141
What does ciprofloxacin do to p450?
Inhibitor
142
What does AA is required to secrete acid from kidney when stimulated by acidosis?
Glutamine--> glutamate + NH3
| This NH3 can combine with H+ and secrete it in the urine
143
Where does nitroprusside act?
Veno and arterial dilator
144
What is the best indicator of severe mitral regurgitation?
S3 heart sound (high filling pressure)
145
If you see herpetic gingivostomatitis (in mouth), what do you know?
This is a primary infection
146
What causes Gram (-) sepsis?
Lipid A from LPS
147
What on x-ray forms the right heart border?
Right atrium
148
What do protease inhibitors due to labs? P450?
Inhibit p450 and can cause hyperglycemia
149
Diabetes, necrolytic migratory erythema, anemia.
Glucagonoma
150
What part of the heart is lateral to the midclavicular line?
None
151
What if you see AChE on amniocentesis?
Suspect neural tube defect.
152
What is the main difference in the immunity provided by the two polio vaccines?
Better IgA response from the oral (sabin) live attenuated vaccine
153
What factor mediates smooth muscle migration into the intima in atherosclerosis?
PDGF (platelets also release TGF-B)
154
What is downstream of RAS often?
MAPK
155
What is the mechanism of calcium sensing receptors on the parathyroids (or anywhere else)?
G-protein coupled
156
What are two PYR positive bacteria?
Strep. pyogenes and enterococcus
157
What is a major functions of pyridoxine?
Transamination and decarboxylation
158
What are the three pairs in transamination?
glutamate and alpha-KG
Alanine and pyruvate
Aspartate and oxaloacetate
Note: the AAs are always on opposite sides
159
MOA of terbinafine
Inhibits squalene epoxidase and thus decreases fungal membrane ergosterol
160
Can repetitive nerve stimulation help with botulism?
Yes
161
With liver injury, what can cause pigmented bile stones (enzyme)?
Injured hepatocytes and bacteria can release beta-glucuronidase and unconjugate bilirubin
162
What is the repeat with fragile X? What is the mechanism of pathogenesis?
CGG repeats cause hypermethylation and inactivation of FMR1
163
What is the substance that suppresses GnRH?
Prolactin
164
What drug kills malaria hypnozoites? What strains of malaria make this a concern?
Primaquine for P. vivax or P. ovale
165
What do you suspect with an increased bleeding time in a patient with renal dysfunction and high BUN?
Uremia can cause qualitative platelet dysfunction and isolated increase in bleeding time (isolated in the realm of hematologic labs)
166
What type of amyloid is associated with dialysis?
Beta-2 microglobulin--> possible bilateral carpal tunnel
167
Which sulfonylureas have the highest incidence of hypoglycemia?
Long acting ones. Since the first gen. arent really used any more, this means the -rides
168
What nerve causes a winged scapula? Muscle?
Serratus anterior and long thoracic nerve (lateral thoracic artery)
169
How long can cardiomyocytes keep contracting after the onset of ischemia?
Less than a minute
170
Most often cause of DIC in pregnancy?
Release of tissue factor (thromboplastin) from an injured placenta
171
What is an important part of Huntington pathogenesis?
Histone deacetylation
172
What is P-glycoprotein?
A product of human MDR1 gene that codes for a transmembrane ATP-dependent efflux pump
173
Best anticoagulation in pregnancy?
LMWH (e.g. enoxaparin)
174
What cancer is associated with Paget disease of bone?
Osteosarcoma
175
What if you see 180 base pair fragments?
Apoptosis- this is called DNA laddering
176
What are the only cells that produce IL-2?
T lymphocytes
177
What is the primary concern of injury with knee dislocations? Describe the arrangement of the nerve, artery and vein in the popliteal fossa.
Artery injury
| Superficial to deep is nerve, vein, artery
178
How long must it have been to diagnose PTSD?
At least 1 month
179
What is the state of glucose, Na+ and K+ in DKA?
Glucose and K+ are high (total K+ body store actually low) and sodium is low
180
What is the test for antigens that is based on a color change?
ELISA
181
What directs preproinsulin to ER?
N-terminal peptide. It is cleaved at the ER to form proinsulin which is cleaved to insulin and C-peptide in secretory granules
182
What thalassemia is associated with pregnancy loss?
Alpha thal., Hb Barts (gamma chain tetramer) and hydrops fetalis
183
What allows local testosterone concentration to be high enough for sperm production in the testicles?
Sertoli cells secrete ABP
184
What acid-base disorder will be present with a PE?
Respiratory alkalosis
185
What is the normal method of initiating translation? Alternate? What type of cells do the alternate?
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
What two things does PPAR-gamma upregulate?
Glut-4 and adiponectin (increases insulin sensitive adipocytes)
187
Which hereditary cancer syndrome is AD with an oncogene rather than an TSG?
MEN2 (RET)
188
Slow speech of primarily nouns/verbs is called what? Associated with what aphasia?
Agrammatism- Broca
189
What are the only efferent nerves that are unmyelinated? Name 3 sensory that are.
Efferent: Postganglionic autonomic neurons
Sensory: slow pain, heat, and olfaction
190
Relation of standard error to STdev?
SE=Stdev/square root of #
191
What is the main thing to think about in PCOS? Effect on LH and FSH?
Increased LH--> increased androgens--> peripheral estrogen conversion--> decreased FSH
192
What are the two antibiotic classes that work at the 30s ribosomal subunit?
Aminoglycosides and tetracyclines
193
What does not transilluminate in the testes and enlarges with standing?
Varicocele
194
What is leuprolide?
GnRH analog
195
Splenomegaly, pancytopenia, and skeletal destruction such as bone pain and AVN?
Gaucher (MOST COMMON LSD), Beta-glucocerbrosidase
196
Cool clammy skin with increased heart rate?
Hypovolemic shock (e.g. hemorrhage)
197
What is the effect of skeletal muscle preload and afterload on contraction velocity?
Like the heart. Increased preload causes increased velocity, increased afterload decreases it
198
Where does the maxillary sinus exit to?
The middle meatus in the semilunar hiatus
199
Cafe-au-lait spots
NF (also neurofibromas and CNS neoplasms that are typically schwann cells)
200
What is a cholesteatoma?
Squamous cell debris that makes a mass behind tympanic membrane and can erode ossicles (actually no fat or cholesterol)
201
What two cell types do superantigens interact with?
APCs and T-cells and activate them
202
What is the one drug that can slow the heart rate with No effects on cardiac contractility or relaxation?
Ivabradine
203
Post transfusion fever, chills, hypotension, and hemoglobinuria
Acute Hemolytic Transfusion reaction (type II HSR)
204
What is the intrapleural pressure at FRC?
Around -5 (always has to be negative to prevent lung collapse
205
What causes insulin resistance in pregnancy?
hPL (helps to decrease FA stores and increases serum glucose to provide for growing fetus)
206
Is Hep. B cytotoxic?
No, but CD8 lymphocyte response leads to hepatocyte destruction
207
Anticholinergic findings, wide QRS, mental status changes? Treatment?
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
What does ustekinumab target? What is it used for?
IL-12 and IL-23 which decreases TH1 and TH17 cell activation. Used for psoriasis
209
What is the mutation in Rett syndrome?
Girls... X-linked MECP2 (usually de novo)
210
What receptors does dantrolene target?
Ryanodine
211
What is nesiritide?
Recombinant BNP
212
What can the result of BPH be on the renal interstitium?
Atrophy due to persistently elevated back-pressure
213
Where do you find enhancers and silencers? Promoters?
Promoters are directly upstream but enhancers and silencers can be anywhere
214
What is lost in Hartnup disease?
Tryptophan
215
Do you include cartilage in Reid index measurement? What is normal?
No, 0.4
216
What do peripheral and central chemoreceptors sense?
Peripheral (carotid body): PO2
| Central: sense pH (indirect CO2 sensing)
217
Is it normal for candida to be in the oral cavity?
Yes, not infective levels, but yes
218
Tinnitus plus hearing loss
Meniere disease
219
Major potential side effect of linezolid?
Serotonin syndrome
220
What should you think of with fainting? What part of the ear?
Vasovagal syncope. CN X does sensation for the posterior external ear canal (anterior is CN5)
221
What causes alcohol induced steatohepatitis?
Excess NADH causes a decrease in FFA oxidation (no reducing agents left after oxidizing alcohol)
222
What does IL-12 do?
Stimulates Th1 cells
223
How is glucose maintained after 24 hours of fasting?
Gluconeogenesis (out of glycogen)
224
Most common assosiation with erythema multiforme?
HSV
225
What is the main determinant of secondary structure?
Hydrogen bonds hydrogen bonds hydrogen bonds
226
What produces beta hCG?
Syncytiotrophoblast
227
What if you see gas in the biliary tree?
Gallstone ileus (made it to ileum)
228
What is the #1 risk factor for aortic dissection?
Hypertension
229
Major side effect of antithyroid drugs?
Agranulocytosis
230
What is the normal A-a gradient?
5-15 mmHg
231
What is the effect of glucocorticoids on liver gluconeogenesis and glycogenesis?
Increases both
232
What STD is a spirochete?
Syphilis
233
Does glucose cross placenta? Insulin?
Glucose yes, insulin no
234
What are the two names for the ligament that contains the ovarian vasculature?
Suspensory/ infundibulopelvic ligament
235
Can you have tourette with only motor OR vocal tics?
No, chronic tic disorder
236
Which rRNA molecule is not transcribed in the nucleolus?
5s subunit
237
What is the inheritance of Leber hereditary optic neuropathy? What is it?
Mitochondrial
238
What is the major pathogenesis for shigella? The toxin?
Not the toxin but cellular invasion
239
What causes S3 in a nutshell?
Imbalance between force of blood into ventricle and ventricle compliance (forceful filling, non-compliance, flow into overfilled ventricle)
240
Watery Diarrhea, Hypokalemia, Achlorhydria
VIPoma
241
What does hCG most resemble? A close second that can cause effects?
LH, TSH which can manifest as hyperthyroid signs and symptoms
242
Cataracts, frontal balding, small testicles. What else will you see? Inheritance?
Myotonic dystrophy. Will also see myotonia, AD defect with trinucleotide repeat on MPK gene (CTG)
243
What causes reticulocytes to be blueish?
residual rRNA
244
What causes finger drop without wrist drop?
Supinator canal radial nerve injury
245
Where do lysine, isoleucine, methionin, and tyrosine enter the TCA cycle?
Ile, Met--> succinyl CoA
Leucine--> acetyl CoA
Tyrosine--> fumarate
246
MOA of ATRA in APML?
Causes differentiation of promyelocytes meaning an increase in transcription and probably some acetylation
247
Which increases potency of anesthetics vs. which increases speed between lipid solubility and blood solubility
Increased lipid solubility causes increased potency
| Decreased blood solubility causes rapid on/off
248
What enzyme can cause lengthened time of anesthesia?
Pseudocholinesterase
249
What cells undergo meiosis one and two in spermatogenesis?
Meiosis I: Primary spermatocytes
| II: Secondary spermatocytes
250
What are the two starting substrates for protoporphyrin synthesis?
Succinyl CoA and glycine
251
What causes a lacunar infarct?
Small vessel occlusion (uncontrolled HTN and DM are RFs)
252
What are three differences in colocrectal cancer that arises from UC?
Early p53 mutations, late APC mutations, multifocal
253
Where are complement proteins synthesized?
Liver
254
Encephalitis, meningitis, flaccid paralysis and rash?
west nile virus
255
Is alcohol metabolism reductive or oxidative?
Oxidative (depletes NAD+)
256
What upregulates ALAS? Downregulates?
Up: p450 inducers
Down: heme and glucose
257
Name three major enzymes that require tetrahydrobiopterin as a cofactor?
Hydroxylases
| Phenylalanine hydroxylase, tyrosine hydroxylase, tryptophan hydroxylase
258
Orphan annie eye cancer?
Papillary cancer of the thyroid. (Pick this unless hematogenous spread or amyloid)
259
What is a drug that ends in -gravir? -navir?
```
Gravir= integrase inhibitor
navir= protease inhibitor
```
260
Where in a cell are VLCFA and branched fatty acids metabolized?
Peroxisomes
261
Life expectancy required for hospice?
less than 6 months
262
What ligament has the uterine vasculature in it?
Cardinal ligament
263
How is liver metabolism related to drug-induced lupus?
Linked to drugs metabolized by N-acetylation in the liver (slow acetylators are at greater risk)
264
Retro-orbital pain, joint/muscle pain, fever, headache
Dengue fever (mosquito)
265
What is the role of glucose in the Lac operon?
Low glucose leads to an increase in cAMP--> increase in CAP which increases binding and activation at the promoter
266
Which things in muscle detect changes in length and force, respectively.
Golgi tendon organ: force
| muscle spindle: length (in parallel)
267
What part of the aorta is likely severed in trauma? Where is it?
Isthmus. Just distal to subclavian where the ligamentum arteriosum attaches
268
What is the pterion? Why is it significant?
Part of skull where frontal, parietal, temporal and sphenoidal bones meet. It is often fractured in epidural hematomas (MMA is right under it)
269
Two possible side effects of Epo therapy?
Increased risk for HTN and thromboembolic events
270
What pathway does PTEN inhibit? What is the normal result of this pathway?
mTOR pathway. mTOR translocates to nucleus and leads to gene transcription
271
Is using the subclavian or femoral entry site for venous catheters more likely to cause infection?
Femoral is more likely to lead to infection
272
What is the best indicator for the degree of mitral stenosis?
A2 to opening snap time interval
273
What causes urine to turn black on standing? Pathway?
Buildup of homogentisic acid due to homogentisic acid dioxygenase. This is in the pathway of tyrosine metabolism to fumarate
274
How do you tell if something messed up in meiosis I or II?
I: heterozygous mistake
II: double homozygous
275
Association with renal angiomyolipoma?
Tuberous sclerosis
276
What inhibits mitochondrial carnitine acetyltransferase and thus beta oxidation?
Malonyl CoA from fatty acid synthesis in cytosol
277
Pseudopallisading brain cancer?
GBM
278
Upper and lower pole atrophy and scarring in kidney is strongly suggestive of what?
Vesicoureteral reflux
279
Big virulence factor for salmonella?
Vi antigen (capsule)
280
What is the effect of restrictive lung disease on radial traction on the airways?
Increases with restrictive lung disease allowing for supernormal expiratory rates when adjusted for lung volume
281
What vitamin will be depleted with chronic hemolysis?
Folate: macrocytic change can occur
282
Where do positive and negative thymocyte selection happen in the thymus?
Positive: cortex
Negative: medulla
283
What happens at the baroreceptor when blood pressure drops?
Less stretch--> less firing--> less inhibition on the SNS
284
What often causes deep parenchymal hemorrhage in the brain?
Charcot-Bouchard aneurysm (burst with HTN)
285
What does C1 esterase inhibitor do besides stop complement?
Blocks bradykinin production
286
Match OR and RR with Case Study and Cohort
Cohort: RR
Case: OR
287
Pattern of breathing that slowly increases and decreases cyclically?
Cheyne-Stokes breathing which is indicative of advanced congestive heart failure
288
Anemia, but normal labs as far as size and reticulocytes go. What causes it?
PRCA. Thymoma, lymphocytic leukemias, parvovirus B19 (Inhibition of erythropoietic precursors by IgG autoantibodies or cytotoxic T cells)
289
What three molecules can integrins bind to to help cells bind to ECM?
Collagen, fibronectin, and laminin
290
What is the major virulence factor of H. influ type b?
Capsule (Polyribosylribitol phosphate- PRP)
291
What is the MOA of PCP?
NMDA antagonist
292
What drug blocks chemo-induced vomiting by indirectly decreasing substance P release? How does it work?
Aprepitant is an NK1 antagonist. Normally NK-1 stimulates substance P release.
293
Bacterial overgrowth causes deficiency of most vitamins except?
Vitamin K and folate
294
What is St. John's Wort to p450?
Inducer
295
What part of the kidney gives rise to clear cell carcinoma?
PCT epithelium
296
What removes the RNA primer in prokaryotes? How?
DNA polymerase I removes the RNA primer with a 5' to 3' exonuclease
297
Which diabetes is associated with HLA DR3 and DR4? Amyloid? What is the amyloid?
HLA- DM I
| Amyloid is amylin in DM II
298
What does tourniquet sign suggest? What is the deal with the first infection?
Dengue hemorrhagic fever. The first infection is often asymptomatic, secondary infection with another serotype is more severe
299
Difference in Hawthorne effect and Berkson's bias?
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
What is responsible for IL-2 anti-cancer activity?
Activation of NK and T cells
301
What is the relation between NF-KB and LPS?
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
What vessel causes AVN of the femoral head?
Medial circumflex artery (posterior circumflex is in the shoulder accompanying the axillary artery)
303
What is most of the diaaphragmatic heart surface?
Inferior wall of left ventricle (supplied by PDA usually from RCA) (Think in IVF myocardial infarction)
304
Fabry disease: What is the buildup and enzyme deficiency? What kills them?
alpha-galactosidase A deficiency with a buildup of globotriaosylceramide. Killed by RENAL or CV disease
305
What do you suspect if you see varicies but a normal liver biopsy?
Pre-hepatic congestion such as portal vein thrombosis
306
What arteries are ligated to stop uterine bleeding in emergency?
Internal iliac
307
Relationship between flow and radius?
Flow is inversely proportional to radius to the fourth power
308
What are, and what causes decorticate and decerebrate lesions?
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
Is fidaxomycin bactericidal or static?
Bactericidal with minimal systemic absorption
310
Where is uric acid most likely to precipitate in kidney? Why?
Acidic environment of distal tubules and collecting duct.
311
Where does pyruvate go in hypoxia?
Shunted to lactate by lactate dehydrogenase to replenish NAD+
312
What is carboxyhemoglobin?
CO bound Hb
313
What nerve is under the piriform recess in the pharnyx?
Internal laryngeal nerve (afferent cough reflex)
314
Hypotonia, umbilical hernia and protruding tongue in baby?
Congenital hypothyroidism
315
With increased ACTH does the adrenal undergo hyperplasia or hypertrophy?
Hyperplasia
316
What two drugs do you give for status epilepticus? Why?
Benzo to stop immediate seizure, phenytoin to stop recurrent seizures
317
Triad of hypercoagulability, pancytopenia, and hemolytic anemia. Genetics?
PNH: PIGA gene for the GPI anchor (DAF CD55)
318
What can alcohol abuse do to the RBCs?
Macrocytosis (not even necessarily vitamin related but often are folate deficient if long term users)
319
What metabolizes natriuretic peptides? What class of proteins is this in?
Neprilysin which is a metalloproteinase
320
Anti-Yo, Anti-Hu, Anti-P/Q antibodies
Subacute cerebellar degeneration with probable small cell lung cancer
321
MOA of fibrates? Fish oils?
Fibrates: PPAR-alpha activators to increase LPL activity and decrease hepatic VLDL production
FIsh oils: Decrease VLDL production and inhibit Apo B production
322
What causes TTP?
ADAMTS13 deficiency
323
Granules in neutrophils? Why?
In leukemoid reaction there are Dohle bodies (granules) in neutrophils
324
What forms the superficial and deep inguinal rings?
Superficial: External oblique aponeurosis
Deep: Transversalis fascia
325
What do you use to treat restless leg syndrome?
Dopamine agonists such as ropinirole and pramipexole
326
Marfanoid habitus, lens subluxation, thrombosis. Problems possible?
Homocyteinuria
1) Decreased cystathionine synthase to cystathionine (B6)
2) Decreased folate or B12 with methionine synthase
327
What is the MOA of amatoxins from mushrooms?
RNA polymerase II inhibitor
328
What type of blood in mothers causes fetal hemolysis? What kind doesn't? Why?
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
What causes outflow obstruction in HOCM?
Abnormal motion of the anterior mitral valve leaflet toward the hypertrophied septum
330
Describe renal osteodystrophy.
Kidney disease causes decreased calcium and increased PO4. This causes secondary hyperparathyroidism
331
What part of the spine is affected by RA? OA?
RA: cervical
OA: Lumbar
332
What is the relationship of the descending thoracic aorta and the esophagus?
Desc. thoracic aorta
333
What cephalosporins treat pseudomonas?
Cefipime, ceftazidime
334
Mononuclear, sudden and painless blindness
Central retinal artery occlusion
335
Hyperpigmentation, hypotension, fever. Treatment?
Acute Adrenal Insufficiency. Treat with immediate glucocorticoids and aggressive fluids
336
Fibrous bone dysplasia, endocrine abnormalities, and unilateral cafe au lait spots. Defect? What makes it survivable?
McCune Albright. Mutation affecting G protein signaling. Only survivable if after fertilization mosaicism
337
Soft tissue malignancy with scalloping of nuclear membrane
Liposarcoma
338
What parts of the brain atrophy in chronic alcoholism?
Anterior lobes and cerebellar vermis (looks almost like parkinson disease)
339
Brisk and painless lower GI bleed in infant
Meckel
340
What is the state of the coronary arteries in HOCM?
Normal
341
What part of the body is affected in alkaptonuria?
Joints: homogentisic acid is toxic to cartilage
342
Why does lactose intolerance develop in older people?
Gene expression gradually declines
343
Hypersexuality, put things in mouth..
Kluver-Bucy: Bilateral amygdala destruction (temporal lobe)
344
MOA of orlistat?
Intestinal lipase inhibitor causing down fat absorption and weight loss
345
Spikes in kidney biopsy?
Membranous glomerulonephritis
346
What type of receptor is composed of 7 alpha helical transmembrane proteins?
G-protein coupled receptors
347
Isolated hypertension in young teen girl with no virilization?
Possible 17 alpha hydroxylase deficiency
348
What may accelerated atresia cause? What type of process is it?
Premature ovarian failure. Apoptotic
349
How do parathyroid anomalies affect bone density?
Really not very much at all
350
Cramps, myalgia, fatigue in a patient with a loop diuretic.
Check potassium deficiency
351
What syndrome is associated with a CDKN2A mutation?Chromosome?
Dysplastic nevus syndrome (leads to melanoma). c9p21
352
What hormone is responsible for maintaining sodium levels in the body? For example, keeping it level even if you eat 5x more
ADH
353
Chromosomes for p53, RB, BRCA-1, BRCA-2
p53 and BRCA-1 on c17
| RB and BRCA-2 on c13
354
What is the function of a leucine zipper?
Eukaryotic transcription factor class (dimers with 2 alpha helical domains)
355
Which type of molar pregnancy is completely from the male? p57 positive?
Complete: 46c, sperm to empty egg, p57 negative
Partial: 47, two sperm to non empty egg, p57 positive
356
Where does purine and pyrimidine synthesis occur?
Cytosol
357
What causes MODY? Meds?
AD glucokinase deficiency. No meds required and is not insulin dependent
358
Hypoglycemia, lactic acidosis, hyperlipidemia, hyperuricemia. Describe
Von Gierke= glucose-6 phosphatase deficiency
359
What is the most common benign liver tumor? Rule for treatment?
Cavernous hemangioma. Do not biopsy
360
Absent thumbs with aplastic anemia?
Fanconi anemia
361
Why can axonal regeneration not occur in the CNS? What is different in the PNS?
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
Most important part of diphtheria treatment? Most often cause of death?
Passive IVIG, cardiomyopathy
363
Which class of anti-arrhythmics have strong use dependence? WHich have "reverse" use dependence?
Class IC stong, Class III reverse
364
First line tx for essential tremor?
Propranolol
365
What is dobutamine?
Beta one agonist (isoproterenol is B1=B2)
366
What type of inflammation leads to an AAA?
Transmural inflammation
367
Low levels of what can cause calcium kidney stones? High levels of what can cause calcium stones in Crohns?
Low citrate can cause stones. In Crohns, high oxalate causes it.
368
What are the numbers for Z scores with 95% and 99% CIs? Is it with SEM or STdev?
```
95%= mean +/- 1.96 * SEM
99%= mean +/- 2.58 * SEM
```
369
What if you see increased B-hCG and inhibin A in amniocentesis?
Down syndrome (nothing is increased with Patau or Edwards)
370
Where is urea absorbed in kidney?
Only in medullary segment of CD
371
Halo around eye?
Glaucoma
372
How does Crohns cause kidney and gallstones?
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
What is the relationship between nephrotic syndrome and sudden onset abd/flank pain, hematuria and right sided varicocele?
You may lose ATIII in nephrotic syndrome--> hypercoagulability--> right renal vein thrombosis with extension into the IVC
374
Name the four parts of the body affected by Henoch-Schonlein purpura
Skin, Kidney, GIT, JOINTS
375
What gene in HIV is proteolytically cleaved in the ER and golgi?
env gene (gp 120 and gp 41)
376
Where is the most airway resistance? Least?
Most: 2nd- 5th gen bronchi
Least: small airways/bronchioles
377
Major prognostic factor in urothelial carcinoma?
Tumor penetration of bladder wall
378
If there is a mutation in what, anti-EGFR therapy is obsolete.
KRAS (transcription factor downstream)
379
Differential clubbing and cyanosis without BP or pulse discrepancy?
PDA complicated by eisenmenger syndrome
380
What causes wet, age related macular degeneration?
Retinal hypoxia--> VEGF--> neovascularization with leaky vessels
381
Opsoclonus-myoclonus syndrome is with what?
Neuroblastoma
382
What effect does estrogen have on thyroid hormone levels?
It increases total levels due to increased thyroid binding globulin, but free levels are still the same
383
What is osteitis fibrosa cystica?
Caused by hyperparathyroidism. Subperiosteal erosions and brown bone tumor cysts
384
Where does the shoulder most often dislocate? Nerve at risk?
Anterior, axillary
385
What layer is absent in psoriasis?
Granulosum
386
What enzyme allows for fructokinase deficiency to be benign?
Hexokinase. May phosphorylate fructose to F-6-P
387
What substance correlates closely with meningococcal toxic effects and prognosis?
LOS
388
Brain tumor that is biphasic and S100 (+)?
Schwannoma
389
What is first line for moderate to severe alcohol use disorder to decrease craving?
Naltrexone (decreases rewarding and reinforcing effects)
390
What is the effect of PGs on aqueous humor?
Increases outflow
391
Ovarian cancer with each tumor marker.
1) LDH, B-hCG
2) AFP
3) CA-125
1) Dysgerminoma
2) Yolk sac
3) Epithelial (e.g. cystadenocarcinoma)
392
What do many cancer cells upregulate to evade apoptosis?
Programmed death receptor 1 ligand (PD-1). When the T-cell receptor (PD-1) binds this, the immune response is downregulated
393
What is the conversion of glucose in the lens that can cause cataracts?
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
What does grapefruit juice do to p450?
Inhibits
395
What synthesizes NO?
Arginine+O2--> NO2 via NO sythase (eNOS)
396
What is a mechanism by which mu opiod receptors can block pain?
Increased K= efflux--> hyperpolarization and blocking of pain transmission
397
How do Beta blockers lower blood pressure?
Decrease renin release from the JGA via B1
398
Which type of leprosy has a positive skin test?
Tuberculoid, lepromatous leprosy does not since it is primarily a humoral reaction
399
What mutation can cause PAH?
BMPR2
400
Where are nosebleeds usally located?
Anterior nasal septum (Kiesselbach plexus- ant. ethmoidal, sphenopalatine, and superior labial artery anastamosis)
401
What does myelin do to the time constant and length constant with nerve transmission?
Lowers time constant, increases length constant
402
What two hepatitis viruses are spread via fecal-oral transmission?
A & E
403
What is edrophonium?
Tensilon, short acting AChE inhibitor
404
At what lung volume is pulmonary resistance at its lowest?
FRC
405
What type of gastric adenocarcinoma forms a projection?
Intestinal. Diffuse forms thickened walls (linitis plastica)
406
What is danazol?
Partial androgen agonist
407
What does ANCA stand for?
Anti-neutrophilic cytoplasmic antibody
408
What should you associate with pseudohyphae with blastoconidia?
Candida
409
What finding in the brain is relatively specific to HIV associated dementia?
Microglial nodules (Neuronal damage is likely due to cytokine release)
410
Most common predisposing condition for native valve infective endocarditis in developed nations?
Mitral valve prolapse
411
Where and in what population will you most often see hematogenous osteomyeitis?
Children in the metaphysis of long bones (slower blood flow and capillary fenestrae)
412
What sequences help to initiate translation in eukaryotes and prokaryotes?
Eukaryotes: Kozak
Prokaryotes: Shine-Dalgarno
413
Non-smoker with lung cancer
Adenocarcinoma every time
414
Levels for thracocentesis?
Mid-clavicle: ribs 6-8
Mid-axilla: ribs 8-10
Paravertebral: ribs 10-12
415
What are three options to treat cyanide toxicity? Note: this is not carbon monoxide
1) Nitrite to induce methhemoglobinemia
2) Hydroxycobalamin (direct CN- binding)
3) Sodium thiosulfate
416
How does the body get rid of copper?
Secretes into bile and eliminates in stool
417
What is familial chylomicronemia caused by?
Defective LPL or Apo CII (cofactor for LPL)
418
Epistaxis and many telangiectasias. Inheritance?
Osler-Weber-Rendu Syndrome= hereditary hemorrhagic telangiectasia (AD)
419
Scoliosis is a hint for what spinal cord injury?
Syringomyelia
420
What is the genetic predisposition to cervical cancer?
None, no genetic component
421
IgG4 to PLA2
Membranous nephropathy
422
What vitamin deficiency can closely mimic Friedreich ataxia?
Vitamin E
423
What will you see on histology with a hypersensitivity to intradermal tobacco extract?
Buerger's disease (thromboangiitis obliterans) segmental vasculitis extending into contiguous veins and nerves
424
Marker for hepatocellular carcinoma? Colorectal cancer?
AFP, CEA
425
Posture dependent LE pain and paresthesia
Spinal stenosis. Narrowing of spinal canal due to disc herniation, ligamentum flavum hypertrophy or osteophyte formation
426
Bands that connect right colon to RLQ peritoneum passing across duodenum and causing obstruction?
Midgut malrotation
427
What is the serum sodium level in hyperaldosteronism?
Normal- aldosterone escape
428
What does the vitelline duct connect?
Ileum to umbilicus
429
What type of hypertrophy is caused by aortic regurgitation?
Eccentric (expansion)
430
What genetic cancer syndrome deals with a ubiquitin ligase component?
VHL
431
What hormone will be at a high level 1 hr post exercise?
VEGF (GH during)
432
N-acetylglucosamine 1-phosphatase?
I cell disease
433
What drugs do PPIs notably decrease absorption of?
Azoles
434
What causes paradoxical splitting?
aortic outflow problems
435
Which two blood pressure meds may cause lipid abnormalities?
Thiazides and beta blockers
436
What if you see a starving person with maintained glucose levels and positive ketones?
Breakdown of adipose tissue by hormone sensitive lipase
437
Garlic odor? Treatment?
Arsenic poisoning, dimercaprol
438
Infarction of renal cortex with medulla sparing? Association?
Diffuse cortical necrosis often with DIC.
| Oliguria, anuria, uremia
439
G subtypes with D1 and D2?
S and I
440
What is the cause of endocardial cushion defects with down syndrome?
Failure of neural crest migration
441
Whitish, needle shaped crystal in urine?
Orotic acid
