Step 1 All content Flashcards

1
Q

Sudan III staining

A

Checks the stool for presence of fat globules indicating steatorrhea

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2
Q

Prader willi genetic error that occurs

A

2 copies of a chromosome from the mother (fathers copy is lost) Pray for Willi he’s only 15 but short fat and dumb

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3
Q

ankylosing spondylitis HLA assoc

A

HLA-B27

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4
Q

Papillary Carcinoma of thyroid

A

P’s. Psamoma bodies, Prevalent, palpable nodes.
Also Orphan annie nuclei.

RET/PTC and BRAF mutations

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5
Q

Leuprolide and hormones as function of time

A

First stimulates GNRH but once chronically stimulated it actually therapeutically decreases FSH and LH

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6
Q

Zones of adrenal gland

A

G- aldosterone
F- cortisol
R- Androgens
medulla- chromaffin cells catecholamines

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7
Q

thrombo thrombocytopenic purpura symptom pentad and issue

A

fever, Microangiopathic hemolysis, neuro, thrombocytopenia and renal issues
can be older pt

ADAMS 13 a metalloprotease that usually degrades vWF

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8
Q

most common embryonic structure that leads to congenital diaphragmatic hernia

A

pleuroperitoneal folds

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9
Q

I cell Disease

A

bilateral, hip abnormalities, corneal clouding, course facial features. lysomal disease where an important phosphorylation enzyme (N-acetylglucosaminyl-1-phosphotransferase)

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10
Q

Kaposi Sarcoma

A

HSV 8 often GI bleeds or hematochezia involvement

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11
Q

measles distinguishing features

A

rash starts on the neck, koplik spots and conjunctivitis

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12
Q

Scurvy biochem issue

A

proline and lysine of collagen are not hydroxylated in the endoplasmic reticulum

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13
Q

Absolute risk

A

AR = a/(a+b) - c/(c+d)

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14
Q

Albinism biochem defect and embryologic issue

A

tyrosinase deficiency. melanocytes are derived from neural crest cells

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15
Q

Mechanism of isoniazid resistance

A

less KatG, so the catalase peroxidase enzymes need to activate drug are not expressed

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16
Q

receptor found on all T cells that is often targeted by anti rejection meds

A

CD3

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17
Q

CD16

A

natural killer cells

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18
Q

hemolytic anemia and gallstone type?

A

UNconjugated bilirubin stones. (liver overwhelmed)

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19
Q

ERBB2 (formerly HER2) drug

A

Trastuzumab, watch for cardiotoxicity

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20
Q

Thiazide diuretics common side effects

A

HyperGLUC (glucose, lipids, uric acid, calcium)

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21
Q

What does the axillary nerve branch from?

A

posterior cord

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22
Q

complication of tumor lysis syndrome

A

arrhythmia

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23
Q

Atypical cells in mono

A

CD8 T cells have abnormally abundant cytoplasm

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24
Q

RNA virus mnemonic

A

I went to a RETRO TOGA party, and drank FLAVored CORONA and ate CALIfornia PICkles. +reo virus which is only Ds RNA virus.

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25
Q

non-Enveloped viruses

A

DNA- PAPP

RNA- CPR + hepevirus

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26
Q

what neurotransmitter helps you sleep

A

acetylcholine in reticular formation

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27
Q

NF1 gene and symptoms

A

NF-1 tumor suppressor gene on chromosome 17q

cafe-au-lait, neurofibromas, lisch nodules. Autosomal dominant

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28
Q

NF2 gene

A

misprediction of the gene product merlin.

Schwannomas

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29
Q

mom introduces juice to infant then lethargy

A

aldolase B deficiency in fructose intolerance. fructose-1-phosphate inhibits gluconeogenesis leading to hypoglycemia (All die, more severe)

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30
Q

MEN syndromes inheritance

A

all are autosomal dominant

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31
Q

lead poisoning treatment

A

dimercaprol

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32
Q

krugenberg tumors

A

gastric tumors that met to the ovaries. associated with supraclavicular lymphadenopathy

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33
Q

what transports botulism towards cell center

A

dynein

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34
Q

polyarteritis nodosa path?

A

transmural inflammation and fibrinoid necrosis.

and beads on a string

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35
Q

yellow fever post mortem biopsy finding and symptoms

A

High AST, bloody emesis, jaundice Counselman bodies (they are degenerated eosinophils)

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36
Q

CML genetics

A

Philadelphia chromosome 9:22 translocation that turns on a tyrosine kinase

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37
Q

Ewing Sarcoma genetics

A

11:22 overactive transcription factor

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38
Q

Herpes zoster/CMV path

A

Cowdry A inclusion bodies

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39
Q

Call-exner bodies

A

granulosa cell tumors

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40
Q

Mallory bodies

A

alcoholic hepatitis. Damaged intermediate filaments

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41
Q

Reinke crystals and what are they

A

Leydig cell testicular cancer. Eosinic inclusions

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42
Q

G6PD inheritance

A

XR but can display lyonization

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43
Q

Horshoe kidney gets tuck on what

A

Inferior mesenteric

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44
Q

anaphylaxis immune elements

A

IgE with bound C3a C5a on mast cells causing histamine release

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45
Q

Signs of hydrops fetalis (Rh incompatibility)

A

purpura, thickened placenta, hepatosplenomegaly with ascites, dead baby

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46
Q

benzo overdose trx

A

flumazenil competitive inhibition so shifts benzo dose response curve right.

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47
Q

Distinguishing between Barter and Gitlemans

A

Calcium is high in Bartter and low in Gitelman

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48
Q

ethylene glycol overdose trx

A

fomepizole

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49
Q

Alport’s defect and inheritance

A

type 4 collagen. Cant hear cant see cant pee. x-linked dominant

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50
Q

Goodpasture

A

anti basement membranes specifically against alpha 3 chain of type 4 collagen. Cough hemoptysis and renal loss of proteins and red cells

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51
Q

cholinergic excess ( organophosphate poisoning ) trx

A

atropine in organophosphate poisoning

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52
Q

difference between repression and suppression

A

unaware of repression. Consciously suppress

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53
Q

Job syndrome

A

Defective helper T cells (Th17) cant make tnf-gamma to recruit neutrophils. recurrent staph accesses. retained teeth. High IGE and dermatologic issue.

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54
Q

Midline midbrain localization

A

Motor pathway (corticospinal) CL
Medial Lemniscus CL
MLF- IL
Motor nerve nucleus- IL 3,4,6,12

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55
Q

Lateral midbrain localization

A

Spinocerebellar IL
spinothalamic CL
Sensory of CN5 IL
Sympathetic IL

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56
Q

Diuretics in kidney stone Hx + HTN

A

Thiazides

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57
Q

really quick rhabdo and cramping with exercise in a young pt, biochem?

A

McArdle disease; myophosphorylase def occurs in cytosol

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58
Q

AML with Auer rods genetics

A

T (15;17) translocation

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59
Q

Hep C med with tons of side effects including depression

A

peginterferon alpha

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60
Q

how does hodgkin lymphoma evade immune system?

A

downregulates MHC1

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61
Q

Neuro reflex roots

A
Bicep- C5,C6
brachioradialis- C6
tricep- C7
Patellar- L2,4
ankle- S1
Cremasteric- L1, L2
Anal wink- S3, S4
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62
Q

how does exercise lower glucose?

A

increased expression and transport of glut 4 to the surface

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63
Q

Desmopressin hematological use

A

increases vwf and VIII (8) from Weibel Palade bodies

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64
Q

if a mixing study does not correct bleeding?

A

usually an antibody against something

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65
Q

Bernard Soulier vs Glanzman thrombasthenia

A

Bernard Soulier- low Gp1b, large platelets

Glanzman - no platlet clumbing low GPIIb/IIIa

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66
Q

T(12:21) and T(9:22)

A

ALL
T(12:21) Better prognosis most common
T(9:22) Worse prognosis. less common

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67
Q

CD20, CD23 and CD5 positive B cells

A

Chronic Lymphocytic Leukemia

Small Lymphocytic Lymphoma

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68
Q

TRAP positive and treatment

A

Hairy Cell Leukemia, Cladribine or pentostatin

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69
Q

what is APL?

A

AML t(15:17) translocation associated with auer rods and myeloperoxidase positive. Responds to Vit A and arsenic

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70
Q

t(9:22)

A

CML BCR-ABL

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71
Q

JaK2 mutations cancer?

A

Polycythemia vera

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72
Q

t(8:14)

A

bukitt (burk8) lymphoma: C-MYC overexpression (causes transcription factor overactivation

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73
Q

BCL2 and BCL6 mutations

A

Diffuse large cell B-cell lymphoma

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74
Q

t(14;18)

A

Follicular lymphoma. BCL-2 overexpression

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75
Q

t(11;18)

A

Marginal zone lymphoma assoc with chronic inflammation.. AYY (11) I’m Aching (18)

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76
Q

t(11:14) and cell cycle area

A

Mantel cell lymphoma. Increase in Cyclin D1 and skips G1-S checkpoint

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77
Q

Collagen types and associated diseases

A

type I: Osteogenesis imperfecta
type 3: Ehlers Danlos,
type 4: Alport, Goodpasture

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78
Q

heme synthesis what defects mitochondria vs cytoplasm

A

Mitochondria- sideroblastic anemia (X linked)
cytoplasm- porphyria’s
both- lead poisoning

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79
Q

vasculitis associated with Hep B and inflammation type?

A

polyarteritis nodosa. Transmural necrotizing inflammation

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80
Q

urine build up in porphyrias?

A

acute intermittent porphyria- protoporphyria

porphyria cUtanea tarda- Uroporphyria

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81
Q

MACROlides (azithromycin, erythromycin, ect.) adverse effects

A
Motility issues
Arrhythmia (QT prolongation)
Cholecystic hepatitis
Rash
eOsinophilia

also inhibit p450 enzymes

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82
Q

mumps complications

A

parotitis, pancreatitis, orchitis, meningitis, sub acute pan-sclerosing encephalitis

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83
Q

meniscus tears and rotation

A

medial- click on external rotation

lateral- click on internal rotation

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84
Q

lateral knee trauma’s unhappy triad

A

MCL, ACL, and medial meniscus tear.

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85
Q

Pathology of H-Pylori infection?

A

solitary lesions with underlying tissue replaced with chronic inflammatory cells

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86
Q

Ménétrier disease path?

A

Hyperplasia of surface mucosal cells with enlarged rugae . Atrophy of parietal cells and hypertrophy of mucosal cells

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87
Q

How do eosinophils attack parasites

A

antibody-dependent cell-mediated
parasite covered in IL-5 on eosinophils then attack. They also slowly induce a chornic type 1 hypersensitivity against the creature.

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88
Q

Courvoisier sign

A

painless jaundice, weight loss = pancreatic adenocarcinoma. most common risk factor is smoking

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89
Q

decreasing risk of hemorrhagic cystitis with Cyclophosphamide

A

mesna- binds toxic metabolites in urine

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90
Q

amifostine

A

prevents cisplatin induced nephrotoxicity

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91
Q

VACTERL

A

Vertebral, anal, cardiac, TE, Renal, Limb abnormalities

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92
Q

High drug metabolism what zone of liver

A

zone 3 furthest from triad

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93
Q

anesthetic that can cause seizures

A

enflurane

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94
Q

pain, stiff joints, hyperpigmentation of sclera or skin

A

homogentisic acid oxidase def resulting in an accumulation of homogentisic acid. Limit dietary tyrosine and L-phenylalanine

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95
Q

AAA repair common complication

A

Inferior mesenteric artery ischemia

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96
Q

Diuretics that can cause gout

A

Thiazides

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97
Q

Molar pregnancy gentics

A

full Mole. No fetal parts 46XX

Partial. fetal parts 69XXX

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98
Q

how does DCIS to IDC what mutation

A

metalloproteases to degrade basement membrane

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99
Q

Saliva ion concentrations and flow rate

A

Lower K, Higher Na Cl, and HCO3 secretion with higher flow rate

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100
Q

Infliximab vs Etanercept mech difference

A

Infliximab- binds soluble TNF-a

Etanercept- competitive inhibitor at TNF-a receptor

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101
Q

Symptomatic Pheochromocytoma two drugs for MM before surgery

A

Phenoxybenzamine- long acting for most symptoms Irreversible inhibitor
Phentolamine- SA, short word for acute hypertensive crisis. reversible inhibitor
both nonselective alpha blockers

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102
Q

achondroplasia

A

most common congenital dwarfism.
mut in fibroblast growth factor3 gene.
assoc with advanced paternal age.

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103
Q

CREST syndrome

A

calcinosis, Raynaud’s, esophageal dysmotility due to atrophy, sclerodactyly, telangiectasias

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104
Q

Rosacea vs pityriasis rosacea

A

Rosacea- face, sun bad, telangiectasias possible

pityriasis rosacea- back, herald patch, Christmas tree,

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105
Q

Maple Syrup Urine Disease

A

lethargy, seizures, early in life. Deficiency of branched chain α-keto acid dehydrogenase.
Limit “I love Vermont” I,L,V amino acids and give thiamine (B1) bc it is required by enzyme

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106
Q

zidovudine class and side effect

A

NRTI, anemia

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107
Q

HIV NRTI associated with hypersensitivity rxn

A

abacavir (atopic-avir)

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108
Q

Abx that bind 30s ribosome classes

A

Irreversible binding to 30s- aminoglycosides

reversible binding to 30s- tetracyclines

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109
Q

PDE-5 inhibitors mechanism to stop ED

A

increase cGMP

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110
Q

Desquamative interstitial pneumonia

A

middle age pt, hx of smoking, dry cough, SOB, hypoxia

ground glass opacities, low DCO. pigment laden macrophages

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111
Q

post strep glomerular nephritis

A

2 weeks after strep, hematuria. Low C3
LM: large hypercellular glomeruli
IF: granular appearance due to IgG and C3
EM: sub epithelial IC humps

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112
Q

Gq mnemonic

A

HAVe 1 M&M

activate phospholipase C and increase protein kinase C

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113
Q

antifungal that can increase skin pigmentation

A

ketoconazole

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114
Q

Gi mnemonic

A

people who are 2 MAD inhibit themselves

decrease cAMP production

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115
Q

SCC precursor lesion

A

actinic keratosis

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116
Q

GLP-1 mechanism

A

increase insulin via the incretin pathway

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117
Q

midline neck mass and embryologic remnant

A

thyroglossal duct cyst

foramen cecum

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118
Q

HNPCC (Hereditary nonpolyposis colorectal cancer or lynch) genetic issue

A

mismatch repair defect. Occurs during S phase

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119
Q

Ataxia telangiectasia genetic issue

A

Non homologous end joining (drunk strands are ataxic)

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120
Q

xeroderma pigmentosa genetic issue

A

Nucleotide excision repair defect. due to thymidine dimer accumulation

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121
Q

BRACA 1 and fanconi anemia genetic issue

A

homologous end joining (2 boobs are homologous)

homologous bloodlines are down

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122
Q

hormone that increases in starvation?

A

cortisol

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123
Q

constipation in a diabetic which nerve affected?

A

pelvic splanchnic

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124
Q

cleidocranial dysplasia

A

skull, teeth, bone abnormalities. Autosomal dominant affects osteoblast abnormalities

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125
Q

HLA inheritance in siblings

A

25% share all, 50% share some, 25% share nothing

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126
Q

Statin mechanism

A

Inhibit HmG CoA and increase LDL expression drawing cholesterol out of the serum

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127
Q

determining monoclonality of an endometrial Ca?

A

X linked isoenzymes

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128
Q

what does liver do in response to glucagon

A

Beta fatty acid oxidation to create energy for gluconeogenesis

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129
Q

most common urea cycle def?

A

ornithine transcarboxylase. Causes build up of ammonia. Emesis, refusal to feed, lethargy, comma

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130
Q

dont get enough protein what happens to nitrogen?

A

negative nitrogen balance, part of every amino acid.

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131
Q

cyclosporine moa?

A

decreases interleukin 2 signal via calcineurin inhibition

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132
Q

hypertrophic osteodystrophy

A

clubbing, arthritis, new bone formation. Usually due to bronchogenic carcinoma

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133
Q

Gardner’s syndrome

A

APC mutation
100% chance of colon Ca.
osteomas also common

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134
Q

Vit deficiency in carcinoid syndrome?

A

niacin bc more tryptophan converted to serotonin and not vit B3 (niacin)

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135
Q

heartburn med that causes constipation

A

aluminum hydroxide (aluminum binds phosphate and gets heavy and bound up)

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136
Q

rIbavIrIn mech?

A

antiviral Inhibits IMP dehydrogenase so it can’t be converted to GMP

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137
Q

Orotic aciduria?

A

megaloblastic anemia in child that is unresponsive to folate and B12. Treat with uridine, due to UMP synthase deficiency

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138
Q

endometrial carcinoma (endometrial type) risk & histology

A

risk: increased estrogen (especially obesity)
histology: glandular invasion of myometrium and disorganized tissue

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139
Q

Pancoast tumors cause horner’s how?

What damages each order neuron?

A

Horner’S (second order sympathetic neuron)

1st order is in spinal cord - spinal cord damage
3rd order goes back up anterior- carotid dissection

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140
Q

cells and signaling molecules GI?

A

Gastrin- G cells
Somatostatin- DIE!!! stops everything D cells
CholecystokInIn- I cells
Secretin- S cells
Gastrin inhibitory peptide- Kalk water is basic. K cells

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141
Q

6m baby low glucose, high lactic acid/uricemia, hepatomegaly?

A

Von Gierek a glycogen storage disease. Loss of G6P which breaks down. glycogen which builds up in liver.

Baby starves between feeds. sucrose and fructose makes it worse.

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142
Q

Immune thrombocytopenic purpura blood smear findings

A

increased megakaryocytes

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143
Q

topical abx that inhibits peptidoglycan wall synthesis

A

bacitracin. topical due to extreme nephrotoxicity

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144
Q

pharyngeal pouches mnemonic?

A

Ears, tonsils, bottom to top

  1. ears
  2. tonsils
  3. bottom of parathyroid
  4. thymus (3 and 4 are especially related)
  5. top of parathyroid
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145
Q

pharyngeal arches nerves mnemonic

A

At golden arches children first chew, then smile, then swallow stylishly - or simply swallow - then speak

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146
Q

ganciclovir toxicity and mech

A

nephrotoxicity and myelosuppression

Inhibition of the incorporation of dGTP by viral DNA polymerase

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147
Q

thiazolidinediones mechanism and major side effect

A

acts on peroxisome proliferator-activated receptors (PPARs) and sensitizes cell to insulin.
water retention “pioglitazone”

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148
Q

what is RA factor?

A

immunoglobulin M antibody against the Fc portion of immunoglobulin G

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149
Q

bifid testes embryologic issue?

A

malunion of the labioscrotal swellings

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150
Q

glactose vs fructose metabolism issues

A

galactose issues- start with breastfeeding, infantile cataracts
fructose- begin with introduction of fruit, juice, honey

mild: galactokinase def; essential fructosuria
severe: galactosemia (galactose 1-p UDIE transferase); hereditary fructose intolerance (All dielase B)

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151
Q

allergic (eosinophilic) granulomatosis and angiitis

symptoms and Dx

A

sinusitis, asthma, lung infiltrates, eosinophilia, vasculitis, neuropathy. Confirm with ANCA (anti neutrophil antibody)

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152
Q

What diuretics can make osteoporosis worse?

A

loop diuretics bc calcium is lost

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153
Q

abx that can cause nephrogenic DM

A

topical demeclocycline, used primarily for acne

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154
Q

Carnitine deficiencies vs medium chain acyl-coA dehydrogenase def

A

Both have hypoglycemic hypo ketosis

carintine def- cardiomyopathy
Acetoacetate formation is deficient

MCAD def- liver dysfunction and hyperammonemia

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155
Q

Pompe Disease?

A

enlarged muscles and heart. hypotonia, hepatomegaly secondary to HF. acid maltase deficiency. PAS positive glycogen accumulates in the lysosome

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156
Q

cori disease

A

limit dextrans accumulation. possible cardiomegaly. mild hypoglycemia. Due to debranching enzyme def

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157
Q

Filgrastim

A

recombinant GCSF cytokine. Helps with immunosuppression from ALL or cancer treatments

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158
Q

spike and dome on EM

A

membranous glomerulonephritis

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159
Q

Henoch-Schönlein purpura on IF

A

Large deposits of IgA in mesangium

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160
Q

lead poisoning mechanism

A

disrupts the incorporation by ferrochelatase of iron into protoporphyrin IX also disrupts ala (aminolevulnic acid)

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161
Q

rhomberg test positive, what structure is affected?

A

medial lemniscus

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162
Q

organic acidemia’s treatment mnemonic

Can’t convert proponyl CoA to methylmalonyl CoA

A

Limit VOMIT
valine, odd chain FA’s, methionine, isoleucine, threonine.
Presents at 1-2 weeks

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163
Q

CLL complication

A

warm and cold hemolytic anemias

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164
Q

Gynecomastia drugs mnemonic

A

Some Hormones Create Funny Knockers

spironolactone, Hormones, Cimetidine, Finasteride, Ketoconazole

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165
Q

Disulfiram like reaction drugs mnemonic

A

Sorry Pals Cant go Mingle

Sulfonylureas (first generation), Procarbazine, certain Cephalosporins, Griseofulvin, and Metronidazole

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166
Q

Placental abruption vs previa symptoms

A

abruption: painful, with contractions
previa: painless bleeding without contractions

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167
Q

Cremaster muscle comes from what muscle in development?

A

internal oblique

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168
Q

Juvenile Idiopathic Arthritis symptoms/ path

A

periodic temperatures associated with rash; enlarged lymph nodes, liver, and spleen;
RBC-laden macrophages with low hematocrit.

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169
Q

indinavir and side effects

A

protease inhibitor. thrombocytopenia and kidney stones

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170
Q

Raltegravir and side effects

A

integrase inhibitor can cause high CK and Rhabdo

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171
Q

laryngeal cancer greatest risk factor?

A

smoking

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172
Q

PTH main effects

A

increases calcium decreases phosphate in kidney and causes bone to resorb both by breaking down. Net effect ins more Ca and less Phosphate

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173
Q

Primary CNS lymphoma description

A

single ring-enhancing lesion with an angiocentric pattern of CD20+ cells

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174
Q

ALS affects what?

A

Anterior horn and corticospinal tracts

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175
Q

Anitschkow cells

A

Rheumatic fever

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176
Q

Di George embryology

A

3rd and 4th pharyngeal pouches don’t develop normally.

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177
Q

potter sequence embryology

A

failure of uretic bud to form properly

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178
Q

Vit E deficiency symp

A

ataxia and even hemolysis bc the red cell membranes get weak

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179
Q

midbrain vessel

A

PCA

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180
Q

Pons Vessel

A

Basilar- medial

AICA- lateral

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181
Q

Medulla Vessel

A

ASA- medial

Pica- PICA lateral

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182
Q

Wecners (granulomatosis with polyangiitis)

A
coughing blood
chronic sinusitis
cervical facial infection
kidney
C-anca
Caseating granulomas
cyclophosphamide and corticosteroids
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183
Q

churg strauss (eosinophic granulomatosis with polyangiitis)

A

asthma, sinusitis, eosinophilia
cardiac issues and purpura/nodules
pauchi immune glomerulonephritis

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184
Q

Trisomy 18 (edwards)

A

clenched fists with overlapping fingers
rocker bottom feet
low ears
micrograthia

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185
Q

Trisomy 13 (patau)

A
cleft lip
holoproencephaly
polydactyle
aplasia cutis
polycystic kidney disease
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186
Q

how does kidney reabsorb more HCO3

A

increased Na/H exchange in proximal tubule

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187
Q

where do sperm acquire motility?

A

spermatogenesis takes place in seminiferous ducts
but,
motility is acquired in the epididymis, which is lined with a layer of pseudostratified columnar epithelium with stereocilia

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188
Q

If you are putting a central line in the jugular where do you go?

A

within the carotid sheath lateral to the common carotid artery and anterior to the vagus nerve.

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189
Q

renal osteodystrophy physiology?

A
  • Kidney sucks so phosphate increases
  • phosphate blocks calcium in blood
  • PTH responds to low calcium and bone is broken down
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190
Q

dantrolene mech

A

binds to ryanodine receptors and blocks calcium release from the sarcoplasmic reticulum.

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191
Q

RB mutation cancers?

A

Osteosarcomas, Bladder cancer, Retinoblastomas

ROB the RB gene

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192
Q

esmolol role in arrhythmia

A

See if the pt will tolerate a beta blocker with comorbidities. It only acts for 7mins so pt wont die if they become hemodynamically unstable

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193
Q

common finding in obstructive and restrictive pathology?

A

Decreased vital capacity and inspiratory reserve volume

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194
Q

HOT T-Bone stEAK

A

IL 1- Hot (fever)
IL 2- T (Stimulates T cells)
IL 3- Bone (bone growth)
IL 4- E (class switching to IgE and IgG)
IL 5- A (class switching to IgA) eosinophils asthma
IL 6- K (aKute phase reactants, megaKaryocytes) also increases plts as part of inflammation

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195
Q

Telling ANCA disorders and Goodpasture’s apart?

A

good pastures is usually a young male and will light up glomeruli on immunostaining

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196
Q

Hereditary hemochromatosis

A

AR. Dysregulated hepcin leading to increased iron absorption

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197
Q

Langerhans cell histiocytosis?

A
skin macrophages invade various organs
Birbeck granules (look like tadpoles) on EM

bone tenderness
eczematous rash and spontaneously resolving brownish purple papular lesions.

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198
Q

How does Staph aureus TSS toxin work?

A

cross links MHC II

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199
Q

Most common genetic hyper coagulability?

A

Factor 5 Leiden (AD)

preventing protein C from degrading factor V

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200
Q

Vascular tumor growth is driven by what?

A

VEGF and FGF

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201
Q

Inability to fight mycobacterial infections and poor rxn to BCG vaccine?

A

IL-12 receptor deficiency

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202
Q

allelic heterogeneity?

A

different mutations in the same locus resulting in a similar phenotype.

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203
Q

jaw mneumonic

A

Remember “Lateral Lowers” and “M’s Munch”
Lateral pterygoids
Medial pterygoids, Masseter, teMporalis

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204
Q

Familial hyperlipidemia with high LDL who fail statin next step?

A

and ezetimibe or a psk9 inhibitor

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205
Q

BCL-2 function?

A

inhibits apoptosis

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206
Q

VWF deficiency

A

most common cause of increased bleeding

vwf acts as a ligand in plt adhesion

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207
Q

Trigeminal nerve exits V1, V2, V3

A

standing room only

Superior orbital fissure, foramen Rotundum, and foramen Ovale,

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208
Q

Norepi sympathetic mechanism

A

increased AV nodal conduction velocity via increased Ca2+ influx

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209
Q

methotrexate mech

A

inhibits dihydrofolate reductase.

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210
Q

drug metabolism and solubility

A

fat soluble- thoracic duct (no first pass)
water soluble- portal vein (first pass)
ports assoc with water

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211
Q

prostate cancer is found in what zone

A

peripheral zone

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212
Q

what artery supplies Merkle diverticulum

A

Superior mesenteric artery

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213
Q

Leukocyte adhesion deficiency molecular issue

A

loss of CD18 integrin

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214
Q

malignant PKU enzyme def.

A

dihydrobiopterin reductase

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215
Q

Steatorrhea kidney consequences

A

decreased oxalate/calcium complex exertion so more kidney stones

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216
Q

abciximab

A

Inhibits glycoprotein IIb/IIIa

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217
Q

low blood volume and afferent arteriole

A

High NE and Angiotensin II constricts but is counteracted by vasodilation on prostaglandins

Don’t give lots of NSAIDS to volume down pts

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218
Q

Bleomycin vs Busulfan pulmonary fibrosis?

A

Bleomycin- months to weeks post trx

Busulfan- years after trx

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219
Q

macrolides mechanism?

A

50S ribosome subunit

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220
Q

Aorta rupture from deceleration common location

A

aortic isthmus (right where it starts to go down after left subclavian)

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221
Q

Absolute contraindication with Cocaine MI

A

B blockers. Would lead to unopposed alpha leading to vascular constriction

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222
Q

polyarteritis nodosa hypersensitivity type

A

Type III

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223
Q

Hyper IgM syndrome molecular issue

A

Defective CD40L on T-helper cells doesn’t allow class switching

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224
Q

hepatorenal syndrome physiology

A

dilation of splanchnic vessels. constriction of renal vessels. causes pre-renal azotemia

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225
Q

pilocarpine and pupil

A

constricts pupil and decreases intraocular pressure via M3 agonism

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226
Q

ulnar nerve comes from what trunk?

A

lower

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227
Q

what cells produce androgen binding protein?

A

Sertoli cells

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228
Q

Muscular dystrophy inheritance

A

X-Linked recessive

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229
Q

Bleomycin mechanism

A

induces DNA strand breaks by producing superoxide and hydroxide free radicals that lead to DNA cleavage

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230
Q

IgA nephropathy vs PSGN?

A

both can be in kids
IgA- sore throat and hematuria at the same time. Mesangial deposits
PSGN- sore throat 3-6wks before hematuria. sub epithelial humps

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231
Q

Quinidine adverse effects?

A

Torsades and cinchonism, a syndrome that includes headaches and tinnitus

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232
Q

WPW blood flow issue

A

decreased filling of the ventricle during diastole due to early ventricular depolarization

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233
Q

Splenomegaly, burr cells, transfusion

A

pyruvate kinase deficiency

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234
Q

pancreatitis electrolyte complication

A

hypocalcemia

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235
Q

Trousseau syndrome and cause

A

pancreatic ca + migrating swelling and pain

thrombophlebitis from tissue factor liberating clotting factors.

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236
Q

Dubin Johnston

A

High direct bilirubin

black liver

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237
Q

Gram negative coccobacillus. Rapidly expanding infection post dog or cat bite

A

Pasteurella multocida

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238
Q

TB Ghon complex description?

A

caseating granulomas with multinucleated giant cells and epithelioid cells surrounding an area of central necrosis

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239
Q

eczema hypersensitivity type

A

type 1 Hypersensitivity

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240
Q

PHENYTOIN side effects

A
P450 induction
Hirsutism
Enlarged gums
nystagmus
Yellow Brown Skin
Teratogen
Osteopenia
Inhibited Folate
Neuropathy

Rarely SJS, DRESS and drug lupus

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241
Q

women hormone replacement therapy effect on thyroid

A

Increased TBG and total T3/T4 and normal everything else. No symptoms

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242
Q

Carbonic anhydrase inhibitor mechanism and changing urine effects

A

Increases HCO3 and volume losses alkalizing the urine

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243
Q

LH in PCOS?

A

High

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244
Q

What error type decreases with increased sample size?

A

Type II or missing the statistical significance

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245
Q

How does Warfrin work

A

suppresses carboxylation of precursor proteins that utilize vit K

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246
Q

Infusion rate formula

A

Drug clearance x Steady State Drug concentration plasma

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247
Q

How does Breast Ca mets get to vertebral column

A

intercostal veins

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248
Q

Glucosamine from F-6-P required cofactor

A

glutamine

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249
Q

eversion ankle sprain muscle that causes pain

A

Fibularis (peroneus) brevis

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250
Q

Jersey finger injury and innervation

A

flexor digitorum profundus (C8)

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251
Q

Autosomal trisomy with increased b-HCG

A

Trisomy-21

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252
Q

Autosomal Trisomy all values down

A

Trisomy 18. Inhibin may be normal or decreased

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253
Q

Nerves that may impair reinnervation peripherally

A

Schwann cells

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254
Q

What do 5-FU and capecitabine inhibit

A

thymidylate synthetase

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255
Q

What binds TATA box

A

RNA polymerase

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256
Q

Feathery appearance on contrast GI x-ray due to what

A

A lot of mucosal surface area

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257
Q

trx for child with severe diarrhea

A

sodium and glucose IV (or orally if worried in an office setting)

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258
Q

Interosseous muscle innervation

A

ulnar nerve

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259
Q

Plantar flexion nerve

A

tibial nerve

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260
Q

most common surgical injury during radical proctectomy

A

pelvic parasympathetic nerves

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261
Q

prostate cancer what type of lesions

A

osteoblastic lesion

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262
Q

nicotinic acid mechanism in cholesterol distribution

A

takes cholesterol from hepatocytes to VDRL in circulatory system

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263
Q

aspirin allergic pts should use what for headaches?

A

acetaminophen

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264
Q

Binding of prednisone?

A

Binds cytosol receptor with translocation into nucleus

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265
Q

Islets cells of pancreas comes from what cell type embryologically

A

Endoderm

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266
Q

In SCID due to adenosine deaminase def what enzyme is inhibited by high dATP levels?

A

Nucleoside monophosphate kinase

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267
Q

What lipid lowering agent increases muscle issues of statins?

A

Gemfibrozil

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268
Q

Respiratory compliance equation

A

Change in volume/ Change in pressure

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269
Q

Dicumarol?

A

Depletes Vit K just like Warfrin. Prolongs PT

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270
Q

Common secondary Ca from hodgkin lymphoma trx?

A

AML

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271
Q

What pharmacology value does not change with pt GFR function?

A

Loading dose

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272
Q

Chronic granulomatous disease susceptibility

A

Catalase positive organisms

S. Aureus, pseudomonas, serratia, nocardia, aspergillosis and candida

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273
Q

seizure with aura lobe of the brain?

A

Temporal lobe

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274
Q

stenting right kidney catheter advanced just beyond what artery

A

Right testicular is just below the renal access.

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275
Q

laxitive abuse electrolyte issue?

A

hypokalemia

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276
Q

First line for someone with recurrent pancreatitis or at high risk and has familial hypertriglyceridemia?

A

Niacin (works on VLDL) as fibrates are contraindicated

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277
Q

Major component of surfactant?

A

dipalmitoyl lecithin

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278
Q

diarrhea drug that has opiod properties at high doses

A

loperamide.

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279
Q

Foam cells in child?

A

Niemann-Pick composed of sphingomyelinase

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280
Q

Rheumatoid arthritis HLA assoc?

A

HLA DR4. 4 walled Rheum (room)

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281
Q

Thyroid hormone secreting ovarian tumor?

A

struma overii

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282
Q

tropic spastic paraparesis cause?

A

HTLV-1

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283
Q

amantadine

A

used to treat influenza, now used for parkinson thought to increase Dopamine release and inhibit degradation

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284
Q

Renal Cell Carcinoma

A

palpable mass, often spreads to lungs trx is recombinant IL-2 called aldesleukin

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285
Q

Osteopetrosis which cell has the issue?

A

dysfunctional osteoclasts. However normal osteoblast then make bone too thick after.

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286
Q

What is influenced by the disease prevalence in a population?

A

Positive predictive value

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287
Q

Chronic rejection (over 6m) of liver transplant what is damaged

A

small airways Bronchiolitis obliterans

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288
Q

lung changes with normal aging?

A

less compliance decreasing the FEV1 and increasing residual volume

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289
Q

Anesthesia that causes bronchodilation and is preferred in asthma?

A

halothane and sevoflurane

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290
Q

fluorinated anesthetics and the brain side effect?

A

Increase ICP and cerebral blood flow

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291
Q

Harnup disease

A

rash, ataxia and neutral amino acids in urine trx with niacin.

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292
Q

Most important immune component of lung abcess formation

A

Neutrophils releasing lysosomal contents

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293
Q

Subdural hematoma

A

crescent (crescent roll sub) bridging veins (slow decline bc venous)

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294
Q

Antiviral mechanism of interferon a and b?

A

Decreases protein synthesis in any cell with double stranded RNA due to viral infection

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295
Q

ragged red fibers on muscle biopsy, what type of diseses?

A

mitochondrial inheritance

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296
Q

amyl nitrate

A

cyanite tox antidote. coverts heme to methemoglobin which then binds cyanide keeping it in the blood so it cant poison mitochondria

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297
Q

locus ceruleus location and function

A

posterior rostral pons under floor of 4th ventricle. Secretes Norepinephrine for arousal

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298
Q

last cell type to disappear from bronchioles down to alveoli?

A

ciliated cells

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299
Q

toxo physical description?

A

intracellular and crescent shaped

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300
Q

how does insulin activate glycolysis?

A

activates PFK2 which produces fructose 1,6 bisphosphate

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301
Q

Anticholinergic toxicity (ex; jimson weed)

A

Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, full as a flask, fast as a fiddle. Physostigmine

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302
Q

GI atresia embryologic issue

A

Duodenum- recanalization issue 8-10wks double bubble x-ray

Jejunum/ilium- vascular injury

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303
Q

Macrophage cell surface marker

A

CD14

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304
Q

Kozac consensus sequence?

A

Bunch of gcc’s before AUG that help initiate translation

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305
Q

sickle cell biochem?

A

mutated protein hydrophobic pocket allows for sickling

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306
Q

on release from SR calcium binds what in the muscle

A

Troponin C

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307
Q

Heparin overdose bleed trx

A

protamine sulfate

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308
Q

Nerve block for anything in medial leg

A

femoral block. Inject under inguinal ligament

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309
Q

achlasia electrophysiology

A

upper normal, esophagus low amplitude and Lower spincter is hyperexcited and does not relax

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310
Q

celcoxib?

A

(Selective cob b- or 2- inhibitor just what is sounds like

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311
Q

S 100 positive cancers?

A

neural crest derived cancers schwannoma and melanoma

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312
Q

Carpal tunnel ligament what structure traps median nerve?

A

Transverse carpal ligament (flexor riticulatum)

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313
Q

IL-10

A

released by macrophages. Anti inflammatory. Important in healing

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314
Q

primary hyperparathyroidism?

A

Common cause of isolated elevated Ca. Due to cortical reabsorption and sub periosteal erosions.

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315
Q

Class 1 antiarrhythmic mneumonic

A

A Queen’s Panini Doesn’t Beat Lidie’s Mexican Carne Fajitas Platter.

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316
Q

Deep brain simulation for Parkinson’s what area?

A

Gp internus or usually the subthalamic nucleus

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317
Q

knee flexion nerve

A

sciatic L4-S3

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318
Q

DMII drugs that increase insulin secretion via closing a K+ channel in B Cells of pancreas

A

Sulfonureas 1st gen- “amides” disulfiram rxns
Sulfonureas 2nd gen- “glipizide & glypuride”
Meglitinides- “glins”

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319
Q

Before alanine is converted to glucose in the liver who takes the amino group?

A

Alphaketoglutarate which requires Vit B6 (thiamine)

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320
Q

accuracy of a screening test?

A

area under the curve

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321
Q

PCOS infertility trx if clomiphene fails?

A

Drugs that mimic FSH of LH surge near ovulation

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322
Q

post MI scarring involves what type of collagen?

A

Type 1

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323
Q

Central DI how do you know where it happened

A

Permanent: Hypothalamus
transient: posterior pituitary

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324
Q

Fenoldopam

A

D1 agonist with multiple positive effects in hypertensive emergency especially if there is kidney damage.

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325
Q

Sirolimus?

A

anti IL-2

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326
Q

ENaC inhibitors?

A

Amiloride and triamerene

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327
Q

Who is predisposed to Drug induced lupus

A

People who’s livers are slow acetylators

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328
Q

Halothane?

A

Inhaled anesthetic with MAJOR acute hepatocellular Liver injury causing the organ to shrink and increases LFTs and PTT

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329
Q

Oral HPV locations?

A

young pt. base of tongue or tonsils, keratized pearls.

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330
Q

methadone adverse effect?

A

QT prolongation

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331
Q

CAH 21 hydroxylase def treatment?

A

ACTH low doses therapy to provide negative feedback

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332
Q

Ankylosing spondylitis inflammatory molecules

A

IL-17 and TNF-Alpha

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333
Q

how does thiamine deficiency cause damage

A

low erythrocyte transketolase activity

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334
Q

Ectopic pregnancy description on histology?

A

Decidualized endometrium- dilated, coiled endometrial glands and vascular stroma

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335
Q

Diabetic cataracts biochemistry

A

glucose is converted to fructose but sorbitol and intermediate accumulates.

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336
Q

Ethosuximide (anti-epileptic) mechanism

A

Blocks thalamic T-type Ca channels

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337
Q

Major Biochemical rxns of the mitochondria?

A

TCA cycle, Beta-oxidation of FA’s, gluconeogenesis (carboxylation of pyruvate)

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338
Q

Major Biochemical rxns of the cytosol?

A

Glycolysis, Synthesis of FA’s, pentose phosphate pathway

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339
Q

Why is Amphotericin B so terrible (amphoterrible) ?

A

Renal damage that causes Low Mg and K via epithelial damage?

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340
Q

REID index?

A

comparison of mucus glands to area of between epithelium and basement membrane. High ratio indicates more severe chronic bronchitis/COPD

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341
Q

Enzyme produced by mast cells in response to anaphylaxis by mast cells

A

typtase

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342
Q

protoporphyria’s and symptoms relative to pathway

A

Early enzyme deficiencies- neuropsychiatric symptoms PBG def

Late enzyme deficiencies- sun sensitivities Uroporphyrinogen def

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343
Q

tissues that increase Glut 4 in response to insulin

A

Muscle cells and adipose

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344
Q

Rifaximin and Lactulose moa?

A

Rifaximin decreases gut flora’s ability to produce ammonia bc it is an abx
Lactulose lowers pH after conversion to short chain FA and increases conversion to ammonium in the gut

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345
Q

Mifepristone and misoprostol moa’s?

A

Mifepristone- progesterone’s stop (antagonism)

misoprostol- prostaglandin E1 agonist

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346
Q

enfuvirtide

A

stops gp41 conformational change inhibiting fusion of HIV virus to host cells

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347
Q

HIV integrase inhibitors drug name ending

A

“tegravir” all can cause elevated ck

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348
Q

what type of muscle does not rely of extracellular calcium to work?

A

skeletal muscle uses RyR channel to get Ca from SR instead

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349
Q

Lac operon 2 methods of regulation

A
  1. Positively- cAMP-CAP upstream of promoter

2. Negatively- repressor protein binding to operator locus

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350
Q

germinal centers of lympnode follicles B cell actions

A

Isotype switching and proliferation response to invader

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351
Q

what is in the lower leg anterior compartment?

A

Tibial artery/vein, deep peroneal nerve, foot extensor muscles

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352
Q

what immune cells cause inflammation in gout?

A

neutrophils

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353
Q

Metyraphone stimulation test physiology?

A

Negative feedback to HPA axis to decrease cortisol synthesis. Leads to reactive ACTH surge and build up of intermediates 11-deoxycortisol and 17-hydroxysteroid levels.

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354
Q

fixed dilated pupils

A

midbrain lesion

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355
Q

RNA interference?

A

Short double stranded RNA molecules block translation in ribosome

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356
Q

BPHP that responds to finasteride that has what cellular predominance?

A

Epithelial predominance. Non-responders usually have a smooth muscle and collagen predominant hyperplasia

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357
Q

How does gigantism result in big hands/feet/jaw

A

Excess GH stimulates liver to produce insulin like GF 1 which directly stimulates bone, soft tissue, cartilage

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358
Q

Bacterial and chemo agent resistance mut?

A

Multidrug resistance gene mutations result in a ATP dependent transporter that just pumps drugs out of the cell

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359
Q

Treatment of absence seizure + tonic clonic activity?

A

Valproic acid

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360
Q

Di George Embryologic issue

A

failure of III and IV pharyngeal pouch development

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361
Q

Stop codons

A

UAA, UGA, UAG

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362
Q

Linkage disequilibrium and calculation

A

Genes are inherited together more or less than expected. Just multiply frequency allele 1 x frequency allele 2

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363
Q

Postpartum thyroiditis cell type

A

Lymphocytic invasion with diffusely decreased R-iodine uptake. Similar to Hashimoto’s but occurs within 1 year of P and resolves

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364
Q

Initial drug for status epilepticus

A

IV Bezo’s

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365
Q

Cdiff treatment that inhibits RNA polymerase

A

Fidaxomicin (has less effect on good bacteria than vancomycin)

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366
Q

midline neck mass that moves

A

thyroglossal duct cyst

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367
Q

most common protein altered in familial dilated cardiomyopathy?

A

titin. Often Autosomal dominant with variable penetration

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368
Q

essential fructoseuria enzyme def and why is it so mild?

A

defect in fructokinase but hexokinase can still covert the fructose

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369
Q

what happens to pyruvate during hypoxic conditions?

A

NADH accumulation inhibits pyruvate dehydrogenase so production is shunted to lactate instead

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370
Q

testicular hydrocele what is the issue

A

tunica vaginalis

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371
Q

chronic diarrhea or illeostomy and stones?

A

pure uric acid stones due to low urine pH

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372
Q

when does expiratory stridor occur?

A

tracheomalacia

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373
Q

treatment for pressor leak that threatens to vasoconstrict a limb to death?

A

Phentolamine locally to antagonize a1 stimulation

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374
Q

nondisjunction in trisomy 21?

A

maternal nondisjunction during meiosis 1

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375
Q

Osteoclasts in paget’s disease of bone

A

numerous & large up to 100+ nuclei. Excess differentiation driven by M-CSF and Rank-L (aka nuclear factor kappa beta)

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376
Q

shortening of 4th toe and ephysial dysplasia

A

Refsum disease. Peroxisome issue phytanic acid build up

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377
Q

what happens if the midgut fails to rotate around the SMA?

A

fibrous band obstruction of duodenum and/or volvulus

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378
Q

murmur best heard with the pt sitting up and leaning forwards?

A

aortic regurgitation

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379
Q

excess raw egg white consumption decreases what vitamin?

A

B7 (Biotin)

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380
Q

Biochemical rxn that utilize vit B7?

A

Carboxylase enzymes

  1. Pyruvate to oxaloacetate (gluconeogenesis) pyruvate carboxylase
  2. Acetyl CoA to Malonyl CoA (FA synthesis) Acetyl CoA carboxylase
  3. Propionyl CoA to methylmalonyl CoA (FA oxidation) Propionyl CoA carboxylase
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381
Q

What meds should be avoided in HCM?

A

anything that drops preload is bad. Vasodialators and diuretics

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382
Q

Gerstman syndrome lesion location

A

angular gyrus of dominant parietal lobe

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383
Q

Embryonic origins of craniopharyngioma

A

Rathke’s pouch which forms anterior pituitary

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384
Q

skateboarding associations of distribution skew

A

Positive skew: Camel hump
Negative skew: ramp
named after the tail of data which pulls mean out

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385
Q

MEN mutations

A

Men 1: Menin (MEN1) 3P’s
Men 2A: Tyrosine kinase (RET) 2P’s & 1M
Men 2B: Tyrosine kinase (RET) 2M’s & 1P

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386
Q

Chronic glucocorticoids and liver enzymes

A

increased gluconeogenesis enzymes

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387
Q

Antibodies in thyroid diseases

A

TPO: Hashimoto’s, postpartum thyroiditis

TSH receptor: Graves

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388
Q

Nerve most commonly injured during thyroidectomy

A

external (recurrent) laryngeal nerve innervating the cricothyroid

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389
Q

Temporal lobe epilepsy path findings?

A

Temporal Astrocytic proliferation in response to hippocampal sclerosis/atrophy

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390
Q

Ulcer in the distal duodenum?

A

Zollinger Ellison syndrome

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391
Q

Secretin test and ZES?

A

paradoxical increase in gastrin due to abnormal adenyl cyclase activity

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392
Q

What is need to calculate CO from a Swan Ganz catheter?

A

rate of 02 consumption/ arteriovenus 02 content difference

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393
Q

Important gene in granulation tissue and vascularization?

A

VEGF can overproduce granulation tissue in secondary intent healing delaying recovery

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394
Q

gap junctions made of what protein?

A

connexins (connect/communication)

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395
Q

hemidesmosomes are made of what cell type?

A

integrins

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396
Q

Oxybutynin mechanism?

A

antagonizes M3 receptors to decrease detrusor contraction exact opposite of bethanechol

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397
Q

retroperitoneal hematoma can cause what neuropathy

A

femoral nerve (patella reflex and anterior thigh)

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398
Q

Nitric oxide is synthesized from what AA

A

arginine

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399
Q

PPI inhibitors and nutrient absorption

A

Increases: fat absorption
Decreases: calcium, iron, Mg, B12

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400
Q

Octreotide mech and indications?

A

somatostatin analog. acromegaly, carcinoid syndrome, variceal bleeding

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401
Q

Molecular motor proteins mneumonic?

A

REaDY AttacK
Retrograde- dynein
Anterograde- Kinesin

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402
Q

Interscalene block risk

A

also paralyzes unilateral diagram so avoid in pts with underlying lug dz

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403
Q

What major reactions is NADH used for?

A

cholesterol/FA synthesis and as a gluthione anti oxidant mechanism

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404
Q

Dark bit inside the nucleus what is it?

A

Nucleolus this is where RNA polymerase 1 transcribes ribosomal gene

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405
Q

Pulmonary Arteriole Hypertension signaling disfunction

A

Too many constrictors: Thromboxane and endothelin

Not enough dilators: NO and Prostacyclin

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406
Q

Heart failure cells in lung parenchyma?

A

hemosiderin laden macrophages described as “golden brown granules that turn blue with prussian stain”

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407
Q

Aortic notch artery branches right to left?

A

brachiocephalic, left common carotid, Left subclavian

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408
Q

most common part of the nephron obstructed by uric acid stones?

A

Collecting duct due to low pH causing precipitation

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409
Q

Epidermolysis bullosa and mutated protein

A

minor trauma = bullae. Keratin mutated

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410
Q

Angelman vs Williams syndrome

A

Angelman: inappropriate laughter chromosome 15 paternal silencing and maternal bit lost
Williams: Will Pharrell in elf. Friendly, elfin appearance chromosome 7

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411
Q

PSaMoMa bodies mneumonic

A

Papillary carcinoma of the thyroid
Serous cystadenocarcinoma of the ovary
Meningioma
Mesothelioma

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412
Q

B1 (thiamin) chemical reactions

A

Be APT (all dehydrogenase rxns)

  1. Branched-chain ketoacid dehydrogenase
  2. a-ketoglutarate dehydrogenase (TCA cycle)
  3. Pyruvate dehydrogenase (glycolysis and TCA cycle)
  4. Transketolase (HMP shunt)
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413
Q

Location of the parietal cells and chief cells in gastric mucosa

A

Top simple columnar cells
upper glandular layer- parietal cells
Lower glandular layer- chief and delta cells

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414
Q

Hennoch schonlein purpura other name

A

Ig A vasculitis

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415
Q

why does one get hypogonadism in hemochromatosis?

A

iron deposition in the pituitary gland

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416
Q

Staph aureus that causes tissue necrosis?

A

MRSA that gains leucocidin via a bacterial phage

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417
Q

when are monoclonals (cetuximab, panitumumab) against EGFR ineffective?

A

mutated KRAS

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418
Q

clasp knife spasticity location

A

internal capsule

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419
Q

what anesthetic are myasthenia gravis pts susceptible too?

A

vecuronium, but are resistant to succinylcholine

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420
Q

What is homocysteine normally converted too?

A

methionine (homo that does meth)

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421
Q

how does physiologic pleural fluid get there?

A

in from micro intercostal vessels out through parietal pleural lymphatics

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422
Q

in a pacemaker where is the LV pacing lead placed?

A

coronary sinus in the atrioventricular groove

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423
Q

Pip-Tazo antibiotic class

A

penicillin and a beta lactamase inhibitor

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424
Q

TRX for nephrogenic DI

A

Thiazide diuretics so more sodium and H2O is absorbed proximally

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425
Q

How many half lives to reach a steady state concentration?

A

4-5

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426
Q

cyclophosphamide mech and cell cycle area?

A

alkylates guanine. Cell cycle non-specific

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427
Q

didanosine mech and adverse effects

A

NRTI used in HIV. Hepatitis and pancreatitis

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428
Q

Protease inhibitor ending

A

“navir”

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429
Q

why is imipenem given with cilastatin?

A

cilastatin prevents its degradation by dhp-1 in the proximal tubule

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430
Q

single loud S2 in cyanotic baby?

A

transposition of the great vessles

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431
Q

Esophageal webs and iron def. anemia?

A

Plummer Vinson syndrome. Can be detected in middle age.

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432
Q

Common pathologic cause of bloody nipple discharge

A

papillary carcinoma described as epithelial cells lining fibrous core

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433
Q

p450 inducers mneumonic

A

Rif some Carbs, Barbs, and Herb and have a Phen Time!

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434
Q

p450 inhibitors mneumonic

A

Certain Silly Compounds Very Annoyingly Inhibit Enzymes, GRRR

Cipro, sulphonamide, cimitedine/omeprazole, valproate, antifungals/amiodarone, Isoniazid, Erythromycin, grapefruit juice

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435
Q

inhibin in males

A

produced by sertoli cells inhibits just FSH

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436
Q

Jaw jerk reflex what nerve

A

Trigeminal nerve in and out

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437
Q

Chromaffin cells appearance and what stimulates them

A

adrenal medulla is Blue on H&E

stimulated to produce catecholamines by acetylcholine

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438
Q

tap protein?

A

transports bacterial polypeptide fragments to b2-microglobulin and MHC1 in the ER for cell surface expression of pathogen

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439
Q

Disease causing pallor of catecholaminergic brain regions

A

PKU does this

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440
Q

Eosinophilic granulomatous polyangiitis

A

peripheral neuropathies, late onset asthma, eosinophilia, p-anca

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441
Q

CAH sheet rules

A
first #- mineral corticoid/BP
Second #- sex hormones
K is always opposite bp
Cortisol always low, MSH always up
1 = up
not 1= down
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442
Q

how do inflammatory molecules increase insulin resistance?

A

upregulate serine/threonine kinases

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443
Q

What’s a way to get Wallenburg syndrome following trauma?

A

vertebral artery dissection

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444
Q

pharmacologic permissiveness

A

when a hormone exerts no effect by itself but allows other hormones to exert their maximal effect

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445
Q

what drug class can mask the symptoms of hypoglycemia?

A

non-selective Beta Blockers

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446
Q

how can niacin be synthesized endogenously?

A

from tryptophan

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447
Q

uniform enlargement of uterus, heavy periods

A

adenomyosis. Endometrial glands and stroma in endometrium

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448
Q

common triggers for COPD exacerbations?

A

infections or air pollutions

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449
Q

celiac disease cancer association?

A

T-cell cancer

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450
Q

what happens to c peptide after insulin synthesis

A

secreted together in vesicles after being cut in the golgi.

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451
Q

calories and common molecules

A

1 gram carbs and protein- 4kcal
1 gram ethanol- 7kcal
1 gram fat-9kcal

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452
Q

TEE probe lies closest to what chamber and what is posterior

A
left atrium (anterior)
descending aorta (posterior)
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453
Q

primary moa of 2’ed gen antipsychotics?

A

D2 and S2 receptor antagonism

1st gen only do D2 but more potent

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454
Q

HIV associated dementia description on path

A

microglia that form multinucleated giant cells

occurs bc HIV infects microglia which are immune like cells

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455
Q

Medullary Thyroid cancer path description

A

polygonal cells with congo-red positive deposits. calcitonin is a type of amyloid

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456
Q

In untreated MG what happens to acetylcholine receptors over time?

A

endocytosed and degraded due to lack of stimulation

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457
Q

common injury site of the common fibular (peroneal) nerve?

A
neck of fibula on knee injury
remember PED (peroneal everts and dorsiflexes)
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458
Q

monotherapy for men with BPH and HTN?

A

non selective a1 blockers “azosin” such as prazosin.

Tamsulosin is uroselective so does not address HTN

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459
Q

Why do P women get constipated?

A

progesterone decreases colon smooth muscle activity

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460
Q

TMJ nerve?

A

Mandibular (V3) branch of trigeminal nerve

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461
Q

why doe RBC’s have a lot of chloride in the venous blood

A

it is exchanged in order to get rid of HCO3 produced by carbonic anhydrase

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462
Q

doxycycline mechanism?

A

inhibits protein synthesis by inhibiting 30s ribosome subunit

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463
Q

burning pain medial thigh/ anterior scrotum nerve?

A

ilioinguinal nerve

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464
Q

orbital floor fracture possible nerve damaged and symptoms

A
numbness in upper lip, cheek and gingiva 
infraorbital nerve (part of maxillary nerve)
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465
Q

HIV diarrhea associations

A

ulcers/owl eyes- CMV
nonulcerative inflammation- cryptosporidium
distortion of villi/ no inflammation- microsporidium
MAC- necrotizing and non-necrotizing granulomas

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466
Q

embryology of hypospadias

A

lack of urethral fold fusion

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467
Q

epithelial ovarian cancer tumor marker

A

Ca-125. Most common class of ovaria ca. can be serous or mucinous

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468
Q

osteogenesis imperfecta physiology

A

Osteoblast don’t make osteoid which in crucial in type 1 collagen.

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469
Q

naltrexone for ETOH withdraw mech?

A

block mu receptors useful to reward pathway

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470
Q

what cells produce aqueous humor?

A

epithelial cells of ciliary body

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471
Q

Umbilical cord vessles

A

1 vein: Oxygenated blood from mom

2 arteries: deoxygenated blood from fetus

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472
Q

pylocytic astrocytoma

A

children. well circumscribed with a cyst

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473
Q

pulsus paradoxus physiology during inspiration

A

drop in BP, bc with set cardiac volume due to tamponade

RV fills and septum moves toward LV so it cant fill as much and SV decreases

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474
Q

alkaptonuria

A

arthritis + urine turns dark
deficiency of homogentisic acid oxidase, an enzyme in the tyrosine degradation pathway, that converts homogentisic acid to maleylacetoacetic acid.

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475
Q

Bilirubin conversion disorders

A

unconjugated: Crigler-Najjar (severe) gilberts (mild)

Conjugated/direct: Dubin Johnson (black liver/severe) and rotor (mild)

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476
Q

lacrimal glands M subtype

A

m3 uses Gq.

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477
Q

Hodgkin lymphoma treatment

A

1st line: ABVD

2nd Line: MOPP

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478
Q

DIC with leukemia?

A

PML likely M3 auer rod subtype T:15,17

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479
Q

Uvula deviation Cranial nerve

A

Vagus (X) contralateral to deviation direction

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480
Q

late catecholamine synthesis defects

A

dopamine β-hydroxylase deficiency: hypotension hypotonia (uses vit C)
catechol-O-methyltransferase: hypertension

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481
Q

indinavir side effects

A

crystal induced nephropathy, thrombocytopenia

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482
Q

Folate Vit B9 def biochemical issue

A

important in 1 carbon transfers and DNA/RNA synthesis

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483
Q

High AFP and acetylcholine esterase in amniotic fluid?

A

failure of neural tube to form bc neural plates do not come together

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484
Q

muscle that is under voluntary control that allows for defecation when relaxed?

A

puborectalis

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485
Q

where do bacteria from an aspiration abscess come from?

A

oral flora

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486
Q

Most common component of acute transplant rejection?

A

Type IV hypersensitivity. CD8 T-cells against recipient against graft MHC molecules

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487
Q

Voltage gated Na deadly poisons

A

Close- Pufferfish/ red tide blooms

open (persistent depolarization)- poison dart frogs (batrachotoxin)

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488
Q

Marfan’s biochemical issue?

A

Fibrillin-1 mutation. This normally forms a sheath around elastin

489
Q

murmur in coarctation of the aorta?

A

flow through collateral blood vessels

490
Q

receptors that decrease insulin secretion

A

Alpha 2 and somatostatin 2 (SomA(TWO)statIN)

491
Q

Where do H-pylori reside?

A

gastric antrum

492
Q

angiotensin II and GFR?

A

constricts efferent tubule increasing GFR

493
Q

what happens after recovery from renal tubular necrosis?

A

Massive K drop. can be life threatening

494
Q

Hypertrophic osteodystrophy

A

adenocarcinoma (usually of lung) causes AV shunting and megakaryocytes get into systemic circulation where they release PDGF and VGF in the distal bones causing new bone formation and digit pain

495
Q

sensation of back of posterior tongue and mouth/tonsils and afferent branch of gag reflex?

A

Glossopharyngeal IX

496
Q

Why can isoniazid cause a sideroblastic anemia?

A

inhibits pyridoxine phosphokinase which produces PLP a necessary cofactor of ala synthase

497
Q

hypovolemic shock and urea reabsorption?

A

increased urea reabsorption in order to maximize the concentrating ability of the nephron and resorb more water

498
Q

acute Aortic dissection med

A

IV esmolol

decreases contractility and heart rate to lessen further damage.

499
Q

What anti arrythmics cause QT prolongation?

A

1A (Q,P,D) and class III (Amiodarone, ibutilide, dofetilide, sotalol)

500
Q

A-galactosidase A deficiency

A

Fabry disease
neuropathic pain and decreased sweating
telangiectasia
death from CVA’s, cardiac dz, renal failure

501
Q

what in the extracellular matrix does integrin often bind?

A

fibronectin

502
Q

What enzyme does warfarin inhibit

A

epoxide reductase. Takes a while for previously made clotting factors to be cleared so bridge with heparin

503
Q

symptoms of a subfalcine herniation

A

contralateral leg weakness

504
Q

If the pringle maneuver does not stop bleeding where is the blood coming from?

A

hepatic veins or inferior vena cava

505
Q

cell types female ovaries and hormone production

A

Theca cells: respond to LH produce progesterone and androgens in the interna
Granulosa: respond to FSH convert androgens to estrogen

506
Q

CREST and diffuse scleroderma antibodies

A

CREST: anti-centromere

diffuse scleroderma: anti topoisomerase 1 (scl-70)

507
Q

most common labs in people with renal stones

A

normal blood calcium

high urinary calcium exertion

508
Q

why does a normal aortic valve calcify with age?

A

thought to include fibroblast differentiation to osteoblast like cells

509
Q

Follicular lymphoma symptoms

A

Long indulgent waxing and waning course
painless lymph node involvement
t(14:18) blocks cell death
nodular pattern on x-ray

510
Q

mixed connective tissue disease

A

features of lupus + other diseases like scleroderma

antibody against U1 ribonuclear protein

511
Q

metformin mech

A

inhibits gluconeogenesis

Check Cr before starting

512
Q

mech of fibrates for hypertriglyceridemia?

A

act on PaRR-a protein to increase transcription of lipases in endothelial cell targets of TAGs. This lowers hepatic VLDL production

513
Q

DNA laddering?

A

process of apotosis wherein DNA is cut into 180 bp fragments as the cell degrades

514
Q

atropine mech

A

Ach antagonist

515
Q

germline mutations often affect what cells?

A

gametes and oocytes

516
Q

calcium dependent intercellular connections?

A

cadherins form desmosomes and adherens junctions removing extracellular Ca causes dissociation

517
Q

molluscum contagious on path?

A

caused by poxovirus

molluscum bodies. Eosinophilic inclusions

518
Q

posterior dislocation of the tibia relative to the femur injured structure?

A

popliteal artery

519
Q

sublimation?

A

mature defense mechanism. Channeling impulses to socially acceptable behaviors

520
Q

in a healthy pt whith a nephrectomy what is the GFR eventually get too from the healthy kidney?

A

80%

521
Q

PD5 inhibitors for erectile dysfunction moa?

A

increase cGMP in corpora cavernousa leading to relaxation

522
Q

High flow in the pancreas due to what?

A

secretin causes a high HCO3 output and low chloride

523
Q

false positive rate

A

1 - specificity

524
Q

what do leukotrienes C,D,E promote in asthma?

A

bronchospasm and vessle permeability

525
Q

nitrates and the heart

A

decrease preload and cause a reflex tachycardia

526
Q

Albright hereditary osteodystrophy?

A

GNAS1 mut. short stature and fingers

Causes resistance to PTH so low Ca, high Phosporus and lots of PTH that cant act on receptor

527
Q

what does a N terminal signal sequence addition signify?

A

bound to the ER so it can be inserted into membrane or secreted. If this is non functional the protein will accumulate in the cytosol

528
Q

Infertility + Normal serum testosterone but low testosterone in the seminiferous tubules

A

Sertoli cell cell dysfunction causing a lack of androgen binding protein.

529
Q

Pheo vs carcinoid breakdown products

A

Pheo- palpipations, sweating: Urine metanephrines

carcinoid- diarrhea, flushing, cardiac sclerosis: urine 5-HA

530
Q

Activating tumor mutation that works by transfering signals to the nucleus via the MAPK pathway?

A

RAS

531
Q

tumor that stains positive for chromogranin and synaptophysin

A

carcinoid tumor

532
Q

alternate method of protein translation that takes place during apoptosis

A

translation via “internal ribosome entry sites” where it can begin in the middle of mRNA

533
Q

osteomalacia what cant be formed?

A

Osteoid bone. Usually due to low Vit D, or calcium

534
Q

what type of abnormal bone is formed in Paget’s?

A

lamellar

535
Q

what muscles does the L. Recurrent laryngeal nerve innervate

A

L. recurrent laryngeal can be compressed by aortic dilation. Innervates multiple muscles ending in “arytenoid”

536
Q

achalasia imaging and pathophysiology

A

“birds beak” loss of neurons in Auerbach’s plexus

537
Q

examples of unmyelinated or type C fibers

A

pain, heat and autonomic postganglionic nerves

538
Q

part of MHC II molecule that is digested during antigen processing?

A

invariant chain

539
Q

what molecules determine cellular differentiation?

A

transcription factors

540
Q

pernicious anemia

A

gastric mucosa attacked and parietal cells die. High gastin levels from G cells

541
Q

type of nephrotic syndrome associated with sickle cell, HIV, and heroin addiction?

A

Focal segmental glomerulosclerosis

542
Q

what section of muscle stretchers and lengthens during relaxation and contraction

A

I band (non overlapping portion beside z disk)

543
Q

how does prostate ca. met to the spine?

A

Via prostatic venous plexus

544
Q

Thiazolidinedione’s mech and effect

A

decrease insulin resistance by binding Parr-gamma a nuclear transcription factor

545
Q

Lesch-Nyhan biochem

A

HGPRT defect so PRPP is able to compensate some with increased activity

546
Q

Type 1 and II error mneumonic

A

Type I: I=P false positive

Type II: II=N false negative

547
Q

apical wall thinning and dilated esophagus or colon +- dilated cardiomyopathy?

A

Chagas disease

548
Q

Seronegative spondyloarthropathies HLA serotype?

A

HLA type 1. assoc with B27 HLA allele

549
Q

erythromycin non-antibacterial indication?

A

motilin receptor agonist in gastroparesis

550
Q

Metoclopramide mechanism and side effects

A

D 2 antagonist
dystonia and tardive dyskinesia
Benadryl can help motor symptoms

551
Q

what types of receptors may have zinc finger nucleases?

A

intranuclear receptors may act as transcription factors (ex thyroid receptor)

552
Q

where does a bladder rupture to cause intraperitoneal fluid?

A

bladder dome

553
Q

what portion of the bowel is always involved in Hirschsprung disease

A

rectum

554
Q

Do diuretics improve mortality in reduced EF HF?

A

No but ACE, ARB’s, NE-ARB’s, B-blockers, and mineralocorticoid receptor blockers do

555
Q

new drug +/- fever with urinary eosinophils if urinary WBC’s are characterized

A

interstitial nephritis

556
Q

Fasting and hormones

A

Glucagon and epi= transmembrane binding

prolonged fasting= cortisol binding intracellularly to alter transcription

557
Q

Decerebrate (extensor) posturing. What is damaged?

A

Pons and/or midbrain below the red nucleus where the rubrospinal tracks feed

558
Q

why does alveolar capillary blood have slightly higher O2 than systemic arteriolar circulation?

A

The blood used by bronchi and heart drain venous blood into arteriolar system

559
Q

where does urethral injury from trauma often occur in males (assuming penis is not broken)

A

right below the prostate by the cowpers gland. Membranous portion of the urethra

560
Q

Down and out eye. what nerve is still okay?

A

Abducens innervating the lateral rectus

and Trochlear innervating the superior oblique

561
Q

most common early ETOH withdraw symptom

A

Tremors

562
Q

Penicillin resemble what bacterial cell wall component?

A

D-ala D-ala

563
Q

Where does phrenic nerve arrive from?

A

C3-C5 symp: hiccups and shoulder pain with diminished breath sounds on one side

564
Q

Vit A toxicity symptoms

A

teratogenic, hepatosplenomegaly, Intracranial hypertension, skin changes

565
Q

Pseudo allergic rxn with opiods

A

Histamine release no IGE component

566
Q

how does radiation therapy damage cancer?

A
  1. Double stranded DNA breaks

2. Formation of free radicals

567
Q

free fatty acids and DM?

A

Increase insulin resistance and increase hepatic gluconeogenesis

568
Q

Heart pressures

A
RA: <5
RV: 25/5
PA: 25/10
PCWP: 4-12
LA: <12
LV: 130/10
569
Q

SCC and ear pain?

A

nasopharyngeal SCC tumor obstructing the eustation tube outlet

570
Q

What do ventral and dorsal portion of pancreas go on to form

A

Ventral: most of body
Dorsal: most of head and main pancreatic duct

571
Q

Infection in pts receiving systemic chemo usually come from where?

A

endogenous flora penetrating mucosal barriers

572
Q

male genitalia and lymph drainage

A

interior thigh/penis= superficial inguinal to deep

internal testes= para aortic

573
Q

internal hemorrhoids veins

A

superior rectal originating for inferior mesenteric

574
Q

what are the two major mechanisms of NAD+ regeneration?

A

arerobic- TCA cycle

anaerobic- lactate formation

575
Q

How does Ventoclax (BCL2 inhibitor) help in CLL?

A

makes chemo more likely to induce apoptosis via caspases

576
Q

GBM on stained brain biopsy

A

central area of necrosis surrounded by pseudo-palisading bodies + vascular proliferations

577
Q

large difference between alveolar and pulmonary venous blood PaO2 but CO2 is normal. Why

A

indicates diffusion impairment. CO2 is normal bc it is 20x better at diffusing so is not as affected

578
Q

NPH (Wet wacky wobbly) Why these symptoms?

A

Stretching of descending cortical fibers

579
Q

Ovarian/ testicular Venus drainage

A

Left into Left Renal

Right goes ‘Right’ into the IVC

580
Q

The endothelium secretes what in order to oppose Thromboxane A2?

A

prostacyclin (prostaglandin I2)

581
Q

Ketamine moa?

A

NMDA antagonist that mimics catecholamine release. Improves bronchospasm. Increased HR and may cause higher ICP

582
Q

What AA is important in renal ammonia genesis?

A

Glutamine. Helps acidify urine and provide bicarb for buffering the blood

583
Q

Wilms tumor chromosome

A

Wilhelm is an 11 year old boy who is Wide (Beckwith Wideman)

584
Q

Why does Rigor Mortis happen?

A

actin and myosin remain bound in the absence of ATP

585
Q

Paget’s disease of breast path description

A

large cells and halo’s (Think nipples in the nipple)

586
Q

What organ does polyarteritis classically spare?

A

lungs

587
Q

VWF disease inheritance?

A

autosomal dominant

588
Q

Hep B first line trx?

A

tenofovir disoproxil fumarate (Down to fuck)

589
Q

embryologic origin of the pituitary

A

anterior: Rathke’s pouch, surface ectoderm
posterior: neural tube

590
Q

sevelamir mech

A

binds phosphorus in intestine decreasing absorption

591
Q

Vit E deficiency symptoms similar to what disease

A

Friedrich ataxia

592
Q

Internal laryngeal nerve mech of injury and symptoms

A

purely sensory of mucosa above vocal cords.
Afferent limb of cough reflex.
Injured during food choking injuries and retrieval

593
Q

unilateral swollen red arm and face what VEIN obstructed?

A

brachiocephalic

Bilateral would be superior vena cava

594
Q

neurosarcoidosis most frequently associated with what tumor type

A

prolactinoma

595
Q

Loading dose formula

A

Steady state conc x Volume distribution

596
Q

maintenance dose formula

A

Steady state conc. x clearance x dose interval

597
Q

BCL2 inhibits what

A

cell death cascade

598
Q

Berylliosis vs silicosis on biopsy

A

Berylliosis- noncaseating granulomas

silicosis- birefringent particles, laden macrophages

599
Q

Prokaryotic DNA Polymerase III function?

A

5 to 3 DNA synthesis. 3 to 5 exonuclease (mismatch repair) activity

(prokaryotic DNA polymerase I can do this + remove primers in 5 to 3 exonuclease fashion)

600
Q

Desmopressin moa’s

A

Hemophillia A and vWF def= increases endothelial secretion of VIII and vWF

CDI and nocturnal enuresis- Binds V2 receptor and causes increased aquaporin expression and more water absorption

601
Q

Thyroid treatments during P in mothers with Graves dz

A

Thyroid is developed by 12 in infants but if mother must be treated
1st trimester: PTU (not teratogenic but hepatotoxic)
2nd and 3rd trimester: methimazole which is less hepatotoxic

602
Q

Why is blood venous oxygenation increased in septic shock?

A

The massive vasodilation and and increased HR causes blood to flow so fast the oxygen cant be properly extracted by the tissue

603
Q

stimulant laxatives?

A

senna and Bisacodyl

604
Q

VHL disease

A

AD tumor suppressor gene mutations

Pheochromocytoma, clear cell renal ca, cerebellar and retinal hemangioblastomas

605
Q

physiology of diabetic neuropathy

A
  1. glycosylation leads to hyalinization of endoneurial arterioles
  2. sorbitol formation promotes oxidative stress
606
Q

Kidney embryology

A

pronephros- regresses
mesonephros- males deferens and epidymis
mesonephros- females vestigial Gardner’s ducts
Metanephros- Glomeruli to the distal convoluted tubule
ureteric bud- collecting system and kidney

607
Q

foscarnet side effects

A

chelates causing low Ca and Mg resulting in seizures

608
Q

How does hypothyroidism cause high cholesterol?

A

Decreased LDL receptor gene transcription

609
Q

Insulin special cell signaling

A

Receptor- Tyrosine kinase
Growth and division- RAS/MAPK
Glut4 translocation- PIK3 activates > protein phosphatase activates > glycogen synthase

610
Q

midshaft humerus fracture

A

deep brachial and radial nerve

611
Q

demyelination and electrophysical constants?

A

Time constant- increases bc takes longer

length constant- decreases bc ap travels less distance before needing a boost from ion channel depolarization

612
Q

pembrolizumab mech?

A

Antibody against overexpressed Program death ligand 1. Causes CD8 T cell activation to fight cancer

613
Q

gout crystals

A

needle shaped and negatively birefringent

614
Q

GLP1 agonists

A

“tide” (tide of modern drugs)
weight loss, pancreatitis
delayed gastric emptying
more glucose dependent insulin, less glucagon

615
Q

Ezetimibe moa

A

reduces cholesterol absorption at brush boarder via Nieman-pick like transporter protein

616
Q

acute dystonic reactions caused by what

A

D2 antagonism in nigrostriatal pathway

617
Q

what can be injured during c section when transecting abdominus rectus?

A

Inferior epigastric artery

618
Q

Best indicator of the severity of a MR and M stenosis murmur?

A

MR: Presence of an S3
MS: A2 to opening snap time interval. shorter is worse

619
Q

Ehlers Danlos physiology

A

Type III collagen C and N terminal cleavage issue

620
Q

What is first line for HTN due to cyclosporine or tacrolimus?

A

Diltiazem

621
Q

Only pathogenic fungus with polysaccharide capsule?

A

Cryptococcus neoformans. Lets it chill if phagocytosed

622
Q

Barrett’s esophagus predisposes to what type of Ca?

A

adenocarcinoma

623
Q

What muscle can compress the nerve in the sciatic foramen?

A

Piriformis

624
Q

Motor innervation to muscles of mastication?

A

Trigeminal nerve V3 exits through foramen ovale

625
Q

Malignancy in 3rd part of duodenum what is compressed?

A

SMA

626
Q

OCD first line treatment?

A

SSRI

627
Q

TMJ what muscles can spasm?

A

masseter and pterygoid

628
Q

Fructose 2,6-Bisphosphate concentrations and rxns

A

High levels activate activate PFK-1 (glycolysis) and inhibit fructose-1,6 bisphosphatase (gluconeogenesis)

629
Q

What anesthetic carries risk of large K increases?

A

succinylcholine can also have increased time of duration in pts with pseudocholinesterase mutations

630
Q

Cleft lip and cleft palate

A

cleft lip: maxillary prominence and intermaxillary segment

Cleft palate: failure of palatine processes fusion

631
Q

maraviroc moa

A

CCR5 inhibitor to stop macrophage entry

632
Q

Lung cancer endocrine secretions

A

Small cell: Cushings (ACTH) and SIADH (ADH)

Squamous cell: hypercalcemia (PTHrP)

633
Q

Graves opthalmopathy physiology?

A

Inflammatory expansion (due to fibroblast activation, causing glucosamine accumulation) of muscle and fat pushing eye out. Treatment is steroids

634
Q

Middle meningeal artery is a branch of which artery?

A

maxillary artery

635
Q

Cricothyroidotomy goes through what?

A

superficial cervical fascia and cricothyroid membrane

636
Q

Ovarian torsion always includes rotation of what ligament which tracks with the blood supply

A

suspensory ligament of the ovary

infundibulopelvic ligament

637
Q

What leads to nephrotic syndrome in minimal change disease

A

loss of anions in basement membrane allowing albumin into the urine usually due to autoimmune dysregulation

638
Q

Where are VLCFA (very long chain fatty acids) degraded?

A

peroxisome

639
Q

Sobosfuvir mech

A

Inhibits RNA dependent RNA polymerase in HepC

640
Q

What structures are in cubital fossa? (front of elbow)

A

brachial artery and median nerve

641
Q

Functional residual capacity in COPD?

A

Goes up due to expansion

642
Q

high mitotic index (near 100%) is typical of what

A

Burkitt lymphoma

643
Q

Why do you get panacinar emphysema in alpha 1 antitrypsin def?

A

elastases destroy interalveolar septa

644
Q

Annular pancreas embryology

A

abnormal migration of the ventral bud

645
Q

serum sickness rxns

A

7-14 days post exposure
fever, rash arthralgia
low complement and Ig deposition
Vessels have fibrinoid necrosis and neutrophil invasion

646
Q

Celiac dz HLA assoc

A

HLA DQ2 and DQ8

647
Q

What causes obstruction in HOCM?

A

mitral leaflet and intraventricular septum

648
Q

Benzo mechanism

A

modulate GABA channel causing more Cl influx in the presence of GABA. Causes more hyperpolarization

649
Q

Medical management of gallstones

A

ursodeoxycholic acid. basically a hydrophilic bile acid

650
Q

Ghrelin and bariatric surgery

A

produced by stomach in response to fasting

Many ghrelin secreting cells are lost in procedure leading to less hunger

651
Q

Common tamoxifen side effects

A

VTE, hot flashes, endometrial hyperplasia and Ca

652
Q

Imiquimod moa

A

a topical agent that activates Toll like receptor 7 upregulating nf-kb and causes an immune response against abnormal/or proliferating cells in dermatologic conditions. Also increases apoptosis and inhibits angiogenesis

653
Q

phenytoin moa

A

blocks Na in the motor cortex

654
Q

Neural tube defects what week of development?

A

4th

655
Q

parotitis serum marker

A

amylase

656
Q

Ketogenic amino acids that will not be metabolized to pyruvate

A

Lysine and Leucine. can be protein supplement of ketogenic diet for pyruvate dehydrogenase deficiency

657
Q

Pierre Robinson sequence first embryologic insult?

A

mandibular prominence misunion leading to micrognathia

658
Q

peptide hormones effect on kidney (ANP and BNP)

A

dilate afferent, constrict efferent
Increase GFR, increase natriuresis and diuresis
decrease renin to lower volume status

659
Q

Ortic aciduria vs Ornithine transcarboxylase def

A

Both have high orotic acid in urine

Ortic aciduria- presents at months old can be saved with uridine supplementation. No hyperammonia. megaloblastic anemia

Ornithine transcarboxylase def- presents within days or weeks. arginine supplementation helps minimally. no megaloblastic anemia

660
Q

Low BMI what causes low estrogen state?

A

Low leptin inhibits GnRH pulsatile release and then LH and FSH are low as well

661
Q

parvo virus genetics

A

nonenveloped single strand DNA virus

662
Q

Multiple myeloma antibodies produced and renal obstruction cause?

A

mostly IgG.

The Kappa and lambda light chains cause renal obstructions

663
Q

Organophosphate poisoning (farming or serine type gases)

A

Muscarinic: DUMBELS
diarrhea/diaphoresis, urination, miosis, bronchospasm/bradycardia, emesis, lacrimation, salivation
nicotinic: fasciculations/ paralysis

atropine and pralidoxime

664
Q

Loud pulmonary component of S2

A

pulmonary HTN a condition assoc with BMPR2

665
Q

where do lower rectal lymph nodes go to?

A

inguinal region

666
Q

how are monoclonal antibody drugs cleared?

A

phagocytosis at the target or in the spleen

667
Q

fibrates side effects

A

gallstones (block bile acid synthesis)

myalgias, not to be combined with statins

668
Q

G6PD deficiency inheritance?

A

XR

669
Q

Neurotoxic proteins in frontotemporal dementia

A

TAU (also in Alzheimer’s)

abnormally ubiquinated TDP-43 (also in ALS)

670
Q

confidence interval equation

A

mean ± z score of confidence interval x (sd / (√n),

671
Q

what promotes sickling

A

low O2, acidosis, dehydration

672
Q

One kidney stenotic what happens in other kidney

A

decreases renin and excretes more sodium

673
Q

Lack of gag reflex major insight

A

damaged medulla oblongota (brain death)
afferent- glossopharyngeal
efferent- vagus

674
Q

cholestyramine

A

binds bile acids in bowel leading to their excretion. To compensate liver makes more cholesterol

675
Q

what enzymes make fibro atheromatous caps unstable?

A

metalloproteases secreted by macrophages

676
Q

bicornate uterus embryologic issue

A

lateral fusion of the paramesonephric duct

677
Q

Other name for hereditary telangiectasia

A

Osler-Weber-Rendu

678
Q

what is immune privledge?

A

organs (testes and eye) that are shielded from immune responses

679
Q

young pt back injury with anterior disk displacement

A

spodylolysis (fracture of pars interarticularis)

680
Q

bacteria produce which vitamins?

A

K and folic acid

681
Q

Aortic Arches mneumonic

A

Medical Startup Conference at Science Park

  1. Maxillary
  2. Stapedial artery
  3. Common corticoid/ internal Carotid
  4. Aortic arch, rt Subclavian
  5. Pulmonary arteries, PDA
682
Q

What underlies AAA

A

chronic transmural inflammation

683
Q

how does pre-eclampsia damage organs?

A

widespread spasm

684
Q

The liver requires expression of APOE3 and APOE4 to take up what?

A

chylomicrons and VLDL’s

685
Q

AIRE deficiency

A

without air your body would char

chronic mucocutaneous candidiasis, hypoparathyroidism, adrenal insufficiency, recurrent candida infection

686
Q

Wernicke’s aphasia what artery

A

Inferior MCA. Broca’s aphasia is superior MCA.

687
Q

Asthma small molecule bronchoconstrictors in pathogenesis

A

LTB C4, LTD4, LTE4 CDE’s ends with e for eosinophils

688
Q

Meniere’s disease triad

A

sensorineural hearing loss, vertigo, hearing loss.

Due to increased endolymph

689
Q

pinworm trx

A

albendazole, mebendazole, or pyrantel pamoate. The latter should be used in pregnant women.

690
Q

where does excess copper usually go?

A

bile

691
Q

cAMP utilizing hormones cause what?

A

activate protein kinase A

692
Q

immune cell types in COPD

A

macrophages, neutrophils, CD8 T cells

693
Q

What predisposes to giardia infection

A

any condition with low IgA.

Giardia looks like horse shoe crabs on slide

694
Q

Why do you have to take mefloquine for 4 weeks upon return from malaria endemic area?

A

Inactivated in the liver so cant fight schizonts in the liver

695
Q

Cytokine important in Giant cell arteritis?

A

IL-6 (the giant of inflammation) can be targeted with tocilizumab

696
Q

Raspuricase

A

Think Rasputin’s big penis

oxidizes uric acid so it can be excreted in the urine

697
Q

Why are the acyclovir family of antivirals not universally effective?

A

many virus’s can’t convert the drugs to their active forms

698
Q

True vs false diverticula?

A

True diverticula- Merkel’s all the layers

False diverticula- Zenker’s mucosa and submucosa only

699
Q

Light’s criteria

A

Protein ratio over .5
LDH ratio over .6
Pleural/serum

700
Q

postpartum pt with fecal incontinences nerve injured

A

pudendal

701
Q

UV light convers what part of vit D pathway

A

first step: 7-dehydrocholesterol to vit D3 (cholecalciferol)

702
Q

most deoxygenated blood in the body?

A

coronary sinus bc myocardial oxygen demand is so high

703
Q

Dementia meds that can cause AV block/syncope?

A

acetylcholinesterase inhibitors Donepezil and rivastigmine

704
Q

NRTI med specific mechanism

A

interfere with phosphodiester bond in growing strand

705
Q

what are P bodies?

A

CYTOPLASMIC structures important in mRNA translation regulation and decay

706
Q

most common cause of degenerative arthritis in back?

A

disk herniation, ligmentum flavum hypertrophy, and osteophyte formation

707
Q

Thiamine (Vit B1) def. syndromes

A

Wernicke-Korsakoff

Wet/dry Beriberi

708
Q

life threatening hemoptysis in chronic lung dz

A

usually due to blood leak from high pressure hypertrophied bronchial arteries.

709
Q

Class III anti-arrhythmic drugs

A
AIDS
Amiodarone (lipophilic class I,II,III activity)
Ibutilide
Dofetilide
Sotalol
710
Q

Exercise and paO2 paCO2 venus and arterial system

A

everything in the arteriole system remains relatively constant.
In the viens a lot more O2 is extracted and CO2 is produced

711
Q

How is it easiest to hear an S3

A

end of expiration bc it brings the heart closer to the chest wall

712
Q

Treatment for any generalized myoclonic or tonic clonic seizure?

A

Either Levetiracetam or valproic acid. Broad spectrum anticonvulsants.

713
Q

most specific and sensitive test for c. diff toxic strains

A

NAAT only drawback is it may identify asymptomatic carriers. ELISA is more sensitive but cant destinguish toxic vs nontoxic

714
Q

Regular rate tachycardia narrow QRS rhythm?

A

AVNRT. often affects young pts

715
Q

common microbes in septic abortion?

A

Staph aureus and E coli

716
Q

AA’s in collagen

A

Glycine X-Y

717
Q

porcelain gallbladder assoc with what type of cancer?

A

gallbladder adenocarcinoma

718
Q

what embryologic layer makes spleen and blood vessles/blood

A

mesoderm

719
Q

what is a low volume of distribution and what does that mean

A

low is 3-5. Means the drug stays in the plasma well. This occurs if the drug has a high molecular weight, is highly charged, or binds to plasma proteins

720
Q

what is in-between vagina and anus cut during episiotomy

A

perineal body

721
Q

what is commonly affected in acute rhinositus?

A

the maxillary sinus gets all stuffed up bc it can’t drain into the middle nasal meatus

722
Q

Didanosine side effect

A

DiDanosine causes pancreaDiDis

723
Q

Niacin moa in hypercholesterolemia?

A

antagonizes VLDL cholesterol secretion

724
Q

Family with righ Cholesterol, TG’s and cholesterol with eruptive/itchy xanthoma’s biochem issue?

A

Lipoprotein lipase or apoprotein C-II

725
Q

CNS damage stages

A

12-48hrs red shrunken neurons
1-3 days neutrophils and liquefactive necrosis
3-5 days macrophages (microglia)
1-2 weeks reactive gliosis and vascular changes
2 wks + glial scar

726
Q

Pie in the sky and pizza on the ground lobes

A

Pie in the sky is temporal lobe Meyers loop

pizza on the flor is parietal Baum’s loop

727
Q

Genitalia and hormones male

A

Sertoli cells- anti-mullerian Hormone (no female internal)
Leydig cells- Testosterone (male internal)
5-alpha reductase- DHT (male external)

728
Q

What are IL-2’s anti tumor effects in high doses ?

A

activates NK cells (and its T cell effects as well)

729
Q

Propofol good and bad

A

Quick, decreases airway resistance

vasodilation, and increases TG’s and lipase

730
Q

What do SLG2 inhibitors stop?

A

a glucose sodium symporter in the proximal tubule

731
Q

What happens to urine gravity in proteinuria

A

Urine becomes super concentrated so high gravity all due to 3rd spacing will loss of protein to keep stuff in

732
Q

Triad of botulism

A

dysphagia, diplopia, dysphonia (difficulty speaking)

733
Q

angiogenesis substances

A

VEGF and Fibroblast growth factor

734
Q

What muscles generate most intra-abdominal force during valsalva?

A

rectus muscles

735
Q

What cells does RCC carcinoma usually come from?

A

Proximal tubules. Most important and can cause Ca.

736
Q

what abducts arm over 100 degrees?

A

trap

737
Q

what activates trypsin?

A

enteropeptidase in the brush border

738
Q

Why fat in alcoholic liver dz?

A

lack of FA oxidation due to excess NADH

739
Q

Effects of adrenergic agonists

A

a1= (midodrine, nor and phenyl ephrine, dopamine high dose) Vasoconstriction
B1: ( Dobuatmine) increased heartrate and output
B2: (albuterol) vasodilation, bronchodilation
D1= (fenoldopam, dopamine low dose) renal arteriolar vasodilation

740
Q

Transplant rejection type most likely to make a macopapular rash?

A

Graft vs Host disease

741
Q

Triglyceride breakdown 2 components

A

Glycerol: glycerol kinase (liver) can make substrates for gluconeogenesis
Fatty acids: beta oxidation or ketogenesis

742
Q

Restless leg syndrome trx?

A

pramipexole a Dopamine agonist

743
Q

Filtration fraction?

A

GFR (from creatine) /RPF (from PAH)

can use..
(urine conc x urine flow rate)/ plasma flow rate
for both substances if only give Cr and PAH

744
Q

What drugs can be used if a cholinesterase inhibitor causes bad side effects? I.e treatment of MG

A

glycopyrrolate, hyoscyamine, propantheline

all selective muscarinic antagonists that don’t interfere with therapy

745
Q

What part of Epinephrine synthesis requires cortisol/ACTH?

A

PNMT the final step to produce epinephrine from NorEpi

746
Q

pseudogout crystal makeup

A

calcium pyrophosphate (calcium that burns)

747
Q

cauda equina syndrome nerves?

A

S2-S4 pelvic splanchnic nerves. Parasympathetic

748
Q

intrapleural pressure at resting equilibrium?

A

-5 cm H2O

749
Q

what can be used as a marker of lung maturity in ammonitic fluid

A

Lecithin (phosphadylglycerol) increases
Sphingomyelin decreases
2:1 or higher ration of L/S shows maturity

750
Q

Pigmented gallstone types

A

Black- hemolysis, enterohepatic bilirubin circulation

brown- chronic infection and microbial B-glucuronidase activity

751
Q

Ace inhibitors and interactions

A

NSAIDS- renal failure due to lowering of GFR in pts with previously poor function
diuretics- first dose hypotension. So must start with low doses

752
Q

PCP moa

A

NMDA receptor antagonism

753
Q

What CN goes through the parotid gland?

A

Facial CNVII

754
Q

Neurophysins?

A

carrier proteins for oxytocin and vasopressin

755
Q

lower extremity lymph drainage

A

lateral- popliteal to superficial inguinal nodes (pop to the side)
medial- directly to superficial inguinal nodes

756
Q

aldosterone normal function

A

increases Na/K ATPase pumps in collecting tube. promotes H+ and K secretion. Blocked by spironolactone

757
Q

how do systemic contraceptives work?

A

decrease GnRH secretion

758
Q

Where are anal fissures?

A

posterior midline distal to the dentate line. (line up with the butt crack)

759
Q

trx for opioid induced constipation without precipitating withdraw symptoms

A

methylnaltrexone

760
Q

best medical treatment for insomnia in older adults

A

Ramelteon a melatonin agonist

761
Q

Physiology of Factor V leiden Def.

A

Thrombosis bc the mutated factor 5 does not get degraded by protein C.

762
Q

What cells produce EPO?

A

Peritubular interstitial cells

763
Q

Important cell types in granulomas

A

TH 1 and TH17

macrophages- become multinucleated giant cells

764
Q

Addison’s disease (primary adrenal insufficiency)

A

low aldosterone- low BP, low Na and high K, skin pigmentation due to high ACTH production by pituitary
low cortisol- low glucose, eosinophilia, anemia

765
Q

What does IgA protease do?

A

allows for attachment of bacteria to mucosal surfaces

766
Q

paraneoplastic cerebellar degradation

A

truncal ataxia and visual disturbances with and a tumor usually small cell or breast ca. Assoc with anti yo/hu/pq antibodies

767
Q

Ferguson bodies

A

asbestos particles

768
Q

High altitude and 2,3 BPG ?

A

Goes up to facilitate unloading of oxygen at tissues

769
Q

GI cancer genetic development sequence

A

APC mut- catenin accumulation. hyperplasia
KRAS mut- adenoma
p53- carcinoma

770
Q

Antifungal that targets cell wall

A

Caspofungin

771
Q

Antifungal that targets cell membrane

A

synthesis- azoles

binders- nystatin, Amphotericin B

772
Q

antifungal that inhibits mitosis

A

Griseofulvin

773
Q

hypocalcemia symptom

A

muscle twitching

774
Q

Hairy cell leukemia vignette

A

MASSIVE splenomegaly, middle aged man, dry bone tap. TRAP

775
Q

occular side effects of PD-5 inhibitors

A

blue vision, ischemic optic neuropathy

776
Q

What cytokine is tied to neutrophil phagocytosis and pus formation

A

IL 8- (ate up the bacteria)

777
Q

What activates Azithropine?

A

HGPRT turns it to active 6-MP

778
Q

NF1 what are neurofibroma’s composed of?

A

Schwann cells which are neural crest origin

779
Q

what does ureter obstruction do to GFR and FF?

A

Both decrease.

780
Q

antiviral pyrophosphate analog that does not require intracellular activation

A

foscarnet

781
Q

What nerves may be injured during lymph node removal for masectomy

A

intercostal brachial- pure sensory to medial upper arm
long thoracic- serratus anterior
thoracodorsal- latissimus dorsi
medial pectoral- minor and major pec muscle

782
Q

How do Vit D analogues help in psoriasis?

A

activate a nuclear transcription factor resulting in decreased T cell and keratinocyte proliferation

783
Q

What nerve innervates the proximal arm flexors?

A

Musculocutaneous nerve C5-7 innervates bicep, brachialis, and coracobrachialis (makes baseball throwing throw cocked position). also sensory for lateral forearm

784
Q

Why do oral contraceptives and P make gallstones more likely?

A

Estrogen- cholesterol hypersecretion

Progesterone- gallbladder hypomobility

785
Q

embryologic connection between bladder and belly button that may persist?

A

Urachus

786
Q

If you cant use asprin for cardiovascular protection what is second line?

A

clopidogrel

787
Q

Treatment for urea cycle disorders?

A

low protein diet

788
Q

what other hormone can cause hyperthyroid symptoms by binding to the TSH receptor

A

When in huge excess (tumor) hCG can bind.

789
Q

Possible adverse effects of aggressive osmotic diuretic therapy to treat cerebral edema

A

Increased hydrostatic pressure can worsen CHF or cause pulmonary edema in those who already have excess pulmonary fluid

790
Q

prolonged exposure to loud noise damages what?

A

stereo ciliated hair cells of the organ of Corti

791
Q

Tertiary amine acetylcholinesterase inhibitors that can cross the BBB

A

physostigmine, galantamine, donepezil and rivastigimine

792
Q

ehrlichia on peripheral smear

A

morula (mulberry shaped intracytoplasmic inclusions in leukocytes)

793
Q

P’s of Eosinophilic granulomatosis with Polyangiitis (churg-strauss)

A
Pale (atopic/ asthma)
palpable purpura
peripheral neuropathy
Pauci immune glomerulonephritis
p-ANCA/mPo-ANCA

granulomas

794
Q

Probability of finding a difference if one exists (study power equation)

A

power= 1-B

power is usually around 80%

795
Q

alpha/ beta errors

A

alpha risk-type 1 error = false positive

beta risk- type II error = false negative

796
Q

ribosomes and location

A

free floating- cytosolic, mitochondrial, peroxisome, and nucleolus proteins
Rough ER associated- secreted proteins, membrane proteins and proteins within ER, Golgi and lysosome

797
Q

Pagets disease

A

enlarged head, fractures, bone deformities, pain/ hot areas, radiculopathy, hearing loss, lytic sclerotic lesions
Only ALP is elevated

798
Q

How long can sperm be viable after vasectomy?

A

3 months or 20 ejaculations

799
Q

L5 radiculopathy symptoms

A

sensory lateral shin, dorsum of the foot

foot dorsiflexion, eversion, inversion, great toe extension

800
Q

Viral recombination vs reassortment

A

recombination- 2 non-segmented virus genetic exchange via crossing over
reassortment- 2 segmented virus’s via segMENT swapping. BOAR

801
Q

what causes zenker diverticulum?

A

cricopharyngeal muscle dysfunction (innervated by vagus nerve)

802
Q

meds that can cause SIADH

A

Carbamazepine , SSRI’s , NSAID’s

803
Q

Trochanteric bursitis (Greater trochanteric pain syndrome) occurs at insertion of what?

A

Gluteus minimums and Medius

G’s for greater trochanteric

804
Q

What cells form the fibrous cap in atherosclerosis?

A

migrated smooth muscle cells that secrete extracellular matrix

805
Q

Why hypotension in tension pneumothorax?

A

increased pressure causes vena cava to collapse

806
Q

What vitamin is required for specialized epithelium differentiation?

A

Vitamin A

807
Q

Drugs that target the PD-L on T cells to prevent T cell exhaustion and continued battle against cancer?

A

pembrolizumab, nivolumab, atezolizumab

808
Q

Isoniazid side effects?

A

neuropathy, hepatotoxicity, drug induced lupus

809
Q

POMC can form what hormones

A

endorphins, ACTH, MSH

810
Q

what happens to phosphate during refeeding syndrome

A

increased insulin due to carbs causes phosphate to move into muscle and and the liver for ATP production

811
Q

Niacin (B3) and biochemistry

A

Part of NAD/NADH needed in many dehydrogenase and redox enzymes.
Tons of dehydrogenase enzymes of the TCA cycle require this vitamin

812
Q

what can chronic hemolysis do to the kidney

A

Hemosiderosis (iron deposition)

813
Q

what enzyme in DNA synthesis catalyzes the formation of RNA strands

A

primase. remember uracil is only found in RNA

814
Q

NK-1 antagonists

A

end in “pitant” used for chemo induced nausea. can cause neutropenia

815
Q

phrenic nerve pain is referred where?

A

shoulder

816
Q

Releasing factors?

A

recognize stop codons, UGA, UAA, UGA

817
Q

Who is at high risk of vibrio vulnificus?

A

Iron overloaded pts or those with hepatic damage

818
Q

arsenic poisoning

A

galicy breath, severe watery diarrhea. May be found in insecticides. Dimercaptol is firstline treatment

819
Q

osteosarcoma

A

lytic lesion on x-ray. usually in metaphysis. bone, osteoid and spindle cells

820
Q

What breaks down 6-MP?

A

Xanthine oxidase and thiopurine methyltransferase which is genetically depressed in up to 12% of the population

821
Q

Why are old ppl bad at breathing in high altitude?

A
  1. decreased chest wall compliance
  2. decreased alveolar elastic recoil
  3. increased a-a gradient and v/q mismatching
822
Q

primary hypothyroidism

A

TSH: High. telling to make more thyroid
T4: low. thyroid not working
T3: usually normal. small amount anyways and not made until at the tissue

823
Q

ovarian tumor that secretes thyroid hormone?

A

struma ovarii. a germ cell tumor that causes hyperthyroidism symptoms

824
Q

why do old people have yellow/brown intracellular spots on autopsy?

A

lipid peroxidation, especially those who are malnourished before death

825
Q

Wecner’s polyangiitis path description?

A

necrotizing arteritis and epithelioid histocytes

826
Q

eosinophilic polyangiitis path description

A

necrotizing granuloma’s with eosinophilic predominance

827
Q

what vessels are most susceptible to atherosclerosis?

A

lower abdominal aorta and then coronary arteries

828
Q

pulmonary alveolar proteinosis

A

macrophages cant clear surfactant. Surfactant goops up into lamellar bodies

829
Q

Milrone

A

PDE 3 inhibitor used in refractory systolic HF

  • positive inotrope
  • vasodilation
830
Q

which Histone molecule is on the outside of and packs in the wrapped DNA

A

H1

831
Q

failed femoral catheterization above the inguinal ligament where does the blood go

A

retroperitoneal space

832
Q

Trendelenburg gait after IM injection

A

superior gluteal nerve in superior medial quadrant of the buttock was injured

833
Q

nerves of carotid sinus hypersensitivity

A

afferent- glossopharyngeal IX

efferent- Vagus X

834
Q

propranolol and thyroid hormone

A

decreases adrenergic effects of thyroid hormone and decreases peripheral T4 to T3 conversion

835
Q

Common Poisoning that causes oxalate crystals and AKI

A

ethylene glycol its metabolites include oxalate and other renal toxins. Fomepizole prevents degradation to toxic metabolites

836
Q

common cause of multiple small hemorrhagic strokes in the elderly?

A

cerebral amyloid angiopathy

837
Q

supracondylar humoral fracture potential injuries

A

If displaced portion moves laterally- radial nerve

If displaced portion moves medially- median nerve brachial artery

838
Q

what happens to chest wall with pneumothorax?

A

springs outward as there is no longer negative pressure pulling it in

839
Q

Specific B cell surface proteins

A

CD 19,20,21

840
Q

treatment for age related macular degeneration?

A

VEGF inhibitors

841
Q

metronidazole + alcohol

A

disulfiram like rxn

842
Q

Testosterone receptor inhibitors

A

flutamide, cyproterone, spironolactone to some degree

843
Q

MI and timeline of ischemia

A

takes only 60S for area of affected myocardium to stop beating. within 30+ minutes damage may be irreversible

844
Q

proximal lymph drainage

A

internal Iliac nodes

845
Q

HIV in CNS

A

preferentially replicates and infects macrophages

846
Q

death cap mushroom mech

A

halts mRNA synthesis in the liver

847
Q

where does coronary sinus drain?

A

right atrium

848
Q

male androgen cells

A

Leydig (outside)- LH responsive makes Testostrone

Sertoli (inside tubule- FSH responsive makes androgen binding Hormone and inhibin B

849
Q

how does hyper ammonia cause CNS symptoms?

A

increases glutamine which disrupts Glutamate release and disrupts excitatory neurotransmission

850
Q

Isoniazid can deplete what hormone?

A

B6 (pyridoxine)

851
Q

what vessel provides blood to the femoral head?

A

medial circumflex artery

852
Q

Why wipe out CD3 + cells before a marrow transplant?

A

reduce graft vs host dz

853
Q

ganciclovir side effects

A

can cause neutropenia, thrombocytopenia or anemia

854
Q

G6PD converts what to what?

A

G-6-P to 6 phosphogluconate

855
Q

Treatments for idiopathic pulmonary fibrosis?

A

Drugs that target growth factors

856
Q

Hypothalamic nuclei

A

Ventromedial- satiety. VentromediFULL
Lateral- hunger, Fatterall
Anterior- heat dissipation. AC
posterior- heat conservation, your ‘posterior is hot’
arcuate- dopamine
medial preoptic- GnRH ‘gonads are modestly optical’
paraventricular- oxytocin PAIRaventricular
Supra optic- ADH look up to see water/rain
suprachiasmatic- sleep. Charismatic if you get enough sleep

857
Q

Non sedating antihistamine agents?

A

loratadine, cetirizine. Use in the elderly

858
Q

What comonent of FA synthesis inhibits beta oxidation?

A

malonyl coA

859
Q

contrast induced nephropathy path findings?

A

proximal tubule necrosis. may have muddy casts

860
Q

Breathing speed and obstructive/restrictive

A

obstructive- lowest work when breath slow

restrictive- lowest work when breathing fast

861
Q

hemorrhagic pancreatitis on path description

A

chalky white fat necrosis with interspersed areas of hemorrhage

862
Q

Large VSD cardiac pressures?

A

RA: unchanged

everything else increased due to intraventricular equalization and increased flow through pulmonary circulation

863
Q

Xanthelasma

A

lesions around the eye filled with lipid laden macrophages . Signals high serum lipids possible biliary obstruction

864
Q

exact missense error in sickle cell

A

normal GAG to a GTG switches glutamic acid to valine

865
Q

what bacteria besides Pseudomonas and s. aureus are cystic fibrosis pts at risk for

A

non-typeable H-flu and Burkholderia

866
Q

loss of vagus nerve gastric consequences?

A

low HCL and delayed gastric emptying/gastroparesis

867
Q

Bluish lesion under nailbed differential

A
  1. Melanoma

2. glomus tumor (proliferation of small surface vessles important in thermo regulation)

868
Q

first vs zero order kinetics

A

first order- same rate of metabolism with differing dose

zero order- diminishing rate of metabolism with higher doses

869
Q

What innervates the tensor tympani

A

Mandibular nerve (V3 of trigeminal nerve) causes muffled hearing +/- ear pain in injured

870
Q

Where do you sample to get a diagnostic biopsy of Hirshprung’s disease?

A

submucosa of the rectum

871
Q

How does sodium bicarb infusion help in salicylic poisoning

A

reduces protonated form by lowering PH so it cant enter tissues and is excreted in the urine

872
Q

low intravascular oncotic pressure does what to lipoproteins

A

increases lipoprotein production in the liver and decreased lipoprotein catabolism

873
Q

Priapism medical treatment

A

a1 adrenergic agonist injection

874
Q

lidocaine MOA

A

blocks voltage gated sodium channels from inside the neuron

875
Q

What cells secrete hepcidin?

A

hepatic parenchymal cells

876
Q

Distal Clavicle fracture why is it displaced

A

Distal fragment goes down due to pull of deltoid

proximal fragment goes up due to trap and sternocleidomastoid pull

877
Q

Phenotypic mixing?

A

When a coinfected cell contains viruses that share surface protein but do no alter their genetics so viral progeny will not have mixed surface proteins.

878
Q

what are the superficial and deep inguinal rings covered by?

A

superficial- external oblique aponeuroses

deep- transversalis fascia

879
Q

Why do old people have poorer response to vaccines?

A

Less naïve T and B cells

880
Q

What cells only go though glycolysis but sometimes produce no ATP?

A

erythrocytes can corm 2,3 BPG with intermediates instead of energy on some rounds of the rxn

881
Q

pancreatic pseudocyst?

A

occurs weeks after pancreatitis. PSEUDOcyst bc it is lined by fibrous tissue rather than epithelial cells

882
Q

Systemic mastocytosis ?

A

Monoclonal proliferation of mast cells. Histamine release = flushing, itching (especially after showers) and gastric acid secretion. assoc with KIT mutations. Kit Herron has rosy cheeks!

883
Q

Charcot vs berry aneurysm?

A

charcot- intraventricular hemorrhage

Berry/saccular- subarachnoid hemorrhage

884
Q

what opiod can precipitate withdraw symptoms in a chronic user?

A

buprenorphine

885
Q

Cause of most isolated systolic htn

A

age related stiffness of arteries

886
Q

What electrolyte is important in metabolic alkalosis

A

urinary Cl level because it can impair renal excretion of HCO3

887
Q

C1 cleaves what?

A

C4 so these levels will be low inhibitor def

888
Q

Subacute granulomatous thyroiditis (de quervian)
vs
Hashimoto’s thyroiditis

A

De quervian: transient hyperthyroid, follows infection, painful. macrophages and giant cells. high ESR/CRP

Hashimoto’s: autoimmune, painless, hypothyroid dominant. lymphocyte infiltrate with germinal centers. Hurthle (eosinophilic epithelial) cells

889
Q

Henoch-Schonlein purpura (Ig A vasculitis) on biopsy

A

Ig A immune complex deposition with neutrophilic perivascular damage

890
Q

What abx has MAOI activity and can cause serotonin syndrome

A

linezolid

891
Q

What can cause opioid overdose in a methadone therapy pt?

A

any p450 inhibitor

892
Q

What myopathy causes normal strength but delayed reflexes?

A

hypothyroid myopathy

893
Q

What enzyme turns heme into biliverdin?

A

heme oxygenase

894
Q

What kind of drugs are dose adjusted based on ‘ideal’ body weight?

A

Hydrophilic drugs that are limited to the extracellular fluid compartment

895
Q

what causes strictures in crohn’s

A

thickened muscularis mucosa

896
Q

which adrenergic receptors are found in eye and uterus?

A

eye- alpha 1

uterus- beta 2

897
Q

What are the two most important buffers that the body uses to safely excrete H+

A

HPo4 and NH3

898
Q

What features of a drug make it more likely to be hepatically cleared

A

Highly lipophilic drugs with high volumes of distribution

899
Q

Phospholipase A2 antibodies?

A

assoc with membranous nephropathy

900
Q

Hereditary hemorrhagic telangiectasia symptoms?

A

TGF-B signaling issue. Telangiectasia, nosebleeds, organ AVM’s. High output HF, pulmonary HTN, paradoxical emboli and Iron deficiency are complications

901
Q

refractory urge incontinency treatment?

A

stimulation of S3

902
Q

Vaptans?

A

Act on V2 and treat hyponatremia by causing water diuresis without affecting K or Na excretion

903
Q

Klinefelter’s

A

XXY, long legs, gynecomastia, sparse facial hair. No sperm High FSH, LH tying to stimulate dysfunctional Sertoli and Leydig cells

904
Q

What disease is assoc with renal angiomyolipomas?

A

Tuberous sclerosis

905
Q

Homebox or Hox genes usually code for what?

A

transcription factors

906
Q

Patiromer

A

Exchanges Ca to bind K in the intestine. A slow acting treatment for hyperkalemia

907
Q

Why can ethanol consumption causes hypoglycemia

A

decreased pyruvate and oxaloacetate required for gluconeogenesis in the liver

908
Q

FEV1/FVC ratio in COPD?

A

Decreased

909
Q

Neutrophil invasion steps

A

Margination: improved contact with wall
Rolling: sialyl Lewis X on neutrophils and P/E selectins on wall
Activation: Integrins start to get expressed
Tight adhesion: CD18 integrins and ICAM
Transmigration: PECAM

910
Q

Adenosine side effects

A

AV block
Flushing. hypotension
Bronchospasm

911
Q

class of diuretics that can cause hearing loss

A

Hoop earings (loop)

912
Q

What do you monitor in ankylosing splondylitis?

A

chest wall expansion

913
Q

Granulosa cell tumor on histology?

A

Call-Exner bodies (Cuboidal cells in a rosette pattern with coffee bean nuclei)

914
Q

Medulloblastoma vs pilocytic astrocytoma?

A

Both childhood tumors in cerebellum
Medulloblastoma- malignant, solid, small cells, cells surrounding neurophil
Pilocystic astrocytoma- cystic and solid components, GFAP +, eosinophilic cytoplasmic inclusions (rosenthal fibers)

915
Q

3’ end of T-Rna molecule

A

CCA tail
T loop helps binding to ribosome
D loop helps proper tRNA synthetase recognition

916
Q

What drug should be given to pts requiring chronic blood transfusions?

A

Deferoxamine. Helps bind iron to prevent CHF from iron overload

917
Q

What test is more specific than karyotyping for the diagnosis of large duplications/ translocations or deletions?

A

FISH

918
Q

Disease that involves loss of internal elastic lamina?

A

fibromuscular dysplasia

919
Q

Ribs overlying spleen/liver and kidney

A

spleen/liver- 9-11th ribs

kidney- 12th rib

920
Q

Myofibril layers

A

ZAM
Z line
Actin (light)
Myosin (heavy) middle darker

921
Q

Leukoclastic vasculitis

A

neutrophil predominant vasculitis with purpura. Due to drug reaction. often abx or allopurinol

922
Q

Retinitis pigmentosa?

A

genetic issue
First loss of rods- peripheral vision/night blindness
then loss of cones- central vision loss

923
Q

What does chronic heavy use of NSAIDs do to kidney

A

Chronic interstitial nephritis- shriveled kidneys
and/or
papillary necrosis- infarcts

924
Q

terbinafine antifungal mech?

A

Inhibits Squalene epoxidase

925
Q

McArdle dz

A

loss of myophosporylase and muscles cant break down glycogen

myoglobin in urine after exercise, muscle pain, cramping

926
Q

Baby extracranial head bleeds

A

subgleal- crosses suture lines. BTW periostea and galea aponeuroses
cephalohematoma- btw skull and periosteum

927
Q

polycistronic mRNA

A

one mRNA codes for multiple genes common in prokaryotes. ie lac operon is one such gene

928
Q

vascular smooth muscle and phosphorylation

A

phosphorylated lc- contracted

dephosphorylated lc- relaxed

929
Q

normal P with delivery then a mole. What happened?

A

proliferation of trophoblasts

930
Q

What does pathology in brain look like in Rett syndrome

A

MECP2 gene. loss of brain development rather than signs of neuronal death

931
Q

Feared cause of death in ALS

A

diaphragmatic atrophy

932
Q

SIADH urine sodium?

A

becomes high as BNP and ANP ramp up to prevent frank volume overload

933
Q

Whipple Dz

A
Loose stool, abd pain, weight loss.
Gram + actinomycete
PAS (visualizes cell gylcoproteins) +
Diastase resistant
Pass the foamy whipped cream CAN (cardiac, arthralgia, neuro)
934
Q

Benign liver tumors

A

hepatic adenoma- can regress with contraceptive dc

hepatic cavernous hemangioma- most common. big caverns with vessles on histology

935
Q

Barorecpetor reflex signaling

A

Usually M3 causes decreased cAMP in myocytes
decreased B1 and increased M2 cause decrease depolarizing Ca in SA node

all in response to increased BP

936
Q

Hypothyroidism and galactorhea?

A

High TRH can stimulate lactotrophs

937
Q

repetitive screwdriver use injury

A

radial nerve injury (usually finger extension without full wrist drop) due to repetitive contact with supinator muscle

938
Q

What stimulates firs step of gluconeogenesis?

A

High Acetyl CoA tells rxn to make more glucose

939
Q

water soluble drugs in neonates

A

need more of it to get same volume of distribution bc neonates have more relative total body water content.

940
Q

cyanide tox treatments

A
  1. Sodium Thiosulfate- donates sulfur for detox
  2. Sodium nitrate- induces methemoglobin
  3. hydroxocolabumin- binds cyaninde ions
941
Q

Opiod binding on mu receptor effects

A

Presynaptic CNS neuron- block Ca influx so no neurotransmitter release
postsynaptic spinal neurons- influx of K hyperpolarizing the cell

942
Q

buserelin and bicalutamide dual therapy?

A

Buserelin- GnRH analogue

Bicalutamide- blocks initial GnRH surge

943
Q

Homocysteinuria trx

A

High dose vit B6 (pyridoxine)

avoid methionine

944
Q

Why is some proteinuria (<300mg/24h) normal in P

A

Increased GFR, decreased reabsorption and increased permeability

945
Q

embyologic products of the vilintine veins and cardinal veins

A

villintine- portal system

cardinal- systemic venus system

946
Q

Where does ablation for A-flutter target?

A

aria btw tricuspid valve and IVC in RA

947
Q

Hawthorne effect

A

acting better bc you are being studied

948
Q

What innervates posterior portion of external ear canal?

A

Vagus nerve

949
Q

Cellular staging of oocytes

A

during childhood- arrested in Prophase of Meiosis 1
Menses- Some eggs complete Meiosis 1
Fertilized egg- arrested in metaphase of Meiosis 2 just before union with sperm

950
Q

PURE red cell aplasia associations

A
  1. Parvovirus

2. systemic dz (often thymoma)

951
Q

Trx for removal of parathyroid gland

A

oral calcium and calcitriol (active Vit D)

952
Q

Hypersensitivity pneumonitis on biopsy

A

Poorly formed noncaseating granulomas, lymphocytes, septal fibrosis

953
Q

Early CVD and tendon xanthomas/Xanthelasmas Defect?

A

LDL receptor or ApoB-100. elevated LDL in serum

954
Q

Early CVD + Peripheral VD. Palmar Xanthomas. Defect?

A

APO E. elevated circulating VLDL and chylomicrons

955
Q

Acute pancreatitis + itchy skin xanthomas, hepatosplenomegaly. Defect?

A

lipoprotein lipase or APO C. high chylomicrons

“Itchy pancreatitis due 2 lipase”

956
Q

False negatives on urea breath test for H-Pylori

A

anything that suppresses growth but does not kill. abx, PPI’s or bismuth

957
Q

Mid diastolic murmur + hemoptysis in immigrant

A

Mitral stenosis can cause hemoptysis via high pressure of bronchial veins

958
Q

Histology difference btw lipoma and liposarcoma?

A

liposarcomas have scalloping/ indentations

959
Q

Alcoholic cerebellar dysfunction vs. mamillary body damage

A

cerebellar vermis dysfunction- truncal instability, wide based gate +/- tremor
Mamillary body damage- Wernicke presents as triad of ataxia, encephalopathy, horizontal nystagmus

960
Q

Calcineurin inhibitors side effects

A

Tacrolimus and cyclosporine can cause renal damage.. Decrease IL-2 gene transcription

961
Q

In PCR what direction does Taq polymerase work?

A

5-3

962
Q

where do intestinal epithelial stem cells reside?

A

crypts of Lieberkuhn

963
Q

What cells are in cirrhotic nodules?

A

hepatocytes

stellate cells just make fibrosis (TGF-B)

964
Q

What antibiotics bind the 23S pocket of the bacterial 50s ribosome subunit?

A

The clorox clean prince Linezolid of the macro 50s ribosome!

Macrolides and clindamycin specifically bind at the 23S pocket

965
Q

cystic hygromas?

A

transilluminating cysts usually on left head or neck associated with trisomy’s and turner syndrome

966
Q

why would a neuronal action potential that used to go to +40mv now only go to +10mv?

A

decreased sodium conc. outside the cell

967
Q

what gland is particularly sensitive to radiation exposure?

A

Thyroid. Papillary and follicular cancers specifically. Give potassium Iodide prophylactically in case of significant radiation exposure

968
Q

Why does tardive dyskinesia develop?

A

upregulation of dopamine receptors in respose to chronic antipsychotic use

969
Q

What do cancer cells do in a petri dish

A

cover the whole thing then make mounds bc they lack catenin and cadherin mediated contact inhibition

970
Q

midshaft humerous fracture. what nerve?

A

radial

971
Q

Skewed X inactivation

A

refers to women who do not evenly inactivate X chromosomes across thier cells

972
Q

Filtration fraction in a stenotic kidney?

A
Filtration fraction (GFR/RPF) increases bc
GFR is saved (afferent dilates, efferent constricts)
RPF is sacrificed. So FF is a higher number
973
Q

Psoriasis pathology

A

hyperkeratosis and epidermal hyperplasia.

Due to DENDRITIC cells recruiting helper T-cells.

974
Q

Venous drainage above the dentate line

A

Superior rectal > inferior mesenteric > portal venous system. This is why lesions above the dentate line often metastasize to the liver. Below the dentate line often metastasize to the lungs

975
Q

trx for old people with dry skin in the winter

A

moisturize after bathing

976
Q

why use probenecid with penicillin G?

A

increases concentrations by inhibiting renal tubular secretion. (can also be used to increase uric acid exertion)

977
Q

tetracycline teratogenic effect

A

slow bone formation and destroy tooth enamel

978
Q

mech of post cough or valsalva syncope?

A

decreased venous return to the heart due to increased intrathoracic pressure

979
Q

bloom syndrome

A

DNA helicase issue.

Photosensitivity, short stature, telangiectasias. predisposed to lymphoma and GI ca.

980
Q

complication of endometriosis?

A

infertility

981
Q

In collagen synthesis hydroxylation and glycosylation is important for what step?

A

Triple helical procollagen formation

982
Q

uncal (medial most segment of the temporal lobe) herniation sign?

A

CN III palsy making a ipsilateral fixed dilated pupil

983
Q

microsatellite instability?

A

microsatellites are areas of repeated units. They are especially vulnerable if mismatch repair enzymes are not working as in lynch syndrome.

984
Q

Dacubitrol valsartan therapy

A

neprilysin inhibitor increases ANP/BNP and blocks aldosterone production
ARB blocks remaining aldosterone at the receptor.
Angiotensin II is elevated but cant increase aldosterone

985
Q

HLA subtypes that do not mount an effective IgG response? What happens

A

improper antigen presentation and no T cell response with is heavily dependent on IgG

986
Q

ARDS physiology

A

fluid filled aveoli still get perfusion. Causes a V/Q mismatch and right to left physiologic shunting

987
Q

Where does Kayser-Fleischer ring deposit in the eye?

A

Descemet membrane of the cornea

988
Q

Dysplastic nevus syndrome genetics

A

9p21 chromosome. CDKN2A gene. predisposes to melanoma.

989
Q

leucine zipper?

A

transcription factors that have two alpha helixes rich in leucine c-jun and c-fos are examples

990
Q

How do G-protein coupled receptor work

A

PIP3 > DAG > protein kinase C > calcium release and protein phosphorylation

991
Q

First step of purine synthesis?

A

Carbamoyl phosphate synthetase II combines CO2, glutamine and ATP in the cytosol

992
Q

what does leg raise in appendicitis test?

A

peritoneal irritation against the psoas (on the groove of the vertebrae then goes toward groin)

993
Q

How do retinoids work for acne

A
  1. Decreased epithelial cohesiveness.
  2. increased turnover,
  3. normalizes keratinization
994
Q

What enzyme is def in a normal weight/ young pt with elevated blood glucose level (mild DMII)

A

glucokinase in the pancreas leading to higher setpoint before insulin is released.

995
Q

Pontine hemorrhages

A

fixed pinpoint pupils loss of horizontal gaze, decerebrate (extensor posturing) death in hours

996
Q

the brain: cytotoxic edema vs vasogenic edema

A

cytotoxic- usually ischemia (due to ATP dependent pumps malfunctioning)
vasogenic- often tumors

997
Q

reactive arthritis triad

A

cant see, cant pee, cant bend my knee

998
Q

types of cells in cervical transitional zone?

A

simple columnar epithelium and simple stratified squamous epithelium

999
Q

Sleep Stages

A

BATS Drink Blood
B- Awake
A- Awake eyes open
T- Theta N1 light sleep
Spindles/ K complex N2, bruxism
Delta- bedwetting night terrors, sleepwalking
Beta- REM sleep, erections, dreams/nightmares, muscle paralysis

1000
Q

What becomes an essential AA in PKU?

A

Tyrosine

1001
Q

Hallmark of TB meningitis on autopsy?

A

Thick grey exudate on base of brain. Usually subacute, includes vasculitis

1002
Q

Is diabetic diarrhea a thing?

A

Yes. Secritory Persists with fasting (even at night) due to autonomic bowel dysmotility.

1003
Q

How do stimulants work?

A

Block NE and D reuptake

1004
Q

What combats hyperphosphatemia and too much vit D?

A

Fibroblast growth factor 23 for when your GRF is 23!!! Released by osteocytes

1005
Q

what cells produce elastase?

A

alveolar macrophages

1006
Q

What nerves can be injured during prostatectomy?

A

prostatic plexus (inferior hypogastric nerves and + pelvic and splanchnic nerves) This contains nerves that innervate the corpus leading to erectile disfunction

1007
Q

Injury location of median nerve signs + whole lateral palm is numb

A

proximal to palmar branch of median nerve often compression by the pronator teres

1008
Q

2 associations of non-bacterial endocarditis

A

technically any hypercoagulable state but especially Lupus and Advanced malignancy

1009
Q

Klienfelters hormones

A

Low Testosterone, high estradiol

High FSH and LH due to lack of negative feedback

1010
Q

Why is sputum green with pneumonia?

A

neutrophils releasing myeloperoxidase turns it green

1011
Q

What antiemetics are used in motion sickness nausea

A
anticholinergics (scopolamine)
anti histamines (promethazine is clutch in hyperemesis gravidarum)
1012
Q

acetazolamide and urine K

A

Promotes excretion of potassium

1013
Q

Where are B1 receptors found?

A

juxtaglomerular cells (this is why B blockers decreases renin) and cardiac muscle. Not in the vasculature

1014
Q

What drugs is HIV 2 immune too naturally

A

NNRTI’s, fusion inhibitors

1015
Q

Cells important in Sarcoidosis

A

Macrophages (convert active vit D and secrete Ace)

CD 4+ T cells (secrete TNF-a / INFN Gamma to activate macrophages)

1016
Q

Why don’t selective arteriolar vasodialators work as longterm monotherapy for HTN?

A

hydralazine and minoxidil dont work alone bc

  1. sympathetic reflex tachycardia
  2. RAS activation making them bad longterm
1017
Q

alcoholic + chelitis, glossitis what is deficient

A

Vit B2 (riboflavin) FAD is needed for succinyl dehydrogenase in the TCA cycle

1018
Q

humoral neck fracture complication

A

Avascular Necrosis

1019
Q

chronic alcohol use and receptors

A

less GABA more glutamate NMDA receptors. The latter is responsible for excitatory symptoms of withdraw

1020
Q

duodenal ulcer posterior wall can erode into what?

A

gastroduodenal artery

1021
Q

what is analogous to EC50 for inhaled anesthetics. measure of potency

A

MAC. Mean alveolar concentration. lower is more potent

1022
Q

Spermatic cord mnemonic

A

ICE TIE
Internal s. fascia- transversalis fascia
Cremasteric muscle & fascia- internal oblique
External spermatic fascia- external oblique
(Orchiplexy for non descended testicle pulls it through this)

1023
Q

Diabetic most common mononeuropathy

A

CNIII ischemic

1024
Q

Over 24hrs without food how does glucose stay steady?

A

Gluconeogenesis utilizing glucogenic AA’s to make oxaloacetate and convert it to posphopenyl pyruvate

1025
Q

Normal cardiac changes with aging

A

lipofuscin, shortened length, decreased ventricular cavity size, sigmoid septum, dilated aortic root

1026
Q

Chikungya fever

A

southern hemisphere, severe arthralgia/arthritis, lymphopenia, alpha virus, transmitted by Aedes mosquito (same as zika)

1027
Q

Crohn’s or UC which has granulomas?

A

Crohn’s has granulomas

1028
Q

elevation of testicle feels better for what dz?

A

epididymitis

1029
Q

ichthyoses vulgaris

A

“fish scale disease” due to filaggrin mutation. ineffective desquamation

1030
Q

Tongue sensation

A

anterior sensation 2/3 Trigeminal V3 mandibular
anterior taste 2/3 Facial nerve
posterior sensation + taste 1/3 glossopharyngeal

1031
Q

mixture of normal and abnormal cells what kind of mosaicism?

A

somatic mosaicism

1032
Q

Fas ligand?

A

Helps self reactive T cells undergo apoptosis

1033
Q

drunk colleague working?

A

contact supervisor ASAP

1034
Q

RAS active state vs inactive

A

GDP inactive

GTP active

1035
Q

Right sided ascending
vs
Left sided descending colon cancers

A

RT-ascending (larger), occult fatigue, iron deficiency

LT- descending (smaller) constipation obstruction

rectal- tenesmus, small caliber stools

1036
Q

Best drug for bulimia nervosa?

A

fluoxetine

1037
Q

Why are immature RBC’s blue after Wright Giemsa stain?

A

Residual ribosomal RNA

1038
Q

Why give ACE inhibitors after MI?

A

prevents left ventricular chamber dilation

1039
Q

Mechanism of duloxetine, nortriptyline for neuropathic pain?

A

decreased serotonin and NE release

1040
Q

Haldane and Bohr effect of Hgb?

A

Haldane- to accept more oxygen heme releases H+ and CO2. In lungs
Bohr- to accept CO2 more H+ is created and oxygen is released. In tissue

1041
Q

Golgi Tendon organ?

A

negative feedback to prevent muscles from exerting too much force

1042
Q

Why do we get wrinkles?

A

Decreased collagen fibril production and up regulated metalloproteases

1043
Q

leishmania

A

intracellular parasite transmitted by sand fleas. Are oval and have a rod shaped kinoplast.

1044
Q

Theophylline intoxication

A

seizures and tachy arrhythmias. TRx usually includes benzos or barbiturates

1045
Q

cholangiocarcinoma on biopsy

A

adenocarcinoma with mucin production and desmoplastic response

1046
Q

What vitamin is a cofactor in AA transamination and decarboxylation reactions?

A

B6 (pyridoxine)

1047
Q

cystic fibrosis restrictive or obstructive?

A

obstructive due to a mutated ATP activated chloride channel

1048
Q

Acute intermittent porphyria treatment

A

Heme infusion, decreases ALA accumulation and so porphobilinogen accumulation is not enough to cause attacks and symptoms are controlled

1049
Q

mech of hydrocephalus in sub arachnoid hemorrhage?

A

blood blocks CSF absorption

1050
Q

reactive neutrophils on blood smear?

A

Dohle bodies (peripheral tiny blue cytoplasmic inclusions

1051
Q

interstitial nephritis vs tubular necrosis

A

white blood cell casts vs granular “muddy” casts

1052
Q

what vessles may bleed in diverticulosis?

A

vasa recta

1053
Q

oral pharyngeal cancer and nerve compression?

A

base of tongue- glossopharyngeal

back of throat- vagus

1054
Q

geneticly inherited RB mutation cancers

A

retinoblastoma and osteosarcoma

The worst retinal and bone cancers

1055
Q

Glaucoma meds and inflow/ outflow

A

less inflow: beta blockers, alpha 2 agonists, carbonic anhydrase inhibitors
more outflow: prostaglandin agonists, muscarinic agonists

1056
Q

Why is Hep B genetically unstable?

A

lacks 3-5 exonuclease proofreading

1057
Q

B-thalassemia genetic issue?

A

abnormal transcription or translation of mRNA

1058
Q

abciximab

A

blocks platelet IIb/IIIa binding to fibrin.

1059
Q

Glucagonoma

A

Often affects insulin resistant/ DM.

migratory necrolytic erythema and tons of skin symptoms. often affect groin, face or extremities

1060
Q

Cremasteric and anal wink reflex roots

A

L1, L2 testicles move

S3, S4 winks galore

1061
Q

risk of longterm TMP-SMX therapy

A

hyperkalemia

1062
Q

global brain ischemia most vulnerable regions

A

hippocampus > purkinje cells

1063
Q

Treatment for prolactinoma?

A

dopamine agonist cabergoline

1064
Q

Why do Cystic fibrosis pts get so many infections

A

mucus cant be cleared allowing for bacterial macrocolonies and protective biofilms

1065
Q

communicating hydrocephalus

A

symmetric enlargement of ventricles. due to disruption of arachnoid granulations

1066
Q

where does reactivation TB take place?

A

upper lungs

1067
Q

late phase of a type 1 hypersensitivity rxn?

A

eosinophil recruitment and release of tissue damaging major basic protein

1068
Q

PCL vs ACL on MRI?

A

PCL connects toward side with fibula (small bone)

ACL connects toward side with tibula (big bone)

1069
Q

What abx can decrease metabolism of statins and cause myopathy?

A

Macrolides (azithro, clarithro, erythro)

1070
Q

Athletes can have what type of physiologic murmur

A

pulmonic flow murmur due to increased stroke volume

1071
Q

muscle that can cause both hip and knee problems

A

rectus femoris

1072
Q

NNRTI’s

A

Do not require phosphorylation to be active.
Elephants never delay
Efavirenz, nevirapine, delavirdine

1073
Q

During pregnancy what hormone suppresses lactation

A

progesterone secreted by the placenta

1074
Q

What is a sign of MILD mitral stenosis

A

Loud S1

1075
Q

Why do you get myocyte swelling in transient ischemia?

A

ATP pump failure in sarcoplasmic and cell membrane leading to increased intracellular Ca and Na that draws water in

1076
Q

Cystic Fibrosis + hyponatremia?

A

Salt wasting in the sweat

1077
Q

obturator nerve

A

thigh adduction and medial thigh sensation

1078
Q

hematologic consequences of uricemia ?

A

impairs platelet function. Causes prolonged bleeding time

1079
Q

Lower extremity cyanosis and clubbing

A

PDA

1080
Q

panic disorder pharmacotherapy

A

SSRI

1081
Q

Miosis vs mydriasis

A

Miosis- constriction, short ciliary nerve

MyDriasis- Dilation, long ciliary nerve

1082
Q

Topoisomerase drugs mnemonic

A

Tucan- Kaitlyn’s #1 favorite animal. Topoisomerase 1. Irinotecan, topotecan
both sides- poside. Topoisomerase 2. Etoposide, teniposide

1083
Q

ecological study

A

uses population level data

1084
Q

acute intermittent porphyria

A

wine colored urine, abdominal pain, +/- neuro symptoms PBG/ALA in urine.. Dextrose may help

1085
Q

nerve injured during appendectomy sensation to suprapubic region

A

illiohypogastric nerve L1

1086
Q

HAART and fat??

A

HAART is associated with body fat redistribution towards more truncal obesity

1087
Q

Glioblastomas staining?

A

EGFR

1088
Q

Infective endocarditis and renal issues and presenting signs

A

abcess/emboli- flank pain

complex deposition- proteinuria/hematuria.

1089
Q

posterior hip dislocation nerve injury?

A

Sciatic nerve

1090
Q

candida skin test

A

Used as a cheap way to test for T cell function. Induces a type IV hypersensitivity response where CD4 + T cells, macrophages and later CD8+ T cells respond.

1091
Q

Neuroblastoma

A

in children, catecholamines, Homer Wright rossettes. neural crest origin. may cause opsoclonus-myoclonus syndrome. N-myc

1092
Q

Near sighted and far sighted

A

myopia- near sighted focuses too far anterior of eye that is too long. Kaitlyn near sighted and very long
hyperopia- far sighted. Focuses too far behind retina. eye is too short.

1093
Q

What anti-emetic is good for people with GI infections

A

5-HT antagonists

1094
Q

most commonly affected nerve route in cervical spondylosis

A

C7

1095
Q

what type of collagen is scar tissue?

A

type 1. Granulation tissue is type 3

1096
Q

Types of eukaryote RNA polymerase

A

RNA polymerase I: in nucleolus. Makes most of ribosome
RNA polymerase II: mRNA, snRNA, Micro RNA
RNA polymerase III: TRNA, small component of 60s subunit

1097
Q

Dermatome that goes over the kneecap

A

L4

1098
Q

hemodynamically neutral anesthesia induction?

A

Etomidate

1099
Q

Central vs peripheral chemoreceptors and breathing

A

peripheral (carotid) sense oxygen levels

central (medulla) sense CO2

1100
Q

intermediate acting benzos

A

COLA

clonazepam, oxazepam, lorazepam, alprazolam

1101
Q

Difference between HLA 1 and HLA 2?

A

HLA 1: aka HLA B27 Present to CD 8+ T cells. Spondylonegative arthropathies
HLA 2: DR and DQ alleles. Present to CD 4+ T cells. RA, celiac dz, type I DM

1102
Q

Action sports and sympathometics :)

A

Action junkies do EPIc DOPe shit! ^CO/BP

Epic cousins (Nor & Pheny) are pressing action sport progression! ^BP -CO

Petrol and butane cars are going faster than ever! ^CO Lower BP

1103
Q

Liddle syndrome

A

Ameliorate a little HTN.

Collecting duct. Causes HTN via Na resorption. treat with amiloride.

1104
Q

Explain how translation of stop codons works?

A

The anticodon of the trinucleotide before the stop codon will be the last to code in a 5-3 direction

1105
Q

mamillary body on MRI

A

Bird’s beak

1106
Q

RTA’s

A

Type 2: Proxitwo. loose acid and K in urine
Type 1: The distal one. loose K and HCO3 in urine. Ca stones. assoc with calcium stones and AI conditions
Type 4: loss of aldosterone. high K assoc with DM and ACE/ARB. TRX fluticortisone

1107
Q

chronic diarrhea or ileostomy and pH

A

less bowel HCO3 resorption so constant metabolic acidosis. predisposes to uric acid stones

1108
Q

Osteoporosis vs Primary Hyperparathyroidism

A

osteoporosis- trabecular thinning

primary hyperparathyroidism- subperiosteal bone resorption with cortical thinning. High Ca. Possible low phosphate

1109
Q

prostacyclin and platelets

A

inhibits platelet binding

1110
Q

Parathyroid blood supply

A

inferior thyroid artery a branch of thyrocervical trunk

1111
Q

case series

A

pts have disease and there is no control group

1112
Q

What makes up the starry sky in Burkitt lymphoma?

A

macrophages and apoptosis of cells

1113
Q

what lymph node would cancer on the tounge metastasize to first?

A

submental

1114
Q

Primary adrenal insufficiency weird symptoms

A

eosinophilia, anemia, hypoglycemia

1115
Q

What is sorbitol usually converted into?

A

Fructose

1116
Q

In MCAD and carnitine deficiency what is the major downstream molecule that can’t be formed?

A

Acetyl-CoA- which is used for ketone formation and the TCA cycle

1117
Q

Triamterene and amiloride moa?

A

Inhibit ENAC sodium channel

1118
Q

Fetal hemoglobin greek letters

A

alpha 2 gamma 2

1119
Q

G6PD causes a failure to produce what?

A

NADPH , which is also used in FA and cholesterol synthesis

1120
Q

Major cytokine in eosinophil recruitment

A

IL-5

1121
Q

What muscle protein is dephosphorylated to cause muscle contraction in both smooth and skeletal muscle

A

myosin

1122
Q

Arginase deficiency

A

Can’t make Urea (CH4N2O) from arginine. Arginine builds up (treatment is to avoid this). spastic diplegia and abnormal movements

1123
Q

what class of HIV drugs can cause metabolic like syndrome

A

protease inhibitors

1124
Q

tubocurarine moa?

A

competitive ACh antagonist

1125
Q

Cardiac node blood supply

A

SA node- RCA

AV node- Depends on dominance

1126
Q

Ehlers Danlos issue in collagen synthesis

A

cleavage of N and C terminal ends in extracellular space by procollagen peptidases

1127
Q

ankylosing spodylitis immunogenetic associations

A

HLA 1. B 27 and T helper 17 cells + TNF alpha

1128
Q

calculating renal perfusion flow?

A

Renal blood flow x (1 - hematocrit)

1129
Q

cholesterol meds that should be avoided in cholecystic dz

A

fibrates

1130
Q

Thalamic vs pons vs putamen intracerebral hemorrhage eye findings

A

Thalamus- unequal pupils
pons- small word pinpoint pupils
putamen- dilated pupils

1131
Q

vWF deficiency and ristocetin test

A

abnormal (poor plt agglutination)

1132
Q

Strongest to weakest binding of Class 1 antiarrythmics

A

Top (strongest) to bottom (Weakest) C.A.B

1133
Q

MecA bacterial gene

A

codes for a PBP with low affinity to beta lactam antibiotics.

1134
Q

baroreceptor reflex nerve roots

A

afferent- glossopharyngeal

efferent- vagus

1135
Q

MacConkey agar

A

turns pink for lactose fermenters

1136
Q

stress hyperglycemia?

A

extremely ill/stressed pts will have more gluconeogenesis due to catecholamine increase

1137
Q

What constitutes active RAS in the MAP K pathway?

A

RAS is activated when bound to GTP

1138
Q

Nitrates moa

A

vasodilation in large veins to reduce preload is the major effect.

1139
Q

Where is vit D3 produced?

A

calciTRIol or D3. Tri to make D 3 in the PCT

1140
Q

Pseudo and Pseudopseudo hypoparathyroidism

A

Both have Albright hereditary osteodystrophy- Short 4th and 5th digits, short stature, subcutaneous calcification)

Pseudo- PTH resistance bc receptor signaling fails

pseudopseudo- PTH works fine bc maternal allele rescues signaling

1141
Q

Type 1 DM pathophysiology

A

T cell mediated B-islet destruction. May have glutamic acid decarboxylase antibodies that prime T cells

1142
Q

Vaptans

A

Block V2 used in SIADH

1143
Q

Anal cancer proximal to dentate lymph mets

A

first to internal illiac lymph nodes

1144
Q

Phenoxybenzamine vs phentolamine

A

Phenoxybenzamine- irreversible a1 and 2 antagonist

Phentolamine- reversible a1 and 2 antagonist. so it can be overcome by high doses

1145
Q

Consequences of midgut malrotations

A
  1. obstruction by ladds bands (connect retroperitoneum to colon/cecum) wraps around SMA
    OR
  2. volvulus
1146
Q

zero order kinetics vs first order kinetics

A

zero order- constant amount of drug eliminated

First order- constant Fraction of drug eliminated

1147
Q

anaphylactic shock what happens to the vasculature?

A

massive vasodilation

1148
Q

Carbon monoxide binding to heme

A

competitive. that’s why High flow O2 can knock some of it off

1149
Q

Maraviroc vs Enfuvirtide

A

Maraviroc- inhibits CCR5 gp120 interaction needed for Macrophage infection (120 is macro than 41)
Enfuvirtide- binds gp41 inhibiting entry

1150
Q

Basophilic stippling what is it comprised of?

A

ribosomal RNA makes the RBC inclusions.

Happens in Lead poisoning, or sideroblastic anemia

1151
Q

LEAD poisoning mneumonic

A

L- lead lines on bones metaphysis
E- encephalopathy, erythrocyte stippling
A- abdominal pain/anemia
D- wrist/ foot drop. Dimercaprol, eDta, succimer

1152
Q

Peripartum cardiomyopathy type?

A

Dilated with increased compliance

1153
Q

IL-8

A

attracts neutrophils

1154
Q

what hormones inhibits lactation during P despite high prolactin

A

progesterone

1155
Q

primary aldosterone’s serum Na, Serum K, and HCO3

A

Normal Na due to aldosterone escape
Serum K low due to excretion
HCO3 high due to metabolic alkalosis

1156
Q

What can be used to check for hyperthyroidism during P

A

Free T4

1157
Q

Explain pathophys of Sheehan’s syndrome

A

Pit enlarges during P. But blood supply does not increase proportionally, and with excessive blood loss ischemic necrosis can occur

1158
Q

Other name for Tau

A

microtubule associated protein

1159
Q

How is salmonella typhus typically transmitted

A

fecal oral, typically contaminated food or water in other countries

1160
Q

Consequence of bad BPH on kidney

A

bowmans capsule pressure increases, paranchymal hydrostatic damage, hydronephrosis

1161
Q

What major abdominal organ has dual blood supply?

A

Liver. So it is less affected by infarcts from atrial clots. Blood can go into the portal system retrograde from accessory intercostal and phrenic arteriole vessles. In a transplanted liver these accessories are no longer a backup option

1162
Q

Cystinuria

A

COLA (Cysteine, ornithine, lysine, arginine) in urine. Risk of SIXtine kidney stones. May be dx by cyanide-nitroprusside test

1163
Q

Differential cyanosis arms vs legs + signs of a PDA

A

It is a reverse shunt through the PDA (right to left) usually due to left outflow obstruction or persistent pulmonary hypertension of the newborn

1164
Q

Which HLA’s are related to MHC 1 vs 2

A

MHC 1- All only have 1 letter (A,B,C)

MHC 2- All have 2 letters (DQ, ect)

1165
Q

Myenteric (Aurbach’s plexus)

A

In the submucosa. Damage causes dilation via chaga’s or Hirsprungs.

1166
Q

Aldosterone’s main effects in the serum

A

Increases Na
Decreases K and CL
creates a Metabolic alkalosis H loss and HCO3 gain

1167
Q

Drugs that have zero order elimination (constant amount/time)

A

PEA’s are shaped like a Zero

Phenytoin, Ethanol, Aspirin

1168
Q

Midodrine

A

When your old and in the doldrums you need some midodrine to keep you up (a1 used for postural hypotension)

1169
Q

What Beta blockers help in HF

A

B-blockers Curb Mortality

Bisoprolol, carvedilol, metoprolol

1170
Q

excessive internal rotation or quick direction change + hemarthrosis knee injury

A

ACL

1171
Q

ABPA signs/symptoms

A

Hx of asthma or CF.
eosinophilia/ IgE
fleeting infiltrates/bronchiectasis
positive aspergillus skin test

1172
Q

What type of cell releases renin?

A

juxtaglomerular cell of the afferent arteriole which is a modified smooth muscle cell

1173
Q

TB locations

A

primary infection: upper portion of lower lobe

reactivation: Upper lobes

1174
Q

Valgus and varus stress and knee injury

A

Gus is a guy his legs are together. Us is a girl spreads legs apart
valgus- forced stress inward breaks MCL
Varus- forced stress outward breaks LCL (less common)

1175
Q

How do you treat Hartnup dz

A

High Niacin diet

1176
Q

Supplementation of normal infants

A

Vit D, especialy if in north or dark skin
Iron after 4months of age until substantial eating of solid foods. Or earlier if preterm
Vit K at birth

1177
Q

Atrial Septal Defect murmur

A

wide fixed split S2

1178
Q

Histology of late stage radiation dermatitis

A

telangiectasia, fibroblast proliferation, homogenization of dermal collagen (mediated by TGF-B)

1179
Q

A fib and cauterization

A

recurrent- destroy origin near pulmonary veins

permanent- destroy AV node near the coronary sinus

1180
Q

Fixed dilated pupils what is injured

A

midbrain containing the Pretectal and EdingerWestphal nuclei

1181
Q

external hemorrhoid pain mediated by what nerve?

A

pudendal

1182
Q

bowel and bladder control nerve and root

A

pelvic splanchnic nerve part of cauda equina or tumor met injury S2-S4 relaxes muscles allowing for defecation

1183
Q

Femoral hernia comes out where

A

Below inguinal ligament just medial to femoral Vein

1184
Q

Why is elastin so stretchy

A

lots of nonpolar AA’s and lysine residue crosslinking

1185
Q

What does RT-PCR detect in a sample

A

m-RNA

1186
Q

2, 3 bpg and sickle cell

A

High levels promote sickling

1187
Q

Enzyme deficiency similar to G6PD

A

gluthione reductase

1188
Q

Homocysteinuria nutritional treatment

A

Avoid methionine and add B6 (pyridoxine)

1189
Q

Intravaginal block numbs what nerve?

A

pudendal

1190
Q

Muscles in sitting up from laying down without hands

A

illiopsoas, rectus abdominus and external oblique

1191
Q

abulia

A

lack of will usually damage to cingulate gyrus

1192
Q

Ovary, Uterus, Cervix, Vagina, vulva lymph drainage

A
Ovary- para aortic
Uterus- external Iliac
Cervix- internal iliac
Vagina- proximal to internal iliac; distal to inguinal
Vulva- inguinal
1193
Q

Hip fracture direction and injury

A
posterior dislocation- sciatic nerve
anterior dislocation (rare)- femoral artery
1194
Q

lacunate injury can compress what?

A

median nerve similar to carpal tunnel

1195
Q

Niacin is synthesized from what AA?

A

tryptophan

1196
Q

How do fibrates cause gallstones?

A

Blocking cholesterol 7-hydroxylase

1197
Q

Left upper sternal border vs Upper sternal border

A

LUSB- pulmonic murmurs and PDA

LSB- Aortic regurgitation and HCM

1198
Q

What cells release Interferon gamma?

A

T cells

1199
Q

What types of malaria have a form that is dormant in the liver

A

Vivax and Ovale. These must be treated with primaquine in addition to chloroquine

1200
Q

What anesthesia med may help in bronchospasm?

A

Ketamine bc it is a sympathomimetic

1201
Q

What do integrase inhibitors stop

A

production of viral MRNA by incorporation into host genome

1202
Q

What pump is important in taking drugs out of CNS that may be inhibited to improve penetration of some drugs like HAART

A

P-glycoprotein efflux pump

1203
Q

Histology of a liver infected with Hep B vs Hep C vs Hep A?

A

Hep A: Spotty necrosis, ballooning, Counselman bodies

Hep B: Ground glass, pale eosinophilic hepatocytes

Hep C: lymphoid aggregates and steatotosis

1204
Q

Hardy Weinberg secret/ meaning of equations

A

p^2 + q^2 = 1 Refers to Population alleles

p^2 + 2pq + q^2 = 1 Refers to individuals

1205
Q

FBPase-2 and PFK-2

A

Fasting: FBPase-2 is activated (more glucagon and cAMP)

Fed state: PFK-2 is activated (more insulin and less cAMP)

1206
Q

Fructose 2,6 bisphosphate

A

More F 2,6p gluconeogenesis sinks

activates glycolysis

1207
Q

Urine sodium in hyperaldosteronism and SIADH

A

High

Due to aldosterone escape in hyperaldosteronism and downregulated renin in SIADH

1208
Q

50S ribosome inhibitors mnemonic

A

The Clorox clean prince Linezolid of the macro 50s ribosome.

Macrolides are azithro, clarithro, erythro

1209
Q

abx class that does not work against anaerobes?

A

Aminoglycosides
Mean (amino) GNATS cannot kill anaerobes.

Bind irreversibly to the 30s ribosome

1210
Q

lactase def stool findings

A

low pH

1211
Q

Why are most monoclonal therapies just fragments?

A

better tissue penetration

1212
Q

What disorders are REM sleep changes associated with in the elderly?

A

alpha-synuclein diseases especially Parkinson’s

1213
Q

Contact dermatitis immunology

A

sensitization: Langerhans cells
Reaction: CD8 cells and Tnf gamma

1214
Q

Frontotemporal dementia molecular issue

A

Tau neurofibulary tangles creating Pick bodies

TDP-43 inclusion bodies

1215
Q

pathophysiology of diaper rash

A

spares skin folds.

poop urease producing bacteria increase the local skin pH producing irritation

1216
Q

club foot anomaly type

A

deformation

1217
Q

TOF murmur and severity

A

pulmonic stenosis murmur that gets worse with increased preload causing right blood to go to left circulation without going through the lungs and LA during episodes.

1218
Q

Homocysteinuria what do you supplement

A

cysteine